Abstract
In Illness or deviance: Drug courts, drug treatment, and the ambiguity of addiction, Jennifer Murphy examined the competing views of drug use as addictions requiring treatment or crimes requiring punishment. She also explored how drug control policy in the United States has begun merging treatment and criminal justice responses to drug use. For example, drug courts may be considered treatment, despite being firmly ensconced within criminal justice, and drug treatment programs may utilize punitive measures that resemble criminal justice sanctions. Murphy utilized the term “therapeutic punishment” as an organizing concept, defining this term as “discrete punishments packaged as extensions of therapy; their goal is to extinguish the allegedly poor values and irresponsible behavior inherent in drug addicts” (pp. 19–20).
Using an institutional ethnographic methodology, Murphy observed one city’s drug court, interviewed staff and participants, and examined drug court documents and the National Association of Drug Court Professionals website. She also observed two outpatient drug treatment programs, one that provided intensive outpatient therapy and the other a methadone maintenance program, interviewed therapists and clients, and examined treatment documents. Although this methodology encompasses a variety of data collection techniques, two concerns are evident. The judge and assistant district attorney of the drug court refused to be interviewed, so although their courtroom behaviors were observed by Murphy, there were no formal interviews with these crucial actors who wielded great authority in the drug court program. Murphy substituted a radio interview from the local National Public Radio station with the judge to provide this perspective. Additionally, Murphy disclosed that she had previously been a research assistant at the drug treatment facility and that her relationship with a gatekeeper made access easier. While these two methodological concerns do not appear to impact the research, earlier disclosure of these issues, rather than in the methodological appendix, would be more appropriate.
In the drug court, Murphy observed that addiction was evaluated by client self-report rather than clinically evaluated. Given that clients faced jail or prison time if not selected into the drug court, she noted that exaggeration of drug use may be an issue. Murphy explored how some clients did not appear to actually be addicted to drugs and how selling drugs and the drug lifestyle were also considered addictions in both the drug court and drug treatment settings. This is truly problematic, given that these individuals are taking spaces in programs that they do not actually need. This could artificially boost the effectiveness of the drug court, showing that clients are now drug-free even though some were drug-free before beginning the drug court program. Murphy noted that Becker’s “double problem” is well illustrated in that drug courts must demonstrate both success and that they are needed. The solution has been to broaden the criteria for those who qualify as “addicted” while illustrating success with low risk offenders. Murphy’s interviews and observations in the drug treatment programs revealed that a substantial number of clients were referred from the criminal justice system, which required them to be there and paid for their treatment, illustrating the dependence such programs have on the criminal justice system for their very existence. Widening the net thus also benefited drug treatment programs, which were able to continue operation. Individuals who sell drugs or are involved in the drug lifestyle may be in need of resources, but without an actual addiction problem their presence in drug courts and drug treatment programs should be questioned. This practice illustrated how the drug court and treatment programs considered irresponsibility and poor socialization to be part of the addiction experience, broadening the definition of addiction.
In both settings, the immorality of drug addiction was evident. Many criminal justice and treatment personnel believe that addiction is a disease, but the emphasis on personal responsibility, values, and employment illustrate the moral components of drug addiction as deviant behavior. How those working in drug court and drug treatment settings reconcile these differing views may be through the use of “therapeutic punishment.” Interestingly, in the drug court setting, clients who did not follow the rules were punished with more therapy (such as attending 12-step meetings). In the treatment setting, clients who did not follow the rules were punished with less therapy (such as reduction of methadone dose). Personnel in both settings viewed these responses as “helping” clients become more responsible, though Murphy noted that the design of these responses was punitive. The idea that people who use drugs are “bad people” who do “bad things” was also expressed, with therapists having clients describe “character defects” as part of their treatment, leading Murphy to ask, “Is there any other disorder … where treatment demands that a person do a moral assessment of his or her own defects and weaknesses” (p. 131)? This focus on irresponsibility was also evident in the drug court, where success focused on clients getting jobs or pursuing education rather than focusing on eliminating drug use.
Murphy ended with several recommendations. Although she acknowledged that drug courts are preferable to incarceration, she questioned why these are the only two choices. She recognized that drug treatment needs to be accessible prior to criminal justice involvement and not conditional on that involvement. Finally, and most importantly, Murphy argued that we need to “stop treating all drug use as drug abuse” (p. 178). Selling drugs is not the same as being addicted to drugs and experimental or infrequent drug use is not addiction either. Drug courts and drug treatment programs are meant for drug addicts, but the criteria for being an addict are broad and ill-defined.
Illness or deviance highlights an important topic in criminal justice by delving into issues of addiction, its definition, and how the criminal justice system approaches addiction. In an era where we are increasingly debating the sentencing of drug offenders and whether punishment or treatment is best, Murphy’s book illustrates the blurring of these two responses and eloquently demonstrates the problems with how we currently handle drug crime and addiction.