Josepher: From Harm Reduction to Recovery

From Harm Reduction to Recovery: Exponents

by Howard Josepher, LCSW

Recovery to Practice Weekly Highlights  March 29, 2010

Exponents is a community-based organization in New York City that consists of 14 programs focused on improving quality of life for people affected by drug addiction, incarceration, and HIV/AIDS.

Most of Exponents’ clinical practices were developed as a result of a successful experience with its first and longest running program, ARRIVE. Now in its 24th year, ARRIVE was one of the earliest initiatives in the U.S. to address the devastation that HIV/AIDS was causing in the injecting drug-using community.

ARRIVE held its first class in a church basement with seven recently released parolees. It was 1988 and the AIDS epidemic was at its height. Tens of thousands of drug addicts, their lovers, and family members were becoming infected and dying from AIDS-related illnesses. AIDS medications had yet to be discovered and the stigma surrounding the disease was severe. Addicts with Wasting Syndrome were refused treatment at hospitals and those known to be HIV positive were barred from drug treatment programs. HIV was considered a death sentence-a challenge only intensified by the crack epidemic and draconian prison sentences for possessing relatively small amounts of drugs.

I was hired to develop the ARRIVE pilot project because of my experience as a clinical social worker and staff trainer for prison-based drug treatment programs. I was also a person in recovery and had a fairly traditional background in addiction treatment. ARRIVE’s mission was to prevent people from becoming infected or spreading the virus to others. If individuals were already living with the virus, we aimed to help them take better care of themselves. Naturally, I wanted to help these people overcome their addiction, but it was clear to me traditional methods would not be effective.

There were numerous factors that influenced the design of the program. Because participants had recently been released from prison, they were not open to long-term commitments. For ARRIVE to have an impact and change behaviors, participants had to be invested. We created a brief intervention model with 24 classes held over an 8-week period. Before enrolling, prospective students could see a clear beginning, middle, and end. We felt it was a manageable commitment-something people could feel good about upon completion.

Considering the daunting challenges our participants faced, we wanted them to have role models-individuals who had grappled with the same challenges and persevered. Peers, people in recovery, and those with HIV/AIDS would lead the program so we could ignite the hope and spirit so desperately needed to address these issues. We adopted a social learning approach where positive, healthy behavior was practiced by staff and peers. It became a community of recovering individuals supporting one another-similar to the one that helped me overcome my addiction. I was very familiar with the concept, but when it came to AIDS, we were all learning together.

Back in those days, if you wanted to learn about HIV/AIDS, you didn’t go to doctors or medical textbooks. You either read about it in the newspaper or spoke to people living with the virus. I found my resources in the gay community, where incredible outreach was taking place. Early on, I learned if we were going to be successful and create a safe space, we had to be nonjudgmental. We adopted a hierarchy of needs: keeping people alive and healthy took precedence over getting them off drugs. We simply could not tell someone he had to get clean before we would educate him about HIV/AIDS. A decision was made that all students-whether they were active addicts or in recovery-would be welcome, as long as they weren’t disruptive. Our “open arms” policy resulted in one of the first harm-reduction programs in the country. To make everyone feel welcome and safe, we loosened the requirements for participation and began meeting people where they were at.

Most people who came to the program had many failed drug treatment efforts, and we intended to break that cycle. Rather than focusing on what was wrong with them, we chose to focus on their strengths and what was right. We certainly wanted to address their problems (for example, if they were using or in relapse), but would not lose sight of the fact that they were showing up for classes. We saw power in their ability to overcome what seemed like insurmountable obstacles to get high every day. Addicts could move mountains when the goal was getting high. We wanted them to realize what their minds could accomplish if they focused on something positive. We developed a client-centered approach, supporting multiple recovery pathways while maximizing the importance of good health and well-being.

Given treatment limitations at the time and the chronic and mental health conditions our participants faced, we adopted a holistic approach to teach about complementary and alternative medicines. In our efforts to address the whole person-the body, mind, and spirit-we taught students how to self-manage conditions and provided them with skills and tools to cope with stress. We held classes on nutrition, diet, exercise, and positive thinking. We developed relapse prevention and psychoeducation training to address underlying conditions like depression, which goes hand in hand with drug misuse. And we discussed spiritual and philosophical concepts that questioned if nature, God, a higher power, or whatever it is that’s out there is trying to teach us something through life’s experiences.

Most importantly, we wanted our students to learn about the self-destructive and self-sabotaging nature of their illness-that recovery is about self-healing, from a fragmented sense of self to wholeness. From self-condemnation to self-love and self-respect.

ARRIVE enrolls more than 500 participants each year and typically sees 75 percent complete the course. At the end of 2011, the program had conducted 117 cycles of 24 classes, with more than 9,770 graduates. Studies show that recently released inmates who become involved with ARRIVE are more socially adjusted and exhibit safer behaviors than those who do not participate. SAMHSA has also listed ARRIVE as a best-practices model in Treatment Improvement Protocol 44.

When the original research grant for ARRIVE came to an end in 1990, my clinical team and I refused to let the project die. We founded Exponents to keep ARRIVE going. Over the years, we have added drug treatment, recovery, and re-entry programs to fill gaps and better address the needs of people who seek us out. Today, Exponents has 14 evidence-based programs designed to work with and engage individuals at whatever stage they have reached in the addiction–recovery continuum. We have 50 full-time staff members and a thriving peer component. Exponents receives Federal, State, and city funding, as well as contributions from foundations and private donors.

Howard Josepher is the President and CEO of Exponents. Contact him at hjosepher@exponents.org or visit the Exponents Web site to learn more about available programs.