Pathways to recovery

State officials in Alaska are aware of the shortage of options for alcohol treatment, particularly at detox centers, but are struggling to fill the void. However, a few youth detox centers have been able to balance the number of beds and incoming patients.

*Medical research has done wonders to rid populations of diseases; however, the U.S. health care system has failed to appropriate the right resources to Medicare patients with one or more chronic conditions. Health Quality Partners in Doylstown, PA enrolls Medicare patients with at least one chronic illness and hospitalization and sends a trained nurse to see them on a routine basis, whether they are healthy or sick. As a result, the HQP program has reduced hospitalizations and cut Medicare costs.

Across the country, hospitals are embracing intensive intervention programs to help victims of violence — including those who have criminal histories — after they have been brought in for treatment of injuries. Such programs can help prevent retaliation, reduce the chance a patient will be violently injured again, and put people on track for success.

In Colorado, four communities are piloting a program that offers low-level drug or prostitution offenders an alternative to prison. This program, known as Law Enforcement Assisted Diversion, matches the offender with a case manager who in turn connects them with treatment and training resources.

Across New Hampshire, youth are leading the fight against substance abuse. Programs like Dover’s Youth-to-Youth, Stand Up Sachems, Youth Leadership Through Adventure, and the Making it Happen Coalition, are all youth-led, adult-supported initiatives that are empowering young adults to create and disseminate substance abuse awareness and prevention campaigns. Fundamental to each of these efforts effective communication and creating a sense of community as key to prevention.

The Law Enforcement Assisted Diversion (LEAD) program in Alamosa, Colorado, gives police officers the option of sending people to substance abuse treatment rather than straight into the criminal justice system. Used in non-violent cases, the diversion program is based on a harm-reduction model that uses a health-care approach rather than a punitive approach to address the underlying issues when a crime is committed. Some police officers object to the program's mission, but proponents say that forcing compliance would be counterproductive.

Vermont's hub and spoke model of care has gained notoriety as being a system that has successfully played a positive role in creating better access to health care, especially as it relates to the opioid crisis. Now, officials in New Hampshire are looking to scale and adapt the program to work in their state.

Fifty years on, America's war on drugs has failed at its principal goals: to eradicate illicit drug use and sales, to repair communities damaged by the drug trade, and to prevent drug-related deaths. Despite massive amounts spent on law enforcement, which has created great social harms and fueled incarceration, drug use has rebounded to 40-year highs, drug overdose deaths are peaking, and supply of illegal drugs is abundant. Policy advocates say a combination of legalization and public-health approaches to the problems would accomplish more than the wasteful, ineffective "war" mentality used to date.

New Hampshire's Rockinham County gives some people with extensive drug and criminal histories an offramp from the criminal legal system, in the form of housing at Cross Roads House and a drug court to emphasize treatment over punishment. But, while other cities in the state meet such needs with multiple programs, the second-most populous county in the state has a severe shortage of supportive housing and services. Such services can make the difference between prison and success, and even between life and death in a place with high rates of overdose deaths.

San Francisco considers the scaling of safe injection sites, which were successfully piloted in Vancouver, to become the first city in the United States to offer this service. However, the main challenge of starting such a service in San Francisco is helping the public get over the concern that safe injection sites encourage drug use for non-abusers. Community groups actively educated the public on the benefits of safe injection sites and politicians made trips to Vancouver to observe the success in action.