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回答问题，赢新手礼包Dying To Be Free - The Huffington Post
Illustration by Jan Diehm / The Huffington Post
Dying To Be Free
There&s A Treatment For Heroin Addiction That Actually Works. Why Aren&t We Using It?
The last image we have of Patrick Cagey is of his first moments as a free man. He has just walked out of a 30-day drug treatment center in Georgetown, Kentucky, dressed in gym clothes and carrying a Nike duffel bag. The moment reminds his father of Patrick’s graduation from college, and he takes a picture of his son with his cell phone. Patrick is 25. His face bright, he sticks his tongue out in embarrassment. Four days later, he will be dead from a heroin overdose.
Life, Abbreviated
Patrick Cagey’s final photograph, taken five days before he overdosed.
2010 Patrick at Winter Commencement at the University of Kentucky, where he majored in sociology and minored in psychology.
2008 Patrick and his mother celebrating his 21st birthday.
2003 Patrick with his mother at an Easter dinner. Patrick was recuperating from surgery for a knee injury suffered during his sophomore wrestling season.
1994 Patrick flying off the high dive in Lexington, Kentucky.
1991 Patrick with his father, Jim, on their front porch.
1987 Patrick’s mother, Anne, holding him.
Photographs courtesy of Anne Roberts and Jim Cagey
That day, in August 2013, Patrick got in the car and put the duffel bag on a seat. Inside was a talisman he’d been given by the treatment facility: a hardcover fourth edition of the Alcoholics Anonymous bible known as “The Big Book.” Patrick had tagged some variation of his name or initials on the book’s surfaces with a ballpoint pen, and its pages were full of highlighting and bristling with Post-its.
Back in the wood-paneled living room of their Lexington, Kentucky, home that afternoon, Patrick and his parents began an impromptu family meeting about what to do next. Patrick’s father, Jim, took his usual seat in the big red chair, and Patrick’s mother, Anne Roberts, sat on the couch. Patrick took the footrest between them, sitting with his hands on his knees. Was he ready to be home? Did he have a plan to get a sponsor? Maybe he should start looking for a job or apply to graduate school?
Before he entered Recovery Works, the Georgetown treatment center, Patrick had been living in a condo his parents owned. But they decided that he should be home now. He would attend Narcotics Anonymous meetings, he would obtain a sponsor — a fellow recovering addict to turn to during low moments — and life would go on. As they talked, though, a new reality quickly set in. Their son’s addiction was worse than they had thought. It wasn’t just pain pills, Patrick told them. It was heroin.
In her shock and heartbreak, Anne looked away. “I didn’t criticize him for it because I knew he felt so bad,” she explained later. “I knew he felt he had let us down.” Patrick stared at the floor, unable to look at his parents. He’d lost a year to the drug, along with a girlfriend he adored and a job caring for victims of traumatic brain injury — a job that made him feel that he was doing something worthwhile with his life. He didn’t want to be a heroin addict.
Jim had worked for decades as a public school English teacher and taught at aviation camps as an amateur pilot. Anne was in nursing and health care administration. Before Patrick was born, she had even helped run a methadone clinic treating heroin addicts and later had worked in substance abuse and psychiatric wards for the Department of Veterans Affairs. Jim and Anne knew how to be steady in a crisis.
Anne’s thoughts raced to her days at the methadone clinic. So many of her clients had done well: the smartly attired stockbroker who came in every day, the man who drove a Pepsi truck making deliveries all over the state, the schoolteacher who taught full time. She was also familiar with a newer maintenance medication on the market sold under the brand name Suboxone. Like methadone, Suboxone blocks both the effects of heroin withdrawal and an addict’s craving and, if used properly, does it without causing intoxication. Unlike methadone, it can be prescribed by a certified family physician and taken at home, meaning a recovering addict can lead a normal life, without a daily early-morning commute to a clinic. The medical establishment had come to view Suboxone as the best hope for addicts like Patrick.
Yet of the dozens of publicly funded treatment facilities throughout Kentucky, only a couple offer Suboxone, with most others driven instead by a philosophy of abstinence that condemns medical assistance as not true recovery. Even at clinics that offer the medication, the upfront costs and budget limitations render it out of reach for the vast majority who come through their doors. But Patrick had insurance, and Anne, with her treatment background, thought she could find a prescribing doctor.
“Patrick, we can get you the medication,” Anne told her son. “There are other options. We can put you on methadone or we can get you Suboxone. There are other things that you can do besides the 12-step program.&
Patrick knew firsthand about Suboxone’s potential. He had tried it on the black market to stave off sickness when he couldn’t get heroin — what law enforcement calls diversion. But Patrick had just left a facility that pushed other solutions. He had gotten a crash course on the tenets of 12-step, the kind of sped-up program that some treatment advocates dismissively refer to as a &30-day wonder.& Staff at the center expected addicts to reach a sort of divine moment but gave them few days and few tools to get there. And the role of the therapist he was assigned seemed limited to reminding him of the rules he was expected to follow. Still, by the second week, he appeared to take responsibility for his addiction. When they could reach the facility’s staff, his parents were assured of their son’s steady progress. Patrick was willing to try sobriety one meeting at a time.
“No,” Patrick told his parents. “I think I can do it. I want to try this first.”
Patrick made for a natural 12-step convert. The rituals of self-discipline were nothing new. He’d kept a journal since the 8th grade documenting his daily meals and workout routines. As a teenager, he’d woken up to the words of legendary coaches he’d copied from books and taped to his bedroom walls — John Wooden on preparation, Vince Lombardi on sacrifice and Dan Gable on goals. He had been a dominant wrestler in high school and a competitive bodybuilder in his early 20s. At his training peak, he measured and recorded his water intake down to the ounce.
Patrick (in red), 16, swiftly pins his opponent.Courtesy of Jim Cagey and Anne Roberts
Patrick went undefeated in county high-school tournaments. He made stickers with the words “STATE CHAMP” written on them in black marker and put them all over the house. But multiple knee injuries — and knee surgeries — ended those dreams. Around the time he graduated from the University of Kentucky, the knee pain returned, and he developed an addiction to pain medications.
Patrick’s habit built steadily and in secret. He needed a Percocet just to get out the door. After a statewide and federal crackdown on pain pills made them too expensive, he switched to heroin. He shot up alone in the privacy of his condo — neither his best friend nor his girlfriend at the time ever saw him with a needle. His habit developed to the point at which he was shooting up a half-gram of heroin a day.
On his first night home from rehab, Patrick attended a Narcotics Anonymous meeting. He woke up the next morning and told his mother of the relief he felt at not having to worry about scoring drugs. “It’s like being normal,” he said. He sounded astonished and grateful. The next morning, he told her the same thing.
Share Your Story
To share a story about your or a loved one&s experience with drug treatment, write to
or leave a voice mail at 860-348-3376. Please include your phone number.
Anne had stocked the fridge with Patrick’s favorite mini cinnamon rolls and made up his bedroom before he came home. Although she had long ago taken down most of his “STATE CHAMP” stickers, she had left one up on the frame of his bedroom door. He was an only child and they were close. Now they had to be closer.
Patrick spent the next few days taking steps toward finding a normal routine. He looked for construction jobs, and he thought about enrolling in graduate school for physical therapy. He visited a troubled childhood friend who had become a shut-in, just to keep him company. He made plans to get back in the gym with his best friend, and he apologized to his former girlfriend, hoping for a second chance. “It was the most wonderful conversation we ever had,” Stacey Hawkins recalled. “I said, ‘Everything’s going to be OK. You keep talking this way, I’ll marry you tomorrow.’” Patrick, she added, “felt very victorious, almost.” Over meals, he quoted the Big Book from memory to his mother.
At one Narcotics Anonymous meeting, Patrick ran into two young women he knew from rehab. Those women could be bad news, he confessed to his mother one afternoon in their kitchen. Let’s get out the NA schedule and find a different meeting, Anne offered. Patrick told her he’d already found a later one to attend. He had it covered.
Anne and Jim kept working on a Plan B. Anne was worried that her son hadn’t found a sponsor yet, so she called a friend in AA; he promised to help get Patrick a sponsor after the weekend, when he’d be back in town. Jim called doctors to see if they prescribed Suboxone. He had already put Patrick on a waiting list for a long-term 12-step facility in Lexington. He was told that a spot might open up in six months or so but there were no guarantees.
By Friday night, three days after leaving rehab, Patrick’s willpower showed signs of strain. He came home late, hours after his meeting ended. The next morning, while Anne was out jogging, Patrick left the house, telling his father that he’d be back later. He hadn’t returned by that evening. His parents’ calls went s their texts went unanswered.
9:17 p.m.: “Patrick, let us hear from you tonight. I hope all is well. Stay strong & take care.”
10:49 p.m.: “We need to hear from you — it’s getting late.”
After attending Sunday church service the following morning, Jim drove to Patrick’s condo. He spotted his son’s car in the lot, knocked on the condo’s door, and then let himself inside. He checked the bathroom. “I tried to open the door, you know, and something was blocking it,” he recalled. “And it was Patrick. He had fallen back against the door.” On the kitchen counter there was a spoon, a cotton ball, a lighter and the cap to a syringe.
Jim Cagey, Patrick's father, describing the moment he discovered his son's body.
Jason Cherkis / The Huffington Post
&I had this ugly feeling coming up the steps...&
In the days and weeks that followed, Patrick’s parents grieved. They notified friends and relatives, wrote a eulogy for their newspaper, and made funeral arrangements. They held the memorial service on what would have been their son’s 26th birthday. At Recovery Works, Patrick’s former treatment facility, his name and photo were added to a memory wall in a common room — another fatal overdose in a system full of them. Staff turnover in the treatment industry meant that soon enough hardly anyone there would remember Patrick at all.
Even for staff members at the facility who stick around, it can be hard to keep straight all the names and faces of the dead. In the months before Patrick’s death, Sydney Pangallo, 23, a recent Recovery Works alumna, suffered a fatal overdose. Dan Kerwin, 23, attended a Recovery Works program in the spring, and his sister found him dead of an overdose during the July 4th weekend. Tabatha Roland, 24, suffered a fatal overdose in April — one week after graduating from Recovery Works. And in November, Ryan Poland, 24, died of an overdose. He too was a Recovery Works graduate.
There’s nothing uniquely tragic about these results. The problem is not with heroin treatment at one facility in Kentucky over the span of a few months. The problem is with heroin treatment.
The charred remains of a trailer a dealer once used to sell heroin in London, Kentucky.Jason Cherkis / The Huffington Post
The opioid epidemic took hold in the U.S. in the 1990s. Percocet, OxyContin and Opana became commonplace wherever chronic pain met a chronic lack of access to quality health care, especially in Appalachia.
The Centers for Disease Control and Prevention calls the prescription opioid epidemic the worst of its kind in U.S. history. “The bottom line is this is one of the very few health problems in this country that’s getting worse,” said Dr. Tom Frieden, director of the CDC.
U.S. Heroin Use By Year
Between 2002 and 2012, the number of people who reported using heroin within the previous year increased by 265,000.
Source: Substance Abuse and Mental Health Services Administration
“We had a fourfold increase in deaths from opiates in a decade,” Frieden said. “That’s nearly 17,000 people dying from prescription opiate overdoses every year. And more than 400,000 go to an emergency room for that reason.”
Clinics that dispensed painkillers proliferated with only the loosest of safeguards, until a recent coordinated federal-state crackdown crushed many of the so-called “pill mills.” As the opioid pain meds became scarce, a cheaper opioid began to take over the market — heroin. Frieden said three quarters of heroin users started with pills.
Federal and Kentucky officials told The Huffington Post that they knew the move against prescription drugs would have consequences. &We always were concerned about heroin,” said Kevin Sabet, a former senior drug policy official in the Obama administration. “We were always cognizant of the push-down, pop-up problem. But we weren’t about to let these pill mills flourish in the name of worrying about something that hadn’t happened yet. … When crooks are putting on white coats and handing out pills like candy, how could we expect a responsible administration not to act?&
As heroin use rose, so did overdose deaths. The statistics are overwhelming. In a study released this past fall examining 28 states, the CDC found that heroin deaths doubled between 2010 and 2012. The CDC reported recently that heroin-related overdose deaths jumped 39 percent nationwide between 2012 and 2013, surging to 8,257. In the past decade, Arizona’s heroin deaths rose by more than 90 percent. New York City had 420 heroin overdose deaths in 2013 — the most in a decade. A year ago, Vermont’s governor devoted his entire State of the State speech to heroin’s resurgence. The public began paying attention the following month, when Philip Seymour Hoffman died from an overdose of heroin and other drugs. His death followed that of actor Cory Monteith, who died of an overdose in July 2013 shortly after a 30-day stay at an abstinence-based treatment center.
In Cincinnati, an entry point for heroin heading to Kentucky, the street dealers beckoning from corners call it “dog” or “pup” or “dog food.” Sometimes they advertise their product by barking at you. Ohio recorded 680 heroin overdose deaths in 2012, up 60 percent over the previous year, with one public health advocate telling a local newspaper that Cincinnati and its suburbs suffered a fatal overdose every other day. Just over the Ohio River the picture is just as bleak. Between 2011 and 2012, heroin deaths increased by 550 percent in Kentucky and have continued to climb steadily. This past December alone, five emergency rooms in Northern Kentucky saved 123 heroin- those ERs saw at least 745 such cases in
more than the previous year.
For addicts, cravings override all normal rules of behavior. In interviews throughout Northern Kentucky, addicts and their families described the insanity that takes hold. Some addicts shared stories of shooting up behind the wheel while driving down Interstate 75 out of Cincinnati, or pulling over at an early exit, a Kroger parking lot. A mother lamented her stolen heirloom jewelry and the dismantling of the family cabin piece by piece until every inch had been sold off. Addicts stripped so many houses, barns, and churches of copper and fixtures in one Kentucky county that the sheriff formed a task force. Another overdosed on the couch, and his parents thought maybe they should just let him go.
Northern Kentucky Hit Hard By Heroin Overdoses
Between 2011 and 2014, heroin overdoses at five Kentucky emergency rooms outside of Cincinnati & Covington, Ft. Thomas, Edgewood, Florence and Grant County & increased by 669 percent.
Source: St. Elizabeth Healthcare
Chemistry, not moral failing, accounts for the brain’s unwinding. In the laboratories that study drug addiction, researchers have found that the brain becomes conditioned by the repeated dopamine rush caused by heroin. “The brain is not designed to handle it,” said Dr. Ruben Baler, a scientist with the National Institute on Drug Abuse. “It’s an engineering problem.”
Dr. Mary Jeanne Kreek has been studying the brains of people with addiction for 50 years. In the 1960s, she was one of three scientists who determined that methadone could be a successful maintenance treatment for an opioid addicted person. Over the years, various drug czars from both political parties have consulted her at Rockefeller University in New York City, where she is a professor and head of the Laboratory of the Biology of Addictive Diseases. According to Kreek, there’s no controversy over how opiate addiction acts upon the brain.
“It alters multiple regions in the brain,” Kreek said, “including those that regulate reward, memory and learning, stress responsivity, and hormonal response, as well as executive function which is involved in decision-making — simply put, when to say yes and when to say no.”
A heroin addict entering a rehab facility presents as severe a case as a would-be suicide entering a psych ward. The addiction involves genetic predisposition, corrupted brain chemistry, entrenched environmental factors and any number of potential mental-health disorders — it requires urgent medical intervention. According to the medical establishment, medication coupled with counseling is the most effective form of treatment for opioid addiction. Standard treatment in the United States, however, emphasizes willpower over chemistry.
Dr. Mary Jeanne Kreek, a pioneering researcher who runs the Laboratory of Biology of Addictive Diseases at Rockefeller University in New York City.Damon Scheleur / The Huffington Post
To enter the drug treatment system, such as it is, requires a leap of faith. The system operates largely unmoved by the findings of medical science. Peer-reviewed data and evidence-based practices do not govern how rehabilitation facilities work. There are very few reassuring medical degrees adorning their walls. Opiates, cocaine and alcohol each affect the brain in different ways, yet drug treatment facilities generally do not distinguish between the addictions. In their one-size-fits-all approach, heroin addicts are treated like any other addicts. And with roughly 90 percent of facilities grounded in the principle of abstinence, that means heroin addicts are systematically denied access to Suboxone and other synthetic opioids.
On average, private residential treatment costs roughly $31,500 for 30 days. Addicts experience a hodgepodge of drill-instructor tough love, and self-help lectures, and dull nights in front of a television. Rules intended to instill discipline govern all aspects of their lives, down to when they can see their loved ones and how their bed must be made every morning. A program can seem both excessively rigid and wildly disorganized.
After a few weeks in a program, opiate addicts may glow as if born again and testify to a newfound clarity. But those feelings of power and self-esteem can be tethered to the rehabilitation facility. Confidence often dims soon after graduation, when they once again face real life with a still-warped brain hypersensitive to triggers that will push them to use again. Cues such as a certain smell associated with the drug or hearing the war stories of other addicts could prompt a relapse.
“The brain changes, and it doesn’t recover when you just stop the drug because the brain has been actually changed,” Kreek explained. “The brain may get OK with time in some persons. But it’s hard to find a person who has completely normal brain function after a long cycle of opiate addiction, not without specific medication treatment.”
An abstinence-only treatment that may have a higher success rate for alcoholics simply fails opiate addicts. “It’s time for everyone to wake up and accept that abstinence-based treatment only works in under 10 percent of opiate addicts,& Kreek said. &All proper prospective studies have shown that more than 90 percent of opiate addicts in abstinence-based treatment return to opiate abuse within one year.& In her ideal world, doctors would consult with patients and monitor progress to determine whether Suboxone, methadone or some other medical approach stood the best chance of success.
A 2012 study conducted by the National Center on Addiction and Substance Abuse at Columbia University concluded that the U.S. treatment system is in need of a “significant overhaul” and questioned whether the country’s “low levels of care that addiction patients usually do receive constitutes a form of medical malpractice.”
While medical schools in the U.S. mostly ignore addictive diseases, the majority of front-line treatment workers, the study found, are low-skilled and poorly trained, incapable of providing the bare minimum of medical care. These same workers also tend to be opposed to overhauling the system. As the study pointed out, they remain loyal to “intervention techniques that employ confrontation and coercion — techniques that contradict evidence-based practice.” Those with &a strong 12-step orientation& tended to hold research-supported approaches in low regard.
Researchers have been making breakthroughs in addiction medicine for decades. But attempts to integrate science into treatment policy have been repeatedly stymied by scaremongering politics. In the early 1970s, the Nixon administration promoted methadone maintenance to head off what was seen as a brewing public health crisis. Due to fears of methadone’s misuse, however, regulations limited its distribution to specialized clinics, and it became a niche treatment. Methadone clinics have since become the targets of NIMBYs and politicians who view them as nothing more than nuisance properties. In the late ’90s, then-New York City Mayor Rudy Giuliani tried unsuccessfully to cut methadone programs serving 2,000 addicts on the grounds that despite the medication’s success as a treatment, it was an immoral solution and had failed to get the addicts employed.
A new medication developed in the 1970s, buprenorphine, was viewed as a safer alternative to methadone because it had a lower overdose risk. &Bupe,& as it’s become known, was originally approved for pain relief, but knowledgeable addicts began using it as a black market route to drug rehabilitation. Government approval had to catch up to what these addicts had already field tested. After buprenorphine became an accepted treatment in France in the mid-’90s, other countries began to treat heroin addicts with the medication. Where buprenorphine has been adopted as part of public policy, it has dramatically lowered overdose death rates and improved heroin addicts’ chances of staying clean.
In 2002, the U.S. Food and Drug Administration approved both buprenorphine (Subutex) and buprenorphine-naloxone (Suboxone) for the treatment of opiate dependence. Suboxone combines bupe with naloxone, the drug that paramedics use to revive overdose victims. These medications are what’s called partial agonists which means they have a ceiling on how much effect they can deliver, so extra doses will not make the addict feel any different.
Whereas generic buprenorphine can produce a high if injected, Suboxone was formulated to be more difficult to manipulate. If an addict uses it improperly by injecting it, the naloxone kicks in and can send the person into withdrawal — the opposite of a good time.
Dan Kerwin writing to heroin. He fatally overdosed over the July 4th weekend in 2013.Courtesy of the Kerwin family
In the U.S., the more abuse-resistant Suboxone dominates the market, making it the most widely prescribed of the medically assisted treatments for opioid addiction.
Neither Suboxone nor methadone is a miracle cure. They buy addicts time to fix their lives, seek out counseling and allow their brains to heal. Doctors recommend tapering off the medication only with the greatest of caution. The process can take years given that addiction is a chronic disease and effective therapy can be a long, grueling affair. Doctors and researchers often compare addiction from a medical perspective to diabetes. The medication that addicts are prescribed is comparable to the insulin a diabetic needs to live.
“If somebody has a heroin dependence and they did not have the possibility to be offered methadone or Suboxone, then I think it’s a fairly tall order to try and get any success,” said Dr. Bankole Johnson, professor and chair of the Department of Psychiatry at the University of Maryland School of Medicine. “There have been so many papers on this — the impact of methadone and Suboxone. It’s not even controversial. It’s just a fact that this is the best way to wean people off an opioid addiction. It’s the standard of care.”
&There have been so many papers on this & the impact of methadone and Suboxone. It’s not even controversial.&
Dr. Bankole Johnson
But as the National Center on Addiction and Substance Abuse study pointed out, treatment as a whole hasn’t changed significantly. Dr. A. Thomas McLellan, the co-founder of the Treatment Research Institute, echoed that point. “Here’s the problem,” he said. Treatment methods were determined “before anybody really understood the science of addiction. We started off with the wrong model.&
For families, the result can be frustrating and an expensive failure. McLellan, who served as deputy director of the White House’s Office of National Drug Control Policy from 2009 to 2011, recalled recently talking to a despairing parent with an opiate-addicted son. The son had been through five residential treatment stays, costing the family more than $150,000. When McLellan mentioned buprenorphine, the father said he had never heard of it.
Most treatment programs haven’t accepted medically assisted treatments such as Suboxone because of “myths and misinformation,” said Robert Lubran, the director of the pharmacological therapy division at the federal Substance Abuse and Mental Health Services Administration.
In fiscal year 2014, SAMHSA, which helps to fund drug treatment throughout the country, had a budget of roughly $3.4 billion dedicated to a broad range of behavioral health treatment services, programs and grants. Lubran said he didn’t believe any of that money went to programs specifically aimed at treating opioid-use disorders with Suboxone and methadone. It’s up to the states to use block grants as they see fit, he said.
Kentucky has approached Suboxone in such a shuffling and half-hearted way that just 62 or so opiate addicts treated in 2013 in all of the state’s taxpayer-funded facilities were able to obtain the medication that doctors say is the surest way to save their lives. Last year that number fell to 38, as overdose deaths continued to soar.
Waiver Required
Federal waivers are required for doctors to prescribe buprenorphine products like Suboxone. Kentucky has 518 doctors with such waivers, most clustered around cities like Louisville and Lexington.
Source: Drug Enforcement Administration
Waiver data as of Jan. 19, 2015
In multiple states struggling to manage the epidemic, thousands of addicts have no access to Suboxone. There have been reports by doctors and clinics of waiting lists for the medication in Kentucky, Ohio, central New York and Vermont, among others. In one Ohio county, a clinic’s waiting list ran to more than 500 patients. Few doctors choose to get certified to dispense the medication, and those who do work under rigid federal caps on how many patients they can treat. Some opt not to treat addicts at all. According to state data, more than 470 doctors are certified in Kentucky, but just 18 percent of them fill out 80 percent of all Suboxone prescriptions.
There’s no single explanation for why addiction treatment is mired in a kind of scientific dark age, why addicts are denied the help that modern medicine can offer. Family doctors tend to see addicts as a nuisance or a liability and don’t want them crowding their waiting rooms. In American culture, self-help runs deep. Heroin addiction isn’t only a disease – it’s a crime. Addicts are lucky to get what they get.
A detox bed in Northern Kentucky.Jason Cherkis / The Huffington Post
Among Kentucky’s taxpayer-funded rehabilitation options is a network of 15 facilities — eight for men and seven for women — created about a decade ago and known as Recovery Kentucky. It represents the state’s central drug treatment effort, admitting thousands of addicts per year. Few if any of the hundreds of employees at the 15 facilities implementing the program are medical professionals, and because of this lack of a medical approach at the centers, the state doesn’t technically define what they offer as “treatment.” “We look at it as an education, self-help program,” said Mike Townsend, the head of Recovery Kentucky.
The Recovery Kentucky network embraces the 12-step method pioneered by Alcoholics Anonymous. Its treatment centers are modeled after the Healing Place, also part of the network, in Louisville. “Clients work with peers in similar circumstances to motivate one another to adopt social skills and to learn core principles central to Alcoholics Anonymous and Narcotics Anonymous programs,& according to the facility’s promotional materials. “Our clients also learn the basics of responsibility and move away from a ‘street’ mentality.&
Karyn Hascal, The Healing Place’s president and CEO, said she would never allow Suboxone in her treatment program because her 12-step curriculum is “a drug-free model. There’s kind of a conflict between drug-free and Suboxone.”
For policymakers, denying addicts the best scientifically proven treatment carries no political cost. But there’s a human cost to maintaining a status quo in which perpetual relapse is considered a natural part of a heroin addict’s journey to recovery. Relapse for a heroin addict is no mere setback. It can be deadly. A sober addict leaves a treatment program with the physical cravings still strong but his tolerance gone. Shooting the same amount of heroin the addict was used to before treatment can more easily lead to a fatal overdose.
Three counties in Northern Kentucky — Campbell, Kenton and Boone — are among the hardest hit by the state’s heroin crisis. In 2013, those counties had 93 fatal heroin-related overdoses, according to coroner records.
No central clearinghouse exists to gather background on overdose deaths, and so The Huffington Post relied on a variety of methods to learn more about these fatalities. Local coroners and their staffs were helpful in identifying victims and providing records. Family members were located independently and relayed information about their loved ones. Court documents also proved useful, as did corrections department records, jail wardens, defense attorneys and corrections officials from Kentucky and Ohio. HuffPost was able to obtain histories for 74 of the 93 victims.
Of the 74, 53 had some experience with 12-step or abstinence-based treatment. Their involvement in such programs ran the gamut from multiple long-term residential and detox stays to outpatient treatment and court-ordered attendance at Narcotics Anonymous meetings. These were addicts who wanted to stop using, or at least heard the message. They went to abstinence-based, military-themed rehabs and out-of-state Bible-themed rehabs. Some had led meetings or proselytized to addicts in church groups on the power of 12-step. They participated in 12-step study nights. One lived with his NA sponsor.
Writing to her mother from a 12-step facility, Kayla Haubner worries she'll relapse if she moves back home. She died from an overdose shortly after graduating.Courtesy of the Haubner family
In letters home from an abstinence-based facility in Prestonsburg, Kentucky, Kayla Haubner gushed about how she was taking to the program, but worried it wouldn’t be enough. “I’m so ready to stay sober,” she wrote in early 2013. “Believe me, I know how hard it’s gonna be when I leave here + go back into the real world. I’m safe here.” It was a sentiment that she would repeat often to family and friends during her time in treatment. In a subsequent letter, she confessed, “I’m so scared for when I leave here + go back home.” Two weeks after graduating from the program, she fatally overdosed in a gas station bathroom.
For all the people who graduate from 12-step and abstinence-based programs and then relapse, many more drop out before completing them. Recovery Kentucky facilities across the state admitted to HuffPost dropout rates as high as 75 percent.
Chrysalis House, a Lexington treatment center for women, most of whom are mothers, has more success than most, with about a 40 percent dropout rate, administrators said, but among those who complete the program, roughly half will relapse within a year. Many, if not all, had previous treatment stays. (The facility is not part of Recovery Kentucky, but does receive public funding.)
Jennifer Stamper, Chrysalis House’s treatment director, said the mothers can stay up to two years at the facility. Chrysalis House does not offer Suboxone, but it does accept mothers who are on the medication — although Stamper said they make up less than 5 percent of the residents. Despite the clinic’s failure rate, she has not considered making the medication more accessible. &I don’t know how to answer that question,” she said. “We are an abstinence-based program by nature.”
The state’s treatment providers have little idea how their patients fare once they walk out the door. Hascal of The Healing Place said she didn’t know the relapse rate of her graduates. When Diane Hague, the director of the largest licensed addiction treatment facility in Jefferson County, was asked what happens to addicts once they leave, she replied, “How would I have that?” Right now, the surest way Hague and others know the fate of former residents is if they return after a relapse.
The high dropout rates have provoked neither an internal crisis nor a re-evaluation of programming. Stamper dismissed dropouts as “attrition by personal choice.” An addict’s failure is considered a result of not being ready for treatment, never an indication that there might be a problem with the treatment itself. “We welcome them to come back and try again,” said Tony White, program director of the Morehead Inspiration Center, a Recovery Kentucky men’s facility.
In order to track Recovery Kentucky outcomes, the state contracts with the University of Kentucky to conduct an annual survey. In its 2014 report, researchers claimed that 92 percent of all illicit-drug addicts who went through Recovery Kentucky were still drug-free six months after discharge. The figure, if accurate, would represent an astounding rate of success in an industry beset by failure.
The survey and its findings, however, didn’t show the whole picture. Robert Walker, an assistant professor at the university’s Center on Drug and Alcohol Research and a designer of the study, conceded that his team surveyed addicts early in their recovery. “You are probably seeing some honeymoon effect,” he said. “If you had a follow-up 18 months out, you’re not going to see that number.” How long addicts’ commitment to sobriety lasts after they graduate from Recovery Kentucky is “the bigger question,” he said.
Another possible reason why University of Kentucky researchers came up with such a high success rate: the survey did not include addicts who quit or who were kicked out during the first few months of the program. That means a substantial percentage, potentially a majority, of heroin addicts treated by these publicly-funded facilities were simply not accounted for at all.
“This would really be picked apart by peer reviewers,” said Dr. Yngvild Olsen, the medical director for the Institutes for Behavior Resources in Baltimore, who reviewed the study for the Huffington Post. “It speaks to the gap in really high-quality research that exists in this area.”
Walker said he thinks his UK research team should include all addicts who enter Recovery Kentucky. “If I had my druthers I would include them,& he said. &We would include everybody.” But the parameters of the study are not up to him, he explained, but determined by Recovery Kentucky – the subject of the study.
The addicts who quit during those early stages weren’t ready to accept 12-step so they don’t count, explained Townsend of Recovery Kentucky.
But nobody wants to be a heroin addict. These were individuals who were desperate enough to seek help, who had often languished on long waiting lists to get it or who, if a court had ordered the treatment, faced incarceration if they dropped out. A rigorous study would include every addict who attempts treatment at the facilities in question. “That is your true outcome,” said Dr. Johnson of the University of Maryland. “The outcome isn’t a selective number of people who are devoted to the program.”
What addicts face is a revolving door, an ongoing cycle of waiting for treatment, getting treatment, dropping out, relapsing and then waiting and returning for more. Like so many others, Tabatha Roland, the 24-year-old addict from Burlington, wanted to get sober but felt she had hit a wall with treatment. “I hate my life so much.. I’m fuckin miserable and I feel like I’m stuck.. I hate it more than anything in this world.. and I hate to see you hurt even more,” she texted her mother, who wrote back, “What can I do to help you get the help you need??? Anything…!!” Roland replied: “Idk and that’s what scares me so much.”
Tabatha Roland texting her mother before suffering a fatal overdose.Courtesy of the Roland family
Roland participated in an outpatient program, went through detox many times, quit in the middle of two different long-term residential stints, and completed a stay at Recovery Works, in Georgetown, before her fatal overdose a week later, on April 16, 2013.
For the treatment centers, the revolving door may be financially lucrative. “It’s a service that rewards the failure of the service,” Johnson said. “If you are going to a program, you don’t succeed and you pay X-thousand dollars. When you fail, you go back — another X-thousand dollars. Because it’s your fault.”
Johnson has received honors for his research, including a 2001 award from Hazelden, a Minnesota-based drug and alcohol treatment provider that helped to popularize the 12-step method, for having furthered “the scientific knowledge of addiction recovery.” In a recent interview, he called conventional 12-step treatments by themselves “inadequate care.”
Eliza Clontz has run abstinence-based treatment programs for opiate addiction in Kentucky and worked as a counselor in the state’s private and public sectors. She said the prevalence of the abstinence model for drug treatment parallels the faith-based approach to sex education. “They believe in the abstinence model because that’s what’s drilled in. You have a lot of the old-timers running the programs now. They have been running them for years,” said Clontz, who now works as a director of a substance abuse program that provides counseling for addicts including those taking medications. “They have this mentality of abstinence, abstinence, abstinence. … It’s always been that way.”
Since the heroin epidemic first hit, the 110 beds at the publicly-funded Grateful Life Center have become some of the most coveted real estate in Northern Kentucky. The facility for men, part of the Recovery Kentucky network, is located in Erlanger, just down the road from the Kenton County jail. Addicts can stay nearly seven months or longer in the program, more than at most facilities. Some addicts transitioning out of Grateful Life can also qualify for housing assistance if they meet certain requirements. The center is run by a defense attorney, and it is the place that judges and the Department of Corrections tend to send addicts under their jurisdiction. It is one of the first places that parents call to see if there are empty beds.
If you are a heroin addict looking to get sober, Mike Greenwell, the center’s intake supervisor, is the first man you talk to. On a Saturday night in late March, Greenwell, 61, was still at his desk doing paperwork. He used to be a nightclub manager before alcohol and drug use got the better of him. He keeps a little radio tuned to classic rock. A Jesus bumper sticker is slapped on the wall above his desk.
I asked about a former resident, Keith Lillard, a 29-year-old who overdosed in October 2013. Lillard struggled with heroin for a decade and had been through Grateful Life, as well as The Healing Place in Louisville. He logged a turbulent history of rehabs, detoxes and relapses. The day before he died, he watched his 7-year-old son participate in a karate exhibition. His mother and sister would find him dead from an overdose in the room he was renting at a sober-living house.
Greenwell conceded that Lillard’s fate was not unique. Two-thirds of addicts drop out or get kicked out of his program, he said. He estimated that only about 1 in 5 who complete the program have a “real shot” at staying off drugs. And that’s being optimistic, he said. He later compared Grateful Life to the Marines: “Only the top 15 percent make it long term.”
Might Suboxone have saved Lillard?
“Could have,” Greenwell said. “But it’s not sobriety.”
Greenwell underlined his point. “It’s being alive,” he said dismissively. “But you’re not clean and sober.”
As the broader war on drugs is being reconsidered — even in conservative states like Kentucky —
officials have concluded that an incarceration-first strategy is not only costly but also bad policy. Drug courts that shuttle defendants to rehabilitation facilities instead of locking them up are now ubiquitous. But a reforming justice system is feeding addicts into an unreformed treatment system, one that still carries vestiges of inhumane practices — and prejudices — from more than half a century ago.
John Peterson got hooked on heroin in the mid-1950s, soon after returning home to Los Angeles from a stint in the Army. He struggled to stay in college and to kick the drug. He tried to detox at home with codeine-laced cough syrup. He made regular visits to a clinic on West Pico Boulevard where he was injected with a mysterious brown liquid that he was told could cure him. The infusions were nothing but a painful hoax. “I didn’t know anybody that cleaned up and stayed clean,” Peterson, 81, said. “It was an impossibility.”
&I didn't know anybody that cleaned up and stayed clean. It was an impossibility.&
John Peterson, 81, former addict
Peterson thought of Charlie Parker’s exuberant 12-bar blues “Relaxin’ at Camarillo.” It was more than a standout tune to him — it was a code: Camarillo was the state mental hospital where in the 1940s Parker had been sent to address his own heroin addiction. A decade later, Camarillo was still the closest approximation of drug treatment available. Peterson decided he could do it like Bird.
He entered the Spanish Mission-style facility, located 60 miles north of Los Angeles, under the wrenching spell of heroin withdrawal. In the room Peterson shared with 50 other patients, he was the only drug addict. Not once did a doctor treat him, a nurse attend to him or a psychiatrist hear his story. In the eyes of the staff, he recalled, all that distinguished him was that he was a little more sane than the rest of the patients. Instead of receiving treatment, Peterson was recruited for staff duties. He was ordered to help restrain other patients during electroshock therapy. “Either you are the shocker or the shockee,” the orderlies told him.
Patients were forced to strip naked before bed and to leave their clothes in a pile outside the dormitory. After lights out, Peterson said, some residents would rape the weaker and more vulnerable. His best friend was an alleged murderer who had been deemed mentally incompetent
to stand trial. As he had to do with others, Peterson was made to hold his friend down for shock treatments. But the friend understood Peterson’s dilemma, and he would serve as Peterson’s bodyguard against the nightly threat of attacks. &The door was locked and you got 50 guys in various stages of insanity, so what happened happened and one tried to survive it,& Peterson said.
Once signed into the facility, Peterson wasn’t permitted to leave until his three months were up — precisely 92 days and five hours, he recalled. “It didn’t make any sense to me then. It wasn’t treatment,” he said. “I don’t know what you’d call it.” Peterson relapsed immediately after he left Camarillo.
At the time, addicts were lucky to find a hospital bed to detox in. A hundred years ago, the federal government began the drug war with the Harrison Act, which effectively criminalized heroin and other narcotics. Doctors were soon barred from addiction maintenance, until then a common practice, and hounded as dope peddlers. They largely vacated the field of treatment, leaving addicts in the care of law enforcement or hucksters hawking magical cures.
Jails and prisons filled with heroin addicts. They became so despised by wardens that early in the Depression, the federal government established two model facilities just for addicts. (One of the two was built in Lexington.) They became known as &Narcotic Farms,& places where addicts tilled rolling pastures and cared for livestock as part of their therapy. These so-called hospitals still bore all the marks of a prison, and at least 90 percent of the residents relapsed after leaving. To this day, getting locked up is the de facto treatment for a large percentage of addicts.
Given the options available to Peterson and other addicts mid-century, it’s easy to see why Narcotics Anonymous — founded in 1953 as an offshoot of Alcoholics Anonymous — became such a success.
The philosophy of AA co-founder Bill Wilson, also known as Bill W., a former Wall Street analyst and a recovering alcoholic, offered empathy and promised lasting sobriety. Wilson’s organization came out of evangelical Christian movements. His cure wasn’t a jail cell or a scheme to separate addicts from their money but a meeting space where people shared their problems and admitted their vulnerabilities. This was considerably less frightening and more affordable than electroshock therapy.
The Big Book, first published in 1939, was the size of a hymnal. With its passionate appeals to faith made in the rat-a-tat cadence of a door-to-door salesman, it helped spawn other 12-step-based institutions, including Hazelden, founded in 1949 in Minnesota. Hazelden, in turn, would become a model for facilities across the country.
“The history of 12-step came out of white, middle-class, Protestant people who want to be respectable,” said historian Nancy Campbell, a professor at Rensselaer Polytechnic Institute. “It offers a form of community and a form of belonging that is predicated upon you wanting to be normal, you wanting to be respectable, you wanting to have a stake in mainstream society.”
In the mid ’60s, the federal government decided that drug treatment should become more widely available. In ways that may be familiar to reformers today, government officials began to rethink incarceration policies toward addicts. Mandatory sentences fell out of favor, and a new federal law, the Narcotic Addict Rehabilitation Act, gave judges the discretion to divert a defendant into treatment.
The law also laid the groundwork for our current system by encouraging local communities to open their own treatment facilities. “There was a scramble away from centralized treatment at the Narcotic Farm and a scramble to get it in every city or small town,” Campbell said. &Who was best positioned to provide care at the time [the law] went into effect? Faith-based and 12-step programs, despite the fact that they had little experience with drug addicts in the late 1960s and early 1970s.&
The number of drug treatment facilities boomed with federal funding and the steady expansion of private insurance coverage for addiction, going from a mere handful in the 1950s to thousands a few decades later. The new facilities modeled themselves after the ones that had long been treating alcoholics, which were generally based on the 12-step methodology. Recovering addicts provided the cheap labor to staff them and the evangelism to shape curricula. Residential drug treatment co-opted the language of Alcoholics Anonymous, using the Big Book not as a spiritual guide but as a mandatory text — contradicting AA’s voluntary essence. AA’s meetings, with their folding chairs and donated coffee, were intended as a judgment-free space for addicts to talk about their problems. Treatment facilities were designed for discipline.
Something else has been lost with the institutionalization of the 12 steps over the years: Bill Wilson’s openness to medical intervention. From the start, Wilson intended AA to work with, not against or instead of, the latest and best medical science to treat addiction. In 1965, he recruited Dr. Vincent Dole to become a member of AA’s board of trustees. Along with Dr. Marie Nyswander and Dr. Kreek, Dole pioneered methadone treatment for heroin addicts.
In one of their mid-’60s papers, the three scientists wrote of the limits of non-medical intervention. They described the addict as being “functionally disabled” and the life of the addict as a cycle of relapsing and repenting. But they found that methadone treatment worked. “The present state of these patients is so dramatically improved over their previous condition, and the improvement began so soon after entry into the program, that there can be no doubt that these patients have made a significant response to treatment,” they wrote.
Kreek recalled Wilson’s pleading for a similar treatment for alcoholism. “Bill would say, ‘Vince, please develop a methadone maintenance treatment for alcoholism. AA is very helpful, but as you know most relapse…And that’s the bottom line,’” Kreek said.
In a Northern Kentucky detox facility, the definition of “manage,” a sign above a bed and an inspirational quote.Jason Cherkis / The Huffington Post
Dole wrote about this episode in a 1991 article: “[Wilson] suggested that in my future research, I should look for an analogue of methadone, a medication that would relieve the alcoholic’s sometimes irresistible craving and enable him to progress in AA toward social and emotional recovery.”
The Twelfth Step calls on addicts to carry the program’s message to other addicts, which is considered central to one’s own recovery. But many rank-and-file 12-steppers took a hardline message from some of Wilson’s written philosophy. Those who can’t stick with the program are &constitutionally incapable of being honest with themselves,& reads the Big Book. &They seem to have been born that way.&
Charles Dederich, a gravel-voiced salesman and an alcoholic, built an empire on this harsh sentiment. After attending AA meetings in Southern California in the late 1950s, he grew to believe that they were not tough enough. The addict needed more than brotherhood. He needed to be challenged, and &to grow up.& After a singular LSD experience, Dederich conjured up a drug-free commune for heroin addicts in Santa Monica.
Dederich held that addicts lacked maturity or the ability to handle freedom responsibly. They must be broken down to be built back up. &Comfort is not for adults,& Dederich argued in a taped speech during the commune’s early days. &Comfort destroys adults.&
John Peterson was one of the first to move into Synanon, as the commune was called. It worked for him, though not for many others.
&Comfort is not for adults. Comfort destroys adults.&
Charles Dederich, Synanon founder
At Synanon, sobriety was achieved not just with mutual support but through mob-directed brainwashing. If an addict broke the rules, he faced public humiliation, such as being forced to wear a sign around his neck or shave his head. A centerpiece of the treatment was a confrontational form of group therapy that became known as the Game.
The Game was a primitive court-like spectacle where addicts sat in a circle and leveled indictments against their peers, screaming at each other in the hope of a breakthrough. Dederich once proudly described the Game’s verbal spewing as “emotional bathrooms.”
At one point, the verbal shock therapy went on three days a week, an hour or so at a time. The Game would evolve into longer versions that played out over the course of several uninterrupted days. Sleep deprivation was supposed to act as its own mind-altering drug. Many of Dederich’s harsher prescriptions were unique to Synanon, but his basic idea — that addicts would improve themselves by punishing each other — gained currency throughout the U.S. treatment system and particularly in prisons.
Synanon’s agonizing ordeals proved appealing to many addicts desperate for the promise of a cure. By the early 1960s, former members and others began branching out across the country forming their own versions of the Synanon model. These eventually were dubbed &therapeutic communities.&
&It does sound harsh but you have to remember we were a community of drug addicts, recovering drug addicts, and these kind of punishments became rites of passage for many of us.&
Howard Josepher, early Synanon member
“It does sound harsh but you have to remember we were a community of drug addicts, recovering drug addicts, and these kind of punishments became rites of passage for many of us,” said Howard Josepher, 76, who in the ’60s was one of the first members of New York City’s Phoenix House, which was a Synanon-type program when it was established. He went on to work there and became a regional director.
Daytop Village, also in New York, stood for “Drug Addicts Yield To Persuasion.” In what eventually became common practice for other communities, addicts who wanted to get into Daytop were required to sit in a “Prospect Chair” and beg for help. The program also developed marathon versions of the Game. In its early years, if an addict threatened to leave Daytop, the staff put him in a coffin and staged a funeral.
One of Daytop’s founders, a Roman Catholic priest named William O’Brien, thought of addicts as needy infants — another sentiment borrowed from Synanon. &You don’t have a drug problem, you have a B-A-B-Y problem,” he explained in Addicts Who Survived: An Oral History of Narcotic Use In America, , published in 1989. “You had all the freedom you wanted, and you couldn’t handle it. Do what you’re told. That’s what they do for the first five months. The orders are coming from ex-addicts who are role models for them. It’s much easier to obey them because they were there on that same floor some months earlier.”
David Deitch, a former Synanon member who co-founded Daytop Village with O’Brien, now sees the philosophy as fundamentally flawed. “It brought about a conversion for some without a willingness to look at the great masses that it didn’t work for,” he said. “Those that became part of the inner circle had the best success rates, but the huge majority that went through this experience — as is true of all treatment for this disorder — relapsed.”
True believers were promoted in the ranks and, when left unchecked, terrorized the more skeptical addicts. “Reward was dependent on gaining status, and with status came power — generally power over others,” said Deitch. He left Daytop and then moved to Chicago, where he worked in public health helping to oversee a variety of drug treatment programs including innovative ones that integrated a softer version of the “therapeutic community” with methadone maintenance. He is currently an emeritus professor of clinical psychiatry at the University of California, San Diego, and director of its Center for Criminality & Addiction Research, Training & Application.
By the early ’70s, variations of the Game used on addicts and other crude behavior-modification techniques caught the attention of Congress. A report from the Senate Judiciary Subcommittee on Constitutional Rights compared the extreme approaches of these group therapies to “the highly refined ‘brainwashing’ techniques employed by the North Koreans in the early 1950s.” Congress was alarmed that these techniques were being applied to teenagers.
Listen: The Scars Of Teen Drug Treatment
&And the next thing I know, my parents said goodbye to me and I started to cry, like &Wait... what&s going on?&& & Patty Payne
Official outrage soon dissipated, however, and widespread policy change is still slow in coming. Programs modeled after the &therapeutic community,& seeking to break the spirit of addicts through punitive measures, remain inf humiliation, degradation, and the drive to “reprogram” addicts are still part of mainstream treatment. Anne Fletcher, the author of Inside Rehab, a thorough study of the U.S. addiction treatment industry published in 2013, recalled rehabilitation centers derisively diagnosing addicts who were reluctant to go along with the program as having a case of “terminal uniqueness.” It became so ingrained that residents began to criticize themselves that way.
Zachary Smith, a Northern Kentucky resident, attended a South Carolina boarding school for issues with pills and marijuana in 2006. His mother, Sharon, remembered that he had to earn the right to sit in a chair, to drink anything other than milk or water, and to make phone calls. To move up in the ranks, he had to offer a series of confessions, but he was not considered convincing enough. She recalled a “therapy” session in which parents had to scream at chairs “to get the anger out.” Smith died of a heroin overdose in June 2013.
In 2007, the U.S. Government Accountability Office published an examination of the deaths of several teens attending programs in which endurance tests were part of their treatment. In testimony before Congress, GAO officials quoted from one program brochure, which advertised that the first five days were “days and nights of physical and mental stress with forced march, night hikes, and limited food and water. Youth are stripped mentally and physically of material facades and all manipulatory tools.” One young girl with a drug addiction died after collapsing on Day Three. The girl’s parents had taken out a $25,000 loan to pay for the program.
Dr. McLellan, of the Treatment Research Institute, recalled a prominent facility he encountered in 2014 that made addicts wear diapers if they violated its rules. It was not a shocking find — he knew others that use diapers as a form of punishment. Maia Szalavitz, a journalist who covers the treatment industry — most notably with her 2006 book, Help At Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids — said that coercive techniques are still seen as treatment. “Addiction is a condition that is incredibly stigmatized, and because we still see addiction as crime more than a disease, that carries over into our treatment,” she said. “What you end up with is something that in any other part of the medical system would be considered absolutely abhorrent bedside manner, [but here] is actually seen as the treatment itself.”
&What you end up with is something that in any other part of the medical system would be considered absolutely abhorrent bedside manner, [but here] is actually seen as the treatment itself.&
Maia Szalavitz, a journalist who covers the treatment industry
According to Deitch, the Synanon-style approach continues to be particularly popular among administrators of prison treatment programs. In October 2013, he advised the mother of Jesse Brown, a 29-year-old Idaho addict who, as a precondition of his early release from prison, was compelled to enter a psychologically brutal “therapeutic community” behind bars. Years earlier, Brown had suffered a traumatic brain injury in a car accident. His short-term memory was shot, and he crumbled at the slightest sign of stress. But if he didn’t participate in the program and endure the terrors and public humiliations, he would have to serve all of his time.
Once enrolled in the prison’s program, Brown was no longer allowed to sit on his bed during the day or to speak during meals. Inmates in the program played a version of the Synanon Game. The leaders and fellow participants “singled people out in the room and talked about how they were not up to code,” Brown said. No matter how untrue the allegations were, you had to admit fault and apologize to “the family.” If your apology wasn’t deemed sincere enough, you could lose phone privileges for days, even weeks, or be made to wear an embarrassing sign around your neck. This adaptation of the Game went on all day.
Brown didn’t last more than two days in the program. His mother, panicked that he would be penalized, contacted Deitch, who helped her make her case to prison administrators. The officials compromised, and Brown was permitted to take a different class to gain an early release.
The question was not whether Brown would have succeeded in the program, Deitch said, but “would he have been able to survive?” Brown compared being in the “therapeutic community” to torture. “It felt like you were a prisoner of war,” he said.
The Grateful Life Center in Erlanger, Kentucky.Jason Cherkis / The Huffington Post
Central to drug treatment in Kentucky is the idea that addicts must not just confront their addictions, but confront each other. On a Monday morning in late March, the confronted was a reticent 44-year-old