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A generally accepted estimate is that about 80 percent of all people in prison have a problem with substance abuse and addiction, according to Faye Taxman, professor of criminology at George Mason University.

In Cumberland County, more than a third of all people brought into the county prison in 2015 — roughly 1,000 inmates — required some form of medication to help them detox and deal with withdrawal from drugs and alcohol.

“I think one of our problems is do we want to deal with this as a medical issue or a crime policy issue,” Taxman said. “…We don’t make policy around specific offenses. We make policy around the global piece and that has been this war on drugs.”

But, what is addiction?

“The science proves this is a disease of the brain,” Sarah Atencio, licensed clinical professional counselor and lead clinician Kolmac Outpatient Recovery Center in Silver Spring, Maryland, said. “It impacts logic. It impacts reasoning. When people say ‘this is a choice,’ well really the part of your brain that makes logical, reasonable decisions is actually hijacked. ... There’s a lens on there that we cannot remove.”

Atencio said environmental and genetic factors can contribute to a substance abuse disorder.

Diagnostic manual

Professionals use the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, to diagnose substance abuse disorders.

The DSM 5 utilizes 11 different criteria to identify individuals with a substance use disorder and rate them from mild to severe.

For example a person who meets at least two of the 11 criteria would indicate an alcohol use disorder. However, the presence of two to three symptoms would be considered mild compared to six or more would be considered severe and potentially require a different treatment approach.

The criteria include in the past year wanting to stop or cut down on drinking more than once but couldn’t, having wanted to drink so badly that the patient couldn’t think of anything else and continued drinking even though it was causing trouble with family or friends.

Atencio said that not all people who enjoy drinking alcohol or even get arrested for DUI have a substance abuse disorder.

She explained one of the main differences is whether or not that drinking is negatively impacting a person’s life and well-being.

“Are they having cravings for it? How often are they thing about it?” Atencio said. “If you think about how often during a day you think about broccoli. Is it the same as the number of times you think about alcohol and kind of compare those, because really if you don’t have an alcohol problem, you shouldn’t be thinking about it over and over and over during the day.

“That’s a big indicator,” she added. “What in their life revolves around (drinking)?”

Atencio said that does not mean people who commit crimes as a result of a substance abuse disorder should not be held accountable.

“For people who get DUIs, of course, the first thing they need evaluated for is substance abuse problems, because clearly they are endangering lives,” she said. “Although I think treatment should be the go to intervention, people don’t get commit murder and rape and say ‘oh, but I’m an addict, so it’s OK.’ We still need to have morals and reasons and justice.”

Two views

Policy involving people with addiction and drug use can be viewed in two ways, criminal and medical, Taxman said.

Under the “war on drugs,” these issues were viewed largely as a criminal one, which led to steeper penalties for things like drug possession.

“As with the war on drugs and the era of mass incarceration, we have expanded the things that criminal justice system is basically used for,” she said.

More than half of all new criminal cases started in Cumberland County so far in 2016 included either the charge of DUI or a drug related offense, according to Cumberland County Insight.

“Part of the cost issue is that we are happy to control people, but we don’t include in there how we can help people become more effective citizens,” Taxman said.

Without breaking the underlying problem of addiction, many people wind up back in prison.

“What happens is people fail and the fail then means they are still addicted, they are still drinking or they are still engaged in drinking and driving behavior because they haven’t been given the tools to change,” Taxman said. “When they fail, we think we have to punish them more.”

She said that criminal justice systems can do things like utilize drug treatment courts — which Cumberland County has — and leverage the system’s ability to compel behavior to get people into the treatment that is needed.

Ultimately, Taxman said public perceptions of addiction, punishment and the role of the criminal justice system need to change.

“I think our country has to come to some decision on how we are better able to handle these low-level offenders, where it’s clear they have an addiction disorder,” she said. “The reality is that sending people to treatment, especially for those who aren’t interested in treatment, is actually more punitive is some ways, because you are asking people to do harder work.”

Taxman cited a study that found that roughly one third of individuals surveyed said they would rather go to jail than treatment because of the work involved in intensive treatment programs.

“I think the public sees a non-incarceration scenario as sort of a slap on the wrist,” she said. “…I think we need to recognize that these alternatives or other ways of legitimately dealing with these issues are valuable and we need to recognize them as legitimate.”