HOPE BEYOND HEROIN.

• Author: WAISMANN, ANDRE

Treating opiate dependency as a central nervous system disorder has opened up new alternatives for coping with addiction.

SUBSTANCE ABUSE unquestionably is a major health concern in the U.S. and the world, with annual treatment costs in the billions of dollars. The social impact in relation to crime, family life, and lost productivity is immeasurable. Diseases such as hepatitis C and AIDS have become common in many communities. Heroin, one of many opiate drugs, is the key player in this rapidly growing dilemma. Opiate-dependent babies have become an everyday reality in many cities, and heroin use among eighth-, 10th-, and 12th-graders has significantly increased over the last decade. Based on the most recently published statistics by the National Institute on Drug Abuse, 600,000 people in the U.S. are addicted to heroin.

Remedies in the past have included addictive opiate replacements and long-term isolation from society in centers outside general hospitals. Rehabilitation centers were developed to offer opiate dependents an array of alternatives, all of which involved suffering through long and tormenting withdrawal symptoms. Detoxification procedures often require lengthy and costly inpatient hospitalization, with dropout rates of 30 to 50% for inpatient and 70% for outpatient clinics. Despite these statistics, governmental institutions continue to support centers for treatment of opiate-dependent patients outside general hospitals and outside the realm of mainstream medicine.

Methadone has become the treatment of choice and is widely endorsed by the scientific community as an effective remedy for heroin addiction. In fact, methadone masks the problem and simply replaces one dependency with another. Abstinence achieved by regular detoxification, psychotherapy, and methadone maintenance is not the solution.

Throughout the years, patients' demands have been in direct opposition to the options for available treatment. Most patients desired freedom from the dependency, and tried abstinence without medical assistance. As a consequence, "cold turkey" became recognized as a valid treatment. When a no-treatment treatment became a workable idea, many experts were willing to apply therapeutic values to vomiting, pain, diarrhea, and other symptoms of withdrawal. Statements such as "no pain, no gain" became part of many physicians' vocabularies. The scientific community continues to ignore the need to challenge the existing perceptions of opiate dependency and treatment.

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