SCIENTIST AT WORK: A. THOMAS MCLELLAN

Addiction on 2 Fronts: Work and Home

WASHINGTON -- His son had been dead from an overdose only three
months when A. Thomas McLellan, among the nation's leading
researchers on addiction, got a call from the office of Vice
President Joseph R. Biden Jr. Would he accept the nomination to be
the government's No. 2 drug-control official?

Dr. McLellan, 61, makes no secret of his cynicism about government --
"I hate Washington," as he put it in an interview -- and he had no
intention of leaving his job as a professor of psychology at the
University of Pennsylvania School of Medicine and scientific director
of the Treatment Research Institute in Philadelphia.

But the loss of his younger son, who overdosed on anti-anxiety
medication and Scotch last year at age 30 while his older son was in
residential treatment for alcoholism and cocaine addiction, changed
his perspective.

"That's why I took this job," said Dr. McLellan, who was sworn in as
the deputy director of the Office of National Drug Control Policy in
August. "I thought it was some kind of sign, you know. I would never
have done it. I loved all the people I've worked with, I loved my
life. But I thought maybe there's a way where what I know plus what I
feel could make a difference."

Married to a recovering cocaine addict, Dr. McLellan has been
engulfed by addiction in life and work. His own family has been a
personal battleground for one of the country's most complex and
entrenched problems, while as an expert he has been a leading voice
for the idea that addiction is a chronic illness and not a moral issue.

This view squares with that of his boss, R. Gil Kerlikowske, a former
Seattle police chief who declared on taking office as drug czar in
May that President Obama's administration would no longer use the
term "war on drugs" -- and that the term implied the government was
waging a battle against its citizens.

Instead, the two men say the government needs to change its
drug-control strategy, redirecting some of the resources into
prevention and treatment and away from law enforcement and
antitrafficking efforts, which consumed 75 percent to 90 percent of
the budget during the Bush administration.

Dr. McLellan said that of the 25 million substance abusers he
estimated were in this country, only about 2 million were receiving
treatment. He and Mr. Kerlikowske want to triple that number, partly
by spending more money and partly through other tactics, like
integrating addiction treatment into the primary health care system.

Many veterans of the long and frustrating fight against addiction say
it is about time. "This is an extraordinary moment of opportunity,"
said Dr. Nora D. Volkow, director of the National Institute on Drug
Abuse and one of the colleagues and friends who helped persuade Dr.
McLellan to take the job.

Still, even Dr. McLellan's most ardent supporters say the challenges
are formidable. The federal drug-control office can do only so much,
and the Obama administration decided the drug czar would no longer be
a cabinet-level position. State and local governments, law
enforcement agencies, the health care system and schools are all big
players. And taxpayers tend to have little sympathy for addicts or
for treatment programs with track records that are mixed at best.

"I can tell a state legislator that if you would only provide
treatment for these guys, we'd have the greatest reduction in crime,"
said Joseph A. Califano Jr., chairman of the National Center on
Addiction and Substance Abuse at Columbia University. "But those
constituents want computers in the schools, better roads, better
sewage systems."

Mr. Califano, who was been involved with government efforts to combat
the drug problem since the days of President Lyndon B. Johnson, said
that he had great admiration for the new leaders of the drug-control
office but that "you need a presidential commitment here."

"I think if Obama gave these two guys the spark, they would know how
to turn into a fire," he said.

The office is preparing its drug policy strategy, to be released in
February along with Mr. Obama's budget. "We are going to get the
money to do this," Dr. McLellan insisted. "I can't tell you the
amount or where it's coming from, but we're going to get it."

The drug czar himself, who has made passing reference to his adult
stepson's struggles with drugs but does not discuss it openly, was
more cautious, as he tends to be.

"I think for some folks, radical change will be their only measure of
success," Mr. Kerlikowske said in an interview. "I don't think we'll
see that. I think we'll make a lot of progress, we'll slow the
freighter down and start turning it in the direction of the more
balanced view."

The two make an interesting pair -- the former police chief who has
plenty of experience parsing words with reporters, and the
plainspoken, quirky and mustachioed psychologist who says "ain't" and
"yeah," and whose candor can make Washington insiders nervous.

Dr. McLellan, who has written or collaborated on more than 400 papers
on addiction, is well known among his colleagues and friends for both
his passion for the subject and his bluntness.

In a recent interview in his office here -- still sparsely decorated
except for a photocopied picture of his family, including his
surviving son and two young grandsons (or "grand felons," as he
called them) -- Dr. McLellan put his feet up on the coffee table and
declared, "I hate this job."

"This is a job that needs scientific background," he went on. "But if
you come to it with the kind of desires to turn everything into a
scientific experiment, you will have your poor little heart broken."

Despite Mr. Kerlikowske's insistence that putting more resources into
prevention and treatment does not mean the government is going soft
on crime, such policies are bound to be controversial. Conservatives
point out, for example, that drug treatment and detoxification
programs have relapse and dropout rates as high as 80 percent or 90 percent.

"I'm not sure the federal government has an obligation to try to
rehabilitate addicts," said Heather Mac Donald, a senior fellow at
the Manhattan Institute, a conservative policy research group.
"Government has an obligation to provide safe streets to people, and
policing has an extremely effective track record in places in like
New York City and Los Angeles."

Dr. McLellan grew up in Mechanicsburg, Pa., and while his family was
"riddled" with addiction, he says he wound up in the field almost by
accident. He said that while he drank, he was "constitutionally unfit
to be an alcoholic," and therefore did not have what he and many
others consider to be a genetic disease.

He earned his doctorate in experimental psychology, with a focus on
animal learning, from the University of Pennsylvania in 1976.

"You've undoubtedly -- I think almost every American has read my
Ph.D. thesis by now," he said. " 'Negative Autoshaping in the Rat,
Cockroach, Pigeon and Crayfish.' And armed with this kind of
knowledge and obvious preparation for the business world, I was
shocked to find that there weren't many jobs available."

So he went to the veterans' hospital in Coatesville, Pa., to see what
was available. He was offered a job as a technician to evaluate the
effectiveness of one of the nation's first drug and alcohol
rehabilitation programs, and that led him and a team of researchers
to develop the Addiction Severity Index, now established as a
standard assessment tool for drug and alcohol abuse.

In recent years, Dr. McLellan has focused on the lack of addiction
screening in primary health care settings like doctors' offices and
emergency rooms. For example, he said, just as with hypertension or
diabetes, there is a concrete way to measure whether someone has an
alcohol problem.

The measuring stick is known as "3-14" -- so if someone is having 3
or more drinks a day, or 14 per week, that should raise a red flag,
and physicians should be much better equipped to intervene and offer
treatment options if there is a problem. Ideally, Dr. McLellan said,
that treatment would be available in the medical system itself, not
segregated in rehabilitation and detox programs, with their high failure rates.

He said another goal was to get a better handle on measuring the use
of drugs and alcohol by those under 21, the time of highest risk for
the onset of addiction. His younger son was in eighth grade when he
began to struggle with addiction, and by then Dr. McLellan was a
prominent researcher in the field.

"If it has to happen, better it happens to me, I'm an expert, right?"
Dr. McLellan said. "I didn't know what to do and none of my buddies
knew what to do, and let me tell you they were experts. So I said,
'What the hell are we doing?' "

That prompted him to start the Treatment Research Institute to
evaluate addiction treatment. But both of his sons continued to
struggle with addiction.

Dr. Volkow, of the national drug-abuse institute, said the death of
the younger son "epitomized how unprotected people who are addicted
to drugs are, even with that father." Of Dr. McLellan, she added,
"He's an absolute true warrior in the best sense of the word."

The older son is doing well now, and the two enjoy working together
to restore houses and sell them. "Maybe when I get out of here, I'll
do more of that," Dr. McLellan said.

Then he quickly added, "There's a lot of need for drug-free housing."