Terra Sigillata

By way of my substance abuse blogger colleague, The Discovering Alcoholic, I learned of yesterday’s New York Times article by Sarah Kershaw on Dr. A. Thomas McLellan. McLellan is a psychologist and drug abuse researcher with over 400 peer-reviewed publications to his credit. He held an academic appointment at the University of Pennsylvania School of Medicine and was scientific director of the Treatment Research Institute which he co-founded in 1992 with Jack Durell, MD, and other researchers from Penn’s Center for the Studies of Addiction.

However, McLellan is not a career bureaucrat like many in Washington (“I hate Washington,” he is quoted as saying.). Beyond being a substance abuse researcher, he has experienced firsthand the pain and suffering of addiction:

But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.

“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I thought maybe there’s a way where what I know plus what I feel could make a difference.”

Married to a recovering cocaine addict, Dr. McLellan has been engulfed by addiction in life and work. His own family has been a personal battleground for one of the country’s most complex and entrenched problems, while as an expert he has been a leading voice for the idea that addiction is a chronic illness and not a moral issue. [emphasis mine]

McLellan notes that his experience in substance abuse research and treatment did not make him any better prepared for facing the addiction challenges of his sons:

“If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ “

Kershaw’s article speaks in greater depth about the shift in drug abuse policy from one of a “war on drugs” to one of treatment and prevention. Even McLellan’s boss, former Seattle police chief, R. Gil Kerlikowske, has had family members with substance abuse issues.

Many veterans of the long and frustrating fight against addiction say it is about time. “This is an extraordinary moment of opportunity,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse and one of the colleagues and friends who helped persuade Dr. McLellan to take the job.

As you might suspect, treatment and prevention vs. law enforcement and harsh penalties tend to break down between political alliances:

“I’m not sure the federal government has an obligation to try to rehabilitate addicts,” said Heather MacDonald, a senior fellow at the Manhattan Institute, a conservative policy research group. “Government has an obligation to provide safe streets to people, and policing has an extremely effective track record in places in like New York City and Los Angeles.”

I have to say that I am still cynical, especially since the Obama administration took the Office down a notch from a cabinet-level position. But I think we at least have leaders at the highest level who understand that the human costs of substance dependence do not warrant a military campaign.

To close on a lighter note, here’s a gem for the scientists who may think of their long ago thesis research as toiling in a vast oasis – McLellan speaks of his own PhD work:

He earned his doctorate in experimental psychology, with a focus on animal learning, from the University of Pennsylvania in 1976.

“You’ve undoubtedly — I think almost every American has read my Ph.D. thesis by now,” he said. ” ‘Negative Autoshaping in the Rat, Cockroach, Pigeon and Crayfish.’ And armed with this kind of knowledge and obvious preparation for the business world, I was shocked to find that there weren’t many jobs available.”

Do yourself a favor and go read this article by Sarah Kershaw. It’s a good example of excellent science writing because she engages you with a fresh look at an age-old issue, addresses the real-world challenges in the face of everyone’s optimism, and gives you a personal insight into Dr. McLellan’s life and personality. Can’t ask for more than that.

I also look forward to any discussion from any of our neuroscience and substance abuse researchers who may know more about McLellan than I.

Comments

  1. #1 pinus
    December 9, 2009

    Great Article, thanks for posting. I can only hope that with somebody who realizes that substance abuse is a CHRONIC DISEASE RATHER THAN A PERSONALITY FLAW, we might make more headway in treatment and prevention.

  2. #2 anjou
    December 9, 2009

    Thanks for posting- he was one of my dissertation advisers many years ago!!

  3. #3 Jonathan
    December 9, 2009

    Sadly I think sensible drug policy will happen about the same time someone cuts $100 billion/year out of the defense budget to fund healthcare…

  4. #4 Katharine
    December 9, 2009

    Totally unrelated, and I’m sorry for hijacking the thread, but I had a thought.

    Menthol activates TPRM8 receptors, which also control cold.

    Is the effect cumulative when an individual’s TPRM8 receptors are exposed to both menthol and cold? (Anecdotally, I had a drink of water after eating some gum that contained menthol, then compared the temperature of the water on my hand, and there seemed to be a disparity in temperatures)

    Has menthol ever been used, say, in conjunction with other temperature-changing medical techniques, and if not, why not?

  5. #5 Katharine
    December 9, 2009

    Note that I am aware menthol is used in, say, cough drops for analgesia.

    However, is menthol used to, for example, alleviate burn pain or in conjunction with capsaicin (besides in Ben-Gay – I’m talking about non-over-the-counter applications of capsaicin), or as a numbing agent for, say, cryotherapy (though I’m only marginally sure it can work)?

  6. #6 k8
    December 10, 2009

    I am vastly pleased with this appointment. And I do see it as a step in good direction. Because with this statement,

    “If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ ”

    McLellan admits that the so-called experts are anything BUT expert when it comes to managing addiction on a personal level. An expert in research is not an expert in the trenches by any means. And until the experts in the trenches get heard, I don’t believe much change will happen.

  7. #7 DrugMonkey
    December 11, 2009

    k8, you seem to be implying that there’s some great silver bullet solution out there on the front lines of addiction treatment that is being ignored by the ivory tower researchers. If this was your intent, nonsense.

    Nobody has a silver bullet solution at present, all we have are bits and pieces. Any possible treatment you can think of works for some, most frequently a minority. I think it was David Sheff who observed in Beautiful Boy that if anyone tells you that they have an ironclad addiction solution this is a good indicator to run away as fast as you can.

  8. #8 k8
    December 15, 2009

    DM – you’re right. There is not a silver bullet for treating addiction. And frankly, I don’t think there ever will be. What seems to work for some populations works not at all for others. I’ve had people tell me they’d run down the street naked during rush hour if I thought it would help them. That’s how desperate some addicts are. You know that. And that’s why I come here and to your blog and read everything I can find on addiction research and clinical trials and – well – pretty much anything on treating addiction. I want to soak it all in if I can be of help to someone down the road.

    However, what I experience as someone who works in the field of addiction is that as a layperson and not a scientist, I am often not heard. When the science and the front lines start working together more tightly, I think more answers will come. As I said, I see this appointment as a step in the right direction.

  9. #9 Bill Hoch
    June 18, 2010

    Tom, I don’t know if you remember me but I am Dana’s cousin and I have spoken to you on many occassions. I was very disturbed when I heard about the death of your son…I want to extend my sympahties…I never want to bury a son or a daughter. I consider you one of the intellegent most men I’ve known, and I would like you to give me a call. If you don’t rspond, have a good life. (P.S. what you said years ago greatly changed my life…thank you) Bill

    Note: Bill, I removed your phone numbers from the above comment to keep you from getting spam. Abel

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