What does it mean to be a recovery advocate? Who should stand up and be counted? Why is it more difficult for some people to become recovery advocates? This online discussion will explore how individuals can make a difference by raising their voices in support of recovery.

Anita R. Marton is a Senior Attorney with the Legal Action Center, a public interest law firm specializing in legal and policy issues concerning substance abuse, AIDS, and the criminal justice system. Since joining the Center in 1988, she has provided training, policy assistance and legal services to individuals, policymakers and organizations concerned with such subjects as: the laws prohibiting discrimination against ex-offenders and individuals with drug and alcohol histories or HIV-related illnesses; the confidentiality of substance abuse treatment records and HIV-related information; and issues relating to welfare reform and the criminal justice system.

Ms. Marton has testified before numerous legislative committees; lectured in more than 35 States; participated in ground-breaking litigation defending the rights of people with alcohol and drug histories, HIV disease and criminal histories, authored a number of publications, and served on numerous state and federal advisory panels.

Before joining the Center, Ms. Marton was a staff attorney with the Legal Aid Society's Criminal Defense Division and Criminal Appeals Bureau.

Ms. Marton has a law degree from Northeastern University and a BA from Brandeis University, where she graduated Summa Cum Laude.

Chat Transcript

MODERATOR: Anita Marton is a senior attorney with the Legal Action Center, a public interest law firm specializing in legal and policy issues concerning substance abuse, AIDS, and the criminal justice system.

Since joining the Center in 1988, she has provided training, policy assistance, and legal services to individuals, policymakers, and organizations concerned with such subjects as: the laws prohibiting discrimination against ex-offenders and individuals with drug and alcohol histories or HIV-related illnesses; the confidentiality of substance abuse treatment records and HIV-related information; and issues relating to welfare reform and the criminal justice system.

Our topic today is Civic and Appointed Officials: Raising Voices for Recovery. What does it mean to be a recovery advocate? Who should stand up and be counted? Why is it more difficult for some people to become recovery advocates? This online discussion will explore how individuals can make a difference by raising their voices in support of recovery.

Please note that the views and opinions expressed by non-CSAT staff members in the Web chats and Webcasts should not be interpreted as official CSAT policy, but, as the views and opinions of the individuals participating in these events.

farra: What is the best way for me to get involved?

ANITA MARTON: There are many different things that individuals can do to advocate for better and sounder policies that promote recovery. There are currently in place many different laws and policies that create barriers for people in recovery who are entering the workforce. For example, many individuals in recovery find that employers are reluctant to hire them even though there are laws in place to protect individuals with drug and alcohol problems from discrimination in the workplace. So one thing that individuals can do is try to work with their elected officials to put policies in place and get laws enacted to make it illegal for employers to discriminate. For example, in New York we have a law that forbids employers from discriminating against individuals with a history of drug and alcohol use and people who have current problems but are able to perform their jobs. Individuals who wish to get involved in the recovery effort can try to advocate for such sound policy, and individuals who are in recovery and feel comfortable doing so should go public with their stories to try to combat some of the stigma that still remains.

Herbert Mann: Are there any HIPAA/medical privacy record issues that you've dealt with or you feel the public should know about?

ANITA MARTON: First of all, you should know what HIPAA is. It stands for the Health Insurance Portability and Accountability Act of 1996. This was a law that was passed in 1996 designed to protect health information transmitted in electronic, written, or oral form. Just last week the U.S. Department of Health and Human Services (HHS) issued final regulations for HIPAA implementation beginning April 2003. We at the Legal Action Center have been studying the HIPAA regulations for the last few months. The HIPAA regulations address many of the same issues as the Federal Drug and Alcohol Confidentiality Regulation. The overlap of these two sets of regulations present drug and alcohol treatment programs with the challenge of being governed by two Federal laws that have established different, and in some cases, seemingly inconsistent privacy standards. We are in the process of analyzing how the HIPAA standards apply to the alcohol and drug confidentiality regulation. So at this time we do not have a complete assessment, since the regulations were only finalized last week. In general, the most important point to remember is that there are actually few conflicting provisions between the alcohol and drug confidentiality regulation and the health privacy regulation. Many HIPPA provisions permit but do not mandate the disclosure of health information, while the confidentiality regulation prohibits all disclosure except those specifically allowed by the regulation. HHS has stated that no conflict exists in this context because the health privacy rules are permissive, not mandatory.

MODERATOR: For more information, please visit http://www.samhsa.gov/hipaa/ and http://www.cms.hhs.gov/forms/

treasa: Is advocacy more effective from the top down, or the bottom up (through education)?

ANITA MARTON: In general, advocacy is important at every level. We clearly need more funding for such services as education, prevention, treatment, and recovery research. We need to hear from individuals that need these services. And we need to hear from public officials who are willing to take a stand and expand substance abuse prevention treatment and research.

freddie hegle: I'm a recovered addict with a criminal record and have paid my debts to society but find that my past limits my employment options. What can I do to prove to prospective employers that I am not the same person I was?

ANITA MARTON: Unfortunately, discrimination does exist not only against individuals with drug and alcohol problems, but also against individuals who have prior convictions. You are absolutely right that many individuals with criminal records do find that employers are often reluctant to hire them. At the Legal Action Center, we work to fight discrimination on behalf of individuals with criminal records, drug and alcohol problems (current or past), and individuals with HIV and AIDS. And unfortunately we know all too well the barriers that many individuals have to overcome in order to find gainful employment. I don't know if your State has any laws that protect against this kind of discrimination. In New York for example, we have a law that forbids employers from having flat bars against hiring ex-offenders. Under this State law, an individual with a criminal history may be denied a job due to that criminal history only if the conviction is directly job related or if the conviction indicates that the applicant poses a threat to people or property. The Legal Action Center has a new national program called the HIRE Network that helps to promote the hiring of individuals with criminal records. If an individual wants to know what the policies his or her State has with regard to the hiring of individuals with criminal records, they should call the HIRE Network at 212-243-1313 and we can provide more specific State information.

drbuck: Do you see drug and mental health courts as a positive direction for public officials to impact needs of consumers?

ANITA MARTON: I believe it is a positive step that criminal courts have begun to recognize that drug and alcohol and mental health problems are often precursors to criminal activity, and that in order to effectively address that activity they have to address the underlying drug or alcohol or mental health problem. Clearly, no one should have to commit a crime in order to find a treatment slot. Individuals should have access to treatment way before any criminal activity takes place. Thus we clearly all need to continue to advocate for more funding for prevention, treatment, and research so that there is treatment on demand. However, for those individuals who find themselves involved in the criminal justice system, I believe it is a step forward that many courts are not using incarceration as the only way to address criminal behavior, but instead are referring people for treatment. Practices vary around the country with regard to how drug and mental health courts operate. Some courts, for example, are better at understanding that relapse is part of recovery and use graduated sanctions before they incarcerate an individual, while other courts are less willing to give individuals a second chance. So while the practices do vary, in general, I believe the growth of drug and mental health courts is a good thing.

Angie: What advice would you give for those individuals who are currently in recovery who may want to become an advocate, but may not feel comfortable doing so?

ANITA MARTON: Clearly individuals have to feel comfortable coming forward and identifying themselves as being in recovery before they do so, and should not be forced to make such a disclosure. So we are in a catch 22. In order to combat the stigma that people face, individuals have to be willing to come forward and say they had a disease, recovery is possible, I am a tax paying citizen, and we should treat addiction no differently than any other disease. If enough people come forward it will help combat the stigma. For those individuals who are not comfortable revealing their own recovery, there is still much that they can do to help the recovery movement. Many individuals who advocate for better policies with regard to drug and alcohol prevention, treatment, and research are not in recovery, but understand that drug and alcohol problems cost our Nation billions of dollars annually and that without a serious investment in education, prevention, treatment, and research, the millions of individuals with alcohol and drug problems do not receive the treatment they need. And they will not receive the treatment they need until there is a serious investment. So individuals can advocate for more funding, they can advocate for laws that prohibit discrimination against individuals with alcohol and drug problems, and they can work to promote sound policies without having to identify themselves as being in recovery.

Jessica Bellinder: Have you found strategies that are particularly effective when advocating at the State or local level for more money for drug and alcohol treatment or for the development of more treatment and prevention services?

ANITA MARTON: Yes we have found strategies that are helpful. Clearly, we know there is a need for more treatment but the more specific that we can get with regard to what the need is, the more likely it is to get increased funding, which is increasingly difficult given the tough fiscal times we are in. For example, if you know there are waiting lists for treatment in your community, it should be documented. Also, if there are specific stories that individuals have about the difficulties they faced in finding an appropriate treatment program or if there are specific stories that people have that show that treatment works, they should be dually noted. These are the kinds of things the public policy makers often need to hear in order to demonstrate the need for increased funding for treatment, prevention, education, and research. In addition, public officials, especially those who are elected, need to hear from constituents about the need for treatment. Consumers are a very, very important part of the advocacy effort to get increased funding for education, prevention, treatment, and research.

drifter: The medical community has determined that addiction is a disease. Does the law view addiction as a disease as well? What legal implications does the addiction as disease model hold for the prosecution of individuals who commit crimes related to their disease (theft to fund drug-seeking behaviors, etc)?

ANITA MARTON: Even though the medical community does view addiction as a disease, it is clear that our criminal laws do include activities involved with drug use. Thus, we see drug courts that try to straddle both views by enforcing the prosecution of drug cases while at the same time referring individuals for treatment in lieu of incarceration and acknowledging that the disease drives the activity that is considered criminal. There have unfortunately been many laws passed over the last few years that particularly single out criminal activity involving drug and alcohol use as worthy of special attention. For example, the Higher Education Act of 1998 suspended eligibility for any grant, loan, or work assistance for students convicted of a drug related offense. The Federal welfare law denied cash assistance and food stamps to individuals with drug felony convictions, not individuals with other types of convictions, though States can opt out of this provision. So on the one hand, we do see with the growth of drug courts an increased understanding that addiction is a disease and should be treated as such. But on the other hand, we also see policies being promulgated that demonize the drug addicted offender.

sal: When advocating for the funding of treatment programs, what is the best way to address the issue of the high rates of relapse when many feel that this causes a very poor return on investment?

ANITA MARTON: It is clear that some individuals are not successful in treatment and that relapse is part of recovery. However, there are numerous studies that have found that treatment is effective at reducing drug use and crime. At the Legal Action Center we have a list of those studies. Just to cite one for example, a 1997 grant corporation study found that drug treatment was 15 times more effective at reducing serious crimes committed against people and property by drug offenders than mandatory minimum sentence. Thus despite the failure rate which greatly varies, depending on the studies you look, at modalities of treatment, and the context of treatment, i.e., self-referral or criminal justice mandated, it is clear that treatment works and that there is a major benefit to the local economy. There is a reduction in crime, a decreased burden on the foster care system, etc., when individuals successfully complete treatment.

MODERATOR: Our host has some concluding remarks...

ANITA MARTON: I want to thank everyone for your terrific questions. There is a lot of work that needs to be done by all of us to fight discrimination and to advocate sound public policy. If individuals would like to work with the Legal Action Center and find out what they can do, or find out about the work we do, you can contact us at 212-243-1313.

MODERATOR: Our hour has concluded. For more information, visit CSAT's Recovery Month Web Site at http://www.samhsa.gov and click on the Recovery Month icon.

We would like to thank our host, Anita Marton from the Legal Action Center for her participation in this online event, and thank our participants for their questions. This transcript will be available shortly so that others may benefit from the dialogue.

Join us for our next live Web chat on Wednesday, September 18 from 3 to 4 p.m., featuring Elena Carr, national coordinator of Working Partners for an Alcohol and Drug Free Workplace, U.S. Department of Labor. Our topic will be Employers and Employees in Unison: Supporting Through the Workplace.

The chat has now officially ended.