dana at cures-not-wars.org
Tue Jan 21 21:40:11 EST 2003
Author: Maia Szalavitz
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
THE BIG IDEA: SICK TREATMENT
When Drug Counselors Attack.
Gloria Holmes didn't need any more hassles. A working,
36-year-old mother of three, she had been in and out of drug
years. Following a 2001 suicide attempt serious enough to
land her in Columbia-Presbyterian Hospital for a week, doctors had
given her a prescription for the antidepressant Paxil.
Arrested for drug possession not long after that, she was facing
Holmes asked to be sent to a women-only treatment program.
Instead, in the fall of 2001, the city Office of Special Narcotics'
Treatment Alternatives to Prison Program sent her to a co-ed
rehab residence run by the Veritas Therapeutic Community in
Barryville, New York. There, according to Holmes, she was
forced to stop taking Paxil. ( Veritas says its general policy is to
Adding to her misery, her treatment often consisted of being
bullied and humiliated by her counselors. "They insult you all the
time," says Holmes. Once, she says, a staff member told her,
"If I was your husband, I would put you in chains and tie you up and
throw you out the window."
The final straw came as she was sitting outside at a picnic
table, enjoying the countryside. A counselor snuck up behind her and
dumped a five-gallon bucket--which had been used as an
ashtray and was full of cigarette butts--over her head, and banged it
or four times. "He said he did it as a joke," she says. "He
was laughing. But I was crying."
Jurrant Middleton, the program director at Veritas in
Barryville, says what happened to Holmes was no big deal. "I am
this incident, and think that it was blown out of
proportion," he told City Limits. "It was inappropriate, it was
dealt with and the
counselor was disciplined."
But Holmes says the incident made her feel worthless. "She
felt that she was physically abused, violated tremendously and made a
mockery of," says her husband, John Holmes, a former cocaine
and heroin addict now training to be an addictions counselor. "It
certainly didn't do anything for her self-esteem. She felt
she could no longer take it, and she left." Holmes dropped out of the
program, violating the conditions of her sentence, and
started smoking crack again. Now she is upstate, serving three to
six, as a
result of her failure in rehab.
Imagine if physicians could justify being abusive, arrogant
and condescending by arguing that it improves patient health. Imagine
that these professionals could decide not to use chemotherapy
for cancer, for example, because they "don't believe in it," despite
overwhelming research data. That's what addiction care has
been like for the last half-century. To this day, there's a huge gap
between clinical psychiatric knowledge and the way drug
treatment actually goes down.
Clinical research shows that, like anyone else,
addicts--particularly women and the mentally ill--respond better to
treatment than to attacks or humiliation. The University of
New Mexico's William Miller, for example, has demonstrated that
patients are less likely to drop out and relapse if they have
counselors who are compassionate, and not confrontational.
Yet for years, the sort of "care" Gloria Holmes received has
been par for the course in addiction treatment. Many providers
that addicts needed to be "broken down" and then
re-socialized, and that insults, humiliation and degrading treatment
process. And while the National Institute on Drug Abuse has
shown that medications like antidepressants aid recovery, a large
proportion of rehab programs still routinely deny addicts
standard psychiatric medications on the premise that they could lead
Recently, a number of federal, state and local government
initiatives have begun trying to reform drug treatment, through both
regulations and research. But they'll have to overcome a
deeply entrenched legacy of anti-science and even anti-addict
Until very recently, abusive treatment was almost universally
praised. A 1993 book by the founder of the Daytop treatment
network, Monsignor William O'Brien, calls addicts "babies"
and "stupid," and says that addiction treatment "has to be harsh," and
that "being too gentle...doesn't do anybody any good."
John Holmes, who works at an agency that provides housing for
former addicts, doesn't think his wife's experience was unique.
"I've heard about people who were made to wear dunce hats or
sit in a corner for hours, about men dressed as women, or made to
wear diapers," says Holmes.
These ideas about how addicts should be treated pervade
almost every type of addiction care. But they have their roots in one
specific type of treatment: therapeutic communities, often
called "TCs," like the one that Gloria Holmes attended.
Therapeutic communities began in the late 1950s, after
physicians and psychiatrists essentially decided that addiction was
untreatable. While some doctors continued to try, the
treatment of addicts and alcoholics became a backwater of the medical
profession, populated largely by profiteers and quacks with
little concern about and no financial interest in determining whether
their treatment actually worked.
Alcoholics Anonymous, developed by two alcoholics in the
1930's, offered some hope to excessive drinkers. Based on the idea
that one alcoholic could help another, it showed the public
that alcoholism--and later other addictions via copycat 12-step
like Narcotics Anonymous--weren't always hopeless conditions.
As "the program" grew, doctors and psychologists began to
offer residential treatment to help initiate people into self-help.
of these, Pioneer House, opened in Minnesota in 1958 and
became the model for modern programs like Hazelden and Betty Ford.
That same year, AA member Chuck Dederich opened a small
storefront in Santa Monica and began treating heroin addicts. He
found that living in a dedicated community, where addicts
forced each other to look at their problems, could help some stay away
from drugs. Synanon--named after the way one resident
mispronounced "seminar"--became the first American therapeutic
community, spawning countless imitators.
Two of them, Phoenix House and Daytop ( both based in New
York ), are now the country's largest providers of addiction
Unfortunately, Synanon's program became increasingly bizarre
over time, eventually devolving into a violent cult. After putting a
rattlesnake in the mailbox of an attorney who was suing
Synanon, Dederich and several other members were ultimately convicted
conspiracy to commit murder.
Synanon is gone now, but its methods live on. Before Synanon
imploded, mainstream programs picked up many of its methods,
including "marathon" therapy sessions lasting days without
breaks for sleep or food, brutal emotional confrontation, humiliating
punishments--such as being dressed as a bum and wearing a
sign saying "I am an asshole"--and other techniques aimed at
dehumanizing and degrading participants.
Like fraternity initiations, this "tough love" tradition is
highly resistant to change, often because many TC staffers are
themselves. A large proportion of graduates believe that
what was done to them was necessary to their recovery. They come into
the field with an evangelical urge to spread the word--and
some, unfortunately, relish the chance to do unto others as others had
done unto them.
As a result, they often not only disregard science as being
irrelevant to what they do, but also tend to view medications and more
humane treatments as inimical to recovery.
"Remember that Synanon and TCs started as an anti-psychiatry,
anti-medication movement, because those things weren't doing
anybody any good," says Jim Dahl, director of program
planning for Phoenix House. "To have the same people embrace
it's a total culture clash."
In the last few years, state and federal governments have
tried to bring research into practice. The National Institute on Drug
Abuse's Clinical Trials Network, which has outposts at NYU
and Columbia, runs trials of research-based treatments in community
programs, in the hope that such collaboration will encourage
providers to adopt effective new methods.
Similar work is also being done by the federal Center for
Substance Abuse Treatment. New York State's Office of Alcohol and
Substance Abuse Services uses a federally funded network to
bring together local providers and researchers for meetings and
Kevin Wadalavage, vice president of the Outreach Project,
which runs a variety of treatment programs as well as New York State's
largest training program for addiction counselors, thinks
that ideological barriers are starting to fall. "The new generation
open," he says. "I think as we start to understand the
disease of addiction as a brain-based phenomenon, we are getting
Sometimes people will have a 'drug-free' philosophy, but I
don't think it's as pervasive as people think."
Nonetheless, even Wadalavage recognizes numerous obstacles to
change. The research projects and collaborations can only exhort
providers to improve care, not force change. As courts
sentence more and more people to rehab as an alternative to prison,
have little choice about which program they enter--but they
are blamed for it and incarcerated if they "fail" treatment.
And since drug courts provide a steady stream of patients--at
least 50 percent of clients, in some residential drug
programs--providers have few incentives to improve their practices.
There are also practical problems. Addiction counseling pays
little and has high turnover, and many programs don't require much
training beyond having graduated from a therapeutic community
or being a member of a 12-step program.
"The problem is that therapeutic communities are the only
modality which really grooms its recovering people to work in the
says Ira Marion, executive director of the Division of
Substance Abuse at Albert Einstein College of Medicine, which runs a
methadone program for 4,400 patients. "TCs now integrate
Narcotics Anonymous, which is totally against medication. Even if you
train such people up the wazoo--and one big issue in the
field still is training--they still have their experience and the NA
their gut and in their soul."
Despite the obstacles, there is definitely a shift underway.
"We try to create an environment where if someone says, 'AA was the
only way for me,' someone else can say, 'Well, that didn't
work for me,'" explains Wadalavage. "Or if someone says, 'I'm opposed
to methadone' [someone else can reply], 'Well, methadone
saved my life.'"
Dahl, too, is adamant about abandoning infantilizing
techniques. "That reduces self-esteem, and the self-esteem of most
clients is already quite low," he says. "We have a manual
for operating a TC, and we try to hold [staff] accountable if they do
like making someone wear bum clothes, put on a dunce hat, etc."
He acknowledges that the change is not yet complete, however.
"Here and there you still do find that old tradition rearing its ugly
head," Dahl admits. "A lot of people still carry those toxic
methods with them. It's very hard to change. But we're trying
Note: Maia Szalavitz is a co-author of Recovery Options: The
Complete Guide: How You and Your Loved Ones Can Understand
and Treat Alcohol and Other Drug Problems ( Wiley 2000 ).
More information about the Ibogaine