A HALFWAY HOUSE FOR NARCOTIC ADDICTS

Br. J . Addict. 1965, Vol. 61, pp. 79-89. Pergamon Press Ltd. PAnted in Great Britain

A HALFWAY HOUSE FOR NARCOTIC ADDICTSM

GILRERT GEISt Austin Hall, Harvard Law School, Cambridge, Mass., U.S.A.

Tlhe basic explanation for the existence of the East Los Angeles Halfway House lies in the tradiltional observation that the weakest link in attempts to keep former narcotic addicts from reusing drugs is found in the realm of post-institutional program- ming (Duvall et al 1963, Buckwalter 1961, Foran 1962, Diskind 1960, Proceedings of White House Conference on Narcotic and Drug Abuse 1962). The most dangerous period, the h e at which relapse is most likely ‘to occur, follows very closely upon release from an institutional detoxification and treatment program. The onetime addict generally returns to a social situation which probably had somathkg to do with his original use of drugs, and he is usually not only without resources or with limited resources, but he also now carries the additional burden of having been officially labeled a “dope fiend”-a category which is believed to indicate unemployability, crime-proneness, and similar social deficiencies.

The Halfway House is designed to provide some sort of a refuge between the time that a man is relased from prison and the time when he returns more fully into (the total environment from which he was earlmier withdrawn. House residents are all males, and all felons with a previous history of drug use, though

* This paper was presented at the meeting of the Committee on Drug Addiction and Narcotics of the National Academy of Science, National Research Council, Houston, Texas, February 16, 1965. The project reported upon here has been financed by Grant No. MH-808 of the National Institute of Mental Health. Viewpoints expressed in the paper do not necessarily reflect the opinions of the Institute, or of the California Department of Corrections, or of the Institute for the Study of Crime and Delinquency, which is the sponsoring agency for the federal grant.

t Ph.D., University of Wisconsin, 1953. Professor of Sociology, California State College, Los Angeles. Currently 1964-65, Fellow in Law and Sociology, Harvard Law School.

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they have generally been drug-free for the previous several years, during their prison time. They are gathered into (the House from a variety of California institutions: San Quentin, Folsom, Vacadle and others. Originally, they reported to the House immediately upon prison release; more recently. those men destined to reside in (the Halfway House have been sent to Chino, about a monkh prior to the beginning of their parole 90 that they could receive some better understanding of what would be expected of them. At Chino, under the new program, the men are visited by a representative of the Halfway House, and they take part in group meetings involving other persons with whom they will be living at the, House.

The House has an average residential population in the mid- twenties, and the men stay there approximately five to six weeks. Tihis comparatively short residential period is by design, since one of the aims of the experimental project is to determine whether or not it is possible to control the use of narcotics with a short- term program intervening between prison and standard parole status. It may be that it is necessary to maintain residential status for a longer period-perhaps for one or two years-in order to be effmtive, but we think it important to determine this with some certainty before embarking upon so extraordinarily expensive and restrictive an undertaking.

A demographic portrait of the men who have resided in the Halfway House shows that approximately 80 per cent are Mexican- Americans, 16 per cent “Anglo” Caucasians, and four per c a t Negroes. About half of the mothers and slightly fewer of the fathers of the men were born in Mexico. The age range is from 20 through 45 years, with a large percentage of the men falling into the 27-37 year bracket. About half report never having been married, and only 18 per cent completed high schml. Eighty-two per cent say they used drugs (including marihuana) before the age of 21. These items, I perhaps should point out, do not represent a general profile of southern California drug users, since the Halfway House deals with a selmtive geographic population.

It is perhaps also worth noting that the heavy Mexican- American concentration in the House population may be a notable biasing factor, pushing in the dirmtion of failure, since Mexican- Americans are reputed to be (though I have not yet seen empirical data eithex confirming or refuting thia particular item d folklore) the ethnic group most resistant to current programs to inhibit

THE BRITISH JOURNAL OF ADDICTION a1 drug use. Part of this resistance is said to be rooted in maternal ties which are so strong and suffocating as to be destructive, at least in terms of narcotic addiction, particularly when they are combined with an ethos stressing in lower-class Mexican neighbour- hoods that you are either a picudo, a tough guy, or a pendjo, a fool (Lewis 1961). This resistance among Mexican-Americans to narcotic rehabiliation efforts may also be related to an absence at the present time of deep personal and group investment in the values of the dominant culture. Such an investment, it could be hypothesized, often becomes a significant lever by means of which drug-free behaviour can be induced. At least we can, in terms such as these, account for the astonishing success thai is reported in 'having medical doctors who become addicted to drugs give up the practice (Blomquist 1957).

The operation of the East Los Angeles Halfway House was originally financed by a grant of $188,441 from the National Institute of Mental Health for a three-and-a-half year perid- from May 1962 through October 1965. On July first of last year, the California Department of Corrections assumed responsibility for the operating expenses o€ the facility. The same agency has also established two additional halfway houses for narcotic oeen- ders paroled from its civil commitment program, and has drawn upon the East Los Angeles experience as a blueprint for the new operations.

The remainder of the federal grant is being used to complete the research report on the Halfway House. Formal research inquiry was concluded during the past summer and case materials and statistical data are still in the process of being analyzed, so that I cannot, unfortunately, present any definitive conclusions regarding aspects of the programme which may be of particular interest to you.

The House itself is located about five minutes from midtown Los Angeles iin an area that was vividly portrayed in a pioneering sociological treatise, Pilgrims of Russian-Town, which described life among the Molokans, a religious group from Russia which had settled, with characterisbic self-defeating stubbornness, in East Los Angeles near the {turn of the century (Young 1937). The area in which t!he Halfway House is located has the highest narcotics use rate in the city of Los Angeles; nonetheless the House was placed there because i t was presumed that it was to this area that the men would in all likelihood return, and it was with this


area that they would eventually have to make their non-narcotic peace, if they were going to make it at all. Ecologically, the East Los Angeles section k an area in transition, with an elderly indigenous Jewish settlement and an in-migrating and now p r e dominant Mexican-American population. It is a characteristic Los Angeles slum which presents a deceptively placid fapde represented by single dwellings, many of them surrounded by aEtractively-planted gardens. Despite this, the various indices of social malaise are extremely high.

There has been no community hostility of note to the location of a narcotics facility in this neighbourhood: indifference, in fad, seems to be: the best word to describe the reactions to our presence. There was a fatal stabbing with an ice pick of a narcotics informer that took place about six o’clock on a Sunday about a year ago within 50 feet of the entrance to the Halfway House. Neither the victim nor the murderer wexe from the House, though the l m l newspaper for a brief period turned upon the facility. But this assault was short-lived, dying from lack of nourishment. This passive acceptance may be because the community business leaders, havling the wherewithal, do not reside in the immediate area. It may be that we are in a location that is rather commercial, and it may also be that residenits of East Los Angeles are more tolerant of efforts such as ours. I am not certain, in any event, that this tolerance has necessady been an asset. The strong demonstrations against the Synanon establishments in Santa Monica, San Franoisco and Westport, Connecticut, and against the Daytop Lodge in Staten Island, may have contributed sig- nificantly to a certain esprit de corps among the managers and the residents that cannot be achieved except through the forced necessity to resist outside threats.

The House itself is a former day nursery that most recently served as a Buddhist temple. The men live in five dormitory- type rooms on one side: there is also a large auditorium in bhe rear of the House; a fairly roomy dining area, and a kitchen of some size. There is little privacy for the men in these living arrangements, but they seem to complain infrequently about this, except when one or another of them is upset by a resident returning late and loudly. Perhaps complaints tiuch as these are choked off by a tendency not to “snitch” on another resident; perhaps other complaints take precedence over this one. The staff has expressed a preferexme for the dormitories, in fact, because f%ey

THE BRITISH JOURNAL OF ADDICTION 83

allow the men to congregate more readily and to exchange views on all matter of things, perhaps in a helpful way.

In front of the House are offices for a parole unit of the State Department of Corrections, a circumstance which, of course. detracts considerably from any atmosphere of cozy bforma&ty that might perhaps prevail in the House. At the same time the; parole office helps pay the rent and makes it convenient for the agents to offer services and control in the House. It has been one d the more important aims of the facility to bring together parole agents and residents in an informal setting where during regular contact they might come to a better appreciation of each other as persons with particular life histories, problems. social demands upan them, individual values, and similar human characteristics. Close human contact does not, of course, guarantee increased tolerance and understanding-it may in fact aggravate more than alleviate difficulties-but it does offer an opportunity for more realistic undesstanding of the issues and the people involved in a particular situation.

The research operation, as noted, is designed to determine what value, if any, the House and its progwm have in keeping persons coming to it from returning to the use of narcotics. The men entering the House are selected on a purely random basis (and I might add that bhey usually say that they resent fihis) from among a greater number of eligibles; that is, all felon addicts coming into the East Los Angels area or prison release. Some effort was undertaken to have men assigned to the House released 30 days earlier that those going on straight parole status so that their resistance to their selection might be mitigated, but the Adult Authority, California’s paroling body, rejected this proposal, apparently on the ground that it represented a research consideration and not a casework decision based upon the partiicular needs of the individual felon’s situation.

The careers of the two groups with which we are concerned, one experimental and the other control, will be compared to determine the effect of the House experience. The controls, who are not part of the House programme, are supervised by agents having offices in the Halfway House, and are part of regular 30-man case loads, which are considerably under the loads normally carried by parole agents not handling narcotics offenders. It would be less than honest, though it is hardly professional, to say that when I hear that a man has been


rearrested for use, I am always a little happier if it turns out to be a control man rather than an experimental who lives or had lived in the House.

But we are not unprepared for the outcome that the House does not make a signiscant ditference in relapse rates, or that it works only for certain men with certain oharacteristics, both personal and social. If so, then it would seem that future operations should be conditioned upoh such hdings. Perhaps it is unfair, then, to subject the men currently undergoing involluntary residence in the House to its program; but I do not think this is necessarily so, since for one thing, it might in fact help them, whethet or not they think so, and if it does, i t miight be well worth their while in the long run; also, I believe the House represents to some extent not only the recommendation of virtually every person who has studied the gaps in programs aimed at rehabilitation, but also of narcotic users themselves who, if they lhave not favoured legalization of drugs as a solution to the narcotics problem, have as often as noit indicated the need for a Halfway House facility, at least before they were in fact in one. On the other hand, I would not underestimate the moral problem involved in involuntary assignment to a Halfway House of a man who cares to be elsewhere, even if baing elsewhere is to his own detriment.

When it was first opened in the fall of 1962, the House was taken on a non-experimental shakedown cruise, with selected men brought into it from general parole status. In this operation it was hoped to begin with a small coterie of individuals who could be molded into a coherent group with an esprit de corps which would lend immediate glow to new entrants. This endeavour proved quite painful, apparently because the odds are heavily sat against suddenly withdrawing from total freedom a group of individuals and establishing them successfully in a halfway house. Also, of course, many procedures which are now routine were still in the process of development, and the first group, which was poorly selected in terms of the demands made upon it, received the full burden of tentative programme efforts.

Compared to this group, the present residents seem somewhat more agreeable to residence in the House, though their complaints are routine and vocal. It is however quite difficult to separate the content of the complaints from the reality of their meaning, though such distinctions may often be very important. Many


words and stances are responses to group and personal expecta- tions: one must say certain things in order ,to be part of the group and comfortable with oneself. On the other hand, it is always equally, if not more, dangerous to read beyond the normal meaning of words and impute to them ulterior and hidden well- springs without sufficient evidence of the validity of such interpretations.

I would think that the major impact, in terms of program, will be made by the existence of the House itsdf, of the bed that the man sleeps in, the table at which he eats meals, and of the fact that he is ,&ere, and must remain there for an unspecified time, usually at least 30 days' duration. There is also a very important impact made upon each man by those with whom he associates in the House, and the constant rating and grading of the men by each obher is very much in evidence.

Any or all of these experiences may be inhibitory for return to drug use, and any or all may equally well be propellants toward more rapid return to narcotics. A man may find the House itself frustrating and threateruing and may seek out drugs which he might not otherwise have gone after because of this. Another man may find refuge from diisconcerting home and family problems within the House. The Halfway House might help to provide at least a partial escape from drug-connoted cues; on the other hand, association with so many addicts might become too reminiscent of narcotics to allow for adequate suppression d yeamlings for opiates. These are very diflicult threads to unravel, and in general one resorts to examination of figures on gross outcomes of the process and +hen to informed speculation concerning the operation of dlifferent factors as part of an inter- twined causal pattern.

There are other aspects of the House operation that I might indicate without going into extended description. All residents. like all parolled narcotic offenders in Los Angela, undergo Nalline (Nalorphine hydrochloride) testing both routinely as well as on unexpected occasions. The Nalline ,test seems to be a rather effective control device in that men are deteoted if they return to use of heroin withiin relatively brief periods, unless $bey manage to space their use with great care and to keep its content fairly low. If they can accomplish these last things, then it might readily be argued that they are harming no one with their indulgence.


The men themselves seem divided in their feelings about Nalline testing. Many say that they believe it is de-humanizing and coldly impersonal. They say that congregating with addicts from throughout the area s t Nalline testing often leads to information about new temptations. They seem, in particular, to dislike the hypodermic shots used in Nalline. “ If I can’t put a needle into my arm,” one said characteristically, “nobody else should be able to either.” Other men say that Nalline provides them with a prideful indication of their drug-free condition, and that a negative result is useful in convincing chronically doubting relatives of their abstinent condlition.

Nalline celtainly gives us a comparative check on the drug activities of our experimental and control groups that we might not otherwise have were the results of the House left primarily to be determined by the vagaries of law enforcement arrests and parole supervision. In fact, on the basis of equivalent opportunity for detection in violations, Uhe House group begins somewhat behind since by the nature of their residence the men are under closer scrutiny than would be possible were $they liiving in the community on regular parole status.

Men in the House are usually encouraged to seek work, and if they are employed they are charged $21 a week for room and board. If they are not working, they are required to perform housekeeping duties for approximately five hours each weekday, and are not charged for their stay. The employment situation is complicated by the fact that many of the men are incompletely trained to compete in the job market. Job-seeking iis, in addition, for many persons, former addicts or not, an inordinately debilita- ting emotional experience. For some of the House residents there also appear to be further complications involving the whole realm of work and money. Many of them have spent very considerable sums of money in the past to nounish their narcotic habit; however acquired, suah money spoke loud and clear in the economic world, and it is not easy to move from a life of easily acquired, easily dispersed money to a more demanding life of difficult labour for often quite meagre finanoid rewards. The folklore of capitalism speaks only in whispers when the need is seen as essentially involving the putting together of enough money to afford a decent weekend of proper care and feedling of a girl and oneself. It takes a real pleasure postponer to plan for the vague future under such conditions, and residents usulally have been around


enough and seen enough failure to have somewhere inside themselves the nagging doubt concerning their own prospects of remaining clean over a long period of time.

It is, in fact, this problem of self-concept which seems to underlie one of the early-and tentative-findings of the Halfway House experiment. We have found that men who return to drug use and are then sent to an institution for a brief period of detoxification befkxe being sent back to the Halfway House have an extraordinarily high rate of relapse thereafter. and that such reilapse occurs very quickly. It has been hypothesized that the inability of the addiict to continue to conceive of himself as a person who might remain drug free, his striking loss of self- confidence in (the face of his recent failure, undercuts the advantage that could seemingly be gained from not returning him to an institution for a more prolonged period.

The decision to allow a man to move from the Halfway House to another residence is made on a casework basis. and Eke all casework decisions, the ingredients entering into it are hard to specify and virtually impossible to weigh. It is not difficult to guess in general which men will be released early and which will not. Some success has been achieved with having the men themselves partiiuipate in decigions rdating to the release of their fellows, though the m@her rapid turnover among House residents and the generally complex nature of the endeavour has at various times handicapped effective employment of this tech- nique. The vagueness of the rdease criteria allows, of course. a certain flexibility, but it also creates anxieties in the men (which may or may not be a good thing) and confuses them somewhat in regard to just what it is that is expected of them. and what kinds of behaviour will be rewarded.

The more formal program of the House whiuh, as I indicated, may be of lesser importance than the informal aspects, rmlves around group counseling sessions. There are group meetings for all House residents each weekday evening, and several afternoon meetings for unemployed residents during the week. On Wednesday evenings, bath residents and former residents are expected to attend su& meetings. These sessions are very diifficult to evaluate, and it may be something of a dis- service to take literally what the staff indkates it thinks is h a p pening or what the participants believe is ocourring. Nor can the words spoken during the group meetings. or the many pregnant

H


or Pstless silences, be accepted at faw value or more than a rather superficial level. Any of these items, of .course, can be compared and a disparity noted between or amongst them, but the; meaning of this disparity is an elusive item. On the other hand, it is obviously important to learn what effeot, if any, the group sessions produce. and what aspects of them are related to what outcomes, and the research endeavour is employing a number d recording devices which are directed toward this end.

It is worth n h g , in this respect, that while the program is conducted by personnel of the California Department of Cor- reotiom, the research is being carried on by persons without affiliation with the; Department, thus providing the advantages and some of the risks and shortcomings of extramural investigation of an agency operation. The research certainly has not been without its own tension-producing features, some of them related to its very nature. Program personnel are often uncomfortable with questions which they view as biased and inhospitable to their work and, even with the best of good will, they often find themselves answering obliquely or ignoring inquiries from research. It seems unfair to them that research may ask for information concerning what they are doing, and presumably judge the adequacy of this effort in terms of the statement, while they are cut off almost entirely from knowledge 01 judgment of the research operation.

Research on the other hand has professional obligations relating to the way it proceeds and the adequacy of that perform- ance. At the same time. however, by its very remoteness, seen as necessary for objectivity, the research operation can frustrate program operations and can, while enhancing the objectivity, paradoxically undermine it by creating bodies of information no longer made known to it. Any other research strategy, it needs 6s be noted, would carry with it other, perhaps equivalent or worse disadvantages. A most intriguing point is that the research operation, if only by its very presence, enters at a large number d points into the way the program is run, and thus influences the direction, and the perfmance of the very endeavour it is seeking to assess.

References BLOMQUIST, E. (1957) Operation narcotics. Med. Times 85, 349-353. BUCKWALTER, J. (1961) Merchants of Misery. p. 121. Narcotics Edu-

cation, Inc., Washington, U.S.A.

THE BRITISH JOURNAL OF ADDICTION 89 DISKIND, M. H. (1960) New horizons in the treatment of narcotic

addiction. Fed. Prob. 24, 56-63.

of narcotic drug addicts five years after hospitalization. Pub. Hlth. Rep. 78, 190.

FORAN, E. T. (1962) Narcotic addiction and the teenager. A m J. Corrections 24, 12.

LEWIS, 0. (1961) Children of Sanchez. p. 38. Random House, New York, U.S.A.

PROCEEDINGS ON THE WHITE HOUSE CONFERENCE ON NARCOTIC AND DRUG ABUSE (1962) Report on an ad hoc Panel on Drug Abuse. p. 297. Government Printing Office, Washington, U.S.A.

YOUNG, P. V. (1937) Pilgrims of Russiarz-Town. University of Chicago Press, Chicago, USA.

DLJVALL, H. J., LOCKE, B. Z. a d BRILL, L. (1963) Follow-up study

Documents

A HALFWAY HOUSE FOR NARCOTIC ADDICTS