In the corner of a decrepit shack in the early morning hours he snorts the cocaine he spent his last paycheck to get. Why trouble himself thinking about where the money will come from for the next time? Meanwhile he slumps over listlessly in a daze, "high" on life...

These pictures are commonly painted in association with alcohol and substance abusers, but are exceedingly stereotypical. Though these issues seem far-removed from everyday life, they are nevertheless prevalent in the nation and worldwide. According to the National Council on Alcoholism and Drug Dependence, one in ten Americans is alcohol and/or chemical dependent. And each individual substance abuser affects four to five others, usually family members. Unfortunately, the problem is not limited to any specific segment of society; the Jewish community suffers the effects of this affliction, possibly to a greater extent than expected.

As for exact statistics, "nobody knows," said Dr. Abraham Twerski, Medical Director of the Gateway Rehabilitation Center, an institution he founded in 1972 for the treatment of alcoholism and other substance abuse addictions. "Among Jewish college youth there is a great deal of substance abuse. Among Jewish older folks alcohol abuse is more prevalent. There is also an enormous amount of prescription drug abuse."

Tami Crystal, executive director of Jewish Alcoholics, Chemically Dependent Persons, and Significant Others Foundation, Inc. (JACS), a UJA-Federation agency headquartered in the New York area, said, "There are two odd things about Jews [regarding alcohol and substance abuse]. It very often skips a generation [in Jews] a little more than in other groups. Also, there is a greater percentage, a higher degree per capita, of pill abuse... because we go to doctors more."

Whether or not this problem is growing is unclear. Some argue that diminishing religious life is an important factor in the rising numbers of alcohol and substance abusers. Others speculate that increasing "acculturation" of Jews plays a key role in the advance. "But it can't all be related to intermarriage. Jews are coming into more contact with the outside world. They are no longer confined as they were in the shtetl," Twerski said.

"I'm not sure if it's a growing problem or if there is just a growing recognition of the problem," Crystal said. It is possible that Jews with addiction problems are not a new phenomenon at all, but that more are willing to admit to problems in a context of diminishing social stigma. "[Alcohol and substance abuse] is the kind of thing that nobody talks about. The Jewish population tries to cover it up," Twerski explained.

According to the Encyclopedia of Alcoholism, Second Edition, "Difficulties in treating Jews who are alcoholics stem from a generalized denial of the problem by the Jewish community and a lack of tolerance, which makes subjects feel isolated from their community and may worsen their situation." Also, although groups such as Alcoholics Anonymous are available, they commonly meet in churches, which increases the sense of isolation for Jews.

Organizations such as Gateway and JACS play a vital role in helping those with alcohol and drug dependencies. "Alcohol and substance abuse works like an equilateral triangle. The first end of the triangle is the drug enforcement. The second end is treatment, including outpatient and detoxification rehabilitation. The third end is recovery, helping people stay clean and sober," Crystal said.

The Gateway Rehabilitation Center, on the treatment end of the triangle, is nonsectarian, with only a small number of Jewish clients. "We strongly subscribe to the `Twelve-Step' program of the Alcoholic Anonymous, a program of recovery designed to help an alcoholic achieve sobriety by making major changes in the way he thinks, behaves and relates to others," Twerski said. Gateway's programs operate with two main objectives. "People with poor self-esteem become alcoholics; we help people raise their esteem. Family involvement is another goal in our programs."

Gateway offers continuous treatment ranging from the highly intense detoxification program to individual outpatient counseling. Programs include inpatient rehab (28 days), intensive outpatient day programs (five days plus a family day), and evening intensive outpatient (three nights plus a family night) falling progressively in between. In addition, their services include support groups such as a women's group, an aftercare group, a cocaine group, and a relapsers group for people that slip and must learn how to cope.

"People are not referred to JACS, they find us." JACS, which has been around for 15 years, enables recovering Jews and their families with varying degrees of Jewish background to connect with each other, re-connect with Jewish traditions and Jewish spirituality, and tap existing resources within Judaism to assist and strengthen continuing recovery.

JACS has adopted a three-fold purpose. It conducts retreats and support programs for alcoholics, chemically dependent persons and their loved ones. It also provides community outreach programs, and seminars to educate and sensitize Jewish spiritual leaders, health professionals, and the Jewish community about the disease of alcoholism and drug dependency on Jewish life.

People from all aspects of the Jewish spectrum can become alcohol or substance abusers. "The orthodox community has a severe problem because of `closet drinkers'," Crystal said. Yet, according to Twerski, "there is somewhat of a lower incidence among the ultra religious."

One study shows that in general the more observant the participant, the lower the incidence of intoxication. l However, "there are orthodox Jewish rabbis who are alcoholics," Crystal noted, and religious disaffiliation is not necessarily an indication of a drinking problem.

Research has indicated that Jews have lower rates of alcoholism than any other ethnic group, but Twerski said, "We're finding larger numbers than assumed."