THE MANY FACES OF ADDICTION

With New Initiatives And Insights, A Problem That Exacts A Heavy Toll
On Lives And Society Comes Into Clearer Focus

Actor Robert Downey Jr.'s fall down the hole of drug relapse comes as no
surprise to those in the recovery field.

And that, they say, is what should be the news --- that effective treatment
continues to elude many of the nation's 14.8 million illicit-drug users,
whether they be famous, infamous or Joe Average Addict.

Today, the federal government plans to launch a National Treatment Plan
Initiative aimed at bolstering health insurance coverage for substance
abuse treatment and establishing standardized care for it.

"Treatment programs have a wide range of effectiveness," said Dr. H.
Westley Clark, director of the Center for Substance Abuse Treatment, a
division of the U.S. Department of Health and Human Services. The center
developed the initiative after six months of public hearings around the
country.

"We're hoping to create an effective, seamless system based on high-quality
programs proven to work," Clark said. "Research leads to good practice. If
we're spending a billion dollars in research on drugs, we want to make sure
that research reaches the streets."

Clark's plan will call upon private insurance companies to provide or
broaden what's known as "parity," or allowing for equal coverage of drug
addiction and mental illness on par with what is allowed for other
ailments. Another goal of the initiative is to change attitudes that
stigmatize those in recovery.

Drug or alcohol dependency is not a bad habit or a moral failing, Clark
said, but a physiological disease.

Currently, about $11.9 billion a year is spent to treat drug addiction,
Clark said.

But even having the luxury of time and money to spend at the nation's
premier private rehabilitation centers does not guarantee an end to the
addiction, as Downey, Darryl Strawberry, Joan Kennedy and a host of other
high-profile people can attest.

When it comes to recovering from an addiction, whether it be alcohol or
cocaine, each individual is different. Some may stay sober while others
relapse three or four times, and still others may end up battling addiction
like a chronic disease.

Relapses are common because an addict's brain gets essentially tricked into
wanting, needing and craving the pleasurable feelings that alcohol and
drugs provide. With PET scan technology, doctors have been able to track
the physiological changes in the brain through the cycles of abuse,
recovery and relapse.

Drugs that fall into the category of pyschostimulants, such as cocaine and
methamphetamine (Downey's choices), give the same sense of emotional
well-being as a grand meal, sex or other activities that provide us with
doses of euphoria.

"Cocaine taps into this naturally occurring pleasure center so you feel
compelled to do it again and again," explains Dr. Michael Kuhar of the
Yerkes Regional Primate Research Center of Emory University. Cocaine
addicts describe the rush as being like a whole-body orgasm, a tremendous
thrill to the body and brain.

Crack cocaine, the smokable version of that drug, has become one of the
most abused illegal drugs because it gets to the brain within seconds.

In describing his overwhelming urge for drugs, Downey told a judge last
year that it's "like I've got a shotgun in my mouth, with my finger on the
trigger, and I like the taste of gunmetal." Downey relapsed less than four
months after being released from prison and relaunching his acting career.

Cocaine addicts also don't yet have a substitute drug to help wean them
through their cravings, as heroin addicts do with methadone. But several
such compounds are proving promising, including one developed at Yerkes
under Kuhar's research.

Keeping triggers at bay while sober is one of the biggest challenges for
addicts, experts say. They can be encouraged to relapse by seeing old
friends, depression or even driving through a particular neighborhood.

"People with money have one of the biggest triggers at their disposal,"
said Dr. Andrew Spickard Jr., founding director of the Vanderbilt Institute
for Treatment of Addiction at Nashville's Vanderbilt Medical Center. "I
have a client who told me his major trigger is getting his paycheck."

Another trap in recovery can actually be the location of the treatment
facility, said James Cole of the Metropolitan Atlanta Council on Alcoholism
& Drugs.

"Metro Atlanta has several of its treatment programs located in high-use
neighborhoods," Cole said. "People that may have resource or transportation
problems who may not be able to afford a private center in the suburbs are
then exposed to the drugs and people they need to avoid."

To get help for drug or alcohol abuse, call the Metropolitan Atlanta
Council on Alcohol & Drugs, 404-351-1800 or 770-239-7442, or visit
www.livedrugfree.org.

Drug abuse by the numbers

An estimated 14.8 million Americans used an illicit drug in 1999, or 6.7
percent of the population 12 years old and older.

Marijuana is the most commonly used illegal drug, the choice of 75 percent
of current drug users. Fifty-seven percent of illicit drug users consumed
only marijuana, 18 percent used marijuana and another illicit drug, and the
remaining 25 percent used an illegal drug but not marijuana in the past month.

An estimated 1.5 million Americans used cocaine in 1999. That represents
0.7 percent of the population age 12 and older. The estimated number of
current crack users was 413,000 in 1999.

An estimated 900,000 Americans used hallucinogenic drugs, and 200,000 used
heroin.

Some 3.6 million Americans were dependent on illicit drugs in 1999, and 8.2
million were dependent on alcohol. Of these, 1.5 million were dependent on
both alcohol and illicit drugs.

An estimated 2.8 million people (1.3 percent of the population age 12 and
older) receive some kind of drug or alcohol treatment each year in the
United States.

Untreated alcohol and drug problems cost an estimated $166 billion annually
in the United States, for health care, criminal justice, social services
and lost productivity.

Sources: Substance Abuse and Mental Health Services Administration, an
agency of the Department of Health and Human Services; Hazelden Foundation
of Center City, Minn.