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H
E A L T H
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.
Getting
Straight
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.
Jean
SELIGMANN with LISA DE MORAES in Denver, ELIZABETH BAILEY
in Los Angeles, NIKKI FINKE GREENBERG in Washington, Barbara
BURGOWER IN Houston, SANDRA GARY in San Francisco, BOB LEVIN
in Atlanta and NEAL KARLEN in New York
(Source:
Newsweek, June 4, 1984)
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