In considering the importance of advocacy groups to growth of other fields, the role of anti-tobacco groups, treatment providers' groups, and others that advocate better drug and alcohol abuse prevention and treatment should not be underestimated. Yet, unlike other fields in which patient groups provide a strong voice for research, there is very little heard from people who suffer from addictive disorders, particularly if illicit drugs are involved, and a certain hesitancy on the part of families to speak out because of stigma.

The National Alliance of Methadone Advocates (NAMA) is one advocacy organization that encompasses methadone maintenance patients, health care professionals, and other supporters of high-quality methadone maintenance treatment. NAMA's goals are to eliminate discrimination against methadone patients, create a more positive image about methadone maintenance treatment, help preserve patients' dignity and their rights, make treatment available on demand to every person who needs it, and empower methadone patients with a strong public voice (NAMA, 1996). NAMA is one organization composed of individuals with addiction problems and their supporters that provides a working example of how those most affected by addiction can become advocates for themselves.

The willingness to expose oneself to public scrutiny is a critical part of the formation of strong advocacy groups. The willingness to "go public" and organize is severely inhibited by the stigma resulting from the behavior changes induced by intoxicating drugs, the assumption of willful self-destruction associated with drug abuse, and the public perception of addicts as disreputable and hopeless. Further, for those addicted to drugs that are illegal, there are both real and perceived dangers in becoming involved in an advocacy organization that could bring one to the attention of law enforcement officials.

Celebrities often provide important visibility and access for an advocacy agenda, such as AIDS and spinal cord injuries. Although some high-profile persons, including Betty Ford and Carroll O'Connor, have spoken out about addiction and worked to increase public understanding, openness from a variety of celebrities about these problems and how they affect individuals and families will be a continuing need and potent force for changing public attitudes.

Many disease-oriented advocacy groups are able to mobilize behind the hope for a vaccine or a cure, even though research tends to produce only small, incremental improvements in the management of a chronic disease. Because many people see addiction as a defect of will, it is often difficult for advocates to rally behind a "race for the cure" or vaccine.

One difficult problem is that other advocacy groups with similar interests have refused to align themselves with the field of drug addiction. For example, the dual diagnosis of drug dependence and depression is quite common, but advocacy groups for depression are reluctant to form coalitions with advocates supporting

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