It is no secret that The United States has a mass incarceration problem. At the end of 2019, the U.S. prison population totaled a staggering 1,430,800 individuals. This number situates the United States as the global leader for incarceration, and the American Civil Liberties Union writes, “Despite making up 5% of the global population, the U.S. has nearly 25% of the world’s prison population.”
What has led to such sobering statistics and a disproportionate number of American citizens behind bars? Mass incarceration in the United States is marked by longer sentencing for minor crimes, over-policing in marginalized communities, and a “war on drugs” initiated by the Nixon administrations’ Drug Policy Alliance.
We still witness these legislative ramifications in the most recent data from the U.S. Department of Justice’s Bureau of Justice Statistics. Again, in 2019, 176,300 incarcerated individuals in state prisons served time for a drug offense, with an additional 73,210 individuals in federal prisons—most of these individuals identified as women in both federal and state cases.
Dr. Kim Sue has dedicated much of her career to highlighting these womens’ stories, researching American social policy for managing national drug use, and illustrating the deleterious impacts of mass incarceration.
Dr. Sue, can you talk about the relevance of addiction medicine for all Americans right now?
We’ve had the deadliest year from addictions to date.100,000 Americans on record have died of overdoses from April 2020 to April 2021. This is a justice issue because many of these people are dying due to a lack of access to evidence-based care and restrictive local, state, and federal health policies. It feels incredibly dire because we haven’t made a dent; we’ve only had more and more deaths every single year for the last five years. These are our patients, family members, friends, and community members.
I think an ideological shift still needs to happen when it comes to addiction medicine. I’ve noticed a sentiment of internalized meritocracy and the idea that addictions are not a disease; they’re about self-control. How do you respond to those rebuttals, Dr. Sue?
You’re right; those are potent sentiments in this country. In fact, we just opened two overdose prevention centers in New York City—the first sanctioned places where people can use drugs under supervision and receive care if they overdose. The comments to the article explaining these centers were ridden with hate, judgment, stigma, and morality.
Many of the responses said addicts belong in prison, and the only way for people “to get clean” was to stop their drug usage immediately. Overall, this reflects deep prohibitionist narratives and beliefs, and we’ve exported these views to the rest of the world as well.
For example, in the Philippines, you can be sentenced to death for using methamphetamines. Lives are at stake because of our attitudes that drug use is a moral failing or merely a matter of individual willpower. Science has revealed that addiction is thought to be 50 percent genetic. It is what I tell my patients: right off the bat, they are dealing with something they can’t necessarily control.
The other 50 percent is how you were raised, what you saw in your family. The trauma you experienced in your life, your access to care, your access to money, being able to meet your basic needs. We have so much work to do.
In addition to the potential stigma from the public, what kind of stigmas exist about drug usage among healthcare professionals? How can we address it?
Even healthcare professionals are acculturated beings. We grew up with D.A.R.E. (Drug Abuse Resistance Education) programs and other antiquated approaches. We must understand that healthcare is a part of a larger cultural milieu, and healthcare is as much about hearts as it is about minds. As an anthropologist, I recently conducted grand rounds to the Michigan Medical Society, and many of the physicians I spoke to asked, “how do we talk to our legislators about this issue?”
There’s an economic argument—these interventions save local and state governments money. Also, it’s a human rights issue supported by urban policy evidence. As health care providers, it is our responsibility to help politicians recognize that we are doing evidence-based work while incorporating a narrative approach because narratives *are* evidence.
A narrative approach seems like a good reason to increasingly integrate social sciences into healthcare, no?
Absolutely. I like to teach trainees to regard hospitals as an “ideal medical environment.” Hospitals have labs and beds; hospitals have food and consistent sanitation. They have medications, and patients have schedules when they take those medications. The hospital environment is optimized for healthcare, yet, when patients walk out of a hospital’s doors, they enter into alternative settings where they can’t consistently enact the same measures they experienced. Sometimes patients have no place to sleep, no one to change their dressings if they have open wounds, no place to store or refrigerate their medications. Our patients only spend a fraction of their lives within hospitals, so we must reenvision their healthcare within the boundaries of their lived experience. That’s where a deep understanding of social sciences comes in.
Dr. Sue, what is the last thought you want to share with healthcare professionals who hold the same interest in revolutionizing our carceral system and treating drug usage?
I want other health care providers to get comfortable with humility. I want them to dedicate themselves to being continuous learners. It’s easy to feel shame; I recognize I’ve made errors, that my language isn’t always perfect, and I am still learning, but this challenge doesn’t dissuade me. Consistently reframing our views is important in this work, and I want to constantly be called in by my patients or trainees about my attitudes and behaviors in order to become a better clinician and human being.
Learn more about Dr. Kimberly Sue’s work:
