The question in the title of this post is the headline of this New Republic piece by Zachary Siegel. Its subheadline captures its themes: "Traditional treatments often take place in expensive facilities, demand total abstinence, and rely on punitive methods of control. A harm reduction model turns all of that on its head." Here is an excerpt (with links from the original):
In contingency management programs, a positive urine screen does not result in punishment the way it might in other treatment programs, especially when those are court mandated and using drugs can result in jail time. The only negative reinforcement in contingency management is that a positive urine screen means the reward cycle resets, along with the bonus count. You have to start over.
“People can come high,” Mike Discepola, vice president of behavioral and substance use health at the San Francisco AIDS Foundation, said. The whole idea of the program is to match a participant’s interest with their ability, Discepola explained. If someone is continually testing positive for stimulants, then treatment, counseling, and care are still available to them. If a participant tests positive, they’re encouraged to discuss why they used, and counselors try to motivate them to keep showing up and try again. No one gets turned away, and no one gets punished for using again.
But that’s exactly what conventional treatment, and the legal system, does. People who use drugs are often given an ultimatum to either comply with an abstinence-focused treatment program or go to jail. In Pennsylvania, one type of probation called “addict supervision” runs on a strict zero-tolerance approach where if participants test positive for drugs, or even miss a drug test, they’re detained and potentially given an even harsher sentence than the one they are hoping to avoid by agreeing to supervision in the first place. All this, mind you, for low-level drug arrests and minor offenses. Federal data from 2012 shows that 44 percent of men aged 19 to 49 who are on probation or parole could benefit from addiction treatment, but just over one-quarter actually get it. Even when they do, it’s hard to know if that treatment is truly grounded in compassionate health care or just punishment by another name....
Providing financial incentives is a common practice in health care and most of our regular lives. Employers offer their workers gym memberships and Fitbits to encourage certain behavior. If you’ve ever used points earned on a credit card or accumulated miles from traveling, that’s an incentive, too....
Prevailing stigmas and stereotypes label people who use drugs as selfish, irresponsible, and criminal. Why pay them money? Aren’t they just going to buy more drugs? Attitudes against “coddling” people who use drugs are often deployed to prevent effective harm reduction interventions from being implemented. Rod Rosenstein, Trump’s former deputy attorney general, argued against supervised consumption sites in The New York Times, saying the goal was to “fight drug abuse, not subsidize it.”
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