By Rachel Crumpler
For 25 years, Lars Paul worked on the front lines of the war on drugs with the Fayetteville Police Department — making arrests for drug possession, responding to overdoses, leading the Narcotics Division and serving on a SWAT team that carried out hundreds of narcotics searches.
Over time, he saw arrests and jail time often amounting to an expensive revolving door, and not to meaningful change in the addiction crisis underlying many low-level crimes. Again and again, he said, people would leave jail only to return to the same circumstances and soon cross paths with police again. It’s a common cycle across the state and nationwide: About 60 percent of people in jail and prison have a substance use disorder, according to the U.S. Department of Justice.
“I got to see firsthand over all those years that, ‘Hey, we’re not winning this. We’re doing the same thing over and over again, and things aren’t changing. People are still dying of overdoses. People are going to jail. They’re getting arrested and going into that revolving door,’” Paul said.
His frustration with that pattern grew, and it eventually compelled him to help spearhead a new approach to handling low-level, nonviolent crimes typically tied to substance use — one that emphasizes diversion over detention. Instead of automatically arresting, charging and taking someone to jail, officers could divert them to treatment and social services.
In September 2016, the Fayetteville Police Department launched the state’s first Law Enforcement Assisted Diversion program — the fourth in the nation. First introduced in Seattle, LEAD connects eligible participants to case managers and peer support specialists who help link them to needed resources, such as substance use treatment, housing and transportation, with the goal of reducing involvement in the criminal justice system.
“For many years, the only tool we had was to arrest,” Fayetteville Police Chief Roberto Bryan Jr. said. “Today because of LEAD, our officers have a bridge and a tool that addresses the root causes behind the calls for services that we respond to.”
Last year, the program provided peer outreach and support to more than 140 people.
“This has proven to be a smart investment,” he said. “We have seen individuals who once cycled multiple times through the justice systems that finally get connected for housing, treatment and stability.”
Over the past decade, the program has grown into a model that is being replicated across North Carolina.
On March 24, officials with the N.C. Department of Health and Human Services announced a $1.5 million expansion of LEAD programs across the state. The North Carolina Harm Reduction Coalition will work with seven public safety agencies across the state to launch or expand their pre-arrest diversion programs:
- Fayetteville Police Department
- Albemarle Police Department
- Gaston County Police Department
- Greensboro Police Department and Community Safety Department
- New Hanover County Sheriff’s Office
- Robeson County Sheriff’s Office
- Harnett County Sheriff’s Office
Mooresville, Statesville, Waynesville and Wilmington police departments also have LEAD programs, along with Burke, Catawba and Watauga counties, according to the NC Harm Reduction Coalition.
Gov. Josh Stein, an early supporter who visited the Fayetteville program in 2017 during his time as attorney general, was on site in Fayetteville last month to support the spread of LEAD. The expansion follows his Feb. 5 executive order directing NC DHHS and other state agencies to strengthen support for people with mental health issues who are involved in the criminal justice system, after several high-profile cases cast increased scrutiny on gaps in care.
“We will not be able to arrest ourselves out of our addiction crisis,” Stein said. “That is a certainty. We have to intervene in effective ways to reduce the problem. We need treatment and recovery services so that people can get well, abide by the law and contribute to the community.”
‘Not a jail free card’
Paul — an admittedly tough, “kick-in-the-door” officer and Marine Corps veteran — wasn’t an initial champion of diversion. But he became convinced the approach worked, for participants and for law enforcement. After retiring from the Fayetteville Police Department as a captain in 2020, he joined the North Carolina Harm Reduction Coalition as the law enforcement program manager working to build momentum for these types of programs statewide.
When Paul pitches LEAD, he’s clear: It’s not a “jail free card.” Instead, he describes it as a tool that allows law enforcement officers — who, by default, often end up responding to complex social issues — to connect people with support.
LEAD programs rely on two main referral pathways: arrest diversion and “social contact” referrals.
Arrest diversion lets officers refer a person to the program in lieu of arresting them for low-level offenses like drug possession for personal use, posssesion of drug paraphernalia, petty theft, trespassing and sex work.
Social contact referrals happen when officers or outreach workers encounter someone whose unaddressed mental health or substance use issues put them at risk of arrest. Instead of waiting for a crime to occur, the officers can offer support through LEAD. In some departments’ programs, community members can also suggest these referrals.
In both cases, if the person is eligible and agrees, they have to complete an assessment with a LEAD case manager to identify their immediate needs and priorities. From there, case workers consistently work to connect participants to resources that align with their goals, including housing, behavioral health services, substance use treatment and harm reduction supplies.
“It’s completely participant-centered,” said Greg Berry, statewide director of Law Enforcement Assisted Diversion and Deflection programs at the North Carolina Harm Reduction Coalition. “They determine the direction, and the case manager says, ‘Okay, I’m gonna work with you to try to put a plan together, and then I’m gonna check in with you each week to see how things are going.’”
There is no required length of participation in the program, and abstinence is not required. The program is rooted in harm reduction, which focuses on meeting people where they are and improving stability — not on punishment.
Berry, who has lived his own journey of incarceration and substance use, has seen the approach change lives.
He recalled one woman referred to Fayetteville’s LEAD program after an overdose. By then, she’d lost custody of her children and was living in a hotel, struggling to stay afloat. Through LEAD, she connected to housing, transportation and substance use treatment. Eventually, she secured stable employment, permanent housing and custody of her children.
“She was really kind of at a fork in the road, where things were really bad and it could have got a lot worse,” Berry said. “But instead of being punished further, she was really met with support, compassion and connection — and that’s what she needed.”
In another case, as law enforcement were clearing out an encampment, officers connected a man experiencing homelessness to LEAD. The program helped place him in temporary housing, paid for transportation to a job interview at a local factory and covered rides to work until he got his first paycheck. After about a month, Berry said he no longer needed any assistance and has remained employed and housed since.
What the research shows
Stories like those are backed up by a growing body of research that shows a reduction in criminal justice involvement and an increase in connections to treatment and services among LEAD participants.
A 2022 Duke University study of four North Carolina LEAD programs found that citation and arrest rates for people referred to LEAD decreased by one-third in the six months after referral, compared with people with similar drug charges who were eligible but not referred. The study also found that, for people enrolled in a LEAD program, the use and cost of crisis-related services was reduced by 50 percent in the six months after their referral, while costs doubled among similar people who were referred to LEAD but chose not to enroll.
Researchers found that higher engagement with the program was associated with better outcomes.
“North Carolina has been on the forefront for implementing LEAD programs,” said Allison Gilbert, a researcher at Duke University, who led the three-year evaluation of North Carolina’s LEAD programs.
Based on interviews with participants, program staff and law enforcement, Gilbert said support for the model was consistent across groups.
“What we found was all of our stakeholder groups really valued their programs and thought it brought something really important to their communities,” she said.
With expansion of LEAD underway across the state, Gilbert will conduct more research tracking outcomes and interview more stakeholders to better understand the model’s effectiveness.
A growing model
Even with growing support, there’s a long way to go before LEAD and other diversion programs are the norm across North Carolina.
“We think it’s the right program,” said Kelly Crosbie, director of the state’s Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Use Services. “It’s an evidence-based model. We want to be at a place, at the department, where we say there are programs like this in every county of the state.”
Across North Carolina, law enforcement officers are increasingly responding to calls rooted in homelessness, poverty, substance use and mental health challenges, she said, often with few options beyond arrest. In response, more departments are testing a variety of approaches to address underlying issues instead of simply cycling people through jail — from embedding social workers in their departments, to sending mental health workers to respond to calls alongside officers, to implementing diversion and deflection programs such as LEAD.
“A lot of officers on the front lines of this do get frustrated,” Paul said. “When they do slow down and really think about what a good pre-arrest diversion program can do, then a lot of them are willing to try it.”
State leaders are encouraging that shift. At last month’s LEAD expansion event, Stein and state health officials urged other county officials to use opioid settlement funds to launch or expand diversion programs. It’s one of a dozen approved strategies for investment.
From summer 2022 to summer 2025, 16 local governments have spent more than $2.1 million on criminal justice diversion programs, according to the state’s opioid settlement dashboard.
In Greensboro, officials used such funds to launch a LEAD program in late 2023 — driven in part by the recognition that about two-thirds of people in jail in Guilford County have committed low-level offenses related to drugs.
Mary Houser, Greensboro’s LEAD case coordinator, said building buy-in from officers has taken time.
“They were trained to arrest or do nothing,” Houser said.
Now, she said, referrals to LEAD are picking up as officers see the results when participants transform their lives. She said the city is also working to make LEAD referrals a routine part of their response. Over the last year, Houser said the program has received 47 referrals.
Greensboro will use its additional state funding to expand the program’s capacity by hiring a peer support specialist to work with participants.
Meanwhile, the NC Harm Reduction Coalition is helping launch a statewide diversion and deflection learning collaborative where stakeholders can meet regularly to share best practices and strengthen diversion efforts.
“My hope is that one day programs like LEAD are no longer the exception, but are the standard,” Berry said. “Can we flip the paradigm?”
KEEP UP WITH THE LATEST
Republish our articles for free, online or in print, under a Creative Commons license.
