Kicking Cocaine

A novel way to get straight

Two kinds of snow abound in Colorado: powder for the slopes and powder for the nose. According to a state survey, a quarter of the people at ski resorts like Aspen ("Toot City") have got their Rocky Mountain highs from cocaine. So it is appropriate that Colorado also boasts the country's only clinic of its type exclusively for coke abusers. Operated by the University of Colorado School of Medicine in Denver, it has been extraordinarily successful in helping people kick the habit. Its principal method? Self-blackmail. The abuser, who comes to the clinic voluntarily and usually in desperation, promises to quit and then designs a painfully severe penalty for failure. The nature of the punishment varies with the individual.

"Edith," 24, a registered nurse, had a three-gram, $300-a-day habit. She went on binges, took coke intravenously and started mixing it with such drugs as heroin, morphine and Demerol. "The highs were terrific," she says, "but the lows outweighed them by a mile." When she signed a contract with the Denver clinic, she agreed to write two letters: one to her parents, confessing her dependence on cocaine and asking that they no longer support her; the other to the state board of nursing, admitting her habit and turning in her license. The letters were to remain in the clinic vault as long as Edith stayed drug free. But if thrice-weekly urine tests revealed the presence of cocaine, the letters would be mailed. They never were. The contract, says Edith, "gave me the motivation to quit."

"Tom," a conservative Aspen businessman, blamed his cocaine habit on the morphine he was given during hospitalization for an accident. Eventually, he was doing a couple of grams a day and suffering from paranoia, roller-coaster mood swings and an inability to work. "I lived my whole life for cocaine," he recalls. Tom, too, went to the clinic and made a pact. A diehard Republican, he could think of no penance worse than forking over $1,000 to Democratic Senator Edward Kennedy. A year ago he agreed that a check should be mailed if he resumed his habit. Ted Kennedy will have to find that money elsewhere. Tom is clean. Says he: "I don't ever want to get near the fire again."

Seventy patients have signed such contingency contracts during the clinic's two years of operation. Doctors, lawyers and accountants have written confessional letters that would jeopardize their careers; others have penned self-incriminating letters to district attorneys; one Jewish man wrote out a check to the American Nazi Party. Contracts run three months and volunteers are encouraged to renew them. In all but four cases, patients have lived up to their vows. The clinic duly executed the contract on all four delinquents; two subsequently returned to the clinic to try again. The failure rate was much greater for the 76 users who came to the clinic but did not sign contracts: none managed to stay coke free for more than a month.

The clinic provides weekly crisis-oriented psychotherapy sessions to all patients, recommending life-style changes--finding new, nonsnorting friends for example--and helping them to understand the reasons for their habit. Cocaine is not, strictly speaking, physically addictive. But, says Clinic Coordinator Antoinette Helfrich, it has a "reinforcing nature--people want more and more." The self-blackmail contract seems to stir up the resources necessary to break the cycle. The key, says Helfrich, is that "patients have a reason not to do the drug that is stronger than any reason to do it."

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