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

.522than a State psychiatric hospital for this t\-pe of pcrsonahty, since the greatmajority of these patients refused to see themselves as sick. Furthermore, for someof the patients, the hospital setting led to development of unrealistic therapeuticexpectations. Their subsequent disappointment tended to reinforce their everpresentantogonisms while increasing their sense of the liopelessness relative toany attempt to treat their addiction.Group therapy.—The group psychotherapy sessions turned out to be a helpfulmedium for the psychiatrist to obtain a better understanding of the patient. Agroup just getting underway was one in which there was a great deal of discussionabout drugs, their urge for drugs, complaints, and many demands and expressionsthat the doctor do something for them rather than that thej' do something forthemselves. Subsequently, as a group identification mechanism began to malieitself apparent, discussions evolved which generated much feeling concerningtheir living and working conditions and their family problems. An increased senseof awareness developed, relative to the significance of the discussions of theirproblems, which frequently found expression in such remarks as, "After talkingabout this last week I wasn't angry anymore." Some of the members dropped outof the group, with a subsequent return to a correctional institution. The remainingmembers seemed to focus on the more complex aspects of their immaturity andimpulsiveness. The therapist's attempts to point out some of their manipulativebehavior and channel their thinking into approaches which might provide someinsight seemed to become more meaningful.The parole officer.—The parole officer made arrangements with the parolees tosee them once weekl3^ However, the occurrence of a positive reaction or an unauthorizedabsence from the clinic led to an immediate confrontation as soon as aninterview could be arranged. Continuing failure to complj-- with the program at alevel which was considered satisfactory (and this varied somewhat from patientto patient) could lead to the patient's return to the correctional institution.The most difficult issue confronting the parole officer was the return of the breadwinnerof a family to a correctional facility. Quite often his release had resulted inhis family being taken off the relief rolls. In addition, the patient might be doingquite well on the job and getting along with his famil.v. It was especially difficultto make a decision in some of these cases, particularly when the decompensationhad been gradual and occurred only over a rather long period of time. However, asthe frequency of narcotic usage increased and the possibility of physical dependencebecame accentuated, a decision was made to return the indiviudal to a correctionalinstitutioi'DISCUSSIONThe attempts to achieve maintenance of abstinence in the narcotic addict oruser have in the great majority of such patients been so imrewarding that controversystill continues relative to the usefulness of this concept {1, 11). This isemphasized by the observations in the study; namely, that sporadic deviationsoccurred in practically all. However, the observation that laboratory controlseemed to be of value in helping many of the parolees quickly regain their controland in extending their period of abstinence was repeatedly made. This program,which required an almost dailj^ report on themselves, nevertheless allowed thepatients on parole to carry out their daily lives in the context of their social setting,famil}^ and work relationships. It was found that such control could be carriedout over a period of months, as indicated by the duration of this study to date.Many of the patients, in their efforts to bypass this system of control, occasionallyreverted to alcohol, amphetamines, and barbiturates. The degree towhich these were utilized in dealing with their recurrent dysphoric states is as yetnot known. As far as could be learned during the present period of study, even asthe narcotic exit was being closed, there did not appear to be any increased antisocialbehavior in terms of further arrests or infractions of the law. On the otherhand, this does not mean that while these patients were restricting tlieir usage ofnarcotic drugs the.y did not have disturbances in their social relationships, workactivities, and within themselves.The opportunities for stud.ving nascent deviant behavior in drug users have notbeen as rewarding as anticipated. This may be due to the fact that the processesinvolved may be much more conqjlex than is superficially indicated by the banalityof the explanations offered and the difficulties in probing beyond these. Whileconfrontation of the patient with a deviation from abstinence in most instances