The Week Online with DRCNet
Issue #199, 8/17/01

DRCNet Book Review:  Hooked: Five Addicts Challenge Our
   Misguided Drug Rehab System

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 is published by New Press and lists at $24.95.