The Recovery Revolution: The Battle Over Addiction Treatment in the United States, by Claire Clark, Columbia University Press, 336 pages, $35
Though nearly forgotten today, Synanon—the first organization to claim to have a drug-free cure for heroin addiction—had an enormous impact on American culture. At the peak of the drug war of the 1980s and early '90s, at least half of all publicly funded addiction treatment was based on its model of communal and intensely confrontational living.
Synanon was founded in 1958 by Chuck Dederich, a member of Alcoholics Anonymous who felt that A.A. wasn't tough enough. (Dederich claims to have coined the popular self-help phrase, "Today is the first day of the rest of your life.") By the mid-1960s, it had evolved into a California-based commune widely celebrated as the counterculture's antidote to drugs, and populated by hipsters, Hollywood stars, and jazz musicians. In those days it was lionized by Life magazine, the major TV networks, and even a 1965 Columbia Pictures film; Milton Berle, Jack Lemmon, and other celebrities promoted it.
But then came word—and later proof—of child abuse and beatings for non-compliance of both adults and children. Dederich decided that members' children were a drain on the community, so he pressured men into having vasectomies performed by Synanon doctors on the spot and ordered women to get abortions or be forced out. "Marathon" groups extended for days without food or bathroom breaks, featuring sadistic emotional attacks on those who were seen as backsliding or disloyal.
To the extent that it is remembered now, Synanon is probably best known for having put a four-and-a-half-foot-long de-rattled rattlesnake in the mailbox of an attorney who was starting to win legal cases against it. Among journalists it also has the notoriety of winning the largest libel judgment in history, after Time called the group a cult in 1977. Only later was the truth about the organization fully established, thanks to the courageous reporting of the small-town Point Reyes Light, which won a Pulitzer for its exposés in 1979.
Claire Clark's The Recovery Revolution prefers to emphasize the positive. The book doesn't even mention that snake attack, nor the fact that Dederich was convicted of conspiracy to commit murder as a result of it.
Perhaps the author wanted to avoid covering familiar ground. But by failing to explore how Dederich and Synanon set the precedent for the abuses she chronicles in later programs based on it—and by failing to wrestle with how those harms stemmed directly from its structure and practices—she undermines her credibility as an objective observer.
Worse still: Even though a great deal of evidence suggests that the methods pioneered by Synanon do more harm than good, she doesn't mention any of this scholarship. Instead, she uncritically accepts studies that claim to show that what has become known as the American "therapeutic community" is an effective model for addiction treatment.
Synanon made it acceptable to use tactics in treating addiction that had long been seen as barbaric when used for mental or physical illness. Since the group's core idea was that the "addict" personality was marked by "character defects," Synanon aimed to eradicate it by brute force: shouting abuse at participants for hours and even days on end, spitting in people's faces, humiliating them by making them dress in diapers or drag, and combining food deprivation, sleep deprivation, and relentless confrontation in an attempt to erase a person's old identity.
Not a single study shows that these methods are superior to kinder, safer approaches. Indeed, researchers have shown conclusively that shame, punishment, confrontation, and humiliation are ineffective and often harmful in addiction treatment. As early as 1973, a study of Synanon-led groups showed that attack therapy led to lasting psychological damage in 9 percent of the participants. While living in a supportive community has been shown to help people recover from addiction and mental illness, that is not what Synanon innovated. As the cliché goes, what was effective at Synanon was not original to it, and what was original was not effective.
Despite these failings, the book is well worth reading. Clark presents an excellent overview of the history of American addiction treatment, the ideological battles within the field that continue to plague it to this day, and the way that Synanon sparked dozens of imitators. Many of those imitators still exist in modified form, such as Phoenix House and Delancey Street.
And she makes a fascinating argument about the importance of the "ex-addict" activists who founded Synanon and its descendants. Essentially, she says that their political activism played a critical role in convincing America that treatment—not punishment—is the best way to deal with addiction.
Synanon created a genuinely radical community that embraced group living, racial integration, and emotional honesty while at the same time enforcing rigid hierarchy, authoritarian leadership, and conformity.
This apparently lefty/hippie group of outsiders bought into, and then sold others on, the idea of a drug-free America, creating a form of treatment so punitive and moralistic that it was easily embraced by the right. First lady Nancy Reagan called the Synanon-inspired Straight Inc. her "favorite" drug program and visited with teens there several times, once even bringing along Princess Diana.
Clark recognizes how ex-addicts with tales of redemption both improved their lot and undermined themselves by supporting this type of treatment. By promoting shame, humiliation, and moralizing as essential aspects of rehab, they were able to help America move away from simply arresting and incarcerating people. (Only within the last 10 years or so has the field begun to move away from Dederich's idea that confrontation and humiliation are necessary aspects of addiction "care," and to accept that people with addiction also deserve to be treated with dignity and respect.)
But by failing to challenge the idea that addiction is sin, these activists simultaneously supported continued criminalization and repression. Treatment is often offered as an alternative to incarceration, but when the "alternative to incarceration" involves being locked up in an even harsher environment, it's not much of an alternative.
Clark chronicles and analyzes many of the complexities of Synanon's legacy. But a better book would have addressed the damage it did to tens of thousands of people by legitimizing the dangerous notion that addiction therapy can't fix people until it breaks them first.
This article originally appeared in print under the headline "Breaking Addicts in Order to Fix Them".