Viewpoint: Teaching Recovery, Rather Than Treating Addiction

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Today is the final day of Recovery Month, during which we celebrated those who are overcoming addictions. But as the month winds down, the question of how best to spur recovery remains. One New York program, Exponents, has pioneered an approach that I think deserves to be more widely considered and replicated.

It’s based on the idea that offering beneficial social services, even if they don’t entirely relate to drug treatment, and supporting multiple visions of recovery works better than using one rigid approach.

“In ‘treatment,’ the focus is on individual pathology. You’re looking at what’s wrong with the person and how you go about fixing them,” says Exponents founder and president Howard Josepher, himself an ex-addict. “[But] to engage someone in a teaching dynamic, they’re a student and their only job is to be open, to be receptive. You’re not telling the person there’s something wrong with them.”

In other words, honey works better than vinegar. Likewise, encouraging people to take part in treatment leads to better care than using the criminal justice system to coerce people into it — not least because when the government doesn’t force customers to either accept a recovery program’s services or go to prison, that program has got to step up its game.

“I’m not against coerced treatment. It did happen to work for me,” says Josepher, explaining that he got into treatment through a court order. “But I just think we need to be much more creative and adaptable.”

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Exponents began as a research project in 1988, when New York City was at the epicenter of the AIDS epidemic. At the time, at least 50% of intravenous drug users in New York were infected with HIV. “The epidemic changed priorities,” says Josepher, noting that there was a need to reach active drug users to fight the spread of disease, and that precluded focusing only on those who were ready for complete abstinence.

Exponents’ ARRIVE program (for AIDS Risk Reduction for IV Drug Users in Re-Entry) started by recruiting people who had been newly released from prison and, regardless of whether they were HIV-positive or whether they continued to take drugs, taught them about AIDS prevention and healthy behavior. After research found that ARRIVE helped cut HIV infection risk, the two-month program expanded to include other drug users, not just ex-offenders, and has since graduated more than 9,700 people.

Focusing on HIV took the emphasis off abstinence from drugs, and the atmosphere in classes that taught risk reduction was different from that in therapy groups. Though Exponents now does offer explicit treatment and other services for those who want them, it found that taking the focus off drugs often made it easier for people to quit or cut down.

Necessity was the mother of invention in this case, but working with addicted people without requiring abstinence provided new insight into how to spark recovery itself. And research now shows overwhelmingly that programs that use kindness and reward, rather than punishment, are actually more effective.

Devin Phillips, 46, came to ARRIVE after becoming addicted to crack in his 30s. Although he was employed, he supported his habit by stealing and selling goods from department stores. Since 1995, he had attended several rehabs. “I felt like I was in a herd,” he says, describing his earlier treatment experiences. “Everything was just cookie cutter. Instead of addressing what was going on with me, [they said], You must be in this category.”

Phillips didn’t come to Exponents for treatment; he came because he wanted to improve his health. “They didn’t care about anything except you showing up and being part of it,” Phillips says, describing how he wasn’t pressured about drug use. “That made me feel like I was worth something. Everyone took the time to talk with me if I needed to talk.”

Phillips is now employed by ARRIVE, where 75% of the staff are graduates of the program. He has been off crack for more than a year.

Derrick Riley, 44, whose drug use involved years of using marijuana multiple times a day, enrolled at ARRIVE after being laid off from his job at a bank. At first he wasn’t interested when a friend told him about it, but “I decided I may as well get out of the house,” he says.

“I’ve never been in any other treatment,” Riley says. “It was inspiring. I totally cut back because I have other things to occupy my time. I know for a fact now that I don’t have to smoke weed to have a good day.”

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In recent years, as people with addictions have begun to advocate for themselves, the debate over who can be considered as being “in recovery” has heightened. Are you in recovery, for instance, if your life has stabilized and you show up for work and family, but you rely on maintenance doses of methadone or buprenorphine to function? Or are you in recovery if you have cut down on your using, but haven’t quit entirely?

In 2007, the Betty Ford Center published the results of its consensus panel on this question, defining recovery as a “voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship.” While Betty Ford and other 12-step-based treatment centers had previously excluded people on maintenance, the new definition [PDF] of recovery now explicitly includes them.

Exponents’ view is even more expansive, including people like Riley who cut down but didn’t quit. Josepher defines recovery as a “sustained, responsible lifestyle” after prior dysfunctional engagement with alcohol or other drugs.

If we want to encourage recovery, I believe such inclusiveness is essential. Programs like Exponents demonstrate that giving addicts choices doesn’t result in chaos, but instead, reaches more people. And, sometimes, the best way to fight addiction is to ignore people’s failings and spotlight their strengths.

Maia Szalavitz is a health writer for Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland‘s Facebook page and on Twitter at @TIMEHealthland.