A Review of “Hooked” by Lonny Shavelson

hookedWhen most people talk about addiction they do so in a way that neglects one important dynamic about it: namely, that addiction has a human face. Addiction impacts real people, individuals who have unique backgrounds, experiences, and bodies. Addiction has names, like Crystal or Mike. Lonny Shavelson knows this well as he writes Hooked. While the book is a bit of an expose on the weaknesses of the drug treatment system it is explored the lives of five individuals. Hooked reminds us that in order to be the most effective in helping we must remember that we don’t treat a problem, we treat people.

Lonny Shavelson is a bit of a renaissance man. He is a physician, specializing in end of life care, a photojournalist, and an author. His diverse talents lend themselves well to this book. While he is able to speak intelligently to medical, mental health, and drug treatment issues, he is also able to weave together a story that is gripping and compelling. He can write about “harm reduction” or “dual diagnosis” in ways that evidence his erudition, yet never lose the more amateur reader.

Shavelson explores the late 90’s boom of “Treatment on Demand” in San Francisco. TOD is defined as “appropriate treatment within forty-eight hours for all addicts who say they’re ready to kick drugs” (7). The goal was to provide help for any addict who wanted to change, and of particular interest were those addicts who were the most destructive to themselves and to society. While the more “relatively well-behaved” addicts were often getting help, there was still a big problem with drug related crime. So, San Francisco launched a new program just as the nation itself was seeking to expand its treatment potential for addicts. They were on the front end of advancement. What Shavelson shows, however, is that in reality the system itself was deeply broken and real people were suffering. Treatment on Demand had actually left something like 10,000 people on wait-lists.  It had also failed many in the program through its “attack methods” and its failure to recognize and treat “dual diagnosis.” Furthermore, there was still the problem that some 33,000 people were never actually treated at all, some who didn’t want treatment.

The failures and oversights were not a result of a lack of care and interest. Shavelson is not bent against the helping or treatment industries. He speaks favorably of many workers, counselors, and administrators who are doing the best they can. Yet, the oversights are still real. Sometimes, blind optimism was the cause of oversight, other times inadequate systems were the cause. As a result, however, real people were suffering the consequences. Shavelson’s ability to detail the journeys, heartaches, struggles, and desires of the five addicts he follows is what makes this book so compelling. The systemic problems are real but its the faces, names, and stories of real addicts that make those problems so frustrating. The issue is not a drug problem, but addicts themselves who need real help.

As Shavelson turns to the second part of his book he explores “coerced treatment,” and discovers, somewhat surprisingly, a better story of recovery. He writes:

For that treatment-resistant group the city launched another approach, to force them into treatment. When I first heard of this absurdity I didn’t believe it even warranted a  closer look. Strong-arming unwilling addicts into rehab seemed not only unpalatable, but from what I had already seen in the programs with motivated addicts, logically unlikely to succeed. But then I saw what happened to Glenda Janis, who, on June 12, 1998, was literally kidnapped from the street by a city rehab worker and dragged into treatment. I had never known a more pitiful, disheveled, near-death, long-term street alcoholic than Glenda. After being carried off to a program, she came out three months later – cleaned up, sober, and healthy. (188-89).

Forced treatment seemed different as Shavelson explored it more. The key difference, he says, was the Court’s faithfulness and oversight of treatment. Here, he says, was a secret to effective rehab:

That secret, however, lies not only in coercing addicts into programs, but in coercing the programs to do rehab right. With the power of the court looming over them, both the addicts and the programs behaved better. (189)

The court’s diligence made a difference. Throughout part two, then, he talks about a number of related points of contact showing the strengths and weaknesses of issues like forced treatment, death prevention, and legal intervention.

As the book ends, Shavelson describes some essential insights he has learned about effective rehab. He lists his conclusions about effective rehab in the Afterword to the book and describes what he believes needs to happen moving forward. They are good thoughts and insights about the nature of treatment, addiction, and healthy practices.

The book is obviously dated, and some of his complaints regarding treatment have been addressed; some of his complaints, surely. have not been addressed. Biblical Counselors won’t agree with all that’s discussed here, and there’s an assumed disease model approach to addiction that I disagree with. The discussion on dual diagnosis is important, and the issues related to harsh confrontation ought to serve as warnings. The book’s highest value, however, comes in its exploration of the lives of five actual addicts. Through their stories we see the “misguided” efforts of the “drug rehab system,” as the book’s subtitle suggests. Addicts are real people and their road to recovery is a real story that makes our efforts at treatment worthy of constant evaluation and modification. When we treat problems we don’t have to worry about the details, but when we treat people we need regular accountability, evaluation, and modification.

As a biblical counselor this book served as a good reminder. I believe the Scriptures are key to helping people fight addictions, but our methodology ought to be regularly evaluated. Since I took over responsibility for our Recovery program we have made significant modification three times in three  years. The overhaul has not caused a disruption to our care and process, but it has been significant. I’ve been disappointed by the need to do these overhauls but I recognize that they are necessary because we need to provide the best care we can for the individuals we see. If we treat problems then we can just pick an approach based on how others have found it useful. But to help people we need to consider more carefully how to tailor a program to the needs of the people we see. That, then, is what we want to do. Treat people, not just problems.

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