DR. DAVE: Had she tried withdrawing from the opiate painkillers?

BILL: Yes, at a rehab clinic last year. The pain was so bad she could not sleep. She left after three days. The candid interview with Paula Abdul in last month’s Ladies Home Journal had her thinking about a way out again.

DR. DAVE: And she was asking whether you, Bill, really believe that if she joined Narcotics Anonymous, held hands and said The Lord’s Prayer at the end of each meeting, the pain would go away?

BILL: How did you know?

DR. DAVE: A lot of my addicted patients begin like that, too. I’m working in Juneau, Alaska this week. They’re struggling with an explosion in the use of highly addictive painkillers by their young people. Similarly, Paula Abdul says her use of pain medications began with a cheerleading accident at the age of 17.

BILL: Where you and I may disagree, Doc, is that I don’t care if the person in torment is someone like Paula Abdul, my dinner partner or a junkie in a back alley buying oxycodone to ease the anguish of addiction. When someone in real pain is sitting right there with you, asking for help, I’d say put all the moralizing aside and give it to them.

DR. DAVE: Which is the spirit of the times. Addiction treatment changed back in the late 1990s when the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the national health care licensing body, ruled that we in the health care field -- including addiction counselors -- were going to be held accountable if we did not relieve patient pain.

BILL: And here I thought I was being so bold, new and daring. Am I fighting yesterday’s battles?

DR. DAVE: Actually, you’ve hit on a basic truth. Pain is rooted in the opiate receptor sites in the brain chemistry. How those sites have become disrupted and accommodated to drugs becomes irrelevant. The professional rule today is if we want people to recover, we need to first meet the need for pain management. Of course, that does not mean replacing pain with euphoria of drug abuse.

BILL: So, you support moving people into Methadone maintenance clinics instead of the 12-step programs?

DR. DAVE: Of course not. I see the opiate replacement drugs as a stopping point BETWEEN the pain and euphoria. Methadone and opiate replacement drugs are closer to relapse into euphoric drug abuse than I like.

BILL: Which is why you always recommend setting up a formal detoxification program first?

DR. DAVE: It can be short-term like Paula Abdul's, or longer-term using Methadone as part of the transition to a traditional, abstinence-focused treatment program. If the Methadone program is effective, it does offer a better life than most persons on Opiates can aspire to. But I would always recommend integrating that treatment with a strong 12-step program.

BILL: You know, I can remember how many patients at Scripps took that walk from Building A to Building B -- across the courtyard -- with their luggage and family. They were moving from a week of detoxification and gradual involvement in counseling groups, into the traditional rehab center in Building B. And a month later, in the aftercare groups I’d sit in on, they’d describe how the welcoming environment of visiting AA and NA members convinced them to fully detox and learn more holistic methods of pain management.

DR. DAVE: And between both buildings, was the 12-Step Serenity Garden, where you could see the pajama-clothed detoxers talking earnestly to the new alumni in their jaunty “I survived the McDonald Center” T-shirts.

BILL: The perfect metaphor of compassion and recovery. Doc, I wish you luck in your work with communities like Juneau, suffering under the weight of this new addiction crisis. Let us know how you make out.

Dr. David Moore is a licensed psychologist and chemical dependency professional who is a graduate school faculty member at Argosy University's Seattle campus. Bill Manville is a novelist and writer whose most recent work, 'Cool, Hip & Sober,' is available at online bookstores. Formerly the host of the No. 1 radio show 'Addictions & Answers,' he has been sober now for over 20 years.