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drug use, health and mental health issues, employment patterns,
criminal behavior and mortality. The study focused on 581 male
heroin users who were admitted to the California Civil Addict
Program between 1962-1964, and have been followed since that time
by UCLA researchers. Follow-up rates were exceptionally high; only
12 were lost to follow up. Very few participants were on methadone,
and thus the study shows the natural history of heroin addiction (in
males), when methadone treatment is not utilized.

The 33-year follow up (1996-1997) revealed that 49% were dead and
most of the rest were doing poorly. Many were using heroin and other
drugs, drinking alcohol daily, and smoking tobacco. They had high
rates of health problems and criminal justice involvement, and
psychological distress. Of those who were alive, only 20%-22% were
abstinent, and these participants had less criminal involvement, health
problems and better health and employment status.

The outcome data on methadone patients provides a striking contrast.
Methadone patients have been extensively studied, in part because the
legal requirement that they obtain their medication from special clinics
means they are a favorite for researchers. It is possible to locate and
follow methadone patients more easily than participants in other types
of programs. A voluminous research base permits us to examine a
variety of questions, and over long periods of time. Many of the early
studies were done before it was widely accepted that persons with the
history necessary to qualify for methadone treatment are unlikely to be
able to discontinue and preserve their gains. Thus it is possible to
examine the trajectories for patients who remain in treatment, who
discontinue voluntarily, and who are involuntarily tapered from the
medication. Those who remain on medication continue to improve
and maintain their gains, with some continuing to improve over a
period of years. While those who discontinue voluntarily do
somewhat better than those who do not, by the end of a year, they too
have relapsed.

This is consistent with the expectations of Drs. Dole and Nyswander,
who state that methadone is necessary to correct brain chemistry
anomalies. It normalizes but does not cure a dysfunction, in much the