Q&A with Brooke Feldman, M.S.W.

You have said that wellness and recovery are not about good fortune but more about individuals and families having access to what they need, when they need it, and for however long they need it. How does that notion guide your work as center manager for CleanSlate centers in Philadelphia?  

CleanSlate’s mission and values already align with this notion, which is in large part what attracted me to my role as center manager for our two clinics in Philadelphia. Our model is centered around a low-threshold, person-centered, harm-reduction orientation that meets people right where they are and offers treatment and support from there. Particularly in our clinic situated just outside of Kensington, we engage people who may or may not be seeking or able to benefit from the treatment we provide at CleanSlate. There are some folks who come just because it is the one place they feel loved and accepted just as they are. Even if somebody doesn’t engage in treatment with us, our team will work hard with that individual to connect them to whatever treatment or other resources they are seeking. I see some of our greatest successes as connections we made to other treatment programs that better meet the needs of that person, including local harm reduction organizations for people not looking to stop their use just yet. I think that’s unique—too often, people are just turned away. Additionally, somebody can walk into our clinic uninsured, with no money, ID, etc., and we’ll help them get that in order and get started with treatment quickly.  

Also, there is no requirement for total abstinence to engage in treatment with us and no penalizing people for exhibiting symptoms of what brought them to us seeking treatment. Too often, if a person doesn’t recover the way that treatment providers think they should or in the timeframe they think it should happen, that person is kicked out of treatment. This is not something we do. We stick with folks and often find ourselves working with a population of people that the traditional behavioral health system repeatedly failed to engage, retain, and support. 

Your current work centers on building strong collaborative partnerships with criminal justice and behavioral health stakeholders in the community. Why is this important to ensure continuity of care for the people you work with?  

While my north star is the complete decriminalization of substance use, my pragmatic understanding is that this is not happening today or tomorrow, so we must figure out how to best support people ensnared in the justice system right now. The best way to do so is to collaborate and partner with that system’s gatekeepers and stakeholders. For instance, we know that the overdose death rate skyrockets exponentially upon release from incarceration. In order to prevent overdose deaths upon release, we must work with the criminal justice system to build as tight a bridge as possible to immediate post-release community-based harm reduction, treatment, and recovery support services. This cannot be done without developing strong partnerships and collaboration.  

When it comes to behavioral health partnerships, this is key to the work I do. I often get phone calls from a loved one of a person struggling with a substance use disorder. The caller is typically seeking the name of the program I think is the best. I always have to explain that there is no single “best” treatment program, but rather there are best options based on the individual’s unique needs. It is important to have strong collaborative partnerships with as many behavioral health providers and stakeholders as possible in order to best support individuals and families.  

You have spoken about your prior experiences with a substance use disorder and justice involvement. How do those experiences inform the work you do today?  

My past experiences walk alongside me in all of my work today. For certain, there is a deepened level of empathy and compassion that I have for others as a result of my having lived with a substance use disorder and juvenile justice system involvement. I think that it also makes me more sensitive to the trauma that often leads to, and is then compounded by, justice system involvement. For instance, I think of how the sound of my many keys for the clinic could sound like a correctional officer coming. I also remember the feeling of having to urinate in a cup in front of more strangers than I could count, and how even the act of having to produce a urine sample conveyed a distrust of me each and every time. Perhaps most important, those prior experiences fuel an undying passion to do all I can to support others in not having to experience some of the painful things I and many others experienced. I see this as macro-level work to advocate for change and then micro-level work with each individual I cross paths with.  

You’ve urged people in recovery to speak up about their experience in order to shift public perception around substance use disorders. How can people recover “out loud” and impact the lives of others with substance use and criminal justice histories?  

The discrimination, stigma, and internalized shame surrounding substance use and substance use disorders is deadlier than substance use in and of itself ever could be. People who use drugs or live with a substance use disorder are pushed to the margins of society in every possible way, from criminalization to familial and social distancing to substantial barriers surrounding employment, housing, and education. This marginalization drastically increases when intersecting with other marginalized identities, such as being a person of color, a member of the LGBTQ+ communities, a non-English speaking person, a poor person, etc. When we put faces and names to people who use drugs or have lived with a substance use disorder, we humanize a dehumanized condition.   

While each person’s recovery is unique, the more people who talk openly about what worked for them, the more opportunities for others to hear of possible solutions. It is important to note, however, that it is not until the most marginalized among us is humanized that any of us are. The face of the current opioid crisis is a White male with opioid use disorder, often painted as a victim of evil pharma and irresponsible doctors rather than as a person who chose to use drugs. If a Black trans woman who is poor and uses drugs isn’t benefiting from the decreased criminalization, discrimination, stigma, and internalized shame that the White male who uses opioids is benefiting from, then our shifting of public perception has failed.   

The same is true for those of us with criminal justice histories. Nearly everybody has been socialized to see a person with a criminal justice history as a bad person who has done bad things. This fails to take into account the disparities in how those of us with marginalized identities are policed and incarcerated. When we humanize the dehumanized condition of criminal justice involvement, we see decreased social distancing and barriers to full citizenship in the community. It is my belief that being seen in one’s full humanity and being able to participate in the community with full citizenship is as critical, if not more so, to sustaining long-term recovery as any treatment or recovery support services could be.  

Behavioral health, GAINS, Recovery supports, Treatment courts