To the Editor.—
Dr Dole1 proposes that opiate addiction is related to a "persistent" derangement of the endogenous ligand-receptor complex system. This theory seems to have some merit but if we conclude, as Dr Dole does, that the defect is best "compensated for" by methadone we must ignore a lot of conflicting data. The facts show that even when taking methadone, a large percentage of addicts continue to abuse illegal drugs and alcohol; now that cocaine is as prevalent as it is, the situation seems to be getting worse.2 In fact, most of the people who do well in methadone maintenance programs have the same demographic variables as people who do well in drug-free treatment programs.3Fortunately, there is an effective form of treatment for many opiate addicts that seems to allow the receptor complex to normalize. It consists of a program of abstinence from all mood
Coleman P. Methadone and Theories of Addiction. JAMA. 1989;261(13):1879–1880. doi:10.1001/jama.1989.03420130041012
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