CORVALLIS, Ore. - Drug addiction expert John Gillis has trekked along heroin smuggling routes from Pakistan to Nigeria, watched addicts put coal tar in their ears to prolong an opium high, and seen junkies so desperate for a fix they have resorted to sniffing gasoline and insect spray.
And he has come to a simple, frightening conclusion: Drug treatment programs don't really work.
There is no magic elixir, no 12-step program that will effectively take a majority of dopers off their dope, said Gillis, a psychology professor at Oregon State University who has conducted research as a Fulbright fellow in India and Greece and as a visiting professor in Egypt, Pakistan and the U.K.
The motivation for getting clean, he points out, must come from within.
"You have to be willing to go through a lot of pain and suffering," Gillis said. "Most addicts don't want to do that. Those who really are motivated to quit often will do it on their own. Ninety percent of the Vietnam veterans who became heavy heroin users during the war quit on their own when they returned to the U.S.
"They really weren't at risk in the first place. When they got home they saw it was dangerous and it was expensive, so they just quit. End of story."
Gillis' own research in Oregon reached a similar conclusion - it isn't the physiology of drug abuse that needs to be addressed, but the psychology. Gillis and his OSU colleagues have found that treatment strategies which focus on detoxification - or eliminating the physical dependence on a drug - are beneficial only in the short term.
Eventually, the underlying causes of addiction must be addressed, Gillis said, or relapse is inevitable.
Not everyone agrees. Some treatment centers claim a high degree of success but those claims, Gillis says, should be taken with a very large grain of salt. He cited one example of a center that claimed successful "rehabilitation" because its patients had not returned for more treatment.
"They could have been dead or lying in a gutter, though," Gillis said.
Other success claims are based on drug-free stretches of three, six or nine months, Gillis said. Relapses after a year, however, are not uncommon.
The Oregon State University professor has become something of a drug counselor to the world. During the last several years, Gillis has been invited to a number of Third World countries to work with health and social services officials on drug addiction problems. His "patients" have included India, Pakistan, Cyprus, Nigeria, Bangladesh, Micronesia, Bahrain and Qatar.
His message to those countries carries a common refrain: You can invest billions of dollars in drug treatment programs with very little effect. In the long run, that money would better be spent on prevention through education.
And the earlier, the better.
Gillis says that some individuals can successfully be rehabilitated through treatment programs. But the odds, he added, are stacked against them.
"The most successful treatment programs in the world tend to be those with the harshest methods," Gillis said. "In Singapore, for example, they are like boot camps. They follow patients around for three years after they leave the centers, taking frequent urine samples to test for drug use. If the patients are caught on drugs, it's right back to boot camp.
"Even at that," he added, "they have a 50 percent relapse rate."
The best treatment centers in the United States can offer only a one-in- three chance of recovery, Gillis says, and that "is awfully optimistic." Treatment centers shouldn't be completely forsaken in the war on drugs, he added, but more money should be diverted to education.
"The best way to address the drug addiction problem, essentially, is to produce people who aren't going to do drugs," Gillis said. "It isn't a question of supply - drugs will always be available. It's more a question of attitude and of outlook on life."
Cutting off shipments of illegal drugs from other countries is a noble idea, Gillis said, but it is hardly an effective one. Whenever supplies of cocaine or heroin are threatened, new waves of synthetic compounds like PCP, Fentanyl and a variety of methamphetamine designer drugs hit the streets, from Portland, Ore., to New York City.
And those designer drugs are more powerful, more addictive and more difficult to trace than "traditional" street drugs, Gillis pointed out.
"With drugs like crack and ice, you only need a few exposures and you run a high likelihood of being addicted. People talk about cutting off the supply of drugs, but the truth of the matter is that anyone with high school chemistry can produce all the drugs they need in their own basement."