Bridging the Gap: An Interview With Dr. Robert Whitney

This week we bring to Points an interview with Dr. Robert B. Whitney as part of an ongoing interdisciplinary dialogue inspired by last month’s “Courtwright Symposium.” Whitney served as Clinical Director of the Division of Chemical Dependency at Erie County Medical Center from 1976 to 2011.  In addition, Dr. Whitney worked for the Research Institute on Addictions in Buffalo, NY in the early ‘90s.

Can you tell us a bit about your unique professional experience, and perspective regarding addiction and the War on Drugs?

I have a slightly different perspective than people whose primary focus is research, including historical research.  My experience has been in trying to synthesize relevant information from any source and to apply that information in helping people cope with their drinking and drug problems.  Over the years, I’ve also been on different committees at the county and state level looking at addiction policy questions.  So most of my experience as a clinician, was a little different.  But I have some sense of what the policy issues are and how ill-informed most of it is.  So I have a slightly different take on the whole thing.

In your 35 years of experience, did the patient demographics change significantly?  If so, how?

Yes.  In many ways the demographics changed some.  People got younger.  I still don’t really know if that’s a product of changes in prevalence of drug use or whether we just got better at catching people earlier in the course of their problems.  I think it’s probably some of both.  We found other ways to engage people before they are having trouble with the law for example, or having trouble on the job.  So the age has changed and certainly the patterns of drug use have changed.  Ten years ago in Buffalo if we saw one or two people a month who were primarily in trouble with prescription drugs that was a lot out of say 100 admissions.  When I left in September [2011], and I don’t think it’s changed very much since, it was around 40% of admissions. That’s a huge, huge, change.

My research focuses on drug policy reform in the mid-to-late 1980s, reform largely associated with the emergence of crack.  Can you point to any significant changes in your own facility at ECMC during this period?

We certainly began to see people with shorter drug histories.  Clinical populations tend to be people who are more troubled than your average user or abuser.  If you’re having trouble spending too much money on cocaine every once in awhile you don’t necessarily end up in treatment.  If you spent the family fortune on it and everyone has given up on you we might expect to see you in treatment.  So often, it would be a number of years before they ended up in treatment.  I think when crack came to Buffalo, we did see a lot of people with crack as the main reason that got them to treatment earlier.  It seemed like they would get deep into trouble in months, rather than several years. People were getting into trouble with it, I think, because you could get started on it with smaller amounts of money.  You didn’t have to have a great deal of money in your pocket to get going. This seemed to be a difference in typical patterns.  Moreover, because of the rapid onset of inhaled cocaine, the drug is particularly reinforcing, contributing to more rapid progression of problems.

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