To be clear, addiction is a chronic, progressive, lethal brain disease. We don’t criminalize other diseases by virtue of having the disease. That is, if someone with type 2 diabetes is under supervision through the criminal justice system for a crime, he doesn’t get sanctioned for having a diabetic episode – because society recognizes that he has the disease of diabetes.
Continuing that analogy, here’s what we do expect: if he commits a new crime, for example, a car crash that causes injury, he is typically held responsible for the crime even though the accident can be traced back to the disease of type 2 diabetes – ESPECIALLY when we know that he refuses to manage his diabetes.
So why, oh why, don’t we use that same assessment for the disease of addiction? I’m not suggesting that those who suffer from the disease of addiction shouldn’t have expectations placed on them from outside systems, but I am suggesting that we can’t incarcerate our way out of the addiction crisis our country is facing.
And we also cannot ignore our way out. In the recent past I’ve had several conversations about drug testing as a means of holding people with the disease of addiction accountable. The conversations have been with a variety of people from different professions, but their response is consistent: “We can’t criminalize addiction.”
I couldn’t agree more. We shouldn’t be criminalizing addiction with any populations…even those who have been charged or convicted of crimes due to their addictions. On the other hand, there’s no reason to dismiss criminal behavior because someone has an addiction. Instead, what we should be doing is helping those who have the disease of addiction to recognize it.
Rather than buying into the myth that an addiction diagnosis can only be made by those with the substance use disorders (SUDs) or that we have to let them reach bottom before they can get better or whatever other nonsense we’ve bought into about recognizing the disease of addiction in others, we should be helping those who have SUDs see that about themselves, just as people do with all other diseases. It’s not a difficult concept if we really believe that addiction is a disease.
We don’t let people die from other diseases without advocating for help; we don’t ignore symptoms of multiple sclerosis, diabetes, heart disease, and other diseases under the guise of “It’s not my business,” yet people – especially those of us who work in the social service or helping sector – consistently give lip service to the idea that we believe addiction is a disease and treat it as though it’s a weakness of character, blaming people for having the disease and leaving them to their own devices because addressing it may be awkward or uncomfortable.
One great way of helping someone come to terms with the disease of addiction is by testing, especially testing that allows for a longer lookback period around substances of abuse. Urine tests have their place, but recognizing addiction and supporting recovery is unlikely to be sustained in any great way by urine testing. The tests have too short of a lookback period, only approximately 72 hours, and they are easily adulterated. Fingernail and hair testing as done at USDTL (USDTL.com), on the other hand, provides an approximate 3-6 month lookback of a person’s history of use.
Just as a person with another disease has regularly scheduled tests to indicate appropriate levels of medications and treatment, a person with the disease of addiction can have tests to indicate appropriate levels of treatment. A negative direct biomarker test shows that recovery is occurring rather than a positive one being an occasion for negative consequences.
People are dying, children are suffering, and society is negatively impacted because of the fear that a positive test will lead to negative consequences. It never needed to be an either/or proposition. The choice isn’t to not test at all or criminalize all positive results. The choice isn’t to take away babies whose mothers used while pregnant or not test at all. There’s a real solution…treating addiction as the disease we say we believe it is and using testing to see how treatment is working.
Guided by Guida 
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