Former Assistant Drug Czar Slams the Medical Establishment

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Former Assistant Drug Czar Slams the Medical Establishment

By Dirk Hanson 05/04/11

Provocative Penn psychologist wonders what would happen if our health care system treated diabetics like it treats most addicts. Nothing good.

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Drug reform could end "bottoming out."
Photo via drugfree

Thomas McLellan, a psychologist widely recognized as one of the top researchers in substance-abuse treatment, served as the White House's deputy drug czar under current director Gil Kerlikowske, previously the Seattle police chief. But McLellan was always an uneasy fit at the law enforcement-oriented Office of National Drug Control Policy (ONDCP), and when the plain-spoken professor—who famously said, "I hate Washington," upon his appointment to the government post—returned to the University of Pennsylvania School of Medicine after only one year, few were suprised.

McLellan's research has focused not on the causes of addiction in lab tests but on treatments and measuring what works and what doesn't in the real world. He has also been outspoken in his promotion of  the view of addiction as a chronic illness. When McLellan quit as deputy drug czar last April, he was reported to have had no particular policy disagreements with the administration—but he found the bureaucracy and politics of the job very diagreeable indeed. 

Little has been heard from McLellan since his return to civilian life—he heads the Penn Center for Substance Abuse Solutions. But now, in an article for the Partnership at Drugfree.org entitled “Addiction and Segregation,” McLellan deftly lays out some of the current obstacles to better treatment, noting how frustrating it is that “so many of those who so obviously need care deny the existence of a problem.” Consequently, by the time many addicts finally get care, they “usually have serious, chronic addiction…and a much diminished chance of recovery." Then he asks (rhetorically): "Are these features specific to addiction, or would they be common features of any illness that has been systematically segregated by the medical community?”

Consider, for example, if the health industry treated diabetes like drug addiction: “First, insurance would restrict treatment only to the 'truly diabetic,' those who had lost toes or some of their vision. Prevention and early interventions so common in primary care would not be reimbursed and thus rarely practiced. Hence, most of diabetics entering treatment would be very overweight, have multiple co-occurring physical and psychiatric problems and a guarded prognosis.” As McLellan argues: “These are typically not the kinds of patients that health care professionals aspire to treat.” Soon these very ill patients and the segregated treatment settings set up for them “would come to define the illness of diabetes in the eyes of health-care establishment and the public at large; and it would not be a favorable image." From segregation it would be only a small step to stigma. "Individuals who were early in the course of diabetes would find it impossible to imagine that they had anything in common with those in treatment.”

McLellan's point? Addiction is defined not only by the behaviors exhibited by addicts, but also by the way the medical system relates to and treats addicted individuals.

But his brief is not all doom and gloom. He also points out that with the passage of the Parity Act and the new health-care reform bill, an end to the segregation of addicts and addiction treatment may be in the offing. Primary-care physicians and mental-health professionals will be reimbursed for providing prevention, early intervention, medications, and other services not only to addicts but to patients on the road to addiction. "Maybe patients won't have to 'bottom out' before they are willing to seek treatment," he says.

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