Friday, September 13, 2013

Addiction and Crime - A Way Forward


Addiction and Crime – A Way Forward

Randy Hunt, State Representative
Massachusetts 5th Barnstable District
September 2013

  

Serving on the Joint Committee for Mental Health and Substance Abuse as well as the Interagency Council on Substance Abuse and Prevention has given me a view into the problem of substance abuse that few people outside of the treatment arena are afforded. Three truths I have come to realize are 1) substance abuse is wider spread than most people believe, both geographically and socioeconomically; 2) treatment works; and 3) relatively few people seek out treatment.

Over the past ten years, legislators, governors and state administrators across the country have begun to see the folly of incarceration as a solution to the problem of substance abuse. It is the most expensive and least effective way to address the issue, a veritable turnstile for repeat offenders who do not get the treatment they need. Nonviolent criminals with a substance addiction are crowding our prisons—about one-quarter of all inmates in the U.S.—and costing enormous sums of our states’ limited resources, resulting in other areas of state governments, such as education spending and transportation infrastructure investments, getting short-changed.

Addiction and Crime, A Way Forward is a policy initiative to reduce substance abuse in Massachusetts by focusing on the population of nonviolent criminals with a substance addiction who interface with the criminal justice system. It is, by no means, an omnibus solution for all addicts, the majority of whom never encounter the police, courts and detention; but it is a way to deal with thousands of people who are responsible for the majority of our property crimes, domestic abuse situations, and serious vehicular crashes—all of this with the promise of saving taxpayer dollars.


Why Addicts Commit Crimes

Is Free Will No Longer Free?
Much has been said in recent years about addiction being somewhere between an uncontrollable behavior and a conscious choice. Some characterize it as a mental disease that should be de-stigmatized and dealt with as we do physiological diseases; that is, treatment by professionals in appropriate settings for the appropriate amount of time with the backing of health insurance or public assistance. Others believe in a personal responsibility model that is essentially “you broke it, you fix it” (http://abcnews.go.com/US/story?id=90688&page=1&singlePage=true).

A debate has emerged about whether an addict loses free will, particularly an abuser of opiate drugs which present very powerful physical withdrawal effects. Why would a previously productive person start down the road of committing petty crimes, wrecking relationships, and defying common sense? Would a person with free will choose to ruin their lives and the lives of people around them?

Some argue that it is not free will that is lost, but rather that an addict’s belief in free will turns to disbelief (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757759/). That may seem a bit nuanced, but someone who declares “I can’t help it” probably finds it expedient to disavow his free will, thus avoiding self-incrimination.

Irrespective of the academic debate about addiction’s connection to loss of free will, it is a fact that, by force or by choice, addicts engage in destructive behaviors and often are unable to pull themselves out of their downward spiral. Along the way, many addicts commit crimes, from illegal drug possession to property theft, from embezzlement to robbery.

Sometimes, the first significant manifestation of a loved one’s drug habit is an arrest. Perhaps changes in the addict’s behaviors and routines went unnoticed or were chalked up to the stresses of school or a job or a relationship. Often the crimes committed are of a nonviolent nature but come with stiff penalties. In fact, about a quarter of all inmates in the United States are nonviolent criminals with a substance addiction (http://www.nationalreview.com/corner/269208/prison-math-and-war-drugs-veronique-de-rugy).

At the point where interdiction and treatment are most called for, our justice system parks nonviolent criminals with a substance addiction in prison, where recovery is rare.


Treatment versus Incarceration
 
Treatment Does Work
Doug Sellman, Professor of Psychiatry and Addiction Medicine at the National Addiction Centre in Christchurch, New Zealand, describes the ten most important things known about addiction (http://www.scribd.com/doc/45303234/The-10-Most-Important-Things-Known-About-Addiction-Sellman-Addiction-2010-See-response-by-Sobels-Missing-the-Continuum):

(1) Addiction is fundamentally about compulsive behavior;

(2) Compulsive drug seeking is initiated outside of consciousness;

(3) Addiction is about 50% heritable and complexity abounds;

(4) Most people with addictions who present for help have other psychiatric problems as well;

(5) Addiction is a chronic relapsing disorder in the majority of people who present for help;

(6) Different psychotherapies appear to produce similar treatment outcomes;

(7) “Come back when you’re motivated” is no longer an acceptable therapeutic response;

(8) The more individualized and broad-based the treatment a person with addiction receives, the better the outcome;

(9) Epiphanies are hard to manufacture; and

(10) Change takes time.

The referenced article provides a summary on each of the ten points and encapsulates some of the difficulties and frustrations related to addiction treatment, but however difficult and frustrating treatment options can be, there is one consistent finding across many studies of treatment versus incarceration: Treatment costs a fifth or less compared with the costs of incarceration (http://www.justicepolicy.org/uploads/justicepolicy/documents/04-01_rep_mdtreatmentorincarceration_ac-dp.pdf).

With such a “bang for the buck,” why wouldn’t legislators, administrators and adjudicators call for more treatment and less prison time for nonviolent criminals with a substance addiction? Even with relapses and recidivism being factors in treatment cost, an addict could go through treatment five times before equaling the cost of one incarceration. The fact is that drug offenders who complete treatment programs recover and stay sober at much higher rates than those who receive no treatment while incarcerated.


Drug Diversion Programs
Non-Violent Offenders Get A Second Chance
The good news is that states have started to embrace the concept of treatment as an alternative to incarceration, including Massachusetts. One of the staunchest advocates of treatment for nonviolent criminals with a substance addiction is Judge Mary Hogan Sullivan, the Dedham District Court’s presiding justice and director of specialty courts in the District Court Department (http://www.boston.com/news/local/massachusetts/2013/03/23/newton-district-court-launches-drug-court-program-newton-court-adds-drug-treatment-session/LU9zGdBpysehw2ZVGLujDN/singlepage.html).

The system she has created is essentially probation with required addiction treatment and drug testing. Drug court, as it is commonly called, is an option for a convicted drug offender with the alternative being incarceration. In a 2003 study by the Center for Court Innovation, the recidivism rate among 2,135 participants in drug courts in six states was 29% lower over a three-year period compared with drug offenders who did not participate in the programs (http://www.samhsa.gov/samhsa_news/volumexiv_2/index.htm). Unfortunately, only twenty drug courts exist in Massachusetts and they depend greatly on the talent of their probation officers who, in many cases, learned their craft through on-the-job training.

Mission Direct Vet, a program specific to Massachusetts veterans with criminal charges combined with mental health disorders, such as post-traumatic stress disorder (PTSD), recently completed its five-year grant period, producing a model for dealing with this growing population. Paired with veterans who have had similar experiences, the results in terms of reduced recidivism were excellent. Moreover, given the statistical probability that the participant group would normally suffer several suicides, the fact that none were committed is particularly noteworthy (http://www.ndci.org/conferences/2011/agenda/F-21.pdf).

Critics argue that more should be done to offer treatment before an addict becomes a convicted criminal. It is not a matter of “either/or” but rather an issue of funding, which is hard to come by in either scenario, and creating points of interdiction that occur before an addict becomes a convict. Gosnold on Cape Cod, for example, is working to develop an interdiction program in primary physicians’ offices by training people to identify symptoms of addiction in patients who are there for other reasons. School-based drug education programs are a requirement of the omnibus opiate drug addiction bill that was passed in July last year but are yet to be incorporated in the statewide curriculum.


The Texas Experiment
Mandatory Treatment Saves Billions
In 2005, Texas began reforming drug sentencing and shifting money to drug rehabilitation and prevention programs, which has saved the state billions of dollars [in avoided costs] and reduced crime. Such reforms have earned the praise of unlikely bedfellows: NAACP President Ben Jealous and conservative activist Grover Norquist. The NAACP argues that sending people to jail for nonviolent drug offenses turns young people into hardened criminals and disproportionately affects black people, while Norquist argues that states waste taxpayer money locking up people who could be rehabilitated more cost-effectively (http://news.yahoo.com/blogs/lookout/texas-close-prison-first-time-state-history-175703769.html).

In August of 2011, the Texas governor announced that the state would, for the first time in its history, close down a prison due to a reduced prison population and the lowest crime rate since 1968. Two other prison closures have been authorized by the state legislature.

What Texas did to accomplish this seemingly herculean feat was to invest heavily in drug courts, electronic monitoring, and improved parole and probation monitoring of nonviolent criminals with a substance addiction. Texas is also not hamstrung by mandatory minimum sentencing, something once popular with both conservatives from the “lock ‘em up and through away the key” school of thought and liberals, whose unions saw job security in long sentences and overcrowded prisons (http://www.nationalreview.com/corner/355661/conservatives-welcome-eric-holder-criminal-justice-reform-bandwagon-vikrant-p-reddy).

The idea of offering, or forcing, treatment programs pays off in a number socially beneficial ways as well. Addicts who receive treatment find themselves able to hold a job, repair relationships, and return to productive society; all huge upsides compared with years of incarceration. Additionally, opportunities to “give back” abound in recovery programs that rely on peer counselors as an element of their treatment protocol.


Other States Climbing Aboard
Discovering That Treatment Is Effective and Cheaper

Since 2010, a number of conservative legislatures have passed major criminal justice reform packages. Ohio, Georgia, Pennsylvania and South Dakota joined Texas by moving from “tough on crime” to “a focus on recovery” when it comes to nonviolent criminals with a substance addiction. Overall, 28 states have embarked on major reforms during the past five years, with 19 of those states being led by Republican governors or GOP legislatures and nine by Democratic governors or legislatures.

There are still holdouts in some legislatures, primarily Republicans who believe that they’ll be cast as “soft on crime,” a stigma they believe could threaten their political futures. Legislative efforts in Florida and Indiana fell victim to arguments that public safety would be compromised if nonviolent criminals with a substance addiction weren’t locked up (http://online.wsj.com/article/SB10001424127887323836504578551902602217018.html).

Paradigm Shift for Massachusetts
Time to Expand Successful Programs

The message is clear that incarcerating our way out of the drug and alcohol addiction crisis has not worked. The “War on Drugs” has also proven that, in spite of all efforts to stop illegal drug flow into this country, the fundamental economic model of supply versus demand overwhelms all attempts to stamp out supply. If there is demand, someone will supply it. Is there any shortage of heroin on the streets of Boston or Hyannis?

Massachusetts needs to get serious about fully implementing criminal justice reforms relative to nonviolent criminals with a substance addiction and investing heavily in expanding our successful drug diversion programs. No one can sincerely argue that it’s not a good idea to repair lives, put families back together, get people back to work, reduce crimes that go hand-in-hand with substance abuse, and save taxpayer dollars at the same time.

There are three key items that need to be addressed in order to construct a reform bill. I will file legislation to authorize three commissions to both independently and collaboratively study and provide methods and costs for implementing the key objectives:

1)      Judiciary Commission: This commission would be comprised of members from all three branches of state government and nongovernmental advocacy groups to create eligibility criteria for mandated treatment/monitoring and propose necessary changes in existing laws to accommodate for this reform.  – The Texas law requires judges to put nonviolent criminals with a substance addiction with no previous felony convictions into a treatment program. For those with a prior felony conviction, the judge has latitude in choosing between a treatment program and incarceration. A similar construct should work in Massachusetts along with adjustment to or elimination of some mandatory minimum sentencing guidelines that extend to otherwise eligible nonviolent criminals with a substance addiction.

2)      Treatment Commission: This commission would be comprised of members from all three branches of state government and nongovernmental advocacy groups to develop plans to expand Massachusetts’ drug diversion programs to include every district court in the commonwealth. Additionally, this commission would specify the necessary resources and related costs for both internal and outsourced assistance required to accomplish this expansion. – There are 62 district courts, of which only 20 have a drug court. Clearly the cost of adding 42 more drug courts needs to be determined, but as important, the commission must create a plan for how Massachusetts would apply best practices with the goal of having consistently high quality of personnel and services across all of the drug courts. This expansion would also contemplate the subdivisions of drug courts, such as veterans’ and juveniles’ drug courts. Finally, the commission should consider a hybrid approach of incarcerated treatment for addicts who require the additional discipline of a 24/7 treatment facility.

3)      Corrections Commission: This commission would be comprised of members from all three branches of state government, unions, and nongovernmental advocacy groups to project the effects of a reduced prison/jail population on the operations and capital needs of the corrections system. – A few years into the implementation of the nonviolent drug offender changes in Texas, its legislature authorized the closing of three state prisons. The first actual closure was announced in 2011. These reforms also allowed the state to scrap plans to build two additional facilities. Similar results should be expected and planned for in Massachusetts. As prison/jail population declines, a plan needs to be in place to adjust operating and capital requirements to maximize cost savings. To this end, it is critical that consideration be made to retraining people to fill roles in the expanded drug court system and to repurpose space in our prison system to serve as treatment centers.

We must cast aside the old paradigm, be up to the pushback of status quo special interests, and tackle this issue head on. Working with my fellow legislators, I am confident that we will advance legislation to accomplish these goals and make Massachusetts a better place to live.