More than 2,100 people died in 2021 in Cook County from opioid overdoses, twice the number of homicides attributed to gun violence. Black residents accounted for more than half of these overdose deaths despite making up less than a quarter of Cook County’s population.
America’s response to drug crises like the one we’re experiencing today has traditionally involved the threat or use of criminal sanctions. Mandatory minimums for drug offenses in the late 1980s attempted to deter drug use through long prison sentences. Drug courts in the 1990s and 2000s combined required treatment for substance use disorders with the threat of punishment for not complying or reoffending while in treatment.
These approaches have done little to stem the steep rise in overdose deaths in the U.S. since the 1990s. Could there be a different way to connect people with treatment while reducing our use of criminal justice system resources — without compromising public safety? To answer that question, it helps to understand why past approaches have failed.
During the “Just Say No” era of the 1980s and early 1990s, law enforcement agencies operated under the assumption that the only way to reduce drug use was with the threat of criminal punishment. The implicit assumption was that people struggling with substance use disorders simply didn’t want to enter recovery, and sanctions were the only way to incentivize treatment. The result was zero-tolerance policies such as three-strike laws and mandatory minimum sentencing, which could lead to long prison sentences even for first-time drug possession offenses.
This approach did little to address the root cause of drug use. Between 1990 and 2010, the number of overdose deaths in the U.S. increased from just under 10,000 per year to nearly 40,000.
Realizing that harsh sentences alone failed to limit drug use, policymakers turned to drug courts, which mandate substance use treatment and ongoing drug testing in lieu of prison time. Today, half of all U.S. counties have at least one operating drug court, and Congress recently made $750 million available to help expand them.
This approach centers treatment but continues to assume that people need to be motivated by external factors — such as the threat of criminal sanctions — to enter recovery. Here in Cook County, participants are required to plead guilty, participate in mandatory drug testing and remain on probation for two years. As a result, these drug courts continue people’s entanglement with the criminal justice system, including the creation of a criminal record that can harm their chances of getting employment down the road. And because the monitoring of people that drug courts involve is so resource-intensive, it means that drug courts usually operate at just a tiny scale — often serving only a few dozen individuals each year.
What if we reexamined the assumption that individuals with substance use disorders need to be coerced to get help? Countless studies have proved the efficacy of treatment as an effective response to substance use disorders, but the reliance on sanctions and heavy monitoring has never been well justified. Put a different way, what if the problem wasn’t motivation for treatment but rather treatment access?
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Chicago’s Narcotics Arrest Diversion Program, or NADP, offers us a chance to answer this question. NADP is a partnership among the Chicago Police Department, Chicago Department of Public Health, behavioral health provider Thresholds, and the University of Chicago Crime Lab and Health Lab.
NADP connects people with treatment, including medication-assisted treatment, without using the criminal justice system’s resources to monitor or sanction them, opening up the possibility of reaching individuals at a much greater scale.
NADP offers people arrested on nonviolent, low-level drug offenses the opportunity to receive substance use treatment instead of a criminal record or jail time. The program is different from drug courts, as it does not require people to go through jail, several court appearances, a guilty plea and the start of a probation term before they engage with a treatment provider.
Under NADP, eligibility is determined as soon as people are arrested. If arrested with small amounts of drugs without any serious co-occurring charges, people who are eligible are immediately connected with treatment. They are not formally charged with a crime and are not monitored for compliance with the treatment program. As a result, participants are not punished if they return to use or drop out of treatment.
Does this approach work? The first sign of success is that take-up has been exceptionally high. Unencumbered by resource bottlenecks, the program has connected more than 1,100 people with treatment since its launch in 2018. More than 98% of those offered diversion opted in, and 79% of diverted participants began treatment.
The second sign of success is a reduction in future arrests among program participants. The Crime Lab’s evaluation found that NADP participants were 72% less likely to be rearrested in the future — driven by a reduction in arrests for drug and violent offenses. These results demonstrate that enabling recovery instead of punishing drug use can simultaneously reduce the unnecessary use of criminal justice system resources and increase public safety.
Last year, the Chicago Department of Public Health responded to these early findings by making the program available in every single neighborhood in the city. Earlier this year, the program was scaled up even further — the eligibility criteria were expanded to nearly double the number of people who qualify for diversion.
As the opioid crisis continues to loom large, NADP offers a new blueprint for connecting Chicagoans with addiction recovery support where and when they need it. These early results show that a sanction-free approach to reducing substance abuse not only works but also can work at scale and without incurring the harms of harsh penalties.
Ashna Arora is a research director at the University of Chicago Crime Lab. Panka Bencsik is an assistant professor of medicine, health and society and of public policy at Vanderbilt University.
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