The data is clear – Substance use is one of the most prevalent mental health issues in justice-involved individuals. According to the Bureau of Justice Statistics, over half of state prisoners meet the criteria for substance dependence or abuse. Every defense attorney and prosecutor will encounter defendants where substance use is central to understanding the events leading to the case.
The presence of psychoactive substances of abuse can shape nearly every stage of a case. For defendants, substance use may contribute to the behaviors that led to their arrest, and it often affects their decision-making capacity, impulse control, and judgment. For courts and prosecutors, this creates a challenge: balancing accountability for criminal conduct with recognition that untreated substance use disorder, colloquially often referred to as addiction, is a medical condition requiring intervention.
Most people who use addictive substances do not become addicted to them. But there are some notable exceptions. Research consistently shows that individuals exposed to trauma are far more likely to progress from substance use to the development of a substance use disorder, which are often colloquially referred to as addiction. A national epidemiological survey found that people with post-traumatic stress disorder (PTSD) are up to four times more likely to meet criteria for substance dependence or abuse compared to the general population. And Adults with any history of Adverse Childhood Experiences (ACEs) have a 4.3 fold higher likelihood of developing a substance use disorder.
Unfortunately, many accused individuals face harsher outcomes precisely because their substance use, and its drivers, are misunderstood or underappreciated. Without proper evaluation, a defendant’s addiction history may be seen only as a character flaw, rather than a diagnosable and treatable illness or an outward manifestation of unresolved trauma. This gap can lead to missed opportunities for diversion programs, mitigation at sentencing, or treatment options while incarcerated or under court supervision that could change the trajectory of a person’s life.
An exploration and understanding of the substance use, trauma, and criminal justice interplay is essential for any criminal case substance use is an issue. With our holistic approach to evaluation, Lorio Forensics clinicians are primed to appropriately evaluate for these factors. Additionally, our team features two psychiatrists who are boarded in addiction psychiatry: Michelle Durham, MD (Texas based) and Billina Shaw, MD (Maryland based). They have additional training and have successfully completed a national board exam demonstrating their knowledge in deciphering the complex relationship between substances, trauma, and observed behaviors.
Dr. Billina Shaw, MD
Dr. Michelle Durham, MD
Attorneys who leverage this expertise are better positioned to advocate effectively—whether that means supporting effective accountability measures or ensuring treatment is prioritized when appropriate. As the criminal justice system continues to grapple with the pervasive role of addiction, high-quality forensic evaluations become increasingly essential. Lorio Forensics offers demonstrable, highly-relevant expertise through a comprehensive evaluation and consultation process.
