The idea that treatment in place of prison is inevitably beneficial is so naïve and wrong-headed that it must be challenged each time it is introduced — even when done so by drug policy reformers who are right that imprisoning both casual users and addicts is a horrible mistake. This article describes in both theoretical and practical terms (with numerous examples from Stanton's vast correspondence) just how ineffective therapy may be, as well as some truly horrible outcomes from coercive therapy.

Reconsider Quarterly, Winter 2000-1001, pp. 20-23

Stanton Peele, Ph.D., Esq.

This past June, New York became the first state in the union to require all nonviolent criminals found guilty of drug charges to be offered treatment for drug addiction instead of serving jail time. The benefits are obvious: this policy will sharply reduce the number of repeat offenders clogging the courts, relieve crowding in state prisons and jails, and help addicts conquer their disease. Surely, this is an enlightened policy that can only help drug users. Well, not quite.

Labeling Drug Users as Disease Causes Further Problems

In the first place, receiving treatment in this context requires one to be labeled a drug addict. Thus, everyone who enters such a program is saddled with a dependence diagnosis, and counseled for addiction, even if they are merely recreational users. Furthermore, virtually all substance-abuse treatment in the United States is rooted in the assumption that drug addiction and alcoholism are diseases, the so-called medical model. Yet, virtually all adopt a decidedly non-medical, spiritual model of treatment — the 12-step Alcoholics Anonymous (AA) program. The primary technique of 12-step programs is the group-confrontation session in which addicts are prodded to acknowledge the error of their ways, that they are powerless over their drug use, and that they must turn themselves over to a higher power. This mea culpa/self-abnegation treatment is supervised by former addicts or alcoholics. In this context, all "addicts" are counseled — more like commanded — to adopt total abstinence. According to the federally sponsored National Treatment Center Study, 93 percent of private substance abuse treatment programs are based on the 12 steps, and public programs are, if anything, even more dominated by this philosophy. Almost 100 percent of programs, according to this survey, endorse only abstinence.

But to tell everyone who uses a drug or has had a drinking problem he is diseased, and must abstain forever, leads to worse problems for many than those with which they originally reported to treatment. As a psychologist with more than 30 years' of experience working with drug users, both addicted and non-addicted, I have seen again and again that 12-step programs not only fail drug users, they can have negative impacts. When 12-steppers "fall of the wagon," they tend to fall hard and fast into binge use, rather as a dieter will gorge after starving himself for days or months. This is not only due to a reaction against "starvation," it is due to the core philosophy 12-step programs teach — that people are "powerless" over their drug use. For these and other reasons, I co-wrote, with Charles Bufe and Archie Brodsky, Resisting 12-Step Coercion.

Forced Abstinence Can Lead to Powerlessness and Depression

What does it mean to feel powerless? Depression is marked by such feelings. Indeed, for many, it is such feelings which cause them to reach for a drink or a drug to make themselves feel better. Through my Web site, www.peele.net, I frequently answer questions about drug use, abuse, and treatment. The stories I receive are grim testimony to how compulsory treatment policies regularly fail. Recently, I heard from Marie, who wrote me about her son, Johnny a 19-year-old college freshman:

My son was charged with DWI in October...[As a result,] he enrolled in alcohol classes through the college, which he says were a joke (they showed them a movie once a week for five weeks). In January, he moved off campus into a house with four other students. Well, in April, police raided their house and they were all charged with possession. The police found a small amount of marijuana and cocaine in the house.

The court offered Johnny a diversionary program, involving "group counseling four times a week and attending two AA meetings a week for 20 weeks." Under our current policy choices, Johnny can either "fess up" to alcoholism/addiction and abstain for as long as he is supervised by the court, or else face prison time as a 19-year-old college freshman! According to his mom, "He has been very good about attending meetings including roller blading over two miles to the classes because his license was suspended." But, she indicates, it's not really working.

The problem is my son says that he does not feel that he is an alcoholic. Does he drink and sometimes abuse — yes, but does this mean he is an alcoholic or a typical college student? He is really trying hard to get his life together and is trying to cooperate, but he is finding this process isn't working for him; what should we do?

Of course, facing negative consequences for antisocial behavior like drunk driving is to be expected and may even be beneficial. Unlike the idea that we should replace ordinary judicial processes with therapy, outcomes in a massive government experiment — in which several Southern California counties presented treatment options for drunk drivers while other counties simply suspended licenses and jailed repeat offenders — found that the counties which did not offer treatment recorded fewer re-arrests and lower recidivism rates.