Mental Health Matters: Why did Prohibition fail, and what did we learn?
Mental Health Matters
In a recent column, summarizing a talk I gave to the North Tahoe AAUW, I argued that the criminalization of drug possession has been a failure, not because of the good people who work in the system, but because of the politically driven idea of criminalizing private behavior.
I reasoned that drug abuse and addiction are a form of mental disease and disease, and that the punishments of prison, parole and probation, because of their punitive nature, are doomed to fail this population. Outcome data reflects this truth, including high rates of relapse, and even death, for substance abusers convicted of felony drug possession.
How did we get to this low point in our nation’s approach to drug abuse, and what can be done to improve outcomes for this troubled population?
Prohibition, or the War on Alcohol, survived from 1920 to 1933. It was the nation’s first bold effort to regulate private behavior.
Two social and political currents created that era (See “The War on Alcohol” by Lisa McGirr). The dominant social and religious culture of the time, evangelical Protestantism, was unsettled by mass immigration and the growth of saloon culture. Also, the United States, seeking a leadership role in the world, argued at international forums that alcohol and other “narcotics” were a fundamental cause of social unrest and poverty.
These factors had little to do with the protection of individuals and the community, the primary purpose of criminal justice. Or a medical science that might have emphasized the harms caused by alcohol and drug abuse.
The object lessons of Prohibition were several: Criminalizing the consumption of alcohol did little to curtail use or improve public safety, and criminalization created a violent criminal culture to ensure the continued availability of alcohol.
Criminalizing private behavior produced a new class of criminals, alcohol users, a perverse disregard for the law, and distrust of law enforcement. Criminalization also created a vast expansion of federal and state power over individuals and communities.
Prohibition ended when popular opinion learned about the documented ills created by it. Unfortunately, state power and control continued to grow as many of the same people and agencies that fought the losing War on Alcohol turned their energies to a War on Drugs.
And like that earlier War, the Drug War, vastly expanded in the past 40 years, has had similar dramatically awful results, both for drug users and America.
What, then, are the lessons of recent history? That private behavior cannot be punished out of existence by state power. That private behavior that becomes dysfunctional, like alcohol abuse, can be humanely and medically treated with a public health approach utilizing diverse therapies.
There is hope. Drug warriors are under pressure to reform as interest groups, and politicians come to understand the depressing outcome data.
Two programs, one on each coast, provide encouraging news.
The police department in Seattle has initiated a now 5-year-old program staffed by social service, mental health and substance abuse providers. The program, Law Enforcement Assisted Diversion (LEAD), is a pre-booking diversion program for low level drug offenders who are no longer subject to prosecution and incarceration, but instead diverted to community based treatment and support services.
The results after five years are dramatic: Program participants are 58% less likely to be arrested than a control group. If these were the results of an experimental protocol for a new cancer drug, the drug trial would be stopped, and the drug adopted as a new best practices treatment.
Another decriminalization approach has been adopted by the police chief in Gloucester, Mass., even in the face of protest from local district attorneys (New York Times, 1/25/16).
Chief Leonard Campanello offers heroin users an alternative to jail. Explains Campanello, “Any addict who walks into the police station with the remainder of their drug equipment or drugs and asks for help will NOT be charged.”
Instead, a trained police officer takes a history and immediately finds an appropriate treatment resource.
Moreover, by understanding that early relapse is a part of the disease, relapsing addicts are welcomed back into that program, rather than charged with additional crimes, the traditional model of law enforcement. 56 police departments have started similar programs and scores more are preparing to do so. Unfortunately, there is no such similar effort in this region.
The death toll from the epidemic of heroin and prescription pain pills is starkly compelling — 47,055 deaths in 2014 alone, more than car accidents or homicides.
Law enforcement can play a pivotal role in addressing this national tragedy. But it will take outsized courage, and political risk, to lead the way.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at email@example.com.
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