LEND SUPPORT, NOT A FIRM HAND (2 OF 2)

To the Editor:

Re "For Addicts, Firm Hand Can Be the Best Medicine": As an addiction
psychiatrist, I would like to echo Dr. Sally Satel's ideas regarding
coercion and predictable consequences as a vital element of addiction recovery.

But remember that while regulatory boards, motivated parole officers
and legal diversion programs all involve successful coercion
strategies, they are time-limited, and addiction is a lifelong struggle.

In my practice, the most successful patients are the ones who are
fortunate enough to have families or support systems that are willing
to emulate the various agencies named above and to work closely with
a clinical team to set up realistic treatment goals, with
individualized consequences.

True, resistant addicts have a chance when coerced, but the ones who
feel safe enough to allow social and family network systems to be a
part of the overall treatment picture have a better chance of
developing the skills to police themselves -- and that is the
ultimate goal of recovery.

Scott Bienenfeld, M.D.

Manhattan