September 9, 2007

Appellate court: Parolee cannot be forced into 12-Step treatment

In what could be a blow to the 12-Step Movement's stranglehold over substance abuse treatment, an appellate court has ruled that a parolee cannot be ordered into a treatment program that uses the model.

At least eight other federal and state courts have issued similar opinions in the past, holding that coerced treatment in a religion-based program is unconstitutional. On Friday, the Ninth District Court of Appeals reiterated that precedent.

The case involved a Buddhist, Ricky Inouye of Hawaii, who had objected to religiously oriented drug treatment while in prison on a drug case. Over his objection, his parole agent ordered him to attend Narcotics Anonymous meetings after a urinalysis tested positive for drugs. He has since died, but Friday's ruling allows his son to continue Inouye's civil lawsuit against his parole agent. The opinion held that Narcotics Anonymous has pronounced religious overtones, including references to God, a "higher power," and prayer.

For decades, most treatment programs have unquestioningly followed the Alcoholics Anonymous model. With more than half a million people pouring out of U.S. prisons each year, the bulk of them drug offenders, the treatment industry is an enormous cash cow.

From a social science perspective, the court's position is good news. The 12-Step philosophy flies in the face of much empirical data on substance abuse and recovery patterns, yet its dominance makes it hard for more scientifically based, cognitive-behavioral treatments to gain a foothold in the marketplace.

The 12-Step model fits with the medical model dominant in modern culture. It describes certain people as "alcoholics" suffering from an incurable, progressive "disease." Its treatment approach, therefore, proscribes lifelong abstinence.

"The essence of the AA approach resembles revivalistic Protestantism, with elements of ritual prayer, public confession and surrender of will to a 'higher power,' and dogmatic religiosity reinforces the defensive barrier against innovation," says critic C. Gary Pettigrew, Ph.D., also a forensic psychologist.

In the past half century, since the American Medical Association endorsed the AA model, much scientific work has debunked both the disease theory and the superior efficacy of 12-step treatment. However, this knowledge has been largely suppressed by religious, political, and industry forces. Many "therapists" and "counselors" in 12-Step programs are "recovering" alcohol and drug abusers, and many clinicians are not aware of the critical research base in this area.

Not all of the resistance to more secular, empirically based treatment is innocent in motive. Herbert Fingarette, a critic of the industry, points out that the concept of certain defective people as innately prone toward "alcoholism" benefits the alcohol industry by blaming individuals for the collateral damage of its products. In addition, the treatment industry benefits financially by hiring less educated, non-professional "therapists" at low salaries and by receiving third-party insurance payments for treating a "disease."

Friday's court ruling in Inouye v. Kemna echoes earlier rulings out of the Seventh and Second U.S. Courts of Appeal, which probation and parole officers have ignored in continuing to force parolees and probationers to attend AA/NA meetings as conditions of their release. Indeed, the Ninth Circuit commented that this area of case law is "uncommonly well-settled." (Previous cases include Kerr v. Farrey, 95 F.3d 472, 7th Circuit, 1996, and Warner v. Orange County Dept. of Probation, 115 F.3d 1068, 2nd Circuit, 1997, respectively; see Inouye v. Kemna for a listing of related court decisions.)

Harm Reduction Therapy is one of the promising alternative approaches that these court decisions - if anyone ever heeds them - could assist. Rather than a one-size-fits-all approach, this treatment method addresses the complex social, occupational, psychological, and emotional factors that may contribute to an individual's drug and alcohol problems.

And, by the way, the second national Harm Reduction Therapy Conference will be November 2-4 in Philadelphia.

Photo credit: Johnny Wood (Creative Commons license); vodka ad at trendy Union Square in San Francisco. Alcohol manufacturers spend more than $1 billion each year advertising their products and hide behind the "disease" concept of alcoholism to deny responsibility for the carnage their products produce.