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

475treated in the community centers are over two-thirds black or Chicano and havean average age in the early- to mid-twenties. Moreover, the two groups are notequivalent in terms of employment histories, arrest histories, or education. Whatwe can say now, however, is that both programs seem to be helping a large percentageof the patient populations whom they are treating.The exact percentage of patients who are being helped depends on what measureyou use to evaluate the patients' improvement. For example, you can look at the"percent of patients who are working, or the percent who are staying out of jail,the percent who do not become re-addicted, 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 8.5 percent were employed, 70percent were not arrested and spent no time in jail during that period, 3.5 percentwere in self-help therapy, and 33 percent were pursuing their education. In addition,80 percent of the patients who had been in aftercare for 3 months or morewere completely free of heroin use. A similar statement can be made regarding theheroin use of patients who were in the community treatment programs. As youknow, manj?- patients during the treatment of their addiction may abuse drugsother than heroin occasionally, such as marihuana, amphetamines, or barbiturates.Of the patients in the civil commitment program who had been in aftercare for 3months or more, 60 percent were not abusing any drugs. The same is true of patientswho had been in the community treatment program for 3 months or more. If thepatients who are in the civil commitment aftercare phase, we know that 60 percentdo not become re-addicted during their first j^ear in aftercare. Of the remaining,25 percent do abuse some drugs or become re-addicted and require further hospitaltreatment. The remaining 15 percent drop out of the program.As the committee is well aware, there is a great deal of public interest currentlyin methadone maintenance treatment for narcotic addiction. Many claims andcounterclaims are being made regarding its effectiveness. How effective is methadonemaintenance treatment? The answer I am about to give you is a cautiousone, but I beUeve represents the state of our knowledge at this time. The Food andDrug Administration, which has responsibility for determining the degree ofsafety and efiicacj^ of drugs, has determined that the exact degree of safety andefficacy of methadone maintenance treatment is unknown at this time. Manygroups, including groups in New York City, Illinois, and here in Washington,D.C., are evaluating methadone maintenance. The National Institute of MentalHealth is currently sponsoring the use of methadone in both its civil commitmenttreatment program and its community-based treatment programs under carefullycontrolled conditions so that we can generate data to help determine methadone'ssafety and efficacy.With regard to comparing methadone and other treatment modalities, I mustagain point out that the patients who are being treated with methadone differin many characteristics from the patients who are being treated with othermodailities. For example, they differ in age, sex, race, length of addiction, historyof criminal behavior, and so on. Lastly, I might again say that comparisons ofefficacy depend on which measures or benefits one looks at—employment, arrestrecords, drug abuse, or pursuit of education. Although the results I am about togive you have to be viewed in the light of differences in the groups being compared,it appears that there are no large differences between the benefits achieved bymethadone patients compared with the benefits achieved by patients treated inother ways. For example, more than 70 percent of both methadone and nonmethadoiiepatients in the civil commitment program were not arrested and spentno time in jail during 1970. Approximately equal percentages of the two groups,that is about one-third, were engaged in educational activities. Although it wouldappear that more methadone patients were working than nonmethadone patients,that is 87 percent of methadone patients versus 65 percent of nonmethadonepatients, this figure is misleading since in some programs methadone patients arerequired to be employed before they can be admitted into treatment. The oneexception to the generally comparable results between methadone and nonmethadonetreatments is that in the community treatment program a largerpercentage of patients treated with methadone remain in the program longer thanthe patients treated with other modalities.In addition to evaluating methadone maintenance, therapeutic communitiesand comprehensive centers which offer these treatments as well as emergencycare, partial hospitalization, and consultation and education, the Institute is also