Recovery Advocates, Drug Courts Seek Common Ground at Conference

Drug courts need to be more understanding of relapse and more open to the broad range of interventions -- particularly methadone -- that help their clients beat addiction, recovery advocates told judges, prosecutors, and others attending the recent New England Association of Drug Court Professionals (NEADCP) annual conference in Boston, Mass.

The Aug. 5-6 meeting allowed drug-court professionals and recovery advocates to meet and mingle professionally, and perhaps alter the mutual perceptions of people more accustomed to a relationship based on the roles of prosecutor, judge, and offender. Conference sessions included testimonials by drug-court graduates and other people in recovery, as well as a panel discussion about how treatment professionals and criminal-justice officials learned to work together and become advocates for each others' issues.

The exchanges showed that while most of the conference attendees share the goal of increasing treatment resources and promoting recovery to cut recidivism, some significant ideological differences remain.

A Call for Advocacy

Keynote speaker and recovering addict William Cope Moyers, vice president of the Hazelden Foundation, opened the meeting by urging drug-court professionals to get more involved in advocating for treatment and recovery resources, and against the stigmatization of people addicted to alcohol or other drugs.

"Intoxication is not unnatural or deviant, and absolute sobriety is not a primary or natural state," said Moyers. "It is unusual -- even extraordinary -- to live a life of sobriety, which makes what you do truly remarkable. You are helping people with a terminal illness to say yes to life by saying yes to sobriety and recovery."

Smartly dressed and well-educated, Moyers differed in appearance and bearing from a typical drug-court client. But, he said, "I'm an alcoholic and a drug addict, and this is what we look like."

Moyers -- who grew up in a prosperous community on Long Island as the son of television journalist Bill Moyers -- noted that he once lived in a crack house in Harlem. "I went to treatment not once, not twice, but three times before I learned to take personal responsibility for living with this disease," he said. In some drug courts, however, relapse still is seen as a failure that can land participants back in prison.

"I today am productive, obey the law, and am involved in my community, despite the fact that I still have the disease of addiction," Moyers continued. "There are millions of people like me, many because they got your help to be the solution and not the problem."

Moyers pleaded with the judges, prosecutors, and people in recovery in the audience to extend their involvement in the addiction issue to the public-policy arena.

"We have the power and the responsibility to tear down the biggest obstacles, to make recovery America's business ... We're not doing enough to smash stigma ... the stigma is allowing people to die," said Moyers. "It seems that every disease has a face these days ... but where are the faces and voices of people like us, and people like you? How many of you have ever written to a state legislator or your governor about what you know? How many of you who are in recovery have ever shared your story, or your family's story? Help us erase the stigma once and for all, because if you don't do it, who will?"

Paul Samuels, director of the Legal Action Center, echoing Moyers' message, honed in on the difficulties that drug-court graduates have reintegrating into the community. Imploring drug-court judges to "end discrimination against people who have done what we have asked them to as a society," Samuels noted that in most states, employers can ask job applicants if they have ever been arrested, regardless of whether they have been convicted -- a standard that undermines the drug court's promise of wiping the slate clean in exchange for completing treatment.

"Few states have a system for evaluating convictions," said Samuels. "Most allow employers to refuse to hire based on a felony record. People shouldn't be forced to live the rest of their lives as if they are wearing an orange jumpsuit."

Methadone Discussion Sparks Debate

The presentations by Samuels and Moyers were well-received. But a later discussion designed to educate judges about office-based opiate treatment exposed some deeply set disagreements between treatment advocates and drug-court practitioners.

Boston Medical Center physician Dan Alford, M.D., detailed recent legislation that allows primary-care doctors to prescribe the anti-opiate medication buprenorphine in the offices, and Percy Menzies, president of Assisted Recovery Centers of America, discussed naltrexone, another alternative to methadone.

"Clients in DWI and drug courts are good candidates for naltrexone," which Menzies pointed out is non-narcotic. "Judges like it because there is no potential for abuse or diversion," the drug can be prescribed and administered in many settings, and it costs just $3 a day, he said.

But Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, offered a spirited defense of methadone in the face of what he termed "ideological barriers and misperceptions."

"Methadone is not a treatment, it's a medication," said Parrino. "But when it is combined with treatment is when it is most effective. I've heard judges say, 'I don't believe in it.' It's not a belief system; it's evidence-based. We have more than 35 years of scientific evidence, and if evidence exists, you go with it."

In response, Diana Maldonado, a NEADCP board member and associate justice of the Chelsea, Mass., District Court, rose to say, "I'm a judge, and I don't believe it." Maldonado said that treatment experts warn drug-court participants not to allow their dentists to prescribe narcotics during treatment because it could trigger relapse, while Parrino and others endorse prescribing methadone, which she feared also could trigger relapse.

"The message that I'm sending to the rest of the community is we need you off drugs," she said. "I can't treat this person differently because their disease is different." Maldonado added that she has been disturbed by seeing methadone patients in her courtroom "nodding off."

Parrino replied by saying, "Methadone won't trigger the use of other drugs; pharmacologically, it does the opposite." Methadone alone won't cause patients to zone out, he added, though taking the drug in combination with alcohol or other drugs could.

Alford added, "Where do you see successes? You need to go to a methadone-maintenance program. These people are not in jail or the hospital; they're getting meds and going to work. Don't discount a whole treatment because of the people you come in contact with."

From Adversary to Advocate

Despite occasional disagreements, however, a Friday afternoon session entitled "From Adversary to Advocate" showed that many treatment providers, recovery advocates, and drug-court practitioners have found common ground in working together to make drug courts work.

Jim Cameron, a Maine assistant attorney general, says the drug-court board he works on has been successful because "everybody has an obligation to become an expert in the other person's areas, to the extent possible."

"We have lawyers trained to think about drug treatment ... and treatment providers trained to think more about sanctions," criminal law, and court procedures, he said.

"I didn't know much, but I knew there had to be something better than the punitive model," recalled Sonya Pence, a Cambridge, Mass., defense attorney, about her first exposure to the drug-court model. Pence said she came into drug court with a lot of skepticism and concerns about due process, confidentiality, and ethics. "Is zealous advocacy [for my client] subordinate to the team concept?" she wondered.

"I found that as we coalesced as a team, we became aware of our biases and learned to respect each other's participation as a team member," Pence said. "Now, I'm completely sold on drug court."