Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...

:123When we look at reasons for discharge by ethnic group as shown in figure 7,we note that alcohol problems are more common among the black patients anddrug abuse is more commonly a factor among the white and Spanish patients.Voluntary withdrawals and discharge for behavioral reasons account for themajority of dropouts in the first year. Chronic problems with alcohol abuse, andcontinued drug abuse were the major causes of discharge in the second and thirdyear.FOLLOWUP OF DISCHARGED PATIENTSWith the assistance of two medical students, (Michael Lane, Downstate MedicalSchool, and Mary Hartshorn, Medical College of Pennsylvania) during thispast summer, we completed an intensive foUowup on a sample of patients whohad left the program. We selected all patients who were discharged alive byDecember 31, 1969, and who had been in the program 3 months or longer at thetime of discharge. This gave us a pool of 562 persons. We divided this group intotwo segments: (1) those who had left the program voluntarily, and (2) thosewho had been discharged from the program for cause.Our primary source of followup was the New City Narcotics Register whichreceives reports from the police and correction agencies, hospitals, and treatmentprograms, and from private practitioners. Another very useful source wasa series of interviews with patients who left the program and have subsequentlybeen readmitted. This was a major contribution by the medical students.For the sample of 281 patients on whom we could obtain 6 months of followupthe results are shown in table 2.Those patients who left the program voluntarily had a lower arrest and detoxificationrecord, than the rest. They also had a larger proportion admittedto other treatment programs an one-third had been readmitted to the program,contrasted with only 6 percent of those discharged for cause. If one considersthat no record found is roughly equivalent to remaining "clean," one-third ofthis group were still "clean" 6 months after leaving the program.The same sampling procedure was followed for the 396 patients on whom wecould obtain 12 months to followup. These results are shown in table 3. In thisgroup only 21 percent would be considered still "clean." The readmission ratewas somewhat lower (13 percent). Except for arrests and deaths those who leftthe program voluntarily are very similar to the other group.Table 4 shows the results of the followup on our sample of 181 patients onwhich we had a followup of 1 year or more. Here the readmission rate is 22percent and the proportion who appear to have remained "clean" is only 18percent and the death rate reaches 5 percent.These data would tend to indicate that, among those patients who withdrawfrom methadone maintenance treatment, only a small portion have been able to"make it" on their own.Because of the tremendous current interest in "criminality" associated withaddicition, we looked into the previous arrest records of those patients whohave remained in the program, contrasted with those who left the programvoluntarily, and those who were discharged for cause. We contrasted this, in a"before and after" picture, as shown in figure 3. It is interesting to note thatthe past history of those who were discharged for cause with reference to arrestsis worse than either of the other two groups—and that their behavior followingdischarge is as poor or worse than before admission. Those who left voluntarily,demonstrate a short preiod of improvement but also tend to return to theirprevious arrest pattern. Those who remained in the program show a constantand accelei'ated decline in criminal behavior as measured by arrests.Enough of failures. Now let's discuss successes.CRITERIA FOR SUCCESSThe criteria established by our evaluation unit with the approval of the evaluationcommittee for measuring success of the program has resolved around fourbasic measures(1) Freedom from heroin "hunger" as measured by repeated, periodic "clean"urine specimens.(2) Decrease in antisocial behavior as measured by arrest and/or incarceration(jail).(3) Increase in social productivity as measured by employment and/or schoolingor vocational training.(4) Recognition of, and willingness to accept help for excessive use of alcohol,other drugs, or for psychiatric problems.