The numbers are staggering. Recent studies estimate that between 8 and 16 percent of American adults are addicted to a harmful substance. Increasing numbers of addicts are found in depressed areas of the country and in wealthy enclaves alike. Because abuse of opioids has reached epidemic proportions in many areas, there is increased focus on this particular substance. Credible evidence, however, points to alcohol, a legal drug easily obtained (a pint of vodka can be bought for $2.37 at my local pharmacy), as the addictive substance more difficult to overcome and with the most devastating long-term health consequences. But whatever the substance, the effect on court systems is undeniable. Poor addicts often appear in criminal courts, whether for “drunk in public”-type offenses or theft crimes committed to support their habits. Impaired driving offenses are committed by all demographics. Drunk drivers may injure or kill others, leading not only to criminal but also civil liability.
Special drug courts have been created in recognition of the inadequacies of the criminal justice system to rehabilitate and the tremendous effort it takes for an addict to recover sufficiently to lead a sober and productive life. Family units break under the pressure of an addicted spouse or parent, leading to family court proceedings. In administrative hearings, when a professional license is at risk, substance abuse is often the reason.
Ironically, medical professionals, including doctors and nurses, also suffer from addiction in numbers similar to other groups, whether to alcohol or prescription drugs; and some studies reveal the problem is growing among this population. And of course, lawyers and judges become addicts too. It is heartbreaking to see years of education and so much promise fall victim to substance abuse. It is devastating to see members of small struggling communities seek relief from economically caused despair in drugs and alcohol, only to worsen their circumstances.
Accordingly, it is essential for judges, no matter the context in which they serve, to have the best information about the causes and effects of addiction and the best practices for treatment. This issue endeavors to provide the very latest in the neuroscience of addiction. Potential authors were asked to provide answers to the toughest questions, including: What causes addiction? How does it affect the brain? What are the best treatment options?
Jodi Gilman, Ph.D., is a neuroscientist, and the title of her article is: “What Happens in the Brain When a Person Becomes Addicted?” She answers this question and more, helping us understand the depth of the problem, including by her description of the addiction cycle and explanations of treatment options.
Spencer Bujarski, Aaron C. Lim, and Lara A. Ray, psychologists and researchers, explain the neuroadaptive changes brought on by substance abuse, as well as the role genetics and co-occurring psychiatric disorders play in this “brain-based” disease. Several of our authors believe that substance abuse treatment should be fully integrated into the mainstream health system in the same way as other chronic diseases.
In her very thoughtful piece, Dr. Anna Lembke, a psychiatrist and addiction medicine specialist, presents this point of view, arguing that, despite some shortcomings, the disease model and medically based treatment present the only viable approach. Also addressing primarily treatment options, Drs. Robert L. DuPont and Lisa J. Merlo describe how physician health programs assist addicted physicians to return to safe practice. Studies of the efficacies of these programs are surprisingly informative across the board, revealing, for example, that 12-step programs, which are free and easily accessed, received the highest ratings from recovering physicians.
Dr. Sarah E. Wakeman focuses on opioids, including how addiction to such substances develops, continues, and is best treated. An estimated one-half to three-quarters of those incarcerated in the United States suffer from substance abuse disorders. Drs. Jonathan Giftos and Lello Tesema are in the trenches—they treat addicts in a jail setting. Their article includes descriptions of medications used to treat addiction and also presents their plea for removing addicts who pose little threat to society from the criminal justice system. In an article combining a discussion of case law with forensic analysis, Judge Stephanie Domitrovich, a state court trial judge, and Dr. Jeffrey M. Jentzen, a forensic pathologist and medical examiner, discuss the shift over time from criminalizing addicts to holding drug suppliers criminally responsible for the death of customers.
And our judicial ethics expert, Marla N. Greenstein, raises the issue of context, noting that the weight and consideration judges can give to addiction will vary depending on the type of case heard. As an example, she describes a pending case concerning the punishment of an addicted probationer who relapses on probation. Is this cruel and unusual punishment of a person with a disease?
In a very different vein, this issue also includes a review of The Case of the Piglet’s Paternity by attorney Robert Edmunds, a former North Carolina Supreme Court justice and a former Judges’ Journal Editorial Board co-chair. He discusses a 2015 book by Judge Jon C. Blue, who sought respite from presiding over a challenging case by studying trials held in seventeenth century New England. The cases covered the gamut: arson, bestiality, adultery, statutory interpretation, and others. Edmunds opines that Blue’s book is an interesting and entertaining snapshot of American legal history.
Finally, Judge Herbert B. Dixon Jr., our technology columnist, provides very practical and useful tips to increase our cybersecurity in these times, when computer hacking has become all too common.
As we grapple with the numbers that help describe the depth of the problem of addiction in America today, it behooves us all to remember the humanity behind these numbers. At the beginning of my legal career, while working in a district attorney’s office, it was common to refer to crimes by their California Penal Code section. My supervisor urged me to always remember that “a 187 means someone died.” Likewise, behind the devastating addiction statistics, there are real people affected: our family members, our colleagues, our neighbors, and our friends. Someday, addiction will be better understood, more effectively treated, and perhaps even curable. In the meantime, we hope the information in this issue proves helpful.