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The mission is the work

A recovery program for substance abusers run by a street-smart former addict has become a national model for both treatment and social entrepreneurship.

April 26, 2011

When Kevin McDonald came to Durham, N.C., in 1994 to start a drug treatment center, the county gave him an old schoolhouse in a rough neighborhood flanked by empty warehouses. He saw some neighborhood kids throwing rocks through the windows, bribed them with $1 a day to guard the place and shot video of them holding up the letters with the initials of his organization -- T-R-O-S-A -- like cheerleaders.

Inside, he beamed over the swimming pool. “Hey, this is pretty classy,” he thought. Then he realized it was a basketball gym submerged by leaky pipes.

“It was wild, wild West at first,” he said.

But McDonald figured out a way to turn what was broken into something useful. Starting with $18,000 raised by local advocates, McDonald used convicted drunk-drivers completing court-ordered community service to make the building habitable.

“Duke got all the Ph.D.’s,” he said; “I got the Hell’s Angels and the drug addicts.

“I started bringing people in. I used kerosene heat, a little four-burner electric stove,” he said. “It was just real rough, but what the hell, you’ve got to start; people are on the street.”

Seventeen years and 1,100 graduates later, McDonald has built Triangle Residential Options for Substance Abusers into the largest drug treatment facility in North Carolina and a national model for both treatment and social entrepreneurship. He took a social problem -- addiction -- and made its victims the solution.

With seven distinct businesses ranging from masonry to moving, TROSA offers residents two years of free treatment, plus an aftercare program that sets them up with low-cost housing, cars and ongoing group therapy, all while they’re gaining the job skills and the confidence that will usher them into their new lives.

The organization is able to operate with only about 10 percent of its $10 million annual budget coming from government and private grants; its businesses generate more than $6 million a year, and in-kind contributions exceed $3 million.

“Even if I got a lot of money donated, I would never stop,” McDonald said. “It’s not just money. It’s about therapy, it’s about work ethic, it’s about learning job skills. You can just say, ‘Stop shooting dope,’ but once you stop shooting dope, you’ve got to be able to work, you’ve got to be able to get along with people.”

Made in California

McDonald, 63, didn’t invent this model. He learned it from the Delancey Street Foundation, a therapeutic community in San Francisco that works on an “extended family model”: residents work and contribute what they can. In the late 1970s the organization began to establish satellite campuses in select cities, and in the 1980s McDonald helped set up a Delancey Street facility in Greensboro, N.C.

McDonald never graduated from college. He spent his 20s and 30s in and out of jail and hooked on heroin until a judge sent him to Delancey Street. Over the course of 12 years recovering from addiction, McDonald learned the moving and construction trades and rose to leadership in the organization.

Out of Delancey Street grew McDonald’s “each one, teach one” philosophy, the notion that everyone has something to learn and to teach, and that lost, broken addicts have something to offer the world if they just believe that they do.

McDonald talks in a sarcastic Boston dialect, peppered with four-letter words and barely dulled by decades in California and North Carolina. McDonald’s past as a “street punk” gives him credibility with the clients and insight into what works. He puts in long days, showing his face on the TROSA campus day and night.

“I can’t spell ‘entrepreneur,’” McDonald said, with self-deprecating humor. But he is one, and the development of TROSA shows his skill in tending to the health of the people in his care and of the organization that supports them.

“The heart and soul of TROSA has always been Kevin McDonald,” said Jerr Boschee, a co-founder of the Social Enterprise Alliance, which honored TROSA for innovative fundraising in 2004 and 2009. “Kevin McDonald is one of the stars in the social enterprise universe.”

When the founding TROSA board recruited McDonald to Durham, he wanted to open the doors to physically sick, injured and mentally ill addicts, populations Delancey Street couldn’t accommodate. To do that, he needed to develop moneymaking businesses to support the high cost of care.

 

Questions to consider:

  • Kevin McDonald saw a way to integrate TROSA’s mission with its organizational sustainability through entrepreneurship. Where would you look for such opportunities in your work?
  • What are the advantages if your organization’s employees and/or constituents learn to tell their stories with a sense of personal responsibility?
  • Trust is an important component in McDonald’s work with his clients. What are ways to build trust in order to help people make the hard changes they need to make?
  • Building leaders from within the ranks is one of TROSA’s goals. What practices can you implement to build and groom leaders within your institution?

Adapting the model

At first, McDonald followed Delancey Street’s pattern, relying on skills residents already had or responding to specific business opportunities that arose: peeling potatoes for a local caterer, painting, removing trees that fell during Hurricane Fran in 1996. But that strategy was haphazard and resulted in a revolving door of businesses as residents came and went and community needs changed.

Seeking sustainability, McDonald realized that long-term employees could give the businesses the strong word-of-mouth reputation they needed to survive, because TROSA could never use typical advertising.

“Would you do a marketing campaign, ‘Hire a junkie to move you’?” he said.

McDonald shifted the model to build expertise from within, encouraging residents to remain after graduation in inexpensive housing and management positions in the businesses. That served both to strengthen the businesses and to support the graduates’ personal recovery. Among the model’s successes is the moving company, which regularly wins “best mover” awards from local newspaper readers.

McDonald later adapted the model further and began hiring talented people from outside TROSA with know-how he couldn’t find within. For example, Wendy Noel had a vision and the experience to open a grocery store in an underserved neighborhood but lacked the capital. TROSA hired her to execute her vision.

“I couldn’t have done this exact store myself,” Noel said. “TROSA’s infrastructure has made this store possible.”

By building its own leadership, TROSA has made a name for its moving and landscape companies, frame shop and holiday tree sales. Jobs range from retail sales and physical labor to back-office accounting. The division of labor not only allows the businesses to grow but also teaches residents diverse job skills and the confidence they need to succeed on the outside.

These businesses require no mere manual labor but careful craft and knowledge of complex computer software to keep track of millions of dollars of commerce every year.

“When people think they’re just drug addicts, we’re not doing anything but using an old-days abacus or something like that,” McDonald said. “But you can stretch people, and you can put ’em in jobs where they can succeed, and that’s what a lot of this is about. …

“Most of our people have been raped physically, beaten or verbally abused. That isn’t fixed by medication.”

McDonald said the size and complexity of the businesses demand greater and greater expertise from their managers. If TROSA is to keep growing, he said, it’s going to need a stronger internal leadership program in order to train graduates to replace him and other veteran managers. Two 75-bed dorms are under construction, but McDonald said he needs to solve the long-term leadership problem before pursuing his goal of expanding into nearby Raleigh.

Time makes a difference

At most treatment facilities, 30 days is the end; at TROSA, 30 days is just the start.

Experts who have studied TROSA say it’s the combination of financial sustainability and social mission that make it stand out, earning national awards from the Social Enterprise Alliance and the Ford Foundation’s Leadership for a Changing World initiative.

Meaningful work in a therapeutic setting not only builds confidence but also buys time for other treatment strategies such as group therapy, one-on-one counseling, psychiatric care and community-building exercises like a weekly seminar on current events to have an effect. These cost the organization about $75 a day per person.

“The big difference is that TROSA isn’t treating substance abuse as a disease; it’s treating the whole person,” said Deena Murphy, an N.C. State University psychology professor who studied TROSA graduates and found that fewer than 10 percent return to drugs or crime within a year, compared with 40 percent or more of those who finish other programs. She also found that 95 percent had jobs a year after graduation, compared with about 60 percent from other treatment programs.

“Most … treatment programs are outpatient: they’re treated and then they leave, and there’s no real understanding of what the factors are in their outside lives,” Murphy said.

TROSA is a place for resurrection, but first comes the death of residents’ former lives. They break off most contact with the outside world, committing to two years of sobriety, unpaid labor and strict rules in exchange for housing, meals and treatment.

“Each one, teach one” might mean words of encouragement, but it also means holding one another accountable.

“Recovering addicts, you give ’em an inch, they’ll take a foot,” said Anthony Stanford, who went from homelessness to become head of TROSA’s intake office. His recovery reunited him with his wife and three daughters after years of aimlessness. “If you’re going to joke and play, then you’re not taking it seriously.”

Some people like Stanford remain beyond their mandatory two-year commitments, staying on as staff members or “TROSA scholars,” finishing community college degrees. The ongoing connection to the TROSA community through support groups and just plain friendships helps graduates cope without drugs or alcohol when hard times come on the outside.

McDonald, a Catholic, said TROSA is a spiritual experience in the sense that residents are trying to live rightly: caring for themselves and others, volunteering in the community.

“It’s the pride of belonging to something,” he said.

Organized religion is something residents can choose to pursue on their own, but it’s not integrated into the program. “I really just want to keep it separate,” McDonald said. “You’ve got to take care of their other parts -- their mental health, their physical health -- which the church is not always able to do.”

Practicing for success

TROSA’s offices are located in a renovated dairy plant; on any given weekday, more than 100 residents and staff members are on the 13-acre main campus, which includes apartments, a kitchen and an auto repair shop. Three hundred other recovering substance abusers are scattered around the city, working on moving or landscape crews or in one of the organization’s retail shops.

The linchpin of TROSA’s social entrepreneurship is the in-kind department, where a dozen residents work the phones, soliciting donations of food, toiletries, medical supplies, furniture, and building and landscape materials.

As with TROSA’s other enterprises, the work is part of the therapy. When a visitor arrives in the office, the six on-duty staff members stand at their desks, dressed in slacks and ties or skirts and blouses. They each tell their names, their past drugs of choice, how long they’ve been at TROSA and what sorts of donations they’re responsible for collecting. Each one thanks the visitor for coming.

“It’s practicing for success,” said in-kind department manager Greg Fenn, a TROSA graduate. “I don’t allow people to speak incorrectly. It’s something we practice. It’s a sign of respect.”

Twenty-three-year-old Marquis from St. Petersburg, Fla., said she was caught with drugs in North Carolina, a groupie wandering the East Coast with touring musicians. “I was just traveling, following music, getting high and selling drugs,” she said. A judge sent her to TROSA, and now she works getting free tickets for plays, concerts, ballets and other performances so residents can enjoy a clean, fun night on the town.

With responsible behavior comes more responsibility in the form of increasingly independent living, transportation and employment. Most TROSA residents share dorm rooms, travel in pairs and work for TROSA’s own businesses, but those in their last three months of residency go on “work-out,” taking jobs with outside businesses and saving money to build their own lives beyond TROSA’s gates.

“People coming in, we make decisions for you, but what you’re going to learn along the way is making your own decisions,” said McDonald. “Not everyone knows how to work hard at first. People can succeed and slowly build up that self-esteem. Getting a GED, going to classes -- little things make a lot of difference.”

On a recent day, residents gathered in the TROSA coffee shop for their daily afternoon “seminar,” where they discuss current events from the newspapers. One by one, men and women with lives ruined by drug and alcohol addictions walked to the front to talk about something else -- anything else -- with the goal of re-integrating themselves into society after they complete their two-year residencies. Jason (not his real name) wanted to talk about Scotty McCreery, a teenage contestant on American Idol from nearby Garner, N.C.

“It’s been a good week,” said Jason, dressed in a blue shirt and pants, matching work clothes given to people in their first 30 days of treatment, who are assigned as campus janitors. He told the group that he loves to sing.

“I’m really, really serious, man,” he said. “I came here to change myself. If you came here to change yourself, … if you have a passion for [music], come out and join me; I’ll sing with you. That’s what it’s all about. You know, try to get your recovery. And how I get my recovery is, I go out and I spend some time with the Lord, singing.”