Pubdate: Sun, 11 Sep 2005 Source: Contra Costa Times (CA) Copyright: 2005 Knight Ridder Contact: http://www.contracostatimes.com/ Details: http://www.mapinc.org/media/96 Author: Judy Silber Bookmark: http://www.mapinc.org/heroin.htm (Heroin) PROFESSOR ADDRESSES ADDICTION IN IRAQ Keith Humphreys spoke no Arabic. He also knew little of Iraqi culture. Nonetheless when offered a position as the lead U.S. adviser to Iraq on addiction issues, he decided to take on the challenge. "I'm of the belief that if you want to be useful, when opportunities come along, you have to take them," Humphreys said. An associate professor of psychiatry at the Stanford University School of Medicine, Humphreys specializes in addiction. But he was still surprised to learn that stigmas around addiction are reversed in Iraq, compared to the United States. While heroin and opium usage are accepted, alcohol is not. And he discovered that Iraqi doctors have far fewer resources for dealing with addiction than American physicians. In general, the Iraqi health care system is in disarray. Approaches toward mental health care lag far behind that of the Western world. So Humphreys says much of what he's doing is "small deed democracy." That is, he's supporting his Iraqi colleagues in whatever way he can as they try to piece together a new health care system and play catch-up to modern medicine. Q What is your role as the addiction adviser to Iraq? A I just wanted to be helpful in any way that I could. I guess that's probably what my role is. I'm helpful in any way that I can be. Sometimes it's been things like giving them advice in how they should spend money for their budget, or telling them about medications that have been developed for addiction that they didn't know about. Or the importance of policing the borders. You probably know, but most of the world's heroin comes from Afghanistan. Q How have you been working with the Iraqis? A In December, we had a meeting in Washington of principals, the lead Iraqi and American mental health people. That's where the plan came together that we wanted to have an annual mental health conference in Iraq. The original hope was it would be in Iraq. But they had some concerns about safety. Doctors are assumed to have money, so they can become targets for kidnappers. They moved the March meeting out of Baghdad and into Amman, Jordan. We were arguing in the group, as people will do. This one guy was really quiet during the two days, but he talked to me afterward and he said, "So you guys just argue and then you go home," and I said, "Yeah, that's right." And he got this big smile on his face and he said, "That's wonderful." I asked people why it was such a big deal. They told me this famous story. At some point during the Iran-Iraq war, Hussein called a cabinet meeting. He said, "Tell me your candid opinion of the war." The health minister said, "Well, lots of Iraqis have been killed. Maybe we should pull back. Maybe we should step aside until this blows over." Hussein said, "Thank you for your opinion," and then he had the guy executed immediately. The Iraqis have all heard this story. It's all part of the legend of Saddam Hussein. If that's the most powerful doctor in the country, if that can happen to him, then you have no protection. Q What was the most surprising thing that you learned about addiction? A They think alcohol is worse than drugs. There would be these disconnects when I would talk about (alcohol) services. They had this really negative reaction. They would say there is no alcohol abuse in Iraq. But they had no problem saying that lots of people are smoking opium and taking benzodiazepines on the street. Q What is the stigma associated with alcohol? A It goes back to the Quran. You're not supposed to be under the effect of alcohol when you pray, and you pray five times a day. It's been a part of Islamic teaching for 1,500 years. Q How bad is the heroin problem? A That's one of the more severe problems. Heroin and opium, both. Religious pilgrims smoke it. They would never drink alcohol, but they have no problems smoking opium. Most people say the most widespread problems are prescription drugs. If you wanted to go out in Baghdad and get pain pills, you could do it pretty easily. You could get it from a pharmacy. You could get it from the street. Q What was your advice to the Iraqis? They must have a limited budget, limited resources. A Their mental health system is like our mental health system was 40 years ago. It's like the old state hospital system where you send your strange old uncle up to the hospital and that's where he spends the rest of his life. There are still not enough beds for all the patients. There are patients who sleep on the floor. The guy who heads it says the average patient is there for at least a decade. The staff doesn't even know all the patients' names. There's only a very small number of psychiatrists for these patients. One piece of advice coming from everyone is to try and build a modern system around primary care. There are primary care centers being built all over Iraq. So there's that, and consultation stuff around the development of drug laws. The draft laws were way too weighted toward law enforcement, the lock-'em-up approach. It's just terribly ineffective. Who knows whether or not they will listen, but I encouraged (the Iraqis) to develop an alcohol and tobacco policy, as well as drug laws. But I don't think that it has gone very far. Q Is there enough methadone in the country for heroin treatment? A No. That was one of the first things I brought up. You can imagine the problems of trying to run a methadone program. The pharmacy system is not secure enough to do that. What I've been trying to do, I'll be taking with me Arabic Narcotics Anonymous materials to Jordan. It's been Arabized and Islamized. I'm trying to get long-term support for addictive people. Q How would you start an NA program? A They are Arabic pamphlets for patients and how to run an NA meeting. All I can do is give them to them. I've presented all the evidence about it, and of course, everyone likes the fact that it's free. You can start running groups, ask people to meet. I think that would be a great legacy. Q Would you say that the doctors are discouraged or excited about doing something different with regards to rebuilding their health care system? A First off, everyone is so happy that Saddam Hussein isn't there any more. The idea that this is a new era is exciting to everyone. But there are also people who find that frightening. The decisions you make will be more consequential. There are people who aren't quite ready to step into those roles because they're so beaten down and oppressed under Hussein, all they really know how to do is complain. It may take awhile for them to feel you can do this, you have a right to do it, and now do it. That's the whole thing, will there be a civil war? Will there be restoration? If civil war happens, everything I'm doing is a waste of time. But in Iraq, you have to take risks. Because if everyone sits back and says, "As soon as it's all fine, I'll do something," it will never be fine. * Name: Keith Humphreys * Age: 39 * Title: U.S. adviser to Iraq on addiction, associate professor of psychiatry at Stanford University School of Medicine, and staff member of the Veterans Affairs Palo Alto Health Care System * Location: Palo Alto * Career: Humphreys has been a professor of psychiatry at Stanford since 2002. Before that, he was a visiting senior policy fellow for one year at the Office of National Drug Control Policy for the White House. Humphreys has also served as a consultant on addiction for the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services, as well as for Gov. Gray Davis. * Education: Humphreys graduated from Michigan State University with a B.A. in psychology in 1988. He went on to earn his Ph.D. in clinical/community psychology from the University of Illinois in 1993. - --- MAP posted-by: Elizabeth Wehrman