Arms crossed and locked tightly together, teens walked barefoot each morning into Pathway Family Center in Indianapolis. If it was cold, Nicky Lanpher said, they wrapped grocery bags around their feet.
At 14, Nicky was using drugs as a way to control the mood swings that come with bipolar disorder, said Rose Gagen, her mother. About five years ago, she called police as a way to get Nicky into court-ordered treatment. The family chose the Pathway Family Center in Indianapolis because representatives at an assessment told her it had professionals on staff who could treat both Nicky's mental illness and her drug problems.
During her nine months at Pathway, Nicky said she spent nine to 11 hours a day, forced to sit in a rigid position on a straight chair with a cushion, legs pressed tightly together, feet straight out, hands on knees, elbows straight.
Should she cross her ankles, let her gaze fall away from the speaker, Nicky's peers could pick her "consequence," she and her mother both said. Once she was punished for just uttering pop star Brittney Spears' name.
"Sack lunch was a favorite punishment they would dish out for the slightest little violations of all their rules. Sack lunch was the hardest one for me to do," said Rose Gagen, who was the rule enforcer when she kept other teens in her house as a Pathway host parent.
For a sentence of "sack lunch," Nicky would get a peanut butter sandwich while smelling the casserole the others staying in her host home would be having for supper. Then she'd do homework and write in a journal called a "moral inventory." After that, forbidden to talk to other girls staying in the home, Nicky played board games by herself until bedtime.
Truths and consequences
To Mike Pendergast, a Valparaiso father who put his 17-year-old daughter in Pathway after two other local programs failed, its intense regimen of behavioral conditioning provides a "solid foundation" by teaching teens to link bad consequences with the bad behavior that creates them.
For others, like the Gagens, "it was just too extreme," they said.
Diane Norton filed a treatment abuse claim in Butler County after she in 2003 pulled her 17-year-old son Ed out of Kids Helping Kids, a Pathway Family Center in Cincinnati. In a sworn statement, Ed said KHK staff members hit him when he didn't "motivate" enthusiastically enough and restrained him. Diane and Ed Norton say he suffers post-traumatic stress from his time in the program.
Rose Gagen and other Pathway critics say its rules institutionalize secrecy in a way that can put teens in a dangerous and inescapable position. In first phases of conditioning, program participants can't talk to parents, teachers, an attorney -- even to each other. Another rule forbids talking about someone who isn't present.
Kristine Flannery, who was in the Straight program recognized by many critics as a Pathway Family Center predecessor, now is a vocal Pathway opponent. She is with a group called the International Survivors' Action Committee that staged two protests at the Cincinnati facility last year.
"Any time a kid is kept out of school and prevented access to his parent, attorney or a guardian ad litem, that is creating an environment that invites abuse," Flannery said.
If an adolescent leaves the program before graduating, policy forbids parents from letting them live at home. They wind up on the streets or moving in with drug-using friends, Flannery said.
The philosophy guiding Pathway is to deprive clients basic privileges and then allow them opportunities to earn them back through a series of five stages. Even the most basic rights -- like privacy in the bathroom and interacting with family and peers -- are withheld, parents and teens who have been in the program say. Program administrators say some of the most restrictive practices like arm-locking now have been dropped, program coordinator Terri Nissley said.
Except for two hours in an onsite classroom, Nicky Lanpher said, her day was a succession of group therapy sessions. Each starts with "motivating," raising the hand stiffly up beside the ear and waving wildly to be called on to answer questions.
"Why don't you get your head out of your - - - and work on your issues instead?" is an example Nicky remembers.
"They would get right up in you face," she said. "They would yell so loud and get so close I could feel the spit hit my face."
Newcomers at Pathway stay in host homes, the houses of parents of other kids in the program. Critics like those at ISAC for years have attacked this aspect of Pathway, which also was an integral part of Straight, claiming foul play because host homes are not licensed foster homes.
Newcomers, or teens in the first phase of therapy, can't talk to each other. In recent years, they had to walk in the lock-arm position with a peer who was further along in the program or a staffer. Participants in the first phase can't use the phone, watch TV or listen to music. Rooms aren't locked, but there are alarms on outside doors.
It's a recipe for power abuses, says Maia Szalavitz, a former New York Times and Newsweek contributor who wrote a book "Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids." Pathway is an example of the type of treatment programs Szalavitz doesn't trust, she said.
"When you put disturbed kids in positions of power over other disturbed kids, it's 'Lord of the Flies' writ large," she said in a telephone interview.
Rules require first-phase patients to leave bathroom and shower doors open, host parents say.
In his written statement, Ed Norton said a peer held him by the belt loop everywhere he went and watched him in the bathroom.
It can take months to move out of the first phase because the slightest infractions can impede progress. In the nine months before her parents pulled her out of the program, Nicky Lanpher hadn't moved out of first phase. By then, the Gagens had "lost stomach" for locking up kids' shoes and forbidding them to talk to each other, they said. They were disillusioned because they felt the agency was using "excessive" tactics to treat Nicky's drug issues while neglecting her bipolar condition.
Can't go home again
The National Institute of Health in 2004 released a state of the sciences statement that "get-tough" treatments "do not work and there is some evidence that they may make the problem worse."
Nicky Gagen, like many of the hundreds of Straight, Kids Helping Kids and Pathway alumni Szalavitz has interviewed during the past five years, said she went on a drug binge when she left.
Kids suffering post-traumatic stress are more susceptible to drug abuse, research shows. Youth suffering psychological trauma in their environment are 100 times more likely to use drugs than others, said Randolph Muck, the lead public health adviser in adolescent treatment programs with the Substance Abuse and Mental Health Services Administration.
Even those who graduate and remain drug-free often have broken relationships with family members because they are bitter their parents subjected them to involuntary treatment. Parents are discouraged from allowing kids who drop out to move back in to their homes.
Muck wouldn't comment on the Pathway program specifically. But he did say kids suffering drug and mental health problems need family support.
"Whatever the treatment approach is used, the goal should be to reintegrate teens back into their normal environment and homes," Muck said.
Chesterton parents Gus and Julie Brown, whose two youngsters graduated from Pathway several years ago, agree with Pathway administrators who say the components of isolation and regimentation are necessary to break negative family patterns and to block kids in treatment from associating with friends who still may be using drugs.
Pendergast and his wife finished six more months in treatment at Pathway even when their child turned 18 and left the program after completing four of the five phases in six months. They "can't say enough good things about the program," he said. His teen went on to college and now is self-supporting.
It wasn't easy to follow through on rules that say parents can't allow kids to move back home without graduating from Pathway, Pendergast said.
"That's one of the things we learned at Pathway," he said. "Not being able to live at our house anymore was one of the consequences of not finishing the program."