Beyond the 90-Day Substance Abuse Prevention Program

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Drug-related convictions place a substantial burden on the criminal justice system and on society. The MD Magazine Peer Exchange “Medication-Assisted Treatment in Drug Abuse Cases: A Path to Success” features a panel of experts in the criminal justice field who provide insight on medication-assisted re-entry programs.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons, and an associate director of Surgical Intensive Care at New York-Presbyterian Hospital.

The panelists are:

• Phillip Barbour, master trainer with the Center for Health and Justice at Treatment Alternatives for Safe Communities, in Chicago, IL
• Jac Charlier, director for consulting and training, also with the Center for Health and Justice at Treatment Alternatives for Safe Communities, in Chicago, IL
• Jonathan Grand, MSW, LICSW, senior program associate at the Advocates for Human Potential in Sudbury, MA
• Joshua Lee, MD, MSc, associate professor in the Department of Population Health, and a research clinician at Bellevue Hospital Center, NYU Langone Medical Center, and the New York City jails

Peter L. Salgo, MD: This brings us to people who want to get clean, want to not use drugs any more. But the physiology is driving them the other way. Perhaps you’re an example of someone who really wants to turn things around, wants to get off drugs, wants to go forward and lead a productive life. How hard is that, and can it be done without help?

Phillip Barbour: Well, I would say no, it can’t be done without help. I couldn’t do it on my own. I did try. There were many days that I said, “Okay, today I’m not going to use, I’m not going to use, I’m not going to use,” and because of the physiological aspect…And with heroin, yes, you understand that withdrawal is a very uncomfortable feeling. It’s like having the flu times 10.

Peter L. Salgo, MD: Is it called drug sick when you…?

Phillip Barbour: Yes, you’re sick. You want to “get your sick off.” That’s a term that’s often used on the street. So, that just kept compelling me to continue to use, to avoid withdrawal. The other thing I wanted to point out, and there was a word of powerlessness that was used, but I want to put that in proper context. In the 12-step community, they talk about being powerless over drugs or alcohol, my life has become unmanageable. Just for purpose of clarification, you are powerless over the substance. If you stop using, you actually become empowered to change your life, which is what happened in my situation. So, yes, I realize I’m powerless over drugs and alcohol, but I’m not powerless over changing my life, and no one is. They just have to do the right things in order to get there.

Peter L. Salgo, MD: But even people who have detoxed, with people who are clean, who are trying to get their lives back together, there’s a stigma, right?

Jac A. Charlier, MPA: Sure.

Peter L. Salgo, MD: Oh, this guy was an addict; this woman used heroin. They don’t get jobs. My sense is it’s very hard to reintegrate back into productive society. Am I right?

Phillip Barbour: Absolutely.

Jonathan Grand, MSW: It’s true that there is the stigma, but I think it’s also helpful these days that everyone knows someone who, for instance, has been addicted to nicotine and is trying to get off of it. You have friends and family who are trying to kick the smoking habit. They try all sorts of smoking cessation aids and they’re really working at it. And 3 days later, they’re smoking again and you can see how hard addiction is to beat. You also have people who decide that they’re drinking too much coffee, too much tea. The caffeine is getting to them so they decide they’re going to get off of that, but they can’t. It’s difficult.

Peter L. Salgo, MD: So, the public perception is to enter a 90-day program, that’s it. You’re going to go in, you’re going to get clean, you’re done, welcome to the world.

Jac A. Charlier, MPA: That’s right. The interventions for people who are using drugs are looked at like an intervention for a broken leg, right? Go in, get the cast on. Then, you take off the cast, you’re healed, your addiction is done. It’s over with, right? It’s over with. It is not true at all. So, very quickly, and I want to go back to answer something Josh said, about how we, in the United States, look at drugs. Some of the stigmas associated with drug use, which by the way is not a good thing. Let me be very clear, it is not a good thing because of the impact it has, not only on our lives, but the families, and our ability to work. Phil can talk about that from his experiences. But a lot of that has to do with how we in the United States look at it. We say that it’s not a public health problem; we see it as a criminal justice problem. And so the framing is not only, he’s using drugs; he’s also now got a criminal record.

You put those things together in the United States, and you do your time, and you never stop doing your time once you get that conviction. And a felony conviction can affect all sorts of what are called collateral consequences—student loans, home mortgages—all these bizarre things that come into play that then might drive you back into what Josh was talking about, the people, places, and things. To use the Alcoholics Anonymous terminology, I’m going back to the “people, places, and things” where I started and I tried to get out and now I’m right back here.

Peter L. Salgo, MD: There’s a radio personality, Don Imus, who is an alcoholic and he was using drugs. I believe he talks about it on the air a lot. He used cocaine for a long time. And what he says is, “Every day I’m clean, but I’m not cured, and I have to think about it every day. And it’s been over 20 years, not 90 days.” Does that resonate with you?

Jac A. Charlier, MPA: He’s in recovery.

Phillip Barbour: I also want to mention the fact that I still am in recovery. However, my recovery looks different now than it did when I first got clean 25 years ago. When you say, “Can you do it alone?”, I have a different support network now, which is actually through my faith and my church. But in the beginning, I followed the suggestions of the 12-step model programs. It did help me talk about my addiction in the context where other people could understand it. And I didn’t feel I was being judged going to those kind of meetings. But I’ve grown. And like I say, I get most of my support now from my local church. We have a very strong men’s group; we have a recovery ministry. So, everybody’s pathway is going to be different.

The other thing I wanted to mention is about 90 days of treatment. Well, when I went into treatment back in the 80s, I stayed for 9 months, and I believe I needed every day of the 9-month program. I thank God every day that I don’t need to seek treatment now, because most programs are quite a bit shorter, and I don’t think it would have been enough. I had always looked at the inpatient treatment program as just my time to clean up, and that was it. Put on a few pounds, that kind of thing. But the actual treatment occurs in the community and with the kind of support I’m going to get and what I’m going to do every day in order to stay clean that day.