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Old 12-23-2011, 10:39 PM
Ocean Ocean is offline
Join Date: Jun 2008
Location: US Northeast
Posts: 6,784
Default Re: Values Added: Refuted By Facts (Mark Kleiman & Harold Pollack)

In the other thread you said you would be interested in my thought about this diavlog, so here.

Pollack talked about his impression of the Russian drug czar's views of the problem of drug addiction. He explained that due to the risk of AIDS, rejecting alternative treatments such as methadone or suboxone or needle exchange programs is rather ridiculous. He also criticized the idea that methadone maintenance is like substituting one drug for another.

I pretty much agree with all those observations. The only caveat is that both positions are right. Methadone and needle exchange are the best programs if you know you won't be able to stop opiate addiction. It's a damage control measure. And it makes a big difference compared to the damage caused by intravenous heroin use, sharing needles, and all the social consequences.

On the other hand, methadone and suboxone are, indeed, about substituting one drug for another. The idea should be that once heroin use is no longer an option, the person will come off methadone and resume a drug free life. But, a lot of the time, that point isn't reached for years and years. I think that overall there has been a more active effort to taper people off methadone in the last decade or so.

Kleiman tried to make a point about the overall ineffectiveness of treatment. I quite wasn't sure what he was trying to get at, in part because Pollack kept interrupting him. I will assume that what Kleiman was trying to say is that if the person isn't motivated for treatment, the only treatment that will work is that which is based on punitive consequences of use. So, he seems to be pointing at motivation/ desire for treatment. And indeed, people who have strong addictions have to be motivated for treatment (developing skills to stay away from drugs in spite of the strong physiological urges to use, or the strong psychological craving for a high/relief of some other unpleasant mental state), or coerced into not using.

The issue of motivation is key. Treatment programs try to give everybody an opportunity, because "you never know". And indeed, there is a balance between strength of addiction, external pressures, internal motivation, pre-existing skills, expertise of the treatment team, treatment approach and how treatment matches the needs of the person seeking it. But, the reality is that the stronger the motivation the more likely it is that there will be success.

Anecdotally I make the distinction between a highly motivated person, and someone who, well, is just bullshitting.

Person A: " I can't continue to do this. "X drug" is killing me. It's destroying my life and my family. I'll do whatever it takes to stop. I can't go on like this."

Person B: "Yeah, okay, I'll give the program a try. After all, I have nothing to lose. It would be nice if I could, you know, stop or cut down using "Y drug". It'll save me some headaches. I'm not doing this just because of my probation officer. The only problem I see, is that I don't know that I'll be able to make it three times a week. I have to get a ride, and my friend sometimes forgets, and I don't like to depend on public transportation. Taxis are expensive, and the bus leaves me on the other side of the mall... "

I think you get the picture. It would be rather easy to save resources to send person B to do some soul searching and come back when he/she's ready. But, person B is being mandated to treatment. The poor results seen in statistics about results of treatment are due in great part to people like this. Simply not ready, not willing to do what it takes. It would make sense to work on motivation first. Some programs have that preliminary step, others mix it with the rest of treatment. But in this situation, coercing person B into maintaining sobriety may be effective if maintained long enough and supported by ongoing treatment.

In terms of cost/benefits, I would have to defer to the discussants. I would imagine that they know what they're talking about and that indeed the cost is low considering the benefits.

Lastly, Kleiman mentioned in passing the situation in CA with medical marijuana. Indeed, this comes back to the discussion in the other thread, just to confirm that marijuana dispensaries are a joke.

Interestingly there wasn't much discussion about legalization. The conversation was about treatment and enforcement of prohibition. It would have been interesting and informative to have someone discuss the topic from the perspective of legalization, since it seems to be a recurring topic.
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