from the Newsletter of the Multidisciplinary Association for Psychedelic Studies
MAPS - Volume 4 Number 2 Summer 1993


Interrupting Drug Dependency With Ibogaine:
A Summary of Four Case Histories

Bob Sisko, Director
International Coalition for Addict Self-Help (ICASH)


The use of ibogaine as an addiction interrupter was first discovered by Howard Lotsof in 1962. Twenty years later, he applied for a United States patent based upon his anecdotal findings. In 1985, he was awarded the first in a series of patents relating to ibogaine's ability to interrupt a wide range of addictive disorders including heroin, methadone, cocaine and amphetamine, alcohol, and nicotine as well as poly-drug dependency.

Lostof's findings were replicated in 1990, when the International Coalition for Addict Self-Help (ICASH) reported their findings relative to nine individuals treated with ibogaine for drug dependency. That body of work has since been elaborated upon and expanded to include 21 case histories. These treatments occurred over the past five years. It also represents the second phase of human research with ibogaine, conducted in relation to the treatment of drug dependency. This report on four case histories represents cases 16-19 of the work in progress.

ICASH pioneered the para-clinical application of ibogaine by addicts for addicts. We transferred the methodology and technology we had acquired to our Dutch counterparts who formed guerrilla treatment groups under the DASH (Dutch Addict Self-Help) banner. We have been successful not only in treating our own, but with challenging the medical establishment and their conventional practices. We have succeeded in inspiring a group of honest and dedicated researchers who would defy convention and report on their findings.

One such group, headed by Charles Kaplan, speaks of the value of focus group studies as a tool in applied research and public health programs. One such study underway involves heroin users in the Netherlands who were treated with "lay healers" with ibogaine. As with the cases presented herein, Kaplan's report is not the result of a controlled clinical trial. Nor are they meaningless anecdotal findings. They are the result of focus group studies which have surfaced as the mid-ground between casual experimentation and clinical trials. "Focus groups are principally data-collection procedures," Kaplan states. Therefore, they produce data. Kaplan reports that "All [the heroin addicts] reported an interruption of heroin-seeking behavior for relatively long periods of time, a state they never thought they would reach given their former nihilistic, depressed view of life.

Kaplan's conclusions from his focus group studies raise several basic questions. How long is the "relatively long" interruption of heroin-seeking behavior? By what yardstick do we measure success? Success by one standard (for example, progress defined as the substitution of occasional use for addictive abuse) might equally be viewed as failure by another standard (for example, progress as defined by substitution of total abstinence for addictive abuse). How shall we evaluate these following case histories, and by what rating system?

There are, no doubt, those who would insist that only one standard need apply, DRUG FREE. Although it may express popular sentiment, it is little more than rhetoric and is a wholly unrealistic approach. A more realistic point to start with would be ADDICTION FREE, where the individual has the ability to choose whether or not he or she wished to ingest a given substance or not.

Establishing the standard for evaluation must be based upon two points. The first must be an agreement upon an understanding of what addiction is or is not. Volumes have been written on the subject, many of which take opposing viewpoints. For the sake of simplicity, let us take the position that addiction is a chronic ailment, one which has the propensity to re-emerge months or even years later.

The second point is an agreed upon understanding and definition of just what ibogaine is and does relative to addictive disorders. Although ibogaine has been touted in the media as a "cure for addiction", ibogaine is far from a cure. It is, however, an extraordinarily effective vehicle by which to detoxify a person. It interrupts the majority of withdrawal symptoms normally experienced by heroin and methadone users. What ibogaine does is to place the disease of addiction in remission. Ibogaine also has after-effects, and even delayed effects which are discernible. Some of these effects are to eliminate or ameliorate the craving and desire to do drugs. Ibogaine interrupts cravings, and interrupts self- administration for protracted periods.

Ibogaine represents an entirely new class of treatment modality, the interrupter. The most popular modality for the past hundred years has been, of course, the substitute. The current incarnation, methadone, has been widely used for the past 25 years. Its long acting version, LAMM, is about to make its debut with the help of the National Institute on Drug Abuse (NIDA).

Another treatment approach has been the use of antagonists such as Naltrexon which was hailed as a breakthrough at first. However, addicts didn't like to take antagonists and by and large won't use them.

An agonist-antagonist, Buprenorphine, is currently being pushed into clinical trials by NIDA. This is taking place despite the fact that it has been widely reported that Buprenorphine itself has a high potential for abuse. For example, amongst i.v. drug users in Scotland, it was reported that Buprenorphine was "used more often and by more people than was heroin [British Journal of Addiction, 1990, 85, 301-303].

Other treatment modalities utilize anti-hypertensive agents, anti-depressants, and anti-psychotics drugs. There is no accepted treatment for cocaine dependency.

Ibogaine has been called a "Single Administration Modality", or SAM for short. The difference between a SAM and other treatment modalities is how many times you must take it. Therapies like methadone are on-going, theoretically in perpetuity. LAMM will have to be taken twice weekly. Another treatment in NIDA's pipeline is Disipramine which also has to be taken daily for any effect to be felt.

The effects of a single treatment of ibogaine, however, do not last forever. Although for some individuals one treatment is enough, we have found increasingly that people request re-treatments. Sometimes the request came three months after the initial treatment. Other times, years have elapsed before a request for a second treatment is made. Often it is a request for a preventative measure. Other times the client may have already become re-addicted. In every case, every effort has been made to accommodate the individual.

These requests for re-treatment also indicate that there is an acceptance by addicts of ibogaine as an effective way to interrupt their drug dependency. We believe that widespread acceptance of a treatment modality by the addict population will foster and promote the concept of treatment among those who need it most.

The use of a so-called SAM-interrupter to fight addiction may sound space age and futuristic to some. Nevertheless, this appears to represent a giant technological leap in the field of addiction medicine.

In January, 1993, four addicts from New York City travelled to the Netherlands to participate in an experimental treatment program which they hoped would result in the interruption of their addiction. The two day treatment regimen, referred to by its developers as The EndAbuse Procedure, has been awarded five U.S. patents. Yet the procedure is still prohibited in the U.S. and it's active agent, ibogaine, remains a Schedule 1 substance.

This prohibition, however, did not stop the addicts from coming, nor did it stop a number of American, German, Dutch, and Israeli researchers from attending the First International Ibogaine Treatment Symposium ( See MAPS Newsletter, Vol. IV, No. 1, p. 32). Since then, an application to commence Phase 1 clinical trials was submitted to the Food and Drug Administration (FDA) by the University of Miami research team who were present.

For those who came for treatment, it was the culmination of months and even years of waiting. Their patience and persistence had paid off, and they had succeeded in making it to the top of a rather long waiting list of potential clients. They had all undergone extensive pre-treatment evaluations, which included a thorough physical examination with complete blood chemistry, cardio-vascular evaluation, and neurological testing. In addition, they had participated in dozens of counseling sessions as part of the intake procedure.

In the six months that have passed since these treatments were initiated, we have followed the progress of the patients. We have shared with them many of their trials and tribulations, some of which are included in this summary of four case histories.

Subject 1: "Marc", A 32 year old male, resident of New York

Of the four subjects chronicled in this report, Marc had been waitlisted the longest. He first contacted ICASH in November, 1989 and requested help with his heroin and cocaine problem. He had learned of the ibogaine procedure through two friends, both of whom had been successfully treated.

At the time of his initial contact, he had been using both heroin and cocaine for the previous seven years, during which time he had smoked, sniffed, and injected the drugs. When first interviewed, he was spending about $100 per day on drugs.

Since then, Marc had remained in contact with our office. Over the past few years, a number of Marc's close friends have died as a result of drugs, including a best friend who died in his arms. These incidents prompted him enroll in a Harlem out-patient treatment program, Reality House, Inc., where he was placed on methadone.

Despite placement in a methadone program, and twice weekly acupuncture treatments, Marc continued to use heroin and cocaine regularly. Still, the program has a stabilizing influence on him. His attitude towards himself improved. Along with his general appearance and sense of self-esteem.

Nevertheless, Marc wanted to get off of methadone, and stop the endless cycle of doing more and more drugs. He continued to call and visit the ICASH office regularly to inquire about a treatment slot opening up. One of the obstacles to treatment was the fact that Marc was totally without resources, except for the meagre monthly public assistance check he received. Thus, he had to wait for the opportunity to participate in either a government or university-sponsored research project, or for the opportunity to be piggy-backed over to Europe for treatment, along with a fee-paying client. Meanwhile, he used his Medicaid benefits to obtain pre-treatment medical requirements.

Unlike most methadone programs. a goal of Reality House is, 'From methadone to abstinence'. They were therefore very supportive of Marc's efforts to get off methadone, and cooperated with ICASH throughout. The clinical director of Reality House, Rommell Washington, flew to Holland to observe Marc's treatment.

On January 11, the night before his treatment was scheduled to begin, Marc began a diary. a handwritten chronicle he would keep for the next two and a half months. The following day, he describes the ibogaine as "coming on slow" but when it began to work, "I started to remember things I had not thought of in years. One, about a kid I knew in the first grade, things that happened when I was two years old. I saw my whole life before me, all my mistakes, why I did the things I do."

Upon returning to New York, Marc said, "What gets me the most is how I don't want to get high anymore. I think about it, but I don't act on it, it's just like I don't want to do it. I don't have that little voice in the back of my mind saying, Let's do just one, let's do just one. It feels good not to have to give in to that."

Marc returned to Reality House. "It felt good. It felt even better when I came in and gave back my methadone bottle, and didn't want any more meth." Ten days after treatment, Marc wrote in his diary, "I have a kind of peace of mind now that I don't have to methadone anymore, or have to want to get high anymore. I hope and pray that I can keep this up, because there is more to this than meets the eye, and I hope that I am up to it."

Ten days after returning to New York, Marc wrote, "I can't believe how I feel so good about myself, about life, about what I can do with myself, how I feel like today I can succeed, and how I can get that job. I can get what I need to go on with my life."

Marc then considers the relationship between ibogaine and his treatment program. "Ibogaine may show me the right direction, but Reality House and other support groups will make sure that I get there. Recovery is a tool box, and ibogaine is one of the many tools."

As the weeks pass, he remains clean and in good spirits. "It's nice not to have to wake up and drink my meth first thing in this morning. The one thing that gets me is how good I feel. Every day keeps getting better."

He begins to go out and enjoy himself, as if for the first time. "It makes me feel good to do things like movies, and to go out to eat. When you're junked out, your life, it's like a long dark tunnel. You can only see one way, in one direction. Life is so vast, and there are so many things to do, but with drugs, you don't realize it because you're into getting high."

"I was thinking abut when I was in Holland, and how the conference went. I like the way it was set up, where everyone was on an equal place, where my input was just as important as the doctors. The thing I think that's wrong with drug treatment in the U.S. is that instead of working with you, it seems more like they tell you what you will do. A lot of places, they are more interested in their pay check than your interests. I think that for a higher success rate, one much work more with the person on an equal basis, so that it makes him feel more human, more loved, and more cared, for. I think drug programs in the U.S. have to become more human, more understanding, not just places to get paid so people can just make a buck."

"I was thinking today how, now it's a month since I did anything. I'm scared. I wonder if I can keep it up. It's not that I don't feel good. It is just that these things come up, and I feel that I should write them down. I don't want to lose what I have so far."

Marc recorded a number of drug-related dreams in his diary, which serve as constant reminders of the problems he must face. "I had a weird dream last night. I was walking around with someone, looking to cop some dope, then we got some, and I snorted it. I could feel it go up my nose, in my hand. It was weird, and as I was doing it, I said to myself, I cannot do this, I'm fucking up my recovery. I can't do this. I was really mad, then I woke up. I just wonder what these dreams all mean. I think it shows how addiction really as a grip on you, and how nasty it can be. This is something that will be with me for the rest of my life. you know, it makes me wonder how it will be when it gets to six months. How will I be in the months to come? But the more clean time I have, the more I want to stay clean and fight off the want to get high. I just hope that I can keep this up."

Six weeks after treatment, Marc wrote "Today I had a strong want to get high. I really thought about tossing it all away and going out and getting a bag, but I just dealt with it, and did not get high. Now that I think about ibogaine and what it did for me, this is what I think. It did not stop me from the wanting of drugs so much as it gave me the chance to look at what goes on behind, why I want to take drugs in the first place, to be able to look at my pain in an unemotional way so I can see my mistakes and from this maybe have the strength to tell myself to say no to that want to get high."

On March 14, Marc wrote, "Well, now I got over two months clean, this is pretty wild. I never thought I could say that. I still want to get high, but I am not acting on it". But, two days later, he did.

"Last night, I did a bag of dope. I did not write about it because I was ashamed of myself. Now I am confused. I do not know what to think. I don't like how I feel. Before, I just used to do it, and that's that. Now, I feel weird. I just have to pick myself up and brush myself off and move right along and do what I have to do, re: Look at what I am doing and see what is wrong with my recovery as far as I am concerned. This feeling I have for getting high will be something that I will have to deal with for the rest of my life".

A week later, Marc concluded in his diary, "There are some things I would like to say about the last few months. First of all, as far as my experience with ibogaine, it was the most incredible experience I ever had. I have to say, it was one of the strongest turning points of my life. It gave me a chance to look at my past without any emotion, and thus was able to process all the things that went on in my life that I feel led to where I am today. I was able to face my pain and let go of it. I do not think I would be able to do this with the ordinary therapist, or it would take me a long time at that. For me, the release of pain, old pain, was like lifting a life sentence. It felt great. It was the best thing that happened to me in my recovery. Now remember, that is not to say that it was my whole recovery. If not for Reality House, I would have been dead a long time ago, like many of my friends. I don't think that I will ever go back to what I was, the way to move is forward, and I know what I have to do."

Three months after Marc was initially treated, he requested a re-treatment. Although he reported using heroin on a number of occasions, he had not become re- addicted. His request for a second treatment, therefore, was as a preventative measure. Travel arrangements were made, and a second treatment was administered. Six months after his initial treatment, Marc has applied for and been accepted to college, which he plans to start in the fall.

Subject 2: "Sandy", a 37-year old male, resident of New York.

Sandy first contacted ICASH in December, 1991. It was just over a year before the opportunity for treatment became available. Sandy was scheduled to travel to Holland with Marc, and treated at the same time.

Sandy's primary addiction was cocaine, which he cooked up into base form and smoked. His drug use had gone unabated for the previous eight years, and he reported using between one and two grams per day. In addition, he frequently used heroin to come down after protracted cocaine binges. He also consumed large amounts of vodka or other spirits throughout the day to "take the edge off".

Except for odd jobs, Sandy has been unemployed for over three years. His last full time job, as a cab driver, ended when his license was suspended for failing to pay a number of tickets. Sandy managed to maintain his habit but exploiting the sympathy and generosity of others, which he managed to do with great skill. He constantly pestered others for money until their resistance weakened and they gave in.

The prognosis was only slightly tilted toward success. On the positive side, we had a 37 year old man with an eight year drug history who claimed that he sincerely wished to quit. He stated that he was tired of being an addict, and may well be reaching the "maturing out point" of his addiction. On the negative side, he had few, if any, marketable skills. Nor has he had any substantive job experience in nearly a decade. He clearly needs employment training and counseling to succeed.

Enhancing his change to succeed was the strong support network which Sandy had acquired. But, during the year-long intake process, it was shattered. Initially, his support network consisted of a Hassidic rabbi, his wife, and a small orthodox congregation. Sandy, who was the son of an orthodox rabbi, was adopted for a time by the congregation.

Perhaps it was the meals, which were regularly served, or the sponge cake, cholent, and schnapps that first attracted Sandy to the shul, but it wasn't long before he became an active participant. He not only did odd jobs before he became an active participant, He not only did odd jobs at the synagogue, but attended services on Friday night, Saturday, and Sunday. He was well liked by the congregation, whose membership had offered to pay his airfare to Europe for treatment with ibogaine.

All that changed, however, when Sandy committed the ultimate chutzpah, and was banished from the shul. The loss of his major support network sent Sandy into a tailspin, and he began drinking and doing drugs with still greater veracity than previously reported. He continued in this manner for almost three months, until such time as he left for Holland to be treated.

Once in Holland, he was stabilized and treated. His post-treatment recovery was remarkably rapid, and he was up and about shortly after the 24 hour mark, and began eating enormous amounts of food. Since this was his first time outside the United States, he decided to extend his stay an extra week, and visited Amsterdam, Rotterdam, and other places.

The following week, he returned to New York's lower East side. For about a month, he remained clean, but then started to coke cocaine once again, although he would comment, "I don't enjoy it anymore, the way I used to."

Although it appeared at first that the treatment had not been effective with this particular person, something was occurring within Sandy which would alter the course of events. This could be characterized as the delayed effects of ibogaine, as opposed to the acute effects or the short-term effects. This culminated with a specific realization which was the result of an intensive thought process, and was the decision to mark a new course of action.

Sandy came to the realization that he had little or nothing going for him in New York, and that he has the opportunity to do anything or go anywhere he wanted in order to start a new life. And if he was sincere about giving up drugs, he would have to consider starting a new life. Sandy decided he would go to Israel, but he wanted to go there clean.

Sandy asked, "If I get a ticket to Israel with a stop-over in Holland, could I get a re-treatment? I would like to be completely de-toxed when I arrive in Israel." The answer was affirmative.

Sandy participated in mapping out his own recovery program. He has been living and working on a kibbutz in Northern Israel for the last three months, and has been completely drug-free for that period.

Subject 3: "Al", A 36 year old male, resident of New York City

"Al" is a percussionist who performed for 13 years with a well-known rock and roll band. Although he is no longer with them he stated that he still works as a musician and supplements his income by working in music and electronics stores. He prefers, if possible, to just hang out. He has no dependents, other than himself, and is quite happy doing what he does for a living providing he can make ends meet.

"Al" began using cocaine twenty years ago, at age 16. At times, he characterizes his cocaine use as minimal but often he is boastful about the huge amounts of cocaine he can consume on a single binge. Based upon twenty years of use, he estimated an average daily dose of 1/2 gram per day.

"Al" also reports regular use of alcoholic beverages, and occasional use of heroin. However, free-base cocaine is his major problem. He reports spending an average of $1,000 per month on drugs, principally on cocaine. He has never been treated before for drug dependency, either in an in-patient or out-patient setting.

"Al" has been hospitalized on two occasions. The first involved an operation to remove his gall bladder, and required a ten day stay. The second incident occurred three years ago, when he was run over by a drunk driver. He was hospitalized for six months after the incident, and suffered broken arms, legs, and a shattered pelvis. He reports being "bolted back together" by doctors who inserted steel pins throughout his body. Since that incident, he reports that he suffers from painful joints and stiff muscles. He also reports chronic asthma, numerous allergies to dust, pollen, etc., and requires the use of an asthma spray on a regular basis. He finds it difficult to breathe and often finds himself out of breath long before anyone else. He also reports frequent bouts of fatigue or exhaustion.

"Al" maintains his own apartment, and resides there by himself. He has a long-standing relationship to a strong, stable woman who is not addicted to drugs. Although they did live together for some time, in her apartment, his cocaine problem interfered with their relationship to such a degree that she demanded that he move out and find his own apartment, which he did.

The relationship, however, did not fade. They continued to see each other on a regular basis, go out, and occasionally spend the night together. Both feel that their relationship will strengthen and further bond if "Al" can only stop doing cocaine.

"Al" possesses humor, wit and charm. He is sharp as a tack and usually is fun to be with. However, there is another side of him which appeared within the context of this relationship. That side is nasty, hostile, abusive and threatening. When these outbursts occurred, their relationship teetered on the brink of dissolution. After a cooling off period, they would inevitably reconcile.

Was this bullying behavior a result of cocaine abuse, or part of his psychopathology? Perhaps it was a combination of both. When discussing the effects and aftereffects of treatment with a client, it is stressed that ibogaine will not effect the personality of the individual nor alter behavioral characteristics other than to interrupt drug-seeking behavior. You remain the same person you were before. There are, however, new understandings and insights which prompt psychological and emotional growth which often leads to a more mature approach to life.

"Al" was impressed with the ibogaine treatment. "It's the heaviest thing I've ever done," he said shortly after the treatment. He didn't speak much about what he saw, but indicated that there was a great deal of material that he did see.

Returning to New York, "Al" began to pursue what was formerly a hobby and turned it into a business; collecting antique games and toys. He and his significant other quickly reorganized and began buying at auction and selling at flea markets and bazaars.

"Al" reported that for three months following treatment, he remained cocaine free despite living near a particularly notorious corner and being offered it on numerous occasions. "Man," he said, "I don't even want to do it."

Six months after treatment, "Al" reports that he now occasionally uses cocaine but confines his use to weekends only. He is still involved with the same woman, and appears to have redefined the direction of his life.

Subject 4: Nancy, a 33 year old woman, Resident of New York

Born and raised in the Bronx, Nancy left home when she was 15 years old. Although her first experience with heroin occurred when she was 12 years old, it was not until her twenties that she became addicted. When she first contacted ICASH, she stated "I have been addicted to heroin and methadone for the past ten years."

After many years of living on her own, Nancy returned to her mother's home in the Bronx and was living there with her mother and two brothers. She has four brothers ranging in age from 34 to 22. The younger brothers, who were living at home, both use drugs frequently, but the older ones do not, except on weekends.

Nancy dropped out of high school but later obtained her G.E.D. and then attended college for two years. She had been recently employed as a bookkeeper and worked as a travel agent on occasion. However, when she first contacted ICASH, she was on welfare.

A nervous person, she is often keyed up and jittery. She suffers from high blood pressure and has previously taken prescribed medications to control the problem. When interviewed, she stated that she had discontinued using the medication and had been regulating her blood pressure by using methadone and/or heroin instead.

Nancy has detoxed several times in the past and has received both in-patient and out-patient treatment at a number of different facilities. Yet, none of these treatment programs were able to achieve long-term success in either curbing craving or use of drugs. She also advised us that on previous occasions, whenever she had detoxed, her blood pressure would skyrocket. This was a matter of great concern.

When first interviewed, Nancy was enrolled in a private, for-profit methadone maintenance treatment program (MMTP) where she was receiving 80 mg. per day of methadone. We contacted her counselor and submitted a consent form for the release of her records which were provided to us. We then referred Nancy to a clinic for pre-treatment evaluations.

Once her pre-treatment evaluations were completed, arrangements were made for her to travel to Holland for ibogaine treatment. She, along with Al, would comprise Group Two and would be treated during the second week of the symposium. Since both she and Al were to be treated simultaneously, we booked them on the same KLM flight. Although they had never met, Al was aware that his counterpart was on the same flight. Shortly after take-off, he began to stroll about the plane, scrutinizing each passenger wondering if he could spot the one. At the very back of the plane, under a cloud in the the smoking section, he spotted a woman wearing dark sunglasses. Smoking a cigarette and nervously flicking the ashes, looking around, she then noticed a man with long dreadlocks and an ear to ear grin staring at her. "Pardon me, " he asked Nancy, "But are you going over to Holland to take ibogaine?" Six hours later, they arrived in Holland just like old friends.

During pre-treatment medical screening, Nancy was found to be suffering from multiple abscesses and infections, the result of a two week binge of shooting cocaine and heroin. Medical attention was immediately provided and a Dutch physician tended to her wounds twice daily for the next ten days before, during and after her treatment with ibogaine.

Additional pre-treatment interviews revealed that in addition to the 80 mg. of methadone provided to her by her clinic, Nancy was scoring an additional 40 mg. per day on the streets which she had previously not reported to us. Nor had she reported that she was also shooting heroin and cocaine.

The treatments occurred as planned. As is often the case, the post- treatment recovery period is usually shorter for the cocaine dependent person than for the opiate dependent person. Al was on his feet and fully recovered 24 hours ahead of Nancy.

After treatment, both Al and Nancy decided to go to Amsterdam. Both had previously been to Europe and had friends there. In Nancy's case, it was an old boyfriend whom she hadn't seen for a number of years.

Off they went to Amsterdam as the treatment group prepared to treat Group Three, comprised of two Dutch addicts. We were all curious to see if Nancy and Al would get to Amersterdam and immediately go and use drugs. After three days, they returned having had a wonderful time without either of them using heroin, methadone, or cocaine. Both stated that they could have scored drugs of they had wanted to but that they just didn't have the desire to do so. But it was Nancy who, with the utmost joy, announced news of a monumental nature to all assembled. "Last night," she shrieked, "for the first time in years and years, I had an orgasm." Applause filled the room.

Shortly thereafter, Nancy returned to New York. Her first major realization was that her recovery demanded that she not return to her mother's house in the Bronx, where her brothers were doing drugs. She immediately contacted a friend and borrowed $100 to spend her first night back in a mid-town hotel.

The next day, she activated a support network of old friends and was able to secure the beginnings of a new life in a relatively short period of time. She was able to find an apartment in the Chelsea section of Manhattan as well as a job as a bookkeeper. She went to a physician immediately upon her return and was prescribed medication for her blood pressure condition. Then, she made an appointment to see her counsellor at the MMTP.

There is a fundamental difference between the treatment program at Reality House, where Marc (Subject #1) was a client, and the MMTP program where Nancy was a client. Reality House maintained a policy which they called "From Methadone to Abstinence". Although they had clients on methadone for years, the goal nevertheless was abstinence. At Nancy's MMTP, the program could be characterized as "Methadone for Life."

Rather than encouraging Nancy's recovery, her counsellor sensed that she might lose a private fee-paying customer. She encouraged Nancy to go back to methadone saying, "Wouldn't you feel more comfortable taking just 20 mg. of methadone per day?" Eventually, Nancy relented and agreed to go on 20 mg. per day.

After being on methadone for just over a month, Nancy decided that she had had enough and contacted ICASH again requesting referral for a re-treatment. Approximately three months after her initial treatment, Nancy flew back to Holland for a second treatment. Since then, she has returned to New York and pursued her career options. She has remained completely free from heroin, cocaine, and methadone. She now steers clear of her old clinic.

Six months after her initial treatment, Nancy was interviewed by a psychologist specializing in addictive disorders. When asked about the pro's and con's of the treatment, Nancy responded, "There were no negatives, only positives." When asked, "What makes it work?", she acknowledged, "that's the big mystery. I think it does something unconsciously. It helps to enhance your decision making ability."

Asked about what has happened since she first received the treatment, Nancy stated, "Everything has gotten better since I took the ibogaine. I can work and I can function. I'm ready to take another step."