Alexander DeLuca, M.D.
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Abstinence... at all costs? 

by Captain Tim H. M.; circa 1998; ASAM discussion forum. NOTE: This document was posted on an ASAM website discussion forum in 1998. I have tried to find “Capt. Tim H. M.” without success. He is an entirely anonymous author to me; I've just copied it from a public web page and edited punctuation and spacing for web viewing. Reformatted 12/20/2004. ..alex… Alexander DeLuca, 2/3/01.

My question is why so many in this forum [devoted to addiction professionals] are fixated on abstinence at all costs. I agree that the only people that I have seen with long term abstinent clean time are twelve step folks, and that for the people that do "get it", they are privileged to a wonderful life. 

But we make it seem that it is a moral do or die question of how and when they are ever going to hit bottom. I have been in AA & NA for twenty years and have a few friends in NA with 10-15 years consistent clean time, honestly, especially with opiates, it is 1 in 10 that makes it to a year clean, 1 in 200 or more that make it to five years, and 1 in a 1000 that makes it to 10 plus years. That is my observation and at that only a educated guess. 

Ask a number of long timers in NA for an honest guess of the numbers and I think you may be in for a shock. Of course there are no real statistics, and at a NA convention where you do see a lot of long term recovery, it's scientific "Mary Kay;" - what you don't see are the missing that didn't make the pyramid. 

I do not believe that:

  • if a patient was told that he had a 1 in 50 (great odds) chance of staying clean from opiates long term, and that the consequences for not [becoming abstinent], while he was trying to "get It," were jails, institutions, HIV, hepatitis, and death;
  • or, worse, [if a patient was told that he might very well end up] with a life where he lives in constant shame and agony of being the moral retard who "can't get It", and slowly being ostracized by his peers;

I'd bet you wouldn't have a whole bunch of takers. 

In NA under the "TOTAL DISEASE CONCEPT OF ADDICTION" [I call it the "abstinence uber-alles!" concept of addiction medicine ..alex...]  in which the opiate addict is told that: --> addiction is the same no matter what the substance and that one's chances for recovery are the same as any other substance addict. <--  This sounds great, but it is not true.

First is my personal experience [that all addictions and addicts are not the same, that some get better one way, some another, and other don't],

Second is every major study from the past [challenges the one-size-fits-all approach], and,

Third all the new data on opiate addiction brain chemistry changes and genetic predisposition for irreversible chemistry changes.

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The real immorality of the whole picture is the fact that a number of medical alternatives are possible with much, much greater chances of patient survival; maybe no where near the quality of life as the 1 in 500 perfect abstainer, but at least an improved life.  

The sin is the fact of the political repression of those alternatives, the medical profession's apathy, ignorance, and justified fear of opiate addicts because of eighty years of witch hunts on the physicians that have had the compassion, courage, and / or greed, to work with them. 

There truly is a police state of medicine in this country: "THE WAR ON DRUGS is a War against ADDICTS and it is a War against SCIENCE." The systematic blocking of studies, the scapegoating and propaganda, the fear surrounding the practice of addiction medicine or pain medicine, (what would your reaction be when the receptionist calls back that the D.E.A. agents are waiting in the lobby). Reminds me of Nazi Germany.

If you feel I'm emotionally overstating the case to justify the fact that in 25 years of consistent effort I still haven't "gotten it", I invite the reader to do some more research with an open mind. First for some historical background read Mike Gray's book "DRUG CRAZY", for a cultural and political overview. Next go to DRCnet Online Library of Drug Policy and read the whole section in there on the opiates (a wealth of other studies, but "Licit and Illicit Drugs" is a great place to start.) Also read everything in there by Dr. Robert Newman, especially "SQUARE PEGS IN ROUND HOLES." 

I know that this has been terribly presumptuous of me to suggest these readings and they are only the tip of the iceberg. But from what I see in these conservative "chicken shit" opinions [on the major ASAM and NIH websites], I feel that a whole area of debate is left out and my #$%@#&* life is at stake, and more importantly the lives of thousands of addicts to come.

My voice is only a cry in the wilderness, but your professional opinions could be the ones that break the critical mass of ignorance and fear. Maybe I'm wrong and obviously I'll be the one to pay the consequences. But if addiction medicine clinicians close mindedly go along with the Conservative Status Quo of "Detox'um and turn them over to god," I think that history will judge them poorly and this as a "Medical dark Age".

All the best,

Capt. Tim H. M.



Dr. DeLuca's Addiction, Pain, and Public Health website

Alexander DeLuca, M.D., FASAM

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Originally posted:  11/19/2001

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Most recently revised: 12/20/2004
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