In a previous life, I had a job for a couple of years working as a “clinical counselor” at an alcohol and drug addiction rehabilitation facility – to be called The Rehab for the purposes of this article. This can certainly be included in the list of “toughest jobs you've ever loved” category. While I worked there, I was sure I had fallen into some heretofore unidentified circle of hell and I must be the butt of some supreme galactic joke. But at the same time, I would otherwise never have met any of the urban inner-city minorities caught in the web of drug addiction and the criminal justice system, an entire American sub-culture that is publicly reviled when not being ignored and forgotten. Nor would I have come to recognized myself in their painful and desperate struggles. At The ReHab, I faced and conquered challenges far outside my “usual” experience. Perhaps most importantly, what I learned at The Rehab would later provide the groundwork for some of my greatest professional accomplishments. I now think of myself as uniquely lucky to have had this job.
It is this unique experience I hope to describe with a series of articles I call Working At The ReHab. This series will focus on life at The ReHab, and issues of drug addiction and drug addiction treatment in America. For interested readers, part 1 can be found here (http://www.dailykos.com/...).
No one gets up in the morning and thinks to themselves “this is such a great day and things are going so well for me that I'm going go get me some treatment for my addiction”. People only come to The ReHab if they are in desperate trouble. At The ReHab, the saying is that people come to treatment for two reasons: either they were mandated to treatment, or they were momdated to treatment. Roughly three quarters of the residents at The ReHab were involved in the criminal justice system and court-ordered to attend treatment as a condition of staying out of prison (mandated to treatment). The remainder largely come to treatment at the insistence of a parent or a spouse or more rarely an employer (momdated to treatment).
The conventional wisdom is that drug use is a causative factor in 50% of crime committed in the USA. Nowadays, the courts would prefer to send drug criminals to treatment if possible. The prisons are already overcrowded, and it cost somewhere between $35,000 to $45,000 to incarcerate an adult for one year. Additionally, the recidivism rate for those coming out of prison is sky-high. Long-term residential drug addiction treatment is much cheaper (in the area of $20,000 to $30,000 per year), and some of those residents actually get clean and enjoy long-term sobriety after completing treatment. One reason residential drug treatment is cheaper than prison is the pay levels of the staff; as a “senior” counselor, I made $26k/yr, while starting salaries for unionized corrections officers start upwards of $50k/yr. In defense of the unionized COs, they face a much greater threat of workplace violence than do clinical counselors in a treatment facility.
Through the years, as states have come to recognize the benefits of drug addiction treatment, the process of moving drug offenders into treatment programs has been optimized and streamlined. Judges and the public have become more accepting of treatment instead of incarceration as an outcome of criminal cases. Many municipalities now run drug treatment courts that work collaboratively with drug addiction treatment programs. This collaborative approach means judges, prosecutors, defense attorneys, law enforcement, and treatment providers work together to shepard offenders to complete a course of treatment. Drug treatment courts are generally voluntary: the alternative is a prison sentence, so offenders have a large incentive to accept the drug treatment court alternative. The offender, his attorney, the prosecutor and the judge all sign a contract that stipulates the nature and duration of the treatment program, provides for regular court review of progress through treatment, describes what happens with the criminal case when the offender completes the treatment program (it might be dismissed entirely), and details how much time in prison the offender will serve if they don't complete the treatment program.
Treatment at The ReHab is totally voluntary. There are no locks on the doors and no bars on the windows. Residents are told they can leave anytime they like (and they do). As far as The ReHab is concerned, all residents are there because they choose to be. As a counselor, I frequently remind residents that they have freely chosen to come to The ReHab, and are free to leave should they not find the activities to their liking. And if you have some agreement with a judge, and face some severe consequence for not fulfilling that agreement, that is your obligation, not mine. So if you insist on leaving, we won't stop you; we will even provide you with transportation if you have none. Of course, if you are under a legal mandation, I am required by law to report your attendance or lack thereof to the courts.
When a new resident arrives at The ReHab, they are given a folding wooden chair and instructed to go sit in the main hallway facing the wall. They are not allowed to speak and can not have anything in their hands. This is to symbolize that the new resident has not yet been accepted into the community. They have been thoroughly searched, washed, all facial hair has been shaved, and they have been given a very short hair-cut – a symbolic act of cleansing for the first day of their new life. In order to be accepted into the community, the new resident is told they must first meet with and be approved by the representatives of this community. One of my duties as clinical counselor is to lead this initial introduction into life at The ReHab.
For this purpose I need four other residents: I'm looking for people who have already been at The ReHab for some period of time and who at least are pretending to buy into the program. I need to keep it racially balanced so it's not all white guys interviewing one nervous black guy. If the prospective resident is a woman, I need to find four women residents to interview her (we don't want a bunch of lonely and horney ex-cons being overly aggressive or overly solicitous around the vulnerable new person). All of the residents chosen for this task went through a similar interview themselves when they came to The ReHab, so they are generally eager to now have the shoe on the other foot. We chose an empty room where we can close the door and have some privacy. Typically, I will be given some information about the new person from the intake process; it might include arrest records or information about previous treatment episodes. I often share this information with the team so we have some idea about the new person before we meet with him/her. I lay out the plan, give instructions, and try and set a productive tone.
In the old days, the primary purpose of this initial interview was to get the new guy to ask for help. But it wasn't good enough for the new guy to say “I need help”. “Buddy, if I was getting ready to kill you right now, you would be SCREAMING for help. Well, you know what? Your life IS in DANGER RIGHT NOW; you go back to the streets and you could be dead by morning. But I don't hear you SCREAMING.” Egged on by the interviewers, the new guy would be made to ask, beseech, beg, plead, and pray for help, usually at top volume. Tears were often required as part of this process: all the residents at The ReHab are professional liars, so tears are one of the few reliable signs of sincerity. Acceptance into the community was usually finally granted only after the new inductee was begging for mercy, weeping and hoarse.
Nowadays, this kind of thing is considered abusive, so we don't do it that way. But the interview will continue until I am satisfied that the new guy is willing to buy into the treatment process. I want him to give us something. In reality, nothing that goes on in this initial interview matters to the admission process: The ReHab has already accepted the new admission, has committed the bed-space, and is already processing the funding paperwork with the various state agencies involved. But the new guy doesn't know this, and I don't think the residents helping with this interview are savvy to that reality, either. As far as they are all concerned, this interview will determine whether the new guy goes or stays. Because that fiction works in my favor, I never bother to set the record straight. I want the new guy to be nervous, and I want the resident in on the interview to feel they have a say in the workings of our community.
The new guy is led into the interview room carrying his wooden chair by an Expeditor (a resident of middle rank). We are arranged in a row in front of him, and he stands with his chair until I give him permission to sit. I start things off by introducing myself, telling the new guy that this interview is the beginning of the treatment process, and invite him to tell us about himself. I intentionally keep the questions open-ended, because I want to see what the new guy will ante up. Residents at The ReHab have typically spent their entire adult lives either on the streets, in prison, or in a residential treatment facility such as this: they don't have much to be proud of and their experience has largely taught them to be closed-mouthed.. And for this interview, I don't really care about where they are from, or how many brothers and sisters they have, or even whether they snort or inject their dope.
What I want the new inductee to talk about is the trouble their drug use has caused them. I want them to say it out loud with their own words. And while by and large, addicts like to talk about their drug use, which drugs, how much they use, and what a historic figure they cut on the streets, they hate to admit the problems their drug use cause them. And I and my team are their to help them. So we ask: Are you under a legal mandation? How many years will you serve in prison if you do not complete this treatment? Did you give your PO a dirty urine? How many children do you have and who is looking after them while you run the streets? How didja get that broken arm? And slowly the stories come forth: how much time they spent in prison, the number of times they have been through a treatment program, the wives, girlfriends and children they lost contract with, how many times they've woken up in an ER, why their grandmother won't let them into her apartment.
Once I am satisfied that the new inductee has made an decent recounting of the various difficulties that have brought him to The ReHab, he is now ready for the next part. “Well, so that all sounds like a pack of troubles. What are you going to do about it?” This usually brings them up short: there is a lifetime of learned helplessness to overcome, as well as the hope that The ReHab is going to fix their problems for them. But after the many stories about what they did to get into trouble, I want the new guy to tell us what effort they are willing to devote to getting out of trouble. And here there is only one acceptable answer. “It sounds to me like you were willing to do anything to get your drugs, right? So what are you willing to do to get your treatment?” The only acceptable answer is “anything that is asked of me”. This is important because I want the new guy to know that his effort is required, and that things, often things he doesn't like, will be asked of him. Also because when a week or so has gone by and he has broken the rules and I have to discipline him, I want to be able to throw it back in his face, and remind him that he told me with his own tongue that he would do anything that is asked of him. So we help him clarify his thinking. Are you willing to make your bed every morning? Yes. Are you willing to do the dishes? Yes. Are you willing to smoke your cigarettes only on the smoking deck? Yes. Are you willing to take instruction from a kid 15 years younger than you who you don't like? Yes. OK, we're making progress.
Once the new inductee has volunteered to do whatever is asked of him, we got him by the short and curlies and he is now ready for the money round. “OK, so you just told us you are willing to do anything for your treatment, right? So let's put that to the test: we want you to do something for us. We want you to tell us a secret: tell us something true about yourself that you have never told anyone else.” Watching the new guy try to avoid answering this request is always fun for me. They'll tell me “I ain't got no secrets”, or they will tell us a secret about someone else. Or maybe they will tell us some “popcorn guilt” (something insignificant that pops up when the heat is applied). I find my best strategy is to maintain eye-contact and wait in silence. The other residents are rarely so patient: they are TC (therapeutic community) sharks and they sense blood in the water: “Everybody gots a secret.” “That ain't no secret.” “That's bullshit. Are you gonna bullshit us on your first day?!?!” They all sat sweating out this inquiry themselves and they are enjoying being the ones in control.
Eventually the stories come out. “I went to the crack-house and there was my daughter selling her ass. I didn't do nothin'. I just got some shit for myself and left.” “One year, after my wife had gone out Christmas shopping for the kids, I took all the new toys and sold them for dope money. I told my wife that the apartment had been broken into.” “I was selling dope, but I told my girlfriend she shouldn't get high. She kept asking me, so one night we got high together. When I woke up in the morning she was dead. She had never used before, and I gave her a hot-shot.” The stories may be harrowing, and I am sometimes brought to tears hearing them. That's OK, and I don't try and hide it After all, we are about honesty here, and hearing their most closely-guarded secret come out of their own mouths and seeing a grown man who doesn't know them from Adam tear up at the telling (for all their years and experiences in the streets, they never saw that before) sometimes brings it home like nothing else can.
But we are not done yet: I ask: “Why is that a secret?” It's a secret, of course, because it shows off the new guy in what he thinks as the worst possible light: not as the King Of The Streets, tough-guy ghetto-gangster gritty street rapper of his dreams, but small, scared, vulnerable, in trouble and in pain, addict, sneaky, needy, petty, punk-ass, alone, and finally, all too human. The desire to be something I am not is typically what makes drug use so attractive in the first place. And hiding that drug use from family and friends means keeping secrets. The resulting dope-sickness is what perpetuates the addiction, but the mental effort required to hide that unavoidable and all-too-messy humanness means I can never see my reality nor marshal the psychic energies needed to address that reality. So we talk at length about why we keep secrets and what those secrets cost us. The saying goes: You are only as sick as your secrets. So the primary therapeutic goal of The ReHab is the telling of those secrets out loud to banish that sickness.
Often, once the secret is out, a visible change comes over the new guy. Rather than belittled as a conniving, sneaky dope-sick criminal as he expects, the new guy finds himself in a room of five other guys now eager to share their secrets with him. Yes, he is told, you are an addict. We know and recognize you because we are too. Your secrets can not harm you here. Anything you wish to keep hidden, has already been openly discussed here by many others before you. Here, if you wish, you can be part of a family, one you don't need to hide from, but should you try, we will know it and call you on it.
Welcome to The ReHab, new guy. You just completed your first therapy session.