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Brief thread on what I perceive to be a problematic, yet common set of views that underlie way our criminal justice system (and larger society) engages people who use drugs and/or struggle with addiction. Not all views held by all people, but these tend to travel together. 1/x
1. Many judge harshly the decision to start using substances. Despite an evolving understanding of role of genetic risk factors, & of common environmental exposures including trauma, mental illness, stress & poverty, many continue to view substance use & addxn thru a moral lens.pic.twitter.com/daofLcUOC0
2. Many under-appreciate role of prohibition & racist war on drugs in destabilizing people’s lives, marginalizing them from opportunity or safety & exposing them to harms of illicit drug market. We also under-appreciate role of stigma in driving these punitive polices & outcomes.pic.twitter.com/2WpTIKQvSv
3. Many justify incarceration by promoting the *false* notion that suffering — or hitting rock bottom — is a prospective pathway to behavior change. It is true that many reflect back on their use and identify a rock bottom, but hitting rock bottom is not a treatment strategy.
4. Additionally, addiction is marked by continued use despite negative consequences. Layering on more negative consequences does not meaningfully change behavior. It just layers harm or potential harm on people who are already struggling, thereby making recovery more difficult.
5. Many under-appreciates complexity or behavior change. Many think linear path from addiction 
treatment recovery. But life is more complex. Ambivalence is common. Struggling or set backs are normal. Dichotomous outcomes (abstinent yes/no) limiting, but courts love them.pic.twitter.com/scR6Wt9EsG
6. Many under-appreciate complex ways trauma - including violence, neglect or abandonment - influence behavior, including one’s relationship w/ courts & healthcare system. Instead of patience & compassion to extinguish challenging behavior, CJ system often layers on more trauma.pic.twitter.com/M1OGKT23bw
7. There remains clear misconception by many regarding role of pharmacotherapy in treatment of opioid use disorder. Too many think OAT simply trading one addiction for another. Little tolerance for medications that alleviate suffering, afford stability & reduce mortality.pic.twitter.com/zrhxrcu6fU
8. CJ system over-utilizes interventions that may not be necessary, & that may limit person from working or being closer to family (ie, long-term residential treatment), often w/ harsh sanctions if treatment discontinued, and under-utilizes treatments shown to reduce mortality.pic.twitter.com/moe0ZL19uR
9. Many under-appreciate how destabilizing incarceration can be to people’s lives. Judges like when evidence-based treatment available in jails, but I don’t think they fully appreciate how detention threatens the very things that support recovery — housing, employment, safety.pic.twitter.com/R92rS7j49F
10. In summary, problems:
Moral frame
Prohibition / War on Drugs (racism)
Stigma & Discrimination
Promoting suffering (rock bottom)
Over-simplifying behavior change
Minimizing trauma (retraumatizing)
Stigmatizing OAT
Minimizing harms of jail
SDOH
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