The furry Freakonomics brothers report on a Washington State proposal to mandate fluorescent yellow license plates for a year for those convicted of DUI offenses. (Ohio, readers report, already has such a system in place.) The argument is that it would alert traffic enforcement officials to the need for closer scrutiny and warn other drivers. The preponderance of responding readers think it is a bad idea. Some object to “scarlet letter” public shaming as an ineffective deterrent, others argue that family members driving the tagged vehicle should not be inconvenienced or humiliated, or that the offender can just refrain from registering a vehicle in her/his name. What about vehicles the offender rents or drives at work? License plates do not go with individuals, they go with vehicles, so why not tattoo the offender instead? Or, as one reader facetiously (I hope) suggests, put them to death or keep them preventively detained? Readers bridle at continuing to exact a penalty from an offender who has already “paid their debt to society”, to put it in clichéd terms. Parallels in this regard are drawn to the sex offender registry system, which some readers feel also exacts continued punishment, humiliation or at least inconvenience after a penal sentence has been served.

I must say that I am mixed on this issue. We are obviously headed down a very slippery slope here — one we are already way down. But, as threats to public safety go, driving under the influence and sexual offenses against minors are viewed as some of the most dramatic ways to harm or kill innocents in our society. They are, in particular, seen as moral failures, abnegations of personal responsibility and the social contract. To varying extents, these behaviors are targets of public frustration over the “I-can’t-help-myself” application of a disease model to behavior. Related to this is the compulsive quality of both behaviors. It is considered likely that, once having offended, one is likely to re-offend, which fans the flames of demand for preventive measures after punitive ones have ended. If these behaviors arise from medical conditions rather than moral failings, frustration arises at the evident failure of treatment or rehab approaches.

I am certainty discouraged about the minimal success rate and dramatic recidivism I see as someone who frequently treats alcohol dependence and abuse (although rarely sexual predation) in my hospital practice. It is an area of practice in which I have the greatest degree of difficulty with the disease model, especially with offenses committed under the influence of alcohol. FmH readers know of my objections to the medicalization of behavior, especially as it pertains to legal defenses in criminal cases. But in mental health practice it is also a struggle to keep moralistic judgments out of our work with our patients.

Because treatment works so rarely and because the public safety implications are so great, I think prevention must be the main goal of our interventions, and I do think the state is the proper instrument for this. Any objections I have about the yellow license plate approach are practical, not moralistic.

What do readers think?