White pillars at a court house

Why Addiction Should Be Considered a Disease

Why Addiction Should Be Considered a Disease

Effective real-world examples of contingency management can be found in drug courts. Hawaii’s Opportunity Probation with Enforcement (HOPE) is one example [sic]. HOPE uses contingency management to reduce drug and alcohol use among nonviolent offenders on parole [sic] for drug- or alcohol-related crimes [sic]. Urine drug testing is done at parole meetings. If the parolee tests positive and subsequently admits to having used substances, he or she immediately spends two to three days in jail—swift and certain punishment. If the individual tests positive but denies having used substances, he or she spends 15 to 20 days in jail. Note how lying, an antisocial behavior, is punished more severely as a way to promote truth telling in the future, even when the behavior (having used substances) is the same. If the parolee fails even to present for a parole meeting, he or she is apprehended by law enforcement and spends 30 days in jail. The punishment is commensurate with the transgression. Using this strategy, HOPE has been able to cut arrests and failed drug tests by more than half.
This approach differs from the failed War on Drugs that has marked our nation’s drug policy for the past three decades. The War on Drugs got it wrong. Jailing a person for a decade for carrying an ounce of marijuana, two years after the original request, defies all of the rules of contingency management and does not change behavior.
I advocate for the conceptualization of the disease model of addiction inside of medicine because it is the most expedient and practical approach for our time. Yet, the model feels inadequate when considering the moral, interpersonal, and legal transgressions that are so common in persons with addiction. We know punishment alone doesn’t work, given three decades of the failed War on Drugs. Perhaps the answer is punishment combined with treatment and consequences that are thoughtfully crafted to reduce substance use and promote prosocial behavior, similar to contingency management strategies used to treat SUDs. By studying the active ingredients of programs that are working, like HOPE in Hawaii, we may find answers.