I hadn’t yet met Manny in person but his reputation preceded him. A well-known person in many circles Manny developed a reputation as a mover-and-shaker and wasn’t afraid to tackle important social initiatives even if it rubbed some of the community’s pillars the wrong way. He was outspoken bombastic and what he lacked in formal training he made up for with enthusiasm and drive.

Manny was a guy who had seen way too many frum kids from his community lost to the nightmare of addiction. Taking on a personal commitment to stem the tide of this scourge after a former chavrusa committed suicide Manny had become a community advocate and did his best to make sure it wouldn’t happen again. After finishing yeshivah and completing his semichah exams he’d spent the last decade developing a grassroots organization to publicize the issue of addiction in the frum community. He’d brought together speakers led substance-abuse interventions and created training programs for rabbanim and mechanchim that would teach them to recognize the signs and symptoms of addiction in their talmidim. Manny was a true powerhouse.

As a reward for his tireless efforts Manny had been threatened a number of times by both secular and religious institutions for speaking up publicly about historically taboo issues and upsetting some prominent stakeholders in the process. But Manny always stayed out of trouble because while he wasn’t afraid to break a few eggs he was honest as could be and never said anything that didn’t need to be said or that wasn’t true.

So when I received an e-mail asking for “help with a challenging case ” I was more than happy to call Manny back as soon as I got a break. After all in my line of work he was somewhat of a legend.

“I like your style Reb Manny ” I told him after our introduction. “You get people talking about things that can’t just get swept under the rug.”

“If we don’t talk about it then we’ll keep on losing good kids to overdose. What other choice do we have Yaakov?”

“You know Rabbi Dr. Avraham J. Twerski whom I consider my personal hero was often accused of being the first guy to talk about uncomfortable issues like drug use and domestic violence. You might not have his titles but you certainly have his fire and spirit.”

“Enough accolades Reb Yaakov can you help me or not?”

“Depends what you got ” I answered honestly.

“Okay I have a 23-year-old guy with a history of abuse as a kid. As a result he’s been through every drink and drug in the book — you name it he’s tried it.”

“Detoxes? Rehab?”

“Plenty of them.”

“Medical problems from his adventures?”

“Hepatitis C but it’s under control baruch Hashem.” Manny continued. “Terrible history of failing many frum rehab programs and being prescribed a bunch of drugs that never did much for him.”

“Has he been to jail?” I asked.

“Twice just got out after a three-month sentence and now he needs a new therapist — which is why I’m calling you.”

“He needs a good therapist ” I interjected “and also a psychiatrist who won’t mess around his brain and throw him stimulants or sedatives just because he asks for them.”

“You got it ” said Manny. “By the way he’s also the grandson of a very prominent posek who called me asking for this special favor.”

“Which means ” I cautioned “that he gets the exact same care as everyone else and nothing special beyond it — no kid gloves.”

“Right again Reb Yaakov. So what do you think can we help him?”

I sighed for a moment and thought about how to respond. Manny was tough and had seen and heard enough. He had no illusions and so I told him the most emesdig thing I could. “Only if he wants to help himself.”

“So from your experience what do you think the chances of that are?”

“I’ll tell you the truth ” I said. “Once about a decade ago I worked in a detox center in the old Irish neighborhood of Boston. One of my patients was a guy in his fifties who was famous on the floors for coming in pretty regularly. I myself had already cared for him four times and I was brand-new at the job! When he showed up the next time he was accompanied by a friend who looked a bit too clean-cut and put-together to be just another drinking buddy. As it turned out the friend’s name was Jimmy and he was the patient’s sponsor through Alcoholics Anonymous.

“Now while I was feeling pretty pessimistic about the patient’s prognosis Jimmy was all smiles. ‘This is the time ” Jimmy declared. ‘It’s all about sobriety and success this time ’ he kept saying during my examination of the patient. After making sure that the patient was stable I sat down in the quiet of the doctors’ room to write the admission orders when Jimmy found me.

“ ‘You gotta be positive Doc. This is the time!’ he repeated to me.

“I smiled as nicely as I could and made it clear that I needed to return to my notes. Jimmy wouldn’t let it go however and asked me to guess how many times it had taken him to get sober. Twenty? Thirty? Fifty? A hundred? I guessed incorrectly until Jimmy finally told me — 108.

“ ‘What happened on time 108?’ I asked him.

“ ‘I just woke up one day and realized I was sick of the whole thing ’ he said . ‘I’d hit my rock bottom and didn’t want to be here anymore. Wasn’t sure how to get out but knew if I screamed loud enough Someone would hear and show me the way.’

“After that case I learned to stop being pessimistic about even my toughest patients because one never knows when he’ll finally scream out and how Hashem will pull him out of the pit. Even if it takes 109 tries.”

“Well this kid has been in and out only 20 times so let’s hope that lucky 21 is his time ” said Manny.

I couldn’t help but make a bit of a mathematical play on the famous pasuk from Mishlei so I told Manny “If a tzaddik falls seven times and gets up then getting up the 21st time will make him a triple tzaddik.”

“Forget making him a tzaddik Reb Yaakov. Let’s just work on getting him sober!”

“Deal ” I agreed. Luckily Manny was a big enough tzaddik that having him in the young man’s corner was a siman tov that we’d have a shot.

Originally featured in Mishpacha Issue 674. Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham a national leader providing mental health treatment and outreach within the religious community. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.