The Treatment of Chemical Dependence

To the Editor.—  I was amazed and dismayed after reading the brief communication by Dr Weiss entitled "Relapse to Cocaine Abuse After Initiating Desipramine Treatment."¹ I was amazed that the article, tantamount to the reporting of reactions in patients with known penicillin allergy given penicillin, would be published in a reputable medical journal. What is reported is precisely what can be expected in most patients who are diagnosed incorrectly as cocaine abusers and not as having the disease of chemical dependence. The three patients described are typical chemically dependent² individuals who have a primary disease that requires primary treatment.I am dismayed because what is common knowledge among those of us involved in the medical model treatment of chemical dependence has yet to be embraced by the general medical and psychiatric community. The psychiatric model is one in which substance abuse and dependence are treated as secondary to