DRUG ADDICTS NEED HELP

Jails could have the answer

By Sam Quinones

The New York Times
June 16, 2017

COVINGTON, KY. — Not long ago, I visited a Narcotics Anonymous meeting where men with tattoos and short-cropped hair sat in a circle and talked out their errors.

One had lived under an overpass, pimping his girlfriend’s daughter for cash to buy heroin. As the thought brought him to tears, his neighbor patted his shoulder. Others owned to stealing from grandparents, to losing jobs and children. Soon, most in the room — men with years of street addiction behind them — were wiping their eyes.

What made the meeting remarkable, however, was not the stories, but where it was taking place.

Unit 104 is a 70-man pod in Kenton County Detention Center in northern Kentucky, across the Ohio River from Cincinnati. The unit, and an equivalent one for women, is part of a new approach to jail made necessary by our nationwide epidemic of opiate addiction. Drug overdoses are now the leading cause of death among Americans under 50.

As the country has awakened to that epidemic, a new mantra has emerged: “We can’t arrest our way out of this,” accompanied by calls for more drug-addiction treatment. Yet the opiate epidemic has swamped our treatment-center infrastructure. Only one in 10 addicts get the treatment they need, according to a 2016 surgeon general’s report. New centers are costly to build, politically difficult to find real estate for and beyond the means of most uninsured street addicts, anyway.

So where can we quickly find cheap new capacity for drug treatment accessible to the street addict? Jail is one place few have thought to look.

Jails typically house inmates awaiting trial or serving up to a year for a misdemeanor crime. Many inmates are drug addicts. They vegetate for months, trading crime stories in an atmosphere of boredom and brutality. Any attempt at treatment is usually limited to a weekly visit by a pastor or an Alcoholics Anonymous volunteer. When inmates are released, they’re in the clothes they came in with, regardless of the weather, and have no assistance to re-enter the real world. This kind of jail has always been accepted as an unavoidable fixed cost of government.

But the sheer dimensions of the opiate-addiction epidemic are forcing new ideas. One of them, now being tried in Kentucky, is jail not as a cost but as an investment in recovery. Jails as full-time rehab centers — from lights on to lights out.

Jailing addicts is anathema to treatment advocates. However, as as any parent of an addict can tell you, opiates are mind-controlling beasts. A kid who complained about the least little household chore while sober will, as an addict, walk through five miles of snow, endure any hardship or humiliation, to get his dope.

Waiting for an addict to reach rock bottom and make a rational choice to seek treatment sounds nice in theory. But it ignores the nature of the drugs in question, while also assuming a private treatment bed is miraculously available at the moment the addict, who is usually without insurance, is willing and financially able to occupy it. The reality is that, unlike with other drugs, with opiates rock bottom is often death. (Drug overdose deaths last year most likely exceeded 59,000, the most ever in the United States, The Times found in an analysis of preliminary data this month, up about 19 percent over 2015.)

Jail can be a necessary, maybe the only, lever with which to encourage or force an addict who has been locked up to seek treatment before it’s too late. “People don’t go to treatment because they see the light,” said Kevin Pangburn, director of Substance Abuse Services for the Kentucky Department of Corrections. “They go to treatment because they feel the heat.”

Jail may in fact be the best place to initiate addict recovery. It’s in jail where addicts first come face-to-face with the criminal-justice system, long before they commit crimes that warrant a prison sentence. Once in custody and detoxed of the dope that has controlled their decisions, it’s in jail where addicts more clearly behold the wreckage of their lives. And it is at that moment of clarity and contrition when they are typically plunged into a jailhouse of extortion, violence and tedium.

“Imagine your most stressful day at work, multiply that by two or three, then imagine that every day,” a Kenton County inmate said. “Having to be on your guard. Always tense. Then you’re released from that. The first thing you’re going to take up is heroin” again.

In the red state of Kentucky, a relentless opiate-addiction epidemic is changing long-held dogma about how to deal with addicts. Families who once supported a “throw away the key” approach to addiction are thinking differently now that their loved ones are strung out. Kentucky is also the only state that elects its jailers. This gives them more autonomy than their counterparts elsewhere. It also inspires more budgetary accountability to voters, and thus an acute awareness of the costs of cycling inmates in and out and back in again.

Kenton County is among the latest of two dozen Kentucky county jails that have started full-time “therapeutic communities” aimed at rehabilitation within their walls, providing inmates the services that private treatment centers offer on the outside. Much of the impetus has come from the state’s Department of Corrections, which a decade ago began transitioning its prisons away from pure lockups to providing drug treatment.

With the state’s epidemic of addiction, and $3 million that state legislators approved for substance-abuse treatment in 2015, Kentucky has become a center of experimentation in a new way of doing jail.

Terry Carl, the Kenton County jailer, is a Vietnam veteran, Navy reservist, former operations manager for a local utility and a Republican — hardly a wild-eyed social experimenter.

But beginning several years ago, he watched pain pills and then heroin lead to the kind of low-level felonies that sent people in and out of his jail: needle possession, check forgery, possession of stolen property. The petty crimes of the common street addict almost never meant a lengthy prison sentence. To Mr. Carl, with outside treatment beds full, the question of what form jail took became paramount. So in 2015, with the support of the Kenton County commissioners, he took the unorthodox step of hiring a recovering addict named Jason Merrick to run Unit 104 with the explicit purpose of treating addicts. Mr. Merrick has a master’s degree in social work. He has been clean since 2009.

For its first three months, Unit 104 was not much different from others. Cliques formed. There were fights, thieving, yelling. Then Mr. Merrick and a few inmates serious about their recovery, following the program’s guidelines, wrote up “Cardinal Rules” governing behavior; those who couldn’t go along with them chose to leave. Eighteen months later, in 104 there’s none of the routine jail behavior that leaves inmates tense and isolated.

“Once people see that standard being met, then they abide by it,” said Jeremy Westerman, an inmate and recovering heroin addict who helped write those rules. “They live up to it, and it gets rid of all the other nonsense, and you’re free to work on your problems.”

Unit 104 offers G.E.D. classes, instruction on criminal-addictive thinking, 12-step meetings, overdose-resuscitation training, physical exercise, prayer and meditation, counseling, inmate self-governance and extensive writing assignments for those derelict in confronting the issues that landed them in custody. Classes begin at 8:30 a.m., with beds made military style.

The pod is open to anyone who volunteers for it, but it involves daily work, abiding by rules and cultivating an attitude of self-examination. Malingerers tend to shape up or wash out and be sent back to the general population. Inmates complete up to a six-month recovery regimen. Those who stay longer become peer mentors. Those leaving jail are offered help in re-entering society: a Vivitrol shot (which blocks the effects of opiates for one month and is associated with reduced cravings), connections to jobs, sober-living houses, 12-step meetings, recovering-addict mentors and more. And because Kentucky is one of 31 states that expanded Medicaid under Obamacare, some inmates would be eligible for addiction treatment once released.

After initial hiccups, Mr. Merrick and inmates told me, the culture in 104 evolved from predation to nurturing. I saw guys hugging, crying, admitting weakness, encouraging one another in public — behavior that is believed to be essential to recovery. One man even stood up at a pod gathering and read a poem he wrote.

“I’d never have done that in the other pods,” he told me on the day I visited.

“Here it’s structured and disciplined,” said another inmate, Dominique Evans. “That removes the tension and conflict. It’s a lot of caring here. We tell each other we love each other. Over there, in them other pods, you’d never hear that. You’d probably get jumped if you said that. Here, we hug, we pray in here, we work as a unit.”

In 104, inmate committees enforce the Cardinal Rules and maintain order. The pods don’t require paid janitors; inmates do the work themselves.

Perhaps the biggest departure from typical jail is that inmates call one another out for infractions or misbehavior. Many of them at first viewed that as snitching. But, inmates told me, snitching is telling on someone to benefit yourself; this is to help the other guy change — the informant gets nothing out of it. Inmates will greet a new arrival with a day of grace to dispose of any drugs or weapons he has on him. If he’s found with them the next day, he’ll be ejected.

“It polices itself,” Mr. Pangburn of the state corrections department said. “It’s not perfect, but you find much fewer” fights and contraband. “You start finding that your security staff wants to work there.”

Inmates I spoke to said all this gives them hope they can leave readier for a clean life, even as, having failed before, they remain nervous about how they’ll do on the outside.

“I’m terrified,” Mr. Westerman told me.

In fact, some have gone back to using after leaving 104, as addicts have upon leaving private treatment centers. Addiction recovery is a messy thing. But a 2015 joint Kentucky Department of Corrections and University of Kentucky Center on Drug and Alcohol Research study of 339 inmates who left these programs statewide found fewer risk factors for recidivism 12 months after their release: 70 percent were not incarcerated; 68 percent were employed at least part-time; 86 percent were housed; 76 percent said they spent most of their time with family; and half reported a significant decrease in illicit drug use.

Unit 104 and the pods like it in jails across Kentucky don’t require more money to run; they do require political will, changing our long-held ideas regarding addiction and, above all, rethinking what jail can be. With state funds, Kenton County has expanded its counseling staff to seven, of whom five are recovering addicts — people whose backgrounds, it’s safe to say, would have kept them from finding work in any other jail.

It also matters who is hired to run these new jail pods. Mr. Merrick, for example, is highly regarded among Kenton County elected officials and judges for his passion for the job. It’s unclear whether others with less enthusiasm might have the energy for the experiment.

Nor are these pods some magical cure-all to our national affliction. There is no one solution to what our country faces. But what Kentucky jails are doing seems like a smarter use of public money than the counterproductive way so many jails across the country function today.

Amid this national epidemic of opiate addiction, rethinking jail, as Kentucky has, as a place of sanctuary and recovery for a population that has lost hope, might not just be advisable; it may be indispensable.