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Q&A

‘Methadone Is Better Than Jail’

A conversation with Sandie Alger, former inmate and recovering heroin addict.

On a recent episode of the podcast “Criminal,” a 71-year-old woman named Sandie Alger spoke of her life of crime. Alger, who first started stealing checkbooks (and identities) as a teenager, found herself in and out of California jails and prisons for over three decades before she quit the criminal life altogether in the late 1980s. Throughout, she was addicted to drugs, mainly heroin.

Today, more than two decades after she entered rehab herself, Alger is the director of the women’s program at the Triangle Residential Options for Substance Abusers, an intensive, long-term drug treatment program in Durham, N.C. Many of the young women she works with have cycled in and out of jail because of their addictions, just as Alger did.

She knows much about the old criminal justice system of the 1960s, 70s and 80s, having seen it from the inside. But she also has hands-on experience with the sometimes-destructive ways in which today’s criminal justice system handles people with drug addictions.

We asked her how the system – and the people in it – have changed over time.

Based on your own experience and also what you’ve learned from the women you work with, how has the criminal justice system changed over the last half-century?

Well, for one thing, back when I started out, there were very few women. When I would go to jail, I would be the only woman there on a felony. There’d maybe be a few women who were drunk. But now, there are many, many women in the prison system. That is something that has changed.

Another change I’ve seen is that the system, especially the police, are just meaner. In my time, it wasn’t like that. I was the criminal and they were the police, sure, but they didn’t hate me personally. But then at one point my probation officer told me it was time to [give up a life of crime], because everything was getting meaner, and I could really get hurt. And that’s really turned out to be true. The police are now so much quicker to shoot. Shoot first, ask questions later.

What has stayed the same?

One thing that hasn’t changed at all is that it’s the people without much money who go to prison. If you’re not poor, you get an attorney, probation, house arrest, all that. But if you’re poor you go to prison.

And how has the criminal justice system changed in terms of how it handles people with drug addictions?

One thing that everybody says they’ve “learned” is that addiction is a disease. We all now are aware that it is a brain disease.

But nothing much has changed because we still treat it like a crime. So, so, so many of the people who are in prison today are there because of drugs. That’s always been true, and it’s still true. Even if they’re not there for a “drug crime,” which is a lot of people, they’re there because they’ve stolen to get drugs, or killed people over it, or they’re in the business. Drugs are really the root of mass incarceration.

I don’t know why that hasn’t changed, if we say we know that addiction is a disease. I have many family members with diabetes. If they mess up, and they’re noncompliant with their diet or with taking their insulin – the same way an addict would be noncompliant with her treatment – we don’t send them to prison for it.

Should drugs, including more dangerous drugs like heroin, be decriminalized?

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Absolutely. Like I said, addiction to drugs is a disease, and should be treated that way, not by locking people up. It would also take all the money out of selling drugs, and be helpful in reducing the violence surrounding the selling of drugs.

I think in the beginning, right after you decriminalized heroin, everyone would go a little crazy. There would be some problems. But that would quiet down when people get used to it being legal, and there would ultimately be no more addicts than there are now, because as I said, addiction is a disease, and diseases are things that only some people have. And I think there would ultimately be fewer of the non-addicts, the beginners, because when something is legal and expensive it is less exciting.

The media has suggested that there is now a heroin “crisis” in America. Have you seen any evidence of that?

Oh, I hate to say it, but yes, this is very real. It’s bad. When I first moved here and started this job, 78 percent of the people who came through our program were African-American and had a crack addiction, most of them in their late 30’s or 40’s. Now the people we see are almost all white, middle-class, young opiate users. They are these young white kids – 19 to 25, still adolescents, really – who started off on pills and ended up on heroin.

How do you think this “crisis” developed?

I hate to blame it on the doctors, but I will. There was a point starting about 15, 20 years ago when everybody’s parents started having pain meds in their medicine cabinets. Doctors had just simply started prescribing Vicodin in a heartbeat, like it was nothing. You don’t need prescription opiates unless you’ve had major surgery, but they started prescribing it for all kinds of injuries. And then kids would get the pills and then move on to heroin.

Are there pharmaceutical treatments for addiction that you have found to be particularly effective?

I find Naltrexone, which goes by Vivitrol, to be somewhat effective. It was first made for alcoholics. You get a shot once a month, that doesn’t give you a high, and it’s good at keeping down the cravings.

The other treatments aren’t very good. Methadone is better than jail, better than “life on the installment plan,” going in and out of jail like so many people do who have addictions. But it is not good. It eats up your body. And Suboxone maybe works with less hardcore addicts, but I’m pretty sure it’s a temporary solution. Many of these people will go back to heroin eventually.

So if we’re going to decriminalize drugs, and the pharmaceutical treatments are hit-or-miss, what is it going to take to deal with the “crisis” you said was happening?

What it really takes, for people with addiction, is finding something to replace the addiction. A job that’s challenging. A life.

It’s very easy to say this. But to do it takes a lot of time, effort, engagement, commitment. It’s going to take real investment. We’re going to have to say as a community that we care about these women and we are ready to give them our all. That’s what it’s going to take.