The Physiology of Addiction and Impact on Correctional Policy
Abstract
The relationship between psychology
and law provides the foundation to understand the physiological basis of
addiction and the role of correctional policy (Haney, 1980; as cited in Bartol
& Bartol, 2004). Science has studied addiction among various disciplines.
Research in physiology supports the notion that chronic substance use results
in disease (Chandler, Fletcher, & Volkow, 2009; Glazer, 2015; National
Institute on Drug Abuse [NIDA], 2014). Yet, correctional policy ignores such
evidence and continues to send offenders to prison. As a medical condition that
results in illegal behavior, the criminal justice system plays the most
significant role and has the ability to revise policy for improved treatment
(Chandler et al., 2009). Regardless, addiction progresses and becomes a cycle
that affects the entire nation—the drug epidemic. If correctional policy fails
to grasp the consequences of addiction, the public has a responsibility to take
control. The combination of addictions and corrections, under psychology and
law, brings research to encourage policy recommendations.
Keywords: psychology and law, addiction,
physiology, corrections, policy, treatment
The
Physiology of Addiction and Impact on Correctional Policy
The
relationship between psychology and law is formative within criminal justice
system. According to Haney (1980), there are three pairs of bonds— (1)
psychology and law, (2) psychology in law, and (3) psychology of
law. This is important because each is found in the other and fuels decisions
in practice, impacting the entire society (as cited in Bartol & Bartol,
2004). More specifically, a significant portion of policy focuses on substance abuse
with very generalized standards while ignoring the influence of psychology and
other disciplines that remain at the core of drug-offending behavior. This only
perpetuates the problem as they are rarely addressed fairly within correctional
procedure. To acknowledge the relationship between psychology and law gives
context to both cause and effect: the physiology of addiction and impact on
correctional policy.
It
has been said that “the definition of insanity is doing the same thing over and
over again and expecting different results,” and thus the criminal justice
system is long overdue to update correctional policies through extensive evidence-based
research confirming the physiological effects of addiction. Nonetheless, the
correctional population is largely composed of individuals who have been
associated with substance use. The National Center on Addiction and Substance
Abuse (2010) found that approximately 65% of those incarcerated fulfill the
DSM-IV criteria for substance abuse and addiction; another 20% did not meet the
criteria, but had been involved in some form of substance abuse (as cited in
Pettus-Davis & Epperson, 2014).
Addiction
is often recognized as an epidemic that leads to incarceration or death,
and the criminal justice system has the ability to enforce correctional policy structured
for reform. Yet, substance-related convictions are frequently handled by
incarceration with minimal progress in lowering recidivism of drug-offenses. The
Center for Prisoner Health and Human Rights (n.d.) noted that in 1980 nearly
41,000 individuals were incarcerated for drug-related offenses, which
significantly increased to 490,000 by 2013. This indicates that the
physiological basis of addiction has not really been considered in correctional
policy, despite extensive empirical research that continues to support
effective policy revisions.
Why
should addicts receive correctional considerations? Addiction doesn’t
discriminate and everyone is susceptible. As substance use transforms into
addiction, logic weakens while the brain undergoes physiological and chemical
changes (Chandler, Fletcher, & Volkow, 2009; Glazer, 2015; National Institute
on Drug Abuse [NIDA], 2014). The drug becomes the person—it’s a disease that
requires medical attention and treatment. Incarceration is an expensive band-aid
for a potentially fatal disease that is curable with proper treatment.
Literature
Review
Current Correctional Policies
The
deinstitutionalization of mental hospitals contributed to how correctional
policies were constructed (Glazer, 2015). This movement inadvertently left many
to make the decision to self-medicate, ultimately leading to addiction on top
of mental illness (also, a step toward making inmates an even more vulnerable
population). The “War on Drugs” was the first initiative towards addressing the
problem of substance abuse, and strict mandatory sentencing followed. The
concept was to establish tough correctional policies and overcome the rapidly developing
drug epidemic. Instead, jail and prison populations were overwhelmed with drug convictions
(Chandler et al., 2009; Glazer, 2015).
As
correctional facilities were faced with more substance abuse, reform and
rehabilitation lost credence while retribution became the primary objective
(Glazer, 2015). In reality, there was minimal awareness and poor treatment available
for those struggling with addiction (Chandler et al., 2009). The central
concept was to imprison drug offenders by providing an abstinent environment, which
would be ideal for recovery without expending too much money, resources, or
additional treatment time (NIDA, 2014).
These
policies and approaches have now proven to be ineffective, starting various movements
pushing towards change. The Smarter Sentencing Act of 2015 reduced mandatory
sentencing and allowed judges to use discretion in sentencing. The Second
Chance Act and Justice Reinvestment Initiative both provided support for reentry
programs and recidivism-prevention strategies while incarcerated and
post-release (Glazer, 2015).
Addiction Physiology
Addiction
is a multidimensional consequence of repeated substance use, eventually turning
into a disease (Chandler et al., 2009). There are more questions than answers,
but the physiology behind addiction offers evidence for better understanding, presenting
indisputable reason to construct better correctional policies geared toward
treatment and reform (Chandler, et al., 2009; Glazer, 2015; NIDA, 2014).
Those
who become addicted surpass physical dependence and experience additional
consequences that affect the entire body (Chandler et al., 2009; Shively, 2015).
As a disease, the brain’s chemistry and
anatomy is altered in such a way that affects cognition, behavior, and
physiological functioning, ultimately leading to criminal behavior (Chandler et
al., 2009; NIDA, 2014; Semantic Scholar, 2009).
Once
the drug is ingested, neurotransmitters (like dopamine and serotonin) trigger a
cascade of neurobiological reactions that, after prolonged use, cause significant
damage, ultimately primed for addiction (Semantic Scholar, 2009). The
mesolimbic system, or reward circuit, contributes to the conditioned response of
cravings and behaviors, as well as motivation and memory (Chandler et al.,
2009; Semantic Scholar, 2009; NIDA, 2014). Chronic use is reinforced through
operant conditioning, and with dopamine constantly activating the mesolimbic
system, synapses form alternate pathways in response to the overload (Semantic
Scholar, 2009).
The
body adjusts to a new allostatic state to maintain stress systems as they
become overactive. Now in a constant state of stress, the reward from the drug
decreases while the ability to escape this depressed state is prevented due to an
allostatic overload (Semantic Scholar, 2009). Thus, depression exacerbates the
urgency to get the next “fix,” causing the cravings and compulsive behaviors.
Drugs become the main motivation as they seize control of the mesolimbic system,
and memory of natural rewards is impaired (Chandler et al., 2009). Eventually,
the process becomes automatic that the dopamine release is no longer necessary
in the cycle (NIDA, 2014; Semantic Scholar, 2009).
Focal Themes
There
is an unfortunate, yet obvious, disconnect between addiction treatment and
correctional policy (Chandler et al., 2009). If the physiological basis of
addiction was properly considered, there would be no delay. Recognizing
addiction as a disease would realize the benefit of research to reinforce correctional
policies (Chandler et al., 2009). The reward for those affected, for the criminal
justice system, and for society as a whole would be infinite.
At this point, what has been
implemented has not worked and incarceration alone can no longer be the easy answer.
Addiction as a disease means acknowledging that drug use causes physiological
changes in the brain. While the initial act of using drugs is choice, it
rapidly becomes out of control. By no means does this excuse the responsibility
or illegal behavior of the individual, but “understanding how addictive drugs
affect behavior through brain mechanisms can inform decisions to provide
treatment to addicted individuals,” (Chandler et al., 2009).
Correctional
populations struggling with substance abuse are most likely to be released into
the community. Unfortunately, society has been led to believe the unfair stigma
surrounding addiction and incarceration. Ex-offenders are expected to overcome
barriers that feel impossible to climb, thus creating the perfect storm to
relapse and recidivate. It’s a cycle that needs to end, and the community needs
to be involved, but starts with revising correctional policy (Chandler et al.,
2009).
Policy
Recommendations
Based on the
physiological basis of addiction, correctional policy recommendations should be
broken into phases—preventative, conviction, and reentry. Each involves a range
of factors and benefit from different approaches. The variation between phases is
independent from progress or participation—improvements will occur regardless
of concentration on one or all.
Preventative measures
can be the most revolutionary action, involving society and social supports.
Whether you know someone with addiction or not, it effects every single one of
us and it certainly matters. The stigma against substance abuse overlapping
previous incarceration is detrimental to the individual; it is inaccurate and
counterproductive towards success (Chandler et al., 2009). The physiological
basis of addiction explains that it is more than a decision to continue abusing
drugs, it’s a disease (Chandler et al., 2009; Glazer, 2015; NIDA, 2014). With
any disease, simply being there and understanding for those suffering makes the
difference. Social support can be achieved through education and awareness
(Pettus-Davis, Howard, Roberts-Lewis, & Scheyett, 2011). On the contrary,
as easy as it sounds, this type of unity is difficult to reach. Nonetheless,
every little bit counts and the effort is what matters—it is impossible to
determine what will “trend” from one day to the next, and sometimes that makes
all the difference—locally and even nationally.
Drug courts are steadily
increasing and proving to be extremely effective. This approach keeps offenders
out of jail, while still being held accountable for their charges. Correctional
policy should favor the use of drug courts since it saves time, money, and
resources (Chandler et al., 2009; Pettus-Davis, 2012; Pettus-Davis &
Epperson, 2014). If the offense is co-current with other criminal behaviors,
incarceration should be paired with treatment regardless of sentence length.
Addiction interventions often involve cognitive or behavioral therapy
approaches—both are useful in identifying triggers, learning coping strategies,
and regaining self-control (Bartol & Bartol, 2004; Chandler et al., 2009).
Treatment received while incarcerated must
follow post-release; reentry and reintegration programs should be mandated for
drug-offenders. The development of these programs are becoming the most influential
force in changing correctional policy (Chandler et al., 2009). Gradually,
nonprofit agencies are promoting mission statements targeted for those
previously incarcerated, offering specific services to support rehabilitation
and recovery. These nonprofit agencies are integral to changing policies through
advocating, investing, and teaching beyond the client—they serve clients while
raising awareness within the community (Pettus-Davis & Epperson, 2014).
REAL LIFE (2019), a nonprofit located in
Richmond, Virginia, is a great example of making a difference individually,
communally, and within policy. They offer a sober-living residence,
trauma-informed care, case management, drug testing, court services, external
partnerships, classes focused on developing life skills, groups supporting
recovery, all while taking the time to actively participate at the city and
state level. At this point, courts frequently mandate offenders to receive
services at REAL LIFE as part of their sentencing (REAL LIFE, 2019). This is
the magnitude and standard that needs to flourish.
The more nonprofits like these begin to
advocate, correctional policy will inevitably change. As individual lives
succeed with this approach, data needs to be collected and publicized to
demonstrate the effectiveness of these programs in response to the
physiological basis of addiction. REAL LIFE maintains an online journal where
statistics of success are highlighted (see Brown, 2019).
Conclusion
Incarceration typically
does not yield rehabilitation. While it does provide a rare opportunity for
intervention, the majority of correctional populations never receive treatment
(Chandler et al., 2009). It is time to start going a new direction, especially
with growing physiological evidence to understand addiction. It’s time to adapt
correctional policies to better represent these new findings.
When it comes down to
it, addiction is not the problem alone. Substance abuse is quickly stigmatized,
and more often than not, disregarded as a disease. Until the public and
criminal justice system accept the physiological evidence, treatment will never
be a guarantee (Chandler et al., 2009). Even though there are several phases
that allow for the opportunity—anyone can break the cycle.
Those who become trapped by addiction are
more likely to have unstable housing, insufficient funds, limited
transportation, and no access to health care (Chandler et al., 2009;
Pettus-Davis, 20; Pettus-Davis & Epperson, 2014). These are our friends,
family, neighbors, leaders—it’s a public health crisis. Current correctional
policy reinforces the stigma of convicted addicts when it could be the best
opportunity to provide a long-term solution, or treatment (Chandler et al.,
2009). Instead, the focus is on retribution and incarceration for addicts with
no acknowledgement of addiction as a disease (Chandler et al., 2009; Glazer,
2015). Perspective is missing when it comes to addiction, and the physiological
basis is able to explain the damage caused to the brain and body. The research
is staggering and absolutely needs to be considered when enforcing correctional
policies. Once effort is put in to correcting addiction through prevention,
drug courts, incarceration with required treatment, and mandated reentry
programs, the adversities overwhelming the nation will begin to improve. The
research is out there and growth has to start somewhere. At any stage in the
cycle, anyone can be the change.
References
Bartol, C.R. & Bartol, A.M.
(2004). Psychology and law: Theory, research, and application.
Wadsworth/Thomson
Learning, 3rd ed.
Brown, A. (2019). Life’s numbers to serve REAL humans. REAL LIFE.
Retrieved from
http://reallifeprogram.org/lifes-numbers-to-serve-real-humans/
Center for Prisoner Health and
Human Rights. (n.d.). Incarceration, substance abuse,
and addiction. The
Miriam Hospital. Retrieved from https://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-substance-abuse-and-addiction/
Chandler, R.K., Fletcher, B.W.,
& Volkow, N.D. (2009). Treating drug abuse and addiction in
the criminal
justice system: Improving public health and safety. National Institute of
Health. JAMA,
301(2): 183-190. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/pdf/nihms101882.pdf
Glazer, S. (2015). Prisoners and mental illness. CQ Researcher, 25,
241-264. Retrieved from
https://library.cqpress.com/cqresearcher/document.php?id=cqresrre2015031300
National Center of Addiction and
Substance Abuse. (2010). Behind
bars II:
Substance abuse and America’s prison population. New York: The National
Center on Addiction and Substance Abuse at Columbia University.
National Institute on Drug Abuse
(NIDA). (2014). Principles of drug abuse treatment for
criminal justice
populations: A research-based guide. National Institutes of Health (NIH).
National Institute on Drug Abuse: Advancing Addiction Science. Retrieved from https://www.drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations/principles
Pettus-Davis, C., Howard, M. O., Roberts-Lewis, A., Scheyett, A. M.
(2011). Naturally
occurring social support
in interventions for former prisoners with substance use disorders: Conceptual
framework and program model. Journal of
Criminal Justice: 39:6, 479-488. Retrieved from https://doi.org/10.1016/j.jcrimjus.2011.09.002
Pettus-Davis, C. (2012). Reverse social work’s neglect of adults involved
in the criminal justice
system: The
intersection and an agenda. Social Work
Research, 36:1, 3-8. National Association of Social Workers [NASW].
Retrieved from https://doi.org/10.1093/swr/svs036
Pettus-Davis, C. & Epperson, M. (2014). From mass incarceration to
smart decarceration. Center
for Social
Development: Washington University in St. Louis. Retrieved from https://csd.wustl.edu/Publications/Documents/WP14-31.pdf
REAL LIFE (RL). (2019). Retrieved
from http://reallifeprogram.org/
Semantic Scholar. (2009). The
physiological basis of drug addiction. Retrieved from
https://pdfs.semanticscholar.org/89ce/561f6d488e87193ec38cae71505825839ccc.pdf
Shively, R. (2015). Keeping drugs
out of prison. Corrections Today. Retrieved from
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