Why the world’s drug ad­dicts are off to the Promised Land

Last week, the JC re­ported that Amy Wine­house was booked into detox in Is­rael. A wise move: the coun­try’s state-funded re­hab pro­grammes are at­tract­ing ad­dicts from across the globe, and claim­ing high suc­cess rates

The Jewish Chronicle - - Features - BY MICHAL LEVERTOV

IT IS AROUND 4pm. A gen­tle breeze blows against the hot, dry air en­cas­ing Gi­vat Shemesh (He­brew for Sun’s Hill), five min­utes’ ride from the town of Beit Shemesh, near Jerusalem. At Re­torno, the re­ha­bil­i­ta­tion cen­tre set on the top of the hill, all is quiet. Only the mu­sic play­ing from the speak­ers at the horse farm at­tached to the fa­cil­ity dis­turbs the peace.

At this time of the day, many of the cen­tre’s 80 ad­dicts are busy with their in­di­vid­u­ally tai­lored re­cov­ery pro­grammes, which can in­clude ex­pe­ri­enc­ing the ther­a­peu­tic ef­fects of horse-rid­ing (hence the farm). Oth­ers are rest­ing in their rooms. They will soon get up for af­ter­noon prayers — 60 per cent of the cen­tre’s res­i­dents are re­li­giously ob­ser­vant, but at­tend­ing prayers is com­pul­sory.

The group of 10 pa­tients of the pro­gramme de­signed for English-speak­ers is just about to leave for their weekly treat — a visit to “the En­chanted House”, a nearby fa­cil­ity spe­cial­is­ing in holis­tic treat­ments.

Among them is Moshe (not his real name). He is a 35-year-old Bri­tish Jew who made aliyah sev­eral years ago. He ad­mit­ted him­self to Re­torno (Span­ish for “re­turn”) for five months’ treat­ment for al­co­hol de­pen­dency.

Less than a year ago, he had a heart at­tack. “I was head­ing down south very, very quickly,” he says. “It was ei­ther a ques­tion of tak­ing my life into my hands, or end­ing my life. That,” he grins, “could be a pretty good mo­ti­va­tion.”

That, and the painful com­pre­hen­sion that ev­ery­thing he had was at stake. “I’ve been ad­dicted since I was around 15. I never saw it as an ad­dic­tion, I just saw it as a way of life or re­belling. I only started re­al­is­ing it about 10 years ago. But even so, for me, I was a func­tion­ing ad­dict; I have a fam­ily, I have a home, I have a job. The thing is, it comes to a stage at which, if you don’t take things into your hands, you’re go­ing to lose all of that. You’re los­ing your friends, your fam­ily. Ev­ery­thing that you hold dear.”

Moshe heard about Re­torno from his brother, whose neigh­bour — Is­rael is in­deed a small place — is a mem­ber of staff at the cen­tre and a for­mer ad­dict him­self. The fa­cil­ity’s set­ting ap­pealed to him. He ex­plains that he needs the iso­la­tion and the re­laxed at­mos­phere. “You’re not busy with the day-to-day life out­side and you’re able to con­cen­trate more on your­self.”

Shortly af­ter Moshe’s group leaves for the en­chanted house, a gong sounds. The pa­tients read the sig­nal at once — some­one is in an im­me­di­ate need of emo­tional sup­port. Within a few min­utes, a cir­cle of 11 or 12 men form in the shade of a gi­gan­tic old fig tree. For the next quar­ter of an hour or so, they stand there, talk­ing, lis­ten­ing and shar­ing thoughts and ex­pe­ri­ences.

This type of spon­ta­neous group ther­apy is not un­com­mon at Re­torno, ex­plains Ze’ev Slonim, the cen­tre’s di­rec­tor of de­vel­op­ment. On this hill­top, as in the Is­rael’s other nine long-term re­hab cen­tres, sup­port groups are an im­por­tant in­gre­di­ent in the bat­tle against ad­dic­tion.

Th­ese ther­a­peu­tic cen­tres are a part of a pub­lic re­hab sys­tem, run by the state and achiev­ing rel­a­tively high rates of suc­cess in com­bat­ting ad­dic­tion. Ac­cord­ing to Min­istry for So­cial Af­fairs fig­ures, 84 per cent pa­tients who com­plete a course of treat­ment within the sys­tem stay clean for at least a year, 54 per cent for five years. Cur­rently, 14,000 ad­dicts are in re­hab in Is­rael.

Haim Mell, head of treat­ment and re­ha­bil­i­ta­tion at Is­rael Anti Drug Author­ity, be­lieves the suc­cess rate is lower, but he agrees that the Is­raeli re­ha­bil­i­ta­tion sys­tem is more suc­cess­ful than oth­ers.

The key to the suc­cess of the sys­tem, say ex­perts, is the length of the treat­ment. Pa­tients stay in ther­a­peu­tic com­mu­ni­ties for up to a year, but the whole re­hab process of­fered to Is­raeli ad­dicts lasts from 18 months to a cou­ple of years.

Singer Amy Wine­house’s planned Is­raeli re­hab, as re­ported in the JC last week, is a short, in­ten­sive detox pr o c e s s . An­dre Wais­mann, of the ANR clinic in Ashkelon’s Barzi­lai Medic a l Cen­tre, in which the pro­ce­dure is con­ducted, claims that his re­hab method is a com­pre­hen­sive one. Not only does it pro­vide an ac­cel­er­ated cleans­ing process, done un­der anaes­thetic, he ex­plains, but it also rids the pa­tient of any fur­ther drug crav­ing, due to med­i­cal treat­ment in­tended to block the ad­dicts’ opi­ates re­cep­tors. “There is a mis­un­der­stand­ing about drug ad­dic­tion. Peo­ple think it is a so­cial and psy­cho­log­i­cal prob­lem, but it’s a neu­ro­log­i­cal prob­lem,” Dr Wais­mann says.

Other Is­raeli ex­perts beg to dif­fer. Dr Mell says that there is sim­ply no in­stant cure for ad­dic­tions. Dr Wais­mann’s treat­ment is a valid cleans­ing method, he ex­plains, “but the phys­i­cal re­hab is only the first, unessen­tial, step. The prob­lem lies in what comes next.

“In the Ashkelon treat­ment, the medicine given is nal­trex­one, an opi­ate an­tag­o­nist which is the op­po­site if methadone [a syn­thetic sub­sti­tute for heroin]. The nal­trex­one blocks the heroin. If later the pa­tient stops tak­ing the nal­trex­one pills, he’ll re­treat to heroin. If you don’t un­der­stand that af­ter the [cleans­ing] pro­ce­dure you’ll have to be in a spe­cial care frame­work, you’ve done noth­ing.”

That, Dr Mell adds, is the rea­son for the Is­raeli cus­tom­ary three weeks’ phys­i­cal cleans­ing pro­ce­dure.

“In Amer­ica they do that in eight days,” he says. “We do it in three weeks, in or­der to cre­ate a con­nec­tion with the pa­tient, and bring to his con­scious­ness that we’re only at the first phase of the

treat­ment, and that un­der the drugs lie very dif­fi­cult prob­lems which won’t be solved with­out a long treat­ment. If you let the pa­tient out af­ter a week, then af­ter a cou­ple of weeks he’d use drugs again.”

Ei­tan Sela, di­rec­tor of Or Aviva, a non­govern­men­tal or­gan­i­sa­tion which op­er­ates three of the ther­a­peu­tic com­mu­ni­ties in Is­rael, adds: “The phys­i­cal prob­lem is not the dom­i­nant one in the process of heal­ing from ad­dic­tions. The essence of the ad­dicts’ prob­lem is the lifestyle that had de­vel­oped through­out the de­pen­dency and the feel­ing of empti­ness that is cre­ated with the ab­sence of the drug. Ninety-nine per cent of the peo­ple who had only phys­i­cal re­hab re­treat to the drugs within a month.”

Even fol­low­ing a few weeks of psy­cho-so­cial treat­ment will not do the job, Is­raeli doc­tors be­lieve.

“Many of the Amer­i­can re­hab cen­tres are based on a 28-day model, which is not a suf­fi­cient pe­riod to achieve se­ri­ous pro­cesses,” says Am­non Michael, di­rec­tor of HaDerech Ther­a­peu­tic Com­mu­nity in the north­ern vil­lage of Nes Amim and a lec­turer in so­cial work at Haifa Univer­sity.

Sela adds: “Pa­tients from for­eign coun­tries come to us with piles of med­i­ca­tions, and we slowly re­duce their doses. I’m very crit­i­cal re­gard­ing this use of medicine, and of the ex­ces­sive di­ag­noses. It’s all a re­sult of the Amer­i­can in­sur­ance com­pa­nies’ de­mands for di­ag­noses.”

Should Wine­house opt for the full treat­ment in Is­rael and ad­mit her­self to a ther­a­peu­tic com­mu­nity, she can ex­pect a vast as­sort­ment of pro­grammes, all of them ap­proved and su­per­vised by the Min­istry of Health or by the Min­istry of So­cial Af­fairs, un­der whose aegis the com­mu­ni­ties op­er­ate.

While the phys­i­cal re­hab scene in Is­rael con­sists of around 20 private clin­ics, the psy­cho-so­cial care is, says Iris Floren­tine, di­rec­tor of na­tional ser­vices for treat­ment of ad­dic­tions at the Min­istry of So­cial Af­fairs and So­cial Ser­vices, “ninety-nine per cent con­ducted by pub­lic in­sti­tu­tions or by pub­lic NGOs, all fi­nanced by the state. Our bud­get is 55 mil­lion NIS (£8.3 mil­lion). Thus, we can meet the dif­fer­ent needs of dif­fer­ent com­mu­ni­ties.”

One of Or Aviva’s pro­grammes, for in­stance, is de­signed for ad­dicts who are moth­ers with young chil­dren; an­other for is for ad­dicts who suf­fer men­tal-health prob­lems. The Malk­ishua com­mu­nity in the north of the coun­try spe­cialises in youth care, while a cen­tre in Taibe is des­ig­nated to serve Ara­bic­s­peak­ing pa­tients.

Rabbi Ei­tan Eck­stein, the over­all di­rec­tor of Re­torno, es­tab­lished his cen­tre 15 years ago hav­ing iden­ti­fied a lack of treat­ment for ad­dicts in the Ortho­dox com­mu­nity. Re­torno is open to sec­u­lar and to non-Jewish pa­tients, and the cen­tre runs pre­ven­tive ed­u­ca­tional pro­grammes for all mem­bers of Is­raeli so­ci­ety. But for in-pa­tients, the code of dress is kip­pot for men and long skirts for women.

Lux­ury at the cen­tre is in short sup­ply, as be­fits a fa­cil­ity de­pen­dent on pub­lic fund­ing. Re­torno, if any­thing, re­sem­bles a vol­un­teers’ com­pound in a 1980s kib­butz.

“Here [in Is­rael] it’s back to ba­sics,” agrees Ira Nis­sel, chief ex­ec­u­tive and founder of IMS, an Is­raeli med­i­cal tour- ism com­pany, who refers his clients to Ha’Derech re­hab cen­tre. “But it’s in the open coun­try, and it’s tran­quil.” Sela says that in terms of lux­ury, “ours are in­deed not the Amer­i­can con­di­tions, but they’re av­er­age, and more”.

The mod­est con­di­tions do not seem to de­ter the in­creas­ing num­bers of ad­dicts who want to take ad­van­tage of the Is­raeli re­hab op­tion.

Sev­eral ther­a­peu­tic com­mu­ni­ties have be­gun pro­grammes de­signed for English-speak­ers, which they mar­ket com­mer­cially. Re­torno, for in­stance, puts ad­ver­tise­ments in in­ter­na­tional Jewish publi­ca­tions.

Part of the ap­peal to for­eign­ers is the anonymity the cen­tre can pro­vide, along with rel­a­tively low prices for treat­ment. HaDerech di­rec­tor Dr Michael says: “Amer­i­can fam­i­lies laugh when they hear how much we charge. Cen­tres in Amer­ica charge $30-40,000 for 28 days. In Is­rael, the rates are $36,000 per month.”

The Jewish el­e­ment is also a fac­tor for rel­a­tives who hope a fam­ily mem­ber who is an ad­dict will, as says Dr Michael says, “find the roots, not only of the ad­dic­tion”.

Lack of Jewish long-term re­hab in­sti­tu­tions abroad, points out Udel Bergamn, the so­cial worker in charge of Re­torno’s English-speak­ers’ pro­gramme, is an­other fre­quent mo­ti­va­tion. Also, she notes ad­dicts are sent to Is­raeli re­hab as “a last re­sort”, af­ter try­ing all other op­tions to no avail.

Non-Jewish pa­tients seem just as happy to try the Is­raeli op­tion. An An­golan cit­i­zen who came es­pe­cially to Or Aviva last month in or­der to treat his sub­stance ad­dic­tion says that his choice was the re­sult of long re­search, “in which I nar­rowed choices to three coun­tries, then, when pick­ing Is­rael, I nar­rowed it to Or Aviva’s Il­lanot com­mu­nity”.

What ul­ti­mately swayed him was the higher chances of suc­cess­ful re­cov­ery, rooted, he be­lieves, “in the de­ter­mi­na­tion that char­ac­terises the Jewish cul­ture”.

The for­eign pa­tients’ con­tri­bu­tion to the cen­tres’ in­come is a good mo­ti­va­tion for them to in­vest in such pro­grammes. “They en­able us to fi­nance more Is­raeli pa­tients,” says Ei­tan Sela.

Also wel­comed are do­na­tions from happy cus­tomers, such as the $20,000 do­nated re­cently to Or Aviva by an Amer­i­can busi­ness­man fol­low­ing the re­cov­ery of the cou­ple’s son. But this phe­nom­e­non has its down­side. Sela men­tions the need to bridge lan­guage gaps, to care­fully cus­tomise spe­cial pro­grammes for non-Is­raelis and the ne­ces­sity of re­tain­ing a suf­fi­cient num­ber of English-speak­ing staff.

Dr Michael notes that “some­times Jewish fam­i­lies hope that the fam­ily’s black sheep will even­tu­ally stay in Is­rael, that maybe he’d find a nice kib­butz to settle in. This is just a wish­ful think­ing”. Im­port­ing ad­dicts, says Floren­tine, is not en­cour­aged by the state. “Peo­ple stay in Is­rael af­ter the re­hab,” she says. “They might not have an in­come or a health in­sur­ance, and they some­times fall again into the cy­cle of drugs use and felony.” But the gov­ern­ment is not about to put a stop to the in­flux of for­eign ad­dicts look­ing for treat­ment. “We’re not en­cour­ag­ing and not pre­vent­ing

this,” she says.

Re­cov­er­ing ad­dicts at the Re­torno re­ha­bil­i­ta­tion cen­tre. The rural set­ting al­lows pa­tients seclu­sion and the chance to sam­ple the ther­a­peu­tic ef­fects of ac­tiv­i­ties such as horse-rid­ing

Rabbi Ei­tan Eck­stein, di­rec­tor of Re­torno

Singer Amy Wine­house, with her par­ents Mitch and Janis. Wine­house’s team ar­ranged for her to go to Is­rael for drug re­ha­bil­i­ta­tion

Ei­tan Sela, di­rec­tor of Or Aviva re­hab cen­tre

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