Perspective | A forgotten approach to drug addiction recovery may yield results today – The Washington Post

We are witnessing the deadly convergence between the opioid epidemic and the covid pandemic; a recent study showed that an all-time high of more than 100,000 Americans died of drug overdoses during the first year of the pandemic, up 30 percent from the preceding year. Responses have ranged from the recent opening of safe injection sites in New York City, to a proposed plan in Boston reallocating jail space for a drug-treatment program that blurs the line between rehabilitation and incarceration.
Current strategies to address addiction often focus on reducing overdoses, increasing access to medical treatment and, still in far too many cases, enforcing punitive policies. These measures are rooted in a much longer history of addiction treatment that has toggled between medicalization and criminalization. But a closer look at the second half of the 20th century points to an alternative approach that views addiction as a social problem whose solution requires a radical reimagining of recovery.
At the turn of the 20th century, opiates like heroin and laudanum were sold in drugstores as healing tonics. Habitual users and physicians alike considered the prescription of narcotics a form of treatment for addiction, presaging today’s medicalization approach.
But as public perception of the archetypal “dope fiend” shifted from the pitiable middle-class White housewife to the dangerous urban (male) criminal, a figure racialized as either Black or a White ethnic immigrant, reformers enacted new laws to govern narcotics. Between 1914 and 1924, federal officials banned heroin, restricted the distribution of other opiates and forbade physicians from prescribing narcotics to maintain a patient’s addiction.
The “new” class of addict was considered a source of moral contagion, leading to their forced isolation from society. In 1929, Congress passed the Porter Narcotic Farms Act, which established the first federal institutions to treat drug addicts in Lexington, Ky., and Fort Worth, Tex. Co-managed by the Bureau of Prisons and the U.S. Public Health Service, these facilities institutionalized the slippage between the addict as sick and the addict as criminal.
The period’s narcotics legislation overlapped with the prohibition of alcohol. But soon the regulation of alcohol and drugs diverged, further demonizing drug users. As Claire Clark notes, the end of Prohibition in 1933 ushered in an “era of hypocrisy: alcohol would be sold and celebrated; narcotics would be vilified.”
A postwar panic over increased heroin use in the 1940s and 1950s prompted a dilemma for lawmakers. How should addicts be compelled to receive medical treatment? This conundrum was partially solved by the criminalization of heroin, which brought illicit drug users into the court system and required mandatory hospitalization. However, jurisdictional limitations meant that federal judges could sentence defendants to Lexington or Fort Worth, but had no power over state cases, which constituted most postwar drug violations. As a result, states with the highest levels of narcotics use, like New York and California, began actively designing their own systems of institutional treatment.
Starting in the late 1950s, the California Department of Corrections expanded parole and probationary powers to detect relapse and frequently mandated outpatient psychiatric care for convicted addicts. Following the creation of the nation’s first civil commitment law in 1961, California opened a state-run rehabilitation center in 1963 that was billed as an alternative to imprisonment but functioned like a prison. It and the state’s few mental hospitals that accepted addicts were not only overcrowded, they were also ineffective in preventing relapse. Despite its failures, the state assumed ever more control over the lives of illicit drug users, even surveilling fledgling Narcotics Anonymous (NA) meetings in Los Angeles.
Amid the carceral state’s increasing power over addiction treatment in California, a radically different approach popped up on the beach of Santa Monica in 1958. High on heroin, addicts could walk through the doors of what became known as Synanon and kick their habits in community. Synanon rejected the idea that medicalization or criminalization were the only ways to address addiction. (Disclaimer: Both authors have family ties to Synanon.)
Founded by recovering alcoholic Charles Dederich, Synanon drew on the grass roots mutual-aid recovery model established by Alcoholics Anonymous (AA). Dederich realized there was an entire world of addiction not being addressed by AA or NA when heroin addicts, some of whom were also alcoholics, started showing up at the Synanon House. Many had been jailed on addiction charges, committed to California mental hospitals and even sentenced to federal narcotics farms — but their addiction remained. Newcomers often felt relief at finding an alternative to the institutions that had failed them before.
News of Synanon soon spread among addicts, desperate family members and journalists. Even the occasional parole officer brushed aside the state’s initial hostility toward Synanon and recommended it to their parolees.
Synanon came to understand addiction as not just the problem of an individual addict, but also as a symptom of the collective trauma and alienation that permeated postwar American life. To address it, one had to get to the root problem by creating a new society in which community became the therapy.
In its early days Synanon ran on a dime and depended on a ‘pay-it-forward’ model, where recovering addicts helped others through withdrawal pains and shepherded them into the flow of life. Soon it acquired adjacent residential properties to house the increasing numbers of addicts landing on its doorstep.
Members created social worlds to sustain recovery, including literacy and art classes, reading groups on Freudian psychoanalysis and Buddhist philosophy, and a nursery where residents cared for each other’s children. Weekly Saturday night parties attracted curious crowds, drawing Hollywood actors, noted intellectuals, politicians and average citizens, intrigued by what came to be known as “the miracle on the beach.”
Synanon was home to a thriving jazz scene and to an increasingly interracial community that embodied not only the diverse face of addiction in America, but also the potential to break down racial barriers. In 1963, a time when interracial marriage was still outlawed in some states, Dederich and Betty Coleman, a Black woman and former heroin addict, married, in part because they believed “it would be good for Synanon to have, right at the top of the pyramid, an integrated marriage.” The expectation was that others would follow, and they did.
Synanon, Dederich proclaimed, would promote “a lifestyle that makes possible the kind of communication between people that must exist if we are to prevent this planet from turning into uninhabitable ghettos.” During the ’60s and ’70s, Synanon’s history intersected with other better-known movements — the Black Panther Party, Peoples Temple and United Farm Workers — all of which sought to forge new futures for the dispossessed and despised in society.
As Synanon made communalism a form of therapy, the group reinvented institutions like education, work, marriage, child-rearing and leisure. At its best, it was a place where recovering addicts did not have to choose between the pursuit of sobriety and the fullness of life. Some brought their families into Synanon or started new ones. They trained as lawyers, accountants, artists, carpenters, salespeople, truck drivers and more. They experimented with new social, political and economic structures for governing their community.
This required the organization to expand its mission and provision of services, leading to its mushrooming population size and the spread of facilities into northern California and across the United States, including intake houses in Detroit and San Juan, Puerto Rico. As it gained notoriety, non-addicted members, called life-stylers or squares, began to join in the late 1960s. At its apex, membership numbered into the thousands.
As the community grew and shifted its focus away from recovery, Synanon entered the phase of its history for which it is best remembered — its turn in the mid-1970s toward what many have described as a cult.
Synanon’s decline was sandwiched between the Nixon era’s “War on Drugs” and the crack epidemic of the 1980s which surged through American cities, disproportionately sweeping Black and Latinx drug users into a system of unprecedented mass incarceration. Isolated pieces of Synanon’s model were incorporated into federal policy as drug users were also sentenced to privately-run rehabs that were often led by ex-addicts. Without the ethos of community and the model of consent that underwrote an addict’s entry into Synanon during its early years, though, court-ordered treatment became an extension of the prison industrial complex. Meanwhile, luxury rehab programs servicing a predominantly White clientele appeared across the nation.
Because Synanon is largely remembered for its downfall, its early therapeutic innovations have been read through the lens of failure or forgotten altogether. But the communal model of recovery that Synanon pioneered is worth remembering today. It points to a paradigm for treatment that bypasses the tired and often racialized binary of medicalization or criminalization to reimagine recovery as an opportunity to create new, better ways of living in common with each other.

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