During his 16 years as a Parole Officer, Jeremy Hubbard supervised caseloads focused on opioid use disorder and domestic violence. He now runs a consulting firm dedicated to advancing and expanding the use of MAT in criminal justice.
You have a long and distinguished career as a parole and probation officer. What are some of the attitudes and beliefs around addiction and treatment in the criminal justice system?
The single most detrimental belief is that deterrence and punishment will lead to positive outcomes when working with people suffering from addiction.
This belief that the fear of punishment will lead to positive change has been pervasive within the criminal justice system for the last 30+ years. It does the opposite: it creates hopelessness and disconnects people from the services that help.
Sufferers of addiction don’t change because of threats of or application of punishment.
Instead, they abscond, they go deeper into hiding, and they lose even more attachments to their families and the community.
The second most detrimental belief goes hand in hand with deterrence and it’s the belief in “hitting rock bottom.”
The belief that the consequences of addiction must be so great and damaging, that someone must fall into such depths of despair before they can get better, is tragic and incredibly damaging.
It gives helpers an excuse to give up on somebody or to look for other ways to punish someone so they can hit “rock bottom.” How much damage and hurt could be avoided if we just met people where they’re at? Provide services that reduce suffering without the expectations of abstinence or “hitting rock bottom?”
Of course, I would feel remiss if I didn’t mention the reluctance and avoidance of the criminal justice system to provide “medications for addiction treatment” (MAT). For far too long, the positive effects of MAT have been known, confirmed by research, and ignored by the criminal justice system and many traditional treatment programs.
Many view MAT as a crutch or a substitution for opioids, not as an effective treatment option. This belief has caused countless people to avoid or be denied MAT, and even those who do receive MAT are often persuaded or forced to discontinue treatment too early.
You’ve mentioned feeling disheartened by certain internal procedures and day-to-day realities as a PO. Can you give us examples of those policies or practices?
The criminal justice system doesn’t do a great job with substance use disorders (SUDs). We were doing things that were harmful. The swift and certain sanctions put people in acute withdrawals. The likelihood that they’re going to overdose increases. The likelihood that they’re going to recidivate increases because they go to jail for a short amount of time, they’re incredibly sick, and they make some decisions that are bad.
For example, we might release them at 1 a.m. in the morning with whatever funds they might have accumulated while in custody. Well, where else are they going to go? There’s no other place to go except for their drug dealer’s house – that’s the only person who will answer the phone or answer the door.
Coming from a place of abstinence-only, strong-arming through home visits and disrupting people’s lives, and posting photos of mugshots online every time they’re arrested, even if those were just for probation violations or citations – these kinds of things that we were doing really disconnect people from the care and support systems that they need. For example, employers don’t like to see mugshots of their employees, places like the Gospel Mission stop accepting people after so many entries in the system. Eventually I decided I needed to do something different.
What was the “lightbulb moment” for you?
Unfortunately, the “lightbulb moment” didn’t come quickly or easily. Even though I believed I was helping people, far too many were suffering from my decisions. This was most true for my clients with opioid use disorder (OUD).
The first thing that really struck me was how few of my clients with OUD would report to me for any significant period. This was new to me. I had always taken pride in the fact I could “get people in the door.” But, as I started supervising more and more clients with OUD, my rate of reporting began drastically dropping and the number of warrants I had to request skyrocketed. Since most of these clients were suffering from OUD, I knew the problem was in my approach, not with each individual client.
I figured the first step to better understanding the problem was to ask my clients why they hadn’t been reporting to me. This wasn’t an easy task!
I had to build trust with my clients and assure them they could be honest without fear of retribution.
Then I had to shut up and listen — to hear their feedback and not get defensive or provide justifications (even when warranted). Once I heard them, I had to take what I learned and change my approach, which meant being willing and open to take in feedback on my new approach.
Getting my clients to report more often was a good start, but for me it wasn’t enough. I wanted to help them once I got them in the door. I started researching during work and in my free time. I read research paper after research paper. I watched TED talks and training videos from a variety of sources like the AMA, SAMHSA, and criminal justice and addiction experts.
Based on my research, I then created a proposal to start an OUD-specific caseload that focused on:
- Increasing reporting
- Creating positive relationships with my clients
- Developing partnerships with social services agencies
- Supervising clients to wellness
What are some of the successes you’ve seen when MAT and other types of recovery support were introduced into jails and other resource centers?
From a general perspective, the number of clients who never reported that started taking part after MAT was provided and showing up for supervision was amazing. The reduction in warrants and incarceration time also really surprised me.
I had clients who had been on supervision for 10+ years and over 70 lifetime arrests who got off supervision and didn’t come back!
One success that stands out the most for me was a pregnant woman who started MAT while at the jail. She was serving a long sentence and had zero history of complying with supervision. Once she stabilized on MAT, she was released early to attend residential treatment – which she completed, her baby was born drug-free, and eventually she completed supervision successfully.
How have others, both in and out of the criminal justice system, responded to the kinds of results you’re seeing?
Locally, I’ve seen many positive reactions and outcomes. Collectively, this led to a completely different view of MAT within community corrections, from MAT being a frowned-upon treatment to one that is interwoven within the department. All parole officers are trained in MAT and many received specific training on supervising clients with OUD. We also introduced MAT as a treatment option at the local transition center.
With my clients, I witnessed a significant increase in reporting, reduction in rearrest, and reduction in probation violations. My clients expressed hope and gratitude and my relationships with them improved.
Outside of the criminal justice system, I have been able to share my experience and results with medical providers within my community and across the state of Oregon. I’ve worked hard to bridge the gap between community corrections and MAT providers. Once I started creating partnerships with MAT providers in the community, referral superhighways were created and clients discovered additional support services including peer coaching and coordinated care.
I believe these kinds of partnerships are the cornerstone for creating significantly more positive outcomes for people suffering from SUDs. They create a coordinated response and create the opportunity to provide support for the whole person, not just their substance use issues.
With the decriminalization of drug possession and the move towards a harm reduction model of SUD treatment, hopefully the criminal justice system will continue to move towards treating the underlying causes of criminal behavior rather than focusing on abstinence from drugs.
How might others apply what you’ve learned?
The lessons I hope will resonate with practitioners are:
- Listen more, judge and talk less – meet people where they are and genuinely try to see things from the client’s view
- Read the literature – study, research, and continue to look for proven strategies that provide the best outcomes
- Create relationships between criminal justice, medical practitioners, traditional SUD treatment programs, and social services agencies
- Find common ground within these relationships and be willing to hear difficult things about your approach and your profession
- Cross-train with those who provide valuable services to your clients
- Learn to trust each other – we all want the same thing: a safer community and healthier clients
- Find champions in each field – real change comes from finding others who are motivated to achieve better results and will work to make it happen