Re: Addiction

I find Dr Ian MacDonald’s comments in the letter published in the April issue of the BCMJ resonate with my own [2008;50:123-124], and more particularly with my own experience both in treatment/management of an addict during my general practice, and later, after a residency year in psychiatry, during my tenure as clinical director of the Narcotic Addiction Foundation in 1974–75. 

There is little doubt that the Insite proponents as well as the provincial and federal government politicians are failing to recognize that:
• All drug-abusing persons (no matter the kind of drug) demonstrate a personality disorder.
• The most common major heroin-addicted person’s personality disorder is a sociopathic personality disorder. 
• There is no easy “treatment” of the above; however, there is a therapeutic management usually referred to as “behavioral modification” which can—and does—produce socially acceptable results, although it is always intense, protracted, and one-on-one. 
• Demonstrably, all my heroin-addicted patients had/have a remarkable and always-successful cure to their problem: simply provide more heroin ad libitum (their consistent total lack of insight into the underlying psychodynamics is just as remarkable!).
• A few—but very few—of the ad­diction treatment/management per­sonnel understand that the value of methadone is solely to take the edge off the addicted person’s withdrawal symptoms and provide some res­pite, allowing alternative lifestyles to be learned and internalized. 

One of my powerful mentors (Dr Larson, medical director at the psychiatric hospital in North Battleford, Saskatchewan) observed that the sole process lacking in all personality disorders—particularly sociopathic personality disorders—is the person’s failure to mature (or, as he phrased it, to grow up). 

Thus this truism demands that all treatment be based on this underlying premise. Insite obviously lacks any element of this.

—David J. Brant, MD
West Vancouver

David J. Brant, MD,. Re: Addiction. BCMJ, Vol. 50, No. 6, July, August, 2008, Page(s) 291 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply