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This book assembles and analyzes the relevant information pertaining to prisoner reentry: the systems, people, programs, and prospects for implementing a more effective and just system. This chapter summarizes the data and develops major themes and policy recommendations. No one believes that the current prison and parole system is working. Recent public opinion polls show an increasing dissatisfaction with the purely punitive approach to criminal justice. Data suggest that having to earn and demonstrate readiness for release and being supervised postprison may have some deterrent or rehabilitation benefits—particularly for the most dangerous offenders. Effective programs include therapeutic communities for drug addicts and substance abuse programs with aftercare for alcoholics and drug addicts; cognitive behavioral programs for sex offenders; and adult basic education, vocational education, and prison industries for the general prison population.

In dealing with alcoholics and addicts, politicians and commentators usually would prefer to go with treatment instead of sending these alcoholics and addicts to jail. Rarely is it considered that these victims should be developed spiritually. When alcoholics, addicts, and other people who need such help attend support groups, they come to realize during their treatment that there is a “high power” in which they have to submit to instead of merely finding solidarity within the group. A large portion of the millions of Americans who are treated for alcoholism or addiction of substances are advised to foster a spiritual life through participating in fellowship activities like the Twelve-Step program of Alcoholics Anonymous. This chapter introduces the notion of spirituality and how this is used to help people who practice substance abuse.

Preserving belief in moral responsibility requires blocking deeper inquiry into the systemic causes of behavior. This refusal to consider causal history is clearest in the criminal justice system, but can also be found among philosophers (for example, those who champion the “plateau” of moral responsibility). The insistence on not looking deeper and in greater detail at the subtle causes of behavior is a common feature of both libertarian and compatibilist accounts of moral responsibility. When moral responsibility is represented as a “basic right,” then scrutiny of the differences among those to whom moral responsibility is attributed is seen as a threat to the universal acknowledgment of human rights. Restrictions on deeper inquiry are built into the moral responsibility system.

Adaptations of the reward circuit to intermittent and chronic supraphysiological stimulation by drugs increase reward thresholds. As a consequence, response to non-drug reinforcers in individuals with chronic drug use or addiction, may be decreased. Clinical symptoms include anhedonia and compulsive drug use, at the expense of the attainment of other rewarding experiences and despite detrimental consequences to the individual's functioning. While most addiction studies focus on the increased valuation of drug reward and drug-related cues, this chapter instead reviews the behavioural and neurobiological evidence for decreased valuation of non-drug reinforcers and cues. Future research should directly address the following question: is processing of drug reward enhanced at the expense of non drug-related reward (at least in certain subgroups of addicted individuals)? Or are these two processes independent?

Certain behaviors during pregnancy can harm the developing fetus in utero. In some states, if the woman’s behavior during pregnancy causes her to miscarry, have a stillbirth, or have a child with avoidable health problems, the woman may face criminal charges; she may be sent to jail. Yet the woman could have avoided criminal sanctions by availing herself of the legal option of abortion. It may seem inconsistent to allow women to choose abortion, which kills the fetus, while at the same time holding them criminally responsible for imposing a lesser harm on the child after birth. The interest view explains why there is no inconsistency. Although it denies that fetuses, at least in early gestation, have no interests and no rights, it acknowledges the interests of born children in having a healthy existence, interests that can be thwarted by maternal behavior during pregnancy. However, this chapter recognizes the moral obligations of pregnant women who do not abort their future children, it rejects a criminal justice approach to the public health problem of substance abuse in pregnancy, because this approach does nothing to protect children and nothing to help women get over their addictions.

This chapter takes the same natural science approach to addiction that has proven useful in the physical sciences, and shows that clinic addicts are much less likely to stop using drugs than nonclinic addicts. It suggests that the correlates of quitting are largely everyday events—the sort of occurrences which influence most decisions—and also illustrates that drug use will often fluctuate between periods of heavy use and periods of abstinence. Moreover, the chapter demonstrates that social factors and values significantly play in drug use. The applied implications of the analysis it presents are that prevention programs should enhance nondrug interests and that treatment programs should focus on decreasing the relative reward value of the drug.

A willing addict is one who reflectively endorses their addiction. Some say that there are no willing addicts, only unwilling addicts who are trying to stop but not succeeding, or resigned addicts who are so demoralized they have stopped trying to stop. Willing addiction reminds us that addiction is a phenomenon that involves a person-with-a-lifestyle-inside-an-ecology, that there are good-making features of using even addictively, and that addiction involves many of the same complex, negotiated features (experiential, personal, interpersonal, structural, and cultural) of other person-level lifestyle choices. Willing addiction shows that concepts such as choice, voluntariness, and reflective endorsement have a place in the psychology and phenomenology of addiction. There are implications for the psych-bio-politics of addiction and for the implausible idea that addiction is a brain disorder. Addiction is not a brain disorder, although certain aspects or features of addiction involve brain disorders.

This chapter looks at what is known about the ways in which parents' drug use may influence the lives of their children, and the challenges faced by those seeking to meet these children's needs. It argues that the needs of children and families have attracted too little attention because the policy focus has been elsewhere – on reducing the risk of acquiring and spreading HIV infection, and on reducing drug-related crime. The chapter highlights one of the ‘thorniest’ questions facing professionals: how much adversity is it tolerable for children to experience at the hands of their addict parents?

This chapter presents concluding remarks on defamation. It discusses the story of James Frey, the self-described drug addict, alcoholic, and criminal, and author of a controversial memoir entitled A Million Little Pieces, who appeared on CNN's Larry King Live to defend his veracity. Frey appeared on the show after The Smoking Gun website alleged that he manipulated details of his life to render himself more compelling as a “tragic victim” and to sweeten the “melodramatic narrative.” The chapter also discusses a story taken from the central chapter of An Unfinished Woman, which focuses on a tragicomic episode known as “the trouble,” which involves the “transshipment of a Russian prostitute.” It also argues that objectivity is something people share by balancing viewpoints, not something pure and independent which they come upon in isolation.

In The Reformation of Machismo (1995), Elizabeth Brusco proposed an intriguing theory to explain the mass conversion of Latin Americans to evangelical Protestantism: Protestantism as gender strategy. Based on fieldwork in Colombia, Brusco argued that the Protestant Church is a female-dominated institution and that women convert their male partners to domesticate them. Enforcing the clean-living program of evangelists, Colombian women brought men into the domestic sphere as heads of household, and forced men to give up the male subcultural pursuits of alcohol, adultery, and domestic violence. Using Brusco's argument as a point of departure, this chapter describes conversion among addicted men in Puerto Rico as a male-driven—rather than female-driven—gender strategy that changed the relationship male converts had to their families and their work.

This chapter begins with a discussion of people's lack of sympathy and compassion for the plight of alcohol or drug addicts. It explains how most people think that addiction is self-inflicted and how they consciously distance themselves from those with addictive disorder. It then sets out the book's purpose, namely to share some of the amazing advances the neuroscience of addiction has made over the years. The book presents the author's personal take on what addiction is: a malfunction of some of the most fundamental brain circuits that make us tick, and a disease that is not much different from other chronic, relapsing medical conditions. The chapter emphasizes that addiction is not a moral failing, an inability to say no, or a condition that can be cured by mystic incantations. The book also shows that scientific advances have improved, in major ways, the lives of people with addiction, and that they hold out considerable hope for further progress.

This chapter presents the author's account of his early lessons about the destructive force of addiction. He describes one of his previous patients named Eric, an alcoholic and diabetic who refused treatment for his addiction and died shortly after his release from the hospital. The author believes that he still remembers Eric's story because it freed him of some of his innocence and naïveté. But it also captured several elements from which a journey into the landscape of addiction should start: that addiction makes people continue to use a drug even if they know it causes them severe harm and is likely ultimately to cost them their life. That nice people who might be perfectly able to contribute to society still may end up using drugs until they die. That the potential for denial, both from the patient and from everyone else, until it is too late exceeds most people's imagination.

This chapter considers the link between impulsivity and addiction. It shows that in the absence of protective family and societal factors, children who are impulsive have a higher risk for developing heavy drug use or addiction. Heavy chronic drug use, on the other hand, will make these individuals even more impulsive, in a truly vicious circle. By the time this dynamic has a person firmly in its grip, not even the happiness of a truly beloved child can successfully compete with the immediate attraction of a few drinks. This is not because the person is unable to do the math in theory. It is because when these real-life decisions are made, they are made in real time. And when that processing is carried out, the valuation, decision making, and behavioral inhibition machinery simply does not do the job it is supposed to do. Decades of work in this field have shown that this is not a moral failing but rather a malfunction of sophisticated yet quite sensitive computational hardware.

In this chapter I argue that there is a normative aspect to self-control that is not captured by the purely procedural account to be drawn from dual process theories of cognition – which we only uncover when we consider what self-control is for and why it is valuable. For at least a significant sub-group of addicts their loss of control over their drug use may not be due to a lack or depletion of cognitive resources. Rather it may be that they have little confidence in their ability to exert control over their circumstances and shape the life they would value having and the person they would value being

This chapter explores the governing problems that set the stage for the 1973 drug laws and the ways different groups struggled to interpret and respond to them. It chronicles New York's efforts to manage heroin through drug rehabilitation and looks at how the varied therapeutic approaches coexisted with criminalization. While rhetoric in the 1970s presented “addicts” and “pushers” as stable, essential identities, these terms are best understood as artifacts of the ongoing historical struggles over narcotics. Instead of objective divisions within the social body, the distinct categories of drug users were actually constituted through debates over policy.

This chapter interrogates the notion of the “addict” as the dehumanized internal enemy perpetuated by the drug war. Anti–drug war activists see this notion of the addict as a central part of what they call the “fantasy world” or “ideology” or “mindset” produced by the drug war. This chapter begins by considering the discursive production of this fantasy world that the anti–drug war movement fights against. Those in the movement understand that most people they engage with—politicians, police, medical personal, family members—relate to and understand drug use and users through the lens of this fantasy world. The chapter then considers one of the most significant political tactics utilized by the anti–drug war movement in their attempt to “shatter mindsets.” It is argued and ethnographically illustrated that a disruptive politics of showing is a first-step political tactic by which anti–drug war activists disrupt the dehumanizing fantasy world of the drug war by enacting the “otherwise” they hope one day will become the new nonnormative norm.