Punishment and treatment must be combined

Good article in today’s Washington Post about a drug-addicted prostitute who couldn’t stay clean, and died on the streets. We can help these people, but first we have to tell liberals and conservatives they’re both wrong.

Liberals say addiction is a disease, which is true. But then they say stop punishing them and just give them treatment. What happens? Most addicts and alcoholics say no; that is, when they are being polite. The Amy Winehouse line, They tried to make me go to rehab but I said ‘ no, no, no’  is every addict’s first response to help. So just offering treatment does no good.

Hard-line conservatives want to lock ’em all up. For some addicts, prison is the best thing; it’s the only time they stay clean. But it’s expensive, and untreated, they get released and wind up in trouble again. Prisons are full of repeat offenders who never get treatment.

The answer is coerced treatment. Use the threat of punishment to keep them in treatment. And the moment they stray, throw them back in jail. We’re already doing this across the country with drug courts, HOPE in Hawaii, and dependency court for addicts who run afoul of Child Protective Services. One of my patients told me the best thing that ever happened to her was CPS taking her daughter away, because it forced her to get clean and stay clean to get her kid back.

Also, most people in jail and prison are substance abusers, and despite what the marijuana lobby wants us to believe, they are almost all there for a real crime they committed while under the influence. So why don’t we turn our jails and prisons in huge treatment programs. We’re already covering room and board. Just add some treatment staff.

Why don’t we do this? Politics. Politics and enabling. Enablers are well-meaning people who help an addict keep using. In the WAshington Post story, the chaplain who convinced the judge to send Amy to treatment instead of prison was enabling. Enablers on the left tend to believe that giving people the help and support they need will work. It doesn’t. Their cry is treatment, not punishment, but treatment alone does not work.

The left is now egged on by the marijuana lobby, a collection of politically savvy groups that represent drug users. Like Amy Winehouse and millions of addicts and alcoholics everywhere, they hate treatment. They just want to get high. It seems crazy to let drug addicts and abusers rewrite the nation’s drug laws, but they now have the left on their side.

And the marijuana lobby hates coercion. Two of the four points of the Marijuana Policy Project’s mission statement say they want only “non-punitive, non-coercive” policies. They want us to believe they will get treatment when they are ready. Anyone who works in the addiction treatment field can tell you they are never ready until something really painful happens, like getting busted or fired. So the left won’t help us get to a sane drug policy.

On the far right, we hear lock ’em up. But no money for treatment; that’s just coddling them. But that’s not just inhumane, it’s expensive. Society saves at least $12 in criminal justice costs, health care costs and lost economic activity for every $1 spent on treatment.   However, that’s a bit too nuanced for the far right.

We’re caught between the two tea parties. The tea party on the right refuses to pay for prevention and the tea party on the left (the ones who smoke their tea) just wants to abolish drug laws so they can get high in peace.

Centrist politicians are the ones who usually understand coerced treatment, using tough laws and the threat of punishment to get people clean and sober and keep them that way. Unfortunately, in today’s hyper-partisan climate, centrist politicians are practically extinct.


About Edward Gogek

I've been practicing psychiatry for 25 years, doing general work with adults, children and adolescents. My subspecialties are addiction psychiatry, classical homeopathy and nutritional medicine.
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