Legal Rehabilitation in Lieu of Incarceration:
Can the Judicial System Accept a Softer, Gentler Way?
Judith Miller, Ph.D., Roger F. Carlson, M.A.C., L.A.C., S.A.P.,
and Steve Sewell, CACIII

Introduction: Transitional Thinking From Incarceration to Treatment

An evolving trend within the judicial system is to view alcoholism/addiction as a disease - a disease symptomatic of criminal behavior. Eight decades of genetic research is finally reaching criminal courts across the country. Judges are now realizing that alcoholism viewed as a crime, punishable by incarceration has a predictably high recidivism. On the other hand, as judges recognize that alcoholism is a disease, with an onset, a progression and an end, treatment is ordered in lieu of incarceration.

Perhaps the greatest deterrent for judges to consider in adjusting the way the law views alcoholism is the fact that the disease has so many tragic victims. Judges are painfully aware that drunk drivers have killed more people than all the wars put together. A second deterrent to this transitional thinking has been the low effectiveness rate of traditional alcohol treatment programs. Most traditional programs, including the famous Betty Ford Center have only a slight edge on incarceration regarding relapse. Judges rely upon the fact that society is protected from a Dill, DUR offender if the offender is incarcerated. However, the safety only seems to last until the offender is released back into society to re-offend. There must be a better way.

It is encouraging to note that an innovative, all encompassing treatment regime has been developed, tested and is slowly but progressively working at an 80% success rate. This comprehensive program was created with the acceptance of past decades of research on the biological basis of chemical dependency, i .. e., The Reward Deficiency Syndrome (RDS) as identified in the bio-genetic work of Kenneth Blum and associates (Blum, et al. 1990). The acceptance ofRDS (Blum et al. 1996) as a viable explanation of alcoholism and addiction as a genetic anomaly, has been adapted as the core impetus for this model program.

The Genetics of Drug Addiction

It is recognized that Cocaine can bring intense, but temporary, pleasure to the user with an aftermath of severe psychological and physiological harm. Recent studies lend credence that hereditary factors are involved in the use and abuse of cocaine and other illicit drugs. Schubert et al. (1988) published an analysis of 40 studies showing a strong positive correlation between alcoholism and drug abuse, between alcoholism and antisocial personality, and between drug abuse and antisocial personality. While little is known about the genetics of cocaine dependence, extensive scientific data are available on the effects of cocaine on brain chemistry (Koob & Bloom 1988, Noble -et al. 1993, Volkov, et al. 1993).

Behavioral Disorders and the Dopamine D2 Receptor

Scientists have also recognized that the Ai allele carries a behavioral risk factor that is also evident in antisocial behavior, conduct disorder and violent or aggressive behavior (Cummins et al. 1996, Noble et al. 1991). Scientists from Israel and the National Institutes of Mental Health have recently reported a genetic variation of the dopamine D4 receptor gene as associated with people who are novelty or sensation seekers Ebstein et al. 1996 & Benjamin et aI, 1996). Richard Ebstein and associates at Herzog Memorial Hospital in Jerusalem found that novelty seekers who tended to be compulsive, exploratory fickle, excitable, quick-tempered and extravagant, were much more likely to have a longer version of the receptor gene than individuals who were not novelty seekers. Conversely, they found subjects with shorter version of the gene scored lower on tests of novelty seeking and tended to be reflective, rigid, loyal, stoic, slow-tempered and frugal. Jonathan Benjamin and his associates reported similar results in an American sample of 315 subjects.

NeuroNutrient Treatment Modality

Fortunately research of the 90s while accepting genetic predisposition to addiction, was innovative in establishing a pharmacological approach to treatment of addiction and abberant behavior (Harris & Aston-Jones, 1994). An understanding of the biological basis of chemical dependency and the complexity of how the system of neurotransmitters are involved in brain activity, are essential in planning a successful recovery program (Blum, 1989, Cloninger 1983). Research related to RDS has developed a cascade theory of reward as described for a normal person as when neurotransmitters work together in a cascade of excitation or inhibition-between complex stimuli and complex response-leading to a feeling of well being, the ultimate reward (Cloninger, 1983, Stein & Belluzi, 1986, Blum and Koslowski, 1990). However, a disruption of these intercellular interactions result in anxiety, anger and other "bad feelings" or in a craving for a substance that alleviates these negative emotions.

Prelude to a Successful Treatment Modality

Studies leading to the development of our treatment model are described in this section.

A study illustrating the neurodynamics of relapse prevention for DUI offenders (Brown, et al. 1990) reported that the central nervous system rewarding properties of ethanol, cocaine, and heroin may activate a common catecholaminergic reward system in the mesolimbic circuitry of the brain. A neuronutrient approach was found to significantly reduce relapse rates and enhance recovery in DUI offenders over a to-week period.

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