WHY IS ABSTINENCE NOT POSSIBLE FOR SOME
Dole and Nyswander speculated that when people become addicted to heroin there is a physical change in their systems that may or may not be reversed with abstinence, and to the extent it isn't, it could explain the tendency to relapse after abstinence is achieved. Without question, long-time abstinence after dependence on morphine still leaves lab animals "different" - they develop tolerance vastly more quickly than opiate-naive animals though God only knows why or how (same difference in development of tolerance applies to humans, by the way). The other possibility they put forth was that some people are genetically, physiologically, predisposed to react differently to heroin when exposed than are the majority. We know virtually everyone drinks, but only some 15% or so go on to become progressive, self-destructive alcoholics. About the same proportion was found for Vietnam GIs coming homne after having used huge amounts of very pure heroin for a year or more - about 85% promptly quit upon returning to US and the remaining 15% were quickly indistingishable from addicts whose drug experience was entirely domestic. How did the 15% differ from the 85%? To this day no one has the answer.
Many folks dismissed their hypothesis and I remember a very highly respected leader in the field (maybe the MOST respected leader) at a conference pointing to enforced abstinence in a prison setting, for instance, and the total inability to detect any abnormality among inmates who had been using heroin for years and then were incarcerated. But Dole and Nyswander stuck to their guns. And then, when endorphins were discovered, their hypothesis suddenly made great sense. Endorphins are formed by a hormone system, and we know that every hormone system gets screwed up (a non-scientific description, but it'll do) if one introduces from outside a substance that is essentially the same as the hormone. Take steroids long enough and it can be sheer hell to be weaned off them - and some people never can be. Same with thyroid hormone - or any other. So it makes absolutely perfect sense that taking into the body something akin in all respects to endorphins will screw up the endorphin system - maybe forever, maybe for a while, maybe a great deal in some people and hardly at all in others.
Alas, no one has been able to identify - YET - just what that abnormality is and how it can be measured. But the bottom line: it don't make any difference. The fact is that most people who are addicted to heroin can't achieve and maintain abstinence - can't or won't, makes no difference. They will keep using dope and risk their own health and lives and harm others. That's the reality and wishing it were different doesn't help. And then there's methadone, which enables many (not all) people to lead productive, satisfying, reasonably healthy lives and dramatically lessens the danger of dying. So what's not to like? Beats the hell out of me. I've never understood it, and my experience with nicotine patches makes me even more amazed that so many people detest methadone treatment - I smoked 45 years, never went a day without smoking, hated it for decades and would have given anything to be able to quit. And finally with the patch for 2 years I cut down to about 5 a day and then quit. What kind of idiot would say: yeah, but what proves you needed the patch? And then go on, "I have an uncle whose maid quite smoking without anything" - as if that makes the slightest difference.