Category: Alcoholism

When Craig Stedman began his career as an assistant district attorney 28 years ago, the drug epidemic facing the country was crack cocaine. Heroin or opioids weren’t even a close second.

“You could count on one hand how many heroin cases we had,” he said recently. “Even at the beginning of my term as DA in 2008, we didn’t have as many opioid problems as we do today. In the past five years, we’ve just had an absolute explosion in heroin cases and heroin-related deaths.”

From his position as the county’s top law enforcement official, Stedman sees the impact arrests and convictions are having on the local illicit drug market. Unfortunately, he said, the problem isn’t going away—it’s just going in a different direction.

Just recently, for example, the Lancaster County Drug Task Force captured a long-time heroin dealer who was selling cocaine and methamphetamines. He had no heroin on him.

“We asked him, ‘You’re a heroin dealer! What are you doing with this stuff?’ He said, ‘Look, dude, I’m not catching a body in Lancaster County.’”

Stedman said dealers aren’t giving up, they’re just adapting to changing conditions. Fentanyl-laced heroin is killing people in high numbers, and drug dealers know that if what they sell kills someone, they’re going to jail for a long time.

“And they’re not willing to take that risk,” he said. “So, while we’re definitely making a difference from an enforcement perspective, I’ll be the first to tell you—and I’ve said this a million times—we are not going to arrest our way out of this problem.”

The Bigger Picture

The long-term answer isn’t enforcement, Stedman said. The long-term answer is education, prevention, and treatment.

“And not just treatment—long-term treatment,” he said. “Short-term rehab just doesn’t give the brain of a heavy heroin abuser the time it needs to recover from acute addiction.”

Aftercare is critical, Stedman said.

“As a country and as a county, we need to invest in long-term treatment,” he said. “As a heroin addict, you don’t go into a 15-day rehab and expect everything to be just fine. Heroin addicts are going to struggle with this the rest of their lives. Thankfully, organizations like The GateHouse understand that. They treat the whole person, not just the symptoms of the addiction.”

To truly address the problem, Stedman believes local, state, and national leaders need to make treatment a priority with proper funding.

“So far, unfortunately, I haven’t seen a willingness to do that, so you’re getting this revolving door,” he said. “These people think they’re fine because they’ve been told they’re fine, but they’re not fine. They’re heroin addicts, and their brains are wired that way. It’s science. They need the right tools.”

The Paths to Addiction

Although his focus is on the adjudication of crimes, Stedman said he’s learned a lot about addiction during his time as a prosecutor. He said he sees two typical paths to opioid addiction.

The first is through prescription medication.

“We’re learning that some people are more biologically prone to addiction than others,” he said. “After a surgery, two people might go and get an opioid prescription. One of them might say, ‘I never want to use that stuff ever again.’ The other might say, ‘This is the greatest feeling I’ve ever had. I never want to stop.’ At that point, it’s no longer a choice. It’s an addiction.”

The second path is the “gateway path.”

“That’s the more traditional one, and unfortunately, it’s the one a lot of heroin users take,” he said. “They start with alcohol, or marijuana. They’ve got the biology, they love the high, so they start using or drinking more and more, and they find out they can’t recreate that high they crave. So, they switch to cocaine, and the same thing happens. At first, they’re like, ‘Oh, this is awesome,’ but then they become tolerant to it. Now they’re using cocaine all the time to recreate that high, and it doesn’t work. That’s when they switch to heroin.”

Had they never been exposed to the drug, they would probably be fine living their entire lives never having a concern about it, Stedman said. Once they’re exposed, either through experimentation or prescription, it takes over their lives—and the lives of those around them.

“It doesn’t just damage the person who’s using,” he said. “It destroys everyone who cares about them. It’s this huge wake. The family keeps trying, and they can’t get them to get help. We actually did a public service announcement with a couple of mothers who lost their kids. It’s gut-wrenching stuff. It’s horrible.”

Beyond Arrests and Convictions

Stories like these are why he’s tried to find new and innovative ways to address drug crimes before they start. A few years ago, Stedman hired community outreach coordinator, Sarah Fritz. It was the first hire of its kind in the history of the Lancaster County DA’s office.

“She’s not a lawyer, and she’s not a police officer,” he said. “She’s a civilian. Her whole focus is on building relationships within the county and within the school systems to further the goals of outreach, prevention, and education.”

While she has addressed bullying, pornography, and other social ills affecting the county’s youth, Stedman said Fritz’s primary outreach efforts have centered around drugs.

“Again, we’re not going to enforce our way out of this,” he said. “We need to be much more proactive, and that’s why we’ve really tried to think outside the box—beyond arrests and convictions.”

Speaking of boxes, Stedman’s office also introduced a lock-box initiative using drug money seized from dealers.

“Since one of the key pathways to opioid addiction is prescription drugs, we’ve taken forfeiture money and bought little lock boxes to hand out,” he said. “They have little combinations on them, and they’re designed to encourage people to lock up their prescription medications.”

While the lock boxes aren’t meant to withstand overwhelming force, Stedman said, they’re just sturdy enough to keep dangerous prescriptions out of the wrong hands.

“A lot of people who have surgeries and are prescribed controlled substances don’t even think about it,” he said. “They take them home and put them on the top shelf of their medicine cabinet and forget how dangerous they are.”

The lock boxes are a way for people to make sure these medications are secured.

“This is a tangible way to do something proactive,” Stedman said. “If it saves one life, it’s worth it.”

Diversionary Programs

One of the big issues facing law enforcement is what to do with offenders once they’ve been caught. In Lancaster County, whether to prosecute a case or refer it to a diversionary program is determined on case by case basis, Stedman said.  Sometimes it’s an easy decision, sometimes it’s not.

“The guy who sells heroin for money to people he doesn’t know, and someone dies, he’s going to be treated a whole lot worse than two heroin addicts who were friends and users together and one gives it to the other and that person dies,” Stedman said. “They’re just completely different situations.”

Lancaster County law enforcement reserves its harshest penalties for what Stedman calls “predator dealers.” But not everybody falls into that category. About 22% of the DA’s cases are sent to some sort of diversion or treatment program, whether it’s ARD or a treatment court like drug court, mental health court, or veteran’s court.

“We’ll try to find the right court for the right person,” he said. “Obviously, depending on what the crime is, we have to find the right balance. If a heroin addict broke into someone’s home, for example, there has to be accountability for that.”

It’s tough, because not every case is easily sorted out.

“Many of these people are not bad people,” Stedman said. “They don’t have evil intentions. They’re just addicts. It’s no different than any other disease.”

While Stedman has ultimate authority over how a case is handled in Lancaster County, he doesn’t make the decision himself, he said. Whether a case involving substance abuse is prosecuted or sent to a diversionary program depends on a variety of factors and a variety of input.

“All the programs have teams, so I’ll listen to what the team recommends,” he said. “We also have to talk to the victims. That’s very important. If it’s a victim crime—DUI, personal injury, or something else—we’re going to want to get their input. We also rely a lot on input from the police officers who have often dealt with these people before.”

It is unlikely, for example, that a predator drug dealer would find his way into a treatment court. On the other hand, someone with ties to the community who has slowly descended into criminal behavior as the result of a substance dependence might have the opportunity to enter a diversionary program.

“We’re looking for people who have a chance of success,” Stedman said. “We also look at the drug. Obviously, the marijuana dealer is going to have a better chance of getting more lenient treatment than somebody who’s out there selling fentanyl. With the people selling fentanyl, you know somebody’s probably going to die.”

People who commit sexual offenses are statutorily prohibited from entering diversionary programs, so they’re not even considered, he said.

“We also have a modified track,” Stedman said. “It’s not necessarily a diversionary program, but it’s not a straight guilty plea, either. If you complete the appropriate program, we’ll drop the felony and you’ll just have a misdemeanor on your record. For some of the cases that are in the gray area, a modified track usually works well for everybody involved.”

The Pursuit of Justice

When it comes down to the final decision, however, Stedman said he and the team are asking themselves one very important question: “What should happen here?”

“It’s a complicated question in one way, but in another way, it’s a really simple question,” he said. “What’s the right thing to do? Does this person need to be in jail? Does this person need a second chance? Will this person benefit from a modified track? What is the best thing?”

Stedman said it’s important to treat everyone as an individual.

“They’re not just numbers in a case file,” he said. “The victims are people and the defendants are, too. We’re just tasked with the job of determining what’s going to be the best long-term outcome for the community. If the team can sell me on a case, and they want to take a chance, then I’m not afraid to do that. Sometimes it backfires. Sometimes it doesn’t work.  Unfortunately, nobody gives you a crystal ball.”

While the DA’s drug task force is bringing in more drug-related criminals than ever before, Stedman said more work needs to be done. Drug-related deaths are everywhere—even in places you’d least expect them.

“We just had a case a couple months ago, where we had a death in prison and made arrests,” he said. “A couple of guys who were picking up trash on work release arranged to have someone put heroin out for them. They brought it back to the prison, and one guy died. Another guy almost died.”

Tragedies like these often leave Stedman shaking his head.

“I think we need a stronger word than ‘addiction,’” he said. “I don’t think that word captures it enough. If you put an axe and some heroin on the table in front of some of these addicts and say, ‘If you take the heroin, we’ll chop your hand off,’ they’re not even going to think about it. They’re going to tell you to chop their hand off. They can’t even think straight. It’s just completely taken over their brains. That’s why I really appreciate the work that organizations like The GateHouse are doing to try to help people.”

When Lancaster County’s drug court first opened its doors in 2005, no one knew whether the pilot program would meet its many goals or head to the scrap heap of well-intentioned, but unworkable initiatives.

Expectations were high. Drug court promised to improve public safety, save taxpayer dollars, and reduce drug and alcohol recidivism among repeat low-level offenders. Naturally, there were plenty of skeptics.

Fifteen years later, however, drug court has become a Lancaster County institution and a vital part of the community. Not only has it met or exceeded its lofty goals, drug court has transformed the lives of more than 200 graduates of the program, who have gone on to lead better, more productive lives.

For Judge David L. Ashworth, who has served as drug court judge since the very beginning, it’s one of the most professionally rewarding parts of his job.

“It’s tremendously rewarding,” he said. “It’s really neat to see people get their lives back.”

A Program that Works

When it began, drug court was wholly unique within the Lancaster County judiciary. Part treatment program, part support system, and part judicial proceeding, drug court brings together prosecutors, defense attorneys, probation officers, law enforcement officials, social service representatives and the treatment community. These groups work together to provide sentencing alternatives for qualifying offenders who show a demonstrated desire to change their lives and break the cycle of addiction that has fueled their petty criminal behavior.

Unlike typical courtroom proceedings, drug court can often be quite animated. It’s not unusual to hear members of the public cheering from the gallery as participants describe their achievements in recovery. There are tears, too, of course, as people come to grips with what they’ve done and discuss how their lives have changed since they entered drug court.

“The community has really embraced it,” Judge Ashworth said. “And not just the recovery community—law enforcement, the District Attorney’s office, and everybody else. It is clearly recognized now as a program that works.”

People, Not just Offenders

Be that as it may, the program is not for everybody.

In a TedX talk delivered in 2015, Judge Ashworth told the audience that drug court is not a “hug a thug” program. Those accused of drug dealing, sexual offenses, or violent crimes are not welcomed into the program. Those looking for an easy way out of jail won’t find it through drug court, because drug court is far from easy, he said.

“It’s a rigorous treatment program that’s designed to give people who want to remain clean and sober the tools to do so,” Judge Ashworth said. “In many cases, it’s much harder than spending time in jail.”

For the people who do take it seriously and spend time working the 12-18-month program, the results are rarely disappointing.

“What’s really neat about drug court is that you get to know these people as people, not just offenders,” Judge Ashworth said. “In many cases, I have come to consider them my friends.”

For the last 10 years, Judge Ashworth has taught about drug court, addiction, and recovery at Franklin & Marshall College.

“Quite a number of the graduates who have stayed involved come back and talk to my classes at F&M,” he said. “And I am routinely going out to high schools in the county and taking a drug court graduate with me. I was recently out at Hempfield and Conestoga Valley, and every year, I go to Manheim Township and talk to 400 freshmen.”

Lancaster County was the 13th county in Pennsylvania to adopt the drug court concept. There are now more than 100 treatment courts across the Commonwealth, Judge Ashworth said.

“When I say treatment courts, it’s the drug court model, but now they’ve expanded it to mental health court and veterans court,” he said. “Philadelphia even has prostitution and DUI courts. It’s all the same concept.”

To graduate from drug court, participants must complete an approved treatment program, maintain a permanent recovery sponsor, attend at least three drug counseling meetings per week, maintain full-time employment, remain drug-free for 90 consecutive days, and develop an aftercare plan.

That’s where recovery centers like The GateHouse come in.

Aftercare: The critical role of The GateHouse

“We have a lot of people who have gone through The GateHouse, and we have worked with The GateHouse since the very beginning,” Judge Ashworth said. “In fact, we have graduates who are working at The GateHouse now as counselors. I was just out at the women’s facility not too long ago, and one of our graduates is a counselor there. Another one worked there for years and has since gone on to get her master’s degree and is making a big impact in the recovery world.”

Judge Ashworth said the Lancaster County Drug and Alcohol Commission is the agency tasked with helping drug court find aftercare treatment facilities for its participants.

“There are certain facilities that are approved through county funding, and The GateHouse is one of them,” he said. “Depending on the specific needs of the individual, we will match them up with the appropriate facility.  We have a lot of people, who when they arrive at drug court, they first go into an in-patient program and then transition to a residential treatment program like The GateHouse. We use White Deer Run Cove Forge as the initial in-patient treatment program. When they get out of that facility, often times they’ll go to The GateHouse.”

The GateHouse is actually very well known within the recovery community, according to Judge Ashworth.

“We’re really fortunate,” he said. “Because we have been dealing with The GateHouse for a really long time, if we have an urgent need, very often we can cut through a lot of the administrative stuff and get them in there relatively quickly if there’s a bed available. It’s always tragic when people can’t find the resources. Lancaster County, unlike counties elsewhere, has tremendous resources. The best place to start is the drug and alcohol commission. They can point you in the right direction. Unfortunately, a lot of people don’t know where to start.”

RELATED: Addiction Through the Eyes of the Lancaster County Drug and Alcohol Commission

The Impact of the Opioid Crisis

Although there were at least 1,000 people who could have qualified for drug court in the beginning, the program was only extended to 50 people. Over the years, enrollment has grown to 90 at any given time.

“It fluctuates,” Judge Ashworth said. “We have three drug court officers. We have to be careful not to expand the program too much, because then it just becomes standard supervision, and the individualized treatment part of drug court will get lost. If you lose that, you lose the whole benefit of it.”

One of the reasons the program has expanded, however, is because more and more addicts are seeking ways to get healthy. The attention the opioid crisis has been given over the last few years has placed greater importance on holistic treatment of the individual and on new types of solutions like drug court.

“Those of us who have been involved in the recovery community for so long find it interesting that people are suddenly recognizing it as an ‘opioid crisis,’” Judge Ashworth said. “The reality is that this has been an issue for a long time. Quite frankly, the only reason it’s become so publicized is because people are finally realizing that it’s not just an inner-city issue. It’s not just a minority or low-income issue.”

It wasn’t until it began to impact the middle-class and upper middle-class sectors of society that the opioid problem became a “crisis,” he said. “Addiction affects everybody.”

“Has it become more of an issue since it’s been declared a crisis? I guess yes, because I see young kids whose very first drug of choice is heroin, which years ago was unheard of!” the judge said. “We see a tremendous increase in the number of people who start out with prescription medication and transition to the cheaper heroin when they run out of their prescription. We see a lot more of that than we have in the past. Thankfully, doctors have become more educated about it now, but for the longest time, you’d have a surgery, and a doctor would write a script for 60 oxy and then the person’s off to the races. They become addicted that quickly. Fortunately, that’s changing.”

A disturbing Trend

Recently, however, the influx of deadly fentanyl-laced heroin into Lancaster County has created a shift in the addiction landscape, Judge Ashworth said.

“Tragically, what we’re seeing—and we’re only going to see more of this—is an increasing number of people switching to methamphetamines, rather than run the risk of dying from a fentanyl overdose,” he said. “While Narcan works for heroin, if there’s too much fentanyl in there, they’re dead before the Narcan even has a chance to take effect. The police often find people with needles still stuck in people’s arms, and they’re dead before they can even receive the Narcan.”

Judge Ashworth fears meth is the street drug of the future.

“We’re going to see a huge increase in meth in the coming years,” he said. “It’s going to become even more of a problem. When police roll up on someone taking heroin, they’re usually pretty chill. When they’re all jacked up on meth, though, it’s a much different and more dangerous situation. Instead of a docile heroin addict, the police are now often confronted with a violent person, and it can get very ugly very quickly.”

He said he’s actually had drug court participants tell him they’ve heard about fentanyl-laced heroin, so they “decided to try something safer, like meth.”

“That’s just crazy,” the judge said, “Just because you can’t taint meth with fentanyl—it can’t be cut that way—that doesn’t make it any safer. In fact, meth is just as addictive, if not more so, than opioids.”

While the transition to meth doesn’t diminish the crisis created by the opioid epidemic, Judge Ashworth believes the discussion around street drugs needs to change.

“I think it’s great that we’re raising awareness to the opioid crisis, but I think just focusing on that alone is naïve,” he said. “The conversation should be about addiction to any substance. Any mind-altering substance needs to be addressed. For our 200^th graduate, it was alcohol. The addictive behavior needs to be addressed, not just the substance abuse.”

The future of Drug Court

With drug court having proven its worth to the legal community, the law enforcement community and the recovery community, Lancaster County has bought completely in to the concept. And the idea has spread. Judge Jeffery Wright now oversees Lancaster County’s veterans’ court and Judge Margaret Miller oversees the mental health court. Judge Jeff Conrad is currently being trained as the backup drug court judge, and he’ll eventually take over the role when Judge Ashworth retires.

But don’t expect that to be anytime soon.

“I plan on being around for a while,” Judge Ashworth said. “While I am the second-most senior judge on the bench here, I’m not retiring just yet.”

That’s good news for drug court.

Over the next few months, The GateHouse will be taking a look at the opioid crisis from the perspective of the public officials who are working to eradicate it through funding, public awareness, and education. We kick the series off with an interview with Rick Kastner, executive director of the Lancaster County Drug and Alcohol Commission.

In his 38 years with the Lancaster County Drug and Alcohol Commission, Rick Kastner thought he had seen it all.

Kastner, who has served as the organization’s executive director for more than three decades, said he has never witnessed anything like the opioid epidemic currently gripping the nation and the Lancaster County community.

“What makes the opioid epidemic unique compared to all others that I’ve been involved with is the number of overdose deaths, not only in Lancaster, but at the state and national levels,” he said. “That’s caught a lot of people’s attention—the fact that a person could be experimenting with an opioid one time in their entire life and then suddenly they’re dead.”

It’s also significant, Kastner said, that the epidemic has reached into the suburbs, killing scores of younger people who challenge the stereotypes typically associated with drug addiction. In 2017, 168 died by overdose in Lancaster County alone.

“Luckily, we have those numbers down to about 105 overdose deaths in Lancaster in 2018, so we’re making progress,” Kastner said. “We have a lot more financial resources available to combat the problem, and a lot more people are involved in trying to address the epidemic and turn it around.”

For Kastner, the attention is unprecedented.

“It is by far the most attention the drug and alcohol field has received in the 38 years that I’ve been with the office,” he said. “We’ve got a lot more people working on the effort, and we’ve got a lot of additional resources that we just didn’t have before.”

In fact, the Lancaster County Drug and Alcohol Commission is one of those resources. For those unfamiliar with the role the commission plays in battling addiction in Lancaster County—it is significant.

“The Lancaster County Drug and Alcohol Commission is the county department that receives funding from the state and the federal governments to manage, oversee, develop, and pay for drug and alcohol treatments, education, prevention, and intervention services in the county,” Kastner said. “People who are not eligible for Medicaid, but are low-income, that’s typically where the treatment funding from my office is involved. We pay for treatment, pay for drug and alcohol prevention education programs, we help develop programs, we evaluate them, we monitor them, and we oversee the system here in Lancaster.”

Organizations like The GateHouse play a pivotal role in helping the commission fulfill its mission of providing access to low-income and uninsured addicts seeking help.

“They’re part of our provider network,” Kastner said of The GateHouse. “We’ve been contracting with them for probably 40 years. We—and other providers in our network—refer clients to The GateHouse, and if they’re approved, then many times my office pays for them. Of course, we always try to utilize Medicaid funding first, because there are a lot more Medicaid dollars available, but for those Lancaster residents who are not eligible for Medicaid but are low income, then my office pays for the treatment at The GateHouse.”

That treatment is more important than ever. Kastner says what he’s seeing now from the public is a much different response than what he’s seen from previous epidemics, such as the crack cocaine crisis of the late 1980s and early 1990s.

“I think the opioid epidemic has a lot more people involved,” he said. “The governor himself  declared the opioid crisis an epidemic a while ago, and has a task force at work in Harrisburg, at the emergency management building on a regular basis. He declared it an epidemic or a catastrophe like he would, for example, if there had been a devastating hurricane or tornado. I see a lot more people in the last 3 or 4 years being involved with addressing the opioid epidemic than I’ve seen in the other epidemics like the crack cocaine crisis.”

Kastner does worry, however, that all the focus on opioids may shrink awareness of other drug issues facing the community.

“There’s a lot of people in our field, both in Lancaster and statewide, who are seeing an increase in K2 and methamphetamine addictions,” Kastner said. “We have a lot of resources earmarked specifically for opioid addictions—and some of our funding can only be used for primary opioid abuse disorder—so there is a concern that with strings attached to some of our funding streams and grants that we’ve got a lot of people out there addicted to other substances, including alcohol, that could be left out or hindered by the focus on opioid addictions.”

And these drugs have their own unique problems as their pool of users continues to grow.

“With K2 and methamphetamine, specifically, the biggest problem is that a lot of times they will create behavior in a person that mimic the behaviors of someone with a severe mental illness,” Kastner said. “The treatment facilities are not set up to deal with someone so out of control that they have no place to put them until they detox to a point where they’re no longer exhibiting psychotic behavior. So, typically, the only place that can control a person like that is either the prisons or an involuntary mental health facility. The drug and alcohol field to some degree cannot handle some of the behaviors we’re seeing with K2 and methamphetamine.”

There is, however, a lot of positive momentum that has come from the increased awareness from new segments of society.

“We have a lot more people understanding the disease of addiction,” Kastner said. “We have a lot of people out there who have lost their children and their spouses. People coming from good families and realizing that it’s not just a problem relegated to the homeless population. I think the public and the community are seeing that there is a stigma involved with addiction, that it is an uncontrollable disease that needs to be addressed with treatment, resources, and recovery programs. I’ve never seen that before. I think we’ve taken some great steps.”

As heartbreaking as it is to see people suffering with addiction, Kastner said it’s been eye-opening to see a renewed interest in the work the commission is doing.

“For 30+ years we were quietly just doing our thing and working with clients to get them into recovery programs,” he said. “There were a lot of people out there who individually knew the great work we were doing and what this field was all about, but the general public did not. From that standpoint, it does feel that we’re being validated more and accepted.”

There is still much more work to do, though, Kastner said.

“A lot of folks know some really fantastic people who have lost their lives to an overdose or who have been controlled by an opioid addiction,” he said. “A lot of them were innocent people who were simply taking their pain medication prescribed by a physician. I don’t think anybody realized for about 15-20 years that using long-term strong opioid pain medications was going to create thousands of addicts and that they’d eventually turn to street heroin and then suddenly die. It really is a tragedy.”

If you or someone you know is suffering from addiction and needs help, contact The GateHouse for information on the services we provide or give us a call at 717-393-3215. Our goal is to restore the human spirit through recovery by offering in-patient and outpatient services that treat the whole person, not just the disease.