Less than zero
Witnessing the compassion and optimism with which Moshe Kron and his staff at Jerusalem’s Magal rehab center help young people who are serious substance abusers − one can’t help but believe in the power of the human spirit.
In the heart of the picturesque abandoned Arab village of Lifta, on the slopes of the western entrance to Jerusalem, the sound of applause reverberates and refuses to die down. The dreamy beauty of this village − actually, the ruins of old stone houses surrounded by wild nature − is visible through the large windows of the Magal rehabilitation center, where a group of drug- and alcohol-addicted teens has assembled. It’s late at night and they’re sitting in a circle, emotional and uttering fond farewells to their friend Andrei, who has now completed three months of treatment at the center. First thing the next morning, he will move to a therapeutic community that will provide him with long-term treatment for his substance abuse.
Andrei (a fictitious name, as are the rest of the names here), 23, peers out at the ruins of Lifta and feels things are going pretty well for him. The abandoned houses outside, which addicts on the fringes of society − high-school and yeshiva drop outs, new immigrants who never found their place, junkies and the mentally unbalanced − have squatted in for years, became the home of the Magal facility in 1992. It is the only licensed center in Israel under the supervision of the Health Ministry that provides initial rehabilitation services to drug- and alcohol-addicted teens and young adults.
“What has this place taught me?” Andrei repeats the question, his sadness at leaving apparent. “That there’s a second chance in life. You know, I was here before for rehab a year and a half ago. I managed to get clean from all the heroin for the first time in my life, and to moveon to a therapeutic community. But then I fell in love with a girl there,” he smiles.
“Love started, rehab ended and a serious deterioration began. I lost control and turned into what I’d promised myself I would never be: a drug dealer,” he continues, then falls silent.
Andrei then wandered from drug-dealing centers in Lod (nicknamed “ATMs”) to the so-called “Sing-Sing buildings” in Eilat − buying, dealing, selling and keeping a hefty amount of heroin for himself as commission. “It’s a violent life of escapes, stabbings, beatings,” he adds tersely, admitting, “I lived like an animal. I despised myself.”
When he came to Jerusalem once, he happened to meet Yotam, a counselor at the Lifta rehab center, who urged him to come back and try again.
“I told him that I was clean. But a week later, I called from the street and asked them in tears if I could come. The staff from the center immediately agreed to take me. Now maybe this time I’ll be able to stay clean,” he says.
Andrei was born in Russia. In grade school he found himself on the receiving end of some serious violence: “I switched schools and tried a new approach − I went from being a victim to a victimizer, from being a sensitive and vulnerable child who was spit on, ostracized and beaten up to being cold and aggressive. In order to fit in, I started using drugs, like grass and ecstasy, and started drinking alcohol when I was 12.”
He visited Israel on his own at age 15. In the Hadar neighborhood in Haifa he tried heroin for the first time, and when he returned to Russia he found that the white stuff was easy to come by and became hooked. At 18, he made aliyah and joined the army, thinking it would save him from the drug; he now cynically refers to the “heil hahimush” (munitions corps) in which he served as the “heil hashimush” (users’ corps). From the army, he was sent by court order to the rehab center in Lifta.
“You want to know what I learned from this place?” he repeats again. “I learned that I can be loved because I speak honestly about my feelings, I learned that I can be loved even when I’m insecure, that if I slice a tomato and prepare a meal in the kitchen for the other people in the rehab group − that’s enough. Sometimes you don’t need to do any more than that in order to be loved. Be who you are. Damaged, different, insecure, good-looking, not good-looking − it’s okay, just look for traces of humanity. Here they helped me peel off the layers and carve out a human being. I used to think that for people to love me I had to take drugs and be violent, bad, mean. Weird, huh? That I used to think that’s what would bring me love.”
The Magal rehab facility was founded jointly by the Health Ministry, the Jerusalem Anti-Drug Association, the Israel Anti-Drug Authority and the Jerusalem Foundation. Initially, it was meant strictly for an adult population, but in 2000 it was redesignated to serve 12- to 21-year olds. It has space for a maximum of 16 people, who can stay there for up to three months. At the center, residents undergo physical and psychological rehabilitation, and then move for long-term treatment to a therapeutic community or daytime program − or go back to the educational institution from which they came. The ministry pays NIS 360 per day for a person’s stay there; the family or the welfare services have to cover the remaining NIS 1,500 per month . The Jerusalem Anti-Drug Association does additional fund-raising to help support Magal.
Since its inception, the center has been run by social worker Moshe Kron, 62, who explains that “the young people here come from every part of society: immigrants from the former Soviet Union, Ethiopians, veteran Israelis, Anglos, youths from a religious or ultra-Orthodox background, Arab Israelis. There are kids here who are the children of addicts, teens from violent homes, others for whom the immigration experience caused a breakdown in the family, as well as teens who grew up in affluent families.”
The medical team includes a psychiatrist responsible for treating physical withdrawal symptoms, and a specialist who deals with children and adolescents. The center also has a psycho-social staff and rehab counselors.
“A lot of kids come to us in a poor state of health,” Kron explains. “They’re underweight, with abscesses from the injections and severe skin problems.”
e inhabitants of the abandoned village to life. They start their day at 6:30 A.M., and will be busy continuously until 10:30 P.M., when they go to sleep. At 9 A.M., 12 of them sit down for a “round of feelings” to talk about their emotions.
“Good morning, this is my eighth day and I feel an emptiness,” says one 16-year-old girl. “If I were on the outside now, I would use drugs.”
“Good morning, I’ve been clean for 23 days, I feel good and alert,” says the 17-year-old youth next to her.
“Good morning, this my 34th day here, and I’m missing Andrei. He was like a big brother. Seeing him go yesterday was hard for me,” says another girl.
The young people − whose feelings hardly anyone ever inquired about prior to their arrival at the center − seem to scour their souls and try to translate their feelings into words.
After everyone has had a turn, they start making breakfast. The kitchen is bustling, the chores divided up among everyone. When they sit down to eat, their hunger is obvious. It’s a different kind of hunger − physical, mental, spiritual. At every meal, despite the abundance of food, there’s an inescapable sense that this hunger is a constant, existential thing. Nothing will truly sate these young people. Nothing can fill the void.
Even the 17 staff people are sometimes surprised by the ease with which these adolescents who came from the street and from lives full of chaos adjust to rising early, to a busy schedule, to the boundaries that are set, to talking about feelings.
“It just goes to show how much they need this, what a profound thirst they have for it,” says Kron. “We create a daily schedule that includes social and creative activities, sports and therapy groups. They scrupulously observe all the rules here. No long hours of watching television, no listening to music with earphones, even before bedtime. No cellular phones. Only relatives are allowed to visit.”
Later in the day, residents wait for a treatment group to start. Some are playing backgammon, one girl is reading a book and others are smoking out in the yard and gazing at the magnificent view, which itself seems to have therapeutic value.
“In Tel Aviv, I can tell you where to find the dumpsters with the best contents,” says Ziv, 16, with an endearing grin. “I came here after living on the streets, and found things that I’d forgotten even existed: a bed, a shower, regular meals,” he adds, suddenly revealing a glimpse of the haggard junkie he used to be. “There were months when I didn’t bathe, weeks when I didn’t eat a thing. When you’re using, there’s no hunger; the junk is everything. All you need is water after a hit.”
Ziv, an unmarried father of an infant, says that from the time he was very young he would eat at the neighbors’ since there was no food at home: “Because of debts and trouble making a living, my family kept moving − from the city to the kibbutz, out of the country and then back to Israel, from one apartment to another, and I was a lonely child. I started smoking hash and drinking when I was 11. Basically, the only choice I saw was to commit suicide or use the stuff, so I chose a slow suicide.”
By age 12, he was involved in criminal gangs, and at 13 he started dealing drugs. Then came a string of suicide attempts that brought Ziv into contact with a social worker, psychologist and psychiatrist. At 15, he ran away from home and started living on the street in Tel Aviv, where he experimented with methadone and crystal meth and started shooting heroin. He roamed about barefoot, ate out of dumpsters and squatted in derelict buildings. Eventually, he ended up at the big drug den at 1 Fein Street, by the old central bus station, and became a courier for the dealers there.
“I would go to Fein Street, pick up the drugs and go around the city to the addresses they gave me,” he recounts. And when his addiction intensified, he found a cheap way to obtain drugs.
“I was the guinea pig,” he explains. “The dealers at Fein Street would call me whenever they got new stuff and I’d come try it. They don’t sell pure heroin, you know. They manufacture drugs, they mix other chemicals with downers. Lots of times they would get stuff and weren’t sure if it contained rat poison, or sand − in other words, whether it could kill you or not, and be sold. I couldn’t care less at that point if I lived or died, I was a total addict, all I cared about was shooting up, so I agreed to try everything.”
Ziv was frequently beaten. “I remember the last time really well,” he recalls. “They called me to check out some stuff; four Arab dealers were there. They told me to sniff, to take it up the nose. I told them that didn’t have any effect on me anymore, that I had to shoot up. They got mad that I shot up. I woke up the next day in Jaffa in a stairwell somewhere near the Clock Square, in a daze, unable to remember how I got there, all bloody. My leg hurt so much I couldn’t move it, and I was all bruised and beat up.”
Ziv’s parents, who live in the north, had been searching for him all this time. After he overdosed and ended up in a hospital, they found him. They tried to get him to stay in the therapeutic community in the Gilboa area, but he kept running away. He returned home, but then violently attacked his father when he tried to keep him from running away again, and later brazenly stole money and drugs from a dealer.
The welfare official gave Ziv two options: “It was either a closed institution or a rehab center, so I opted to try this. This is the first time in my life that I’ve been clean for 84 days. It’s my record. It’s not easy for me here. I’m confronting feelings I spent my whole life running away from, which are the reasons I plunged into drugs. I’m not used to being open and talking without drugs. My social skills are terrible. I don’t know how to get close to people. Whenever I try, I end up wrecking things and pushing people away. But I’m learning to work on that here.”
At the “round of feelings” in the evening, Ziv starts crying. “I don’t want my kid to go through what I went through in life,” he suddenly confesses to the group. “I grew up with a stepfather, I don’t want my child to grow up like that, I don’t want him to turn out like me. I don’t want him to end up in the kind of places I did. I don’t want him to see that his dad is a junkie. I want him to have a better life.”
When I return to the rehab center two days later, however, I notice slash marks on his wrists. The blood hadn’t completely dried.
“I did this the next day with a thumbtack,” he tells me. “I didn’t know how to deal with the pain. I’m a father. I’m 16, the mother is 18. We were both users and the baby was born four months ago with infant withdrawal syndrome. This is the first time I’ve lasted in rehab for any length of time. When I got here, I didn’t want to hear anything about her or the baby. Now I’m having other feelings. The day before, she left a message at the center that she misses me. Sometimes I wish I could just stay here for the rest of my life. It’s good for me here,” he says with a wary smile. “Soon I’ll have to choose a continuing treatment program, but I’ve always run away from everywhere and don’t like closed places. I don’t know where to go from here.”
Ziv had previously stayed in Lifta for more than 100 days and completed the treatment successfully, but the success was short-lived: He returned to his parents’ home with the aim of finding a framework in which to continue treatment, but within just a day and a half, he was using heroin, and thus ended up back at Magal. If he can sustain his progress here for another month, he will move directly to another program.
Only half of the youths at the center complete the rehab program. The rest drop out before the end, says Kron, and do not stay in contact.
“Along with the many success stories, it’s not at all unexpected that we have dropouts who go back to using. Still, the rate of kids who return to the rehab center for a second and third time is very high. The relatively encouraging thing is that the third time, the odds of getting clean are better than the first time. Of course, when they come back to us they’re even more damaged, more emotionally broken, but we believe in giving people another chance.”
“I feel like something is burning me from the inside. I don’t know how to make it calm down,” says 16-year-old Brutka. This is her 94th day in rehab. Two days from now, she is supposed to leave to attend a family event and the anticipated encounter is making her restless. She was born in Ethiopia and immigrated to Israel at age nine, and is one of seven siblings. She pushes her long hair off her face and says: “My family is against me staying at the rehab center. They don’t want me to be here. They’re ashamed, they don’t understand, but I know I need treatment. That I have a serious problem. I’m afraid to leave; I feel protected here. On the other hand, I don’t want to lose them.”
After arriving in Israel, Brutka felt rejected. “From non-Ethiopians I kept hearing racist remarks, but the truth is that Israeli-born Ethiopians are even worse. They make more fun of your Ethiopian accent, they laugh at you when you get mixed up in Hebrew, and they won’t let you speak to them in Amharic. I couldn’t find my place in any group. They did awful things to me. One time, all the kids in the class locked me in the bathroom for a few hours. No one wanted to sit next to me in class and they would tell me that I stink.”
After a long silence, she adds: “I realize that ever since then I’ve been searching for friends, for people to love and accept me, because the rejection was unbearable.”
At 13, she started drinking. “A young cousin who used to hang out with a bunch of Arabs said to me, ‘Come hang out with us, have a little to drink, you look like you’re having a hard time.’ I started drinking and felt better. It really helped. It gave me confidence. Suddenly I started speaking freely, doing what I wanted.
I was excited about the change, so I kept on drinking.”
By age 14, a bottle of arak wasn’t enough anymore. “Even before brushing my teeth in the morning, I needed a few glasses,” Brutka explains. “I’d come to school with a single notebook and a bottle of Absolut in my backpack. I’d go into the bathroom and drink before I went to class.”
She frequently lapses into silence while telling bits and pieces of the story of her brother, a homeless alcoholic whose visits home always frightened her. “The family accepts him and his drinking and sees it as a natural thing,” she says. “But they oppose me, and don’t understand my desire to stop.”
At some point Brutka was transferred by the welfare services to a hostel for adolescent girls.
When asked about relations with men, she says she can’t remember a single detail about them. “I couldn’t tell you a name, age or occupation,” she says, bowing her head. “I would drink, go out on my own at 3 A.M., hitch a ride with a man and go on with him from there. Every time I would wake up in a different place with no idea who the guy beside me was or where I was. I would feel disgusted with myself and with my body, and so I would drink. Sometimes the men would say horrible things to me − ‘I’m sleeping with you but don’t get any big ideas. You smell. I’m doing you a favor.’”
She came to Lifta after a suicide attempt at the hostel: “This is the first time I’ve been without alcohol and the first time that I feel I have friends who love me and support me and give me affection. I feel protected. I’m starting to plan for the future. I’d like to go to Ethiopia and open a school for kids who are having trouble, or to help the sick,” she says, daring to dream.
Two days later, Brutka’s arm was bandaged. She had cut herself. That day it was hard to talk with her; she was very withdrawn. A week later, she was in much better spirits, speaking rapidly like before and smiling warily.
“I left the rehab center for the family event and there was alcohol there,” she relates. “The family started offering me drinks and wouldn’t accept my refusal. Like I’m not one of them. And I looked around and saw that everybody was getting drunk and told myself: ‘I don’t want to be like this. I want to be different.’” Afterward, the family refused to bring her back to Magal.
“I called the center in tears,” she continues. “I said I missed it. I explained to my family that rehab was important, and said that if they didn’t bring me back, I’d hitchhike and escape, so in the morning they brought me.”
She only said about the cut on her arm that, “After my family offered me drinks and I said no, I made sure I came back here. I have more faith in my own strength, maybe too much.” She laughs all of a sudden.
Asked what she plans to do, Brutka says: “I’m still wavering. If I continue to a treatment center in the community, my family won’t stand by me. It’s hard for me to lose them. It’s hard for me to lose myself. I just don’t know.”
In the end, Brutka decided to return home. She felt that her family would consider her a traitor if she opted for community treatment. But after two days at home, she couldn’t take it anymore, and returned to the girls’ hostel, where they’d kept a place for her.
Clean, but stigmatized
“The change I want to make is not to feel guilty,” says one girl at Magal.
“The change I want to make is to know how to deal with the pain,” says another.
“I want to learn to get help,” is how another girl describes her hopes during the “circle of changes” workshop led by Yotam, 26, who has been on the center’s staff for three years. Yotam is keenly aware of the void from which he is trying to rescue the youths at the rehab center: He sank into heroin and cocaine use when he was 14.
“I would go through NIS 2,000 a day, trip for 50 hours in a row on crystal meth,” he recalls, adding that he only got clean when he was 20.
“I went from rehab to a daytime program − which isn’t necessarily the most helpful framework to be in,” he recounts, “but there was a counselor there who was a former addict, like I am today, and he was able to get through to me and bring about a real change.”
Yotam has now been off drugs for five years, finished the matriculation exams, studied counseling for two years at the Open University, and has plans of founding his own organization that will help addicts. He is clearly forging a successful path now, but, he adds: “I have a feeling that society is still captive to stigmas. When I talk with people who aren’t addicts, the response always ranges from pity to condescension. I know that I’m an achiever and that I’m doing okay in building myself up and progressing, but I also have the feeling that people will never really look at me as an equal, as someone who comes from the same place.
“Let’s be honest: No father would really want his daughter to marry someone who used to be a drug addict.”
At the “round of feelings” before bedtime, the residents all wish each other a “clean night” and recite the recovering addict’s prayer: “Lord, grant me the courage to change the things I can, the strength to accept the things I cannot change, and the wisdom to know the difference.”
And then, just before they head off to their rooms, one girl who is not yet 18 and is at Magal for the second time, asks Yotam in a sweet and childish voice this heartrending question: “Tell me, is there any chance I will ever have inner peace? Is it really possible that one day it will all calm down and I’ll feel peace?”
‘No rehab by coercion’
In his study, Magal rehab center director Moshe Kron holds his personal bible, “Motivational Interviewing: Preparing People to Change Addictive Behavior,” by Profs. William Miller and Stephen Rollnick.
“Youths who feel they don’t want to continue with rehab are entitled to stop immediately. There is no rehab by coercion here,” he explains. “We believe that in order to develop the motivation for change, you have to take a mature and respectful approach, and create a dialogue with them. We don’t get into confrontations with the kids, we don’t mete out punishments, we don’t shout or humiliate. We don’t invent a new person; we teach them to use what’s inside them.”
During the long days I spent at the center, I didn’t witness any shouting, violence or confrontations. There is no humiliation: Every argument or crisis is resolved in a group discussion or private conversation that is characterized by love and empathy − where people observe the prohibitions against violence and hurting another person. Unlike other institutions, there is no invasive inspection system here, no cameras.
“The therapist’s tools are empathy, love, creating hope and avoiding confrontation and resistance,” adds Kron. “Often the patients want to change, they’re cognizant of the seriousness of their situation. The patient is aware that he’s an addict and that he’s miserable, but doesn’t believe that anybody can help him. Here, we create a cooperative environment: It’s not me versus your illness, but the two of us tackling the problem together.”
Every year, the center takes in about 150 adolescent boys and girls. Since it opened, there has been an increase in the number of girls, who now account for 30 percent of the residents. While there has been a rise in alcohol and drug abuse among the young in recent years, Kron says the numbers of people coming to Magal for rehab haven’t changed.
However, he notes that, “there is definitely a significant increase in the number of independent inquiries we’ve been getting. In the past, most of the referrals came from the welfare and health services, but now we’re seeing more and more youths who are cut off from the system, who haven’t been reached by the welfare authorities − and they’re finding their way to us on their own, from the street. The system that should be finding them isn’t doing its job.”
The cases are also becoming more complex. “In the past, we had to deal just with the problem of substance addiction, and now we also have a lot of patients who come to us with mental problems. The system didn’t identify the emotional distress that led these youths to drugs,” Kron says, adding, “The youths who come to the center are exposed to many dangers − chronic illnesses, crime, sexual exploitation, unwanted pregnancies, mental problems.”
Magal is housed in a beautiful but small building. The residential floor has just 16 beds, and is very crowded. “The kids don’t complain, they love the place because it gives them a feeling of home and there’s contact with nature, but I would certainly like the kids to have larger, newer rooms, with a desk and chair,” notes Kron. “I figure we need about double the budget that we get now from the Health Ministry in order to provide suitable services to the young people who come here.”