But if "treatment" has become a buzzword for citizens tired of seeing billions of their tax dollars wasted on hunting down South American drug lords and warehousing nonviolent offenders in prisons, Lonny Shavelson, a physician and journalist, argues that it's often not a whole lot more than that. In his new book, "Hooked," which follows five addicts through the torturous process of getting help for their substance abuse problems in San Francisco in the late 1990s, he makes a powerful case that America's drug treatment program is hopelessly flawed. Despite "a burgeoning movement in states across our nation to shuffle drug offenders from prison to treatment," he writes, "before we shift hundreds of thousands of addicts into rehab, we must first treat the treatment system."

As these five stories unfold -- at times "unravel" seems the better word for what happens -- the truth behind Shavelson's prosaic play on words becomes agonizingly clear. Lives are ruined and lost, hearts shattered, precious second and third chances squandered, trusts betrayed, hopes stubbed out. And, in a few rare cases, people do manage to miraculously pull themselves out of the pit. Shavelson wants to see those exceptions become the rule, and in figuring out how we can make that happen, he overturns a few of our most cherished notions about addiction and recovery.

The five people he writes about in "Hooked" are part of the kernel of hardcore substance abusers whose lives, according to Shavelson, constitute the front line of the drug war: "the most resistant, demanding, often unlikable, and arguably the least deserving of treatment service ... precisely the type of difficult junkie that rehab programs must succeed with if they are to make a dent in the crime, violence, and craziness that comprise the drug problem." Although the number of illegal-drug users in the U.S. declined from 1979 to 1998, the number of drug-related hospital visits and deaths went up, and most people picked up by the police for criminal offenses test positive for drugs. The Justice Department says drug users account for "an extraordinary proportion of crime."

Shavelson documents their blasted lives: Darrell is a lonely, homeless alcoholic and crackhead who has flunked out of several rehab programs, attended thousands of Alcoholics Anonymous meetings and been hospitalized for countless injuries, including falling out a window, while wasted. Mike is a skilled plumber whose unendurable memories of being molested as a child send him back to heroin again and again despite his heartbreakingly fervent desire to redeem himself in the eyes of his kids and girlfriend. (In the book's opening pages, Mike is described as shooting up while driving a truck down California's Highway 101 -- steering with his knees -- getting in a wreck and then, once ascertaining that he's uninjured, continuing to shoot up in a ditch beside his totaled pickup.) Glenda is a tiny, sweet-natured Native American who has been drunk and homeless since age 16 and looks 60 instead of 37, her actual age. Crystal is a cocky crackhead who boasts of her fearsome street reputation until she trusts Shavelson enough to confess that she was a streetwalker and a "victim." Most daunting of all is Darlene, whose auditory hallucinations ("noises," she calls them) could be caused by psychosis, or by the speed she injects as often as twice a day, or by the brutal conditions of her life in various homeless encampments, each makeshift shelter eventually bulldozed by the authorities without warning.

However desperate their situations, these five people entered treatment at an opportune moment. In 1996, the new U.S. drug czar, Gen. Barry McCaffrey, shifted a bit of the nation's drug policy focus from law enforcement to rehab, declaring that "effective treatment can end addiction" and that drug policy goals "can only be accomplished with a significant expansion of capacity to treat the nation's drug users." (Most of the money, however, still goes to enforcement.) And San Francisco had launched a much-ballyhooed "treatment on demand" policy that promised to get all addicts seeking help into a treatment program within 48 hours. You'd think that seeking rehab just at the time when officials had recognized the importance of treatment would give these addicts a boost -- but you'd be wrong.

Maya Angelou reads from "The Heart of a Woman"