People need support, not punishment.
Friend,
Across America, public suffering is more visible than ever and a huge concern to us all. And overdose deaths continue to rise. Treatment is a needed response to people navigating addiction, including those struggling with homelessness in our streets.
But the media continues to publish troubling pieces from drug war defenders who tout forced treatment and criminalization as a solution for the problems we face. These stories fail to mention the increased overdose risk that comes with forced treatment, lack of evidence-based treatment in the criminal legal system, and long lines faced by people who are seeking treatment every day.
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Learn more about increased overdose risk: [link removed]
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I worked as a social worker at an addiction treatment program and served many mandated clients from the criminal legal system. Probation, parole, or drug court staff with no training in addiction could decide whether these clients should stay in treatment and if they were progressing “fast enough.” Some would recommend jail after a single positive drug test because they believed that the contents of one’s urine dictated if treatment was working or not. I would argue with these officers that these clients deserved support, not punishment. Sometimes I won, but often I lost and clients were incarcerated with no other option for help. Over twenty years of research aligns with my experience — forced clients do not do any better than those who seek help voluntarily. Mandates will not save lives or keep our communities safer.
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See the research: [link removed]
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The questions we should be asking are: What makes treatment effective? How do we increase the likelihood that someone will get the help they need?
Making treatment available, affordable, and accessible should be our priority. People who want treatment should be able to easily get it. This includes telehealth and online options. Unfortunately, many people who want help are on waitlists, lack appropriate insurance coverage, and do not have local options. Our policies must lift these barriers so that anyone who wants help can get it.
Treatment must be evidence-based. Methadone and buprenorphine are two lifesaving medications for opioid use disorders. They cut the risk of fatal overdose in half, yet are inaccessible in much of the country.
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Read more: [link removed]
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Proven treatments include:
Cognitive Behavioral Therapy: [link removed]
Contingency Management: [link removed]
Motivational Interviewing: [link removed]
These should be more available, but aren’t the norm.
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Read more: [link removed]
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People should not be blamed for treatment “failure” when they receive ineffective approaches that do not match their needs. When people have access to treatment that works, they will use it and benefit!
Treatment must be flexible and accept that some people may not be ready, willing, or able to achieve immediate abstinence. I agree with Dr. Nora Volkow, the Director of the National Institute of Drug Abuse, who said that treatment expectations for abstinence can overlook client progress that may include less frequent or risky use and moderation. When abstinence is the only required metric for “success,” it deters people from seeking help. Treatment should welcome all people to achieve their unique goals.
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Read Dr. Volkow's statement: [link removed]
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Read more about how treatment for addiction can achieve the highest standard of care:
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While treatment is vital, it may not be the most pressing need. Many people must address other basic needs first such as housing, mental health treatment, and financial stability. After all, how can one focus on addressing their substance use when they lack stability without other basic needs met first?
Forced treatment will not end the public suffering in our streets. Treatment is one needed response, and our leaders must ensure it’s voluntary, evidence-based, available, affordable, and accessible. We also need to centralize responses to people on the streets by increasing street outreach, offering more housing and humane shelter, creating community-led crisis-response teams, and opening overdose prevention centers to bring drug use indoors and connect people to care.
Sincerely,
Sheila Vakharia
Deputy Director, Research & Academic Engagement
Drug Policy Alliance
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