How America Overdosed on Drug Courts

http://www.psmag.com/politics-and-law/how-america-overdosed-on-drug-courts

by nbj914 • 11 years ago

32 29 11 years ago

psmag.com

gress• 11 years ago

This points to a more general problem of the lack of accountability of judges.

dalke3• 11 years ago

So how do we get there? More mandatory minimums? Less judicial discretion?

Since I think the solution is to get rid of the drug courts and move them into the medical system, and not to demand more accountability.

Plus, what of accountability for the politicians who set up the policies in the first place?

exelius2• 11 years ago

IMO we need to decriminalize drugs, treat addiction as a medical issue, and shift our cultural attitudes away from seeking punishment out of the justice system. But none of those will happen because there are too many people making too much money from the current paradigm.

And politicians have worked long and hard to ensure they have no accountability. As long as the place that they're from is aligned to their party affiliation, they have a job for life regardless of what they do.

the_watcher• 11 years ago

To me, it only hints at that (a problem that I agree is substantial). The main issue is that our legal system is simply not very well-equiped to deal with issues that require true expertise from a professional outside of those with law degrees.

phren0logy5• 11 years ago

By the time Darren was assigned to drug court, his addiction story carried almost every possible red flag for high-mortality risk: prior overdose, prior treatment failure, a childhood ADHD diagnosis, and a family history of mental illness. Any addiction doctor—or anybody who simply follows evidence-based treatment guidelines—would know exactly what to prescribe for him: opioid maintenance, by far the most effective treatment, known to lower the death rate of opioid addiction by between 66 and 75 percent.

I am a psychiatrist, and I treat many people with addiction problems. This formulation is a gross oversimplification. Opioid agonist therapy (methadone or bupronorhpine) is not trivial or one-size-fits-all. There are many other factors to consider, not the least of which is the person's interest in getting clean.

nashequilibrium• 11 years ago

Why is a psychiatrist on hackernews, just curious?

phren0logy5• 11 years ago

During my residency, I did some fMRI research and learned a little bit of programming. The structured thinking involved in programming has been a useful skill that I try to maintain.

Plus there's lots of interesting discourse with smart people, which is a rare thing to find on the internet these days.

stronglikedan• 11 years ago

How right you are. I have a friend whose been on Suboxone for years. First thing she does when she gets her prescription is sell it or shoot it. I have no idea how to help her anymore (as if I ever did). Her ex was the same way.

worik6• 11 years ago

It is a generalisation but a good one. "Getting clean" is a loaded term. Most (not all) people who have "drug" problems actually have police problems. The drugs do them very little harm (impurities are a different story, but not as common as people think) but the police and legal systems do them untold damage.

Making the drugs available is by far the best treatment for most forms of drug addiction in the vast majority of cases. The simplest way to do that is to remove criminal sanctions from drugs and make prescription for addiction legal.

Addiction is a complex beast and demanding that people deal with the chemical dependence before dealing with the other problems in an addicts life is usually a cruel approach and ineffective.

This is something a psychiatrist should know.

phren0logy5• 11 years ago

I can't really agree with your premise. Our current situation is pretty broken, and our drug laws and enforcement have not achieved their stated aims.

That said, the legality of alcohol hardly keeps it from causing lots of people very serious problems. "Drugs do them very little harm" is fantasy, though you are quite right that a felony history and time behind bars only makes things worse.

CodeWriter23• 11 years ago

This article focuses on a single failed case, the actual worst case scenario. And though it is true cases like this exist, it is a tiny part of the story of Drug Court. It gives no credit to Drug Court's immense success. I have personally met dozens if not hundreds of addicts that came into recovery only through drug court, and have achieved long term recovery, and have become productive members of society.

After touting the worst case scenario and ignoring the success, this article puts a little missive in there about how doctors (those mostly with no personal experience in addiction or recovery) prefer opioid maintenance. This is but another marketing message for Suboxone, in the massive PR campaign underway to create an alternative to drug-free recovery through long term addiction to a pharmaceutical product. In the recovery community, Suboxone is referred to as Drug Replacement Therapy (DRT) because that is what it is, switching street dope for dope that comes from your doctor. It gets you high enough to avoid withdrawal, but not so high that you can't move boxes or burgers in an entry-level job. If you do try to get off the Subs, you will experience withdrawal that makes heroin withdrawal look like a walk in the park on a sunny day with a sno-cone and a puppy. This article also fails to mention the suicide rate of people on Suboxone. While I have no hard data on that (ONLY because it has never been studied), I can tell you it happens. It's happened to people I've known. It happens because so long as they are addicted to dope, doctor prescribed or otherwise, the deeply traumatized individual who is an addict remains traumatized. They will never experience the true freedom, healing and wholeness that comes only through deep self-examination and a conversion process of equal or greater magnitude, that leads to self- and social integration. DRT only treats the most visible symptoms of addiction, and does nothing to treat the underlying cause.

While I know not everyone succeeds as a result of drug court, on balance, it is a net positive. Some people need to be re-arrested 2 or 3 times before it takes. And some die. This is an unfortunate reality of addiction. And opioid maintenance IS addiction. It really is up to the individual to work through their trauma, and find the needed support to exist and find a reason to continue living. That cannot be imposed by law, coercion, or prescription.

Bottom line though, research the history of Heroin in the United States. A hundred or so years ago, heroin was touted as the solution for morphine addicts. It was the Drug Replacement Therapy of that time. We have been down this road before and we know where it leads.

andrewstuart• 11 years ago

Prohibition/The War on Drugs is stupid. All it does is put money into the hands of criminals and costs the state money by locking people up who should be leading normal lives and paying taxes.

mindslight• 11 years ago

Why is your comment written with an assumption that one of the great things a person can do is to pay taxes? That same attitude is what got us drug laws in the first place.

Smeevy• 11 years ago

There's another problem with drug courts which I think is a bit more serious. Given the amount of judicial and supervision time required for a drug court, the courts tend to be very selective as to who can be diverted into that process. They prefer young people with no prior history and those individuals are put through a very stringent process with the threat of going to jail or prison for noncompliance.

The rub here is that that group of people (young, nonviolent first-time offenders) tend not to reoffend anyway. In that light, these courts take credit for putting someone through this process who would have been just as likely to never see the court again if she or he had just been issued a fine or given a stern talking-to. For this group, just being in jail for a night is enough to stop (or never get caught again).

What makes this sadder, I think, is that there are many other people in the system that would benefit from this kind of specialized attention from judges and probation officers. The success rate for that group would be much lower, but the individual successes would be more impressive. They just get put into prison over and over until all they can do is be a criminal.

How America Overdosed on Drug Courts

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