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    We can’t incarcerate our way to recovery

    Plymouth-10/25/17- The Massachusetts Alcohol and Substance Abuse Center looks more like a prison than an addiction treatment center. Inmates stand outside their rooms before lunch. A barbed wire fence surrounds the perimeter. (John Tlumacki/Globe Staff) (metro)
    John Tlumacki/The Boston Globe
    Civilly committed men stand outside their rooms before lunch at the Massachusetts Alcohol and Substance Abuse Center in Plymouth.

    Invest in community-based treatment, not prisons

    Re “An innovative approach helps civilly committed kick drugs” by Jennifer C. Braceras (Opinion, Oct. 14): Maybe there are families with not one member who has ever struggled with a drinking problem or other substances. Assuming, though, that most of us have such family members or know someone who does, I would hope that there are very few, if any, who would willingly choose to place a loved one who desperately needs the right kind of help in a prison or jail instead of in a community-based residential treatment center.

    And why? Because when you see how much your loved one is suffering, and how different they are under the influence of too much alcohol or other substances, you understand that this is a complex chemical dependency that requires a highly specialized understanding of the impact of addiction on the brain and human body.

    It also requires an almost unfathomable quantity of compassion, patience, and belief in the ability to overcome trauma.

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    There are special people who are qualified to administer and oversee such treatment. Many of the most successful providers have survived the recovery journey themselves and know what perseverance feels like. They also know that we should be funding therapeutic community-based treatment instead of sending that money to prisons and jails.

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    If our Commonwealth has learned anything from lessons of the past, and if its elected officials truly care about addressing the havoc wreaked on our communities, economies, and schools by substance use, then we will get serious about treating this disease by following the advice of the overwhelming majority of medical professionals across the state and the nation. We cannot just incarcerate our way out of this again.

    Elizabeth Matos

    Executive director

    Prisoners’ Legal Services

    Boston

    Jail setting places barrier in path to recovery

    In Jennifer C. Braceras’s laudatory op-ed about a jail-based addiction treatment center in Springfield, Sheriff Nick Cocchi of Hampden County questions whether it even matters where individuals receive treatment for substance use disorders when they are being compelled against their will. His cynicism disregards the implication, for individuals who suffer from these disorders, of being detained in a jail or prison. Treatment provided in the prison setting for those who have committed no crime is fundamentally punitive, demoralizing, and stigmatizing and can only undermine their successful recovery.

    It is widely accepted in medicine that low-barrier methods of delivering treatment for substance use disorder are most successful. By meeting patients “where they are” in their recovery, providers can build trust. Patients then call on that trust before they feel they can risk abandoning the substances that have helped them cope with painful emotions. Indeed, for many patients, these substances, which cause permanent neurological changes, have become necessary for them to feel somewhat “normal” emotionally and physically.

    Trauma is prevalent, and the shame associated with trauma causes people to hide and avoid treatment. Imprisoning individuals recapitulates shame and becomes counterproductive to engaging people in the process of recovery.

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    Regardless of which treatments may be offered in jail, individuals are set up for failure. We should be investing more in health systems, not prisons, for individuals with substance use disorder.

    Dr. Elizabeth A. Davis

    Founder and director

    Support Wellness treatment program

    South End Community Health Center

    Boston

    Doctor saw the damage done by ‘therapeutic punishment’

    As a physician who treats people with substance use disorders, I am concerned about the Hampden County Sheriff’s Department’s Section 35 treatment program featured in Jennifer C. Braceras’ op-ed. Addiction is a chronic disease, not a moral failing. People who desperately need help for severe substance use disorders should never be jailed to receive treatment.

    I recently saw a patient with alcohol use disorder, a Vietnam War veteran, who experienced the trauma of incarceration through Section 35 civil commitment. Fearing he would die from drinking, his family petitioned the court for involuntary treatment. My patient was handcuffed, brought before a judge, and detained in a correctional facility — all without committing a crime. He suffered 78 days in prison, receiving substandard treatment and strict supervision by correctional officers. His family was not permitted to visit. He was traumatized by this experience, and it has been medically counterproductive to his recovery.

    No other chronic disease would lead to handcuffing and jailing a person for treatment. There is no role for so-called therapeutic punishment in treating addiction. In fact, we have good evidence that incarceration settings are not effective for treatment of substance use disorder, nor are they the standard of care.

    The Commonwealth must create more beds for substance use disorder treatment across Massachusetts in specialized care facilities. Without investing in treatment infrastructure, prison beds will continue to masquerade as treatment beds.

    Dr. Marco Tori

    Internal medicine and preventive medicine resident

    Boston Medical Center

    Boston

    Drs. Ben Bovell-Ammon, Jordana Laks, and Ricardo Cruz contributed to this letter.