ADDICTION HUNGRY

In "Hungry for the Next Fix" (May), Stanton Peele writes, "The main factor
in successful resolution of a drug or alcohol problem is the ability to
find rewards in ordinary existence and to form caring relationships with
people who are not addicts." What a bunch of touchy-feely crap!

As someone with personal experience with addiction, I can tell you why I
used to drink and smoke too much: I liked it! It had nothing to do with
"caring relationships" and everything to do with how it made me feel.

I loved booze from the first sip. My boss, on the other hand, has two
drinks and starts to feel queasy or sleepy. A drinker he ain't. Since
alcoholism runs in my family, and not his, I have every reason to believe
those studies that show a genetic link at the root of some, if not most,
alcoholism.

This suggests a chemical cause and justifies the search for a
pharmacological solution, the "magical elixir" that Peele disparages. Maybe
naltrexone doesn't work for alcoholics, and certainly methadone is a poor
substitute for heroin, but the effort is scientifically justified.

Peele argues that psychotherapy, in particular an approach he calls
"motivational enhancement," does as much good as attempts to induce total
abstinence. While this may be true, before I believe moderation is an
effective treatment for alcoholics, I will have to see studies that have
multiyear follow ups and studies where the results are not dependent on the
responses of the subjects being studied. After all, what sort of answer can
you expect from the "Are you still beating your wife?" type of question?

I will tell you one thing about abstinence: It works. I haven't had booze
for over 13 years, cigarettes for over 10. It's hard to implement but easy
to maintain. Moderation, on the other hand, is easy to implement but hard
to maintain. Let me give you an example: We all know people who have quit
smoking, but how many people do you know who have gone from two packs of
cigarettes a day to half a pack -- and kept it there? Or from a pack a day
to just two or three cigarettes a day? Nice in theory, but almost
impossible in practice.

If Peele is advocating moderation therapy as better than nothing, no one
would disagree. But I don't think that's what he's preaching. He's
preaching that abstinence is too tough, so don't even try it. Instead, put
yourself in the hands of your friendly, trained psychologist. This might
work for alcohol abusers, but not for the addicts, where loss of control is
a given. "One is too many, a thousand not enough" is all too true.

Peter V. Burrows Waupaca, WI
------------------------------------------------------------- I could
not possibly correct all of the selective uses of facts and
misinterpretations in Stanton Peele's article without writing an article
possibly longer than his, but here are some examples.

Peele completely ignores all of the rather extensive evidence for a genetic
basis for addiction, especially alcoholism. He freely commingles facts
related to drug dependence and abuse with addiction. They are three
different conditions.

Peele severely distorts the views of Drs. Leshner and Gordis by saying that
they believe that addiction should be treated primarily with drugs. This
level of nonsense can only be due to willful lying or pathological
ignorance. The idea of treating addiction with medicines is an area of
research, but it is nowhere near a reality. When it does become a reality,
it is not expected to obviate the need for treatment.

Peele completely ignores the fact that recommended treatment includes four
of the five ingredients that he mentions: identifying the problem, getting
the addict to believe that change is possible, making the addict
responsible for carrying out changes necessary for his recovery, and
letting addicts know that they have many people to support them on their
path to recovery.

Peele is wrong that reducing substance use -- as opposed to abstinence --
is a viable treatment. Studies have shown that 2 percent or less of addicts
can ever again use their addictive drug normally. Encouraging an alcoholic
to drink is like giving someone who has an allergy to penicillin a week's
worth of the drug and saying, "Here, take this, but just don't get a rash
or stop breathing."

Finally, Peele confuses harm reduction with the real goal of treatment,
which is to teach addicts how to have a good life. Those of us in the field
of addiction medicine want the best for our patients, not just a little
less misery.

James T. Hamilton, M.D., J.D., FAAFP

Newport Beach, CA