“Aside from prenatal drug exposure, people aren’t born addicts. The problem doesn’t arise overnight, and the cure doesn’t come overnight,” he explains from his sunny office in Boca Raton. “But,” he qualifies, “when the addict can eventually come to identify his triggers and reactions, he can turn his life around.”

At its core, addiction is the “disease of escape.” Although research indicates that on a neurobiological level, there may be certain individuals who struggle with insufficient dopamine, the vast majority who fall into addictive patterns are struggling with an inability to modulate their emotions, Yachnes explains.

“They haven’t developed healthy coping skills to deal with their overpowering thoughts and feelings, and so they pick their drug of choice to escape rather than cope in a healthy way,” he says. “But this escape becomes the flawed solution, and once the pattern develops, dependency sets in and the cycle is extremely difficult to break.”

Moshe Yachnes comes from a family famous for community involvement. His great-grandfather was Reb Chaim Gelb, whose extraordinary midcentury efforts on behalf of the Williamsburg community led to his becoming the subject of an ArtScroll biography, A Life of Chessed. His grandfather was a rav in  New York for over 40 years, his father is a community rabbi in the Miami area and the author of several sefarim, and his mother founded the first resource room for elementary school students struggling with learning disabilities, in  one of the largest Jewish day school systems in Florida.

At 36, dressed in a blue shirt and navy blazer, Moshe has that wholesome boy-next-door look and an out-of-towner’s friendly, relaxed manner — which serves him well when dealing with the crises he confronts daily. Moshe was raised in Miami, one of the elder children in a large family, in a staunchly community-oriented home open to all sorts of people.

“As children, we were used to see people walking into my parents’ house crying, and coming out laughing,” he says. “Helping others is in our blood.”

Following yeshivah years in Eretz Yisrael and New York, Moshe began volunteering at Our Place, a drop-in center in Brooklyn catering to kids at risk, and then became a supervisor at the Yatzkan Center, a rehab facility for substance abusers (which has since closed) run by social worker Lew Abrams. The work led him into contact not only with Abrams but with Rabbi Dov Silver, the founder of Madraigos (an organization helping at-risk youth) and Rabbi Zvi Gluck, the founder of Amudim — who helped Moshe develop the clinical thinking that has shaped the program today.

After earning an MSW and becoming a licensed social worker, Yachnes began working as a rebbi and drug counselor at Priority One for struggling students, while simultaneously starting private practice in both Boro Park and the Five Towns. While that gave him a taste of the full spectrum of Jewish clients — from the chassidic to the unaffiliated — he realized early on that when it comes to addictions, the pattern of behavior and recovery tends to be the same. He also served as clinical director at Madraigos, a Five Towns organization serving young people at risk, before moving to Boca Raton three years ago to take the job as corporate director of clinical programming at Sunspire Health Recovery Road, a national company with ten facilities designed to help addicts from the detoxification stage through outpatient reentry into life.

Back to Life

At Moshe’s latest endeavor, Onward Living, residents are offered therapy, group sessions, vocational training, and life skills workshops, which cover everything from preventing relapse to money management, anger management, and how to get along with employers and roommates. Twelve-step meetings are an integral part of the program, which include admitting powerlessness over the addiction (it’s virtually impossible for a person to get clean on his own), surrendering to a Higher Power (Hashem) for help overcoming the addiction, working on identifying the pain of loss, dashed hopes, and perceived unmet needs that translate into resentments and acting out, and strengthening spirituality and a personal relationship with G-d.

Yachnes admits, however, that there are no guarantees. “While I was still with Sunspire — which is a very well-run inpatient rehab facility — several months after one of our residents graduated the program, he suffered a severe relapse and died of an opioid overdose,” Yachnes remembers. “This news is always devastating, and as his primary therapist, I still think of him, his struggle, and his wonderful family who have to cope with the loss daily. The take-home lesson for me is one of motivation. This tragedy actually continues to empower me to continue doing what I do — because the devastating consequences for those struggling with addiction are ingrained in my memory. It helps me stay focused on the critical nature of the work.”

Recovery doesn’t happen overnight, though — there are stages in the process. First, the addict has to detox, to go through the withdrawal process to rid his body of the drugs. Once he’s clean, he has to rebuild himself from the ground up. The issues that led to the addiction have to be addressed in a therapeutic setting — dealing with the issues of shame, pain, and loss of autonomy that led him to drugs in the first place.

“He has to learn to identify triggers that might lead him to relapse, and to create boundaries to prevent those triggers, and deal with them when they do present,” Moshe explains. Finally, he has to learn to live in the real world in a healthy way. “You need to create a platform in which the person can develop his independence and test the waters of ‘regular life.’ Addictions treatment is about consistency, not intensity.”

Moshe has partnered with local businesses so that his clients take jobs in the outside world and build some self-esteem by gaining skills and becoming somewhat self-sustaining. One hot kosher meal is offered per day, but clients are encouraged to become self-sufficient for the other meals, developing the executive skills necessary to plan ahead, shop, cook, and clean up.

The program is designed to last from three to six months, but since it has an outpatient component, the costs are a third of the price of traditional inpatient programs. That means the clients benefit from living in a community, where they find companionship and make friends. Since repairing family relationships is crucial to the recovery process, they participate in weekly phone sessions with family.

“You can’t go home to a sick system,” Moshe points out. “The goal is for people to reengage with their families, but to first work out the systemic issues.”

Yachnes calls those who go through rehab “the most courageous population in the world,” because these people have taken enormous steps to right themselves and reexamine and challenge every aspect of their life.

“I remember recommending a certain treatment protocol, but the individual continued to argue the point and refuse support,” Yachnes says of one courageous young man. “But when we probed deeper, we discovered that the very reason for the pushback stemmed from a deep-rooted fear of success. This young man had never been successful in the past, so the thought of actually succeeding was extremely uncomfortable and threatening for him. Once we uncovered this dynamic, we were able to work through all the rejection, and he then turned a corner in his recovery. Although it just seems on the outside that he became ‘normal,’ it takes real guts and fortitude to make the switch in such deeply rooted patterns.”

Toxic Shame and Pain

There’s no denying that drug use has now infiltrated frum circles of all stripes. “When I started out, it was about promoting awareness of the problem,” Moshe Yachnes says. “I believe the next decade will be primarily about how to treat addictions.”

The legalization of marijuana in many states reflects a new societal nonchalance in how we view “recreational drugs,” and for too long, doctors have been quick to prescribe opioids for pain.

“I would guess 70 percent of Jewish families have some sort of opioid pain medication lying around the house,” Moshe says. “Many receive them after surgery or dental work.”

Opioids became cheaper on the street, too, as dealers found sources in other countries such as China.

According to Menachem Poznanski, director of the Living Room, a community recovery program, it used to be rare for young people to experiment with heroin. They were more likely to try marijuana or party drugs. Today, the situation has reached new lows.

“Kids even as young as 14 are no longer embarrassed to try it, to talk about it,” he says. “I’ve been to more funerals in the past two years than in 16 years of working in this field. Drug deaths used to be more predictable, addicts who were visibly struggling and wasting away. Today a young, vibrant kid can show up and sit in a meeting, and be dead two weeks later — the street drugs are much more dangerous.”

But what’s so baffling about addiction is that it’s resistant to treatment, and the effects are even worse when addiction begins young. Retired Navy Admiral James Winnefeld, who served as the vice chairman of the Joint Chiefs of Staff from 2011 to 2015, lost his 19-year-old son Jonathan to a fentanyl-laced dose of heroin last year. In response, he founded SAFEProject.us, an initiative to prevent and fight drug abuse.

“Drug overdose, like the one that took Jonathan from us, is now the leading cause of death for Americans younger than 50 years old,” he wrote in last November’s Atlantic. “Because the brain is so adaptable while it’s still developing, it’s highly susceptible to dependencies, even from non-opioids such as today’s new potent marijuana strains… Early marijuana use not only inhibits brain development; it prepares the brain to be receptive to opioids.”

That means that once the brain is accustomed to drugs, the temptation to return to them is ever-compelling and ever-present. Even flashing images of drug paraphernalia create a flood of dopamine in the brain.

“Every relapse reestablishes the neural pathways that make an addict feel he can’t live without the drug,” Poznanski says.

What would propel a person toward such self-destructive behavior? “Drug abuse is a symptom, not a cause,” says Rabbi Zechariah Wallerstein, founder of Ohr Naava in Brooklyn. He cites three reasons kids are drawn to drug use: lack of acceptance (“The worst pain is not to feel accepted”), anesthesia for pain or abuse, and escape from feelings of anomie or unhappiness. He notes that girls are particularly susceptible to emotional pain.

“They’re more fragile, and they tend to blame themselves when something awful happens,” says Rabbi Wallerstein. “Boys will blame someone else. Women — and especially Jewish women — will feel terrible guilt.”

Moshe Yachnes says loneliness and shame are the two major triggers. “Addiction is a reaction to overwhelming feelings and thoughts,” he says. “It’s a surface behavior that has underlying causes, like an escape from anxiety, fear, or pain.” Young people today, despite their myriad connections through technology and social media, ironically often end up lonely, bereft of any true friends.

Moshe believes most people who abuse pain-deadening substances suffer from a damaged self-image. “Our sense of who we are is a reflection of what others tell us,” he explains. “You see yourself as smart, or funny, or nice-looking because other people tell you so. But many people feel broken. They have toxic levels of shame about themselves, and that leads them to self-sabotage or escape.”

Amudim’s Zvi Gluck explains how that toxic shame often comes as a result of having been the victim of abuse. “There’s a very big overlap between abuse and addiction,” he says. “If you go to Our Place, with all the off-the-derech kids, you’ll find maybe 95 percent of them were abused.”

Menachem Poznanski concurs, saying abuse often leaves the victim with post-traumatic stress disorder that never gets addressed, and leads to risky, self-injurious behavior.

A tool called the Adverse Childhood Experience questionnaire is a good predictor of later drug use, according to Dr. Akiva Perlman. Scoring four or more out of ten raises one’s chance of falling into addiction tenfold. “For frum kids, that would mean family trauma, abuse, or academic struggles like a learning disability.”

Rabbi Dov Silver, the founder and executive vice president of Madraigos and Yachnes’s former boss, echoes that the reasons for addiction are manifold. “You can’t pin it down,” he says. “The core of the issue is emotional pain.”

While addiction follows similar patterns for everyone, Moshe says that the family context is somewhat different for frum patients. “Our families are larger and closer, often more enmeshed,” he says. “There’s a stronger sense of right and wrong, and more shame. A boy who can’t read Gemara will struggle. The families worry about shidduchim for their children when one child has an issue.”

Bumps in the Road

Once an addiction has developed, regardless of origin, the addict is in the clutches of a life-threatening disease. “Addicts aren’t bad people. They are ill people,” Zvi Gluck says. “People blame them in ways they would never blame someone with a different sort of medical condition.”

Gluck notes that working with an addict’s family can be as crucial as working with the addict himself. “If a child is addicted, you work with the parents,” he says. “If a married person is addicted, you work with the spouse, giving him or her tools to handle the interactive situation and their own pain. Al-Anon and Gal-Anon, which are for family members, are crucial, because the addict’s lifestyle change has to be a team effort.”

He points out that fraught family relationships tend to come to a head during Yamim Tovim and family simchahs, so recovering addicts and their families must be particularly vigilant against triggers and relapses during those times.

Recovering addicts need a comprehensive sober living plan, one that creates a new lifestyle in which they come to identify the negative interactions and situations that can drive them right back to using, even against their rational will. And as with sobriety from alcohol or gambling, drug sobriety is a lifelong battle.

“There will be many bumps on the road after an addict is clean,” Menachem Poznanski warns. “It hits first when the addict gets home. Then there will typically be struggles after three months, then a year, then two or three years down the line. As teenagers move into adulthood, they hit bumps when they face adult challenges like marriage and earning a living, or when mental illnesses that present in adulthood start to emerge.”

Relapses are extremely dangerous on several levels. A person who has come clean no longer needs as high a dosage to get high. But when he relapses, he tends to administer himself the doses he was used to when his tolerance was higher, and he may end up overdosing. He will feel doubly distressed because he’s not only failing to handle his challenges, but succumbing to his triggers. Even more frightening, the drugs on the street today are much more likely to be toxic.

Many desperate, well-meaning parents bring their drug-addicted children to facilities that offer treatment programs lasting one to two months, at prices that range from $20,000 to $50,000 per month.

“The two-month limit is what insurance companies will pay for, if they’ll pay,” Moshe says. “Some people don’t have insurance, so they have to raise the money privately. It pains me to say this, but oftentimes that money is wasted. True, people get clean, but they don’t get the time or opportunity to build themselves up to avoid relapses.”

Because addiction is resistant to short-term treatment, years of work in the field have led Moshe to advocate for a more long-term, person-building approach to getting people not simply dried out, but prepped to reenter society as fully functioning members able to deal with their issues in a non-destructive way.

“From my dealings with addicts, the people who do the best are those who get good jobs and start feeling good about themselves,” says Rabbi Wallerstein. “The old addiction is still in their psyches, a road to fall back on. You have to find them bigger, better roads — something huge and meaningful enough so that they won’t want to lose it to go back.”

No More Pretending

Is it possible, in this day and age, to keep drugs and addiction far from our lives and communities? The first step, says Zvi Gluck, is to acknowledge the facts and not pretend they don’t exist: alcohol and drugs are in every high school, even middle schools.

“We should be doing random drug testing, and if someone tests positive, he shouldn’t be expelled, but suspended on the condition he gets help,” Gluck says.

He also believes schools must actively educate students about drugs in age-appropriate ways, which is already happening in some schools.

Children spend most of their days in school, so educators should be on the lookout for warning signs: swift changes in behavior patterns, signs of disconnection from peers and school.

“We have a saying that addicts are like everyone else, but more so,” says Menachem Poznanski. “If a teen sleeps a lot, seems agitated or emotionally withdrawn, engages in stealing or other shady behavior, or is unable to function, those are red flags. Another would be if the teen seems obsessed, angry, or panicked if he or she isn’t allowed to go out of the house.”

Parents should be vigilant for any unusual smells on their children’s clothing, and make sure no painkillers have disappeared from the medicine cabinet. (Better yet, hide them.)

Moshe Yachnes advises reinforcing the family unit. “Try to keep your children connected to the family,” he says. “They should know that parents can also be vulnerable. Let them see your human side, to understand that pain is sometimes part of the human condition. That way they’ll feel more comfortable sharing their struggles with you.

“An early sign to watch out for in our children is how they cope with extreme emotions,” Yachnes continues. “Do they have the natural skill to embrace fear, loneliness, anger, anxiety? The best recommendation I would give is for us as parents to model for our children. Given the appropriate situation, we can share our own emotions and vulnerabilities, facilitating a platform for our children to develop in a healthy and well-adjusted way.

“You see, we as parents have the unique opportunity to empower our children, by being able to separate who they are from what they’ve done. Addiction stems from loneliness, profound isolation, and a feeling that no one will accept and love them for who they are. Children need reassurance that we acknowledge them, and need to feel they and their emotions are acceptable to their families and peers.”

Yachnes says he keeps a personal log of individuals he’s worked with over the years who have long-term sobriety today. “This helps keep me focused that there is hope, and that people can recover provided they make the necessary changes. “

When recovery succeeds, everyone rejoices. “Yitz” is one of Moshe’s happy stories. He came to Onward Living with an addiction to marijuana, cocaine, and Xanax. Then in his early twenties, he had come from a rather rigid chareidi family. He struggled in yeshivah, and never managed to cultivate any close friendships. Drugs connected him to other people, even though those friendships were superficial.

When he came to Onward Living, he began learning about healthy relationships. He’d let his Yiddishkeit slip, but as he got healthier, he was able to begin incorporating more of it. He had never taken care of his own needs, but now developed pride over keeping a clean room, doing his own laundry, and preparing his own meals.

“He was scared of filling out a job application, because he’d never held a job,” Moshe says. “But he started working, and left the program with $6,000 in his pocket, enough to start over somewhere else.”

Rehab Choices

A small facility like Onward Living can’t possibly meet all the needs of the frum community, and parents often have no choice but to send their children to non-Jewish rehab centers. But Zvi Gluck of Amudim advises caution on choosing a facility just because it advertises and accepts insurance. There are many types of facilities, he explains, and most of them — like nursing homes — are businesses hoping to turn a nice profit.

“Many people enroll their family members in facilities that are frum but are not licensed, and there are more than a few of those,” he warns. “For some teens, you’d do better not to insist they go to a frum place. Part of drug use is rebelliousness, and if you insist they can only go to a frum place, you give them all the more reason to resist.” Because it is a question of pikuach nefesh, one should consult with a halachic authority before deciding on a facility.

Dr. Akiva Perlman of LIU concurs. “Addiction destroys your soul,” he says. “You can’t serve Hashem without a soul.” Only after the addiction is resolved does religion become relevant.

Not all secular centers are the same, though. In fact, Rabbi Wallerstein recommends staying away from rehab centers on the East Coast. “They’re completely liberal,” he says. “They view religion as a cult, they rip the Yiddishkeit out of a person. You send in a sick Jewish kid, and get out a semi-healthy goy.”

In Rabbi Wallerstein’s experience, centers in Middle America and the Southwest are more likely to have values in line with religious Jews, emphasizing the importance of G-d, family, and community. Some of these centers are run by Mormons, who are careful not to proselytize openly. That said, Jewish kids who have felt rejected and have lost trust in their own community may find the Mormon outpouring of love so compelling they decide to join their ranks.

“These kids were always told that non-Jews were terrible, and then they meet very loving people who seem much nicer than the people they left behind,” Rabbi Wallerstein says. “You’re better off simply removing frumkeit from the equation. Most facilities — and there are hundreds of them — can arrange for kosher food and a local rabbi.”

Spirituality — not religion — is an integral part of the recovery process, according to Gluck, and if a child does start to have a spiritual awakening, it’s easy to find support for him. “Many facilities are culturally sensitive and accommodate frum Jews.”

Addiction Resources for Religious Families

United States

Amudim: Manhattan, New York. Case management for families dealing with addiction, abuse and other crises

Onward Living: Boca Raton, Florida. Residential treatment combined with outpatient living

The Living Room: Brooklyn and Wesley Hills, New York. Community oriented program for people in recovery from addictions

The Ranch at Bethel: Bethel, New York. Residential psychological treatment for Orthodox girls, not an addictions facility per se

Chabad Residential Treatment Center: Los Angeles, California. (not exclusively frum, but offers kosher food and minyanim)

Eretz Yisrael

Retorno Jewish International Rehabilitation Center

Jerusalem Sober House

(Originally Featured in Mishpacha, Issue 697)