Wednesday, May 29, 2013

A place where graduates overcome addiction

Elisha GahaganFor Elisha Gahagan, it was the day she lost custody of her kids. She?d been using since she was 12 years old ? first wine coolers and pot, then cocaine, eventually heroin ? but she had always promised herself that she would not turn out like this, just like her own mother, an opiate addict who spent her days chasing pain pills. Gahagan was supposed to be the June Cleaver mom she?d always wanted in her own life, but when the time came she found that she could not pull her head above water. The physical addiction had her in its grasp, and every move she tried to make toward a normal life was thwarted by a need she could not control.

Her quest to get clean took her through rehab and methadone clinics and a string of ever more desperate situations, until finally even the detox center turned her away because she'd been there too many times. That?s when she found TROSA.

Tucked into a quiet neighborhood in Durham, N.C., TROSA ? Triangle Residential Options for Substance Abusers ? is an outpost for addicts who have run out of options. The people who come here are among the hardest cases in the substance abuse world. They?ve been battling addictions for years ? sometimes decades ? and have burned through whatever support networks they once had. They come with tragic pasts and mental health issues and criminal records. Some lived comfortable middle-class lives until their addictions drained everything away; others have been camping out in cars and under bridges for years. They come in their 20s and in their 50s. Many are high school dropouts. Some don?t know how to read.

But more remarkable than the people TROSA takes in are the ones it turns out. Unlike typical treatment centers, which run for a few weeks or months and focus mostly on getting clean, TROSA is a two-year, live-in program that helps addicts rebuild their lives from the ground up. People come here to get off the drugs but also to dig deep, to discover who they really are and what they?re capable of doing. Those who didn?t finish school will earn GEDs; others can attend college classes. Everyone who graduates from the program will leave with a job. And everything they need along the way, from toiletries to interview coaching, will be provided. For free.

This is the other unusual thing about TROSA: It costs nothing to attend. Instead of paying for housing or meals, the people who come here work. Nearly half the money needed to fund the program comes from businesses run by the residents themselves, including a moving company, a lawn care service, and a frame shop. Residents also take jobs in the offices, kitchens, and garage on campus. This model has earned TROSA a reputation among some on the streets as a ?work camp,? but staff and residents insist the work is a central piece of the recovery process. It helps people build job skills, resumes ? and most importantly, a work ethic. That work ethic, combined with the program?s overall mission, has generated a lot of good will and repeat business in the community. The moving company regularly pulls in ?best of? awards, and locals are quick to praise the drive and discipline of TROSA crews. As Marge Nordstrom, who has used the lawn care service for several years, explains, ?These are men [and women] who are trying to get their lives back together and learn a trade so they stay out of trouble. And if I can help them to do that, I?m game.?

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For Ashley Hill, it was the day she sat in a holding cell in a Georgia jail, waiting to be led off to prison. She was 21 years old and had been in and out of trouble ever since an arrest for possession at 17. She?d even done a six-month stint in rehab for cocaine addiction but had come out ?cross-addicted? to opiates; her peers in the program talked up the high so much she was hooked. By the time she was busted for her fourth or fifth probation violation, her lawyer told her there was nothing he could do. She watched the guards come to take her away, but by some lucky mathematical error in court ? a twist of fate she still can?t explain ? they led her out to her family instead. ?I got a second chance,? she says, ?so I knew I had to do something. I wasn?t getting any better.?

Her parents suggested TROSA, but to Hill it seemed extreme. She didn?t want to be so far from home for so long. She dragged her feet and found reasons to put off leaving. Finally, one night, she nearly overdosed. Her parents stood firm: If you don?t go now, we?re done. She went.

A lawn care worker outside the gymNewcomers to TROSA learn quickly that they?re not just along for a ride. For the first 30 days they?re put on ?internship,? tasked with emptying trash cans, sweeping the halls, and attending therapy sessions as they come down off the drugs. Their days are scheduled from 6:30 a.m. until 11 p.m. The rules are many and strict: No cursing. No talking back. No makeup. No dating. No unmade beds. And no contact with family members for the first several months. Comings and goings around campus are tracked with sign-in logs and monitored by leaders. People caught breaking the rules are called into a place known as the ?Blue Room? and confronted about their behavior. Then they?re punished with ?contracts? ? extra work duty ? and sent back out stinging.

Later, the people who make it through the program will thank the staff and senior residents for this ?tough love,? but at the time it can be hard to swallow. For Hill, it was like nothing she?d ever known. At other programs, she says, ?you could fail drug tests, and your punishment was that you couldn?t go lay out at the pool that weekend.? Here, on top of the physical torment of withdrawal, she found herself being called out again and again ? sometimes for things she didn?t even realize she was doing. No one had ever held her so accountable for her behavior. She panicked. More than once she called her parents from the Blue Room to beg them to come pick her up. She didn?t know if she could make it.

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In 1993, Kevin McDonald was working at a gang parolee program in Los Angeles when a group from Durham called. The city needed his help, they said; the drug situation was taking a steep toll. They knew he had set up a treatment program in Greensboro, N.C. ? could he do the same here? Eventually he accepted, and with just $18,000 and a four-burner electric stove, he set up shop in an abandoned elementary school in a ?transitional? part of town. The school was in shambles, the basement so flooded he thought it was a swimming pool. He paid the neighborhood kids a dollar a week to stop throwing rocks through the windows. He had no written marching orders ? just an understanding of how addicts think and a determination to give them another chance at life.

Dorms on the main TROSA campusToday the main campus of TROSA is a cluster of more than a dozen buildings on land that was once a Flav-O-Rich dairy. What started as a 30-bed program now houses 431 residents ? here and at a number of smaller properties around the city. Aside from the old dairy structures, everything on campus has been built by the residents themselves. The two-story dorms line meticulously landscaped quads. Inside, shoes are arranged under the beds in pairs, clothes hung neatly in closets. Against the walls stand scuffed wooden dressers. ?Donated by Duke,? McDonald points out.

The word ?donated? figures prominently in a tour of TROSA ? if something wasn?t built by residents, chances are it was donated. ?This kitchen? Donated.? Conference table? Donated. Blue-and-white diner booths? You guessed it. An entire department is devoted to reaching out to companies across the country to ask for things the program needs; McDonald estimates their efforts saved the organization up to $3 million last year. Residents even drive to local bakeries each day to pick up unwanted pastries for the snack bar.

??You?ve got to hustle,? McDonald says with a wink, and this seems to be one of the keys to the program?s success over the years: seeing opportunity where others don't. As the organization has expanded, it has snapped up run-down buildings in overlooked parts of town and transformed them into useful spaces ? a pattern Durham Mayor Bill Bell says has had a ?very positive effect.? Instead of walling itself off, TROSA has made its presence felt throughout the city.

As he crosses the campus, McDonald calls out to every resident he passes: ?Hey, man, how you doing?? and ?Good to see you, man.? They clasp hands; sometimes they hug. This, too, is part of the therapy: to be recognized as visible, a human being.

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One thing recovering addicts will tell you about themselves is that they are self-centered. That after being driven by their own needs for so long, they have forgotten how to care about other people.

Vinicent? Alexander came to TROSA after he looked up on Thanksgiving Day 2010 and realized he was sitting alone in his apartment with a bag of drugs. He had waded so far into his ?obsession? that he?d pushed everyone away. ?Something?s got to change,? he thought.

Because Alexander had run his own tailoring business for decades, the structure and discipline at TROSA weren?t so jarring; for him the hard part was being held responsible for other people's recovery. The proverb ?each one, teach one? is a core philosophy here, emblazoned on signs and repeated in the hallways. It means, essentially, that one day you come in and learn how to sweep the floors, and the next you?re showing someone else how to do it.

But Alexander ended up teaching far more than one. At the end of his first 30 days, instead of being sent out to train at the moving company or one of the other businesses, he was named intern crew boss, which meant that he was on call around the clock, serving as a mentor, enforcer, and father figure to new waves of people coming in. For more than a year, as he counseled the interns through various crises, he found himself reliving his own intense transition to recovery again and again. Soon he realized that helping others was doing more than anything else to change his way of thinking. It had awakened something in him. He had really started to care.

For this reason, even residents assigned to other training schools during the day are given a ?people business? to manage on the side ? a handful of more junior residents to monitor and guide. Often ?guiding? means laying down the law. Strict as the program is, it runs largely on the honor system ? so it?s up to the residents to blow the whistle when someone screws up. ?That?s a really hard thing,? Kevin McDonald says, ?because you want people to like you. And you don?t know how to get people to like you without [drugs]. ... But if you really care about somebody and they?re doing something wrong, you?ve got to say something.? Speaking up makes residents more invested in the whole process ? and reminds them what they?re here to do.

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As visitors approach an office, the word ?Tour!? ripples through the room and instantly everyone rises. The men wear crisp button-down shirts and ties. The women are in slacks and business-casual blouses. One by one they introduce themselves.

My name is Krystal. Robert. Tyrone.

I?ve worked in this office five months. Eighteen months. Twenty-one months.

I started drinking alcohol when I was 11.

I?ve been using since I was 15, and my addiction was crack cocaine.

My addiction was opiates ? pills and heroin.

I started out using crystal meth, and then it was pretty much anything.

I was in my addiction for 13 years. It tore my life apart.

At TROSA this is an everyday part of the culture: owning your addictions, putting your story front and center, talking about the darkest chapters of your life in the same tone someone else might use to lament a bad investment they made years ago. This openness is also one of the main points of departure from programs that emphasize anonymity. McDonald appreciates what those organizations have done to help people, but to him the thinking is backward. ?You have to educate people,? he says ? which means sharing what you?ve done in the past and who you are now.

A common frustration for those who work in the substance abuse world is the belief that addiction is a choice, that addicts go back to using because they are weak. ?The perceptions haven?t caught up with the science,? says Paul Nagy, a clinical associate in Duke?s Department of Psychiatry and Behavioral Sciences who serves as an adviser to TROSA. ?The science is very clear that it is a brain-based disorder.? A person may choose to use drugs at the beginning, but then the drugs create physical changes in the brain, disrupting the normal communication and reward systems in ways that inhibit the user?s self-control and drive more and more compulsive behavior. Some people are more susceptible to this than others, thanks largely to their genes. Recovery is a complex and ongoing process.

TROSA founder and president Kevin McDonaldBut for McDonald, it?s important to show the world that it?s possible ? that addicts are people ?who can get healed.?

?We?re not lepers,? he says. ?We?re not society?s garbage. We?re not people who shouldn?t be around people.? TROSA members interact with the community through the moving company and other businesses, but they also go on speaking engagements around Durham in the hopes that their stories will inspire others to get help and shed light on the larger issue of substance abuse.

?People can?t ? from the top down ? acknowledge what a serious problem this is in our country today,? McDonald says. According to the Substance Abuse and Mental Health Services Administration, an estimated 21.6 million Americans needed special treatment for a drug or alcohol problem in 2011 ? but only 2.3 million received it. Many won?t admit they have a problem unless they?re pressured by loved ones or caught in the criminal justice system. Meanwhile they're out on the streets, posing a danger to themselves and possibly others.

Cumulatively, the effects of addiction are staggering. The National Institute on Drug Abuse estimates that substance abuse costs the U.S. more than $600 billion annually ? factoring in health care, lost productivity, and crime ? and emphasizes that even that number doesn?t reflect the full destructive effect on society: the disintegration of families, domestic violence and child abuse, and failure in schools. More than 10,000 people are killed in alcohol-related driving accidents each year.

?Why wouldn?t we be doing more?? McDonald asks. By more, he means not just getting people into treatment, but also funding research and development into better ways to stop the destructive cycle of behavior. Over the years he?s seen so many people conquer their addictions only to suddenly relapse. ?Why does that moth go to that flame?? he says. ?That?s what we?ve got to figure out.?

In the meantime, he?s doing what he can to put a human face on the issue and raise awareness beyond TROSA?s gates. He hopes that among the dozens of groups that tour the center every year ? including students from Duke and other schools ? there are future leaders who will have a better understanding of what?s at stake, thanks to what they?ve seen and heard.

?That?s what we have to think about,? he says. ?Not just TROSA, but this whole field. Until somebody?s directly affected by [substance abuse], they don?t get it.?

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Kevin McDonald started using alcohol when he was 13 years old. He was living in Germany, where his dad was stationed in the Air Force. He was a shy kid. His mother was abusive. He had trouble connecting with people. When the family moved back to California, McDonald tried to fall in with the hippie crowd ? ?weed, hash, regular stuff? ? but he didn?t quite fit there, either. Soon he turned to heroin and the rougher scene that came with it. The heroin took over his life and kept him from holding down a job. He overdosed multiple times but kept going back for more. His father didn?t understand why he couldn?t just quit. Eventually, McDonald began robbing pharmacies to feed his addiction. That?s when he landed in jail.

From there McDonald caught a lucky break ? after a few months, he was released into the Delancey Street Foundation, a therapeutic community in San Francisco that inspired the underlying model of TROSA. Hardened by years of abuse and paranoid from his time behind bars, McDonald was skeptical of these people who wanted him to share his feelings. He was in his early 30s then and hadn?t cried since he was a teen. ?I was thinking, ?I don?t know if I can handle this,?? he says. ?I was burnt, you know. I was crisp.? He spent his days and nights on edge, half-waiting to get jumped. But eventually the anxiety subsided, and he learned to open up. Here were people who truly wanted to know how he was doing every morning. Who wanted to give him tools he could use in the world. ?All I knew when I got there was anger and hate,? he says, ?and to change that around was life-saving.?

At TROSA, McDonald has borrowed many of the core elements of the Delancey Street model ? most importantly peer mentoring and job training ? but he?s also added other pieces over the years. Unlike Delancey Street, TROSA has a paid staff. They use evidence-based therapy and Seeking Safety (a program geared toward post-traumatic stress disorder) in their work with residents. McDonald has also brought in psychiatric support through Duke, which allows TROSA to help more people with mental health issues.

That mental health component has become increasingly important, says adviser Paul Nagy. In recent years he?s seen more and more residents come in with co-occurring disorders, especially depression and anxiety, and with histories of PTSD ? not from war but from ?life trauma? and abuse.

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Behind a set of blacked-out glass doors a ?dissipation? is in full swing. Here, residents who have been at TROSA long enough to build a solid foundation gather for 24 hours to unleash whatever demons still need freeing. Some come to purge deep-seated guilt over the things they?ve done in the past ? to confess and seek forgiveness. Others come to work out anger at their families or fellow residents. ?It?s very raw,? McDonald warns, and indeed when the door opens the air is charged. A group of 15 to 20 residents sit facing one another on couches arranged in a square, the lights so dim their expressions are barely visible. A man is gesturing and shouting at his neighbor.

One of the old dairy structures ?The stories I?ve heard in dissipations for 30 years...? McDonald says. ?What people will do to each other and what people will do for dope is just mind-blowing. Nothing comes before it, when you get to a certain point. It?s just horrific.?

Equally horrific is what some of the residents have endured before coming here. Nearly everyone has been abused in some way, McDonald says. He tells the story of a recent graduate who grew up with a schizophrenic mom, was adopted by a violently abusive aunt, and then molested by her own father. He tells the story of Susan, who jumped off a bridge and broke her neck but survived ? only to be attacked with a claw hammer in an attempted rape.

Upstairs, in the intake office, resident Dawn Sakowski hears stories like these every day. Before she came to TROSA, Sakowski spent years on the streets of Philadelphia, living in abandoned cars and turning to prostitution and theft to fund her crack cocaine habit. From the calls she makes as she?s screening applicants, it?s clear: ?It?s still the same out there.? This week the reality of that hit home in a much more personal way, when her 22-year-old daughter was admitted to the program. Sakowski is glad she?s here, getting the help she needs, but ?it?s hard to see,? she says. She fights off tears as she speaks.

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At TROSA, time is measured in days and months. At 30 days, residents can write and receive mail. Ninety days until phone privileges. Six months to a wristwatch and an MP3 player. At 12 months, they?re called onstage to receive a medal, and new worlds begin to open up: They?re allowed to date. Families can come to campus to visit and, soon after, they can visit their families at home. At 21 months, they go on ?work-out,? taking a job in the community.

Not everyone finds success at TROSA. The graduation rate hovers around 30%, and the average stay is 11 months. Most of those who leave do so in the first two months, when emotions are running high and the transition is most difficult. Some leave later, after six or 12 or 18 months, because they think they?ve healed enough to strike out on their own. Others are sent away ? for breaking the rules too many times, for health issues TROSA can?t accommodate, or for making threats. (Violence ? even the threat of it ? is not tolerated at TROSA; the program won?t accept rapists and certain other offenders for this reason. ?There are wolves and lambs in the substance abuse world,? McDonald explains. ?You?ve got to equal the playing field. There has to be a safe feeling.?)

Elisha Gahagan quit TROSA at six months. She thought she had everyone fooled into believing she was a ?goody-goody addict,? but then she broke a couple of rules and was presented with a contract. Suddenly she realized that these people were just like her; they could see through the manipulations and weren?t going to fall for her ?crap.? She decided she didn?t need their help ? she was off the drugs, she could handle herself now ? so she called her ex to pick her up. The kids were thrilled to have her home, but within hours she realized she hadn?t thought it through. She had nothing ? no change of clothes, no way to get to and from a job. Intense anxiety kicked in, and she found herself reaching for a beer. The kids watched her in disbelief. The next day she called TROSA and begged to return. When she came back, she started the program all over again.

?It was the best thing that could have ever happened to me,? she says, ?because at that point I realized what I was doing. Everything hit me. I?ve got to really dig deep. I?ve got to take advantage of this opportunity and find out who I am and why I do the things I do. And to try to change and be a different person.?

Those who stick it out through graduation receive jobs and diplomas, but also continued access to inexpensive TROSA-owned housing and transportation to and from work. When donations allow, they?re given a car. Some stay on to finish their studies or train for full-time positions on staff (more than half of the 50-person staff went through the program). As the rest venture out into the world, they can stay connected to TROSA through group activity nights and, if they need them, free meals. They?re still not ?cured,? Paul Nagy points out, even after two years ? because there is no permanent cure for addiction. They?ve started on the total life change required for recovery, but they will be working at it every day for the rest of their lives. And they?ll need all the help they can get.

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It?s Sunday afternoon ? Mother?s Day ? and a group of black-robed graduates is gathering for a picture under a concrete awning. ?Everybody say, '1, 2, 3 ... sh-t!'? McDonald jokes. ?It?s a special occasion.?

Less than two miles away, Melinda Gates has just finished addressing 5,000 graduates on the campus of Duke University, and celebratory horns can still be heard in the distance. Here, as the crowd files into the TROSA gymnasium, there?s a different kind of energy: excitement mixed with relief, wariness, and hope.

Ashley Hill with her parents Ashley Hill is here, adjusting her cap and gown. It?s the day after her 24th birthday and two years since the near-overdose. In the end, all that trouble she got into early on paid off ? she got tired of losing her free time to extra duty and started focusing on the future. ?I proved to myself my strength,? she says. ?I?m really proud of myself today.? She?ll be staying on at TROSA to finish her associate degree so she can transfer to a four-year college. She waves to her parents as they arrive.

As the ceremony begins, a static recording of ?Pomp and Circumstance? leads the graduates to the stage, where one by one they collect their diplomas and rings and stop in front of the microphone to address the audience. They offer variations on refrains one hears a lot at TROSA: ?This place saved my life? and ?I don?t know where I would be.?

?You talkin? 'bout a miracle?? asks Robert Murphy. ?You?re looking at it. Right here.?

TROSA is not a religious program, but nearly everyone thanks God. They thank the staff for that ?tough love? and ?extra therapy? they hadn?t known they?d needed. They assure the interns in the crowd that it will all make sense in the end.

Then they turn to the families, who are the other stars of this day. ?I?d like to ask my family to rise.? Each time, the crowd turns and erupts in applause.

Ashley Hill looks out at her parents: ?I apologize for the things I put you guys through. I can?t imagine what it was like for you to watch me go through that.?

Vinicent Alexander on graduation dayVinicent? Alexander promises his family: ?I am a better man and will be a better man until the day I die.?

Men of all ages speak to loved ones they left behind:

?You?ve got your son back.?

?You?ve got your brother back.?

?Y?all got your Daddy back.?

Will Crooks points out his brother, who graduated from law school the previous day: ?I am so proud of him.? He tells the crowd about his mother, who passed away when he was 19. ?I had to watch her as she slipped away,? he says, ?and I sat there and promised her, ?Mom, I?m going to change. I?m going to be a different man.? And today, I am changed. This is for my mother. Happy Mother?s Day, Mom.?

After the ceremony, Elisha Gahagan mingles with the graduates and staff. She shares a text message she just received from her 11-year-old daughter. ?Happy Mother?s Day,? it reads. ?I love you more than words can express.?

Gahagan finally collected her ring and diploma last year; today she works at TROSA as one of the president?s assistants. She still lives on campus but has reconnected with her kids and sees them regularly. Her life, she says, is complete: ?I look at everything, day in and day out, and it is so perfect right now that I wouldn?t change a thing. I wouldn?t change my past. I wouldn?t change the experiences that I had. This is how I had to get here. I?m just glad I got here.?


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