Narcotic addicts and the potential of horticultural therapy

Calais, Maine: You may not have ever heard of it. Speaking frankly, it is a community of good natured people, drug addicts, and good natured drug addicts. The last category is absolutely that, as anyone who has had the displeasure of interacting with a drug fiend can understand.  It wasn’t always this way, but in the 1990s, this community and the surrounding county were beset by an onslaught of narcotic prescriptions (namely Oxycontin). The area became nationally and internationally known for its rates of addiction and overdose, which were (and are) remarkable.

I grew up in this area, and have returned to it. I know the pinch of poverty and the pain of a parent with a prescription pill addiction. I was lucky that my mother survived, but I know others are not as lucky. And I know that there are children who are watching their parents kill themselves as we speak.

That said, I believe that this is a trend we can reverse. There is indeed an abundance of good people here. Rather than approaching this as a problem to throw another pill at, however, we need to look at the cause of the addiction. What hole in each life is the pill trying to fill? One very important part of it is diet. A diet that does not sustain nor satisfy the body is not doing its primary function.

I decided to focus one of my research papers on the topic of food gardening therapy and its potential for providing a foundation for the community as well as the individual drug addict, specifically in Washington County.

 

Introduction

For over a decade, Maine has been recognized nationally (and internationally) for its high rate of prescription drug abuse, a trend that began in the 1990s with the introduction of Oxycontin. Nicknamed “Hillbilly heroin”, this potent pain-killing narcotic became rapidly sought after by those destitute and down on their luck for its euphoric effects. The poorest county in the state—Washington County—was the hardest hit, with the highest rates of recorded overdose in the state from 2005 to 2008, and the highest number of those seeking treatment for addiction.

Aside from struggling with high rates of drug abuse and unemployment, Washington County is also faced with the highest food insecurity in the state, leaving more households without consistent meals. The trend shows no sign of reversing with a 2010 report indicating that “Washington County’s poverty rate trended upward almost every year from 2000-2008.”

Is there a way to reconcile these problems simultaneously? Gardening (ornamental and vegetable) has been used for therapeutic purposes for many generations and in many cultures, and at times, it has been utilized for drug addiction therapy. If it is indeed effective, the creation of community gardens, greenhouses, or rehabilitation centers would serve to prevent drug addiction or relapse while contributing to the food supply of the area.

To examine the efficacy of gardening as a rehabilitative therapy, we’ll start by seeing what effect the act of gardening has on gardeners, as well as what effect drug addiction (particularly prescription narcotics) has on the addict. We’ll then have a look at the successes or failures of specific case studies and examples, including “The Narcotic Farm”, the federal prison for drug addicts.

The Therapeutic Value of Gardening

Gardening has long been associated with physical health benefits due to its incorporation of exercise and the end result of producing nutritious food. The psychological benefits of gardening are not as well researched, though nearly all gardeners agree on an improved feeling of well-being.

In the past century, social movements have emerged from the growing belief that interacting with ecology can have a positive effect on emotional and psychological health. In the 1990s, “ecotherapy” was coined as an umbrella term for this understanding. Since its widespread introduction, it has become more and more accepted, with related degrees now offered at leading institutions. The movement is rapidly becoming global, with England initiating a 30-year plan to bring half the population of the country within the vicinity of at least 1 of 12 newly planted community forests.

In prisons, horticultural therapy has been practiced for decades in an effort to relax and rehabilitate prisoners. In Horticulture as Therapy: Principles and Practice (1997), Simson and Strauss state that a 1990 telephone survey of 55 prisons reported that 51 had some kind of active horticulture-related program. The benefit gained from gardening goes beyond regular vocational therapy in its psychological effects due to its nurturing nature. “Taking care of plants cultivates the experience of being responsible for other lives.”

Ecotherapy supporter Craig Chalquist compiled an impressive list of studies reporting the benefits of horticulture therapy in his essay, A Look at the Ecotherapy Research Evidence (2009). He summarizes: “[Horticulture therapy] has proved effective for treating alcohol addiction and substance abuse,” as well as in “decreasing vulnerability to drug abuse in violent offenders” and “fostering emotional restoration.” He adds that it also has the capacity to reduce or ease trauma disorder.

The evidence for the positive potential of ecotherapy and gardening in particular is present in abundance, and the public response is gradually shifting to include an understanding of its psychological impact. However, how well does that actually translate to rehabilitation or relapse prevention in the drug user (and in particular, the narcotic abuser)? One notable example brings to the forefront the reality of the situation of addiction: The United States Narcotic Farm.

“Narco”: Its philosophy and failure

In 1935, following a boom in the use of heroin by teenagers after the First World War and the popularization of its use in the Harlem jazz scene, the United States opened its first prison for drug addicts, the United States Narcotic Farm (“Narco”). Intended to treat federal prisoners as well as those who willingly volunteered for rehabilitation, the institute pioneered a number of new treatments and conducted extensive research on drugs and related substances (including the first use of methadone).

The Narcotic Farm (2008) states that “[The Farm’s] goals were audacious: nothing less than the complete social rehabilitation of America’s drug addicts and the discovery of a permanent cure for drug addiction.” Chief in their philosophy for rehabilitation was integrating vocational therapy into the idyllic setting of 1,000 acres in rural Kentucky. “Fresh air and sunshine would reinvigorate addicts, farming would teach them the virtue of hard work, and their newfound work ethic would sustain their lifelong abstinence from drugs.”

Narco housed a massive agricultural operation, complete with livestock (cows and pigs, which were milk and/or butchered appropriately) and numerous kinds of crops (kale, corn, beans, tomatoes, etc), each of which were harvested and processed. Prisoners and volunteers worked side by side, often in the company of the children of the staff of the institution (who were housed onsite). All of the food was cooked and served in the prison, providing nutritional benefit and meaningful purpose to the efforts of the addicts.

Despite the ongoing success of the farm and constant abundant harvest, “by the early 1950s, it was obvious to everyone that farmwork didn’t cure drug addiction,” The Narcotic Farm reports. Most inmates were from the city and had no use for the skills they learned on the farm, and for many, the activities of farming came as something of a culture shock.

In 1968, when the institute transitioned from prison hospital to hospital (and the ensuing loss of workforce that could be compelled to run it), the farming aspect of the United States Narcotic Farm ceased.

Horticultural therapy was but one of many performed at Narco, where inmates could also choose to work in textile, woodcrafting, or automotive industries, to name a few. Arts and crafts and other leisure activities were heavily encouraged, and the institute had a performing arts stage that played host to some of the most legendary musicians of the mid-century. Group therapy and social events were held often in an effort to promote “talk therapy”.

Although clearly a massive, sprawling institutional prison, the interior design of Narco was aimed at providing a peaceful, humane environment that was favorable for recovering from drug addiction in. Day rooms were large and airy with big windows permitting views of the landscape, and the arched doorways were reminiscent of serene monasteries. The most modern understandings of the psychological effect of the environment were employed.

Even with all of these advantages, however, the truth uncovered by relapse rates belied the efficacy of the “Narco cure”. Far from its original goal of curing drug addiction, a 1962 study of 2,000 former inmates of Narco uncovered that 93% reported going back to drugs almost immediately after their release. Over the course of its existence, that rate hovered around 90%.

Drug addiction, it seems, had proved far more complicated than anyone could have predicted.

Narcotic Addiction: Understanding the Sickness

Most of the inmates and volunteers that came through Narco were suffering from heroin addiction, which bears a number of similarities to its narcotic brethren. Oxycontin has been one of the frequently abused prescription drugs in Maine, though other opiates are also on the list (Percocet, Vicodin, morphine, etc).

Recent reports from the National Institute on Drug Abuse indicate that prescription drug abuse has been on the rise dramatically in the past few decades. Deaths from overdose from prescription drugs have increased from 3,300 in 1999 to 12,000 in 2008 while those related to cocaine have decreased and those related to heroin have increased, but by only a few hundred.

In response to this escalation of abuse, new forms of Oxycontin capsules have been released that cannot be melted down and injected, which is, in turn, contributing to the introduction and increased usage of heroin in this area.

What is it that makes these narcotics so compelling? Like all opiates, they produce a feeling of euphoria. Injected heroin produces a rush of intense elation, while Oxycontin users experience a much longer lasting high that is amplified if the pills are crushed and snorted (or injected). All pain and often all sensation is numbed or blocked, allowing the imbiber to detach themselves from their physical forms. This release becomes highly addictive.

Considering the nature of narcotics, it becomes easier to see why the United States Narcotics Farm had such a discouraging relapse rate, despite its well-intentioned environment and cutting edge therapies. However, some of the therapies (including horticulture) seemingly hold real value in terms of treating substance abusers, as we examined earlier.

Does horticulture therapy have viable potential in Washington County for narcotic addicts? Are there area characteristics that may affect its success?

Local Potential of Horticulture Therapy for Narcotic Addicts

The consensus among many of the former doctors of the Narco is that the primary factors in the high relapse rate were the lack of follow-up after release and the reabsorption of the recovering addict back into their old community (and consequently, their old habit).

With the small population and large area of Washington County, families and communities tend to assume a tribe-like mentality, existing in pods that more or less float independently. Outsiders are regarded with curiosity and are generally unwelcomed (other than during tourist season). Once you become involved with the community, it is very difficult to interact with other parts without meeting the same folks. Because of that, drug abusers here face one of the biggest vulnerabilities for relapse—falling back into the same crowd and patterns after they kick the habit.

It is that same tendency of rural Mainers, however (staying close with their family and flocking together with their friends and relatives), that may make horticulture therapy more valid here. Maine has a long history of small-scale farming, with much of its early European history hallmarked by family-run agricultural operations, and in recent years, small, single-family farms have been multiplying all over the state as interest rises in fresh, local food. Reinforcing this trend along with the familial ties that many here have to farming and gardening is not a difficult proposition to consider, especially if the recovering addict feels that they are contributing positively to their community.

One of the primary failures that the Narco farm experienced was that many of its inmates were from the city, did not take well to farming, and did not continue to gain from the habits that they learned. This is clearly not the case for residents of Washington County, who typically work rugged, seasonal jobs, and have some land available to them (even if it’s simply their yard).

It is important to consider that Narco’s farm closed when it could not compel its inmates to work on the farm any longer (when they were no longer prisoners, but strictly volunteers). Unless drug offenders in Washington County were forcibly kept at an agricultural rehabilitation center where they could be compelled to work, it will likely not be sufficient to send recovering addicts home with a brochure and a suggestion. A follow-up program implemented to help encourage and enforce active therapy would be necessary for long term success.

In reality, there is no simple or surefire way to handle the epidemic facing Washington County and other parts of the nation. For Big Pharma, who introduced Oxycontin to the area initially, the answer is another drug: Suboxone, introduced in 2000 as an alternative to methadone. Sales of Suboxone have climbed from $137 million in 2006 to $1.4 billion in 2012.

For those of us who believe the answer is not another drug, we are planting our roots.

“If you want to treat an illness that has no easy cure, first of all, treat it with hope.”  — George Vaillant, former Narco psychiatrist

 

References:

Acheson, Ann W. Poverty in Maine 2010. http://mcspolicycenter.umaine.edu/files/2010/09/PovertyinMaine2010.pdf

Campbell, Nancy D., Olsen, JP and Walden, Luke. The Narcotic Farm. 2008. Abrams.

Center of Substance Abuse Research (2012). Suboxone Sales Estimated to Reach $1.4 Billion in 2012—More than Viagra or Adderall. http://www.cesar.umd.edu/cesar/cesarfax/vol21/21-49.pdf

Chalquist, Craig. A Look at the Ecotherapy Research Evidence. 2009.

Department of Health and Human Services (2008). Treatment Episode Data Sets: State     Admissions to Substance Abuse Treatment Services. http://wwwdasis.samhsa.gov/teds08/teds2k8sweb.pdf

National Institute on Drug Abuse (2011). Prescription Drug Abuse. http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse

PBS. Opium Throughout History. 2008. http://www.pbs.org/wgbh/pages/frontline/shows/heroin/etc/history.html

Richardson, John. (2011 October 16). Washington County Named Ground Zero for Prescription Drug Abuse. Kennebec Journal.

Simson, Sharon and Straus, Martha. Horticulture as Therapy: Principles and Practice. 2003. CRC Press.  

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