Series: Drugs Uncovered: Part 13 Of 17

CAN YOU KICK IT?

Perhaps. While Some Experts Talk Of An Addictive Personality And Others
Argue Addiction Is A Myth, Caroline, Naomi And Giles Tell Us Of Their
Struggle To Beat The Habit

Caroline opens her hands and pushes them towards me, palms up. They have a
strange, orange glow. 'You know what I do now. Carrots. My hands have gone
orange. Look.' She and a group of four fellow substance-abusers in recovery
are sitting around a table discussing the nature of addiction.

Caroline believes she has what the psychologists call an addictive
personality. Since she has been in rehab she has been denied all access to
her drugs of choice: heroin, crack, cocaine, prescription pills.

Instead she turns to carrots whenever she feels low.

She and her counsellors believe she has deeply ingrained patterns of
behaviour into which she retreats when she gets unhappy. 'If I haven't got
drugs, I can either get obsessed with a man or...' she breaks off and turns
to Rachel, a heroin addict who has been watching Caroline's intake of
carrots with concern: 'How many carrots do I eat a day?' 'Loads,' says
Rachel, with a mixture of sympathy and irritation. 'About two big bags
full,' says Caroline. 'I can't stop, and I never really ate carrots before.'

Caroline, a 35-year-old mother of two from east London, had been to five
treatment centres before she checked in to Broadway Lodge in
Weston-super-Mare last December. As one of the country's
longest-established institutions for addicts, it has a regime of total
abstinence, backed by medical treatment, counselling and a system of
aftercare for former clients.

Unlike some other centres, which allow addicts to relapse from time to
time, it does not believe that using drugs is an option.

This is the hard core of drug treatment: any broken rule can lead to
immediate expulsion.

It is difficult to measure its success rate because people who return to
drugs do not advertise themselves and addicts are difficult to track once
they start using again.

But Broadway Lodge believes around 60 per cent of those who clean up at the
centre stay off drugs for good.

First, though, they have to address their addictive behaviour, and that
includes carrots or whatever else they choose to obsess about.

Residents of the sprawling gothic house on a hill just outside the
Victorian seaside town all describe experiencing these patterns of
excessive behaviour while they try to recover: three spoonfuls of coffee
per cup or bingeing on chocolate are the favourite diversions in this
drug-free environment - anything to get some artificial kick. The job of
rehab is to wean addicts not only off drugs, but off these patterns of
addictive behaviour.

Like Caroline, 29-year-old Rachel, from Stockton-on-Tees in the north-east
of England, believes she is addictive by nature.

At Broadway Lodge she has been taught to see her behaviour as part of an
illness. 'That's what it's all about: challenging each other on your behaviour.

I thought I just took drugs because I liked them. But I understood when I
got here that it was because I couldn't cope with any of my feelings.' Like
others at Broadway Lodge, Rachel has to accept that her susceptibility to
drugs is a disease over which she will have no control unless she stops
using them altogether. 'My drugs were heroin, crack, cannabis,
tranquillisers, anything.

Drink. But I can see addictive behaviours in me long before the drugs came
along.

That was just a symptom.

My addiction can come out in other ways: in food, in relationships.'

The idea is that addicts in treatment help each other through the process
of detoxification and the cravings that still follow.

Only addicts can understand how it feels to need something so badly; only
addicts, so the logic goes, can read the signs when people start slipping
back into addictive behaviour.

Jason, 29, from Oxford and, like Caroline, a veteran of treatment, has
progressed through cannabis to amphetamines, LSD and ecstasy, and
eventually heroin and crack. 'It didn't matter what the substance was, I'd
have a problem with it. But here we can't kid each other.

We all know how to put one over on people.

But all of us, being addicts, can see when people are acting out their old
attitudes.'

The brochure for Broadway Lodge is clear about its position on drug
dependency: 'We believe that addiction to alcohol and drugs is a chronic,
progressive, primary and incurable disease, not a problem of morals or
willpower.' The addicts I spoke to had no time for the simplistic,
individualist notion that addiction was a question of self-pity winning out
over self-respect. 'Addiction is real,' said Jason. 'We are the living proof.'

Addiction as an illness with drugs as a symptom: it's a philosophy borrowed
from Narcotics Anonymous and Alcoholics Anonymous and, though there is no
hard medical evidence to prove it, it acts as an effective metaphor for
what happens when people get addicted to hard drugs.

And it's increasingly a model that the Home Office and the British criminal
justice system is turning to.

Increasingly, the courts have been encouraged to turn to treatment and
rehab as an alternative to custody for addicts in an attempt to cut the
financial and social costs of drug abuse - or misuse as it is now called.

Over 2,000 Drug Treatment and Testing Orders have been issued by the courts
since they were introduced in April 2000. These replace a prison sentence
for repeat offenders with obligatory treatment at a recognised centre such
as Broadway Lodge and regular testing by medical staff to ensure the
resident stays clean. Any breach in the order and the addict returns to the
courts.

Early results are inconclusive: only 47 per cent of DTTOs have been
completed. But, say supporters of the new approach, that still means that
1,000 addicts have got through the programme.

As each criminal addict is estimated to commit UKP4,000 worth of crime a
year this works out as a substantial saving.

Broadway Lodge operates the '12-step' programme, developed originally by
Alcoholics Anonymous. This means working through a series of
quasi-religious stages towards drug-free enlightenment. A monastic
lifestyle is demanded of residents, so that not only are drugs and alcohol
banned, but also 'exclusive relationships' between recovering addicts.

Through written work and therapy sessions, addicts are first made to
recognise their powerlessness over drugs and to reveal how their values and
principles have been undermined by substance abuse.

The most controversial parts of the treatment are steps two and three,
where addicts are asked to believe in a power greater than themselves and
hand their will and their life over to the care of God. Although the steps
have adapted to the demands of an increasingly godless world, there remains
an undeniably religious, some would say cultish, core to the 12-step programme.

At its heart is the 'Serenity Prayer', a bizarre mixture of homespun folk
wisdom and new-age ideology, which all residents at Broadway Lodge are
expected to memorise: 'God grant me the serenity to accept the things I
cannot change, courage to change the things I can, and wisdom to know the
difference.'

The medical and scientific research on the nature of addiction is patchy
and poorly funded.

Meanwhile, the 12-step approach, developed over many years of working with
addicts, has developed a solid reputation for helping people recover. The
emphasis on the 'higher being' is, paradoxically, highly pragmatic. It's
what seems to work best. Addicts appear to need - some would even say crave
- - a spiritual dimension to their lives, and many find themselves turning to
Buddhism or Christianity when they leave.

Others develop their own non-religious ways of interpreting the 'higher
power'. Naomi, a 27-year-old heroin addict and dealer from Bracknell,
Berkshire, who was sent to Broadway Lodge by the courts on a DTTO, equates
the 12-step God with the collective struggle of herself, her fellow addicts
and the staff at the treatment centre.

'For me, my higher power is the guys in treatment around me,' she says.
'They have got me through this; not God or anyone else. It's the
counsellors and everyone around me. It's not me on my own doing this, it's
us together.' She takes a similarly practical approach to meditation. 'What
I understand by meditation is just spirituality. What all of us have in
common is low self-worth. You are taught to have a long, hard look at
yourself, to start accepting yourself.

You build a relationship with yourself and then you start to interact with
people in the community better.

You're not so defiant. You're not so angry with everyone.'

But there are other serious issues with Britain's treatment culture.

For a start, it is driven by the market in addicts: rehabilitation is a
lucrative business (a Drug Treatment and Testing Order costs UKP6,000) and
treatment centres spring up to meet the need. Broadway Lodge is a
registered charity, but many treatment centres are strictly commercial
operations, often converted old people's homes that have ceased to be
financially viable.

In Weston-super-Mare, the law of supply and demand has led to treatment
centres and halfway houses springing up all over the town. At the last
count there were 11 drug rehab centres, 10 per cent of the total for the
whole country. Council leader Mike Roe says there is an obvious financial
incentive when care homes can get UKP230-250 for an elderly person, but, by
offering a modicum of counselling and support, anything from UKP500 for an
addict or an alcoholic.

'It's self-perpetuating,' says Roe. 'Some people set up in the area and
others saw it was lucrative.

The local feeling is that it's causing problems in the town as the larger
properties switch over.' The council has now commissioned the University of
Bath to see if there is any truth in the belief that people are dropping
out of rehab and staying in the area. Anecdotally, the evidence is already
there.

Caroline says the town has a serious problem: 'None of the users round here
are from Weston. They are people who have come out of treatment centres and
relapsed.

It has made it into a drug town.' She quickly checks herself: 'Or a
recovery town I suppose.'

After a while, the psychobabble of Broadway Lodge starts to pall and you
begin to wonder if the residents are being taught anything more than a new
vocabulary to help them buy further in to the programme.

There is at times a sense that the reason the 12-step programme works so
well for addicts is that it just replaces drug addiction with another form
of obsessive behaviour.

Sceptics of 12-step such as Mike Jay, a lecturer in drug culture and the
author of Emperors of Dreams, a history of drugs in the nineteenth century,
believes that the disease model of addiction, especially concerning heroin,
is a result of a 'power-grab' by the medical profession and psychiatry at
the beginning of the twentieth century. 'Helpless and metabolic dependency
is a convenient fiction around which doctors and addicts can meet. An awful
lot of people take heroin and give it up, so it can't be the drug that does
it.' In the early nineteenth century, says Jay, drug consumption was seen
as a personal choice which resulted, occasionally, in some people turning
into addicts. But as the use of opium as a legitimate, if somewhat sordid,
leisure activity was phased out in favour of medically prescribed morphine
or codeine, the doctors began to take control. 'The disease model of
addiction is one of the few residues of this period.

The 12-step model is really valuable for crisis management, but it doesn't
mean it's true,' says Jay.

Pauline Bissett, the director of Broadway Lodge, has her own issues with
the emphasis on the 'higher power'. All staff are expected to go on a short
12-step course and Pauline found the process difficult to accept. 'I was
extremely resistant.

I thought: nobody's going to ram religion down my throat. I flatly refused
to say "God" at the beginning of the Serenity Prayer for most of my first
week. Until it dawned on me that it sums it up for all of us really, even
in a normal, well-balanced lifestyle, you can spend an awfully long time
struggling to change something over which you have no control.'

But as someone who came to the treatment centre as a nurse, she says it is
impossible to ignore the fact that the system has brought relief to
thousands of addicts. 'What we ask our patients is to accept that they are
not the most powerful being on this earth.

Their higher power can be a tree in the garden, their therapy group or God
if they want it to be.' Addicts, she explains, are 'deeply paradoxical
beings, utterly in thrall to their addiction, but convinced of their
omnipotence while they remain in denial.' Addiction makes them feel they
are the centre of the universe, that they are the most powerful being on
this earth and that they have control.

In an addict's life, control becomes all-consuming. They think they can
control everyone around them and they need to be taught to let go.'

One alternative to treatment and abstinence - also being considered by an
increasingly desperate government - is to provide addicts with a free and
ready supply of clean heroin from licensed GPs. This was the approach
favoured in Britain until the mid-1960s when the authorities became
concerned about the black market that had grown up around prescription
heroin. Already, David Blunkett, the Home Secretary, has extended the
number of licences in Britain. Those convinced of the benefits of
abstention, like Pauline Bissett at Broadway Lodge, are concerned by the
apparent contradictions of the new approach, at once encouraging treatment
and an increase in legal heroin prescription.

Some addicts are so fragile, it is hard to imagine how they had the
strength to get themselves into recovery.

When so many have turned to heroin precisely because it is the only thing
which makes life bearable, then it seems almost perverse to ask them to end
their love affair with the drug. Except that by the time most people end up
in Broadway Lodge, their addiction is so extreme that the choice is between
rehab and death.

Naomi discovered heroin through the clubbing scene. 'I started on pills,
speed and acid and there was no addiction there, but I became addicted to
the lifestyle.

I loved clubbing so much, it was the first time I felt part of something.

People accepted me and I felt like I was on the same wavelength.' She was
'working', selling drugs in Ibiza when she first came across heroin.

She was caught dealing by the Spanish authorities and deported to such
people wherever possible, except when to do so would injure them or others.
10 We continued to take personal inventory and when we were wrong, promptly
admitted it. 11 We sought through prayer and meditation to improve our
conscious contact with God as we understand Him, praying only for knowledge
of His will and the power to carry that out. 12 Having had a spiritual
awakening as a result of these steps, we tried to carry this message to
others, and to practise these principles in all our affairs.

. Courtesy of Narcotics Anonymous