Task Force report : narcotics and drug abuse annotations and consultants' papers.

  • United States. Task Force on Narcotics and Drug Abuse.
Date:
[1967]
Catalogue details

Licence: Public Domain Mark

Credit: Task Force report : narcotics and drug abuse annotations and consultants' papers. Source: Wellcome Collection.

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    as he keeps taking the drug. In the pilot studies noted above, this treatment has been well reecived by the first 20 addicts begun on it, with only one failure. The drug is well-tolerated as a treatment procedure in addicts. The treatment is monitored by frequent urinalysis. Philadelphia Board of Parole. Here prisoners with a history of addiction are begun on group therapy sessions in prison several months before release. They continue with the same therapist after release and receive relatively intensive parole supervision and casework from specially trained parole officers with small caseloads. Some urine testing is done. A 60-percent success rate for the first year after release is reported. Baltimore Drug Addiction Clinic. Here, addicts are contacted in prison concerning interest in a daily urine testing program. If they volunteer for the program and can obtain a job, they are followed daily in a clinic in downtown Baltimore with active parole supervision and some group psychotherapy. Positive urine tests are ini- tially used as a basis for intensive discussion of the patient’s dynamics and problems. Continued drug taking leads to return to prison. About a 30-percent abstinence rate for the first year appears to be achieved. TREATMENT FOR PERSONS USING NON- OPIATE DRUGS OF ABUSE There are no special treatment facilities specifically de- signed to serve individuals dependent on nonopiate drugs and most programs are restricted to opiate addicts. Withdrawal detoxification of patients heavily depend- ent on barbiturates or most other sedatives and some tran- quilizers (e.g., meprobamate or chlordiazepoxide), can pose serious difficulties requiring more intensive medical supervision than does opiate withdrawal. If dependence is undetected and convulsions and delirium occur, admin- istration of barbiturates can sometimes fail to reverse the process. Deaths can occur. Although adequate data are lacking, abusers of bar- bituates and amphetamines probably include more medical (doctor-dependent) abusers and fewer street users than is true for opiate abusers. It seems likely that some combination of intensive supervision and treatment plus regular urine monitoring to detect relapse might be useful, but more study of this group or groups of drug abusers is needed urgently as a basis for clearer recommendations. Abusers of LSD or other hallucinogens who develop psychiatric symptoms (schizophrenic-like or panic re- actions) can probably be adequately handled in conven- tional psychiatric settings. POSSIBLE NEW METHODS OF TREATMENT 1. A cyclazocine-like drug with a much longer dura- tion of action (3 days to 2 weeks) would be useful since the patients would have to come to the clinic less frequently. 2.. Formal conditioning theory, as extended by Wikler and Martin, suggests that cyclazocine or similar treat- ments could be made more effective if the addict tried heroin or a similar drug several times and got no effect, thus extinguishing his earlier conditioned positive re- sponse to the drug. 3. Behavior therapy—a form of conditioning treatment developed chiefly by Wolpe in this country has been ap- plied successfully to one physician addict. This work could be extended. 4. Preliminary reports from Iran claim that an anti- depressant phenothiazine combination (amitriptyline- perphenazine) is effective in Persian addicts in preventing relapse. 5. Obviously addicts are a heterogeneous group of people and if further research could tell us which patients do better on which kind of treatment, a substantial ad- vance would have been made. 6. As with alcoholism, it is likely that addicts might benefit from better integration and coordination of the various medical, social rehabilitation, and welfare services available in most large cities. 7. It is possible that the treatment of heroin addicts in nonaddict settings—general hospitals, psychiatric clinics, a doctor’s private office—might aid his separation from the addict culture. This possibility should be explored. ROLE OF STATE, LOCAL, PUBLIC, AND PRI- VATE GROUPS It is difficult to comment on the question, “Who should do what in the treatment of drug addicts?” At present in most places the answer is that more agencies should do more, and that at least one agency should provide a solid, comprehensive program, alone or in col- laboration with other agencies. Detoxification facilities should be available without the addicts having to be committed or convicted. It is probable that both volun- tary and involuntary programs should be available, the latter being used for failures of the former. At the present state of our knowledge the availability of several different treatment programs seems preferable to a simple rigidly fixed program. A picture, projected into the future, of a comprehen- sive program for a city with a substantial drug abuse prob- lem (500 new cases per year) based on current knowl- edge might include the following components and inter- relationships: 1. A major centra] treatment facility integrated into a medical school and a community mental health center providing inpatient detoxification for about half the city’s voluntary and committed patients plus longer term in- patient intensive treatment for selected treatment-resist- ant patients from all over the city. The inpatient unit would also start appropriate patients on cyclazocine and methadone treatments and would carry out careful pre- release planning for aftercare, utilizing staff of the after- care portion of the facility.