by Hon. K. Michael Mayes
Editors's Note: This is the first of a three-part series on Addiction in Court.
Before the mid to late twentieth century, “alcoholism” and “drug addiction”1 were words whispered about fallen friends and relatives. Since that time, the recovery community has made significant strides in explaining to non-addicts what it means to be an addict, and how recovery and relapse co-exist in the addict’s world. But fully explaining these concepts in terms that make sense to non-addicts can be an insurmountable task and the resultant lack of understanding by those who are not touched directly or indirectly by addiction has created an atmosphere of distrust between addicts and non-addicts. This, in turn, has resulted in little empathy from various professionals and industries that have the capacity to create positive change for addicts. We see this in sparse funding for research and treatment, rejection of coverage by the insurance industry for necessary mental health care, and denial by those in the judicial field that addictions should be viewed differently than crimes.
The recovery community fights preconceived biases that have existed for years. For example, many well-intentioned non-addicts find it easier to blame the abuse of alcohol or drugs on a lack of courage or an unwillingness to just say “no” than to thoughtfully consider the painful and costly alternative that addiction is a mental health condition that in fact exists and cannot be cured. Moreover, since our society values accomplishment through hard work, it is difficult for many to accept the notion that simple effort and a willingness to quit alcohol or drugs is not the answer to addiction. These people find it easier and, quite frankly, more satisfying, to simply assign culpability to a failure in the addict’s morality, thereby satisfying their human desire to assign fault.
While we have known for some time that addiction affects the addict’s psyche in ways that promote the disease process itself,2 only in recent years have the medical and technology communities weighed in with their expertise, explaining and showing in vivid detail the direct effects addiction has upon the brain of an addict. Advanced CAT scans, MRIs and other radiological devices now confirm with remarkable specificity how addiction, as a mental disorder or disease, operates in the brain of an addict, and how substance abuse alters and damages the brain. Medicine has proven what addiction and substance abuse experts have suspected for years: (1) an addict’s brain is different than other brains and (2) drugs and alcohol damage the addict’s brain in specific locations and in demonstrable ways. Being able to see verifiable changes in an addict’s brain has brought undisputable proof to even the most skeptical of minds.
Medical studies support the conclusion that heredity and genetics play a large role in the susceptibility of certain persons to become addicted; that is, the propensity to addiction is predetermined and not based on some conscious decision-making by the addict. These modern advances also confirm the mechanism of how the abuse of substances affects the frontal region of the brain where judgment, decision making and regulation of impulse behaviors are governed.3
These brain alterations result in an inability to recognize or acknowledge that one is even sick and convince the addict that they do not have a problem or need any help. The resulting denial cannot be assigned to laziness, a lack of will power or an unwillingness to accept the truth.
The continued refusal by some judges to recognize addiction as a mental disorder is not only refuted by this current medical knowledge, but serves to detract from the desperate need for solutions. This reluctance to acknowledge the medical truths about addiction fuels an unwarranted loss of hope for those who are addicts or who suffer as a result of the addiction of another. Combining current medical knowledge with the reality that addiction is a disease generates an entirely new impetus to implement treatment whenever and however possible, including in the judicial setting.
For judges, especially, it is imprudent to approach addiction with an attitude that ignores the realities of the diagnosis. It is even less judicious to ignore our ability to implement an intervention or require treatment for this disorder simply because we feel uninformed or uneducated about the disease. This does not mean that we allow defendants to escape consequences for their actions, but it does mean that we join the recovery and treatment communities with a protocol that addresses the problem head on. A judge has the unique ability to oversee and manage the devastating consequences of addiction. How to use this ability in a positive, healthy and therapeutic way can be better understood once addiction is defined in terms that are appreciated. Once addiction is understood, lives can and will be saved.