The Rehab Wars

Can a radical nun and a house full of junkies save Philadelphia from drug addiction?

by Isaiah Thompson

Photographs By: Neal Santos

It's a cold, drizzly Monday night in early December, and the members of New Jerusalem Now — a community of about 30 recovering drug addicts, who live together in a few houses in North Philadelphia — have gathered to interview a new candidate to the program.

"Zoe" — not her real name — has been here before, and knows the drill. A plastic crate is dragged out from beneath the television and placed on the floor in the middle of the room. Zoe sits down on the crate, arms at her side. Like everyone else here, she prefaces her remarks with, "My name is ... and I'm a recovering addict." A pretty, sharp-witted black woman in her early 30s, Zoe first came to New Jerusalem eight years ago, but left before completing the six-month program. One by one, the members of New Jerusalem ask Zoe about her life since then. It doesn't take much prompting.

Soon after leaving, she says, she began using again — crack and heroin were her drugs of choice. She met a guy. He was a dealer, but apparently not much of a user, at least until he and Zoe hooked up. She got him using, she continues. Before long, they'd smoked and shot up all of their money, and were out on the streets. Zoe went home to her mother and tried to get clean again, but it didn't last. Then one day, during a trip to get Chinese food, she got into an altercation with another woman and, in her words, "stabbed her up." Zoe went to prison for three years.

She came home clean, but started using again soon after. She went back to prison. She got out and, a few relapses later, managed to get clean and hold down a job for three and a half years. But, on the day before her birthday, she visited a friend, a user. And once again, she relapsed, this time with a vengeance.

"I spent all the money I had in my account, and the check that I had just got from being paid," Zoe tells the group. "And I stayed at her house using for probably three months." She left her friend's house only when a heart attack drove her to the hospital. But even then, she kept using. She sold all of her jewelry and clothing, and then her body, to buy drugs. And then, just a week before, Zoe turned her last trick, took her last hit, and came back to New Jerusalem.

"Thanks for letting me share," she concludes.

"Thanks for sharing," the group answers.

A few minutes later, the members unanimously vote to allow Zoe back in. The decision, it seems, is easy: Zoe's failures matter less than her attitude and purported willingness to play by the rules. But the truth is, almost everyone who comes through New Jerusalem's doors is given the benefit of the doubt.

Admission is, of course, but the first step in a lifelong journey. The goal at New Jerusalem isn't just to get clean — some of its residents have battled addiction for decades — but to stay clean, permanently. It's a daunting task, and many won't make it. Within a week of this meeting, three members will have left the house — one of his own volition and two others forcibly ejected. Even among the community's most stable members, several have been through New Jerusalem and other addiction programs before, only to relapse and return.

New Jerusalem is a recovery house unfunded by any government agency. It employs neither medicine nor doctors. Instead, it relies upon the mere act of community living, and a healthy dose of God. It's an ambitious, almost audacious project, started 20 years ago by a radical nun in the middle of the hood; but the evidence, both anecdotal and empirical, suggests that New Jerusalem and programs like it are, in fact, better suited to keeping addicts clean over the long haul than their mainstream — and better-funded — outpatient counterparts. They're not perfect; the recovery-house industry is wholly unregulated by any state or local agency, and prone to fraud and abuse. At their best, though, their backers say they can do something that no amount of funds, pharmaceuticals or medical science has been able to replicate — give addicts the chance to change who they are, forever.

New Jerusalem claims that it can do just that; well over 50 percent of its graduates, the program boasts, will never touch drugs again. In Philadelphia, where 25,000 people seek treatment for drug and alcohol addiction every year, these results have caught the eye of the city officials tapped with helping them.

So, what's its secret?

THE FACE OF A RADICAL: Sister Margaret McKenna went into the heart of the North Philly ghetto to practice "desert spirituality."

At the heart of New Jerusalem is its unlikely founder and director, Sister Margaret McKenna —"Sister Margaret," as she's known. Seventy-nine years old, with a penchant for knitted sweaters and a warm, grandmotherly voice that erupts occasionally into disarming cackles, "radical" might not be the first word you'd use to describe her. But Sister Margaret, a member of the order of Medical Mission Sisters for more than a half-century, is not your average nun.

She's got a rap sheet, for one thing. Long an outspoken critic of American militarism, McKenna has engaged in various acts of civil disobedience that landed her in jail more times than she can count.

Her longest stint came after an incident — Easter Sunday, 1988 — when she and three other radical Catholics took a tour of the U.S.S. Iowa, a World War II-era battleship then docked at the Norfolk Naval Station in Virginia, secretly carrying a pile of hammers and a baby bottle filled with human blood. The plan was to carry out what they called "ploughshare action" — a protest of nuclear weapons named for the Old Testament prophet Isaiah's vision that humanity should "beat their swords into ploughshares."

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After charming their way through two baggage checks, they climbed a service ladder to the ship's third deck —which housed the battleship's missile launchers — and unfurled a banner that read, "Follow the nonviolent Christ." McKenna uncorked the bottle of blood, and splashed it over the missiles.

"It was very, very effective," McKenna recalls. "Because the metal was very smooth, and [the blood] just went all over it, like a big star. Ha ha! Then we took our hammers and put a few dents in the thing."

The four were arrested and charged with trespassing. (McKenna told a magistrate that the protest was an act of "divine disobedience.")

McKenna was sentenced to four months in prison. She loved it. "It was a whole population of people I hadn't had contact with," she says. "It was wonderful discovering how much potential and goodness these people had."

Less excited about her political activities, perhaps, were her fellow Medical Mission Sisters, who shortly thereafter asked McKenna to pay for her own extracurricular political activities, a proposition she found untenable. She and a colleague, Richard Withers, began to plot their next move. As she tells it, the two shared a passion for social justice and the "desert spirituality" of the early church — a time when a small sect of Catholics, disenchanted by the rise of the Christian empire under Constantine, retreated to desert communities and cultivated a religion rooted in humility and nonviolence.

"We had these conversations about, 'Where is the desert today?'" she says. "We figured, either it's in our remaining wildernesses, or it's in our abandoned inner cities. We had debates about which way to go."

They decided on the latter. In 1989, McKenna and Withers bought and moved into a shell of a house at 20th and Norris streets, in the heart of blighted North Philly. Of the many problems, the one that stood out most to her was addiction: "We became very friendly with the kids in the neighborhood. They robbed us right and left, of course —ha ha!" remembers McKenna. "But we'd ask them, 'Why aren't you in school?' And one of the answers was, 'My mother's an addict.' Everything, the answer was addiction."

Then McKenna saw something that would shape the next 20 years of her life. "Every morning, this group of people would walk past our house," she remembers, "and they were the healthiest-looking aspect of life in North Philadelphia. They looked healthy, happy. And I said, 'Who are these people?' And the answer was, 'Oh, they're recovering addicts.'"

They were members of One Day at a Time, a community founded by the Rev. Henry T. Wells, who had built from scratch the city's first robust recovery community. An ex-con and former addict, Wells conceived the model that New Jerusalem would later emulate. The recovery houses would be financially self-sufficient; the addicts would pay small rents from their welfare allowances and pool their food stamps to feed the community. They would find in each other the salvation from drugs that the system seemed unable to provide for them.

McKenna began attending the group's meetings, and eventually she got an idea.

"In the beginning, [One Day at a Time] was so idealistic, they thought nobody would relapse," she says. "But when the reality of relapse set in, they took a kind of a tough love approach to it. ... I thought that wasn't quite right, so I thought I'd set up a program for the repeat relapsers."

New Jerusalem was born.

HIGHER POWER: God is everywhere at New Jerusalem.

The house that McKenna moved into 20 years ago now serves as New Jerusalem's cozy headquarters. Its walls are lined with books on faith and recovery, and covered with posters of community heroes: Martin Luther King Jr., Gandhi, Malcolm X. Above one wall is a small placard: "In order to recover, you must help the society that made you sick recover." It's a quote from Wells, and one of New Jerusalem's mottos. McKenna lives in a trailer behind the house, near her prized vegetable garden.

The residential component of New Jerusalem consists of nothing more than the three weathered row homes —meager, but clean — in which its residents eat, sleep, cook and hold daily meetings. There are no bars on the windows, no gates outside the door. The distance between the small domiciles and the drug-ridden streets outside is purely mental.

New Jerusalem's rules center first and foremost around maintaining sobriety. Before being granted an admission interview, newcomers must spend a week as "guests." They do no chores, and take on no responsibilities. "They live like a king for seven days," says Robert Hardwick, who manages the entry-level men's house. But they are also monitored constantly, and can leave only with an escort. And, of course, they have to stay clean. A significant number of newcomers don't finish the first week.

Once voted into the house, guests enter a "blackout" period of 60 days, during which their activities remain strictly controlled. They may not use the phone or go anywhere unescorted. Meanwhile, they take on a litany of chores and duties — cooking, cleaning, attending meetings and performing community service. Every Friday, New Jerusalem residents turn the house parking lot into a makeshift food pantry, distributing donated bread and produce to neighborhood residents in need. The line for food goes around the block. As McKenna sees it, service is integral to recovery.

"Getting involved helps them change their vision of themselves," she says. "They have a vision of themselves as being harmful to others. ... It seems to me [that community service] quickens something in them. 'Oh, I can be a good person, I can do good things, I can help people.' It's very natural, it seems to me, for addicts to want to be helpful people."

But by far the most onerous requirement of residents, and, McKenna says, the most important, is that they attend meetings — daily, countless, endless meetings with each other. There are the Monday meetings to vote on new members; on Tuesdays, they hold Narcotics Anonymous meetings; on Wednesdays, the men and women meet separately to discuss (and, often, complain about) the internal dynamics of their households — the list goes on.

Recovering addicts are both vulnerable and raw. Meetings erupt with accusations over indiscretions, some petty — one man refusing to open the bathroom door while defecating to let another man shower — some serious — allowing a newbie to go to an appointment unattended. There are profound apologies and heartfelt encouragements.

It's this co-dependency that's the focus of New Jerusalem's recovery model. There is no escape from your peers. "Addicts are extremely clever at lying to everyone, plus themselves. So counseling isn't always effective, because they might be trying to please their counselor or whatever," McKenna argues. "But in a recovery community, you can't get away with it, because it shows. It forces you to be honest."

Ultimately, McKenna says, the community forces individuals to change their behavior —"and changing behavior is key to recovery. In these medical models of recovery, there's no community obligation, you're just a patient. The day they get out, they use. I've heard that I don't know how many times."

Graduates — those who stay the full six months — relapse far less than those in outpatient programs, McKenna says. She doesn't have hard data to back it up, but she has her alumni. She guesses three or four come to see her every day, still clean. An in-house survey concluded that, of the program's 38 graduates between 2002 and 2003, 15 were known to be clean and only three were using. As for the rest, "When a graduate is using, word usually gets around," McKenna says.

A series of studies on recovery houses in Chicago supports McKenna's claims of success. This research found that, while traditional outpatient programs are successful in getting addicts off drugs, well-run recovery houses perform better in keeping them clean over the long haul. In particular, a study of "Oxford Houses" — a network of addict-run recovery houses in Chicago — found only 31 percent of residents relapsed after two years, compared to nearly 65 percent of those who got outpatient treatment. What's more, graduates of recovery houses had higher average incomes and considerably lower incarceration rates than their counterparts — saving the state, the study estimated, some $8,000 per member.

But not all recovery houses are well run, and not everyone cares what the statistics have to say.

Even as New Jerusalem developed into a more and more substantial program — incorporating as a nonprofit in 1989, recruiting a small paid staff from its members, developing an active board of directors — an explosion of recovery homes, of every kind and quality, was taking place across Philadelphia. Then, as now, virtually anyone can open a recovery house; neither the city nor state requires any special license. All you need is a cheap house and clients — drug addicts.

To the people who live near these facilities, they can easily resemble crack houses. In fact, some are just that. This recovery-house boom led to a wide range of programs, some of which were thinly disguised scams. As McKenna points out, recovering addicts run many of these houses, which has its advantages and disadvantages. The recovering addicts can relate to their clients; but they are also vulnerable. Recently, she says, the operator of one Philadelphia recovery house returned to New Jerusalem seeking treatment.

Moreover, the houses tend to appear disproportionately in certain disadvantaged neighborhoods —Kensington, Frankford and North Philly, among others — leading to a backlash from some neighbors and local leaders. It's a problem with which McKenna is well acquainted. In 1994, New Jerusalem was on the verge of acquiring a vacant property across the street, which they planned to turn into a transitional community for ex-offenders —a plan for which it had been awarded $150,000 to renovate the property from a fund for offender re-entry programs.

"It was the most money we'd ever seen, then or since then. Ha ha!" McKenna says. But, at the last minute, and after they had spent about $88,000 on a new roof, windows, heating and electricity, a representative from then-Councilman John Street's office intervened. The city, the representative said, planned to demolish the building, and build in its place a low- to moderate-income housing development. New Jerusalem pleaded with the city, inviting Street's constituent service representative, Darrell Clarke — who now represents District 5 himself — over for tea. But it was to no avail. New Jerusalem sued. After a judge threw out the city's motion to dismiss the case, the city settled, paying New Jerusalem $100,000 and giving them four empty lots on their side of the street.

It wasn't McKenna's last run-in with the system. A few years ago, New Jerusalem decided to try to use those four lots to expand their facilities. But they needed two more lots — both vacant — on which to build. New Jerusalem approached now-Councilman Clarke. They were shot down.

"He said, 'I don't want recovery [houses] in my district,'" McKenna says. Clarke did not respond to City Paper's repeated attempts to contact him for this story.

Most recently, New Jerusalem has seen the city's hand in the form of visits from the Department of Licenses and Inspections (L&I), which has visited New Jerusalem properties several times this year, in response to various complaints — one from the Philadelphia Fire Department and the rest anonymous, according to L&I records. These complaints usually cited unsanitary conditions in the houses. L&I closed all of the cases after New Jerusalem refused to allow L&I inspectors on premises. ("Was refused entry by nun," one case note reads.) McKenna doesn't let them in, she says, because she doesn't have to, and because she's suspicious of their motives: "L&I doesn't just stop in to check on everybody."

McKenna acknowledges one complaint as valid — a broken pipe, which was fixed — but denies the rest.

McKenna says she's heard similar stories from other recovery house operators, and worries that inspectors are targeting recovery houses. L&I says that's not the case. However, as deputy commissioner of operations Bridget Greenwald acknowledges, the department recently conducted a large-scale inspection of recovery houses, as part of an effort driven by Councilwoman Maria Quiñonez-Sánchez, whose district encompasses Kensington and Frankford. Sánchez says she's simply responding to concerns from her constituents. "I inherited what appears to be close to 300 recovery boarding homes within two of my ZIP codes," Sánchez says. "It's become a big issue."

L&I inspected more than 100 recovery houses. Of those, about 50 (including New Jerusalem) were deemed fully compliant, 12 were scheduled for reinspection, 13 were sent to court, and one organization was ordered to cease operations for "fire code, licensing and zoning code violations."

Sánchez, for her part, maintains that she's not anti-recovery, and says that she has declined constituent requests to propose legislation that would regulate recovery houses until she and other city leaders can "sit down with the good providers and see what makes sense." But the reality is that even if all the "bad" facilities disappeared overnight, the others could still face a backlash. That, says Department of Behavioral Health and Mental Retardation Services (DBH/MRS) Director Arthur C. Evans Jr., is a problem. The hundreds of houses that do exist point to a real need that's not being met elsewhere.

"I'm very concerned about NIMBYism," he says. "And to the extent that people are doing a good job, and people just say we don't want them there, I really have a hard time with that. ... Quite frankly, I'd rather have someone in recovery than someone who's not in treatment living next door to me."

THERE'S NO ESCAPE: New Jerusalem's close-knit environment "forces you to be honest," says McKenna.

Evans says he's determined to see more done to move addicts toward long-term recovery — including working more closely with recovery houses. He's earned national attention, most recently from The New York Times, for his push for what he calls a "recovery revolution." The idea, he says, is to acknowledge the shortcomings of mainstream outpatient programs and begin incorporating other "evidence-based methods" into the current treatment model.

"We know that when people have a job, they're less likely to relapse," he says. Likewise with family support, friends in recovery and positive engagement with society. Yet most of the services that actually get funding treat only the symptoms of addiction.

"If you look at what insurance companies pay for," Evans says, "they pay for you to stop drinking and drugging. If you look at the criteria of discharge [from treatment hospitals], it's sobriety."

And without ongoing support, Evans says, sobriety doesn't always last long on Philly streets. He wants to bring into the fold as many avenues of ongoing help as he can — including recovery houses. But for all of Evans' enthusiasm, his department allocates only $5 million to help fund just 21 recovery houses — New Jerusalem is not one of them — out of hundreds around the city. (These 21 were selected after bidding on city contracts.) Many of the rest remain tiny, self-sufficient operations that run on shoestring budgets.

Indeed, New Jerusalem has few resources at its disposal. It has little in the way of money or staff — three volunteers, and one part-time employee, who makes about $100 a month. According to the nonprofit's 2007-2008 tax records, it took in about $233,000, about $160,000 of which came from private donations, and most of the rest from the rents the programs' clients pay. But that fiscal year was atypical, thanks in part to an unusually large private grant. Previous years' tax filings show that, on average, the organization takes in between $40,000 and $80,000 annually in private contributions.

(Last year, McKenna says, the program discovered that a staff member and former resident had embezzled money. He was fired — they've not yet pressed charges — but not before leaving the nonprofit nearly broke and forcing McKenna out of retirement. She's once again acting as the program's director, although she works for free. McKenna says she's never taken a cent from New Jerusalem; rather, she lives off her stipend from the Medical Mission Sisters.)

Why doesn't the city just fund more recovery houses? Part of the answer, of course, is money. While local officials may want to explore the possibilities of community recovery, these services are mostly paid for by federal programs like Medicaid and private insurance, both of which fund symptomatic treatment, but not ongoing recovery.

DAILY BREAD: On Fridays, New Jerusalem members pass out food to the needy. Service, says McKenna, is integral to recovery.

And even those programs have gotten stingier over the years. With a few exceptions, inpatient treatment stays have declined drastically, from months to weeks to days. "The treatment has gotten briefer and briefer," says Bill White, a researcher at Chestnut Health Systems who consults for DBH/MRS, "and the outcomes, meanwhile, get poorer."

At the same time, the pot of money allocated to the city for programs that aren't covered by insurance or Medicaid has shrunk, too. DBH/MRS lost $3 million in funding for the uninsured in the most recent fiscal year, even as the number of uninsured has grown. Instead of focusing strictly on funding, Evans says, he's trying to develop better, more symbiotic relationships with the city's private recovery houses.

As Evans points out, funding comes with strings attached. For better or worse, being off the grid has turned hundreds of Philly recovery houses into de facto experiments, each a unique test tube of drug recovery. Who knows what will come out of them?

New Jerusalem, its residents believe, is overseen by a power much greater than the DBH/MRS or L&I. God — or, in the Narcotics Anonymous parlance, a "higher power" — is everywhere here. Meetings begin and end with invocations and benedictions. God erupts spontaneously from the mouths of residents in the most mundane of conversations. God is not just the helper of those on the path of recovery, but also the destination. God, in other words, is the secret ingredient that makes their recovery work.

Surprisingly, perhaps, for a Catholic nun,McKenna rarely speaks of Jesus, or Catholicism, or Christianity. She can seem so unconcerned with religion as to be almost dismissive of it. It's not that she doesn't believe. It's more that she senses so strongly the presence of God at New Jerusalem that to quibble over something as mundane as religion seems frivolous. She hosts a nondenominational Bible study every morning, although Sufi poetry and the letters of Martin Luther King Jr. often supplement scripture.

"We should really read some Malcolm X soon," she muses. "We need to keep our Muslims happy, you know? Ha ha!" At New Jerusalem, where chaos is never far away, the Bible study is the most peaceful and introspective part of the day, and members listen raptly as Sister Margaret holds forth on what she calls the "spiritual dimension" of recovery.

"We all have that deep longing inside of us, and we think, at a certain point in our process, that we can satisfy that longing without addictions," she tells the group. "But then we find that that doesn't work. This longing is what makes us great. Without it, we wouldn't move. We wouldn't grow. Why do you want to deaden it? That's what I don't understand about you addicts — ha ha! Why do you want to deaden this longing? These pains are so deep and so productive that you wouldn't want to miss them."

While we might see addicts simply as sick people —and recovery, therefore, as being about making them well again — McKenna sees it differently. For her, drug addiction is a manifestation of a universal problem.

"We're all addicts," she says. "Money can be an addiction, power can be an addiction. It's human nature that we persist in habits that we know are unhealthy."

To McKenna, recovery is about more than just kicking a habit. It's about giving up a false way of life and finding one's "true" self. Recovering addicts, as she sees it, may actually be closer to that truth than the rest of us, who have the luxury of avoiding it.

"I love recovering addicts," McKenna says. "I love their honesty. I feel inspired and challenged by it, and by the courage it takes, because they're stepping into a way of life opposite to the one they've become accustomed to. They have the courage to do that."

As she weaves in and out of her morning theme, one of New Jerusalem's members rises from his seat to offer a spontaneous thought. "I was thinking about space," he says. "Like outer space, and how the more we know about space, the less we know. But if you've ever seen the pictures from the telescopes, you see that space is beautiful."

"It's a mystery, it's bigger than us," McKenna responds. "But that's where God's grace is, in the mystery of life." She pauses.

"The grace is in the space. Ha ha!"

(isaiah.thompson@citypaper.net)