NY TIMES ON ADDICITON AND ABSTINENCE

NY Times News of the Week in Review, 7 May, discusses "abstinence" as a treatment goal, and contrasts it with what is described - but not named - as "harm reduction." It clearly denigrates methadone and buprenorphine by labeling each of them "a substitute drug . . . replacing one habit with another." Furthermore, prescribing these medications seems to be equated to "moderation" as a technique and a goal in treating alcoholism. In other words, the author appears to affirm the long-held myth that clinically prescribed methadone for the heroin-dependent person is analogous to "vodka for gin" for the alcoholic. Obviously, this is nonsense.

The article goes on to state, "When studying these pharmaceutical crutches and prescribing them, doctors tend to emphasize improvement over abstinence . . . " What is not stressed here is the reality, confirmed by over 40 years experience worldwide, that the former - "improvement" - is achievable for the majority of dependent individuals receiving opiate agonist treatment, while long-term "abstinence" is overwhelmingly not achievable. And "not achievable" is translated for a tragically large proportion of individuals not only as relapse per se, but criminality, arrest, incarceration, infection (with HIV or a host of other viral or bacterial agents), and death.

Finally, the author fails to make the analogy that really is on target: addiction is a chronic medical condition like diabetes, epilepsy, hypertension, coronary artery disease, hypercholesterolemia, etc. - and "improvement" rather than cure is the near-universal objective in the treatment of all of them.