In Israel, perhaps the only orthodox-run addiction therapeutic (residential) treatment program is the Retorno program in Jerusalem. As someone who suffered from drug/ alcohol addiction, I entered this program with high hopes of a progressive program. I found that while outreach (or marketing) staff may have been well intentioned, my family and I were grossly misinformed about the nature of the program. It appears that laws governing patients' rights in Israel are not comparable to the well protected status afforded most patients in the United States.
RETORNO'S SUCCESS RATE
Retorno's promotional website boasts an "80%" success rate. While the site appears to be dedicated to their program for juveniles, a similar statistic was used to sell Retorno's adult program to my family and me, but no answers were provided when simple questions were asked about this figure. Anyone in the field of drug rehabilitation knows that recidivism is extremely common and the rule rather than the exception. An 80% success rate is a dream for any drug rehab facility. So some questions are in order: Is the 80% success rate reflective of the juvenile division, the adult division, or both? How was success measured? Was every individual who entered through Retorno's gates for treatment tracked? Or only those who maintained contact with Retorno after discharge? And what constitutes success? Abstaining for 1 year? 2 years? You can see that the very enticing "success rate" advertised requires just a little bit of elaboration to be meaningful.
RETORNO'S TREATMENT APPROACH
In my discussion with a Retorno social worker to learn about their treatment approach, I was told that the 12 step program is used, but that the program did not strictly adhere to this approach. I was told that their approach is extreme on one thing: communication. Sounds good. The beautiful expansive pictures of hills and fields and horses sounds like a wonderful environment to rehabilitate the body while the doctors of the soul would guide the mending of my spirit. I was not at all prepared for their actual treatment approach, a description of which follows.
An ever-present theme is that of humiliation. Between 5 to 10 times a day, patients are alerted by the banging of a gong that they must form a circle with their assigned group. You are awakened with the gong, go to meals at the sound of the gong, clean up at this signal, and so on. While at the circle, one must place hands behind the back. Anyone guilty of any sort of infraction risks being called to the center of the circle, where they must bow their heads and listen to rebuke by staff or the group leader. Often, they must then listen to their peers who are encouraged to continue the verbal harassment. And, to show good sportsmanship, the rebuked individual must not answer a word, except the required "thank you" after its over.
Any insubordination may be answered with a command to go the bench. This is the red bench featured on the Retorno site on which a youth is sitting alone. One must not talk on that bench and peers may not visit. At the end of the bench treatment, peers are sent to repeat the message of rebuke and then signal the end of the bench treatment. Again, the offender must not answer except to say thank you. The bench treatment can last for hours. I know of a middle-aged woman, mother of several children, who was sent to the bench for asking a social worker a question without first approaching her group leader.
Other means of humiliation are the wearing of a kitchen apron throughout the day, humiliating tasks, or ultimately, isolation in what is known as "the cave": what appears to be a bomb shelter built into a cave. During my stay, I was aware of an individual who was there for about a week, including the Shabbat.
POPULATION FOR WHICH TREATMENT IS USED
While at Retorno, I was amazed that the treatment described above was intended for such a broad range of problems and individuals. The adult population ranged from 18 years of age to the mid 50's. About half were sent by the Israeli criminal justice system. The range of problems were equally remarkable. They ranged from young adult women with eating disorders to hardened heroin addicts to a sexual offender and a gambler. But they had one thing in common: they received the same basic treatment approach.
FREEDOM TO LEAVE THE PROGRAM
Although one can enter Retorno of one's own free will, leaving is not quite as simple. After about a week into it the program, I communicated my intention to leave the program at the end of my fourth week of treatment. Nevertheless, I received no individual counseling until the third week of treatment. Furthermore, my family was not notified of my intentions as I had requested. I was led to believe my wife was notified via faxes which I gave to the Retorno staff to fax for me. Apparently, the faxes were never sent. (This did not stop staff from blaming my wife for mishandling the situation when they abruptly called her on the day I left.)
I was tipped off by a veteran of the program that I was unrealistic to think I could simply leave. Indeed, I received no help whatsoever in planning a safe and reasonable departure from the program. My social worker, who was also the director of the adult division, told me that he had no obligation, morally or otherwise, to help me leave since he didn't agree that I should leave. Despite days of advance notification, my possessions in safe-keeping at the office were withheld from me (including my passport and money).
After being stalled for over 7 hours, I realized that the only way to leave was to escape without my passport or money. I jumped through a hole in the fence and hitchhiked my way to a friend. A couple of days and many phone calls later, with further stalling tactics and much aggravation, I was privileged to be able to pick up my remaining belongings. When confronting the social worker that (mis)represented the program to me prior to admission, I was told that if the program would have been described accurately, I never would have come. Hmmmm...
It seems the same rationale was applied when selling the program to my wife, since she too, had no idea of Retorno's treatment approach - only of the spiritual mending amidst the beautiful hills, fields and horses. She was misled to believe that the program was essentially a 12 Step oriented program. At a rate of $4,000.00 per month (apparently a special price for non-Israelis) it is no wonder that a sort of bait and switch approach is used to recruit patients, that extreme efforts are made to hold on to patients and that a six month minimum is generally the norm.
For adults, fair disclosure of what is and is not included in a treatment program is the kind of thing one would and should expect of a professional treatment program. Addiction is a very complex phenomenon. No one approach will work for everyone and most people probably need an approach using multiple prongs of attack. Psychiatric treatment, stable employment, therapeutic interventions of various types and proper nutrition are all likely to be an integral part of treating addiction problems. An approach that is narrow and does not reflect the cutting edge of biochemical and behavioral science will short-change individuals seeking to be healed. Worse yet is to misrepresent a program to prospective patients and their families.
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