Chasing the Scream: The First and Last Days of the War on Drugs (31 page)

Gabor had been a successful family doctor for years, he explained to me, when he applied for a job on the Downtown Eastside of Vancouver in 1998. To many people this decision was puzzling. These ten blocks had one of the highest death rates in the developed world. The scene in this neighborhood is
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notorious to Vancouverites: against every charred or boarded-up building lean glassy-eyed addicts. On a typical day, some are passed out; others are looking around them very fast, as if trying to spot a buzzing insect with a nasty sting.

As I walked around, I tried to picture it as it must have been when Gabor first came here. There is an insistent rhythmic chant on the streets as you walk past dealers: “Rock? Rock?” “Powder?” “Rock? Rock?” “Powder?” Women with hollow faces and painted red lips pace nervously, offering a date to passing cars. Oversized pigeons peck around them.

The glamorous names of the hotels here—the Balmoral, for example, gets its title from a castle belonging to the queen of England—seemed to mock the people who live in the tiny single room occupancies into which the hotels have been carved, in a last gasp, to suck up the thin dust of government housing assistance. Overdose and hepatitis C seem to come with these rooms, the way minibars do in other hotels. The streets were cluttered with bottles of mouthwash and hand sanitizer that had been swigged by alcoholics who wanted the maximum possible intoxication for the lowest possible price. The police appeared periodically to pluck out a person or two to jail, then they vanished. The sea breeze wafted through indifferently.

This neighborhood is the end of the line in the city at the end of the line of North America—the terminus of Terminal City. There is nowhere left on the continent to head after here.

There are ghosts of what the Downtown Eastside used to be in the names of these buildings. On one street there is the Loggers’ Social Club, a reminder that this was once the place where workingmen would come after chopping down the forests. The logged trees would be placed on skids and dragged through here to be put on the train to travel across America, so this was known as Skid Row: the first and the original. The men would stay, flush with money, for a month or two of partying, and then vanish again. But there came a time when they had cut down all the trees. The party continued, for a while, as it slowly soured.

The businesses that serviced the loggers vanished one by one. The Woodward’s department store used to be the Macy’s of Vancouver; by the time Gabor arrived, it had become an echoing concrete husk,
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and there were men injecting women straight in the jugular
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vein out in the open air of the alleys. The Vancouver writer Charles Demers explains: “People in Vancouver
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talk about the Downtown Eastside the way that people throughout the Western world talk about Africa. Some call for apolitical charity and aid; others call for armed intervention. Everyone agrees it’s a problem to be dealt with, filled with people who are their own worst enemies and whose lives are a mess.”

What good, people wondered, could a doctor do here? But Gabor gave up his practice as a family doctor and went to work with the Portland Hotel Society, a local charity that had begun an experiment that was regarded by the local drug warriors as insane. Routinely in this neighborhood—and across North America—the moment the authorities found out you were an addict, they would throw you out of public housing and cut you off from all social support. Get clean, they would say, or you will never have a home again. Often, even the homeless shelters would then turn you away.

A young nurse named Liz Evans working in the Crisis Psychiatric Unit at the local hospital saw the results of this policy coming through her doors the whole time. She would look across her ward, and see it was full of people who had been forced onto the streets and were only deteriorating further. They were offered a few pills to cope with their disturbance—but nothing to help them deal with the fact their lives had fallen apart.

So she decided to pioneer a totally different approach. Her nonprofit took over a hotel and turned it into a place for the people who could not be housed anywhere else—the most chronic addicts and most severely mentally ill people. Liz was put in charge,
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with a commitment to the residents that they would never be kicked out or lectured to. Instead, they would be offered a room of their own, and—whenever they wanted it—staff who would sit with them, and listen to them, and try to love them. That was all.

“Our method is—be a human being with other human beings,” Liz tells me. “Be there for them. Don’t judge. Don’t tell them how to live their fricking life. Just be in their life. Be a nice, solid presence. Somebody who isn’t going to bow and bend . . . and walk away. Who’s not going to abandon them. Who’s not going to leave. Who’s not going to kick them out.”

The almost universal reaction was that this is mad. Surely the addicts will just drink or drug themselves to death faster if you give them a place to do it, with no critical judgment? One doctor told Liz a better solution would be to drop a bomb on the Portland Hotel and kill everyone in it. But Gabor wanted to be part of this experiment. At the Portland, he was tasked by Liz with doing everything from lancing abscesses to prescribing psychiatric medications. But the core of his work was something more radical. He wanted to listen to the hard-core addicts here—to let them talk about their feelings.

These are people, he soon discovered, who have spent their lives being chased away or chastised. Most of them have never sat down with a person who wanted to listen to their life story sympathetically. Authority figures with questions have, to them, only ever been people who will take something away or inflict pain. Most of the users, then, were critical. They found it hard to believe they were being given a place to live and the offer of help. What’s the trick? Where’s the scam? When is the crackdown coming?

Gabor was divided between his desire to listen to the addicts and his instinctive revulsion toward them. Out in the chaos of the streets, he thought the addicts looked like ghoulish extras in a Fellini film.
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Alone in his office, he still felt judgmental at times. Why are they doing this to themselves? Why would somebody be so foolish? “I had a somewhat moralistic attitude towards them,” he says.

As he explains in his book, one of the residents who came to talk to Gabor, a thirty-six-year-old man named Carl,
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began over time to open up. He had spent his childhood shunted from one foster home to another, unwanted. When he got hyperactive, one set of foster parents tied him into a chair in a dark room. When he swore, they poured dishwashing liquid into his mouth. Carl learned from them that you can’t ever express your anger without being punished; so when he felt fury, he took out a knife and started cutting into his own foot. As Gabor wrote later, Carl revealed this in a shamed crouch: he expected to be condemned, just as everyone had always condemned him.

Gabor heard a variant of this story over and over again. The addicts had been made to feel disgusting and ashamed all their lives—and only the drug took this sense away. “The first time I did heroin,” one woman told him, “it felt like a warm, soft hug.”
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After a while, Gabor started to see patterns in the psyches of the people at the Portland. As he spoke, I found myself thinking about the addicts I had written about so far in this story: Billie Holiday, Chino’s mother Deborah, Marcia Powell cooked in her cage. What did they all have in common? Horribly disturbed childhoods, marked by violence, sexual assault, or both.

Gabor was finding that virtually all his patients fit this description. And then it occurred to him. Could it be that these hard-core addicts were all terribly damaged
before
they found their drugs? What if the discovery of drugs wasn’t the earthquake in their life, but only one of the aftershocks?

Gabor started to pore over a series of scientific studies, and he noticed something striking.

All over the Western world, people are being given very powerful opiates every day, legally. If you have been badly injured in a car crash, or had a hip replacement, or had significant dental surgery, you have probably been given opiates, perhaps for quite a long time. These are pretty much the same opiates taken by Gabor’s patients (except yours didn’t have the contaminants added by drug dealers). So if the pharmaceutical theory of addiction is right—if the drugs are so chemically powerful they hijack your brain—then it’s obvious what should happen. You should, at the end of your treatment, be an addict. When you are discharged from the hospital, you should be looking to score on the streets, because now you need your fix.

Yet you will have noticed something. You didn’t become addicted.

You are not alone. The
Canadian Journal of Medicine
reviewed the best academic research into people who had received opiates from doctors following surgery. It found, Gabor writes, that “there was no significant risk
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of addiction, a finding common to all studies that examine the relationship between addiction and the use of narcotics for pain relief.”

This happens in every city every day, and it passes mostly unnoticed.

You can take the same drugs as an addict for long periods of time, and not become addicted at all. And at the same time, you can take no drugs whatsoever—and become just as severe an addict. If that sounds odd, go to any meeting of Gamblers Anonymous in your town this evening. Listen to their stories. Early in this journey, I went to sit in—with the permission of everyone there—on a Gamblers Anonymous meeting at the Problem Gambling Center in Las Vegas. I found—just like you will—that they were indistinguishable from those of alcoholics or heroin addicts in their essentials. But you don’t inject a deck of cards into your veins; you don’t snort a roulette wheel.
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How can we begin to make sense of this? After thinking about it deeply, Gabor came to suspect that it means, as he told me, “nothing is addictive in itself. It’s always a combination of a potentially addictive substance or behavior and a susceptible individual. So the question we need to keep asking is—What creates the susceptibility?”

Since the drug alone can’t explain the addiction, there is clearly an additional ingredient, or several—things that are present in some people but not in others.

Gabor began to read about a group of American scientists who had carried out something called the Adverse Childhood Experiences Study. It is the most detailed research ever conducted into the long-term effects of early childhood trauma. It looked at ten different terrible things that can happen to a kid, from physical abuse to sexual abuse to the death of a parent, to track how it shapes that child over their lifetime.

These scientists discovered that for each traumatic event that happened to a child, they were two to four times more likely to grow up to be an addicted adult. Nearly two-thirds of injection drug use, they found, is the product of childhood trauma. This is a correlation so strong the scientists said it is “of an order of magnitude
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rarely seen in epidemiology or public health.” It means that child abuse is as likely to cause drug addiction as obesity is to cause heart disease.
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Another long-term study, published in
American Psychologist
,
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followed kids from the age of five until they were eighteen, to figure out how much the quality of your parenting while a child affects your drug use as you get older. When the children were still small, the scientists gave them a task to carry out with their parents—like piling up building blocks—and then they watched how well the parents helped and encouraged them through a one-way mirror. They wrote down which kids had parents who were loving and supportive, and which had parents who were disengaged or nasty to them. It turned out the kids whose parents had been either indifferent or cruel were dramatically more likely to heavily use drugs than the others. They had grown up, they found, less able to form loving relationships, and so they felt more angry and distressed and impulsive a lot of the time.

If we can figure out at the age of five which kids are going to be addicts and which ones aren’t, that tells us something fundamental about drug addiction. “Their relative maladjustment,” the study found, “precedes the initiation of drug use.” Indeed, “Problem drug use is a symptom, not a cause,
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of personal and social maladjustment.”

And Gabor found that another scientist, Dr. Vincent Felitti, had conducted a similar huge study of the effects of childhood trauma, looking at seventeen thousand kids for the insurance company Kaiser Permanente. Felitti concluded, as Gabor writes, that “the basic cause
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of addiction is predominantly experience-dependent during childhood, and not substance-dependent. The current conception of addiction is ill-founded.” This fact forces us to radically reconsider many of the stories we are told about drug epidemics—including, I was to learn later, the prescription drug epidemic in the United States.