Late last month, in taking up the cause of Cameron Douglas, the son of actor Michael Douglas, a group of prominent addiction specialists has finally acknowledged something they have ignored for decades: That, for the 1.5 million people in prison for nonviolent, drug-related crimes, treatment is better than more prison time.
An amicus brief submitted by Douglas' doctors and mental health advocates to the United States Court of Appeals argues that his December sentencing of an additional 54 months in jail for possession of heroin and Suboxone -- a prescribed medication used to stem the effects of opioid withdrawal -- would do nothing to rehabilitate him or repay his debt to society. In it, they asked not only for a reduction of the 33-year-old's sentence but also for treatment while serving it, calling Douglas a textbook example "of someone suffering from untreated opioid dependence."
"What the judge has imposed has zero benefits for the community and has staggering consequences for society," Dr. Robert Newman, one of the brief's signees and the director of the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center, told the New York Times.
He's right. An overwhelming body of evidence suggests our criminal justice system has the capability of administering cost-effective screening for the disease of addiction, as well as spearheading intervention and recovery for its sufferers. Yet, we still choose a punitive approach over a truly rehabilitative one.
Prison and jail inmates are seven times more likely to have a substance use disorder, and they have likely spent most of their lives battling that addiction, according to "Behind Bars II: Substance Abuse and America's Prison Population," a report issued last year by the National Center on Addiction and Substance Abuse at Columbia University. However, of the 1.5 million inmates who met clinical diagnostic criteria for a substance use disorder in 2006, only 11.2 percent had received any type of professional treatment, including time in a residential facility or unit professional counseling, or pharmacological therapy such as methadone, antabuse or naltrexone.
Rather, in 2005, federal, state and local governments spent $74 billion in court, probation, parole and incarceration costs of these adult and juvenile substance-involved offenders.
In all cost-benefit analyses of criminal justice-based treatment for adult offenders, the monetary benefits of treatment -- including reduced crime, reduced incarceration and reduced prison health care costs -- outweighed the $623 million price tag. In fact, the return on investment in treatment may exceed 12:1, according to a comprehensive review by the National Institute on Drug Abuse; that is, every dollar spent on treatment can reduce future criminal justice and health care expenditures by $12 or more.
And even before the doctors' amicus brief in the Douglas case -- a high-profile sentence believed to be one of the harshest ever handed down by a federal judge for prisoner drug possession -- the practice of using treatment alternatives in place of incarceration had gained some momentum.
But much room remains for improvement. First and foremost, courts need to realize that treating a disease and holding people accountable for a crime are not antithetical, especially when, time and again, addiction has proven its mettle as a progressive, chronic, and often fatal disease characterized by continuous uncontrollable use of mood-altering substances despite deep and long-term consequences.
Secondly, courts and other legal bodies must not only fit the punishment to the crime, but also make treatment for substance use disorders a central component of criminal sentencing. In addition to properly screening and diagnosing pre-trial prisoners for addiction, governments should eliminate mandatory sentences and expand federal grants to states and localities to broaden the use of treatment-based alternatives to jail and prison, including drug courts and prosecutorial-diversion programs.
Finally, when an alternative to incarceration is not possible, the criminal justice system must make available prison-based treatment programs, including peer-to-peer support, addiction counseling, cognitive behavioral therapy and psycho-pharmacology. Upon release, an inmate also needs access to effective re-entry initiatives, including addiction treatment and management, mutual support programs, education and job training and family support.
The scion of a well-known Hollywood family, Douglas could attract derision for the appeal. But he has long suffered the common captivity the disease of addiction imposes on life: an adolescence of heavy drinking and drugging; a gradual descent into criminal behavior to feed his fix; and a heavy prison sentence that, at times, has mandated such things as solitary confinement and the loss of prison privileges, such as family visits.
Few inmates have the resources needed to wage an appeal in federal court. But fewer might seize an opportunity to openly state the ways in which the federal corrections systems, in particular, have ignored the treatment need of their inmates. Addiction already imposes a life sentence; our job is to make that remand more manageable, in or out of a prison cell.
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