DRCNet
Book
Review:
Hooked:
Five
Addicts
Challenge
Our
Misguided
Drug
Rehab
System
8/17/01
In 1997, the city of San Francisco embarked on an ambitious and groundbreaking effort to provide drug treatment on demand in an effort to rid the city of its human blight. The targets of the program were the hardest of the hard-core, those drug and alcohol abusers, familiar to all urban residents, who wreak havoc on everyone's quality of life through a multitude of minor (and not so minor) sins from passing out in public to using public spaces as urinals to breaking car windows in order to steal radios. San Francisco emergency room physician, author and photographer Lonny Shavelson followed five of these people through the course of their encounter with the city treatment bureaucracy for the next two years. "Hooked" is the result, and it presents a deeply disturbing and depressing portrait of the myths and realities of drug treatment in contemporary America. "Hooked" should be required reading for drug reformers no matter what side of the "coerced treatment" debate they come down on. For those who cheer experiments such as California's Proposition 36, Shavelson delivers a bucket of cold water. For those who decry "coerced treatment" as morally akin to brainwashing, Shavelson makes arguments for its success that must be confronted. Shavelson works squarely within the tradition of those people of good will who insist that we must help our stupefied brethren to regain sobriety, and thus will disappoint reformers who question both the premises of prohibition and the very concept of addiction itself. Shavelson does neither. In fact, he never mentions the role of prohibition in exacerbating the problems faced (and created) by his subjects, and while paying lip service to the nebulousness of the addiction concept, never really challenges it. But even those who accept the premises undergirding the turn to drug treatment will find themselves shaken by what Shavelson reports. The five problem drug users Shavelson followed -- a gay alcoholic, a white junkie, a black female speed freak, a Native American female alcoholic, and a black female crack user and seller -- enter into a Kafkaesque world where programs ostensibly designed to help them more often serve to thwart them. In instance after appalling instance, San Francisco's treatment apparatus proved cruelly contrary and counterproductive. Gloria, a 37-year-old Lakota alcoholic living in a Mission district SRO, is grabbed off the street by the city's Death Prevention squad and placed in a Native American-oriented, 90-day program where she makes great progress. But then, with funding limited to 90 days, Gloria is sent to a zero tolerance residence from which she is evicted two days later for drinking. "Let me see if I've got this straight," says one health care worker reviewing her case. "This is what we bust our asses for? To take housed alcoholics and make them into homeless alcoholics? Goddamn!" Mike, the white junkie, checks into Walden House, a "therapeutic community" treatment program in the Synanon mode, endures a year of psychologically abusive "tough love" treatment, moves into independent living at a Walden House residence, relapses, and is promptly thrown on the street. He quickly returns to 16th and Mission to resume his bad habits. When last seen, Mike is in court facing 25-to-life as a "three strikes" offender after breaking in to his sister-in-law's apartment to steal a signed football and an uncashed check. Shavelson's account is down in the trenches; he follows his subjects from program to program, he talks with their counselors, he harries administrators, he provides real flavor for those whose experience with the gritty side of the drug and drug treatment world is limited to television specials and quick glances through rolled-up car windows. Along the way, he becomes a fan of coerced drug treatment, and Drug Courts in particular. He does not skirt the moral and ethical issues surrounding such coercion -- he simply ignores them. Shavelson does come up with solid, precise recommendations based on his observations. For those who share his faith in drug treatment (such as it is), they make sense. Drug treatment can work, Shavelson argues, but it must be good drug treatment. Good treatment includes increasing treatment when clients relapse, not withdrawing it, he concludes, and to that end, each rehab program must be required to have a formal association with a detox center for those relapsed clients. And "attack therapy" in the Synanon mold must end, he writes. "Kicking addicts out of programs because of relapses, or heaping abuse on them while they are in the programs, keeps them from coming back," Shavelson notes. What is so depressing about Shavelson's recommendations -- be trained to deal with people with "dual diagnoses" as drug abusers and mentally ill, have a comprehensive case management system to help clients work through a maze of services, demand that government-funded programs meet certain standards, shift funding from interdiction to rehab -- is the fact that, after decades of drug treatment, they need to be made at all. "Does rehab work for those who are most disastrously addicted?" asks Shavelson. "I still don't know. In the two years of this investigation I rarely saw rehab done well enough to learn if it might." But it could work, he maintains, "in a cohesive, coordinated system that links drug programs to mental health services, and joins both together to provide addicts with lifelong care and case managers who stick with them through thick and thin." Whatever you think of Shavelson's conclusions, "Hooked" will challenge your preconceptions. It should also send a clarion call of danger ahead for the drug reform movement as it increasingly embraces "coerced treatment." Reading Shavelson makes one extremely pessimistic about the ability of San Francisco, let alone Michigan or Ohio or Florida, to implement "treatment not jail" programs that will actually reduce problematic drug use. And once "treatment not jails" has failed, then what do we say to the drug warriors? Hooked was published by New Press and lists at $24.95.
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