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.

Continue reading

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.

Continue reading

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

What’s the matter with Georgia? Thoughts on substance abuse statistics, policy, and history

Last month, I attended the American Public Health Association conference in San Francisco. While there were many interest groups  and high-profile lectures that appealed to my interest in the history of addiction, I wound up spending most of my time at the Public Health Expo. In a stadium-like open space, my research team’s posters competed for attention with potential employers, university recruiters, and lots of public health swag.

Public Health swag!

As I was making the rounds, I stopped by the SAMDHA table. SAMDHA —short for the Substance Abuse and Mental Health Data Archive—is a fabulous database of survey results collected by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The University of Michigan’s Inter-University Consortium for Political and Social Research (ICPSR) maintains the archive, from which researchers or quant-savvy members of the public can download datasets and run analyses using a range of different statistical software programs. They can also use the online analysis tool provided on the SAMDHA website.

Finding this tool even cooler than swag, I asked the representative to help me run some basic descriptive statistics about Georgia’s alcoholism treatment admissions, drawn from the Treatment Episode Data Set (or TEDS) survey. We clicked through the site to the analysis tool, and clicked again. No data. We tried another year—no luck. Toggling through the site, we discovered that Georgia had not reported its treatment data to SAMHSA since 2006—and that it was the only state to fail to do so.

Wait.. where’s Georgia’s data?

Since 2006, there have been big changes in Georgia’s substance abuse policies. Governor Nathan Deal (a former Democrat who switched parties in 1995) was elected in 2010 and immediately began an overhaul of the substance abuse policies that had driven Georgia’s rate of incarceration, which was among the highest in the nation. While pursuing other austerity measures for the cash-strapped state, Deal recommended over $5 million for the creation of residential substance abuse treatment centers and $10 million to support the creation of new drug courts that would divert offenders from jail and prison. The Obama administration and other media outlets hailed Deal’s enlightened drug policy. But without accessible TEDS data from previous years, it will be more difficult for the public to evaluate the impact of policies designed to increase access to residential addiction treatment or encourage treatment rather than incarceration.

The rapid expansion of addiction treatment and drug courts was accompanied, ironically, with a populist challenge to Georgia’s long-standing Blue Laws. A coalition of libertarians, fiscal conservatives, and unchurched beer enthusiasts passed ballot initiatives allowing Georgia counties to overturn the state-wide ban on Sunday alcohol sales. Of the 128 cities that placed Sunday sales on the November 2011 ballot, 105 approved the referendum. While several extra hours of access might not lead to an increase in individuals seeking alcoholism treatment, the circumstance is exactly the kind of natural experiment that has occupied alcohol policy researchers—and historians—for decades. That is, when they can get the statistics.

Georgia: finally totally red
[Source: Creative Loafing Atlanta]

Scholars will face a challenge in determining whether the new Georgia policies moved population-level treatment data. According to my later correspondence with a SAMDHA representative, the state reportedly “had issues with their data system contractors” which “caused them to have no data in the TEDS database since 2006.” The problem has apparently been solved, and figures will be reported again beginning with 2011. The five years of data from 2006-2010 is probably lost.

I admit, I was disappointed— until it occurred me that the missing survey data makes early twenty-first century Georgia a lot like the vast expanse of alcohol and drugs history. Most of the blockbuster surveys that fall under SAMHSA’s purview today—including studies like the Drug Abuse Warning Network (DAWN) and the National Survey on Drug Use and Health (NSDUH) — didn’t get underway until the 1970s, when federal officials began viewing addiction as a large-scale social problem and promoting the expansion of drug treatment.

The surveys like TEDS and DAWN work a lot like the epidemiological approach to monitoring diseases: hospitals or treatment centers report cases of drug overdose or drug treatment admission up the chain of command. When states report the cases to the federal government, officials are able to analyze particular areas of interest, identify national trends, and coordinate appropriate responses. The research process is far from perfect—there are some lively debates in early National Institute on Drug Abuse publications— but I still view the longevity of surveys like TEDS as evidence of a moment in which government officials sought to align new drug policies like the promotion of treatment with an ambitious national research agenda. The studies continue to be a wonderful resource for historians as well as policymakers.

In the absence of representative national survey data, we synthesize secondary data, estimate, and speculate. Those three useful tools have inspired provocative arguments about the validity of addiction statistics from the Anslinger era, or the hypothesis that national alcohol Prohibition was a short-lived public health success. But the systematic, national, population-based research of the last 40 years helps us say with some confidence that, for example, marijuana is making a comeback among youth or the main source for non-medical prescription drug use is doctors, not dealers. While all surveys have limitations, the insights they provide offer a useful starting point for research questions and plenty of fodder for historical interpretation.

Doctors, not dealers
National Survey on Drug Use and Health (NSDUH) 2011

One scholar summed up the importance of Census data to historians thusly:

“Imagine a history of the Revolutionary era written with Census returns. Imagine a history of the Civil War era written without them.” As an alcohol and drugs historian, you could say that the addiction treatment revival of the 1960s and 1970s is my Civil War, and surveys like TEDS are my Census.

And Georgia? It’s on the wrong side.

Special report: Addiction treatment growing as a financial investment

Editor’s Note: Today, we’re pleased to welcome Alison Knopf, editor of the Alcoholism & Drug Abuse Weeklyas a first-time Points guest blogger.   We’re republishing, with her kind permission, her article on addiction treatment as big business, which first appeared at A&DAW on November 5th, 2012.  Several interesting issues raised in this piece, we thought, will merit further discussion among our readership. 

In September, when Tennessee-based Acadia Healthcare Company paid $90 million for Timberline Knolls, a 122-bed inpatient treatment program in Chicago, treatment providers wondered if their programs were worth that kind of money, bed for bed. Other deals in recent months, including Foundations Recovery Network’s acquisition in early October by Nick Pritzker Capital Management for an undisclosed amount, point to the possibility that addiction treatment — at least in the commercial (non-Medicaid, nonpublic) sector — is a profitable enterprise. For this story, ADAW talked to some of the most influential leaders of the addiction treatment field in the private for-profit sector.

In early September, Michael Cartwright, founder and former CEO of Foundations, and Jerrod Menz of Forterus, which in 2008 began investing in addiction treatment programs (see ADAW, October 20, 2008), joined with Treatment Solutions to form American Addiction Centers, which announced that it would provide “a comprehensive and cutting-edge suite of treatment-related services to the masses.” Forterus’ main treatment program is A Better Tomorrow.

Cartwright, who started his career as an inner-city case worker making $16,000 a year and is now on his fourth addiction treatment company, said that the treatment business is not ready for the stock market. “Forterus went public, and that was a mistake,” he told ADAW. But it is ready for private equity, or for just personal investment, he said.

Cartwright thinks addiction treatment is a good investment — for commercially insured patients — because 3.5 million people a year go to treatment, there have been no rate decreases and the average length of stay is consistent.

Cartwright’s first company was a not-for-profit. His second was a managed care company that he sold to the employees. The third was a privately held company that he sold to private equity — Foundations. And his fourth — American Addiction Centers — now has operations in six states and a healthy revenue stream, he said. But it is not ready for an initial public offering, which he said requires $100 million, and which most addiction treatment providers — with the exception of CRC Health Group — don’t have. Continue reading

The Points Interview — Howard Padwa

Editor’s Note:  “For an otherwise law abiding morphine addict struggling to overcome addiction in the late 1920s, Britain was a more welcoming place than France.”  So begins Howard Padwa’s Social Poison: The Culture and Politics of Opiate Control in Britain and France, 1821-1926 (Johns Hopkins University Press, 2012).  A graduate of the University of Delaware, Padwa continued his studies at the London School of Economics and the Ecole des Hautes Etudes en Sciences Sociales in Paris before securing a doctorate in history from UCLA.  In our interview, Padwa highlights the place of  differing conceptions of proper membership in a national community as a deep source of Britain’s and France’s differential responses to illicit drugs. 

1.  Describe your book in terms your mother (or the average mother-in-the-street) could understand.

I started with two simple questions: First, why did opiates become so tightly controlled in the early twentieth century? Second, were the reasons the same everywhere? While a lot of scholars have looked at these questions, most have focused on studying things either globally (why did drugs become tightly controlled everywhere), or nationally (why did drugs become tightly controlled in this country or that country). In Social Poison I blended these approaches, looking at things internationally, but with a detailed focus on two countries (Great Britain and France).

As for the first question—why did opiates become so tightly controlled? I approached this question by looking at what people were afraid would happen if they didn’t control opiates. What would society look like if everyone could use them as much as they liked whenever they liked? I found that two fears were particularly common in the nineteenth century. First, people feared that opiates would take a toll on physical and mental health, eventually making users unable to care for themselves or contribute to society. Second, they feared that people who used opiates would essentially “tune out” of society, neglecting their duties to their friends, families, and countrymen when they were under the influence. In both cases, what made opiate use problematic was not just that use was considered “immoral,” but also that it seemed to compromise users’ abilities to act as good citizens. Drug use was understood as more than just a medical or psychological disorder—it was also a threat to the normal functioning of social relationships.

This led to the second question—were the reasons drugs became tightly controlled the same everywhere? The kind of social problem opiate use could become depended, to a large degree, on how “society” was defined. In Britain, where the national community was imagined as individuals functioning in a free market, fears focused on the impact drug use could have on self-sufficiency and commerce. In France, on the other hand, the nation was understood in a more collectivistic way, and engagement of citizens with society was considered most important. So, in the French context, fears that drugs would make users disengaged or disloyal were much stronger. Each country developed its own specific brand of what I call “anti-narcotic nationalism”—reasons for opposing drug use that were particular both to opiates and to specific national concerns.

Anti-narcotic nationalism went beyond the ways that the British and French talked about opiate use in the nineteenth century; it also influenced the development of drug control in the early twentieth century. In Britain, concerns about the effect the drug trade could have on commerce facilitated the landmark piece of legislation that established opiate control on the British mainland during World War I. In France, concerns about drug use, treason, military discipline, and national security were the driving forces behind drug control initiatives that took effect in 1908 and 1916. Once drug control was established, anti-narcotic nationalism also influenced how British and French authorities treated their addicted citizens. In Britain, when it became clear that opiate use was not necessarily incompatible with self-sufficiency or productivity, the government sanctioned maintenance treatment for some addicts. In France, on the other hand, associations of drug control with national security remained in place, as did strict regulations limiting the provision of drugs to confirmed addicts. Continue reading

Teaching Points– Addiction Research: History, Policy, and Practice

Editor’s Note: The Teaching Points series is a celebration of pedagogy on drugs.  In our second installment for the back-to-school season, we look at a rare specimen– a med-psy class that emphasizes history and its relevance for clinicians, researchers, and treatment providers.  Guest blogger Christine Grella is Professor of Psychiatry and Biobehavioral Sciences at the Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, and Associate Director of ISAP.  Her research focuses on the relationship of service delivery to addiction treatment outcomes, and she brings that “meta” perspective to graduate students and postdocs when she teaches “Addiction Research: History, Policy, and Practice.”

Addiction Research: History, Policy, and Practice
This course will take a big-picture view of research on substance abuse and its relationship to social interventions and policies that attempt to address problems related to substance use.

Teaching the Big Picture

The goal is for you to understand the history and evolution of the field of substance abuse research, so that you can situate your own research interests within this context, as well as understand the influences that continue to shape research priorities (and associated funding streams), social policies regarding substance abuse, and the organization and delivery of drug treatment within the context of the broader health care system. Moreover, because prior research on drug users, especially those who were incarcerated, was interwoven with the development of current policies regarding research with human subjects, we will examine these issues.  We will address questions such as:

  • What is the origin and evolution of research on drug use and addiction in the United States?
  • What is the relationship of the federal government to addiction research and how has this relationship changed over time?
  • What is the relationship of basic research on the effects of psychoactive substances, pharmacology and behavioral pharmacology, treatment-outcome and patient-oriented research, market-oriented research on drug development, and emerging new fields of addiction research (e.g., neurobiology, behavioral economics, translational research)?
  • In what ways does (or does not) research on drug abuse and its treatment inform social policies aimed at eradicating problems that stem from drug misuse?
  • What are implications of health care reform for the organization, financing, and delivery of drug treatment?
  • How do we determine the effectiveness of substance abuse treatment and what are current efforts to improve the quality and delivery of treatment services?

Readings:
N.C. Campbell.  (2007). Discovering Addiction:  The Science and Politics of Substance Abuse Research.  Ann Arbor:  University of Michigan Press.

Report of the Blue Ribbon Task Force on Health Services Research at the National Institute on Drug Abuse. (2004). Bethesda, MD: National Institute on Drug Abuse.

Institute of Medicine. Committee on Crossing the Quality Chasm. (2005). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, D.C.: The National Academies Press.

NIDA 35th anniversary papers in Drug and Alcohol Dependence, 107(1), 80-118.

National Center on Addiction and Substance Abuse at Columbia University.  (2012).  Addiction Medicine: Closing the Gap between Science and Practice.  New York:  CASAColumbia.

Course Schedule
Week 1: Introduction to addiction research and social policy in the U.S.:  History, policy, and practice
The field of addiction research has been described as having amnesia with regard to its history.  What can we learn from the history of addiction research about our current research priorities and practices?  What are the social policy precursors of our current efforts to regulate alcohol and drug use?  This class will present a “Brief History of Alcohol & Drug Use and Social Policy in the U.S.” Continue reading

Lessons of the Narcotic Farm, Part Five: Matrix House, continued

From the outset of the Matrix House treatment program, there were concerns among non-medical staff at Lexington that neither Dr. Conrad nor Wildes appreciated the explosive nature of allowing addicts free reign within a building isolated from the rest of society. Before long there were also signs that something was amiss inside Matrix. In my interview with Dr. Jack Croughan, Matrix’s attending physician and the only person other than Dr. Conrad with a key to the Matrix building, recalled meeting a young woman inside Matrix whose withdrawn behavior struck him as odd, particularly given the generally upbeat feel of the place — which he described as “slightly hypomanic.” But with no evidence of wrongdoing – and the denials of the woman that anything was wrong – he voiced no concerns.

Matrix House residents enjoy a little posed quiet time on the front porch.

Some months after that incident, Matrix was shut down in dramatic fashion by the FBI amid allegations that members were being tortured and that bombs were being assembled in the basement. The bombs – it was initially reported – were part of a plot to overthrow the federal government. This turned out to be false; the group was in fact building pyrotechnics for a musical theater production they were intending on presenting later that year.

In April of 1973, however, Jon Wildes appeared in federal court in downtown Lexington to face weapons charges. Continue reading