Polydrug abusers who persistently use benzos, alcohol plus methadone and stimulants from time to time are the hardest patients to treat and no one really knows what to do with them.  Thankfully, most people on methadone do not fall into that category.

And methadone has *more* successes than the other approaches *and* it helps the “failures” which the others don’t. See U.S. Institute of Medicine for review.

Methadone cuts crime more than any other form of addiction treatment-- when you add a program to a community, crime goes down, when you remove one, it goes up (see Doug Anglin’s work for this).  This is why Giuliani was persuaded not to end methadone in NY:  when he saw the actual data, he backed off.

Further, methadone *can* relieve addiction, however.  Addiction *isn’t* physical dependence-- unless you want to call diabetics and people on antidepressants and certain high blood pressure meds (who can die from withdrawal)addicts.  Addiction is compulsive use despite negative consequences-- what methadone does when it works is replace this with simple physical dependence.  And the person gets on with employment, family, etc-- no different from diabetic who still needs insulin.

Recovery isn’t being drugfree-- it’s being freed of compulsive use despite negative consequences and this is why methadone is one way of achieving it.

TB said: “Well opiates are legal and regulated. As far as heroin or cocaine, what system do you envision? Would pharmacies distribute? Bars? Would the FDA be responsible for the safety of the drug?”

I am no expert. I know that drugs were unregulated for most of history. Trying to prevent their use has caused big problems for society. Prohibition of alcohol in the 1920’s should have taught us something. It created a whole new criminal enterprise and it didn’t work. As I pointed out above, the price of illegal drugs has been dropping for 25 years. If the ‘War on Drugs’ was working at all the price would be going up.
If we took some of the money we’re spending on enforcement, courts and prisons and put it into treatment and regulation we would immediately be better of. Without profit, the availability of drugs to minors would be cut. Prohibition for drugs isn’t working any better than it did for alcohol. It seems silly not to try something else. There is no perfect solution, but there are better ways to handle it than what we’re doing now.
As far as safety is concerned, controlled drugs would certainly be safer than street drugs. They would also, probably, be safer than the scotch and cigars that I use.

I am a drug and alcohol counselor.
There is no one answer that works for everyone.
People are individuals, what gets one person off of drug addiction, might not get someone else off of their drug addiction.
“Tough love” does work for some, for others it doesn’t.
The same is true with going to a therapist. Some need it more than others do.
The methadone program in my opinion is just there to reduce crime, it doesn’t “cure” an addiction.
AA and NA programs work for some, not for others.
Other techniques, such as cognitive behavioral therapy, or motivational interviewing therapy, can be effective for some. The field of drug and alcohol counseling is somewhat new, only a few decades old. As scientists learn more about the brain and addiction, and as drug counselors and treatment centers learn more in regards to treating addicts, more progress will be made.
Whether addiction is labeled a “disease” or not, is less relevant than using the right techniques and approaches to get the addict to lead a functional clean and sober life.

Drug addict need more than love, they need serious moral and professional support. My brother was a drug addict, he had a very tough fight, we almost lost him. Our whole family was crushed but we found the strength to support him and convince him that he needs treatment… Now he is recovering and he is getting better, I can see the hope in his eyes.

Whenever drug abuse is discussed, some hothead is bound to drag out the emotive word “prohibition” along with the assertion that it “doesn’t work”. Who says? Alcohol has been effectively prohibited in Moslem countries for 1300 years. Half of Afghanistan is covered with opium poppies, but until very recently there were virtually no addicts there. The phenomenon of large-scale addiction is uniuqe to modern Western countries with large segments of their population who have all their material needs met and over-ample leisure time and who have been persuaded to discard religion resulting in their inability to see any real meaning in their lives. Perhaps the best thing governments can do to reduce drug abuse and addiction is to stop trashing religion and start supporting it.
You want addicts to be able to legally buy as much heroin and cocaine as they want, Mr Page? If it’s none of the government’s business whether anyone wants to obtain a sharmful substance, it would then be very difficult to justify why my mum needs to go to the doctor and pharmacist to get her blood-pressure pills, or why anyone needs a special permit to buy arsenic or cyanide.

Ronk said: “Whenever drug abuse is discussed, some hothead is bound to drag out the emotive word “prohibition” along with the assertion that it “doesn’t work”. Who says? Alcohol has been effectively prohibited in Moslem countries for 1300 years. Half of Afghanistan is covered with opium poppies, but until very recently there were virtually no addicts there.”

Of course, Ronk, who wouldn’t want to live in a Muslim country? Especially Afghanistan. We should support religion in the West just the way Islam was supported in Afghanistan by the Taliban. Good grief! Are you well!

Mr P, the Taliban didn’t kill the addicts, there had never been any until the last couple of years, and still very few. The vast majority of Moslems are not Taliban, and of course I was referring to Judaism and Christianity in the Western context, not Islam. I notice you have no answer to my substantive points.

As an outside observer in this very emotive and complex debate, it seems to me that some crucial points are being overlooked: What prompts most drug addicts to start using in the first place? At what stage, if at all, do most of them realize that they have a problem? How many of them genuinely want help? What would prompt a drug addict to seek help? What part do family and friends have to play in a drug user seeking help? Does the average drug user really and truly want to do everything possible to stave off his or her addiction? And perhaps most important of all, what are the rest of us doing to make sure that the drug addict is seen as a person with dignity, duty and destiny, rather than just a simple statistic to be argued about over a web-site? Perhaps these questions may help to lift this debate out of the conundrums and doldrums of the stalemate that it seems to have become. I rest my case.

What prompts most drug addicts to start using in the first place?
As I said, the phenomenon of large-scale addiction is unique to modern Western countries with large segments of their population who have all their material needs met and over-ample leisure time and who have been persuaded to discard religion resulting in their inability to see any real meaning in their lives.

At what stage, if at all, do most of them realize that they have a problem?
IMO they all realise it but most of them are in denial.

How many of them genuinely want help?
To get off the drug, not many.

What would prompt a drug addict to seek help?
Hitting rock bottom, usually when they end up in gaol. Or in some cases when they reach about 45 they realise there is more to life.

What part do family and friends have to play in a drug user seeking help?
Refuse to “lend” them money etc and ensure their drug abuse is reported to the authorities so they get compulsory treatment.

Does the average drug user really and truly want to do everything possible to stave off his or her addiction?
IMO, No.

And perhaps most important of all, what are the rest of us doing to make sure that the drug addict is seen as a person with dignity, duty and destiny, rather than just a simple statistic to be argued about over a web-site?
Personally, I am working with them and for them on a daily basis.

I can see from the above that many people commenting are experts in this field. As a lay person, but with direct experience of drug addiction (my partner’s son) it sounds like Dalrymple is on the right track. My experience was that the addict tended to surround himself with facilitators - ie people who had drugs or would supply money, often his father, or help him steal to gain money or drugs etc.

I think Tough Love has been misrepresented in a comment above. My understanding is that it is not about confrontation - although this may happen. I have attended Tough Love groups to help me bring up my own teenage children. Tough Love’s premise is that people must experience the consequences of their actions. Ie if you spend all your money on drugs you have no money. If you steal money to fund drugs you will end up in prison. Lending money removes the consequences. Thus, my opinion, the best way to help a drug addict is to make the path between action and consequence as short as possible and stop softening the consequences. Finally the addict will realize that they are responsible for their own actions and want to give up. You can be kind to people and care for them, but still be firm on the action = consequences link.

If this is the path Dalrymple is on (I haven’t read the book), good on him. The ‘coddling’ drug treatment industry needs a wake up.