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Out with Orthodoxy

January 1, 2007
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To reach the marginalized, a New York center tried flexible approaches before they were fashionable

Don’t tell the 40-person staff at the addiction treatment, outreach, and advocacy organization Exponents that terms such as “incentives” and “harm reduction” represent newfangled or unproven ideas in the treatment community. The New York City-based center, with roots dating to a late 1980s grant program targeting parolees with an injection drug use history, was engaged in these kinds of creative strategies for reaching clients long before most of the ideas even had a label.

At a time when many addiction treatment organizations are shoring up a foundation of 12-Step treatment with a variety of supportive services and individualized approaches to improve client engagement, Exponents can serve as a model for being willing to meet the client where he/she is situated—whatever the implications may be.

“We see our role as that of a conduit; we work with people in a noninvasive manner,” says Exponents’ charismatic co-founder and executive director, Howard Josepher, LCSW. “We tell people that we’re not here to modify their behavior and break them down. We can help people to change their behavior and develop new and enduring values.”

From humble beginnings teaching a class of post-release offenders in the basement of a Lower East Side church nearly 20 years ago, Josepher has seen his program of support grow into an organization serving 13,000 in a typical year and encompassing a smorgasbord of treatment, outreach, life assistance, and advocacy services.

From the time he and his cofounders didn’t take a salary for 18 months to their present status as an influential force in New York's drug treatment and policy community, Josepher and his team have consistently infused the organization with outside-the-box thinking. Perhaps that makes sense when one contemplates Josepher's own uncommon path, as a man with several advantages who in the 1960s found himself injecting heroin dozens of times a day and later being one of the first beneficiaries of New York's fledgling therapeutic community movement.

Exponents staff and former clients talk about the sense of belonging that for participants characterizes its programs, many of which are run by those who went through Exponents programs themselves.

“If the newcomer can see someone very much like them who's now making it, that can create the hope and spirit that is necessary,” Josepher says.

Program's roots

Exponents traces its roots to Josepher's being asked by a team of researchers to join a National Institute on Drug Abuse-funded project targeting criminal offenders reentering society. This late 1980s project marked the first time NIDA was focusing on a population of injecting drug users with or at risk of HIV infection, says Josepher, and he recalls the intense stigma that prevailed over how to address this group.

“This was a very dark time; people who were infected were being refused admission to treatment programs because of the fears that existed,” Josepher says. “There were reports that prison guards were wearing scuba gear when they transported inmates.”

At the time, Josepher had been consulting for drug treatment programs in the community and in the New York prison system. Under the NIDA-funded research project, he was asked to help develop the program's curriculum and lead its clinical component, consisting of educational sessions for reentering offenders. Seven men showed up for the first session taught by Josepher in the church basement; the program was known as Project ARRIVE (AIDS Risk Reduction for IV Drug Users on Parole), and retains that name today.

“People coming out of prison did not want a residential [treatment] situation, or an arduous commitment,” Josepher says. “The program we developed was similar to a three-credit college course. “They would come to three two-hour classes a week for eight weeks.”

This was also a time when few offenders who did not know their HIV status wanted to be tested, for fear that another form of prison sentence would be imposed on them if they received bad news. Grant administrators wanted testing to be a mandatory part of the program, but resistance from participants proved so strong that the research team made it optional.

Yet that did not stop Josepher from engaging in efforts to persuade participants to get tested. He even got tested himself, in an attempt to demystify the process for the others.

Soon women began to enroll in the ARRIVE classes as well. Topics covered in the curriculum ranged from HIV education to general health and wellness information to relapse prevention to tools for accessing health and social services in the community. Josepher and his team also had another item at their disposal to encourage participation in the early days: They paid participants $10 a class for their attendance, at a time when offering incentives in this fashion was practically unheard of. The team knew it was better to have people in the learning sessions, receiving the needed information about healthy lifestyle behaviors, than somewhere on the streets.

By the end of the two-year grant period, 167 people had graduated from the educational program, and the classes were supposed to cease. But based on positive feedback from participants and a small waiting list to enroll, Josepher and his team decided to keep the classes going, even without identified funding.

One day, Josepher was telling a friend how each class had gotten larger and had graduated more individuals than the previous one, and the friend remarked that such growth was “exponential.” The reference stuck, and the organization Exponents was born as a nonprofit corporation in 1990.