Statement on Drug Decriminalization

California Association of Marriage and Family Therapists
February 25, 2022

The California Association of Marriage and Family Therapists (CAMFT) recognizes that substance use is a public health issue. The criminalization of drugs hurts families and communities who would greatly benefit from access to trauma-informed mental health and addiction treatment, family support services, and community reinvestment, but instead face over- policing, arrest, incarceration, and a host of sanctions and collateral consequences. Drug decriminalization would make drug possession a possible civil offense, like jaywalking, instead of a criminal offense. CAMFT believes that decriminalization will make it easier for people to get connected to the services they want and need, rather than subject them to the harsh and traumatizing effects of our criminal justice system.

While 15 percent of Californians—people of all races, ethnicities, genders, and age groups—used an illicit drug in the past month, we know that the legal consequences of using drugs were not experienced equally (Substance Abuse and Mental Health Services Administration, 2020). Black Californians continue to bear the brunt of the war on drugs in the state and are arrested for drug charges at significantly higher rates than White Californians (Mooney et al., 2018). And whether or not drug arrests result in incarceration, the lasting effects of drug charges can haunt people for life (McGinnis, 2018). They can impact a person’s ability to pass background checks for jobs, housing, and other opportunities; lead to challenges with child custody; contribute to deportation and family separation; result in the loss of public benefits; and so much more (Drug Policy Alliance, 2021). As many marriage and family therapists and other health providers have witnessed with their clients, these consequences can be deeply disruptive and harmful to families, relationships, and communities. Families need stable housing and a source of income to flourish. They also need freedom from the fear that they will lose a loved one to the criminal legal system. People who use drugs problematically need support and services, not sanctions.

We at CAMFT also know that people who develop substance use disorders often have a history of traumatic and adverse childhood experiences that have led them to self-medicate through substance use (Zarse et al., 2019). The current criminal justice system is set up to arrest people with these histories and further traumatize them through punishment, instead of making it easier for them to seek help and get support for their problems. Drug decriminalization would change how we approach people who use substances by removing all criminal penalties for possessing small amounts of drugs that are currently illegal and by providing them with an opportunity to be referred to case management, social services, treatment, medical care, housing, and so much more. When decriminalization makes these services readily accessible and on- demand, people can choose to pursue them voluntarily, eliminating our current system of mandated or coerced treatment under the guise of “alternatives to incarceration.” This public health approach also creates avenues for people who use drugs to heal themselves, their families, and their communities.

Drug decriminalization would help to justify the reallocation of funding to this new public health approach by shifting resources away from law enforcement and punishment and toward more compassionate interventions. We have seen time and time again that when law enforcement serves as the first point of contact for people struggling with substance use and/or mental health issues the result is often unsuccessful and even tragic. Several recent high-profile cases illustrate how the criminalization of drug possession, with law enforcement as first point of contact, has led to unwarranted lethal engagement, particularly for Black people and other people of color. From Ramarley Graham, killed in his grandmother’s home for possessing marijuana, to Breonna Taylor, killed in her own home as police recklessly executed a no-knock warrant in a drug case, drug criminalization is deadly.

Money spent on treatment and services is a better investment in our families and communities than money spent to punish people who need help. Incarceration is costly to taxpayers and to communities, and people often leave jail or prison more traumatized and less healthy than when they first arrived, requiring more services after they leave than if they had been able to remain in the community. Providing beneficial treatment services and avoiding the high costs of incarceration can save our communities money while also avoiding the mental, emotional, and physical costs of criminal punishment.

The criminalization of drug use also serves to perpetuate stigma, deterring people who use drugs from seeking help (Radcliffe & Stevens, 2008). In particular, parents may be afraid to report their substance use in marriage or family treatment for fear that they could lose child custody or that the child could be removed from their home. If drugs are decriminalized, people may feel less stigmatized and less afraid so that they may be more willing to self-disclose use and pursue treatment. Portugal decriminalized all drugs in 2001 and found that the shift to a public health approach actually led to increased treatment enrollment because there was less stigma attached to seeking help and a more positive environment for social reintegration (Slade, 2021; Hughes & Stevens, 2010).

Drug criminalization has also made it impossible for mental health providers to provide clients with a full menu of potential treatment approaches that would address their trauma, depression, and anxiety, by excluding promising psychedelics such as psilocybin, LSD, and MDMA (Barone et al., 2019; Muttoni et al., 2019). Decriminalization would make it easier for researchers to conduct studies on the efficacy of these drugs, which may create a pathway for providers to find innovative ways to work with clients who want to use them as part of their care.

There are several ethical considerations for marriage and family therapists and other mental health providers to recognize their own biases regarding substance use:

• Develop self-awareness about one’s own biases, preconceptions, stereotypes, and prejudices surrounding substance use and criminal involvement that may impact therapeutic relationships with clients and family members. Therapists should reflect upon how these issues may impact clients’ ability to self-report substance use and/or criminal records and to openly discuss their concerns in therapy.
• Develop knowledge of how the criminal legal system enforces drug laws in ways that discriminate against BIPOC communities, low-income communities, and other marginalized groups. Be sensitive to the fact that communities that have frequent contact with the criminal legal system may be suspicious of, untrusting of, and traumatized by these systems and thus reluctant to engage with these systems even when victims of crime.
• Become familiar with the systemic and structural challenges faced by people with criminal records as well as the collateral consequences that may negatively impact clients and families, such as experiencing inordinate difficulties in securing employment, housing, U.S. citizenship, and other resources and public benefits.

Below are some resources for clinicians to educate themselves to help ensure they are moving toward responsiveness and greater awareness of the mental health impacts of criminalization:

• Uprooting the Drug War: 
• Drug Policy Alliance Decriminalization Exchange: 
• Movement for Family Power report “Whatever they do, I’m her comfort, I’m her protector”: How the foster system has become ground zero for the US drug war:
• National Advocates for Pregnant Women, Birth Rights: A resource for everyday people to defend human rights during labor and birth:
• National Inventory of Collateral Consequences of Conviction: 

This statement was created in collaboration with Drug Policy Alliance (DPA) for publication at www.camft.org. Individual contributors to the development of this statement include:

• Jules Netherland, Managing Director of the Department of Research and Academic Engagement, Drug Policy Alliance;
• Sheila Vakharia, Deputy Director of the Department of Research and Academic Engagement, Drug Policy Alliance;
• Holly Daniels, Managing Director of Clinical Affairs, CAMFT; and
• Robin Andersen, Juan Gavidia, Ronald Mah, and Lisa Romain, CAMFT Social Policy Task Force.

Any correspondence or inquiries regarding CAMFT Social Policy Statements should be addressed to communications@camft.org.

The CAMFT Board of Directors has prioritized the publishing of Social Policy Statements to raise understanding and awareness about the impact of social and systemic issues on mental health and well-being, and to emphasize the importance of culturally responsive training for mental health clinicians.

CAMFT develops these positions and responds to social issues relevant to the practice of psychotherapy, mental health policy, and social concerns impacting the mental health of individuals, families, and communities in California in order to guide the profession, amplify the voices of marriage and family therapists, educate the public, and influence decision makers.

CAMFT is aware that social justice issues are dynamic developmental processes responsive to evolving social, political, economic, and other world circumstances, as well as clinical, ethical, and legal considerations. This statement is both a commitment on the part of CAMFT to address these issues and intended to provoke discourse and evolution in recognition of the realities of members of all communities.

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References

Barone, W., Beck, J., Mitsunaga-Whitten, M., & Perl, P. (2019). Perceived benefits of MDMA- assisted psychotherapy beyond symptom reduction: Qualitative follow-up study of a clinical trial for individuals with treatment-resistant PTSD. Journal of Psychoactive Drugs, 51(2), 199–208. 
Drug Policy Alliance. (2021). Uprooting the drug war 6-part report series.

Hughes, C. E., & Stevens, A. (2010). What can we learn from the Portuguese decriminalisation of illicit drugs? British Journal of Criminology, 50(6), 999–1022.

McGinnis, B. L. (2018). Beyond disenfranchisement: Collateral consequences and equal citizenship. Politics, Groups, and Identities, 6(1), 59–76. 
Mooney, A. C., Giannella, E., Glymour, M. M., Neilands, T. B., Morris, M. D., Tulsky, J., & Sudhinaraset, M. (2018). Racial/ethnic disparities in arrests for drug possession after California Proposition 47, 2011–2016. American Journal of Public Health, 108(8), 987–993. 
Muttoni, S., Ardissino, M., & John, C. (2019). Classical psychedelics for the treatment of depression and anxiety: A systematic review. Journal of Affective Disorders, 258, 11–24. 
Radcliffe, P., & Stevens, A. (2008). Are drug treatment services only for “thieving junkie scumbags”? Drug users and the management of stigmatised identities. Social Science & Medicine, 67(7), 1065–1073.
Slade, H. (2021). Drug decriminalisation in Portugal: Setting the record straight. May 13, 2021. Transform Drug Policy Foundation. 

Substance Abuse and Mental Health Services Administration (2020). 2018-2019 National survey on drug use and health: Model-based prevalence estimates (50 states and the District of Columbia). 
Zarse, E. M., Neff, M. R., Yoder, R., Hulvershorn, L., Chambers, J. E., & Chambers, R. A. (2019). The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases. Cogent Medicine, 6(1), 1581447..