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Social History of Alcohol and Drugs, Volume 26, No. 2 (Summer 2012)
“Chemistry is the new hope”:
Therapeutic Communities and
Methadone Maintenance,
1965-71
Claire Clark
Abstract. Historians generally agree that the “classic era” of narcotics
control, a period of punitive drug policies and limited treatment options,
came to an end in the early 1960s along with, among other things, the
emergence of methadone maintenance treatment for heroin addiction.
But methadone was not the only treatment model competing to replace
the punitive system; throughout the 1960s therapeutic communities also
competed for funding and political legitimacy. A close examination of the
debate between promoters of these different approaches complicates the
progressive narrative of addiction policy moving seamlessly from punitive
and conservative to sympathetic and liberal approaches. A compromised
treatment infrastructure that combined methadone, therapeutic communities, and criminal justice approaches to addiction, ultimately emerged
from the conflict – a compromise that retained key elements of the carceral
approach while minimizing the boldest challenges to it, thus laying the
groundwork for the drug wars that followed.
Introduction
“Chemistry is the new hope” for the intractable problem of heroin addiction,
read the headline of a New York Times feature in March of 1971. The statement was a revelation because addiction was understood as an intractable
problem; addicts were a “hopeless” population, resistant to moral or psychiatric intervention. The article described how, after “five years of waiting and
hoping,” New York City’s elected officials had turned away from ineffective
psychotherapy and toward the new chemical solution of methadone maintenance, an outpatient drug treatment for heroin addiction.1 The early 1970s
were a period of expansion for methadone; the Times piece was preceded by
favorable coverage in popular periodicals, including Look, Time, and Science
Digest.2 Yet ten years later, the co-founder of methadone maintenance Vincent
Dole lamented the popular emphasis on a new “cure” for the complex problem
of addiction. “Some people became overly converted” to the therapy, Dole
Claire Clark is a graduate student in Behavioral Sciences and History of Medicine at
Emory University.
SHAD (Summer 2012): 192-216
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
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claimed. “The stupidity of thinking that just giving methadone will solve a
complicated social problem is to me beyond comprehension.”3
Methadone did not solve the complicated social problem of addiction, but
it did alter the medical and political establishment’s approach to it. The innovative application of methadone to heroin addiction marked the end of what
historian David Courtwright termed the “classic era” of narcotics control, in
which harsh drug laws limited treatment options to detoxification programs
and penitentaries.4 Methadone, which had been in use as an aid for detoxification since the 1940s, suddenly had boosters. The drug also had detractors.
Synanon, a drug-free California commune for narcotic addicts, was founded
in 1958; by the mid-1960s, its methods had inspired a new network of “therapeutic community” (TC) treatment centers. Therapeutic community advocates
were equally influential participants in the treatment revolution that brought
about the end of the classic era of narcotics control. Their philosophy of recovery, however, stood in stark contrast to the biomedical methadone maintenance model. The debate between the two therapeutic camps profoundly
influenced the shift in drug treatment and policy that occurred in the latter
decades of the twentieth century.
Most alcohol and drug historians have overlooked therapeutic community
advocates’ impact on addiction treatment, concentrating instead on mutual
aid groups such as Alcoholics Anonymous or on biomedical breakthroughs in
treatment such as methadone or buprenorphine maintenance.5 Re-examining
the influence of the emerging TC treatment model complicates the progressive
history of addiction treatment that tracks a straightforward path from punitive,
conservative addiction policies to more friendly liberal modalities like methadone maintenance. In order to understand the swift return to harsh (albeit revised) drug policies that followed the brief period of therapeutic experimentation in the 1960s, we must first understand how the politicization of both TCs
and methadone laid the foundation for the development of the drug treatment
industry. Drug treatment that emerged at the end of the classic era was not
simply an alternative to incarceration; it was also a complement.
Addiction treatments, by definition, are oriented toward restoring social
functioning, as historians, critics, and treatment providers themselves have
shown. Sociologist Scott Vrecko has called addiction treatments “civilizing
technologies,” suggesting that even seemingly apolitical approaches to the addiction problem offer clues for understanding civilizations – that is, the social
and historical contexts of therapeutic inventions.6 The historical context in
which therapeutic communities and methadone maintenance emerged influenced the social and political meaning assigned to their treatments.
Telling this story is significant in that it counters the notion that addiction
policies in the twentieth century have been top-down, large-scale government
endeavors dreamed up by politicians and bureaucrats like Harry J. Anslinger.
For example, the idea that Richard Nixon’s concern over returning heroinaddicted Vietnam veterans caused him to support the expansion of home-
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grown addiction treatment is overly simplistic.7 Disenfranchised ex-addicts
who developed the TC model were instrumental in promoting it as a viable
alternative to the classic era system. Likewise, methadone maintenance pioneer Vincent Dole and his partner Marie Nyswander developed their treatment
method outside the epicenter of government-sponsored narcotic research in
the midcentury United States, the US Public Health Service hospital/penitentiary in Lexington, Kentucky.
Historian Nancy Campbell noted that the Lexington penitentiary was presented as a “New Deal for the drug addict,” with the $3.6 million-dollar facility being “portrayed as an institutional solution to a problem of national scope
that crosscut racial, ethnic, and class divisions.”8 Lexington thus represented
big-government social engineering that aligned with many other FDR-era solutions.
Table 1. Timeline of key events in the history of TCs and methadone, 1935-74
1935 1937 1941 1944 1948 1958 1962 1963 1964 1965 1965 1966 1967 1967
1968 1968 1970
1971 1970 1970 1973 1973 1973 1974 1974 US Public Health Service establishes the “Lexington Narcotic Farm”
Methadone invented in Germany
Vincent Dole begins metabolic research at the Rockefeller Institute
Doctor Marie Nyswander begins medical residency at Lexington
Methadone first used to stabilize recovering heroin addicts at Lexington
Synanon established near Venice Beach, California
Harry J. Anslinger (the first Commissioner of the U.S. Federal Bureau of Narcotics and a
defining figure of the classic era of narcotic control) retires
Daytop Lodge established in Staten Island
Dole and Nyswander begin clinical tests with methadone treatment
The results of Dole and Nyswander’s methadone treatment are published in JAMA
Drug Abuse Control Amendments (DACA) places strict controls over amphetamines, barbiturates, and LSD
Narcotic Addict Rehabilitation Act (NARA) passed, allowing treatment as an alternative
to jail
Phoenix House established in New York City with George Deleon as Director of Research
and Evaluation
Jerome Jaffe establishes multimodal (combined therapeutic community and methadone
treatment) in Illinois Drug Abuse Program in Chicago (IDAP)
David Deitch leaves Daytop, joins IDAP
First National Conference on Methadone Treatment
Robert Dupont co-founds the Washington, DC-based Narcotics Treatment Administration
(NTA), a methadone-based treatment program
Special Action Office for Drug Abuse Prevention (SAODAP) established with Jerome
Jaffe as Chief
Matrix House, a therapeutic community based on the Synanon model, established at Lexington
Comprehensive Drug Abuse and Control Act updates previous laws concerning narcotics
and other dangerous drugs, placing an emphasis on law enforcement.
Rockefeller Drug Laws passed
Methadone Control Act regulates methadone licensing
Robert DuPont named first National Institute on Drug Abuse (NIDA) director and second
White House Drug Chief
Public Health Service Hospitals turned over to Bureau of Prisons
Synanon officially declared a religion; legal authorities begin investigation of Synanon’s
practices
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
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Methadone maintenance pioneers espoused a subtler sort of liberalism.
Methadone was brought to the U.S. from Germany as a “spoil” of World War
II and was used in Lexington to wean addicts off heroin since 1948 (Table 1).
“Maintaining” addicts on the drug – or dispensing it on an outpatient basis –
was considered medically risky by Lexington’s lead researchers.9 The suite of
treatment services offered at Lexington was a synthesis of old and new fashions in addiction treatment and research: nineteenth century pastoral labor,
Freudian psychoanalysis, ambitious drug trials. The narcotic farms took on
a political symbolism that was almost as important as the therapies they employed; as sky-high relapse rates were leaked to the public, the project came to
be perceived as a big-government failure, coercive and wasteful. Methadone
maintenance seemed an enlightened and efficient alternative.
In the mid-1960s, the twilight years of what has been called the “golden
age of American medicine,”10 methadone pioneers Vincent Dole and Marie
Nyswander believed that the solution to the medical problem of addiction
was not to corral heroin users into massive treatment centers, but to grant
addicts access to supervised, clinic-based medical care. The first methadone
maintenance clinics began in 1964 as a local experiment in New York City; as
the clinics proliferated, their leadership accepted the necessity of government
support and regulation for the sake of promoting patients’ social mobility.
This revived medical model of addiction reduced social stigma against heroin
addicts, but it did so without absolving addicts of their responsibility for their
own economic advancement once their medical status had stabilized. The
philosophical subtext was liberalism in an almost classical sense: methadone
maintenance was an Enlightenment-style investment, rooted in scientific advancement, individualism, and a commitment to promoting equality of freemarket opportunity. It should come as no surprise that Dole’s early methadone
trials were bankrolled in part by the Rockefeller Foundation.11
In contrast, the ex-addicts who staffed some of the first therapeutic communities in the 1960s often billed themselves as radicals. They believed that
American society had grown permissive and vice-ridden. A booming market of
licit and illicit drugs was for them a primary example of the moral indulgence
that characterized a society in decline. From this perspective, Lexington’s sin
was not its size but its fervent search for pharmaceutical cures. Synanon and
other early TCs preferred nineteenth century pastoral labor; they sent initiates
to work at “character-building” activities, such as cleaning dishes or mopping
floors. By the time Synanon was founded in 1958, mainstream society had
traveled so far from such regimens that the neo-Victorian approach to addiction was a fringe affair.12 But it was also on the cutting edge; seminal TC
founders such as David Deitch of Daytop and John Maher of Delancey Street
viewed addiction recovery as a vehicle for transformative, disciplinary social
reforms. As a result, the countercultural posture of many early TCs could align
with social conservatism, despite the political inclinations of some staffers.
Methadone maintenance and TCs were politically multivalent “civilizing
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technologies.” The previous recovery success story, Alcoholics Anonymous,
was a mutual aid society that had helped humanize the nation’s approach to
the treatment of alcoholics. In contrast, methadone maintenance clinics and
therapeutic communities were not support groups; they were “treatment,” a
designation that came with expectations of time-limited care, professional
supervision, ethical and legal guidelines, and record-keeping.13 These bureaucratic elements were open to external scrutiny and regulation, and treatment advocates eventually found that support for their new programs was not
entirely benevolent. By the time the Rockefeller Drug Laws were passed in
1973, methadone maintenance was being promoted as a method of crime control.14 Due in part to a politically motivated schism at an influential therapeutic community in 1968, the TC establishment modified their original goal of
transforming a depraved society, and concentrated instead on refashioning a
subpopulation of “immoral” individuals. The ideologies espoused by TC and
methadone advocates shifted as the models were institutionalized, but – for
the sake of efficiency and consistency – this article classifies methadone advocates’ philosophy as aligned with classical liberalism, while TC advocates
represented a new brand of countercultural conservatism.
Scholarship on alcohol and drugs offers a range of explanations for the historical shift from conservative to liberal drug policy approaches in the 1960s.
David Musto, David Courtwright, and Caroline Acker have demonstrated how
and why legal, medical, and political approaches to opiate use shifted over the
course of the twentieth century; the appeals of methadone and TC advocates,
and their subsequent influence on policy, are also well documented.15 In contrast, this article does not focus on advocates’ modest success in overturning
classical era approaches to addiction recovery, but rather pays closer attention
to their failures. Why were crucial aspects of methadone maintenance and TC
philosophies minimized as the treatments were mainstreamed? Popular and
historical wisdom has used the famous cases of Prohibition, narcotics farms,
and mass incarceration to frame U.S. alcohol and drug policies as ideologically-driven failures on a massive scale. This article explores why other, equally
bold solutions to the addiction problem were never fully implemented.
The Origins of Therapeutic Communities
Methadone maintenance and therapeutic communities arose from different
institutional settings – the federal penitentiary and the California commune
– before becoming neighbors in New York City boroughs. The treatment
models were based on different philosophies of addiction recovery: methadone maintenance was a biomedical model, while therapeutic communities
were framed as a developmental one. These contradictory ideas about the root
causes of addiction emerged early in the treatment models’ histories and set
the terms for debate about addiction policy in the mid-1960s.
The first debate broke out in an Alcoholics Anonymous clubhouse when
Charles “Chuck” Dederich, a recovering alcoholic, left his local AA chapter
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and started his own group for heroin addicts in an Ocean Park storefront.
The first U.S. therapeutic community, which Dederich later called Synanon,
grew out of his followers’ dissatisfaction with the AA model. AA leadership
and local groups were distrustful of drug addicts, and Dederich and his followers likely perceived the original offshoot Narcotics Anonymous – which
was incorporated in 1951 and reached Los Angeles in 1953 – as bound to the
12-step doctrine that they critiqued.16 AA encouraged confessional “sharing”
but prevented “cross-talk” (the practice of directly discussing the content of
AA members’ confessions). Dederich and his initial followers came to believe
that restricting cross-talk often meant substituting AA’s general spiritual platitudes for difficult, direct, and highly personal conversations. They developed
a new form of group therapy that encouraged “cross-talk” and confrontation
in group sessions, which, according to group lore, were christened “synanons”
by a tongue-tied addict’s attempt to pronounce the word “seminar.” The iconoclastic therapy worked; successfully clean addicts grew in number and the
group grew in stature, eventually occupying a palatial former hotel on the
Santa Monica beachfront by 1961. The “miracle on the beach” housed over
one hundred “incorrigible” addicts who had apparently healed themselves
through a novel combination of total detoxification, brutal honesty, honest labor, California sunshine, and charisma. The do-it-yourself addiction treatment
invited encouraging investigations by Walter Cronkite, Life magazine, and the
Department of Health, Education and Welfare.17
They also attracted professionals who brought credibility to the therapeutic
experiment. In 1962, psychiatrist Daniel Casriel visited Synanon; before that
visit, he held the typical professional opinion that “heroin addiction was incurable.”18 The months he spent observing Synanon changed his mind. “With
certain modifications” to the Synanon model – and the support of the local
Department of Corrections – Casriel helped establish Daytop Lodge on Staten
Island in 1963.19 The Synanon model was initially difficult to transplant; drug
use ran rampant in Daytop during its first year of operation. The following
year, Casriel hired two former Synanon members, David Deitch and Ronald
Brancato, to clean up the organization. Their methods proved successful. The
reconstructed Daytop Lodge became a private corporation – Daytop Village –
and cut official ties to the Probation Department in 1965.20
The Synanon model continued to gain ground. In 1967 Daytop Village
helped fund the establishment of a second treatment center, Phoenix House.
Efren Ramierez, the New York City Commissioner of Addiction Services,
endorsed the project, saying that “Every addict is curable until he proves
otherwise.”21 Phoenix House embraced the Synanon method of “cure.” The
organization’s first director, Mitchell Rosenthal, was a Navy psychiatrist and
former Synanon affiliate. Rosenthal, however, was wary of being too closely associated with Synanon’s anti-professional stance. He rejected the label
“second-generation Synanons” as a descriptive term for Phoenix House and
Daytop.22 Instead, Rosenthal branded the organizations “therapeutic commu-
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nities,” a term borrowed from a former mentor, British anti-psychiatry pioneer
Maxwell Jones.23 Rosenthal’s tactical distance ultimately proved beneficial.
By 1970 Synanon had turned away from its rehabilitative mission and had
frightened many former supporters with apparently cult-like activities. Meanwhile, Phoenix House and Daytop opened new branches across the country,
successfully institutionalizing the therapeutic community model.24
The Origins of Methadone Maintenance
Marie Nyswander began her career in the center of U.S. addiction treatment and research, housed in a narcotic penitentiary in Lexington, Kentucky.
Nyswander later called her psychiatry internship at Lexington “the hardest
year” of her life. She became disillusioned with both the injustices of the
institutional setting and the obvious failure of psychoanalysis – the dominant
treatment paradigm in her psychiatric circles – to address the problem of heroin addiction.25 Nyswander’s frustration with her residency led her to look
for alternative forms of addiction treatment, just as early Synanon residents
viewed their treatment model as a sharp contrast to their own failed stays at
Lexington. Nyswander found her solution in methadone maintenance – and
in Vincent Dole, the maintenance pioneer who became her second husband.
The New York City Health Research Council funded Nyswander and Dole’s
observational research on the effects of various narcotics on addicts, including
heroin, morphine, and finally, methadone. When addicts on methadone made
drastic, positive behavioral changes, Nyswander and Dole’s research turned
experimental. In 1965, they published their data on twenty-two methadone
patients in the Journal of the American Medical Association (JAMA), and
used these results to advance a “metabolic theory” of addiction.26 Notably, the
JAMA study hinted that methadone could be used for crime reduction. Dole
and Nyswander described four patients’ heroin relapses as “unscheduled but
perhaps necessary experiments,” noting that the patients “discontinued these
unrewarding experiments without the need for disciplinary measures.”27 The
results of the study were cautiously optimistic, but the idea that an inexpensive medicine could rid addicts of their demons – and urban centers of addiction-related crime – enticed New York City’s journalists and politicians.28 The
number of patients in New York City methadone programs increased almost
tenfold by early 1970s, yet maintenance itself did not outpace the problems it
was supposed to solve.29
Metabolic Theory vs. “Growing Up”
New York City became a laboratory for the two competing treatment models in 1969, when Phoenix House champion Ramirez resigned and the city’s
first voluntary methadone clinic opened. TCs and methadone maintenance
treatment both began to gain national reach, and they encountered similar
arguments everywhere they opened. Congress convened hearings in 1969 and
1971, allowing TC and methadone advocates from New York and Washington
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D.C. an opportunity to debate the merits of each treatment model and press for
federal and other funding.30 Because the hearings took place before results of
large-scale evaluation research were published, and few programs had more
than five years of data to work with, the testimony tended to forefront philosophical differences rather than numbers. Each side made arguments based
on fundamental premises about the nature of addiction, promising to produce
formative research – and to bring hope. In 1969, investment in trial TCs and
methadone programs were primarily local; the federal government funding
remained relatively modest. When the Nixon administration put forth a new
budget in 1971, however, they doubled federal drug spending to over $200
million, more than half of which were allocated to treatment.31
But even before the funding boom, even hoped-for expansion brought complications, especially for methadone treatment. Historian Eric Schneider has
argued that “[methadone] was far more effective than any other form of treatment and suffered mainly from having been overpromoted.”32 Yet methadone
suffered just as much from the passionate responses its promotion evoked.
Methadone maintenance appealed to a variety of interest groups, for fairly rational reasons. But the struggle with young TCs also had an emotional component with powerful political resonance. Early TC advocates (especially those
who had personally experienced highs from substitute substances in Lexington or Fort Worth) viewed methadone as liberal indulgence and technocratic
hubris, not the character-building discipline that they considered necessary
for legitimate treatment. Because methadone maintenance was embraced by
“old bureaucratic politicians” and big businesses, it represented “a failure of
America’s democracy. A failure of our wasting all this time sending people
to the moon and not concentrating on things around here.”33 For TC advocates, the transformational solution to individual and social depravity would
be grassroots and ground-up.
Synanon’s shrewd marketers billed it as a “tunnel back to the human race”
for heroin addicts trapped in a degenerate subculture.34 Second-generation
TCs likewise aimed for “habilitation,” not “rehabilitation”; they operated under the assumption that the addicts who came to them were characterologically deficient and emotionally stunted. Cure took the form of a miraculous
personal rebirth. As a Daytop brochure explained,
To effectuate treatment, one must first remove the encapsulating shell. Then, once
exposed to the light of reality, powerless to isolate himself without his fortressprison, he is in a position to be taught how to grow up. For the primary addict,
also called the “street” addict, a full-time institutional therapeutic environment
must be utilized to enable the individual to grow up and develop emotionally,
sexually, vocationally and educationally. This is no small undertaking, but nothing less will suffice.35
Second-generation TCs such as Daytop, Phoenix House, and Odyssey House,
all employed confrontational “encounter” therapies designed to break down
the addict’s “shell.” They also shared with early Synanon two primary rules:
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no violence, and no drugs – including methadone. As Daniel Casriel told Congress, “methadone will prevent stealing, but it doesn’t cure [the addict’s] personality. No chemical does. The thing that drove them to search out heroin
is still driving them. Long before they took heroin they were not functioning
effectively, either vocationally or socially.”36 Therapeutic community advocates on both coasts called methadone a crutch, a band-aid, a handkerchief,
and an alcohol rub.37 It looked like medicine, but failed to address the underlying causes of addiction, which TC advocates believed were spiritual and
characterological. Critics borrowed an analogy from Alcoholics Anonymous’s
Big Book and compared supplying heroin addicts with methadone to “switching an alcoholic from scotch to cheap wine.”38 They told horror stories about
children getting into methadone-laced orange juice39 and expressed concern
for the well-being of fetuses exposed to the drug in utero long before fetal alcohol syndrome was a widely recognized condition.40 Born into a chemically
saturated culture, innocents with the propensity for chemical addiction would
need a therapeutic retreat to get out of it.
Methadone maintenance advocates called these arguments biased hysteria,
and they countered them with quantitative data. In 1964, one year after Daytop Village was founded in New York, Dole and Nyswander launched their
methadone maintenance program. Their first twenty-two methadone patients
experienced remarkable results; unlike patients “maintained” on heroin (a
mainstay of the British system of drug control), patients stabilized on 80120 mg of methadone were “blockaded” from the euphoric experience associated with heroin injection. Once stabilized, the threat of withdrawal receded
and criminal behavior – believed to be inspired by illegal drug-seeking, not
personality defects – ceased. The researchers further theorized that, once exposed to narcotics, addicts underwent a permanent metabolic change. After
that change, they needed the drugs in a visceral way, just as “a diabetic needs
insulin.”41 Dole and Nyswander’s participant pool grew into the hundreds, and
the positive results scaled up to higher sample sizes. The expanded studies
tracked arrest records of heroin users maintained on methadone. In 1968, after
measuring the employment and crime status of 750 methadone patients over a
four year period, Dole reported “unequivocally” that “criminal addicts can be
rehabilitated by a well-supervised maintenance program.” Eighty-eight percent of the patients were “socially acceptable, maintaining arrest-free records
since admission,” while a subset of fifty-nine percent had become “productive
members of society” by gaining and maintaining employment.42 Researchers
used this evidence to suggest that methadone was a solution for crime and – if
not exactly a cure – a workable treatment for a chronic disease (Figure 1).43
The local methadone-aided “cures” attracted national attention. The Narcotic Rehabilitation Act (NARA), passed by Congress in 1966, granted federal courts the right to compel addicts to participate in addiction treatment.
The law was supposedly a more sympathetic alternative to criminal drug sentences, but it continued to funnel addicts into the newly designated “clinical
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research centers” at the U.S. Public Health Service hospital/penitentiary in
Lexington. The residential care that addicts received at Lexington had more in
common with the therapeutic community model; philosophically compatible
Figure 1. Growth of the methadone maintenance treatment program
Source: Vincent Dole, Marie Nyswander and Alan Warner, “Successful Treatment of 750 Criminal Addicts” JAMA 206 (1968), 2708.
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local programs supported by the National Institute of Mental Health provided
“aftercare” treatment. Some political conservatives saw prison as preferable
to methadone not because it functioned as simple punishment or deterrent, but
because it was part of what they saw as a valuable effort at rebuilding moral
character. Seen as a benign extension of the “growing up” process, the therapeutic community model could be viewed as appropriate treatment for “atrisk” young adults from middle class families, despite its links to the criminal
justice system.
TC proponents, for their part, refused to recognize the concept of acceptable (i.e., iatrogenic or purely physiological) addiction; any form of drug dependence, to them, always signified underlying psychological or spiritual ills,
regardless of the addict’s success in avoiding consequences. Drug use was a
personal failing that could only be cured through re-socialization into appropriate community norms.
Vincent Dole challenged this theory at a congressional subcommittee hearing in 1971. His pilot study data failed to convince his conservative audience,
so Dole used an anecdote to argue that addicts could be referred to methadone
maintenance as a form of civil commitment. Dole told the story of a “tough
Irish kid,” a high-school dropout and heroin addict who had been jailed twice
for stealing and who had failed at previous attempts at detoxification. Seven
years into methadone treatment, the “kid” had a wife, a family, and a college
degree in aeronautical engineering. “Now,” Dole asked Republican Representative Robert McClory, “is he rehabilitated?”44 “My answer to that,” replied
McClory, “would be that from the standpoint of rehabilitation from narcotics,
no, he isn’t.” The boy’s continued reliance on the drug – perceived as an “easy
way out” of addiction – undermined Dole’s uplifting story. McClory continued, “Sure, we can rehabilitate persons by putting them on another form of
drugs or, I suppose, through the British system of letting heroin be received
free of charge and thereby rehabilitate a criminal. He won’t be out stealing in
order to support his addiction. But that isn’t the kind of rehabilitation we had
in mind: no.”45
Conservatives had in mind a “slow gradual [program] which required a lot
of spiritual and mental rehabilitation, a change in attitude and thinking, an
aftercare program.”46 Dole’s data failed to move McClory, who admitted that
he would sooner send his son to a NARA-designated research center than to
Dole’s methadone program.47 And Dole had ample data: prior to 1965, JAMA
had published just three articles on methadone; from 1965-71, the journal published seven times that many. Metabolic theory, however, did not make sense
to audiences who were predisposed to moral or developmental explanations
for addiction. As scientific consensus about methadone’s efficacy emerged,
therapeutic community advocates continued to traffic in narratives of personal
reformation rather than data.
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Faith or Record-Keeping: A Religious War?
The question about which treatment model worked better was not merely a
technocratic issue; the evidence had larger implications for national drug policy. Drug addiction was a major issue in the late 1960s and early 1970s, and
approaches to it continued to be strongly politicized. One survey found that
drug addiction rated third in a list of issues that most concerned the American
public, behind only the economy and the Vietnam war; the article surmised
that the Nixon administration’s attempts to combat heroin addiction were likely to become a potent issue in the upcoming election.48
Some scholars likened the philosophical and funding conflict between TCs
and methadone to another kind of war. Herman Joseph, then-supervisor of
New York City’s probation office, told Congress that “In some quarters the
medication of methadone is looked upon as heretical, and opposition to it has
taken on the proportions of a virtual religious war.”49 Joseph’s metaphor was
apt, for therapeutic communities in the late 1960s were taking on a distinctly
religious cast. Synanon grew increasingly cultish while its east coast progeny
supported the transformative capabilities of their confrontational therapies
with allusions to traditional, “historically tested” religious practices. Social
scientists had long investigated “addictive personalities,” but therapeutic
community directors preferred the language of “character,” a quality shaped
by religious ritual for centuries.
The focus on transformation created awkward partnerships in the TC establishment, as the concept proved equally compelling to religious conservatives and social reformers. The two groups eventually clashed in a high
profile schism at Daytop in 1968. Executive board member Monsignor William O’Brien and Daytop’s second director, David Deitch, clashed over Deitch’s left-wing political views and policies. Both men believed strongly that
confrontational therapy, like the Catholic sacraments of confession and reconciliation, was a powerful ritual for spiritual cleansing. But for Deitch, the
therapeutic community had as much to do with consciousness-raising as with
enlightenment. Deitch partnered with a group of Black Panthers who were
similarly critical of mainstream society’s complicity with drug use; O’Brien
preferred the Pope.50 After Deitch was ousted, the organization became
aligned with O’Brien’s philosophy. Conservative elements of the emerging
TC establishment, in other words, eclipsed countercultural ones. This association with established religious traditions gave therapeutic communities a
kind of legitimacy beyond their own ranks, but it also aroused suspicion, as
groups like the ACLU questioned whether civil commitment to addiction TCs
violated religious freedom.51 The spiritual awakenings promised by the TC
model proved difficult to legislate.
They were equally difficult to track. Therapeutic communities were notorious for spotty residential records. Early TC professionals claimed that longterm, residential treatment of at least one year, often two was necessary for
the complete socialization of addicts. Anything less amounted to a half-dose.
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This philosophy biased the results of TC efficacy studies: residents who left
the therapeutic community before the recommended “graduation” date were
not factored into TC data. The majority of therapeutic community residents
left within the first three months; therefore published results of initial studies
only pertained to a self-selecting minority of the addicted population. Inferences about this population were further compromised by the difficulty of
locating former residents after graduation. Loss to follow-up bias was a major
problem, since the programs’ main metric was based on the long-lasting transformation of former residents.
Ten years after Daytop’s incorporation, a researcher affiliated with the
Canadian Addiction Research Foundation surveyed the available TC efficacy studies, analyzing the success rates of Synanon, Daytop, Phoenix House
and several other US-based, second-generation TCs. The author lamented the
paucity of available data, including an absence of controlled studies of TCs
that were unaffiliated with correctional institutions. The survey concluded
that TCs generally had low retention and graduation rates and limited success
in preparing residents for employment outside addiction treatment agencies.
The initial Daytop follow-up studies conducted after Deitch’s departure had
low response rates, “no check of addict statements with official records,” and
“information for splitees [program drop-outs] so incomplete as to be unreliable.”52 Since their inception, methadone clinics had been highly regulated
medical enterprises; in contrast, early TCs relied on stories of personal transformation rather than statistics. In 1971, Daniel Casriel and his colleague
Daniel Amen published a book, Daytop: Three Addicts and their Cure, that
recounted the recovery trajectories of three Daytop residents. Before Daytop, said one former resident, “we were like vegetables with big dreams. We
weren’t doing anything.” By spending time in the TC, “you suddenly go back
to simple things you never felt before. And you start from there. It’s so different from the old way.”53
Publishing detailed studies of several successful cases was standard practice for members of the psychiatric establishment like Casriel. TC research did
undergo a subtle transformation when psychologist George Deleon of Phoenix House began to investigate the mechanisms of TC-facilitated recovery.
Deleon hypothesized that cathartic confrontational group therapies relieved
stress, and he measured blood pressure before and after the sessions to test this
theory.54 He operationalized characterological transformation by administering a psychopathology scale to Phoenix House residents, ultimately identifying an association between length of stay and decreased pathology scores.55
Deleon published two years’ worth of Dole-like efficacy data in a 1971 issue
of the JAMA; these “systemically gathered” arrest records for program dropouts, late-stage residents, and graduates demonstrated an association between
length of stay and decreased post-program arrests, even among “splitees.”56
Whether TCs were more efficacious than methadone clinics in this respect,
however, remained an open question.
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Historians and addiction scientists have long criticized therapeutic communities for spotty efficacy data and vague descriptions of therapeutic processes.57 Yet the ideological underpinnings of methadone research became equally
apparent as methadone treatment transitioned from a quasi-experimental
study to a large-scale social program. Methadone programs kept extensive
patient records, partly due to federal regulations and partly due to their primary occupation: the functioning of patients currently taking part in methadone
treatment. Few methadone studies examined the outcome of patients who terminated treatment, leading critics to suggest that methadone advocates were
complacent enablers of life-long dependence on the drug. The early methadone studies were also subject to selection bias: initially, long waits on the
rolls for few spots in the available treatment programs selected for heroin
users who were highly motivated to begin treatment. Later, some users would
admit to using methadone to help lessen their dependency on heroin, thus liberating them to enjoy other drugs recreationally. Methadone programs might
have rebutted this critique with ample urinalysis data, but initial studies failed
to do so. The programs also were initially unconcerned with the use of other
nonprescribed drugs – a central preoccupation of the recovery model promoted by drug-free therapeutic communities.58
Dole and Nyswander supported methadone maintenance with data and theory, and illustrated their results with descriptions of individuals’ behavioral
changes. Dole and Nyswander did not mention spiritual transformation in
their 1965 article; instead, they simply pronounced that their first twenty-two
patients had “ceased to behave as addicts.” The article reported that twentyone of twenty-two initial methadone patients were either gainfully employed
or looking for work.59 These were not conversion narratives. The only religious aspect of the therapy was, perhaps, the zeal of its proponents (one New
York resident likened successful methadone maintainers to “missionaries”
who returned to their old neighborhoods to preach the gospel of metabolic
stability).60
The zeal was not limited to ex-addicts and doctors. Researchers lined up to
study the new patients who entered methadone programs in the mid-1960s.
The First National Conference on Methadone Treatment was held a few
months before the publication of Dole and Nyswander’s 1968 crime-based
efficacy study; at that time there just a handful of Washington, D.C. addicts
enrolled in a single methadone treatment program. When the third conference
met in 1970, more than 2,300 people were enrolled in the city’s programs, and
Robert DuPont (who would be named Nixon’s second “Drug Czar” and the
inaugural director of the National Institute on Drug Abuse in 1973) presented
a study that tracked declining crime rates alongside the scaled-up methadone
program.61 DuPont, then head of the city’s Narcotics Treatment Administration, cited methadone as a critical part of “how corrections can beat the high
cost of heroin addiction.” Still, DuPont noted, by 1971 it had already become
clear that methadone was “no panacea.”62
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In 1976, Vincent Dole reflected on ten years of methadone treatment, noting
the success of the pilot methadone programs from 1965 to 1970. He argued
that because of government meddling and the rapid expansion of methadone
clinics over the next three years, many of the programs had “lost their ability to attract and rehabilitate addicts.”63 Making matters worse, he argued,
was increasingly skeptical media coverage and the changing perception of
the addicts themselves, as methadone failed to live up to its earlier reputation.
The enlightened, technocratic, consensus-driven liberalism that characterized
midcentury politics was also showing signs of strain as crime rates rose and
partisan political discourse grew increasingly paranoid.64 Dole hypothesized
that skepticism and conspiracy theories – of babies born addicted to methadone, guileless suburban teens hooked on methadone, the creation of a methadone shadow market, and even the notion that methadone was a form of government mind control – were important preconditions for the unsatisfactory
relapse rates among 6,000 New York addicts who entered treatment in 1972.65
Despite their supposed failures, both treatment models endured. A few farsighted researchers took an ecumenical approach. Jerome Jaffe attracted the
attention of the Nixon administration when – along with an illustrious staff
that included Deitch, following his break with Daytop – he successfully managed a multimodal treatment program that offered methadone and therapeutic
community programs, despite initial resistance from stakeholders who viewed
methadone as a “substitute addiction.”66 The goal of the project was to “attempt to serve the needs of the patient rather than the needs of the personnel
operating treatment programs,” wrote Jaffe.67 In order to gain more comprehensive data about which treatments worked best for particular patient populations, in 1969 the National Institute of Mental Health (NIMH) contracted
with Texas Christian University to produce a large-scale evaluation study of
the drug treatment models employed by 52 agencies taking part in the Drug
Abuse Reporting Program (DARP). The study concluded that drug treatment
had the greatest effects on welfare enrollment, opiate use reduction, maintaining employment, and decreasing alcohol use, non-opiate substance use,
and illegal activities. “Treatment effects on arrests and jail were negligible,”
the authors wrote. Yet this analysis of variance mattered little to government
officials; by the time the results were published, their primary concern was
crime.68
Crime as the Bottom Line and the Taming of Treatment Radicalism
Methadone and TCs both had the potential to develop into truly revolutionary types of treatment. When outcome measures were reduced to criminal
recidivism, however, much of the creative potential that came with moving
addiction treatment out of the criminal justice system was lost. Treatment pioneers tried to leverage the issue of addiction to redress more philosophical and
social issues, but this opportunity was ultimately seized by those with more
political power, who guided new treatment research to their own ends.
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
207
Those ends did not include a wholesale rethinking of the licit drug establishment and the pharmaceutical industry. David Herzberg has documented
how, in crafting the 1965 Drug Abuse Control Amendments, pharmaceutical companies, politicians, and addiction scientists acknowledged that minor
tranquilizers such as Valium had a “potential for abuse.” The Drug Abuse
Control bill of 1970 outlined a drug schedule that matched drugs with criminal repercussions based on this “potential,” then undermined condemnation
of licit drugs by including a less severe category created just for minor tranquilizers (the so-called “Roche schedule.”)69 Several years before the hysteria
surrounding tranquilizer use amongst white, middle class women appeared in
staid periodicals like Good Housekeeping and Redbook, ex-addicts (some of
them former Synanon members) employed by therapeutic communities in the
late 1960s critiqued the depravity of a drug-saturated mainstream culture. Exaddicts crafted these critiques of mainstream culture even as they promoted
the TC model’s efficacy in helping them conform to it. In 1969, ex-addict
Samuel Anglin minimized the importance of chemical effects and emphasized
the influence of a dysfunctional culture:
We have to find out what it is in our culture and the attitudes of our culture that
encourages drug abuse. And you see it on television and everything else: you
take the little blue pill if you get up tight. You see it about Compoz: it doesn’t
bother him, the war and everything, because he takes Compoz. If we keep dealing with this problem chemically, we will in 20 years have a bunch of people
sitting around tranquilized not caring about anything.70
Conservative and liberal drug-free ideologues disagreed on which issues
were worth examining, but both sets of arguments considered the physical
properties of the chemicals as less important than their symbolic function – as,
indeed, a sign of false consciousness. Monsignor William O’Brien, like Anglin, viewed the therapeutic community as a response to the “loneliness and
alienation” of modern life. “The elimination of the symptom,” he proclaimed,
“be it substance abuse or other disorders, is only part of the treatment.”71 TC
proponents departed from psychoanalysts, who believed psychological revelation was the key to alleviating the expression of addiction. TC advocates
framed the “truth” at the center of addiction recovery as the total alignment of
personal behavior with the community’s particular moral philosophy.
Therapeutic communities were perceived as a promising treatment model
as long as their philosophies were uncontroversial and the methods used to
achieve behavior change seemed reasonable. And “uncontroversial” ultimately meant “conservative.” Highly punitive, socially conservative, explicitly
Christian organizations later adapted the TC model for “at-risk” youth, yet
criticism took decades to surface; many liberal politicians were unwilling to
take the political risk of challenging any component of the “drug war” agenda.72 The TC approach for treating addiction proved to be most acceptable to
social authorities when residents were socialized into appropriate religious
and gender roles along with their new abstemious behaviors. For better or
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worse, the Synanon model of social experimentation – which involved alternative family, labor, and educational structures – was not replicated or faithfully amended. Additionally, the “community” itself became a bounded entity,
delineated by funding structures as well as walls. Deitch’s model of TC residents as “change agents” who challenged mainstream culture and impacted
local neighborhoods was short-lived; as TCs became established as legitimate
agencies, “community” was largely reduced to an efficacious method of delivering addiction treatment for the individuals that entered it.73 This efficacy,
moreover, came to be defined in terms of individual recidivism, not social
or cultural changes. Though TC advocates raised awareness about a drugsaturated society, for the most part politicians turned the attention back to
incorrigible individuals. Some TC proponents changed direction in response.
Judianne Densen-Gerber, the psychiatrist who directed Odyssey House, argued in favor of using civil commitment of individual addicts to bolster the
client base of the emergent private addiction treatment industry.74 In a 1971
discussion of the expansion of civil commitment for addiction treatment, one
Republican congressman concluded that addiction was an epidemic and that
forced treatment was a justifiable “quarantine of people who are sick and infect others with this sickness wherever they go.”75 Addiction was framed as a
problem of contagious agents rather than social environments. Rhetorically,
transformative countercultures became quarantine wards.
Methadone’s liberalism might also have been pushed further left. When the
racial and socioeconomic make-up of the methadone patient population crystallized in the early 1970s, delivering a medication looked more like social
justice work. Methadone tended to treat the most abject addicts – the so-called
“street addicts,” who were usually older and nonwhite.76 Liberals who were
attentive to issues of racial justice embraced the de-stigmatizing implications
of the programs. Historian Caroline Acker has argued that one significant
legacy of methadone maintenance was its usefulness for later arguments in
favor of harm reduction – including calls for needle exchanges or even drug
legalization.77 When local groups picketed outside of methadone clinics in
New York City, leftist editorials in the Village Voice used the controversy as
an opportunity to advocate for the British model of heroin maintenance and
decriminalization.78
These left-wing advocates of methadone maintenance had shifted their
perspective by the early 1970s, however, turning their attention away from
the chemical properties of the drugs and instead focusing on minimizing the
harms associated with them. Nearly twenty years later, Robert DuPont reflected that his endorsement of methadone treatment and marijuana decriminalization caused him to be wrongly “seen by many as part of the group that
supported harm reduction.”79 He had since been convinced that most forms of
harm reduction increased criminal behavior and social dysfunction and undermined norms that discouraged substance use.
Methadone was an exception. DuPont did not repudiate methadone mainte-
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
209
nance, though he came to favor “stricter” programs than the ones he pioneered
– programs that screened for any form of drug use and “imposed sanctions for
failure to meet program goals.” Methadone, he argued, could be successfully
used to promote “prosocial values, including cessation of criminal behavior.”80 Both Dupont and Jaffe acknowledged the value of probationary drug
treatment during in the 1971 congressional hearings. But the nuances of this
approach were later lost. Nixon “was a man who knew that the public wanted
simple statements [about drug policy] and you would have to speak to them
in that way,” said Jaffe years later. “The rhetoric had to be simple; behind
the rhetoric [about criminality] he knew the complexities of what had to be
done.”81
Some academic scholarship also simplified the problem by emphasizing the
criminal element of addiction and overlooking other variables. The American
Journal of Public Health published a ten-year follow up study of 500 Beth Israel methadone patients in 1972; like early methadone and TC outcome studies, the article discussed criminal behavior (incarceration) as a primary health
outcome.82 Though incarceration was framed as a negative health outcome for
addicts in 1972, in the following decades prisons would increasingly become
treatment providers for addicts and the mentally ill.83 The eventual integration
of methadone and therapeutic community programs into the prison system ran
counter to the intentions of early treatment providers.
The new addiction treatment programs operated in the era of de-institutionalization, and so were not alone in providing psychiatric services to local
populations. Therapeutic community and methadone maintenance promoters offered variations on community psychiatry rhetoric. TC and methadone
proponents placed an emphasis on cure rather than incarceration, much like
advocates of the community psychiatry centers promoted by the National
Institute of Mental Health in 1962. The earlier policies might have inspired
a more holistic concept of cure, one that included a complete reintegration
into society, participation in the labor force, and even a healthy family life.84
Methadone and TC proponents each claimed the opposing treatment failed
by this metric: half-cures kept patients reliant on treatment services, rather
than reintegrating patients into their families and society. One TC proponent
argued, “you get a kid at sixteen and he gets on methadone and he lives to be
fifty-six and the prognosis is he stays on methadone; how can he take a vacation or do anything?”85 Barry Stimmel, co-director of Mt. Sinai’s methadone
clinic, countered that his program could “show the addict he is indeed able to
be a functioning member of society and able to stay with his family and not be
interred in a closed artificial community and that he is not degraded and need
not defeat himself. All this is done without removing the addicted individual
from his family unit.”86 Ironically, despite the programs’ pledges to return
addicts to their families, ultimately the promises of both TC and methadone
maintenance were eclipsed by the swift return to carceral drug control strategies designed to remove drug users from their communities.
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Conclusion
The supposedly rational, humanitarian approach that emerged from the conflict between TC and methadone treatment models was eventually compromised. Rather than emphasizing the humanitarian argument that worked so
well in alcoholism advocacy – that the alcoholic was “sick and worthy of
saving” – the political success of methadone rested on the argument that it
would bring down crime.87
Many medical authorities and consultants hoped that methadone could be
used as a lure to attract and maintain street addicts in rehabilitation programs.
Methadone might link street addicts to other social services, making metabolic stability a basis for social uplift. Unfortunately, the Nixon administration was interested in low crime rates, not the moral or even socioeconomic
progress of drug users. Methadone advocates accordingly pitched the clinics
as part of an “anti-crime” initiative rather than as a “rehabilitation” program.
Critic Edward Jay Epstein wrote, “The net result was that those with the technical competence to see the limits of methadone treatment chose not to deflate
the unrealistic claim that methadone would substantially reduce crime.”88
TC advocates who lacked “technical competence” had nevertheless pointed
out that methadone, as a single-drug solution to heroin dependence, was useless in treating the supposed personality defects that also lead to addiction to
psychedelics and stimulants. But by the early 1970s, the public – even the supposedly enlightened liberal community – was becoming less worried about
alleviating the condition of addiction than in addressing its consequences.
Popular media coverage of addiction treatment was no longer so hopeful.89
The New York Times featured a Lower East Side resident with little interest in the basic causes of addiction or in the humane treatment of addicts. “I
wouldn’t care if someone came along with a machine gun and killed all of
them,” he said in 1971. “I’ve been robbed, my wife has been robbed – I’m
sorry, I just don’t care any more.”90 Unfortunately, as methadone maintenance
advocates well knew, a simple chemical solution was an inadequate response
to the era’s trends in drug use and crime. Some historians argue that when
the Rockefeller Drugs Laws were passed in 1973, the treatment revolution
was over before it started.91 Conservatives such as Governor Ronald Reagan
de-funded local methadone clinics and adopted other measures for controlling
drug-related crime.92
Therapeutic communities fit well with those measures. The 1970s “neoclassical” era of drug control ushered in mandatory sentences for drug possession and a militaristic focus on drug trafficking that functioned as addiction
prevention. TCs’ emphasis on moral development and disciplinary structure
meant that therapeutic communities were viewed as an ideal setting for middle-class, wayward youths and prisoners convicted of drug related crimes. In
1975, investigations into the harsh disciplinary measures employed in some
therapeutic communities lead to the creation of the Therapeutic Communities
Association (TCA) and a code of ethics for TC treatment providers.93 It did
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
211
not lead to a substantial reduction of TC-inspired programs in prisons, however, as advocates successfully continued to pitch the programs as a form of
punishment as well as rehabilitation. Prison-based therapeutic communities
still exist today – and many of these programs also use methadone.94
In 1971, as chief of Nixon’s Special Action Office for Drug Abuse Prevention (SAODAP), Jerome Jaffe did not limit the federal drug treatment strategy
to a single therapeutic model. Instead, he hoped research and programmatic
support would help cities and states develop a variety of evidence-based programs. He was partly right; methadone and TC purists put aside some differences and treatment programs grew into institutions. Vincent Dole and William O’Brien were willing to share the stage at national addiction conferences
in the 1980s, by which time the curtain was lowering on the renewed promises
of addiction treatment.95 David Deitch, echoing Vincent Dole, acknowledged
that the language of cure is “better gone” – but there were, of course, costs to
its elimination.96
Therapeutic communities and methadone maintenance clinics were designed to be affordable and accessible in their infancy. Public funding was
available, and addiction treatment was too new for tiers. The methadone and
TC models both faced competition on two fronts in later years: from upscale,
private treatment centers who “siphoned off” financially comfortable patients
with insurance, and from the correctional system, which increasingly took
drug users out of the patient pool by incarcerating them on minor possession
charges. The result was a two-tier system of “treatment for the middle and upper classes, and incarceration for most others.”97 Methadone clinic and therapeutic communities marked the end of the classic era of narcotics control,
but the influences of these prominent treatment models on the institutional
infrastructure that ultimately emerged in the following decades was mixed.
American TCs did not revolutionize the psychiatric profession, and in fact
were fairly insulated from the field of mental health in general. “TCs came out
of corrections,” said Charles Devlin, the first Daytop patient and its lifelong
director, citing probation and parole officers’ initial influence in promoting
the model.98 So did methadone, if critics like Epstein are to be believed. For
alcohol and drug historians writing under the glare of recent history, the more
appropriate question might be whether they ever left.
Emory University
[email protected]
Endnotes.
1. Caroline Acker, Creating the American Junkie: Addiction Research in the Classic Era of
Narcotic Control (Baltimore: Johns Hopkins University Press, 2002), 7; Richard Severo, “Addiction: Chemistry is the New Hope,” New York Times, March 19, 1971.
2. “Medicine, Narcotics: One Answer to Heroin,” Time, September 3, 1965, 46; “New Hope
for Heroin Drug Addicts,” Look, November 30, 1965, 23-27; “Now – A Drug that ‘Cures’ Drug
Addicts,” Science Digest, November 1965, 38-41.
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Social History of Alcohol and Drugs, Volume 26, No. 2 (Summer 2012)
3. Vincent Dole, MD, in Addicts Who Survived: An Oral History of Narcotic Use in America,
1923-65 ed. David Courtwright, Herman Joseph, and Don Des Jarlais (Knoxville, TN: University
of Tennessee Press, 1989), 338.
4. Ibid.
5. Two seminal AA histories are Ernest Kurtz, Not God: A History of Alcoholics Anonymous
(Center City: Hazelden, 1979) and Trysh Travis, The Language of the Heart: A Cultural History
of the Recovery Movement from Alcoholics Anonymous to Oprah Winfrey (Chapel Hill: University of North Carolina Press, 2010). For overviews on the history of methadone and buprenorphine,
see David Courtwright, “The Prepared Mind: Marie Nyswander, methadone maintenance, and
the metabolic theory of addiction,” Addiction 92 (1997): 257-65 and Nancy Campbell and Anne
Lovell, “The history of the development of buprenorphine as an addiction therapeutic,” Annals of
the New York Academy of Sciences 1258 (February 2012): 124-39.
6. Scott Vrecko, “Civilizing Technologies and the Control of Deviance,” Bio societies 5 (March
2010): 36-51. For further discussion of the socio-cultural construction of addiction treatments, see
Helen Keane, What’s Wrong with Addiction? (New York: New York University Press, 2002) and
Darin Weinberg, “On the Embodiment of Addiction,” Body & Society 8 (December 2002): 1-19.
7. For a thorough overview of the political response to the fear of addicted Vietnam veterans,
see Jeremy Kuzmarov, The Myth of the Addicted Army: Vietnam and the Modern War on Drugs
(Boston: University of Massachusetts Press, 2009).
8. Nancy Campbell, Discovering Addiction: The Science and Politics of Substance Abuse Research (Ann Arbor: University of Michigan, 2007), 55.
9. “Methadone: A Synthetic Drug Relieves Pain and Dope Addiction,” Life, August 9, 1949,
87-91. On the risky nature of methadone treatment, see Nancy Campbell and Joseph Spillane,
“Medicating Substance Abuse: Pasts and Futures of Pharmacotherapies to Treat the Addictions,”
University of Michigan Substance Abuse Center, http://sitemaker.umich.edu/substance.abuse.
history/pathway_7 (accessed January 21, 2013)
10. John C. Burnham, “American Medicine’s Golden Age: What Happened to It?” Science
215 (1982): 1474-79.
11. David Courtwright, “The Prepared Mind,” 257.
12. For a discussion of Synanon’s relationship to Victorian values, see Geoffrey Skoll, Walk
the Walk and Talk the Talk: An Ethnography of a Drug Abuse Treatment Facility (Philadelphia:
Temple University Press, 1992) and David Deitch and Joan Zweben, “Synanon: A Pioneering
Response in Drug Treatment and a Signal for Caution” in Substance Abuse: Clinical Problems
and Perspectives, ed. Joyce Lowinson and Pedro Ruiz (Baltimore: Williams & Wilkins, 1981),
289-302. For a scholarly version of the decline of these values, see John Burnham, Bad Habits:
Drinking, Smoking, Taking Drugs, Gambling, Sexual Misbehavior and Swearing in American
History (New York: New York University Press, 1993).
13. William White, Slaying the Dragon: The History of Addiction Treatment and Recovery in
America (Bloomington, IL: Chestnut Health Systems, 1998), 175-77.
14. As Jessica Neptune discusses in this volume, the “Rockefeller drug laws” is the term that
came to describe the harsh drug sentencing requirements passed by the New York state legislature
in May 1973 at the behest of Governor Nelson Rockefeller.
15. David Musto, The American Disease: Origins of Narcotic Control, 3rd Edition (Oxford:
Oxford University Press, 1999); David Courtwright, Dark Paradise: A History of Opiate Addiction in America, Enlarged Edition (Cambridge: Harvard University Press, 2001); Acker, Creating
the American Junkie. For an overview of the clash between methadone and TC advocates, see
Courtwright, Joseph, and Des Jarlais, Addicts Who Survived and David Courtwright, “A Century of American Narcotic Policy,” Treating Drug Problems: Institute of Medicine Report, Vol. 2
(Washington DC: National Academy Press, 1992): 22-33.
16. William White, Chris Budnick, and Boyd Pickard, “Narcotics Anonymous: Its History and
Culture,” http://www.williamwhitepapers.com (accessed January 21, 2013).
17. Senator Thomas Dodd, Sr. pronounced the organization a “miracle on the beach.” Synanon
subsequently used the term in their promotional materials and self-produced documentaries. Rod
Janzen, The Rise and Fall of Synanon: A California Utopia (Baltimore: Johns Hopkins University
Press, 2001), 25.
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
213
18. Daniel Casriel and Grover Amen, Daytop: Three Addicts and Their Cure (New York: Hill
and Wang, 1971), xic.
19. Ibid.
20. Barry Sugarman, Daytop Village: A Therapeutic Community (New York: Holt, Rinehart &
Winston, 1975), 7-10.
21. Carlton Carl, “Old At Fifteen: The Story of a Junkie,” New York Magazine, May 13, 1968,
25.
22. This term continued to be used in TC professional circles.
23. Casriel and Amen, Daytop, xv; George Deleon, The Therapeutic Community: Theory,
Model, Method (New York: Springer, 2007), 25.
24. Richard Ofshe, “The Social Development of the Synanon Cult: The Managerial Strategy
of Organizational Transformation,” Sociological Analysis 41 (1980): 109-27; Mitchell Rosenthal,
“The Therapeutic Community: Exploring the Boundaries,” The British Journal of Addiction 84
(1989), 141-50.
25. Courtwright, “The Prepared Mind,” 261.
26. Vincent Dole and Marie Nyswander, “A Medical Treatment for Diacetylmorphine (heroin)
Addiction,” Journal of the American Medical Association 193 (1965): 646-50.
27. Ibid., 649.
28. For example, William L. Claiborne “A Daily Dose of Methadone Could Be Answer to
Crime,” The Washington Post, December 6, 1970.
29. Vincent Dole and Marie Nyswander, “Methadone Maintenance Treatment: A Ten-Year
Perspective,” Journal of the American Medical Association 235 (1975), 2119.
30. Inquiry Into the Problem of Alcoholism and Narcotics: Hearing Before the Special Subcommittee on Alcoholism and Narcotics of the Committee on Labor and Public Welfare of the
United States Senate, 91st Congress, First and Second sessions (1969); Treatment and Rehabilitation of Narcotics Addicts: Hearing Before the Subcommittee to Amend the Narcotic Rehabilitation Act of 1966 of the Committee on the Judiciary of the United States House of Representatives,
92nd Congress, First session (1971).
31. Peter Goldberg and James V. DeLong, “Federal Expenditures on Drug Abuse Control” in
Drug Abuse Survey Project, Dealing With Drug Abuse: A Report to the Ford Foundation (New
York: Praeger, 1972).
32. Eric Schneider, Smack: Heroin and the American City (Philadelphia: University of Pennsylvania Press, 2008), 176.
33. Testimony of William Satterfield, Inquiry into the Problem of Alcoholism and Narcotics,
713.
34. Richard Stolley, “A Tunnel Back to the Human Race,” Life, March 9, 1962, 54-67; Lewis
Yablonsky, Synanon: The Tunnel Back (New York: Macmillian, 1967).
35. Daniel Casriel and David Deitch, New Success in the Cure of Addicts (Staten Island: Daytop Village, Inc, 1967), 3.
36. Testimony of Daniel Casriel, Inquiry into the Problem of Alcoholism and Narcotics, 787.
37. For an example of each of these analogies in context, see the Congressional testimony of
recovered addicts on pages 698 and 704 of Inquiry into the Problem of Alcoholism and Narcotics.
38. Alcoholics Anonymous, fourth ed. (New York City: Alcoholics Anonymous World Services, 2001), 31; Interview with Judianne Densen-Gerber, Addicts Who Survived Collection, Center
for Oral History, Columbia University; William L. Claiborne, “A Daily Dose of Methadone Could
Be Answer to Crime,” The Washington Post, December 6, 1970.
39. Testimony of Samuel Anglin, Inquiry Into the Problem of Alcoholism and Narcotics, 698.
40. For the history fetal alcohol syndrome, see Janet Golden, Message in a Bottle: The Making
of Fetal Alcohol Syndrome (Cambridge: Harvard University Press, 2005); for one example of an
article on methadone’s effect on infants, see Stuart Auerbach “Babies born addicted to methadone,” Washington Post, February 26, 1972.
41. Courtwright, “The Prepared Mind,” 259; Vincent Dole and Marie Nyswander, “Heroin Addiction: A Metabolic Disease,” Archives of Internal Medicine 120 (July 1967): 19-24.
42. Vincent Dole, Marie Nyswander and Alan Warner, “Successful Treatment of 750 Criminal
Addicts,” Journal of the American Medical Association 206 (1968), 2708.
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Social History of Alcohol and Drugs, Volume 26, No. 2 (Summer 2012)
43. Herman Joseph and Vincent Dole, “Methadone Patients on Probation and Parole,” Federal
Probation 34 (June 1970): 42-48; Robert L. DuPont and Richard N. Katon, “Development of a
Heroin-Addiction Treatment Program: Effect on Urban Crime,” Journal of the American Medical
Association 216 (1971): 1320-24.
44. Dole, Treatment and Rehabilitation of Narcotic Addicts, 399.
45. McClory, Treatment and Rehabilitation of Narcotic Addicts, 399.
46. Ibid.
47. Ibid.
48. “Methadone Approval Sparks Controversies,” Nature 235 (1972), 323.
49. Herman Joseph, “Heroin Addiction and Methadone Maintenance,” Probation and Parole:
The Journal of the New York State Probation and Parole Officers Association 1 (Spring 1969),
reprinted in Inquiry into the Problem of Alcoholism and Narcotics, 736-58.
50. Joe Pilati, “Schism on 14th Street: The Daytop Explosion,” Village Voice, November 21,
1968; David Deitch, interview with author, May 25, 2011.
51. The ACLU contended that isolating drug addicts for treatment is tantamount to incarceration and that treating addicts as criminals in this way fails to recognize due process. For conservative commentary on the ACLU’s stance that strangely concludes with a rousing endorsement
of methadone, see William Buckley, Jr. “Rockefeller is on the Right Path,” Los Angeles Times,
March 7, 1966.
52. Reginald G. Smart, “Outcome Studies of Therapeutic Community and Halfway House
Treatment for Addicts,” The International Journal of the Addictions 11 (1976): 143-59. Daytop
studies cited include W. V. Collier, E. R. Hammock, and C. Devlin, An Evaluation Report on
the Therapeutic Program of Daytop Village, Inc. (New York: Daytop Village, 1970) and W. V.
Collier, An Evaluation Report on the Therapeutic Programs of Daytop Village, Inc., for the Period 1970-1 (New York: Research Division, Daytop Village, 1971). For another methodological
critique, see Richard Bale, “Outcome Research in Therapeutic Communities for Drug Abusers:
A Critical Review, 1963-1975,” The International Journal of the Addictions 14 (1979): 1053-74.
53. Casriel and Amen, Daytop, 83.
54. George Deleon and Vincent Biase, “Encounter Group: Measurement of Systolic Blood
Pressure,” Psychological Reports 37 (1975): 439-45.
55. George Deleon, Andrew Skodol, and Mitchell Rosenthal, “Phoenix House: Changes in
Psychopathological Signs of Resident Drug Addicts,” Archives of General Psychiatry 28 (1973):
131-35.
56. “The longer the residence, the larger the postprogram reduction, eg, dropouts after 12
months’ residence showed a 70% change in arrests in one year of follow-up,” George Deleon,
Sherry Holland, Mitchell Rosenthal, “Phoenix House: Criminal Activity of Drop-outs,” Journal
of the American Medical Association 222 (1972): 686-89. Quotation from page 868..
57. For two high-profile critical studies of TCs, see James V. DeLong, Treatment and Rehabilitation. Dealing with Drug Abuse: a Report to the Ford Foundation (New York, Praeger Publishers, 1972) and EM Brecher and the editors of Consumer Reports, Licit and Illicit Drugs (Boston:
Little Brown & Co, 1972). For historical critiques, see the discussion of Matrix House in Nancy
Campbell, JP Olsen and Luke Walden The Narcotic Farm: The Rise and Fall of America’s First
Prison for Drug Addicts (New York: Abrams, 2008) and Janzen The Rise and Fall of Synanon, 24.
58. Richard N. Bale, William W. Van Stone, John M. Kuldau, Thomas M. J. Engelsing, Robert
M. Elashoff, and Vincent P. Zarcone, Jr., “Therapeutic Communities vs. Methadone Maintenance:
A Prospective Controlled Study of Narcotic Addiction Treatment: Design and One-year Followup,” Archives of General Psychiatry 37 (1980): 179-93.
59. Dole and Nyswander, “A Medical Treatment for Diacetylmorphine (heroin) Addiction.”
60. Severo, “Chemistry is the New Hope.”
61. Robert DuPont and Richard Katon, “Development of a Heroin-Addiction Treatment Program: Effect on Urban Crime,” Journal of the American Medical Association 216 (1971): 132024.
62. Robert DuPont, “How Corrections Can Beat the High Cost of Heroin Addiction,” Federal
Probation 43 (June 1971): 43-50.
63. Dole and Nyswander, “Methadone Maintenance Treatment: A Ten-Year Perspective,”
Clark: Therapeutic Communities and Methadone Maintenance, 1965-71
215
2119.
64. For a different view of the midcentury big-city liberalism that embraced methadone maintenance, see Samuel Roberts in this volume. For the notion that a liberal political consensus dominated post-Depression US politics, see Richard Hofstadter, “The Psuedo-Conservative Revolt,”
American Scholar 24 (Winter 1954-55)”: 11–17; Daniel Bell, ed., The New American Right (New
York: Criterion, 1955). For an overview of the recent historiography that takes the rise of “fringe”
conservatism seriously, see “Conservatism: A Round Table,” Journal of American History 98
(2011): 723-73.
65. The backlash happened quickly, at least in the Times. For example, see James Markham
“New Problem in Drugs: Addiction to Methadone,” New York Times, August 14, 1972; James
Markham “Study Finds Black Market Developing in Methadone,” New York Times, January 2,
1972.
66. Jerome Jaffe, Misha Zaks, and Edward Washington “Experience With the Use of Methadone in a Multi-modality Program for the Treatment of Narcotics Users,” The International Journal of the Addictions 4 (1969), 483.
67. Jerome Jaffe, “Further Experience with Methadone in the Treatment of Narcotics Users,”
The International Journal of the Addictions 5 (1970), 385.
68. Saul B. Sells, ed., Studies of the Effectiveness of Treatments for Drug Abuse, Vol. I (Cambridge: Ballinger, 1974), 170.
69. David Herzberg “‘The Pill You Love Can Turn On You’: Feminism, Tranquilizers, and the
Valium Panic of the 1970s,” American Quarterly 58 (2006): 79-103.
70. Testimony of Samuel Anglin, Inquiry Into the Problem of Alcoholism and Narcotics, 700.
71. William O’Brien, Address to the Ninth World Conference of Therapeutic Communities,
San Francisco, CA 1985, reprinted in Lewis Yablonsky, Therapeutic Community: A Successful
Approach for Treating Substance Abuse (Lake Worth: Gardner Press, 1994), 38.
72. Maia Szalavitz, Help at Any Cost: How the Troubled-Teen Industry Cons Parents and
Hurts Kids (New York: Riverhead, 2006). For an argument about how liberals came to join the
drug war, see Jessica Neptune in this volume.
73. For a discussion of “community as method” and an overview of changes in TC structure,
see George Deleon, The Therapeutic Community: Theory, Model, Method (New York: Springer,
2007).
74. Densen-Gerber wrote that NARA revisions should “make clear… that the private sector,
including non-profit agencies, should take an active role in commitment and rehabilitation programs.” Treatment and Rehabilitation of Narcotic Addicts, 694.
75. Testimony of Maryland representative Lawrence Hogan, Treatment and Rehabilitation of
Narcotic Addicts, 695.
76. For demographics, see Saul B. Sells, Studies of the Effectiveness of Treatments for Drug
Abuse, Vol 2 (Cambridge: Ballinger Publishing Company, 1974). For a summary of popular
discourse, see James Markham, “Issue and Debate: Methadone Therapy Programs,” New York
Times, April 17, 1973.
77. Caroline Acker, “Liminal Methadone and the Shifting Contours of American Drug Policy,”
paper presented at the Sixth Biennial Meeting of the Alcohol and Drug History Society, Buffalo,
NY June 24, 2011.
78. Kenneth Bradney, “Legalizing Heroin: The Biggest Bet,” The Village Voice, March 25,
1971.
79. Robert DuPont, “Harm Reduction and Decriminalization in the United States: A Personal
Perspective,” Substance Use & Misuse 31 (1996), 1933.
80. Ibid, 1941.
81. “Journal Interview: Conversation with Jerome Jaffe,” Addiction 94 (1999), 24.
82. Alex Richman, Marvin Perkins, Bernard Bihari, and J.J. Fishman, “Entry into Methadone
Maintenance Programs: A Follow-Up Study of New York City Heroin Users Detoxified in 19611963,” American Journal of Public Health 62 (1972): 1002-7.
83. For a review of the evidence of the shift from institutionalization to incarceration, see Bernard Harcourt, “From the Asylum to the Prison: Rethinking the Incarceration Revolution,” Texas
Law Review 84 (2006), 1751-86.
216
Social History of Alcohol and Drugs, Volume 26, No. 2 (Summer 2012)
84. Gerald Grob, The Mad Among Us: A History of the Care of America’s Mentally Ill (New
York: The Free Press, 1994), 259.
85. Testimony of Anglin, Inquiry Into the Problem of Alcoholism and Narcotics, 698.
86. Testimony of Stimmel, Inquiry Into the Problem of Alcoholism and Narcotics, 783.
87. For a discussion that slogan’s history, popularized in Marty Mann’s alcoholism campaign,
see David and Sally Brown, A Biography of Mrs. Marty Mann: The First Lady of Alcoholics
Anonymous (Center City: Hazeldon, 2001).
88. Edward Jay Epstein, “Methadone: The Forlorn Hope,” Public Interest 36 (Summer 1974),
14.
89. For an overview of the shifting media coverage, see Ronald Bayer, “Liberal Opinion and
the Problem of Heroin Addiction: 1960-1973,” Contemporary Drug Problems 93 (1975): 93-112.
90. Severo, “Chemistry is the New Hope,” 23.
91. For an introduction on the historical significance to the rise of mass incarceration in the
United States, see Heather Ann Thompson, “Why Mass Incarceration Matters: Rethinking Crisis,
Decline, and Transformation in Postwar America,” The Journal of American History 97 (2010),
703-33. For an accessible overview of mass incarceration in relation to punitive drug laws, see
Michelle Alexander, The New Jim Crow: Mass Incarceration in an Age of Colorblindness (New
York: The New Press, 2009).
92. Reagan reduced the funding for California’s proposed methadone program from $5,020,000
to $20,000. Associated Press, “Reagan Methadone Veto Draws Sharp Criticism,” Modesto Bee,
August 21, 1972.
93. George De Leon and George M. Beschner, eds, The Therapeutic Community: Proceedings
of Therapeutic Communities of America Planning Conference, January 29-30, 1976 (Rockville,
MD: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse,
and Mental Health Administration, 1977).
94. Laura Bonetta, “Study Supports Methadone Maintenance in Therapeutic Communities,”
NIDA Notes 23 (December 1, 2010), http://drugabuse.gov/NIDA_notes/NNvol23N3/Study.html
(accessed January 21, 2013).
95. By 1996, O’Brien’s central concern was not methadone, but incarceration: William
O’Brien, interview by George M. Anderson, “The Crisis in Drug Treatment,” America, March 16,
1996, 10-13. Though O’Brien had once considered Dole’s methadone program a sin-promoting
endeavor, upon his death he published a memoriam in which he stated “We often jostled over the
state of the art in responding to the mounting addiction crises, yet very early on we found it so
very difficult to overlook the caring physician in Vince Dole. He genuinely grieved over the plight
of this town’s young caught up in the mad whirl of the needle and the spoon His words breathed
their agony. Indeed, we have lost a giant and a dear friend.” New York Times, August 4, 2006.
96. David Deitch, interview with author, May 25, 2011
97. Acker, Creating the American Junkie, 9.
98. Charles Devlin, interview with author, October 6, 2011.