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."