There's some debate about what should happen. Given his history, should Hamilton be treated as a multiple-time offender? Since he has previously reformed his life and was upfront about this latest episode, should he be treated as a first-time offender? Should he be banned for a year? A month? Not at all?  Let me make a suggestion. Maybe we're asking the wrong question. Every once in a while, I like to put on my "other" hat. I'm probably one of the few members (the only?) of the baseball media -- and I'm only sorta a member of the baseball media -- who also has experience as a mental health worker. (I hold a Ph.D. in clinical psychology, although I am no longer practicing nor do I hold a license now, by my own choice.) And right now, I think we need to talk about Mr. Hamilton, substance abuse, and how baseball even approaches the subject.  Let me start off with a better question. What actions can Major League Baseball take to help Josh Hamilton overcome his problems with substance use? If you start from there, which I would argue is the more humane approach, then the list of things to do looks a little different. Let's start from the position that Josh Hamilton is an actual human being who needs help rather than some sort of avatar for a broader cultural issue.  I don't know how many players in baseball have a substance use problem, but I can at least draw a few reasonable conclusions. The National Study of Drug Use and Health is a Federal study on the drug use habits of people in the United States. In 2013 (most recently available data), they estimated that roughly 8 percent of adults had a diagnosable substance use problem that would require treatment, but that only a small handful of those people were receiving treatment. Even among the 12-17 age group, that number is roughly 5 percent (and jumps to around 10 percent for the age group 18-25). Even if you restrict the percentage to those with a "hard" drug problem, the numbers come in around 2 percent. Now, it's not likely that the rate of substance use problems is that high among MLB players (or minor leaguers), because someone with a serious substance use problem isn't likely to be able to maintain elite athletic performance. But it means that there are probably guys out there, and that they have come into baseball with a substance use problem that started in high school.  Prolonged substance abuse physically changes the structure of the brain. It isn't that the drug goes in and starts whacking neurons. In fact, most of what illicit drugs do is to turn on the dopamine pumps in the pleasure center of the brain. But the brain is a very delicate environment. When it sees that there is that much dopamine floating around, it pulls back some of the receptors that the dopamine binds to. That's why it takes more of a drug to get the same high. There are fewer receptors, which means you need more dopamine around to activate them more quickly. It becomes a nasty cycle. Those receptors come back very slowly. In the meantime, when someone is abstinent from the drug, it means that there aren't a lot of dopamine receptors around to feel happy about normal things in life. That's something else that someone in recovery has to deal with.  I wouldn't wish substance addiction on my worst enemy. It's awful. Even in the recovery stage where someone has been abstinent for a long time, it's rough. Imagine that you are told that the only way that you are going to stay alive is that you have to leave your hometown, go to another place entirely and begin a new life from scratch. You have to build up your entire sense of identity there, and worse, you can never ever go back to the old hometown and visit, even though it would be easy to get there. It's kinda like being in witness protection. Some people do build their lives back up and that deserves some major congratulations, but understand thatâs what Mr. Hamilton and others like him are up against. Before you point fingers, ask yourself if you could do the same.  I realize that there's a conversation about how any substance user got to this point and whether there's a moral component to whether "he shouldn't have done it in the first place." Maybe. I find that whole conversation rather fruitless. He's here. If we're lucky, he wants help. Seems an odd time to argue whether, more than a decade ago, he is morally culpable for taking the first hit. When someone is having a heart attack, yes a poor diet might be to blame, but in that moment that conversation can wait.  Getting Josh Hamilton help is a little more complicated than saying "He needs treatment." That might be accurate, but people often don't understand what "rehab" really is. Initially, the goal is to get the person through the physical withdrawal stage and to work with him on handling stress and on a plan to rebuild his life around something else than substances. Sometimes it's just getting the person to really come to terms with the fact that he has a problem. Real recovery takes a while, sometimes years. Even then, you have to maintain it. It's possible that stepping away from baseball is what Josh Hamilton needs to get things together. Then again, it might be one of the best support systems he has for keeping his life on track. Maybe we ought to ask that question first.  Let's look at what happened here. Josh Hamilton made a bad decision. I don't want to excuse his bad decision, but I also want people to understand the full context of everything that went into that decision. This is not the same thing as being a bad person. He is a person in recovery and recovery is really hard. Sometimes life isn't so black and white.  While I appreciate that Major League Baseball doesn't want to be associated with drug use, I worry that its decision here will be more rooted in that avoidance than in the best interests of Josh Hamilton's health and well-being. The truth is that there are people struggling with addiction in every walk of life, including among professional baseball players. Baseball can either pretend that it is a magic land where "that sort of thing never happens" or it can be real about the problem. There's a way to say "We don't agree with what Josh did in using drugs, but we're going to make sure he gets what he needs."  In MLB's defense, it has taken some positive steps. Teams are required to have someone on staff who can provide counseling for mental health and substance use problems (although some teams do it better than others). Problems can be handled quietly (as they should be -- people have a right to their privacy). It's fine if MLB wants to say that a player who has a substance use problem must show concrete steps toward getting his life in order, but right now the policy is based on punishment for using rather than encouragement for seeking help.  MLB needs to make a calculation. If it continues to base its drug policy on punishment, then there are going to be players who need and may even want help but fear coming forward for it. Speaking as a (former) clinician, if you want them to come forward, you have to accept them as they are, wherever they are on their path to recovery. You want as few barriers in their way as possible.  If MLB were to change its primary motivation, it means that it would have to admit that there are people among the ranks who suffer -- and I used that word precisely -- from addiction, but it might just be able to better help those people.
As Major League Baseball ponders what kind of discipline (if any) it will hand to Josh Hamilton, Russell Carleton suggests the league should change its focus from punishment to prevention.