Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
Narcotics research, rehabilitation, and treatment. Hearings, Ninety ... Narcotics research, rehabilitation, and treatment. Hearings, Ninety ...
436The first drug that we studied with this end in view was cj'chizocine,which is a very potent drug, but ])roduces some undesirable side effectsAvliich has made it necessary for physicians to be both knowledgeableof its pharmacology and skilled in its use. The second drug thatwas studied was naloxone, which iproved to bo a pure antagonist withoutimdesirable side effects, but which suffered from the disadvantagesthat it was short acting and quite ineffective by the oral route. We havecontinued to study other narcotic antagonists and have recently investigatedEN-1639A, which combines the structural features of bothnaloxone and c3^clazocine, and have found that this agent is two tothree times more potent than naloxone and cyclazocine and that ithas a longer duration of action than naloxone. We have further foundthat we can, for all intents and pur])ose, antagonize both tlie euphorogenicand the dejjendence-producing effects of large doses of morphinewith an oral dose level of 50 milligrams per day. Thus, we feel that wehave made substantial progress in finding the ideal narcotic antagonistwhich meets the criteria of: (1) Being potent, 10-50 milligrams perday; (2) having a long duration of action; (3) having no side effects,being a pure antagonist; (4) being orally effective; and (5) beingsuitable for depot administration.Additional efforts need to be undertaken to develop not only longeracting pure antagonists, but depots which will allow antagonists andmethadone-like drugs to be administered at 2-week to monthly intervalsand which will provide effective levels of the drug for this period oftime. If we can achieve these goals, I believe that certain motivatedaddicts can be benefited by this a])proach. Because the antagonists donot produce physical dependence and are nontoxic, they may find arole in the treatment of the juvenile experimenter.Turning now from the anatgonists to the general problem of drugdependence, it is my personal, though professional, oi)inion thatmounting an effort to deal effectively with drug abuse problemsspecifically and the problem of psychopathy generally should startAnth the assumptions that we do not have an understanding of thebasic psychopathology or ]:>athophysiology of these disease ])rocessesand that we do not have effective and nontoxic therapeutic measuresto deal with all except a small proportion of the patients incapacitatedwith this disease process.It is further my conviction that both the size of the problem and itsimpact on society will continue to increase until we find definitivesolutions. The reasons for this conviction are: (1) The number ofabusable drugs will increase because of the growth of the chemical andpharmaceutical industries, (2) the impact of psychopathic behavioron society will become less tolerable as our society increases in sizeand complexity, and (3) the complexity and stabilit}^ of our societylessens the im})act of social controls on i)sychopathic behavior. Becauseof the imminence of the i)roblem, I would recommend that thefollowing stei)s be taken: (1) Increase our efforts to identify drugswith an abuse potentiality early and to utilize ap])ropriate controlmeasures, (2) increase our efl'orts to understand the psychopathologyand pathophysiology of psychopathy and through this efl"ort to rationallyi'ornndiii(» therai)eutic processes, (3) aggressively search fornontoxic, nonaddicting drugs that may be effective in the treatmentof psychopathy.Thank you, sir.
437Chiiirmtin Pepper. Doctor, I think some of my colleagues willshare my curiosity, and want to know what psyclioj)athy is.Dr. Martin. I guess, in the general sense, we mean people whomanifest criminal types of behavior. Looking at this more from abehavioral aspect, many of these individuals are characterized by thefact that the}^ are overl}^ concerned with themselves and overly concernedwith the immediate present, which has the implication that theydo things primarily to gratify themselves and think ^ory little aboutthe future.Chairman Pepper. Have you anything else you would like to sayuntil 12:30, or shall we recess now until 1:30?Dr. Brown. I think this would be an appropriate time to recess.I just want to add my comment on the term "psycho])athy," whichDr. Martin has used. Those who have worked in the fields for 10 or20 years become deeply impressed by some of the behavioral andother character aspects either caused by or seen as related to seriousdrug addiction and drug dependence.This particular behavior, which we often describe as hedonistic,self-seeking, or self-serving, is, of course, one of the most troublesomefeatures, and one of the hallmarks of ^^our committee's charge, that is,those persons who will violate society's mores, who steal and do otherillegal things.Dealing with this basic behavior, either as a cause or an effect, isone of the mos^t important dimensions and one of the reasons we feelit is so important to extend our research efforts in this area.Chairman Pepper. In general, is there a certain type of mental, orwhatever you call it, complex that results in such human behavioristhere some general characteristic that j^ou would find in peoplewho are the users of heroin, addicts of heroin? Do they come intocertain jjsychiatric categories and have certain general characteristics?Dr. Brown. Dr. Mai tin has had more direct experience with that.Again, my information is more based on extensive contact with peoplewho themselves have worked extensive!}' with addicts, as we wouldsay, in a scholarly world on secondaiy sources rather than an extensiveprimary source. There seems to be some generally central characteristicsalong the lines of self-seeking, gratifying, hedonistic aspects.However, there seem to be many routes into heroin addiction. Manytypes of people are involved, and it is my own professional judgmentthat it is a complex thing with no simple one-character behavioralI)ersonality facet. That is my own judgment from the material, but ifyou would like to answer the quest^ion that Chairman Pepper gave tous, it might be useful.Dr. Martin. Thank you, sir. I think I would agree completelywith what Dr. Brown has said, and perhaps just elaborate a small biton it.When you look at the characteristics of individuals that come to,for example, our hospital for treatment for drug addiction, they fallinto probnbh- three or four categories which mdicate the complexity ofthis problem.The first is the t3^pe tliat I have called the psychopath, a person whoneeds immediate gratification and is not very particular about howhe goes about obtaining this gratification.
- Page 406 and 407: 386Mr. Brasco. But that is another
- Page 408 and 409: 388Mr. Ingeksoll. Well, that is the
- Page 411 and 412: NARCOTICS RESEARCH, REHABILITATION,
- Page 413 and 414: -39,3,Dr. Edwards held a surgical f
- Page 415 and 416: 395of Narcotics and Dangerous Drugs
- Page 417 and 418: 397Naloxone, recently approved for
- Page 419 and 420: 399for example, who might be abusin
- Page 421 and 422: 401Now, because of our attention ha
- Page 423 and 424: 403and this is only for the investi
- Page 425 and 426: 405effects this drug will produce i
- Page 427 and 428: 407Now, if it is not used intravene
- Page 429 and 430: 409Mr. Wiggins. Dr. Jennings, does
- Page 431 and 432: 411Penicillin is good for pneumonia
- Page 433 and 434: 413Mr. R ANGEL. But from the studie
- Page 435 and 436: 415Dr. Gardner. Again, we don't hav
- Page 437 and 438: 417Dr. Edwards. I suspect it at lea
- Page 439 and 440: 419On the other hand, if serious si
- Page 441 and 442: 421of the best known programs. Alth
- Page 443 and 444: 423Medical Association, American Ps
- Page 445 and 446: 425of the United States Pharmacopei
- Page 447 and 448: 4275. Repeated examinations. Physic
- Page 449 and 450: 429agement and rehabilitation of se
- Page 451 and 452: —431As the agenc.v within HEW whi
- Page 453 and 454: 433and complex acts such as driving
- Page 455: 435(Inig induces physical and psych
- Page 459 and 460: 439A large proportion of youngsters
- Page 461 and 462: 441Dr. Brown, what would you say is
- Page 463 and 464: 443Chairmiui Pepper. Wliat is tlie
- Page 465 and 466: 446The state of the art is promisin
- Page 467 and 468: 447Lot nie ask you first, is tlic d
- Page 469 and 470: 449Chairman Pepper. Do you happen t
- Page 471 and 472: 451want you to take a look at. We w
- Page 473 and 474: 453In addition to that, there seems
- Page 475 and 476: 455the Mfldict is having a program
- Page 477 and 478: 457—on drugs? By that I mean, vei
- Page 479 and 480: 459\\ e are basically saying, in or
- Page 481 and 482: —;461that this is the extent to w
- Page 483 and 484: 463We could go into the drug area a
- Page 485 and 486: .465program that was i)ut into Jack
- Page 487 and 488: 467Mr. Brasco. Possibly. However, w
- Page 489 and 490: 469him, arrange to get somebody els
- Page 491 and 492: 471ainpheta.mines, or barbiturates.
- Page 493 and 494: 473In the meantime, the Institute d
- Page 495 and 496: 475treated in the community centers
- Page 497 and 498: 477research on narcotics in the sam
- Page 499 and 500: 479c 53 03E
- Page 501 and 502: NARCOTICS RESEARCH, REHABILITATION,
- Page 503 and 504: 483spending for research through NI
- Page 505 and 506: 485There has been no concerted seri
437Chiiirmtin Pepper. Doctor, I think some of my colleagues willshare my curiosity, <strong>and</strong> want to know what psyclioj)athy is.Dr. Martin. I guess, in the general sense, we mean people whomanifest criminal types of behavior. Looking at this more from abehavioral aspect, many of these individuals are characterized by thefact that the}^ are overl}^ concerned with themselves <strong>and</strong> overly concernedwith the immediate present, which has the implication that theydo things primarily to gratify themselves <strong>and</strong> think ^ory little aboutthe future.Chairman Pepper. Have you anything else you would like to sayuntil 12:30, or shall we recess now until 1:30?Dr. Brown. I think this would be an appropriate time to recess.I just want to add my comment on the term "psycho])athy," whichDr. Martin has used. Those who have worked in the fields for 10 or20 years become deeply impressed by some of the behavioral <strong>and</strong>other character aspects either caused by or seen as related to seriousdrug addiction <strong>and</strong> drug dependence.This particular behavior, which we often describe as hedonistic,self-seeking, or self-serving, is, of course, one of the most troublesomefeatures, <strong>and</strong> one of the hallmarks of ^^our committee's charge, that is,those persons who will violate society's mores, who steal <strong>and</strong> do otherillegal things.Dealing with this basic behavior, either as a cause or an effect, isone of the mos^t important dimensions <strong>and</strong> one of the reasons we feelit is so important to extend our <strong>research</strong> efforts in this area.Chairman Pepper. In general, is there a certain type of mental, orwhatever you call it, complex that results in such human behavioristhere some general characteristic that j^ou would find in peoplewho are the users of heroin, addicts of heroin? Do they come intocertain jjsychiatric categories <strong>and</strong> have certain general characteristics?Dr. Brown. Dr. Mai tin has had more direct experience with that.Again, my information is more based on extensive contact with peoplewho themselves have worked extensive!}' with addicts, as we wouldsay, in a scholarly world on secondaiy sources rather than an extensiveprimary source. There seems to be some generally central characteristicsalong the lines of self-seeking, gratifying, hedonistic aspects.However, there seem to be many routes into heroin addiction. Manytypes of people are involved, <strong>and</strong> it is my own professional judgmentthat it is a complex thing with no simple one-character behavioralI)ersonality facet. That is my own judgment from the material, but ifyou would like to answer the quest^ion that Chairman Pepper gave tous, it might be useful.Dr. Martin. Thank you, sir. I think I would agree completelywith what Dr. Brown has said, <strong>and</strong> perhaps just elaborate a small biton it.When you look at the characteristics of individuals that come to,for example, our hospital for <strong>treatment</strong> for drug addiction, they fallinto probnbh- three or four categories which mdicate the complexity ofthis problem.The first is the t3^pe tliat I have called the psychopath, a person whoneeds immediate gratification <strong>and</strong> is not very particular about howhe goes about obtaining this gratification.