DON'T POLITICISE DRUG DEBATE

MANY college members are concerned by recent reports in your newspaper
about addictive disorders in general and naltrexone in particular.

These addictive disorders are complex in the extreme, embracing the abuse
of a wide variety of legal (alcohol and prescription drugs) and illicit
drugs, of which heroin is one.

There is no simple solution to any of them and no single treatment for all.
Heroin addiction is no exception. Individuals suffering from these
disorders should have access to a holistic approach involving a full
assessment of the individual and his or her condition and the opportunity
to explore all treatment options. Management needs to be comprehensive,
involving biological, psychological and social treatments and to have a
long-term focus.

The assessment should include careful evaluation of each individual's
mental state, searching particularly for underlying psychiatric disorders
frequently present in addictive disorders and equally in need of treatment.
The lifetime risk of coexisting alcohol use disorder and mental illness is
35 per cent, and for illicit substance use and a coexisting illness, about
30 per cent.

New treatments in the form of a variety of anti-addictive drugs are being
developed and evaluated. As is true for all medications, naltrexone needs
to be subjected to careful and continual evaluation to ensure that best
practice is in place and deaths caused either directly or indirectly by
these medications are eliminated.

The treatment and management of people with addictive disorders should not
be jeopardised by the politicising of the issues and the conflicts that
never seem far away. The whole thing is far too complex.

Dr JOHN POUGHER, consultant psychiatrist, Social and Cultural, Alcohol and
other Drugs Section of the Royal Australian and New Zealand College of
Psychiatrists, WA Branch.