America’s Drug Policies: What Works, What Doesn’t

Background

Our current policy mix is not working the way we want it to. The ease with which drugs can be obtained, the price, the number of people using drugs, the violence on the border all show that. We need to rethink our responses to the health effects, the economic impacts, [sic] the effect on crime. We need to rethink our approach to the supply and demand of drugs (U.S. Senator, James Webb, 2008).

For over a century, America’s drug policy has been from a law enforcement perspective.  This approach, has led to a circle of violence across America, particularly in the inner cities.  From a policy stand point; the enforcement centric approach has not worked.  It produced some unintended consequences.  By defining the mission as a war on drugs, the psychology follows that we treat every drug incidence as a war.  In wars, there are casualties.  Cash strapped cities, drug victims needing help, and over policed minorities are the unintended casualties of the war.

War involves weapons, force, killings, and enemies.  War involves an us vs. them approach.  This is hardly beneficial or effective because criminal elements tend to adapt.  As a result, policing adapts by escalating the “war.”  Since our ability to end all drug abuse or supply is unlikely, there seems to be no clear end in sight for the drug war.  Worse still, a chunk of the critical dollar is channeled toward prosecuting the drug war, as opposed to increasing drug education, treatment, and rehabilitation programs.

Historically, drug enforcement has tilted toward minority citizens, since the 1870s anti-opium war, which was largely a race-centric policy, specifically targeting Chinese immigrants.  The various drug law enforcement regimes have predominantly targeted minorities disproportionately for drug enforcement and felony sentencing.  The Harrison Narcotics Act of 1914 was targeted at what was then referred to as the cocainized blacks (Sterling, 2001).  Likewise, the subsequent anti-marijuana policies around the same time in the West were directed at the immigrant communities of Mexican descent (2001).  As a result, minorities have been disproportionately targeted for drug enforcement and felony sentencing.  These policy proposals will seek to address these problems.

The First World War ended in 1914, and the Second war ended in 1945. War ultimately ends, and combatants eventually retreat. When will the drug war end?  One issue that this policy proposal will address is the way the drug problem is being approached.  Defining the mission as a “war on drugs” promotes violence between the law enforcement community, the peddlers, and the user community. What policy proposals might we put in place to address the circle of violence on America’s streets as a result of the war?  If there is a war going on, will a truce be apt?

This policy paper will recommend policy alternatives that will replace the old enforcement regimes with emphasis on treatment and decriminalization. The policies’ outcome will also be measured against their cost effectiveness or cost benefits.  Treatment and decriminalization as potential replacement policies will be analyzed.  A review of much of the issues associated with treatment and decriminalization will be discussed.  The problem will be defined, questions will be raised, and finally, various policy proposals will be made.

 

Key Terms: Definitions

Terms such as Drugs, War, and Minorities will surface in this Policy memo.  To avoid confusion, there is need to define them relative to this proposal since these terms and concepts sometimes have multiple connotations.   For example, since the term drug is interchangeable with medication (as in medicine), a distinction has to be made with regard to its usage in this policy memo.

Drugs.  For the purpose of this policy brief: “Illicit drugs are those that are illegal to make, sell, or use” (Mara et al, 2014).  Drugs refer to illicit drugs of abuse.  See Appendix for a breakdown of drugs according to the Drug Enforcement Administration (DEA).

War.  For the purpose of this policy memo, war applies narrowly to: “Terrorism, coordinated riots, a high crime rate, brutal policing, or criminal predation” (MUELLER, 2009, p.299).  I define it as legal use of force or violence by the agents of the state against perceived criminal elements over a period of time (usually years).  For example, the war on drugs as lasted over 44 years since President Nixon launched it on June 17, 1971 (Drugwarfacts.org, 2007).

Minorities.  This policy brief views a minority as:  “A subordinate group whose members have significantly less control or power over their lives than members of a dominant or majority group” (Schaefer, 1979, p. 5-10).  In the United States, racial minority groups include Blacks, American Indian, Asian Americans, and Hawaiians.  Note: There is often systemic unequal treatment of these groups in the criminal justice system (Schaefer, 1979).

 

Theoretical framework and principles

  1. We must do away with ideologically driven drug policies. New drug policies must hinge on facts and evidence.  Policy makers must understand what works and what doesn’t?  Drug policy must be measured based on reduction of violence (harm reduction)—including law enforcement induced violence—treatment, and overall wellbeing of communities.
  2. Policies must de-emphasize labels by focusing on bringing drug users from the periphery of society into the core by ending marginalization and criminalization (i.e., decriminalization). This policy brief adopts the “patient not criminal” (i.e., treatment) approach.

Problem Definition

The United States spend more money as a percentage of its GDP on drug law enforcement in comparison with other enforcement:

Between 1981 and 2008, federal, state, and local governments are estimated to have spent at least $600 billion (adjusted for inflation) on drug interdiction and related law enforcement efforts; factoring in costs associated with treatment and rehabilitation, the overall total rises to around $800 billion.  If one were to also add in ‘invisible’ losses brought about by curtailed job opportunities and reduced workplace productivity, the true cost would be far higher.  (Chalk, 2011)

This policy brief will reveal that despite U.S.’s astronomical spending on the drug war, it has yielded little to no result in terms of reducing overall harm to society.  In fiscal year 2011, when Chalk conducted his study, U.S.’s national drug control budget (NDCB) was $24,365.4 (in billions).  By fiscal year 2015 drug enforcement costs ballooned to $26,336.7 (see Figure 1 for illustration).  In FY 2016, the President requested $27.6 billion to fund the “2015 National Drug Control Strategy (Strategy) effort to reduce drug use and its consequences in the United States” (Office of National Drug Control Policy [ONDCP], 2015)—an increase of $1.2 billion or 4.7% increase (2015).  The NDCB is also expected to increase beyond fiscal year 2016.

 

Figure 1: Drug Control Resources by Function; adapted from ONDCP, 2015.

Federal Drug Control Spending by Function

(Budget Authority in Millions of US Dollars. Source: ONDCP, February 2015)

Function FY 2014 Final FY 2015 Enacted FY 2016 Request
Treatment 9,481.8 10,267.8 10,960.5
Percent 36.9% 39.0% 39.8%
Prevention 1,316.9 1,306.2 1,381.9
Percent 5.1% 5.0% 5.0%
Domestic Law Enforcement 9,340.5 9,367.0 9,736.6
Percent 36.3% 35.6% 35.3%
Interdiction 3,948.5 3,805.0 3,880.3
Percent 15.3% 14.4% 14.1%
International 1,637.1 1,590.7 1,613.0
Percent 6.4% 6.0% 5.9%
Total $25,724.9 $26,336.7 $27,572.3

 

Clearly, based on the historical and future budgetary allocations and spending, the current policy of enforcement, incarceration, and prohibition has produced dismal success.  Common wisdom would suggest that drug control cost should be reducing yearly, but that has not been the case given the yearly budget increase.

Along with increased budgetary spending on the drug war, there is a social cost.  There has been an explosion in incarcerations as a result of the reliance on the law enforcement and prohibition model of drug control policy.  According to the report by Sabol et al (2007) of the Bureau of Justice Statistics (BJS), the U.S. is the leading nation in terms of the number of people serving time behind bars for various offenses (2007).  The U.S. is the global leader when it comes to the number of individuals imprisoned for drug offenses.

In addition, the same BJS report noted that there are two million incarcerated Americans in the federal, state, and local correctional facilities (Sabol et al, 2007).  One quarter of those serving time, are doing so for various drug offences.  According to the Substance Abuse and Mental Health Services Administration (2015), approximately 6.8 million Americans suffer from drug addiction.  Drug addictions continue to drive the increase in the number of incarcerated Americans serving time for various drug offenses.  The law enforcement and incarceration model is unsustainable and unaffordable in the long run because it diverts dwindling resources from other government—i.e., federal, state, and local—programs into prosecuting the drug war.

 

Racial disparity in incarceration

The findings of racial disparities in incarceration due to drug related offenses threaten to unravel America’s criminal justice system.  A foremost democratic and multi-ethnic nation like America should exhibit equity in its criminal justice system or risk long-term social and political chaos.   According to Carson (2015), in a BJS report, out of the approximately 208,000 individuals serving sentences for various drug offenses in 2013: “67,800 were non-Latino/Hispanic white (32.6%), 79,900 were non-Latino/Hispanic black (38.4%), 39,900 were Hispanic (19.2%), and the remainder were unaccounted for or not specified in the report” (Carson, 2015).  These findings fly in the face of the knowledge that minority Blacks make up 13.2% of the U.S. population, Hispanics, 17.4%, and Whites, 62.1% (U.S. Census Bureau, 2015).  A federal household survey in 1998 found that Whites make up 72% of illicit drug users, Blacks 15%, and Latino 10%, but 37% of arrests are Blacks and 58% of drug convictions are Blacks; Latinos making up 21% (SAMHSA, 2013)

From the available data cited above, it is clear that:

  • The law enforcement model (i.e., the drug war) and prohibition is costly, ineffective, and socially and fiscally unsustainable.
  • There is a healthcare crises because of the over reliance on the law enforcement model as against the treatment model.
  • Minorities have been disproportionately targeted for drug enforcement and felony sentencing.

 

Methods

This policy analysis utilizes a multi-strategy approach.  That is, a combination of rational (cost benefit analysis) and non-rational approach (normative approach based on the principle of equity).  This memo utilizes cost-benefit analysis giving the new era of budgetary and fiscal constraints (i.e., post great recession climate).  There has to be judicial use of limited resources.  Alternative strategies (i.e., decriminalization and treatment) to the current regime of prohibition and incarceration will be considered based on cost to benefit ratio.

Yes, numbers speak but reason must also prevail.  Aside from the fiscal portion of the analysis, this proposal adopts a normative strategy by addressing the question of: What is and what ought to be?  What is the right thing to do in the face of the inability of numbers (dollar) to solve the problem?

 

Issue analysis

The discussion within the country over the issue of drug policy reform is divisive among policy analysts, law enforcements practitioners, and lawmakers—at all levels of government.  There are those who advocate for doubling down on the existing policy regime by arguing for the allocation of more funding for law enforcement (U.S. Department of Justice Drug Enforcement Administration, 2015).

Overwhelmingly, the advocacy for the doubling down of the status quo is from the political right and law enforcement intelligentsia (Freiburger, 2014).  One argument that pro prohibition and criminalization employ is the “Flouting Federal Law” (FFL) argument (Stimson, 2010).   Proponents of the FFL argue that:  “Supremacy Clause of the Constitution of the United States, the Controlled Substances Act, is the supreme law of the land and cannot be superseded by state laws that purport to contradict or abrogate its terms” (2010, p. 7).  As such, the current marijuana legalizations in the states are illegal (2010).

There is also the health risk argument for the continuation of the current drug policy.  Proponents of the health risk (HR) argument point to scientific finding that “marijuana use during the teen years can permanently lower a person’s IQ and interfere with other aspects of functioning and well-being” (National Institute on Drug Abuse, 2014).  On the other hand, a report of the national survey on drug use (between 1975-2013) revealed no concrete evidence on the effect of drug use (i.e., Cannabis) on adolescents (Johnston et al, 2013, p. 401).  However, as more states decriminalizes (e.g., marijuana), it is expected that adolescents’ use will increase (2013).  By and large, proponents of the HR argument asserts that marijuana (i.e., poster child for pro legalization and decriminalization arguments) is “addictive and that its use significantly impairs bodily and mental functions” (Stimson, 2010).

In addition to the health risk argument, there is the crime escalation (CE) argument for retaining the current policies.  The proponents of the CE argument assert that: “Even where decriminalized, marijuana trafficking remains a source of violence, crime, and social disintegration” (Stimson, 2010).  This policy memo argues that behind the CE arguments lies the silent “broken window theory” (BWT).  BWT is the notion that societies can prevent big crimes by “checking” small crime (in this case, possession of marijuana).

This policy memo does not discuss the argument for change because that is essentially what this whole memo is all about.  However, there is clear evidence that public opinion is moving away from the status quo towards decriminalization, treatment, and regulation.  It is appropriate to say that the public appears ready to call a truce and bring an end to the drug war.  According to a Pew Research Center (PRC) survey:

67% of Americans say that the government should focus more on providing treatment for those who use illegal drugs such as heroin and cocaine.  Just 26% think the government’s focus should be on prosecuting users of such hard drugs. (PEW Research Center, 2014).

 

Policy Alternatives and Proposed Solutions

Recently, the stasis in policies is starting to show signs of movement.  Since 2012 when Colorado passed the law legalizing the recreational use of marijuana, a wave of anti-prohibition initiatives has been proposed at the state level.  States across America have flirted or weigh policy alternatives to current policies but there are still no agreements on what courses of action to take.  This policy memorandum shall examine alternatives to the status quo (i.e., criminalization and incarceration).  As noted above, studies show that the current enforcement regime is ineffective.

As a result, alternatives must consider fiscal sustainability and harm reduction.   Harm reduction principle is based on the notion that society can reduce the damages that drugs cause individuals, family, and societies in general by emphasizing treatment over incarceration (Ciment, 2006, p. 579).  Basing alternatives on fiscal sustainability and the principle of “harm reduction” will ensure that facts and evidence, not ideology, drives policymaking.  The alternatives to the policy problems are decriminalization, regulation, and treatment over incarceration.

 

Alternative 1:  Decriminalization.

The law enforcement or criminal justice model to the country’s drug epidemic lacks efficacy in preventing drug abuse.  It is unsustainably costly and counterproductive.  Criminalizing (i.e., prohibition) is costly because it drives up the cost (both monetary and nonmonetary) of the drug.  High drug cost, in turn, means that more suppliers will enter into the drug economy (law of demand and supply).

One effect of criminalizing the drug problem is the never ending circle of violence. According to the findings by Jensen (2000), decriminalization:

Would decrease violence associated with attempts to control illicit markets and as resolutions to disputes between buyers and sellers.  Moreover, because the perception of violence associated with the drug market can lead people who are not directly involved to be prepared for violent self-defense, there could be additional reductions in peripheral settings when disputes arise. (p.33)

Stopping prohibition would improve the “violence-scape” of the American society.

Additionally, a research conducted by Miron and Waldock (2010) revealed that:

Legalizing drugs would save roughly $41.3 billion per year in government expenditure on enforcement of prohibition.  Of these savings, $25.7 billion would accrue to state and local governments, while $15.6 billion would accrue to the federal government. Approximately $8.7 billion of the savings would result from legalization of marijuana and $32.6 billion from legalization of other drugs. (p. 1)

No doubt, the fiscal situation of the government (federal, state, local) would improve considerably.  Better still, the savings could be deployed into drug treatment and counseling.

 

Alternative 2:  Regulation.

Aside from decriminalizing drugs, drugs should be regulated like other pharmaceutical drugs.  Regulation (i.e., targeted at usage, sale, and age restriction) will bring the market out of the underground economy into the open regulated market.  Drugs in the open regulated market will eliminate the need for violence.  Regulation would also normalize drug price and reduce potential profit margin (Insulza, 2013).

In addition, regulation will potentially reduce overall demand “because legal sellers face a stronger incentive to obey such regulation than underground sellers, who are already hiding their actions from authorities” (Miron & Waldock, 2010, p. 53).  The underlying assumption is “that the marginal costs of evading tax and regulatory costs is zero for black market suppliers who are already conducting their activities in secret” (p.53).

Another important impact of regulation is the potential tax revenue accruals from taxation, which is estimated to be:

$46.7 billion annually, assuming legal drugs were taxed at rates comparable to those on alcohol and tobacco.  Approximately $8.7 billion of this revenue would result from legalization of marijuana and $38.0 billion from legalization of other drugs. (Miron and Waldock, 2010, p. 53)

Regulation will greatly reduce the vices associated with illicit drug trade and increase government revenues.  The revenue accruals from regulation can channeled into treatment and prevention programs.

Alternative 3: Treatment.

Between January 1994 and December, 2000 the government of Switzerland conducted a study of 1969 drug dependent individuals on treatment, and the result was a resounding success.  The result concluded that:

Heroin-assisted treatment programs are cost-beneficial to Swiss society, since patients often show great improvements in medical and social variables, including criminality.  In other words, the financial benefits from less criminality, less health-care use, and improvements in social variables are higher than the costs of treatment. (Rehm et al., 2001, p. 1420)

An analysis of the Swiss findings revealed that for treatment participant, criminal infractions fell by 60 percent (2001).  For participants, incomes generated from illegal sources also dropped from 69 to 10 (2001).  Use of illicit/ illegal drug declined.  Participants of the study also showed an improvement in gainful employment (i.e., from 14% to 32%) (2001). Overall health improved and incidence of HIV infection declined among the controlled groups—i.e., those who stayed in treatment program (2001, p. 1418).  There were no deaths from overdoses, and no prescribed drugs were diverted to the black market.  A cost-benefit analysis of the program found a net economic benefit of $30 per patient per day, mostly because of reduced criminal justice and health care costs (2001).

According to the Justice Policy Institute (JPI), treatment is more cost effective than incarceration (JPI, 2008, p. 3).  The result of the policy brief by JPI showed that for every increase in funding (+14.6% between 1995-2005) for drug treatment there is a corresponding decline in violent crime by twofold (-31.5% between 1995-2005) (p.3).  For every +14.6% increased spending, there is a +37.4% increase in drug treatment admission rate (p.3).  Clearly, the cost advantage is in favor of treatment because +14.6% expenditure yields -31.5% and +37.4% in violent crime reduction and drug treatment admission rates respectively (p. 3).  By and large, community based drug treatment is comparatively more beneficial and cost effective than incarceration (Aos, et al, 2007).  For every dollar spent on drug treatment in the community is estimated to return $18.52 in benefits to society” (JPI, 2008, p. 16).

 

Evaluating the alternatives using the decision matrix (DM).  The evaluation was conducted using six criteria (narrowed down) that were determined to be more socially beneficial.  Weights were assigned to these criteria based on the importance of policy outcomes of the alternatives.  The alternatives were scored based on their effectiveness at achieving policy outcomes (i.e., meet criteria).  The scores were then multiplied by weights to determine ratings per alternative, which were tallied to determine total rating.  The alternative with the highest total rating will be recommended (or at least will top the list of recommendations).

Decision Matrix
Criteria Weight Alternative 1: Decriminalization Alternative 2: Regulation Alternative 3: Treatment
Reduce violent crimes 5 3 X 5= 15 5 X 5= 25 5 X 5= 25
Reduce drug abuse 1 1 X 1= 1 1 X 1= 1 5 X 1= 5
Overall harm reduction 5 1 X 5= 5 3 X 5= 15 5 X 5=25
Reduce overall cost 5 5 X 5= 25 5 X 5= 25 5 X 5= 25
Reduce incarceration 3 3 X 3= 9 3 X 3= 15 5 X 3= 15
Wage gain 3 1 X 3= 3 5 X 3= 15 3 X 3= 9
Total Rating 58 96 104

 

Score:  5= fully satisfy                     Weight: 5= High Importance            (Score X Weight= Rating)

3= substantially satisfy                     3=Medium Importance

1= partly satisfy                                  1= Low Importance

CBA Matrix of Most Desired Alternative vs. Status Quo. (Source of data: Justice Policy Institute)

Benefits
Benefits Status quo: Incarceration Desired Alternative
Reduction in the cost of drug-related crimes -$4.00 to -$7.00
Violent crime rate (California) -11.2%
Costs
Costs Status quo: Incarceration Desired Alternative
Addiction treatment programs +$1.00
Incarceration per year (per person) $24,655.00
Number Treatment facilities (California) +25.9%

 

Strategic Recommendations

The data analysis conducted in this policy brief show a preponderance of evidence (qualitative and quantitative, see DM and CBA) suggesting that the government should adopt Alternative 3, Treatment as an alternative to incarceration for low level non-violent drug offenders.  Alternative 3, is most effective at a) reducing violent crimes, b) reducing drug abuse, c) reducing overall harm to society, d) reducing overall cost, e) reducing incarceration, and f) improving wage gain among drug users.  Therefore, I recommend alternative 3 (i.e., treatment) for this committee.

Alternative 2, Regulation, is second most effective alternative but it can only work if alternative 1, Decriminalization, is adopted because it will eliminate the underground—criminal—economy for drugs.  The market for illicit drugs can then be regulated and taxed like any other commodity.  Behind this idea is the notion that demand drives supply.  As such, as long as there is a demand for drugs, criminal elements will continue to occupy the supply chain.  The concomitant effects are—as has been—violent crimes and overall harm to society (e.g., HIV and Hep-C infections).  Regulation and decriminalization will reduce and eliminate the need for violence as a means for guaranteeing procurements and supply.  Better still, regulation would buoy the tax revenue of the government and ameliorate the fiscal dilemma that it faces.

Therefore, in the order of effectiveness, this policy brief recommends the following as the alternatives to the current law enforcement approach:

  • Regulation
  • Decriminalization

It is my opinion that if these recommendations are adopted and implemented, the overall wellbeing of the society will improve.  There will be a significant harm reduction as a result of the illicit drug problem.

 

_________________________________

References

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Trends in Substance Abuse Treatment and Application for Sex Offender Treatment

Introduction

Interest in sex offenders and their treatment has been the subject of study since 1886 (Schwartz & Cellini, 1995). Since then, many changes have been made in the treatment of sex offenders. Current treatment for sex offenders includes: cognitive behavioral therapy, relapse prevention, behavior modification, harm-reduction, and self-regulation. Specifics in the type and time-frames of treatment are based on the program or clinicians approach, risk level, and community support available (Bumby, 2006). While there are many treatment options available, it is difficult to determine the success rates of these treatment methods. One study determined that out of 130 previously conducted studies on sex offender treatment, only 25 of these studies met the minimum quality control guidelines established for scientifically reliable research (Brockett, 2012).

While sex offender treatment has been compared to other methods of treating mental health issues, there is limited research available comparing sex offender treatment to the “lifelong” treatment model utilized in treatment for substance abuse. Treatment experts have identified a combination of group psychotherapy and a twelve-step program as the “gold standard” in substance use treatment (Korshak & Delboy, 2013). Currently, twelve-step programs provide fellowship, resources, and support. This model was developed by Alcoholics Anonymous (AA), which originated in 1935. AA currently has two million members’ worldwide and 200,000 weekly meetings (Galanter, 2014).

According to the rational model, policy makers seek to gather and examine all relative data, and after analyzing all the alternatives, construct a plan.  This model is sometimes called “means-end” thinking, and is built on the premise that problems can be solved by examining and choosing the best method to reach a goal. Often the solution that is deemed the “best” is based on cost effectiveness and maximum total welfare (Stone, 2011).

On the surface, this model appears to be the most logical. However, humans are not rational decision makers. This phenomenon can be described as the “human problem”, which asserts that humans are never truly rational because of personal bias, emotions, and world views we are never able to make purely rational decisions (Clemons & McBeth, 2009). An example of policy making that is not considered “rational” are policies surrounding sex offenders and their treatment.

In an effort to construct a more rational approach to treating sex offenders, I will be comparing and contrasting the models of treatment used for sex offenders and substance users and offering alternatives to current treatment models used for sex offenders.

 

Policy Implications

There are currently 747,408 registered sex offenders in the United States (National Center for Missing & Exploited Children, 2012). Since 1994, we have required that these offenders make their address, crime, photo, and physical description public record, and thus easily accessible to the general population.

The Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act of 1994 required that offenders of sex crimes against children be registered with law enforcement after release from confinement (Comartin, Kernsmith, & Miles, 2010). Subsequently, Megan’s Law of 1996 stipulated that this registry is made available to the public and included community notification policies. Other legislation, such as The Pam Lychner Sexual Offender Tracking and Identification Act (1996) and the Adam Walsh Child Protection and Safety Act (2006), increased registration periods for sex offenders and made community notification rules more stringent (Wagner, 2011). By invading the privacy of a sex offender, the general population feels safe. However, studies have shown that allowing public access to the sex offender registry discourages compliance with the registry (Murphy, Fedoroff, & Martineau, 2009).

The passage of these, and other pieces of legislation, has had a negative impact on registered sex offenders. Increasingly, research has shown that sex offenders have been plagued by problematic housing restrictions (Levenson & Cotter, 2005), harassment by the communities in which they live (Pogrebin, 2004), lack of accessibility to forms of public assistance (Travis, 2002), and employment (Wagner, 2011). Additionally, research has illustrated that perceptions and attitudes towards sex offenders are overwhelmingly negative (Olver & Barlow, 2010; Elbogen, Patry, & Scalora, 2003), with one study finding that participants thought it “acceptable” for sex offenders to be physically injured (Wagner, 2011, p. 267).

Some have suggested that the media has assisted in reinforcing myths and stereotypes about sex offenders by over-generalizing them as sexual predators (Katz-Schiavone, Levenson, & Ackerman, 2008). Morrison (2007) aptly summarized that much of the public thinks that registered sex offenders are “incurable, resistant to treatment, and all but certain to offend again” (p. 24). Perhaps not surprisingly, studies examining the public perceptions of sex offenders have found that stereotypes are often not congruent with accurate information related to this population (Church, Wakeman, Miller, Clements & Sun, 2008). In an ideal world, the media would portray objectivity, truth, balance, and accuracy. Unfortunately, there is little evidence to show that the media can live up to these expectations. Regardless of the apparent bias of the media, the general public continues to regard news stories as the “political watchdogs” or “guardians of the public interest” (Schnell, 2001, p. 186).

In the case of Jacob Wetterling and Megan Kanka, there was significant media attention which led to increased emotions surrounding these events. These news outlets play a vital role in drawing attention to political issues and deciding what is “news” and who is “newsworthy.” This attention is a powerful weapon in creating public interest in an issue and can be crucial in generating momentum behind policy issues. Altogether, “some scholars find that the media exert substantial influence in deciding what problems will be given attention and what problems will be ignored” (Oswald, 1994).

Media coverage is also an essential part of bringing the issues to the attention of policy makers. Some problems, no matter how large, are unable to generate enough attention, while other crises events generate enough focus and public support to be placed on the policy agenda. Robinson (1999) calls this phenomenon the “CNN effect”. The basis of the “CNN effect” is that news outlets and media can shape policy. Some argue that political elites influence the media to report stories in a way that is favorable to the political agenda. Alternatively, media reports weigh heavily on emotional response and this emotional response impacts voters and lobbyist (Robinson, 1999), and due to the irrational nature of humans, these emotions play a large part in irrational policymaking.

While the majority of citizens desire to be active political participants, studies show that the majority of the population is not consistent with political participation and is often uninformed. Additionally, even when individuals attempt to be more engaged in the democratic practices like attending political events, voting or researching legislation, they are often swayed by the media. The issue of sexual violence is clearly and easily understood by the general public, and requires no expertise on the subject. This issue is also one that is closely followed by the mass public and, like many political issues, is highly emotionally fueled and fear driven. Also, this issue has the potential to polarize interest groups, who play a dynamic role in effecting policy changes. These specialized groups attempt to influence policy changes in two major ways: insider strategies, and outsider strategies. Insider strategies appeal to our emotions by providing personal stories and expert testimony to influence legislation. Alternatively, outsider strategies attempt to enlarge the scope of conflict and political discourse. Often, this includes media coverage of the issue which may or may not be accurate and can be easily manipulated by the media outlets (Schnell, 2001).

To influence true change, it is vital for policy makers to strive towards a common goal, and work together to provide solutions to current issues. One of the ways to encourage alliances among policy makers is to merge disagreements into a more common goal (Stone, 2011). Reducing the prevalence of sexual violence is a goal I believe we can all agree on. However, the approach to achieving this goal is the subject of much debate. On one end of the spectrum is the punitive approach to managing this problem, and at the other end we have the treatment and preventative approach. While both methodologies have their merits, it is important to assess their individual feasibility.

 

Background of Sex Offender Treatment

Interest in sex offenders first peaked in 1886 with the release of Psychopathia Sexualis: eine Klinisch-Forensische Studie (Sexual Psychopathy: A Clinical-Forensic Study). This work by Richard von Krafft-Ebing proposed consideration of the mental state of sex criminals in legal judgments of their crimes. During its time, it became the leading textual authority on sexual pathology. Works by Krafft-Ebing depicted all sex offenders as pedophiles and demented strangers. After this work, Freud (1893) and Schrenck-Notzing (1895) published pioneer works in the area on sexual abnormalities (Schwartz, & Cellini, 1995).

In the 1930’s through the 1960’s, the view of sexually deviant behavior was thought to be a product of a mental disorder and that the offenders were too “sick” to be punished. As a result, the sexual psychopath laws were created as alternatives to the criminal justice system. Sex offenders were involuntarily committed to state hospitals for as long as the individual was deemed a threat to society. The purpose was to cure sex offenders in a shorter time than they would serve in prisons, and to protect society against the sex offender population (American Psychiatric Association, 1999).

In 1954, California’s Atascadero State Hospital became the leader in inpatient sex offender treatment, with the primary treatment method being assertion training. The thought that sexual offenders have difficulty relating appropriately to adults led to regression techniques which were believed to meet their sexual needs. This treatment was conducted by psychiatric technicians rather than professionally trained clinicians and did not have a consistent treatment philosophy or protocol.

In 1981, Theodore Frank was released from Atascadero State Hospital. Within three months of his release Fank kidnapped and murdered a two-year-old girl who was playing in her front yard. This crime unleashed a public outcry against the inpatient treatment model for sex offenders, state legislature quickly declared the inpatient treatment model a failure and repealed the sexual psychopath laws. The view that sexual deviance was connected to mental disorder was discredited, and by 1990, all but twelve states had repealed their sexual psychopath laws (California Coalition on Sexual Offending, 2009; Schwartz, & Cellini, 1995).

The 1990’s marked a turn in the management of sex offenders as treatment programs were transferred from hospitals to prisons. Washington became the first state to recognize sex offender treatment as a mental health profession and to begin the certification of sex offender treatment providers. The Association for the Behavioral Treatment of Sexual Abusers, now known as the Association for the Treatment of Sexual Abusers, was formed and became the national organization for sex offender treatment providers around the world (Schwartz, & Cellini, 1995).

Recently treatment for sex offenders has attempted to implement a more holistic approach. These methods utilize a multitude of approaches including; cognitive behavioral therapy, relapse prevention, behavior modification, harm-reduction, and self-regulation (Bumby, 2006).

 

Background of Addictions Treatment

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 8.2% of Americans meet the criteria for a substance use disorder (Bergman, Kelly, Nargiso, & McKowen, 2016).

One of the most prevalent approaches to treating substance use disorders is the Cognitive Behavioral Model. This model encourages mastery over one’s environment and internal experience by identifying triggers and how this influences their internal experiences and external reactions. This method also teaches assertiveness skills, identification, and avoidance of high-risk people, places and situations, with ways to examine positive and negative consequences of continued substance use. Using this model, therapists and clients work together using problem solving and communication skills to identify, construct and implement a treatment intervention plan (Bergman, Kelly, Nargiso, & McKowen, 2016).

An example of a behaviorally based intervention is AA’s 12-step program. This intervention encourages belief in a Higher Power, recognition of helplessness, the importance of sustained motivation with social support, and complete abstinence. These philosophies have been deeply rooted in substance use treatment in the US. However, the 12-step program has been subjected to criticism when compared to other evidence-based practices due to the reliance on internal rather than external motivators.

Opposite the behavioral model is the method of medically assisted treatment. This model attests that substance use is an illness that is largely outside of individual control and should be treated in the same manner as other medical illnesses.  The US Food and Drug Administration has approved several medications to facilitate medically assisted treatment starting with the approval of disulfiram in 1951. Other approved medications include methadone, acamprosate, naltrexone, and buprenorphine. However, medically assisted treatment does not indicate isolation from therapeutic treatment methods. Ideally, medically assisted treatment would be utilized in conjunction with other psychosocial treatments. However, due to its reliance on chemicals, the medically assisted treatment method could be seen as adversative to behavioral and abstinence-based models (Edmond, Aletraris, Paino, & Roman, 2015).

While abstinence is a large proponent of many substance use treatments, lifelong abstinence is not necessary. In one study of alcoholism recovery, it was discovered that three years of abstinence increased the likelihood of a stable recovery. Another study suggested that five years of abstinence from any substance should be standard practice and that after five years of abstinence the risk of relapse is no longer greater than that of the general population. While the precise duration of abstinence from any substance is still a topic of debate, it has been indicated as an essential part of the recovery process (DuPont, 2015).

In the past, there was a significant stigma attached to treatment for substance abusers. More recently this stigma has been reduced, and access to affordable treatment services has increased. Contributions to these changes can be partially attributed to the implementation of multiple health care reforms within the federal, state and private sectors. Examples of this are, the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (Parity Act). These pieces of legislation require health insurers to cover, and health care organizations to provide, prevention, screening, brief interventions and treatment for substance use disorders. Due to the expansion provided by the ACA, an estimated 1.6 million Americans with substance use disorders have gained insurance coverage in Medicaid expansion states (Abraham, et al, 2017).

Together, the Affordable Care Act and the Mental Health Parity and Addiction Equity Act assure that care for substance users has the comparable type, range and duration of services as other medical conditions. Additionally, this legislation mandates that financial burden for patients seeking substance use treatment be comparable to patients seeking treatment for an equivalent physical illness.  Illnesses considered “comparable” to addiction are acquired, chronic illnesses. Equally important, this legislation has mandated accessible care delivery such as treatment available within mainstream health care settings including primary care (DuPont, 2015). Implementation of the ACA and its expansion to substance use disorders is still new, and as such, we are unable to determine how it has impacted long-term changes in substance use treatment.

 

Comparison of Treatment Models

Substance use treatment and sex offender treatment have similar backgrounds in that they both were previously addressed in a punitive manner. More recently, access to substance use treatment has been addressed, and these treatment options have become more affordable with the passage of the ACA. While there are medically assisted options for both substance use and sex offender treatment, this option is deemed more acceptable for substance use than for sex offender treatment. Both models utilize group treatment, however, in the case of sex offender treatment these groups are time limited and follow a strict curriculum. Groups for substance treatment utilize an “open-ended” model which allows for participants to be in different stages of recovery, this allows for better peer accountability. Another significant difference in sex offender and substance use treatment is that sex offender treatment is primarily provided in prison settings whereas community-based options for substance users are readily available.

 

Alternative Treatment Design

Bardach (2011), provides many definitions of “alternatives”, and the definition most appropriate for this paper is “alternative strategies of intervention to solve or mitigate the problem” (p. 16). For this paper, the identified problem is the prevalence of sex offenders and the possible shortcomings of current treatment. Attempts to mitigate this problem include examining possible alternatives to current treatment and designing approaches based on harm reduction.

Studies on the topic of treatment return conflicting reports. In one study, combined cognitive-behavioral treatment and relapse prevention was shown to reduce the recidivism rate by 40% (Losel & Schmucker, 2005). In a comparison study of treated and untreated sex offenders, 10% of the treated offenders were rearrested as compared to 17% of untreated sex offenders (Hanson, Gordon, Harris, Marques, Murphy, Quinsey, & Seto, 2002). However, another study found no difference in the arrest rates of treated sex offenders as opposed to untreated offenders (Marques, Wiederanders, Day, Nelson, & van Ommeren, 2005).

Notably, policy changes rarely take place by constructing a plan from scratch (Clemons, & McBeth, 2009). While there is no easy solution to the problem of sex offender treatment, we can use the positive pieces of current models of substance use and sex offender treatment to construct a more complete approach. A primary issue is the limited access to sex offender treatment. While treatment for substance abuse has recently been addressed as a health issue, sex offender treatment continues to be addressed from a punitive approach. To increase the success of treatment, it is imperative that we increase the accessibility to these services. One way of doing this is mandating that health insurance cover these services in the form of prevention, screening, brief interventions and treatment for sex offenders.

As an alternative to the current treatment model for sex offender treatment, I propose that more funding is allocated for researching alternative treatment models. Currently, data has not indicated that changes occur within these groups and research has not been done to compare this model with other types of treatment (Wakefield & Underwager, 1991).

 

Preliminary Implications

In this day of advanced knowledge and research, it seems alarming that there is such limited research on the effectiveness of treatment for sexual offenders, and that the research conducted yields such mixed results. However, current treatment programs were not developed as clinical trials with control groups and scientifically measurable outcomes. As a result, there are no specific standards used to measure success and failure rendering clinical trials nearly impossible to develop. Another limitation to the development of treatment models is the ability to determine success. One measure of success is relapse rates. While this measure works well for substance users it is more difficult for sexual offenders. For substance users, the ability to measure relapse can be as simple as a drug screen, however with sexual offenders you must rely on complete honesty from the participants. Other measure that is commonly used for sexual offenders is rearrests rates. While this measure can be useful at times, it is hard to determine how many sexual offenders may reoffend without being caught, which is further compounded by the number of sexual assaults that are never reported.

 

Conclusion

While substance use and sexual offending are community health problems that impact multiple individuals and families, there are stark differences in the approaches for treating these populations. On its surface, substance abuse may seem to be harmful to self, while sexual abuse is harm to others. However, this view does not account for the community, family and public health impacts of both these issues. There are many similarities and differences in treatment models for substance use and sexual offender treatment and the political influences impacting regulations for treating both populations. Currently, there are limited studies to illustrate proven success rates for sexual offender treatment, and this is an area that requires more extensive research and development. While there are apparent correlations for treating these two populations including cognitive behavioral therapy and group interventions, there are still significant differences in the accessibility and funding for treatment. To comprehensively address this issue, it is imperative that more attention and funding be allocated for research in this area.

 

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Editor’s Note

 

Many an interdisciplinary researcher will question themselves, and rightly so. Altogether, disciplines are merely puzzle pieces, that when combined, lead to a bigger picture. As suggested by Allen Repko and Rick Szostack in Interdisciplinary Research: Process and Theory, to ignore one or more of the other pieces would make for a fairly haphazard puzzle by denying “the focus [on the particular] problem or issue or intellectual question that each discipline is addressing” (7). In order to construct the larger picture, there are calls for unbiased research. Not surprisingly, interdisciplinary can, at times, be confused with neutrality.

Even if neutrality were attainable, it might not result in good research. As Katrina Griffen believes, “preferences and inclinations can fuel a person’s enthusiasm or provoke attempts to comprehend the facets of the universe” (3). When taking a biased stance toward research, it’s a sort of driver. Understandably, too much bias is bad, but a nugget of bias can be beneficial to research. A certain kind of bias guides passion for knowledge. If everyone were neutral all the time, their dispassion would lead them nowhere.

Perhaps neutral or objective is not a word that should be placed alongside interdisciplinary studies, but rather, an open-mind. The terms might seem similar, but they are different. Neutrality or objectivity is assuming a stance from a distance, and how can anything be learned from a distance? However, keeping an open-mind allows for proximity, while utilizing the nugget of bias necessary for research results. Admitting to and assessing disciplinary and personal bias can help toss out the bulk of it. Yet, Griffen contends that it’s impossible to get rid of bias, and scholars should avoid pretending it’s not there. Not taking all the facts into account is a sort of bias all by itself. It is the mission of Penumbra to encourage transformative ideas and storytelling, which means calling for greater interdisciplinarity of research.

Interestingly, there is a bias towards interdisciplinary scholarship, which as Tom McLeish notes, is often seen as a periphery concern. Scholars should strive to synthesize foundational knowledge with multiple facets, to lead them to a larger and illuminating summation. Indeed, identifying bias allows for richer interdisciplinary conversations, and a niche from which to begin research.

 

  • §

 

This issue of Penumbra includes seven critical articles, two essays, two short stories, and various poems. The work comes to us from scholars in academe and out, established and emerging writers and artist in the U.S. and abroad, individuals using traditional and experimental styles to explore the power of critical and creative expression as it relates to the interdisciplinary approach.

In his essay, “The Power of Poetry: Story, Symbol, and Incantation”, Robert Ratliff examines three elements fueling the healing power of poetry: story, symbol, and incantation by breaking down the meanings of these basics, and shedding light on how poets who possess an understanding of them can use this knowledge in making their own poems more powerful. Similarly, Dr. Dana Kroos’s “How to Find a Blackhole in Your Kitchen” is an all-encompassing series, condensed with emotion and beauty, including photographs of enthralling carvings, with accompanying poetry. “Harry’s Last Trick”, by Dusty McGowan, echoes the epic narrative as shown by Kroos, and places it in short story format. In another deviation on storytelling, Matt Grinder offers his essay, “Discourse on Anxiety: An Analysis of Gilman’s ‘The Yellow Wallpaper’.” His research suggests the rift between men and women has been a social construction that began taking profound roots in the nineteenth century Western conception of what social spheres men and women should occupy, as exemplified in Gilman’s work.

Rollin Jewett’s poem, Junk and Treasure, focuses on the unwanted material possessions, and the true meaning of treasure. Another poem collection by Jose Duarte, is untitled, based on the work of C.S. Lewis to examine imagination and form. Sherri Moyer reviews Magdelana Kubow’s article, “Women in the Church: A Historical Survey”, to assess the arguments made about why women are not ordained in the Roman Catholic Church today.

In keeping with perception and change, Jose Duarte shares his untitled poetry collection based on the work of C.S. Lewis. Next comes a fictional piece from Dr. Matt Weber, who combines science fiction variations and post-apocalyptic themes to underscore the use of weapons in this timely satire of violence and the police.

In conjunction with domestic affairs, Jacinda Lewis proposes new methods for dealing with sex offenders in “Trends in Substance Abuse Treatment and Applications for Sex Offenders.” Likewise, Dr. Kendra Preston Leonard offers political commentary about her year in Syria in her poetry collection, including the piece Highway Drone. More on domestic policy comes from Olatunbosun F. Leigh in “America’s Drug Policies: What Works, What Doesn’t.”

Once again, Robert Ratliff shares his writing, this time in the form of a poignant creative non-fiction, “The Dead Television.” Picking up on the emotional elements of Ratliff’s work, Dr. Sandy Feinstein’s poetry collection boasts strong selections, such as Learning to Write in Two Languages and 40 Martyrs Church.

Danielle Johnson writes of the need to study magical ruralism in “No Place Like Home: Magical Ruralism as Cultural Discourse.”

“Mr. Big Stuff” is the last short story featured in this issue, written by the illustrious Alex Pilas. Likewise, the last poetry collection comes from Michael S. Begnal: Five Homage Poems.

The last critical article underscores philosophy and a need for a post-structural analysis in “Kant We Hegel Our Way Out of This? The Problem of People in Postcolonial Studies” by Charlie Gleek.

Adding greater perspectives is the mission of this journal. Indeed, the above submissions encompasses a myriad of disciplines, such as art, history, literature, education, law, and more.

Overall, by distilling issues among different perspectives, the spectrum of possible solutions and/or theoretical approaches becomes clearer. Additionally, the formalities of methodologies and epistemologies will help to sharpen learning skills, and narrow focus by acknowledging and moving past bias. Part of that focus is what Repko and Szostak term “telescoping down”, which is a “strategy that forces us to think deductively, to move from the general to the particular,” and then later we will understand “how the parts interact, and […] identify gaps between the disciplines.”

As emerging scholars, the ultimate goal should be to see what has not yet been seen, to explore what has been missed.

 

—JONINA ANDERSON-LOPEZ