In this installment of Healthland's series on addiction, we speak with Howard Josepher, a former heroin addict who has been an energetic and committed advocate for people with addictions for more than 40 years. He has worked with or participated in virtually every form of addiction treatment and recovery — from residential therapeutic communities like Phoenix House to 12-step programs to an erstwhile British program that used maintenance doses of cocaine and heroin as therapy. (Note: the UK has recently re-introduced a much more structured program of heroin maintenance, which research has found to be effective).
Josepher is now President and CEO of Exponents, Inc., a nonprofit program he co-founded in 1988 to provide primary and mental health care and job training to people with substance abuse problems and high risk for HIV. He does not require abstinence for participation in the program, nor does he consider abstinence a necessary part of recovery in every case.
Although he is now abstinent from heroin, he still drinks alcohol moderately. I spoke with him about his journey and his vision of recovery.
Q: How do you define recovery?
A: It's a sustained responsible lifestyle [engaged in] by someone who had been addicted to alcohol or drugs.
Q: How long have you been in recovery personally?
A: Well over 40 years.
Q: How did you first get involved in drug use?
A: I was a heroin addict for about seven years. I was in my 20s and began using heroin shortly after I graduated from Long Island University. There was a crowd I was running with; it was part of what we consider a very "hip" scene in Manhattan, a "cool" jazz scene right at the tail end of the Beatnik [era].
There came a point where I was with another friend who had never done [heroin] and we were curious. I thought I would try it just one time. I liked it so much, that one time became many, many times. It gave me a sense of serenity. It gave me a peaceful floating feeling whereby I felt for those moments content. I felt the opposite of what I experienced most of the time without drugs, which was a kind of void or emptiness. (More on Time.com: Will the Government's Drug 'Take-Back' Do Anything to Reduce Misuse?)
Q: When did you realize you had a problem and try to quit?
A: I lost count of the detoxes I was in. Back in the late '60s, we didn't really have drug treatment in the U.S. I did apply for the early methadone program under Drs Marie Nyswander and Vincent Dole [who developed methadone maintenance as a treatment for addiction], but I was rejected because I was not hard core enough!
"Hard core" for the administrators of the methadone program at that time was someone who had 10 years of addiction and 10 arrests. I had five years of addiction and six arrests — for possession, burglary and credit card forgery.
Q: How did you wind up getting prescribed heroin and cocaine by a British doctor?
A: I went to London because I understood that they had a different kind of system. Doctors could prescribe drugs like heroin legally. I [found a doctor] who said, "What do you use, heroin and cocaine?" I answered in the affirmative even though cocaine in those days was considered a rich man's drug and addicts like myself used heroin and only heroin.
I thought I could turn my life around. But while other people did stabilize, I continued to abuse the drugs and ultimately came back to U.S. That experience of having heroin legally and not being able to manage myself any differently told me that the junkie's dream about having drugs without being a criminal, for me personally, it still didn't work.
Q: Why do you think it didn't work?
A: I asked myself that question a lot. I didn't have other activities going on in my life whereby there could have been some structure. [When] I was there, that's all I did. I think it was boredom. The very few friends I did have were also using heroin. Occasionally, we would use together, but it wasn't the same scene you had back in States, where you would have running partners. You got your prescription from the doctor, went to the pharmacy to get it filled and went home. It was an isolated and lonely experience for me.
Q: Where did you go from there?
A: When I left the U.S., I had absconded from a court case. I went back to my [American] probation officer the day after I landed. [Because I turned myself in], he felt I saw the error of my ways and gave me another opportunity to get into a drug program.
This is early 1967. We just had the start of a number of new approaches to treat addiction. They were called therapeutic communities. And while I was in the [Phoenix House] program, I was in a community of people very much like me, junkies striving to turn their lives around.
I saw a future for myself that things could be different and I ended up surprising myself by completely buying into the community concept of drug treatment and being part of it, belonging. I was in the first group of Phoenix House graduates. And [Phoenix and similar] fledgling therapeutic communities became the vanguard of drug treatment.
Q: What was helpful to you about this program?
A: The community and the spirit [of one addict helping another]. Also, we had a clearly defined beginning, middle and end to the program. And when we were in the final phase, we were given drinking privileges. The concept of successful treatment was for participants to [become] responsible members of society, and part of that reintegration was to be able to socially drink.
It actually worked really well for me. I had drinking privileges when I was still part of a therapeutic process. [If they saw that] people were abusing or misusing alcohol, it could be dealt with clinically to help us to gain more understanding and better control. (More on Time.com: How Religion Was Edited Out of AA's Bible)
Some of us did very well and never had a problem; others did not do well. I believe that [the failure of those who did poorly] is the reason they changed the [desired] outcome of treatment from becoming a responsible member of society to becoming a lifelong teetotaler, someone who was expected to be drug free for the rest of his life.
Q: At the same time, there was the growing influence of treatment centers like Hazelden, based on 12-step programs.
A: Yes. There was that expansion of the 12-step model into addictive behavior other than alcohol addiction. We started to see programs like Narcotics Anonymous and Cocaine Anonymous growing in the '80s. I was fascinated by it. In the late '70s, I attended a few [AA] meetings, more out of curiosity than anything else. I stopped drinking for a while. I thought it was great, extremely helpful and spirited and energetic.
I'm still a fan! [But] I have my own personal understanding of addiction and how to deal with it. I see addiction somewhat differently than 12-step people who see it as a disease. I see addiction as a beast — but a beast that can be mastered.
Q: So you moved away from the idea that total abstinence was required for recovery and from the idea that people had to be confronted and forced into abstinence.
A: The reason for the existence of one of Exponents' most successful programs, which is called ARRIVE, was the rampant spread of HIV. The AIDS epidemic dictated the urgent engagement of IV-drug users in New York City. It just seemed unfeasible to tell addicts that you have to get off drugs before I can help you to prevent the spread of HIV or help prevent you from getting it or if you're living with it, how to take better care of yourself.
It was sort of an accident that we shifted the emphasis to health and well-being and away from being clean and sober. At the same time, many of my staff are people in recovery who are practicing an abstinent lifestyle. Having done this now for over 20 years and witnessed the extraordinary response by New York's drug using population, whereby thousands of people have voluntarily entered our program, it tells me that there's a better way to go if we want bring more people into recovery.
Q: How do you manage to mix people who seek abstinence with those who are still using without threatening their commitment to abstinence?
A: First, the idea of recovery and abstinence for many is in the background of everything. We're just not shoving it down people's throats. That gives them an opportunity to move along the recovery path at their own pace.
The whole world of addiction is a very black-and-white, clean-and-dirty world. My effort in hoping to have a more inclusive definition of recovery means that we start to take the world of addiction out of black and white and define a gray area, where most of life exists.
We want to help people feel better, and take any positive steps that a person is making and acknowledge those steps. [People who have not been able to achieve abstinence] have been considered failures, and we keep reinforcing the low self-esteem they have, so their depression deepens and the pain becomes larger and with that so does the need to self medicate. [We want to end that cycle].
[ARRIVE now has] 9,378 graduates and they keep coming. The commonly held belief about addiction is that addicts won't seek help without a gun held to their heads. Our experience just shatters that.
More on Time.com:
Tuesday, 19 July 2011
Addiction Files: Recovering From Drug Addiction, Without Abstinence – TIME Healthland
