Patrick is 30, tall and rangy, with sandy, short-cropped hair and a neatly trimmed goatee. He and I are in
the small library of Center Point, a substance-abuse treatment facility in San Rafael, Calif., about half an
hour north of San Francisco, where he is enrolled in a six-month residential program. Patrick is a
"retread": this is his second time through here in a year, initially in exchange for a suspended sentence on
charges of possessing drugs and stolen property. He completed the program last June and got a job
restoring boats in Sausalito, convinced that his own ship had finally come in. But within five weeks he
had moved from swallowing pain pills for a bad back to downing a couple of beers with his older
brother. Then he started lighting up a few joints. In less than two months, he headed to San Francisco on a
meth binge. He had planned to stay high until his money ran out, he was arrested for violating probation
or he died. But one night, holed up in a transient hotel with an old crime partner and a prostitute, Patrick
had a revelation. "I was suddenly disgusted with the whole scene," he recalls. "I had this thought -- or
this thought was given to me -- that I just couldn't do it anymore. I just couldn't." He called Center Point
and said he needed help. Within 24 hours he was back.

    As Patrick talks, members of ''the family,'' as the 40 clients here call one another, drift in and out,
browsing through the self-help books that line one of the room's walls or -- since the program frowns on
privacy -- listening to our conversation. A disheveled heroin addict who has been through six treatment
programs in 11 years comes in to sharpen a pencil. After he leaves, Patrick says, ''What scares me are
people like him, who are intelligent. That can be one of the biggest obstacles. You substitute intellectual
understanding for actual change.''
    I ask Patrick what odds he gives himself this round for staying off drugs. ''Fifty-fifty at best,'' he says,
evenly. ''But anyone who'd give their chances as being any better than that is practicing self-deception.''

    Patrick is one of thousands of addicts in this country who are doing exactly what the new conventional
    wisdom says they should: going through treatment and probation rather than jail (or in exchange for a
lighter sentence) with the promise of a better outcome. It's the latest salvo in America's other war -- the
one on drugs -- which many would acknowledge we've been losing for years. Consider: The federal
government spends about two-thirds of its $19.2 billion drug budget on law enforcement and interdiction.
A result has been a skyrocketing prison population -- it has tripled in the last two decades -- with at least
60 percent of inmates reporting a history of substance abuse. The cost of warehousing nonviolent drug
offenders is more than twice as great as treating them. Meanwhile, a study by the RAND corporation's
drug-policy center found that for every dollar spent on treatment, taxpayers save more than seven in other
services, largely through reduced crime and medical fees and increased productivity. A visit to the
emergency room, for instance, costs as much as a month in rehab, and more than 70,000 heroin addicts
are admitted to E.R.'s annually.

    Those facts, along with an enormously successful campaign by the National Institute on Drug Abuse
(NIDA) to portray addiction as a disease rather than a moral weakness, have already persuaded
Californians and Arizonans to pass voter initiatives requiring nonviolent drug offenders to be offered
treatment with probation in lieu of jail. Similar measures are being targeted for November ballots in
Michigan, Florida and Ohio. By 2003, systemic changes in the New York courts are expected to divert
10,000 nonviolent drug addicts to rehab annually. And Senators Barbara Boxer and Orrin G. Hatch,
hardly ideological soul mates, have proposed bills to increase federal funds for treatment, although they
differ considerably in details.

   As the call to treat drug offenders grows -- an ABC News poll showed that more than two-thirds of
Americans favor treatment over jail for first- and second-time offenses -- one of the thorniest questions
will be how to define success. Because the truth is, Patrick's estimation of his own chances is about right.
Center Point, which was established in 1971, runs one of the oldest and largest treatment networks in
California and has what are considered excellent success rates. Still, one-third of its clients leave
without completing the program, even if that means going directly to jail. Nationally, dropping out of
treatment is the rule. Among those who do finish, few maintain the gold standard of total abstinence for
long: a Congressionally mandated study showed that more than half of cocaine addicts and nearly
two-thirds of those addicted to both heroin and cocaine were using drugs within a year.

    Center Point's adult program house sits at the nexus of the business and residential districts in downtown
San Rafael. Bland, dorm-style bedrooms line three halls, each room containing two single beds, two
dressers, two night stands, two lamps. Out back, beyond the TV room (which is off-limits most of the
time), there is a concrete slab for smoking breaks. Clients spend much of their day in a large central room
that, depending on the configuration of chairs and folding tables, serves as dining room, therapy space or
study hall. Its only decor are two small handmade signs: One reads, ''And the day came when the need to
remain closed became more painful than the risk to open.'' The other, the map of a land called re-entry,
highlights the Ten Concepts -- initiative, effort, completion, etc. -- that are the backbone of Center Point's
program, the precepts upon which clients are supposed to build their new lives.

    The 40 family members file in and sit silently in a circle on straight-backed chairs. They are mostly white
and mostly male, many with prison tattoos covering their forearms. Most are in their 30's, which is
typical in treatment. They place their hands in their laps, feet on the floor, and look straight ahead in what
is called ''group protocol.'' When anyone deviates, a brother or sister corrects him. He may not talk back.
When anyone deviates, a brother or sister corrects him. Women and men sit on opposite sides of the room
and may not speak unchaperoned. When anyone deviates, a brother or sister corrects him.

    Strict adherence to what to an outsider can sometimes seem like arbitrary rules is integral to the
therapeutic-community method: a self-help-based approach to addiction that most of the large
drug-treatment franchises employ. At the heart of the method is the belief that daily interactions within the
family -- a kind of round-the-clock peer pressure -- are the main agent of change. Drug use is viewed as
symptomatic of a ''whole person'' disorder. If, through resocialization, an individual's attitudes, values
and lifestyle are transformed, the addiction will take care of itself. Governing everything from how long
clients can shower to what they can drink (no coffee, for example), the rules are supposed to instill
self-control and provide structure for those who may never have had it. The idea is that if you sweat the
small stuff, the big stuff, like not stealing or not using drugs, will follow.

    Instilling a work ethic is also essential to a therapeutic community. Everyone helps maintain the house,
doing laundry, cooking, cleaning. New clients are assigned a ''big brother'' or ''big sister'' who
accompanies them everywhere, even to the bathroom. As they participate in the family, write essays
exploring such issues as their attraction to drugs, memorize the Concepts and generally behave
themselves, they move up in ''status,'' earning rewards that are both tangible and affirming, like receiving
mail. After three months, clients ease into the real world by finding a full-time job, some for the first
time. After six, they either move to transitional housing or home, cautioned to attend ''continuing care'' or
12-step meetings for at least a half-year.

Each day at Center Point is punctuated by group therapy sessions guided by a counselor, in which a client
brings up an issue -- past sexual abuse, a craving for drugs -- and the rest of the family responds,
sometimes bluntly, with opinions and advice. The feedback is supposed to break through calcified
defenses and challenge ingrained thinking, helping clients recognize the need for change. 

Today is ''grief and loss'' group, and Micky Wickersham, a blond, ponytailed counselor who is leading
the session, asks Sharon A., 32, if she has anything to share. Sharon is addicted to a volatile combination
of meth and pain pills. She was ordered to treatment by the Child Protection Program under the threat of
losing her 23-month-old daughter. (She also has an 8-year-old son.)

''I'm drawing a blank,'' Sharon responds, smiling appeasingly.

Wickersham, a 33-year-old recovering alcoholic and meth addict herself, eyes Sharon, who has been
here for several weeks sliding by, evading attention. Like most clients, Sharon resists kicking up the murk
of an unhappy life. It's time to give her a little push.

''No problem,'' the counselor says, turning to the family for inspiration. Hands shoot up. One brother tells
Sharon that she acts detached from her own experience, as if it happened to someone else. A sister begs
her to ''open up'' for her own sake, then bursts into tears. ''Let us help you, Sharon,'' she says.

Patrick goes on the attack. ''You want to put things out in a pretty package so everything will sound good,''
he snaps. ''Forget sounding good. Sound real.''

Wickersham lets that thought hang for a moment. ''We could unwrap that pretty package right now,'' she
says, sweetly ominous. ''Do you know what it looks like on the outside?''

Sharon shakes her head almost imperceptibly, looking dazed.

''You like to present yourself as a middle-class white woman with a little drug and alcohol problem who
some stuff happened to and now you're here to get your life back.''

''No,'' Sharon says softly. ''I don't mean to.''

''Do you know what's inside that box?''

Sharon shakes her head again.

''Because I'm going to tell you,'' Wickersham continues. ''You are a homeless dope fiend with no
education who chose drugs over your kids.''

Wickersham goes on to say Sharon could become the woman she pretends to be by dedicating herself to
the program. She could take advantage of Center Point's G.E.D. tutoring and vocational training. She
could learn a new values system. She could get her children back. ''Do you want this program?''
Wickersham asks.

''Yes,'' Sharon says.

''Let me hear you say it.''

''I want this program.''

''Again.''

''I want this program.''

''Choose four men and four women,'' Wickersham says. ''Look into their eyes and say, 'I need your help
because I want this program.' ''

Sharon steps across the circle to a brother who is addicted to crack and meth. ''I need your help because I
want this program,'' she says softly.

''Sharon, I need your help because I want this program,'' he replies.

She moves on to three more men, then to the women, who cry and hug her. Finally Sharon stands before
Wickersham, unexpectedly grabs the counselor by both hands and yanks her to her feet. ''I need your help
because I want this program,'' she says, a tear rolling down her cheek.

It's a poignant, triumphant moment. Sharon has admitted her problem. She has allied herself with the
group. She has bonded with her counselor. And she has been offered hope that, with diligence, she can
turn her life around. On other visits, I would watch a prison-hardened man weep like a little boy over the
death of his father. I'd witness a woman mourn over neglecting her children. I'd listen to a brother grieve
years of molestation by a coach. The family would confront or cajole, console or criticize. As moving as
it all was, I wondered: can such catharsis, or even a series of them, keep an addict clean?

''Of course it can't,'' says Sushma D. Taylor, a clinical psychologist and Center Point's C.E.O. ''But
they're related. Our clients are seeking emotional sanctuary, especially the many who have suffered
abuse. The only way you can grieve the things that have been done to you is to cry in a place where you
know the tears are going to get mopped up and somebody is going to put you back together and say we
love you, where no matter how ugly the past is, it can be viewed within the context of being a therapeutic
issue.'' Realistically, the groups can't resolve past traumas in six months, Taylor says. They are just a step
toward self-awareness, toward learning healthier ways of coping with pain.
........................
Drug use, of course, is not the same as addiction. The former is clearly a choice. But over the last
decade, scientists have begun to see the latter as something else: a chronic, relapsing brain disease. At
some point (when, precisely, is unclear) the neurochemistry and receptor sites of a user's brain change
radically, causing drug-seeking to become as biologically driven as hunger, sex or breathing. Long after
the addict quits, some of those brain changes remain, creating a vulnerability to relapse. The implications
for the criminal-justice system are profound, reinforcing the need for treatment: it would be ineffective,
not to mention inhumane, simply to punish someone for an illness without helping to heal him.

Some researchers, however, call the brain-disease model little more than a gimmick, one that undercuts
the role of choice and personal accountability. ''I'm not disputing the fact that certain areas of the brain
light up when an addict thinks about or uses cocaine,'' says Sally Satel, staff psychiatrist at the Oasis
Drug Treatment Clinic in Washington and a fellow at the American Enterprise Institute. ''But it conveys
the message that addiction is as biological a condition as Multiple Sclerosis. True brain diseases have no
volitional component.''

Casting addiction as a brain disease rather than a behavioral disorder, Satel says, gives addicts an easy
excuse for relapse. It also suggests that the remedy is primarily pharmacological, which has not, so far,
proved true. ''The search for a magic-bullet cocaine vaccine has been under way for 10 years, and I'm
skeptical anything will come of it,'' she says. ''The only way to get better is to harness free will. Ask any
addict; they'll tell you.''

Alan I. Leshner, under whose leadership NIDA aggressively promoted the brain-disease concept, agrees
that addicts should not be let off the hook. ''The danger in calling addiction a brain disease is people think
that makes you a hapless victim,'' he says. ''But it doesn't. For one thing, since it begins with a voluntary
behavior, you do, in effect, give it to yourself.''

Nor does biology trump responsibility. ''Just like any other disease, you have to participate in your own
treatment and recovery,'' he says. Still, he doesn't like the moral tenor of Satel's argument. ''What about
people with high cholesterol who keep eating French fries? Do we say a disease is not biological
because it's influenced by behavior? No one starts out hoping to become an addict; they just like drugs.
No one starts out hoping for a heart attack; they just like fried chicken. How much energy and anger do
we want to waste on the fact that people gave it to themselves? It can be a brain disease and you can have
given it to yourself and you personally have to do something about treating it.''
..............
Not all people with a drug or alcohol problem will self-destruct the way Patrick and Mike and Sharon
did. In fact many, like President George W. Bush, will quit spontaneously before their lives unravel.
Others do well (at less taxpayer expense than treatment) on probation with contingencies: rewards for
abstinence and sanctions for testing positive for drugs. Those tend to be lighter-weight users with more to
lose. Have they not yet contracted the brain disease? Or has it not progressed as far? Or, as Satel might
say, have they merely harnessed their free will?

Both sides of the brain-disease debate agree on one thing: a significant subset of addicts do need help,
which jail alone can't provide. ''I'd be happy with incarceration if it were effective,'' says A. Thomas
McLellan, director of the Treatment Research Institute and professor of psychiatry at the University of
Pennsylvania. ''Here's what happens now. They go to jail. Why? They've broken the law, and we're going
to teach them a lesson. They'll realize it's bad, and they'll stop. Then they leave jail and go into the parole
system. The parole officer has a caseload of up to 1,000 people. The individual is not monitored or only
monitored briefly. And, anyway, he was supposed to have learned his lesson. What happens is relapse.''
McLellan and James W. Cornish undertook a study comparing punishment in conjunction with treatment
to stricter punish without treatment, to see which was more effective in reducing crime. They found that
opiate addicts who were forced to increase the number of times they met with their probation officers
were twice as likely to be rearrested or reincarcerated within a year as those who received only standard
probation but with therapy and naltrexone, a drug that blocks their high.

The question remains, however: Just how effective is rehab? The treatment system, which evolved as a
piecemeal, grass roots movement, has been subject more to faith than to scrutiny. In many states, like
California, the rehab industry remains largely unregulated, with lax licensure and few standards for
quality or effectiveness. Since conventional wisdom blames the addict for his relapse, if the courts are
involved only the addict is sanctioned: judges rarely ask whether programs delivered the services
promised.

As public interest in treatment grows, though, researchers have been taking a closer look at traditional
methods to tease out the strengths and limits. ''For many counselors the litmus test of good treatment is
whether you can get the patient to cry,'' says Richard Rawson, associate director of the Integrated
Substance Abuse Programs at U.C.L.A. ''If you look at the data, there's not a lot to support a causal
relationship between talking about feelings and not using drugs and alcohol. I'm not suggesting it should
be ignored. Having a safe place to process that material is an important element. It's the other half of the
equation: 'O.K., so we've done therapy. What do I do next?' ''

One answer, Rawson says, is to incorporate techniques that have been proved in clinical trials.
Medications like naltrexone, along with with counseling, work well with heroin addicts. Meth and
cocaine addicts, particularly males, respond to cognitive behavior therapy. Used primarily in outpatient
programs, cognitive therapy does not focus much on the psychological causes of addiction. Instead,
therapists act more like coaches, teaching addicts why they develop cravings and working on coping
skills, like planning in microscopic detail how to get from today until Wednesday without using. For less
severe addicts motivational enhancement therapy peels away resistance to change through positive
reinforcement rather than confronting an addict with his denial.

Those methods are slow to gain ground in a field wary of outside intervention. Counselors -- whose only
qualification is often that they, too, are in recovery -- resist replacing entrenched, it-worked-for-me
ideology. Consider the maxim that an addict has to be ''ready'' for treatment, that he has to ''hit bottom.''
That idea gives providers a free pass when rehab fails. It's also a myth: addicts forced into treatment by
the courts do surprisingly well. Apparently if you lead a horse to rehab he may indeed quit drinking.
.............
While improving all these aspects of treatment may well lead to better outcomes, according to a study of
more than 10,000 addicts in 96 programs, the single most important factor (assuming a program is well
run) is the length of time an addict stays in it. And 90 days -- not the managed-care-driven 28 or the brief
3-to-5-day detox that is the most common ''treatment'' in many cities -- was the minimum for enduring
benefits to manifest.

............................
If treatment is conceived of as an ongoing process rather than as a cure, a different, more optimistic
notion of success emerges. Although addicts may relapse, a year after treatment their drug use decreases
by 50 percent, according to the National Treatment Improvement Evaluation Study, and their illegal
activity drops as much as 80 percent. They are also less likely than before to engage in high-risk sexual
behavior or to require emergency room care. Other studies have shown that they are less likely to be on
welfare, and that their mental health improves. For chronic addicts like many of those at Center Point,
it may be that treatment should never entirely end;it should just be tapered down.
''You don't let a schizophrenic out of case management,'' argues the
University of Pennsylvania's Thomas McLellan. ''Your expectation is that there will be a relapse if they
leave. Good practice would be to continue to monitor and support that person to see early signs of
intensification. At that point you intensify treatment not to 'cure' but allow them to remain in a state that
maintains them and doesn't have an impact on society.''