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

By Michal Levertov, May 30, 2008

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

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 process. Andre Waismann, of the ANR clinic in Ashkelon’s Barzilai Medical 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 non-governmental 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 Arabic-speaking 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 tourism 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 $3-6,000 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.

Israeli rehab in numbers

Of the “50,000 alcoholics and 30,000 drug addicts” in Israel, says Iris Florentine of the Ministry for Social Affairs, 14,000 are currently in rehab. About 400-500 of them, according to the Anti-Drug Authority, are staying in long-term therapeutic communities.

The Israeli policy, states Haim Mell, head of treatment and rehabilitation department of Israel’s Anti-Drug Authority, is to enable each Israeli citizen who suffers a drug or alcohol addiction a fully subsided rehab process. Normally,  an addict would be firstly attached to a case manager — a social worker who accompanies him throughout the process.

The process starts with a three-week detox in one of Israel’s Ministry of Health’s five drug-cleansing units (where the patient is charged with the maximum sum of 600 NIS, around £90).

The next step is a tailor-made programme designed to meet the needs of individual addicts. It could include treatment at a day-care facility, in a half-way house —  a hostel that enables the patients integration back in society — or a stay in a secluded therapeutic community such as Retorno, or a  combination of all or some of these.  Treatment lasts at least a year-and-a-half and is entirely voluntary.

According to 
Social Affairs Ministry figures, of the patients who completed the  treatment, 84 per cent stayed clean for at least a year and 54 per cent managed to stay clean for five years. 


Last updated: 3:02pm, November 2 2010