Howard Josepher, Recovery Rebel - Page 2

By Sally Chew 06/08/13

Before getting clean, "Howie" was a junkie with a gun, dealing and stealing. Since the '80s, his nonprofit has helped thousands of the neediest addicts—even if he had to break the rules along the way.

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Josepher at a pot-decriminalization rally photo

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The 1988 NIDA grant to teach prison parolees about HIV got Josepher started on his path. He helped found ARRIVE based on two radical practices: First, don’t test participants for the virus at all—anti-HIV stigma was so strong, Josepher argued, that this might deter the very people he intended to lure—and let actively using junkies join in, no judgments, no problem. It was a time when fully half of New York City’s needle-using population already had HIV, so risk reduction was literally a matter or life and death.

Many of Josepher’s colleagues in drug treatment took a while to come around—New York’s Office of Alcoholism and Substance Abuse Services (OASAS) was only able to acknowledge harm reduction’s successes very recently. Federal funding for needle exchange is still banned in the US, and some recovery organizations, including 12-step and prison-run programs, oppose the very premise of harm reduction. Yet hundreds of studies over two decades have proven that this approach is effective—at both dramatically cutting HIV transmission and encouraging drug users to access treatment.

The current-day agenda at Exponents itself has moved less than you’d expect, says Josepher. The underlying HIV issues are the same, despite the fact that medical advances have transformed both treatment and prevention, with more than 20 antiretroviral drugs that manage the disease.

And the social and psychological dysfunctions that have long driven the epidemic persist. “Many new infections happen among people who are unstable, homeless or lead chaotic lives,” he says. Hence the enduring value of the life-skills ("meet the person where he or she is at" and "treat the whole person") approach. 

Also extra-relevant now is Josepher’s mantra that illness and addiction is fueled by public disgust with people who are gay, use drugs and/or have HIV. The self-hate inspired by that stigma is still the main issue for lots of the addicts in his programs: “They’ve been through so many treatment programs and so many bad experiences telling them how character-flawed they are.” 

The federal ban on clean needle giveaways only reinforces the stigma, sending a message to addicts that in society’s view, their lives are not worth saving. Yet what separates heroin addicts from prescription drug takers, argues Josepher, is often just the law: “We’re telling our people, ‘You’re doing what 25 million Americans are doing. You just chose an illicit substance, and that’s the only real difference.’”

Josepher’s mantra is that addiction is fueled by public disgust with people who are gay, use drugs and/or have HIV.

“Denise” takes a legal drug now: Suboxone, an opiate replacement therapy. She doesn’t consider herself clean yet, because while she hasn’t shot heroin in 23 years (and put down her crack pipe and pills "a while back"), she stayed on methadone that whole time and wants off the Suboxone, too. 

Denise thinks she’s ready now because she has “people”—Exponents offers periodic daylong “retreats” (all free of charge) so that graduates can stay connected—and because she has begun to take care of herself in a more deliberate way. At ARRIVE, “I learned to like who I was,” she says. “Before, I wasn’t living a life.”

Whether “Obamacare” will help Exponents help many more of the most needy addicts learn to "live a life" remains to be seen. Josepher says the government’s thinking on recovery is still too rigid to significantly support programs like his: “For instance, there are people whose health is negatively impacted by their use, but they’re not necessarily drug addicts. Where [under "Obamacare"] is the primary care physician going to send that person when the only option is 'We’ve got to get you off of drugs'? "

Already the federal budget sequestration, which mandates 5% across-the-board cuts in discretionary spending, has resulted in low-income people with HIV losing access to treatment and housing, while HIV prevention is also being slashed. An estimated 200,000 Americans—many of them the target population of urban nonprofits like Exponents—will be denied access to substance use treatment. Josepher says, "The high cost of drug care in terms of addiction is that substance use exacerbates other health concerns." The long view that treatment is cost effective—a given of public health policy—has yet to move partisan politicians in the budget wars. 

The day after Denise’s ARRIVE graduation last month, she went to her first 12-step meeting in 20 years: the same Woodside Narcotics Anonymous meeting she had once attended. There were a lot of the same people at the meeting who she used to see there back in the day. “A lot of them are clean. But a lot of them are not,” Denise says, clearly embarrassed on behalf of the ones who are not.

Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas. 

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Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas. She last wrote about marijuana, the way our ancestors smoked it and which drugs belong on the suicide list. You can find Sally on Linkedin and Twitter.

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