PROFESSOR ADDRESSES ADDICTION IN IRAQ

Keith Humphreys spoke no Arabic. He also knew little of Iraqi culture.
Nonetheless when offered a position as the lead U.S. adviser to Iraq on
addiction issues, he decided to take on the challenge.

"I'm of the belief that if you want to be useful, when opportunities come
along, you have to take them," Humphreys said.

An associate professor of psychiatry at the Stanford University School of
Medicine, Humphreys specializes in addiction.

But he was still surprised to learn that stigmas around addiction are
reversed in Iraq, compared to the United States. While heroin and opium
usage are accepted, alcohol is not.

And he discovered that Iraqi doctors have far fewer resources for dealing
with addiction than American physicians. In general, the Iraqi health care
system is in disarray. Approaches toward mental health care lag far behind
that of the Western world.

So Humphreys says much of what he's doing is "small deed democracy." That
is, he's supporting his Iraqi colleagues in whatever way he can as they try
to piece together a new health care system and play catch-up to modern
medicine.

Q What is your role as the addiction adviser to Iraq?

A I just wanted to be helpful in any way that I could. I guess that's
probably what my role is. I'm helpful in any way that I can be. Sometimes
it's been things like giving them advice in how they should spend money for
their budget, or telling them about medications that have been developed
for addiction that they didn't know about. Or the importance of policing
the borders. You probably know, but most of the world's heroin comes from
Afghanistan.

Q How have you been working with the Iraqis?

A In December, we had a meeting in Washington of principals, the lead Iraqi
and American mental health people. That's where the plan came together that
we wanted to have an annual mental health conference in Iraq.

The original hope was it would be in Iraq. But they had some concerns about
safety. Doctors are assumed to have money, so they can become targets for
kidnappers.

They moved the March meeting out of Baghdad and into Amman, Jordan.

We were arguing in the group, as people will do. This one guy was really
quiet during the two days, but he talked to me afterward and he said, "So
you guys just argue and then you go home," and I said, "Yeah, that's
right." And he got this big smile on his face and he said, "That's wonderful."

I asked people why it was such a big deal. They told me this famous story.
At some point during the Iran-Iraq war, Hussein called a cabinet meeting.
He said, "Tell me your candid opinion of the war." The health minister
said, "Well, lots of Iraqis have been killed. Maybe we should pull back.
Maybe we should step aside until this blows over." Hussein said, "Thank you
for your opinion," and then he had the guy executed immediately.

The Iraqis have all heard this story. It's all part of the legend of Saddam
Hussein. If that's the most powerful doctor in the country, if that can
happen to him, then you have no protection.

Q What was the most surprising thing that you learned about addiction?

A They think alcohol is worse than drugs. There would be these disconnects
when I would talk about (alcohol) services. They had this really negative
reaction. They would say there is no alcohol abuse in Iraq. But they had no
problem saying that lots of people are smoking opium and taking
benzodiazepines on the street.

Q What is the stigma associated with alcohol?

A It goes back to the Quran. You're not supposed to be under the effect of
alcohol when you pray, and you pray five times a day. It's been a part of
Islamic teaching for 1,500 years.

Q How bad is the heroin problem?

A That's one of the more severe problems. Heroin and opium, both. Religious
pilgrims smoke it. They would never drink alcohol, but they have no
problems smoking opium.

Most people say the most widespread problems are prescription drugs.

If you wanted to go out in Baghdad and get pain pills, you could do it
pretty easily. You could get it from a pharmacy. You could get it from the
street.

Q What was your advice to the Iraqis? They must have a limited budget,
limited resources.

A Their mental health system is like our mental health system was 40 years
ago. It's like the old state hospital system where you send your strange
old uncle up to the hospital and that's where he spends the rest of his life.

There are still not enough beds for all the patients. There are patients
who sleep on the floor. The guy who heads it says the average patient is
there for at least a decade. The staff doesn't even know all the patients'
names. There's only a very small number of psychiatrists for these patients.

One piece of advice coming from everyone is to try and build a modern
system around primary care. There are primary care centers being built all
over Iraq.

So there's that, and consultation stuff around the development of drug
laws. The draft laws were way too weighted toward law enforcement, the
lock-'em-up approach. It's just terribly ineffective. Who knows whether or
not they will listen, but I encouraged (the Iraqis) to develop an alcohol
and tobacco policy, as well as drug laws. But I don't think that it has
gone very far.

Q Is there enough methadone in the country for heroin treatment?

A No. That was one of the first things I brought up. You can imagine the
problems of trying to run a methadone program. The pharmacy system is not
secure enough to do that.

What I've been trying to do, I'll be taking with me Arabic Narcotics
Anonymous materials to Jordan. It's been Arabized and Islamized. I'm trying
to get long-term support for addictive people.

Q How would you start an NA program?

A They are Arabic pamphlets for patients and how to run an NA meeting. All
I can do is give them to them. I've presented all the evidence about it,
and of course, everyone likes the fact that it's free. You can start
running groups, ask people to meet. I think that would be a great legacy.

Q Would you say that the doctors are discouraged or excited about doing
something different with regards to rebuilding their health care system?

A First off, everyone is so happy that Saddam Hussein isn't there any more.
The idea that this is a new era is exciting to everyone.

But there are also people who find that frightening. The decisions you make
will be more consequential. There are people who aren't quite ready to step
into those roles because they're so beaten down and oppressed under
Hussein, all they really know how to do is complain. It may take awhile for
them to feel you can do this, you have a right to do it, and now do it.

That's the whole thing, will there be a civil war? Will there be
restoration? If civil war happens, everything I'm doing is a waste of time.
But in Iraq, you have to take risks. Because if everyone sits back and
says, "As soon as it's all fine, I'll do something," it will never be fine.

* Name: Keith Humphreys

* Age: 39

* Title: U.S. adviser to Iraq on addiction, associate professor of
psychiatry at Stanford University School of Medicine, and staff member of
the Veterans Affairs Palo Alto Health Care System

* Location: Palo Alto

* Career: Humphreys has been a professor of psychiatry at Stanford since
2002. Before that, he was a visiting senior policy fellow for one year at
the Office of National Drug Control Policy for the White House. Humphreys
has also served as a consultant on addiction for the Substance Abuse and
Mental Health Services Administration within the U.S. Department of Health
and Human Services, as well as for Gov. Gray Davis.

* Education: Humphreys graduated from Michigan State University with a B.A.
in psychology in 1988. He went on to earn his Ph.D. in clinical/community
psychology from the University of Illinois in 1993.