Recovery for lots of people doesn’t involve a 12-step program or necessarily even getting clean and sober. At a nonprofit program in New York City calledExponents, you can study “life skills” instead: What exactly happens in your body when you swallow your HIV meds (or eat green vegetables), for instance, or how to care enough about your classmates to get off the couch and take the subway to Exponents three times a week, on a schedule.

Ex-junkies, ex-cons and people with HIV have a lot of the same problems, and Exponents founder Howard Josepher has applied the same basic solutions, for all 25 years he’s been in the business: Stability, peer support and a smidgen of science. You’ll start using again anyway, says Josepher, if you don’t get to the root of the matter—that “habitual drug taking is a form of self-medication.”

Josepher pioneered the still-controversial concept of bringing together active drug users, former users on methadone, and users practicing abstinence, all in the same room. “The idea of recovery and abstinence is in the background of everything. We’re just not shoving it down people’s throats,” Josepher says. It’s a branch of the harm reduction movement that quietly shoulders on, less in the spotlight than needle exchange. It’s all a little too quiet, in Josepher’s opinion. He worries that even though “Obamacare,” when expanded coverage kicks in next January, is expected to connect many more severe addicts to treatment (mainly via Medicaid), his holistic approach still won’t get the attention it needs—and demonstrably deserves. It is based on an alchemy of interventions that have proved their effectiveness over several decades of evidence-based research and are now the gold standard for federal funding from SAMHSA, a longtime Josepher backer.

Indeed, ARRIVE, the oldest and largest of what are about a dozen programs at Exponents, began as a first-of-its kind HIV reduction study funded by the then–National Institute of Drug Abuse, for recently released parolees with IV drug problems. Then as now, ARRIVE had a remarkable retention rate: 69% of the first cohort and 81% of the second graduated from the program, and follow-upresearch found that graduates had a significantly lower rate of high-risk sex and drug use.

Josepher hosts a “graduation” every eight to 10 weeks at a Manhattan church to recognize the New Yorkers who make it through Exponents’ ARRIVE training program—more than 10,000 grads since 1988. This year he has negotiated use of the massive sanctuary at St. James Church on the Upper East Side, a lush Episcopalian landmark.

Josepher’s rangy frame and full head of near-white hair were unmistakable at the back of the church when he stepped in from Madison Avenue just before the ceremony last month. The graduates, primped and fidgeting like high school seniors, turned at the sight of him and each seemed to require his brief attention: “Howie!” they rasped, church-polite but insistent. “Mr. Howie!”

Josepher calmly met each request, greeting several women as “Dawling” in a heavy Bronx drawl. Then he shook hands with a long row of ushers in bright white button-downs and shiny blue ties.

ARRIVE graduations are like Baptist revivals, especially when Josepher takes the mic. The audience gasps and chuckles, and there are shouts of “That’s right!”

“The trip in life is to be true to yourself,” Josepher prompted his Spring 2013 graduates, “but the mind, left on its own, where’s it gonna go, guys?”

Drugs! 

Alas, no words were needed. Happy, conspiratorial belly laughter broke out all around and pews and pews of people rose noisily to their feet, clapping, beaming, hopeful. 

These are, by definition, people who have been through hell, and you can see it in some of their raw cheeks and loose jackets; a handful of the graduates are silent and solemn. Josepher is not trying to sweep those grim years under the rug; on the contrary, it’s the gooey center of the Exponents community.

“Denise,” a rosy, freckled graduate who dressed for the ceremony in all-white, is a classic ARRIVE grad, with as many drug problems as you can think of, plus HIV, hepatitis C and lots of experience with domestic violence. A youthful 54-year-old who wears her hair in a bright henna shag, Denise grew up with junkies.

“Myself, my brother and my sister, we had people going into the basement and getting high. My mother did everything she could, but all three of us got infected [with HIV].” Her brother and sister died of AIDS in 2004. “I didn’t get tested until 1990, but I knew I was positive; I was sharing needles with my sister.”

What’s different about the ARRIVE program, which Denise just happened upon in February after a lifetime of ignoring her mental and physical health? Understanding HIV, for starters: “I continued to live a lot of years like ‘I’m dying anyway, so who cares.’ I had never made a mental commitment to taking my meds until I went to ARRIVE.”

Ex-junkies trust Josepher not just because his path-breaking approach works (the organization continually scores high when funders evaluate its ability to “change destructive behaviors”), but because he’s one, too. The first time he took drugs was in the late ‘50s, when he enjoyed acid and mescaline while listening to live jazz at Birdland and Latin dance bands at the Palladium Ballroom. He drove a cab to pay for theater classes. “The racially and sexually mixed crowd I was running with were the coolest in the world,” Josepher recalls. But he was starting to become attuned to the underlying grief of his fellow partiers: “I saw that people were wearing masks, not as happy as they seemed.”

One night when Josepher was in his early 20s, he snorted a small amount of heroin and “fell in love.” “There was a particular day I decided to get high every day. Screw the peaks and valleys, I was going to stay up there. Naturally I thought I could control it, but within a few months heroin became the main focus of my life,” he says.

It was a crippling focus: Josepher was arrested for burglary, forgery and possession; started carrying a gun; and went through detox 15 or so times. He was only able to quit shooting up because he lucked into the first wave of social learning, the 12-step-plus-therapy model that has increasingly defined drug recovery since the ‘80s. (“Social learning” focuses on training in a diverse range of psycho-social skills, including how to resist relapse, make rational rather than impulse decisions and cope with aggression and anxiety. Josepher’s Exponents adds its own unique gloss: Education in “destigmatizing” helps nurture self-respect, taking responsibility and trust. Trained staff who are also in recovery serve as peer role models. Services in mindfulness, meditation and acupuncture foster targeted relaxation, while targeted rabble-rousing comes by way of political action, such as recent “Drop the Rock” demos against the Rockefeller Drug Laws.)

Josepher’s venture into harm reduction advocacy in the ‘80s took inspiration from a powerful health measure developed by AIDS activists: “safer sex.” “I learned about how the gay community was doing outreach—it was nonjudgmental,” Josepher says. “They didn’t say, ‘You got to stop doing that.’ No, they just said, ‘This is how to be safer.’ ”

Safer-sex campaigners and injection-drug users took a page from each other on the idea of peer education, too: Who better understands the issues of addicts, young people and gay people than other addicts, young people and gay people? And evidence was quickly mounting that abstinence-only approaches to HIV prevention—“just say no” to sex and drugs—were a failure.

The 1988 NIDA grant to teach prison parolees about HIV got Josepher started on his path. He helped found ARRIVE based on two radical practices: First, don’t test participants for the virus at all—anti-HIV stigma was so strong, Josepher argued, that this might deter the very people he intended to lure—and let actively using junkies join in, no judgments, no problem. It was a time when fully half of New York City’s needle-using population already had HIV, so risk reduction was literally a matter or life and death.

Many of Josepher’s colleagues in drug treatment took a while to come around—New York’s Office of Alcoholism and Substance Abuse Services (OASAS) was only able to acknowledge harm reduction’s successes very recently. Federal funding for needle exchange is still banned in the US, and some recovery organizations, including 12-step and prison-run programs, oppose the very premise of harm reduction. Yet hundreds of studies over two decades have proven that this approach is effective—at both dramatically cutting HIV transmission and encouraging drug users to access treatment.

The current-day agenda at Exponents itself has moved less than you’d expect, says Josepher. The underlying HIV issues are the same, despite the fact that medical advances have transformed both treatment and prevention, with more than 20 antiretroviral drugs that manage the disease.

And the social and psychological dysfunctions that have long driven the epidemic persist. “Many new infections happen among people who are unstable, homeless or lead chaotic lives,” he says. Hence the enduring value of the life-skills (“meet the person where he or she is at” and “treat the whole person”) approach.

Also extra-relevant now is Josepher’s mantra that illness and addiction is fueled by public disgust with people who are gay, use drugs and/or have HIV. The self-hate inspired by that stigma is still the main issue for lots of the addicts in his programs: “They’ve been through so many treatment programs and so many bad experiences telling them how character-flawed they are.”

The federal ban on clean needle giveaways only reinforces the stigma, sending a message to addicts that in society’s view, their lives are not worth saving. Yet what separates heroin addicts from prescription drug takers, argues Josepher, is often just the law: “We’re telling our people, ‘You’re doing what 25 million Americans are doing. You just chose an illicit substance, and that’s the only real difference.’”

“Denise” takes a legal drug now: Suboxone, an opiate replacement therapy. She doesn’t consider herself clean yet, because while she hasn’t shot heroin in 23 years (and put down her crack pipe and pills “a while back”), she stayed on methadone that whole time and wants off the Suboxone, too.

Denise thinks she’s ready now because she has “people”—Exponents offers periodic daylong “retreats” (all free of charge) so that graduates can stay connected—and because she has begun to take care of herself in a more deliberate way. At ARRIVE, “I learned to like who I was,” she says. “Before, I wasn’t living a life.”

Whether “Obamacare” will help Exponents help many more of the most needy addicts learn to “live a life” remains to be seen. Josepher says the government’s thinking on recovery is still too rigid to significantly support programs like his: “For instance, there are people whose health is negatively impacted by their use, but they’re not necessarily drug addicts. Where [under “Obamacare”] is the primary care physician going to send that person when the only option is ‘We’ve got to get you off of drugs’? ”

Already the federal budget sequestration, which mandates 5% across-the-board cuts in discretionary spending, has resulted in low-income people with HIV losing access to treatment and housing, while HIV prevention is also being slashed. An estimated 200,000 Americans—many of them the target population of urban nonprofits like Exponents—will be denied access to substance use treatment. Josepher says, “The high cost of drug care in terms of addiction is that substance use exacerbates other health concerns.” The long view that treatment is cost effective—a given of public health policy—has yet to move partisan politicians in the budget wars.

The day after Denise’s ARRIVE graduation last month, she went to her first 12-step meeting in 20 years: the same Woodside Narcotics Anonymous meeting she had once attended. There were a lot of the same people at the meeting who she used to see there back in the day. “A lot of them are clean. But a lot of them are not,” Denise says, clearly embarrassed on behalf of the ones who are not.

Sally Chew was an editor at Time Inc.’s Health.com as well as at Vibe, Out and POZ magazines. She also authored a true crime book and was a wire-service reporter overseas.