Editor’s Note: This is the second installment in “The Way Back Machine,” a series of interviews with key theorists and practitioners of alcohol and drugs research, treatment, and recovery among women and communities of color during the 1970s, ‘80s, and ‘90s. Through these interviews, Points co-founder and Managing Editor Emerita Trysh Travis works out some of the theoretical issues she articulated almost ten years ago in “Feminist Anti-Addiction Discourse: Towards A Research Agenda.”
The coronavirus pandemic has brought to light not only America’s glaring health inequalities, but also the community health centers (CHCs) that serve many of the nation’s most marginalized populations. One of the most enduring features of President Lyndon Johnson’s War on Poverty, these comprehensive facilities began with sprawling missions—not just biomedical and psychiatric health care, but also early childhood education, adult job training, and (you guessed it) alcohol and drug education and treatment. The recent spotlight on the CHCs’ strengths and vulnerabilities prompted Points’ Managing Editor Emerita Trysh Travis to dig a little deeper into this last aspect of their mission as part of her ongoing efforts to understand the grassroots theories of substance abuse and recovery that were elaborated in the 1970s, often in urban environments far from the bucolic precincts of “the Minnesota Model.”
Jackie Jenkins-Scott is the former President of Wheelock College, a founding partner of JJS Advising, and the author of the Seven Secrets of Responsive Leadership (Career Press, 2020). Before she became a “thought leader” in organizational change, however, she was a pioneering presence in community-based substance abuse treatment, working at the Dimock Community Health Center in Boston’s Roxbury neighborhood (among other places). Is there anybody better qualified to talk about the evolution of service delivery and recovery during the last decades of the twentieth century? We didn’t think so either.
Trysh Travis: Let’s take it back—way back: how did you get into substance abuse work?
Jackie Jenkins-Scott: I came to Boston from Michigan in 1971 to get an MSW at Boston University. In my first year in the program, my internship placement was in the South End at the Methadone Clinic in Boston City Hospital. In my second year, I was one of six or seven rabble rousers appointed to the Roxbury Court Clinic. The clinic dealt with mental health issues but included problems with alcohol and drugs as well—we saw the whole thing. After I graduated in 1973, I was hired by Dr. Edward Blacker in the State Division of Alcoholism.
It was important to me to work in Roxbury and serve the Black community. But the Regional Director position that was open didn’t include Roxbury. Instead, I was assigned to be the Regional Director for the North Shore, an area that ran from Cambridge up through Lynn to Newburyport. I oversaw the detox facility in Cambridge and another one in Lowell. I was angry at the time—I wanted to be with Black people. But I think it worked out well. I witnessed up close the movement of recovering people—driving from behind the scenes—to get legislation in place.
TT: And what exactly did the Regional Director’s job entail?
JJS: The alcohol focus at that time was detox facilities. The state was decriminalizing public inebriation—they weren’t going to be able to just send that drunk guy to Long Island anymore. There was a real push toward treatment in the community, and that began with detox. The state required that every community have a detox unit. You could stay there up to twenty-one days then transition to a halfway house—as they called them then.
There was no plan to create a detox in Roxbury, but there was a real need. I was able to work with some recovering men there to form a non-profit organization and agitate to get a detox located in the neighborhood. We had help from [State Representative] Doris Bunté and Joe Freeman, the Regional Director whose assignment included Boston. That work went well, and in 1978 I took a job as Director of the Roxbury Court Clinic.
TT: This was before what we now call “drug courts” became commonplace—what was the Court Clinic?
JJS: Massachusetts began a statewide Court Clinic program in 1956. In the Clinic, social workers and psychologists would triage and process cases for mental health issues, advise the court, and connect defendants with appropriate social services. Inevitably, they also dealt with alcohol and substance abuse. By the 1970s, there was federal funding for alcohol and drug counseling, because attitudes towards those problems were changing. They were beginning to be seen as legitimate public health issues rather than personal flaws or character deficiencies. That created possibilities for useful interventions—diversion programs for people who got a DUI, for example, or making counseling a condition of probation.
Dimock Community Health Center. Image courtesy of James Woodward via Wikimedia.
TT: And after the Court Clinic, you moved to the Dimock Community Health Center. Can you tell us a bit about its history?
JJS:The old New England Hospital for Women and Children was founded in 1862. It closed in 1969 and then, with a combination of state and federal funds and a grant from the Ford Foundation, it reopened as a comprehensive health center. (It was named after Susan Dimock, one of the old hospital’s earliest trainees who died tragically while still very young.) Dimock Community Health offered medical care, job training, and early childhood education. When I arrived in 1983, a combination of budget cuts and some financial mismanagement had landed it in state court bankruptcy.
I was able to stabilize the finances and ultimately grow the program. When I left in 2004, Dimock had a budget of $26M with a staff of over 400. During that time, we started many programs for women, families, and children. On the substance abuse side, we moved the detox to Dimock, established a large outpatient program, a residential program for women in prison (Framingham State), a residential program for men, two residential programs for women (off campus), and a transitional housing program for families (on campus—including primary care services), job training, and many community drug education programs. We were a leader in HIV/AIDS programming and much more.
TT: The alcohol and drug treatment worlds—and funding streams—were separate at the start of your career but merged while you were at Dimock. What did that mean for how you all thought about service delivery?
JJS: There were different attitudes towards alcohol and substance abuse: alcoholics were an older population; drug problems were emerging. I appreciated the AA [Alcoholics Anonymous] community’s ability to humanize the issue and to push for change. George H. [a regular AA attendee] and the Roxbury AA group made huge contributions to the community and to our programming.
The detox facility at Dimock was for alcohol or drug users—it didn’t matter. But there were two separate streams for funding, and there was some competition. Working in the two different tracks became difficult, especially once HIV became an issue and there was so much competition for funding. At the same time, HIV created more activism in the black community—similar to the [white] AA activism of earlier years. That created more support for drug issues as health issues [and] for a detox as a medical facility.
TT: What other alcohol and drug services were available in Roxbury at the time?
JJS: East Boston Health Center and the Whittier Street Health Clinic offered methadone maintenance. As far as more comprehensive treatment, Nate Askia started FIRST, Inc. (“For Individuals Recovering Sound Thinking”) in 1967 with a group of drug addicts at Deer Island Correctional Facility. They offered methadone detox—not maintenance—and had several residential facilities for men as well as drop-in groups [and] youth programs. Kattie Portis, also a former heroin addict, started Women, Inc,. on Warren Street over by the old Roxbury Tech High School. That was one of the first residential programs in the country to serve women and their children. They opened in 1975. Both of those programs stayed open into the late 1990s, but it was hard for the small community-based programs to keep up—with the changes in substance abuse itself and with the changes in federal funding.
TT: Mainstream treatment at the time was heavily influenced by 12-Step recovery, which has been criticized as a white, middle-class, masculinist theory of substance use and sobriety. Were community-based organizations like yours developing “recovery of color” approach?
JJS: A wise man once said that “Black people take things they find in the world and make them into what they need.” What was special about this time period was the flexibility we had to improvise on 12-Step recovery and to adapt guidelines from the state to make a program that really reflected and served the community. You have to code to reach the community, and we did that. We took baseline requirements for operating a detox and added the culture that would make the detox meaningful to the people it was meant to serve.
TT: It seems like a key part of those federal grants was money to hire community members into staff positions. In addition to offering treatment, organizations were jobs programs.
JJS: Yes, through the 1970s, federal funding included staff positions and training grants. Positions like “outreach worker,” “community worker,” “community liaison”—these “parapforessional” roles brought people into the work force, but unfortunately they came and went. As a result, this work has not been given visibility and credibility, but it was incredibly important: it kept our services real. The people in those positions put pressure on the organization to be responsible to the clients and the community—that was especially true during the AIDS crisis.
At the same time, those jobs put people on professional tracks. They offered an opportunity for meaningful work as well as credibility, salary, and benefits. For people in recovery, that work allowed them to distance themselves from their old lifestyle—gave them a different orientation. That could be stressful, but it gave long-term stability and leadership. That allowed them to become part of political process.
TTL If you could wave your magic wand and bring back one aspect of the community-based treatment from this period, what would it be?
JJS: We were at our best when we really honored the history and culture of the neighborhood environment where people came from. We did that by bringing in recovering people from the community and respected and promoted them as equals—let them guide us and help us develop our programs. That diversity in the staff helped us understand what really worked for the people around us. When we started treating them like second-class citizens, we lost that knowledge.