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Vitka Eisen, MSW, Ed.D.

President and CEO HealthRIGHT 360, Board Member, National Council for Behavioral Health

Addicted to Coercion

October 29, 2019 | Addictions | Criminal Justice | Comments
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Beginning in 2011, with California’s state prison system overseen by the federal courts due to severe overcrowding, the state legislature and voters passed a series of laws to reduce sentencing severity for non-violent crimes, most notably drug-related offenses.

As a result, fewer people faced felonies for crimes often associated with problematic substance use, like simple drug possession. Additionally, fewer people were returned to prison for positive urine toxicology screens for illicit drug use. The number of people in state prison dropped by nearly 35,000 – or 20 percent – over the next seven years.

A byproduct of these positive policy changes left the state’s drug courts flummoxed: What leverage was available to compel people into addiction treatment without the threat of incarceration? Around that time, I received a call from a reporter who told me, “Local providers are concerned that under the more lenient sentencing guidelines, nobody is going to enter treatment anymore.”

He asked me if I cared to comment, and I did. “That’s absurd! Are our services so noxious that the only way we can get people to participate is to threaten them with prison?” But I get it.
Engaging clients to enter into treatment for addiction – and remain there long enough to benefit – is, indeed, a challenge. Substance use disorder is a complex brain condition that affects the very organ needed to make reasoned decisions, including to delay gratification and to take steps in the service of one’s own health.

Most people struggling with addiction are ambivalent, at best, about entering treatment. Given this ambivalence and the degree a person’s judgment is skewed by their drug use, isn’t compelling people into treatment the most humane course of action? Absolutely not.

The criminalization of substance use has harmed low-income people, with disproportionate harm to African American and Latinx communities. Incarceration is a traumatic event that fragments families and negatively impacts socioeconomic status and health. So, even if the threat of incarceration compels some people to opt for treatment, the social and humanitarian costs on balance are not worth it.

The state’s power to compel people into care lets us treatment providers off the hook. Clients come and stay because they must. I’ve never met a treatment provider who isn’t mission-driven but operating in a coercive environment removes the immediate necessity for client-centered innovation.

I often say to staff, “If we ran a restaurant like we run treatment, we would be out of business in a week. What successful restaurant owner faults the customers for not liking the food or for not being hungry enough? It’s easy to understand that the customer doesn’t fail the restaurant, but how often do we say, ‘the client failed treatment?’” And we get away with it because our customers will go to jail if they walk out the door.

It’s time to sever our complicit relationship with the prison industrial complex so that we are truly compelled to meet our clients where they are. It’s time to break our addiction to coercion. Maybe there is a support group for that.