Volume 35 - Issue 4

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Grant and Fellowship Opportunities at the

Yale Center for International and Area Studies Funding for 2003-2004 is available for Yale University undergraduate, graduate and professional students interested in international and area studies-related research and study, including dissertation and pre-dissertation research, language study, summer study and travel, and summer internships.

Application deadlines are fast approaching.

For information and applications, visit www.yal e.ed u/ycias/gran ts or stop by Luce Hall, 34 Hillhouse Avenue.

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THE NEW jouRNAl-~

TheNewJournal

Volume 35, Number 4 February 2003

I

FEATURES

11

The Exorcists It takes more than chemistry to master childhood psychosis.

by Clinton Carroll

16

Better Homes and Gardens A teenage dealer is exiled by neighborhood families-including his own.

by Paige Austin

20

The Gift and The Curse The makers of OxyContin stem abuse oftheir drug, but their atonement goes only so for.

by Ana Munoz

16

26

Seers and Profits Can you overcome a gambling dependency by cheating the odds?

by Maeve Herbert

STANDARDS 4 5 32

Editors' Note

34 38

The Critical Angle: The Future of an Illusion by jacob Bluhtr

Points of Departure

Essay: M edicine Man by Dagan Coppock Endnote: Smoke IfYou Got 'em by Coco Krumm(

., THa Nnr JoullNAl. is published fivt times during tbt acadtmic ytar by THE Nr:tr jOURNAL at Yale, Inc., P.O. Box }4}1 Yale Sation, N~ Haven, CT o6s>o. Offi~ address: 19- 45 Broadway. Phone (103) 432· '9S7. Email: mj@y:alc.edu. All comcnts copyright 1003 by TH£ Nr:tr JoullNAl. at Yale, Inc. All Rights Reserved. Rq>roducrion eithes in whole or in pan without written permission of the publisbcr and editor in chit£ is prohibited. While this magazine is published by Yale CoUtgc srudents, Yale Uni""nity is nO< responsible fo r its contents. &Yen thousand fi"" hundred copies of each issue arc distributed fret to members o( the Yalt and N~ Ha""n community. Subscriptions are available to those outside the area. Rates: One year, s t8. Two ytarS. S}:t. THE Nr:tr JoullNAl. is printed by Turley Publications, Palmer, MA; booltlcecping and billing services are provided by Colman Booklceeping ofN~ Haven. THE Nr:tr )OUilNAL encourages leners to the editor and comments on Yale and N~ Hnen issues. Write to Editorials, }4}1 Yale Station, New Ha_..,n, CT o6s>n. All letters for publication mwt include address and signature. We rcsetVe tht right to edit aU lmm for publication.

s time passes and our country's concerns about drugs have become commonplace, every story about drugs starts to sound the same: urban youths get caught in a lucrative but dead-end spiral of using and selling; faddish des igner drugs explode on the club scene and disappear; the FDA approves the latest miracle cure; the average college student's weekend is a four-day drunken haze; suburbanites huff nitrous from condoms before the prom.

In light of this, a theme i.s sue on drugs might seem to offer nothing new. The stories that follo.w prove that assumption wrong.

Our writers have approached drugs from a variety of perspectives, often blurring cliched conceptual boundaries by examining questions anew. What is a drug? What is addiction and how should we address it? Why have drugs remained a primary national concern for longer than we have been alive? By asking questions like these, we are reminded that the place of drugs in our society is more complex than we have come to assume.

We don 't pretend to answer any of these questions with finality.

Yet we believe that the function of journalism is not only to conclude narrow investigations, but also to catalyze fresh thinking about issues pigeonholed by timid platitudes.

A

-THE EDITORS -

4

THE NEW JouRNAL

Drug Court Dropout I N THE WEEKS LEADING UP TO LAST YEAR'S

gubernarorial election, two-term Governor John Rowland found himself the object of an unlikely attack given his usual popularity in hard-on-crime-soft-on-caxes circles.

Rowland, speaking on the record with a reporter, had dropped the word "decriminalization" inro a discussion of state drug policy. When ami-crime crusaders, the media, and strategists for the Democratic opponent seized on the (apparently taboo) term, Rowland's handlers went into damage-control mode: The Governor would never, they assured, "decriminalize drug use"; he meant simply that "the state must work harder" to keep non-violent drug offenders in rehabilitation and out of prison, where jailhouse drug dealers far outnumber viable treatment options.

And indeed, Rowland's record on that front was strong. Until last year, Connecticut boasted one of the nation's most extensive networks of drug courts.

Busted users could sidestep jail by submitting themselves to the authority of a lone judge who would guide them thr~ugh local rehabilitation programs, checking on their progress in biweekly meetings. When a urine test or a subsequent arrest revealed continuing use, he could wag a stern, fatherly finger and impose a tailor-made punishment, fashioned in consult with counselors, lawyers, and social workers familiar with the individual case.

The drug courts were, in their day, a principal component of a statewide alternative sentencing program that sought to replace the principle of retribution with the principle of rehabilitation. Last year, however, New H aven's drug court closed its doors. Ir was the vicrim of a statewide budgee crisis that is forcing the Republican

FEBRUARY 2003

governor to cut almost $1.5 billion in state services. As the slashing and burning continued, the in- and out-patient rehabilitation clinics that treat court-sentenced users were similarly hard hit: In November, Rowland announced that he would cut funding for alternative sentencing programs by over $5 million, ten percent of their total annual budget. "These were programs operating on the fringe of their budget," says Nora Duncan, who oversees alternative incarceration centers for the Connecticut Association of Nonprofits.

"There was no fat to trim, so they'll have to cut beds or dose down."

Since its launch in 1990, some 50,000 non-violent offenders have passed through Connecticut's Alternative Incarceration Program. Most of them were facing prison for the first time, and many were addicts driven to criminality by an expensive habit-in short, exactly the type of offender once herded into perpetually overflowing prisons in astounding numbers.

Alternative sentencing diverted most nonviolent drug offenders (excluding those involved in heavy dealing) into independent, state-funded treatment centers, where they could serve our their sentences in rehabilitation sessions, therapy groups,

job training, and community service projects. The idea was to keep people away from the hardening environs of a correctional facility and instead ship them, as one New Haven drug counselor puts it, "out into society as full people and productive citizens."

The results were unequivoca11y positive. In th e regular prison system, recidivism rates for drug offenders are astronomical; a recent Department of Justice study, for example, found that 66 percent of drug convicts are back in court within three years of their release. In New Haven, treatment centers like the APT Foundation-the state's second largest rehabilitation facility-report that 70 percent of patients who complete its program stay not only out of jail, but clean as well. "It doesn't matter if they're forced by a judge ro come," explains Allen Brown, APT's Chief Executive Officer.

"No matter how you got into it, if you complete your treatment, you're many times more likely to stay clean than someone who didn't."

- APT ca1ls itself a "therapeutic community" for drug offenders. "It's an intense experience," Brown says. "In a p rogram like ours, you're committed to a treatment process, and you have to work at it. Every once in a while someone will say, 'I'd rather be in a prison, this is too hard.'" In fact, APT has built itself into a mostly self-sustaining facility, where patients early in the treatment process work various jobs in the building, which serves, in addition to its 100 residents, 1500 nonresident users, half of whom are there at the behest of a court. As patients "become more stable and more able ro cope," they go out into the community to perform service or hold down a job, the proceeds of which subsidize their treatment.

Eventually, Brown claims, they "reenter

5

.. society as healthy, employable members of a community."

As the effects of budget cuts trickle down from state agencies,, the damage to centers like APT is becoming evident.

According to Duncan, almost 200 alternative incarceration slots have already been eliminated, and there are rumblings that several treatment centers may have to close.

"Social ramifications aside, this is going to mean ·a strain on the prison system," she notes. It's hard not to see the cuts as a peculiar kind of policy regression: Alternative sentencing was adopted by pragmatists searching for a solution to prison overcrowding, not bleeding hearts preaching the virtues of compassion. Curiously, we're back where we started: slashing alternatives and sending non-violent drug offenders back into overflowing prisons.

What is most ironic about Rowland's spending decisions, however, is that centers like APT have proven not only that they can handle drug cases better-their recidivism rate for drug offenders, after all, is barely half the figure of the state prison systembut that their services carry a lower price tag as well. On average, an alternative incarceration program spends $7,000 on a patient in a year. It costs, on the other hand, $25,000 a year to keep someone behind bars. (Despite a fourfold increase, from $100 million to $400 million, in spending on prisons over the course of the 1990s, Department of Corrections officials still complain of massive shortfalls.)

Government estimates confirm the longterm financial benefits: Connecticut has saved over $619 million by diverting relatively paltry sums from prisons to treatment centers.

But the rwisted political logic of budget cuts, crime fighting, and the War on Drugs supercedes whatever fiscal and human benefits alternative sentencing provides. Brown offers a scholastic analogy: "When cuts are happening, prisons are like high-school football programs. They're always the least vulnerable. Drug treatment is like the marching band or advanced physics"-the first thing to go. Ultimately, few people disagree with the wisdom of alternative sentencing. But unfortunately, in sound-byte form, "tough on crime" always beats out "smart on drugs."

-Daniel Kurtz-Phelan

6

Naughty Professor LET's CALL HIM PROFESSOR BROWN. In college, he had no trouble cutting loose. It was the late 1970s. Drugs and college just went together like rama, lama, lama, kadingy, kading-a-dong. The drinking age had not yet been raised. There was a joint at every party. He smoked a lot of pot. Most people did. It was a "climate of experimentation'': Cocaine, opium, hash, mushrooms, nitrous, acid-in fact, lots of acid. To this day, Professor Brown values every drug experience he ever had; he has no regrets.

Three decades ago when he looked around en route to class, he saw drugs and lots of people doing them. Now, loo.k ing at students from the flip side of the academic equation, Professor Brown sees a very different scene: We fit comfortably inside the box and aim to strive within its bounds; few of us make bold statements with our appearance; we are eager to please our professors; and of course, few of us experiment with drugs the way he did. There is, accorCling to his gauge, an atmosphere of unquestioning acceptance and not much of a margin at a place like Yale. And if there is, to choose the margin is ~o choose that which has already faded-the counterculture Professor Brown found so cozy has been co-opted and marketed. The main concern is no longer "to avoid selling out."

Instead, Professor Brown sees students who are preparing themselves to sell out better and faster than their parents.

Sitting at his desk for afternoon office hours, Professor Brown is dressed comfortably in a gray turtleneck sweater that is just shy of business casual. With no students on hand with questions, he confesses that he wishes more of them would get sroned once in while. Or rather, he wishes that they would be the kind of kids who would get stoned more readily, and more readily question professorial authority as well. He suggests the same for those professorial authorities, whose "tight-ass attitude," in Professor Brown's words, keep them buttoned up well into the night. He calls the academic career a "life of quiet desperation." One of his colleagues once said that she finds the faces of those around her "marked by the books they haven't read."

To be sure, Professor Brown is nostalgic for his acid-dropping days, but-after a respite during the Reaganite 198os-he's

managed to reincorporate drugs into his life. As a Yale professor, he confesses that he has little time to relax and experiment, but his monthly marijuana ritual is a guaranteed way to unwind from the high stress and fast pace of the work day. Of course, Professor Brown still appreciates its other effects on his "pretty type A " personalitygetting in touch with the sides of himself that stay suppressed in the normal professorial existence. Simple things, like "the pleasure of inhabiting a body" and "the beauty of the world."

Professor Brown recalls a wedding he attended not long ago. Seconds after the recepti~n began, he and his wife made a bee-line for the bar. The only people ahead of them in line were rwo old ladies. He was expecting them to order a couple of screwdrivers. Something that goes down easy and eventually gets the job done. He was wrong. They ordered scotch. Straight scotch. He thought that was right on.

Wasting time is never a good thing.

So now Professor Brown smokes pot once a month, drinks in moderation, does ecstasy with his wife, and imbibes the occasional cup of "poppy-pod tea," a very mild form of opium which he "imagine(s] is legal." When asked why he doesn't do more of the harder stuff like he did in college, he responds wryly: It probably has to do with access.

-Emily Lodish

Save Another Drunken Bum ON SEPTEMBER 29, 1902, Carrie Nation came to Yale to save souls. O ne of America's best known temperance leaders, Nation was notorious for her habit of nor only condemning saloons, but destroying them with a hatchet as well. She caused a stir wherever she went, and Yale was no exception. Accounts vary as to how long she stayed in New Haven, but it was cer· tainly long enough to make a lasting impression. Seven years later, ..she would write, "It is a school of vice to a greal extent.... The controlling party at Yale . · · will desolate and enslave our darling boys."

For Nation, the demise of"our darling boys" was part of a larger problem. The whole country was steadily moving down the path to hell, and liquor-or "devil·

THE NEW Jou.RNAI-

soup,"as she sometimes called it-wasn't Though this letter may have been written the only perpetrator. Tobacco, fraternities, by a prudish boy with a weak stomach, it is kissing, and low bust lines were all at fault, more likely that its author was a member of and it was her God-given mission to save a prankster society called The Jolly Eight.

America from damnation.

But either way, the prospect of exorcizing Nation first wielded her hatchet in a "devil-soup"from Yale was enough to bring Kansas saloon in January, 1901. At the peak Nation's imposing figure (she stood almost of her career, she was selling souvenir six feet tall in her prim black dress) to New hatchets for about fifteen cents a pop; and Haven. even when her credibility began to wane, After a brief stop at the Mayor's office, her unique methods and catchy battle where a smoking secretary convinced her cry-"Smash! Smash! For Jesus' sake! that the Mayor was incapable of saving the Smash!"-kept her in the news. In 1902, a Yale boys, she proceeded to the campus brief encounter on a . - - - - - - - - - - - , - - - - - - - - - , itself-the training Hudson River Ferry grounds for the prompted her to demons of tomorrow. direct her powers Accompanied by The towards saving college Jolly Eight and a throng of raucous stuboys. She was, according to legend, so hordents, Nation marched rifled to see a young to the steps of Osborn man chewing tobacco Hall, where Bingham that she squeezed his Hall now stands, and cheeks until he was cried to address the forced to spit it out. crowd. Around the With the bewildered country, Nation had student nursing his been greeted by a range she of responses. One red face, exclaimed trisaloonkeeper broke a umphantly, "There! chair over her head. A I've saved you!" more chivalrous barCollege students tender sicked his wife around the country began to send her leton her. At Harvard, students followed her ters, asking her to exert her influence on around campus jabbing her with pipes and their wayward institutions. According to cigarettes. At Yale, students responded biographer Herbert Asbery, the following characteristically by-what else?-singing. letter brought Nation to Yale: Each time she tried to speak, they started to wail, alternating between drinking songs Dear Mrs. Nation: - As an ardent and temperance ballads such as "Good-bye prohibitionist and an enemy of the Boou"and "Down with IGng Alcohol." liquor traffic, I feel obliged to bring Understandably frustrated, she to your notice some of the things allegedly asked a student, "What's the matthat are served to the young men at ter with these rummies? Don't they want to Yale Dining Hall by the college hear me?" The student replied, "They're authorities [including Claret Wind drunk. They had ham with champagne Punch, Cherry Wine Sauce, Apple sauce for lunch, and they haven't gotten Dumpling and Brandy Sauce, Roast Ham and Champagne Sauce, and over it yet. " Wine Jelly]. You will see how many A discussion with Yale President Dr. of these dishes are served with Anhur T. Hadley left her un$3-tisfied (He intoxicating liquors as sauces. Yale is had the audacity to say that "he thought supposed to be a Christian College, the intoxicants were 'fruit juices,'"she later but to give these poisons by consent complained). So Nation indignantly of the college authorities is nothing returned to the mass of students waiting for more or less than starting them on her.

She tried to deliver her speech again the road to hell! Please give this and again, but each rime she was greeted matter your earnest attention and with the same response: a wild roar of song. see if you cannot stamp this serpent Before she retreated, she allowed herself to OUt.

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.. be photographed with The Jolly Eight, who had transformed themselves into a temperance group for the day. Obligingly assuming the position of "The Sylph of Temperance," Nation raised a glass of water in her left hand. As the photographer prepared his shot in the dark, the students produced pipes, mugs, and bottles from under their coats, so that their guest appeared to be in the center of some raucous debauchery. For the final print, a crafty student doctored the picture such that Nation seems to be smoking a cigarette, blowing smoke rings like the best (or worst) of them. When one of The Jolly Eight later described the incident, he wrote, "Poor Lady! In that her attempt to interfere with the divine right of man to scramble his cerebral processes in alcohol led her. into such company as ours!"

Nation devotes a section of her autobiography to her visit to Yale. "I have been to all the principal Universities of the United States ... " she declares, "Yale ... being the worst I have ever seen." A copy of the photograph hangs in Mory's.

-Charlotte Howard

Fuzzy Math CoNCERNED CITIZENS TAKE NOTE: The New Haven Police Department is cracking down on drugs in our city. Thousands of New Haven residents have been arrested for drug crimes the past several years. In 1997, 2,061 citizens were arrested; in 1998: 1,860; in 1999: 1,632; in 2000: 1,547; in 2002: 1,311. Don't let these decreasing figures worry you-crime rates in the city have been dropping as well. In New Haven, 7 to 10 percent of the population is estimated to use drugs-putting the number of users in New Haven somewhere around 10,000.

At Yale, however, there is still work to be done. Because the school claims that it has no idea how many students use drugs, the best estimates come from national surveys. The Sourcebook for Criminal Justice Statistics found that about 35 percent of college students used drugs during 1999, 2000, and 2001. Assuming Yale meers this estimate, approximately 18oo Yale College students used drugs over the past year. The Yale Police Department has maintained a

8

relatively low arrest rate for drug crimes. In 1999, there were zero arrests for drug crimes. In 2000, there were also zero arrests. In 2001 there was a crime spree and the number of arrests surged to three-.6 percent of the undergraduate population.

This means that from 1999 to 2001, for every Yale student arrested for a drug crime there were approximately 1400 New Haveners arrested. To some extent this can be explained by the vast population difference. A better comparison is the number of estimated drug users arrested every year. In New Haven, 15 percent or so of the total estimated users have been arrested. At Yale .2 percent of the estimated users were arrested--during a good year. ¡ The num~er of disciplinary referrals for drug violations didn't make up for this disparity. There was one referral by the Yale Police Department in 1999; none in 2000 and one in 2001. Other colleges and universities in Connecticut had better luck when it came to enforcing the law. At Eastern Connecticut State University from 1999 io 2001~ there were 20 arrests and 76 judicial referrals for drug violations. At Fairfield University, there were only seven arrests from 1998 to 2000, put there were 132 disciplinary referrals for drug violations. At Southern Connecticut State University, there were 6o drug violations cited from 1999 to 200. All three schools are smaller than Yale.

-Flora Lichtman

Immaculate Deception AFTER A DANCE LAST OCTOBER, Jane's blind date started to come on very aggressively.

"All of a sudden we were having sex. There was no condom. I asked, 'Did you come?'

And he said, 'No."' He was lying. Five years ago, Jane would have faced an agonizing wait to find out if she was pregnant.

Instead, Jane went to Yale University Health Services the morning after, took an emergency contraceptive, and did not get pregnant.

In 1998, two kinds of emergency contraception, Plan-B and Preven, went on the us market. Taken within 120 hours of intercourse, the pills prevent pregnancy by inhibiting ovulation, inhibiting fertilization, or prohibiting a fertilized egg from

implanting in the uterus. Emergency contraception aims to fill a big need: contraceptives fail, people forget to use protection, and, in the worst cases, women don't have the choice to use protection. And it works. A study conducted last year by the Alan Guttmacher Institute, a reproductive rights agency based in New York, estimated that the availability of emergency contraception accounted for a 43 percent decrease in the number of abortions performed nationwide.

The Guttmacher Institute, however, also found that only one woman in ten is aware of emergency contraception, a distressing.finding given that half of all pregnancies are unintended. In New Haven, which has one of the highest teen pregnancy rates in the state, school and public health officials have tried to counter this persistent ignorance by integrating information on emergency contraception into high school health courses. This effort, however, is all too ofren undermined by the reality of women's reproductive care: Ideological battles have eclipsed the welfare of the patient as a primary concern. Antiabortion groups consider emergency contraception a form of abortion, and doctors, according to Kirsten Moore, the president of the Reproductive Health Tecnhologies Project, are in many cases not letting their patients know their options. In focus groups she conductS, most of the women involved say their doctors have never even mentioned emergency contraception. The Catholic-affiliated St. Raphael's Hospital, New Haven's second-largest health care provider, refuses to tell patients anything about emergency contraception. Even a rape victim will hear nothing of the option.

Access to emergency contraception is often blocked because of censorship of medical information by groups with religious and political agendas. This month, the Food and Drug Administration (FDA) will receive a petition from the makers of Plan-B for over-the-counter status.

"Approval is supposedly a nonpolitical process," Moore says. But the case, which will be evaluated by the FDA's Reproductive Health Drug Policy Advisory Committee, leaves much room for worry. The committee was appointed

by President Bush and includes Dr. W. David Hager, an oBIGYN who along with other members of the panel has strong ties

THE NEW JouRNAL

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to anti-abortion groups like the Christian Medical Association and Focus on the Family. In the past, Hager has relied on religious beliefs to make medical decisions, refusing birth control to unmarried women and recommending prayer to alleviate headaches and premenstrual syndrome.

Jane was lucky. As a Yale University Health Services patient, she was able to take emergency contraception when she

FEBRUARY 2003

needed it. With David Hager and others who share his ideology heading federal health advisory panels, however, it is certain that other women in N'ew Haven will not have the same option anytime soonan option that, if medicine and not politics were truly at stake, would not be left to luck.

-Sophi~

/Utsmzan

A GOOD MANY COLLEGE FRESHMEN know (or at least secretly hope) that when they first ~et foot on campus, an oversized plastic cup of warm keg beer is destined to find its way into their hands, despite any state law or university regulation to the contrary.

Yale is no exception. At every party, the obligatory "you must be at least 21 years of age ... " appears above far less discriminating kegs. But if Yale's policy on underage drinking is baffiing now, it was no less so three centuries ago.

In keeping with the puritanical spirit of the day, the laws of 18th century Yale prohibited everything from attending a play to ordering a "strong drink," including beer and wine. A student with alcohol in his room literally paid for his crime: He was fined the price of the bottle. Yet despite these seemingly rigid regulations, the Yale College dining hall had no qualms about serving hard cider to students at meals. The threat of typhoid fever made cider preferable to water, which was believed to carry the disease. But deadly fever or no, the damage was done, and Yalies have been imbibing ever since.

For lchabod Academicus, the comic book creation of WT. Peters, an 1848 Yale graduate, drinking alcohol marked a Yale man's coming of age. lchabod begins innocent, ambitious, and arrogant. But his experience at college soon squashes these tendencies. He throws up after his first cigar, fails his first test, and feels generally down in the mouth. In time, he enters the ranks of mature Yale men: He joins a society, drains pints at the local saloon, and still manages to earn high marks. In fewer than 40 pages, lchabod embodies the college ideal.

While Yale policy may have frowned upon the lchabods of past generations, certain administrators hardly stood in the way.

In 1939, former University President Charles Seymour even went so f.u as to mock undergrads for preferring milk to beer. This public accusation was Seymour's way of recruiting more spirited applicants from the West coast.

But times changed, laws stiffened, and administrators were forced to sober up. In the 1950s the state notified the University that underage drinking, particularly in fra-

9

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ternltles, would no longer be tolerated.

University President A. Whitney Griswold could not comprehend why the state refused to distinguish between fraternity indiscretions and College-sanctioned social drinlcing: "I think we've all been too chickenhearted regarding these fraternities per se ... Can't some fine legal brain resolve this compromise? Isn't there a moral as well as a legal difference between giving carefully prepared and well-diluted punch to minors and selling them strong red eye under a license?"

When fraternities were forced to shut down, the administration faced a new dilemma. The Council of Masters lamented in 1956, "It is agreed that young men will learn to drir:1k and in the absence of fraternities will have to resort to such places of evil memory as Jigger McCarty's and the Paradise Inn, where liquor laws will also be ignored and where women of dubious virtue will be hanging around."

As a result, fraternities were forced to obey liquo.r laws, or at least appear to obey them. A 1956 memo dictated, "either the fraternities will develop in more' WO(.thwhile ways than they have to dace . . . or they will turn within themselv.es and wither and die. Either alternative would be advantageous to the Yale community. To close them up on account of the bars would be ill-advised because the colleges themselves serve hard liquor." Rather than eliminate underage drinking, the enforcement ofliquor laws persuaded the administration co bring alcohol within the University's walls.

With the alcohol question at least temporarily resolved, che administration was caught off-guard by che arrival of drugs on campus. In 1963, che administration was not prepared for the kind of public interest drugs would occasion. After Timothy Leary was arrested for passing out hallucinogens at Harvard, Yale invited a member of Leary's department, Michael Kahn, to join che Yale faculty. At Yale, Kahn lectured about the therapeutic uses for LSD and observed of Yale's attitude cowards drugs: "This is the Yale approach . . . cool, adult and scrupulous in its respect for academic freedom."

Unforrunacely, the scace of Connecticut had a different concept of "cool" and "adult." Arrests rose, and police raided one Yale suite. As more Yalies land-

ed behind bars, some outraged students took notice. Future Deputy Secretary of State Strobe Talbott was first among them.

Launching a personal crusade against che criminalization of marijuana in a 1967 issue of the Yak Daily News, Talbott wrote: "About one in four Yale students has smoked marijuana. It is a simple enough fact, but there are many ways of saying ic: You can say one in four Yale students has broken the law. . .. It is a bad law, but the city plans to enforce ic as though the American Way depended on ic.... The situation is going to be more and more a source of embarrassment to the University and mise!}' to the many students who use pot, until respected professionals--especially educational administrators, doctors, and lawyers--do all they can to get the law substantially changed o r repealed." Strobe, we're still waiting.

-Ellen Thompson

THE NEW JoURNAL

THE

ORCISTS It takes more than chemistry to master ChildhOOd pSyChOSiS By Clinton Carroll

I

at Yale-New H aven Hospital, and 15 children sit around a table silently weaving placemats. Each mat is constructed in a methodical way by methodical little fingers-three incisions in a piece of black cardboard, then red, green, and yellow strips of paper woven through.

T he number of possible patterns is astronomical, but almost every child has settled on the same design-red strip, green strip, yellow strip, repeat. 15 sets of fingers loop in, through, out, and back in.

There is Juan, who hears voices. There is Shaina, a veteran of numerous foster homes, who is prone to violence. There is Jamal, who is manic. There is Dana, who likes to fight. Hardly anyone talks, and the ward moves as one plodding unit-loop, loop, study, loop, loop, study. The plain lighting, the floor of congruent tiles, the blank television screen, and the circle of near silent, smiling nurses-at this moment, the ward is as simple and uniform as the white walls lining its interior.

The scene is so uneventful that I leave and re-enter the room several rimes. There is no activity in the hallway. The bedrooms are empty. T he kitchen is quiet. The collective life-force of the ward, one of the most vital and progressive psychiatric institutions in the T IS MID-MORNING IN THE CHILD PSYCHIATRIC WARD

FEBRUARY 2003

world, is concentrated on one table and 15 sets of working fingers.

First a red strip, then a green strip, then a yellow strip. Repeat.

Every room in the ward is situated along a straight hallway.

There is a classroom with a chalkboard and desks arranged in rows.

Down the hall is a common room with an area for eating and an area for watching television . Salmon-colored couches and chairs are arranged in a loose semi-circle around the TV. Light streams in through windows that overlook a small parking lot. Further down the hall, there are eight bedrooms arranged in alcoves, which are numbered so children can be called and dismissed in groups. To the right of the reception desk, there is a small room with padded walls where children are taken in moments of crisis.

At the end of the main hallway, there is a gallery of children's art. The pictures are not the work of madness, but the scribbles of children, more happy-faced sun~ and dancing animals than ominous dark. Yet there is something troubling about the work. O ne , picture depicts a tree, drawn in green and orange slashes, being overtaken by a wave. "The Storm of Life" is written above the water in block letters. One might almost attribute the piece to a fourth grader pushed to draw something sad. But the lines are too blatant,

II

the lettering too exact. The feelings are very real, at once childlike and not.

T

HE CHILDREN AT YALE-NEW HAVEN

are among the sickest any doctor will ever see. They suffer from a range of disorders that extends well beyond the usual psychological babble. "This is the deep end of the swimming pool," as Dr. Andres Martin, medical director of the ward, puts it. The list of conditions treated at Yale-New Haven is long and varied, and when multiplied across gender, age, body type, and background, it is formidable: Obsessive Compulsive Disorder (oco), severe Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder, Conduct Disorder, depression, mania, autism, Post Traumatic Stress Disorder, Childhood Onset Schizophrenia.

Because the ward at Yale-New Haven is a hospital, not a group home or clinic, it is able to accommodate children whose problems extend beyond the merely psychiatric. One girl named Robin, for example, was brought to the ward after undergoing a battery of physical tests. She was catatonic, and her doctors thought she might be

1'2.

suffering from encephalitis or epilepsy.

When her tests came back inconclusive, Robin was admitted to the ward. Once there, she engaged in bizarre behavior, masturbating publicly and humping doors. Dr. Martin and his team, perplexed, explored several possible explanations. Was she schizophrenic? Had she been abused? But when Robin became physically ill, these questions became irrelevant. She stopped swallowing. Her heartbeat grew irregular.

New tests uncovered a deep-seated epileptic focus in her brain. She was immediately given anti-seizure medication. Within days she was moving about on her own, but her mind was so addled she could not form new memories and had to be reminded of her actions and thoughts constantly. After living like this for a while, something raised her from the dead, and she slowly started to improve. By the time she left Yale-New Haven, she had regained 8o percent of her memory. She was keeping a journal and was expected to fully recover in time.

Yale-New Haven dispenses every psychotropic drug in the book. Stimulants.like Ritalin and Dexedrine are used to treat children with ADHD. Selective seratonin reuptake inhibitors like Prozac, Zoloft, Paxil, and Luvox are used to treat depression and anxiety. Mood stabilizers like Lithium and Depakote, among the most popular psychotropics in America, curb aggression and alleviate depression.

Antipsychotics like Risperdal, Zyprexa, and Clozaril, an especially popular class of drugs in the ward, help soften aggression and psychotic symptoms like voices and visions.

The liberal use of these medications requires patience and knowhow, and the ward spends as much time detoxifying kids as giving them new drugs. "Kids will come here on six different medications. . . . This is not supported by the medical literature," Dr. Martin told me. When children arrive at the ward, they are usually taken off of their old medications immediately.

Once their systems are drug

free, they are reassessed and their disorders are pinpointed. New medications are prescribed, and progress is monitored. The process is slow and careful. Medicine is dispensed at regular intervals, and every behavior from yawning to tantrums is noted in detail by counselors who spend every waking hour with the children. This system creates a highly controlled and simple environment, saturated with some of the strongest synthetics on the market.

Most psychiatric wards, however, in no way resemble Yale-New Haven. If children like Robin were not an exception and if drugs were universally handled in the way Yale--New Haven handles them, the story of child psychiatry would end right here. But the cost of such care is substantial-almost $1,500 per child per day at Yale-New Haven, where the average child stays for 34 days-and over the last decade, hospitals around the country have been buckling under the financial burden.

About half of the psychiatric beds for children in Connecticut have been converted within the last four years. The only reason the Yale-New Haven ward is open is because the hospital is willing to lose money. Less renowned institutions are forced to close, and sick children are sent home. In the worst cases, the sickest are sent to adult mental hospitals; some stay for days in emergency wards, locked in rooms with minimal supervision.

While caring for troubled children does not even approximate a money-making venture, pharmaceutical companies have carved out a lucrative market in psychotropics. In the last ten years, spending on in-patient care and out-patient clinics has dropped significantly, and spending on pharmaceuticals has skyrocketed. The science of child psychopharmacology, however, is still in its infancy, and with pediatricians prescribing more psychotropic drugs than ever, the field is getting sloppy when research has barely begun. Dr. Martin plainly acknowledges, "Drugs are cheaper than relationships." And drugs -do often work, in some cases very well. But health practitioners seem disturbingly eager to hasten their proliferation. As pharmaceutical companies storm the marketplace, many physicians wait with open arms, hoping for a panacea that simply does not exist.

Drugs have become the "quick fix" in a field where a quick fix may not be possible.

THE NEW JouRNAL

T

at YaleNew Haven serves two distinct populations. Thomas Black, Patient Services Manager at the ward, describes the two groups that fill its beds as "children with families and children without them."

At any one time, about half the ward consists of children with stable families who communicate frequently with doctors, visit the ward, and ensure that treatment continues for their children afrer they leave the hospital. The rest of the children are in the custody of the Department of Children and Families (ocP) or Protective Services.

These children are the most difficult to care for, and are usually in the hospital the longest since placement is hard to come by.

Residential facilities and subacute hospitals-which lack the resources ofYale-New Haven Hospital but will ofren accept kids after they have completed treatment there-are almost always full; the waiting period for a free bed can be as long as four months. Foster families, meanwhile, rarely take in older children. Often the failures of this larger system undermine treatment.

Shaina is a small, plump girl with dark eyes and wiry black hair. A motherly eleven-year-old, she spends most of her free time caring for the only five-year-old in the ward. Today she fills a bucket with water and dish soap and invites the child, a little boy with curly black hair and stern eyebrows, to splash with her. The play gees out of hand, and both end up wet and soapy.

Since she was taken away from abusive parentS as a baby, Shaina has been shuttled from foster home to foster home. It is now late afternoon in the ward, and she sics with the older children in group therapy. Even here she is the mother hen, first facilitating a discussio~ on the unacceptibilicy of ward gossip before launching into a brief speech on her own tragic history. Shaina has lived in six foster homes and remembers only one good caretaker-an old woman who listened to her. She does not know where she will end up, and at eleven she is already too battered to be optimistic.

I am sitting in the room, listening. In my backpack, I have a report on child psychiatry in Connecticut, and as Shaina speculates as to what her fate will be, I map it out step-by-step based on the numbers.

Shaina will likely leave Yale-New Haven much better. She .will be functional and vigorous. She will probably be transferred HE CHILD PSYCHIATRIC WARD

FEBRUARY 2003

to a residential facility, where she will live for six months to two years, and then be refiltered into the foster care system. Just like her previous caretakers, her new parentS will keep her for a while and then discard her. Many of them will be older women who lack the energy to care for children, and the problems that landed her in the psychiatric ward will likely return. Like most children in DCP custody-who are six times more likely than their peers living at home to be prescribed psychotropic medication-Shaina will likely be put on a regimen of pills. In the foster care system, these drugs serve a regulatory function.

They keep children manageable, and that is exactly what Shaina will be. That is, until she has her next breakdown. that very nearly stretches from ear to ear. He is the type of kid you grin at in public, a firecracker, giddy and round. He is also one of the sickest children Or. Martin has ever seen. To hear Jamal speak is to listen to a cassette tape in fast-forward-his words slur together in mono-syllabic bullet fire that is at best comprehensible and at worst "word salad," utter nonsense. Jamal is the most manic child ever treated at Yale-New Haven, and the first approved for Electroconvulsive Therapy. The procedure works by sending electric current through highly localized areas of the brain. It operates under the assumption that a manic mind will re-equilibrate when given a jolt.

The treatment, however, does not seem to have worked on Jamal, who sics at the lunch table, downing chicken wings without comment or breath.

He bobs his head as he eatS and goes from manic grandiosity to pouty defiance without warning. He is a mess, and loveable like an alcoholic, stinking of sickness but so human it makes the heart sink.

When lunch is over, I find Jamal dancing oucside of his room. Nelly is blasting from his headphones. He crosses one foot over the other, spins, gives a quick pelvic thrust, and scrunches up his face in tribute to the music and his own genius. One therapist laughs and whispers to me, "He's been doing that dance since he was a little kid."

Most of the children are in community meeting, and everything is running smoothly. But then there is a problem in the hallway. A twelve-year-old boy has

J

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13

emerged from his room, angry and flailing.

He is brought down .b y two nurses, his head pinned to the ground, eyes wide and searching. He struggles at first, and then acquiesces, relaxing his body as the nurses pick him up and walk hi~ to the padded room. As soon as the door is shut, the boy begins to pound loudly and rhythmically.

"You fucking bitches!" One beat every two seconds.

Half an hour later I am standing in the bedroom of the boy who was restrained.

His name is Tyrone, and he sits at his desk writing in a journal, face calm, hair cleanly buzzed. He is urban-cool, with baggy jeans, an oversized t-shirt, and immaculate tennis shoes. Far from a kid rocking in the corner, disheveled and aimless, Tyrone is the sort of boy you expect to find at a mall, picking up girls and high-fiving his buddies. He shakes my hand and shows me his writing, a simple treatise on his own frustrations. Tyrone is a badass living among tattered little ·children, and, for this reason, he is the most tragic character of all.

It is unclear what is wrong with Tyrone. Dr. Martin and I stand in the main hallway, watching him through a window.

He is working on a project, his head lowered in concentration. He might be psychotic. He is frequently disorganized and has an imaginary friend, a surprising fact considering his age and personality. (His friend, Tyrone told Dr. Martin, moved to California when he entered the ward, and wears basketball jerseys and his hair in braids.) Or Tyrone might simply have processing difficulties, a problem that Dr. Martin likens to a learning disability: "If you have a reading disorder, and I ask you to paraphrase a difficult passage, you may give me a nonsensical answer ... and I may wrongly conclude that you are psychotic."

Perhaps Tyrone cannot process directives, and his oppositional nature has formed as a result.

IfTyrone is diagnosed as psychotic, his treatment will follow a normal trajectory.

He will be given an anti-psychotic like Risperdal. If his problems are purely cognitive, like a learning disability, he will be treated with educational therapy. The path to recovery is long in either case, and only days in the hospital, following routine and being tested, will reveal the nature of his

troubles. Until this happens, he will remain a cool train-wreck.

Before lunch, the children line up single-file. The meal is fried chicken, macaroni, and green beans-a surprise, and everyone is excited. Some grumble about having to wait, and a brazen few try to cut in line but are immediately sent back to their places by the supervising nurse.

Portions are slopped onto paper plates. The children sit down at the table, their new placemats already positioned, and eat noisily and happily. One by one, they are called from the room to take their medication. A nurse leads each child away from the

trammg in psychopharmacology. This is minimization at its most potent, and evidenced by the sheer number of children who show up at Yale-New Haven drugged out of their minds. It is easy for overworked doctors to experiment on difficult children: If mood stabilizers don't work, try antidepressantS. Last winter, a boy named Ryan was released from the ward at Yale New-Haven after a month of treatment. Ryan's problems began in preschool. His symptoms were elusive, and all the school could do was recommend he be evaluated by a psychiatrist. His initial diagnosis was "neurological impairment," an illdefined disorder on the spectrum of autism and other Pervasive Developmental Disorders. Ryan

It iS easy for overworked doctors , • • • • tO experiment On diffiCUlt Children: If mood stabilizers don't work try also displayed classic ADHD ' symptoms-restlessness, un- . anti-depressantS. tability, short attention span. In

14

group, and no one seems to notice when one chilq returns and another leaves. This is routine--the nurse giving out the medications knows each kid's name, condii:ion, and favorite color. When routine turns to free-time, Jamal runs to his room and starts dancing.

N TREATING CHILDREN LIKE SHAINA, Jamal, and Tyrone, the biggest danger is reducing them to abstractions. "I can't tell you how many times I have asked about a child at a medical conference and received a haiku presentation: 'Johnny is 13, he has oco, he is taking Risperdal, Ritalin, and Prozac,'" Dr. Martin told me.

This kind of "patient minimization" is not a new problem, but with the mass extinction of long-term psychiatric facilities and the new aggressive drug market, it is becoming increasingly acceptable. In a 2001 report compiled by the the Child Health and Development Institute of Connecticut, Connecticut Department of Mental Health, and Yale Child Study Center, it was found that in 1998 and 1999, 45 percent of all psychotropic presecriptions for children on Medicaid were filled by primary care physicians. This is partly due to the shortage of mental health specialises in Connecticut, and partly a reflection of the times-the state's most complicated children are being seen by pediatricians with heavy case loads and no formal

I

second grade, he was put on Ritalin. H e took poorly to the drug, which not only did nothing for his ADHD, but also seemed to adversely affect his psychological state. He began to roll his head and developed oco. He became increasingly paranoid, convinced that other children were out to get him, and was unable to concentrate in school. He developed an arm flap and became agitated whenever anyone pointed at anything. He was prescribed Adderall, Paxil, and a handful of other drugs to no avail, and fmally announced to his father, "I have to go the hospital." By this time, his parentS had collected a box of forms, signed and compiled by pediatricians, pharmacistS, neurologists, and psychiatristS, and still, Ryan was sicker than ever.

Ryan entered the ward at Yale-New Haven on Halloween, his favorite holiday, and was immediately taken off his medications. Drug-free, Ryan became increasingly paranoid and began to hear voices. One voice told him to saw off his own head, and another demanded he say "fuck you" to God. Bur eventually his _condition improved. A new antipsychotic, Risperdal, kicked in, and he was given Luvox to calm down and help with his compulsions.

Within a month, Ryan was able to graduate to the hospital's partial program, consisting of school and minimal day the.rapy. and was functional for the . first time in years.

THE NEW JouRNAL

This is not to say that Ryan got better.

Mental illness is not dimensional, and Ryan still has problems. After receiving the best care in the world, he is merely functional, not free. Dr. Martin offers an overlooked caveat when describing this sort of outcome: "What people don't realize is that we give these drugs to kids so they can function, so they can go back home and attend school. They are not cures." In some ways, Ryan's story represents the best of child psychiatry: He was so crippled he could not attend school and was turned around in just one month. But he also represents a darker side of the field: It took bad drugs, emerging psychoses, problems at school, problems at home, and a box full of forms to finally get Ryan where he needed to be.

The uncommon denominator between Yale-New Haven and most of child psychiatry is not access to drugs or number of doctors-it is time. It is the plodding nature of the ward, its structured days and slow pace and the patient dedication of its staff. that is indispensibly therapeutic. Dr. Martin will spend a week studying Tyrone before assigning him a diagnosis. He will test him and piece together his history. He will start him on a medication, go slowly at first, and then speed things up if the drug is a match. Tyrone will get better because monotony and routine work.

And this is why in-patient psychiatric wards can never become obsolete-they afford structure and coherence to the lives of children who are, by defmition, incoherent.

When I first visited the ward, I expected, at the risk of seeming voyeuristic, to see spectacular sights-schizophrenic rages, panicked back-room conversations between doctors and nurses. But what I saw could have been a scene &om any school in the country. Only slower. One kid got a little upset and had to be disciplined. Another was hyper. Children tried to push in line to get food. Kids talked about their problems. And for one hour, the children at Yale-New Haven worked meticulously on a craft in absolute unison-just the kind of slow motion and monotony that makes the ultimate case for child psychiatry as something much more than chemistry.

IDI Clinton Carroll, a junior in Branford Co/leg~. is associau ~ditor for TN}.

FÂŁBRUARY 2003

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A teenage dealer is exiled by neighborhood families -including his own

By Paige Austin F

EW AMONG THE CROWD that gathered in front of 209 Rosette Street on November 12TH actually knew Quincy Smith. T hey had come to march in front of his mother's house because they knew his type. Since returning to the neighborhood lase spring, 19-year-old Quincy and his friends had occupied the front porch at 209 Rosette, drinking, smoking, and selling drugs into the late hours of the night.

Legally, Quincy was not even allowed to be there-his aunt, living upstairs, had filed a restraining order against him· several months earlier. Despite the growing tide of complaintS, his mother let him stay. The crowd was here to demand that Quincy move elsewhere.

Holding candles and posters and chanting their demands-"freedom from drugs" and "safe streecs"-hundreds of people marched in a circle in front of the drug dealer's house. At the center was the Smith's next door neighbor, Mark Colville, who lives with his wife, Luz, and children in the Amistad Catholic Workers' House. The Colvilles and another family founded the Amistad house nine years ago as a shelter organizing base for the people on Rosene Street, a decaying inner-city stretch a mile south of the Yale School of r-.I.VIle<litcu:te. When drug dealing on the block to spiral out of control last fall, the called on Elm City Congregations • 6 .u._......... (ECco), an association of 18 city 'CIIIUT•chc::s and non-profit groups, to round its members for an "action."

Unlike most of the people who ,....,.,,...... up that night, Mark Colville knows Smiths personally. But that did not stop from seizing the megaphone and ~n:1er1·1n2 Quincy to stop dealing or leave. crowd understood his frustration.

Drug dealers bring more than drugs to a neighborhood-loud noise, broken botdes, and gang violence are inevitable byproduccs. A few days earlier a stray bullet had pierced the wall of the Colvilles' newborn son's bedroom.

The evening of the action was my first visit to Rosette Street. When I returned by the light of day I could see what the protesters meant about the tokens of drug dealing. The sidewalk across from the Smiths' house was littered with empty liquor bottles; houses were boarded up; idling cars dotted the one-way street, giving the ominous impression of an active trade.

Weeks after the march, I went back to find out whether the Smiths had finally turned out their deviant son, and to see how the Colvilles and the Smiths were getting along in the state of mutual neighborly hatred that the rally had presumably engendered. As it turned out, though, once the dust had settled on Quincy's unceremonious expulsion, no one was more pleased to be rid of him than his own weary family.

B

DIANE SMITH look like sisters, with slightly graying hair pulled back from tired, feminine faces. Before moving to 209 Rosette Street, they shared another house on Atwater Street in Fair Haven. When their landlord lost the lease there, the women immediately had co find someplace cheap. The brow"n house on Rosette Street with a sunken front porch and peeling paint was their best option.

Barbara and her children had lived farther down Rosette Street before, but they had been forced to move after Quincy broke all the windows in that house, a stunt that landed him in juvenile hall until last ARBARA AND

spring. His move back home coincided with the family's return to their old neighborhood, which was also home to Quincy's old friends.

Diane has six kids. The youngest, John, is a year old. He has a strikingly full head of hair and is just beginning to string together tottering steps. Shortly before my visit, the oldest, IGta, had gotten an A on her AP European History midterm. She wants to study forensics, according to her mother, and she plans to go to the University of New Haven next year if the school offers her enough funding. "She used to want to be a pediatrician," Diane said with a chuckle. "But then she said she doesn't want to have to hurt people.

Forensics is better because they're already dead." Barbara has four children besides Quincy, ages six, eight, 13 and 14. Peachy, a precocious eight-year old, is the only daughter. Three of the kids go to the Jebson Magner School, the same one attended by Mark and Luz Colville's kids next door.

No one in the Smith house seems to miss Quincy. Day and night, Quincy's friends made the family's front yard a base for their own means of employment: using and dealing drugs, playing loud music, fighting amongst themselves, and fending off rivals from other streetS. "They hated it," recalled Diane, sitting on the couch in her sister's first floor living room. "They couldn't even go on rhe porch." Quincy himself was shot in the neck last summer while sitting in a parked car down the block. A few weeks earlier he had been beaten across the eyes with a wrench. (Luz Colville drove him to the hospital.) As the protesters chanted his name oucside the house in November, Quincy defended

17

himself to a N~ Havm Register reporter: "I to shutter their windows and wait to be HE FIRST TIME I WENT to the Amistad can't tell the drug dealers to leave. They'll washed back out. "So every year is like an Catholic Workers' House next door, shoot at me." adventure," said Mark ruefully. shortly after the action in November, the Even Looking back, his mother speaks of Quincy used to come to the crowd was thin and none of the kids Amistad house. her son's reckless habits with.quiet sympaIn recent months, he seemed too excited about the corn and thy. "I think in his own way he was scared," appeared a few times while high on drugs chicken breasts on the table for dinner. The Barbara said. Yet Quincy, by all counts, was and told the Colvilles that he wanted to second time, the dining room was filled already beyond his mother's control, and end his destructive lifestyle.

Invariably, his with over a dozen people, and the house the sisters' discomfort never thinned the resolve was gone by the next morning.

"A had the air of a jovial winter retreat. lot of dealers used to come to tutoring crowd on the porch. "We could smell the Anyone is welcome to join the residents of gunpowder afterwards, right here on the here," sighed Luz wistfully. "I don't know the Amistad House for a meal; some of the porch," recalled Diane. The family was frewhen they decided they'd make more guests that night, like James Davis, live at money drug dealing." Mark cut in abruptquently awakened by the ringing of the doorbell late into the night. When ly: "And it's true." Given the poor quality the police came, they were helpful of local schools and the lack you don't have nobody to back and nosey at turns, but their deparof well-paying jobs throughout the ture was always marked by the you up, you belong to the ¡ streets. city, he said, one might argue that the quick return of Quincy's crowd, boys did have more to gain from huswith its stock of noise, drugs, and You're going to die in the streets." tling than tutoring. " Here people violence undiminished by the brief grow up with the assumption that the system won't work for them. It's not interruption. The presence of Quincy's the house full-time while they beat a thankmother didn't deter them either. "They designed to work for them," said Mark. ful retreat from what the directors deem But, as the Colvilles know, miracles are knew exactly when I came and went. They the life of sin. knew my work schedule better than me," not impossible.

James Davis, who has lived While Luz handles the cooking, Mark them in the Amistad house for the last with said Barbara incredulously. She locked anyis generally busy planning and carrying out eight months, used to deal drugs on the thing of value in the basement when she "community actions," targeting everything same streets that Quincy now calls home. went out. She added, "It's nice to go from war in Iraq to budget cuts for city serChristmas shopping, and I don't have to After his years of hustling and stints in jail, vices to neighborhood drug dealers like the police knew Davis by name and were worry about anything being gone when I Quincy. quick to admonish him against loitering. come home."

In the living room of the Amistad "I'd tell them, I ain't got nowhere to go," he Barbara's solution was to throw up her House, Mark still keeps the sign that he recounted after dinner at the Amistad hands and ignore the problem, remaining used to drive Quincy away this fall. It is a house, watching Luz help Elizabeth with doggedly loyal to her son until the protestlarge white posterboard with writing in her homework.

"It was about getting girls, ers from ECCO arrived on the block, bringblack marker: "THEY'RE DEALING DRUGS getting money, and getting cars. That's it. ing news vans, policemen, and a represenHERE!" When drug dealers appeared outWe'd say, 'Stay fresh.'

That's what you've tative from the Livable City Initiative with side 209 Rosette Street two days after the got to do to stay fresh."

Exiled from his them. After that, Quincy could no longer initial rally, Mark began marching in front of his relamother's house nearby because defy his aunt's restraining order by staying of the house by himself with his poster in tionship in the house. " He don't got no choice; he with his step-father, Davis spent hand. When Diane recalled the incident most knows what's at stake," said his mother. of his nights in the basement or stairshe added the obvious conclusion: "He's of a retirement home on Dewitt Street well Barbara expressed a vague hope that crazy." that he and his friends would break into for her son might join a city program to find a Since the one-man protest, the drug shelter.

Because he did not get along with job and finish school, but her words dealers have disappeared. The Colvilles his stepfather, Davis, like Quincy, was not sounded like the tired prayer of a mother came to the neighborhood to effect at home.

He could find only one welcome with no idea what else to say. "I've got four changes just like that, though they alternative.

"The streets are always open. other kids I've got to take care of, and acknowledge that the effeets are ofren The streets never dose.

The streets always they're trying to better themselves," she short-lived. "In this neighborhood and accept newcomers; they don't discriminate. added. She is hopeful that her other sons, neighborhoods like this there's a lot of tranIf you don't have nobody to bac!t you up all avid basketball players in ECco's winter sition," Mark explained. The drug dealing you belong to the streets. You're going to basketball league, will not follow in and violence are endemic to the area, condie in the streets," he said. "I stopped Quincy's footsteps. Barbara's only daughter, tinually reinvigorated by waves of newcombecause I'm not ready to die yet."

Peachy, is bright and talkative. Her cousin ers who bring their trade along with their Alonna cuts a more staid figure. When furniture. "Most people's solution to this is Peachy declared her intention to marry a HERE IS SriLL HOPE, OF COURSE, that to try to make enough money to move out rich man, Alonna announced, "I'm not things will turn out as well for Quincy. of the neighborhood." But families like the going to have kids. I'm going to adopt kids Ecco's lead organizer, Pat Speer, said lacer Smiths are swept in on a tide of eviction that are poor and need a home." that the little follow-up that was done with notices and bad luck; most of them prefer

T

"If

T

18

THE New JouRNAL

the Smiths was more than most targets of actions receive. "We've never paid this much attention to the aftermath before because it's not our business. Ecco is not a social work agency," he said. Still, the Colvilles' intimacy with their neighbors left them little choice but to take note of the aftermath. An ECCO pastor, the Reverend Scott Marks, went to the Smiths' home to offer his help to Quincy, ironically, on the day after the ECCO rally had kicked him out. Quincy of course was not in, and Marks's words seemed wasted on Barbara, who said she wanted to see her son reform but doubted that anyone could make him do it. Hoping to help Quincy join Job Corps or another outreach program, Marks gave Barbara his phone number and called her once afterwards. She did not respond.

When I visited, Barbara was still talking about the possibility of Quincy joining Job Corps. With her son dividing his time between friends' houses and only returning home for occasional, illegal visits-"when he needs clean clothes"-Barbara seemed to have few other aspirations for her son to latch onto. "I really, really tried to convince his mother that she needed to help me to get this meeting set up with Quincy," Marks said later. "Basically she just doesn't have any control and that was clear." The blame does not lie with Quincy's mother alone, he added. Single mothers in New Haven fuce an almost insurmountable burden just trying to pay rent with low wage service jobs, let alone spend time with their children. "That means there's going to be some hustling, part time job here, part time job there," explained Marks.

Marks did not agree that Quincy had been ill-served by the community activists who hollered him off Rosette Street in November. Quincy's lifestyle left no other choice-if not for his departure, Quincy's neighbors would have wimessed his violent demise at the hands of other young men resigned to life on the streets. "I've been on the street and stood over the bodies of guys who've had that happen to them," Marks said resolutely. "Then you can rally all you want to but nothing is going to bring them back."

ECCO

Paige Austin, a freshman in Davenport Colkge, is on the staffo[TNJ.

F£BRUARY 2003

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19

THE MAKERS OF OXYCONTIN STEM ABUSE OF THEIR DRUG, BUT THEIR ATONEMENT GOES ONLY SO FAR

2.0

THE NEW JouRNAL

M

he was seven years old.

He wanted to change the way he felt, and when he eyed the cool lines of a liquor bottle it seemed an obvious place to start. This youthful experiment launched a 2o-year career in drug abuse. At the height ofKinzly's addiction he used anything he could get his hands on-crack, heroin, prescription drugs. Addiction bankrupted him and spawned a complementary nihllism. He moved to Cumberland County, Maine, to work as a commercial fisherman, one of the most dangerous jobs in America. Trips lasted for days at a time, and Kinzly spent his winters bent at the waist and knees, hauling trawls loaded with 20-pound sea bass. Fortunately, Kinzly already knew how to ease the pain of the ocean's beating. "When you're in the middle of the Atlantic in February it's pretty fucking cold and taking a narcotic can really help," he recalls.

Maine includes some of the poorest rural areas in the country.

Work for many Mainers is physically excruciating. They stoop to rake blueberries, stoop to chop pine trees, or, as Mark did, stoop to pull 6o-pound lobster traps out of So-foot waters. When they need to self-medicate, instead of turning to urban drugs like heroin and cocaine, Mainers more often go to their doctor's office or local pharmacy, or they just open a medicine cabinet stocked with orange cylinders of prescription drugs. Lately, rural Maine's pain reliever of choice has been OxyContin, a powerful new opiate first released in 1996.

Anyone who watched television or read the newspaper could hardly have missed it: 2001 was the year of OxyContin. In the spring, a group of young men wearing baseball caps and bandanas over their faces held up a dozen Boston pharmacies and demanded OxyContin at gun-point. The Boston Globe carried a dozen articles on the robbery, and named OxyContin "the hottest drug on the street." On July 29, a cover story in the Nnu York Tima Magazine followed addicts in Man, West Virginia, where every trailer seemed to¡be a drug den, and every Medicaid recipient a hardened dealer of "hillbilly heroin." On back-to-back nights in December, css's 48 Hours and MTV's True Lifo series showcased Maine srudent Troy Swett's futile efforts to kick his OxyContin habit. Much as cocaine and crack had in the 1980s, OxyContin was revolutionizing drug habits. It promised to ravage the nation.

ARK I<INZLY STARTED DRINKING WHEN

BY ANA MUNOZ

FEBRUARY 2003

21

The press quickly identified the mastermind behind America's latest drug epidemic: Purdue Pharma of Stamford, Connecticut, the pharmaceutical company that manufactures OxyContin. Purdue Pharma's aggressive marketing campaigns, according to cnucs, misrepresented OxyContin as an abuse-resistant miracle drug. In visits to doctor's offices across the country, field representatives pitched OxyContin not just to anesthesiologists and oncologists, doctors who rypically treat severe pain, but also to family doctors running small, private practices. Purdue Pharma ran full-page advertisements in mainstream medical journals like the journal ofth~ American M~dical Association, an unprecedented tactic for pitching an opiate pain reliever. Underestimating OxyContin's power, doctors over-prescribed it, saturating communities with a very powerful drug that was easy to abuse.

In the summer of 2002, now twelve years clean, Mark Kinzly returned to rural Maine. This 0 time, however, he came as a researcher, part of a Yale team investigating OxyContin abuse in the state. Over the last few years, emergency medical technicians and police have noticed an alarming increase in overdose deaths in the state. Last December, the state medical examiner validated what had been just a hunch, reporting a 500 percent increase from 1997-2002 in accidental overdoses, 17 percent of which were attributable to prescription drugs.

Nancy Green, a midwife from tiny Calais, Maine, testified before a Senate panel that ten of the 40 babies she had delivered in 2001 were born suffering from opiate withdrawal. More people were dying from, and being born with, drug addiction.

Bur OxyConrin's exact role in the epidemic was unclear. Up until last summer, reports of wide-scale OxyContin abuse remained anecdotal-an MTV story on some strung-out prep school kids, a country midwife's stories about shivering OxyContin babies. The Yale researchers would collect objective data and then organize it in a scholarly analysis of OxyConrin and opiate use rates in Maine. Kinzly and his colleagues intended to hit the streets to talk to doctors and police officers. More

importantly, the investigators would find drug users themselves and talk to them about their habirs. Kinzly thought that given his long personal history with drug use, addicts would trust him, and he would easily get the information his team needed.

But often times, especially in rural Maine, the addicts he found refused to talk.

Maine's drug users didn't trust Mark Kinzly because Mark Kinzly's study was funded by the enemy: Purdue Pharma.

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20TH CENTURY, the medical establishment confined opiates-familiar drugs like heroin and morphine, as well as a slew of more obscure formulations-to cancer wards and field hospitals. Opiates are by far the most powerful of all pain medication, but their effectiveness also makes them one of the most addictive. Government regulations long kept opiate-based medicines locked inside hospitals to prevent mass addiction.

OR MOST OF THE

had long treated pain as a mere symptom of an underlying illness. In recent years, however, anesthesiologists have started to label pain itself a disease. Hormones released during pain production can permanently damage internal tissue.

According to this new logic, the almost 50 million Americans complaining of chronic pain-persistent, severe pain that lasts for six months or more-were not just whining. They were sick.

In 1996, Purdue Pharma introduced a new miracle opiate for treating chronic pain-OxyContin. Most opiate-based pain medications contain small dosages, around 5 milligrams, of active ingredient, that minimize the potential for misuse. Purdue researchers had invented an ingenious new way of packing more opiate into each pill without, they claimed, increasing the risk of addiction. A rime-release mechanism in OxyContin dispenses active ingredient oxycodone gradually over a twelve-hour time period. Pills could now come in much higher dosages-20, 40, 8o, and 160 milligrams. Certain that they had solved the traditional problem of opiates, Purdue Pharma marketed its drug aggressively, claiming that, since the time release mechanism would make abusing the drug impossible, opiates would no longer be a medical paradox. The company believed it had harnessed opiates' power to relieve pain while diffusing their potential to foster addiction. By 2000, OxyContio was the number one selling opiate painkiller in America. Last year, gross sales totaled $1.5 billion.

But as sales mounted, drug users discovered OxyContin's Achilles' heel. Crush the tablets, and the clever time-release system falls apart. Recreational drug users began snorting and injecting pulverized and dissolved OxyContin powder for an immediate, powerful high, one comparable to that from heroin. (One drug co~nselor told me that a recovering addict described the OxyContin high as equivalent to taking 50 doses of percocet.) Because OxyContin is commercially distributed to pharmacies across the United States, it does not require extensive illegal distribution nerworks or black market infrastrUcture: Purdue's own efforts to market and disseminate the drug

F r . every .injured Coast Guard officer saved by an OxyContin miracle, a bored teenager in backcountry maine was sniffing his grandmother's prescription.

22

But during the 1980s, pharmaceutical companies and patient advocacy groups organized a campaign asserting the rights of pain victims to access more effective treatment. Purdue Pharma was at the forefront of this movement. It had invested millions of dollars to develop new kinds of pain drugs, and it made equally generous contributions to activist associations like the American Pain Association to kickstart the lobbying effort to ensure that government regulation didn't keep its product out of the hands of consumers. The company maintained that to treat pain effectively, drugs had to contain opiates. Through initiatives like an interactive website called "Partners Against Pain" launched in 1994, Purdue Pharma trumpeted the power of opiates and channeled the growing demand for pain relief into a cry for more access to opiate-based medications.

In the heat of this campaign, Purdue Pharma gained a powerful ally. Doctors

THE New JouRNAL

meant ease of access for both pain victims and those who would finagle it out of a pharmacist or rob a supply truck for their fix. Five years after irs release on the market, OxyConcin exploded across newspaper headlines as the hottest new drug in America.

When the Food and Drug Administration approved OxyContin, they too accepted Purdue Pharma's assurance that the time-release marrix would be tarnper-proof and that Purdue had resolved opiate's inherenr contradiction. But in 1999. the FDA formulated a new policy designed to combat any "remaining uncertainties" about approved drugs. In a memorandum issued in May of that year, the Task Force on Risk Management required pharmaceutical companies who marketed potentially addictive drugs to design a "risk-management program." Companies had to collect data from around the country on how their drugs were being used. If their research uncovered any previously unforeseen "special risks," the manufacturer had to intervene by limiting distribution or designing mandatory education programs for doctors on cautious prescribing.

But by 2001, zealous regulators were not the only ones threatening OxyContin's future. Newspapers and television specials were suggesting that for every injured coastguard officer saved by an OxyContin miracle, a bored teenager in backcounrry Maine was sniffing his grandmother's perscription. Scared doctors started prescribing OxyContin less. With hysteria spreading and Purdue Pharma's bottom line threatened, Oxycontin's "special risks" were cropping up everywhere. Purdue Pharma had no choice but to intervene.

PuRDuE PHARMA, Dr. Sidney SchnoU spent over 20 years on the fronclines of the drug war, treating opiate addicted patients lost in the hazy territory becween abuse and legitimate pain relief. ln 2001, Purdue Pharma lured SchnoU away from his clinical battles to its corporate headquarters, where he became Executive Medical Director for Health Policy. Despite a growing public relations disaster and the demands of watchful regulators, Purdue's CEO convinced SchnoU that they wanted him to monitor OxyContin abuse not out of concern for their bottom line but "because it's the right thing to do."

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EFORE HE CAME TO

FEBRUARY 2003

From the start Schnoll engineered Purdue Pharma's surveillance of OxyConrin.

With the help of an External Advisory Board of what SchnoU termed "worldrenowned experts," he masterminded a $5 million a year risk management program called Researched Abuse Diversion and Addiction Related Surveillance (RADARS).

In the first phase of RADARS, Purdue Pharma would collect data from across the country. Schnoll would reap informacion from databanks in Missouri, Delaware, Pennsylvania, and Colorado, compensating centers that invested in additional research to meet Purdue Pharma's demands. Backed

by Purdue Pharma's funding, teams would be dispatched to hot zones in rural Virginia and Maine. For Schnoll, this effort-which would divert five million dollars from Sl.5 billion in gross sales-reflected Purdue Pharma's commitment to civic responsibility. "We're a part of society. Even though we are a corporation, we cannot separate ourselves from the society in which we function."

To head up the Maine portion of the study, SchnoU enlisted a Yale doctor named Robert Heimer. When Schnoll first approached him with the offer, Heimer did not hesitate to accept despite the bad press Purdue Pharma had been receiving. While acknowledging that "a lot of negative press...compromises their ability ro achieve their free market potential," he saw their desire to combat "media hype" as perfectly reasonable. Whether or not Purdue hoped that Heimer would expose the alleged OxyContin epidemic as media invention-allowing them to continue their aggressive marketing and distribution campaign guilt-free-he saw no intention on the part of Purdue Pharma to hide or manipulate his findings. In fact, SchnoU had insisted that researchers retain full control over any data collected in Maine, and only barred investigators from publishing any proprietary information, like a technical description of OxyContin's time-release matrix. Nabarun Dasgupta, a field coordinator for Heimer's srudy, spent the entire summer in Maine and ne-Ver saw, met, or spoke with anybody who worked for Purdue Pharma.

On June 28TH, 2002, three days before Yale researchers arrived in Maine, Purdue Pharma representatives convened a press conference in Portland. They had arrived

'â&#x20AC;˘

23

with the team of Yale researchers to help Maine figure out why young men were overdosing and infants were being born addicted to drugs. The press conference was meant to showcase the company's good intentions and civic integdry. But once researchers were on the ground, the effect of the event-and the publicity that surrounded it-seemed to be the exact opposite: Purdue Pharma's spectacle left Mainers distrustful and wary of participating. As Dasgupta recalled, one man refused outright "because it was paid for by Purdue."

B

UT BEFORE POTENTIAL PARTICIPANTS

could turn down Nabarun Dasgupta and Mark Kim.ly, the Yale team had to fmd some. OxyContin adc::Ucts, to no one's great surprise, proved somewhat hard to find. It's easy tO pick out some kinds of opiate addicts. For example, Kinzly could stroll through a neighborhood known for its drug trade and identify heroin users by the scars in their elbow crooks, between their fingers, and, since it was summer, on the tops of their feet. But pills do not leave similar tracks.

To find prescription pill users, Heimer's team used a research method called respondent-driven sampling. They printed up hundreds of yellow coupons emblazoned with the acronym CASUMCommunity Assessment of Substance Use in Maine-with three c::Ufferent phone numbers where investigators could be reached. Respondents who could prove they were opiate abusers would get $20 for their interview, and five dollars for every additional person they referred to CASUM. Kinzly and Dasgupta carried booklets in their pockets, gave them to methadone clinics and doctors' offices, and deposited them in unemployment offices. Word of the study spread much the same way that word of OxyContin had a few years earlier.

A user might pass his friend a coupon as a way of making some extra cash. When a dealer slipped his buyer a baggie, he might tuck a folded coupon underneath.

Dasgupta and Kinzly went anywhere users were comfortable being interviewed: coffee houses, parks, people's homes.

Investigators first presented participants with an 8.5 by II chart, a sort of police lineup of 20 different tablets, and asked them to point to the drugs they had done in the

last 30 days. They slipped OxyComin somewhere into the middle, a diagonal staircase of pink, gold, and green pills.

Respondents who signaled any opiate qualified as participants. After some initial quantitative questions, the sessions turned free-form, flowing into conversations that lasted anywhere from five minutes to three and a half hours.

Kinzly and Dasgupta heard countless stories like that of one accident victim, a former Coast Guard officer who had been hurled against the side of a yacht by a wave.

The impact severed one testicle, pushed the other inside of his body, and paralyzed his entire right side, leaving him unable to perform even the most menial tasks without pain. Doctors prescribed everything-

say hello--although sometimes passerbys had an ulterior motive since, as he put it, "they knew we had condoms and other harm reduction tools and we would give them out."

The Yale team also used Purdue Pharma's money to fight Maine's addiction problem in more systematic ways.

Researchers taught EMTs and policemen to use Naloxone, an opiate antagonist that neutralizes a high when injected, and connected local authorities with funding sources to keep it in stock. Since users were often amateurs playing in a league of drug habits way above their skill level, Dasgupta and his colleagues trained them as well.

They designed and disseminated pamphlets on how to snort, smoke, and inject while doing as little damage as possible.

Purdue Pharma has also intervened to fight OxyContin abuse. When pharmacies complained that dealers were using fake prescriptions to obtain OxyContin, Purdue Pharma created a new forge-proof prescription pad for doctors to use specifically for OxyContin. They pulled a 160 milligram pill from the market because its danger to adc::Ucts outweighed its medical value. Six months ago, RADARS data revealed that Maine's dealers smuggled much of their OxyContin in from Canada. Purdue Pharma now stamps each Canac::Uan tablet with the letters CAN, allowing law enforcement officials to identify illegal tablets on the street. When an armed gang robbed a Mexican warehouse, Purdue Pharma halted distribution there. Purdue Pharma scientists have started work on a reformulated OxyContin pill, one that keeps the timerelease mechanism intact even when pills are crushed.

Accorc::Ung to Schnoll, Purdue Pharma will unveil the second phase of its riskmanagement program, its official intervention plan, in the next six months. He maintains that if the CASUM team's programs and Purdue Pharma's reforms last year are indicative of anything, it is that Purdue Pharma will maintain a community-oriented focus, and will make the commitment to "understand the problem and assist in any way we can." But Purdue Pharma has already staked out firm boundar!es to their magnanimity. As SchnoU sees it, Purdue

Purdue Pharma has already staked out firm boundaries to its magnanimity.

Percocet, Methadone, Vicoc::Un-but nothing worked. After a doctor's suggestion that he try street heroin left him strung out for two years, he c::Uscovered OxyContin. It worked.

"We were going 12 to 16 hours a day. It . was a lot of damn work," Kinzly remembers. In the end, the Yale team conducted 275 interviews over two and a half months.

This spring, they will release a full report of their findings.

D

ASGUPTA DOESNT NEED A REPORT co validate his efforts for Purdue Pharma.

He knows he helped suffering addicts. One man arrived to his interview with puffY hands infected from using dirty needles at shallow angles to shoot up. Dasgupta connected him with a local needle exchange program and taught him how to inject properly. He met an AIDS patient who first used OxyContin co alleviate pain caused by anti-retroviral drugs. When Dasgupta met him, he was struggling to get clean, but hated attending crowded, often useless Alcoholics Anonymous meetings.

Dasgupta gave him the number for Narcotics Anonymous, a much smaller program targeted at opiate addiction. By the end of the summer, people recognized Dasgupta on the street and would stop to

THE New JouRNAL

Pharma "is a pharmaceutical company; we make medications to help physicians do their jobs better." After 20 years of working in addiction therapy, Schnoll knows there is a "definite need for better treatment," but adds that "is simply not our job." What this means is that Purdue Pharma will never direcdy fund any treatment programs.

Mark Kinzly is proud of his work in Maine last summer because "as someone who has been on both sides of the streetboth as a research subject and as a researcher-it's critically important to me that we do good work in the community so that they can make changes." Still sometimes he knows he could have done more: "Yeah, I wish we had one percent of their profits to do really good intervention, like treatment programs. I also wish that frogs had wings so they wouldn't bump their asses when they jump."

ATE IN JANUARY, Carrie PerkinsMcDonald got a call from a desperate, middle-aged father. His 19-year-old son had become addicted to OxyContin over a year ago and had robbed his parents to support his habit. Now they have been forced to file for bankruptcy. Lately, McDonald, who works a double shift as the co-director of Neighbors Against Drug Addiction and the director of the Opiate Treatment Planning Grant, in Calais, Maine, fields phone calls like this at least twice a week.

Perkins-McDonald spent her entire life in Calais, a town whose one cab is the only taxi service in all of Washington County.

One of her best friends from high school

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FEBRUARY

2003

won a full scholarship to Boston University Law School, but her addiction to OxyContin prohibited her from attending. Last time PerkinsMcDonald saw her, she weighed 90 pounds and had contracted hepatitis c from injecting unclean drugs. Another best friend's OxyContin habit precipitated a miscar. riage three months into her pregnancy. Over the last year and half, Carrie has tried to supplement this anecdotal evidence with hard data illustrating the growing public health crisis ravaging her hometown.

People in Washington County, Maine's most rural region, where almost a fifth of residents live below the national poverty line, have always turned to drugs.

In a 2002 survey, the Maine Office of Substance Abuse interviewed high school seniors about their drug habits. While Washington County teens, according to the data, binge drink as much as their peers in the rest of the state, almost twice as many use O:xyContin-5.8 percent in Washington County versus 3.2 percent everywhere else. There are ads in the local paper urging people to become foster parents-a dire need in a county where last year the number of children removed from the homes of addicted parents increased 50 percent.

Kicking an opiate habit is almost impossible in Calais, however. The nearest methadone clinic is three hours away, and state and federal agencies have rebuffed Perkins-McDonald's efforts to create a closer one. Ironically, Purdue Pharma is the only institution that has come to Washington County's aid over the last two years. They gave Perkins-McDonald $5,000 last year, which allowed her to rent an office space in downtown Calais and print prevention pamphlets with the leftover money. Last fall, the local-high school ran out of money to pay their in-house drug counselor. Perkins-McDonald had the city council write Purdue Pharma a letter lamenting the loss. Within three days, the company donated $40,000 to keep a counselor in the school.

In October 2001, a Purdue Pharma representative arrived in Calais claiming to have a solution. At a banquet dinner funded by the company, the representative announced a new education plan that would keep children from trying drugs. It was called "Painfully Obvious." Inside each kit was a gelatin model of a human brain.

A glossy pamphlet inside described the gory effects of opiate withdrawal--constant diarrhea, vomiting, and severe shivering. A few gradations of the obvious later, under heading labeled "RidiCulously Obvious," the pamphlet let kids know that "DEAD PEOPLE ARE NO FUN"

But the parents of Washington County's opiate-dependent teens were impatient with anyone offering gimmicky prevention tools and simplistic pamphlets bearing sober warnings. Their children were already beyond their control. As tensions rose, one man stood up and demanded to know why Purdue Pharma could not spare a fraction of the millions of dollars in profits from OxyContin to give Calais what it needed most-a treatment center to help those already addicted get clean. In reply, the spokesman repeated the company line: Purdue Pharma's obligations extend only so far. The company only makes drugs. While they want to make sure their products are properly used, getting addicts off drugs is somebody else's business.

Ana Munoz a junior in Branford Co/kg~. is on th~ staffo[TNJ.

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EHIND A PARKED TRACTOR on a racetrack in Queens, cwo men in raincoats squeeze the belly of a horse. The horse bucks, the jockey approaches, and the stable-hands pull the saddle strap around the horse. Above them the American flag waves in the snow-heavy sky, and the national anthem begins to play.

340 people, who each paid $300 for the chance to compete in the richest and toughest gambling tournament outside of Las Vegas, are watching from an off-crackbetting stadium (OTB) almost 8o miles away, in the outskirts of New Haven. The contestants rise for the anthem as it filters through the speakers high above. They stand between rows of white-clothed tables, their faces lifted towards the moving mosaic below the stadium's ceiling. It is there, on one of four giant television screens, that their horses are waiting to run at the racetrack in Queens.

The contestants before us are gathered for Sports Haven's seventh annual National Handicapping Challenge. This is a contest becween some of the best gamblers in the country. It is a contest to determine who can best predict the future by looking at the past. They are waiting for the races to start,

for the chance to show that they have mastered a game in which everyone loses. They are studying the Daily Racing Form, they are gripping their lucky pens, they are calculating the odds. .

The rules for the contestants are simple: place ten wagers on any ten horses over the course of cwo days. Whoever wins the most money on these ten will win the tournament, collect $40,000 in prize money, and find himself on an all expense paid trip to Las Vegas for a chance to compete m the National Handicapping Championship. Everyone here today thinks he has discovered the secret to gambling. Only one will walk out a winner.

In Queens, the anthem has ended.

The jockeys are mounting, the owners are perhaps praying, and the handicappers in New Haven are about to find out what it takes to win the game of chance.

H

ANDICAPPING CONTESTS, like this one at Sports Haven, have reached an unprecedented level of popularity in recent years. They are part of an ongoing proliferation of gambling venues across the country, a trend that began over 20 years ago when America placed its first wager. The

wager was simple: legalize gambling, the ancient pastime of sin and vice, and hope for the best. In New Haven, the bet was placed early: In 1979, the city became the first in the country to build an OTB. On opening night," a crowd gathered in the parking 'lot of the towering stadium just off I-95¡ The doors opened to reveal a strange new world where wagers could be placed on horses running hundreds of miles away; where you could lose your last dime and be only a hop, skip, and a jump from a home-cooked dinner of mac and cheese. These first patrons were wined and dined on the top tier of the stadium, with musi~ and a feast. Thus began a ritual that for some gamblers has continued until this day. Some still park their cars in the same spots and cast their bets from the same tables. They come for the thrill of the game, the fine service, and the good company.

On some scoreboards, this national wager has paid off. Thousands of Americans across the country gamble¡every day and have a grand old time. In 1998, gambling grossed $50 billion, more than movies, theme parks, and the music industry combined. Last year's champion of the

THE NEW JouRNAL

Sports Haven Handicapping Challenge drove home with an enormous cardboard check for $40,000 in his backseat and woke up to his name in the paper. As the brochures at Spores Haven assure the novice gambler who wanders through its renovated doors, Racing is Fun! On ocher scoreboards-scoreboards that are not displayed in the casinos-the dice fall differently. A few years after chat first opening night, a father forgot his son in the new OTB in Norfolk. It became the big family joke: a little boy at the OTB all by himself with the gamblers. This little boy's father was a gambler. Every night at dinnertime, his father would say, "We need milk. Milk and cookies." And then he would drive over co the store to pick up milk and .cookies. On the way, he'd stop at the phone booth, drop in a dime, and call his bookie to place a bet. The house had more milk and cookies than any ocher house on the block.

Walk into any OTB in the country and chances are one of any four gamblers sitting at a cable watching the screens-perhaps the one who is snapping his fingers in circles and scamping his feet and shrieking "holy mother-of-god"-is there because he

FEBRUARY

2003

can't say no to gambling. But then again, there is always the chance that he will master the game.

HE FIRST TIME STUART "BEEP" Rubin, defending champion of the toughest handicapping tournament in che country, went co the racetracks, he fell in love. In 1977 his father-"the best guy on earth, may he rest in peace"-took him co watch Seattle Slew win the triple final. The young Beef fell head over heels in love with the pageantry, the color, the ambiance of the races. But, as is sometimes the case with love, it took four or five brutal, painstaking years before he made sense of the game.

Today, he has come back co win. He will use his mind and strategy co control the races that once almost controlled him.

After the anthem has filtered through the broadcast system on this first morning of February, Beef pulls his gray beanie back over his shoulder-length curls and makes his way through the crowd. Beef is stocky and moves quickly. He carries with him a scotch, no ice. Around him, the darkened stadium is abuzz and swirling. Jazz muzak is falling from towering speakers. The Lakers are dancing and dribbling across a

T

giant screen, looking down upon another screen on which dogs are chasing rabbits.

The contestants are burying themselves in the Daily Form, under ringlets of smoke.

Beef seems impervious to it all.

Beef has set up an "office" from which he will implement his finely tuned plan to beat the odds. He has chosen the far-end of a table that faces a wall of mini-television screens. A placard of sorts marks his seat: a torn-out ad featuring a red slab of beef.

Beef sics down at his desk and starts talking strategy. His face is damp with perspiration.

In the Bronx, Beef has another office from which he runs his second career as an Education Evaluator for the New York Department of Education. In that office, Beef once tried to hang a beautiful calendar of Churchill Downs. But he had to cake it down: Parents told his colleagues they did not want a gambler evaluating their children.

Here in his temporary office, nobody says anything about the beef ad. This is where Beef will take his expertise of statistical analysis for evaluating children and apply it to evaluating horses. Beef's secret to gambling lies in the sprint-pace race--

27

meaning he will generally only bet on races shorter than seven eighths of a mile--but that's only part of the story. "The people who win at this-it's a lot of work," he says, nodding at the contestants around him. Beef put in six hours yesterday, analyzing the races to predict which horse will bring home the money in a complex and very difficult process known as handicapping.

The basic premise of handicapping is that if you take the time to study the horses, to research the sire of the horse, the sire of the horse's dam, the number of workouts the horse last run, the post position of the horse, the horse's doses of the steroid lacix, if the jockey is a journeyman or not, if the turf is soft or hard, if the blinders are on or off-you can control the races. A retired horse-owner who flew up from Florida spent an hour on the plane and another three at his hotel handicapping. One contestant, a meteorologist, has created an entire website to showcase his own statistical analysis of the winning probability of every breed. The Tournament Maverick spends every day working nine to five busily computing an infinite number of variables.

Handicapping helped wean Beef off the addiction that sometimes likes to curl up in the laps of gamblers. He has created a successful career of controlling the races. Now, he says, he can go rwo, even three weeks without placing a bet . "Unfortunately, the bad apples, the compulsive component of the game, get the spotlight.

And so business guys like me don't get the spotlight, the ones that

look a~ it like a business, as opposed to a compulsion." Beef takes a sip of his drink. The turquoise stone on his ring glimmers. He is not nervous. The first race is starting, and today may be his day to control the races. The spotlight is where it should be: on the real winners, the people who treat this game as a skill. Not on the bad apples, the degenerates who give gambling a bad name.

Across the room from where Beef is placing his wagers, another man has set up camp in his usual spot. A custodian by day, he and his buddies have been gambling at Sports Haven for as long as any of them can remember. They usually come here, to this corner of the stadium that overlooks the sea of glowing televisions below, to bet on the dogs. This is the place where a few months back, on a late Monday afternoon, he and his buddies sac down to calculate their cumulative losses.

They came up with over $I million. On that afternoon, the custodian admitted that he has a gambling problem.

The custodian, who has paid his three hundred dollllfs for a chance to win, has seen the best experts lose it all. Mr. Sports H aven, pushing 65, was there that afternoon when they counted up their losses. Mr. Sports Haven earned his name when he made $27,000 in one day. You could say he saw the future--that is, until he turned around and lost every penny of it. He is still trying to win it back.

The custodian used to work as a clerk at the Plainfield dog cracks in New Jersey before he moved to New Haven and made

Beef takes a sip of his drink.

He is not nervous. Today may be his day to control the races.

THE NEW JouRNAL

Sports Haven his second home. He has seen traders shoot up the dogs to make them run faster, he has seen people win $39,000 in one day and then blow it all in a couple of hours. He knows now that no matter what the brochures tell you about it being a game of skill and education, when it comes right down to it, there are no experts and anything can happen to anybody. Even to the best.

Today, the custodian is back to gamble on the horses. Dogs are his specialty, but he knows that sometimes luck can be a lady. A couple years ago--this was over at Plainfield-a lady with tarot cards served him luck on a silver platter. She laid her cards out and looked right at him and said: "Five, eight, and six are your lucky numbers." When it came time for the races, he looked at the numbers written out on a slip of paper. Then he studied the odds on the screen and handicapped. He sat down and watched as the dogs set out from their starting pins and raced around the track. The little number five passed the line, followed by number eight, and right after that number six, who brought up the rear. The custodian had lost his shot at $I3o,ooo.

The table where the custodian gambles, has seen a lot of losses. But it has been good to the ones who lose. It brings them back every afternoon and every night and into the morning and gives them a place to go. But if the custodian could have one day backthe day when he first walked through Sports Haven's doors-he would turn around and walk right back out. Knowing now what he didn't know then, no questions asked, he would never have started to bet. Because in this game, he says, you always lose.

A MAN ow ENOUGH to be the custodian's father is working on his .flhobby while the countdown to the Aqueduct race begins in Queens. Frank Aureimma is sitting quietly, alone at a large table in the non-smoking section near the wash-closet. He breathes deeply, looks up at the race countdown on the screen, and turns back to the newspaper resting in his hands. He has a broad face and widespaced eyes and seems to be in no particular hurry.

When Frank set out from his home in Long Island, his wife threw her arms around him and said, "Go get 'em kid." When he arrived at Sports Haven, his son called him on his cell phone to say hello. It didn't always used to be like this.

Frank grew up at the races. He lived four blocks from Aqueduct, the track that is now coming into focus on the screen above him. By fifteen, Frank was already making the walk to Aqueduct and gambling there every day. By 20, he was gambling twice a day. By 30, the losses were building up and up and Frank was banging his head into walls. The addiction had settled in and made itself at home. The races had become more important than family. It was around this time that Frank cashed in and bought a horse himself, a trotter named Three 0 One. Three 0 One helped break the strength of the addiction. For the first time, Frank saw the gambling's seemy underbelly. He was there when Three 0 One got sick, he learned about all the ailments that can plague a horse and upset even the best handicapper's analysis. Frank began to put all his energies into the horse, and away from gambling. He eventually became the proud owner of twelve horses. The addiction was slowly being pushed away, forced now to sit at the very base of his chair. It is still there, he says, and it will never leave. But for the past 30 years, he has been the one in control. fEBRUARY

2003

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"Must have gone through a billion dollars before I found it out," he muses today. This man, th e President of Carvel Ice Cream, has finished in the top four in at least four recent h andicapping tournaments. He has forbidden his children and grandchildren to gamble. "There's really nothing to be derived as a positive thing when it comes to this," he says solemnly in the lull before the races start. "There's a lot of people that shouldn't be gambling."

Frank himself is here for the sheer pleasure of the men tal challenge that the races present. H e is here because of the good fun that comes from handicapping, one of his favorite hobbies. And because he is still trying to get back the 20 dollars he lost in 1955. H e smiles. He is still chasing his losses.

S

OMEWHERE THE RACES ARE STARTING.

The wagers are in, the horses are ready, the handicappers are watching.

203-787-4496

I

And thry're off! The favorite numb" seven is making the lead at the pace call flashing speed chasing to midstretch, numb" two is breaking slowly, making a wide move on the extreme outside of the turn, and numb" five is picking up the dijfirence from the inside, trailing c/ou behind numb" seven. Numb" seven is stili holding onto h" six length lead, numb" five is cutting the difference, number six leading now by four lengths, slipping back to two, one... and number five has reigned in for a clean break-away, holding the pace up top, numb" seven has fallen back and number five has taken the lead. And were in the final stretch now, number two is gaining pace, and it is neck and neck between two and seven, five stili holding the lead.

It looks like a win for number five, place for two and show for sev~.

Another race is over. The winning wagers are being tallied. The final resul~ will be posted after the last race has been run. All that is left to do is wait for the score.

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ONIGHT, AS THE HANDICAPPERS

are

leaving the tournament, after the scoreboards have been wiped clean and the white table cloths fold ed away, a man who,

30

THE NEW JouRNAL

as a little boy, was once left alone in an OTB in Norwalk will drive up to the back door of St. Brendan's church. He will have come for his first session at Gambler's Anonymous. He will make his way to the basement. It will be silent, save for the hum of the overhead lights that run the length of the long room filled with cafeteria-style tables. Flat pink walls will frame a stage at one end of the cold room. Jason will sit down at a table to talk, because his life is spiraling out of control. He lost it all. H e wants his life back, but he doesn't know how to do it.

At night he can't sleep. He eats fast food because he doesn't have time to cook.

He can't be away from the phone because he has to know the score. He gambles for the action, for the constant hope of making the score.

When he finishes his story, he will look down at the table where the old ladies play bingo. Thirteen compulsive gamblers, sitting in a horseshoe, will clap. The former pro-baseball player, who was released from the team in 1967 and turned to gambling and walked into his own world, his own cellar where $8o,ooo disappeared the next year, will tell Jason it will be alright. A teacher will tell Jason he understands his story. The salesman, who used to lie to his wife, will offer advice. (He would tell his wife he was going to the mall. He'd drive right up to the mall and right on through it.

He'd stop at the OTB in Hamden tO place his bet, drive home, add lie in bed with his ear next to the radio on low so as not to wake his wife because he had to hear the scores.)

These a.re the gamblers who some would lab~l the "degenerates": the ones who have lost control of gambling. They will remember that the closest friendship you have when you're a gambler is with the mailman who brings the bills-the $1000 telephone bill to the sports line to bet on the horses, the five pages of cash advances to make up for the losses. They will remember that the main link with the world is the phone booth-where you step inside and slip in your dime and hope for the best. They will remember the kind of hoping that makes you forget your twin daughters sitting in a locked car, waiting half an hour for their father to return from scratching the lotto ticket.

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2003

Jason will listen to these stories and will know that he has found where someone knows what it means to be addicted to gambling. Tonight the compulsive gamblers in the room will be calm. Some of them will be the most serene they've been in years. They will be far away from the OTB stadiums, where the final scores for the best and dedicated handicappers are now being posted. have been tallied.

The hobbyist, who held third place for the better part of the morning, finished tenth out of a 340 contestants. He is driving home to his family with $2,550 of contest money in his pocket. He is looking forward to attending another tournament in July, where he will use his skill to master the game. The custodian finished in the top 50, with his name posted on the website. He will be back to Sports Haven. And as for the defending champion: When Beef drove home to the Bronx last year with his $40,000 check in the back seat, he drove home blind. He thought he was going to die. The check took up the whole of his back window. He drove through a rainstorm so bad he couldn't see where he was going or what was coming up from behind.

The champion made it home, went to the pub, bought everyone a drink, and woke up the next day at 3:30 in the afternoon.

This year, Beef drove home on a losing ticket. Despite all his expertise, despite having picked many of the winning horses, Beef didn't even make it into the top two hundred finishers. But it was worth it, he says. He'll be back. Maybe not this year, but he'll be back.

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HE FINAL SCORES

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31

Medicine Man A t three o'clock, on the day of what I was sure to be my death, ,...,os was a hotbox of crowded flesh, gasoline fumes, oil palms, unseen microbes, and screaming children returning from a concrete-block school. Dust kicked up under feet and wheels, volatile molecules shuddered and rose from open sewers, sweat evaporated off the cuticles of plants and people, and all these particulates took communion in a heat-trapping screen above the city. Jos. Its name is an acronym for Jesus Our Savior--dubbed so by missionaries, the first Westerners to visit the town, which later became part of Nigeria's Plateau State. Since those first missionaries, many foreigners have come to Jos. Lying in a bed at the Jos Government Clinic, I wondered how many of those foreigners had died. I kept asking myself, How did I get here? Where did I go wrong?

The year before I entered medical school, I was studying Yoruba traditional healers in southwestern Nigeria. My research was to last ten months. Having traveled for long periods in the past, I understood the intensity of such a commitment abroad. To avert homesickness, I invited my father to visit me halfway ~.r;ough my stay.

Upon his arrival, I showed him all around Yorubaland. Taking him both to tourist centers and the rural sites where I did my research, I gave him a full introduction to Yoruba culrure. I took him through the fetish markets of Ojo, where he saw the antelope skins with the mark of Ifa, the diviner-god. I brought him to University of Ile lfe for dances where they blared the Afro-pop of Lagbaja, Femi Kuti, and his great father Fela Kuti. I broke bread and drank palm wine with him and the witches of the Yoruba Kabbalah Center-an instirute that unifies Judaism with the Yoruba oro. I delivered him into the presence of Egungun, the beautiful and frightening festival of elaborately masked men, who were not men but gods. We also traveled to the North, an area with a lifestyle influenced more by the Sahara than by the tropics and with animist traditions influenced more by Islam than by Christianity.

Learning the Peril

On that trip to the North, things fell apart, slowly and irrevocably. I woke on the morning of our flight with a high fever, joint pains, a pounding headache, and mild vertigo. I was sure I had malaria. On a previous excursion to West Africa, I had contracted the disease after refusing to take Lariam, the medical prophylactic of choice. I knew my relatively mild symptoms like an aura before an epileptic fit.

Canceling the trip wasn't an option. Our tickets were nonrefundable, and our flight left m~ch too early for me co visit a doctor and confirm my self-diagnosis. I could, however, self-medicate.

Fighting my fever, I worked through my options. Chloroquine was the first treatment that came to mind. But Malaria folciparum, the most common strain of malaria in West Africa, had been developing a resistance to chloroquine for years. In any case, I bad left my only chloroquine stashed at my rural research site. All I had with me was a supply of Lariam.

A 250 milligram dose of Lariam, taken once a week by mouth, has kept many travelers malaria-free for more than a decade. It seems easy-just swallow a little pill and you stay free of the parasite. In reality; it's more onerous. It is not rare for Peace Corps Volunteers (Pcvs), diplomats, researchers, and others who take have taken Lariam to complain of upset stomachs, diarrhea, vision problems, headaches, and dizziness-symptoms strikingly similar to malaria itself-as well as strange dreams and a sense of having "not been right in the head." Locals often tell stories of PCVs that have "gone crazy" and who have been sent back home. I once heard a story of a PCV stationed in a small village of Akonsi in the Akwapim hills. He began to develop what the psychiatric community calls "ideas of reference" and "delusions of grandeur." He believed he was a holy man, sent by local gods to save the village. When the Peace Corps reps found him in the bush, he was screaming to the locals, "I am not a white man! I am a god! No, really, white men have acted as gods in the past. But I'm different. I AM a god. Really. I WILL save you. I have a plan, an elaborate plan for eco-tourism that .... " He

;of Self-Medication

went on and on. Of course, none of it was in Krobo, the local language; the PCV hadn't been in Akonsi long enough to learn it. When I asked her, the man's Peace Corps replacement said the madness had been attributed by their doctors to Lariam and "a predisposition for psychosis."

In me, Lariam's side effects had been mild, and in Nigeria I had faithfully taken Lariam once a week for the entirety of my stay. (The drug's 99 percent effectiveness should have made me suspicious of my self-diagnosis of malaria, but that fact seemed to slip my mind.)

The side effects that I knew, however, were the result of one pill, the prophylactic dose--250 milligrams-to be metabolized over a whole week. The treatment dose, however, is five pills-1250 milligrams. If I took that much at once, I could very well go crazy. I argued to myself, I probably have a ton of residual Lariam circulating through my bloodstream already. My body seems to tolerate that well. What will a few more pills hurt?

I took the pills. We flew to Jos. My malarial symptoms resolved.

As my father and I wandered the streets and markets of]os, my world began to change. My headache, my vertigo, my joint pain, my fluctuating fever-they all returned with a fierceness that surpassed my previous definitively-diagnosed case of malaria. My senses began to expand. The colors of the market seemed to rise from their surfaces. The din of the busy streets began to separate out into their components-the blare of a car horn, the sputter of a lorry's engine, the rumble of Hausa voices, the howl of a baby, the palpitations of my own heart. The noonday heat worked its way into my skin. Ic became electricity, pushed aside my cells, worked its way into the interstitium of my consciousness. At first my heightened senses elated me. I thought it was the inherent awareness of being in a new place. Soon though, something told me it couldn't be just that.

Three hours later, I was lying in the Jos Government Clinic.

Though the peripheral blood smear at the clinic's lab showed no

FEBRUARY

2003

By Dagan Coppock malarial parasites, I developed a fever-not a known side effect of Lariam. In an attempt to reduce the fever, I removed my shirt and khakis. All night, my father wiped down my skin with a wet cloth.

On that bed in ]os Government Clinic, I wasn't a doctor. I wasn't my father's all-knowing guide. I was a boy who had swallowed a pill without thinking.

My father was more frightened than I was. He asked me, "What if the lab is wrong? Isn't there just another pill-something different we can give you for the malaria?" "Yes, I could take chloroquine. But, if the lab's right, and all of this is drug-induced and not malaria, it could get worse. Lariarn and chloroquine are in the same drug family. Maybe chloroquine will just add to the damage."

The next morning, my father and I flew back co Lagos. I was treated by both the American Embassy's physician and a hospital run by Israeli expatriates. Though the embassy's lab discovered one malaria parasite in my blood, neither the American nor the Israeli physicians could confirm that my debilitation had been caused by malaria. They felt that one parasite in a microscope's high-power field meant little and could easily be a lab error. None of the doctors could make a definitive diagnosis. They could simply keep me hydrated, monitor my vitals, and control my fever.

After a few days of being monitored at the Israeli hospital, I recovered. At the American Embassy's request, I flew home, underwent a physical, and received a clean bill of health.

A few weeks after my research in Nigeria was complete, I entered Yale Medical School. Now in my third year, I have recently completed rounds on a pediatrics ward, where on an out-patient basis doctors deal largely with seasonal colds. I've been struck by how often parents demand antibiotics for their sick children despite the warnings that the drugs do nothing for the common cold and ultimately make bacterial infections more difficult to combat.

At first the parents' insistence frustrated me. One man refused to leave until his child was given "a shot or some pills or something." But I recall the temptation to abandon the protocols of evidence-based medicine in favor of a quick fix. Is it hypocritical for me as a doctor-in-training to refuse my patients' demands for a pill, any pill, to stop painful symptoms when I learned first hand in Nigeria how strong the temptation to seize a simple solution can be?

The answer is no, because I also learned in Yorubaland that to be a doctor is more than simply to be the guardian and dispenser of precious, omnipotent pills. It is to form the holiest of bonds--one based on the sustenance of life and health. Ic is a bond that could have saved me from my own mistakes and my near-death experience on that day in Jos.

'â&#x20AC;˘ Dagan Coppock is a third-y~ar stulknt at th~ ~k School ofM~dicin~.

33

..

The Future of an

N SEPTEMBER 1968, RicHARD NtxoN STEPPED up to a podium and uttered a few words that changed the course of history: "As I look over the problems in this country, I see one that stands our."

What Nixon called "the modern curse of the youth" was encouraging crime, fostering apathy, and "decimating a generation of Americans." The scourge was narcotics, and the remedy that Nixon proposed-the War on Drugs-has not only endured, but also permanently infiltrated American discourse. On that day, drugs became part of a netherworld, the realm of outsiders and sociopaths. They became a symbol of sickness, dystopia, decay, poverry, and anomie. They became, in Nixon's words, "just like the plagues and epidemics of former years."

More than chirry years later, these notions of disease and degeneracy resurface in Nick McDonell's novel Tw~/v~. Penned when McDonell was seventeen and soon to matriculate at Harvard,

I

34

T~/w follows protagonist "White Mike" as he tours depraviry and nihilism in the world of spoiled Manhattan private sch~ol kids.

Though White Mike has deferred admission to college for a year to selJ drugs on the streets of New York, he is meant to be an outsider to this culture of depraviry. He deals drugs but refuses to take them.

He goes to parties but never drinks. He knows everyone but has no real friends. He is an observer, one who is attracted to, but cannot ultimately identify with, decadence.

And, oh, is the immoraliry copious! We watch with White Mike as his peers pay with sex for expensive drugs, including che

THE

New JouRNAL

Illusion

by Jacob Blecher

Down by the River by Charles Bowden (Simon and Schuster 2002) pp. 448.

Twelve by Nick McDonell (Grove Press 2002) pp. 256.

H ow to Stop Time by Ann Marlowe (Anchor Books 2000) pp. 304.

mysterious, titular "Twdve"; tartoo their names in gold on their backs; ponder cutting school, flying down co Key West, and getting "shitfaced and laid all the time"; and even kill each other with .38 calibers and uzis. It is a hopeless world, a milieu that is frightening and bleak, which we are rem inded of alJ too often by White Mike's habit of re-reading Camus's Th~ Plague.

FEBRUARY 2003

If the world of Twelv~ is scary, however, it is also familiar.

Decadence means more than just drugs, alcohol, sex, an d violence: It also means consumption of brand name luxuries. Characters invariably buy their dope with Nokia phones in hand, North Face jackets on their backs, and Prada bags over their shoulders. The clever and ironic idea at work here is that mainstream American consumerism and decadent drug use aren't all that different. This parallel is of great concern to McDonell. Like Brec Easton Ellis's classic Less Than Zero (the book from which McDonell shamelessly cribbed his plot) and Larry Clark's film Kids, Tw~lv~ identifies a societal problem and revels in the tragedy of it all. It is an extravaganza of futility. If only we didn't live in such a screwed up, materialistic world, McDonell piously laments.

This mostly hackneyed portrayal suggests that systemic conditions-capitalism, perhaps-might be at work. But McD onell never follows through on this move. In the end, his assessment of h is characters' lives hinges on a simple, puritanical moral judgm ent: that they are participating in a corrupt, materialist culture. This is a Nixonian horror-drugs and luxury goods d rive people to h arm themselves physically, to prostitute themselves, and to kill each other. McDonell, who, according to The New l0rk", does "no illegal substances" and was class president at his New York prep school, essentially succumbs to the myth that drugs are somethin g o f an exotic disease, one that is ruining our world . But we don't h ave co descend into that netherworld if we try hard enough, he says. We can espouse moderation and resist, or at lease escape. We can be like Whire Mike, who goes off co Paris at the end of the book and opines, "I don't know why, but Paris seems a better place than New York."

Twelve represents the muddle that is the current debate on drugs. Most of us probably agree with McDonell's assessment of the drug situation, even if we discan.ce ourselves from the governmen tal pontification that says the same thing. We agree that most drugs are unhealthy in some way, that the drug trade can be exploitative and ' dangerous, that drugs can inhibit one's ability to succeed in life. We sh are a basic understanding that some kind of societal change is needed. But beyond that common sen timent, no consensus exists.

35

No one knows how to solve the problem.

Every solution either fails-as in the case of our government's War on Drugs-or is vague and implausible. In plaC<e of a viable course of action, we spout some form of Nixonian rhetoric: drugs are bad; they're not good for society; we must be vigilant in our crusade against them.

But could it be that the very impulse to ask, "What should we do about drugs?" stems from a deeper condition? This is the approach that journalist Charles Bowden, who spent more than half a decade along the United States-Mexico border reporting the drug trade, takes in his bold new book Down by th~ River. Bowden's conclusion, which he arrives at through telling the story of a Drug F.nforcement Agency head whose brother was mysteriously murdered in 1995, is that American society is intimately bound up in the Mexican drug trade.

Accordingly, our urge to call it a "problem" reflects our fear and confusion in the face of a pervasive and ungovernable force.

-NO-One knows for sure how large the global drug economy is, but one thing is dear: It redistributes hundreds of billions of dollars across the earth every year.

Bowden estimates that the drug industry brings between S27 and S32 billion to Mexico each year. That is about $20 billion more than oil, the cOuntry's largest official export. For Bowden, this fact reveals one of the most urgent-and most ignored-stories of our time: that the drug economy and the legal economy are one and the same, that the effects felt on either side reverberate across both. If Mexico were to lose the S30 billion that drugs pump into the economy, the country would simply collapse. Ten percent of the nation's gross domestic product would vanish. A study leaked to the press by the Mexican internal security agency CISEN guesses that the country's economy would shrink by as much as 63 percent. The same study pins the us decline between 19 and 22. percent.

For Bowden, the accuracy of these figures is questionable. But as someone who has experienced the drug business firsthand, his gut tells him that the underlying condition the numbers imply is accurate.

What's more, the very condi_tion itself predudes -as from gaining access to concrete facts. All we have are Oeeting peeks into the inner workings of an endemically corrupt international drug network. There is the

record of a S300 million transfer of money from Citibank by one of the richest drug dealers in Mexico, Amado Carillo; there is the taped conversation between the us Attorney General and the CIA director hushing drug-related crimes by CIA agents; there are the accounts of Carillo offering a deal to Mexican President Ernesto Zcdillo that included the transfer of half of Carillo's fortune to the government in exchange for immunity. None of this amounts to anything concrete. That may sound like the apology of a conspiracy theorist, but Bowden never pretends to be writing an objective account. His gossamer prose intends only to be suggestive.

Our inability to comprehend the workings of the drug world is one of the reasons that Bowden thinks we tend to push drugs into the margins of daily life with other seemingly ineradicable ills, like poverty and guns. Like White Mike, we feel the need to call drugs a "problem" in order to deal with them. We put drugs in another "world" in order to localize and convenie'n tly distance ourselves from them.

We even fight a War on Drugs, as we woUld against some distant country. But Bowden thinks that such reasoning only succumbs to a convenient illusion. To leave the drug "problem" to be solved by someone else in a far off place is to deny that we are all implicated in it. Bowden wants us to call the drug world a "business," to see dru~ as a multi-billion-dollar industry enmeshed in the same economic network as McDonald's, Ford, Microsoft, and Pfizer, so that the drug trade can be perceived, in his words, as "elemental and part of the fabric of" the United States, Mexico, and the rest of the world. It is a chilling thought, but it seems to speak some truth.

It starts to explain how something not much different from Prozac could hold such a powerful place in the public imagination.

Part of Bowden's motivation for bringing the drug economy in line with the legal economy has to do with globalization.

Though he does not say so explicitly, Bowden believes that the term "legal economy" may no longer be the most accurate way to describe any economy. Over the past several decades, corporations have become increasingly transnational-stateless, in other words-and the difference between black markets and legal markets

has diminished. Bowden goes so far as to call the Juarez cartel, one of the largest drug distributors in the world, a "model of the New Economy"-a description normally reserved for corporations that constantly move labor and capital across national borders in the pursuit of profits. The cartel, he says, is "stateless, borderless, global." It "rewards merit, ignores class origins," "hires and fires at will," and "despises regulations and ducks tariffs." And as in all good businesses, the profits are colossal.

This is a fascinating move, one that Bowden delicately weaves into his haunting narrative. Why, after all, should we think that drug cartels are any different from transnatio~al corporations, if both share similar contempt for the law?

Where Bowden hedges on taking a moral stand on drugs, Ann Marlowe, in How to Stop Time: Hn-oin from A to Z, is more explicit. Marlowe's book is an autobiographical account of a life spent as a heroin addict, but it is one like few others: that of a Harvard-educated yuppie who never truly became addicted to the drug, even after dozens of years. On the surface, Marlowe's story is interesting as an odd and anomalous account. As she hints early on, however, this surface oddity is merely a device for making a much bolder point: that she is not so much the exception as the rule among heroin and other drug users.

She believes that addictive drugs are a choice, one ultimately not very different from others we make as consumers on a daily basis.

Marlowe's thesis is that both serious drug use and commonplace consumption play into what she calls a "consumerist ideology" that most people sublimate on a daily basis. The idea isn't so much that drugs are just another commodity, but the reverse--that aU commodities in our society function like addictive drugs. The impulse to consume lots of things is, in other words, on par with the desire to do drugs. Marlowe is able to argue this because, in her opinion, addictioQ is controllable. This was her experience as a heroin user, at least. She led a rich, intellectual life-both at Harvard graduate school and in the New York business world-that revolved around consistent, planned drug use, and she quit without difficulty.

Marlowe doesn't deny that some drugs cause chemical dependency, but she

THE NEW JoURNAL

believes that no drug causes an "uncontrollable need." She argues that all drug use implies some willful decision to give in to a pleasure or mystique. But when one realizes that no drug can ever really satisfy a chemical need-because every time one takes it, the body adjusts and demands a higher dose--there exists the possibility of taking control of the addiction. Most people want to deny this because they insist that their everyday consumption is free and does not involve any addictive physical need. "But hadn't someone who obsesses hours every day for years about buying a pair of Gucci loafers better see a shrink?" she asks. "Why is obsessing over doing dope any different?"

While McDonell links drugs to the decadent extreme of consumer culture, Marlowe brings them into the very fabric of commonplace consumption.

Marlowe's logic is inconsistent throughout the book, but her general point-that consuming addictive drugs is not psychologically different from consuming legal commodities-is, at the very least, a refreshing contraSt to the reigning propaganda. If the consumption of drugs is not perceived as pathological, but instead as unavoidable in the most highly developed capitalist country in the world, then its roots as a "problem" must lie beyond the drugs themselves. When Marlowe writes that heroin is for those "most suited to capitalist society-bossy wired hustling obsessive-compulsives," she offers an intrigujng way of thinJcing about the abundance of drug use in this country, especially among those in the upper tier of society who see themselves far above the netherworld of the drug industry. It may be a vague explanation of the drug "problem," but when the alternative is fear and horror, we may not have a better choice.

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So come to Galaxy and reinvent yourself Haircuts-- Colors-- HiLites -- Elumen 168 YoRK

STREET

772-4666

International Studies Major Applications Due The program in International Studies is designed for students who seek to combine the discipline-based requirements of a first major with an understanding drawn from several disciplines of the transformations occurring globally in their interconnected socioeconomic, environmental, political, and cultural dimensions.

For details, visit www.yale.edu/ycias/ iac/is_ba.htrn.

Applications to major in the International Studies Program are due in Suite 210, Luce Hall, 34 Hillhouse Avenue, on March 3, 2003.

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YALE CENTER

"\ FOR INTERNATIONAL AND AREA STUDIES

jacob Bkchn-, a junior in Davenport co/kg(, is associau (ditor for TN].

fEBRUARY 2003

37

T

HE DEATH OF THE AMERICAN specialty shop is old news. For years we've watched, with mixed emotions, the rise of Targets and Wal-Marts and Super-Ks: monuments to entrepreneurial gumption.

A modern American city boasts neither panaderias nor gelaterias, and nary a zapateria; any visiting Parisian in search of a wheel t>f roquefort will find his hunger satisfied not off some cobblestone road but"on the refrigerated shelving of the dairy aisle.

And yet, despite the rhetoric, there are those hardy establishments that have endured the consolidation of consumption and remain kicking. .

It is fitting that the Owl Shop, one of New Haven's only specialty shops, caters co a uniquely American obsession. The College Street store is a "Tobacco Cafe," the product of a nation obsessed with tobacco-not so much with its consumption as with debating its moral legitimacy.

The legal history of the "dirty weed" is as old as this country, and modern litigation asks: Where on the spectrum of admissible behavior are we to place the pastime?

Tobacco regulation lies at the intersection of temperance and civil liberty, rwo quintessentially American virtues.

For Joe Lentine, a gaunt, amicable man and the general manager of the Owl Shop, the answer is clear: Smoking is both enjoyable and virtuous. "Tobacco increases the alpha waves in the brain," which are ass9ciated with a state of relaxation, he say~. Sure, there ace health risks. But "we all start the process of dying the minute we're borh."

Mr. Lentine lives his philosophy.

Seated near the shop window with a cigar and a pensive air, he is a man steadfast and comfortable in his dominion. When he stands to assist a customer, he exudes the confidence of a salesman whose produce sells icselÂŁ Behind Mr. Lentine is a paltry display of cigarettes, ("We don't scock many; cigarettes are associated with addic-

cion" says an employee named Jesse.) To his left are a dozen canisters of blended tobacco. Across the store, which is carpeted with a thick, absorbent brown shag, is a glass case exhibiting music boxes, chess sets, and backgammon boards. The shop sells cigars (the fmest, says Mr. Lentine, are made by Davidoff), lighters, pipes and accessories, even breath mints.

Although the store is welcoming and the staff is well-versed, there is the sense chat secrets ace unfurled only slowly and only to those who take time to listen. The Owl Shop is a refuge for the dawdler and the connoisseur, lending credence to Joe Lentine's notion that cigars and pipes make for "contemplative smoking." One Yale sophomore explained, "I enjoy browsing the fine selection. When you ask the right questions, the tobacconist will really begin to talk."

The Owl Shop provides more than selection and service. It is also a meeting place. Regulars gather to converse and smoke, filling the dowdy and smokeinfused armchairs in the back of the store.

Mr. Lentine calls his clientele varied: a handful of professors, some members of the community, and a surprising number of Yale students. Most of the younger smokers belong to what he classifies as "the artistic type"-"actors, writers, creative people."

The connections forged to the shop are deep, with many alumni continuing to buy products through mail order long after they graduate.

When the Owl Shop was opened in 1934, it was located next door to Naples Restaurant and served as a sort of Yale coop, selling caps, shires, and notebooks in addition to the signature products. In 1951, it moved to its current location across from the Shubert Theater, and visiting luminaries began to call. "Arthur Miller used co stop in when he had a show up," says Mr. Lentine. "AA Pacino came in once to gee his lighter fixed."

The 1960s and 70s saw a renewed interest in cigars and especially pipes, due in part to a 1964 Surgeon General's report decrying the dangers of smoking-cigarettes were deemed far more pernicious than ocher forms of tobacco. (According to Mr. Lentine, Luther Terry, then surgeon general, was himself an avid pipe smoker.)

About ten years ago, the Owl Shop noticed an immense resurgence in the popularity of cigars. "The magazine Cigar Aficionado single-handedly brought on this revolution," says Mr. Lentine, because it created a new image of the cigar smoker. "Cigars began to denote that you had power, that you were a power broker. Smoking makes you feel rich even if you're not rich."

Recently, tobacco seems to have taken a few blows in the legal arena. Now that America's relationship to cigarettes, and even to cigars, has become somewhat more antagonistic, is Mr. Lentine worried about the future? His answer is a definitive 'no.'

He cites the historical involvement of the government-for better or for worse--in the fate of tobacco. In the 18TH century the crop was legal tender in the state of Virginia. Tobacco has a far greater yield per acre than corn or soybeans: The Agriculture Adjustment Act of 1933 was instituted to introduce price supports and save tobacco farmers from ruin. And the Owl Shop--forming, along with J. Press and Mory's, a sort of old school triumvirate around a University chat is often only amused by tradition-is standing its ground. These days, sales are strong, and for Joe Lentine, it's business as usual. After all, even as the ship was sinking, the gentlemen of the Titanic sac down, L"l up, and enjoyed one lase smoke.

1111

Coco Krumm~. a sophomor~ in Ezra Stiles co/kg~. is on th~ staff ojTNJ

THE NEw JouRNAL

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