The Nightmare of Recovery

Those who believe, as most sensible people do, that the current war on drugs is a boondoggle and a disaster also usually say that we ought to be spending our dollars on treatment, not law enforcement, if we want to diminish the trade in illegal drugs. As long as rampant demand -- in the form of a buzz-hungry populace with fistfuls of ready cash -- waits inside our borders, enterprising individuals and organizations in other countries will find a way to supply it, no matter how many helicopters we send to Colombia or smugglers' boats we seize off the coast of Florida. Menacing teenagers will shoot each other on street corners and grizzled bikers will cook up methamphetamine in backwoods sheds provided there are enough people, in the end, willing to pay enough money for those little packets of white powder. (Or at least as long as selling that white powder remains against the law, but let's stay in the realm of political possibility.)

But if "treatment" has become a buzzword for citizens tired of seeing billions of their tax dollars wasted on hunting down South American drug lords and warehousing nonviolent offenders in prisons, Lonny Shavelson, a physician and journalist, argues that it's often not a whole lot more than that. In his new book, "Hooked," which follows five addicts through the torturous process of getting help for their substance abuse problems in San Francisco in the late 1990s, he makes a powerful case that America's drug treatment program is hopelessly flawed. Despite "a burgeoning movement in states across our nation to shuffle drug offenders from prison to treatment," he writes, "before we shift hundreds of thousands of addicts into rehab, we must first treat the treatment system."

As these five stories unfold -- at times "unravel" seems the better word for what happens -- the truth behind Shavelson's prosaic play on words becomes agonizingly clear. Lives are ruined and lost, hearts shattered, precious second and third chances squandered, trusts betrayed, hopes stubbed out. And, in a few rare cases, people do manage to miraculously pull themselves out of the pit. Shavelson wants to see those exceptions become the rule, and in figuring out how we can make that happen, he overturns a few of our most cherished notions about addiction and recovery.

The five people he writes about in "Hooked" are part of the kernel of hardcore substance abusers whose lives, according to Shavelson, constitute the front line of the drug war: "the most resistant, demanding, often unlikable, and arguably the least deserving of treatment service ... precisely the type of difficult junkie that rehab programs must succeed with if they are to make a dent in the crime, violence, and craziness that comprise the drug problem." Although the number of illegal-drug users in the U.S. declined from 1979 to 1998, the number of drug-related hospital visits and deaths went up, and most people picked up by the police for criminal offenses test positive for drugs. The Justice Department says drug users account for "an extraordinary proportion of crime."

Shavelson documents their blasted lives: Darrell is a lonely, homeless alcoholic and crackhead who has flunked out of several rehab programs, attended thousands of Alcoholics Anonymous meetings and been hospitalized for countless injuries, including falling out a window, while wasted. Mike is a skilled plumber whose unendurable memories of being molested as a child send him back to heroin again and again despite his heartbreakingly fervent desire to redeem himself in the eyes of his kids and girlfriend. (In the book's opening pages, Mike is described as shooting up while driving a truck down California's Highway 101 -- steering with his knees -- getting in a wreck and then, once ascertaining that he's uninjured, continuing to shoot up in a ditch beside his totaled pickup.) Glenda is a tiny, sweet-natured Native American who has been drunk and homeless since age 16 and looks 60 instead of 37, her actual age. Crystal is a cocky crackhead who boasts of her fearsome street reputation until she trusts Shavelson enough to confess that she was a streetwalker and a "victim." Most daunting of all is Darlene, whose auditory hallucinations ("noises," she calls them) could be caused by psychosis, or by the speed she injects as often as twice a day, or by the brutal conditions of her life in various homeless encampments, each makeshift shelter eventually bulldozed by the authorities without warning.