A new way to look at addiction

One of the first tenets of the criminal (in)justice system we are taught in law school is that for there to be a crime there must be both an act and intent. We aren't supposed to punish people who have a bad thought without a corresponding bad act, nor are we to punish those who might commit a bad act without the intent to do so.

Malus actus + Mens rea = Crime

Most crimes listed in the penal codes in these United States require that the actor act with the intent to commit the bad act. He may act intentionally, knowingly or recklessly. In some cases the level of intent determines the severity of the crime, while in others, as long as their is intent, there's a crime.

Driving while intoxicated, however, has always had a special place in the penal code, for there is no criminal intent required. DWI is, for all intents and purposes, a strict liability crime. In other words, if you're driving and you're intoxicated, you've committed the crime, regardless of whether you intended to drive drunk or not.

Now comes word that addiction is a brain disorder and not a case in which someone behaves badly. The American Society for Addiction Medicine (which, in and of itself, may not be such a grand idea) has redefined  the term addiction.

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.

Addiction is more than a behavioral disorder. Features of addiction include aspects of a person’s behaviors, cognitions, emotions, and interactions with others, including a person’s ability to relate to members of their family, to members of their community, to their own psychological state, and to things that transcend their daily experience.

 And no, since I'm not a neurologist, I don't know what all of that means. What the ASAM seems to be saying is that addictive behavior is the result of chemical reactions in the brain. If this is indeed the case, should we re-evaluate the manner in which we handle drug and alcohol crimes? Punishing an addict does nothing to "cure" the problem. If a person has a brain disorder before entering prison or court-ordered supervision, that person will still have a brain disorder when they leave prison or are discharged from probation. We wouldn't be punishing folks for their bad acts, we'd be punishing them for something beyond their control.

"The behavioral problem is a result of brain dysfunction," agrees Dr. Nora Volkow, director of the National Institute on Drug Abuse.

Alcoholism is one of this country's worst addictions. It destroys bodies, lives and families. Yet try explaining to a gung ho young prosecutor that your client is an addict, not a criminal. See how far that gets you.

Now if the point of the criminal (in)justice system is to punish those who break the law and provide a disincentive for others to commit criminal acts, how does it serve a purpose to punish a person who has an addiction? If the person is acting due to a brain disorder, does the application of the criminal law benefit either that person or society? Is it just to punish a person who has a disease or a disorder?

Even if you're not biologically vulnerable to begin with, perhaps you try alcohol or drugs to cope with a stressful or painful environment, Volkow says. Whatever the reason, the brain's reward system can change as a chemical named dopamine conditions it to rituals and routines that are linked to getting something you've found pleasurable, whether it's a pack of cigarettes or a few drinks or even overeating. When someone's truly addicted, that warped system keeps them going back even after the brain gets so used to the high that it's no longer pleasurable.

As I've said on numerous occasions, our criminal (in)justice system is not designed to heal the sick. It's designed to punish and rehabilitate. As long as we treat medical conditions as legal problems, we are never going to give folks the help they really need. The system isn't working. We're forcing too many people into the criminal (in)justice system who don't need to be there. Branding an addict as a criminal for life does nothing to help him or her get over their addiction.

But it sure does help you get elected judge.