MUSIC
The facts on heroin addiction in Australia are hard to find.
No one really knows how many heroin addicts there are in Australia, or how much governments
are spending to try and rehabilitate them.
Treatment of heroin addiction ranges from the cold turkey therapy programs of Odyssey
House to the use of methadone as a substitute for heroin.
State governments are spending more and more money on methadone treatment, and there are
about 2,000 addicts now receiving methadone on government prescription.
But there are said to be at least 10,000 addicts in New South Wales alone.
What other treatments are they offered?
Odyssey House provides the most widely publicized drug-free therapy in Australia.
Odyssey bans all drugs in its treatment program, including methadone.
And its American founder, Dr. Judy Ann Denson-Gerber, prefers to go after the underlying causes,
as she sees them, of heroin addiction.
We are psychiatric.
We do not focus on the symptom.
Drugs are only the symptom.
You have to look for the person behind what has happened to that person, and what is that
person's makeup, because an individual is a product of their own genetic composition
and their environmental stresses.
Odyssey demands immediate withdrawal from heroin.
It's a harsh, and some say unnecessarily cruel, therapy that either makes or breaks the addict.
For kickoffs, you don't tear anyone's head off in here, because you...
No, you listen.
Because I don't like people throwing that sort of insinuation around,
give me what I want or I'll tear your head off.
Because you start running that crap and I'll throw you out.
The two Odyssey Houses in Melbourne and Sydney have taken about 4,000 addicts during the
last eight years.
But at best, only one out of ten who have been treated by Odyssey stay off heroin for good.
And yet Odyssey gets more than $2 million a year in government funds.
So can anyone really claim to have a cure for the heroin addict?
Do we give away more methadone, force addicts into withdrawal, or simply lock them away?
Well tonight in our Melbourne studio, we have two women who approach the heroin cure from
two different directions.
Dr. Julie Ann Denson-Gerber, a psychiatrist, and the world founder of Odyssey House.
Dr. Stella Dalton is also a psychiatrist.
She was responsible for introducing the methadone drug treatment into Australia in the first
place.
And she's director of the Paramata Drug and Alcohol Clinic.
Dr. Denson-Gerber, can I come to you first?
The Australian federal government and the government in New South Wales have both declared
themselves interested in expanding their methadone programs.
If Australia is going to go down that track, why doesn't Odyssey include methadone in its
program?
Well, first of all, the Odyssey program in and of itself is a therapeutic community based
on drug-free treatment.
Therefore, it would be inappropriate to include a methadone unit within that.
Certainly methadone can be used as another part of the armamentarium of treating addiction.
It is not, however, part of the modality of therapeutic community.
Is it incompatible with your kind of therapy?
It's incompatible with the...
How so?
Why is it incompatible?
No, no.
It is incompatible with a drug-free therapeutic community.
It is not incompatible with the therapeutic community that used replacement opiates.
The particular module that we have here in Australia is a drug-free therapeutic community.
Right.
So why do you find...
Why do you prefer to exclude it then from your form of treatment?
It just does not work with this particular module.
There are many different ways of treating addiction.
There are many different modalities for treating addiction.
These drug-free psychiatric long-term unit does not include in it drug replacement because
we do not feel you get the requisite anxiety or you get down to the basic underlying problems.
That's only one method of treating addiction.
Could I ask you, though, Dr. Dalton, first of all, you introduced the use of methadone
into Australia.
Mm-hmm.
What makes you so certain that it is the road down which we ought to go?
Well, I also started a therapeutic community.
I think it was about the same time as Dr. Denson-Gerber.
And I was running a therapeutic community which treated all forms of addictions.
And after three years, we did a follow-up study, and we found that the one group of
patients that we were getting absolutely nowhere with was the young herrin addict.
And truly, out of desperation, I looked for something else.
And I read up about methadone, at this time I only read up about it in the medical journals,
et cetera, and that's how I introduced it.
I found our results have been quite spectacular in comparison to what they were before.
And that's how I got into methadone.
And so what, in a decade and a half of its use in Australia, you have seen nothing to
lead you to another opinion?
Certainly not with the treatment of the opiate addict.
I think it's very interesting if I can just say and share with Dr. Dalton that I started
the other way.
I started with replacement therapy.
I started with methadone maintenance and something called cyclasazine replacement, which is an
antagonist rather than a competitor.
So I started first prescribing drugs for addicts and found that it did not really solve the
basic problems.
Perhaps we have to go still further back then, because I started in the United Kingdom prescribing
heroin for addicts.
From the United Kingdom, I wished to start a therapeutic community in Australia for all
forms of addiction.
And from that, I went on to methadone.
Can we just clear up one thing about methadone?
What is the prognosis for somebody who goes on it?
I mean, is there a point at which you can reasonably expect them to come off it, or
is it something you go on for life?
Is it like insulin, as some people describe it?
Well, it is like insulin in one way.
In other words, you can put somebody on methadone.
It is not a cure in itself.
During the time that the person is on methadone, they are able to live a normal life.
They're able to get new friends.
They're able to get a family, get work, study, do all sorts of things.
So in other words, they're free to do all these things.
They no longer suffer from narcotic hunger.
They're no longer obsessed with drugs.
What I find is that some people, after they have been on the program for a minimum of
three years, and depending on how much they have accomplished, that is to say, if they
really changed their lifestyle, got away from the drug subculture, have a new group of friends,
etc., have interest in life, then I find that over an 18-month period, you can take them
down very gradually, and you get a good recovery rate.
We've done our study on the first 50.
We have to date done two studies on the first 50.
We've done a three-year and an eight-year.
And in the three-year study, we found we had 12% off all drugs and leading a normal life.
And in the eight-year, we found a 28% recovery rate, which I think we will find now we're
doing the 12-year study is far too much.
I'm sure we'll find that a lot of those people have gone back and have relapsed and have
gone back onto methadone.
Now, for certain people, and I can give you some examples.
We have one of our patients is Chinese, and he has been on opiate since the age of 15.
What age is he now?
He's now about 60, I think.
Well, he obviously is going to be on methadone for the rest of his life.
And for other people who really are very hardcore drug addicts and just are not going to make
it, I think they should stay on it for the rest of their life.
Over the years, Odyssey House in this country and in the United States has attracted its
fair share of criticism for the style in which it tries to rehabilitate people.
It's been called confrontationist.
It's been called hierarchical.
You have been described as authoritarian.
In fact, I think on one occasion you even acknowledged that perhaps you were a little
bit authoritarian.
I call myself a benevolent fascist.
I accept that.
How does that work?
Why should it work?
Because it does offend a lot of people who believe that one ought to be more compassionate,
more kind, more caring, more sympathetic, more patient, more listening, if you like.
Well, none of the things that you have said go against having structure.
I look at the addict coming in primarily chaotic, living a chaotic and difficult life, needing
to have rules, needing to begin to learn to be socialized, because it's an asocial disease.
It's where you don't respect the needs and rights of the people to the right and the
people to the left.
And so we begin very much by saying that you have, if you were the addict, you have the
only person to gain from this thing, and you're going to have to learn to live in a community.
And that's why it's called therapeutic community.
You're going to learn rights and respects and not to step on other people and etiquette
and concern.
And we will give you that as long as you earn it.
But if you start in stepping on other people, those other people are going to tell you right
off where it's at, and they're people who've been where you're at, and they're going to
tell you the truth about yourself.
So basically you're trying to reorient or redevelop the person's individuality and self-motivation?
By challenge, by increasingly difficult challenge, by a sense of accomplishment, but also by
playing by rules, because part of what's gone wrong, Mr. Evans, in our society worldwide
is that almost no one plays by rules.
You said yourself that you don't play always by the rules that other people play by.
You've also, if I can remind you of an interview you gave to New York Magazine, which I think
you probably don't like very much, you're quoted there as saying, I don't need to be
liked.
These were in the days when perhaps you were slightly more flamboyant than you are now.
I wouldn't say I like people, you said.
I have very little pity, very little compassion, very little sympathy.
I think compassion is destructive.
That's an extraordinary thing for somebody purporting to provide a kind of therapy, to
say.
I don't think so, any more than a surgeon can go in when you have to operate an amputated
leg.
If you had compassion, you wanted to save that leg and you had to cut it off.
You have to be able to do that.
No one should treat addicts who cannot make demands.
No one should treat addicts who allow their own needs, their own needs to be loved, their
own needs to be liked, their own needs to get kadoos, to interfere with what the patient
needs.
So that our program begins first with diagnosis.
Right, and the diagnosis that you're looking for, you're looking for in terms of psychiatric
disorder.
That is correct.
We consider addiction a symptom of an underlying psychiatric disorder.
Well, let's spell out how you evaluate diagnosis in that sense.
Is that the way you approach it?
No, I don't.
I approach heroin addiction with the use of methadone, as I've said already.
Methadone does three things.
First of all, it removes narcotic hunger.
Secondly, it immunizes virtually the patient from all forms of opiates.
And therefore, if they take a shot of heroin, it has no effect at all.
And the net result is that it turns somebody who is a criminal, taking drugs all the time,
way out into a normal person.
We put them very slowly onto methadone.
It takes about six weeks once we've assessed them and seen them, or six weeks to two months,
going up very gradually.
And then we go through into what we call blockade.
And blockade is an AI.
If I may just explain this, when an ordinary person who's never taken opiates takes an
opiate, they go up from normality into a euphoric zone, and then they come down into normality.
When a drug addict takes a narcotic, he goes straight up into the euphoric zone, which
lasts a very short time, and then comes down into the withdrawal part because of tolerance.
So when somebody is on methadone, the whole idea is to keep them in the middle zone of
normality.
In other words, they're never euphoric, and they never go into withdrawals.
But how does that explain your perception of the problem as being, as I understand it,
a physiological problem?
Yes.
Well, I believe the answer to addiction will be found in the biological.
I must beg to differ with Dr. Dalton.
Since we now have three times as many methadone overdose deaths in five American cities, and
we have heroin deaths, it doesn't seem to answer the problem.
Since they do continue to use alcohol, they do continue to use barbiturates, they do continue
to use amphetamines, and methadone is only a blockade for opiates, we have not seen any
lessening of the addictive use of drugs.
We have only seen a switch from using opiates if they're blockaded to using other drugs
that are equally or more dangerous.
Just let me ask you this.
When you say you're seeing methadone deaths in the United States, how do you know that
they are, how are they measured?
My husband happens to be the medical examiner of the city of New York.
How is it determined?
How do they know that it's that?
When they die, there is a classical overdose death syndrome.
In heroin, it does consist of pulmonary edema, et cetera, et cetera.
But how are these methadone addicts then overdosing on methadone?
Is it because of the...
Because of overdose rather than an anaphylactic reaction the way it is with heroin?
What does that mean?
Anaphylactic is an allergic reaction such as how you would die from a penicillin drug.
So they're taking too much methadone.
That is correct.
So if they were on a program where their methadone intake were regulated properly and clinically,
that wouldn't happen.
What are you going to do with the illegal market in methadone?
That's not the question I asked you.
What I'm asking you is if they were taking a regular program, clinically administered,
it would not happen.
They would not die if they did not take more than they were prescribed or they did not
have an illegal market.
So I feel that if methadone was freely available to all people who needed any true addict,
narcotic addict, then first of all, there'd be no black market because any drug addict
worth their weight will take heroin but will not choose methadone if they've got the choice.
That's not true.
The people who are buying methadone at the moment in Sydney at any rate, I can assure
you, are the people who should be in treatment programs.
Is there a black market in Sydney?
Is that what you're saying?
There is, yes.
There is a black market because people cannot get onto programs.
And there are people who prefer methadone as their drug of choice than heroin.
Well, I have never ever found anyone who prefers methadone to heroin, no drug addict.
Well, I can introduce you to one sitting in Odyssey at this moment here in Melbourne who
is primarily a methadone addict.
And I dare say that Dr. Dalton has encountered people who've been through Odyssey House for
different reasons and who have finished up.
I mean, there's a lot of cross-over.
No, but I'm not saying that.
I'm only saying that there are people who prefer methadone.
There are people who prefer speed.
There are people who prefer coke.
There are people who prefer...
I've never found an opioid addict who prefers methadone.
Yes.
Do you see its use expanding in the world communities that are drug-affected at the
moment?
I see that it will expand.
I do not think that it will answer the problems because we are seeing a shift in drug use.
And that shift in drug use is primarily to drugs such as cocaine, the amphetamines, and
the more stimulating drugs which have very dire and dire effects.
So that it will not...
I mean, are we going to blockade ourselves?
At one point, there was Dr. Maxime Fink in the United States who wanted us injected with
antagonists to 3,000 drugs because there are 3,000 drugs of abuse.
I mean, I don't know how we would sit down if we had that kind of blockade.
I mean, at some point, we've got to deal with the basic underlying reasons that young people
have no values and use drugs.
But you see, you were mentioning cocaine.
The problem at the moment in Australia is that we have an epidemic of heroin addiction.
The drug-related crime is enormous.
And for example, the jails, in the jails, there are 64% of people who are there because
of their heroin addiction.
They've committed crimes in order to get money to keep their habit going.
They're the break and enters.
I mean, once upon a time in Sydney, you could live, you could leave your door open, you
could leave your windows open.
Nowadays, everyone's barricading themselves in as they used to.
But of the few things that are available in terms of statistics about this problem, there
are a few reasonable guesstimates of that kind of thing.
But let me just say this because it's very important.
New York City has 40,000 people on methadone, and we have more crime now than when we had
1,000.
Yes, but you've got 100,000 opiate heroin addicts.
So we have close to 400,000.
Can I bring us into the Australian circumstance because it really is the one we're trying
to make some sensible comments about, though.
The recent estimates I was talking about are that in Australia, something like $376 million
was spent on heroin last year.
But that something like three quarters of that money came from property crime.
There seems to be a perception in the community.
In fact, in a recent opinion poll, the community is heartily sick of property crime, which
it now perceives as being associated with heroin addiction, to the extent that something
like 55% of all Australians want greater prison sentences for heroin addicts.
They want a harsher police force.
They want harsher penalties.
That to them is the immediate answer to the problem.
What Dr. Dalton seems to be saying is that if you have an expanded methadone program,
you at least address in part that criminal aspect of heroin behavior.
And I would say to you that that is not borne out by the American experience.
Well, it's borne out here.
I mean, what...
Well, you have not put that many people on methadone to say that they commit...
Well, let's take Hong Kong, shall we, where they have 10,000 people picking up daily.
Hong Kong.
Yes.
Now, in 1976, they started a program, a no-frills program.
They got Robert Newman to come over and to set it up.
But this time, they didn't have the money, so they didn't have all the counselors and
all the psychologists and all these social workers.
And they said, we'll just have a methadone program and we'll have an emergency force
that if anybody really needs somebody, they'll go.
They'll be there day and night and they'll go to them.
But they won't have all the frills that the Americans, not of the American clinics, had.
And they found that crime statistics have gone down.
They've closed a lot of the jails.
The treatment programs have closed down.
And their retention rate is very good.
They've got a 70% retention rate in one year.
I think the retention rate is a terribly important thing to look at.
Because, I mean, if you don't...
They also have the highest per capita heroin addiction of any place in the entire world.
It's interesting that you...
So that while they have all these people on methadone, they still have a higher number
of people on heroin than any other place in the world.
They've got very little, very few of the people in their program are taking heroin at all.
And they've only got 30% loss rate.
How do you explain the public view about it, though, that in a sense, their only response
to the heroin problem is to say, lock them up?
How do you explain that?
I think the public is angry, and justifiably so.
I also think, though, that so many of the public are becoming the moms and dads that
they're beginning to ask the questions, why are our children in difficulty?
And I think that that's really what we have to take a look at.
Why are our children in difficulty?
And why are they acting out?
And why are they enraged?
And what are they saying?
But if you take the approaches you do, that you must try and look at the individual, you
must try and look at psychiatric problems, and all the cost that goes with that, I mean,
there's no secret about it.
It's expensive to deal with the problem in that way.
What rate of success are you likely to have?
How are you likely to be able to say to the taxpayer who pays for those facilities, who
commits money for those sorts of programs, that they're getting a result that is going
to lessen the crime rate in their country?
Well, if the individual does not return to drugs, of course, you have the same results.
It really is a question of values.
But they do return to drugs in large numbers, in very depressingly large numbers, don't
they?
Depends upon where you start your statistics.
Well, what are your statistics in Australia, for example?
Well, it depends upon where you started.
If you started a program as it should be started, first in prison, and you get over the first
six months, which is the six months that Dr. Dalton discussed, in which the craving is
there, and the craving can be dealt with with methadone, the craving can be dealt with with
acupuncture, the craving can be dealt with with the production of the, as we've talked,
endogenous endorphins, which is the naturally made substances.
If you can get over the craving phase, which is a terrible phase to get over, and lockup
does get over it, then the success rate runs in about the 80s.
Twenty years, just about, but the 20 years, though, we've had heroin in this country
in ever-increasing proportions, and our prison system don't do anything like that.
I mean, so in a sense, we've lost that battle already, haven't we?
No, no, no.
You can always decide to run good programs in prison.
We have run good programs in prison repeatedly.
Even if you have a drug-free prison, totally drug-free, and you have programs in the prisons,
unless, I don't know what sort of program you're going to think of inventing to do anything
about it, but you'll find that you can lock the person up for six years, and they'll come
out, and within the first month they're on drugs again.
What happens in the prisons at the moment?
Well, the prisons in the moment, first of all, the drugs are available.
The majority of people there don't take them regularly.
They take them, as they say, for birthdays, for Christmas, and for anniversaries, because
it's very expensive and difficult to pay for.
I've heard it said that people in the police forces and people in the prison officers'
groups try to turn a blind eye to it if it happens because it makes the prisons more
manageable.
Would that be a fair comment?
I would say that sedating anyone in a lock-up makes prisons more manageable.
And there'd be a few who profit from it, I do say.
I would assume so.
Well, can I come back to this point with you, though, and that is how do you try and expand
other programs to make some kind of dent on this criminal problem?
Well, you see, I think that when we diagnose at least 50 percent of the patients that we
see, the drug addiction is concordant or simultaneous, as we say, with an antisocial criminal personality.
They will commit crimes whether they are on methadone.
They will commit crimes whether they are drug-free.
And we have seen again and again that in many instances in America, the methadone patients
commit better crimes because they're less frenetic about getting the drugs.
They can plan better and they can strategize better.
Are we talking about a dependent personality type here?
No, we're talking about an antisocial individual, a raging individual, a hostile individual,
an individual who's been child abused.
How do you recognize them before they get into heroin, though?
How do you say, that's you, we're going to stop you before you get there?
Well, if you asked me how, that's a different program, which I'm very pleased to talk about,
which is how you start recognizing it when they're first in trouble in school, in the
school, high school, dropout problems.
I mean, there are many, many signs of children in trouble long before they go to drugs.
And if we began to impact as a society and really cherished our children and began to
invest in our children, we would have a much less of a problem of people in difficulty.
You were objecting a moment ago.
Yes, I was objecting because I don't believe or find that the people on drugs are all disturbed.
Out of my clear and clear on my patients, I would say that 5% are disturbed.
And I would say that the other remainder are not.
And that they just click back into a normal and happy life.
We have people with availability, the escalation of availability towards the end of the 60s
and the beginning of the 70s, all strata of society got onto heroin.
And we have people now who are on programs and who have gone on programs, methadone programs,
and who are now off them, who are in all walks of life and doing very well.
And we've...
I think the strata makes a difference, you can be very disturbed and be very wealthy
and you can be very disturbed and be very powerful.
In fact, unfortunately, too many of those people are.
What I'm saying is that in the people we're treating, we find that 5% are disturbed and
the rest are not.
Well, you see, I have a very great problem understanding how a person could inject themselves
with a potentially lethal substance five, eight times a day, playing Russian roulette
with their lives and not be disturbed, to me by definition.
The risking of one's life, the lifestyle that goes with heroin is indiscriminate disturbance.
Young people generally like to experiment with things if they think it's a bit dangerous.
Besides, we know that out of every 100 people who is experimenting or playing with it, only
10 get addicted.
What we're really arguing about here, aren't we, is whether that behavior is the result
of the addiction or the cause of it.
Yes, that is it.
That's right.
So what sort of balance then would you like to strike in our community between open methadone
programs if you like and the sort of programs that you're running at Odyssey House?
What sort of balance?
How does the community know that there should be that much of that one and that much of
another?
How do they lock together to form a cohesive attack on this problem?
I think that the best way to do that is to very much educate and to have the doctors
take a look at this as a medical, not a political problem, and to begin to understand what are
the alternatives, what are the reasons for the addiction, to deal with the child abuse
which leads to it, to deal with the sexual abuse, and to begin to make the quality of
life better, but also to understand that in this day and age we need some value clarification
and we need not to be compassionate, but we have to care that we have a society that really
makes it possible for children to grow up healthy.
How have you been able to attract so many high flyers in powerful and political places
in many cases to support Odyssey House?
I suppose that in a sense people in high places are beginning to feel responsible for the
society we live in nationally and internationally and locally.
Is it because they have a similar outlook to these things to you in that they think
that life ought to be hierarchical, structured, a little authoritarian perhaps?
I think that most high achievers are compulsive, obsessive, very seriously workaholic.
Can I ask you what sort of mix you think ought to be struck between a method and program
and the sorts of work that Odyssey House does?
I believe that a hardcore addict, that is somebody who has been on narcotics for more
than two years, would benefit from a method and program and would be wasting the time
of the therapeutic community.
So I think that the therapeutic communities should be working on the young, the adolescents,
the young delinquents, the young people with problems, the young experimenter.
But I think when it comes to somebody who has been on drugs for more than two years,
I think it's a waste of time and a waste of money.
What happened to the money that was pledged by Premier Ran in New South Wales just before
the drug summit?
He said he was going to quadruple the funding to the method and program in New South Wales.
What happened?
Have you seen any sign of it?
You, after all, handle the majority of the stuff.
You handle what, 600 patients?
600 patients, yes.
Well, so far we haven't seen any results from that.
I don't know, I think they're planning to open some drug addiction buildings, but that's
all I know about it.
Nothing's happened to date.
How many, how many?
In other words, what worries me is I feel that what we need to do is to treat the addict
and not to start building hospitals.
You know what I mean?
Putting the money in bricks and mortar.
I couldn't agree more with Dr. Dawkins on that.
I think there are too many people who need help, and I'm terrified that that may be where
the money will go.
How many people do you have to turn away?
Oh, hundreds.
Absolute hundreds, and I'm not exaggerating.
I mean, how many a week, for example?
About six a week, ten a week.
And what happens to them?
Well, some of them go to Queensland.
I've sent a lot of, sent 300 people to Queensland.
And that's why, that's because it's more easily available there.
Well, they can go and get on a program straight away there.
The figures are interesting.
They, for the drug summit, figures were prepared by the Commonwealth Department of Health.
They gave 840 people on methadone in New South Wales, legally.
150 in Victoria, and Queensland was 700.
You would try...
Those are some of my referrals, yes.
Well, that's an extraordinary thing, that people have to move from one state to another
in order to get a basic sort of form of medication.
There have been reports just recently that there are now prospects, not more than prospects,
that it is happening, that scientists are synthesizing a substance so closely chemically
related to heroin that it would make no difference to an addict.
If it is possible to do that in the backyard of a home, it renders presumably all the custom
screening procedures irrelevant.
What, what is the answer when that sort of dimension is added to the heroin problem?
To ask why the demand instead of focus on the supply.
And that's what we've been saying all night.
Why the demand?
Why do I know young people need it?
What has gone wrong that they need it?
And that's really where we have to take a look.
What's happening to the family?
That is the prevention.
But is the response to prohibit the supply, which is what we do?
Well we cannot prohibit the supply because we wouldn't have the addicts that we have.
Of course we try to.
Prohibiting the supply does keep the problem less than if we didn't prohibit the supply.
But you can never prohibit the supply sufficiently to meet the fact that if somebody wants it
enough they're going to get it.
And that's really the issue.
Why do they want it?
And that is because we are a society that doesn't ask questions concerning values.
Dr. Denson-Gerber, thank you very much for taking part in this discussion.
Bringing us the benefit of your perspective on therapy and the quality of the individual
that you give such emphasis to in your programs.
Thank you also to Dr. Dalton and your concern about the treatment of the symptoms in this
very large problem.
What has been interesting has been the common ground that you've been able to find and the
very clear concern you both share for the quality of life of both the addicts and of
course of the wider community.
Thank you both.
Next week Pressure Point will be coming from Monash University where we'll be discussing
with a panel of people and an audience the issue of euthanasia of infants or infanticide
as it would be called by some people.
The question of how defective a child has to be at birth for it legally to be able to
be destroyed.
So join me for that program and until then good night.