Introduction

Abstinence-oriented therapists and 12-step expounding "recovering" drug misusers rarely find common cause with opponents of the current War on Drugs. However, evidence can be found in the published literature that at least some members of both camps agree that pharmacological treatments for behavioral disorders, including drug misuse itself, are inappropriate and/or dangerous when given to those with current or past histories of excessive involvement with reinforcing psychoactive chemicals. The purpose of this paper will be to challenge the opposition to pharmacological treatments in this, subject population. Nonetheless, this paper will simultaneously utilize an antiprohibitionist perspective to argue that the punitive absolutism and vicious militancy of the drug warriors prevents the realization of the potential benefits afforded by compassionate use of the pharmacopeia. Thus, rather than a blanket condemnation of the pharmacological treatment of drug misuse, this paper will, after presenting arguments for the use of pharmacological treatments, examine the effect of prohibitionism upon this branch of research on and treatment of drug misusers. Finally, this critique will be used to develop suggestions to aid the sparse, but pleasing to this author, efforts of researchers and physicians whose activities reveal the counterproductive effects of the current antidrug hysteria even as they seek to provide pharmacological aid to those who truly desire to reduce or halt their own self-administration of recreational drugs.

Arguments of Advocates of Sobriety

The unusual agreement between some antiprohibitionists on the one hand, and abstinence-oriented therapists and 12-step expounding "recovering" drug misusers on the other hand, is a fragile communion easily disrupted by an examination of the motives for opposition to the use of pharmacological treatments of drug misuse. Advocates of sobriety argue that any use of psychoactive chemicals by the abstinent "recovering" addict puts the individual at risk of relapse," while the use of chemicals to aid initial cessation of recreational drug use prolongs a dependency on external chemicals at the expense of spiritual advancement obtained, at least in part, through suffering. One set of authors ended an overview of dependence on psychotropic drugs with a caution about "withdrawal under cover of some other pharmacological agent". These reviewers stated "a word of warning here about the substitution of one addiction for another. This has been demonstrated over and over again."5 They even went so far as to provide a figure which showed a never-ending circle where the introduction of a new drug was followed by first isolated, and then multiple, reports of dependence. After generalized acknowledgement of the problem, a pharmacological treatment of this dependence is introduced and the cycle begins anew. In a discussion of the use of benzodiazépines for anxiety, commonly prescribed to prevent the agonies of withdrawal from alcohol or other sedatives, 2,14 a physician stated flatly that "patients with a dependent history or a history of multiple drug abuse or alcoholism should not be treated with benzodiazépines."1 Another physician wrote that "for the individual recovering from chemical dependence, the most important rule of thumb with regard to lifestyle is no mood-altering drugs" (emphasis in original).4 In an editorial in Postgraduate Medicine, a physician opined,

"Alcoholism is by all definitions a chronic  disease...The treatment goal for those who  suffer the disease is sustained maintenance of productive sobriety. The ideal in  sobriety is best achieved with total abstinence from alcohol or any other mood- or mind-changing drug."6

Further support for this rejection of the use of psychoactive chemicals in the treatment of drug misuse was provided by two authors who claimed that "it has been accepted since the 1940s by alcoholics themselves, and more recently by treatment professionals, that the foundation of treatment for any addiction is abstinence from all potentially addictive chemicals."23 A different author decried the use of nicotine-containing chewing gum on the basis of an overheard conversation in which a woman asserted that without Nicorette a work place ban on smoking would have forced her to quit cigarettes. This eavesdropping physician claimed that this "side effect...make it more than just another casual drug in the long list of pharmacological agents that have become easier quicker and less-effective substitutes for thinking."28 The epitome of this adamant assertion of the inappropriateness and dangerousness of drug treatment for drug misuse or, indeed, any psychological problem displayed by a present or former drug abusing population is the book 500 Drugs the Alcoholic Should Avoid.34 While it may be  easy to dismiss inflation of danger in a lay text, even the recent scientific literature contains articles such as "Drug use in the chemically dependent: How to avoid relapse to addiction"23 and "Staying off the merry go round: Prescribing habits for recovering patients."4

Arguments of Antiprohibitionists

Antiprohibitionists must express their gratitude towards individuals such as Thomas Szasz 33 and Stanton Peele25,26 for stressing the lack of scientific support for the popular notion that drug use and misuse is a disease that requires professional help and life-long abstinence from all psychoactive chemicals. However, despite Peele's essentially correct assertion that most drug misusers eventually halt or reduce their intake without professional intervention, his opposition to the "current treatment binge" does make him a strange bedfellow with abstinence-oriented opponents of pharmacological aids to cessations or reductions of drug use. Libertarian antiprohibitionists might find cause to agree with Peele's opposition to pharmacological treatment of drug misuse when they think about the militant hysteria exemplified in a recent article with a title asserting that "NIDA (the National Institute on Drug Abuse) aims to fight drugs with drugs...A Manhattan Project for chemists".35 Antipsychiatrists like Szasz and Peele correctly object to the medicalization of deviance that increases the power of psychiatrists and other physicians to interfere in the personal choices of autonomous human beings. Antiprohibitionists influenced by Szasz and Peele are likely to object to pharmacological treatment of drug misuse on the grounds that it suggests a biomedical reductionism that emphasizes the determinist power of chemicals, rather than the choices of free women and men. Antiprohibitionists aware of the hypocrisy of the differential legal status of alcohol, nicotine and caffeine versus marijuana, heroin and cocaine may be excused when they think of legislatures and physicians consorting in an unholy alliance to compel individuals who want to self-administer some particularly reviled illicit recreational compound to instead take some physician-prescribed compound. Similarly, libertarian antiprohibitionists who rightly oppose the compulsory pharmacological treatment of "mental illness" can also be excused for opposing drug treatment of drug misuse when the NIDA publishes a research monograph which lauds the "compulsory treatment of drug abuse"" and scientific publishing firms put out books with titles such as The Psychopharmacology of Addiction,17 The Neuropharmacological Basis of Reward,20 and Molecular and Cellular Aspects of Drug Addiction.12 These titles do, indeed, imply an overemphasis on the role of purportedly irresistible biochemical processes in the etiology and maintenance of excessive drug use. In addition, drug warrior advocates of pharmacological aids to cessation provide numerous, and sometimes conflicting, rationale for pharmacotherapy, some of which dress up culturally-determined notions of "psychological dependency" and "brain damage" with a thin veneer of scientific respectability. The clearest example of this latter phenomenon are provided by the writings of Dr. Frank H. Gawin. Dr. Gawin makes the assertion that clinical and preclinical data creates "the foundation for a new hypothesis that clinical cocaine dependence was associated with sustained neurophysiological changes, but in brain systems that regulate only psychological processes — particularly, hedonic responsivity or pleasure — and therefore involved a true physiological addiction and withdrawal, but one whose clinical expression appears primarily psychological."9 Thus, libertarian antiprohibitionists may see the pharmacological treatment of drug misuse as just one more example of coercive applications of biomedical technologies by individuals with deterministic biomedical reductionist philosophies that do violence to individual autonomy.

Rebuttal to the Arguments of the Advocates of Sobriety

The above paragraphs reveal the disparate concerns underlying the common opposition to pharmacological treatments of drug misuse displayed by some antiprohibitionists on the one hand and by abstinence-oriented therapists and 12-step expounding "recovering" drug misusers on the other hand. This renders more difficult the task of the advocate of pharmacological treatment of drug misuse, since the advocate must answer the concerns expressed by each of these strange bedfellows. Fortunately, the concerns raised by abstinence advocates are relatively easier to dismiss than those of some libertarian antiprohibitionists. Abstinence advocates who feel that the disease of chemical dependency requires complete avoidance of all chemicals are curiously ambiguous about the use of nicotine, caffeine and even powerfully psychoactive prescription drugs, under some circumstances. Two authors who presented information about prescription and over-the-counter drugs that they feared could challenge sobriety actually constructed a table where caffeine and nicotine were listed as drugs that did not present a risk of "relapse in (the) chemically dependent"!23 They did not explain how the use of these stimulant drugs failed to present the same risk as other presently illicit stimulants, such as cocaine and damphetamine. Similarly, abstinence advocates who fear that "all intoxicating drugs were dangerous because the user was actually dependent on the phenomenon of intoxication and obtained it anyway available"23 seem remarkably willing to make what are blithely referred to as "medical exceptions". One abstinence-advocating physician has argued that over-the-counter and prescription products with small amounts of alcohol presented "no real problem".4 Abstinence advocates have also argued that the administration of narcotics and other central nervous system depressants for the purposes of surgery present no risk so long as a minimal dose is employed.32 Similarly, sedation during a heart attack has been proclaimed acceptable.23 Despite these medical exceptions, abstinence advocating opponents of pharmacological treatments of drug misuse return to absolutism when they fret about the "dependence potential and abuse liability of nicotine replacement therapies?"13 Such articles ignore the health benefits that accrue to asthmatic smokers who are able to substitute compulsive nicotine-containing gum chewing for the compulsive inhalation of hot globules of volatilized tar containing nicotine, carbon monoxide, etc.22

The lack of validity of abstinence-based arguments against pharmacological treatment of drug misuse is mirrored by the similar weakness of the argument that "recovering" drug addicts can never safely consume any psychoactive drug, even after decades of sobriety. One physician had even gone so far as to argue that hyperactive children of recovering parents should not be treated with methylphenidate, since "such a child may merely have his addiction, heretofore latent, kicked into full activity at a much earlier age.4 Stanton Peele has, of course, repeatedly pointed out the experimental evidence demonstrating the fallacy that alcoholics, let alone their offspring, must forever abstain from intoxicants.25,26 Similarly, scientific evidence clearly reveals that a variety of psychotropic agents 14,18 are helpful in the initial and the long-term treatment of drug misuse and other psychiatric difficulties in opioid abusers,16.39 alcohol abusers,2,31 and cocaine abusers.9, 10, 21 A review examined the published literature aimed at determining the degree of use and misuse of benzodiazepines by individuals labeled as alcoholic. It was discovered that the prevalence of benzodiazepine use was not higher among alcoholics than among other psychiatric populations. In addition, it was concluded that, despite the pronouncements of proponents of the concept of chemical dependency, methodological deficiencies of published reports made it impossible to assert that alcoholics were any more likely to misuse benzodiazepines than the general population.3 Thus, despite the passionate assertions of individuals who have found that abstinence works best for themselves, the scientific evidence belies the claim that the use of pharmacological agents to aid reductions or cessations in drug misuse are inherently inappropriate, and hence doomed to failure at best and the creation of new addictions at worst.

Rebuttal to the Arguments of Antiprohlbitionists

The misgivings aroused in some libertarian antiprohibitionists when they contemplate the use of pharmacological aids to drug cessation present a serious challenge to advocates of such pharmacotherapy. As mentioned above, the literature contains many examples of the unfortunate perversion of therapeutic interventions which have resulted from the differential prohibition underlying the War on Drugs. Militaristic metaphors, overinflation of the dangers of chronic use of illicit or illicitly obtained drugs, underestimation of the dangers of the chronic use of pharmacological aids to cessation, glorification of compulsory interventions, and deterministic biomedical reductionism abound. Whereas libertarian antiprohibitionists must continue to oppose these misapplications of science, they should also take comfort in evidence that the expression of their concerns has already had some positive impact. The remainder of this paper will be dedicated to demonstrating that certain members of the scientific community are working towards the use of pharmacological treatments to drug misuse in ways that need not be repellent to the ethics of libertarian antiprohibitionist. Finally, suggestions will be made as to how a further application of the ideology of libertarian Atntiprohibitionist can enable the full exploitation of the pharmacopeia.

One promising trend is reflected in the efforts of researchers and physicians who are presently investigating the use of pharmacological aids to the reduction or cessation of drug misuse. Libertarian antiprohibitionists rightly object to the sadistic insistence that complete abstinence from an individual's drug of choice is the only criterion for success of pharmacological intervention. However, a certain compassion for the subjective discomforts experienced during drug cessation is evident in recent efforts to find compounds that can reduce the "craving" for drugs such as cocaine.11 A physician advocate of pharmacological treatment of drug misuse nonetheless noted that "the heterogenous nature of patients with psychoactive substance abuse problems requires flexibility and sophistication in treatment design, with attention to biopsychosocial variables."7 These promising statements of concern provide evidence that the hegemony of deterministic biomedical reductionism among physician advocates of  pharmacotherapy of drug misuse is (perhaps slowly) giving way to a more compassionate concern for individual autonomy. Evidence for this happy possibility is provided in a recent publication that detailed the consequences of providing physicians with specific knowledge about how to determine the need for benzodiazepine treatment for alcohol withdrawal. When provided with information that enabled evaluation of the probability of life-threatening withdrawal symptoms, physicians drastically reduced the number of patients given benzodiazepines and simultaneously did a better job of ameliorating alcohol withdrawal symptoms in those few individuals who were given benzodiazepines.36 This reveals that the education, rather than mere indoctrination, of physicians can lead to a compassionate and judicious use of pharmacological aids to drug misuse.

Even better than these slight, yet hopeful, advances in the behavior of physicians, a powerful counter force to the present dominance of deterministic biomedical reductionism is being provided by the efforts of behavioral psychologists. A review of substance misuse training programs in graduate psychology programs showed that 'both abstinence and moderation training are included in many curricula as potential goals of treatment.”30 Unfortunately, psychologists are not presently allowed to prescribe pharmacological compounds to aid in the reduction or cessation of recreational drug misuse. However, this evidence of spreading acceptance of moderation as a treatment goal provides hope that reduced use (that is, moderation) will one day be included as unequivocally positive evidence of the utility of pharmacotherapy, even for presently illicit drugs.24 Books entitled Determinants of Substance Abuse: Biological, Psychological and Environmental Factors,8 and Learning Factors in Substance Abuse 27 provide evidence of a growing and direct challenge to the hegemony of deterministic biomedical reductionism that is now, but need not forever exert a corrupting influence upon the appropriate use of pharmacotherapy of drug misuse.

Remaining Tasks for Antiprohibitionists

Even while applauding the above-mentioned indications that pharmacotherapy of drug use need not by its very nature be antithetical to the concerns of libertarian antiprohibitionists, it is possible to remain distressed by the way the present militarism of the War on Drugs prevents the realization of the full potential of such treatments. There are at least three tasks that must be accomplished to insure that people who sincerely wish to reduce or halt any facet of their recreational drug use can take full advantage of advances in scientific understanding of the complex interaction between biochemistry and behavior. First, hard fought victories against deterministic biomedical reductionism must not be rendered void by an acceptance of a psychological determinism. Advances in the understanding of the biochemical basis of behavioral phenomena such as positive reinforcement and negative reinforcement have already led some to ascribe as much deterministic power to the subjective psychological experience of "craving'', as others have previously ascribed to the supposedly medical/biological concept of "addiction".38 Libertarian antiprohibitionists can advocate the use of pharmacotherapy for drug misuse once they have realized that these compounds can be used without recourse to deterministic biomedical reductionism. However, they must simultaneously be wary of the insults to the autonomy of drug users that can arise as the biological basis of psychological constructs are explicated.

The second task facing libertarian antiprohibitionists who advocate pharmacotherapy for drug misuse is to marshall resources against the compul-sory treatment of drug users. Psychiatrists realized during the last few decades that the evaluation of the efficacy of techniques for conversion of homosexuals into heterosexuals was rendered hopeless by the fact that these techniques were often forced upon individuals who had no desire to alter their sexual orientation. At present, rational discourse upon the efficacy of techniques to alter sexual orientation has become possible, simply because American psychiatry no longer views homosexuality as an illness requiring treatment, but instead provides help only to those egodystonic homosexual individuals for whom changing of sexual orientation is a persistent concern. Similarly, dispassionate evaluation of the utility of pharmacotherapies that punish drug consumption (Antabuse), block the reinforcing effects of drugs (Naltrexone), lesson the symptoms of drug cessation (clonidine), or treat psychiatric disturbances that may underlay attempts at self-medication (tricyclics, lithium, methylphenidate) requires that subjects in research experiments be well-motivated volunteers. It is presently recognized that incarcerated individuals cannot truly give consent to participation in biomedical or behavioral experiments. It should similarly be recognized that, in a country where even a single consumption of an illicit substance can lead to loss of employment and liberty, even individuals who "volunteer" for studies investigating the pharmacotherapy of the misuse of illicit drugs can not provide true consent. Psychiatrists have already made alterations in DSM-III criteria for what are referred to as "substance use disorders,'29 thus conceding that the accurate "diagnosis" of these "diseases" requires conceptual advancement. Libertarian antiprohibitionists who wish to explore the utility of pharmacotherapy of drug misuse can aid these conceptual advances by insisting that consideration be given to the idea that therapeutic intervention is inappropriate except in cases of what may be called "ego dystonic substance misuse".

The success of gay liberation in getting psychiatrists to officially convert homosexuality from disease into lifestyle choice should give hope to advocates of a pharmaco-liberation. Despite the appearance of monolithic stability given by the alliance of psychiatry, religion, law, and the scientific and lay press, psychiatry can be made to realize the folly and the insult inherent in compulsory intervention in the recreational activities of free citizens.

If this psychiatric enlightenment towards sexual activity can be extended to recreational drug use, it will be easier for libertarian antiprohibitionists to complete the third and most important task of their critique of pharmacotherapy of drug use. Prescriptions of liquid  methadone for intravenous heroin users, nicorette-chewing gum for cigarette smokers, and amantadine pills for smokers of "crack" cocaine all represent what some refer to as replacement therapies.15 Compassionate advocates of such treatments note that they do not lead to some chimeral drug-free existence, but are instead pharmacotherapies designed to "improve or restore functioning, to alleviate distress, and to prolong life"15 or lead to "improvements in general health".39 Libertarian antiprohibitionists must push advocates of replacement therapy to investigate the implications of the fact that, just as "the most effective pharmacological treatment for cocaine craving is cocaine itself,"38 the most effective replacement therapy for any drug is the drug itself. Antiprohibitionists long for the happy future when discrimination against someone for their choice of drug is considered by the law to be as inappropriate as discrimina-tion based on religion, age, nation of origin, gender or sexual orientation. Under those circumstances, pharmacotherapy of ego-dystonic misuse of recreational drugs can include new options involving manipulation of dose and method of administration of the individual's preferi:ed drug or drugs. Individuals unhappy with the personal and physical costs of inhalation of "crack cocaine" must be given the option of "low-cocaine" crack, just as a cigarette smoker truly concerned with the consumption of non-filter, high tar and nicotine cigarettes can now freely choose to purchase filtered, low tar and nicotine cigarettes. Those crack smokers who wish to completely halt their inhalation of the drug must be given the option of non-prescription cocaine-containing chewing gum, just as the ego-dystonic cigarette smoker can now resort to non-prescription chewing tobacco (even as the availability of nicotine-containing chewing gum is, inappropriately, restricted by a requirement for a physician's prescription). Marijuana smokers concerned about the pulmonary consequences of their activities must be given the option of edible confections with known THC content. Intravenous heroin injectors concerned about the threat of AIDS must be given the option of heroin that can be insufflated. Antiprohibitionists must work to see that the day comes when egodystonic drug users know that they have the option of personal experimentation with replacement therapies involving their own drug(s) of choice in alternate doses and/or methods of administration. Then, and only then, will it be possible to evaluate the true efficacy of pharmacotherapies for drug misuse that treat presumptive underlying psychological disorders, ameliorate the distress of drug cessation, block the reinforcing effects of recreational compounds, or even punish drug consumption.14.18

Arthur P. Leccese is a professor of psychology at Kenyon College, Gambier, Ohio 43022.

Footnotes

1. Ananth, J. Benzodiazepines: Selective use to avoid addiction. Postgraduate Medicine, 72, 271-276, 1982.

2. Castaneda, R. and Cushman, P. Alcohol withdrawal: A review of clinical management. Journal of Clinical Psychiatry, 50, 278- 284, 1989.

3. Ciraulo, D.A., Sands, B.F., and Shader, R.I. Critical review of liability for benzodiazepine abuse among alcoholics. American Journal of Psychiatry, 145, 1501-1506, 1988.

4. Eames, B. Staying off the merry go round: prescribing habits for recovering patients. Journal of the South Carolina Medical Association, 86, 4245, 1990.

5. Edwards, J.G., Cantopher, T. and Olivieri, S. Dependence on psychotropic drugs: an overview. Postgraduate Medical Journal, 60, 29-40, 1984.

6. Fleming, T.C. Sobriety at risk. Postgraduate Medicine, 68, 25, 27, 1980.

7. Frances, R.J. Update on alcohol and drug disorder treatment. Journal of Clinical Psychiatry, 49, 13-17, 1988.

8. Galizio, M. and Maisto, SA. Determinants of Substance Abuse: Biological, Psychological and Environmental Factors. Plenum Press, New York, 1985.

9. Gawin, F.H. Chronic neuropharmacology of cocaine: Progress in pharmacotherapy. Journal of Clinical Psychiatry, 49, 11-16, 1988.

10. Gawin, F.H., and Kleber, H.D. Evolving conceptualizations of cocaine dependence. Yale Journal of Biology and Medicine, 61, 123-136, 1988.

11. Gawin, F.H., Morgan, C., Kosten, T.R. and Kleber, H.D. Double-blind evaluation of the effect of acute amantadine on cocaine craving. Psychopharmacology, 97, 402-403, 1989.

12. Goldstein, A. Molecular and Cellular Aspects of the Drug Addictions. Springer-Verlag, Berlin, 1989.

13. Hughes, J.R. Dependence potential and abuse liability of nicotine replacement therapies. In 0.F. Pomerleau and C.S. Pomerleau (Eds.) Nicotine Replacement: A Critical Evaluation. Alan R. Liss, New York, 261-277, 1988.

14. Jaffe, J.H. Pharmacological agents in treatment of drug dependence. In H.Y. Meltzer (Ed.) Psychopharmacology: The Third Generation of Progress. Raven Press, New York, 1605- 1616, 1987.

15. Jasinski, D.R. and Henningfield, J.E. Conceptual basis of replacement therapies for chemical dependence. In 0.F. Pomerleau and C.S. Pomerleau (Eds.) Nicotine Replacement: A Critical Evaluation. Alan R. Liss, New York, 13-34, 1988.

16. Kleber, H.D. The use of psychotropic drugs in the treatment of compulsive opiate abusers: The rationale for their use. In B. Stimmel (Ed.) Controversies in Alcoholism and Substance Abuse. Hayworth Press, New York, 103-119, 1986.

17. Lader, M. The Psychopharmacology of Addiction. Oxford University Press, Oxford, 1988.

18. Leccese, A.P. Drugs and Society: Psychiatric Medicines and Abusable Drugs. Prentice-Hall, New York, 1991.

19. Leukefeld, C.G. and Tims, F.M. Compulsory Treatment of Drug Abuse: Research and Clinical Practice: N1DA Research Monograph 86. US. Dept. of Health and Human Services, Rockville, MD, 1988.

20. Liebman, J.M., and Cooper, S.J. The Neuropharmacological Basis of Reward Clarendon Press, Oxford, 1989.

21. Milman, R.B. Evaluation and clinical management of cocaine abusers. Journal of Clinical Psychiatry, 49, 27-33, 1988.

22. Mulry, J.T. Nicotine gum dependence: A positive addiction. Drug Intelligence and Clinical Plusrmacy, 22, 313-314, 1988.

23. Mulry, J.T. and Stockhoff, J. Drug use in the chemically dependent: How to avoid relapse to addiction. Postgraduate Medicine, 83, 279-290, 1988.

24. Newrnan, R.G. Methadone treatment: Defining and evaluating success. New England Journal of Medicine, 317, 447-450, 1987.

25. Peele, S. Can alcoholism and other drug addiction problems be treated away or is the current treatment binge doing more harm than good? Journal of Psyclwactive Drugs, 20, 375-383, 1988.

26. Peele, S. Diseasing of America: Addiction Treatment out of Control. Lerdngton Books, Lexington, MS, 1989.

27. Ray, BA. Learning Factors in Substance Abuse: NIDA Research Monograph 84. U.S. Dept. of H.H.S., Rockville, MD, 1988.

28. Richards, J.W. Cigarette smoking and nicorette gum. Aatnols of Internal Medicine, 106, 1013-1014, 1987.

29. Rounsaville, B.J., Spitzer, R.L. and Williams, J.B.W. Proposed changes in DSM-III substance use disorders: Description and rationale. American Journal of Psychiatry, 143, 463-468, 1986.

30. Schlesinger, S.E. Substance misuse training in graduate psychology programs. Journal of Studies on Alcohol, 45, 131-137, 1984.

31. Sinclair, J.D. The feasibility of effective psychopharmacological treatments for alcoholism. British Journal of Addiction, 82, 1213-1223, 1987.

32. Stimmel, B. Prescribing psychotropic agents in opiate dependency: the need for caution. Advances in Alcohol and Substance Abuse, 5, 121-133, 1985.

33. Szasz, T.S. Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers. Revised Edition. Learning Publications, Holmes Beach, FL, 1985.

34. Van Almen, W .J. 500 Drugs the Alcoholic Should Avoid. Hazelden Foundation, Center City, MN, 1983.

35. Waldrop, M.M. NIDA aims to fight drugs with drugs. Science, 245, 1443-1444, 1989.

36. Wartenberg, A.A., Nirenberg, T.D., Liepman, M.R., Silvia, L.Y., Begin, A.M. and Monti, P.M. Detoxification of alcoholics: Improving care by symptom-triggered sedation. Alcoholism, 14, 71-75, 1990.

37. Weiss, R.D. Relapse to coc,aine abuse after initiating desipramine treatment. JAMA, 260, 2545-2546, 1988.

38. Wise, R.A. The neurobiology of craving: Implications for the understanding and treatment of addiction. Journal of Abnormal Psychology, 97, 118-132, 1988.

39. Zweben, J.E. and Sorensen, J.L. Misunderstandings about methadone. Journal of Psychoactive Drugs, 20, 275-281, 1988.