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""Sixteen-year-old Chad Barnes found himself pinned face down on a cold tile floor, his arms and legs stretched out from his body. Four other boys were holding him, pressing so hard that Chad screamed in anger. Just a few moments before, Chad had tried to start a fight in the gymnasium-size meeting room of one of the toughest adolescent drug-treatment programs in the country: Straight, the program chosen by Republican gubernatorial nominee Clayton Williams to cure his own son.
Chad, a wiry boy with eyes the color of coffee, was furious ever the way a veteran in the program, known as an oldcomer, had confronted him. "You're lying to us, Chad!" the older teenager had yelled. "You're not working the program!
You're holding -the rest of us back, Chad!" Chad had shouted an obscenity and shoved another kid next to him, and within seconds, other teenagers had thrown him down. Anyone who rebels at Straight is quickly restrained by oldcomers or by recent graduates working as counselors. Wild-eyed, like a trapped animal, Chad tried to shake loose. A "first phaser" like himself- someone in the first level - couldn't take one step anywhere in the building without an oldcomer holding on to one of his back belt loops. He couldn't even use the bathroom without someone watching him.
At Straight, kids who don't admit to having a drug-oriented lifestyle are yelled at by the other kids until their defenses are broken Nearly 120 young people, ages 12 to 22 and in various stages of treatment, spend almost the entire day in this windowless room in a brick office complex in the Dallas suburb of Irving. For nearly twelve hours each day, they must sit erect in blue plastic chairs, not speaking or standing or making eye contact with another person without permission. Those who misbehave are held back in their chairs or, like Chad, spread-eagled on the floor. The theory at Straight is that kids on drugs are more likely to accept therapy from peers who have been through the program than from adults who have not. A fourteen-year-old program with treatment centers in nine U.S. cities, Straight has been called the best program of its kind in the country. Clayton Williams was so impressed with Straight that he wants the state to spend at least $50 million for adolescent-treatment centers based on Straight principles.
But others are not so impressed. Acting on complaints from parents and teenagers who had been through the program, the Texas Commission on Alcohol and Drug Abuse launched an investigation last year to determine whether Straight abuses kids. The head of a rival treatment program calls Straight "fiercely controlling" and questions its long-range success. "It decides what a kid's identity is going to be and then does all the thinking for him," says Mike Townley of Bedford Meadows psychiatric hospital in Bedford, a dozen miles west of Straight. "By the time a kid gets out of the program, he really has trouble thinking for himself."
The controversy over Straight underscores a dirty little secret: Our vast drug-treatment system, with its armies of therapists, medical conferences, and marketing strategies, don't really know what it's doing. Even though hospitals treatment centers bombard the public with haunting commercials about costly state-of-the-art treatment pro and claim that they have high success rates, one jarring
statistic is always left out: According to the latest indent research, about 80 percent of the adolescents who complete such programs will, within a year, relapse and back to drugs, regardless of the program they attended. Adolescent drug treatment is portrayed as a science, but in reality, it is a huge psychosocial laboratory, where therapists attempt an array of experiments -from fierce behavior modification techniques to ancient superstitious practices, chemical aversion to spiritual conversion-just to see it takes to keep the laboratory mice, our kids, from wanting to get high. Considering this is where the real war on drugs will eventually be fought-people must learn not to want drugs-the results so far haven't been exactly impressive. There is very little good scientific evidence that any of these programs really work.
By the time Chad Barnes arrived at Straight, he was already a savvy player in the drug-treatment game. Having been to three treatment centers since the age of twelve, Chad knew exactly what to say and how to act in order to make his counselors and his parents believe he was turning his life around. He could talk about life's pressures and family problems. He had mastered all of the Alcoholics Anonymous phrases. For him, like many of his peers, going to a treatment center was a rite of passage. Invariably, however, within days of his release from each facility, Chad would be back with his old friends, happily using a variety of drugs.
But Straight was unlike anything Chad Barnes had ever seen -a modern-day Lord of the Flies, where teenagers control other teenagers. The other boys finally released Chad, only to slam him into his chair, and the group therapy continued. Another boy, Will, was asked to stand up, and an oldcomer began telling him that he wasn't being honest about his drug use. Will seemed to lose it. He leapt over his chair, screaming at the group to leave him alone, and then rushed toward the girls' side of the room, causing two girls to smash backward into one another and start fighting. Suddenly, Chad was up again, his jaws clenched, and he stepped toward another teenager, letting fly a hard right that would have knocked even a grown man off his feet. By then, a small riot was breaking out. Another boy took a swing at someone, and a couple of boys tried to escape out the back door. More counselors and other adults poured into the room, and Chad, gasping, his shirt torn across his chest, was dragged to a time-out room where he would remain for the rest of the day.
Ann Petito, who was Straight's clinical director last October, at the time of the brawl, said that such a large fight was not entirely unexpected. "In treatment like this, we're dealing with little animals," she said. "People forget that these kids are druggies. They cannot maintain any self-control. It's our job to get out their anger and remold their lives."
But does treatment really remold their lives? Or are these programs ultimately better at teaching kids to remain sick rather than teaching them to be well? For nearly six months I followed Chad Barnes through Straight, and I also visited ten other adolescent-treatment centers. I watched a kind of contemporary morality play unfold, one in which hundreds of young people were asked to transform their lives and save themselves. The play itself, however, was often dwarfed by it's own dark setting: a treatment industry that seems to be driven more by economics than by clinical research, that knows how to turn parents' deepest into profit margins, and that always has simplistic solutions for our kids solutions that, when analyzed, lead only more questions.
In Texas the Age of Treatment dawned in 1985, when state lawmakers, under pressure from the medical community, eliminated a legal requirement that an unserved demand for a particular health service had to be proved before a hospital could be built or expanded. Insurance companies had started covering problems like substance abuse, creating a huge cash cow in insurance reimbursements for physicians and treatment advocates. Psychiatric hospitals and chemical-dependency centers quickly moved in, and traditional hospitals added substance-abuse units. In just a few short years, the number of treatment and psychiatric centers increased dramatically. Of the state's 441 centers and 84 psychiatric hospitals, about half of them have opened since 1986.
Since most insurance policies were geared toward inpatient care rather than office visits, many parents found it less expensive to stick their kids in a hospital. Thus, all a treatment center had to do was figure out how much it could get from insurance and then build a program around it at amount. Thirty days became the standard length of a hospital stay, for instance because insurance policies were written to that limit -not because that was the time needed to "cure" a kid's drug problem.
In many ways, the Dallas-Fort Worth area perfectly reflects the changes in adolescent drug treatment. In 1984 the metroplex had only 5 programs for kids with drug problems; today there are 52. The treatment centers, mostly on the outskirts of the two cities, often have soothing nature titles (the Cedars, Willow reek, Bowling Green), and some even look like country clubs, complete with lakes, tennis courts, and cabins. The centers regularly promote themselves in slick television commercials that suggest that any outhful unhappiness is somehow related to drugs and that every kid needs help more than his parents realize. One commercial simply lists a series of words: Family, parents, brothers, sisters, acceptance, rejection, love, hate, loneliness, isolation." Then a deep male voice pronounces, "Just a few reasons kids may turn to drugs or alcohol." Using such seductive tactics, these programs have helped create a new kind of treatment program, where hospitals are seen as the last refuge in a world of screaming teenage disorder.
Despite all the hoopla~ no one can get into a treatment program unless he has health insurance or a lot money. Eight out of ten families who call the Dallas Council on Alcoholism and Drug Abuse looking for treatment cannot afford the available programs. Inpatient costs at a psychiatric hospital can start at $500 a day, but with therapy and various fees, the bill can quickly double. Chemicaldependency treatment centers, which don't have staff psychiatrists, charge at least $400 a day. A few public and nonprofit facilities charge $150 a day or less -but there are only a few, and the waiting lists are long. Dallas County, for instance, has only one 16-bed unit for boys and no such unit for girls. Even state aid is marginal: The State of Texas spends only $9 million a year for adolescent treatment-dead last among the states.
Admission to a program is no guarantee of cure, of course. The problems start with the diagnosis. Frequently, kids are labeled as having two problems: chemical dependency and serious emotional disorders. Although experts rarely dispute the idea that hard-core drug abusers have other problems, many teenagers with less severe maladies end up being hospitalized. One psychologist who studied adolescent treatment centers found kids being diagnosed with "adjustment reactions and behavior disorders." When he asked what that meant, he was told, "The kid fidgeted." What many treatment programs ignores is that adolescence itself is like a developmental disorder. This is the time when teenagers experiment with attitudes and lifestyles- including drugs. By their senior year in high school, more than 90 percent of our nation's youths have tried alcohol, and 57 percent have tried an illegal drug. A fact of life in this society is that teens are going to try drugs.
There needs to be a way to treat truly sick teenagers. But how sick are most kids in treatment programs? Sorry, no one is sure. "The sixty-four-dollar question is trying to figure out which kids need treatment," says Elizabeth Rahdert a psychologist with the National Institute on Drug Abuse. "And when you figure that out, then what kind of treatment do you give them? No one knows.""
