Rebecca Tan | Longreads | August 2019 | 13 minutes (3,006 words)
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.
In the months following that bright Monday, as Clarke’s classmates settled into high-paying jobs in New York City and San Francisco, he overdosed on heroin three times.
When he was admitted to Penn in 2012, Clarke was a precocious, first-generation, low-income 18-year-old plucked from Kensington, Philadelphia — a neighborhood where heroin is sold often and openly in public — and ushered into the ivy-cloaked buildings of a storied campus. 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.
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.
But Kensington, the neighborhood where Clarke grew up, isn’t just poor. In October 2018, the New York Times Magazine ran a feature on the area by Jennifer Percy, dubbing it the “Walmart of heroin.” Alongside a photograph of drug users shooting up underneath the Kensington Avenue underpass, the magazine describes the area as “the largest open-air narcotics market for heroin on the East Coast.”
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. Later that year, he asked one of his stepfather’s buddies for cocaine, but mistakenly got a bag of heroin. 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. His preferred cocktail was a combination of cocaine and benzodiazepines.
“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.”
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.
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. James Winnefeld, a cochair of the nonprofit SAFE Project lost his college-age son to fentanyl-laden heroin in 2017. 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.
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.
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. Then, a week later, on New Year’s Day, he took heroin with a friend, and came close to dying in the emergency room of the Aria-Jefferson Health hospital on Frankford Avenue. Luckily, he survived.
“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.”
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.
Kickstart your weekend reading by getting the week’s best Longreads delivered to your inbox every Friday afternoon.
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.”
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.”
“I know that,” he repeated softly. “But maybe it doesn’t have to be that way.”
Rebecca Tan is a journalist based in D.C. Her work has appeared in Vox.com and the Washington Post.
Editor: Kelly Stout
Fact checkers: Ethan Chiel and Matt Giles
Copy editor: Jacob Gross