Monday, Mar. 16, 1970
How Addicts Are Treated
HEROIN was believed to be harmless when it was developed in Germany in 1898 as a morphine substitute and cough suppressant. Only later was it realized that it was twice as potent as morphine. No one treatment for heroin addiction works in all cases, and there are almost as many approaches to the problem as there are experts.
One method is the so-called "British system," based on the operating premise that heroin addiction is a sickness, not a crime. As originally conceived, the system allowed British physicians who were convinced that complete withdrawal would endanger the addict's physical and mental health to prescribe maintenance doses of the drug. This was permitted only if the addict patient could not be persuaded to undergo a cure or enter an institution. The program had one obvious advantage: by making drugs legally available, it eliminated the addict's dependence on black-market suppliers and made it unnecessary for him to steal to support his habit.
The law also had disadvantages. Continuing rather than curing drug addiction, it led to an increase in addict registration: the number of known heroin addicts rose from 454 in 1959 to 2,782 by 1968. The system was also subject to abuse. Some doctors grossly overprescribed heroin to addicts, who sold what they did not use. Their action forced the government to change the law in 1968 so that only specially designated consultants at certain hospitals could prescribe drugs.
Another approach to the problem of heroin addiction is the methadone maintenance program. Pioneered in New York beginning in 1964 by Drs. Vincent Dole and Marie Nyswander, the program involves switching an addict from heroin, which can cost $50 or more a day on the black market, to methadone, a synthetic substitute that can be made available legally for about 150 for a day's dosage. Administered as part of a total rehabilitation program involving counseling and therapy, methadone eases heroin withdrawal and blocks heroin's euphoric effects. This enables an addict to function normally and hold a job, something that few heroin users can do. But methadone itself is addictive, which means that those who use it must either be helped to taper off from the synthetic, or continue their habit for the rest of their lives. Methadone advocates maintain that this is no worse than a diabetic's daily use of insulin.
Many medical and legal authorities object to substituting one form of addiction for another. Others are concerned about the lack of supervision in some treatment centers. Unless the cen ters check urine samples daily, addicts can continue to use heroin. But the program has solid support among those addicts enrolled, who see in it their only hope of leading a relatively normal life. Their hope is justified by a recent study of New York's methadone program. According to Dr. Dole, 82% of those who originally enrolled in the New York program are still participating, and three-quarters are now either at school or at work. But funds and facilities are limited. Only 2,500 are participating in the New York program, and thousands of others are on a nine-to twelve-month waiting list for admission, a situation that Dr. Dole compares to "asking someone to wait for artificial respiration." -
The most accepted means of dealing with the drug addict is through a small, controlled therapeutic community. These residential communities first detoxify, then attempt to rehabilitate the drug user by restructuring his eqo and life pattern. Some, like California's famed Synanon, are run largely by former addicts. They accept only those who have proved their determination to kick the heroin habit, and seek to increase the addict's understanding of himself and his problems through often brutal group-encounter sessions. Others, like New York's city-run Phoenix and Horizon Houses, utilize both ex-addicts and professionals.
Still others, like Marathon House, serving the Providence, R.I.-Attleboro, Mass., area, rely heavily on addicts and ex-addicts to help one another under staff scrutiny. A few, like the two federal narcotics hospitals at Lexington, Ky., and Fort Worth, Texas, are more conservatively run; most of their patients are ordered there by the courts rather than entering voluntarily and have less motivation for reform. More than 90% eventually return to heroin.
The programs in a therapeutic community are long, running from 18 to 36 months for an individual. Though those who leave the communities often return to narcotics, most of those who complete the programs stay on. forming a cadre to help other addicts through the ordeal of rehabilitation. A few go on to form similar communities. More than five Synanon chapters have sprung up across the country since Synanon was founded in 1958.
There is no agreement within the medical community as to which of these approaches is best, and there is serious competition for the relatively small amount of money available to combat addiction. "Everyone sees everyone else as a threat to his program," says one New York physician, and his observation is as accurate as it is unfortunate. For while the experts are arguing, people are becoming addicted and dying.
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