Reflections on “Addicts Who Survived”: Willis Butler’s Narrative

Editor’s note: Not every interview conducted for Addicts Who Survived was of an addict.  The work includes some fascinating oral histories of individuals with notable roles in the modern history of addiction and the drug war.  Among these, Dr. Willis Butler, who operated one of the most notable narcotic maintenance clinics opened around the time of the Harrison Act and closed soon thereafter.  We’ll have commentary to Dr. Butler’s oral history tomorrow.

WILLIS BUTLER

Willis Pollard Butler was the most celebrated and controversial of all the early clinic doctors. Born in modest circumstances in Gibsland, Louisiana, in 1888, Butler moved with his family to Shreveport in 1899, where he took a summer job as a drugstore delivery boy. (Ironically, his chores included the delivery of dram bottles of morphine to the local addicts.) He eventually worked his way through Vanderbilt Medical School, graduating in 1911. Returning home, he applied his talents as chemist and bacteriologist for the Shreveport Board of Health, until he was elected parish physician and coroner in 1916. He served in that capacity for no fewer than forty-eight years. When interviewed in 1978, he was over ninety years old.1

            Butler was above all else a superb politician. He was handsome, charming, articulate, and on a first-name basis with everyone who counted in Shreveport. That, together with the efficient and discriminating manner in which his clinic was run, assured local support and temporarily frustrated the designs of interloping federal agents.

            Although Butler’s memory was phenomenal for a man of his years, it should be borne in mind that his is only one side of the story, that the agents who hounded him and the doctors who turned on him can make no rebuttal. As Butler himself observed, “I don’t know anybody connected with it—top, bottom, or middle—still living except me.For the sake of confidentiality, the names of addicts mentioned by Butler have been changed, as have the names of those who may have violated the law.

I was health officer, medical examiner for this district, and parish physician. One day—it was the third of May, 1919—Dr. Oscar Dowling, president of the state board of health, came to Shreveport. As usual, he called me, because I was representing the state board of health up in northern Louisiana. He asked me down to the hotel to make a culture of his throat—he had a sore throat. I went down there to see him and, as we walked out of the hotel, he said, “Butler, you having any problem up here with addicts?” I said, “Yes. I don’t know about particular problems, but we got a lot of them. I’m having trouble with them in jail, and there’s an awful lot of thievery and that sort of thing going on, and the police say that a lot of them are responsible.” He said, “Well, we have opened up a clinic down in New Orleans, under Dr. Marion Swords. I suggest that you come down there and see how it’s being done, because we have the approval of the government and the Treasury Department Narcotic Division. Maybe you could start the same thing up here.”

Well, I went to New Orleans. I knew Dr. Swords quite well; he was secretary-treasurer of the state board of health. He had this clinic right across from the courthouse on the corner of Conti Street; it looked like a little alley down in the French Quarter. What I saw was a bunch of derelicts coming in, and they were giving them a little vial—it looked like it might hold 15 or 20 cc. He said that they were putting morphine in there, a certain amount according to what they wanted them to start with. The next day, they would put in a little less, but the same amount of water. They were going to get them off of it by reduction. I said, “You don’t know much about addicts if you think that you can fool them as to whether they’re suffering or not.” I said I’d have nothing to do with that sort of thing at all, and I told Dr. Dowling that I did not want to assume any such responsibility. Continue reading

Setting the Record Straight, Part 5: A Disease They Didn’t Have

Editor’s note: Today marks the final installment of guest blogger Marcus Chatfield’s eye-opening exploration of the role that peer-reviewed research played in facilitating the survival of Straight Inc. into the 1990s, as well as its ongoing legacy in coercive youth drug abuse treatment.

In the 1989 Journal of Substance Abuse Treatment article “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.”, Alfred S. Friedman, Richard Schwartz, and Arlene Utada state that 99 percent of Straight’s clients were white and that 30 percent of clients attended church regularly prior to intake. It is relevant to consider the type of teens that were recruited for “treatment,” as well as how they were recruited for treatment and why their parents placed them in Straight. Notably, several authors have reported that many clients at Straight were treated for a disease they didn’t have. This was due in large part to Straight’s assertion that even the experimental use of alcohol or marijuana was the symptom of a disease. And because this disease was the cause of even initial drug use, treatment was required whether teens had experimented with drugs or not. Many clients in Straight were “dry druggies” who had never used an illegal substance but were displaying “druggie behavior.”

Spot the druggies.

Spot the druggies.

Continue reading

Setting the Record Straight, Part 4

Editor’s note: Marcus Chatfield continues his series on Straight, Inc., the coercive treatment program for children and teens suspected of drug use that flourished with White House and NIDA support in the 1980s. In today’s entry, Marcus breaks down the flaws in the peer-reviewed research that helped cement this official legitimacy.

In “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.” (1989), Alfred S. Friedman, Richard Schwartz, and Arlene Utada claim that their report will include: “(1) the description of the study sample, (2) the outcome of the improvement that occurred between intake and follow-up, (3) the comparison of the outcome between graduates and ‘dropouts,’ and (4) the relationship of the amount of time in treatment to treatment outcome.”

"This report is in fulfillment of NIDA Professional Services Contract #64986."

In their sights.

However, in each of these areas the study is flawed: (a) their description of the study sample reveals major problems, such as selective sampling; (b) the intake-to-follow-up comparisons show limited correlation and also, the authors state that they are meant to measure outcome of improvement rather than actual outcome; (c) they completely fail to discuss their promised comparisons between graduates and dropouts (they also claim to discuss a comparison between “respondents” and “nonrespondents” and then omit this comparison as well); and (d) perhaps most importantly, but left unexplained, they found that “time in treatment” had no effect on drug use reductions. Continue reading

Setting the Record Straight, Part 3

Editor’s note: Today Marcus Chatfield continues his series on Straight Inc., the involuntary treatment program for adolescents suspected of drug use that operated in several states between the 1970s and 1990s. Parts 1 and 2 of the series can be found here and here.

In Help at Any Cost (2006), Maia Szalavitz reveals some of the troubling history of coercive programs. The sub-title of her book is, “How the Troubled Teen Industry Cons Parents and Hurts Kids,” and this is one of the hardest things for a survivor to describe – the deceit that protects abusive programs. Dr. Charles Huffine writes, “I cannot tell you how many youth I’ve been in contact with that do not tell their family about the painful aspects of their experiences for fear of making their family feel bad — though I can say they number in the majority. All too frequently, simply, they did not know they were abused, or worse, that the abuse was justified and necessary for them to ‘get better.’”

Straight-inspired TV movie Not My Kid (1985). Spoiler alert: they got their kid back.

Straight-inspired TV movie Not My Kid (1985). Spoiler alert: they got their kid back.

Tough-love programs often ritualize emotional testimonies and require testimony about conversion experiences as a prerequisite for release from treatment. Because there is no scientific evidence to validate the safety and efficacy of coercive methods, these anecdotes are the “hook” that this multi-billion dollar industry is built upon. Many victims of thought-reform treatments, like victims of domestic violence, will defend their captors as a self-protective survival response. Similar to abusive dynamics in families, when people are beaten down long enough they may believe it’s normal, deserved, and even good for them. As one former staff member of the program said to me recently, “at the time I graduated I was so duped into believing that I’d been helped, I couldn’t even begin to see the damage caused to me.”

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Pharma Gamesmanship in the Booming Business of Addiction Therapeutics: the Case of Suboxone

Editor’s Note: Points welcomes another new guest blogger to the ranks today. Kimberly Sue is an M.D.-Ph.D. candidate in medical anthropology at Harvard, doing ethnographic fieldwork with opiate-addicted women. Below, Kim details some very recent developments in the ways pharma companies invoke societal values around drugs in order to manage their market share, and discusses how the outcomes are likely to affect people in treatment.

Pharmaceutical companies and opiates have a complicated, intertwined history. Analgesia was and continues to be a big business as well as an ongoing medical conundrum. Opiates, as we know, are wildly popular analgesics. Yet when did opiates specifically indicated for treating addiction become such a big business, a lucrative niche market inciting pharmaceutical companies to aggressive industry maneuvers? As Penn professors John Kimberly and Thomas McLellan wrote in a 2006 article on the substance abuse treatment industry, “Pharmaceutical companies that, not long ago, refused to allow the use of even their discarded medications for clinical research in addiction now invest hundreds of millions of dollars in the marketing and sales of approved addiction medications.”

Mum, mustard, and maintenance. ( Reckitt Benckiser annual report, 2011).

Mum, mustard, and maintenance. (Reckitt Benckiser annual report, 2011)

Does this say something about the changing cultural attitudes towards addiction—that pharmaceutical companies are no longer afraid of being branded as making drugs for drug addicts—or does it simply speak to the enormous profits to be had?

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Setting the Record Straight, Part 2

Editor’s note: Today guest blogger Marcus Chatfield continues his series on Straight, Inc. and the research it used to burnish its reputation in the 1980s.

As part of my research I sent a questionnaire to 12 former clients of Straight, some of whom I was in treatment with. My purpose was to collect testimony that would help explain the findings of Friedman et al., and to help raise awareness about the abuses that went on in Straight. I asked participants to reflect on their experiences in Straight and compare their current perspective with their perspective immediately following treatment. Their reports also included descriptions of broken relationships with parents, intensified drug use in the first few years after graduation, and long-term trauma resulting from coerced participation in the program. All of the participants reported being “extremely dissatisfied” now but most reported high levels of satisfaction with their treatment during the time soon after their release. As one former staff member responded, “my answers to these questions are completely different than they would have been immediately after completing aftercare because I was still brainwashed by Straight’s doctrine well beyond my involvement with Straight.”

Large group therapy

“Large group therapy process” (Straight brochure)

The only peer-reviewed research specific to clients of Straight was conducted by Straight’s own Medical Director, Richard Schwartz. Looking at the history of the program, it appears that this research began during a financially critical time. Continue reading

Setting the Record Straight: Part 1

Editor’s Note: Points is pleased to introduce a new guest blogger today. Marcus Chatfield is currently writing a book about coercive therapy in the “troubled-teen industry,” based on research he has conducted as a student at Goddard College. A client of Straight, Incorporated from 1985-1987, he is associate producer of the upcoming documentary film, Surviving Straight Inc. Marcus’s five-part weekly series for Points focuses on the research that enabled this program to win the trust of families, media, and high-ranking officials during its operations in nine states between 1976 and 1993.

“The problem, of course is that Straight really does not know what happens to a good many of its graduates. And it will be criticized for this in the future.” Andrew I. and Barbara E. Malcolm, report to the White House drug czar, 1981.

Straight building 1

The building that housed the Straight Inc. program in Springfield, Virginia.

Straight Incorporated is one of the most infamous adolescent treatment programs in the history of America’s War on Drugs. Straight was an intervention and prevention program, established in 1976 with a federal grant from the Law Enforcement Assistance Agency (LEAA). The LEAA funded hundreds of behavior-modification programs in America and many of them were found to be dramatically unethical. The coercive methods that were used at Straight were not only ineffective, but quite harmful for a large percentage of clients. This essay is a critical examination of an article published in 1989 by the Journal of Substance Abuse Treatment (JSAT), entitled “Outcome of a Unique Youth Drug Abuse Program: A Follow-up Study of Clients of Straight Inc.” Authors Alfred S. Friedman, Richard Schwartz, and Arlene Utada claimed that Straight was highly effective at reducing drug use and that 70% of the former clients from the Springfield, Virginia facility were “satisfied” with their treatment. Program executives presented this statistic to parents and the media as scientific proof that Straight worked.

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Drugs and the Couples Who Love Them

Wine, chocolate, cigarettes: psychoactive substances have long been trappings of romance. As far back as high school English, I was instructed that the definition of romanticism owes a debt to the Shelleys and their opiates. For lovers who make substance use a routine rather than a romantic ritual, the days of wine and roses turn tragic. Psychologists have other words for this dynamic: codependency, misplaced loyalty, marital dysfunction.*

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Some anthropologists take issue with the way substance-using couples are depicted in mainstream public health scholarship: “While other people have lovers and spouses,” wrote Nina Glick Schiller, “drug users have only ‘sex partners.’”  People who use drugs—whether in couples or subcultural social networks—are seen as a special population at greater risk for contracting and transmitting infectious diseases such as AIDS or hepatitis. Neutral scientific terms like “sex partners” are designed, at least in part, to de-stigmatize at-risk populations by objectively describing pathways of disease transmission that might necessitate public health interventions.

But even before the AIDS crisis reinvigorated the perception of substance-using sex partners as vectors of disease, self-help and social science literature depicted the relationships as degrading. Continue reading

Remembering David Musto

Editor’s note: As has become apparent in this symposium, how individuals read The American Disease depends on when and where they first encountered the book. In today’s post, Caroline Jean Acker, author of Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control  (2002) reflects on how The American Disease played in the social world of street-level drug education and ethnography in the late 1970s.

On February 1, 1979, I walked into the office of Up Front Drug Information in Miami’s Coconut Grove, my first day on the job as Coordinator of the agency. Smaller and less well known than the Do It Now Foundation or the Student Association for the Study of Hallucinogens (STASH), Up Front shared these groups’ conviction that scare tactics did little to deter drug use once people found even one of their claims false.

Up Front’s desire to establish a street drug testing lab arose in 1978 due to the concerns of American consumers that they might have purchased Mexican marijuana sprayed with the herbicide paraquat. Up Front’s logo (lower left) was a stylized representation of a mescaline molecule designed by Leon Rosenblatt.

Up Front established a street drug testing lab in response to the concerns of American consumers that they might have purchased Mexican marijuana sprayed with the herbicide paraquat. Up Front’s logo (lower left) was a stylized mescaline molecule designed by Leon Rosenblatt.

Founded in 1973 by Tracy Brown, Up Front assumed that if people were going to use psychoactive drugs, they would be less likely to experience undesirable effects if they had accurate information about them. Lacking clear understanding of drug effects, they risked overdose and other untoward outcomes.  The organization maintained a small library (books ranged from Goodman and Gilman to Peter Stafford’s Psychedelics Encyclopedia; periodicals, from The New England Journal of Medicine to High Times), fielded questioners’ phone calls, developed and distributed pamphlets on drug effects and risks, managed a DEA-licensed anonymous street drug testing laboratory, and produced a small monthly magazine called Street Pharmacologist.

My first published writing appeared in this venue where, as editor, I accepted my own submissions. When I was hired, I knew little about psychoactive drugs, and Tracy set about educating me before he went off to law school.

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The Points Interview — Michael E. Staub

Editor’s Note:  Michael E. Staub’s  Madness is Civilization: When the Diagnosis Was Social, 1948-1980 (University of Chicago Press, 2011) is bedecked with a number of favorable comments at its Amazon storewindow site.  Staub’s previously authored books include an oral history, titled Love My Rifle More than You, about a woman soldier who served in Iraq in 2003 and 2004.   The author suggested this work might also interest drug and alcohol historians. 

  1. Describe your book in terms your bartender could understand.

It would depend on how old this hypothetical bartender was. Is she old enough to remember the 1960s? Let’s assume that she is. Then I’d ask her to remember her reading of Ken Kesey’s One Flew Over the Cuckoo’s Nest or Marge Piercy’s Woman on the Verge of Time or seeing Alan Bates in King of Hearts or listening to Arlo Guthrie’s riff in “Alice’s Restaurant,” where he discusses how he evaded the draft not because he yelled at the military psychiatrist that he wanted to “kill, kill, kill” but because he’d been arrested for littering. (Admittedly, this is a pretty cultured bartender I am concocting, but it’s my bartender and I’ll imagine who I want to.) So I’d tell the bartender how the 1960s are routinely remembered today for all kinds of things like hippies, Che Guervara, Tricky Dick, Neil Armstrong, Ho Chi Minh, Black Power, and SDS, among others. But what almost always gets left out of the history books is how much critical and popular attention in the 1960s and 1970s was lavished on issues relating to madness and the asylum. And I’d say that explorations into madness often became a means to address a host of other political and social concerns, ranging from the dysfunction of the nuclear family to the devastations of militarism to the problems of gender and race relations to the failures of the educational system. As one social psychologist put it in the early 1970s, and I am paraphrasing here, this was an era in US history when many Americans felt that the entire country had gone crazy, and the question for many was how to maintain their sanity in an increasingly insane society. That’s what my book is about.   Continue reading