By Jared Chausow
By Katie Toth
By Elizabeth Flock
By Albert Samaha
By Anna Merlan
By Jon Campbell
By Jon Campbell
By Albert Samaha
The guidelines, which went into effect October 1, lay out expectations for welfare recipients in drug treatment, including the number of unexcused absences allowed (none, in most cases) and the frequency of drug tests. And while a recently published National Institute on Drug Abuse guide says that most patients need three months of drug treatment to make significant improvement, the city guidelines specify that people getting methadone maintenance and outpatient services must abstain from drug use after 31 days in treatment, while those in residential programs must be abstinent from their first day.
Even before these changes went into effect, the loss of public assistance had left many drug addicts and alcoholics "homeless on the subways," says Corinne Carey, a lawyer at the Urban Justice Center. "Now with the treatment programs having to abide by these strict parameters, those numbers are going to be much higher."
Much of the controversy over the guidelines stems from what critics say is disregard for the nature of relapse. John Coppola, executive director of the Association of Alcoholism and Substance Abuse Providers, describes occasional setbacks as a normal part of the recovery process. "As a person moves from being severely addicted, it's not always a straight line from point A to point B." (Coppola says several treatment providers participated in drafting the regulations and stressed the importance of allowing for relapse in treatment but that their input was largely overlooked.)
Others point out that relapse and addiction itself is not a matter of will. "People think it's about drug users not wanting to comply when in fact it's about their inability to comply," says Carey. "My clients are not happy to be out chasing the drugs they're chasing."
Nevertheless, an isolated slipup can cause a recovering addict to lose their public assistance and, in some cases, Medicaid for up to 90 days under the new rules. HRA spokesperson Debra Sproles says such consequences are designed to make sure that treatment works. "The bottom line is that individuals who are receiving public assistance are receiving treatment through taxpayer dollars," says Sproles, who emphasizes that sanctions are one of several possible responses to "noncompliance." "Our first interest is to move an individual toward self-sufficiency," she adds. "But there has to be a certain amount of accountability."
But some advocates question the city's motivations. "They're more interested in kicking off people from welfare than helping them overcome their addiction," says Michael Kink, who works for Housing Works, an AIDS organization that's regularly at odds with the mayor. Kink also complains about the "cookie-cutter" approach of the guidelines, which provide charts to define treatment of drug users who may have complex problems.
"If a person has been using heroin every day for 20 years, and then that person is only smoking pot and having a beer once in a while, that might be considered progress," says Kink.
Providers no longer have the discretion to make that call, however. And, in what Kink calls a "classic Giuliani squeeze play," those who choose to use their own definitions instead of going by the guidelines will not be paid by the city. "It's 'I'm squeezing hard on your air supply, now let's talk about public policy,' " says Kink.
Regardless of whether it's in the client's interest, some lawyers say state welfare law specifically gives providers not HRA authority over treatment decisions. Robb Cowie, a lawyer with the Legal Action Center, is confident the center, which advocates for both drug users and treatment providers, can convince HRA to improve the guidelines. "We're hopeful we can work with the city and the state to insure that the guidelines aren't used in a way that will disrupt treatment for people who are making a good faith effort to comply with them."
But that remains to be seen. HRA's Sproles says that the new guidelines represent "the most compassionate thing we can do." And that they're final.
While the policy debate goes on, people in drug treatment who relapse may begin to see their benefits cut off, a blow that experts say will only set them back further in their recovery. "Losing benefits is just going to make it more difficult for the person who wants to return to treatment," said one drug-treatment provider who wanted to remain nameless for fear of retribution. "It's like giving an anchor to someone who's having a hard time swimming."