Saturday, March 21, 2009

Neuroscience, Treatment, and Drug Courts

After the morning panels, it seemed that reforming our sentencing scheme was almost as impossible as being in three places at once, which is why I was only able to attend one of the concurrent panels on alternative sentencing. Dr. Emily Murphy, a behavioral neuroscientist working at Stanford, provided us with some fascinating information on the potential of neuroscience in rehabilitation in general, and in drug addiction situations in particular.

One of the problems with the emerging trend of neurolaw, which is otherwise a fascinating and promising field, is the tendency of some professionals to aggrandize its promise and advocate it as a cure-all, magic bullet for social ills. Murphy strongly advised against such simplistic perspectives, and her talk was an excellent example of nuanced, intelligent, sane discourse on the promise and limitations of science. Having briefly examined California's history with brain-altering therapies, in particular the controversial UCLA Violence Project of the 1970s, Murphy turned to dicussing three avenues in which neuroscience could be helpful in criminal justice enterprises.

The first of these, prediction, focuses on the ability to foresee who might recidivate or benefit from a certain kind of treatment. This is a goal we are, at this point in time, far from achieving; there is no such thing as a single "crime spot" or a "violence spot" in the brain we can identify. One thing some scientists have done is focus on the category of psychopathy; psychopaths, sophisticated and manipulative, are highly overrepresented in the incarcerated population. Current diagnostic tools are not very helpful for screening purposes, since they consist of lengthy interviews by extensively trained people; however, Dr. Kent Kiehl has done some research on this on New Mexico inmates using a portable MRI scanner and is optimistic about its predictive potential.* Another issue is the possibility of predicting dangerousness. The Macarthur foundation has devleoped some multifactorial quantitative measures which, albeit imperfect, might have some predictive value. The key would be to obtain brain mapping, follow up on the inmates after their release from prison to see recidivism patterns, and then use the correlation to offer predictions. It should be remembered, however, that typical analysis of MRI relies heavily on statistical correlations, rather than on identifying a single spot on the brain, and therefore cannot be dispositive. It is also quite difficult to predict whether a certain type of treatment would be suitable for a certain offender; pharmacological treatment is akin to a sledgehammer in that it impacts the entire brain, and therefore often has complicated side effects.

Some treatment options are also being explored. In drug addiction cases, this mostly consists of substitution (replacement of the drug with another drug) and/or direct antagonism (drugs which suppress the craving by creating adverse consequences). Going through the existing substitutes - the well-known methadone and several others - was fascinating; naturally, treatment efficacy is seriously impacted by compliance. Also, some of the antagonizing drugs produce other bad reactions that might, ironically, exacerbate drug use.

Some more extreme treatment measures include psychosurgery and brain stimulation, which share an ugly, frightening history. However, brain stimulation has been found to be effective for treating Parkinson's disease, and may also be valuable for various addictive conditions. The problem is finding dependable studies, based on ethical research, and published in reputable journals, that would confirm the efficacy of treatment.

The mixed results of treatment led Murphy to advocate a research focus on prevention. Several avenues were explored, such as the possibility of vaccination against addiction (which raises compliance issues) and the potential for actual erasure of drug-related memories, thus eliminating the positive associations to drug use. The problem is, as some audience members pointed out, that drug use becomes such a pervasive aspect of a person's whole life, that a great many things and situations may be associations.

Murphy closed her talk by emphasizing the fact that neuroscience cannot be, in itself, a magic answer to drug prevention, and that holistic, environmental factors should also be taken into account. The perfect environment for considering all these factors is a drug court, which could create the sort of support system that would enhance the efficacy of any treatment chosen. She also reminded us of the need to be subtle and sophisticated about raising ethical questions - not accepting things at face value, but also not ruling them out with a knee-jerk reaction.

* props to Nadja Habinek for the link.

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