Kevin Sabet paper argues for sentencing marijuana users to drug treatment

A new study looks at the increased arrest of marijuana smokers in New York City and the increase in marijuana smokers seeking treatment, and comes to a conclusion only a hardened drug warrior like Dr. Kevin Sabet could make:

In the mid-late 1990s Mayor Rudy Giuliani and Police Chief William Bratton focused on arresting and detaining people for crimes that contributed to a lower “quality-of-life” in New York City. This aggressive arrest policy (AAP) resulted in a record growth in marijuana arrests. In 1992, the number of marijuana arrests was around 5,000. By 2000, the arrest rate hit an all-time high of about 60,000 (the large majority of which were for misdemeanor arrests in both years). Through a triangulation of data sources, including the Uniform Crime Reports and the Treatment Episode Data Set from 1992 to 2003, and other published accounts, this paper shows that entries into treatment for marijuana dramatically increased in New York City at the same time as misdemeanor and felony arrests for marijuana also rose. 

via Marijuana Treatment Entries Did Not Decrease After Aggressive Arrest Policies Were Implemented in New York City.

Good so far, right?  Matches up nicely with that graph there showing that 1992-2000, marijuana arrests increased 1000% and so did court referrals for marijuana “treatment”.  After 9/11 as arrests declined, referrals began to decline.  Shows what we’ve been saying for a while now, that few people actually seek professional drug rehab for marijuana alone; most are forced into it after being arrested for marijuana possession.

Well, not to Dr. Kevin Sabet:

While it is unclear if these arrests caused the treatment increase (vis-à-vis criminal justice referral programs), the presence of these two phenomena show that policy regimes of increased treatment and increased law enforcement actions can co-exist. The oft-heard phrase “treatment versus law enforcement” may represent a false dichotomy in drug policy analysis.

Unclear?!?  You think 1000% more pot smokers just up and decided they were marijuana “addicts” and voluntarily sought treatment?  Could this paper get any sillier?  (Yes.  Yes it can.)

The purpose of this paper is to document that increases in law enforcement intensity in New York City were not tantamount to decreases in treatment delivery among marijuana and other drug users. The argument that treatment and incarceration work separately as opposing and competing strategies is one of the most repeated dichotomies used in the drug policy discourse (e.g. Zimmer & Morgan, 1997; Drug Policy Alliance, 2007; Blendon &Young, 1998; Justice Policy Institute, 2006; Real Reform New York, 2005;Schneider Institute for Health Policy, 2001). The activist-phrase “treatment over incarceration” or “treatment versus incarceration” is an accepted term within the drug policy discourse.

Indeed, this paper suggests that law enforcement intensity may be one of many different activities that couldincrease treatment entry.

Dr. Sabet, when we argue “treatment over incarceration”, we are arguing that a criminal justice solution — arresting addicts — is counterproductive because forcing them into treatment doesn’t work.  Yes, if you arrest people and sentence them to treatment, surprise! you’ll get more people into treatment!  But remember the old joke — the light bulb has to want to change.

My father, after 25 years of drug addiction, voluntarily went through treatment.  He’s been sober now as long as he was an addict, 25 years.  Following treatment, he returned to school, got a social work degree, and became a drug addiction counselor.  One of the things he hated most in his program were addicts that were sentenced to be there by a judge.  Those addicts didn’t want to change; they wanted to mark time in the program until they could get out and use again.  He was frustrated that plenty of addicts who wanted treatment couldn’t get bedspace because of all the sentenced addicts in the program who didn’t want to be.  They were combative, belligerent, and not only took the time and space a repentant addict could have used, but made treatment more difficult for the non-sentenced addicts in the program.

On the national policy level, it means that perhaps drug arrests can accompany an atmosphere of increased health services delivery in the form of treatment for drug users. … Indeed, many criminal justice practitioners believe that court mandates can “motivate” otherwise “unwilling” addict offenders into treatment (Wexler, Lipton, & Johnson, 1988). Those mandated to treatment are no less likely to be successful in reducing their drug use and crime rates than those entering treatment voluntarily.

And those mandated to treatment are no more likely to be successful, either, while souring the treatment experience for those around them.  Drug treatment facilities are one of the few places in modern healthcare where your actual results aren’t measured and industry-wide standards are non-existent:

(NY Times) Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.

Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.

And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.

Of course, the real underlying false premise here is that someone arrested for possession of marijuana in New York City is an addict in need of rehabilitation.  I’m all for someone getting treatment for a marijuana dependence if that has caused problems in your life.  If you’re skipping school, doing poorly at work, or messing up your relationships because you can’t put down the bong, by all means, get thee into treatment!  But if you smoke responsibly, work hard, pay taxes, play by the rules (well, except that rule) and a judge declares your personality to be defective and in need of re-education because a cop caught you smoking pot, you’re not the kind of person who needs rehab, you just need tips on how not to get caught.

I see Dr. Sabet’s analysis as a justification for government subsidization of the treatment industry.  According to the US Government’s Dept. of Health & Human Services DASIS, 289,988 tokers were admitted to drug treatment facilities in 2006.  Only 15% of tokers admitted themselves to treatment; 58% of tokers were forced there by the criminal justice system.  What business wouldn’t want government to force 168,193 of its customers through the door?  Compare that to heroin, the next highest non-alcohol drug treatment population with 245,984 admitted users, and you find the numbers reversed: 59% of junkies admitted themselves to treatment; 14% of junkies were forced there by the criminal justice system.  Tokers forced by the criminal justice system into treatment make up 9.3% of ALL drug treatment admissions in the United States and 24.6% of all drug users forced into rehab.  By contrast, tokers only make up 7.4% of all drug users who choose to go into rehab.

I don’t mean this rant to disrespect drug treatment.  As I mentioned above, my father would be dead without inpatient drug rehab… but that’s because he was hooked on alcohol and speed, not weed.  If even one serious alcohol, heroin, cocaine, or speed addict who can afford and desires drug treatment is turned away because his bed is taken by a court-sentenced pot smoker, that’s one too many.