The Case of Cameron Douglas: Prison Is Not Rehab, Say Addiction Experts

An unusually harsh prison sentence handed down to the drug-addicted son of actor Michael Douglas has prompted addiction experts to indict the courts for ignoring the treatment needs of inmates.

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Cameron Douglas in 2009.

The case of Cameron Douglas could be an unlikely turning point in this country’s endless war on drugs. Douglas, the 33-year-old son of actor Michael Douglas who is currently serving a five-year sentence for possessing and distributing drugs, was slammed in December with an additional 4.5-year term for possession of heroin and Suboxone, a drug used to treat opioid addiction, while imprisoned.

Although Douglas had not received any treatment for his heroin addiction during his incarceration, a federal district court judge saw his continued drug use as defiance. Judge Richard Berman called Douglas, “continuously reckless, disruptive and noncompliant, notwithstanding [his] co-occurring addictions and mental health issues, which are no doubt serious.”

To anyone who understands addiction, which is often made more severe by mental health problems — and which cannot be treated with punishment or imprisonment — the judge’s “notwithstanding” makes no sense. Addiction involves inability to respond to punishment: it is defined medically as the compulsive use of a substance despite ongoing negative consequences. Since negative consequences and punishment are synonymous, if punishment cured addiction, addiction wouldn’t occur at all.

(MORE: DSM-5 Could Categorize 40% of College Students as Alcoholics)

Moreover, to further imprison a drug-addicted inmate because of his addictive behavior is to ignore his medical needs. That’s why a group of leading addiction experts has filed an amicus brief in support of Douglas’ appeal of the sentence, hoping to get the justice system to recognize this medical reality. The brief was signed by the addiction medicine societies of New York and California, the American Academy of Addiction Psychiatry and 13 top addiction experts, mainly physicians.

Typically, inmates who are caught with drugs in prison are penalized with the loss of prison privileges, such as visits and phone calls, but those sanctions had not stopped Douglas from using, which angered the judge.

The New York Times described the content of the brief this way:

Their argument is that Mr. Douglas, who began injecting heroin daily in his mid-20s, is a textbook example “of someone suffering from untreated opioid dependence” and that more prison time would do nothing to solve his underlying problems.

“My outrage is as a physician for someone who has a medical condition which has been ignored,” said one of the brief’s signees, Dr. Robert Newman, the director of the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center. “What the judge has imposed has zero benefits for the community and has staggering consequences for society.”

Indeed, one of those consequences is runaway spending on incarceration. It costs $28,000 a year just to lock up a single federal prisoner, so if Douglas’ additional sentence is upheld, his imprisonment alone will cost taxpayers an added $126,000.

It’s difficult to determine precisely what proportion of criminal justice spending goes to the incarceration of those convicted of drug possession, whether outside prison or behind bars, but given that 81% of all drug arrests are for simple possession — accounting for more than 1.6 million arrests annually — the cost of prosecuting or incarcerating these cases could be in the billions.

To be clear, the brief does not dispute Douglas’ original sentence, which he received for trying to mail 215 grams of methamphetamine to an informant. The experts who signed the brief aren’t pushing for legalization of drug sales or saying that criminal dealing should go unpunished. Rather, they are arguing that it makes no medical or legal sense to sentence a person with untreated addiction to additional prison time for relapsing.

Ironically, if Douglas were to receive the best therapy available for opioid addiction — maintenance treatment — he would be given either methadone or Suboxone, the drug he was busted for possessing in prison.

(MORE: Heroin Cheaper, More Effective than Methadone For Hard Cases: Study)

About 15% of American prisoners are addicted to heroin or other opioids, and more than 80% of these inmates go without treatment. Those who do get care are not usually offered maintenance, despite the fact that it has been found to be the most effective treatment for opioid addiction, in terms of reducing death rates and disease.

Perhaps Douglas’ extreme case will cast a spotlight on the millions of lesser cases of drug-war excess that occur every day — particularly to our system’s insistence on “treating” addiction with incarceration. The U.S. corrections system seems to believe that if one dose of prison doesn’t do the trick, more is the answer. (Isn’t that the mentality of a drug addict?) More is not better, however, whether you’re an addict trying to solve your problems with another injection or an infuriated judge trying to punish someone who is medically incapable of responding to punishment appropriately. Evidence-based treatment is not only cheaper, but far more effective, even if it doesn’t provide the emotional satisfaction of punishment.

Maia Szalavitz is a health writer for Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.