The interview with Christiane F. has just come out, the adult person who inspired an epochal film on heroin addiction, then painted in an apocalyptic form, like a tunnel with no return, barring a miracle. At the time of the facts, heroinism, as an epidemic, was something theoretically known (already as morphinism in the previous decades), but it assumed rampant proportions, and above all it hit the youth range.
In those years, drugs were a “plague” against which there was profuse in educational efforts and progressive advertising, also admitting the diffusion of raw and realistic films such as Christiane F – we, the boys of the Berlin zoo, inspired by the book of the same name – autobiographical.
A 13-year-old girl becomes a drug addict in the context of her adolescence, and after cycles of unsuccessful attempts to get out of it, she ends up with the exit from heroin and the community. The author leaves it pending, hoping that it will end there.
It was the only discordant note in a book that otherwise realistically describes heroin addiction. At the time, the treatments for heroin addiction existed, developed in the late 1960s in the USA. First the “criminal” drug addicts to be kept out of prison, who crowded and returned to despite any rehabilitation effort. Subsequently, drug addicts were treated in general, with a methadone treatment scheme known as a “narcotic block” developed.
Unfortunately, however, and only in the late 80s that the first treatments begin in Europe, and they begin in a confused way, contaminated by beliefs and prejudices that still hold up, and often reign. Methadone treatment is being developed as a long-term treatment. It does not consist of detoxes, and there are no detoxes indicated as therapies to block the fate of drug addiction. The “I go to community” approach is part of one of those responses to the psychological needs of families and society, which want to think about an environmental problem, which is solved with love, education and rigor, mixed in different ways.
Over the years medical research has instead documented in an ever more detailed way the persistent alterations that heroin, as well as other substances, produces in the human brain, so as to explain the behaviors of heroin addicts, and the chronic tendency to relapse after long or short intervals. of quiet.
Meanwhile, there was also the HIV / AIDS epidemic. Those who at that time were already undergoing methadone treatment are protected. Studies conducted years later show a “shield” effect of treatment on infectious risk, not just HIV. It was not a shield against the infection itself, that is known, but simply the fact that those who were treated took less drugs, or not at all, and stopped a series of risky behaviors, as long as they remained in treatment.
Incidentally, the same thing happens with overdose. This event, less likely in those in continuous use, and even less likely in those on effective dose treatment (due to a pharmacological effect of methadone that hinders the effects of heroin – hence the expression “narcotic block” ). The same risk, on the other hand, increases in those who stop treatment, or leave protected environments (prison, community, hospital) without the protection of the treatment, because at the time of the relapse (announced) the body is fully sensitive to opiates, and the desire returns. in an overbearing way.
Christiane F exactly reflects the point of view of a heroin addict who is treated more or less well, albeit late, who has an incorrect idea of ​​his illness. Or in any case, that when it comes to telling it, he cannot help but highlight the less relevant part, and instead the fundamental one.
After the end of the book, Christiane F did not come out at all, she relapsed herself. Her drug addiction didn’t go away, she just at some point she started “using methadone”, as she says in the interview. She doesn’t specify what dose, or any other technical details. All the gist of the story is here. The problem stops with the methadone cure. On the other hand, when the age limits have been reached, another thing happens, namely the transition to alcohol. Many flank it with heroin, then only end up alcoholics.
The last two questions are the summary of what is missing from the standard for curing drug addiction. The first thing is awareness of the problem.
Because you never stopped taking drugs
I never wanted to stop, I didn’t know anything else in life. I have decided to live a different life from others. I don’t need an excuse to quit. ”
The answer is much simpler. Christiane F stopped taking drugs almost immediately. From there she became a drug addict, which is different from “taking drugs”, and she is about a certain drug, not “drugs” in general. Healing does not mean developing a hatred of drugs, this is a cultural or personal problem, not the cure of a disease. She did not stop taking heroin drugs as a heroin addict.
What state of health are you in now ? I
use methadone. Sometimes I do a joint. I drink too much alcohol. My liver is going to kill me. I have cirrhosis caused by hepatitis C. I will die soon, I know.
He then quit instead. Since she was cured, probably even when she was cured in the past, maybe then stopped taking methadone. Probably, according to the data on the doses, he takes low doses (the average Italian doses are 50-60 mg / day for example), ineffective in extinguishing the desire. So much so that over time this is partly reduced, but partly continues as a link with alcohol. This link unfortunately produces progressive damage, up to cirrhosis.
In conclusion, the story of Christiane F is a parable that describes the heroine very well, and what happens after the book is not told because it causes less hype, and is not well understood. It is the story of a cure, which should be explained and applied well, because fortunately it works. It is also the story of many beliefs or practices that are as widespread as they are unjustified, which only go after addiction, without realizing it. Fake treatments that simply use the spaces between relapses, as if rehabilitation were keeping the relapse away, which then occurs.
Known rehabilitation goes through drug treatment (now not only with methadone) and is not a moral cure. Neither are the treatment of depression, panic, diabetes and appendicitis. Overcoming the addiction doesn’t mean detox, which Christiane does a thousand times on her own in the book. It means preventing the course, relapses, and the effect they have on the person’s life.
Yes and in time to the end. Even in cirrhosis and with a transplanted liver, because even on that there are data that indicate how the treatments are feasible. The first step is to stay long inside the protective band of therapy, which acts as a shield against everything that the fate of the disease otherwise has in store for the patient.


# 1

User 430XXX
December 10, 2016

Hello, I gladly read this very interesting article and written in an irreproachable way.

# 2

Former user
December 10, 2016

Good evening DR,
Shareable word x word except the last three lines, I am and I support science but I remember and underline, paraphrasing Einstein, that man invented the atomic bomb, but no mouse in the world would build a trap for mice.
Have a good evening.

# 3

Then she didn’t understand anything about the article. If he considers the cure a trap, he has not understood anything about the article, about the cure and above all about the disease.

# 4

The problem is that everyone shares everything, they are pleased, but then when the fundamental point arrives, that is to give the medicines, and to take them, then the problems begin. The only reason why a highly curable disease remains difficult to manage is that patients are inherently resistant to taking care (and so far it can be understood, because it is partly due to their condition), that doctors are resistant. to give them (and this cannot be understood), and that others are in favor of not letting them do it and making them stop, in good or bad faith. And they believe that this is the solution. The solution is in error.

# 5

So either one argues for science, or one says cures are a mousetrap. This way of saying “I agree” and then saying exactly the opposite, as if nothing had happened, is meaningless. Because if your thought is that you no longer get out of the treatment, worse than the disease, I repeat, you have no idea what the disease is (and it doesn’t matter if you speak from experience, even Christiane F did not understand much about her illness, even knowing how to tell it very well).

# 6

Former user
11 December 2016

First of all good morning, the mistake lies in assuming more than is not necessary. people enter the sert in the
Because they will use medicines as substitutes for drugs and they become dependent on them. Most likely it will be the services that do not work as they should and she is right when she says that I do not understand …. the expert is she I just observe reality.

# 7

The disease is chronic-relapsing by definition.
The serts do not work as they should, and this is the point, and in fact I write it. Insufficient doses and short therapies. Thousands of people who spend their lives trying to take off methadone and not take it back, rather than trying to take it as soon as possible, for a long time and at an effective dose.
Unfortunately, even when many doctors do not operate according to these scientific principles, the treatments can only be non-existent, botched.
The average dose of 50 mg is not by chance, it is the one that sufferers choose for themselves if they have to decide. Just enough for abstinence, or to stay in balance without even realizing how it works, and just enough to be able to still feel the heroin if they want, even here as if this were the problem (for them it is no longer this).
What you describe to the serts are not the treatments as they have been developed. They are treatments on average poorly done. And it shows.

# 8

Former user
December 12, 2016

There is no protocol that doctors should follow and interested parties know

# 9

Of course it exists, as with all other diseases. There are guidelines from the World Health Organization, guidelines from scientific societies, manuals dedicated to the matter (I am co-authored by a couple), and thousands of articles now, including Italian ones. So much so that Italian scholars are also invited to expose their data abroad.
The problem is that Healthcare is not always organized to give the best. In psychiatry this is certainly not the case. If you meant if there is a binding protocol for doctors who do this job … no, everyone basically does as they like. They range from well-done therapies to the total omission of therapy.
It must take into account that psychiatric patients are not like other categories, they do not necessarily go and ask for well-done therapy, indeed sometimes the solutions proposed are neither more nor less those offered by patients, who are therefore also convinced that they are asking for things. make sense. Insufficient doses, methadone for little, if used and for abstinence, however it is only a help and nothing more etc, the problem you solve it when you really decide and so on … in short, the whole compendium of nonsense that needs to be a distortion given by the disease also comes to be what the layman think, and what they often propose and encourage even the insiders.

# 10

Former user
December 12, 2016

A reality that seen with his doctor’s eyes is even more gruesome than seen with mine. Declaring oneself ill also means expecting a series of services if this does not happen it means only one thing that it is not always good to follow a “vocation” there are doctors who love the sick and wish to heal him and there are doctors who love the disease and wish you should remember what the father of medicine said “the most important thing in medicine is
not both the disease the patient is suffering from and the person suffering from that disease.
Thank you.

# 11

In fact, the situation is in a certain sense gruesome. At least on the level of correspondence between science and practice,
We should begin to consider doctors and the sick of human beings, and therefore as such not take refuge in useless idealizations. Useless because expecting the best prepares the worst.
Humanity is all like this, there is the best and there is the worst. There is no vocation to do good or anything like that, no more in the doctor than in the plumber. There is no innate competence, nor do people come up with who knows what notions just because they have followed a course of study.
Things must be built always and continuously, systems must be built not counting on the fact that they come up on their own.
The production of health is the least quantifiable thing, and unfortunately those who produce health and in a system that instead of producing for the outside, produce for themselves, that is, for those who work there, with the large parastatal market of self-styled “therapeutic” structures (a ‘label that anyone takes more easily than a noble title), various centers, rehabilitation programs and anything else that in reality do not contain any element of recognized effectiveness, indeed sometimes they exclude it a priori (see community without medicines).

# 12

Former user
December 13, 2016

Exactly it should also be remembered that opulence does more damage than indigence, I think this is valid both for some doctors who do not admit comparisons and for some users who think they know more than doctors.

You know, on the subject of comparisons, sometimes the comparison does not exist. And the patient is not looking for a comparison, he wants to impose a vision of things that in the limit would not matter, but it matters if it is a decision on the cure. The right treatments are not necessarily perceived as such when you start them, and sometimes even after you get the results.
There must be human confrontation, while the technical one never exists. Hopefully the doctor knows what he does, as does anyone when you ask him something.
The unclear thing is that a patient with stomach pain needs to know how to take medicine, a psychiatric patient sometimes needs to take it. Drug addiction therapy is simple, but it is difficult, because it is difficult to get the patient to the treatment, and let him stay long enough for him to see the results, and then let him stay to avoid losing them when he is well convinced that the thing is over I save them unforeseen events or bad will.
The information itself is neutral. A patient reads what he wants, and becomes convinced of what he wants. Since his illness leads him to certain beliefs, and even before that to certain decisions, he will be convinced that what he is going to do is also the best thing. And on the net he will find those who take these beliefs of his and pretend that they are a therapeutic method. Type: detox and then try to stay abstinent, a type of idea that is the classic “I can do it by myself”, which in some environments is seen as the peak of maturity to get out of it, and instead is the maximum of thought induced by drug addiction . Treating a symptom as if it were a way out and a dead end, and is the average of what happens with respect to these kinds of conditions.

# 14

Former User
Dec 13, 2016

“treating a symptom as if it were a way out is a dead end” … most likely, putting it on an easier to understand level will be like in the Italian language, the difference that exists between a complement of cause and end or purpose, many confuse it because it is difficult to distinguish as it can be difficult to grasp the difference between means and mode … it is a fine line that makes the difference on the result of healing for this I believe that needs to be encouraged both in spreading the right protocols to nn run into continuous wrong beliefs.

# 15

In the literature, one thing is documented. The beliefs remained the same. Good practice is leopard spot.
It would be enough that basically any doctor could manage patients, on the basis of a relationship of trust, and not just patients in certain structures. The structures offer a service, they must not monopolize the relationship with the patient.
When the issues are technical, the rules unfortunately make organization difficult, and ignore the substance.

# 16

Former User
December 14th 2016

You know that trust is normally given as difficult and maintaining it, monopolizing patients is an unworthy but unfortunately widespread practice, a bit like saying that you can sit for several hours crossing your legs, in the same position when you know that everything prevents you from changing. position, but if a person knows that he should remain seated like this, he will experience cramps with his legs crossed, his legs will stretch and tighten at that point where he would like to stretch them. x their work and the patients on the other hand should do their utmost to rediscover the will to live and therefore to heal.

# 17

User 162XXX
September 20, 2017

Hi, your article interests me as regards the concept of treatment that you propose, even if I disagree with the fact that among the causes of addiction you eliminate the environmental aspect. I believe that in the book when Christiane F. tells of her personal stories she is explaining part of the cause of the problem and these aspects must also be taken into consideration. It is not a question of morals or sentimentality, but mental health is also part of a person’s health, and to be well everyone needs valid emotional bonds. The community also serves this purpose, not to satisfy the psychological needs of a family, but perhaps to give something that the family has not been able to give, in some cases.
I am writing to ask you if therefore a heroin addiction can be cured only with the lifetime use of methadone, and if this can actually be considered a cure, as you switch from heroin to another substitute substance and that creates damage like any other drug. As far as you are concerned, then you think that they are wrong to direct the patient to taper the doses
Psychological and psychiatric therapies how effective they are on an addiction that has lasted for more than ten years
I would like to know more and I would like to discuss with a specialist because I would like to understand better since a dear friend of mine is in these conditions, as well as some other friends and acquaintances always with dependence problems, and if there is something useful that it can be said on the subject that they are not moralisms rather than being completely silent and avoiding it regardless or generally avoiding socializing with dependent people.
Thank you.

# 18

Excuse me, maybe one thing is not clear, as it is not clear to many people. I do not “propose” any model of care. This is the cure that has worked since they developed one, and over the decades it has remained valid. I do not come to hypothesize or discover it in 2017, they developed it in 1968 and confirmed it in the following years. Now we are studying other aspects, trying to improve a whole series of technical aspects. The main problem remains that few do it, and few do it soon.
The environmental factor is heroin, for the disease to come. For it to heal, no environmental factors of any kind are known.
Where health policies have focused on the environmental factor, as in Russia, the therapies are essentially “re-educational”, psychotherapeutic, rehabilitative etc. Result: mortality and HIV on the rise.
There has never been a “scaling” therapy. Psychiatric drug addiction therapy and methadone or buprenorphine in a long-term regimen: what are they but psychiatric therapies
Drug addiction is a brain disease, it is expressed with mental-behavioral symptoms, methadone or buprenorphine that are going to act on areas of the brain and normalize the functioning of these, hence their therapeutic action.
Other psychiatric therapies
No results.
Fortunately, those available work well, the problem is that they are not applied, and the policies of the sert and health services tend, in the end, to adapt to the thinking of drug addicts and public opinion.
The dominant therapeutic model isn’t what works, it’s what people have in mind. In psychiatry too it tends to be like this, not just in addictions.
Psychiatry is medicine without people being really convinced of it, hence a whole series of misunderstandings and lack of therapeutic practices.

# 19

User 162XXX
September 21, 2017

Hi, thank you for your reply.
In fact, the problem on the other side is precisely this, everything that is said (or at least a good part) of the sert in the environment of people who use substances or those who go around them and that are useless, that do not detoxify. and it does not heal, drug addicts use methadone or suboxone to resell them etc … in short, it is not a good image and at least to me, I create a lot of confusion. I remember this friend of mine having this need … to take it within a few months he started again with the old substances. But even while he was taking it he was still using cannabis and alcohol. In the meantime I have read his other articles and the one that contrasts most with my memories is precisely this, the fact that one is convinced that methadone is used to not feel abstinence on a physical level and that’s it. Yes, you are sure that it must be eliminated and you do not see it as a cure, but as a kind of symptom of the disease that is still ongoing, and you feel sick precisely because you have to take it. All this interest of mine basically derives from this friendship, I practically did not think about it anymore because the person in question has gone to live abroad for a few years but lately I have heard him and he told me that he has lost yet another job and also his home, so now he’s a homeless drug addict. I think that even abroad there are services such as the sert, but if he had decided to go there of his own free will to heal himself, I don’t know why he doesn’t do it now. According to her, the idea of ​​the prevailing disease has something to do with it
I mean, even if they told me that to cure myself I have to take a drug and then slowly stop taking it, and in the meantime I see that I can’t stay clean I would think that there is no hope for me, and if I have to decide what to do then it is likely that I will continue on my way without any more intention of improving my condition because I have already tried and failed.
The approach of the Italian serts with low doses in the short term is the same also of the services in other countries or it changes something, that you know
Thank you again,
good day

# 20

I understand, but it would be like imagining that a depressed person has a correct view of their depression. Usually he doesn’t have it at all. Not even after being healed. Not even knowing how he healed, he tells a different story. For example, consider all the stories of famous people who “got out of it”, testimonials etc. They are typically biased in both diagnosis and how one got out, assuming they got out of it and isn’t simply between two relapses.
Basically all here, if we like to think that it is resolved by praying, the State will end up setting up churches in which we pray to stay away from drugs (and partly and so), otherwise if we want something that works, it already exists. but it must be applied. Nobody has to educate anyone, people have to be cared for and managed. Instead they help each other in a thousand ways, they are re-educated, they are saved, but they are not cured, and therefore their fate is decided by the laws of their illness.

# 21

User 413XXX
June 25, 2019

this peremptory nature in defining the only and true cure is methadone in maintenance does not seem to be one hundred percent supported. I know some addicts, certainly not all for charity, who once made a community have no longer used. Many community workers, too, who came in from heroin addicts, got the program and stayed there to work, started a family, and got clean. Just as I have met certain regular patrons of the sert who, when filled with methadone, in fact they no longer use, but then they are wandering the streets with a double malt beer in hand in the early afternoon. and I mean known well, for real, not hearsay. And if in the first place many serts and doctors are reluctant to adopt the line that marries her for a reason maybe there will be
or they are all idealists
it is not that maybe she too tends to be ideological in her point of view
, even the WHO, in reality, certainly does not say that the goal in maintenance is the only real cure, it only says that it has the highest percentage of people who do not falls back … yes, that does not fall back into heroin, then if it does anything else … but the WHO always recognizes success rates also in other treatments. an a priori sheaf and an error. And you can’t even compare TD with a trivial infection .. because it is clear that for the latter you only need a certain antibiotic, while it is not proven that this is the case for the other problem

# 22

AH well, then if you “knows some junkies ….” science needs to be refounded. Read a little
“” He certainly does not say that maintenance meta is the only real cure, he just says that it has the highest percentage of people who do not relapse … ”
Toh, and it is a chronic-relapsing disease. more being such, it eliminates the relapses.
But for you it means nothing, who knows what you understand of all this speech, with your arrogance. The WHO clearly says that the treatment is based on agonists, improved by other interventions. the most important thing is the scientific data, which say even more, and even more in detail.
She ignores them or snubs them, or disgusts them. Or she does not understand them, which perhaps would be the most natural and dignified position, since no one is expected to understand technical issues, but try to understand them calmly, not going around saying “but I have seen addicts .. . “.
Do us the favor, we see that it is in the phase of the incontinence of comments. Fortunately there are people who make more constructive comments, and fortunately there are those who publish data, rather than making great reflections and then arriving at chilling clichés. And wrong, by the way.

# 23

“Stuffed with methadone in fact they don’t use anymore, but then they hang around the streets with a double malt beer in hand in the early afternoon.”
Certainly dear, and we ourselves have published original data on this, explaining why. Not “stuffed with methadone” if anything, but low on methadone anyway. Stuffed with alcohol.
But you are not interested in asking and investigating, in which case I would have provided you with explanations and bibliographical references, however available online without problems, but you write only to make controversy and boasting a knowledge of the basics of the subject that you do not have, and an observation of phenomena, which she then misunderstands as she sees fit without foundation.

# 24

User 572XXX
June 12, 2020

“Christiane F stopped taking drugs almost immediately. From there she became a drug addict, which is different from taking drugs,”
Good morning, I didn’t understand her statement, could you clarify it

# 25

Sure. In the story, the protagonist, after an initial phase of increasing use of heroin, detoxifies alone at home with her boyfriend, with the intention of getting out of the problem. Immediately after they resume, then realizing that once detoxified they can also start again with less money, and promising to do it in a moderate way, in order to avoid ending up “in the wheel” again. This type of reasoning indicates that they are already addicted, which is evident once the detox is complete.
Addicts are able to quit. generally they do it many times and they have already done it after a first period of use, so “soon”. What they are unable to do is not to “stop”, but to control use. In fact they manage to stop the two protagonists, and they will do it again too, but they can’t go back to using them as they want, that is, they don’t gain experience, but they acquire a loss of control, worse each time.
So the meaning of that sentence was that drug addiction is not being able to stop, and not being able to continue in a certain sense, if it grasps the apparent paradox. It has relapse, without the possibility of controlled use, which goes on for phases of use, interruptions, and relapses.

# 26

User 162XXX
June 15, 2020

You are a doctor who specializes in this and I totally respect your preparation and experience in this regard, so I hope not to be out of place if I return to comment under this article to express my ideas on a topic that is close to my heart because it always involves so much. suffering. I’d like to know what you think.
I think the scientific approach alone is not enough. After a few years, I would like to confirm what I thought and what I wrote in the previous comments. In drug addiction there are sociological causes that must be taken into consideration, without eliminating medical-scientific based treatments and indeed integrating them with social and political interventions, which need to be improved or totally changed. I read the investigation book Chasing the Scream by Johann Hari, in which the topic is studied by comparing the data of different health systems that follow different policies and the real stories of the people involved are studied, following what has been and is the war over the years to drugs.
For more than 25 years, heroin has been administered legally in controlled clinics in Switzerland, eliminating the risks of HIV, the risks of drugs with which heroin is cut in the illegal market and those linked to crime. People no longer being criminalized for their drug addiction can work and have a normal life thanks to this system. Today, in Italy, people with this type of problem often find themselves committing crimes and thus being cut off from any possibility of obtaining a job and living a normal life. In Switzerland it has been seen that all subjects under treatment consume less and less in a more or less variable period of time and then come out completely, because they are able to build a life for themselves. The most difficult cases, however, decrease their use and can lead a dignified life because they are not considered as criminal human waste by society. There are other countries that have established systems outside of prohibition, such as Portugal and Uruguay. There is the example of the city of Vancouver where there is also a clinic / hotel where hygienic conditions are provided for the drug to be consumed safely, possibly medical assistance and rooms for homeless drug addicts. Here the subjects can, without obligation or penalty of exclusion, express their willingness to stop and from there they are taken in charge and included in a special program. There is the example of the city of Vancouver where there is also a clinic / hotel where hygienic conditions are provided for the drug to be consumed safely, possibly medical assistance and rooms for homeless drug addicts. Here the subjects can, without obligation or penalty of exclusion, express their willingness to stop and from there they are taken in charge and included in a special program. There is the example of the city of Vancouver where there is also a clinic / hotel where hygienic conditions are provided for the drug to be consumed safely, possibly medical assistance and rooms for homeless drug addicts. Here the subjects can, without obligation or penalty of exclusion, express their willingness to stop and from there they are taken in charge and included in a special program.
Drug addiction is a social disease, people who develop addiction often have SEVERE trauma that no one has helped them overcome. Experienced situations where it would be strange not to look for something to get drugged with.
Those who take drugs to have fun with friends, such as with an aperitif with a glass of wine, do not develop an addiction. The substances are all different but the substance itself is not the main problem. Who becomes drug addict and who needs to escape from their reality and their pain. When you think of the drug addict isolated in his room or on the street taking drugs, one thinks he is isolated because he takes drugs. The truth, however, is the opposite. He takes drugs because he was already isolated and marginalized. And if he is looking for a substance with powerful narcotic effects and because he has great suffering to narcotize.
Assuming that these are subjects who need a hand and who instead are criminalized for this, how much suffering could be saved to them and to those who love them if all drugs were legalized and regulated differently and carefully
How can an addicted person be cured in jail

The state persecutes citizens who use drugs and the mafia enjoys it.

# 27

No, sadly this is scientifically nonsense. You see, the respect is not due to me and my speeches, if anything to the science of addictions, which has decades of studies and data. Unfortunately, on this issue everyone wants to continue to support the theses that are ideologically convenient.
You are right in saying that the “state” controlled heroin programs work, what you have missed, because you are not interested in the scientific part but only in the ideological one, and that the difference between these programs and the disease is not in the legality and in zero cost. There is a macroscopic difference between someone who takes a legal, state-provided injected dose every day, and an intravenous heroin addict “in kind” (illegal and costly drug). The modality of the therapeutic program is NOT drug addiction, it is an artificial modality, which maintains a condition that is useful for therapeutic purposes. Perhaps this was not imagined at the beginning, but in the final data it is evident. Maybe he thought he was just doing harm reduction, or doing something ”
That it is not a disease but a social condition that induces disease, no. It is a substance induced disease (only in certain routes of administration and for certain substances), with the same symptoms induced by intoxication, and largely with social risks. Legalization eliminates some events, not the individual disease. That remains and heavily. Indeed, if from a risk point of view, the reduction of costs is a way to keep the patient safe, for the aggravation of the disease no. The increased availability of the substance induces disease to the extent that it induces more intensive use.
Personally, I made the thesis at the time about the fact that addiction was a complication of other mental illnesses, namely the theory of self-medication. It is the same thing you say, but instead of society put a mental disorder.
The thesis turns out to be false. And also in this case it is common opinion among psychiatrists that employees “self-cure” depression or anxiety, while the data absolutely do not indicate this, and in some cases deny it directly.
So the concept is that, if we want to continue to argue that addiction itself does not exist, well this is the basis that has produced the lack of intervention for years, a therapy already potentially available since 1970, and still feeds these erratic health policies. , where you wander in search of all possible factors, without tightening the bolt where you can and know. In the brain of the patient through the available therapy, which turns off the pathological desire of the substance, leaving two things: the physiological one and the freedom of choice finally rediscovered, which thus can keep the physiological desire still as in any person who evaluates whether to do or no something.
let’s also question the data, for heaven’s sake, there is no unassailable officialdom, but the ones he listed are clichés that we fell in love with too much. There is better: patients, visit them, understand from them how their brain works, evaluate them, discuss the data, compare with the experiences of other colleagues in the world etc. In this way, something ends up very little ideological and very satisfying, when you manage to rebuild a life.

# 28

User 162XXX
June 16, 2020

According to the book I was talking about, which was written on the material of interviews with doctors and politicians involved in these programs and on the related studies, the data show positive results, that is, having free availability of the substance does not encourage or increase the use (a slight increase occurred only with moderate cannabis users, compared to a decrease in alcohol consumption – in a nutshell -). Heroin addicts in the Swiss case would keep their habits unchanged and slowly decrease their use on their own until they quit. I have not personally consulted the data but unless they are falsified at the source, the results are positive. Certainly if I knew that these approaches lead to incentives for use, I would not consider them valid except for the criminal aspect.
The therapy he describes, and therefore intended to last
From addiction, a cure (with its timing) beyond the cure is not considered
possible to cause it. Social factors that lead to mental illness and then to addiction as he said in reference to his thesis. For example, maltreatment not necessarily physical and abuse by parents and / or siblings during childhood, neglect, absence and abandonment at a minor age by parental figures and important economic difficulties that lead to trauma and depression which then leads to addiction. .
For now I continue to see it like this, but I’m always interested in deepening, questioning and comparing. I have never had the opportunity to look at the results of therapies in Italy or in other countries with the same method in detail. If you want to recommend some studies in particular, I would gladly read them, especially those that contradict this view of things.
I have no doubts that the quality of her work and of her colleagues can be able to rebuild lives, but it occurs to me that patients may rely on her and find strength in the doctor-patient relationship, because the mere fact that there are doctors that they are there to treat them and in themselves something that has a human and social value as well as a scientific one.
Thank you for the comparison.
A greeting and good luck.

# 29

The data ! The patients !
Other than interviews with doctors and testimonies. The world is full of people writing books full of nonsense. They are not the ones who unfortunately help to understand. There are congresses, there are scholars who write nothing and produce data, and there are patients to visit and treat.
Much more interesting than theories, which then, I repeat: they are always the same, always with the same now very boring errors.
Unfortunately, those who want to help or redeem themselves do more damage than the disease itself sometimes. Because doing it the wrong way means forcing patients to unnecessary odyssey and sometimes paradoxically more risky (as in the risk of overdose, increased by forced or rapid detoxification, or by those also specifically requested in ultra-super mega centers by drug addicts from wealthy or rich and famous families. themselves.
Here the point is that no one dreams of saying yet that bacteria are produced by spontaneous generation. Because it is a well-established notion for centuries. And yet, when we talk about psychiatric “things”, we always pretend that there is no brain. It all starts with society, with values, and I don’t know what. Instead it all starts in the brain and goes back to the brain, and often ends in the brain. As in this case.
Heroinism has its beginning, which is physiological, its intermediary, which is dictated by a property of the substance in the human brain, and by an effect, which is expressed on the human brain. The rest are variants of a disease, which disease remains because it makes those who have it sick, net of the law and culture.

# 30

User 413XXX
June 28, 2020

the sad thing is that despite the fact that medicine has had almost half a century of “experience” to progress in the study (and related treatment) of heroin addiction, it has not been able to go beyond the proposal of methadone whose therapeutic concept is simply to quell the patient 24 hours a day so that he does not do harm, crime, and the like. And never mind if this subject will live a “halfway” life, with the brain (and heart) watered down by this miraculous syrup!

# 31

User 413XXX
June 28, 2020

Even more sad is the arrogance and presumption, fortunately only of a part of the medical profession, with which this therapy is defended by throwing mud on any other hypothesis of cure. but something is changing however, many serts today at least offer more ways to combat this demon called heroin addiction, from the recovery community, to simple rapid detoxification with or without methadone, to an outpatient psychotherapeutic path, to pharmacological support relating to psychiatric disorders that unfortunately often accompany drug addiction, in a relationship of cause and effect that is still unclear but very interesting. In short, we try to modulate the treatment, as far as possible, on the basis of the single person, looked at more 360 ​​degrees. On the other hand, the disease itself requires it. what we are finally starting to admit is that maintenance methadone is the last of the beaches! son of the old mentality, now outdated in the scientific environment, which tried to generalize the disorder of CT and claimed to solve it with a pill, as they say.

# 32

User 413XXX
June 28, 2020

I say last (then I’m done): obviously the intervention that guarantees 100% non-relapse is not there. but when the person finds the right therapeutic path for him, the times are dilated between possible relapses, and in the meantime he has built, worked, lived, without the methadone sedation that keeps you going at 20% of your functionality, and therefore reacts better to stumbling, more effective and more timely, gets up and starts again.
Of course, in those moments suffering. as in all diseases that tend to become chronic, when and if they flare up, they cause pain. Conversely, the same cannot be said of many of those in maintenance with methadone, perhaps even at high dosages, as some Sert (less and less, however) advise. Just take a tour of the outpatient opening hours to understand.

# 33

Look, this methadone nonsense I’m tired of hearing her say, only to see patients instead, who don’t have anything she says.
He said all the usual nonsense, clichés that only produce death and delay in treatment. From the personalization of the treatments (unscientific concept: first the standard treatment, then the personalization, not the other way around!) From the lies about the effects of a drug worthy of the worst propaganda aimed at the activity of psychosette and fraudulent treatments.
The Sert underdose on average methadone (50 mg) that is, they use it at doses that are often ineffective due to the resistance of doctors and patients to adequate treatment. The “high” dosages do not exist, and whoever speaks of high dosages has not studied, is not aware of pharmacology and especially the clinic.
She either writes in bad faith, or she didn’t understand anything. Be ashamed of the nonsense that you write, one after the other, which is only possible if one, in a malicious way, avoids documenting himself on any aspect of the matter.
I repeat, be ashamed not for the ignorance he expresses, but for the arrogance with which he pretends that these considerations are the result of who knows what wisdom or “street” experience. A drug addict altered by his illness tends to think like you, fortunately then when he is treated he becomes lucid and more functional to his well-being.
Now really enough with people like you who are allergic to science. Long live your allergy away from this blog.

# 34

# 35

She’s right to have a bad impression of some Serts based on the rounds out there, although clearly if she goes to a pulmonary ward she will hear people coughing.
But the observation is right. Often they do not appear and are not patients treated and off drugs.
The reason is that they take little care (methadone or buprenorphine) and for a short time.
The fact that you completely misunderstand the thing, believing that they take a lot and that methadone makes “zombies” expresses, I repeat, a total ignorance of the matter and of the experience reasoned on such knowledge.
In short, those who don’t know anything about it don’t say random things, perhaps with some centered observation inside: they always say the same things. The person must be treated, as if methadone did not cure him …. And as if the disease did not afflict the person. Treating disease is the way to treat people, when you can. Don’t design a custom path that they will never be able to complete because they fall back.
Let him come here to teach me the subject, let’s see what he has to say. Maybe they could be interesting ideas. But these trivialities and this concentration of non-knowledge and the usual waste of time. I regret this non-existent exchange. Do not add anything else because I delete it, perhaps even the one before, the nonsense in the end and good that they have no space.

# 36

User 162XXX
June 29, 2020

“Do not add anything else because I delete it, perhaps even the one from before”
I just wanted to say that if by “the one from before” you mean the comments of June 15 and 16, we are not the same person who wrote.
I wrote in 2017 and now. The other user in 2019 and now.
As for me, I think we have exhausted the conversation as far as possible so I will not return to comment.
A greeting and good day to you and to the other user.

# 37

User 413XXX
June 29, 2020

well, perfect. I only allow myself to observe that if things were as you say, NO sert and NO psychiatrist would dream of assigning methadone-escalating therapies and proposing community-based programs, or in general they would not have such a varied approach to treatment. they would just propose methadone and that’s it. my skills do not center here, kind sir, I only observe the reality of things. I am thrilled and disheartened by his firmness in condemning certain points of view and passing his as a certainty, on a subject that, I repeat for the hundredth time, divides the whole world of science and not always the services of the state, indeed, they almost never follow his philosophy. I could not remain silent in front of these comments. I would like to follow a confrontation between you and the director of the sert of my city, or with one of the many psychiatrists I know who work in communities. here we should talk about science, and one of the main risks is that it is contaminated by ideological visions. it would not be up to me, but it also forces me to point out to you a flood of studies and research documenting all the various long-term effects of methadone, and many are wondering if even on the basis of them it is worthwhile to cure people in that way, just as it now seems evident that, I repeat, then maybe she bothers to recognize it, but methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond his hassles or my skills … and too important for those in need right now here we should talk about science, and one of the main risks is that it is contaminated by ideological visions. it would not be up to me, but it also forces me to point out to you a flood of studies and research documenting all the various long-term effects of methadone, and many are wondering if even on the basis of them it is worthwhile to cure people in that way, just as it now seems evident that, I repeat, then maybe she bothers to recognize it, but methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond his hassles or my skills … and too important for those in need right now here we should talk about science, and one of the main risks is that it is contaminated by ideological visions. it would not be up to me, but it also forces me to point out to you a flood of studies and research documenting all the various long-term effects of methadone, and many are wondering if even on the basis of them it is worthwhile to cure people in that way, just as it now seems evident that, I repeat, then maybe she bothers to recognize it, but methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond his hassles or my skills … and too important for those in need right now but it also forces me to point out to you a flood of studies and research documenting all the various long-term effects of methadone, and many are wondering if even just on the basis of them it is worthwhile to treat people like that, as well as by now it seems evident that, I repeat, then maybe she bothers to recognize it, but the methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond his hassles or my skills … and too important for those in need right now but it also forces me to point out to you a flood of studies and research documenting all the various long-term effects of methadone, and many are wondering if even just on the basis of them it is worthwhile to treat people like that, as well as by now it seems evident that, I repeat, then maybe she bothers to recognize it, but the methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond his hassles or my skills … and too important for those in need right now then maybe she bothers to recognize it, but the methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond her annoyances or my skills … and too important for those in need right now then maybe she bothers to recognize it, but the methadone maintenance therapy is less and less used, it will also mean something even just this fact! I’m sorry, but the matter here goes beyond her annoyances or my skills … and too important for those in need right now

# 38

The latest comments, the ones containing big hits on methadone.
To the other I answer since we are on the subject: he asked if it is only the Italian SerTs that give little methadone as a trend. No. There is a specific reason. If methadone is managed as if it were an antiastinential drug (and then it would be strange to continue it for a long time) then the use is not the correct one, and the patient (especially if left to decide for himself) keeps it at low doses, because it is enough for the initial abstinence, while going up he no longer feels heroin if he does it. That’s why he keeps it low. Methadone therapy is based on the mechanism of narcotic block: those who do not feel beyond certain doses, in addition to having even less desire per se, and above all they cannot easily stop the treatment quickly, which tends to do those who still have desire to take drugs and can no longer do it well because methadone “blocks” heroin. If this middle phase is not passed, and it is the most delicate phase, the vast majority of drug addicts find themselves with “push and pull” methadone in low doses, and heroin that comes and goes in varying amounts, but always with a worsening of addiction. The average dose of the serts is 50 mg. It is no coincidence that the block begins above 60 mg, on average.
Abroad it is the same thing, indeed in some countries even worse, as it was with us before the ’00s, that is, beliefs in freedom, such as those expressed by the user before, which have accompanied entire generations to death by pointing the finger against treatment. The same happens in all psychiatry, but at least in recent times that depression is cured and an accepted thing, on drug addiction we are still allowed to start from scratch, indeed from below zero, with speeches that are worse than bar speeches, because they underlie the will to reject scientific data, or to ignore it in order to argue that reality must be different.
In any case, there are third world countries where treatments are instead viewed with respect, since it is well known that otherwise uncontrollable subjects are made functional and pro-social through therapy. Moreover, even in the USA the initial motive for treating them with methadone therapies was the immediate benefit in terms of imprisonment, public order and prison violence.

# 39

No, his reasoning is wrong and naive. There is full of incorrect care. Even the WHO guidelines on this are clearly expressed, they must pay a pledge and say that the interventions are useful if aimed at rehabilitation but essentially the treatment is that.
The fact that there are centers, professionals etc that indicate therapies to scale the community is one thing, the fact that these practices make sense is another. Methadone therapy is also done in community. The communities that plan to remove it to enter I also define them in the manual as “anti-therapeutics”, because and how to admit tuberculosis to a sanatorium by removing the antibiotic. The purpose of addiction treatment is not to show that the community is beautiful or that methadone is beautiful, the purpose is to obtain scientifically predictable and reproducible results.
You know nothing about this matter. If she wants to know, she must learn not with the ideology she likes, but with a little taste for knowledge.
Medicine is full of wrong practices, even paradoxical laws, and the shelves of pharmacies are also full of sugar and water sold legally as if they were medicines, only to be clarified as to the fact that they are not.
If what people do were a guarantee of science and fairness, we would live in the world of fairy tales. You continue to live in your fantasies, the sick live in the real world with their stories and they need to be well. Obviously they don’t know things either and therefore they go after those who guide them: a guide and the disease that distorts their thoughts on how to be treated, and then they find people who support these beliefs by making a whole series of interventions available. omission of true cures. In practice, carrying around a drug addict for detoxification and rehabilitation without specific drugs means organizing and facilitating the course of the disease, which perhaps spontaneously is more difficult.

# 40

User 413XXX
June 29, 2020

small footnote then I leave this sad space, I promise. I am surprised that she is allowed to call me a scammer or even a sower of death and delays in treatment, as well as insults but that does the same, I am not a touchy one. the fact is that I only report facts, I don’t work in this field so there is no correlation between me and the death of some patient (sic!). In short, accusations and phrases a bit fortine, and just for having exposed ideas shared by entire departments, they are so nonsense! I finished anyway, I will no longer write for her joy, and you can delete what you like best, the important thing is to have put

# 41 back at the center of the facts

Nobody calls her a scammer. You limit yourself to saying things that are not true, but unfortunately propaganda them as if you were aware of them. Unfortunately, those who read things like this sometimes follow the wrong paths, get badly treated or don’t care. You don’t kill anyone, don’t worry. But unfortunately the ideas you express are a source of medical misinformation, and they end in people’s health. I don’t understand why you have this vocation to advise and point out to others things you don’t know.
Strong things are the ideas expressed by entire departments, since science says the opposite. You don’t think so.
Or else the “ideas” based on hundreds of studies from 60 to today have the same dignity, and those of those who carry out real “omissive” crusades of treatments
Strong or not, these are the things that the WHO says too, entire international scientific societies, hundreds of authors. Then you know, if you go to Russia, for example, your ideas find success: you are treated with spirituality, ethics, education … and above all with high mortality rates and the spread of HIV, such as result of the total absence of scientific treatment ,.
If and because of that, I remind you that not many years ago the State authorized anti-cancer treatments without any scientific rationality only to satisfy public opinion, with results that are easy to imagine. And doctors still operate today who insist on these treatments, naturally in the absence of data, not even written and published on their own, today it is also easy.

# 42

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