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measure brain activity by evaluating blood flow in various brain
regions. Opiate addicts in stable recovery (abstinence) were placed
under the PET scanner and given 2 audiotapes to listen to: one was an
autobiographical recording about drug craving (drug stimulus), and the
other was a neutral dialogue (neutral stimulus or control group).
Results showed that the drug-related stimulus activated 2 specific
regions of the brain (left medial prefrontal cortex, left anterior
cingulated cortex) and de-activated another region (occipital cortex)
when compared to the neutral stimulus. They concluded that these
patterns of specific brain-region activation and de-activation reflect the
different brain regions influenced by addiction. This study also
indicates that these addiction-related brain changes persist even after
recovery (stable abstinence from drugs).

In addition to evidence indicating that addiction is associated with
fundamental changes in brain’s endogenous opiate system and its
function, there are also many studies suggesting that the addict’s
ability to cope with stress is also fundamentally altered. For example,
heroin addicts often do not respond, or respond at abnormally low
levels to stressful events when actively engaged in their addiction.
Addicts that are abstinent and medication-free show exaggerated
responses, or excessive susceptibility to stress. In contrast, addicts
who are treated with long-term methadone maintenance tend to show a
normalization of the stress response, as measured by the body’s
release of stress hormones. Again, the weight of recent scientific
evidence continues to support Dr. Dole’s initial theory, that opiate
addiction is a persistent derangement of the endogenous ligand-
narcotic receptor system, and that opiate agonist treatment is a matter
greater than simple substitution or replacement for illicit opioids.
Opiate agonist treatment (methadone) appears to normalize the brain’s
relative opiate deficiency allowing the patient to function more
normally.

Since 1963, when Dr. Dole initially hypothesized that heroin addiction
was a brain disease with behavioral manifestations, and not just a
personality disorder or criminal behavior, 40 years of clinical studies
have clearly demonstrated the safety, efficacy, long-term clinical
utility of methadone maintenance for opiate addiction. In 1998, the