A Promising New Approach to Drug Use in an American City

At age 42, a Seattle resident named Johnny Bousquet celebrated more than year of being drug-free, having benefited from an enlightened new approach to drug use in his city: Law Enforcement Assisted Diversion (LEAD) (Kristof, 2019). In the LEAD approach, people caught possessing small amounts of drugs can be diverted from the criminal justice system, avoiding prosecution. Prosecution is reserved for dealers. When Johnny Bousquet was apprehended by an undercover police officer in 2014, he was referred to LEAD and assigned to a counselor rather than being incarcerated. Over the ensuing years, periods of sobriety and relapse alternated, but his counselor was steadily supportive. Johnny’s success story was told by a New York Times writer (Kristof) who argues for ending the American “war on drugs” that has been such a resounding failure for decades. Considering substance users as criminals and locking them up does not provide rehabilitation. Psychiatric-mental health nurses who espouse humanistic and recovery-oriented philosophy can join hands with Kristof (2019) and others who are advocating for treatment, not jail. Nurses know that recovery from substance use disorders is possible (see Worley, 2017, regarding the factors that improve successful recovery).

Johnny Bousquet’s story is emblematic of many patients with substance use disorders that are seen in psychiatric-mental health nursing practice. As Kristof recounts, “[he] was born with drugs in his system into a dysfunctional household. His mom, who had been raped by her father and her brother, self-medicated with heroin, and Johnny himself began selling crack at 13” (2019, p. 7). The tragic deaths of his mother, stepbrother, and sister occurred while he was still a teen, followed later by abandonment of his wife (who took his children with her when she left). Like countless others, he used drugs to medicate his trauma and pain. He was homeless on the Seattle streets when sent to the LEAD program. Now he is housed, employed, and paying taxes. As he told the reporter, “It’s a big deal compared to being homeless last year and sleeping outside with needles in my arm” (2019, p. 7).

The LEAD program, which includes social services and case management, was established in 2011 by a prosecuting attorney (Dan Satterberg) whose own sister Shelley had struggled with drugs and ultimately died from sequelae of her substance use. Satterberg realized that “what Shelley needed was not a jail cell and not a judge wagging a finger at her, but she needed some support” (Kristof, 2019, p. 7). Drug users who participate in LEAD are 58% less likely to be arrested after program completion, compared to a control group, according to a 2017 study cited in the New York Times article. Yet, this effective program in Seattle is still a rarity in our country. Possession of drugs is still criminalized, and only 20% of Americans with substance abuse disorders receive treatment (Kristof, 2019). Insufficient resources are devoted to prevention and mental health promotion.

Noted Cleary and Thomas in 2017 (p. 7):

Given the immense scope and complexity of addiction issues across the life span, it is clear that much work remains to develop more enlightened public policies, greater access to evidence-based treatments, clinical guidelines and recovery programs, and increased societal compassion toward individuals with substance use disorders and/or comorbid mental health disorders.

The LEAD program deserves wider dissemination and replication. Manuscripts about other promising approaches are invited.