William Reville
Science of life
Does addiction to drugs destroy the capacity for free will in the addicts, rendering them incapable of saying ‘no’ to drugs? This question is currently before the High Court of the State of Massachusetts, US, and will be adjudicated on shortly.
The specific case in question is that of Julie Eldred, a 29-year-old woman who was arrested for stealing jewellery last year to support her opioid habit. The court sentenced her to one year’s probation, allowing her to avoid prison on condition that she refrained from using drugs and submitted to random drug testing. Eldred agreed to these terms but 11 days later she tested positive for the powerful opioid fentanyl.
She was sent to prison where she spent 10 days before her lawyer found a bed for her in a drug treatment clinic. Eldred is now suing the Massachusetts state government. She alleges that the court violated her constitutional rights by ordering her to remain drug-free as a condition of probation, arguing that her substance-use disorder makes it virtually impossible for her to control her drug use by exercising her own will power.
Most addiction specialist bodies such as the National Institute on Drug Abuse (NIDA) look on substance use disorder as a brain disorder and to quote NIDA Director Nora Volkow – “the brain is no longer able to produce something that is needed for our functioning – free will”.
General medical opinion is divided on this matter but if NIDA’s interpretation is true, it means that an addict is not personally responsible for sourcing and using drugs despite knowing the negative consequences, in this case losing probation.
Notion
The notion that addiction is a brain disease that renders the addict helpless and unable to resist drugs is vigorously contested in a submission lodged before the Massachusetts court in Eldred’s case by a group of three psychologists and one psychiatrist.
Drugs, they argue, may well change the brain, but it doesn’t necessarily follow that this change means that drug use is no longer voluntary. All experience changes the brain, even reading this article, and brain change alone is not a valid or sufficient indicator of loss of self-control. The submission was summarised in an op-ed published in the Washington Post on October 2, 2017.
On the contrary, this submission quotes much research demonstrating that many drug addicts can not only learn to say ‘no’ to drugs but addicts recover from addiction at high rates.
Furthermore, the addicts typically recover by themselves with no medical intervention. However, intervention programmes based on the idea that addicts retain the ability to regulate their drug use are very successful also.
And the courts have also found they can help addicts quit drugs by attaching explicit penalty costs to drug use and explicit benefits to sobriety.
The authors cite the 1966 case of Leroy Powell, Austin, Texas, to illustrate that drug addicts are not helpless victims. Powell was a diagnosed alcoholic who was arrested for public drunkenness.
He had over 100 previous convictions on the same charge. He maintained that once he started drinking he couldn’t stop and that therefore his public drunkenness was involuntary.
On the day of the trial his lawyer gave him a drink to control his morning tremors and to steady him up. But Powell was sober in court and he explained on cross-examination that the reason he did not keep on drinking that day was that he knew he had to appear in court. He demonstrated behaviour that much research on addiction confirms: addicts are capable of changing their behaviour and incentives help them to do so.
US drug courts can prescribe mandatory treatment for drug addicts and enforce sanctions for continued drug use.
Compared to those cases adjudicated without mandatory treatment/sanctions, addicts processed through drug courts have significantly lower rates of recidivism.
If the court decides in favour of Eldred, serious problems will ensue. Such a decision would bolster the erroneous idea the drug addicts are involuntary drug users who cannot be held responsible for their use of drugs. Much doubt would also fall on the future of treatment programs already known to be successful but based on the principle that addicts can and often do say ‘no’ to drugs.
A decision in favour of Eldred would also hinder judicial interventions known to help addicts to stay out of jail by making probation and parole contingent on staying off drugs. And finally, accepting that addicts can’t help themselves would have huge consequences for criminal responsibility.
Evidence
I am convinced by the evidence that drug addicts retain some control over their behaviour.
Controlling the addiction is obviously difficult but many succeed in doing so. Many of us personally know alcoholics who either quit drinking altogether or else returned to moderate drinking habits, often with the help of Alcoholics Anonymous but often also under their own steam.
Many alcoholics recover, acting under incentives such as doing it for their families or to avoid destitution and an early death, and so on.
One reformed alcoholic told me that he quit drinking because it was just such “bloody hard work” drinking eight hours or so every day and he got sick of it.
I also think that the fact that you are not necessarily a hopeless case if you are a drug addict offers you hope – a light at the end of the tunnel. Admittedly the light will be difficult to reach but it is possible – you can still help yourself.
William Reville is an Emeritus Professor of Biochemistry at UCC.