Addicted to addictions?

John Grabowski, PhD
University of Texas-Houston

Atavistic and antiscience at its base, the great hue and cry has again been raised against the controlled use of methadone for the treatment of heroin and other opiate dependence. In New York City, Mayor Rudolph Giuliani is seeking to eliminate methadone dispensing to treat heroin users. But this is no different from the call made in cities around the country and even entire states where this treatment is illegal.

But what is the issue?

The mayor and other politicians who lack scientific backgrounds claim that 'addicts'-a stellar pejorative term if ever there was one-should not be treated with drugs, especially drugs that perpetuate dependence. This view is permeated with ignorance of drug dependence.

Treatment undermined by misinformation

Like many diseases, drug dependence is preventable. However, once people have progressed to a state of dependence, whether by 'choice,' environmental circumstances or as an expression of genetic predisposition, they are, of course, just as medically ill as patients with hypertension, diabetes or many other medical conditions and should be treated as such.

How do we treat these diseases? We prescribe medications that change physiological function. These medications can be effective, but the greatest benefit in treatment is achieved when an array of behavioral therapies is implemented. For example, drug users must stop hanging out in places where drugs are used. Hypertensives would be well advised to stop eating at 'fa(s)t food' places.

The question then becomes one of compliance to treatment. Common wisdom states that drug abusers are psychopathic intractables and do not comply with treatment. But in reality, failure to comply with advice from health-care providers may be one of the most pervasive problems of American health care. Dr. A.T. McLellan of the University of Pennsylvania reported that more than 50 percent of insulin dependent diabetic patients, and similar percentages of hypertension patients, fail to take their medications properly, and as a result, have serious medical problems each year.

And so we have it. Methadone and other antidrug-dependence medications such as LAAM and buprenorphine confer great benefit in the treatment of drug dependence-just as antihypertensives benefit those with high blood pressure, and insulin aids those with diabetes. All these drugs stabilize patients and assist them in changing, with professional guidance, other behaviors that contribute to the disorder.

But you may be surprised to learn that many patients are afraid to take methadone. That's because people like Guiliani and a host of other politicians assert that methadone recipients will continue being 'addicts,' if not in reality, at least in their eyes. Similarly, some cancer patients will not accept adequate opiate doses for pain, for fear of becoming 'addicts'-another bit of folklore that many physicians believe and thus it impedes adequate patient care. As with cancer patients, psychiatric patients do not want to be dependent on medications that stabilize their condition even if the drugs would make their lives easier and more enjoyable. So, they discard their medications and return to abysmal levels of functioning, often harming themselves and others.

Who is the culprit here?

We have a vast scientific endeavor working tirelessly to develop new medications to alleviate people's suffering. We have a pharmaceutical industry that is extremely effective in developing medications and introducing them into the marketplace. We have practitioners who laud each new advance in medication. And the public delights in scientific breakthroughs.

But then, in our daily behavior and policy planning, we dig deep down into our Darwinian biases of survival of the fittest, and say, 'No, I will get better without medications.' And we have those ignorant of the fields of which they speak saying, 'No, you should not take these medications, you will be an 'addict.''

This behavior is inhumane as well as antiscientific, and it impedes clinical progress. It also perpetuates the problems of drug dependence. The medications being developed for opiate, cocaine, nicotine, alcohol and other drug dependence are as valuable as and life saving as medications for hypertension, diabetes or cancer. We can only hope that we can convince more people that there is a benefit to the continued controlled distribution of methadone, and that we can convince our policy-makers to provide essential services in this very difficult area.

Only with widespread information-not misinformation-can we prevent and treat drug-dependence disorders.

John Grabowski, PhD, is director of the Substance Abuse Research Center and professor in the department of psychiatry and behavioral sciences at the University of Texas-Houston.





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