TO JAIL OR NOT JAIL FOR DRUG 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
celebrateits 20-yearanniversary on Thursday of serving theNew York
Citycommunity 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 than8,700 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 thatfavor the
punitive, coercive treatment models.The ARRIVE program also doesn't
demand abstinence from drugs in order to access their help.

"ARRIVEchanged 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.