STAYING CLEAN

Peggy Orenstein's cover article "Staying Clean" drew praise from rehab
providers and former users confirming that, as reported, there is no quick
fix in treating addiction and no guaranteed cure. And Lauren Slater's
critique of self-esteem continues to pull in provocative mail.

As an addict in recovery, I found Peggy Orenstein's article (Feb. 10) on
drug treatment refreshingly clear-eyed. People take drugs and alcohol
initially because they choose to -- for fun or to provide escape from lives
with at least some elements of quiet desperation. But in some instances,
drugs rewire the bio-psycho systems to the point where the substance uses
the user. Genetics? Environment? Habituation? Poor character development?
Probably some of each, and each needs to be addressed in recovery.

James W. Greene

New York

Thanks for a thoughtful article. Drug rehabilitation works for many people,
but not all. When compared with the outcomes for other chronic, relapsing
diseases with behavioral components (diabetes, hypertension, asthma), the
outcomes of drug treatment are quite good. And like many chronic diseases,
addiction must be managed throughout the course of a lifetime and may
require periodic professional services.

An equally important component of addiction recovery is after-care. The
truth is that managed-care organizations and medical insurers rarely cover
the costs of effective addiction treatment, much less aftercare. That is
one reason that self-help groups like Narcotics Anonymous and Alcoholics
Anonymous continue to play such a vital role in supporting recovery from
addiction.

The statement that "the rehab industry remains largely unregulated"
requires elaboration, because most states have licensing requirements that
establish minimum standards of care.

Nick Hilger

President and C.E.O., Hazelden Foundation

Center City, Minn.

I was pleased to see Orenstein's article. However, as someone who has been
13 years in recovery and who has spent many of those years working with
addicts and alcoholics, I was disturbed to read that the healing community
still approaches addiction with a brutal self-righteousness that is almost
medieval. We live in a culture that still views addiction as a moral
failure. This is, as Orenstein suggests, inhumane. We are responsible to
one another for our common humanity at all times.

The Rev. Saigyo

Terrance Keenan

Monkton, Md.

Treatment professionals can applaud the skill with which Orenstein lays out
the dilemma of treatment today and the need for more government support.
Her article acknowledges the need to coerce addicts who would never seek
treatment on their own and recognizes that failing to succeed in treatment
is no barrier to subsequent success. Orenstein rightly points out that
staying straight depends primarily upon treatment length.

Mitchell S. Rosenthal, M.D.

President, Phoenix House

New York

Orenstein is right in asserting that research on treatment efficacy is far
from definitive. Addiction is, after all, driven by a complex set of
biological, emotional, social and genetic factors. Because of this
complexity, many with addictions may enter treatment two or three times
before they succeed in getting clean. Repeating treatment does not mean the
person or treatment failed.

Peter Provet

President, Odyssey House

New York

Many times since Sept. 11, I have said that winning the war on drugs is
every bit as critical as winning the war on terrorism. Drugs destroy
families and communities. They are every bit as insidious as Al Qaeda.

Margaret M. Lamb

Columbia, S.C

Your article describes triggers like certain smells, places or people that
can cause an addict to relapse. Readers may be interested to hear of a new,
highly controversial form of behavioral therapy called Exposure Response
Prevention. It exposes addicts to simulated versions of their drugs of
choice and to the equipment to prepare and consume them. Exposure to these
catalysts (bongs, rolling papers, coke spoons, etc.) can elicit powerful
cravings that addicts are taught to handle without giving in to them.

Joseph Santoro

Brewster, N.Y.