Substance Abuse Ballot Initiatives


#1

I’ll try to keep this as apolitical as possible, but my state has a substance abuse related issue on the ballot. I don’t know enough about addiction treatment to make an informed decision and would love to hear from people who work in that field.

The proponents of the amendment want to move the system closer to the Portugal Model by reducing drug possession to a misdemeanor and put the money that would have been spent on incarceration toward treatment programs. The opponents believe that mandatory treatment and jail time motivates addicts who wouldn’t have sought out treatment on their own. It’s a little more complicated than either of those positions, but that’s the gist. (It’s Ohio Issue 1 if anyone wants to know the specifics.)

Again, I’m not trying to get stir up politics. I’m looking for the pros/cons of either system as seen by the people who work in those systems. Efficacy? Relapse rates? Ethics? Etc.


#2

I am not in Ohio, nor do I work with addiction treatment. But, I’ve done a bit of research on incarceration/current state and country laws (specifically in relation to cannabis). In my opinion, drug possession shouldn’t be a crime at all, even a misdemeanor. I don’t think jail time (or other punishments) are actually motivating for seeking treatment. Having easily accessible, affordable treatment programs, on the other hand… But, reducing the punishment is a step in the right direction to ending the stupid war on drugs, I guess.

I would also love to hear the opinions of people who actually work in these fields!


#3

I’ve worked in substance abuse clinics all my life, what I can say is that any jail time is considered a strong risk factor for relapse. More often than not Substance abuse surfaces as a symptom of a bad societal framework that doesn’t provide a healthy environment for addicts to wean off their drugs. Criminalizing drug use in any way shape or form is part of what perpetuates the cycle of drug use.

When I work in a prison setting or with a patient who is on parole, treatment is always more difficult than a patient who has had more access to resources and has not been imprisoned. If we accept that Substance Use is a disease it makes absolutely no sense to imprison drug users. We would not imprison people who are going through a manic phase or who has committed a crime while experiencing paranoid delusions. Why would we penalize criminally, a person who is coping with an addiction?

Some of the best institutions I’ve ever seen that actually reduce the number of fatalities and help the people heal are actually institutions that feature drug use rooms. It seems utterly counterintuitive that offering the safety of a place to use drugs would actually reduce drug use, but the reasoning is actually rather similar to that of Sex education to prevent STD and pregnancy.

More often than not the best way to deal with addiction is to create a safe environment for the patient to understand that we are there to help and we will not judge. Most drug addicts don’t want to be addicted, but they lack an understanding environment that supports them through the process.

From my own personal experience, these places are extremely helpful because:

  1. They offer a safe space from socioeconomic stress
  2. They provide hygienic alternatives for drug paraphernalia like clean syringes, which prevents the spread of blood transmissible and sexually transmissible illnesses.
  3. They provide a community where it is safe to talk about drug use, and when one in the community suffers a loss it motivates others to seek help. (It grants others more visibility into the consequences of drugs use in a safe manner.
  4. More often than not treatment starts by aiding in the social determinants of health, that means these places have psychologist, social workers, psychiatrists and Internists/family practitioners who all take care of the person holistically not only dealing with the addiction but the social issues that keep the patient in a state that makes recovery difficult.
  5. People in these institutions are trained in measures to abort overdoses, which saves lives! Because overdosing in a dump or your apartment is different from overdosing in a center with people trained to help you, surrounded by friends who will support you emotionally after you had a traumatic brush with death,

I can’t even begin to tell you how important humanity and kindness is in treating addictions. And I could talk about this forever because It’s something I’m passionate about.

A great example is the Washington Heights Corner Project which really inspired me and inspired a similar program here in Puerto Rico called Iniciativa Comunitaria. (Which to this date has a better track record than most drug addiction treatment facilities in the island.

http://www.cornerproject.org/

Here are some other sources, two of them aren’t papers but they offer more simple language and I think they are really good.




Feel free to ask me any questions.


#4

I interned at a state forensic hospital last year. I kept up with recently-discharged patients on outpatient probation, and I also helped with two of the dual diagnosis groups for patients still at the hospital. Many of the people I talked to said that getting treatment was incredibly good for them. Unfortunately, they only got treatment after an encounter with the law due to getting very, very sick (as in psychotic enough for the courts to deem them either incompetent to stand trial or not guilty by reason of insanity, which in and of itself is difficult). They had to cycle through jail while waiting for a bed at the hospital, and jail is not a good place to be with a mental illness and/or substance use disorder. Then, they were involuntarily committed for treatment… an experience that can be very traumatizing (on top of the trauma of being arrested and imprisoned). Many were able to make the best of it, but a lot of other people struggled both in and out of the hospital.

I also talked to people (or their caseworkers, group home directors, family members, etc.) who moved into group homes after discharge and simply met new people to get high with. I don’t know what treatment centers and sober living residences are like in Ohio, but in Texas it seems like a bit of a crapshoot. Funneling money into treatment programs sounds great, but substance use treatment in the US has a lot of problems and isn’t very well regulated. It can be a life-changing experience helped by caring and knowledgeable professionals, but it can also be a path to unsupported treatment modalities, toxic environments, or gimmicky money grabs.

All that to say is that it’s complicated. There are a lot of variables, and there is much room for improvement. And yeah, the experiences of my NGRIs may not exactly transfer onto the experiences of those needing only substance use treatment. Still, my two cents is that prison is not, and was never meant to be, a place for people to get better; it’s a place to lock people away from society that exists more for the sake of those outside of prison than for those in it. And while involuntary commitment can be a life-saving experience, it’s also incredibly hard and scary and isn’t something we should be okay with casually using for just any situation. Sure, throwing more money at treatment centers won’t magically motivate people to give up their primary coping mechanism, nor will getting people into treatment necessarily help them get better. But I agree with what’s been said already—based on my research and experience, sending individuals to jail or prison for substance abuse doesn’t generally help them recover.


#5

Even involuntary commitment is questionable in treating substance use. Rising above a substance use disorder is by far one of the most difficult processes that I’ve ever witnessed. The most important factor in healing someone with an addiction is knowing that the person is committed to go through the painful process of withdrawal and the lifelong process of maintenance and preventing relapse. It takes a helluva lot of willpower and thats not something you can force on someone.

It reminds me of one of my fave parts of the recent Haunting of Hill House Series where one character states the usual theory that “insanity is doing the same thing again and again and expecting a different result”, and another character responds that, that’s exactly what recovery from addiction looks like. It’s coming back to recovery, starting from square one every single time you fail and relapse because you have the tenacity to defy your own body’s self programed sense of survival. Recovery from substance use is interpreted by the body as a threat of death and sometimes it is an actual threat of death. Thats why Motivational Interviewing is so important in substance use, because one way or another your main objective is to motivate your patient to WANT it enough to go through the process of feeling like they are dying.