Patrick Hughes Penetrates the Drug Underworld to Find Out How to Turn Off a Heroin Epidemic
How ya doin’, man,” one junkie called out. “Need a fix, Pat?” shouted another. Laughing, the visitor extracted a roll of Turns from his pocket and said, “That’s what I use.”
Psychiatrist Patrick Hughes, 43, was back on his old turf on Chicago’s South Side, not far from the site of the Wall of Respect, a street mural painted as a monument to black pride. It also looked down on one of the city’s main “copping areas” where illicit drugs are trafficked.
Beginning in 1968, the Wall (now torn down) also served as an observation post for Hughes, then an associate professor of psychiatry at nearby University of Chicago. From there Hughes and his team could observe “the dealing, the shooting-up, the nodding and the violence that were all part of that life.”
Hughes, with an M.A. in Public Health from Columbia and an M.D. from Pitt, had first faced heroin addicts while in the Public Health Service in Fort Worth. He tried one-on-one therapy—and realized he was being conned. Addicts were telling him what they thought he wanted to hear. “It taught me an important lesson,” Hughes says. “What the heroin addict does in the therapist’s office is not as important as what he does when he returns to his environment.”
On Chicago’s South Side, Hughes decided to track heroin addiction within the community as if it were an epidemic of flu or cholera, rather than a personality disorder. Three surveys of heroin users, involving 939 middle-aged addicts, proved out his theory. All were the products of a massive heroin epidemic, which began shortly after World War II and had peaked around 1949.
Hughes then set out to prove how an “epidemic” of heroin could be turned upon itself. Gradually he was able to recruit guides to the drug underworld—”ex-addicts who began to trust that we were professionals who would learn from them, not inform on them.” His aim was “to get former addicts to recruit their friends into treatment, just as earlier they had been recruited into addiction.”
Winning the confidence of the drug underworld was slow going. His first successful contact was a scar-faced black called “Rabbi.” “Some of our field-workers were arrested,” Hughes admits, “and the program lawyer had to come down to pull them out.” Oddly, few dealers protested. “They were invariably addicted themselves,” Hughes explains. “They knew they themselves might want treatment some day.” And he adds, “It’s a sellers’ market. If we take some dealer’s addicts away, he still has plenty of customers.”
Backed up by community-based therapy, including methadone outpatient clinics and counseling facilities, Hughes ultimately made one South Side community, Altgeld Gardens, heroin-free for more than a year. Hughes’ recent account, Behind the Wall of Respect, has been heralded as a “historic study.” But to the question “Did heroin come back?” Hughes unblinkingly answers: “Yes.” Why? “The lack of jobs to back up the programs,” he answers. “If there had been enough dollars for occupational rehabilitation, the story would have had a truly perfect ending.”
Today Hughes is fighting heroin on a global scale. On leave of absence from Chicago, he is in Geneva as a senior medical officer of the World Health Organization’s drug-addiction program. “It’s a long problem,” he says, “and we’re not talking in terms of a couple of years.”
Recently divorced and enjoying the international whirl, Hughes has had to move out of his Geneva apartment after irritating neighbors by practicing primal scream therapy. But one problem doesn’t trouble him: heroin. “I’m afraid I’d like the high so much,” he says with a grin, “I’d wind up in the treatment program.”