“…John Barleycorn makes his appeal to weakness and failure, to weariness and exhaustion. He is the easy way out. And he is lying all the time. He offers false strength to the body, false elevation to the spirit, making things seem what they are not and vastly fairer than what they are.” (Jack London: John Barleycorn)
This particular treatment center has to make do with the relatively meager reimbursements it receives from regional tribes and state medical assistance programs. The payments it receives for a 1-month course of treatment are about $12,000. That may sound like a lot to some, but on the scale of health care services, it is laughable. A 2-week stay as a full-fledged in-patient at a major hospital can easily rack up a tab of over $100,000. My student Aetna had to shell out about $40,000 for my first stint in treatment in summer 2011 after I finished grad school. Forced to make do with less, they have to cut corners in areas that aren’t absolutely essential. An ancient building, terrible food, shared rooms and community bathrooms, and larger therapy groups are the trimmings of economy that won’t surprise you. But among the shortcuts they take here is a practice that surprised me at first; later I realized the therapeutic value it has. Patients who arrive intoxicated and/or under the influence of other drugs are housed in the same units as everyone else. That is, as long as they’re non-violent. Detox overlaps the treatment program.
It’s rather striking to observe people as they go through the two to five-day process of detoxing from alcohol. They come in angry at whatever loved one dragged them in, red in the face and yellow in the eyes. Twenty milligrams of Valium helps them decide to go to bed. The next day, they pace up and down the halls, threatening to leave. But most have nowhere to go and no way to get anywhere. They are here because they have hit rock bottom. Usually some combination of the law and their family have decided that they are getting help. That second evening, the nurses take their vitals and dose them with an “A2,” code for 2 milligrams of Ativan to quiet their tremors and racing heart. On the beginning of day-3, the fog begins to lift, and it becomes apparent whether or not they want the help in front of them. The ones who don’t want help and who aren’t ready to venture into the strange new world of sobriety plead with friends and family over the phone, begging for a second chance. By the time they get here, they’ve usually had an extraordinary number of second chances.
It is not until the second week of treatment that most patients give up the fight and begin to re-think their life and consider the benefits of getting sober. They learn that it’s not a moral problem or a lack of willpower. In fact, it’s a disease that when treated, drived people to achieve more success than their non-addicted peers. The amount of work they used to put into hiding their problem and maintaining their supply is channeled into a new addiction — to work and family.
Toward the end of that second week, they start to find pleasure in the little things in life. Often little things they enjoyed as a kid, before they lost their spirit in the grips of the constant drive for more of the substance, more power, more control, more prestige, better stuff, and more novel escapes. Those little things include the daily fight for our fair share of the cookie ration. When staff put out a tray of cookies in the break room, it’s game on. The unit of addicts snatch up the sweets like squirrels fighting over acorns. Meanwhile a guy in the TV room takes the remote control with him on his smoke break in an attempt to preserve his poor choice of programming. When he comes back, someone has out-foxed him by taking the batteries out of the device and manually changing the channel.
The group of men in the “popcorn room” put the final few pieces of the Candy Cane puzzle into place, only to find out that one out of the 1,000 is missing.
Maybe John Barleycorn stole it.
Editor’s Note: The following post was handwritten by Kirk Klocke at Keystone Treatment Center in Canton, S.D. and transcribed, edited, and published by Cassie Rodenberg, an independent journalist in New York City who covers addiction, poverty, and other dark things happening in rough urban neighborhoods. Ms. Rodenberg publishes “The White Noise,” a Scientific American blog that focuses on the scientific, medical and social implications of addiction. Follow her: @cassierodenberg