Replacement Drug Therapy attracts a debate between the medical and moral definition of addiction.  Is this a question of medical necessity or one’s will.  Medical research is breaking down why heroin in particular is so hard to lay down for some.  Alcohol is a progressive disease.  Peak opiate addiction happens fast and it is brutal.  I spoke with Keith a 28 year old recovering addict.  He sees two truths in the debate.  Clean, after 5 years of opiate addiction he talks about his 3 year replacement drug therapy to date.  “I am an addict and alcoholic.  I work the AA program. I have service commitments in AA and some in NA.  I also have been on Subutex for 3 years.  It works good for me if I apply recovery principals and work AA.  I am an alcoholic at heart but when I found opiates, I was off to the races” Keith say’s opiate addiction is far worst than people imagine and takes determination just to work the program he is on now.  Addiction for him is very much a medical condition.  He has explained that quitting opiates after long term use for many young addicts is near impossible and the leap to replacement drug therapy still takes iron clad determination, explaining further.  “Suboxone or Subutex (subs) work for some and not for others.  Subs make you feel normal.   There is no post acute withdrawal (PAWS).  You feel as you did before you started using; normal”…Here is the problem with many… “Most on subs do not fix what is really broken because they perceive that nothing is broken and don’t use the subs correctly”… “Some take sub “vacations” and use opiates off and on”.  This explains why so many young opiate addicts do not recover and continually relapse, even when using subs or methadone.  Keith holds on to the premise that he would would prefer the initial week of heavy physical withdrawal than the many months of the post acute phase.  For him, subs built his bridge to sobriety.