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.

    153/172 (page 143)
    The aftercare program would encompass day and night care, halfway house, a vocational rehabilitation and sheltered workshop facilities, a variety of levels of psy- chotherapy, casework and utilization of other community agencies—public and private. This unit would provide training not only for young professionals from the university but for treatment staffs from other community mental health centers, hospitals, police forces, prisons, and public and private social agen- cies in the area. It would serve as the agency maintaining a local registry of drug abusers and would maintain liaison with the national registry and would assist the schools and community on educational programs. 2. Other community mental health centers and hos- pitals would be open to drug abusers and would provide basic inpatient and outpatient treatment programs, utiliz- ing the local drug abuse center for consultation on special problem cases. 3. Jail, prison, and probation and parole programs would be able to handle detoxification and to provide active treatment for drug abusers. 4. Public and private agencies would be open to and secure in handling drug abusers, working with the center on problem cases. 5. A rapid urine testing facility would be available for use in both the diagnosis and treatment monitoring of drug abusers. EVALUATION OF SUCCESS OF TREATMENT PROGRAMS This problem has two parts: 1. Better descriptions of addicts entering the program on a multidimensional basis—social background, adjust- ment, personality, family or social setting, assets and lia- bilities, addiction, and criminal history, etc. 2. Full description of adjustment during and after treat- ment, using both cross sectional and longitudinal dimen- sions. Drug use is one criterion, but even here, a brief return to ful] addiction or periodic weekend use is not the same as full-time addiction for years. An addiction paid for out of one’s salary should be differentiated from that supported by stealing or prostitution. Involvement in addict groups, job and social adjustment, leisure time and recreational activities, efforts at self-advancement all need to be taken into account. Such measures should be considered in context, by comparison with an appropriate nonaddict control group. For example, support by wel- fare payments may be normal for Negro women of low education with several children and no husband, in Har- lem. Some job instability may be normal for lower class high school dropouts. Most of these phenomena are susceptible to relatively good quantification, but appropriate measuring techniques need to be developed and applied. Comparative studies of treatment efficacy need to be developed. Some effort must also be made to separate the results obtained with a given treatment by a very unique and dynamic person from the results obtained under more usual conditions. Treatment cost is also a relevant concern. 143 RESEARCH Current research in the area of drug abuse is showing increasing evidence of sophistication and clinical rele- vance as well as a healthy growth rate. Major areas of emphasis include the following: 1. Application of new techniques to the elucidation of cellular changes associated with drug tolerance and with the obstinence syndrome. 2. The development of techniques—indwelling venous catheters—which permit monkeys to press a lever to inject themselves with drugs of abuse. Monkeys have already been shown to seek injections of most drugs known to be abused by man. This model can now be used to evaluate new drugs and to study factors influencing drug- seeking behavior. 3. Conditioning methods in the rat have permitted study of the effects of environmental factors associated with earlier addiction on drug-seeking behavior. 4. Better methods for studying effects of drugs of abuse on mood and psychological functioning in man are rapidly becoming available. 5. The development of a number of new treatment ap- proaches to narcotic addicts has increased interest in clini- cal research in this area. In general, the most obvious current research needs in this area, over and above further exploration of recently opened areas described above, include the development of better methods for measuring various aspects of adjust- ment in drug addicts followed in the community and more research looking for predictors of successful clinical response to treatment in general and to specific treat- ment approaches. For example, patients doing well in Synanon-type programs could be quite different from those benefitting from maintenance methadone treatment. Well-designed controlled studies of methadone treat- ment, cyclazocine treatment, urine monitoring, voluntary vs. involuntary treatment are needed, as is a comparison of the Synanon-type approach with other treatment pro- grams. Better evaluative instruments are needed. Such studies will be stimulated in the coming year to comple- ment and extend work already underway. Studies to explore the possibility of prolonged physiolog- ical abnormality after withdrawal are needed to clarify the possibility that bodily changes persist in addicts which may predispose them to readdiction. Such studies might well be combined with a comparative study of the effects of long, intensive vs. minimal brief inpatient treatment, given comparable aftercare treatment programs. Detailed study of abusers of nonopiates at all levels— sociological, psychological, psychiatric, physiological and biochemical—are badly needed as are studies of treatment response in this area. A national registry of drug abusers has frequently been recommended and could provide very useful data on the incidence, prevalence and natural course of various types of drug abuse. Legal safeguards to insure the medical confidentiality of such a system would be necessary to obtain adequate reporting from medical and_ social agencies.