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

5msuccessful or not in that short a period of time and we define successas someone who has been on it for more than 6 months—we are comparing17 patients receiving cychizocine out of this group for 6 monthsor longer, with 22 patients who dropped out of treatment and onthat basis our treatment success rate is approximately 50 percent.Virtually all the patients who are on cychizocine learned of tliistreatment only after their admission to the hospital. In other words,they did not come into the hosjntal in order to volunteer for thistreatment. Few of them had heard about cyclazocine or know it to beavailable as a treatment prior to their admission.Now, these experiences with narcotic antagonists are based on atheory that views narcotic addiction as analogous to a conditionedresponse—the addict responding to stressfvd stimuli in his environmentwith drug-seeking behavior. And in this theory the repeateduse of heroin without liis anticipated relief of stress or without obtainingthe euphoric high should lead to extinction of this learneddrug-seeking beha^dor.In fact, most of our patients who have been successfully treatedwith cyclazocine have, during the course of their treatment, triedheroin on one or more occasions while they were out on the streets.Having done this, and then not experiencing the high, they reportto us feeling relieved at being protected from heroin effects wdiich thenenables them to clear their minds from either thinking about it orbeing tempted to use heroin, knowing that it will have no effect, and,therefore, wdll be a waste of money.Now, the principal shortcoming of cyclazocine as a treatmentfor those addicts in whom it might otherwise be useful is its shortduration of action, not the side effects. Effective heroin blockaderareh^ wdll exceed 20 hours, so that in the face of some acute symptoms,it is easy for a patient to skip a dose of cyclazocine on a particular dayand become high on heroin, and even a patient who is highly motivated,who is symptom free, is on occasion ambivalent about takingcyclazocine on a particular day, having in mind that he can useheroin perhaps just that once or use it once in a while, and hisoccasionally^ skipping cyclazocine and using heroin typicalh' wouldreestablish the cycle of an increased craving and then an eventualreaddiction.So, in an attempt to avert this cycle, we have assigned some familymember the responsibility of administering each day the cyclazocineto the patient.Chairman Pepper. Excuse me. How is cyclazocine administered?Dr. Resnick. By mouth. It is available as a tablet or as a liquid.We use the liquid.Now, when a person in the patient's family or another person whois responsible in his life has the responsibility of seeing whether or nothe takes the cyclazocine, he is much less likely to miss taking itbecause he knows that not taldng it on a particidar day is tantamountto announcing in advance on that da}', todaj' I am going to go outand shoot heroin.Of course, this })rocedm'c also serves as a reassurance to the familyso that they arc relieved of having to look fur signs of ch'ug use in thepatient, to look for needle marks, to search him for possession of drugs