Not surprisingly, a new treatment philosophy has emerged in recent years, called "harm reduction." One advocate tells Shavelson that harm reduction defines what it wants from addicts as "any positive change." Its first commandment is "Meet the clients where they're at." Instead of jettisoning addicts from the program if they don't stay clean, harm reduction offers them different kinds of services, congratulates them for using fewer drugs and does whatever it can to help them "have less violent lives, steal from fewer people, become somewhat less crazy, and even, possibly, a bit happier." The zero-tolerance side considers harm reduction to be an unconscionable betrayal of the addict, who is engaged in a life-or-death struggle in which halfway measures don't work. (One of the drug users Shavelson interviewed, Darrell, agrees.) McCaffrey condemned harm reduction as a plot devised by drug legalization advocates.

Whichever approach works best, the existence of these competing approaches has resulted in a "drug treatment world ... divided into two armed, deeply entrenched encampments that to this day continue to fire bullets of contempt at each other's rehab philosophies." Shavelson clearly favors harm reduction, particularly in the case of someone like Darlene. Remarkably eloquent despite the utter confusion of her life, at one point she drags Shavelson into a store and shows him the cover of a comic book:

It's a busy, medieval scene. Dark, ominous castles are surrounded by wooden carts filled with dozens of blood-soaked, nearly naked women's bodies. Men in armor, holding swords, gawk at their exposed, bloodied flesh. I look at Darlene, puzzled. "Shrinks always want to know about the noises in my head," she says ... "That's a picture of my noises. It's the place I don't want to go no more."

She later explains that she's afraid to stop shooting speed because the "noises" might not go away and she'd be proven to be crazy. Darlene may indeed need structure in her life, but first she needs intensive professional psychotherapy.

Yet Darlene does, eventually, make it to Walden (albeit in a special program -- one that wisely combines full psychiatric care with drug rehab). So does Crystal, a rehab candidate who, while free of psychosis, is almost as unpromising as Darlene because she enters the system without the slightest desire to get off drugs. Shavelson, ever the pragmatist, doesn't think much of the bullying ways of attack therapy, which addicts voluntarily endure. But he finds himself, to his astonishment, endorsing a practice that superficially seems even more disrespectful: coerced treatment. The reason is simple: He has seen it work. Glenda, the most "pitiful, disheveled, near-death, long-term street alcoholic" he had ever known, was kidnapped and forced into rehab by concerned homeless service workers and came out "three months later -- cleaned up, sober, and healthy."

Maya Angelou reads from "The Heart of a Woman"