Heroin addiction used to be called "the American disease." But no more. Starting in the late 1960s, it grew into a worldwide epidemic that shows no signs of abating and is, says Arnold Trebach, "enigmatic." No one knows why the epidemic began, no one knows how to prevent heroin addiction, and no one knows any magical cures for it.
Despite the title of his book, "The Heroin Solution," Trebach does not have an answer to the heroin problem. His aim instead is to trace the history of attempts to control the drug in this country and in England and to argue for more humility and more humaneness in our approaches to heroin addicts. He largely succeeds in this goal, writing a readable and fascinating book about a drug whose emotional connotation as "evil incarnate" complicates any attempts to deal rationally with it.
Trebach began his study of heroin in the 1970s, when as a professor at American University's School of Justice he looked into the Nixon administration's "war on crime." To his surprise, he found that not only was the government investing large amounts of money to control crime, but it also was using most of its drug abuse funds for treatment and prevention programs rather than for law enforcement.
As his interest in drug addiction grew, Trebach founded and served as the director of the Institute on Drugs, Crime, and Justice in England. As a result of this experience, he decided to write his book. But, he says, his guiding philosophy on the problem of how to deal with narcotics addicts was formed when his first wife died of cancer in 1976. When he and his two sons helped his former wife during her final days, he came to appreciate that "human beings seek . . . altered states of consciousness through every conceivable means."
One reason so many attempts to treat narcotics addicts have failed, Trebach argues, is that no one acknowledges that perhaps heroin addicts really need to feel high, that methadone maintenance, for example, simply cannot give these people the experience they desire. "At this point we have reached the same sensitive point we faced in regard to heroin and cocaine for cancer patients: Is it ethical for doctors to deliberately provide euphoria for patients? Few doctors would answer yes, but if we are to attract addicts to treatment, that must be society's answer," he writes.
As for the question of why heroin addicts need the drug to alter their consciousness, Trebach confesses that neither he nor medical experts know. Many heroin addicts suffer from depression, and some medical scientists have suggested that they are drawn to heroin as a form of self-treatment for this mental illness. Trebach notes that heroin addicts frequently are immature and unable to deal with minor frustrations or inconveniences. Perhaps that aspect of their emotional makeup is related to their addiction. He also notes that many addicts simply grow out of their drug dependency, giving up narcotics on their own.
"Heroin addiction occurs primarily in males in their twenties and early thirties. If they are given heroin by doctors during those periods of their lives, if they are given support in other aspects of their existence, more of them will come into treatment, more will stay over the years, and many if not most will mature out of their habits by age 35. Even in a worst-case scenario, in which hundreds of thousands of heroin addicts stubbornly persist in demanding legal heroin from doctors, decade after decade, they would be healthier addicts because they would be under medical and mental health care -- however much doctors might be repelled by their habits," Trebach writes.
Although for the most part such treatment of addicts has not been tried, there were a couple of successful experiments along the line that Trebach suggests. From 1919 to 1923, Dr. Willis P. Butler operated a clinic in Shreveport, La., in which patients were given narcotics, usually morphine, in whatever doses were necessary to enable them to live responsibly without turning to crime. Patients who were unemployed or who had no place to live were found jobs and housing. Those deemed able and ready to be weaned from drugs were hospitalized for detoxification. The Shreveport clinic, however, was forced to close down by federal narcotics agents.
In England in 1971, a Catholic priest, the Rev. Terence E. Tanner, operated the ROMA Housing Association which gave addicts apartments and cash loans to help them start living normal, responsible lives while on drugs. Their drugs were supplied by doctors. Tanner's reasoning was that "ROMA is not specifically concerned with educating its residents to live without drugs. We try to help them live with them." But, in 1979, ROMA too had to close down when British doctors changed their narcotics prescribing habits so as to make it impossible for the addicts to get maintenance doses of heroin legally.
Trebach notes that nothing in the history of worldwide attempts to control the heroin epidemic even hints that a true solution to the problem is in sight. But perhaps the best thing to do is to admit our ignorance and admit that "there is no explainable cause and no complete cure -- only amelioration, moderation, and middle level expectations." Our goal should be to reduce social harm and to try to contain the problem as much as possible