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True, treatment programs are expanding. Narcotics Anonymous, a self-help group modeled on Alcoholics Anonymous, had only four members in Dade County, which encompasses Miami, in 1979; today up to 80 people meet nightly in each of 44 groups throughout the county. Private hospital programs have grown so fast in the 1980s that some experts guess they have become a $3 billion-to-$4 billion-a-year business. But their cost, often $300 to $500 per bed per day, puts them beyond the reach of the innumerable addicts who do not have employers or insurance companies willing to pay. Clinics and residential programs that depend on a mix of private donations and government funding are jammed to overflowing; tales of three-month waiting lists to get in are common. Last year Washington counted a mere 269,711 people in treatment programs that receive government assistance, and federal funding for treatment has actually been reduced in the past four years.
Treatment at best is a long, complex and frequently frustrating process. There are disputes about the best methods. For example, some programs use chemicals in the first stage to ease the crash of a cocaine addict coming down and stimulate the production of natural brain chemicals depleted by the drug. Managers of other programs insist the goal should be to get abusers off % dependence on any kind of chemical right away.
Detoxification is only the first step: it must be supplemented by individual counseling, group therapy, vocational training and a range of activities to fill the void in a patient's life left by withdrawal. Phoenix House, one of the nation's largest community therapeutic programs, with facilities in New York and California, relies on rough-and-tumble group-encounter sessions that have proved effective in reshaping an addict's attitudes. Dr. Mitchell Rosenthal, president of Phoenix House, says lying and rationalizations are a big part of being a drug abuser, and "the encounter enables him to see himself as he really is." For the 20% who stay for the full two-year program, the success rate as measured five to seven years later is an impressive 76%.
Whatever the type of treatment they receive, recovering addicts need follow-up care and counseling, sometimes for as long as five years, to make sure they stay clean. A major treatment problem is to convince an addict that one resumption of drug use does not mean he will never shake his habit. Many recovering addicts do not stay in touch with follow-up programs, so no one knows whether or how long they stay off drugs. Thus the success of treatment programs is hard to measure. Though some claim success rates as high as 80%, Dr. Sidney Cohen, professor of psychiatry at UCLA, fears that nationwide only 40% of treated cocaine addicts are still clean a year after discharge.
EDUCATION
Learning to Say No
"What should you do if someone tells you to buy drugs on the bus and they have a knife?" That anonymous written question startled Police Officer Nicholas Wade, who was leading a drug-education class at a Los Angeles elementary school; he had not expected sixth-graders to be so intimately acquainted with such street savagery. After a moment's hesitation, Wade read the question aloud to the 20 students, whose answer came without any hesitation. "Tell someone!" they chorused.