Karen Reese serves as the director of Baltimore’s first methadone clinic, originally opened in 1967 by the late Richard Lane, a former addict himself. It is the second oldest meth program in the nation, the first being in New York City. In addition to being an outpatient clinic for recovering heroin addicts, Man Alive is running an experimental methadone program in the state prison, directed by Gary, and is now creating a collaborative project with the city’s animal pounds to partner patients with puppies- Project SPIRIT.

Q: How do you view addiction?

KR: Addiction is a brain disease- it should be in the medial arena as opposed to the criminal justice arena. Man Alive functions that way- it’s not their fault. After many years of abuse and use the brain really does change. Once patients understand that, it’s much easier. They go through all kind of guilt. To buy they may have been involved in criminal activity because you can’t just go to the grocery store. They might steal, cut off emotional relationships with their family.

KR: Addicts are some of the most fascinating people I have met in my life. They have survived the most difficult circumstances. If you can re-channel that resiliency they can do amazing things.

Gary: There is very little difference between [drug treatment approaches for] adolescents and adults. It is often said that the age of addiction is the age of maturity. You can’t treat some folks like they’re 30 because they’re not.

“It is often said that the age of addiction is the age of maturity.”

KR: I see addicts looking at things in a very different world. I see an injustice and I say, “Well, that’s the way things are,” or I may try to do something about it. But for them sometimes, it’s almost debilitating- they shut down. It’s almost like they are more sensitive.

Gary: People don’t choose addiction- its biological. During the Vietnam War, 100,000’s of soldiers were using heroin. About 10% needed treatment because when they all got home, most returned to the US and went on without it. Similar to alcoholism, about 10% abuse because of the biological aspect.

KR: I think that will change with time because of education. It is starting to enter mainstream America that this is generational behavior. [Some folks] just can’t call their internist. So much of it is couched in that socio-economic climate.

Q: Recognizing that once folks are addicted it is out of their control and they need medical intervention, aren’t they still guilty of breaking the law to begin with?

KR: People begin using drugs for many reasons- usually what they are doing is self medicating themselves. Usually because they are dealing with psychological issues they haven’t dealt with in the past. They often close up their emotions. Throughout the world we need proper diagnoses of mental health- to see what is bringing them pain. People use drugs for many reasons that you or I can’t readily identify right now.

KR: Its learned behavior- generational. We are treating third generation addicts here. If we were in a perfect world, we would be in a utopia- that’s just not the way people are. Drugs have been around since the existence of man. I don’t see it going away anytime soon. People come home and have wine with dinner and it alters their mood, but with drugs it’s all about morality because they are illegal.

Gary: The government spends most of its money on interdiction and enforcing drug laws, not on helping people.

Q: Do you allow take-homes? [Whereby patients can take several days of medication home with them instead of having to come to the clinic everyday. Usually this is reserved for more stable and committed patients assuming it is legal according to state law]

Yes- if they won’t be involved in diversion [selling the methadone medication on the street] or put it somewhere where a child could reach it. Something people don’t understand about diversion though is that if methadone is sold on the street it is usually to existing addicts who can’t get into treatment. Its not the drug of choice for an addict because it can’t get you high. But it will allow an addict to feel better. Methadone is the most regulated drug around.

Q: Some people say methadone maintenance is just trading addictions- how would you respond to that?

KR: Its not trading addictions. Its endorphin replacement therapy. It goes along with the research on brain chemistry. We have patients that have been with us since we opened in 1967. Relapse from methadone is very, very high. Dr. Tom McClellan has shown that folks on methadone have much higher compliance rates than diabetic patients or patients with high blood pressure! We refer to people here with addiction as if they have a chronic illness. An ongoing illness.