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The tendency of our community to shower disgrace upon people who have personal experience with the problems of substance abuse ensures that those who could speak out must hide in secrecy and shame.

As a psychologist who deals directly with those who suffer from this disease, I hope to accomplish several things with this article, not the least of which is to irritate the reader. After all, the problem is irritating; only we choose to ignore it while it festers.

My aim is also to shatter the myths of denial that have only contributed to the spread, impact, and destructiveness of the problem. It follows that once we turn the shame-based insensitivity into a state of openness, Orthodox organizations, kehillos and yeshivos at every level will examine the problem among their own. They can then extend unbridled caring and support to rectifying the situation in their locales.

Alcohol and drug abuse is a disease. It is a fatal illness that begins with casual or experimental use of a chemical for its mind-altering effects. It rapidly becomes an addiction, which involves loss of control over the substance or behavior, and eventually leads to self- destructiveness. Most experts in addiction consider it a disease, thereby absolving the addict of responsibility for the addiction while leaving him totally responsible for his behavior. Misbehavior and infractions of the law deserve punishment and discipline. Illness deserves treatment.

The myth that Jews are immune to the diseases of addiction prevails, though it has been losing its credibility. The textbooks on substance abuse still cite outdated references that Jews drink more alcohol per capita than any other identified ethnic group, yet have a remarkably low rate of alcoholism. Current experience of addiction professionals does not support this contention. Drugs of abuse were once inaccessible to Orthodox Jews. Unfortunately, times have changed to our disadvantage.

There was once a small number of yeshivah students who left the fold of mainstream Jewish education. We have since witnessed the growth of Torah institutions focused on attending to the wayward, dropout, behavior problem students, many of whom have already been introduced to lifestyles that were never encountered by the Orthodox community. As lofty a goal as saving the wayward adolescents might be, it is also a huge undertaking that meets with less success than intended. One of the chief enemies is drugs. Academic discipline and the best of mechanchim are far too weak to counter addiction.

No accurate surveys on Orthodox teen drug use exist. There are smatterings of numbers that appear in the media and attract attention for a few moments. These are not impressive to the scientist and are misleading to the lay person. I have personally quoted such data, but only to prove that the problem exists and that the low numbers we imagine are wishful thinking. There are known hangouts in Orthodox neighborhoods (in both kosher and non-kosher establishments) where drug dealing is a known activity, and the dealers and customers are predominantly Orthodox youth. The problem is active in our backyard! Law enforcement can do little, since drug spots are portable, and arrests and convictions are not much of a deterrent.

While we need to identify how this deterioration occurred, the rejection of these obvious facts deserves attention. I have spoken to many rabbonim and roshei yeshivah about suggestions to address the problem and have met with resistance. I have no thrill in treating Jewish addicts. I could utilize my skills and experience elsewhere. But I anguish for those whose existence is relegated to fantasy, whose cries for help are dismissed by our own leaders.

Is Marijuana Harmless?

Marijuana, often considered a "soft" drug, can be found in too many yeshivos today. As a long-acting drug which is relatively inexpensive, it is rarely seen as a parallel to "hard" drugs which are more physically addictive. Yet, it is highly destructive to a great many body and brain functions. Its academic consequences are devastating, and include poor concentration, impaired memory storage and retrieval, distractibility, and comprehension impairment. These are witnessed in falling grades and general disinterest. The retention in the body of THC, the active ingredient in marijuana, is quite long -- up to six weeks -- and the impairments continue to be wreaked while even trace levels remain in the system, long after the "high" has dissipated.

From my files...

A 17-year-old yeshivah student is the topic of a call to me from his rebbe. "Moishe" (name changed to protect anonymity) was constantly tired and inattentive, especially in the afternoon. His learning also suffered, even in the shiur every morning. Moishe admitted he was smoking marijuana during recess or lunch break every day, but emphatically insisted he did not have a problem. On threat of being expelled, he agreed to a consultation with me. Moishe defended his behavior, maintaining his learning was better when he was high. His family was an average frum family, and they were as helpless to control Moishe's behavior as anyone else.

Hard Drugs and Our Children

Cocaine, heroin, pills, and hallucinogenics have all commanded pages and hours in the popular media. Drug users may develop a preference for one or more particular drug(s), just as one can prefer certain foods or flavors. The distinction between the various drugs only matter to the treatment of overdose or to help identify the user. One drug is no less serious than any other. One former dealer admitted he once sold several thousand dollars of these drugs at wholesale price for a party that was attended by frum yeshivah boys and girls!

Intravenous (IV) drug abuse is rising again in popularity, having lost some of its appeal with the outbreak of AIDS. The picture of the "bummy"-looking drug user sitting in the back alley with a needle in his arm is not the prototype addict. Many drug users dress well, hold jobs, socialize, and give the appearance of managing well. Many -- particularly younger addicts -- rate the label of "functional addicts," having not met with terrible brain and body damage, yet. Some of these teens -- even our religious ones -- excuse their behavior by claiming to know adults who function well while "successfully controlling their addictions." This is equivalent to being "a little bit pregnant." Addiction is a progressive disease that only gets worse. It doesn't stagnate or improve on its own.

It is a fatal error to judge an addiction by the drug of choice, the route of ingestion, the dollar value or volume consumed, the frequency of use, or the degree of physical dependency. It should rather be seen in terms of the resulting dysfunction in all spheres (health, occupational or academic, financial, legal, social, family, mental, and spiritual). As it destroys the addict, it severely affects many others, including the immediate family, friends and co-workers. In the frum community, where family ties tend to be stronger, this impact is usually quite serious.

L'chaim?

It is easy to forget that alcohol is a drug. It is legal, inexpensive, and sanctioned by all. Drinking has a role in nearly every simchah. The legal age for drinking alcohol in most states is 21, and teens who use alcohol are in violation of state law, even if used as a ritual. When alcohol is used for any mind-altering effect, it is being abused. This includes "Kiddush clubs" which essentially promote and legitimize excessive drinking in the name of kedushah. It is also against halachah to reach the state of intoxication, and Purim and Simchas Torah are not exceptions.

"Feivel" was about 12 years old when he began drinking. His parents were divorced, and he resented both of his parents for different reasons. He took to the streets. When I saw him at age 16, he was drinking very heavily, up to a bottle of strong liquor plus large amounts of beer per day. He denied using drugs, but was able to name many other teens as his friends, whom I knew to be actively using drugs. Feivel had already begun to experience several medical problems as a result of his addiction.

The Experience of the Addict

The alcoholic/addict submits to treatment after "hitting rock bottom." This connotes a state of affairs in which he/she can no longer tolerate the addiction and becomes willing to change. This event is often catastrophic, and may involve arrest, overdose, suicide attempts, major medical problems, job loss, financial ruin, family breakup, or other losses. The addict is generally unable to recognize the loss of control, especially because it crept up gradually. The disease of addiction is the only one known to science where the denial of its very existence is a hallmark symptom.

At this point, the loss of control is often obvious to others, though it may not be clear that addiction is the culprit. The classic sequence of events involves a phase when the addict becomes aware of a downward spiral of his/her life, but feels totally powerless to arrest it. Since denial of addiction is dominant, anybody and anything else is easily blamed. This tends to increase the suffering of family and other close ones. A long list of excuses to avoid change is common. Therapists are often amazed by the creative combination of genius and folly that generate the greatest excuses.

Eventually "rock bottom" hits. Some addicts declare their powerlessness and enter treatment willingly. Some are forced by circumstances, family, the courts, or employers to go for help. Others stick with their destructive illness to the bitter ends of homelessness, poverty, divorce, unemployment, incarceration, disease, or death. Halachically, an addict qualifies as a choleh sheyaish bo sakanah (a sufferer of a life-threatening illness) for whom violating Shabbos may sometimes be indicated.

Those who wish to help addicts need to remember that enabling them to continue their addiction is tantamount to assisting in their murder. We need to be alert, especially with regard to those asking us for money. Addicts have discovered that soliciting tzedakah is a successful technique to finance a drug habit. If a known addict comes to my door for tzedakah, stating that he has no food to eat, I offer food -- not money (which could finance the next purchase of drugs that could kill him/her). Yet the family abandoned by the addict often needs our help and support. The community should not forsake husbands, wives, or children victimized by the addict/alcoholic who is unable to provide for them.

From my files...

"Nosson" came upon hard times. His sources for money ran out, and he was unable to finance his $100-a-day habit of cocaine. He began to frequent shuls in several frum neighborhoods, telling stories about needing money for his wife and children. To some, he told of a relative with a chronic medical condition. He developed mastery of the art of "schnorring." He soon was able to elicit donations of $50-$150 quite quickly. Had he been able to raise such money without spending it on cocaine, he would have soon become wealthier than most of the people he bilked. When I met him, Nosson had not seen his family in several years, and those who supported him simply enabled him to continue his drug habits.

What Came Before the Addiction?

People do not normally take medications they don't need. If feeling "normal" somehow becomes intolerable, one seeks relief and will use medicine to help. Mind-altering drugs are invariably used to self-medicate, not to find pleasure (despite the pleasurable experience of the "high"). Identifying the perceived condition that the addict medicates is most challenging, and this is where skillful group or individual therapy is critical. Commonly found are a plethora of emotional consequences of abuse (verbal, physical, sexual) and neglect, various problems in adjustment related to educational and academic problems, and underlying psychiatric and psychological problems.

From my files...

Binyomin was a young Chassidishe man with several children when I met him. He was sober for several years after a 15 year addiction to alcohol and marijuana. Binyomin suffered from dyslexia, a reading disability. The yeshivah he attended did not identify the problem, seek evaluation, or offer any remedial help. He was disciplined for his inability to read and study Chumash and Gemara as expected. At home, his parents took the same harsh approach. Binyomin was persistently miserable and depressed, feeling his life was a failure. At age 11, he discovered that a shot of whiskey at a Kiddush made him feel better. For several years, he continued sneaking drinks at home, at every Kiddush in shul, eventually stealing liquor bottles to hide in his room.

As years progressed, he married. He could not drink at home, so he moved his alcohol use to a bar, and was introduced to smoking marijuana. This, too, left him feeling peaceful and content, for awhile.

His damaged self-esteem returned to normal after years of sobriety and therapy, but the time lost to addiction (that developed to soothe a treatable, but ignored condition) is irretrievable.

Finding Treatment

Getting the addict into treatment involves another major hurdle. Where should one go? There are many rehabilitation centers across the country that offer residential or inpatient treatment for a specified time period, usually 28 days. Existing health insurance limits this time. Day hospital and outpatient services are also available.

One of the most frequently-asked questions is: Where can I find a Jewish treatment facility in United States? The answer: You can't, and don't bother. I believe an observant Jew should have religious needs respected and accommodated in treatment. But our community has not accepted the disease enough to support such a facility. We would probably not send our family members there, in order to protect our "secret."

Also, the addict obviously cared much less about Yiddishkeit while using drugs; going out of our way to adjust a program to his religious "needs" diverts attention from the real problem, a tendency common among addicts and a major handicap. There are several treatment facilities in the New York environs as well as some in other locations that have Orthodox staff and can accommodate the frum patient.

The prevailing attitude in addiction treatment is that the disease is a manifestation of spiritual deficit. The 12-step approach (Alcoholics Anonymous, and other groups) refers amply to God as we understand Him and to a "Higher Power" (with virtually no reference to any specific religion). Reconnecting a recovering addict to a simple faith in God while allowing the pursuit of his own religious context is just what the addict needs to recover as a mentsch -- and then he can learn more about being an ehrlicher Yid.

We Can Still Save the Future -- If We Dare

To summarize, I urge that several goals be relentlessly pursued by us as individuals and as a community:

Begin to discuss the problems of addiction openly; in your community, your family and your schools. We have tried to avoid the problem, and in doing so, we have failed our children.

Be alert for signs of alcohol/drug experimentation and use . Refrain from denial, e.g., believing that "it cannot happen in my kehillah" (shul, yeshivah, family). It is a contagious disease and contaminates without respect for the kehillah, shul, yeshivah or family.

Address addiction as a disease, which requires treatment. Do not take it as rebellion or bad behavior, with the focus on punishments.

There are resources available to cope with the problems of the addict and his/her family.  These should all be utilized, even if you think there only may be a problem.

I often ask an addict seeking therapy a simple question: Would you be willing to report the names of the dealers who sold you drugs to the law enforcement authorities? The addict's answer may well reflect his or her true level of motivation to recover.

Likewise, the readiness of a community to pursue those who would destroy it is a reflection of its level of caring about every precious soul in that community.

Allowing drug activity to continue is tantamount to supporting it. If you or someone you know is aware of the names of dealers, report them to the police or the local office of the Drug Enforcement Agency. Our community deserves protection -- and we are the only ones who can provide it.

Dr. Benzion Twerski is the staff psychologist at Substance Abuse Services at Elizabeth General Medical Center in Elizabeth, New Jersey. He is on the professional advisory boards of JAADD (Jewish Association for Attention Deficit Disorder) and JACS (Jewish Alcoholics, Chemically dependent persons, and Significant others). He has written and published in a wide variety of lay and professional periodicals, and lectures on addictive disorders in the Jewish population.

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