DRUG ADDICTION IS PROBLEM ONE

We Can't Deal With The Myriad Diseases Devastating The Downtown
Eastside Until We Tackle The Underlying Cause

In the late 1980s HIV/AIDS disease started to appear in intravenous
drug users in Vancouver's Downtown Eastside.

Vancouver's medical health officer at the time, Dr. John Blatherwick,
called for funding for a needle exchange program as a means of
reducing the risk of addicts sharing syringes and thus spreading HIV.

Unfortunately, as our local NEP has never required an exchange of
"used for new" syringes and because up to 40 per cent of those
obtaining syringes from this "giveaway" program continue to share
their needles, the number of lethal syringes circulating within the
drug using community has increased, our communities have become
dumping grounds for used needles, and Hepatitis C and HIV rates have
skyrocketed to levels exceeding those in Third World countries.

With the AIDS epidemic no longer confined to individuals marginalized
by sexual orientation, and as the number infected with HIV escalated,
efforts were made to control the spread of this virus.

However, because the initial response to this epidemic was an attempt
to reduce the spread of the HIV disease itself, addiction was
considered a secondary problem.

Those with expertise in treating addiction disorders were not
consulted or given the opportunity to influence either the types of
studies done on the chemically dependent population living in the
DTES, or the types of treatment provided to these individuals.

Thus was born an enormous social experiment, now failing badly, that
leaves the very disorder which drives the spread of HIV disease --
drug addiction -- untreated.

Misconceptions about addiction disorders abound. It is not poverty
that causes chemical dependence; rather it is the addiction disorder,
and the compulsive use of drugs (including alcohol) that in many cases
cause the kind of crippling poverty seen in the DTES. Addiction is not
just a phase of development, it is an illness.

There is an enormous body of scientific/medical evidence which both
identifies and describes substance dependence disorders as well as the
treatment options that have proven effective in their treatment.

All mood-altering substances disrupt the function of the central
nervous system, the most evident manifestation of this disruption
being intense euphoria. In addition to the change in mood, however, as
drug use becomes compulsive, judgment and impulse control are
impaired, moods become unstable, and the stress of day-to-day living
becomes overwhelming.

As the addiction progresses, partnerships disintegrate and families
fall apart. Ultimately, the addict can no longer work and is faced
with a life of destitution.

When large groups of such individuals are drawn to one area because of
drugs and services that enable their addictions, and when the
situation is further complicated by an epidemic of infectious disease
and untreated mental health problems, the result is what has become so
readily apparent in the DTES.

Addiction is defined as the continuing use of drugs, accompanied by
problems caused by that drug use. Despite an awareness of the often
life-threatening problems caused by drug use, the addict cannot help
wanting to take drugs (intense cravings and compulsion) and thus loses
control of his/her drug use.

Left untreated, this addiction disorder causes extreme social
marginalization, institutionalization or death. Addiction is,
literally, a disorder where the brain wages war against itself. It is
a soul-destroying disease. These unvarying conditions associated with
addictive drug use are described in a formalized fashion in medical
textbooks and constitute the criteria which are used worldwide to
diagnose addiction disorders.

It is important to recognize that addiction disorders are clinical
entities unto themselves. They are not caused by other mental
disorders, although they may mimic any number of other mental
illnesses, including depression, schizophrenia, attention
deficit-hyperactivity disorder (ADHD), or bipolar illness ("manic
depression.")

Although addicts may well suffer from other emotional or mental
disorders such as those mentioned above, those conditions will not
respond to treatment unless the co-existing addiction disorder is
identified and treated aggressively.

As with many chronic diseases (diabetes, coronary artery disease,
asthma) there are no cures for addiction disorders. However, like
other chronic diseases, they respond well to treatment -- provided the
recovery efforts remain consistent.

Treatment options include counselling, intensive outpatient programs,
residential treatment, prolonged periods resident in support recovery
facilities, and participation in 12-step programs.

Although there may occasionally be a role for medications like
methadone, abstinence from all mood-altering drugs, including alcohol,
is the critical condition upon which further recovery efforts must
rest.

To suggest to an individual addicted to crack cocaine, and thus
suffering from an illness which is defined by an inability to control
drug use, that he or she now control or "cut back," or otherwise use
that drug in a safer manner, fails to recognize the fundamental
contradiction inherent in such a suggestion.

Recommendations of "controlled use" serve only to cause further
emotional, physical, psychological and spiritual damage, and may be
ultimately fatal.

There are no wrong reasons for an individual to enter into a recovery
program.

Nor is treatment reserved for those who want to go: Coercive treatment
- -- treatment in order to save a job or a marriage, or instead of jail
time -- can be effective. That such compulsory treatment is effective
in producing sustained recovery is well documented by regulatory
agencies overseeing the conduct of physicians, lawyers, pharmacists,
airline pilots, professional drivers, police officers and teachers.

Sustained recovery in more than 90 per cent of those coerced into
treatment, and closely monitored for periods of up to five years puts
a lie to claims that "treatment doesn't work." Such sustained recovery
delights the addicts and their friends and family.

Finally, as in any chronic disease, there are interruptions in
recovery, and episodes of non-compliance with treatment
recommendations that allow the disease to re-emerge.

Recovery is a long-term process, much akin to losing weight and
becoming fit. Setbacks do not constitute failure, either of the
treatment program, or of the recovering addict. These are commonly
part of the recovery process, and should indicate only a need to
re-examine the recovery program, and make modifications as necessary.

In the DTES we are once again dealing with a marginalized group, which
has been provided with "services" but no treatment, a place to inject
drugs, but limited access to detox beds, and advice on how to "safely"
use crack pipes and needles, but no instructions on what must be done
to abstain and build a life in recovery.

Given the magnitude of the problem now evident there must be both a
willingness on the part of the municipal, provincial and federal
governments to embrace a medical model of addiction and its treatment,
and a financial commitment to funding such treatment -- it will be
expensive -- preferably in a decentralized fashion so that the DTES is
no longer the focus of all our efforts.

Douglas Coleman is a Vancouver doctor specializing in addiction
treatment.