Getting Straight
More and more Americans are struggling to break the grip of drugs and
alcohol-and they’re turning to a growing network of treatment programs
for help.
The snapshot is frightening: a grinning skeleton of a man wearing a
LaCoste shirt. "Look at that," says Paul, 37, a lawyer and owner of a
trucking firm. "Matchsticks for arms and slits for eyes. Eighty-seven
pounds and coked out of my gourd." In the five years before the photo was
taken, Paul explains, he "snorted away" his wife, his suburban home and
$500,000. After the drug ate away the cartilage inside his nose, he
bought liquid cocaine and dropped it into his eyes. Then a year and a
half ago, shortly after posing for the cadaverous photo, Paul pointed a
.38 pistol at his head; luckily, his girlfriend managed to wrest it away.
"That night I saw an ad on TV for a cocaine hot line," recalls Paul, who
now weighs 200 pounds. "If I hadn’t called, you would have read an
obituary last year about an 87-pound man who blew his brains out."
Paul is just one of hundreds of thousands of Americans who in the past
few years have tuned in to the realization that drugs and alcohol were
killing them, turned on to the help offered by a growing network of
treatment facilities-and dropped out of the drug culture. The common
perception is that more Americans than ever are abusing drugs and alcohol
while comparatively few of those already addicted are seeking help, but
U.S. government officials maintain that the opposite is true: they call
it "the cooling of America."
"Since 1979, in terms of national levels of the numbers of people using
drugs and, to a lesser extent, alcohol," reports Dr. William Pollin,
director of the National Institute on Drug Abuse, "there has very clearly
been a peaking, a leveling off and the beginning of a downward trend.
This is really a dramatic change from the explosion of past years."
In fact, the surprising possibility that there may now be more people
trying to kick habits and fewer getting hooked is beginning to be borne
out by statistics on cocaine abuse. According to NIDA, of the 35 million
Americans who were users (defined as those who used drugs 20 days out of
the month immediately preceding the survey) of illicit drugs in 1982, 4.1
million used cocaine-down from 4.5 million in 1979. And government
surveys indicate that between 1976 and 1981 there was an astounding 600
percent increase in the number of Americans who sought help for cocaine
abuse in publicly funded programs. While there are no available
statistics that reflect a surge of enrollment in the private programs
that coke users prefer, experts also noted that reported membership in
Alcoholics Anonymous-which has become increasingly involved with cocaine
abuse-has more than tripled since 1968, from 170,000 to a total of
586,000.
Candor: By all accounts, the "getting straight" movement began with an
unlikely addict: former First Lady Betty Ford, who courageously announced
in 1978 that she was about to enter a hospital for treatment to combat
her dependency on alcohol and painkillers. Most drug counselors agree
that just as Mrs. Ford’s candor about her mastectomy a few years earlier
made it much easier for other American women to handle their own
struggles with breast cancer, her public acknowledgment of her addiction
to alcohol and drugs took away a great deal of the stigma and shame
attached to those problems. "Betty Ford has done more to get people in
treatment than any government program," declares Dr. David Smith, who in
1967 founded-and still runs-the Haight-Ashbury Free Medical Clinic in San
Francisco. Adds Larry Meredith, program chief of San Francisco’s
Community Substance Abuse Services: "Betty Ford made it okay and
respectable-almost in vogue-to have a problem and deal with it. She has
been a national treasure."
But she was only the beginning. After she went public with her problem, a
stream of similar announcements from politicians, athletes and especially
entertainers quickly swelled to a flood, as every actor in Hollywood
suddenly seemed to be queuing up for a chance to confess all on "Good
Morning, America." Several-including recovered alcoholics Jason Robards
and Daniel Travanti, star of NBC’s popular "Hill Street Blues"-have taken
an active role in the crusade to help other alcoholics; both gave up the
bottle in 1973. Some celebrities, like Elizabeth Taylor and Johnny
Cash-who both went for treatment to the Betty Ford Center that opened in
1982 at the Eisenhower Medical Center near Palm Springs, Calif.- put out
forthright press releases that 10 years ago would probably have
euphemistically alluded to a hospitalization for "gastritis." Others,
like comedian Richard Pryor, spoke out only after their drug or alcohol
problems landed them in public trouble.
Athletes, the cherished role models of youth, were also catapulted out of
the closet. A claim that 75 percent of National Basketball Association
players dabbled in cocaine proved exaggerated-but the image conscious
league and its players’ union did adopt the strongest antidrug code in
pro sports. Former Super Bowl heroes like Washington Redskins safety Tony
Peters and Cincinnati Bengals runner Pete Johnson were caught in the
cocaine glare. In baseball, Kansas City outfielder Willie Wilson has been
wearing earplugs to keep out the gibes of fans who resent his conviction
and jail term for possession.
Whether they resorted to public confession, intensive treatment or
earplugs, the celebrities who went public probably opened the straight
road to many of their admirers. Says Dr. Carlton Turner, special
assistant to the president on drug-abuse policy: "When someone with a
position of influence or name recognition says, ‘I have a drug problem,’
it gives a lot of other people the courage to do the same."
One of those people is Julie, 29, a story editor for a film-production
company in Hollywood, who 11 months ago joined Cocaine Anonymous and
kicked a heavy cocaine and alcohol habit that was destroying her life.
Julie exemplifies several significant trends that characterize a new
breed of addicts who are showing up for treatment: she is a woman, she
was addicted to more than one drug and she sought treatment in a program
based on Alcoholics Anonymous, the venerable organization founded in 1935
to help alcoholics stay sober through mutual support, self-examination
and spiritual guidance. Also like Julie, a growing number of the men and
women who are flocking to alcohol and drug (A and D) rehabilitation
programs are educated members of the upper-middle class: doctors,
lawyers, bankers and other professionals.
Mixers: They seek help in a wide variety of settings, ranging from church
basements to locked units in psychiatric hospitals to cabins with
breathtaking views. But what distinguishes them most from an earlier
generation of addicts is "polyabuse," the current medical buzzword that
describes their dependency on a combination of alcohol and drugs, or on
more than one chemical substance.
An estimated 10 million Americans are problem drinkers. "But it’s very
hard to find a pure alcoholic these days," notes Paul Sherman, a Rye,
N.Y., consultant on executive substance abuse. "Most of them are mixers,"
agrees Donnie Brown, executive director of Metro Atlanta Recovery
Residences, Inc., "and I’m talking about everyone from street people all
the way up to doctors." A good example is Johnny, 30, a Los Angeles actor
and ex-abuser who started doing drugs at 15 and who got straight two
years ago. "I was a garbage-can addict ," he recalls. "I wasn’t choosy. I
took pills, drank like a fish, used hallucinogens, did cocaine. I would
carry a small aspirin box which contained all the pills I needed,
according to how I wanted to feel."
Cocaine users are especially likely to abuse-and become dependent on-a
Smorgasbord of "downers" to combat the jittery, strung-out irritability
coke induces. Alcohol, sedatives and tranquilizers are widely used for
this purpose, along with another depressant that a small but growing
number of heavy users consider the perfect antidote to the cocaine
jitters: heroin.
The new candor about A and D addiction may be the catalyst that has
enable so many drinkers and drug users to throw away their pipes,
syringes, pillboxes, bottles, spoons and straws, but a number of social,
economic and historical influences have also combined to provide just the
right climate for the getting-straight movement. For one thing, the
enormous numbers of young people who experimented with marijuana and LSD
in the 1960s and 1970s didn’t all grow up and grow out of their habits.
Some kept on trying new highs and, inevitably, many of them got hooked.
Now entering middle age, these "baby boomers" are trying to put their
lives in order by kicking drugs. Another important factor, says NIDA’s
Dr. Carl Leukefeld, is the current American enthusiasm for physical
fitness and self-improvement, combined with a growing awareness of the
health risks drugs and heavy alcohol use carry.
Perhaps most important, America has changed its attitude towards
addiction. "The alcohol and drug addict has always been looked at in a
moralistic way," says Dr. G. Douglas Talbot, a rehabilitation expert who
operates the Ridgeview Institute Chemical Dependency Program in Smyrna,
Ga. "But now it’s being recognized more and more that this is a disease.
That perception has made more people come into treatment."
Economic factors have also played a role in encouraging drug-dependent
Americans to get help. Large businesses have realized that it is far more
cost-effective to get substance-abus-ing employees rehabilitated than to
hire and retrain new ones; thus, many firms have developed Employee
Assistance Programs (EAP’s) for addiction. Although many insurance plans
will still offer coverage for treatment of alcohol but not other drugs,
next month Blue Cross and Blue Shield will launch a pioneering new
"substance abuse benefit" that emphasizes early identification and
intervention and will cover up to 165 days of treatment.
Discreet: Without insurance, the cost of getting straight can be truly
prohibitive-as much as $350 a day at posh private hospitals like Silver
Hill in New Canann, Conn., and Laurenwood, a three-year-old psychiatric
hospital near The Woodlands, Texas, that may soon become an official
treatment facility for the drug plagued National Football League.
Outpatient programs, of course, cost much less. At New York’s Regent
Hospital, a discreet private facility that caters primarily to affluent
coke addicts, an outpatient program that includes both individual and
group therapy costs $185 a week-far less that the $300 to $500 that
patients have typically been spending on cocaine.
The seemingly insatiable demand for drug and alcohol-rehabilitation
services has spawned a thriving new American industry. Comprehensive Care
Corp., based in Newport Beach, Calif., launched its first CareUnit for A
and D treatment in 1972; today there are 150 CareUnits in 42 states, with
new ones opening at the remarkable rate of two a month. In some cases
health care entrepreneurs have joined with chronically underused
hospitals to turn their empty wards into profitable drug clinics. In
Denver, order rehab centers that once primarily treated alcoholics are
now revamping their images and facilities to attract today’s younger,
more hip polysubstance abuser. Staffers with some of the nonprofit
programs refer disparagingly to the new moneymaking outfits as
"finger-lickin’ franchises."
While there is some controversy over the best way to treat addiction, the
vast majority of private rehabilitation centers-some of which are also
nonprofit-offer regimens that can be described as variations on a theme.
The frills and activities may differ-from strenuous hiking and aquatic
relaxation to "meditation walks" and household chores-but the basics
remain the same: detoxification (with or without medication), group
therapy, family counseling and a long-term outpatient involvement in a
self-help support group like AA, sometimes for the rest of the patient’s
life.
Individual psychotherapy, the rehab experts agree, is notoriously
ineffective in treating addiction. "Unfortunately there are large numbers
of patients who have lain on psychiatrists’ couches, month after month,
intoxicated with Demerol, talking about their mothers," observes Dr.
Thomas Crowley, executive director of the University of Colorado’s highly
respected Addiction Research and Treatment Services (ARTS) program. "What
they really needed to do was to stop using Demerol." Murray Firestone, a
psychologist who heads the rehab program at Beverly Glen Hospital in Los
Angeles, agrees. "The No.1 error in treating people with chemical
dependency is getting seduced by other problems," he says. "Chemical
dependency is their main problem, and if they are loaded when you treat
them, you are wasting your time."
Churches: The granddaddy of treatment programs is, of course, AA, which
spells out 12 steps to recovery and asks members to place their faith in
a "higher power" to help them stay sober. While AA’s tenets and structure
remain unaltered 49 years after its founding, there are winds of change
whistling through the churches, school auditoriums and hospitals where
members gather. At almost any meeting, what’s new about AA is immediately
apparent; recently, there has been a steady and sizable upswing in the
number of women, young people and polydrug abusers who have joined.
Under-30 membership rose 50 percent between 1977 and 1980, and the trend
continues. Women now make up one-third of the membership, compared with
22 percent in 1968. AA has become the program of choice for such a
diverse population that some meetings now attract members just from
specific groups; there are special meetings for doctors, lawyers, gays
and people in the entertainment industry-and one is on posh Rodeo Drive
in Beverly Hills. No matter what their income is, AA members pay nothing.
Chic: With the influx of younger, hipper members and a less lopsided
male-female ratio, some AA meetings have become decidedly more sociable,
and even chic: bottles of Perrier are appearing along with the
traditional coffee and cookies. Members are discouraged from dating
within AA for the first year, but Julie, the Los Angeles editor, admits,
"Sometimes I go to a meeting not to be uplifted but because I know a
great-looking guy is going to be there." But that doesn’t mean she
regards her 11-month sobriety lightly. "So it’s chic," she shrugs. "So
much the better."
Whether the problem is booze, pills. Pot, coke or a pharmacological
potpourri, AA is often the solution that works. Indeed, many drug experts
believe that all chemical addictions are different faces of the same
demon, a craving so strong that it cannot be controlled despite its
destructive consequences. "Everybody has bodily needs: to breath, to eat,
to have sex, to urinate," observes Dr, David Fram, director of drug-abuse
treatment at Washington’s Psychiatric Institute. "The best way to think
of being addicted to drugs is that you have acquired another body need
that that you must pay attention to and that you must fulfill."
According to estimates by the American Medical Association’s Committee on
Alcoholism, just as many women as men feel that "body need." But in the
past, women with alcohol and drug problems were likely to hide at home
behind the convenient curtain of housewifery. Today, Today, in most rehab
programs, women account for 30 to 40 percent of patients.
Immoral: But traditional attitudes still make it difficult for many women
to admit to a drug or alcohol problem. "We’re still chauvinistic in our
thinking about women who use drugs," says William Johnson of Georgia’s
Department of Human Resources. "They are thought of as weak sisters,
immoral and loose. Men are excused much more easily." Apparently: the
National Council on Alcoholism reports that 9 out of 10 wives of
alcoholic husbands stand by them, but only 1 in 10 husbands married to
alcoholic wives does the same.
"Society expects a lady to drink, but not to have a drinking problem,"
notes Betty Ford. "I consider it my life’s work to remove the stigma from
women admitting they are alcoholics." She has made a formidable start at
the Betty Ford Center she founded with recovered alcoholic and
tire-fortune heir Leonard Firestone. Men and women may choose to live
separately during the four to six week-week program. "Women shy away from
a lot of subjects when men are around," explains the former First Lady.
"Also, men tend to take advantage of women’s nurturing nature in group
therapy and the women end up worrying about the men instead of
themselves."
Although the Betty Ford Center looks like a country club, the program is
ascetic. The day begins with an 8 a.m. meditation walk and includes
assigned housework for all patients, including male movie stars and
Elizabeth Taylor, who didn’t flinch when she had to take out the garbage
and hose down the patio. No telephone calls are permitted during the
first five days, and television-an addiction of a different type-is
confined to weekends. The program closely follows AA tenets, especially
the emphasis on reliance on others with the same problem.
The Palmer Drug Abuse Program (PDAP), founded in Houston by an Episcopal
minister 13 years ago, offers another regimen based on AA principles of
mutual support, with a special emphasis on social activities for teen-age
addicts. PDAP’s division for abusers over 24 is whimsically called Over
The Hill, or OTHers. To Jill, 42, it was a godsend. A secretary addicted
to Valium and alcohol, she first joined PDAP because her five children
were all doing drugs. It took her three years to acknowledge her own
problem. "Finally," she says, "You get sick and tired of getting sick and
tired."
Outcon: AA also plays prominent part at Talbott’s 50-acre Ridgeview
Institute. Talbott, whose career as a prominent Dayton, Ohio,
cardiologist crumbled under the weight of alcoholism and drug abuse,
believes AA offers the most effective form of treatment available. "And
it’s nothing more than group therapy," he says. Talbott was instrumental
in the rehabilitation of Martha Morrison, now head of the institute’s
adolescent unit, who says he was the only one she couldn’t outcon. "It’s
very difficult to outcon a con, manipulate a manipulator," says the
59-year-old Talbott.
In Boulder, Colo., the Boulder Psychiatric Institute has launched an
addiction program that captures the atmosphere of an exotic retreat
within the confines of Boulder Memorial Hospital. Called Day At a Time,
the treatment regime for up to 12 patients includes art therapy, yoga,
meditation, aquatic-relaxation therapy-and a solid AA orientation. When
Sandra Haun, 32, came to Day At a Time, she was desperate. The daughter
of two alcoholics-both of whom died from alcohol related problems-Haun
claims she was "born alcoholic;" her mother would slip whiskey into her
baby bottle when she was cranky as an infant. Addicted to pot and a
variety of pills as well as booze, Haun dropped out of college and
drifted from job to job. One morning last year, she says, "I woke up and
looked in the mirror and saw an old woman at 31. I said to myself, ’If
there’s a God, I hope he hears me.’" Now in the programs six-month
aftercare phase, Haun recognizes that her recovery is only just a
beginning. "Alcohol is very cunning and patient," she explains. "It will
wait forever. It’s always going to be there."
Recently the special hazards facing health-care professionals have
received particular attention. Martha Morrison refers to the "M.D.-eity
complex. Doctors say, ’I prescribe all these drugs, I make life-or-death
decisions; it will never happen to me.’" At Denver’s ARTS, which consists
of a network of specialized clinics, including two strictly for cocaine
and one for addicted health-care professionals, counselors are studying
an intriguing but controversial new sobriety incentive that has been
described, accurately, as self-blackmail. The plan is known as
contingency contracting. An addicted doctor, for example, writes a letter
to the state board of medicine admitting he is an addict, and
surrendering his license. The letter is deposited with the ARTS director
Crowley, and a contract is drawn up directing Crowley to mail the letter
if the patient fails-or fails to show up-for one of his regular urine
checks for the presence of drugs. Unfortunately, some of the letters have
to be mailed.
Skiing: Although alcohol and drugs are sometimes called "social" drugs,
addiction is fundamentally a solitary, isolating way of life. Thus a
critical aspect of treating alcohol and drug dependency is pulling the
patient out of his or her self-involvement and into constructive
relationships with others. At the Aspen Addiction Rehabilitation Unit of
the Presbyterian/St. Luke’s Medical Center, group cohesiveness and
reliance on others are fostered by rigorous outdoor activities that
include rock climbing, cross-country skiing, rope crossing and log
walking. The cooperation required, explains the program director Allen
Drum, teaches patients to count on each other for help and prepares them
for long-term involvement in support groups like AA, Narcotics Anonymous
or Cocaine Anony-mous. The three-month-old facility, which treats ten
patients at a time in its 28-day program, operates out of a converted
1945 ranch house situated at the base of scientific Buttermilk Mountain.
Abusers can also benefit enormously from the involvement of their
families. "This is not the kind of illness a person can have all alone,"
says Howard McFadden, founder of The Ark, another A and D "retreat" in
the Colorado Rockies. "This is a family disease. Family members need
treatment, too."
In the past, AA and other rehab groups emphasized that an addict had to
"hit bottom" before treatment could be effective. Now many programs
encourage deliberate intervention by family, friends or employers, before
the abuser has wrecked his life. Sometimes the direct approach works-a
firm but friendly confrontation with the addict about the likely
consequences of his or her behavior. (Both Betty Ford and Elizabeth
Taylor got straight only after their children intervened in this manner.)
In other cases, the intervening person may shock the abuser into
self-realization by provoking a crisis; a six-year-old, for example,
might say to his father, "I’m afraid of you."
Bottom: Some counselors say that families should-if necessary-force the
abuser to go it alone without their emotional or financial support, so
that he or she will hit bottom and have to face the problem. At least one
psychiatrist believes this was where the Kennedy family may have made its
mistake with Robert Jr., 30, who has long struggled with heroin
dependency, and David, who died last month of a polydrug overdose at the
age of 28. With continuing protection from their family, says the
physician, the young men were partly cushioned from the reality of what
they were doing to themselves.
Teen-agers who abuse drugs and alcohol rarely bottom out before their
parents drag them-sometimes literally kicking and screaming-into a rehab
program, and their prospects for recovery are not always bright.
According to a just released NIDA study, 40 percent of American
high-school seniors have used an illicit drug other than marijuana, and
some rehab centers are admitting addicts as young as 12. "The front line
in the fight against drugs is the fifth and sixth grades," declares James
P. Comstock, program manager of San Francisco’s adolescent Care Unit. Lee
Dogoloff, head of the White House office on drug policy in the Carter
administration, agrees. "By adolescence it’s too late," he warns. "Once
the juices start flowing, they can’t hear you."
Gary, now 18, didn’t hear much of anything after discovering the thrill
of marijuana four years ago. "It became a constant struggle to hold onto
the feeling," says the youth, who progressed rapidly to speed, Quaaludes,
cocaine and LSD until "it was like my brain was fried." At 15 he started
dealing. "I’d walk into the bathroom at school and say ‘Quaaludes,’ and
they’d be gone," he reports. By his senior year he was shooting
drugs-cocaine, Percodan, anything he could find. It was Gary’s uncle, a
counselor at the Ridgeview Institute, who finally interrupted the cycle
of disaster. Now drug-free and living in a recovery house, Gary works
full time and is thinking of going to college in the fall. But my main
priority," he asserts, "is just not doing any drugs."
Teen-age abusers face other special problems. For one thing, they often
do not have a clear idea of what it feels like to be sober. As a result,
the goal of treatment seems less comprehensible. If they do successfully
complete a rehab program, they may face relentless peer pressure to take
drugs again once they get back to school. Or even sooner. Cathy, a young
girl who was on the verge of release from the adolescent unit of
Washington’s Psychiatric Institute after struggling to kick an
amphetamine habit, was horrified to receive an envelope containing two
brightly colored capsules of speed-a "welcome home" present from her
dealer.
No Cure: For addicts of any age, perhaps the most effective point any
program can make is that drug and alcohol abuse, once under way, has no
permanent cure. Like diabetes, it can only be arrested or controlled.
Cathy'’ dealer will always be lurking just around the corner, and every
addict knows that getting straight is a piece of cake compared with
staying straight. "All AA asks you to do," observes Ken, a recovering
alcoholic, with some awe, "Is to change your whole life." A sobering
thought, to be sure.
Source: Newsweek, June 4, 1984
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