Law and addiction: How new science is impacting the justice system

For years, people who struggle with drug addiction have often been considered weak or in need of incarceration by the general public and legal community.

But with recent scientific discoveries about the biological and neurological effects of drug addiction, today there is a greater understanding of substance use disorder. Researchers and those in the medical community have worked strenuously to share their findings with the legal community.

This was the focus of the ninth biannual Law and Neuroscience Conference, held Jan. 10 at the Sandra Day O'Connor U.S. Courthouse in downtown Phoenix by Arizona State University's Center for Law, Science and Innovation and the U.S. District Court of Arizona.

“What the program focuses on is science and law,” said Roslyn Silver, senior U.S. district judge in the district of Arizona. “How does the new science affect the law and how does the law impact science?”

Silver, along with Betsy Grey, a professor in ASU's Sandra Day O'Connor College of Law, introduced the conference.

“Science is so important in the courtroom now,” Silver said. “I often ask about the reliability of the science when I am making decisions (in court)."

Twenty experts from the medical, science, academic and legal communities spoke at the event, discussing the latest research on addiction, treatments and what it means for the courts.

“We've come, I hope, a long way from thinking about (drug addiction) as a moral failing … or a simple lack of willpower,” said Dr. Cynthia Stonnington, a psychiatrist at Mayo Clinic who moderated the first panel. 

"I'm hoping that by the end of today's panel, you'll see why it is very important that we integrate neurobiological insights into policy and practice.”

Dr. Holly Geyer, an internal medicine physician at Mayo Clinic, posed the question: “Why do people behave in this manner, particularly in a world where we have so many resources?” 

Geyer emphasized the need to understand the role the brain plays in addiction. She explained how drug addiction can change the structure of the brain in ways that remain, even after recovery.

The brain produces the neurotransmitter called dopamine — the pleasure hormone. But it does not provide the intense euphoric surge that can be obtained by an excessive dose of opioids, Geyer said.

Over time, the brain of the addict determines that it no longer needs to produce the same amount of dopamine and adapts. This makes recovery extremely difficult because the person with the addiction eventually feels flat, unmotivated and often depressed and begins to crave the high of the drug. 

ASU Professor Jonathan Gewirtz also touched on the biological factors that make some people more vulnerable to addiction. 

He said that genome-wide association studies, done with millions of people, have identified a snippet of the genetic code that can predict vulnerability to addiction.

“This has been revolutionary," he said.

“What if an implantable device could be used to treat addiction?” asked Richard Sharp during the second panel, which focused on the treatments and technology being considered for substance use disorder.  

“Deep brain stimulation has been proposed as an additional model (in the future) for those suffering from SUDs,” said Sharp, a biomedical ethics expert at Mayo Clinic who studies the integration of genetic technologies.

“Would anyone want to do this kind of surgery?” he asked. “To have somebody drill a hole in their head and insert a computer into their chest. OK, that sounds pretty extreme. But when you think about all the struggles for people with addictions ... it’s not unreasonable to think that it could be an option. Usually as a last resort if you have tried everything else.”

Chung Jung Mun, an assistant professor in the Edson College of Nursing and Health Innovation, said that pharmaceuticals, such as opioids, are common treatments for pain but have led to record-breaking drug abuse. 

So Mun, who studies the connection between pain, opioid treatment and sleep disturbances, pointed to other options for insomnia, like cognitive behavior therapy, which he described as “the gold standard of treatment for insomnia.”

Michel Sucher, program director for the Addiction Medicine Fellowship program with HonorHealth and Community Bridges Inc., said that SUDs are among the most eminently treatable of diseases but that early diagnosis and treatment was critical.

“If you think of addiction and substance use disorders as a chronic medical condition, then everything works,” he said, explaining that treating SUDs is the same as treating a disease like diabetes. “The treatment should be managed over a long period of time.

“ ... Nobody's hopeless, and anyone can get better."

During the third panel, Maricopa County Superior Court Judge Amy Kalman described the limitations of the court system, especially related to family court, and the lack of services available for people who receive DUIs.

She said that people on probation for DUIs are often burdened with fines up to $6,000, despite the fact that their license has been revoked, which often prohibits them from getting a job to pay fines. Drug testing and treatment is also required for DUIs, but there are no court-supported resources available to pay for them.

“This is the biggest frustration I have,” Kalman said.

Maricopa County Superior Court Judge Lauren Guyton talked about the importance of a more personalized relationship with people on probation.

“It should be a courtroom where I know your name,” she said.

Salt River Pima-Maricopa Indian Community Judge Joshua Heath said that their court system has a fully funded rehabilitation program for those struggling with drug addiction and alcoholism that includes medical care, treatment and case managers.

Offenders who successfully complete the tribal program have their charges completely dismissed.

“It is a great incentive to go through the program,” he said.

Jason Walker, with the Maricopa County Adult Probation Office, explained the department's strategies around substance use intervention.

“Part of what we do is conduct assessments that give us information on areas for intervention for a particular person that we're working with,” he said. “And then we develop strategies and target interventions based on what research tells us works.

“If you would've told me 20 years ago, when I became a probation officer, how involved I would be in the health care system, I would've laughed at you. Today, I spend probably half of my time just as engaged in the health care community as I am in the criminal justice community.

"There's been a really encouraging blending of those two worlds. We still have a lot of work to do, but we're leaps and bounds from where we were.”

Alexandria Hunt-Garcia grew up in a normal household with dreams of becoming a lawyer. 

But at the age of 16, Hunt-Garcia experienced severe trauma, which led to heroin addiction. At 18, she was indicted for trafficking, stolen property and burglary. 

Hunt-Garcia, who is now a community activist with Dream.Org., shared her story of becoming an addict and the legal obstacles to her recovery during the final panel of the day.

“By the time I had finished my prison and incarceration career, I had three separate prison sentences, two parole violations and had been to jail 14 times,” she said. “I had 23 misdemeanor convictions and four felony convictions.”

Hunt-Garcia thought the justice system was going to help her by providing a treatment program but instead, she was taken off of her methadone treatment and went into relapse. She said that she was frustrated that anonymous programs were the only services available to her by the justice system because they don't work for everyone.

Despite what is known about addiction as a disease, Jeff Sparks, a capital appeals attorney who works in the Arizona attorney general's office, said state statutes prohibit the use of a person's intoxication due to alcohol or drugs as a defense to a crime.

“Although it can be used during sentencing and be considered as mitigation,” Sparks said.

Panelist Amy Melcher began her career as a trial lawyer for the public defender’s office, but later the ASU Law graduate found her true calling in the recovery courts. She represents people like Hunt-Garcia in drug or DUI court.  

“The reason they appeal to me is our goal is to get people out of the system, which seems much more meaningful,” Melcher said.

“The program allows me to have much longer relationships with clients than I did as a trial lawyer. My instinct is that, that's what works — the creation of relationships, providing support for people from places that they didn't have support before. That's why I love what I do."