ENDLESS WAR [Day 2a]

A DEADLY GRIP

Treatment Advocates At Odds With Proponents Of Force

With a knock on his apartment door, Jorge felt salvation was at hand. A
friend appeared bearing gifts: two $10 bags of heroin.

After the friend left the Boston apartment, Jorge put four small white
rocks onto a spoon, dissolving the drug in a quarter-teaspoon of water.
With his needle, he drew in the liquid heroin. And then he picked up a belt
and wrapped it around his right arm.

With his left hand, he took the loaded needle and gently pricked the soft
underside of his arm until he found one of his shriveled veins. He emptied
the narcotic into his blood. The belt fell, unfurling like a snake at his feet.

"I'd thank God for this," said Jorge, after a long silence during a cold
afternoon earlier this month. "But I don't know if it's him I should thank.
Should I thank God to bring me something evil? I can't thank God. Should I
thank the devil?"

Such is the power of drugs that users embrace the devil on the wings of a
high. For a high, they would risk custody of their children, sell their
daughters' bodies, and steal from the mother who gives them refuge.

Drug culture has existed as long as human civilization. In 21st-century
America, despite falling crime rates and reports that indicate a leveling
off of first-time drug use among the young, there are still 5.7 million
known drug addicts.

If it seems that the drug problem has been receding, that is largely
percepton. The drug problem has simply shifted away from the sleek,
white-collar culture of recreational cocaine users in the mid-1980s to
today's legion of hard-core addicts in the underclass, where addiction
compounds endemic poverty, despair, and violence.

In just two years, from 1995 to 1997, the number of Americans with severe
drug addictions jumped 23 percent. This group cost American society $110
billion a year, a figure compiled by federal researchers that accounts for
drug-related diseases, traffic accidents, and lost productivity on the job.

Now, Congress is considering a Clinton administration plan that would open
a new, and some say, perilous front in the drug war in hopes of making
drugs less available to Jorge and other addicts -- a $1.6 billion, two-year
package that relies heavily on military force to attack the source of coca
and opium poppies in Colombia, which produces 85 percent of America's
cocaine and 65 percent of its heroin.

Last week Congress began holding hearings on an ambitious proposal to give
Colombia 30 UH-60 Blackhawk helicopters to deploy drug-suppression troops
into remote areas of that country and state-of-the-art APS 145 radar to
interdict drug shipments leaving the region.

Colombians who live around coca and poppy fields warn that even if
US-backed forces poison hundreds of thousands of acres and burn drug labs
to the jungle floor the demand for drugs from the United States will ensure
that the $500-billion-a-year global industry finds a new foothold elsewhere
along the Andean spine.

Social workers and addicts contend that the best way to attack demand is by
devoting more money to treatment, just as President Nixon did on June 17,
1971, when he declared drug abuse "public enemy No. 1 in the United
States." He earmarked two-thirds of new antidrug funding to treatment.
Since the early 1980s, however, treatment has accounted for less than a
third of federal funds.

The Clinton administration's drug budget remains at that level, with the
vast majority of the money aimed at stopping the supply of drugs and only a
small portion going to help wean people like Jorge off them. Barry R.
McCaffrey, White House drug czar and a former general who commanded the
infantry division that led the "left hook" attack on Iraqi forces in
Operation Desert Storm, contends that a robust effort to knock out drugs at
the source will help save the lives of American youths.

But the nation's first drug czar believes antidrug missions in Colombia
will do little to change balance of the drug war. "We have a phenomenally
large border, and as long as demand is there, and as long as people in
other countries have economic situations that make trafficking attractive,
you are going to have drug trafficking," said Jerome H. Jaffe, whom Nixon
hired to head his drug-fighting efforts. "That is something that is an
absolute reality. To do anything, you have to bring down demand."

And fighting demand means fighting drug use on a person-by-person basis.
Antidrug work is a tedious daily campaign of encouragement, tough love, and
therapy that is different for every addict. A year in recovery does it for
some, a decade for others. For still others, it never works. The drugs win.

If you step into Brianne Fitzgerald's size-81/2 red-and-black Arche boots
for a few days, the first thing that you'll realize is that her patient
list of drug addicts is made up of people in great pain who are crying out
for help -- and have been for years, sometimes decades.

The 51-year-old Fitzgerald is a nurse, a South Boston resident who lived
for years in the western suburbs, a divorced mother of four children,
including three sons who play fullback on three different football teams
(Boston College, Northeastern University, and the New York Giants) and a
daughter who trains for marathons in her off hours on the hills of San
Francisco. They comprise a determined family, but perhaps none more
determined than Brianne.

She grew up in Newton, the oldest of eight children. Her father was an
alcoholic. He worked as a bookkeeper for Texaco. Her mother held jobs as a
nurse and fashion model. "I became a caretaker very early on," Fitzgerald
said dryly.

She married at 21 and almost immediately began having children, eventually
settling into a comfortable life in Wellesley. But she wanted something
more, and at 33, she answered a newspaper ad for a job in a "clinic."

It turned out to be an inner-city methadone clinic for heroin addicts. She
got the position. Soon she was spending her mornings pouring methadone into
cups for a line of addicts whose last names began with the letters A to L
and her late afternoons preparing dinner for six in the suburbs.

"The first thing I did before going to work was take off my diamond ring,"
she said, her hands still ringless.

Over the years, spanning a divorce and a move into the city, she stuck with
her work with addicts, attracted by the stark difference from her early
upbringing, lured by "living on the edge a little bit," and buffeted by the
knowledge that she could make a difference in some people's lives. Not all.
But some.

One day recently, she drove her 1998 blue Toyota Corolla to East Boston to
see a patient. Fitzgerald works for Neighborhood Health Plan, an HMO that
has made the determination that the most effective -- and cost-efficient --
care for high-risk patients is to send nurse practitioners on home visits.

On Meridian Street in East Boston, Fitzgerald parked and walked up a flight
of stairs in an apartment building to visit Diane Amaral, 42, a recovering
heroin and cocaine addict, who had lost custody of her four children years
ago because of her addiction.

As Fitzgerald carried her heavy black Bottega Venetta bag over her shoulder
and a Zip-lock bag containing four homemade double chocolate chip cookies
in her hand, Amaral started shouting from above.

"I'm just cracking up in here!" she said, as Fitzgerald walked into her
apartment, closed the door, and handed over the cookies. Amaral ignored
her. "I'm beat up," she said, pacing in her kitchen. "I'm tired. Maybe I
should just die. At least I would die straight."

"Do you want to go to the hospital?" Fitzgerald asked. "No! No! I just want
something for my pain."

Amaral's hands hurt so much that she was sleeping only a few hours a night.
She was not sure why they hurt but the pain was unbearable. "I will try to
help you," Fitzgerald said.

Amaral shouted for another 10 minutes and put her face in her hands. "My
head, my head," she said, weeping.

Fitzgerald had to leave. She set up an appointment for Amaral at Lemuel
Shattuck Hospital in Jamaica Plain; perhaps a doctor would prescribe
something for her pain. As Fitzgerald left, Amaral ran after her, mumbling
apologies, and handed her a small present, a honeysuckle mist-scented
drawer sachet from Victoria's Secret.

"Thank you, Brianne, thank you," Amaral said in a whisper.

In her car, Fitzgerald looked weary. "Where do you begin?" she asked.
"You'd think I'd be burned out, too. I grew up in an alcoholic family, so
I'm no stranger to helping addicts. I learned the hard way in this job,
though. When you work harder than the addicts, you get real disappointed
because then they don't get clean."

Her mobile phone rang. It was a former patient, an ex-heroin junkie named
Walter Applegate. They set a lunch date at a deli on Dorchester Street in
South Boston.

Moments after she arrived, Applegate walked in, the picture of health. Baby
blue eyes. A barrel chest that filled his sweatshirt. "I lift weights four
times a week," he said. "I weighed 105 pounds when I was doing heroin. Now
I'm 190."

By his estimate, he was in and out of 70 treatment centers during the 15
years he was an addict, and six of those years were spent in prison. Now a
plumber, he said he finally got sober on Labor Day 1995. "It was the
consequences," he said. "I just didn't like losing my home, my boy, my
family." He hasn't seen his 15-year-old son in years.

"When I was using, it came down to seeing my son or getting high. I would
rather get high," he said matter-of-factly, his strong hands gripping a
steak sandwich. "I know as long as I stay sober, I'm going to see him
again. I know I can be a good father."

He kept shifting in his seat as he spoke, eyes darting around the
restaurant. He seemed on edge. "You OK?" Fitzgerald asked. "Yeah, yeah,
yeah," he said.

She wasn't so sure. How could she be? Over time, she has learned not to
trust quick assurances.

Fitzgerald visited Jorge the next morning. He wasn't hiding his pain. He
was in withdrawal from heroin, chills running through his body as he lay
under covers in his bed.

"I'm dying, man," he said, his eyes vacant.

"What do you want to do?" she asked, bending her 5-foot-10 frame and
sitting down next to him.

"I'm tired of using drugs. I want to go into treatment. I tried calling all
day yesterday and I couldn't get through."

Fitzgerald made several calls and found a place for him in a detox center.
The two made arrangements for her to drive him there in the morning.

"How bad do you want to get clean?" she said.

"I do, I do, Brianne."

"You better be here," she said. "I'm counting on you."

Several hours after she left was when Jorge's friend appeared with his gift
of heroin. Jorge, 37, who asked to be identified only by his first name,
injected half of the heroin into his veins that afternoon. "I need some
tough, tough love," he said, lighting up a half-smoked Newport 100s cigarette.

He used the last bit of heroin at 7:30 the next morning, an hour before
Fitzgerald arrived. "When you're sick and going into detox, you need
something for the day you go," he said in her car, explaining why he got
high. "Because you get really cranky and frustrated if you don't have it."

He said he hoped to stay in treatment for at least several weeks. "My
opinion is you need longer treatment," Fitzgerald told him. Jorge said he
wasn't sure he could do that. He said he needed to help support his
mother.P> "Don't start to set up roadblocks, Jorge," she said.

They hugged each other goodbye at the center. "I pray to God I'll do good,"
he said.

Fitzgerald turned reflective as she drove away. "I don't envision myself
doing this forever. I need a backup plan," she said. "We all need a backup
plan."

Most of her frustrations were related to her patients; Amaral, for
instance, was calling her daily in despair. And, more importantly, she has
seen them time and again relapse into their addictions, even when all signs
pointed toward recovery. This is her never-ending war on drugs.

But the national priorities in the drug war also have had an impact on her,
especially with the emphasis on locking up addicts. Nearly 1.6 million drug
addicts were arrested nationwide in 1997 for a variety of crimes. That is
up from 1 million in 1991. At the same time, only 37 percent of hard-core
addicts received treatment in 1997.

"The money we are spending fighting this war on drugs is a joke. It's a
bottomless pit," she said. "I liken it to the Vietnam War: We're doing it
for years, and the casualties keep on mounting. We put them in jail. That's
how we kill them."

Fitzgerald also believes the Colombian effort won't work. "People just
laugh at it," she said. Even if it did result in driving up prices and
reducing supply, she said it wouldn't drive down the number of hard-core
addicts.

"If the price rose, the crime rate would rise. And somebody would make a
cheaper drug. The answer has to start locally," she said.

Most of her patients have been in and out jail. She saw two in the course
of two days: Lee Boone, 47, of Charlestown, who injected heroin into his
groin so frequently that his veins collapsed and he lost his right leg; and
Billy Ketchum, 45, who used drugs for 30 years, once working as a
"lieutenant" in a Colombian drug ring where he could earn $15,000 for four
days of work.

"I must have shot up a million dollars worth of heroin," said Ketchum, who
now lives in a faith-based home for recovering addicts in Dorchester.

He closed his eyes and said with feeling: "I used heroin as my lover, there
was no other. James Brown said he sold his wife for a $5 bag. Well, I sold
my life for a $2 bag."

Boone was overjoyed to see Fitzgerald, who in recent years visited him in
an active drug house, a risk that she shudders at today.

"Saint Brianne!" he exclaimed and motioned for her to sit in his living
room. He has been off heroin for five months, receiving a daily dose of
methadone in a clinic, a substitute addiction but one that has allowed him
to function on a much higher level.

"I've got something to show you," he said.

Boone pulled out his wallet, and as his eyes welled up, he held up an
automatic teller card.

"I ... have ... a ... bank ... account," he said slowly as two streams of
tears fell from his chin.

"Lee," she said, moving toward him, "look at you!"

It was a sudden, tender moment of joy. And a fleeting one.

Later, Fitzgerald picked up Iayania Norwood, 23, a recovering addict who
first used crack cocaine with a family member, and the two of them went to
visit another patient, Cassander Johnson, 36.

Johnson had been refusing to attend a group therapy session with other
recovering addicts, and Fitzgerald feared she might relapse.

"It makes me very nervous," she said.

"I'm not going to go. I'm OK. I just get bored," Johnson said. Her friend
Norwood challenged her: "The liquor store's right up the corner. You're
going to go there, aren't you?"

"It's right up the corner in fact," Johnson said, smiling. "If I take a
drink, I take a drink. I suffer the consequences. So what?"

Fitzgerald grew angry: "Last time you took a drink, what happened? One of
these times, Cassander, I'm not going to be there to pick up the pieces.
You're playing with fire. You won't stay sober."

Fitzgerald put her head in hands. Now her eyes filled with tears. Johnson
wouldn't budge, and Fitzgerald said she would tell people in Johnson's
halfway house about her fears of a relapse.

Johnson yelled at her: "Why do that? I'm not even going to talk to you now!"

Fitzgerald and Norwood left. "This is what I hate about my job," she said.

Fitzgerald needed a break. She went to dinner that night with her Wellesley
girlfriends. "We were talking about waxing eyebrows, menopause, all the
girlfriend things," she said. "It was nice. I got an escape, and they live
vicariously when I tell them my stories."

The following week, she learned she was wrong about Cassander Johnson. She
didn't relapse that weekend. Diane Amaral, meanwhile, finally agreed to go
to a hospital, where doctors are monitoring the effects of different
medications.

As for Jorge, he remains in treatment. Two days after arriving at the detox
center, he sat in an empty cafeteria, which was set for lunch with Lay's
chips and Swiss creme sandwiches on white plates. On the wall was an old
window shade, on which was written "The Twelve Steps," the famous recovery
process.

Step No. 9 urges, in part, to "make direct amends to people" whom you have
harmed. Jorge said he must make amends to his mother, because he once stole
her gold necklace, gold rings, and a bracelet in order to buy drugs.

Then he remembered another incident, on the Boston Common, nearly 20 years ago.

"I snatched a pocketbook from a lady," he said, scratching a several-day
growth of beard. "My friend grabbed her and threw her to the ground. And I
stomped her on the chest. I left my footprint on her. I really hurt her.
She finally let go of the pocketbook. We ran right into police on horseback
and were arrested.

"But at court, the lady said she didn't want to press charges. I was
shocked. I said to her, 'I'm very sorry. I have a drug problem.' "

"She said to me, 'Get help.' "

Jorge shook his head. "It takes a long time."

Fitzgerald walked in, plopping her Bottega bag next to Jorge.

"You going to stay in treatment?" she asked.

"Of course I'm going to stay, Brianne," he said.

"Better," she said.