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.
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