Friday, September 29, 2017

Now They Tell Us



I've never bought it, a topic for a much later date. But I'm in a small minority of individuals even to question, as the National Center on Addiction and Substance Abuse puts it, that

Addiction is defined as a disease by most medical associations, including the American Medical Association and the American Society of Addiction Medicine.

Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction.

Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist.  

The consequences of untreated addiction often include other physical and mental health disorders that require medical attention. If left untreated over time, addiction becomes more severe, disabling and life threatening.





The disease theory of addiction has served as the theoretical basis of Alcoholics Anonymous, whose first step is "we admitted we were powerless over alcohol- that our lives had become unamangeable." Unquestioned obedience to it is required for the groups it has spawned, such as Narcotics Anonymous and Gambling Anonymous, and for virtually all treatment centers.

Yet, in some jurisdictions, probationers and parolees can be sent to prison for using illegal and/or legal (i.e., alcohol) drugs, sometimes for even solitary relapse. That may end, at least in one state, through the effort of Lisa-Newman Polk, attorney for

29-year-old Julie Eldred, who was put on probation for a year in 2016 for a larceny charge. Her probation conditions stipulated that she remain drug-free and submit to random drug tests. One of those tests — taken 12 days after Eldred was placed on probation -- came up positive for the opioid fentanyl. Because that was a violation of her probation, she was sent to jail.

"I was in the midst of active addiction, so I was actively using," Eldred said. "But you're forced to go into this saying, 'I'll be drug-free,' or you go to jail."

Eldred says she complied with all other probation conditions — she got into an outpatient addiction treatment program, found a therapist, and started medication-assisted treatment with the drug Suboxone.

"I had one relapse," Elred said. "I told my Suboxone doctor, so he upped my Suboxone. And my PO [probation officer] had happened to call me in the next day. She didn't look at that picture, she didn't look that I had just gotten started getting everything in order. She just saw that I had a dirty urine and sent me in front of the judge to go to jail."

Eldred was sent to MCI-Framingham, where she received no treatment..

(Ten days later, Eldred was released after her lawyer found a treatment bed.)

Newman-Polk

is taking Eldred's case to the SJC, arguing that state officials have repeatedly said that addiction is a disease so it's unconstitutional for the courts to punish someone for a medical condition.

"An order to be drug-free is an order that a person who suffers from substance use disorder needs to be in remission or cured of their addiction," Newman-Polk said. "It's not practical or reasonable in view of what we know about the brain science and what we know about addiction."

Massachusetts Medical Society President Dr. Henry Dorkin maintains

Even [Charles] Lindbergh bounced down the runway a couple of times before he became airborneand some of these people simply are going to have somerelapses on the way to full rehabilitation, and we would not want to incarcerate people at the first sign of a relapse if we're treating this as a chronic disease.

In my previous life working for 32 years in the Judiciary (not in Massachusetts), it was accepted fact- justifiably or not- that drug or alcohol addiction is a disease not unlike cancer, shingles, or chronic obstructive pulmonary disease.

No one would suggest that an individual on probation (served instead of a prison term) or parole (served after a prison term) be incarcerated because he or she suffers from one of these illnesses. Neither should he lose his freedom strictly because of illegal substance use.

The supervising probation and/or parole officer has other means at her disposal, whether to assist in rehabiliation or to ensure compliance, and they are not limited to patience.   If the offender continues to use a prohibited substance, he is not likely to continue the treatment the judge or the officer has mandated and may be locked up (properly) for that.  The probationer/parolee will have been given an opportunity to address his problem and if he chooses not to do so, there would be consequences.  Similarly, if a new offense is committed, punishment is likely for both that and for violating the terms of his original sentence by committing a new offense.

Nonetheless,

a brief from state Attorney General Maura Healey's office argues the "brain disease" model for addiction is not uniformly accepted.

That brief also says drug testing probationers promotes public safety, and it points out that Eldred was on probation for committing a crime, not just for drug use. It says probation violations are "not a punishment for the offending conduct. Instead, they constitute punishment for the underlying crime that led to a sentence of probation in the first place."

Former state Attorney General Martha Coakley filed a brief on behalf of the National Association of Drug Court Professionals that says supervision and drug testing are effective and help keep people in recovery. It says the court should not "allow any particular theory of addiction to influence its decision."

This rates an 8.5 on the disingenuousness scale.  Probation violations are a penalty for the offending conduct because they are not charged without the offending conduct. The degree of punishment, such as the length of a prison term imposed, is affected by the underlying crime but that crime cannot be used to determine whether the individual has actually violated probation.

Moreover, were individuals routinely punished not for a new offense or for ceasing treatment but for relapse, offenders may routinely decide that absconding from supervision is preferable to continuing treatment. If the "brain disease" model for  addiction is not uniformly accepted, it comes as a surprise to the vast majority of treatment professionals and of amateurs involved with AA, NA, and GA.

Out-patient drug counseling is typically a condition of supervision for the probationer or the parolee.  If the offender, absent a new offense, maintains treatment and his counselor believes he should continue to work with him, it is wise to let it run its course, within reason.  That should be obvious if drug addiction is considered a disease. If it is not, the Massachusetts high court should so inform us, and let's have at it.




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