In 1966 Congress passed the Narcotic Addict Rehabilitation Act, a wholesale rethinking of the treatment of drug offenders. NARA rested on a forced marriage between the Bureau of Prisons, the Attorney General, and the Surgeon General. The law gave judges back discretion in sentencing. They could go for voluntary commitment, commitment in lieu of prosecution, or send offenders to aftercare.
To this day NARA remains a singular attempt to minimize criminal penalties for drug use at the federal level. For addicts, NARA was huge. Overnight incarcerated addicts became eligible for status and benefits as NARA clients. Once assessed, good rehab prospects were remanded to their hometown treatment facility. And if there was no treatment back where they came from, the National Institutes of Mental Health (NIMH) would find an agency to provide it.NARA was part of a broader shift towards deinstitutionalization ushered in by the Community Mental Health Act (1963). The CMHA redirected mental health care towards community-based services and transformed the culture of NIMH. Then along came NARA—another complicated law setting forth new relationships between federal, state, and local governments, the courts, and a hard-to-reach clientele. By then the Narcotic Farms in Lexington, Kentucky and Fort Worth, Texas had operated a revolving door for drug treatment for more than 3 decades.
NARA re-packaged the old Narcotic Farms as “Clinical Research Centers.” The CRCs were conduits for evaluation and treatment. NIMH administrators Karst Besteman and Richard Lindblad (whose interview was invaluable for this post) scoured the country to locate providers and set up aftercare not only in cities familiar with drug addiction but in small towns and rural areas. They recruited social workers to operate 11 field offices, working round the clock to implement the short-lived law, which was rarely used after 1973.
Complex and expensive, it was no wonder NARA did not pass the test of time. But NARA enabled the shift from centralized, federal drug treatment to a decentralized, community-based drug treatment infrastructure. NARA prepared the ground for the Nixon-era drug policy reforms and set the stage for a proliferation of Therapeutic Communities (TCs) in the 1970s.
Under NARA, patient-directed rehab modeled on TCs like Synanon and Daytop Village was the main form of treatment available. The TC modality was state-of-the-art. Hundreds of programs copied Synanon techniques. Soon to become Nixon’s drug czar, Jerome H. Jaffe visited Synanon and infused TC principles into his multi-modality program in Chicago, the Illinois Drug Abuse Program. Former Lexington patient David Deitch went west to Synanon before heading back to NYC to co-found Daytop.
TCs were not without controversy. Deitch later lamented the regression to “inane cruelties,” depicting programs as a “caricature of the negative elements of Synanon, without its redeeming qualities” (Deitch & Zweben, 1981). For him, the original Synanon game was an art form when played alongside group-oriented self-awareness processes, mutual affection, and support. At their best, TCs allowed ex-addicts the space to confront their demons and gain a new way of life and a sense of belonging in a drug-free milieu. At their worst, TCs unleashed new demons in the form of abusive physical and psychological behaviors that pervade dominance hierarchies.
NARA irrevocably altered institutional life at Narco.
The old Narcotic Farm sought a new lease on life, allowing clients to form TC-like “houses” inside the institution. In late 1969, a group of Lexington patients organized The Lighthouse, based on a new treatment philosophy that included confrontational therapy in a meditation chamber. Soon after New Year’s, a secret faction broke away and took the name Matrix—“something within which something else originates or takes form.” Founded on Synanon principles—no drugs, no violence—Matrix House was a short-lived, experimental TC on the grounds of the Lexington Narcotic Farm. JP Olsen captures the drama in his 2-part post, Lessons of the Narcotic Farm, Part V: Matrix House.
— Nancy D. Campbell