Types of Abstinence-Based Drug Treatment
• Chemical Detoxification
• Drug-Free Outpatient/Inpatient Rehabilitation
• Self-Help Groups (Alcoholics Anonymous, Narcotics Anonymous,
etc.)
• Residential Therapeutic Communities
• Court-mandated programming
• Methadone Maintenance
– Begins to challenge abstinence-based perspective
Interventions
Harm Reduction/Needle Exchange
Detox
Vaccines
Therapeutic communities
Opiate maintenance
Mainstream Psychology
Drug Court
Alcoholics Anonymous/ 12 Steps
Medical therapies
Lifestyle changes
MEDICAL
ADDICTION IS A
BIOCHEMICALLY
ROOTED DISEASE
MORAL
ADDICTION IS A
PROBLEM OF THE
“WHOLE PERSON”
Program Philosophy
Where are People Going to
Treatment?
How People Start Outpatient Treatment
Drug Courts: Social Context
• 1989 - Miami-Dade County, Florida
• Now over 2,300 drug courts nationwide
• Social factors leading to drug court movement:
– Prison overcrowding, budget crises
– Renewed interest in rehabilitation, research showing link
between addiction and crime
– More power for judiciary after mandatory minimum
guidelines
– A bipartisan project: Addressing drug war issues, but still
not “soft” on crime
– Cost effective
Addiction & Criminality
• Estimated costs of drug-related crime to society in 2012: $107
billion
• Total cost of drug war to date: over $1 trillion (Drug Policy
Alliance)
• In 2011, about half of the federal prison population was there
for a drug offence.
• 1.5 million arrestees at risk of drug abuse or dependence
(Urban Institute).
• 53% of people in state prison were estimated to have a drug
problem, and only 15% were receiving treatment.
The Drugs-Crime Connection
Psychopharmacological
model: substance use
incites short term
aggression or violence
Systemic model: crime
is intrinsic to
involvement with illicit
drug trade
Economically
compulsive model: drug
users engage in
economic crime to
support habit
“Subculture” model:
crime and drug use
coincide and flourish as
a response to structural
constraints
Drug Court Basics
• Drug defendants are “sentenced” to treatment
instead of traditional criminal justice response
• Deferred prosecution v. post-adjudication
models
• Eligibility: established history of substance
abuse problems, non-violence offences
• Three shared characteristics:
– Coerced treatment with maximum judicial power
– Heavy level of surveillance and long term rehab
– Strict reward-punishment system in a therapeutic
community setting
How do drug courts work?
For a minimum term of one year, participants are:
• provided with intensive treatment and other services they require to get
and stay clean and sober;
• held accountable by the Drug Court judge for meeting their obligations to
the court, society, themselves and their families;
• regularly and randomly tested for drug use;
• required to appear in court frequently so that the judge may review their
progress; and
• rewarded for doing well or sanctioned when they do not live up to their
obligations.
Source: National Association of Drug Court Professionals
Perspectives on Drug Court
PROS:
- Reduction in drug use/recovery
from addiction
- Coerced treatment gets better
results
- Recidivism (decreased re-arrest or
reconviction)
- Cost savings
- Restored lives and reunited
families
- Productive citizens
- “Tough love” approach more
compassionate than prison
- Addresses roots of crime, for some
drug-involved offenders
- Provides social supports
1
2
3
4
5
6
7
8
9
CONS:
10
- Net-widening
- Increased sentence length or
11
severity
- Suspends due process, violates
12
basic rights
- Racial disparities – African
13
Americans disadvantaged in
selection process and in treatment
success
- Focuses on individual rather than
social solutions for addiction
14
- A medical framework silences
social factors like role of racial bias
in mass incarceration
(depoliticization)
15
Methadone Maintenance Therapy
• Late 1960s – Jerome Jaffe established experimental
methadone program
• Methadone first applied to a therapeutic program by Dole &
Nyswander in the early 1970s
• 1972- Nixon supported expansion of methadone programs
nationwide
• Crime rates fell, sometimes dramatically
• Deaths from heroin overdoses decreased
• 2/3 of Nixon’s original drug war budget went toward addiction
treatment
• Funding for treatment abandoned for “tough on crime”
approach to drugs in 1980s and 1990s
Dole & Nyswander’s Research
• Methadone patients stopped engaging in crime, “anti social”
behaviors ceased
• Psychogenic theory V disease theory
• Their argument: The consequences or symptoms of addiction might be
anti-social behaviors, but the cause is a metabolic response to drug craving
and withdrawal.
• Medical cause requires medical cure
• Suboxone – contemporary version
• Measure of success in MMT
• Not abstinence-based
• Meeting markers of social functioning and quality of life
• Changes notion of what constitutes treatment
• What is the end goal of recovery?