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If substance addiction is a disease, then why do we put treatment options in the hands of the department of corrections?

The gavel lifts and slams, papers are shuffled, signed, placed in a folder, and a bailiff instructs a twenty-two year old African American male who is seated temporarily in the juror box with other Jefferson County inmates awaiting a hearing in Circuit Court.

Having pled guilty to a possession charge, Roy listens to the bailiff explain the process of entering the Alabama Department of Corrections’ Processing Location, Kilby Correctional Facility. Serving a year and a day actually becomes around three months when tallying time off for good behavior, and is defined as “you’ll be there for a minute,” by those handcuffed to each of Roy’s hands.

Roy’s mother is in the courtroom, self-conscious about the tears streaming down her cheeks, watching the judge with a desperate look. It’s as if she is waiting for the judge to suddenly pull back the papers he has just signed that will send her son to hell with monsters. Maybe he will rewind everything, and even take back what he said to her son that had shaken her to the very core: “Well, obviously you don’t like getting up and making a sandwich whenever you want, Son – I guess you just don’t like freedom. You didn’t even try to go to support group meetings, did you? I don’t really think you can be helped. And Alabama wants you off its streets.”

The judge has moved on to other cases now and has just left her boy sitting there, shackled to men in red-striped uniforms, meaning that they are violent offenders. Her only son sports the blue and white-striped uniform of a non-violent inmate. Maybe she should have put her property up and bonded him out of jail so that he could have been with his family before having to go to prison. All she had wanted to do was to help him stay clean, however, and had allowed him to stay in jail as he was worked through the court process. She really did not think he would be sent to prison – he’s not a bad boy, actually.

And he doesn’t deserve to be there, either.

The Question

In 1956, the American Medical Association recognized alcoholism and other drug addictions as an illness. It is describable and has a predictable and progressive course. The disease is a primary disease, meaning it is not just a symptom of some other underlying disorder. The disease is permanent. The disease is terminal, and if it is left untreated, results in insanity or premature death.

The disease concept has long been accepted by the medical community. The concept proposes that a disease is characterized by a specific set of signs and symptoms and that the disease, if left untreated, will progress to some endpoint or outcome (clinical course).

“Only an estimated 20 percent of U.S. inmates with substance use disorders receive some treatment while incarcerated. Judges may decide to incarcerate drug-addicted offenders instead of sending them to treatment programs because the resources to pay for treatment are lacking or there are no programs available in the community.”

If chemical dependency is defined as a primary illness, progressing and concluding with a predictive and terminal result, and if it is a fact that few addicts are even given help in prison, how can the Department of Corrections be viewed as a likely treatment option for chemical dependency?