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Some folks really do like Alan Leshner:
Author: Miller, Jean Somers. Source: Issues in Science and Technology v. 17 no4 (Summer 2001) p. 8-9 ISSN: 0748-5492 Number: BGSI01167757 Copyright: The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibited.
In "Addiction Is A Brain Disease" (Issues, Spring 2001), Alan I. Leshner demonstrates his great skill at making complicated scientific issues readily understandable to the general reader. The advances in research he describes present great opportunities as well as challenges; as more is learned about the nature of addiction, the potential for treatment of this very, very difficult disease is tremendously exciting. The history of efforts to "cure" alcoholism and drug addiction was marked in the first part of this century by ineffective, if not harmful, treatments that bordered on fraudulent in some cases. As a result, many counselors became cynical about the search for a magic bullet to make the problem go away. They know from firsthand experience that changing the patterns of behavior involved in addiction requires hard, hard work on the part of the individual. These experiences produced, at some levels, a distinct bias against medication. As new opportunities for pharmacotherapy become available, the first challenge facing the field of addiction treatment will be to welcome the use of medications that could prove helpful to clients. In a field that has relied greatly on paraprofessionals and on philosophical and spiritually based approaches, extensive training and education will be necessary. By the same token, as treatment opportunities open, the need for a client to participate in the hard work of counseling and of changing how one lives will remain. Federal and state governments will soon authorize the dispensing of buprenorphine for treatment of opioid dependence by primary care physicians. The significance of this lies in the fact that the other medication authorized to date, methadone, has been dispensed only in highly regulated clinics. Although primary health care practitioners have not emphasized the behavioral aspects of disease in the past, they will have to do so in the future. The implementation of the use of buprenorphine will serve as a precedent for the use of other drugs as they become available. Public policymakers must be aware that the implications for change in practice come at a time when the addiction treatment field is facing many other challenges. The perceptions that addiction is the result of moral culpability and that treatment is not effective are two enduring misunderstandings that make obtaining adequate resources extremely difficult. In addition, major reforms in criminal justice, welfare, and child welfare have created new demands and pressures on the addiction treatment field. And AIDS and hepatitis C are tragic and costly health problems that fall heavily on the addicted. On the positive side, there are extraordinarily committed people who provide treatment. And we should all be grateful for the work of Leshner and other researchers, who are providing so much new insight and knowledge that can enhance our efforts to address this terrible personal and public health problem. Added material. JEAN SOMERS MILLER. Commissioner. New York State Office of Alcoholism and Substance Abuse Services. Albany, New York. More Leshner: JAMA interviews Leshner, March 2003 |