Interview with Redonna K. Chandler, Ph.D. - Addiction, the Brain, and Evidence Based Treatment

• What is Addiction?
• The Relationship Between Drugs and Crime
• Drug Abuse as a Chronic Condition

What is Addiction?

Redonna K. Chandler Addiction is fundamentally a brain disease. It results in changes that occur within the structure of the brain that are manifested in a functional way, and behaviors, the hallmark feature of which is the compulsive seeking and use of drugs in spite of negative consequences. Addiction occurs because of repeated exposure of the brain to different addictive substances. That includes things like nicotine, alcohol, as well as illicit drugs like heroin, cocaine, or methamphetamine; and also certain prescription drugs are addictive. We are talking a lot recently about prescription opiates and their addictive properties.

Why Can't Addicts "Just Quit?"

There is a basic misunderstanding, I think, about addictive disorders. Most people don't really know that repeated exposure to addictive drugs actually changes the brain in a fundamental way, that this change leads to the hallmark feature of addiction, which is the compulsive use of drugs of abuse in spite of negative consequences. The assumption is that the addicted individual is rational, that the addicted individual is capable of choice, that of course the non-addicted person understands that if somebody uses that drug, there's going to be big consequences, so why can't that person understand that? But addiction doesn't work like that. It's not that that person lacks moral fortitude. It's not that that person just is weak. It's that that person's brain is fundamentally different and operates in a different way than someone who is not addicted. Their overriding desire is to seek and take their drug of choice—the drug that they're addicted to—and it is extremely difficult for them, particularly when they are actively involved in their substance use, to be able to take that moment to stop themselves and to think through that choice and take a different path.

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The Relationship Between Drugs and Crime

Chandler Lots of research shows that drugs and crime are linked, that there are many individuals in the criminal justice system that have substance abuse problems. In fact, over half of those who are involved in federal prisons, state prisons, and jails report regular drug use, and when you look at the diagnosis of substance abuse disorders specifically, you find that within incarcerated populations, a high percentage meet the diagnostic criteria for substance abuse disorders. In addition, we know that many people are under the influence of both drugs and alcohol at the time that they commit crimes, including violent crimes, property crimes, and drug trafficking crimes.

Substance Abuse Treatment in the Criminal Justice System

We have lots of different evidence-based treatments and approaches that we know can be delivered within the criminal justice system that match onto what's happening within the system when an individual is involved. In fact, we look at involvement in criminal justice as providing a window of opportunity to intervene in substance abuse and addictive disorders. But we also know that most people are unable to actually be able to benefit from treatment. So if you look across the entire criminal justice system, including those who are under some form of community supervision and those who are incarcerated, we estimate that over 5 million adults are in need of a substance abuse intervention, and yet less than 25 percent actually receive any type of intervention, and that includes drug education. And drug education in and of itself, which teaches people about substance abuse disorders, is not what we would consider to be an evidence-based treatment; it's not sufficient to really help address the underlying root causes of addictive disorders.

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Drug Abuse as a Chronic Condition

Chandler We know from science that addiction is a chronic condition similar to other chronic conditions, like diabetes, asthma, and hypertension. And what that means is that all of these chronic conditions really require a long-term focus for treatment, where you have individuals who may need multi-pronged interventions—they may benefit from medication as well as behavioral interventions—and they may need multiple courses of treatment over time. It's not like strep throat, where I give you a prescription for an antibiotic, you take the antibiotic, and then you're cured. That is an acute disease, where, one time, you go in, you get your medication, you take it, and you don't continue to have strep throat any longer. Addiction is much different than that, and similar to other chronic conditions, it becomes important to be able to provide treatment over time, to be able to engage and monitor the individual over time, so that if they become at risk to relapse, so that you can intervene early, either to prevent the relapse or to reengage them in treatment as soon as they relapse, and so that the individual begins to learn more themselves about how to be active in their recovery and how to begin to manage their disorder, in the same way my grandmother had to learn how to manage her diabetes.

But Will it Work in the Criminal Justice System?

First of all, let me say that our specialty care drug abuse treatment system is still trying to kind of come to grips with how to deal with addiction as a chronic condition, so I don't think that this is something that's unique just to criminal justice. I think one of the classic examples, though, where criminal justice has the opportunity to make a change, is that if someone participates in an intensive type of treatment program while they're incarcerated, often they participate in that treatment program and then they're deemed to be done with treatment, and then they transition into the community and they go home. But what we know from our research is that those who are most successful in making that transition and in not relapsing to drug abuse have a more chronic approach where they participate in treatment while they're incarcerated and then they're followed up in the community and continue participating in additional treatment when they transition back out into the community.

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