Addiction Files: Recovering From Drug
Addiction, Without Abstinence
In this installment of Healthland's Q: When did you realize you had a problem and try to quit?
series on addiction, we speak with
Howard Josepher, a former heroin A: I lost count of the detoxes I was in. Back in the late '60s,
addict who has been an energetic we didn't really have drug treatment in the U.S. I did apply
and committed advocate for for the early methadone program under Drs Marie
people with addictions for more Nyswander and Vincent Dole [who developed methadone
than 40 years. He has worked with maintenance as a treatment for addiction], but I was rejected
or participated in virtually every form of addiction treatment because I was not hard core enough!
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 "Hard core" for the administrators of the methadone program
heroin as therapy. (Note: the UK has recently re-introduced at that time was someone who had 10 years of addiction and
a much more structured program of heroin maintenance, 10 arrests. I had five years of addiction and six arrests — for
which research has found to be effective). possession, burglary and credit card forgery.
Josepher is now President and CEO of Exponents, Inc., a Q: How did you wind up getting prescribed heroin and
nonprofit program he co-founded in 1988 to provide primary cocaine by a British doctor?
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 A: I went to London because I understood that they had a
does he consider abstinence a necessary part of recovery in different kind of system. Doctors could prescribe drugs like
every case. 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
Although he is now abstinent from heroin, he still drinks drug and addicts like myself used heroin and only heroin.
alcohol moderately. I spoke with him about his journey and
his vision of recovery.
I thought I could turn my life around. But while other people
did stabilize, I continued to abuse the drugs and ultimately
Q: How do you define recovery? came back to U.S. That experience of having heroin legally
and not being able to manage myself any differently told me
A: It's a sustained responsible lifestyle [engaged in] by that the junkie's dream about having drugs without being a
someone who had been addicted to alcohol or drugs. criminal, for me personally, it still didn't work.
Q: How long have you been in recovery personally? Q: Why do you think it didn't work?
A: Well over 40 years. 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
Q: How did you first get involved in drug use? was boredom. The very few friends I did have were also
using heroin. Occasionally, we would use together, but it
A: I was a heroin addict for about seven years. I was in my wasn't the same scene you had back in States, where you
20s and began using heroin shortly after I graduated from would have running partners. You got your prescription
Long Island University. There was a crowd I was running from the doctor, went to the pharmacy to get it filled and
with; it was part of what we consider a very "hip" scene in went home. It was an isolated and lonely experience for me.
Manhattan, a "cool" jazz scene right at the tail end of the
Beatnik [era]. Q: Where did you go from there?
There came a point where I was with another friend who had A: When I left the U.S., I had absconded from a court case. I
never done [heroin] and we were curious. I thought I would went back to my [American] probation officer the day after I
try it just one time. I liked it so much, that one time became landed. [Because I turned myself in], he felt I saw the error
many, many times. It gave me a sense of serenity. It gave me of my ways and gave me another opportunity to get into a
a peaceful floating feeling whereby I felt for those moments drug program.
content. I felt the opposite of what I experienced most of the
time without drugs, which was a kind of void or emptiness.
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.
Addiction Files: Recovering From Drug
Addiction, Without Abstinence
saw a future for myself that things could be different and I Q: So you moved away from the idea that total abstinence
ended up surprising myself by completely buying into the was required for recovery and from the idea that people had
community concept of drug treatment and being part of it, to be confronted and forced into abstinence.
belonging. I was in the first group of Phoenix House
graduates. And [Phoenix and similar] fledgling therapeutic A: The reason for the existence of one of Exponents' most
communities became the vanguard of drug treatment. successful programs, which is called ARRIVE, was the
rampant spread of HIV. The AIDS epidemic dictated the
Q: What was helpful to you about this program? urgent engagement of IV-drug users in New York City. It
just seemed unfeasible to tell addicts that you have to get off
A: The community and the spirit [of one addict helping drugs before I can help you to prevent the spread of HIV or
another]. Also, we had a clearly defined beginning, middle help prevent you from getting it or if you're living with it,
and end to the program. And when we were in the final how to take better care of yourself.
phase, we were given drinking privileges. The concept of
successful treatment was for participants to [become] It was sort of an accident that we shifted the emphasis to
responsible members of society, and part of that health and well-being and away from being clean and sober.
reintegration was to be able to socially drink. At the same time, many of my staff are people in recovery
who are practicing an abstinent lifestyle. Having done this
It actually worked really well for me. I had drinking now for over 20 years and witnessed the extraordinary
privileges when I was still part of a therapeutic process. [If response by New York's drug using population, whereby
they saw that] people were abusing or misusing alcohol, it thousands of people have voluntarily entered our program, it
could be dealt with clinically to help us to gain more tells me that there's a better way to go if we want bring more
understanding and better control. people into recovery.
Some of us did very well and never had a problem; others Q: How do you manage to mix people who seek abstinence
did not do well. I believe that [the failure of those who did with those who are still using without threatening their
poorly] is the reason they changed the [desired] outcome of commitment to abstinence?
treatment from becoming a responsible member of society to
becoming a lifelong teetotaler, someone who was expected A: First, the idea of recovery and abstinence for many is in
to be drug free for the rest of his life. the background of everything. We're just not shoving it
down people's throats. That gives them an opportunity to
Q: At the same time, there was the growing influence of move along the recovery path at their own pace.
treatment centers like Hazelden, based on 12-step programs.
The whole world of addiction is a very black-and-white,
A: Yes. There was that expansion of the 12-step model into clean-and-dirty world. My effort in hoping to have a more
addictive behavior other than alcohol addiction. We started inclusive definition of recovery means that we start to take
to see programs like Narcotics Anonymous and Cocaine the world of addiction out of black and white and define a
Anonymous growing in the '80s. I was fascinated by it. In gray area, where most of life exists.
the late '70s, I attended a few [AA] meetings, more out of
curiosity than anything else. I stopped drinking for a while. I We want to help people feel better, and take any positive
thought it was great, extremely helpful and spirited and steps that a person is making and acknowledge those steps.
energetic. [People who have not been able to achieve abstinence] have
been considered failures, and we keep reinforcing the low
I'm still a fan! [But] I have my own personal understanding self-esteem they have, so their depression deepens and the
of addiction and how to deal with it. I see addiction pain becomes larger and with that so does the need to self
somewhat differently than 12-step people who see it as a medicate. [We want to end that cycle].
disease. I see addiction as a beast — but a beast that can be
mastered. [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.
By Maia Szalavitz , Tuesday, September 28, 2010