Document G3qzax7O7QxMxKqd0voqd20q

Health Policy Advisory Center June 1970 HEALTH / PAC BULLETIN BULLETIN Editorial: Who Benefits From the American Drug Culture? Headlines in the mass media scream out day after day that a drug epidemic is engulfing our land. Heroin, they say, is no longer an affliction of the " amoral or ignorant " lower classes and black and brown ghetto dwellers alone; its use is spreading like wildfire among the children of the respectable, white, middle class. As the daily press fans the flames, and as frightened (and voting) middle class par- ents begin to demand action which will deal with " the problem, " treatment " experts " and politicians are moving to the fore with the " solutions. " For the past 30 years, when American addicts were primarily poor and from the black and brown communities, the same men who are now talking about " an- swers " were stone silent. There is simply no comparison between the magnitude of the drug addiction problem in oppressed, black and brown communities and in a middle class setting. Even though a white addict may be isolated or shunned in his own society, the black and brown com- munity itself is strangled by a " drug culture " which affects every man, woman and child who lives in the ghetto. A Muslim from Bed- ford Stuyvesant - , a follower of Malcolm X, de- scribes the total destruction unleashed on his people and his community by the multi - mil- lion dollar heroin industry as follows: " The black community suffers the loss of its youth through physical and mental deterioration as a result of drug addiction. The black com- munity loses financially because the only way for the junkie to exist is by stealing. The only one he steals from is the black com- munity. He's not going to steal in the white community because he is not allowed to exist in the white community.... The white com- munity benefits from drug traffic because all proceeds from any financial transaction end up in the white economy (no black economy exists) and drug traffic is a very lucrative business. " And Michael Tabor, a former ad- dict and a member of the Black Panther Party (he is now on trial with the Panther 21 in New York City) asserts even further that: " The [ power structure is] delighted that black youths have fallen victim to the plague *.. they realize that as long as they can keep our black youths standing on the street cor- ners'nodding'from a'shot'of heroin, they won't have to worry about us waging an effective struggle for liberation. " It could be argued that the relatively small and powerless populace of " hard " drug ad- dicts was singled out as the perpetual whip- ping boy of a moralistic and puritanical America whose more ambitious prohibition campaign was quashed by those who craved an alcoholic " high " when drinkers banded together to repeal the Volstead Act in the mid- 30's. The narcotic addicts were labelled criminals and forced into criminal activity. Once the prohibitionists had created a crimi- nal drug clientele, law enforcement agencies moved in to clear the streets. The affluent and middle class white communities - fearful that desperate black and brown addicts, might venture into their neighborhoods - threw sup- port to those who adopted a " get tough " line. And the resulting scare campaign - L waged by both the politicians and the press in the 50's lead to the passage of extremely harsh measures which took no time to distinguish between the victim of the plague and the per- petrator of it. And now, the move afoot to re- duce penalties for the mere possession of a drug (heroin or marijuana) and to increase the penalties for pushers, once again is in re- sponse of the needs of a frightened, middle class segment of our society. In effect, the " liberalized " laws only represent a liberal- ization for the drug user who can afford to purchase his drugs. The poor, ghetto addict (who must sell to support his habit) will con- tinue to be prosecuted to the full extent of an even harsher law. Harsh drug laws have been used not only against helpless individuals, but are increas- ingly being utilized as a means of political repression and control against two potential- ly powerful forces for social change - the third world community and the white, radical youth. After all, one must count on the hon- esty of the police when they report that an in- dividual was carrying dope. Not only can politically " dangerous " individuals be picked off and sent away for years, but black mili- tants point out a more pervasive function of drug control laws: " The existence of the junkie, and all that goes with his existence enables the white power structure to keep an army of police in our community, supposedly for our protection from the very same junkie that he created. While the police are busy pro- tecting the black community, they manage also to control and contain us... " So far, the " solutions " to narcotic addic- tion proposed by the Establishment, are, at CONTENTS 2 History of Drug Laws 9 NYC Drug Treatment Hustle 15 Methadone or Therapy? worst, themselves repressive; and, at best are designed merely to provide limited, physical " relief " from the degradation and pain experi- enced by the addict whether - middle class or ghetto bound - . Most drug law " reformers " stop short of demanding that all repressive laws that have been perpertrated under the guise of controlling drugs - the most recent being the Nixon Mitchell - " no knock " bill must - be totally dismantled. By now there is abundant evidence more than indicating that " law and order " meas- ures have not only failed to control drug traf- fic, but have encouraged addiction. It is wide- ly acknowledged among liberals that drug control laws have been used almost exclus- ively to punish the victim. Many who would " reform " drug laws would conclude: We must either legalize the outlawed substance Lin this case, heroin - or preferably, find an- other less politically volatile narcotic sub- stance, which the public will agree to legalize Lwhich in America, is methadone. Legalization, however, is not enough. We must go even further to remove the addict from the criminal world. Heroin must be made legal, as well as methadone, since most addicts prefer heroin and would con- tinue to seek it on the black market to satisfy their craving. Furthermore, once drugs are made legal, they must be made available with- out cost to proven addicts. Otherwise, as has been the experience in other countries, the high prices that the government charges forces the poverty stricken addict to return to the black market and to purchase drugs of " questionable'" content. Just as the reformers'move to legalize is not enough, neither do the proliferating treatment programs offer a " cure " for addiction. First of all, the few currently acceptable modes of treatment - designed for the most part by white professionals - have little chance of success for great numbers of black and brown addicts. The very insistence of medical men and self proclaimed - " experts " that even if they don't have answers now, that given enough time and resources they will find the panacea for addiction, is dangerous. Not only do such programs raise false expectations and absorb the energy of community people, but they provide a safe funnel for the limited government money going into treatment. If the white, middle class crusaders are really interested in combating addiction in the op- pressed communities, they ought insist that considerable money be poured into the ghetto and let the community decide where to put it. Appropriate " treatment " to some blacks and Puerto Ricans might mean housing and jobs while to others it would mean setting up lib- eration schools to build black and brown con- sciousness. Community organizations - from local narcotic agencies to groups of Muslims, the Black Panther Party and the Young Lords Lare beginning to serve notice on those who would exploit their people, both " the drug pushers and the professional program pushers. " There is no quick legal or medical " fix " for drug addiction. Any such superimposed solu- tion will at best only ease the pain of the drug casualties. Only when political struggle, waged by the people who are most oppressed in our society, succeeds in changing the con- ditions which are influencing entire genera- tions to seek fulfillment, economic or spiritual, through drugs, will youth black - , brown and white - feel there is a meaningful alternative to drugs. Drugs are inundating and crippling oppressed communities with the tacit approv- al of the power structure, and the struggle against drugs can only be successful in the context of the struggle for total liberation. As Panther Michael Tabor says: " As long as our young black brothers and sisters are chasing the bag, as long as they are trying to cop a fix, the rule of our oppressors is secure and our hopes for freedom are dead. It is the youth who make the revolution and it is the youth who carry it out. Without our young, we will never be able to forge a revolutionary force. " Drug law History: Politics & Prohibition America is a consumer society. Many of its consumers indulge in one " habit " or another _ and American businesses, both " legiti- mate " and " illegitimate, " push products to meet the demand they help to create. Wheth- er it be a housewife who turns to Librium to help her get through another tense or boring day in the suburbs, or a black teenager cop- ping a fix on the corner in an urban slum, the scene is similar - if you have the money, you can get " relief. " But the recent penetration of " hard " drugs into middle class society, as well as the fear of addiction - related crime against property in " good " neighbor- hoods has set up a public outcry which is reverberating in the mass media and the legislative halls. Since the early 60's, politi- cians from urban areas have been under pressure from their constituents to find more Published by the Health Policy Advisory Center, Inc., 17 Murray Street, New York, N. Y. 10007. (212) 227-2919. Staff: Robb Burlage, Leslie Cagan, Vicki Cooper, Barbara Ehrenreich, John Ehrenreich, Oliver Fein, M.D., Ruth Glick, Maxine Kenny, Ken Kimerling and Howard Levy, M.D. 1970. Yearly subscriptions: $ 5 students, $ 7 others. Application to mail at second class postage is pending at New York, N. Y, 2 effective ways to sweep the addicts (i.e., the ban schools and business and industry, (even non white - burglars, the muggers, the thieves) so, 75 percent of addicts are from minority off the streets. Nelson Rockefeller based his 1966 campaign for the Governorship of New groups). Alarmed parents in such places as Smithtown, Long Island, Clifton, New Jersey, York on a civil commitment program, which and Grosse Point, Michigan, are insisting that was called " treatment " to assuage the reform- school officials give their children saliva, er conscience, but in reality merely made it blood or urine tests to determine what drugs easier to pick up more addicts and put them they are using. Even big business is worried. away for longer periods of time without bur- Last fall 60 top business executives who make dening the courts. In 1965, John Lindsay point- up the Commerce and Industry Association ed to addiction as a serious problem, and part- devoted their annual meeting learning how to ly on the basis of his promise to do something recognize addiction among their junior execs. about it, he was elected Mayor of New York. And this spring, top officials of the UAW ad- Richard Nixon picked up on the popular mitted concern about reports of widespread theme emanating from New York and, after use of narcotics in the plants. campaigning successfully on a " law and or- Confronted by an alarmed, middle class der " platform, last fall submitted a " get tough public, most politicians are adopting a modi- on pushers " drug control - bill to Congress. fied line about addiction: The Establishment Such political appeals to the public's fear is shifting the onus of criminality from the of addicts and addiction are an attempt to drug user to the drug pusher, while search- capitalize on what the newspapers call a ing frantically for a medical " fix " with which growing " epidemic. " There are an estimated to treat the victim. Even President Nixon, who 300,000 heroin addicts in this country. US as recently as last summer was calling for heroin addiction rates have climbed faster increased punishment of drug users, has real- than in any other Western country. In the last ized such laws can be applied to the sons 20 years, the number of known addicts has and daughters of his own constituents (and increased 300 percent. Forbes Magazine in any event, have proven unsuccessful). states the magnitude of the problem in bus- After due consideration, he said in a message ness terms: " It's an industry that runs to to Congress last fall: " It has been a com- nearly $ 3 billion a year in the US alone.... mon oversimplification to consider narcotics It's a real growth industry, expanding in the addiction or drug abuse to be a law enforce- US at 10 percent or more yearly. " The US ad- ment problem only. " But Nixon is a mere up- diction rate is 30 times that of Italy, Belgium, start compared to New York's Governor Russia, Poland and Brazil; 10 times that of Rockefeller when it comes to blowing with Britain and France; and twice that of Cana- the wind. The same Rocky who ran unabash- da. (In the early 60's, the census of addicts edly on a " sweep the addicts off the streets in any given European country rarely ex- of New York " platform three years ago, only ceeded 500 individuals. It is possibly of some a few weeks ago told a conference on drug social significance that the severest drug abuse: " Curing addiction is one of the tough- problem in European history was recorded est jobs in our society. It would be a tragedy in pre World - War II Germany, which saw a if there were those who tried to make political phenomenal growth in addiction to hard drugs. By the time the war commenced there gain from the suffering and degradation of narcotics addiction. " were at least 10,000 known German addicts.) New York City's Mayor Lindsay has also The white middle class's increasing con- gained considerable political mileage from cern over addiction comes not merely from the drug crisis. A year ago, just before the the growth in addiction, but from the fear of primaries, Lindsay announced the formation being victimized by the same drug evils that of a Federal - City Narcotics Enforcement Task have plagued the ghetto communities for Force in a joint news conference with US At- years. Not only might ghetto addicts boldly torney General Mitchell. The task force still venture into the white community to steal doesn't exist. Then in October, 1969, just days goods to support their habit, but middle class ' before election day, Lindsay joined Senators teenagers are getting hooked on readily Javits and Goodell in calling for a " moonshot " available heroin. The ensuing publicity and war on drugs and requested $ 1.5 billion in concern has all but obliterated the fact that Federal funds for a five year - program. Even black and brown communities are still the though the money didn't arrive from Wash- primary victims of drug addiction. Most drug- ington, Lindsay continued to seek drug head- related crime [see Box, Page 10], involving lines. Within a few weeks of his re election - , an estimated $ 15 billion in property loss Lindsay announced the appointment of Rob- each year, is still committed in the ghetto. ert Morgenthau to the newly created post of Notwithstanding, the fears of the white mid- Third Deputy Mayor Morgenthau, a crime- dle class have increased, and the poor com- busting former US District Attorney, was as- munities have been placed in double jeop- signed to clean up the drug problem in Feb- ardy by the " law and order " campaigns of ruary. Lindsay established a City Narcotics politicians which reinforce an already repres- Control Commission and made Morgenthau sive police force. the chief. In March, the new Third Deputy Now the fear of violence in the white mid- Mayor announced his candidacy for the dle class community has given way to an- Democratic nomination for Governor. And in other fear: Addiction itself has penetrated some of its most coveted institutions - subur- April, just two and half months after the fan- fare of another call for a total war on drugs, Morgenthau retired to run for the Democratic The prohibitionist attitude toward drugs nomination for Governor, using the drug which led to this country's law enforcement problem as a major campaign issue. The of- approach to drug addiction, has its roots in fice of Third Deputy Mayor was phased out. the last half of the 19th century. Drug addic- tion was growing at home. " Soldiers'sick- Many politicans are beginning to pay lip ness, " or addiction to morphine, afflicted service to the plight of the addict - victim and more than 45,000 Civil War veterans as a a smaller number are fighting for increased result of the liberal administration of the pain appropriations for the treatment of addiction. killer on the battlefield. By the end of the But they are up against all the problems left war, many others had taken to opium smok- by a 50 year - history of laws which force ad- ing which had been introduced by the Chinese dicts to become criminals. All forms of addic- who emigrated to the US during the 1850's tion, though rooted in the social experience of individuals, are shaped in part by society's attitude toward addiction and by the con- trols it imposes. In America (and through America's influence, in much of Asia) the use of " hard " drugs was prohibited in the early part of the 20th century. [See Box, Page 6.] In so doing, the society forced the addict to become a criminal to survive. More- and 1860's. Though many continued to think of opium smoking as strictly an oriental sport, more than half the imported opium reached the general market. At the same time, a flourishing patent medicine industry found that a touch of opium or morphine could ease almost any pain - and, coinci- dently, sell a lot of bottles of medicine. As America turned the corner of the 20th cen- over, if he were part of an oppressed minority group, he might actually be attracted to this one facet of the economy which was " open " tury authorities estimated there were at least 100,000 addicts to morphine, opium and heroin. and offered opporunity. And if he were a suc- The discovery of the drug addiction prob- cessful hustler, he might gain considerable lem around the turn of the century coincided respect among his peers. In most European countries, by contrast, where addiction to historically with the campaign to rid the na- tion of another scourge alcohol. Both the " hard " drugs was viewed as just another general prohibitionist sentiment of the era medical problem with a prescribed treat- ment such a drug subculture never gained momentum. The " British system, " " for ex- and a specific collection of men in the Treas- ury Department who were charged with the enforcement of the Volstead Act were in- ample, merely authorized physicians to write fluential in labeling the addict a criminal. prescriptions for heroin. Recently an unpre- The American delegation attending the first cedented jump in addiction prompted the British to switch from self administered - drugs International Opium Convention at the Hague in 1912 pushed very strongly for in- to a more formal system of clinic dispensaries. ternational drug controls. When no such con- Whether the recent increase in addiction is attributable to Britain's " liberal " policy re- garding addiction, or whether it has other trols could be agreed on, the delegation re- turned home determined to clean up its own backyard. The US made her first stab at con- social bases, is presently being debated. trolling the flow of narcotics in 1914 by pass- MEDICAL POWERS PUSH LIBERAL Three powerful lob- bies -t he AMA, the DRUG BILL APA (American Psy- chiatric Association, and the PMA (Pharm- aceutical Manufacturers Association) - are throwing their considerable combined weight behind a liberal drug control measure which is now being considered in the US Senate. Even though they have the choice of another, more conservative bill, these groups have jumped the fence. Does it mean they have be- come addict advocates and friends of op- pressed people? Hardly. The motivation for switching lies more in the realm of jealously guarded research grants, the doctor's right to privacy and drug industry profits. The first of the two bills, the Administration- backed Dodd bill, would give all powers (en- forcement, treatment and research, and edu- cation) to the Department of Justice. The sec- ond, the Hughes Kennedy / bill, however, reserves the responsibility of treatment and re- search and education on drugs for the Depart- ment of Health, Education and Welfare. Both bills talk about the need to soften the penalties for possession and use of drugs (both mari- juana and heroin) while getting tougher with the pushers. Both bills talk of the need for edu- cation about the dangers of drugs, though the Hughes bill is a little weightier in this respect. Though the Dodd bill seemed virtually as- sured of passage earlier this year, it now ap- pears to be in trouble. There is no indication when either bill (Dodd was introduced last fall and Kennedy late this spring) will be reported out to the floor for a final vote. The AMA - APA - PMA axis'objections to the Dodd bill revolve around three areas of power to be vested in the Office of Attorney General Mitchell: (1) the " no knock " provision which says Federal agents may break into a house and make arrests without a warrant if they have probable cause to believe the person they are about to arrest has committed a felo- ny and that he will destroy the evidence if warned by knocking; (2) the power to desig- nate a drug a " dangerous substance " subject to control, and to set production quotas for drugs according to " medical, scientific and industrial needs of the US "; and (3) the authori- ty to enter into contracts with public agencies, institutions of higher education and private organizations or individuals for research and ing the Harrison Act. The law itself is a rela- tively mild mannered and innocuously word- ed revenue measure. But its subsequent in- terpretation and the attached severe penal- ties set America apart from most other West- ern countries. (Interestingly, the " pro- non - hibitionist " British narcotics control measure passed in 1920 is almost identical to the Har- rison Act.) ; On the face of it, the Harrison Act simply requires that persons and firms importing and handling drugs register and pay a nominal tax - fee. The Act went on to say that addicts who had previously purchased drugs from pharmacies and mail order houses must henceforth obtain their drugs from a physician. The portion of the law which was open to interpretation, however, was the sec- tion that said a physician could dispense drugs only in the course of legitimate prac- tice. What constituted " legitimate " practice? A series of Supreme Court rulings from 1915 to 1922 said: first, that possession of a smug- gled drug (i.e., one on which the tax hadn't been paid) was a crime; second, that a doc. tor could not prescribe drugs to " satisfy the craving " of an addict, but only for purposes of withdrawal; and, finally, that the only cir- cumstances under which a doctor could pre- scribe drugs for withdrawal was for an ad- dict under institutional care. For all practical purposes, since by 1922 there were no longer any hospitals which would treat addicts, all legal access to drugs had been foreclosed. The enforcement of the Harrison Act was initially placed in the hands of internal rev- enue collectors in the Treasury Department. But in 1919, the agents charged with this re- sponsibility were thrown into a newly cre- ated Prohibition Unit along with the agents who were to enforce the newly enacted Vol- stead Act. The Treasury Department's drug control regulations which were issued in 1921 were based on the Supreme Court de- cisions and bore the definite stamp of the prohibition mongers. Their influence is most starkly reflected in the fact that 44 narcotic- dispensing government clinics which had been opened in 1919 under the reign of In- ternal Revenue Service, were summarily or- dered closed in 1920 by the Prohibition Com- missioner. Legally, medical alternatives to the " law and order " interpretation of the Harrison Act, were still not ruled out. Had anyone chosen to challenge the Court's early decisions and the ensuing Federal regulations, a Supreme Court decision handed down in 1925 might have served as an opening wedge. The case involved Dr. Charles Linder from Seattle who, unlike the doctors in the earlier cases who were involved in prescribing rather large quantities of drugs, supplied only four pills, to be used for withdrawal, to an in- former posing as an addict. The Court cleared Dr. Linder of charges, described ad- diction as a disease, and said that a phy- sician acting in good faith could give drugs for withdrawal. But instead of spurring re- form, the Linder incident - which cost the doctor over $ 30,000 and a two year loss of license probably - did more to insure that doctors would stay clear of addicts. After all, they reasoned, bad publicity - whether you win or lose could cost a man his career. Organized medicine - through the voice of the American Medical Association (AMA). was less than valiant when it came to fight- ing for the health and welfare of addicts. But it is probably safe to say that their attitudes were a fair reflection of the attitude of the medical profession in general. They not only willingly acquiesed to the Treasury Depart- special projects related to drug addiction. Many doctors testifying at the Dodd bill hearings saw the " no knock " provision as a green light for agents to rampage through the doctor's offices and homes, which " could en- The Hughes bill meets most of the objections of the drug and medicine lobbyists. It would set up a Drug Abuse, Prevention, Treatment, and Rehabilitation Administration in HEW which in turn would establish a nationwide danger the innocent. " (Actually, " no knock " privileges have always existed under com- mon law in America, and have even been legislated in some states, including New, York.) Only a few of the doctors acknowl- edged the possibility that the Attorney Gen- system of regional and community health centers for addicts. Grants would be provided to state, local and private agencies to educate the public about drugs. A booster for the Hughes Kennedy / package, Daniel X. Freed- man, of APA and the chairman of the Uni- eral might abuse his powers of jurisdiction over medical research records and jeopardize versity of Chicago Department of Psychiatry, put it this way: " The bill envisages realistic patient confidentiality. Several representa- tives of the drug industry and medical profes- grants to private and public facilities which professionally qualify and intend to deliver... sion were concerned with the labeling of drugs as " dangerous substances " and the setting of quotas for their production. Finally, many were concerned that the law would inhibit drug company research on narcotics antagon- ists. Dr. Max Fink, of New York Medical Col- lege, testified that, " Two firms have already indicated that they would be unfair to their stockholders to support fuuther research in it creates the possibility of establishing suffi- cient credibility so that people in trouble may once again turn to health experts who are trained and will to provide preventive and treatment help for drug problems (emphasis ours). " Freedman went on to charge that re- searchers already feel the effects of repression on " independent research. " that senior re- searchers are harrassed from the multiple the antagonists to opiates since present regu- lations restrict the commercial future of these compounds. " agencies they must report to. " Medical sci- ence, " he maintains, " can only advance in an unfettered climate. " THE US ROLE American business- IN THE men were profiteering OPIUM BUSINESS from illicit drug traffic long before the Mafia got in on the action. But in the early 19th century, the participating US merchants - whose contributions of tobac- co, pipes and fast clipper ships had enhanced the sales were eased out of the trade by their more established British counterparts. Britain, operating with the advantage of a colonial master, had begun cultivating poppies (the source of opium) in her Indian colony in the middle of the 18th century. From her Indian base, the East India Trade Company raked in tremendous profits through the sale of the opium it smuggled into China. Eventually, opium became the excuse for Britain to pry open the doors of China's mar- kets to receive other British products as well. Even though a prohibition on opiates in China had existed since 1729, the drug trade flour- ished. Britain was anxious to market other products in China and eagerly seized upon an incident involving the destruction of illicit opium as an excuse for declaring the first Opium War in 1842. The treaty settling the war gave Hong Kong to the British and estab- lished British trading privileges in five former- ly prohibited Chinese ports, but didn't even mention opium. In 1856, Britain once again declared war on China and was joined this time by France, who claimed to want to avenge the death of a French missionary. The treaty which settled the conflict in 1858 granted the right of entry into China of both opium and missionaries. The association of the " two mind benders -" was not lost on the Chinese. In 1869, a Chinese prince realizing - that opium is at least as powerful an " opiate of the people " as religion - told a British of- ficial, " Take away your opium and your mis- sionaries and you will be welcome. " A century later, Malcolm X, who had been a heroin addict, recalled the plight of the Chinese: "... The collective white man had acted like a devil in virtually every contact he had with the world's collective white non - man. The blood forebearers of this same white man raped China at a time when China was trusting and helpless. Those original white " Christian traders " sent into China mil- ment regulations, but wholeheartedly en- dorsed the closing of the government drug clinics. Picking up on the rhetoric of the prohi- bitionists, a spokesman for the AMA said in 1921: " The shallow pretense that drug addic- tion is a disease which the specialist must be allowed to treat, which pretended treatment consists in supplying its victims with the drug which has caused their physical and moral debauchery... has been asserted and urged in volumes of literature by self styled - special- ists. *.. The vice that causes degeneration of the moral sense, and spreads through so- cial contact, readily infects the entire com- munity, saps its moral fiber, and contami- nates the individual members one after an- other like the rotten apples in a barrel of sound ones. " Until the late 50's, the AMA consistently and vehemently opposed all " ambulatory methods of treatment of drug addiction, whether practiced by the private physician or by the so called - ' narcotics clinic ' or dispensary. " Through organized medicine opted out on its responsibility to treat the addict, the fed- eral Public Health Service lent medical re- spectability to the federal addiction program by setting up federal " hospitals " to get the addicts off the streets in the 30's. Procedures for criminal and civil involuntary commit- ments were adopted. The treatment centers which are in Fort Worth, Texas, and Lexing- ton, Kentucky were traditionally long on de- tention and short on treatment. Even their own statistics reveal that fewer than three percent of their " graduates " have been " cured. " From the 20's to the 50's, lawyers showed as little interest in protecting the addict's legal rights as did the doctor in considering his health rights and for many of the same financial reasons. Narcotics laws as defined by the Treasury Department and enforced by the Bureau of Narcotics (established with- in the department in 1930) until very recent- ly made little distinction between the perpe- trator of the crime and the victim of it. And in practical terms, the victim received the harsher treatment of the two both at the hands of the police and in the courts. And given the choice of an addict or a peddler to defend, the lawyer is more likely to choose the man who can pay. Records show that higher courts spend a constitutional disproportionate amount of time on the constitutional rights of traffickers (illegal search and seizure cases), rather than on the same constitutional rights of addicts which may have been abused. Before 1930 and the creation of the Bureau of Narcotics in the Treasury Department, ad- diction was considered a Federal concern al- most exclusively. The newly formed Bureau quickly sought the cooperation of the States in an effort to fill possible gaps in the law. Most States responded by adopting a sug- gested Uniform Narcotics Law which was similar to the Harrison Act although many of the penalties, which varied from state to state, were often even harsher. Many of the state laws added marijuana in the list of dan- gerous narcotics. The Federal law which authorized the establishment of Lexington and Fort Worth Hospitals in 1929 also de- fined marijuana as a " forming habit - narcotic drug. " With the way paved, the federal gov- ernment passed a Marijuana Tax Act (simi- lar to Harrison) in 1937. The laws remained pretty much intact un- der the 1951 Kefauver hearings on organ- ized crime triggered a public outcry for in- creased punishment for those involved in lions of pounds of opium. By 1839, so many of the Chinese were addicts that China's des- perate government destroyed 20,000 chests of opium. The first Opium War was promptly declared by the white man. Imagine! Declare war upon someone who objects to being nar- cotized! The Chinese were severly beaten with Chinese invented - gunpower. The treaty of Nanking made China pay the British white man for the destroyed opium: forced China to abandon Hong Kong; fixed China's import tariff so low that cheap British articles soon flooded in, maiming China's industrial de- velopment. After a second Opium War, the Tientsin Treaties legalized the ravaging opi- um trade, legalized a American British - French - control. China tried delaying that Treaty's rat- ification: Peking was looted and burned...'" Once the US no longer had any vested in- terest in the profitable opiate export business, she adopted a moralistic position, calling for European colonialists to give up opium traf- ficking and, in so doing, gained some favor among the colonized and embittered Far East- ern nations. After World War I, the US began pushing for total international prohibition of narcotics - but, moderation prevailed and Western countries with colonies in the Far East only agreed to institute government mo- nopolies which were to control both the growth of opium and the distribution of the product. The US found itself in a much more power- ful position, especially with regard to Britain, towards the end of World War II. In 1943, the American government's Bureau of Narcotics called a meeting of Allied nations to consider policy toward opium in the countries re- claimed from Japan. Faced with the danger of addiction of " our boys, " the colonial pow- ers agreed to abolish the legalized (govern- ment monopoly) sale of opium. Thus, a pro- hibition system which had failed to stop drug traffic in the US was imposed on the countries of the Far East and subsequently on much of the Middle East. With one swoop, the legal opium smoking problem of these countries be- gan to be converted to an illegal morphine and heroin problem. The hypodermic method of injections began to be adopted and the trade flourished in the underground. Perhaps more significant, the profile of the Asian ad- dict began to resemble his American counter- part a young urban male from the slums. the drug scene. Congress passed the Boggs Amendment which instituted minimum pen- alties for all drug crimes. Possession of drugs and selling them were treated similarly: The penalties ranged from two to five years for a first offense, from 10 to 20 years for a third offense. As before, many of the States passed similar " Little Boggs Acts. " In 1956, the Con- gress passed the Narcotic Drug Control Act. This time possession and sale were distin- guished, and minimum penalties were upped. Possession alone could net a prison- er anywhere from two to 40 years, depend- ing upon whether it was a first or third offense. The sale of narcotics to a person un- der 18 could mean anywhere from 10 years to death. And once again the States followed suit by passing similar Drug Controls Acts of their own. The agency assigned to enforce the drug laws the Bureau of Narcotics and Danger- ous Drugs (it was renamed and moved from the Treasury Department to the Department of Justice in 1968) -has enthusiastically cap- italized on the " signs of the times. " Because it has a large public relations budget, and controls most information on narcotics which is disseminated at the Federal level, it is able to produce data to show effectiveness or establish need. The Bureau - though it failed to produce credible statistical data regarding either its own enforcement activities or on the dimensions of the domestic addiction problem - has been highly critical of non - re- pressive systems of treatment. When reform- ers appeared to be gaining ground in the mid 50's -, the Bureau took it upon itself to widely circulate a report which debunked Britain's medical approach to addiction. The Bureau concluded that the British system was little different than ours and any difference in the size of the addict population was at- tributable to the fact that the British are not " addiction - prone. " Herbert Anslinger, an ex prohibition - of- ficer, who headed the Bureau from its incep- tion until 1962, was a J. Edgar Hoover - type figure who was not beyond appealing to the political fantasies of Congress when appro- priation time came around. During the Cold War, he convinced Congress that the spread of addiction in America was a " commie plot " _ that even the combined efforts of the US Army, Air Force and Navy would have a difficult time stopping the influx of dangerous drugs. Of course, he promised, an increased budget for the Bureau of Narcotics would be a step in the right direction. Since 1960 there has been a general reap- praisal of the harsh punishment of drug users although the " reappraisal " has been more rhetoric than reality. In 1962, the two states with the greatest narcotics problem in the US, New York and California, followed in the footsteps of the federal government which had set up civil commitment proced- ures for Lexington and Fort Worth in the 30's, and instituted state civil commitment pro- grams [see description of New York civil commitment, Page 16]. Because these Fed- eral and State programs are billed as " re- habilitation, " not as " punishment, " the ad- dicts committed to such institutions are often denied even basic constitutional rights - e.g., it is only recently that the courts required a jury trial before commitment in New York. A few months ago, New York City fol- lowed in the footsteps of the Federal and State moves to restrict the addict by institut- ing what was in effect a compulsory treat- ment program for the addict's " own good. " 7 NIXON: President Nixon made NARC OF THE WORLD a splash in the press this March when he announced he would get to the " source " of the heroin problem by signing agreements wtih the countries which cultivate poppies and manufacture most of the heroin Turkey - and France, respectively. The new treaties, which provide subsidies for local police, are con- tributing considerably to US supported - po- lice forces around the world. The primary targets of the Nixon war against drugs would be the opium farmers of Turkey and Mexico and the heroin distilleries in France, particularly in Marseilles. Authori- ties claim that of the three tons of heroin which are smuggled into the US each year, that 80 percent of the original opium poppies are cultivated in Turkey and 15 percent in Mexico. And the Marseilles heroin distilleries, they say, are to the drug industry what De- troit is to the auto industry. The spoils? Turkey will get a $ 3 million loan to encourage her farmers to switch from opium to other crops. Along with the money, Turkish officials will get narcotics - fighting " equipment " with which to train a new nar- cotics police force - ranging from spotter planes to guns and ammunition. Increased cooperation with France also means " mutual police training programs. " Not to neglect other countries, the US will beef up the num- ber of narcotics officers assigned to embas- sies and foreign missions. In addition, the US Bureau of Narcotics, which now has offices in 12 foreign countries, will establish offices in another five. In announcing the new bilateral pacts with France and Turkey, Nixon stressed the point that narcotics traffic enforcement is too im- portant and complex to be left to the police, and promised to throw the weight of the en- tire diplomatic corps into the fight against drugs. So far, most diplomats have kept hands off the local narcotics trade, which often involves prominent local businessmen and public officials. For instance, the US diplomatic corps would be the last people to interfere with the thriving cocaine industry of Peru. Friendly Peruvian businessmen profit from the manufacture and smuggling of co- caine to the US and besides, the Peruvian power structure needs the coco plants to pacify the Andean Indians, who fight hunger and despair by chewing coco leaves. Another miscalculation on Nixon's part was his " Operation Intercept " at the Mexican border last summer. The Mexican govern- ment was infuriated when this massive bor- der blockade almost destroyed the tourist trade. Nixon exonerated himself this spring by giving a parcel of money to Mexican po- lice officials to conduct " Operation Coopera- tion. " The control emphasis has shifted from the border to an all out war on the poppy (and pot) crops. The arsenal supplied by the US will include airplanes equipped with spe- cial drug sensing - devices and crop defoliants. Actually, the illicit flow of hard drugs into the US pales when compared to the uncon- trolled flow of " legitimate, " though equally debilitating, drugs from the US into the foreign marketplace. This spring, a UN commission on narcotics control fought a losing battle to institute " soft " drug control measures pat- terned after those controlling " hard " drugs. Countries with developed pharmaceutical in- dustries, led by the US, West Germany, Can- ada and Japan, rallied to defeat the measure which would have severely cut into the profits from about 100 different drugs (hallucinogens, amphetamines and tranquilizers). The City Department of Social Services issued an administrative order which denies public assistance to an addict unless he is in treatment or a definite treatment commitment is agreed to. The Commissioner of Social Ser- vices Jack Goldberg, claims the City is look- ing for a better return on its 5.7 $ million per year which goes to a minimum of 6,000 ad- dicts. Goldberg assures critics " the junkie will be exposed to a whole series of treat- ment programs. " But there are already wait- ing lines for all the treatments (effective or ineffective) that exist in the city. What is more likely to happen is that these addicts will find themselves in " treatment " in the prison - like State narcotic rehabilitation cen- ters which have been operating at 25 percent below capacity. At the Federal level, officials are trying to capitalize on the political potential of the drug issue, and respond accordingly. Last year, Nixon's newly appointed head of the Bureau of Narcotics and Dangerous Drugs, Robert Ingersoll, sensing the Congress was shifting toward waging war on the pushers while relaxing the penalties on drug users (since many of their sons and daughters were being picked up on dope charges), told a Congressional committee: " Our major con- cern is with [drug traffic's] criminal aspects. ... A greater effort will be expended now and in the future to apprehend and prosecute major drug traffickers and also to prevent violation of the drug and narcotic laws, espe- cially among the young, the naive, and ordi- narily law abiding - public. " Congress granted his request for a program of training and staffing foreign narcotics posts, an incentive plan to persuade foreign growers to stop pro- ducing opium [see Box, this page], substantial increases in border guards and agents for both Federal and local narcotics bureaus and increased reserach and education into the Drug problem. The Bureau's estimated 1971 budget, $ 34.5 million, almost double that of 1969, reflected the Administration's stepped up spending for drug law enforcement. In his first major statement on drug addic- tion in the summer of 1969, President Nixon took a hard line. Among other provisions, Nixon recommended that marijuana use be treated as a felony. This put lead in his trial balloon, and Nixon liberalized the plan un- der heavy criticism from such men as Sen. Gaylord Nelson who said " it is heavy on policing and weak on rehabilitation. " Sub- sequently, the White House bill was incor- porated into the Dodd bill. [See Box, Page 4.] Meanwhile, back in New York State many legislators in Albany were aghast this spring, when the appropriations bank was broken and the legislative session was drawing to a close, and Governor Rockefeller announced " a $ 265 million declaration ' of total war " against drug abuse by those under 16. It's the year of concern for the teenage addict- and Rocky, up for reelection, knows a good issue when he sees one. Many Democratic legislators from New York City made a coun- ter " declaration " that Rocky's " war " was a hoax. Nevertheless, Rocky's call for the legis- lature to trim 64 $ million from other pro- grams so it could be made available on a 50- 50 matching basis to localities localities - which would find it next to impossible to raise cash for teenage drug programs - was heeded. It would have been political suicide for critics to do otherwise. The remaining $ 200 million of the Rockefeller " war, " for con- struction or leasing of facilities for youth treatment centers, was to be provided by State housing bonds to provide loans to local governments. But the lion's share of Rocky's war made headlines then disappeared. The much publicized shift in public policy toward addicts - from one of punishment to one of treatment - will probably not mean much to most addicts. Even though the penal- ty for " possession " has been eased, it will mainly benefit those who can afford to buy their drugs and do not have to push to make money to support their habits, as is the case with most lower class addicts. It is true that there are now many in the medical profes- sion who are willing to treat addicts. Even the AMA, which for decades supported a " law and order " line, came full circle last winter when it declared: " dependent drug - persons should be treated as patients rather than criminals. " But little money is available for " treatment "; most of the effort still goes to repression. Moreover, in the past, " treat- ment " has most commonly been nothing more than a euphemism for imprisonment. Finally, really meaningful treatment means changing the conditions which lead to addic- tion. Even if a medical " cure " for addiction were found tomorrow, poor people would still lack meaningful employment, decent housing, good schools, etc.; the conditions that generate addiction would remain un- touched. - Maxine Kenny ASA: " There are Enough Junkies for all of us " Drug treatment programs are the most popu- lar " hustle " to hit New York since poverty programs passed from vogue a few years ago. And like its predecessor, very few of its - resources are reaching the " target " popula- tion. A recent survey shows that the more than 50 residential centers for addicts (and over 100 outpatient facilities) are part of a multi million - dollar addiction treatment in- dustry ranging from church programs, vol- untary hospitals, and private corporations to City and State agencies. Several of the spon- sors have succeeded in building " mini " em- pires through sheer press release fanfare, hulabaloo and hutzpah. But despite the fact that money is flowing into their programs, the professional entrepreneurs who are mak- ing names for themselves as " experts " have failed to " cure " more than a handful of the thousands of addicts who have passed through their doors. Treatment available to the New York ad- dict ranges from imprisonment, to sipping a paper cup full of methadone in orange juice, to the group therapy provided in therapeutic communities run by ex addicts - and / or psy- chotherapists. Officials who run the public programs for the State and the City claim its only a matter of time before their programs start showing good results. But when pressed for figures, the picture which emerges is a gloomy one. An official of the New York State Narcotics Commission [see Box, Page 16] which provides some degree of " care " for about 11,000 addicts to the tune of $ 50 million a year, says he feels there have been " perhaps a couple hundred cures. " And the City Addiction Services Agency, with a 29 $ million plus yearly budget, claims 79 " cures " out of the 2,500 addicts it has treated since the agency was created in 1967. Both the State and City agencies funnel money to other public and private treatment facilities as well as run their own services. Even though New York City leads the nation in variety of treatment and the numbers of fa- cilities, it is estimated that fewer than three percent of her 200,000 addicts ever receive any treatment, good or bad. Lack of treatment for addicts is nothing new. Until 1950, when the mass media pro- claimed a heroin " epidemic " in New York City some claim the 50's " epidemic " was worse than the present day one few - New Yorkers thought of addiction as a problem. Any addicts or pushers who were arrested were hustled off to Federal drug facilities in Fort Worth, Texas and Lexington, Kentucky. Many white, middle class addicts journeyed there to take the " cure " voluntarily. Then came the " epidemic, " and Governor Thomas Dewey responded by pressing the City's De- partment of Hospitals to open a 141 bed - hos- pital on North Brothers Island. This facility, Riverside Hospital, was a co educational - fa- cility intended to rehabilitate (mostly minor- COPPING Many black and crime, particiularly crime committed in the PROFIT brown community white community. The following figures from FROM DRUGS people maintain that an independent study conducted in New York the police commit City from 1963-1967 reveal that a smaller per- more drug related centage of addicts are involved in crime, and crime for greater profit - than addicts. The even fewer in violent crime, than we have addicts are accused of crimes in the white been - led to believe. If you add to that the communities that they seldom commit, they fact that most addiction - related crime is con- say, though the cops are seldom accused fined to the ghetto, the crimes committed by of profitting from drug traffic in the ghettos. addicts in the white community become mini- Occasionally a policeman is dumped from scule. The research shows: The overwhelming the force for accepting a payoff from big time - majority of the crime committed - both against narcotic dealers, but a recent New York Times property and against people is committed expose reveals that corruption goes beyond a by non narcotic - users. Only about 10 percent few " bad apples. " The narcotics detail is a of major felony property crimes (such as rob- coveted position in the New York Police De- bery, burglary, grand larceny and auto theft) partment because of the volume of cash which are committed by addicts. Burglary and the 1 flows to most officers, even the desk sargeant. possession of stolen goods accounts for the An over zealous - press which - quotes statis- highest percentage of addict crimes. The per- tics provided primarily by politicians and cent of felonies committed against the person police continues to present a distorted pic- (such as homicide, assault and rape) is even ture of the relationship of drug addicts to smaller for addicts - only three percent. ity group) adolescents. The hospital came under heavy public attack in the late 50's for being a den of vice, and the State Commis- sioner of Health began to look for a way out. He turned to the Columbia School of Public grams (maintenance and a detoxification unit serve 11,000 addicts). Soon after Trus- sell, a Wagner appointee, left the City, the Lindsay admiinstration cut off the appropria- tions to Beth Israel's methadone research, Health for an evaluation of the situation, and and the State Narcotics Control Commission Dr. Ray E. Trussell produced a study to show the facility had been almost 100 percent in- effective as a treatment facility. Though the politicians wanted to close the hospital im- mediately, they were unable to do so be- cause of the resistance of the staff - that is, until Dr. Trussell was named City Commis- sioner of Hospitals in 1961 and, as one of his first acts in office, ordered the hospitals closed. From the closing of Riverside Hospital un- til the therapeutic communities took root in 1965, very few treatment doors were open to the addict. Ex Hospital - Commissioner Ray Trussell proudly recalls how he personally pressured his City hospital administrators in- began to pick up the tab. As Dole and Nyswander began to receive worldwide notice for having found a " mira- cle " cure for heroin addiction, Mayor Lind- say began looking for a way to launch a pilot methadone project of his own. Until last year, the Mayor had had all his eggs in the therapeutic community basket. The Addic- tion Services Agency ASA () , a child of the Lindsay Administration, under the direction of its first commissioner, a Puerto Rican psy- chiatrist, Efren Ramirez, pursued heroin ad- diction with righteous, therapeutic religiosity. But Ramirez resigned early in 1969, and the road seemed clear for some diversification. to donating a grand total of only 25 beds (out of 16,000) to the service of pregnant addicts. With " crime in the streets " a major issue, But in the early sixties, the Health Research the Administration was not unaware of the Council (the City agency which funnels pub- lic money into research), called addiction re- search a top priority, and set up a committee to study the problem. Its chairman, Dr. Vin- cent Dole of Rockefeller University, applied in 1963 for a $ 100,000 grant from the Council mileage politicians seemed to be making by recommending " humane " methadone care, at a cost much lower than institutional care. The logical target population for such a ven- ture was the " prone crime - addict. " Lindsay called on his friends at the Vera Institute of to do research on addiction. When the grant ran out, Dr. Trussell encouraged Dr. Dole and Dr. Marie Nyswander (his research part- Justice (a well heeled - civil oriented - liberties - institution in New York City) to work up a plan. The blueprint was unveiled in the ner and wife) to expand their research by providing a $ 1.4 million grant in 1965 and six spring of 1969, shortly before the mayoral primaries. By fall, the money had arrived beds at Manhattan General Hospital (now the Morris J. Bernstein Institute of the Beth Israel Hospital) for their famous now - metha- done maintenance research. Trussell left his post with the City in 1966 and returned to Columbia where he established an " inde- pendent evaluation committee " for the Dole- Nyswander program, and then, about two years ago, he became director of Beth Israel which takes a cool $ 2.5 million annually for the Bernstein's methadone treatment pro- from Washington, and Lindsay held another timely press conference at the dedication of a newly purchased and renovated facility in Bedford Stuyvesant - this time on October 8, just a month before he would be up for re- election. (Insiders say that not only was the hastily prepared application pushed through the Federal bureaucracy - bypassing all re- view processes - but that when the doors to the center opened with the Mayor's press conference, that none of the agencies work- 10 ing with addicts in Brooklyn had been in- to evaluate the center's social and therapeu- formed of the plan.) The Mayor's political op- ponent, conservative candidate Mario Proc- tic programs, have come and gone. The only research unit left is a criminal activities eval- accino called it as he and many others saw it: uation team from Harvard Law School. As " The sheer gall of this man Lindsay is be- part of the criteria for getting into the pro- yond belief. He fought the methadone main- gram, an addict must relate his criminal his- tenance program as long he he could, as tory to the researchers and sign a release in hard as he could. " [As the BULLETIN goes to which he agrees to submit to ongoing inter- press, Lindsay has announced a 1970-71 views on his " criminal behavior " for as long budget which provides $ 7.7 million dollars as he continues in the program. Moreover, to not only expand the Vera program, but to medical backup for the Vera program is non- provide methadone through the City's 20 existent a crucial link to hospital - based District Health Centers.] emergency, inpatient and psychiatric care, The Vera methadone program, which is primarily an out patient - service, has been which originally had been agreed upon with nearby Brooklyn Cumberland - Medical Cen- riven with problems since it opened in Bed- ter, was broken off almost as soon as the pro- ford Stuyvesant - last fall. The Vera program, gram got underway. unlike the Beth Israel prototype, talks about The father of methadone maintenance, Dr. maintaining the addict on methadone only Vincent Dole, used harsh words to describe until he has gotten himself together through therapy and a variety of social services, and the Vera program. In a letter to Herbert Sturz, Director of the Vera Institute, in May, 1969, then gradually reducing the methadone until Dr. Dole said of the proposal: " It is a med- he is drug - free. The program has been caught ically naive, unworkable mess - in my opin- in a cross - fire of attacks from pro metha- - ion, that is.... The administrative and done maintenance - men who allege the Vera clinical personnel that would be needed to program people are basically aligned with operate such a program do not exist, at any the therapeutic community concept and that salary, apart from the personnel that we their deliberately sloppy operation will make have trained.... You have a 10 ton airplane a bad name for methadone; and from anti- with a one horsepower motor. " He saw the methadone black and brown community members who say the addicts are drugged whole thing as a plot. " Mayor Lindsay now can make the next step [apply for the funds senseless on methadone and that the program to run the program], which is to ruin the ex- serves as an instrument of repression. isting program by setting up a duplicating Critics claim that poor medical practices, organization with higher salaries to take i.e., irregular and inconsistent dosages of away key personnel.... " The mayor would methadone (as a matter of practice to see if do better, Dr. Dole maintained, if he put $ 5 addicts can be withdrawn, and as a matter million (less than half the budget of ASA) of poor procedures, i.e., staff wanting to leave into methadone maintenance, preferrably ad- early, etc.) have led to the deaths by heroin ministered by the Beth Israel Medical Center. overdose of at least five patients out of a patient load of less than 200. The overdoses Y'n the therapeutic community side of the happened, say people who work in metha- treatment picture, Odyssey House privately - done maintenance programs, because the ad- owned and operated - has shown the great- dicts'level of methadone dropped so low est growth outside the City's own Phoenix that they felt a craving for heroin, shot up, House program. Odyssey House has used and died as a result. State money, saturation advertising, solicit- According to the director of the program, Dr. Beny Primm, a black anesthesiologist from ing and such gimmicks as " rummage sales " at. Abercrombie & Fitch to contribute to its ' New Rochelle, everything is A OK -. The Vera program officially known as the Addiction Research and Treatment Corporation - is set up as a private, non profit - corporation with an star all - board of directors headed by fot- phenomenal expansion from one house with 65 addicts in 1967 to six houses and 253 addicts and a one and one half million dollar budget at the present. Odyssey is a family affair: directed by Dr. Judianne Denson- mer US Attorney General, Nicholas Katzen- Gerber (psychiatrist and lawyer); her moth- bach. The program received a total of $ 2.5 er is on the board of directors; her lawyer- million (mostly from the National Institute father represents Odyssey in legal hassles; of Mental Health, the Justice Department's " Safe Streets " money, and the rest in match- and her husband heads an advisory council which includes Senators Javits and Goodell, ing funds from the City through Model Cities) last year. So far the center is serving four assemblymen, seven judges and such other notables as Bill Graham of the Fillmore about 200 addicts, mostly court remands East rock concert hall and Roy Campanella. from all over the City. (There are few local Her teenage programs get a constant boost residents in the program, even though local from her husband, Dr. Michael Baden, who, people are given priority according to the as the Assistant Chief Medical Examiner for grant proposal.) Eventually, in the course New York City, does more to remind New of the next five years, the project hopes to Yorkers of the daily deaths of the addict, reach about 5,000 addicts and to set up cen- especially the teenage addict, than CBS ters in the South Bronx and Harlem. News does to record the number of " enemy " So far, in less than eight months in opera- dead in Vietnam, Laos and Cambodia. Doc- tion, three entire research staffs, which were tor Judy, as she is known in the House, bases 11 her periodic and dramatic pushes for more money, more facilities, and more publicity on the figures her husband adds up and re- leases with dramatic narrative to the daily press. In recent months, many community people have banded together to fight what they see as objectionable methods on the part of Dr. Denson - Gerber. They object to the way she displays " her children " (the teenage pa- tients) in order to gain support for her pro- grams. One of her more recent exploits in- volved holding a slight 12 year - - old Puerto Rican boy on her lap at a State Legislative hearing on Juvenile Delinquency, while he told stories of mainlining. Several Senators were reduced to tears, and later the boy went up and down the aisles of the hearing chamber selling Odyssey House buttons for five dollars each. Dr. Denson - Gerber took the child along to Chicago a few days later for an appearance at a meeting of forensic medi- cine specialists. Then, much to her embar- rassment, the little boy left Odyssey and returned home. His older brother told the press his brother kid - was never an addict, that he had been coached to say " those things. " At least three times in recent months com- munity people have rallied - for different rea- sons to keep Odyssey House from moving into their neighborhoods. The first show stopper was in the poverty - torn Hunts Point 0 THE CHANGING FACE OF The history of opiate addiction in this coun- THE ADDICT try goes back to Civil War days when many soldiers were treated with morphine to kill pain and opiate tinctures for dysentery. The hypodermic nee- dle was also first used at that time. Between the 1860's and the passage of laws restricting opiate sale and usage in the early 1900's many more people became addicted via their physicians and patent medicine quacks. Al- most all of the magic potions and liquids sold over the counter had significant amounts of 'o piates in them. Thus, at the turn of the cen- tury, women addicts outnumbered men ad- dicts three to two, and most addicts were mid- dle class - and thus almost entirely white. In addition, there were significant numbers of rural southern whites who were addicted via the " magic " elixir route. Significantly, blacks were almost never addicted at that time. With the passage of the Harrison Act in 1914, the stage was set for heroin (which was first synthesized in 1898) distribution to be transferred into the hands of the underworld. The social and political impact of heroin pro- hibition had been profound. What the prohibi- tion did was to single out one sub group - of drug abusers and label them criminals, while simultaneously denying them access to their drug supply. This forced the addicts into a life of economic crime which was necessary in order to pay for their habits. During the 20's and 30's, addicts became in- creasingly urban males and for the first time, section of the Bronx. In the fall, the Com- munity Progress Center (the Hunts Point poverty agency) invited a coalition of about 12 community groups representing - existing narcotics programs and community - based organizations with narcotic units - to act as " advisors " to design a comprehensive pro- posal for addiction treatment which the agency would submit to the Federal govern- ment for funding. After drawing up the plan, the " advisors " decided that not only should they advise, but that the community should receive the funds and determine how they should be spent. Meanwhile (in February), word reached the coalition that Dr. Densen- Gerber (who had been running an Odyssey House in the neighborhood for three years) was about to seal a deal with the Community Progress Center by which she would be the recipient of any forthcoming poverty funds. The coalition, through a confrontation, forced both the poverty agency and Dr. Densen- Gerber to back down. Of course, the com- munity people said, if Dr. Densen - Gerber was interested in working in a community- planned and controlled drug program, they might consider funding Odyssey along with several other projects. Dr. Densen - Gerber re- sponded: " The community is not going to tell me how to run my program, " and picked up her papers and went elsewhere. The following month, Dr. Densen - Gerber was accused of " blockbusting " in the posh significant numbers of black addicts appeared. By 1945 males out numbered - females six to one, although whites still outnumbered blacks three to one. A recent survey 1969 () of several addict treatment centers in New York indicates that the ratios have now become: blacks 40 percent, Puerto Ricans 35 perecnt, whites 25 percent. The most significant recent changes are the dramatic increases in the number of Puerto Rican and white middle- class youth. Despite the recent appearance of white middle - class addicts. " drug culture " - oriented middle - class white youths are, to a large extent, still sticking with consciousness expanding drugs (pot, LSD, mescaline, etc.) and staying away from the addicting drugs (heroin, barbiturates, amphetamines, alcohol). Heroin addiction has found one middle- class constituency- health workers, espe- cially doctors. A study by Dr. Charles Winick describes physician addicts as private prac titioners who are extremely competitive and competent, who worked long hours, who feel alienated from the medical profession and in addition have significant marital problems. Winick further noted that prior to their addic- tion to opiates, 17 percent of these physicians were heavy drinkers. He hypothesizes that a significant number of these physician - ad- dicts were experiencing severe role strain, which he defines as difficulty in making the transition from a small town, lower class background to the lifestyle of a middle - class physician. Dr. Donald Goldmacher, Mem- ber, New York Medical Committee for Human Rights 12 East 80's. She said she was only trying to move " her children " into some empty apart- ments which had been offered to her by a generous landlord. The angry owners of neighboring brownstones who showed up to try and block the group from moving in said they had no objection to Odyssey itself, that " it's doing a wonderful job, " but that the landlord was using the addicts to try and scare the other tenants into abandoning their apartments. Furthermore, they said, the landlord was trying to get the homeowners next to him to sell out so he could build a 37 story - luxury highrise. The landlord ad- mitted that he planned to build the highrise, but maintained he already had all the land he needed. Odyssey moved in despite the protest, and Dr. Densen - Gerber commented, " Maidman [the landlord] is an angel.. I don't know where we'd be without him. " The third incident involved the residents of Bushwick in Brooklyn. Dr. Densen - Gerber had received an enormous amount of pub- licity, including two lengthy and laudatory editorials in the New York Times, concerning the fact that Odyssey was the only facility which catered to the teenager in (fact, all but one of the houses are adult residences) and if she didn't find shelter for them they would be forced to sleep in the street. Mayor Lindsay magnanimously and with some fan- fare offered a vacant hospital building in Bushwick. When Dr. Densen - Gerber arrived in Bushwick to claim the Evangelical Dea- coness Hospital, she found it occupied by community residents who insisted the Mayor had promised it to them as a day care - fa- cility. Frustrated with City officials, she took her story (and 70 teenage Odyssey resi- dents) to Albany to meet with State legis- lators. The delegation staged a memorial for the teenage addicts who had died so far in 1970 and then Dr. Densen - Gerber and " her children " joined hands to sing " Somewhere (there's a place for me) " from the score of the West Side Story. At this point a group of angry black and Puerto Rican community people from New York City, who were also in Albany looking for resources, broke up the meeting and accused Dr. Densen - Gerber of " making money off of black and Puerto Rican addicts'misery. " Dr. Densen Gerber's - publicity hit its mark, however. Within a few hours Governor Rockefeller called a press conference to say he would pour 265 $ million (which has since failed to materialize) into services for the teenage addict. Most recently, community groups have de- cided to get to the root of the problem: the agencies which handle most of the money for local drug treatment programs - the City's Addiction Services Agency (ASA) and Mod- el Cities. Under the leadership of the city- wide Community Council for Narcotic Pro- grams which was formed last fall by people running money starved - neighborhood - based programs has begun to ask what makes ASA and Model Cities run: Who controls the public money for drug treatment and where does that public money go? ASA directly operates residential treat- ment programs, does education and counsel- ing, and contracts with private agencies to set up programs. The agency has grown from a staff of only six people and a budget of $ 400,000 in 1967, to a bureaucracy with over 400 employees and a 1970 budget which exceeds $ 29 million. It receives its funds from City tax money, the State Narcotics Addic- tion Control Commission, the Office of Eco- nomic Opportunity (OEO), and, most recent- ly, the National Institute of Mental Health (NIMH). Until recently, Phoenix Houses were ASA's only residential program and they followed a strict therapeutic community " line. " Not only did most of the treatment money go into expanding Phoenix House (there are now 17 such centers, with six of them being grouped together on Hart Island for prison referrals) but most private treat- ment programs under contract to ASA were proponents of the same therapeutic com- munity approach. In the spring of 1969, a new ASA Commis- sioner, Dr. Larry Bear, took over and began to talk about a " total systems " approach. ASA, Bear said, was willing to try anything to cure addiction: " Methadone isn't the an- swer to all our problems... but drug avail- ability does have a place, and we've got to use it wherever we can.... We've got to expand our Phoenix House programs... I believe we're on the verge of discovering new techniques that incorporate the best of methadone and the best of therapeutic com- munity programs.'" The most diehard therapeutic community buffs within ASA bitterly fought the agency's new tolerance of methadone. Dr. Mitchell Rosenthal, a Deputy Commissioner, who as director of the Phoenix House program held the most powerful position within the Ramirez regime, was carried over to the Bear administration. From his entrenched position, Rosenthal led the fight against the new guard. As head of the Phoenix program, he had a myopic vision of drug treatment and over the years had managed to direct most public resources toward a therapeutic com- munity end. When Commissioner Bear threat- ened to unload him so that he might install a more flexible Deputy Commissioner, Dr. Rosenthal unabashedly countered: " I own ASA, " reminding the Commissioner that he could cripple ASA by shutting down the Phoenix Houses. Some of the carry - over staff adjusted more rapidly to the new, " total sys- tems " approach. For instance, another Dep- uty Commissioner, Dr. Martin Kotler, as- sumed a neutral stance, saying, " There are enough junkies for all of us. " Dr. Rosenthal didn't like the readings he was getting from the Commissioner nor from City Hall, however, so he moved to solidify the future of the proliferating Phoenix Houses. Under his leadership, a group of staffers set up a private, non profit - founda- tion the Phoenix House Foundation, Inc.- whose ostensible purpose was to bypass the 13 City red tape in the purchase and leasing of buildings, to manage residents'welfare checks and to solicit private money. The Board of Directors includes not only Rosen- thal and some lesser ASA figures, but a heavy sprinkling of prominent businessmen and financiers. Thus, Phoenix Houses are now owned and operated by a private foun- dation which would not be subject to the pro- gram policy whims of a City agency. (This is analogous to the Municipal hospitals in New York City which have been put into a quasi- public corporation outside of City govern- ment.) Officials at ASA were not altogether reluc- tant to let the therapeutic community folks go their own way. ASA has been hinting for the last several months that they would like to get out of the Phoenix House business and set up an " institute " which would provide training in both drug prevention and treat- ment to schools, industry and existing drug treatment programs - i ncluding Phoenix Houses. Moreover, ASA sees the institute, for which it is actively seeking federal funds, as a national center for training and testing " modality multi -" and experimental drug pro- gram designs. The experts already on the ASA staff, they say, would provide an excel- lent faculty for such an institute. The Phoenix Houses, under such a reorganization, would become contract agencies (through the Phoe- nix Foundation) just like any other. Whether the switch in ASA philosophy is politically motivated, or simply an attempt to be more effective, is not clear. But in either case, ASA has been laying the groundwork for a conversion. Last spring it signed a con- tract with the private Phoenix House Founda- tion saying if the Phoenix House program should fold, the City would purchase all real estate at market value. It was the City's way of assuring the Phoenix House Foundation that it wouldn't be left in the lurch. Further- more, ASA has gradually become more cen- tralized, from a time when most of the staff was in the field, to the present with more than half of its staff concentrated in the home office. A glance at the current budget reveals that executive management and ad- ministrative positions have increased by $ 2.5 million and 175 staff positions - while at the same time, money and personal for preven- tive and rehabilitative positions have de- creased in about the same proportion. While the ASA is fighting over whether the answer lies with methadone or the therapeu- tic community, community groups are trying relentlessly to extract some money from ASA for their own programs. So far ASA has claimed bankruptcy, and told community groups to go to Model Cities for money, with the assurance that " ASA will back you all the way. " One organization represented in the Community Council for Narcotic Pro- grams, the Brooklyn Federation of Independ- ent Agencies, played the game to no avail: " We went to Brooklyn Model Cities and they said we would have to federate because they couldn't deal with a hundred little agencies. The Model Cities policy committee met (in March) and declared drug programs a prior- ity and allocated $ 1.8 million to drugs. We submitted a proposal and they said there's no money. They hold us,'You'll have to go. to HUD in Washington.'We went, and HUD said,'Brooklyn Model Cities has all the money and the power that's necessary.'So where's the money? Has it been misappro- priated? Where did it go? " If the Federation ever is granted the Model Cities money, they fear that a recent directive that ASA must administer all Model Cities funds for addic- tion will stall the grant forever. " ASA's OEO money is running out in September - so they have to go somewhere. " In the last few months the militants in the Community Council for Narcotic Programs have let ASA and the Mayor know that they are fed up with inaction. " Officials are al- ways crying for money for the'communities, ' but we never see it, " charges Mrs. Elsie Brown, who runs a storefront referral pro- gram for addicts in the South Bronx. " Those who are doing relevant work are not given money. It's no accident [that addiction is flourishing] -the power structure wants to drive us out of the City so it can implement its Master Plan [the City Planning Commis- sion's 1970 Master Plan]. " The group recent- ly applied pressure on ASA to replace a white regional program director for the South Bronx and Harlem with a black. " Can you imagine? " says Mrs. Brown. " Sometimes they force you to get racial. " This spring, a dozen representatives from the Council seized Commissioner Larry Bear's office and demanded not only that he find money for the communities'programs, but that he do something about the most flagrant abuses in ASA or resign. The Council com- plained of the following: OE Phoenix Foundation: Deputy Commission- er Rosenthal has a conflict of interest as both an officer of the Foundation and as a Deputy Commissioner of ASA. Phoenix House should have to submit proposals like anyone else on the merits of its program. There is even suspicion that Phoenix Foundation is playing some fast real estate deals. Some houses, it is claimed, have changed hands as many as three times in one day. Even if such fast deals are no more serious than a way to get tax write - offs, the Community Council wants all such deals made public. " Just because the Foundation claims to be'profit non '-, " they say, " that really doesn't mean a thing. It only means that your books don't show a profit- but you could have spent millions in the course of a year. " OE Discrimination in hiring: The ASA brags about getting civil service to accept the con- cept of hiring ex addicts - and now has a job description for ex addicts - called " addiction specialists. " The Council claims the qualifica- tions are just as restrictive as those for previ- ous civil service slots for most blacks and Puerto Ricans: The ex addict - must have grad- uated from high school (highly unlikely) or have spent five years in a therapeutic com- 14 munity. For instance, it shuts out the hiring off. They say we don't have money, but we'll of methadone maintained - addicts or ex ad- - let you run the storefront that we have set up dicts who kicked when they became Muslims and pay the rent on. They may even throw - and the Muslims probably have the high- in a couple of City job lines from ASA. But est success rate for curing black addicts in they keep the control. " Such arrangements, the US. Finally, anyone who has been in a they charge, are the only ones ASA has been therapeutic community for five years would willing to make with community groups. probably be from Synanon, since that was But the battlelines are just beginning to be one of the few such places in existence more defined, and if ASA doesn't retrench itself than five years ago. With its $ 500 minimum out of the picture and retire behind the walls admission fee, Synanon has been too ex- of an " institute, " the fight has just begun. pensive for most blacks and Puerto Ricans. Elsie Brown says it for the Council: " ASA OE Prejudical funding: The ASA refuses to has a vested interest in not making change. give contracts to community programs so Our job is to build esteem self - in our own that they can provide services to their own people. The addict is at the mercy of two people. " The only programs they fund are kinds of pushers - the dope pusher and the white - run programs. To give us money for professional program pusher. No more can facilities and treatment, " the Council says, the power structure just pick out somebody " would be giving us power and they don't to buy off the - community will decide. ". want to do that. Instead they try to buy us Maxine Kenny Two Treatments: Methadone vs. Therapeutic Communities Until recently the treatment of narcotics ad- diction was neither controversial nor a major medical concern. But with the advent of dollars and political rhetoric, treatment ten- dencies have polarized into two camps- methadone maintenance and the therapeutic community. Both treatment camps view the addict as sick, but they differ in their descrip- tion of his illness. Methadone enthusiasts view the addict as having a metabolic defici- ency disease, requiring replacement therapy with a drug; therapeutic community - backers view the addict as having a personality de- ficiency requiring a total character reorienta- tion. Both therapies discount the social and political aspects of addiction. Both therapies are distrusted by many black and Puerto Rican community groups. Methadone is an opiate - type narcotic drug with analgesic (pain killing) effects similar to those of morphine. Although it was devel- oped as a substitute for heroin, methadone resembles its infamous surrogate in many ways. Both methadone and heroin are addict- ing drugs, which when withdrawn suddenly induce symptoms including restlessness, sweating, runny nose, tearing eyes, nausea, abdominal pain, and craving for another dose of the drug. Both methadone and heroin, when taken intravenously cause a euphoric sensa- tion called a " high, " although heroin is said to produce a better " rush " (the brief, intense, apocalyptic feeling that immediately pre- cedes the high) than methadone. Both the " rush " and the " high " are not experienced with either drug, once the user reaches the tolerance level through repeated, large doses. If these two drugs resemble each other so much, why substitute one for the other? The major reason is that methadone is legal when dispensed as part of a treatment or research program, while heroin is illegal. In addition, methadone is a relatively long acting - nar- cotic (12 to 48 hours, depending on the dose) compared to heroin, which must be taken every four to six hours. Thus methadone is much more practical for use in a longterm treatment regimen. Methadone has two uses: (1) opiate with- drawal (detoxification "") ; (2) opiate sub- stitution (methadone " maintenance "). The traditional use of methadone has been in de- toxification of heroin and morphine addicts. Methadone is of no benefit to patients who are dependent on other drugs, such as bar- bituates, amphetamines and alcohol. Detoxifi- cation involves placing the addict on a dose of methadone, which is sufficient to prevent heroin withdrawal symptoms, and then grad- ually reducing the dose to zero over one to two weeks. Though the addict may feel some discomfort during this process, the severe pain and nausea of withdrawal are greatly diminished, if not completely absent. This method has been used for over 20 years at the Public Health Service Hospital in Lex- ington, Kentucky, and more recently has been offered from outpatient clinics serving ghetto populations. If detoxification is the only " treatment " given, however, chronic, long- term addicts almost always return to heroin. The failure of methadone detoxification as a cure " " led to the development of methadone maintenance programs. Methadone mainte- nance involves starting the addict on small doses of methadone, which prevent heroin withdrawal symptoms. Then the methadone dosage is increased over a two to four week period until a tolerance level is reached, at which point the addict no longer experiences either the euphoric " high " or the craving for heroin. This level of methadone is sub- sequently maintained, presumably for life. Methadone maintenance may be accom- plished without ever admitting the addict to the hospital. However, most programs prefer . 15 to treat the addict as an inpatient for the first six weeks. Some form of social rehabilitation accompanies most methadone maintenance programs, including job counselling, voca- tional training, and some psychiatric help. Methadone maintenance, as a therapeutic program, was developed by Vincent Dole, M.D. and Marie Nyswander, M.D., both of Rockefeller University in New York City. Dr. Dole hypothesized that continued opiate ad- diction created a metabolic deficiency which could only be treated by replacement therapy (maintenance of opiates or substitutes for them such as methadone). This dovetailed well with the experience of Dr. Nyswander, who had noted that after treatment by all other existing methods, the addict's craving for heroin seemed inevitably to draw him back to his habit. Although there is thus far little more than anecdotal evidence to support the metabolic theory, the results are what counts. In 1965 Dole and Nyswander set up an ex- perimental program (now at Beth Israel's Bernstein Institute) to prove that metha- done works for people addicted to heroin for at least five years, and have no overt evidence of major psychiatric or medical problems. This resulted in a largely older (25 years plus) and predominantly white patient load. Social rehabilitation was centered largely on employment, primarily outside of the treatment program itself. Evalu- ation of the program was arranged through the Columbia School of Public Health and Administrative Medicine. To insure independ- ence the evaluation was funded separately from the methadone maintenance program. There is little debate over the use of metha- done for detoxification. It seems to be a sim- ple and humane method for withdrawing ad- dicts. However, methadone maintenance has stirred much more controversy. Within black and Puerto Rican communities, it is pointed out that methadone maintenance is not a cure for addiction, but rather a substitute of one addiction for another. While they may reduce crime, since methadone is a legal drug, many activists fear the implicit control over their communities that the methadone provider will have. This potential use of " drug control " is not so remote. In one New York methadone maintenance program, patients must remove their third world solidarity buttons before re- ceiving treatment. But community sentiment is not absolutist on the topic of methadone maintenance: Mrs. Elsie Brown, who runs a community based addiction referral service in the South Bronx, suggests that methadone be used on addicts over the age of 40, but not on the youth. To " condemn a young person to a lifetime of addiction makes it seem like you've given up on him already, " she says. To some, these objections pale in the face of the significant results achieved through the methadone maintenance program. In Septem- ber, 1969, Dr. Gearing, head of the Columbia group evaluating the methadone program, re- leased a report that indicated that 92 percent of those addicts in the program for 36 months were employed or in school and that of the ROCKY'S DRUG DETENTION " How to Help an Ad- dict " advertises a PROGRAM New York State Nar- cotic Addiction Con- trol Commission (NACC) hand out, describing the NACC's civil commitment program. It should read, " Put a friend away today. " Governor Rockefeller fought for re election - in 1966 under the " Law and Order " banner. His narcotic addiction control program was designed to appease both the local citizenry who wanted the addict blight removed from the community streets and the liberals who wanted the addicts rehabilitated. The Gov- ernor's program was enacted in 1966 as Article 9 of the Mental Hygiene Law, and went into effect in 1967. Since that time it has received nothing but criticism. The purpose of the act was phrased in grandiose humanitarian terms. " The purpose of this article is to provide a comprehensive program of human renewal of narcotic ad- dicts in rehabilitation centers and after - care programs. " But its dual nature of preventive detention and rehabilitation was clear. " The program is further designed to protect society against the social contagion of narcotic ad- diction and to meet the need of narcotic ad- dicts for medical, psychological and voca- tional rehabilitation, while safeguarding indi- viduals [liberty] against undue interference. " Few people enter the NACC program vol- untarily. Addicts can be committed to the NACC program through either civil or crim- inal procedures. Civil commitments are brought in on the petition of the addict him- self or on the petition of a friend or relative. Criminal commitments are court remands of convicted felons or misdemeanants who are suspected of being addicts. In certain situa- tions an arrested addict can petition for civil commitment, and the court may grant it and dismiss the charges. Both those civilly and criminally committed receive a jury trial on the issue of addiction. But they are denied the constitutional privilege against self - in- crimination and the established doctrine of privileged communication with the examin- ing doctor on the theory that the loss of liberty is for the purpose of treatment. Civil commit- ments and those convicted of misdemeanors, are " given the treatment " for 3 years and fel- ons 5 years unless - rehabilitated before then. The program promises to return the addict to a useful life " through extended periods of treatment in a controlled environment fol- lowed by supervision in an aftercare pro- gram. " The emphasis is on " controlled. " The addict receives about as much rehabilitation as the criminal prisoner with about as much result the recidivist rate for addicts is much higher than for criminals. Moreover the re- habilitation centers are run like prisons: There are guards, most of whom received training for prison work - one guard for every 2 inmates, recalcitrant addicts are beaten and placed in isolation on reduced diets; inmates 16 2205 total admissions to the program, the overall drop - out rate was 18 percent. These impressive statistics are paired with data that indicates a substantial decrease in the num- ber of arrests of program participants, com- pared with their record prior to entering the program. Also, it is claimed that addiction to other drugs is limited: Fewer than 10 percent of those on methadone maintenance are found to be using amphetamines or barbitu- ates, and only 11 percent abuse alcohol. Fin- ally, Dr. Gearing reports that none of the pa- tients who remained on the methadone mainte- nance program has become readdicted to heroin. These positive results have been extrapol- ated by program enthusiasts to apply to all addicts. For example, Dr. Harvey Gollance at the Beth Israel program said, " Methadone ad- ministered daily in controlled doses would al- low 80 percent of all addicts now on the streets to begin self supporting - , normal lives. " And Dr. Vincent Dole, who launched metha- done, has claimed that " maintained " addicts would have " an 80 percent chance of becom- ing acceptable citizens. " However, serious reservations must be raised about such state- ments, because of the selective admissions procedures and the voluntary character of the methadone maintenance program. Success may be directly related to the population of addicts who have been pirmary program par- ticipants. They have tended to be male, white and over 25 years of age. From this biased sample, it is difficult to extrapolate to the en- tire population of addicts (although other programs have reported success with less highly selected groups.) Even the data contained in the independent evaluation report which is the basis for the " success " statements, is open to question. First, the data collection was not independent of the program. When Dr. Gearing was asked if her committee went out and got its own in- formation, she replied: " The evaluation com- mittee did not go out... we got our reports of arrests in two places, both from the program and the police....... Initially we did the em- ployer ployer business business..... We have not done it for some time. " Apparently, the primary evalua- tion data are the unit directors reports com- piled from counsellors'reports, all of whom are employees in the program. Second, the employment data is not so impressive in ab- solute numbers. Only 88 patients have been in the program for three years, so, (if 92 per- cent are employed) only 80 patients are em- ployed after three years in the program. Moreover, some of these patients are em- ployed by the program itself; Dr. Gearing re- fuses to say how many. Thirdly, some doubt is cast on the statement that none of the pa- tients remaining on the program have become readdicted to heroin, since detailed data about heroin usage has not been reported. Methadone clearly has a place in the treat- ment of the opiate addicts, probably more because of its legality than because of its " medicinal " qualities. Few would deny the utility of methadone for narcotics detoxifica- are sexually abused; there is no separation of the young from the old. The few rehabilita- tion programs that do exist are staffed by in- structors and group therapists who have re- ceived little or no training. For the 5,000 or so inmates in the 14 separate institutions there are only 4 psychiatrists, 16 psychologists and 78 teachers and vocational instructors. The prison - like atmosphere has caused a large percentage of the addicts to try to escape. The number of civil commitments fell quickly after the truth got out. Judge Amos Basel in a New York Times interview said: " In the beginning, when addicts were brought before me, I used to give them a sales talk. I used to say that the state program was the best thing for them that had ever been de- vised. But from the reports I have received, I can't see any difference between this and a reformatory. " As bad as it was for the civil commitments, the criminal commitments got even worse treatment. Those committed after conviction for misdemeanors found they had an extra two years tacked on to the maximum one year sentence for misdemeanors solely on the ground that they were going to receive treatment. But for the first year or so they were kept in the same cells as the other prisoners. They received no psychological in- terviews. Their only treatment was voluntary group therapy run by inexperienced college graduates and which, in fact, were open to anyone in the prison who wanted to attend. The situation was so bad that the State courts almost declared the program unconsti- tutional in 1968 for failing to provide even minimal amount of treatment. But the court was dissuaded from cutting the program off only after its first year so as to give it a chance to improve. However, there haven't been any noticeable changes since then. The jail like - atmosphere of the rehabilitation cen- ters has also caused a large number of the counselors to quit in disgust. They find it im- possible to conduct a therapeutic program in such a repressive atmosphere [See May 1970 Bulletin.] Rockefeller, in an election year, feels the rock around his neck and has him- self criticized the program as a waste of money. In a speech to an interfaith conven- tion of clergymen on drug abuse he said, " I cannot say we've achieved success - we have not found answers that go to the heart of the problem. " He told the clergymen that, " It's a goddam serious situation. " " The program has failed everyone. It has failed the " clean streets " people because it has handled only an estimated 5 or 10 per- cent of the state's addicts. And most of those returned from preventive detention have re- mained addicts. Meanwhile, it has cost over $ 250 million in taxes or about 25,000 $ per ad- dict, $ 1.1 million per " cure " It has failed re- formers'expectations because there is no treatment. But worst of all, it has duped the poor addict and his family by incarcerating him for three years on the false promise that it will rehabilitate him Ken. - Kimerling 17 tion, but many would question the implica- tions of chronic methadone maintenance. Methadone maintenance alone appears to be no more than an attempt at a simple medical fix to a complex social, political, and psycho- logical problem. Social and psychological re- habilitation is also necessary. The therapeutic community has emphasized these latter as- pects of the treatment of addiction. The enthusiasm of the methadone buffs is matched only by that of the therapeutic com- munity devotees. When psychiatrist Daniel Casriel first went to Synanon, he left the drug treatment facilities of an elite New York City medical center, where finances were ade- quate and staffing was superb. Yet, he had to admit, " I personally felt that I had cured not one addict. " After visiting Synanon, the proto- type of the drug related - therapeutic commu- nity, for several months, his despair had turned to hope: " I am convinced that Synan- on holds the solution to the enigma of drug addiction. " horse brother - , go buy a saddle. " These en- counter sessions may last three to four hours, but occasionally, when the group is " loose " (for example, when many new members have entered the group) a marathon session is held, which may last for 36 or 48 hours. In most therapeutic communities, encounter ses- sions are leaderless, and doctors and psychia- trists are explicitly excluded. Ex addicts - play an authority role, conferred by experience and not by academic degree, by calling down any new addict who tries to " con " the group. This does not mean that therapeutic com- munities are egalitarian. On the contrary, they are very hierarchical, precisely because status within the community serves as a ma- jor form of reward. Among addicts, this is manifest by the strict and ordered phases re- quired for graduation from the program. The form of these phases is the same in each pro- gram. First, during the induction phase, the addict's motivation for entering the program is tested. He must wait hours at the induction Indeed, therapeutic communities like Sy- center, attend trial workshops or encounters, nanon, Daytop Village, Phoenix House and dress neatly, and gradually withdraw himself Odyssey House are impressive counter - com- from heroin. This phase may take from two . munities, especially when compared with the weeks to six months, after which the addict street - life of the addict, or even the normal may be accepted as a fulltime resident of the day day - to - life of the average suburban therapeutic community. Then, phase two be- American. Within the therapeutic community, gins, the treatment phase. During this phase, there is allegedly an honesty, openness and the addict undergoes complete behavioral truthfulness about interpersonal relationships dissection through encounter therapy and a that cuts through the alienation and loneli- scaled program of house jobs, which start ness of modern society. It is not surprising with dishwashing and progress to ordering that Synanon has even attracted a large fol- supplies and leading group therapy sessions. lowing of non addicts - (squares "") . But this This phase lasts from one to two years, with superficial similarity to the hippie commune increasing responsibility given to the addict breaks down under a more careful dissection for the operation of the therapeutic commu- of the therapeutic community. nity. Finally, the third or re entry - phase is All drug related - therapeutic communities embarked upon, in which the addict progres- share the same concept of the addict: The ad- sively exposes himself to the world external dict is emotionally disabled by his family to the therapeutic community. After six background and present behavior, in such a months to one year, this last phase is brought way that he feels insecure, inadequate, to a conclusion with the now addict ex - taking scared, lonely and isolated from normal so- up employment in the expanding program of ciety. To treat the addict requires focussing on the emotions that drive the addict to the needle. Therapeutic communities are de- signed to provide this type of care through three mechanisms: (1) encounter group therapy, a specific mode of psychiatric thera- py; (2) a highly structured community; (3) a reward punishment - system based on simple behavioral psychology. The key to the therapeutic process is the group encounter, variously called the Synan- on game, attack therapy - or the " verbal street fight. " Usually, encounter groups are com- prised of 12-15 participants, who change each session. The procedure involves singling out an individual, whom the rest of the group questions, cajoles, accuses through any man- ner of violent verbal confrontation. The addict is caught in his lies and manipulations and is forced to confront his present behavior and even his self image - . One addict describes the power of the encounter this way: " If a man tells you you're a horse, he's a liar. If two people tell you you're a horse, it's a conspir- acy. If everyone in the room tells you you're a his therapeutic community or (less frequent- ly) taking up fulltime employment unrelated to addiction problems. This careful staging for the addict of higher levels of status within the program is usually not achieved without some setbacks, with the staff deciding when the addict will be demoted or promoted. The ultimate arbiter of these decisions, in most therapeutic communities, is the director and his staff. In effect, when entering a thera- peutic community the addict surrenders all power of decision over his life, except the de- cision to leave. The director decides when he can go on pass; start dating a girl; and what job he gets. Though not differentiated by dress (directors dress like residents), the distinc- tion between residents and directors is clearly maintained in terms of authority. As one ob- servor of the Phoenix House program said, " The residents make mistakes. The directors don't. " The presumed function of this hier- archy, in which ex addic-t s-t aff member domi- nates the resident, is to provide an incentive toward becoming a director - the role model - of the ex addict - . 18 In its simplest sense, treatment within the therapeutic community is a form of behav- ioral psychology. The resident - addict is re- warded with status for good behavior, such as honestly examining his motives within group sessions and taking on responsibility within the community. On the other hand, the resi- dent addict - is punished for acting out nega- tive feelings and failing to take on responsi- bility in the community, by tactics ranging from verbal torture within the encounter ses- sion to head shaving - and loss of status with- in the hierarchy of the community. These rewards and punishments are meted out on the basis of a stringent set of norms: () 1 no drug utilization within the community, includ- ing alcohol; (2) no physical violence; (3) no homosexual relationships, and initially no heterosexual relationships; (4) no escapism in any form, such as " tripping " (daydream- ing) or " rapping bad -" (criticizing) the pro- gram; (5) masculine roles for the men both - leadership and physicial work roles, and trad- ALCOHOL OE 80 million Americans consume some alcohol every year. @ 6 million Americans are alcoholics and several million more have severe drink- ing problems. M@ 1968 per capita consumption: liquor- 2.4 gallons, beer and wine - 27.5 gallons. @ Alcohol Sales: liquorL $ 10 billion, beer and wine 9.735 $ billion per year. CIGARETTES @ 80 million Americans smoke cigarettes. M@ 1968 consumption: 570.7 billion ciga- rettes. HM 1968 cigarette sales: $ 9.94 billion. PRESCRIPTION DRUGS @ More than one half of all Americans take at least one prescription drug per year. 10 million persons use prescription seda- tives and stimulants. 500,000 people abuse prescription drugs (Federal Bureau of Narcotics figures). Aspirin production has increased by since 1960. Tranquilizers production has increased by since 1960; Vitamins production has increased by almost , since 1960. OE Drug sales at manufacturers'levels, 1967: Barbiturates- $ 2,078,000 Tranquilizers- $ 4,658,000 itional docile and subservient roles for the women, such as cooking and sewing. In es- sence, fundamentally middle class norms of abstinence and puritanism are imposed on the addict with an almost religious fervor. All of this is justified on the basis of the ad- dict as a sociopathic personality, who must be turned about 180 degrees. Addicts are not just wedded to their habits by the craving for a high and the pain of withdrawal. Addicts have created a life style, which gives them an identity and a vocation, in contrast to the meaninglessness of their younger life. " How do you cope with a situation where a man is able to get a profound sense of being of some value, which is what you find in the drug world? " asks one director. By becoming a surrogate family, the therapeutic community seeks to substitute a new identity, a new group to belong to, and vistas of a new voca- tion for the addict. Therapeutic communities for drug addicts have sprung up all over the country. The ma- jor trend setters include: OE Synanon was started by Charles Dederich, an ex alcoholic - in California. Synanon (a word coined by a member who slurred the word " seminar ") has grown into an organiza- tion with over $ 8 million in assets, including real estate, hotels, gas stations, etc. and with eight offices from Santa Monica, California to Puerto Rico. Recently, Synanon has moved away from mere treatment of addicts and al- coholics. For instance, the San Francisco branch has 200 residents (largely ex addicts -) and also 1,250 " squares " who are not resi- dents yet, but participate in the Synanon " game " (encounter sessions). The directors now maintain that Synanon is not set up to cure dope addicts, but rather is a social move- ment that offers its residents " a way of life that is not futile. " Dederich explains, " The rest of society is a mess.... I believe it is beyond reform or change and so we're trying to cre- ate a community where people live and flour- ish. It's not a political movement, even though some politicians are afraid of us; it's more like a religious movement. We're not out to get people's votes, we want their minds. " Hence, Synanon does not attempt to reenter its mem- bers into society, but rather tries to maintain their dependence on the Synanon organiza- tion, by providing jobs, meaningful life style. OE Daytop was founded by former Synanon ex addict - David Deitch and Synanon enthusi- ast, Daniel Casriel, M.D., in 1963 in New York City. It grew rapidly into four centers in the New York metropolitan area with an annual budget over $ 1.5 million. Like Synanon, it used ex addicts - as the primary therapists. Un- like Synanon, it emphasized reentry into so- ciety. In fact, it was a fight over this reentry program, one in which Deitch tried to train addicts as political activists to change their communities, that resulted in a major split within the program. Deitch was forced to resign and Daytop's program has not intro- duced any innovations since. OE Odyssey House was started by a group of ex addicts - and Dr. Judianne Denson - Gerber. They were part of a cyclazocine drug mainte- nance program at Metropolitan Hospital and decided to switch to a therapeutic commu- nity treatment model. Since 1967, Odyssey House has grown to include seven units. Though prominent for its concern for the ado- lescent addict, only one of these units focuses on this age group. Odyssey differs little from Synanon and Daytop, except for the promi nent role of the professional as therapist. In defense of this practice, Dr. Denson - Gerber points out that many addicts feel they want to talk about their problems with a highly 19 trained expert rather than a former addict. ate from therapeutic communities are reem- "the Ex addicts - are employed within the program, ployed within similar programs relating to but their function often serves the needs of addiction. On the one hand, this result derives the professional. Together with the residents ex addicts - assume responsibility for enforce- ment of house rules, so that " the psychiatric staff can devote fulltime to treatment rather than enforcing police or security methods. Thus they are maximally able to utilize their training with minimum waste of effort, talent or money. This prevents much of the frustra- tion and depression often seen in profession- als who treat addicts. " from the rigid reward and punishment system laid down by the therapeutic community. The most successful people are those who are ar- ticulate and capable of taking leadership within the community. Other forms of person- ality expression are not encouraged. On the other hand, there is very little educational emphasis within the therapeutic community. Ex addicts - are not encouraged to go to school during treatment, since that would interfere @ Phoenix House is the therapeutic com- munity program of the Addiction Services Agency of New York City and is the largest therapeutic community program in the coun- try. It was founded by Dr. Efren Ramirez, a Puerto Rican - born existential psychiatrist. This program has grown to include nine cen- ters and over 900 addicts in treatment. It dif- fers from all proviously described programs. in that it has a high percentage of addicts un- der criminal certification, who are not in- volved in the program on a strictly voluntary basis. Thus, the Hart Island facility which houses six of the Phoenix House centers re- sembles a detention center more than other therapeutic communities. No independent investigation has been done to judge the effectiveness of the thera- peutic community approach. But it is clear that claims of success do not tell the whole story. Daytop boasts 85 percent success based on the number of'clean'graduates; Odyssey claims 71.5 percent success based on the number of addicts who stayed clean for one and a half years, including those still in the program. Yet, after three years Phoenix House, Daytop and Odyssey together had fewer than 140 graduates. Also, Phoenix House (s) have only 950 enrollees rather than the predicted three year enrollment of 25,000 addicts. Perhaps this is because only three percent of all addicts volunteering for treat- aS The next BULLETIN will be a special issue on health workers and unions. It is our July / August edition and it will reach you around the end of July. Se with the therapeutic process. From black and brown communities, there comes a barrage of criticism of the therapeu- tic community. Blacks are angered at the per- sonality and identity destruction that goes on in encounter therapy. They feel that blacks have been stripped of their identity by white society long enough, and that the emphasis should be placed on building black identity. Puerto Ricans point out that all encounter groups are usually carried out in English, so that the Spanish speaking - person is always at a disadvantage. The pervasiveness of mid- dle class values as the norm for the therapeu- tic community also negates the past, present and probable future of most black and brown addicts. Middle class values just don't apply in the communities these addicts are expected to return to. The therapeutic community tends to reduce drug addiction to the level of an individual problem. This position derives from the con- cept of the addict as a sociopathic person- ality. If on the other hand, addiction is attrib- uted at least partially to a sick society, then its cure is to involve the ex addict - in changing society. Several groups have taken this posi- tion. The Community Thing is a Harlem neigh- borhood group that unites around the issues of black pride and self help -. They keep the addict in his community and teach him to be functional there. David Deitch, an ex addict - , was fired from Daytop when he proposed a similar program, called GUTS (Guerrilla Urban Training Satellites), which was sup- posed to train addicts to return to their com- munities as political activists. In conclusion, both methadone mainte- ment choose the therapeutic community. And after joining the program, the drop - out rate is over 60 percent on the average. Most of those who leave, do so in the first 30 days, and in- evitably return to the needle. Of those who leave after six months, more than one half - shoot up again. Some say it is too early to make definitive conclusions about the effec- tiveness of the therapeutic community, but certainly the initial data are not impressive. The therapeutic community can also be criticized for incomplete reentry of its resi- dents into the community. Therepeutic com- munities do not appear to make people in- dependent. By providing a life that is better than real life, ex addicts - get " hooked on the community " rather than on heroin. This be- comes only another form of dependency. Over 50 percent of all ex addicts - that gradu- nance and the therapeutic community can expect to come under increasingly severe community criticism. As more money is poured into therapeutic programs, with little visible effect on the community, the question of who is really benefiting from addiction therapy will be raised loud and clear. Black and brown communities are going to want a greater role in shaping the programs that serve their communities, particularly pro- grams with such great social control potential as addiction services programs. [The above article was prepared by a HEALTH - PAC Workshop on Drug Addiction with Special re- search assistance by Harriet Block, sociologist and member of the New York Medical Com- mittee for Human Rights; and Lester Waller- stein, a graduate student in psychology at New York University.] 20