Warring Philosophies Regarding Drug Treatment: To Jail or Not Jail for Relapse

It may or may not surprise you that a majority of Americans support treatment instead of incarceration for people struggling with drug addiction. That's the good news. What you may not know is that there is a raging battle within the treatment community and society at large about how much carrot vs. stick we should use to help people who need treatment.

There are two major flashpoints that divide treatment advocates and the public: 1) the need to hold sanctions or the threat of jail over someone's head in getting them to comply with treatment and 2) the need for total abstinence for people in treatment and recovery.

One camp, usually made up of law enforcement, prison guards and the "tough love" crowd, think we need to threaten people with jail in order to get them to comply with treatment. If someone relapses or drops out of treatment, they want to throw the person in jail for their failure to take treatment seriously. It is not uncommon to hear stories, whether from judges, to family members to people in recovery, all explaining that they needed the threat of jail in order to clean up. This group also believes that total abstinence is the only answer for people with addiction problems. They want to drug test people to make sure there is no drug use and any use or relapse should result in punishment, whether that is expulsion from treatment or being sent back to jail. They basically believe that drug addicted individuals are not motivated on their own, but need threats and coercion in order to comply with their treatment programs.

The other camp believes that substance abuse should be handled as a public health issue, not as a criminal one. They don't believe jail is the answer when someone relapses or continues to struggle with drug addiction. They believe that relapse is common for people seeking recovery and that incarcerating someone who slips up is unnecessary and harmful. They also want to help reduce the harm from people's drug use, even if they are still using. If someone is injecting drugs, they want them to use clean syringes so they don't contract HIV. If you have given up heroin, but still smoke marijuana they say congratulations for giving up heroin, a positive step, rather than you failed treatment and need to be punished and sent back to jail.

Last week, I visited the pioneering drug program, ARRIVE, which will celebrate its 20-year anniversary next week of serving the New York City community in its fight against drug addiction and HIV/AIDS. ARRIVE started in a church basement in 1988 in an attempt to help drug users who were contracting HIV through dirty syringes. In 1990, Exponents was founded as a non-profit organization to keep the ARRIVE pilot project alive. The organization has 40 staff members, the majority of whom have histories of addiction and incarceration and are graduates of ARRIVE. With more than 8,700 graduates, the cutting-edge program differs from many of the status quo treatment programs by challenging the notion that people have to be coerced into treatment by the threat of jail. The program has always been voluntary and has better results in getting people through their program than programs that favor the punitive, coercive treatment models. The ARRIVE program also doesn't demand abstinence from drugs in order to access their help.

"ARRIVE changed the paradigm of how we treat and help drug users and the response has been nothing short of phenomenal. Over the years, thousands of inner-city drug users voluntarily showed up for the program and over 75 percent of them graduated," says Howard Josepher, founder of Exponents and an ex-offender who overcame his heroin addiction 40 years ago. "We now have more than 8,700 graduates and not a single one of them was coerced or mandated to attend. Our experience has been, contrary to popular belief, that addicts will seek out treatment if it is presented in a non-punitive and non-judgmental manner."

The ARRIVE program shows us what is possible. We need open doors that encourage people to get help for their problems, whether it is for illegal or legal drugs, and not insist on inflexible and rigid standards that produce more failure and low self-esteem while driving people away from life-saving programs. While some may desire a more perfect world where people are able to quit all drugs at the same time and never relapse, the reality for some may be a gray area where they quit different drugs at different stages and incremental change should be recognized as steps in the right direction.

Let's help people where they're at and not let perfection be the enemy of good. Let's make sure that we offer compassion and empowerment, not judgment and a jail cell.

Tony Newman is the director of media relations at the Drug Policy Alliance (www.drugpolicy.org)

Comments

[Jonahson]

Addiction should be treated but the addicts themselves must we a willing party to be treated otherwise all the good intention and effort will come to nought.
Addicts who commit crime to feed their addiction should be jailed. An addict's mind is weak due to giving into their craving and hence has weak will power. Some successful treatment involve the strenghtening of their resolve by combining treatment with religious practice.

[bigred1019]

It's possible to be addicted to almost anything. Do you know anyone who needs to lose 50 pounds, but just cant seem to stay on a diet? If I had a dollar for everytime I tried to stop smoking, i could buy a case of them. My best friend is in recovery. Thus far, his personal best is 5 months sober, in a row. He was so messed up that he relapsed. I think that the people who are addicted to ANY thing, wether it be food, or cigarettes, or gambling are more in need of someone who tells them that as long as they did their best, that its ok, and that now that they know they did it for 5 months, that next time they set a goal of 6 months. Then 7 months, and so on until they do it. Encouragement and support is much more valuable to them than sitting in front of a judge, or a parole board, trying to explain to them that, like everyone else in the room, that they are only human, and no human is perfect.

[polyfoamworkshop]

This is one of the reasons why I voted yes on prop 5 in California. In all fairness, it is a health issue.