December 18, 2007

Controversy: Drug Addicts - Mentally Ill or Criminals?

On Rhode Island Congressman Patrick Kennedy's website there is written the following:

"Addictive disorders are a form of mental illness and need to be treated, not criminalized.

"Congressman Kennedy launched the Addiction, Treatment and Recovery Caucus in the 108th Congress, along with fellow lawmaker Rep. Jim Ramstad (R-Minn.). In establishing the caucus, Kennedy cited the need to promote awareness of chemical addiction issues and increase support for greater access to treatment.

" It is estimated that 23 million Americans suffer from substance abuse addiction, and the Brown University Center for Alcohol and Addiction Studies has found that more than half of all adults have a family history of alcoholism or problem drinking.

"Moreover, the National Institute on Drug Abuse concludes that treatment of addiction is as successful as treatment of other chronic diseases, such as diabetes and hypertension. Congressman Kennedy feels very strongly that addiction is a disease with huge social costs and that as a society and government, we need to do much more than we are currently doing to treat it.

"Kennedy has also championed a jail diversion program to reduce the criminalization of mental illness and supported funding for drug courts, which would effectively facilitate drug and alcohol treatment, drawing attention to research showing that the upfront costs of such programs yield major savings down the road."

First of all, I want to thank Congressman Kennedy, who has bipolar disorder as well as a history of addictive behavior, for continuing to focus attention on the many many issues regarding mental illness, and on mental health treatment parity when it comes to insurance coverage. It's good to know that there are people in congress who are dedicated to the long-term fight, not just wedded to the single issue battle in a kind of one night stand. I noticed that Kennedy has many foci of interest at his website, but that when you click on "home" you get to the very same place that you do when you click on "mental health." That says a lot!

All of that aside, though, I want to go back to the idea of drug addiction as a mental illness. It is, of course. Since drug addiction is a behavior, and all behavior is mediated by the brain, therefore, drug addiction is a brain disorder, period. Brain disorder is just another way of saying, and perhaps a better way of saying "mental illness." But, and there is a big but, there are brain disorders and there are brain disorders...What do I mean by that? Well, I don't really mean anything. I was just picking a fight, facetiously.

Seriously, however, where I live, in a large multi-unit residential building for the low-income elderly and disabled, drugs and illegal-drug-users are kept to an absolute minimum with a zero tolerance policy. The result is that all 250+ of us live in a clean and safe dwelling, without the guns and drugs and crime that so bedevil other such places. I cannot say I don't appreciate this. I do, no end -- no ifs, ands or buts about it. What I am saying is that I may believe that drug addicts have a mental illness, or a brain disorder, but I do not want them coming into this building, not here, or not now. Not while drugs are still illegal and criminalized. Because while the drug-seeking and addiction itself may be merely illness, neurotransmitters gone awry, the behavior of getting drugs involves what is for now criminal activity and decidedly dangerous people and weapons. It's all very well and good to say, Let's declare a drug addict "mentally ill" because he has a brain disorder and needs treatment. I'm all for that, if that's what you intend to do and have a good treatment for him. Or her. But in fact, what they did was they declared addicts mentally ill, then criminals as well, then didn't actually offer truly restorative treatment, just gave them the label disabled, and let them loose...

I'm sorry but this really infuriates me. If there is good treatment for drug addiction, then why do so many addicts 1) refuse it, 2) become recidivists. And if it is so good, why is it not given to ALL addicts, because eventually they are all "caught" at some point, unless they come to their senses on their own, in which case they don't need treatment, or they seek it voluntarily. Treatment need not be voluntary to be effective. Not good treatment. Not real treatment. After all, Zyprexa treated my psychosis whether I wanted to take it or not! So addiction treatment, like treatment for any illness, if it is good and real, ought to be effective whether or not you want it. And addicts -- at least while drugs remain illegal -- cause so much havoc in society that they ought at a minimum to be offered treatment, if not coerced into accepting it.

But is there a truly effective treatment that works against addiction? That's one question I have. I do not believe that AA or NA is the answer, much as their adherents swear by them. I think AA and NA are supportive, yes, but not truly curative. I think they help people white knuckle it through their addictions. Perhaps that is the only treatment available, right now. (Do AA and NA consider themselves "treatment" for addiction?...) But I don't know that I'd consider it adequate or truly effective, and it might be time now to admit we do not yet have an efficient and effective way to treat addiction. I suspect that if these organization/ methods were put to the strict tests of statistical analysis, their results would not be as significant as they claim. I realize that I am opening myself up to a great deal of outrage and criticism. But I think that AA is popular among those who are its converts. Just as certain brands of religion are amongst their own. And that is fine. AA and NA do work for some, in some fashion. And support is nothing to sneer at. But those whom AA and NA do not help, are not heard from, because they tend to drop out and go elsewhere, be unheard from, rather than be heard as a counter-voice to those who stay. It also seems to me that there are a lot of people who go to AA and NA and do not actually respond to "treatment" for many years...As a disclaimer, so you should know where I am coming from, I should make it clear that I was good friends with someone who needed but did not accept the AA way, while I myself wanted but found Al-Anon unhelpful.

Anyhow, to go beyond the question of treatment, what would happen if drugs were NOT illegal? To make them legal now is perhaps to ask too much, though I would do so. But I think in fact they should never have been criminalized in the first place, way back when dilaudid, an opium derivative, was first becoming a problem with the Victorians and the swooning ladies would take Laudanum in their afternoon tea. Was cocaine ever truly in Coca Cola? Actually, yes it was, in very mild amounts probably, but real coca leaves were used in the making of coca syrup until the 1914 Harrison Narcotic Act put a stop to it. Heroin, likewise, was an ingredient in several patent medicines until the makers were forced to remove it. Even in the case of industrial hemp, an enormously useful fiber and food plant -- because it contained minute quantities of unuseable THC, the psychoactive component of marijuana, hemp was outlawed in the US in 1937.

By the way, despite what we have been told, Nixon's blue ribbon drug commission actually found that drugs like marijuana did NOT tend to lead to the use of "hard" drugs like heroin and cocaine, and it may have recommended decriminalizing simple use of MJ. Nixon and Rockefeller, however, were so insistent that drugs be banned as dangerous, that they foisted on us a "drug war" that was enormously costly and unnecessary and that may have actually produced the epidemic of "drug violence" we now decry rather than being merely the response to it. Think: if the use of heroin or cocaine were NOT illegal, but were considered a MEDICAL problem, what "war" would we be fighting now? What criminals would there be, needing to carry guns in order to protect what "black market"? The market would be a legal market of legal drugs that the government could control and regulate, because it would know who was taking what drug and at what concentration and at what price etc...And the growers would know who was buying what and when and so forth...All within the scope of legal and a reasonably predictable scheme of open trade.

Instead, we got Reefer Madness and the WAR on DRUGS. We got: Drug Addicts are disabled, yes, they are mentally ill, but they are also criminals and will get treatment, such as it may or may not be, but mostly in prison, where they will live out costly and lengthy mandatory sentences, because the brain disorders that made them behave as they did also made them break laws that we made especially harsh in order to put their kind away for as long as time as possible...THATs what we got. And I think it is a damn shame...

Posted by pamwagg at December 18, 2007 04:10 PM | TrackBack


The War on Drugs will be abolished eventually. I'm just surprised the public is slow to catch on. The Internet is really speeding things up though.

Eventually, all drugs will be legal. This doesn't mean you can go to a deli and choose between flavors of heroin. "Legal" doesn't mean unregulated. The soft drugs will be legalized first (shrooms, pot, etc), with the hard stuff will be available for addicts in clinics. This eliminates crime and deaths (ODs) from drug use. It also saves the tax payer money.

Posted by: ilh at December 18, 2007 11:30 PM

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