DR. LONNY SHAVELSON DISCUSSES FINDINGS FROM HIS NEW BOOK "HOOKED"

This is ALL THINGS CONSIDERED from NPR News. I'm Robert
Siegel.

It is a truism nowadays that drug addiction should be fought through
treatment, a proposition that Lonny Shavelson does not dispute. But
Shavelson would add an important caveat. He says addiction treatment
services need to be fixed.

Lonny Shavelson is a doctor and writer who spent two years
interviewing addicts in treatment. At the end of his book "Hooked,"
he poses this question: Does rehab work for those who are most
disastrously addicted? His answer: 'I still don't know. In the two
years of this investigation, I rarely saw rehab done well enough to
learn if it might work.'

"Hooked" focuses on five addicts in San Francisco. One of them is
named Mike.

Dr. LONNY SHAVELSON (Author, "Hooked"): Michael Paxilian(ph). He is a
34-year-old man who was a plumber, who was married, had two children,
and is one of those tragedies of what we see with heroin abuse. He
was a heroin user, and basically his family and his entire life fell
apart. One of the things that was hidden behind all of this was that
when Mike was young--from the ages of about six to 12--he was sort of
bounced around our foster care system. And during two years in one of
the homes, he was repeatedly raped as a child alongside his sister.

So what you see is a severely traumatized person who had very, very
major trauma in his life as a child; later on, kind of got it
together, then got addicted to drugs. He was using heroin as a way to
get rid of flashbacks and nightmares he was having about those
childhood rapes. He got desperate. He knocked on that door of rehab.
He went to the central intake center where I met him.

Number one, they really focused on his drug abuse. They did
everything they could to get him to stop using drugs and just about
everything they could to ignore the underlying issues in his life that
were causing him, or leading him, to use drugs. And I don't make any
excuses for people who use heroin or who use drugs. But you have to
understand that if you're going to get Mike to not need to use heroin,
you have to have very advanced psychological care to help him deal
with those other traumas.

But what you see in the rehab facilities is the second important
point, is that most people who are counselors and advisers in rehab
facilities are ex-addicts who have zero training except for the fact
that they're ex-addicts, they've become clean and sober and they've
been through a program.

SIEGEL: And the case of Mike, as you discovered, far from being
exotic, involved something that you found amazingly common among men
who are addicts and who are in various stages of rehab: some childhood
experience of sexual abuse.

Dr. SHAVELSON: Uh-huh. Well, as I was interviewing people in the
programs--and I interviewed, you know, close to 200 people by the end,
although I followed this five most intensely--I thought I was making a
mistake in my interview questions because almost everybody was talking
to me about child sexual abuse, and I just thought it's impossible
that this could be such a high rate of people who are molested as children.

It turns out that an article came out in the Journal of the American
Medical Association about the time I was doing this research that
shows that when you are sexually abused as a child, your addiction
rate does not double or it doesn't triple. The rate of addiction in
children who've had sexual abuse goes up 25 to 50 times higher than
the rest of the population. And that's for men. For women--some 70
percent of women in rehab have had prior sexual abuse before they were
addicted to drugs.

So I began to realize that what we're dealing with is a tremendously
traumatized population. We're putting them in houses--for instance,
Walden House, where I spent most of my time in San Francisco, had 120
addicts and they had one single therapist in the house. And those are
the type of people that if they're going to get off drugs need really
good psychological care.

SIEGEL: One of the problems you encountered in your reporting on the
rehab system was the tension between rehab programs that insist on
your being drug-free, and you're not let in if you're high. And on
the other hand, the reality that the people they're dealing with, even
if they're getting off of drugs, will go back and get high. They will
relapse.

Dr. SHAVELSON: Well, this struck me as one of the greatest ironies of
anything that I saw in my two years sort of in the underworld of the
rehab industry. It's very, very clear that drug addiction is a
problem of obsessive use of drugs where people come in and they come
in asking for help because they can't stop drugs on their own. What
happens is they come into the programs and some of them--actually, a
significant amount--will at some point in time lose it, not do well,
go back and use drugs again. And what the programs say is, 'Well,
you're using drugs. We're kicking you out of the program.'

And what amazed me about that was a couple of things. I don't know of
any other disease where you have to be cured of the disease before you
get help. The second thing is that these people were clearly getting
worse. What happened was during the time of their rehabilitation,
they had a relapse and they got worse. And instead of increasing
care--which is the appropriate thing to do for any illness including
drug and alcoholism--what they did was a process called spotting.
Spotting means that, 'We catch you with drugs, you're out the door on
the spot. You can come back in about three weeks and get your clothes
and all that, but we throw you out.' I've seen this happen in the
middle of the night at 3:00 in the morning for a woman who was found
using drugs. It's dangerous in the streets at 3:00 in the morning,
and it's not helpful and it's not therapeutic for programs to throw
out people because they're found to use drugs.

SIEGEL: You're trained as a physician.

Dr. SHAVELSON: That's correct.

SIEGEL: As an emergency room physician, in fact.

Dr. SHAVELSON: Mm-hmm.

SIEGEL: Has the wisdom that this is an illness--if it's
wisdom--actually penetrated the system that's trying to cope with it?

Dr. SHAVELSON: Well, I think you're pointing out one contradiction.
The wisdom really has. Most of the people in the programs really
believe now--and again, most of the counselors are ex-addicts, and
they really believe and have heard the message that this is an illness
and it's a hard-to-treat illness. But they haven't made that next
step, which is that you can't treat an illness by punishing it out of
a person. There are many other ways to deal with it. There's never
been a single shred of evidence that humiliation and this boot camp
approach is effective in treating addiction or any other emotional
problems.

SIEGEL: Well, where did all this leave you in terms of your view of
treatment? After all, the fork in the road we're at is not
necessarily between good treatment or bad treatment, but as you say
between an emphasis on treatment or on incarceration. You didn't come
away from this any more favorably disposed toward incarceration.

Dr. SHAVELSON: No, I did not. What I came away from this thinking is
that what I'm seeing is a fairly unregulated and very important and
very expensive industry. And actually, I had a lot of hope for what
could happen in treatment. I saw some changes that happened to people
that were phenomenal, and then it was lost at some point in time as
the programs began to make some fairly severe errors, especially in
regard to how to deal with relapse.

But what I did see was I saw some people--Glenda Januss(ph), who was
this Lakota Indian, came to San Francisco when she was about 18 or 20
after being an alcoholic for three years, was 32 when I met her and
was still drinking heavily and looked like she was 65. When they
first found Glenda, she was lying in the street. She had maggots in
her legs from wounds that she had had from falling that never healed.
Three months later, she was cleaned up, sober, had insight into her
illness and had a wonderful experience in rehab.

What happened then was this. When Glenda was cleaned up and sober,
there was no connection to housing, there was no connection to job
training, no connection for child care, no family therapy, no other
treatment. And they wound up having to send her back, basically, to
the same neighborhood where she used to hang out with her drinking
buddies and drink, to Salvation Army-sponsored clean-and-sober
housing, which had a very simple rule which is that, 'If you drink,
you're out of here.'

So again, in this particular case, what you were seeing was no
connection to aftercare. In three months they tried to fix an illness
she'd had for 30 years and didn't provide her with further services.
That was basically throwing away our money. We have a budget of, you
know, some $ 9.2 billion in the United States that is dealing with
drug-abuse issues of which only 18 percent goes to rehab. If we take
that 18 percent that goes to rehab, and instead of sending it to
Colombia to buy more helicopters, we use that to find housing for some
of the people that are getting out of the programs who do job training
or provide them with advanced psychological care that they need. And
so we bounce that 18 percent up to let's say 25 percent and then you'd
have a very functioning rehab system with the one other proviso is
that we have to start training counselors because the untrained
counselors are not doing the job that they need to do.

SIEGEL: Well, Lonny Shavelson, thank you very much for talking with
us.

Dr. SHAVELSON: It's my pleasure.

SIEGEL: Lonny Shavelson's book is called "Hooked: Five Addicts Challenge Our
Misguided Drug Rehab System."

You're listening to ALL THINGS CONSIDERED, from NPR
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