I have had a lot of trouble with the idea of criminalization of drug addiction for a very long time.

I am only one of a lot of folks who say “addiction is a real disease.” People feel every bit as sick as people with other diseases, sometimes more.

The patients are certainly able to die every bit as dead.

Someone told me that the first correctional facility I worked at had the best “rock orchestra” of any such facility, because of a large number of incarcerated rock musicians. I was told they were almost always there on drug charges.

Not that I ever actually heard anyone perform during my treks across the prison yard to see folks.

I suspected that jail presence might have been a “rite of passage” for those guys, but I never really knew them, for they rarely seemed to become psychiatric patients.

Later, as I got to know the prison population better and better, I felt that their trials and tribulations were probably no less than anybody else’s.

Everybody in prison seemed to have a life full of psychosocial conflicts. Families were split up, relatives were on the streets now that everyone was missing a primary wage-earner, even a subsistence (or illegal, read drug-dealing) one.

Then I read this article about babies born to mothers who are addicts.

Ooh, America, we got a problem.

Drug addicted pregnant women are a real problem.

Me, I had problems with the part that talked about politicians having problems and insurance companies having problems.

First, let’s deal with politicians. Criminalizing a problem does not necessarily lead to resolution of the problem, and might lead to making it worse. All it does is make the voters feel like you are “doing something” about the problem.

There were some substance abuse counseling or support groups behind bars. Back then, when I worked such places, groups were generally led by visiting Quakers, who seemed to do a very good job. I certainly, however, cannot recall ever having heard a word about them being in any way compulsory.

The only “core” treatment that I can be sure every patient/inmate received at that California state facility was an attempt at “forced abstinence.”

Notice that I said “attempt.”

I have been a doctor long enough to be able to name a whole lot of substances. But I cannot name a single substance that is available on God’s green earth that could not be obtained within the walls of one of those prisons.

Inmates passed (very against prison rules) messages from cell to cell by pulling envelopes along the floor with strings, between the bars. There was some foul concoction imbibed named “pruno,” because of its brownish color. I never saw it, but was told by many, staff and inmates alike, that it contained a mixture of prescription drugs.

As for pills that required a prescription, the same infrastructure that circulated “pruno” organized getting such things through conjugal visits. Often the wife of a prisoner would get prescribed the desired controlled substance, come in for a conjugal visit, leave the bottle where someone on, for example — cleaning detail, would pick it up, and the “network” would deliver.

I never worked a woman’s prison, but I am a firm believer they are as smart as men. Woman who seek drugs could be counted upon to do something analogous if they were incarcerated in great numbers.

The same article mentions managed companies having targeted this situation as a cost issue. Of course, this is a totally wrong way to make any kind of decision. Still, in these insanely materialistic times, noting the excessive cost of something just might be one of the most powerful ways to make it stop happening, or at least, making it happen less. I mean, if this is a factor in helping more babies get born healthy, then the excessive cost can be discussed with my blessing.

Has anyone thought of the increased costs to states (or whatever level of the system is relevant to this problem) incarcerating more people? The cost of high-risk women giving birth in jail? What are they going to do — put high risk neonatal intensive care units in prison?

I remember, when I worked state prisons, the very serious budgetary problems of getting a neurologist to come on site and see patients once a week. Has anybody thought about how much it would cost to get neonatal specialists as well as any special permits required to bring new babies through neonatal withdrawal syndrome?

My main worry is, and always will be, with the notion of human costs. My guess is that people haven’t really looked closely at the psychosocial context, or even the level of medical care, associated with this problem.

Looking more closely at the drug addicted pregnant women, most of the rise in the numbers of women so afflicted is attributed to an addiction to prescription drugs. Everybody wants to treat the mamas before they get pregnant, but this is obviously not happening now.

Human costs.

It is important to realize that some states seem to have already made the decision to think criminally or politically about this matter.

These folks seem to have a serious handle on what is going on.

Nobody is talking about making any specific changes to the system that would make women more likely to seek help.

As a matter of fact, the only change I am hearing about might be criminalization, which may actually make women scared to get help.


I have never, repeat never, known a woman who wanted to be a drug addict, knowing she would expose her unborn child to great risk. I have heard nothing but stories of unplanned pregnancies, things that just “happened.”

To their credit, ABC News not only picked up on the Tennessee story about two years ago, but also tells the personal (and highly typical) story of one of the women in question.

There are a lot of substance abusers, like her, who have been brought up by substance abusers and who seem to me to be sincere about wanting to escape that destiny with their own children.

“We must save the children!” is something I can hear the socially conscious shouting even now.

In general, medically, there is little as fragile as those who are at either end of life. Both the very young and the very old are weaker in their abilities to fight off disease than those “temporarily able bodied” (to steal a phrase from a Canadian parliamentary lobbyist for the handicapped I knew many moons ago) in the robust years of their lives.

The use of structured scales represents a significant advance in a sector where especially heavy nursing costs mean that the especially skilled caretakers required are stretched beyond all imagination.

One of the problems seems to be the extreme variability of this syndrome. It differs with the type of drug to which the woman has been exposed, how long since last use; really, a myriad of things. Moreover, many signs, like failure to feed appropriately, can have a large number of different causes.

Add to this the fact that shame is so rampant that a lot of these mommies are not exactly going to come forward with the lurid details of drug abuse, and the situation becomes difficult. On top of that, presentations of this illness are so variable — from pretty much totally benign to seriously life threatening — that some intensive professional neonatologist intervention will probably be necessary on a fairly regular basis.

And the poor dear nurses? I don’t suppose they need more tiny patients who require, as is often suggested, “calming,” which seems to be accomplished by getting wrapped in swaddling clothes, cuddled, and placed in the dark.

Although I absolutely do not have a drug problem, I will certify that similar interventions, administered by my husband, seem to work for me.

Lots of people try drugs. I mean more than even I can imagine. Several have told me that they get bored with the whole thing pretty quickly, and move on. I ask about it in the office and they shrug their shoulders and we move on to talking about something else.

Others tell me they are hooked after the first bite or taste or injection. The solidest clue, I think, of this kind of danger is the family history. There is a bunch of evidence that something in the chromosomes facilitates addiction.

But people ought really not to risk a clinical trial on this one.

I think we have a need for more than a “Just Say No.”

How about, “Just Run Like Crazy.”

Me, I guess I was never much of a sucker for peer pressure. I have been called a “wimp” and things of that ilk.

I really did run like crazy once when I was at a fairly chic party and smelled something most curious and discovered that the chicken (which I was supposed to eat) was cooked in unknown substances, including hashish oil (illegal where and when this happened).

As for doctors, you don’t have to tell me that they give out prescriptions for controlled-substance painkillers easily, for I know this to be true.

Sometimes they are so overwhelmed, that they do not have time to do much else.

There are a million other things that work.

Ask about them.

Author's Bio: 

Estelle Toby Goldstein, MD is a board-certified psychiatrist in private practice in San Diego, CA.

Practicing Medicine Since 1981

In her medical career, she has studied in Europe and Canada as well as the USA. She has attended specialty training beyond medical school in the fields of general surgery, neurology and neurosurgery and psychiatry (specializing in psychopharmacology).

Experienced In Many Situations

She has worked in a variety of positions, including:

Medical school professor
General and Orthopedic surgeon
Brain surgeon
Army Medical Corps psychiatrist
Prison psychiatrist
Community Mental Health Center staff
Consultant to a major transplant hospital
Drug researcher
“Whatever It Takes!”

She currently has her own indepenent clinic in San Diego where she is concentrating on what she calls Mind/Body medicine — or Integrative Medicine. Her practice is cash-only, doesn’t accept insurance or government payments, and she operates on the concierge, or “private doctor” practice model to give her patients the absolute best quality of care and the highest level of confidentiality.

Dr. Goldstein’s philosophy is “Whatever It Takes!” Her goal is to do everything possible to solve whatever problem she is presented. This includes seeing patients as quickly as possible — not making them wait weeks for an appointment. This includes making appointments days, nights, weekends or holidays. This includes making house-calls. And it includes using the best, most innovative treatments available — most of which are unknown to standard, mainstream doctors.

Her focus is on transitioning patients away from prescription drugs and onto natural substances. She is also a master practitioner of Emotional Freedom Technique, a powerful and dynamic form of energy psychology that usually brings quicker results than traditional psychotherapy.

The Expert’s Expert

She has written an advice column in a daily newspaper and hosted a weekly call-in radio show, and now is enjoying the freedom of speaking her mind on this blog.