The nation’s response to addiction: Moving from rescue to recovery

In a recent obituary, the father of a woman in Vermont who had recently died as the result of a drug overdose pleaded with that state’s child welfare system to “embrace a mission of enhanced rehabilitation”. He asked the agency to “rethink its mission” and move away from its role as the “punisher” of mothers with substance use disorders.

His plea is emblematic of how our systems and institutions treat people with the disease of addiction. Too often we perpetuate a never-ending cycle of arrest, incarceration, family separation, and other responses that have negative outcomes and unintended consequences. 

The idea of changing as an individual is commonly recognized as an integral part of the recovery process. People are told they have to change people, places, and things to sustain their recovery. They are reminded of this constantly, and in some cases, if they don’t change they are punished.

The adage is: The only thing you have to change is everything. 

At the same time, we don’t apply the same standards to the systems that most affect people with substance use disorders. It is not applied in our health-care systems, to government policies, the criminal justice system, child welfare, or to social services. We accept the status quo of each of these systems. We seldom consider that, to improve a range of outcomes for the more than 20 million people in our country with a substance use disorder, and the 23 million people in recovery, our systems have to change. 

The National Academies of Sciences, Engineering and Medicine succinctly stated in a recent report that medications for opioid use disorder (methadone, buprenorphine and naltrexone) save lives. In response to increasing awareness of the efficacy of these medications, as well as in response to successful litigation, more jurisdictions are expanding access to these programs, including in correctional settings. 

One criminal justice leader who has taken up the mantle of change is Sheriff Craig Apple of Albany County, New York. Sheriff Apple began a program in the Albany County jail that provides medication and other evidence based programming for people with opioid use disorder. Within three months of beginning the program, Sheriff Apple saw a reduction in recidivism. As he put it, “[The medication] was saving lives. It’s a no-brainer.”

More and more correctional institutions are following the Albany County example and implementing programs that provide medications to incarcerated people with opioid use disorder. While this is a positive trend, such programs are still the exception. 

Far too many people with opioid use disorder are at increased risk of overdose when leaving a correctional institution. In fact, the reentry population, people leaving jails and prisons, are between 10 and 40 times more likely to die from an opioid overdose than the general population. 

Our drug policies seem to reflect the definition of the disease of addiction itself: engaging in the same behavior, despite harmful consequences. For example, despite evidence that medication successfully reduces overdose deaths and improves outcomes for people, our systems repeatedly put up barriers to prevent people from receiving the standard of care.

This is the case in correctional settings as well as in the child welfare system where parents and families too often lack access to the type of family-centered treatment that will preserve families and improve long-term outcomes for the children and their parents.

A recently released report from Georgetown University’s O’Neill Institute entitled Applying the Evidence, includes a set of recommendations for expanding access to evidence-based treatment in the criminal justice and child welfare systems. 

And while deflecting people away from the criminal justice system and providing care outside of correctional settings should be our ultimate goal, we must simultaneously improve access to treatment for the people most at-risk for overdose. This effort will involve moving from rescue to recovery, taking a long-term approach to build healthier communities. To accomplish this, policymakers and the public must embrace change. 

After all, the only thing we have to change is everything.

Regina LaBelle is director of the Addiction & Public Policy Initiative at Georgetown Law Center and was chief of staff at the White House Office of National Drug Control Policy in the Obama administration.