KNOX, Ind. — Nate Meeks stood before his fellow inmates like a preacher in front of his flock.
An open book in one hand, gesticulating with the other, the 42-year-old talked about his breakthrough in his recovery from heroin and cocaine addiction.
"For me, it was humility," he said, his peers seated at cafeteria tables secured to the concrete floor, two-way mirrors reflecting back at them. "I was able to stand up in front of 94 guys at Westville prison and say, 'I need your help.' "
Meeks, of LaPorte, was surrounded at the Starke County Jail by about two dozen men, also in orange jumpsuits and serving years behind bars, walking the same path he was: the long road back from drug addiction. In a short time, he said, they'd become like family.
The inmates are part of an experiment in Indiana: to find out if substance-addicted offenders sentenced to state prison have a better chance at recovery in county jails. Compared to prisons, the jails tend to be smaller, have less drug and gang activity and are closer to inmates' families.
The pilot project signifies the growing acknowledgement that drug abuse is a public health issue and that treating addicts is more effective than simply locking them up for lengthy stretches. The initiative also fits with the state's mission of reducing its prison population by housing low-level inmates in county jails.
"There was a time when I would give the repeat drug offender the maximum prison sentence and say, 'If you come back, I'll do it again. And if you come back, I'll do it again,' " said Starke County Judge Kim Hall, who helped bring the program to Knox. "They always came back."
Eligible for reduced sentences, graduates of the therapeutic community treatment program have a recidivism rate roughly half that of the general prison population, state officials say. The peer-driven rehabilitation teaches emotional regulation, parenting and job training, among other skills. Each of the inmates has a specific role in the organization, from cleaning to mentoring.
"It is its own community," said Megan Fisher, an addiction counselor with the Indiana Department of Correction. "The thrust is you can't do it alone. It's important to have a recovery community around you."
She believes the treatment can work even better in the more intimate setting. "When you've got 600 guys in a program, it's easy to find a corner to hide in and just kind of skate through," Fisher said. "When you have this small of a group, they're pretty much forced to get real or get out."
The program in Knox includes substance-addicted prison inmates sentenced in Starke and the seven counties that border it: Porter, LaPorte, Jasper, Pulaski, Fulton, Marshall and St. Joseph. According to the Robert Wood Johnson Foundation, Starke, Porter, LaPorte and Pulaski counties each have drug overdose mortality rates higher than the state average.
Tim Lisak, a 27-year-old from LaPorte serving a six-year sentence for burglary, is in therapeutic community for the second time. The former heroin user believes he has greater odds of success in the county jail.
When he did it at Westville state prison, he said, drugs made their way into the unit where the program took place; that hasn't happened in Starke County. He said the group at the jail is also more tightknit.
"Everyone here's got the same goal," he said. "They want to live."
Lisak has a lot at stake. He has two kids, including one born Feb. 20, while he was behind bars.
Chris Walters, who was incarcerated for committing a burglary to fund his heroin habit, was in the program at Westville before coming to Knox to be a mentor. The 35-year-old believes the jail presents a better opportunity for getting clean.
"The atmosphere here is more family-like. You can actually focus on your recovery," said Walters, of Michigan City. "Westville is full of drugs, gang activity. It's a huge difference. You don't have contact with the general population here."
Dan Hensell, another inmate who moved over from Westville, gave up freedoms coming to Knox — the ability to go outside, contact visits with family — but said it's been well worth it.
"I'd trade 115 visits for being sober," said Hensell, of LaPorte, who's doing time for selling cocaine. "My son, who I was locked up with in Westville, is 20, and I'm 40. He's never seen me sober."
Steven Thompson, a native of New Chicago, said he feels "fortunate" he was arrested in Porter County since it's part of the pilot project. He'd been selling heroin and prescription pills, he said, to support his addiction.
The 33-year-old says therapeutic community is more effective than other rehab he's tried. "There, we just sat around in a group, glorifying drugs," he said. "It made me want to do it more."
A great need for treatment
Both inside and outside of jails and prison, only about 11 percent of substance-addicted Americans receive treatment, according to research by the National Center on Addiction and Substance Abuse and the National Institute on Drug Abuse. The difference is, two-thirds of the people behind bars are dependent on drugs or alcohol, compared to just 9 percent of the general population.
However, before addicts run afoul of the law, there often aren't a lot of places they can turn to for help, particularly if they don't have private insurance.
The problem is particularly acute in Indiana. The state has the fourth largest shortage of substance abuse specialists, with just 18 providers for every 1,000 addicted adults, the Pew Charitable Trusts found. The national average is 32.
Also, more than a fifth of Medicaid recipients in Indiana have a substance abuse disorder, one of the highest rates in the nation, according to Pew. But only 55 percent of addiction specialists accept Medicaid due to its low reimbursement rate.
Dr. Johann Farley, a substance abuse specialist in Merrillville, said he has seen Medicaid patients for whom he has not been compensated at all. "We don't want to have to deny people who need help," he said.
Leo Smith, a drug counselor at Porter-Starke Services in Knox and Valparaiso, said the state could use more residential rehab facilities (though, he acknowledges, that would require public funding). The few that exist generally have waiting lists of several weeks.
"The best time to get somebody help if they're an addict or alcoholic is when they're ready," he said. "Once they start thinking about it, they'll surely think of a way out of it."
But rehab doesn't work for everybody. One of the Starke County inmates, Matt Straight, tried getting treatment on the outside but couldn't stay clean. The 29-year-old said he turned himself in for forgery because he knew he'd be going into therapeutic community.
"The only way I could get off drugs was being locked up," said Straight, of LaPorte.
The men obviously can't leave, and the treatment is intensive. The program is five days a week, for six hours a day, and lasts a minimum of eight months. The jail also is participating in a pilot program to give inmates, prior to their release, injections of Vivitrol, a medication that reduces the cravings for opioids and alcohol. The offenders are then referred to a local community health center for continued therapy and monthly injections of the drug.
Knox, about 30 miles southeast of Valparaiso, is that part of Northwest Indiana where heavy industry transforms into farmland. It's one of any number of small rural towns in America where methamphetamine use runs rampant.
Starke County leads the state in per-capita meth-lab seizures. The county sheriff's office arrests three to five people a week for meth. Three-fourths of the inmates at the Knox jail are locked up for meth-related charges.
"Everyone likes to think we're the meth county in the state," said Sheriff Bill Dulin. "We're trying to change that."
After Judge Hall got tired of having the same addicts cycle through his courtroom, year in and year out, he saw an opportunity with the new Starke County Jail. The way the cellblocks are set up, it's easy to segregate populations. He thought it would be an ideal setting for therapeutic community.
So Hall pitched his idea to state officials. He said moving the prison inmates to the jail would make it easier for them to get to court, probation meetings and community corrections, and for their families to visit, improving the men's chances at recovery. He also noted the economic impact: It costs $35 a day to incarcerate someone in jail, compared to $50 in prison. If the 1,700 inmates in therapeutic community were housed in county jails, that would save the state $10 million a year.
"I've come to believe that therapeutic community is the best treatment program in the state of Indiana," Hall said in his chambers on the fourth floor of the imposing Gothic courthouse, the tallest building in the largely vacant downtown. He was flanked by three rifles and a bust of Teddy Roosevelt's head. "But prison's a rough place. Some people come out worse than they came in."
Jail warden Phil Cherry believes fixing the substance abuse epidemic requires a more compassionate approach. "These are our neighbors, our family members," he said.
During the recent treatment session, a handful of the inmates did a majority of the talking. You could tell for some, speaking about their addictions was just too raw. The guys challenged and engaged one another; it was more a conversation than a class.
"The constructive criticism, the debates we have here are just awesome," said David Tierney, 27, of South Bend. "It's like having big brothers."
They talked about acceptance, about accountability, about spirituality. After one inmate explained his concept of a higher power, Fisher, the counselor, said that "sounds like hope." Signs were posted on the wall with such affirmations as, "Progress Not Perfection," "I Deserve Happiness" and "Another Day Clean."
After he was done leading the class, Meeks, his facial features worn from years of substance abuse, talked about his plans for life on the outside. He said he intends to start a support group in Michigan City for ex-offenders and addicts. He wants to become a drug counselor.
A few weeks earlier, corrections officials at Westville had asked Meeks to help launch the pilot program in Knox. He agreed, and became a mentor to the incoming prisoners. By successfully completing therapeutic community, his sentence for forgery was reduced by two-thirds.
"I'm excited about life again," he said, sounding sincerely hopeful. "Even my kids have noticed a difference in the way I talk, the language I use."
"One day, I want to come back and see how this program is doing," he added. "A part of me is here with these guys. We're like the pioneers of this."