The Concept: An Answer to Addiction?
Bennett, Meridan
The Concept: An Answer to Addiction? by Meridan Bennett Imaginative new programs that fly in the face of professional orthodoxy or the self-interest of established public officials rarely...
...In addition, Ramirez added another feature - a prevention program located out in the high endemic areas of drug addiction in San Juan...
...The agency has not been co-opted by the heavily professionalized Health Services Administration...
...Lindsay will run on it-perhaps use it to defend his Human Resources Administration...
...It is mandatory for all ASA staff...
...He spoke glowingly of getting 5,000 addicts into treatment in the first 12 months, 25,000 a few years later...
...This is my stand...
...He pledged himself to an all-out attack, a comprehensive city program that would not only step” up law enforcement but tackle prevention and rehabilitation as well...
...It was upon this record that Ramirez based his “cure rate” figure of 94 per cent...
...Vincent P. Dole and his wife, Dr...
...That much time has not yet passed for ASA...
...Behind the despair, as so often happens, new solutions were being tried by laymen- ex-addicts, frustrated probation officers, priests, jailbirds-sometimes working together with medical men, often not...
...The residents enforce both, aided in the latter case by weekly urine tests to discover traces of heroin...
...Some ex-addicts join ASA as addiction specialists...
...Kicking the habit, one ex-addict told me, is greatly over-dramatized...
...Obviously ASA does not like methadone, but today most informed members of the staff are willing to grant that in a sizeable number of cases, perhaps 20 per cent, the medical problems of addicts are so severe that the high cost of lifetime maintenance on the drug is worth it...
...Each house is nearly self-supporting, since the addicts’ welfare checks are pooled to provide funds...
...Mayor Lindsay could well have done without having to pay the political costs of having a commissioner with no talent for, or interest in, the politics of what he was running...
...ASA employees use such techniques in their weekly staff encounter, a hallowed and highly useful ASA innovation in which internal dissensions, doubts and ambition are dealt with directly, without regard to rank...
...Matthew’s parable of the talents (“to him that has shall be given...
...Yet one such has not only survived in America’s most complex city...
...They could agree that the addict was responsible for his own social behavior before the law and his fellow men...
...To do nothing about one’s situation is to become thing-like...
...Rather than concentrating on the medical aspects of heroin addiction, the usual procedure, Ramirez and his staff were putting addicts through a period of what they called “induction,” aimed at creating in the addicts a self-help attitude toward their problems...
...Given the paucity of successful new approaches to urban problems - especially in New York - the story of how that program made the grade is worth the telling...
...You can read about the effects any day in the papers: a mugging in Central Park, unprovoked violence accompanying a purse snatch...
...it is also a way to tackle directly an employee’s poor performance on the job-to challenge him to improve or get out...
...This, of course, is part of the therapy...
...the purpose is to provide intellectual development to match the emotional maturing...
...Their concept of cure avoids facing the addict’s most seductive manipulation: getting the monkey off his back temporarily so that he can go back to his habit at a vastly lowered cost...
...Ramirez brushed off most of them, unless they prostrated themselves before his methods...
...by Meridan Bennett Imaginative new programs that fly in the face of professional orthodoxy or the self-interest of established public officials rarely stay airborne for very long, even if they are lucky enough to get off the ground in the first place...
...We can handle it here [in the Phoenix House]-it’s no worse than a case of the Hong Kong flu...
...Even less did Lindsay need the scandal-creating potential of a resignation by one of his commissioners...
...Addicts maintained on daily doses of methadone get off the welfare roles and take jobs, usually within a year...
...The message, whatever the medium, is that there is no substitute for confronting one’s total reality...
...He proved that he had trained them well in confrontation, perhaps even too well...
...One staff member calls it “a psychological can opener...
...By showing his ability to clean the latrines, the postulant is allowed to move up to more responsible tasks, until he eventually participates in the management and administration of the Phoenix House...
...Experience in New York, and elsewhere where The Concept has been tried, seems to indicate at least three years must pass before an addict can be counted on to have established drug-free living patterns...
...The Concept may suggest a new kind of education that could make our children less alienated as they grow up, while helping to change a society which seems to require alienation as its fixed overhead cost...
...Despite the fact that vigorous existential confrontation was the mainstay of his program-not only in the cure of addicts but in staff operations as well-he was notoriously unable to accept or profit by confrontation himself...
...He starts by working as an aide in the ward where newly-arriving addicts are detoxifying...
...No one I have talked to doubts this assumption about Fun City...
...Other therapeutic measures are thrice-weekly group encounter sessions in which all pretense is stripped bare and the residents show each other where they are failing to function as members of their new “family...
...Late in 1968, two and a half years after Ramirez burst upon the scene, his Addiction Services Agency was a going concern with a life of its own...
...In the Phoenix House the addict must adhere to two basic rules: no violence and no chemicals...
...The addict, in fact, is incapable of the emotional response required by the standard practice of psychiatry...
...ASA has 500 addicts off drugs .and in treatment in its therapeutic communities, and another 700 in induction...
...Together the two have put together an array of programs designed to change the environment in which addiction thrives...
...A - re-entry program for those who have successfully passed through the therapeutic stage has since been added...
...Audiences came away having experienced the therapeutic power of love...
...It can give you a permanent high...
...There he phases into the job of running the place, which means contact again with the junkies and the ever-present pusher...
...This period, which could mean a year or more of voluntary residence in the hospital, was followed by a final stage in which the now drug-free patients learned how to re-enter the society and environment in which they had acquired their addiction...
...In most civilized places you have trouble choking down a lungful of air...
...There is another problem which faces The Concept and all those who are attempting to deal with addiction as a process in the development of a human being, rather than as an event in his life...
...He said he had wanted to design a program that could not only deal effectively with the heroin problem but turn a faltering city around as well...
...Whether or not The Concept fits the need, we quite obviously need new educational approaches that will place reality squarely before both child and adult, sick and healthy, beggar and grandee...
...it has somehow managed to grow...
...In 1968 it opened “The Concept,” an off-Broadway production staged by Daytop residents...
...They began to confront him on the question of his anti-political, vain behavior...
...This is my position...
...by trying to see that the emotional values are maintained in the elusive work of making New York citizens into effective agents of change...
...Always in such programs there is a mechanism for helping an addict revise his view of himself, to begin viewing his situation as one that he himself can change...
...The ultimate confrontation for Ramirez came just before he resigned...
...ASA demonstrated that therapeutic communities using vigorous existential encounter therapy can get rid of heroin addiction in individual addicts and turn them into social assets -people with strong positive character patterns...
...morning and watch the junkies nodding from their morning fix...
...The Prevention Division is also the home of attitudinal skills training (AST), the technique of commitment to interpersonal involvement which so characterizes the agency’s approach to problem-solving...
...Thus the ASA community orientation center, as it is called, has become the headquarters for all sorts of contacts-school teachers, welfare workers, settlement house workers - whose assistance ASA seeks in preventing addiction...
...This appearance of Concept thinking as the cornerstone of ASA may mark the first time that local or national government has treated with love a problem traditionally regarded as medical or criminal...
...But that is precisely what Ramirez did at the end of last year...
...Methadone appears to be a highly effective narcotic alternative to heroin...
...But ASA’s prevention program has at least shown that a prevention network can reach large numbers of people in the city to create special programs for non-addicts...
...0 When John V. Lindsay ran for mayor of New York in 1965, he issued a White Paper on narcotics addiction...
...He can only produce simulated responses for the purpose of manipulation...
...he said in an interview, “but I’m an architect...
...It is the only way to become more human...
...Mayor Lindsay moved rapidly after his election...
...Psychiatrists tend to turn off under such professional frustration-or blow their cool entirely...
...Ultimately, he may leave...
...Only an ex-addict can communicate his belief in a heroin user’s ability to kick and stay kicked...
...But they insisted that the primary cause of addiction was the dominance in the addict’s character of a set of destructive, negative attitudes-an inability to respond to the stimuli which, in more normal characters, produce growth...
...Let us start with three items: 0 It is commonly assumed that half of the heroin addicts in the United States live in New York City...
...the other residents act as if the subject is not there...
...Efren Ramirez, now 38, a psychiatrist from Puerto Rico who had created an anti-addiction experiment that was reported to have produced promising results...
...Before it was out of sight, the junkies swooped down and began stripping the car...
...The Concept offers one way of catching up before it’s too late...
...These bear promise of changing the underlying conditions in society which contribute to addiction and drug abuse...
...The goal of the program Ramirez began putting together was nothing less than a restructuring of character - the character of a foundering society and of its helpless citizens...
...In a February issue of The Village Voice, Mary Breasted wrote this apt description of Ramirez’s departure: “It was this fond but critical staff which eventually encouraged Ramirez to resign...
...He felt that leadership positions ought to go to those who had earned them in two ways: by shaking their addictive life patterns and by adopting a direct and open relationship with others...
...With teachers, garbagemen, cops, firemen, and minority groups all staging their own guerrilla wars, Lindsay scarcely needed the legions of enemies that Ramirez had created among the bureaucracy and the healing professions, or among the chilled politicians whose egos the psychiatrist steadfastly refused to massage...
...Synanon believes that the world from which addicts come is too devious and destructive to re-enter: thus today there are Synanon jobs in Synanon organizations waiting for Synanon graduates...
...It is a network of contacts with citizens of all sorts, ranging from 12-year-old glue sniffers to black matriarchs in BedfordStuyvesant...
...Naval Hospital in Oakland...
...The interesting feature of the Puerto Rico program was that the patients themselves - addicts in the process of breaking free from drugs-ran the show...
...These four took what already existed in the way of a rehabilitation programa small group of addicts working together to kick their habit in a West 85th Street slum building they called “Phoenix House”-and created a program that now includes nine Phoenix Houses scattered around the city...
...Already the first dribble is coming out of the other end of the pipeline: 72 ex-addicts are in the reentry program and doing vital work in both Prevention and Rehabilitation...
...that he was behaving as if he unconsciously did not want to be commissioner...
...In the 1960’s the problem began to acquire a quality of utter desperation as the newer dangerous drugs, such as LSD, made their appearance...
...While some existentialists may practice their philosophy in private, like a secret vice, Ramirez has always sought to make of his a public concern...
...Both feed the public’s illusion that junkies are incurablean illusion which the junkie himself usually peddles to anyone who will listen...
...Whereas three years ago there was no city drug program, beyond a shaky group of voluntary agencies getting city help, today, besides the voluntary agencies, there are 55 ASA centers in various parts of town devoted to preventing and curing addiction- all placed there by a deliberate city policy to confront one of its worst problems...
...Casriel...
...It consists of three hours of general orientation (the induction period), followed by 16 hours of intensive training in how to confront oneself and others with a belief in the human potential for growth...
...Its appearance in the official policy of Mayor Lindsay’s administration in New York must certainly be one of the strangest of all...
...Not only was he planning a rehabilitation program for addicts, but also a prevention network which would change the underlying conditions in society that cause drug addiction: alienation, powerlessness, violence, and impoverished living...
...The haircut is a period of complete isolation...
...Ramirez created something that was not there before and which, as we shall presently see, may be of considerable value...
...He then works as an assistant group therapist in a Phoenix House, challenging residents on their personal growth...
...The National Institute of Mental Health provided money...
...Needless to say, little academic or professional training is available to help one attain the qualifications to work in the prevention of addiction...
...I attended a number of them and became convinced that the whole brawling procedure has immense value in keeping an organization running efficiently...
...The agency he created, however, is far from dead...
...It gives them a good feeling of having cured someone...
...He mentioned a budget of $100 million...
...The message of ASA, which certainly has some meaning to its own survival in the jungles of New York, is that we are addicts together and there is no one to cure us but ourselves...
...When Rosenthal came to ASA, he brought with him three ex-addicts who left the closed environment of Synanon: Hollis (Candy) Latson, Gary Guttierre, and Frank Natale...
...Our troubles lie in the man, not in the moon...
...Kotler’s staff of department heads reflects the unique philosophy of ASA toward community action: only those who are personally committed to changing themselves are qualified to set about changing others...
...Public Health facilities at Fort Worth and Lexington are the outstanding Examples-are completely staffed and operated by professionals...
...Up until very recently, curing drug addiction did just that...
...a firm family structure to foster love and responsibility...
...Many public health professionals and the public are being attracted to a simpler, single-factor solution to addiction...
...It does not produce euphoria or motor impairment, but it blockades the effect of -and thus the craving for -heroin...
...It has further shown, by employing ex-addicts in all the vital phases of its operations, that such people can become agents for change in a society which badly needs them-a fact which we already know about ex-alcoholics...
...Addicts arrive at the Phoenix Houses either by voluntarily committing themselves or by choosing a three-year commitment from the courts under a New York stat6 law which, for drug-related crimes, provides that option as an alternative to a prison term...
...The addict’s only motivation seems to be a perverse determination to con his healer rather than to get well...
...Prevention is even more difficult to measure...
...A year and a half after his arrival in the city, when Mayor Lindsay created the Addiction Services Agency and installed Ramirez as its commissioner, his exclusion of doctrinal infidels continued and intensified...
...Although ASA employment is not mandatory for an emerging ex-addict, at this early date it appears that that is what he wants...
...Ramirez would participate in these sessions with the addicts as a peer...
...Despite the criticism of ASA set off by Ramirez’s sudden departure-its chief critics being other narcotics professionals and Democrats who want their own turn in Gracie Mansionthe agency is not only still in business but has secured funds to the tune of about $12 million for the next year...
...He refused to acknowledge that he’d been kicked around...
...Lindsay has reaffirmed his support of ASA’s sweeping goals, which still remain intact...
...Though enmity between ASA and Drs...
...AST is open to the public through citizens’ prevention groups throughout the city...
...My job is to establish the clinical feasibility of the program...
...Last year a resident of Spanish Harlem described to me how he heard an automobile crash outside his apartment one evening...
...Thus they are very costly...
...Who can doubt, when he looks at external reality, that we live in a lunatic human environment...
...Daytop went beyond: it began explaining what this new approach to addiction cure was all about to a wide audience of unaddicted “squares...
...Methadone is being touted as cheap, which further heightens its allure to anyone looking for easy answers...
...In it, among Cocteau’s many addict’s cop-outs, was a considerable kernel of truth: the doctors who cure opium addiction do not seek to deal with the troubles which first caused the addiction...
...There are, of course, many ways of stating The Concept, from St...
...It adopted Synanonistic approaches: encounter therapy sessions in which groups of addicts participated in superheated bull sessions...
...Judging Ramirez by his own existential values -his willingness to take responsibility for his actions -we must grant him credit for the existence of ASA...
...You can begin to accept yourself when you find you can be free...
...The schools seem to have failed: many critics now believe that education never was designed to speed or soften the process of change anyway...
...One of the most useful things an addict’s parent can do, in ASAs view, is to throw him out of the house and thus bring him face to ” face with the consequences of his own act ions . Since Prevention’s contacts are primarily in the streets, its program uses ex-addicts coming out of the system to run community centers...
...The experience on stage was the real experience of real people fighting to conquer the bad aspects of their real lives...
...Prevention-both as a division with ASA and as a goal of the program is the other part of the Ramirez dream...
...Both operate on The Concept, which means that their programs follow the three sequential steps: induction, attitude change in encounter groups, and then an action program out in the community...
...Unable to resolve bitter divisions between the rehabilitation and prevention sides of his agency, he embarked on a wild reorganization plan...
...However, using present ASA cost/benefit figures, it only costs about $7,000 to cure an addict, with the further benefit that he emerges into a dysfunctional society as a positive force for change...
...Aha...
...However, in several short years ASA has become a potent enough force in New York so that the cost was worth it...
...Its main exponents are Dr...
...Given the short supply of trained ex-addicts, it was fortunate for drug users elsewhere that not every Synanon graduate found happiness in the self-contained environment there...
...his main role was in challenging them to do something about their self-destructive behavior...
...The lowest figures I have seen on methadone maintenance are roughly $1,500 per year per patient...
...This is the basic clue to the addict’s problem: somewhere in his development his character has been distorted...
...With Larry Bear at the helm of ASA, everyone seems to be relaxing a little Tomorrow the World ASA’s methods-and those of like-minded attitude change programs elsewhere-signal a breath of hope for a world paralyzed by its inability to act meaningfully and fast to meet the crisis of change...
...He said he was quitting to enter private practice...
...One must assume that the rehabilitation program is successful...
...It was, indeed, a flamboyant success in flouting the taboos of bureaucracy...
...Methadone is not cheap, of course -any permanent addiction is vastly expensive...
...If you want to see what heroin addiction looks like, stroll down New York’s East Third Street between Avenues C and D at nine o’clock some spring Meridan Bennett is a free-lance writer and consultant on urban affairs...
...Inside ASA ASA’s two operating divisions, Prevention and Rehabilitation, are the backbone of the agency...
...It must certainly be recorded as an outstanding first in the history of city government that ASA not only has mounted a comprehensive addiction prevention program, but has built and trained a staff to do it...
...Dole and Nyswander waxed hot over the methadone issue, ASA now seems more willing to keep the still hazy question of how to cure a drug addict open to investigation...
...Neither has produced lasting cures...
...They hear outstanding public figures as well as highly controversial issues...
...As late as 1962 a Kennedy-sponsored White House conference of the leading professionals in the field produced only despair or excuses-lack of money, lack of research, lack of public concern-about their inability to cure the heroin addict...
...The Concept” became one of the season’s great successes...
...A methadone addict, on the other hand, will cost $15,000 to maintain over 10 years, and double that if he lives for 20 years...
...The bread and circuses of national affairs keep us hypnotized, as they present us with farm subsidies, “community action,” manned space spectaculars, and wars fought for the minds of men...
...Induction centers, located out in high-addiction areas of the city, are manned by trained, ex-addict ASA staff members who are products of The Concept and who have been hired under an unusual new civil-service classification which ASA convinced the city to adopt: Addiction Specialist...
...The Concept I remember reading, a number of years ago, Jean Cocteau’s book, Opium: The Diary of a Cure...
...However, the dropout rate in treatment has held steady at 17 to 20 per cent...
...you have to get typhoid shots before you go boating lest you fall in the open sewer upon which you take your pleasure...
...He does so with the dogged energy yet worried eyes of a man who has long since learned that those who operate programs with largely unmeasurable results can quickly become politically expendable...
...It is a way of liquidating hostilities before they threaten to impair effectiveness in the office...
...Traditional psychiatry and clinical psychology, when used with heroin addicts, have usually failed...
...The programs that follow the medical approach to addiction the U.S...
...Martin Kotler, once the proprietor of a nursery school and more recently the deputy director of the whole New York City poverty program, runs Prevention...
...The alternative to this type of treatment, of course, has always been the lock-up and cold turkey...
...Despite Ramirez’s bad relations with New York’s blacks, and his none too cordial relations with the city’s Puerto Ricans, despite the ammunition he gave to Lindsay’s political opposition, the dynamism of the anti-addiction program and its outreach into all the city’s boroughs make it one of Lindsay’s few hopeful signs in a season of despair...
...the centers also induct non-addicts into the many prevention activities of the agency as well...
...The Rehabilitation Division is headed by a young psychiatrist, Dr...
...There are periodic marathon encounters, running to several days without surcease, in which the participants intensify the process of piercing the masks of bravado and deception...
...According to the very conservative figures on what addiction costs the City of New York directly, every street addict means $1,500 spent from city revenues...
...These people began describing the addict in new terms...
...It is the part which has to do with turning around a whole society...
...The community, called Synanon, was started by a reformed drunk, Chuck Dederich, who believed strongly that standard health professionals could play no role in addiction cures...
...A final tool in therapy is the daily seminar on a subject of the residents’ own choosing...
...For example, the Black Muslims conducted a rehabilitation and re-entry program in prison, described by Malcolm X in his Autobiography...
...The final stage of rehabilitation, called re-entry, comes when the resident graduates from what may have been a year or more of therapy in a Phoenix House...
...From his window he watched the junkies on the block descend on the injured occupants to strip their rings, purses, and wallets...
...The total number of heroin addicts in New York is estimated to be between 50,000 and 100,000, although no one knows for sure...
...Special groups of relatives and employers of addicts learn how their own attitudes may have fostered addiction and what they can do about it...
...to Bob Dylan (“You’d better start swimmin’/Or you’ll sink like a stone/For the times they are a changin...
...Increasingly, ASA is pursuing the latter course...
...The experiment, begun a few years earlier, reported relapse rates among its patients that were so low as to be unbelievable -in the range of 10 per cent, which was somewhere near the cure rates being achieved by other methods...
...I have no talent or interest in the politics of it...
...Prevention’s program runs all the way from juvenile encounter groups-in which youngsters on the threshhold of drugs are rounded up by referrals from schools, parents, and the courts-to scattered community action organizations whose chief concern is to make the city a livable place...
...lectures and seminars designed to stimulate intellectual growth...
...Addiction cure rates are tricky figures and are to be mistrusted as one must mistrust an addict...
...The resignation was his own choice, he said, and his existentialist’s bag of tricks remained intact...
...Daniel Casriel, a psychiatrist who had tried the methods being used in California, in setting up Daytop Village in Manhattan...
...he proceeds to making confrontations to the partially-committed addicts in day-care centers...
...Those who do become temporarily certified by the board go off welfare and reimburse the program for the costs of their keep...
...It is the non-addict’s mini-version of what goes on in a Phoenix House...
...My purely subjective measure of the effect of rehabilitation in Phoenix Houses is that each time I visit one I instantly feel a quality of love in the atmosphere: order, honesty, lack of obsequiousness, and a complete acceptance of me as a person...
...An ambulance came and removed the injured...
...At the same time he is also responsible for his major weakness - a towering vanity which caused him to prefer the company of sycophants and to neglect almost entirely any meaningful research on his program out of fear that it would reveal flaws or failure...
...Finally, he moves back to the street, to one of ASAs community centers in a high-addiction neighborhood...
...The production’s title, “The Concept,” referred to the method and philosophy used at Daytop for tackling what may be our century’s most perplexing problem: how to bring about rapid personal and social change before it’s too late...
...Marie Nyswander...
...Ramirez was bound to produce shock waves...
...Practitioners of The Concept stress their belief that only an ex-addict can talk meaningfully of personal change ta a using dope fiend (their term), pierce all his deceptions and self-pity, and challenge him to grow...
...It had failed, however, to come anywhere near fulfilling the expansive goals which Ramirez had set in 1966...
...By April, 1966, he had installed as coordinator for all addiction programs in the city one of the least orthodox addiction experts to be found anywhere: Dr...
...He becomes again what he was on the outsidea non-person...
...They did not doubt the presence of some medical problems in the addict...
...Nonetheless ASA has accomplished a great deal...
...Dr...
...Then, after a short withdrawal period, the addicts entered an extended period of group therapy featuring intense attitudinal confrontation among themselves...
...but before it was fully implemented, he re-reorganized it back into something like its earlier shape...
...They did their own chores, policed the ward against drug use, and, as they progressed in their treatment, began to take over the conduct of the group therapy sessions...
...For whites, as clearly a s for blacks, the issue is to become more human...
...Sometime last fall the top ASA staff confronted Ramirez with his shortcomings in an ‘executive encounter group.’ They told him...
...Undoubtedly it works in curing character disorders...
...Synanon believes that what matters most is a sternly ideal community, a family, in which performance establishes hierarchy and upward mobility...
...He bounced out of the job as jauntily as he had bounced into it...
...When Ramirez talks about how The Concept developed for him, he mentions Camus, Jaspers, Sartre, Rollo R. May, Maxwell S. Jones-names which represent a confluence between existential philosophy and psychiatry...
...Lindsay’s position recognized, however, that the problem went beyond law and order: “Arrest and punishment have not solved addiction: there is nothing in our experience to indicate that they will succeed in the future...
...Of 124 addicts who passed through this final phase prior to 1965, only seven went back to the drug scene...
...When an addict, in his contacts with the ASA addiction specialist, begins to show that he believes he can do something about his self-destructive behavior, he is either admitted to a daycare center or a hospital ward for “detoxification”going off the drug-or directly to a Phoenix House...
...It is here that he must make his first decisions to rehabilitate himself...
...The project opened three units around town-plus one in New Haven-and began producing ex-addicts, that essential seed capital for opening other outposts...
...Not only are junkies inducted into treatment there...
...Given the practices of the New York City establishment toward down-andouters - at best, herding them through various types of custodial institutions: at worst, plastering BandAids over the running social sores of...
...it remains under the city’s embattled Human Resources Administration, where it can operate with greater I flexibility...
...There is a strong emphasis in Synanon on games and devices to simulate reality...
...If you recognize that the world’s lunacy starts in inner space, you have only one human alternative, according to The Concept: do something about it...
...It was simply an encounter therapy session (with deadly honest confrontations of the participants’ attitudes) done in the midst of an audience...
...Most of his staff, who are vigorously anti-sycophantic, mentioned this curious weakness in my discussions with them...
...Of the 72 candidates in the re-entry program, only two have split the scene so far, and there is no way of telling whether they went back to drugs...
...It said: “Addicts are responsible for almost half the serious misdemeanors in New York City and about 20 per cent of all felonies against property...
...As coordinator of addiction programs, Ramirez took jurisdiction over much of the funding of many private drug-addiction programs, running all the way from street-corner tambourine revivals to sophisticated experiments in the city’s hospitals and universities...
...Lindsay’s clear risks in appointing him compounded when Ramirez arrived in New York and began to sound as if he intended to take over the whole city...
...Mitchell Rosenthal, who had previously established a therapeutic community along Synanon lines in the ward of the U.S...
...The residents permit no slacking off in the work of running the house, which means that labor is carefully divided among everyone...
...They don’t have to witness the addict going into his next phase: re-addiction...
...This statement might do as an epitaph for Ramirez’s service in city government...
...Occasionally the residents administer a device called a “haircut” to break through a particularly hard shell of habit which one of their number has built up around himself as an addict...
...Other squares have made the same observation about their visits...
...the city- the self-help, non-professiona1 approach of Dr...
...At ASA, heroin problems are the symbol for a much broader reality...
...In effect, The Concept began breaking out in strange places simultaneously...
...The single-factor treatment is the drug methadone...
...In the culture of city bureaucracy it is difficult to imagine a larger act of flamboyance than having such a man, a complete outsider, move in on New York and announce a program that was plainly intended to carve a huge new empire out of the choice meat of other established bureaus...
...Or try Lexington Avenue around 110th Street...
...It was a new therapeutic community in which the addicts ran the show, with occasional visits from Dr...
...The sooner we start change within the man-me, you-the sooner we can improve relations between men, and between man and his environment...
...Through it all Ramirez preserved his image as high priest of existential confrontation among his rapidly growing staff...
...One such defector, Dave Deitch, teamed up with Dr...
...He has so secure a sense of himself that you would hesitate to take him for a psychiatrist...
...Efren Ramirez is a roundish, sideburned man with a faintly Latin way of speaking...
...It provided medical assistance during withdrawal, hospital care for a time while psychiatric evaluation was made, and then a ticket home...
...Ramirez’s project in Puerto Rico was one manifestation of this view of the addict . In California, a group of ex-addicts built themselves a therapeutic community and proved unequivocally that heroin users are capable of “re-growth” into positive, responsive characters...
...The re-entry candidate must pass a special ASA board which can certify him as being cured of his addiction...
...But before entering a Phoenix House, each addict must pass through an induction process which introduces him to the encounter technique...
...I am an existentialist,” he says without hesitation...
...Accomplishments and Some Problems Ramirez’s blue-sky talk in the early days of the agency undoubtedly hurt ASA politically and will continue to hurt...
...When is someone cured...
...Ex-addicts in the final phases of re-entry were stationed in store-front community centers, where they mobilized parents and friends of addicts to fight drug addiction...
...Most healers accept this manipulation...
...Such centers serve double duty...
...His assistant, Jack Rosenblum, an ex-Peace Corps volunteer, complements Kotler’s toughguy facade (“Now that we’ve finished with the love-and-affection crap, let’s get to work...
...There have been other small efforts, some begun much earlier...
...Each division holds its own staff encounter...
...Dederich and company firmly refuse public funds, preferring to finance their own campaigns...
...No one seemed to know what to do about it...
...Each step is more stress-producing than the last...
...Anew commissioner has been named-the one man who could keep the thing together: Larry Bear, an administrative whiz who served as Ramirez’s deputy and tried to keep the architect from building himself into a closet...
Vol. 1 • May 1969 • No. 4
