The formal announcement of Seattle police chief Gil Kerlikowske as Director of the Office of National Drug Control Policy (“drug czar”) will be made this morning. Thomas McLellan, one of the stars of the drug abuse and drug treatment research world, is reliably reported to be Obama’s choice for the Deputy Director post, but it’s not clear whether that announcement will come today.
McLellan teaches at the University of Pennsylvania and is the Editor-in-Chief of the Journal of Substance Abuse Treatment.
The following passage from a paper McLellan co-authored last year, will seem tame to most readers, but it makes me want to sing and dance for joy:
•All AOD [alcohol and other drug] problems are NOT chronic, most do NOT have a prolonged and progressive course.
• All persons with AOD problems do NOT need specialized, professional, long-term monitoring and support — many recover on their own, with family or peer support; again, research is needed to identify who is most likely to need intensive, professional care.
• Among those who do need treatment, relapse is NOT inevitable and all persons suffering from substance dependence do NOT require multiple treatments before they achieve stable, long-term recovery.
These statements are (1) obviously true and (2) often denied by implication. Alan Leshner as Director of NIDA made the formula “Drug addiction is a chronic, relapsing brain disease” into a mantra, and the people wearing the “treatment works” buttons have been chanting it ever since.
Of course that claim is true by definition if you restrict the word “addiction” to the relatively rare chronic and relapsing form of substance abuse disorder. And it’s also true that people with addiction so defined, because they keep coming back for treatment, account for most treatment entries; the majority of substance abusers, who have the acute, non-relapsing form of the problem, mostly recover without formal treatment.
But while it’s also true that most of the volume of recreational psychoactives, licit and illicit, is consumed by those with problem use patterns — half of the alcohol in the U.S. is consumed by the 10% of the adult population that averages four or more drinks per day, year-round — it is not true that most of those people are “addicted.” A focus on treating addiction ignores the opportunities to encourage or nudge people whose substance abuse problems are not (yet) chronic to desist “spontaneously.” And the “brain disease” formulation was and is used, quite deliberately, to deny that drug abusers are moral agents, responsible for their choices.
This looks like very good news to me.
Update A top-flight drug treatment researcher who knows McLellan writes:
Tom is a first class health services researcher with excellent knowledge of treatment systems. He is tough and will not allow politics to get in the road of evidence.