I. “A death sentence”
On May 16, 2016, scores of adoring parents gathered at Franklin Field on the University of Pennsylvania's campus, beaming as 2,225 undergraduates threw their mortarboards into the air, colorful graduation cords swinging from their necks. Paul Clarke, a 22-year-old with brown hair and pale skin, was meant to be on that field. He was meant to have his name emblazoned in black under the list of economics majors, his portrait sitting snugly in the yearbook among the rest of the class of 2016. Instead, the young man was seven miles away, alone, in a dimly lit house littered with half-burned joints, beer cans, and hidden bags of opioids.
2016年5月16日，成千上万的爱慕父母聚集在宾夕法尼亚大学校园的富兰克林球场，2225名大学生将他们的灰泥板扔向空中，五彩缤纷的毕业绳从脖子上摇曳，欢呼雀跃。 22岁的保罗·克拉克（Paul Clarke）有着棕色的头发和苍白的皮肤，原本打算去那个领域。他的名字应该被刻在经济学专业的名单上，并用黑色刻上名字，他的画像正巧地坐在年鉴中，成为2016年其他班级中的一员。相反，这个年轻人独自一人在七英里外的一间昏暗的房子里散落着半烧的关节，啤酒罐和隐藏的阿片类物质袋。
Despite a history of drug use in high school, Clarke stumbled along for his first three years there. He slipped into intense bouts of drug use during his summer breaks, but would always return to school in August, earning a near-perfect GPA. Between joining a fraternity and picking up a binge-drinking habit, he managed to make the dean's list twice. Then, over the course of Clarke's senior year, undiagnosed mental health problems sent him spiraling into addiction. As the summer turned into fall of that year, he switched his beers out for painkillers, stopped attending classes, and started crying himself to sleep.
Soon, Clarke was placed on academic probation, kicked out of his fraternity house, and forced to move back home to Kensington — a decision Penn officials said was based entirely on his poor academic performance that semester. He had failed two of his courses and had either failed or taken an incomplete in another, which according to university policy, meant he had to be “dropped from the rolls” and required to take time away from school. As he struggled to keep his spot at Penn, he found little in the way of support.
His friends and family spent months protesting his suspension, arguing that sending the 23-year-old back to Kensington was not only going to worsen his addiction, but could very likely kill him. In one of multiple emails sent to five of the university's top administrators, Clarke's half brother John Foley wrote, “I'm not convinced Paul will survive this time away.” In another, he stated plainly: “For Paul, a year away is a death sentence.” Aside from some contact with administrators focused on student wellness, who claimed to have no control over the situation, Foley's emails went almost entirely unanswered.
他的朋友和家人花了几个月的时间来抗 议他的停职，他们辩称将23岁的年轻人遣返肯辛顿不仅会使他的成 瘾加剧，而且很可能会杀死他。克拉克的同父异母兄弟约翰·佛利（John Foley）在给五位大学最高管理者的一封电子邮件中写道：“我不相信保罗这次会幸免于难。”他在另一句话中清楚地说：“对保罗来说，一年的死刑。”除了与负责学生健康的管理人员进行一些接触（他们声称无法控制这种情况）外，Foley的电子邮件几乎完全没有得到答复。
The story of how an Ivy League student goes from the dean's list to overdosing half a dozen times before his 25th birthday exposes a question at the heart of how universities respond when students face addiction: Allow them to stay on campus or send them away? Clarke's efforts to claw his way back into school, to graduate, and just to survive, are a stark reminder of the stakes for students like him.
From the day he arrived at Penn, Clarke stood out from his peers. (Disclaimer: I went to Penn as well, and was enrolled at the same time as Clarke, although we never crossed paths socially or academically.) A 2017 study by the Equality of Opportunity Project found that 71 percent of Penn students come from the top 20 percent of the income scale, the second highest figure in the Ivy League. Outside the confines of what students call the “Penn bubble,” 26 percent of Philadelphia residents, including Clarke's family, live below the poverty line.
从他到达宾州的那天起，克拉克就从同龄人中脱颖而出。 （免责声明：我也曾去过宾夕法尼亚大学，与克拉克同时入学，尽管我们从未在社会或学术上跨越过道路。） 2017年机会均等项目的一项研究发现，宾夕法尼亚大学的学生中有71％来自顶部收入规模的20％，在常春藤联盟中排名第二。在学生称之为“潘恩泡沫”的范围之外，费城26％的居民（包括克拉克的家人）生活在贫困线以下。
In his admissions essay to Penn, Clarke wrote about the moment he learned that his home was different: “I found my mom's coke straw after a tip from a friend who was asked to buy her a 20-bag,” he wrote. “I found out how my dad really died. I found out my house was always cockroach-filled and disgusting. I found out none of the things going on in my house were normal.”
When he arrived as a freshman in the fall of 2012, Clarke lacked some of the skills his classmates took for granted. He didn't know he could email professors if he had problems, for example, and he found it hard to maintain eye contact with anyone, said a former girlfriend of his, Lody Friedman. In addition, Friedman said, Clarke's “post-traumatic stress was very, bleedingly obvious.”
“And I'm not surprised,” she continued. “He experienced acute trauma his entire life.”
Clarke was 14 when he first took drugs. It was the summer; he stole a bag of marijuana from his stepfather and smoked it in his bedroom. By the time he was in high school, Clarke was sampling from an extensive menu of substances. When he turned 15, he started taking Xanax, and at 16, picked up Klonopin.
克拉克第一次吸 毒时只有14岁。那是夏天；他从继父那里偷走了一袋大 麻，然后在卧室里抽了大 麻。到他上高中时，克拉克就从大量的物质菜单中取样。当他15岁时，他开始服用Xanax，并在16岁时拿起Klonopin。
“This behemoth of an institution brought him in like, ‘Look who we found from Kensington.' But when he encountered the problems that they probably could have predicted, they sent him back.”
The summer after his freshman year of college, Clarke overdosed at his grandmother's house in Port Richmond, a neighborhood bordering Kensington. When Foley, who lives in Washington, D.C., contacted Penn about the incident, Student Intervention Services, the department in charge of crisis situations, assured him that there would be a dedicated administrator monitoring Clarke in the coming semesters. This worked for a couple of months, until Clarke stopped responding to administrators and they stopped reaching out.
Two years later, Clarke found himself battling a major depressive episode more or less alone. Foley, who watched from afar, believes this was when the university failed his younger brother.
“This behemoth of an institution brought him in like, ‘Look who we found from Kensington.' But when he encountered the problems that they probably could have predicted, they sent him back,” he said.
Friedman, who is now a teacher in Boston, feels similarly: “Students are expected to advocate for themselves, which is fine for those coming from affluent families, but it's not fine for someone who has raised himself. If you knew Paul and understood his background, it's pretty fucking obvious why he wouldn't respond.”
II. To Reset or Derail?
It's common practice at colleges and universities to encourage students struggling with severe addiction to take time off from their studies. At first blush, this policy seems reasonable: College campuses, rife with substance-fueled social events, can often be hostile to recovery. But this policy rests on some assumptions that, with students like Clarke, don't apply.
At Penn, administrators are eager to emphasize that students struggling with their academics or health are urged to take a leave of absence in order to “reset.”
“We've tried to destigmatize the idea that a leave is failure,” said Rob Nelson, the former executive director for education and academic planning at the university. “The actual idea is that something is going wrong and you need to take time off. … Any kind of separation from the university usually has the effect of helping students succeed.”
该大学前教育和学术规划执行董事罗布·尼尔森（Rob Nelson）说：“我们试图淡化请假失败的想法。” “实际的想法是出了点问题，您需要抽出时间。 ……与大学的任何形式的分离通常都可以帮助学生取得成功。”
For Clarke, this wasn't the case. Sending him back to Kensington, by his own account, exacerbated his problems with addiction not just because his environment offered a steady stream of drugs, but because sending him away robbed him of one of the most important anchors in his life: being a Penn student.
Clarke spent four months at a recovery house in Collingswood, New Jersey, while participating in a now-defunct recovery program called Life of Purpose in nearby Cherry Hill. There, trained mentors guided residents through recovery with the aim of transitioning them back to school. Similar collegiate recovery programs have existed since the 1970s, though they remained relatively unknown within higher education until about five years ago. According to the Hechinger Report, there were only several dozen collegiate recovery programs in 2013; today, there are around 200.
克拉克（Clarke）在新泽西州科林斯伍德（Collingswood）的一家康复中心度过了四个月的时间，同时参加了附近樱桃山（Cherry Hill）现已终止的名为“目标生活”（Life of Purpose）的恢复计划。在那里，训练有素的导师指导居民进行康复训练，目的是使他们过渡回学校。自1970年代以来就存在类似的大学恢复计划，尽管直到大约5年前，它们在高等教育中仍相对不为人所知。根据《海辛格报告》 ，2013年只有几十个大学恢复计划；今天大约有200个
At Penn, the central resource for students struggling with addiction is the Office of Alcohol and Other Drugs, housed under the office of the vice provost for university life. The office's director, Noelle Melartin, said in an email that they offer a program called First Step, “a brief intervention for students whose alcohol or substance use is at a lower level of severity.” Students like Clarke, with more severe cases of addiction, are referred to “appropriate outside services,” she wrote.
By the time it became clear to Penn that Clarke was struggling with addiction, he had already overdosed once and secured a steady supply of drugs from Kensington.
At elite universities, collegiate recovery programs can sometimes be seen as bad PR, experts say. He told the Hechinger Report, “[Universities] don't want parents walking around campus seeing posters that imply there is any kind of a substance abuse problem on campus.”
And yet, substance use among college-age Americans is clearly an issue. Figures from the Kaiser Family Foundation show that in 2017, more than 4,760 people ages 0 to 24 died from opioid overdose. According to a 2017 report from the Centers for Disease Control, the number of drug overdose deaths of people ages 18 to 25 increased 411 percent from 1995 to 2015 — the greatest increase of any age group.
Despite this, a 2018 report found that fewer than 5 percent of universities in the United States have in-house recovery programs. Penn, in other words, is not the exception but the rule.
In December 2018, the Ruderman Family Foundation, a philanthropic organization focused on disability inclusion, released a report that concluded that Ivy League institutions are effectively using leaves of absence to push students off campus in order to avoid legal liability and bad press.
In 2013, a Penn report found that 5 percent of the graduating seniors had taken a leave of absence during their time at the school, adding that “almost all Penn students who take a leave of absence return and complete their degrees.” Researchers at the Ruderman Foundation acknowledge that taking a break can be helpful, but note that at Ivy League universities, LOAs “are too often imposed on students with mental illness against their will in situations where other less-drastic alternatives were not explored.” It adds: “Leave-of-absence policies, as they are currently being implemented, are exacerbating the college mental-health crisis.”
Nelson, like Melartin, declined to discuss the specific details of Clarke's case, but insisted that any decision to drop a student from the rolls is based strictly on academic performance. “There are clear measures of performance associated with being dropped,” he said. “The idea that there are mitigating factors [to a student's performance] and those kinds of things … doesn't really enter into this process.”
The factors that caused and perpetuated Clarke's addiction also have roots far beyond the university's control. Many recovery programs are heavily dependent on participants self-reporting their problems. This requires students without much emotional capital to diagnose themselves, admit that they're struggling, and ask for help, explained Keith Murphy, a recovery counselor at Rutgers University.
导致并永久保留克拉克成瘾的因素也有其根源，远远超出了大学的控制范围。许多恢复计划严重依赖于参与者自我报告他们的问题。罗格斯大学（Rutgers University）的康复顾问凯斯·墨菲（Keith Murphy）解释说，这要求没有太多情感资本的学生进行自我诊断，承认自己挣扎并寻求帮助。
By the time it became clear to Penn that Clarke was struggling with addiction, he had already overdosed once and secured a steady supply of drugs from Kensington. Later, as the formal process got underway for him to be “dropped from the rolls,” Clarke made sporadic efforts to protest, but often skipped important meetings with administrators. Throughout this process, he hadn't told his mother or his stepfather what was going on. He figured it wouldn't have mattered.
Clarke and I met for the third time in September 2018, during his time at Life of Purpose. We took a walk, and talked until it got dark and Clarke remembered that he had a curfew to keep. He usually had to be back at the recovery center by 10 p.m. on weekdays, but he had skipped one of his four group therapy meetings that week so his curfew had been moved to 8 p.m.
As we walked down a sleepy suburban street, Clarke admitted that he hadn't quite gotten used to all the rules at his recovery center: no girls in the house, no alcohol, no drugs, and no skipping work, therapy, or outpatient sessions. He chafed against the strict, regimented schedule, but otherwise liked it more than rehab and definitely — definitely — more than Kensington. Here, he felt closer than he had in months to getting back to Penn.
He recounted the story of how he had landed at Life of Purpose: After being placed on academic probation in 2016, Clarke moved back to Kensington and spent a year trying to get a handle on his addiction. In early 2017, desperate for change, he took the Vivitrol shot — a potent medication that blunts stimulation by attaching to opioid receptors and blocking the release of dopamine. It sent him to sleep with chills every night, but it managed to help keep him sober enough to file an application to return to Penn. In April 2017, he registered for classes in the summer and fall.
他讲述了自己如何进入“目标人生”的故事：2016年接受学术试用后，克拉克回到肯辛顿，并花了一年的时间来解决自己的成瘾问题。 2017年初，他迫切需要变革，给Vivitrol注射了一种有效的药物，它通过附着在阿片受体上并阻止多巴胺的释放而钝化刺激。每天晚上，这使他昏昏欲睡，但设法使他保持清醒，足以提出申请返回宾夕法尼亚州。 2017年4月，他在夏季和秋季注册了课程。
But less than five months later, things got tough again. Lamictal, the medication prescribed for his depression and anxiety made it hard for him to focus in class. Some days, he felt 24 hours pass without hearing his own voice. By December, he decided to go on another leave of absence, voluntarily this time, to focus on his medical treatment. In the next weeks, he returned to Kensington and felt his anxiety grow as his Vivitrol shot wore off. Before Christmas, Clarke had overdosed again.
“I get real sad and helpless down there and I just kind of start feeling like that's where I deserve to be.”
“It's the place,” Clarke said of Kensington, two months into sobriety. “I don't know how to describe it. Just being there, seeing the state of my mom's house. The bed bugs and rats. My stepdad is falling apart, my little sister is falling apart. My older sister just had to kick her ex-boyfriend out because he was smoking too much meth and crack. These are the people I'm talking about when I'm down there. People on meth.
“I get real sad and helpless down there and I just kind of start feeling like that's where I deserve to be,” he continued. “The only thing that seems to make it better is getting high, because there's this wave of relief, and for five hours, it all goes away.”
Nearly everyone Clarke knows from home struggles with substance abuse, and none of them, he said definitively, have successfully stayed in recovery. Using his fingers, he counted off the people in his life who have died from drug-related problems: his dad, Paul Clarke Sr.; Frannie, his mother's cousin; Jimmy, a cousin's boyfriend; Conrad, that Polish kid from down the road. Clarke trailed off, then added, “That's why I need to get back to school. That's the last thing I have to look forward to.”
克拉克几乎每个人都知道在家中与药物滥用作斗争，而且他明确地说，没有一个人能够成功地康复。他用手指指望生命中死于与毒品有关的问题的人们：他的父亲保罗·克拉克（Paul Clarke Sr.）；他母亲的表弟弗兰妮（Frannie）；表哥的男朋友吉米；康拉德（Conrad），那个波兰小子。克拉克走了一步，然后补充说：“这就是为什么我需要回到学校。那是我必须期待的最后一件事。”
The day before Thanksgiving 2018, Clarke learned that he was going to be readmitted to Penn for the 2019 spring semester. He was excited, but things didn't pan out exactly as he had hoped. The recovery centers known as Liberation Way had been sold that spring to a group led by a private equity firm, and were rebranded as Life of Purpose. Several months later, though, that company petitioned for Chapter 7 bankruptcy before abruptly shuttering the centers.
Around the time of the sale, the centers, which had been operated as Liberation Way, were under investigation by Pennsylvania's Attorney General, who later charged the former owners and nearly a dozen ex-employees with running an “elaborate insurance fraud scheme”. According to Josh Shapiro, the state's Attorney General, an 18-month investigation uncovered a “blatant disregard for the wellbeing of the people [Liberation Way was] supposed to help” and “took advantage of … those suffering from substance use disorder.” Several employees, including the former CEO, have since pled guilty. (No one within the ownership group of Life of Purpose was implicated or charged with any crime, and a source who worked for the Life of Purpose who requested anonymity because of the fraught nature of the situation denied any wrongdoing, calling it “a totally unsalvageable situation.”)
After the recovery house at Collingswood shuttered its doors, Clarke was left on the street for the umpteenth time. He crashed at three different places before settling in an apartment in West Philadelphia. And as the semester started, Clarke's energy picked up, but waned again just before spring break. He realized over the course of the spring semester how different school can be as a 26-year-old recovering addict — how lonely.
In March, he dropped a class and fell back into the habit of skipping lectures, but managed to do enough to earn a B, a C, and a D. He has faltered on a lot of the rules that governed his life in Collingswood, though it's clear that some of what he learned has stuck. He complains now about his younger sister's substance use, about how she and her girlfriend are “enabling each other.” After spending years resenting the university and himself for what happened, Clarke has also developed a more measured view of his story. He acknowledges more readily than ever before that he wasn't just “being a dick” in 2016; he was sick.
Clarke needs seven more credits to graduate with an Ivy League degree in economics. In what is his longest period of sobriety since 2016, he is lucid enough to know that he can master the material necessary. He also recognizes that despite his smarts and his determination, the odds of graduating are stacked against him.
Earlier this year, on a bright winter day, Clarke and I met in a café next to Penn's bookstore. It was the second week of classes, and he was reckoning with what felt like his third and final chance at college.
“I got through high school, got to Penn, I'm still alive,” he said. “I was flying a plane but I was flying it upside down. … It's not the right way to do it; it's fucking dangerous. Now I'm just trying to land that shit in the Hudson, but I'm all upside down.”
他说：“我中学毕业，去了宾夕法尼亚大学，我还活着。” “我当时正在驾驶飞机，但是却颠倒了。 ……这不是正确的方法；这太危险了。现在，我只是想把这些东西放到哈德逊河上，但我全都倒过来了。”
Clarke paused and stared straight ahead, his green eyes lit by the setting sun. “The stats are against me. I know that,” he said. “Chances are I'll relapse, take something lined with fentanyl and die.”
克拉克停了下来，直盯着前方，绿色的眼睛被夕阳照亮。 “这些数据对我不利。我知道，”他说。 “很有可能让我复发，服用衬有芬太尼的东西而死。”
“I know that,” he repeated softly. “But maybe it doesn't have to be that way.”