Points Roundtable: “American Rehab” from Reveal

In July, Reveal, the broadcast channel of the Center for Investigative Reporting, released its eight-part series American Rehab, which centered on an investigation into the drug treatment program Cenikor and the group’s emphasis on “work therapy.” Examining how Cenikor was able to transform “tens of thousands of people into an unpaid, shadow workforce,” Reveal traced Cenikor’s development, struggles, and ultimate success as it placed “patients” into difficult, and often dangerous, jobs across Texas and Louisiana, keeping the money these workers earned and providing little else in terms of actual therapy or rehabilitation. Led by reporters Shoshana Walter, Laura Starecheski and Ike Sriskandarajah, the series is based off Walter’s previous reporting on the issue, which was a finalist for a Pulitzer Prize in 2018 for national reporting.

American Rehab’s early episodes deal extensively with the history of a group that directly influenced the formation of Cenikor: Synanon. In doing so, the reporters reached out to several members of the Alcohol and Drugs History Society for advice and assistance on the history of addiction treatment. We’re really useful people to ask: roundtable participant Nancy Campbell’s book, co-authored with JP Olsen and Luke Walden, The Narcotic Farm: The Rise and Fall of America’s First Prison for Drug Addicts outlined the history of the Lexington Narcotics Farm, where “work therapy” got its start, and panelist Claire Clark’s book The Recovery Revolution: The Battle Over Addiction Treatment in the United States deals extensively with the long and complicated history of how “therapeutic communities” like Synanon influenced addiction treatment and rehabilitation. These books, as well as Campbell, Olsen, and Walden’s series, “Lessons from the Narcotic Farm” from 2012 (click the links to see parts 1, 2, 3, 4, 5, 6, 7, 8) and contributing editor Jordan Mylet’s initial reaction to the series here, provide further details for those interested in how American drug treatment came to the disturbing point Reveal reveals. 

In response, now that the entire series is available, we decided to post a roundtable of reactions to the podcast. Participants include Nancy Campbell, professor and department head of Science & Technology Studies at Rensselaer Polytechnic Institute; Erin Hatton, associate professor of sociology at the University at Buffalo and the author of Coerced: Work Under Threat of Punishment; Claire Clark, associate professor of behavioral science at the University of Kentucky; Jordan Mylet, doctoral candidate in history at the University of California, San Diego; and me, Emily Dufton, managing editor of Points and author of a forthcoming book about the history of medication-assisted treatment in the US. Our responses focus on the long history of work therapy in addiction treatment, the concept of coerced labor, the promotional model at the heart of many treatment programs, further reflections on Synanon, and assessments of the series’s conclusion. 

We welcome your thoughts on American Rehab and thank the reporters for bringing ADHS historians into the conversation. We hope you’ll enjoy our thoughts on American Rehab, and that you’ll listen to this important and informative podcast. 

Read more

Recent News Round-Up: Hoarders Edition

A few months ago, I was packing for my fifth move since 2008. I emptied every closet, box, and drawer. With every move, I’d shed belongings— a full twelve boxes of books in move number four— so why, I wondered, am I still knee-deep in useless things?

The answer was that, in true academic fashion, I’d redefined “useless.”  Turns out “keep,” “store,” and “toss” are unstable categories: I classified our household belongings entirely differently after reading the New York Times article on Marie Kondo, a home organization expert with a devoted global following.

Kondo has a best-selling book and a robust media presence, but her most famous piece of advice could be summed up in a tweet: Touch every item you own; if something doesn’t “spark joy,” discard it. I applied this method to my packing process, and a lot of things I’d been storing went out the door. (I also made a few personal archival discoveries— see below).

My "Just Say No" buttons from elementary school. Joy!
My “Just Say No” buttons from elementary school. Joy!

The process got me thinking about Americans’ warped relationship with material possessions, an entanglement that has grown more dysfunctional over the past several decades. Even as the middle class flounders, easy credit, cheap foreign labor, and larger home sizes have made it easier than ever for the average American to acquire far more possessions than he needs or can use. Since excessive, compulsive consumption factors into most definitions of addiction, it’s unsurprising that Americans’ increasingly acquisitive habits have led to cultural anxieties about purchasing (and hoarding) behavior.

Read more

Escape from Custody: A Classic Book and a New Collection

Alcohol and drugs historians have long lamented the archival limitations of studying past substance users. Substance users typically enter the historical record through retrospective oral histories, the archives of hospitals or prisons, or popular books and media. All these sources have shortcomings: oral histories are riddled with the errors of human memory, institutional archives are usually limited to clinical and criminal records, and popular culture is distorted by sensationalism or artistry. As Bob Beach, Miriam Kingsberg, and Joe Gabriel have argued on Points’ pages, finding the “user’s perspective” is historically difficult.

I’d like to introduce researchers to another point of access to the past: Robert Straus’s Escape from Custody: A Study of Alcoholism as Reflected in the Life Record of a Homeless Man (Harper & Row, 1974), a classic text that offers a uniquely detailed portrait of one man’s chronic alcohol use in mid-twentieth century America.

Read more

Best of 2014: Media Recommendations for Alcohol and Drugs Historians

EDITOR’S NOTE: Need a last-minute gift for your favorite alcohol and drugs historian? Or something to do on your winter break? Have no fear! Points editors have tons of suggestions for books, movies, TV shows, music and digital distractions. Read on for a breakdown of some of the best alcohol-and-drugs-related media we’ve consumed this year.

screenshot_1215

Read more

Recent News Roundup: The Sobriety Coach Edition

Twelve-step sponsorship is so twentieth century—or so The New York Times would have us believe. In an article published last month in the newspaper’s Fashion and Style section, author Marisa Fox made the case that “recovery coaches,” “once consigned to Hollywood entourages to keep celebrities on the straight and narrow,” are currently trending among upper-class women “from the Upper East Side to the beachfront homes of Boca Raton.”

Last weekend, NPR’s All Things Considered followed the trend, offering a more inclusive description of recovery coaches’ clientele (the stock image that accompanied the report was still a view from the beach).

heroinrecovery_wide-2a6fc5fa05e9de7f53966c3853b923f2d5c80a73-s4-c85
Diane Diederich/iStockphoto featured on NPR.com

The historical angle adopted by both news outlets was obvious. The old-fashioned practice of sponsorship—defined by Alcoholics Anonymous as the process by which a person “who has made some progress in the recovery program shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety”— presents shortcomings in today’s treatment marketplace. The women featured in the Times have the ability to buy their way out of the social awkwardness and fear of exposure that twelve-step meeting attendance invites. The NPR piece notes that people in early recovery don’t always gravitate toward the most adept supporters— coaches, who are trained to provide practical as well as spiritual guidance, can help solve this long-standing problem.

Clipping from Hazelden's MORE program pamphlet. The program offers coaching for clients in early recovery.
Clipping from Hazelden’s MORE program pamphlet. The program offers coaching for clients in early recovery.

As historian and clinician Bill White explained, coaches are not sponsors (they don’t do voluntary twelve-step work on “paid time”) and they’re not quite counselors (they don’t diagnose or probe underlying psychological issues). They occupy a new niche in the service economy that employs more than 75 percent of today’s American workers. They are “the new Pilates instructors,” one coach told the Times. They are compensated to be both “cheerleaders” and “beacons of hope,” another told NPR.

Like NPR reporter Martha Bebinger, I think coaches can produce tremendous benefits, both for people in recovery and for the treatment system as a whole. But the proper role of recovery coaches in today’s health service sector also deserves a systemic critique—and not the trolling, “New York Times Style Suction” sort.

Read more

Rated “SA”? Jack Valenti and the Skirmish Over Movie Ratings in the Reagan Era

What is inspiring the relaxation of social mores regarding marijuana use? Today, theories abound. Perhaps anti-marijuana laws are too expensive to enforce. Or: a growing number of Americans have tried marijuana, and consequently, come to view its health effects as relatively benign. According to Nancy Reagan’s supporters in the mid-1980s, one driving force for pot permissiveness could be easily pinpointed: Cheech and Chong.

Reagan’s anti-drug campaign is well documented. Her campaign stops, speeches, and talking points are spread across more than three series in the Reagan Presidential Library (which was where I got the idea for this post). Likewise, many authors have covered the political debates about depictions of sex and violence in the 1980s, noting that media moguls almost always managed to outmaneuver their critics. Today’s post describes a forgotten episode in this moral epic: in 1985, Reagan’s anti-drug allies urged the Motion Picture Association of America (MPAA) to revise its ratings system and return the silver screen to its substance-free, pre-Sixties glory.

Cheech and Chong's Next Movie Ad, 1980. Submitted to Congress during 1985 subcommittee hearings (via Wikipedia)
Cheech and Chong’s Next Movie Ad, 1980. Submitted to Congress during 1985 subcommittee hearings (image via Wikipedia)

Read more

Texas Veterans for Medical Marijuana: Backstory on a “War Without End”

Last week, I attended a panel discussion co-hosted by Texas Monthly and the Baker Institute for Public Policy at Rice University. The subject for debate was a recent article by Bill Martin, the director of the Institute’s Drug Policy Program. “War Without End,” published in the June edition of Texas Monthly, describes how Texas veterans of the wars in Iraq and Afghanistan are successfully self-medicating for post-traumatic stress disorder (PTSD) with marijuana. (Trigger warning: their stories are not easy reading). The decision to opt for cannabis over the antidepressants, sleeping pills, or psychotropic medications commonly prescribed by Veterans Administration (VA) doctors makes these veterans criminals in the state of Texas. Although Governor Rick Perry recently said he plans to “implement policies that start us toward decriminalization,” the Texas Legislature hasn’t budged in recent years. Unlike Colorado or Washington, Texas does not have a ballot initiative or referendum process, so the Legislature is the state’s main route to reform. Majority support from the public and the best efforts of groups like the Marijuana Policy Project and local chapters of the National Organization for the Reform of Marijuana Laws (NORML) have, so far, come to naught.

Enter the veterans. Reformers believe Texas legislators will listen to war heroes, and state Senator Joan Huffman (R-Houston), a panelist at the Baker Institute event, seems to agree. Huffman told audience members that, in her opinion, a focused campaign for medical marijuana legislation for veterans diagnosed with PTSD would stand a better chance of success than broader initiatives aimed at population-wide medicalization, decriminalization, or legalization.

Photo illustration by Darren Braun for Texas Monthly
Photo illustration by Darren Braun for Texas Monthly

 

“When a guy has done four tours in Iraq, like some of our people, and been wounded in action, it’s hard to look him in the eye and call him a slacker pothead,” one veteran and activist told Texas Monthly. This new depiction of the traumatized veteran as uniquely deserving of marijuana does more than challenge the stoner stereotype. It recalls many of the psychological, symbolic, and treatment policy developments associated with the Iraq War’s most frequently cited historical analogue: the war in Vietnam.

Read more

Doing Drugs (History) at the AAHM

The annual conference for the American Association for the History of Medicine kicks off this Thursday, and there are several great alcohol and drugs history events on the docket this year. You can join the conversation about them on the association’s new-and-improved conference website and blog.

Chicago, here we come!
Chicago, here we come!

On Friday at noon, Points represents at a lunchtime panel on Blogging the History of Medicine. I’m co-chairing the panel with Jacki Antonovich of Nursing Clio; we’ll be in conversation with Nathaniel Comfort of Genotopia, Elizabeth Mullen of the National Library of Medicine’s Circulating Now, and Lisa O’Sullivan of the New York Academy of Medicine’s Books, Health, and History. Our discussion will focus on the hows of blogging, not the whys.

You might also want to check out:

Read more