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

470Studies on the waj^s in which tolerance or physical dependence develops focuson biochemical, pharmacological, and behavioral measures associated with toleranceto narcotic analgesics such as morphine. In an eflfort to understand how addictionoccurs, these studies are exploring the effects of narcotic analgesics onbrain proteins, R,NA, and brain transmitters.In studjang the effects of drugs of abuse in animals and humans, researchersare exploring both long- and short-term effects and effects of both small andlarge doses. Studies are concentrating on the effects of drugs on coordination,thinking, perception, memory, and complex acts such as driving. Research is alsobeing carried out on the potential genetic and carcinogenic effects of these drugs,as well as on their effects on developing fetuses.Research into detecting abused drugs in body tissues and fluids includes researchon opiates, barbiturates, marihuana, amphetamines, and hallucinogens.Better methods of detection will help those who are treating drug abusers andshould reduce the expense, complexitj', and error involved in screening andmonitoring both i^atients and prisoner suspected of drug use. More sophisticatedmethods for quantifying and differentiating various types of drugs will also beuseful to forensic pathologists and medical examiners.Much research is now underway to evaluate the effectiveness of treatmentand rehabilitation methods in the field of narcotic addiction. We are evaluatingboth pharmacological approaches, such as the narcotic antagonists and methadone,and nonpharmacoiogical methods such as therapeutic communities, comprehensivecenters, and desensitization techniques. As members of the conmiitteelasiy know, the Institute supports the treatment of addicts both under the civilcommitment program of the Narcotic Addict Rehabilitation Act and under a grantprogram to establish community-based treatment centers, of which approximateh-16 are now operating and another seven have been funded and are getting underway.In addition, under Public Law 91-513, the Institute is now authorized tofund individual treatment services such as detoxification centers, partial hospitalization,or emergency care.Both the civil commitment program and the community-based comprehensivetreatment centers empio.y pharmacological and nonpharmacoiogical methodsof treatment, and data is being gathered to evaluate the relative efficacy ofthese methods.I should stress that we believe that no one method of treating narcotic addictsis "the answer." Addicts differ in their needs and in the kinds of therapy whichare most helpful to them. As a result, it is necessary to evaluate a variety oftreatment modalities.As of March 1971, the narcotic treatment and rehabilitation programs supportedby the Institute were assisting approximately 2,000 patients under thecivil commitment program, of whom 1,300 were in the aftercare phase of treatment,and approximately 7,000 patients in the community-based treatmentprograms supported by Institute grants. Unfortunately, we cannot at presentcompare the results of the civil commitment treatment program and the communitytreatment programs because the}^ are treating different groups of addicts.However, at a later date it should be possible to extract matched pairs of patientsfrom the two groups and compare their degree of benefit. To illustrate the differencesin the two groups, addicts being treated under the civil commitment programare 60 percent white and have an average age in the late twenties; whereas,the patients being treated in the community centers are over two-thirds blackor Chicano and have an average age in the early to midtwenties. Moreover,the two groups are not equivalent in terms of employment histories, arrest histories,or education. What we can say now, however, is that both programs seemto be helping a large percentage of the patient populations whom they are trenting.The exact percentage of patients who are being helped depends on what measure3^ou use to evaluate the patients' improvement. For example, you can look atthe percent of patients who are working, or the percent who are staying out ofjail, the percent who do not become readdictcd, the percent who have returned toschool, and so on. In the civil commitment program, a study of 1,200 patients whowere in aftercare in 1970 showed that approximately So percent wei-e enii)loy('ti,70 percent wore not nrrestod and spent no time in jail during that jxn-iod, 3.")percent wore in self-help therapy, and 33 percent were pursuing their education.In addition, SO percent of the patients who had been in aftercare for 3 monthsor more were completely free of heroin use. A similar statement can be maderegarding the heroin use of patients who were in the community tr(^atnientprograms. As you know, many patients during the treatment of their addictionmay abuse drugs other than heroin occasionally, such as cocaine, marihuana,