Rory was punished for his illness

Many people with substance use disorder end up involved with the criminal justice system, where they are typically subject to an approach that is punitive, rather than health-promoting.

By Tonia Ahern

A week after his 18th birthday, Rory got a DUI and possession charge. We finally got help finding state-funded treatment, but we had no idea that he would spend the next 11 years trying to get out of the criminal justice system. He was mandated to treatment repeatedly, but the programs never addressed his underlying issues, which now included coping with the grief of losing so many friends to accidents and overdoses.

In the criminal justice system. positive drug tests were considered failure and non-compliance, and resulted in punitive consequences. Violations meant jail and prison, which added trauma to his substance use disorder, bipolar disorder, ADHD and grief. Medications for opioid use disorder were discouraged or considered a temporary replacement that would eventually need to end. As he continued in the system, the worse his symptoms seemed to be. He was a commercial fisherman, the only thing he was truly passionate about, but he was not allowed to fish because of the risk of using substances on long fishing trips. He was so tired of it all.

He was treated like a criminal for nothing more than the symptoms of his illness.

The Problem

Many referrals for substance use disorder treatment come from the criminal justice system, typically through diversion programs, such as alternative to incarceration programs or drug courts, which are meant to provide opportunities for individuals in the criminal justice system to engage in treatment. While both alternative to incarceration and drug court programs have been found to reduce recidivism, there are a number of barriers and limitations, including a dearth of qualified medical staff in the criminal justice system, insurance coverage barriers, limited community treatment programs and resources and rejection of evidence-based care for addiction, namely FDA-approved medications. A lack of knowledge or acceptance of addiction as a health condition also leads to a punitive approach to relapse, rather than recognizing that relapse is a common and expected part of a chronic disease. During relapse, individuals need more intense care and support but, in the criminal justice system, they are often punished and face legal repercussions. Often, program participants who relapse are sent to jail, where very few individuals receive addiction treatment during incarceration and fewer receive evidence-based care.

The Solution

Given the high rate of substance use and addiction among justice-involved individuals and the risks and costs associated with untreated addiction, providing effective, evidence-based addiction treatment should be a top priority. Alternative to incarceration, drug court programs and jails and prisons should all be required to provide evidence-based addiction treatment, including the FDA-approved medications for opioid use disorder (methadone, buprenorphine and naltrexone), to program participants and incarcerated individuals with substance use disorders.

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