BRAIN'S WIRING MAY WORK AGAINST RECOVERING ADDICTS

Under Prop. 36, State's Drug Abusers

Get Shot At One Year Of Treatment

Madeleine started with marijuana and reds, then moved on to alcohol
and cocaine. For 28 years she used and abused drugs, losing her
marriage, children, and nearly her life in the process.

She tried to quit, many times. But always she found herself trapped in
the same heartbreaking cycle that ensnares many addicts: Get hooked,
get treatment, get better, and then embrace drugs all over again. It
is a painful circle that doctors and scientists are struggling to
treat -- and more and more, it is becoming part of public health care
in California.

From recent drug arrests of celebrities such as Robert Downey Jr. to
the very private struggles faced every day in Bay Area rehab centers,
the often circular web of drug treatment and relapse has long drawn in
doctors, counselors and patients trying to break the grip of
addiction. Now, as California embarks on a new way of dealing with
drug abusers -- treating them rather than jailing them -- the
uncertain science of healing addiction is getting new scrutiny.

Researchers have pinpointed ways in which drug use can cause major
shifts in brain chemistry and function, making recovery for some an
issue of biology as well as personal will. But several years after
scientists first discovered that changes in the brain undermine
attempts to get clean, it remains unclear why some people are at
greater risk of dependence -- and why some may never kick the habit.

``You're asking the million-dollar question,'' said Jack Stein, a
director at the National Institute on Drug Abuse. ``There's obviously
a lot of factors to look at.''

What is well understood is that relapse is common -- almost inevitable
- -- whether an addict is a privileged Hollywood bad boy or a former
Catholic schoolgirl.

Madeleine, who follows the Alcoholics Anonymous tenet that her last
name should not revealed, has been sober for 25 years -- but even she
still worries about the possibility of relapse.

``You're always an addict until the day you die,'' said the San Jose
grandmother, who now works as a drug treatment counselor. ``For people
who aren't addicts, it's hard to understand.''

Stars' struggles Disease hits some harder than others

Indeed, headlines have swirled around the addiction problems of
celebrities such as Downey Jr., baseball star Darryl Strawberry and
supermodel Kate Moss, stars with continual troubles over drugs.

For most, it just doesn't make sense that an award-winning actor and
talented baseball player would seemingly throw so much away, even
after undergoing multiple sessions of rehabilitation.

Downey seriously jeopardized his stint on the television sitcom ``Ally
McBeal'' last month after his second arrest on drug-related charges in
five months.

Strawberry, who is battling colon cancer, skipped out on an inpatient
drug rehab program -- and a chemotherapy treatment -- to go on a
four-day crack cocaine binge in March and April. Scheduled to appear
in court today to determine whether he violated his probation on a
drug-related conviction, he could face more jail time.

``It's just a sad fact some people are more heavily affected. Just as
with other diseases, some have a worse case than others,'' said Greg
Hayner, chief pharmacist at the Haight-Ashbury Free Clinic in San Francisco.

That drug addiction is being called a disease -- and has even been
likened to type 2 diabetes -- has raised more than a few eyebrows in
the public arena. Yet there is some scientific evidence to support the
assertion that drug abuse may alter brain chemistry, meaning that drug
relapse may have as much to do with physiology as with a person's
desire to quit.

Most scientists now believe that the brain of an addict is
fundamentally different from that of a non-addict.

In a landmark 1995 meeting in Virginia, more than 100 substance-abuse
experts declared drug addiction a disease of the brain. This concept
was adopted as treatment dogma with the 1997 publication of a paper by
the National Institutes on Drug Abuse.

What they've found is this: Initially, the chemical pathways of the
brain are not much affected by hard drug use, and the decision to take
the drugs remains voluntary. But at a certain point, the drug user
moves into a state of addiction marked by structural or chemical
changes in the cells within brain pathways.

These changes can persist long after addicts stop using drugs -- which
is why relapse is so common, according to neurologist Patricia Janak
of the Ernest Gallo Research Center at the University of
California-San Francisco.

George Koob, professor of neuopharmacology at the Scripps Research
Institute in La Jolla, agrees, calling drug addiction ``a chronic,
relapsing disorder.''

`It's not fair to argue that a drug addict is not responsible because
they have a brain problem,'' because it is every addict's decision to
take drugs, he said. But it is shortsighted to ignore the influence of
brain chemistry, he said.

To better understand relapses, addiction researchers are working to
more precisely identify the drug-induced changes in brain circuitry
that occur over time. They have found marked differences in
individuals' vulnerability to addiction -- and ability to kick the
habit.

Therefore, the vast majority of scientists support Proposition 36, the
California law set to take effect July 1, which requires that people
convicted of using or possessing drugs for the first or second time be
sent to community treatment programs instead of jail.

``Everything we try is useful,'' Janak said. ``Once drugs have
produced changes in the brain, we have to use everything within our
power to treat people.''

Current treatments, such as counseling sessions where advisers are
often recovering addicts themselves, offer innovative, although
imperfect, tools to assist the estimated 15 million Americans who
admitted to using illicit drugs in a 1999 survey. An estimated 3.5
million said they were dependent.

Although relapse rates are hard to calculate, it is estimated only one
in five addicts is able to quit the habit on the first attempt. And
that figure may be generous, said Alan Marlatt, director of the
Addictive Behaviors Research Center at the University of Washington in
Seattle. He estimates that two-thirds slip back into use in the first
90 days.

Taking control Emotions can trigger relapses

Most treatment programs teach addicts that access to drugs is one of
the greatest relapse triggers. To boost their odds of beating their
addiction, abusers are encouraged to change their environment,
avoiding drug-using friends and even moving to a new community if possible.

While those with deep pockets may have access to the best treatment
programs money can buy, they also have the financial wherewithal to
keep supporting a drug habit and therefore are not immune from the
dangers of relapse.

Celebrities such as Downey and Strawberry are ``like kids in a candy
store,'' Koob said. It isn't realistic ``to ask someone to stop taking
cocaine when they have bowls of it right in front of them.''

Emotions such as anger, anxiety and depression can also cause a
recovering addict to seek out drugs. Often, former users don't realize
how powerful that one little taste of drugs can be.

``There's a perception you have more control than you do,'' said
Marlatt, who has studied relapse prevention.

The stakes are high as California gears up for its change in dealing
with drug users. The state's new treatment programs, with an estimated
budget of $660 million over five years, are likely to give doctors and
researchers more insight into treating drug offenders and reducing
relapse rates.

Many in the field believe that a minimum of three months of treatment
is imperative. One or two years, they say, is best. Proposition 36
allows eligible offenders to receive up to one year of drug treatment
and up to six months of follow-up care.

If the state can show that its new drug treatment plan works, ``it
would change the whole national picture,'' Marlatt said. ``So it's a
big one.''