Sticks and Carrots: Kick-Starting Treatment in Vermont

Friday, February 1st, 2013

barbed wire fenceLindsay Lohan reportedly turned down a deal that would give her the option of going to rehab instead of jail—an unfortunate choice since treatment is exactly what she needs. How else will she rebuild her relationships and restart her career…not to mention stay out of jail?

For most people who find themselves facing an addiction-related charge, treatment is the option that helps them change—a truth my home state of Vermont has recognized for decades. We’ve also found that, when motivating folks to seek treatment, “The key [is] offering sticks and carrots,” explains Ann Ramniceanu of Spectrum Youth and Family Services.

She’s exactly right—a combination of rewards and penalties inspires people to get the help they need, fast. For instance, New York Times columnist David Bornstein recently praised a Vermont program that provides “bench referrals” to kick-start the recovery process; judges can refer certain defendants to treatment right after arrest, and clients can expect reduced sentences if they complete the program successfully. It’s a win-win situation.

Another ongoing effort to help, not just punish, Vermont’s drug offenders began in 1994, when Vermont instituted Phoenix Houses of New England’s Intensive Substance Abuse Program (ISAP). In the ISAP, as long as drug offenders continue with treatment and stay drug-free, they spend their sentence on furlough instead of in prison; that’s the “carrot.” However, if a defendant violates the terms, they are sent straight back to prison instead of court; there’s the “stick.”

This swift recourse creates a hefty incentive to stay in treatment, which leads to the program’s high retention rate of 60 percent—far above the average 42 percent retention rate for outpatient programs. Plus, the recidivism rate is only 30 percent for those who complete ISAP, compared with 45 percent for non-completers.

This formula also holds true for a new Phoenix House pilot program that will expand the drug court model to include alcohol offenses. After screening defendants for alcohol issues, an agency refers them to Phoenix House ISAP for assessment and treatment before their trial and sentencing. As a condition of probation (“carrot”) clients agree to undergo treatment and update the judge on their progress. If they violate the agreement, they may lose this probation benefit (“stick”).

Vermont courts deserve accolades for recognizing that drug offenders need crucial help today—not months from today—as well as incentives to stick with treatment. Ramniceanu is correct when she says that “if people are given access to a solution quickly – ideally within 72 hours – the outcomes change pretty dramatically toward the positive.” The quicker you can get somebody into treatment and motivate them to stay, the better you can manage their success.

Richard Turner
Vice President and Senior Program Director of Vermont
Phoenix House

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