Wim van den Brink is a physician who is professor of psychiatry and addiction at the University of Amsterdam. He is one of the Netherlands' leading authorities on drugs and their effect on the human body, and his reputation in medical circles extends internationally. In part three of a five-part series on drugs in Europe, RFE/RL correspondent Jeremy Bransten spoke to van den Brink in Amsterdam about drugs, their relative dangers, and addiction potential.
Amsterdam, 29 November 2000 (RFE/RL) -- Wim van den Brink first spoke of cannabis -- and its derivatives, marijuana and hashish -- which have been decriminalized in the Netherlands. He was asked how dangerous cannabis is from a medical point of view.
"Cannabis doesn't have a lot of negative physical effects. It doesn't destroy your brain, it doesn't destroy your liver like alcohol. So actually, in that sense, cannabis is a relatively safe drug. It has a relatively low addiction potential and it has a relatively mild physical side-effect pattern."
Van den Brink says the medical evidence currently available indicates that even long-term use of cannabis does not permanently impair brain function.
"There have been a lot of studies about whether cannabis creates continuing, persistent cognitive deficits in the brain. There is very little to be found there. If you read the literature, they say: 'Maybe, potentially, there might be some dangers, but they are of a very subtle nature and our tests are probably not sensitive enough to detect them.' Which means: Nothing found, but you never know. That is not the case with alcohol or with tobacco."
Van den Brink was asked how cannabis' effects compared with those of other drugs, especially alcohol and tobacco, which are widely tolerated and often perceived as less dangerous than illegal drugs.
"Cigarettes -- and of course the addictive substance in cigarettes is nicotine -- are known to be one of the most addictive substances that we know. Treatment programs haven't been that successful. The tar in the tobacco, is as we all know, a major killer in public health aspects. The same is true actually for alcohol, which in that sense is a hard drug. It's a very dirty drug. It has very bad effects -- if you use too much of it -- on our cardiovascular system, on our liver, on our brain."
What is the distinction, van den Brink was then asked, between the physical harm a drug can cause and its addictiveness? And to what degree is addiction a physical phenomenon and to what degree is it psychological?
"In the past, we thought that withdrawal was the driving force of addiction, that if you could make people stop and have them stop for a longer period, that this would do the job. Actually, now we do know that stopping with the drugs is not that difficult and getting people off for a while is not that difficult. It's the relapse, it's people coming to a certain situation, they get a cue that is related to drug using from the past and they immediately get this drug-seeking behavior, the craving again."
Van den Brink says current research indicates that this psychological dependence, more than physical addiction, is the driving force behind drug addiction, regardless of the substance.
Among so-called "hard drugs," heroin has become a concern in many European countries. The main dangers with heroin are overdosing and injecting with dirty needles, which risks transmitting the HIV and hepatitis C viruses. The HIV virus causes AIDS.
Van den Brink says heroin itself, if used in strictly controlled amounts, is a relatively "clean" drug, which does not harm the brain or cardiovascular system. Methadone, a chemical substance of similar composition, can satisfy the craving of most heroin addicts without the risks of injecting. For that reason, it is often used as a substitution treatment. Van den Brink explains:
"Methadone has a lot of advantages over heroin. For example, the first thing is we can prescribe it in a medical way, so people don't have to get [it] on the streets. Second, it's taken orally, which means that you bypass the whole thing of injecting and HIV and hepatitis (risk). And third, it works for about 24 to 70 hours, which means that we can provide it once a day, whereas heroin addicts have to get their shot or have to smoke it four to six times a day because it's a short-acting drug. So the big advantage of methadone is that it is legal, it is long-acting, and you can take it orally."
Van den Brink says that nicotine chewing gums and patches, which people who are trying to quit smoking often employ, can be compared to methadone substitution treatment. With heroin addicts, he says:
"We go from injecting to oral use and here [with tobacco] we go from smoking with tar to plasters or spray without the tar. Then, we don't cure them from their nicotine addiction, but their outcome in physical terms is going to be much better and they're not going to die from all kinds of cancers."
Common wisdom has it that the key to quitting tobacco smoking or drinking alcohol is will power -- you have to want to stop. The same appears to hold true for illegal drugs. In some countries, drug addicts are forced to undergo rehabilitation treatment against their will. In rare cases, this is also true in the Netherlands.
Van den Brink says that, based on scientific studies both in the Netherlands and elsewhere, coercive treatment can sometimes be useful, but the results are not that impressive.
"For example, [you] have the famous 'staying out' program in Staten Island, New York, which is a therapeutic community within a prison situation, where people are being treated for about a year during their imprisonment. What you see when they go back to the community is that, in terms of criminal relapse, the ones who got this treatment relapse in about 50 percent of the cases and the ones who didn't get the treatment relapse in about 62 percent. "
As van den Brink puts it, a difference exists, but it is "small." All indications are that working with drug users instead of trying to break their will is a slower, but ultimately more fruitful approach.