Los Angeles Times, Sunday, January 26, 1997, p. M5
Don't Reward What Doesn't Work
Addiction: Harvard honors the U.S. drug czar and others for pursuing failed treatments. Are we ready for contrary messages?
At a conference in March titled, "Treating the Addictions: What Works," Harvard Medical School will present its 1997 Norman E. Zinberg Award for career achievement to Gen. Barry R. McCaffrey, America's drug czar. McCaffrey will share the award with former Sen. George McGovern.
Zinberg was an iconoclastic Harvard drug researcher. He found that how people used drugs, even powerful drugs such as heroin, depended on their expectations ("set") and environment ("setting"). In properly supportive circumstances, Zinberg showed, drug users don't become addicted or they can cut back or quit drugs on their own.
Zinberg also attacked irrational and inhumane American drug laws, suggesting in their place less hysterical, less punitive measures. For McCaffrey to receive an award named after Zinberg is to turn Zinberg's views on their head. McCaffrey campaigned against and is still fighting California's Proposition 215, which permits doctors to prescribe marijuana for medical purposes.
McCaffrey directs a national drug policy that involves more antimedical and inhumane measures than his opposition to medical marijuana. The United States is the only Western country that does not include needle exchange in its drug policy. In every other nation, the provision of clean needles to drug addicts is encouraged as a way to prevent the spread of AIDS.
In August, the prestigious international journal Addiction carried an editorial analyzing Britain's remarkable success in preventing HIV infection among intravenous drug users. Britain accomplished this with a public health policy called "harm minimization," the critical element of which is needle exchange.
Another commentary in the journal compared drug policy in Britain and the U.S., where HIV infection among drug users is epidemic. Needle exchange programs are rejected in the U.S. due to the predominant just-say-no mentality, which views them as immoral. The commentary noted: "Enthusiasm for prohibition survives as a form of national denial [in the U.S.], tragically ensuring the continuation of the shooting galleries which perpetuate the epidemic."
McCaffrey's scheduled speech in March is to be titled, "What Works on a National Level." Needle exchange has been found to work not only by British authorities, but by such prestigious U.S. research bodies as the Centers for Disease Control and Prevention, the National Research Council and the Institute of Medicine. McCaffrey and other public figures in the U.S. nonetheless reject what has been shown to work in favor of pursuing a policy that kills addicts.
The other 1997 Zinberg Award winner, George McGovern, has had a distinguished career in politics but not in addiction research or treatment. His contribution to the addiction field was his 1996 book about his alcoholic daughter, Terry, who died of exposure while drunk. We sympathize with McGovern and his daughter's pain. But this does not make him an addiction expert.
In fact, Terry McGovern had been through treatment many times as she alternated between sobriety and binge drinking. Psychiatrist George E. Vaillant, who is also to be honored at the Harvard conference, operates an alcoholism treatment program that doesn't work. Vaillant won the first Zinberg Award for his book "The Natural History of Alcoholism," in which he assessed the hospital alcoholism program he directed. Vaillant reported that "there is compelling evidence that the results of our treatment were no better than the natural history of the disease." That is, Vaillant's patients fared no better than untreated alcoholics.
One presentation at the conference, titled "What Works Best Is What We Do Least," reviews the evidence on alcoholism treatments.
The effective treatments are not the disease-based ones that dominate American treatment, the kind that Terry McGovern was exposed to and that Vaillant practices. The effective programs teach people life skills and enhance internal motivations to change, rather than convincing them they are lifelong alcoholics whose condition is incurable and who will relapse should they cease to be dependent on treatment.
Harvard's presentation of awards to these three prominent individuals will apparently accomplish important political goals. But it will not tell addiction professionals how to deal better with addicts and alcoholics. The United States is not ready to hear these messages.