

By Maia Szalavitz 01/06/14


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What’s a disease and what’s an excuse for bad behavior? These two questions are at the heart of virtually all debate over addiction and drug policy—and the Texas “affluenza” case may help shed new light on them.

After stealing beer, getting drunk enough to reach three times the legal limit, injuring nine people—and killing four in a gruesome crash—16-year-old Ethan Couch was sentenced to just 10 years of probation and treatment. No prison time. He will spend just a year at a California program for troubled teens (which charges $450,000 annually). Not surprisingly, the sentence has provoked widespread outrage.

But it wasn’t a “my disease of alcoholism/addiction made me do it” defense that got the Texas teen off so lightly. Instead, his attorney argued that the boy had “affluenza,” which the defense psychologist described as a disease of the rich that makes them unable to understand the consequences of their behavior. Unlike substance use disorders, however, affluenza is nowhere to be found in the DSM.

In court, the psychologist testified that Couch, “never learned that sometimes you don’t get your way. He had the cars and he had the money. He had freedoms that no young man would be able to handle.” He gave the example of how the boy had been allowed to drive at 13—and had received no punishment at 15 when police caught him in a car with an unconscious and undressed 14-year-old girl.

In other words, because Couch never learned that there are consequences to his actions, he should learn again that there are none—and that money can always buy an easier, softer way. In case it wasn’t already obvious that Couch received special treatment because of his privilege, reporters soon uncovered a case of a poor black teen who committed a much less severe crime and was given 10 years in juvenile prison by the same judge.

Unequal treatment in the justice system is an old story, of course. The difference here is the blatant use of privilege itself to justify more privilege and the idea that wealth itself can produce antisocial behavior. But by unpacking what would lead to a more just outcome in such cases, we can help clarify better ways of understanding the effects of early childhood experience and addiction on criminal responsibility.

While “affluenza” is obviously not a real disease, emotional neglect of children can occur in any class and can absolutely have lifelong effects on behavior. Failing to discipline a child is one form of emotional neglect. This may be more common for both the poor and the rich because in both cases, circumstances often mean that (for very different reasons) parents and children spend little time together.

In Born for Love: Why Empathy Is Essential—and Endangered, which I co-wrote with child psychiatrist Bruce Perry, we described the case of another rich Texas teen who committed a horrifying crime and wanted an expert witness to use mental illness to help justify his antisocial behavior.

“Ryan” (a pseudonym) raped and publicly sexually humiliated a developmentally disabled girl at a party to celebrate his admission to an Ivy League college. Like Couch, he’d previously avoided discipline for numerous antisocial acts. His parents contacted Dr. Perry in hopes of enlisting him as a defense expert.  

Perry did find that the boy had a history of serious neglect. It turned out that his parents only spent an hour a day with him and that he’d had 18 nannies before finishing preschool, each one fired when his mother discovered that the baby preferred the nanny to herself. Such disrupted attachment has been associated clinically with antisocial behavior and seemed to be appropriate here, given that, from the child’s perspective, he’d basically lost every “mother” he had as soon as he connected with her.

Nonetheless, Perry did not agree to testify or to call the related bad behavior a disease. Instead, citing the majority of cases where children - rich or poor - who suffered similar neglect have managed to avoid committing heinous crimes, he found that Ryan was responsible for his own choices. Still, my co-author had little doubt that the emotional neglect he suffered, and the cultural context in which it happened, significantly skewed his moral compass, which is why we included the case in our book.


Like other types of childhood trauma, neglect increases risk for alcoholism and other addictions, which can even further impair decision making. It’s unlikely that either of these two crimes would have occurred absent the disinhibiting effects of alcohol. Even so, alcohol misuse was also clearly not the only source of the problem in either case. Poor parenting is also implicated, as is social status.

Elevated social status—in both human and nonhuman primates—is linked with both reduced punishment for aggression and, according to a spate of recent research into the behavior and attitudes of those with wealth and power, to increased propensity towards cheating and reduced empathy.

While it is easy to argue that wealth and privileged attitudes should not be a sentence-mitigating factor in these kinds of cases—and possibly could be seen as aggravating—it’s far more difficult to dismiss emotional neglect and addictions as relevant factors.

That doesn’t mean literally letting people get away with murder. Mitigation should determine the level of intent and not preclude punishment. The problem here is that debates over whether addicts should receive “treatment not punishment” often elide both victimless crimes such as drug possession and those like Couch’s in which intoxication results in harm to uninvolved bystanders.

(Is intent important here? Couch presumably had no desire to hurt his victims, while "Ryan" wanted to use his as a way to demonstrate his social power. However, Couch wasn’t simply reckless while intoxicated and lacking agency: he chose to steal the beer that got him drunk, and unlike a poor teen with an alcohol problem, presumably had numerous other ways of obtaining the substance.)

Most of us accept that crimes such as Couch’s and Ryan’s require justice for the victims, in a way that crimes that only harm oneself do not. Society, we believe, should punish those who, even unintentionally, harm others while under the influence of alcohol or other drugs or while in the state of being addicted, in part because these alterations of consciousness only impair, not eliminate, the ability to make decisions.

Addicts do not shoot up in front of the police; drunk drivers try to evade detection. These facts show that moral agency is present, if not functioning well.

My own view is that addiction should be treated in order to reduce the odds of recidivism – and that treatment isn’t a substitute for paying one’s debt to society and to those who are harmed by criminal behavior.

Most addicts actually do not commit violent crimes, and some even commit no crimes other than those related to the legal status of their substance of choice. It’s clear, therefore, that addiction itself doesn’t necessarily cause antisocial behavior. Unfortunately, since many of the same factors that lead to addiction— child abuse, neglect, family violence, other trauma—can also create antisocial behavior, those actions are often conveniently blamed on the drugs.

Disentangling the various aggravating and mitigating factors is hard—and humans clearly have both an evolutionary and a cultural bias towards excusing the rich, even as the data suggests that the early childhood experiences of the poor, and the lack of alternatives available to them, are far more likely to be harmful and to constrain true free choice.

Like it or not, disentangling these realities is the job of the criminal justice system. That system would work a lot better if we carefully considered three factors: our bias towards punishing the poor more harshly; the question of how drugs, addiction and childhood experience alter decision-making capacity; and what mix of legal consequences produces the best outcomes.

The “affluenza” case may be a clear travesty of justice, and yet one can easily imagine an overly harsh sentence that would be just as absurd. If we want to prevent similar crimes —or deal with them appropriately if they do occur—disentangling intoxication, addiction, early childhood influences, intent and developmental capacity is critical.

We won’t succeed with made up disorders like “affluenza”—or by making addiction an all-purpose excuse.


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