No End In Sight

The projections are alarming: 82,000 opioid overdose deaths annually by the year 2025 for a total of 700,000 mortalities between 2016 and 2025. Interventions in their current form will help lower the numbers but only by three to five percent.

What Are We Doing Wrong?

That’s a good question considering that the healthcare, criminal justice, and legal costs associated with substance abuse annually exceed $500 billion.

Systemic Chaos

Funds are lacking. So are resources. But equally debilitating is the helter-skelter, ad hoc approach forced upon administrators as they race from crisis to crisis. It’s clear: Even the best-run, best-staffed, best-funded programs can still be ineffective when there are major gaps in service, as is the norm today.

“Bouncing” Clients

Another major problem is the way clients bounce from street corner to shelter to emergency room to jail, and then repeat the cycle again and again. It’s not unusual—in fact it’s the norm—for clients to make progress while at a facility, then regress almost immediately once they’re back on the street surrounded by danger and temptation.


Stability is a guiding principle of the Fletcher Group. Specifically, that means providing services and treatments at the same location where the client is sheltered. The advantages are numerous and easy to imagine. One that’s critical and shouldn’t be overlooked is accountability.


In a Fletcher Group recovery center, clients remain accountable to the same group of people day in and day out—the people they live with, work with, and learn with. The avoidance of accountability (a skill that life on the street tends to reinforce) is much more difficult to pull off when you’re surrounded by familiar faces to whom you’ve worked with and made a commitment to.

A Positive Environment

This is the kind of environment where promises are much more likely to be kept, not only by the client but also by administrators, counselors, and healthcare providers. And that kind of behavior—the repeated act of keeping promises and honoring commitments—makes for a positive, invigorating, and ultimately successful experience for everyone involved.

Best Practices

For more details about the Fletcher Group approach, click The Model. But before doing that, if you care to, let’s first ask, “What elements and attributes might create the perfect program?” For that, click Best Practices.

“If we reduced our prison population by 25 percent, that’s 20 billion dollars we could save. And if we invested half of that in treatment, we could really increase people’s likelihood of success.”

—“Dopesick” by Beth Macy

“’No matter where you turn in this epidemic,’ East Tennessee State University public health professor Robert Pack told me, ‘there are systems in place to address the problems, but none of them are working together.’ The biggest barrier to collaboration is the fact that everyone involved views the problem too rigidly—through the lens of how they get paid.”

“Dopesick” by Beth Macy

“They don’t rehabilitate you in prison and they don’t make it easy for you to get a job. I truly believe they don’t make it easy because they want you back, and they want you back because that’s the new factory work in so many places now—the prison.”

“Dopesick” by Beth Macy

“As that narrative of addicts as criminals further embedded itself into the national psyche, the public became indifferent to an alternative response that could have eased treatment barriers, he said. As an example he cited Portugal, which decriminalized all drugs, including cocaine and heroin, in 2001, adding housing, food, and job assistance—and now has the lowest drug-use rate in the European Union, along with significantly lowered rates of drug-related HIV and overdose deaths. In Portugal, the resources that were once devoted to prosecuting and imprisoning drug addicts were funneled into treatment instead.”

“Dopesick” by Beth Macy

“I keep coming across patient after patient who has been through rehab with either no benefit or with negative effects. Since really diving into clinical practice in the private sector, my tolerance for the existing way of doing business is gone. It’s atrocious that this is allowed to continue. And the treatment system systematically blames people for not responding. It’s as if you want to buy a car and there is only one model available so you’re forced to buy it. Then when the car you’re sold doesn’t work, you get the blame because you drove it incorrectly.”

—Mark Willenbring, MD, Former Director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism and Founder of the new Alltyr Treatment Clinic in St. Paul, Minnesota.