The Obama administration announced last Friday it was naming a prominent addiction specialist to the number two post at the Office of National Drug Control Policy (ONDCP), widely known as the drug czar's office. If confirmed by the Senate, University of Pennsylvania psychologist A. Thomas McLellan would be deputy director of ONDCP.
McLellan would serve under former Seattle police chief and yet-to-be-confirmed director of ONDCP, Gil Kerlikowske. The nominations of Kerlikowske, a progressive police executive not overtly hostile to drug law reform, and McLellan, a well-respected scientist and researcher, suggest that the Obama administration is moving away from the politicized and ideologically-driven ONDCP of the Bush years.
McLellan is considered a leading researcher on a broad range of issues related to addiction. Working at the Veterans Administration in the 1980s, he developed the addiction severity index and the treatment services review, two measures that characterized multiple dimensions of substance use. He later worked with the state of Delaware to tie payment for treatment at state-funded centers to predetermined measures of success.
In 1992, McLellan co-founded the Treatment Research Institute to study how to transform promising research findings into clinical practice. He is editor in chief of the Journal of Substance Abuse Treatment, and has published some 400 articles on various facets of addiction and treatment.
One of those was a groundbreaking 2000 article comparing drug addiction to other chronic medical conditions. In it, he urged consistent application of the disease model, noting that if diabetes patients relapsed after treatment, doctors would conclude that intervention had worked and more treatment was needed.
Drug addiction should be treated no differently, he suggested: "In contrast, relapse to drug or alcohol use following discharge from addiction treatment has been considered evidence of treatment failure," he wrote.
For those who view the disease model of addiction, humanely applied, as an improvement over arresting and imprisoning drug users, the McLellan nomination signals real potential progress. But for those who view the disease model as less an analog than a fuzzy metaphor, the nomination could signal the expansion of the therapeutic state in the name of our own good.