It’s difficult to alter, without use of chemicals, patterns of behavior that chemical use cultivated–so difficult, in fact, that one of the most effective methods relies on the supposition that chemicals are involved. And in an important sense, the supposition is correct. The Placebo Effect, in many cases potent and sustainable, results from a deluge of endogenous molecules. But even the brain’s considerable arsenal has its limits–a syringe of saline solution won’t dupe a heroin junkie, even if they’re certain, in the lead up to plunger depression, that the contents are legit.

In such Placebo-ineffectual circumstances, I would advocate for officially sanctioned administration of the uncorrupted and genuine agent. The idea is to take advantage of an addict’s presumed willingness to do anything for a fix, where that boundless, italicized word conveniently includes alignment with decorum. Asked to choose from various occupations for which they are deemed qualified, the “patient” would be promised a nightly fix contingent upon their work productivity and law-abiding behavior in the 24 hrs since the last time a nurse injected them. Ideally, the program would be heavily subsidized, so that addicts would get their fix gratis, making the notion of looting a house for drug money all the more irrational.

A reliable source informs me that programs like this already exist outside the US, and that subscribing countries enjoy the concomitant reduction in drug-related crime. Indeed, who would spend currency on underground heroin cut with an unpredictable and potentially hazardous list of additives when the pure stuff can be had for free via a needle that isn’t used more than once? In light of the current unemployment cries, it’s feasible that generous programs like these would motivate sober citizens to dive into the world of drugs simply to gain employment, and I suppose I’d have to put my trust in the negative physiological effects of heroin use as being a strong enough deterrent. As an aside, to satisfy cynics, the formula is easily tweaked to accommodate a future that takes the form of an austere dystopia: rather than any financial compensation for their work, the daily fix alone is the addict’s soul payment.

Addiction treatment navigates a fine line; it must approximate the real thing well enough to be adopted as a substitute, yet not so well as to perpetuate the destructive behavior associated with the addiction. Recognizing that the elements worth imitating aren’t limited to the particular drug itself, efforts have been made to create outlets for the physical rituals (e.g. the fake cigarette a quitting smoker fingers and puts to their lips). However, even the most all-encompassing, multi-pronged treatment regimen will fail to replicate a staple of addiction that may, counter-intuitively, be yearned for: the contentious relationships that typically populate a life centered around substance abuse. What will become of the raging arguments with cohabitants, the thrown dishware? The historically scornful eyes of strangers will be replaced in the rehab room with cheers of encouragement from fellow registrants. How surreal, that. And this calm life that awaits the newly cured? How bland in comparison to the former highs and lows regulated by one’s proximity in time to dosing.

I suspect a fair number develop a compromise between their former life of addiction and the new one facilitated by treatment. Who really knows how many marriages haven’t ended in divorce because “all he wanted to do was attend AA meetings.”?