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

52)1and medical certificates on those patients with a history of multiple admissionsseeking readmission. The wisdom of this was imcertain, since, as time went on, itbecame more apparent that the hospital did render assistance to these patients byallowing some degree of detoxification to occur, thus preventing a compoundingof their difficulties and perhaps allaying the development of a state of panic withthe resultant acting out of additional antisocial behaviour.Parolees from correctional institulions (the outpatient group).—In order to investigatethe deterrent effect of daily laboratory control in an outside environment,arrangements were made with the Deimrtment of Parole and Probation of theState of Maryland to select inmates with a history of narcotic usage or addictionwhose homes were in Baltimore City and who would agree to accept the conditionsof parole associated with this experimental program. The conditions were:Daily attendance at the clinic to provide a urine specimen, attendance at theweekly group psychotherapy meetings, maintenanace of a job and compliancwith the other usual parole requirements.On release, the patient reported to the clinic within a day or two. In the cliniche was seen initially in an individual interview by the psychiatrist and informedof the schedule he was to follow in providing his urine specimens. The importanceof dailv attendance at the clinic for the purpose of providing a urine specimenwas also emphasized. In the event of illness or emergency, the patients wereinstructed to telephone and give the reason for their absence and these absenceswere reported to the probation officer on the following morning. The readinesswith which these patients gave in to minor illnesses and the unending excusespresented concerning the difficulties they encountered in getting to the clinicmade it necessary to take the position that an unauthorized absence would beconsidered as equivalent to a positive reaction.This unit, which came to be known as the narcotic addiction clinic, began tofunction in June 1964. In its first 10 months of operation from June 1964 toApril 1965, a total of 31 patients were referred to the cUnic. Of these, two neverreached the clinic. They apparently obtained narcotics immediately after releasefrom the correctional institution and died from an overdose. The remaining 29patients have attended the clinic for varying periods of time ranging from a fewweeks to 9 months. Six of these 29 patients have had to be referred back to acorrectional institution as control failures after varying periods of time in theclinic ranging from 3 weeks to 9 months, and two have absconded.The overwhelming majority of these patients fell in the sociopathic diagnosticcategory. They presented histories of narcotics usage over varying periods of timeand many had previous arrests for narcotic violations. Their response to theprogram was evaluated from several standpoints, namely: Laboratory control,the meaningfulness and course of the group therapy and the impact of thisprogram on the probation officer.Laboratory con^r-o/.— Initially, the urine testing was on a daily basis. This frequencywas decreased depending upon the level of abstinence achieved by thepatient; there was usually a "night oflf" after several weeks in which his recordhad remained "clean." Specimens were collected under direct observation by apsychiatric aide and delivered to the laboratory for analysis the next day. Abreach in the abstinence of a patient was promptly brought to the deviant'sattention by the probation officer and in the weekly meeting with the psychiatrist.The occurrence of these deviations raised many challenges in terms of the courseto be taken with the patient. He was informed of the laboratory findings and askedfor an explanation of his drug use. The decision as to the patient's subsequentcourse in the program rested on the degree of control he was manifesting over a10-day period with day one beginning with a deviation. If over a 10-day periodthe breaches reached a level of 50 percent, the patient was taken into custody bythe parole oflScer and returned to a correctional institution. Often a decision couldnot be made as to whether the patient should remain in the program or l)e returnedto the correctional institution since the patient would again reestablish his control.In most cases he was allowed to remain in the program. Subsequently, some ofthese did well for a time while others decompensated again and had to be returned.The problem of the failing patient raised many issues. One was whether thepatient should be transferred to a hospital or retruned to a correctional institution.It was decided for the time being that all failures would be returned to a correctionalinstitution. This decision was based to a large extent on the meager therapeuticachievements resulting in the court-referred narcotic addicts and the experienceswith the voluntary admissions group. There was also the feeling that thecorrectional institution could provide greater work and rehabilitative opportunities