Only Place to Go Is Up

A first look inside a Jerusalem rehab center that brings together young people with addictions. They come from different backgrounds, but all have hit rock-bottom.

The abandoned stone houses of the Arab village of Lifta, on the western outskirts of Jerusalem, used to be a place of refuge for eccentrics, yeshiva drop-outs and groups of teenagers, recent immigrants from the former Soviet Union who could not find a place for themselves in Israeli society and had become addicted to drugs. In the last few years the same location has been home to the Magal Adolescent Drug Abuse and Alcohol Treatment Center, the only facility in Israel offering rehabilitation services to teenagers and youths. All around the center stretches the remote, sleepy beauty of the Jerusalem hills, which seems to possess a healing power of its own for the young residents. That, at least, is what some of them said in interviews I conducted with them, when Magal agreed for the first time ever to open its gates to a reporter.

Tamar (an alias, like the names of all minors interviewed in this story), a 16-year-old girl who came here to deal with an alcohol addiction, leads us to the crowded residential floor of the old building. She has decorated the walls of her room, which she shares with two other girls, with colorful pictures torn out of magazines. "This is home to me," she says. "It's the only place where I feel safe. No one harms me, no one puts me down. The trust is returning, I get support, they listen to me."

She comes from a religious family. "Dad was always self-absorbed, indifferent, didn't get involved in anything," she recalls. "Mom was always out of the house, busy making a living, and never had any time." Things at home were tense. "Two weeks before I came here, there was a fight, and my father suddenly beat me up. Inside I was glad that he was finally paying me some attention."

At age 15 Tamar dropped out of school. "I started working as a waitress in a restaurant, and that's where I began to drink. It started with half a glass of vodka, became a whole bottle and soon I was drinking two bottles a day. It made me feel good, you don't think about anything, suddenly everything is all right. Every time I felt bad, I drank. I would argue with my mother a lot to get money for drinking, and when I didn't have any, I stole."

Her mother, she says, did not want to understand that her daughter had a drinking problem. "I tried to send out signals, and she ignored them. One night I deliberately came home very drunk so she would see I was in a bad way, but all she said was that I smelled bad and that I should take a shower." At age 16 Tamar moved to a boarding school for religious girls, "but all the girls there drank alcohol," she recounts. "There was a man from a nearby grocery store who used to come and sell us booze at the school gates. We stole money from the counselors and from other girls at the school.

"A friend of mine and I became friends with a 45-year-old man who lived near the boarding school. He had a beautiful house with horses, and we would go there, experiment with smoking pot, talk. We felt that he understood us. One night we ran away to his house, and I smoked a lot. The next day I woke up and found myself there, wearing clothes that weren't mine. There were 10 other men I didn't know in the house. I wanted to throw up." She says she can't remember what happened that night. "I got up to collect my stuff and felt like my legs wouldn't move. I went home, went to the bathroom, opened the medicine cabinet and swallowed some pills. I told myself I had nothing to live for."

She began to drink three or four bottles of vodka a day. "I became violent, aggressive," she says. "I started being afraid of boys. They all disgusted me. When summer vacation came I was scared. I felt that I was going to take a very deep dive. I called this place and asked to come in for rehab. My mother said, 'You don't need rehab, you're fine,' but I knew I didn't have the strength to face it alone."

Tamar has been at the center for 30 days now. "I want to change," she says. "It's the first time that I've gone a long time without alcohol. True, there are bad days when everything seems to float, but there are also good days. I see kids who break down and drop out just because they feel good for the first time, and it's a feelnig that they don't know how to deal with." When asked about the future, she says, "I want to be a counselor at the rehab center, to help others, and to be a mother. To be a good mother."

Their own initiative

The center was established in 1992 by the Health Ministry and the Jerusalem Anti-Drug Association. Initially a facility for adults, it was re-designated as a youth facility in 2000. Moshe Kron, who has served as director of Magal since it opened, says the center treats some 150 youths of both sexes every year. "This year we have been flooded by an unusually high number of people who have contacted us on their own initiative. If in previous years most of the requests for treatment came from the social and health services, this year we are getting more and more teenagers who contact us themselves and ask to come in for rehab."

The center houses around 16 youths, aged 12 to 21, who spend up to three months undergoing physical and psychological rehabilitation, before being transferred to therapeutic communities, to outpatient centers or to their former educational institutions, under close personal guidance. The Health Ministry requires that the youths pay NIS 1,500 a month, a sum usually provided by the welfare authorities. "Youths who feel that they do not want to continue with the rehab are allowed to stop immediately," Kron explains. "There is no forced rehabilitation here. We believe that in order to obtain motivation for change, you need to use a mature, respectful approach and to create a dialogue. We don't get into conflicts with them, we don't punish and we don't use sanctions."

The day begins at 6:30 A.M. and lasts until the evening. "We create a daily routine that includes social activities, crafts, sports and therapy groups," Kron explains. "The teenagers who were used to waking up late and doing nothing cling to this routine. There are rules and regulations, and they follow them devoutly: They are not allowed to stare blankly at the television, can only listen to music on their headphones before bed, can't use cellular phones and can only receive visits from relatives.

"These are youths exposed to all kinds of dangers - chronic disease, death by overdose, crime, sexual exploitation, unwanted pregnancies, emotional problems. About one-third of those who undergo rehab here have been exposed to infectious diseases, and many of them have been sexually exploited or have worked as prostitutes."

Inside the rehab center, a group of teenagers gather and wait for their therapy group to begin. One boy plays the guitar, a girl reads a book, others play backgammon. There are Israelis, immigrants from the former Soviet Union, youths of Ethiopian origin, an American girl and a Palestinian boy. The center brings together the offspring of parents who are drug addicts, youths from violent homes and some whose families were fractured by the ordeal of immigration, alongside teens who grew up in wealthy families.

Only 32 percent of the youth succeed in completing the rehab program; the remainder drop out before the end. "Over the years we have learned to set modest goals," Kron admits. "Alongside many success stories, one of the most predictable things that happens is that people drop out and go back to substance abuse. However, the percentage of kids who return to rehab a second and third time is very high. I am always willing to take them back, because sometimes the chances of rehabilitation the third time around are better than during the first time. Of course sometimes they return to us more damaged, emotionally broken, but even then we give them another chance.

"The recognition that the dropout rates are high, and that often the youths will go straight from the center to buy drugs and shoot up, has caused us to come up with a damage-control plan. We take care to give the kids life-saving information, such as how to avoid becoming infected and infecting others with HIV or hepatitis B or C, and how to avoid an overdose. We discovered that they don't know that when they go to rehab, their bodies return to the zero point, and that shooting up the amount of drugs they used to do before rehab will put their lives in danger."

Second visit

This is the second time that Michael, aged 19, has tried to kick the habit. He came to Israel from Russia when he was 2, but, he says, "I feel more Russian than Israeli." At age 12 he started drinking, smoking pot and taking ecstasy. "At age 14 I started doing heroin. I would come to school and do lines on the desk in class. I hated stealing, so I dealt drugs in order to get them. After this I saw how friends of mine, who began to shoot up heroin, fell into it hard. I hated what happened to them. I used to break their syringes and yell at them to stop. I promised myself that this would not happen to me."

But when he was 17 he, too, began shooting up. "One day I felt hopeless about life, and I wanted to try something new. I thought that because I had seen what happened to them, I would actually be able to control it." Soon he was injecting heroin on a daily basis. "I walked around high most of the time," he says. "I began to shoot up at home, too. When there was no one home, I would go into the bathroom and shoot up. At this point I wanted to stop. There were unpleasant situations, humiliation, police arrests. I went and told my parents, and under pressure from my family I came to the rehab center three months ago."

Sixteen days after arriving, Michael dropped out. "I had excuses in my head," he says. "I believed that I could do rehab alone, that I didn't need support from anyone else." On the day he left the center, Michael got on a bus to Lod. "Some drug dealers there gave me a place to sleep. I dealt, sold and did stuff for them that I don't want to talk about. After the rehab failed, the drug use was stronger; I was shooting up enormous amounts."

Michael's family searched for him and brought him home. "I learned a lot about myself the last time I went down," he says. "Now I am back here, I've been holding on for 28 days now, and I really want to complete the treatment. I am getting to know myself again, discovering talents that I did not know I had, like cooking and writing. I started drawing again, reading books, and I'm having a long, hard reckoning with myself about everything I did under the influence of the drugs."

The rehab center has a medical team, which includes a psychiatrist who oversees physical withdrawal and a specialist in pediatric and teen medicine. "Many youths come to us in bad physical health," Kron says. "They arrive here underweight, with abcesses from shooting up and bad skin problems." There is also a psycho-social team and a group of rehab counselors.

Jan (not his real name) is the coordinator of the counselors at the center. The tattoos on his body show that he used to belong to a gang; his hands are lined with the cuts and marks of self-inflicted damage. He was born in Russia to a criminal father and an alcoholic mother. At age 12, when his father went to prison, he left home and began to use opium. By age 14 he had already been sentenced to six years in prison for involvement in a robbery. When he was released from jail, he made aliyah to Israel.

A year later Jan began shooting up heroin. "I had a car and I would drive other addicts to Lod. It paid for my 'medicine,'" he says. "The drugs cost me NIS 800 a day. Later I also worked as a security guard, and I would shoot up during my shift."

Encouraged by his girlfriend, Jan agreed to enter the rehab center and end a 14-year addiction. "The kids at the center keep testing me, they say, 'What, you really don't take anything? Really, really nothing?'" he laughs. "I tell them that I am completely clean today, I don't even smoke cigarettes or touch any candy with liqueur in it.

"For the kids at the center, I break the stigma that you can never escape the drugs," he says. "I show them that even when you start out as terribly as I did, you can come up, grow, find a place in society and make a change. The kids come here neglected, their faces locked up, loaded with trauma. My goal is to give them the hope that as long as they are willing to invest in themselves, they have a chance of leading themselves to a place that's good and loving."