Are the words “intervention” and “punishment” synonymous and equally effective in deterring a behavior? Suppose you catch your son or daughter drinking out of the milk carton in the middle of the night. Would you punish the child and take away a privilege for a week or educate the child on how germs are spread and try to build his or her moral character by discussing the idea of respecting those with whom he or she lives? According to The United States Attorney General, Jeff Sessions, he’s taking away that kid’s phone for week. He might even install a camera in the fridge, put an alarm on the milk carton, hire a security guard and, just to be sure, swab the lip of the carton for germs on a daily basis.

Now that sounds like the most cost-effective solution, eh?

Calling All Arms

On May 10th, 2017 Jeff Sessions released a two page memo calling on the judicial system to increase punishment to those that commit crimes. In the United States, it’s illegal to unlawfully possess prescription opioids meaning opioid users are on the chopping block. Much like the current political regime in charge of our country, naysaying scientific evidence is the zeitgeist and Sessions is seemingly not immune that epidemic nor is he showing a willingness to evaluate the growing evidence. The National Institute of Justice had the following to say about punishment by the judicial system:

“… compared to non-custodial sanctions, incarceration has a null or mildly criminogenic impact on future criminal involvement. We caution that this assessment is not sufficiently firm to guide policy, with the exception that it calls into question wild claims that imprisonment has strong specific deterrent effects.”

A columnist in Indiana published an opinionated article criticizing the Attorney General’s way of thinking and essentially suggesting that Sessions should aim to reduce violent crime, chemical dependency and the threat that drug trafficking poses to the public. The National Institute of Justice has actually found that incarceration, especially when the sentences are longer, only increases recidivism rates. Recidivism rates as it relates to the incarceration conversation is an oft-used term when discussing an individual’s chance to return to the same punitive system, essentially communicating that they didn’t learn their lesson at the first go-around.

Albert Einstein famously defined insanity as doing the same thing over and over again and expecting different results.

Indiana’s War Strategy

Particular to Indiana, waging a war on drugs may not decrease substance use disorders or crime associated with drugs such as prescription opioid pain relievers. If we’re going to buy into the paradigm that punishment is not the way to successfully stop the opioid epidemic we may be able to prevent a rise in incarceration rates and taxes, which will open up money for drug treatment programs as opposed to drug punishment programs.

In 2014, more than 1,100 Indiana residents died from drug overdose, which is a 500 percent increase since 1999. If you’re shrugging at that statistic, what’s even more concerning is that 5.6 percent of the Indiana’s population has been involved in non-medical prescription opioid use and the usage rate is highest amongst residents aged 18-25. More than 21 percent of Indiana High School students report using a prescription drug (i.e. Vicodin, Ritalin, codeine, OxyContin, Xanax, etc.) one or more times during their life.

So, let’s roll into high schools with the cuffs and batons and lock them up while they’re young. We may start a lifetime cycle of going back in due to a nationwide attempt to punish rather than treat substance use disorders. An effective approach might be to look at how these drugs are making their way to students with undeveloped brains and nipping it in the bud, so to speak.

In a Psychology Today article, several peer-reviewed articles were cited pointing toward a modern teen’s susceptibility to peer influence. Several studies found that teens often struggle much more with peer exclusion than adults and they also engage in riskier behavior when in the presence of peers. While their example was focused on a teen’s risky driving style, don’t be fooled if you think a teen won’t do drugs to feel like a part of his or her peer group.

It seems necessary to point out that a substance use disorder is a disease and that it should be treated as such. According to the government agency National Institute on Drug Abuse (NIDA), yes the same government that cuts checks for Jeff Sessions, they define a substance use disorder as a chronic disease.

Yes, the initial use of drugs is often voluntary and continued use can cause changes in the brain. Many people often find pleasure in seeing family and friends, watching a movie and playing competitive sports. Those pleasurable activities can increase the production and release of dopamine in the brain, resulting in a happy feeling. When using a drug such as a prescription opioid pain reliever, the brain can be flooded with dopamine, well beyond the pleasure an afternoon barbeque can create for someone. Over time, the drug user will continue to seek that “high” and may recede from their family and friends opting to use drugs instead.

Understanding The Enemy: Signs of Substance Use Disorder

According to a mental health government website, here are some signs that someone is experiencing a substance use disorder:

  • Behavioral changes, such as:
    • Drop in attendance and performance at work or school
    • Frequently getting into trouble (fights, accidents, illegal activities)
    • Using substances in physically hazardous situations such as while driving or operating a machine
    • Engaging in secretive or suspicious behaviors
    • Changes in appetite or sleep patterns
    • Unexplained change in personality or attitude
    • Sudden mood swings, irritability, or angry outbursts
    • Periods of unusual hyperactivity, agitation, or giddiness
    • Lacking of motivation
    • Appearing fearful, anxious, or paranoid, with no reason
  • Physical changes, such as:
    • Bloodshot eyes and abnormally sized pupils
    • Sudden weight loss or weight gain
    • Deterioration of physical appearance
    • Unusual smells on breath, body, or clothing
    • Tremors, slurred speech, or impaired coordination
  • Social changes, such as:
    • Sudden change in friends, favorite hangouts, and hobbies
    • Legal problems related to substance use
    • Unexplained need for money or financial problems
    • Using substances even though it causes problems in relationships

Do you think that someone with the aforementioned symptoms should go to prison to change those behaviors? Will that teach them a lesson? Address the disease? End the epidemic – the “war”? Mostly, how does this provide the treatment necessary to overcome the addiction? This approach fails to take into account the real enemy – the battle is not against the user but, instead, it is against the substances that continue to grow in power.

The Punishment: Prison

An alarming epidemic in Indiana, outside of the opioid epidemic is the increase in incarceration rates in rural counties, where opioids are running rampant. For example, a small rural county in Indiana, Dearborn County, has seen its incarceration rate quadruple between 2003 and 2015. Dearborn County has actually become the envy of neighboring cities and states that think incarceration is the answer. In an attempt to imprison drug dealers with the aim of supposedly curbing the opioid epidemic, informants and undercover officers from Cincinnati, Ohio have steered their dealers toward Dearborn County where the prison sentence for the sale and possession of prescription opioids is much harsher.

While it’s not wise to condone the sale of prescription opioids, what good will it do for an individual to serve 12 years in prison for selling 15 Oxycodone pills to an undercover officer. That’s exactly what happened to Donnie Gadis when he attempted to make that sale in Dearborn County. The system has a glaring flaw. According to a New York Times article writer in September 2016, the county jail has approximately 225 to 250 inmates with a substance use disorder but their treatment program can only serve 40 inmates at a time.

Particular to Dearborn County, for inmates convicted of possession or sale of a controlled substance that were released in 2012, 35.5% of had returned to the county jail for the same charge by 2015. A local prosecutor by the name of Mr. Negangard, is linear in his thinking about those charged with possession or the sale of a controlled substance as he is quoted as saying, “If you’re not prosecuting, then you’re de facto legalizing it”. It’s not that simple because, as was stated earlier, a substance use disorder is a relapsing disease that requires long-term treatment. Providing treatment is an alternative to incarceration versus the idea of legalizing their behavior.

A Way To Fight Without Punishment: Treatment

According to Substance Abuse and Mental Health Services Administration, here are some of the approaches that have been proven to decrease the incidence and chronicity of substance use problems:

  • Individual and group counseling
  • Inpatient and residential treatment
  • Intensive outpatient treatment
  • Partial hospital programs
  • Case or care management
  • Medication
  • Recovery support services
  • 12-Step fellowship
  • Peer supports

Maybe the government website, yes the same government that cuts checks for Jeff Sessions, forgot to include ‘incarceration without access to treatment programs’ to the list. Maybe it will make its way to the amended list once everyone catches wind of his memorandum to increase the punishments thereby increasing the incarceration and recidivism rates.

The Cost of War

If we’re going to use Dearborn County as our guinea pig one alarming expenditure is the $11 million dollars spent to expand the county jail and the additional $11.5 million spent to expand the county courthouse. That’s $22.5 million that could’ve been used to expand the aforementioned clinical services that have been work to reduce the risk of relapse. Hell, even if the clinical services are too expensive the Substance Abuse and Mental Health Administration has also suggested the following cheaper non-clinical services can help someone maintain sobriety:

  •  Transportation to and from treatment and recovery-oriented activities
  • Employment or educational supports
  • Specialized living situations
  • Peer-to-peer services, mentoring, coaching
  • Spiritual and faith-based support
  • Parenting education
  • Self-help and support groups
  • Outreach and engagement
  • Staffing drop in centers, clubhouses, respite/crisis services, or warmlines (peer-run listening lines staffed by people in recovery themselves)
  • Education about strategies to promote wellness and recovery

The problem is that according to Dearborn County prosecutor, Mr. Negangard, “We can’t just let the bad guys go”. If we’re fighting an uphill battle, so be it. It seems that teachers, parents and health care providers may have to serve a crucial role in educating, not punishing youth, when they are caught with a joint hidden in their sock drawer so as to prevent future incarceration. Hopefully Mr. Sessions will get with the times and realize that punishment is not equivalent to intervention.

Waiving Our White Flags

We are undoubtedly facing an enemy – a strong one and it is not going away. While it is encouraging that our government is trying to address the opioid epidemic which is prevalent across the nation, it appears there is a need, in Indiana in particular, to reevaluate their methods. After all, if the true goal is to successfully stop the opioid epidemic, its starts with helping, not punishing, the individuals who actually are fighting their own war against addition.

Who really should be held accountable? Just the drug dealers and the users? Or is it the medical professionals that may have introduced these individuals to the substances in the first place? Does it matter at this point? We need to consider more effective alternatives: education, stricter regulations surrounding prescribing opioids, encouraging our medical professionals to use alternative treatments to opioids, stop criminalizing those who are suffering from addition and instead focus energies and monies on providing more access to treatment and recovery for those who need our help most.

These are some of the reasons why Indiana Center for Recovery exists today. We see the issues in our communities and we are doing something about it. If you or a loved one is struggling with drug or alcohol addiction do not hesitate to call us. We are here 24/7 to work with you.