Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Factors affecting the drug addicts treatment involvement Dryden, David Lloyd George 1967

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1967_A5 D7.pdf [ 2.5MB ]
Metadata
JSON: 831-1.0104513.json
JSON-LD: 831-1.0104513-ld.json
RDF/XML (Pretty): 831-1.0104513-rdf.xml
RDF/JSON: 831-1.0104513-rdf.json
Turtle: 831-1.0104513-turtle.txt
N-Triples: 831-1.0104513-rdf-ntriples.txt
Original Record: 831-1.0104513-source.json
Full Text
831-1.0104513-fulltext.txt
Citation
831-1.0104513.ris

Full Text

FACTORS A F F E C T I N G THE DRUG ADDICTS TREATMENT INVOLVEMENT  A Preliminary  Exploratory,Study  by  David L l o y d George  Dryden  N e r i s s a O i - S i m Lo Edward  Milligan  H e l e n e A n n Sawchuk Edward  Earl  Sibbald  M a b e l Po-Mee Wong  "Thesis Submitted i n P a r t i a l for  t h e Degree  F u l f i l l m e n t o f the Requirements  o f MASTER OF SOCIAL WORK i n  t h e . S c h o o l of- S o c i a l  Work  A c c e p t e d as c o n f o r m i n g to t h e s t a n d a r d degree o f Master o f S o c i a l  School of S o c i a l  required Work  Work  ;1967 The p n i v e r s i t y  of British  Columbia  f o rthe  In p r e s e n t i n g  this thesis  i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s  f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree that  die L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e  study.  and  I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s  t h e s i s f o r s c h o l a r l y purposes may be g r a n t e d by t h e Head o f my Department o r by h i s r e p r e s e n t a t i v e s .  I t i s understood t h a t  copying  or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n  permission.  Department o f The U n i v e r s i t y o f B r i t i s h Vancouver 8, Canada Date  Columbia  ABSTRACT  Since its  the Narcotic A d d i c t i o n Foundation of B r i t i s h  d o o r s - i n •1958 i t h a s b e e n s u c c e s s f u l  drug  addicts  i n the Vancouver  area.  treatment a f t e r  There  the f i r s t  exploratory  study, have undertaken  which might  influence  the drug  h a s , h o w e v e r , b e e n some  The  s t u d y was d i v i d e d  study which u t i l i z e s .for  different  of  .105 a d d i c t s  This study sets  t h e base f o r a p r o j e c t e d  into  two p h a s e s .  The f i r s t  (55) conducted  i s the r e t r o s p e c t i v e  i n 1 9 6 4 . -Though  s t u d y , p r o v i d e s a c o n v e n i e n t , and s u i t a b l e  ( 5 0 m a l e -and 55 f e m a l e )  f o r the present r e s e a r c h .  study i s to i d e n t i f y  certain  pursued sample  The imme-  factors  which  d i s c e r n i b l e a t t h e t i m e t h e a d d i c t p r e s e n t s h i m s e l f f o r t r e a t m e n t and t o  The  second  phase,  a longitudinal  treatment study, w i l l  • f a c t o r s ' - w h i c h emerge -from t h e r e t r o s p e c t i v e related study,  involvement. utilize  s t u d y .as b e i n g  to the addict's continued treatment involvement. t o f u r t h e r prove  the v a l i d i t y  c o v e r a t w e l v e month p e r i o d  from  o f each  the s p e c i f i c significantly The  longitudinal  f a c t o r , has been p r o j e c t e d to  the time t h e , a d d i c t f i r s t  presents himself  treatment. The  of  The a u t h o r s o f t h i s  problem.  r e l a t e "them t o t h e - a d d i c t ' s s u b s e q u e n t  for  who  addict's continued treatment involvement a t  d i a t e aim of t h i s r e t r o s p e c t i v e are  the high r a t i o o f . p a t i e n t s  few c o n t a c t s .  the Paulus Study  reasons, this  concern  t h e - t a s k o f d e t e r m i n i n g some o f t h e f a c t o r s  the N a r c o t i c A d d i c t i o n F o u n d a t i o n . three year study o f the stated  opened  i n c o n t a c t i n g a l a r g e number o f  e x p r e s s e d by t h e agency t r e a t m e n t s t a f f o v e r discontinue  Columbia  results  o f t h e s t u d y p o i n t o u t some o f t h e d i f f i c u l t i e s  and a r e a s  c o n c e r n r e g a r d i n g t h e t r e a t m e n t o f t h e d r u g a d d i c t a n d some r e c o m m e n d a t i o n s  pertaining  to follow-up studies of this kind.  While  the drug ^addict  exhibits  some-characteristics many w a y s . uniqueness that  to c l i e n t s  o f any a g e n c y , he i s u n i q u e i n  The-factors discerned i n this and., i t i s h o p e d , ( u s i n g  they w i l l  future  similar  eventually  lead  study c l a r i f y  the s i g n i f i c a n t  f a c t o r s brought  to better prognostication  success f o r continued treatment involvement.  especially  helpful  to the s t a f f o f the Narcotic  other agencies geared  to t r e a t i n g  out,)  of the addict's  I t should prove  t o be  A d d i c t i o n F o u n d a t i o n and  the drug a d d i c t  t r e a t m e n t program and o r g a n i z a t i o n .  some o f t h i s  i n guiding  changes i n the  iv  TABLE OF CONTENTS  CHAPTER  I.  REVIEW OF THE L I T E R A T U R E Introduction H i s t o r i c a l Background - D e f i n i t i o n s o f Drug A d d i c t i o n M a j o r E x p l a n a t i o n s o f Drug A d d i c t i o n Two M a i n A p p r o a c h e s t o t h e P r o b l e m o f Drug A d d i c t - i o n .Treatment Methods The E x p e r i e n c e o f t h e N a r c o t i c A d d i c t i o n Foundation Summary  CHAPTER  I I .  PROBLEM I D E N T I F I C A T I O N : A N D FORMULATION Statement of the Problem - Assumptions Hypotheses Dependent and I n d e p e n d e n t V a r i a b l e s Operational Definitions  CHAPTER I I I .  RESEARCH DESIGN F i r s t P h a s e - The R e t r o s p e c t i v e S e c o n d P h a s e - The L o n g i t u d i n a l Summary & R e c o m m e n d a t i o n s  BIBLIOGRAPHY  P.  1  P. P. P. P.  1 2 2 4  P. 7 P. 11 P. 15 /P. 17  ;P. 19 P. P. P. :P. P.  20 21 22 23 24  P. 28 Study Study  ,P. 28 ,-P. 36 P. 38 P. 4 1  V  ACKNOWLEDGEMENTS  We w i s h  t o express our -sincere-.appreciation.-to  the Narcotic  A d d i c t i o n Foundation, Vancouver, B r i t i s h Columbia,  f o rthe use o f their  library  staffs.  and f o r t h e generous c o - o p e r a t i o n o f t h e i r  -Williams,  D r . H.R.  C l i n i c a l D i r e c t o r , a n d M i s s I . P a u l u s , R e s e a r c h A s s o c i a t e , .of  the Foundation deserve -special  thanks  f o rtheir  valuable  time-and  advice. We - a l s o w i s h  t o extend our thanks  •of -the - S c h o o l o f S o c i a l preparation  of this  t o . M r s . H. H i c k s ,  Work, f o r h e r a s s i s t a n c e  study.  o f the f a c u l t y  and g u i d a n c e  i n the  CHAPTER ;1  INTRODUCTION In.Canada, the p u b l i c i t y of  narcotic  collective  addicts  suggest  that,  1966 shows  that  though r e l a t i v e l y  criminal activities  t o be f o u n d  i n British  f e w i n number,  those v a l u e s .  Columbia.  apparent,  rehabilitative  was, a l l e g e d l y , Public  Initially  I n the p a s t these s t e p s have been m a i n l y  treatment program.  c o s t s of the drug which  concern resulted  in British  Columbia  i t comprised  While  substance  i s mainly  i s a v a i l a b l e only  illegally  i n c i d e n c e of crime in. the  i n the e s t a b l i s h m e n t o f a N a r c o t i c and t h e C l i n i c  an o u t p a t i e n t c l i n i c  was  Addiction  o p e n e d i n December,  but later  1958.  a small residential  instituted.  i n c o n t a c t i n g , a l a r g e number o f t h e a d d i c t s ,  being expressed over  problem  enforcement  those r e s p o n s i b l e f o r the implementation of the treatment  have been s u c c e s s f u l  ment a f t e r  i n the  t o s e t up some f o r m o f  The a d d i c t i v e  commensurate w i t h the r i s i n g  t r e a t m e n t c e n t r e was  is  These  s t e p s a s w e r e deemed n e c e s s a r y t o  e f f o r t s have b e e n m a d e  and t h e r i s i n g  Foundation  (16).  b u t . as t h e f u t i l i t y o f . s u c h p u n i t i v e m e a s u r e s h a s become  increasingly  area.  institutions  i n C a n a d a o f whom  a r e a o f l e g i s l a t i o n i m p l e m e n t e d and m a i n t a i n e d b y l a w  heroin,  their  h a v e b e e n p e r c e i v e d a s a t h r e a t t o s o c i e t a l v a l u e s and  s o c i e t y ' s r e a c t i o n has been t o take such  officials,  activities  A r e p o r t i s s u e d by, t h e F e d e r a l g o v e r n m e n t  t h e r e w e r e 3,592 k n o w n a d d i c t s  2,068 o r 57 p e r c e n t w e r e  safeguard  the c r i m i n a l  i n v o l v e m e n t w i t h the c o u r t s and c o r r e c t i o n a l  c o n s t i t u t e a s o c i a l problem. in  attendant.upon  the h i g h r a t i o  t h e f i r s t few a p p o i n t m e n t s .  i n i t i a l l y stated,  the c l i n i c  o f p a t i e n t s who  concern  discontinue treat-  As one s o l u t i o n  to the s o c i a l  can claim only l i m i t e d  success.  H I S T O R I C A L BACKGROUND H i s t o r i c a l evidence indicates  t h a t drug a d d i c t i o n has  been  known t o e v e r y c i v i l i z a t i o n o n r e c o r d .  (41)  Chinese emigrated  among them w e r e o p i u m s m o k e r s  introduced in  to North America t  this habit  and  to the Western  I n t h e 1 9 t h c e n t u r y many  people.  However, the marked  the p r e v a l e n c e o f a d d i c t i o n has been a t t r i b u t e d  powerful derivatives  o f opium, the i n v e n t i o n . o f  the widespread use o f o p i a t e s i n p a t e n t m e d i c i n e s . is  i n d i v i d u a l and  to the p h y s i c a l ,  i s hence a t h r e a t  t h a t drug a d d i c t i o n i s of major of i t s a s s o c i a t i o n with  p s y c h o l o g i c a l and  to s o c i e t y .  crime.  not e s p e c i a l l y . l i n k e d  that  I t i s interesting  to O'Donnell:  is  n o t • d e t e r m i n e d o n l y , by  It  c h a n g e s and  t h e way  s o c i a l decay  "The  the e f f e c t s  the s p e c i f i c  revealed a paucity  D E F I N I T I O N S OF  causal  tries  factors.  of r e l i a b l e  the  t h a t d u r i n g the  a t pharmacies., d r u g  addiction  Rather, addicts  n a t u r e of the a d d i c t i o n  of drugs  on  to c o n t r o l  the problem."  use  (52,  little  A r e v i e w of the l i t e r a t u r e  studies  at  problem  t h e p e r s o n s who  i n this  them. in  p.VII) i s known  has  area.  DRUG ADDICTION i n v a r i o u s w a y s . ' One  m o s t p o p u l a r d e f i n i t i o n s u s e d h a s b e e n f o r m u l a t e d by the World  of  drug  are at present.  Drug a d d i c t i o n has been d e f i n e d  of  that  the . c h a r a c t e r i s t i c s o f a d d i c t s change w i t h v a r i a t i o n s  s o c i e t y p e r c e i v e s and  there  f u r t h e r b e e n shown  I n s p i t e of the p r e v a l e n c e of drug a d d i c t i o n s u r p r i s i n g l y about  n e e d l e , , and  the b e l i e f  to note  t o c r i m e as i t i s t o d a y .  t i m e w e r e v i e w e d much a s a l c o h o l i c s According  I t has  the  c o n c e r n t o the g e n e r a l p o p u l a t i o n because  1 9 t h c e n t u r y , when n a r c o t i c s w e r e a v a i l a b l e was  of  I n North America  a s t r o n g taboo a g a i n s t d r u g a d d i c t i o n stemming from  abuse c o n t r i b u t e s  increase  to the d i s c o v e r y  the hypodermic  who  The  of  the  E x p e r t Committee  H e a l t h O r g a n i z a t i o n w h i c h d e f i n e s d r u g a d d i c t i o n as b e i n g  "A s t a t e o f p e r i o d i c o r c h r o n i c i n t o x i f i c a t i o n p r o d u c e d by c o n s u m p t i o n o f a d r u g , n a t u r a l o r s y n t h e t i c . I t ' s c h a r a c t e r i s t i c s a r e f o u r i n number:  the by  (1)  t h e r e i s an o v e r p o w e r i n g d e s i r e , need o r c o m p u l s i o n t o c o n t i n u e t a k i n g t h e d r u g a n d t o o b t a i n i t by a n y means;  (2)  a tendency  (3)  a p h y s i c a l and g e n e r a l l y , a p s y c h o l o g i c a l upon the e f f e c t s o f the d r u g ; and  (4)  an e f f e c t d e t r i m e n t a l t o t h e i n d i v i d u a l and t o society." ( 4 9 , p. 3)  This  d e f i n i t i o n has been s u b j e c t  Stevenson Report. Dr. Abraham W i k l e r  addiction'  i n general  to increase  ( 6 9 , p . 3)  the dose;  A similar  dependence  t o some c r i t i c i s m  as noted i n  d e f i n i t i o n h a s been, p r o p o s e d  who s t a t e s t h a t , " f o r c l i n i c a l  purposes,  'drug  may. be d e f i n e d , a s t h e c o m p u l s i v e u s e o f  agents which are harmful  to the i n d i v i d u a l ,  chemical  to s o c i e t y , or to both."  ( 7 1 , p. 3) A valuable  d e f i n i t i o n i n terms o f d e s c r i b i n g . p h y s i c a l and  p s y c h o l o g i c a l c h a r a c t e r i s t i c s i s p r o p o s e d b y Goodman & G i l m a n who drug  define  addiction.as: "A b e h a v i o u r a l  p a t t e r n o f c o m p u l s i v e d r u g u s e c h a r a c t e r i z e d by a n  overwhelming involvement w i t h supply.and a high  tendency  the use o f the drug,  to r e l a p s e  Inasmuch as t h e d e f i n i t i o n s  the securing  a f t e r withdrawal." identify  of i t s  (22)  c e r t a i n c h a r a c t e r i s t i c s of  d r u g a d d i c t i o n t h e y become e s s e n t i a l i n t e r m s o f i m p l i c a t i o n s f o r t r e a t ment . . F o r a d d i c t s , the drugs produce euphoria  (a 'kick', a  s e n s a t i o n , w h i c h may be e x p l a i n e d  by t h e r e d u c t i o n o f a n x i e t y  with.fear  whatever  initial  of pain.  ( 1 5 , p. 5 2 2 )  use, the regular user  more f r e q u e n t  develops  or l a r g e r doses, or both,  the sensation  tolerance  'high' associated  achieved  t o t h e d r u g ; he  to recapture  the 'original  by t h e requires effect.  R e g u l a r dosage leads  to p h y s i c a l dependence;  i f dosage i s markedly  r e d u c e d o r e n d e d , symptoms o f w i t h d r a w a l w i l l  MAJOR EXPLANATIONS OF  DRUG ADDICTION  Three major explanations the  literature  are  result.  of drug a d d i c t i o n which  (1) P s y c h o l o g i c a l  (2)  S o c i o l o g i c a l and  dominate (3) S o c i a l -  Psychological . Psychological  Explanation  Psychiatrists existence  and  of p e r s o n a l i t y  defects,  d e p e n d e n c y among a d d i c t s . l a r g e r e s e r v o i r of and  many become a d d i c t e d .  the  (9)  part  ification and  the  9,  (15,  addict,  adolescent addicts  7)  since  patients  This  of  there  has  inadequacy that  of  and  there  Brill  sexual  is a  population,  a v a i l a b l e to these  n e v e r b e e n any  is a conflict  universal  (26)  persons,  and  r e a l maturing  r o l e and  on  ident-  v a r i a t i o n s i n sexual  roles  (20)  found t h a t  were more abnormal  the p e r s o n a l i t y p a t t e r n s of  than those of  same e n v i r o n m e n t . addiction  t h e i r unaddicted  While this  suggeststthat  i t i s f a r from  conclusive.  65) As  not  view holds  there  p e r s o n a l i t y problems antedated  are  50)  A u t h o r i t i e s s u c h as  Kornetsky  f r i e n d s drawn from the  p.  almost  at d i f f e r e n t times.  G e r a r d and  (52,  the  traits  r e s u l t i n g i n h o m o s e x u a l i m p u l s e s and  function  to  most o f t e n  f a c t o r s make n a r c o t i c s  indicate that, of  (15,  point  ' a d d i c t i o n p r o n e ' p e r s o n a l i t i e s i n any  t h a t when a c c i d e n t a l  Chein  psychologists  noted  peculiar who  c l i n i c who  i n the  Stevenson Report  to a d d i c t s  alone.  (69,  Except f o r  have n e v e r used n a r c o t i c d r u g s can  would  commonly a s s i g n e d  certainly fall to a d d i c t s .  i n t o one This  or  i s not  the  p.  48)  personality  'medical be  found  other of  t o say  1  that  types  addicts, i n any the there  psychiatric  classifications i s no  basis  for discussing  narcotic addicts  collectively  i n these terms.  the preponderance o f e v i d e n c e i n v o l v i n g p s y c h o l o g i c a l sufficient proportion examine the c a u s a l  t o be s e r i o u s l y c o n s i d e r e d  Indeed,  factors i s i n  when a t t e m p t i n g  f a c t o r s w h i c h d e t e r m i n e why t h e m a j o r i t y  to  of addicts  drop o u t o f t r e a t m e n t a f t e r a few i n t e r v i e w s . Sociological  Explanation  :. S t u d i e s  i n this  area point  to the e x c e p t i o n a l l y high  o f : a d d i c t i o n among m i n o r i t y  g r o u p s ; . t o t h e much h i g h e r  and  larger metropolitan  to the f a c t that in.the  studied  areas.  ( 1 5 , 5 0 , 8)  The i n f e r e n c e  toward a d d i c t i o n must be o p e r a t i n g , relatively  i s that social  perhaps producing a d d i c t s  to the problems o f reaching  their d i f f e r e n t values  with  considerable  questioning  and a t t i t u d e s . ( 5 7 )  Complications  categories  o f m e n t a l i l l n e s s where p a t i e n t s  a p a t h y a n d r e s i s t a n c e a n d who h a v e d i f f i c u l t y  the usefulness  to achieve d i s t a n t goals.  to r e h a b i l i t a t i o n . Other  crisis  addicts  i n  also  evidence  accepting  on.life,  Their  inability  problems  to a r t i c u l a t e  patients  help.  as i n  o f doing something about t h e i r c u r r e n t  d e v e l o p i n s i g h t i n t h e manner o f m i d d l e - c l a s s  obstacles  among  out. a n d w o r k i n g w i t h  One s u c h a t t i t u d e i s t h e i r m a r k e d l y d i f f e r e n t o u t l o o k  and  pressures  t o t r e a t i n g lower socio-economic groups have been observed i n  connection  i n order  m o s t . d e p r i v e d , most  'normal' persons. (9) Adding  relation  f o r males;  areas which have been  m o s t c a s e s o f a d d i c t i o n come f r o m t h e p o o r e s t ,  underprivileged  are  rates  rates  problems  offers additional  ( 2 6 , p. 1 8 5 )  f a c t o r s such as l a c k o f s t a b i l i t y  s i t u a t i o n s and s a c r i f i c i n g  long-range plans  i n t h e home, l i v i n g i n f o r immediate  gratifi-  c a t i o n are c h a r a c t e r i s t i c of the working c l a s s but are r e f l e c t e d i n a d i s t o r t e d way i n t h e a d d i c t . addict  ( 2 6 , p. 186)  f a m i l i e s (97 p e r c e n t ) ,  there  Chein found  was a d i s t u r b e d  that i n almost a l l  r e l a t i o n s h i p between  the p a r e n t s ,  as e v i d e n c e d by s e p a r a t i o n ,  o f warmth and m u t u a l i n t e r e s t .  d i v o r c e , open h o s t i l i t y ,  I n these c o n d i t i o n s  t h e m o t h e r u s u a l l y became t h e m o s t i m p o r t a n t the y o u n g s t e r s .  start using  (55, p. 6 2 ) ; . a c c o u n t i n g  study  their  thirds  (two-thirds) Brill  the adolescent Winick  concentration suggests  that  c o n s i d e r a t i o n and t h i s  i n the drug An i n t e r e s t i n g  ( 7 5 ) who c o n c l u d e d  that a  o f a d d i c t s became i n a c t i v e i n  p r o c e s s f o r p e r h a p s two-  The a p p a r e n t l y which presents  i s a f a c t o r which w i l l  significant  itself  relation-  f o rd e t a i l e d  be g i v e n marked a t t e n t i o n  our study. Socio-psychological This  learning  the gradual  on the p r o c e s s o f becoming a n . a d d i c t , the withdrawal  i n t e g r a t i o n into a deviant  the formation  Eldridge  Considerations  approach focuses  involved,  increased and  twenty-five  t h e s e r e s u l t s make i t p o s s i b l e t o  ( 2 6 , p. 187)  s h i p o f age t o a d d i c t i o n i s a n a r e a  in  population.  t h a t a d d i c t i o n may b e a s e l f - l i m i t i n g  of the a d d i c t s .  t h e age o f  f o r t h e f a c t t h a t most s t u d i e s  deal with  thirties.  speculate  that  parent f i g u r e i n the l i f e of  drugs before  was c o n d u c t e d b y D r . C h a r l e s  substantial  Chein reports  ( 1 9 , p. 274)  Most a d d i c t s  addiction field  or lack  o f new v a l u e s  (14) and L i n d e s m i t h  subculture  and a t t i t u d e s .  a n d t h e g i v i n g up o f o l d ( 1 5 , p. 523)  (39) suggest, b o t h p e r s o n a l i t y  m e n t a l f a c t o r s must be c o n s i d e r e d helping  from the w i d e r c u l t u r e ,  As a u t h o r s  and e n v i r o n -  i f we a r e t o make any p r o g r e s s  toward  the addict. The  drugs are,  proponents o f t h i s approach argue t h a t , given  o r c a n be made a v a i l a b l e , t h e n t h e q u e s t i o n  dependence concerns i t s e l f who c h o o s e s  mostly with  the f a c t  that  of the etiology of  the personality, of the i n d i v i d u a l  to use the drug. (23)  On t h e b a s i s o f s t u d i e s a n d c l i n i c a l  reports of the p e r s o n a l i t y  of the a d d i c t Chein has concluded from (a) a weak ego s t r u c t u r e ,  t h a t the p o t e n t i a l male a d d i c t s u f f e r s  (b) d e f e c t i v e superego f u n c t i o n i n g , and  (c) inadequate masculine i d e n t i f i c a t i o n . addict's  attitude usually involves  I n a d d i t i o n , the t y p i c a l young  (d) a l a c k o f r e a l i s t i c o r i e n t a t i o n  toward the f u t u r e and (e) a d i s t r u s t o f major s o c i a l (9, p. 255)  institutions.  I n a study " T r a n s l a t i o n o f P e r s o n a l i t y C h a r a c t e r i s t i c s i n t o  Hypothetical  E a r l y Environments" (9, p. 271)  Chein found t h a t  family  e x p e r i e n c e s p l a y an important r o l e i n the e t i o l o g y o f a d d i c t i o n .  He  m a i n t a i n s t h a t the environment does i n f l u e n c e b e h a v i o u r and t h a t even when some a s p e c t s o f t h i s r o l e a r e obvious they a r e not n e c e s s a r i l y I t has been g e n e r a l l y life  accepted  simple.  t h a t poor f a m i l y r e l a t i o n s h i p s i n the e a r l y  e x p e r i e n c e promote a l a c k o f t r u s t i n one's f e l l o w b e i n g s , a sense of  everyone's being belonging  out f o r himself,  a sense o f f u t i l i t y ,  etc., Placing a disrupted  would merely serve  to r e i n f o r c e t h i s  In l i g h t o f the f o r e g o i n g , h e r o i n and i t s r e l a t e d s u b c u l t u r e  family  of not r e a l l y  i n a deteriorated  effect. the view has been expressed  give  that perception  that  the a d d i c t a sense o f w e l l - b e i n g and  of s o c i a l a c c e p t a b i l i t y and p a r t i c i p a t i o n . (52, p. 140) measure the a d d i c t ' s p e r c e p t i o n  neighbourhood  of himself  Thus, i n some  and h i s d e s i r e to modulate  a r e areas o f c o n c e r n d i r e c t l y  r e l a t e d to our r e s e a r c h  efforts.  TWO MAIN APPROACHES TO THE PROBLEM OF DRUG ADDICTION Law Enforcement: The and  major attempt to s o l v e  the problem i n the U n i t e d  Canada too, has been l e g i s l a t i o n a g a i n s t  of opium.  The e a r l i e s t e f f o r t s ,  to n a r c o t i c s . (56)  States,  the manufacture and s a l e  t h e r e f o r e , were toward b l o c k i n g  I n the 19th c e n t u r y ,  n a r c o t i c s were f r e e l y  access  imported  and  could  freely  be b o u g h t w i t h o u t p r e s c r i p t i o n .  and m e d i c a l  but  prescribed  t r e a t m e n t , u n a c c e p t a b l e by today's  produced a large p r o p o r t i o n made a t S t a t e  Physicians  and l o c a l  of addicts.  (52)  standards,  Sporadic  a t t e m p t s were  l e v e l s to c o n t r o l the d i s t r i b u t i o n of narcotics  i t was t h e e n a c t m e n t o f t h e H a r r i s o n  embarkation upon a t o t a l l y  new a p p r o a c h  a p p r o a c h c a n b e s t be d e s c r i b e d  A c t (66) which marked t h e to the n a r c o t i c s problem.  i n t o t h e p r o h i b i t i o n o f non-  m e d i c a l uses and t h e c o n t r o l o f m e d i c a l u s e s .  ( 1 4 , p . 9)  Any  a p p r e c i a t i o n o f t h e r e l a t i o n s h i p o f a d d i c t i o n t o c r i m e must a l s o i n t o account the l e g a l s t r u c t u r e which has forced  there  Since  sanction applied  narcotics  take  traffic  into  the adoption of the Harrison A c t  has been b u t one a p p r o a c h i n t h e U n i t e d  criminal (14,  ( 1 4 , p . 27)  That  as an e f f o r t w h i c h s e t o u t t o c o n t r o l t h e  n o n - m e d i c a l u s e o f n a r c o t i c s and e v o l v e d  the u n d e r w o r l d .  them  to a l l offenders  States,  against  namely, t h a t o f  the n a r c o t i c  laws.  p . 4 7 , 6) S o c i e t y h a s made a j u d g m e n t t h a t i n d u l g e n c e i n n a r c o t i c s i s  wrong and s u p p o r t s basis  t h i s judgment w i t h  f o r the judgment l i e s  laws.  i n the e t h i c a l  Perhaps t h e most and p h i l o s o p h i c a l  o f o u r r e l i g i o u s and m o r a l c u l t u r e which m i s t r u s t (14,  p. 13)  This  approach toward "drug one  a t t i t u d e found e x p r e s s i o n  the addict.  This  leads  nevertheless,  myths, i . e . t h a t largely  the addict  due t o i n c r e a s e d  sociological,  been very  of the  t h i r t y y e a r s ago b u t  slow i n dying.  ( 5 , p. 227)  Other  i s a " s e x menace" e t c . have a l s o b e e n e x p o s e d ,  knowledge r e g a r d i n g  m e d i c a l and p s y c h i a t r i c  severity of penalties  r u l e o f the senses.  us t o the s t e r e o t y p e  the addict  from  psychological,  sources.  Recent y e a r s have seen l e g i s l a t i o n the  foundations  i n t h e laws and subsequent  f i e n d " and "drug m a n i a c " - a myth exposed  which has,  significant  that has markedly  imposed on such o f f e n d e r s .  ( 6 0 , p. 3)  increased These  increased they are as he  p e n a l t i e s were aimed a t difficult  is fairly  brings  him  sellers.  t o t r a c e and  the  sellers  i t i s u l t i m a t e l y the  easy f o r the p o l i c e to d e t e c t  i n t o t h e o p e n and  i n t o the  As  noted:  Lindesmith  has  of n a r c o t i c s .  However,  a d d i c t who  suffers  b e c a u s e h i s need f o r d r u g s  company o f known a d d i c t s (40,  p.  and  231)  "Laws h a v e become i n c r e a s i n g l y c r u e l and i n f l e x i b l e and a r e now, to a c o n s i d e r a b l e extent, designed i n the i n t e r e s t s of p o l i c e e x p e d i e n c y r a t h e r than of justice. I n t h i s w h o l e p r o c e s s , t h e f o r g o t t e n man has b e e n the a d d i c t . " The and  supporters),  other  regard  by  the use  o f d r u g s as There has  p o l i c e a u t h o r i t i e s toward  the  (law enforcement  an o f f s h o o t  of  control. first  (64,  The. . u n d e r l y i n g  and  drug a d d i c t s  treatment apart a beginning  p.  201)  addicts.  He  philosophy  s e c o n d and  f o r law  within  realm of p o l i c e concern. In a recent  i s presented  that  the  e f f e c t of drug use, i n many, b u t  not  study  i n Lexington,  i s due  a l l cases,  voluntary  criminal record  t h a t 50  per  there  to a c c e p t a d d i c t i o n  (53;  9,  an  p.  62)  a direct  Other current  c e n t of a sample of  evidence  necessary research 176  t r e a t m e n t a t t h e N a r c o t i c A d d i c t i o n F o u n d a t i o n , had  before  t h e y became a d d i c t e d ,  but  50  per  as  activity  w h i c h becomes  to o b t a i n n a r c o t i c s .  i n V a n c o u v e r , Canada p o i n t s o u t seeking  life  and  criminals  seem t h a t a l t h o u g h  Kentucky  of  underlying  committal  i n crime a f t e r a d d i c t i o n i s not t o t h e way  as,  accorded s p e c i a l  a d d i c t i o n t o n a r c o t i c d r u g s as  increase  but  I t would  n o t be  enforcement o f f i c i a l s  they s t i l l  the  regard  should  defined  to h i s  i s that drug a d d i c t s are  therefore  a disease,  addict's  i s now  They recommend e n f o r c e d  from the n o n - a d d i c t . trend  the  officials  b e e n some c h a n g e i n - a t t i t u d e  a b n o r m a l i n d i v i d u a l whose a d d i c t i o n i s p r i m a r i l y due  mental i n s t a b i l i t y . "  is  the p u n i t i v e a p p r o a c h  c r i m i n a l tendencies.(58)  recently "an  advocates of  c e n t h a v e had  addicts no some  criminal  (55)  activity.  associated violence  I t h a s f u r t h e r b e e n shown t h a t c r i m e s a r e  with u t i l i t a r i a n  as i s commonly b e l i e v e d . One c o u l d  speculate  a g e n c i e s when c o n s i d e r i n g istics from  v i o l a t i o n and a r e s e l d o m c r i m e s o f s e x a n d  show t h a t  1,906  in  1965  as t o t h e e f f e c t i v e n e s s o f l a w e n f o r c e m e n t  the increase  in British to  ( 1 4 , p. 2 4 )  i n t h e number o f a d d i c t s .  C o l u m b i a t h e number o f k n o w n a d d i c t s i n  2,068  1966.  increased  A u t h o r i t i e s a t the N a r c o t i c  (16)y  A d d i c t i o n Foundation i n Vancouver b e l i e v e  Stat-  that  there  a r e many more who  a r e unknown. Insofar addict  as t r e a t m e n t i s c o n c e r n e d ,  i n the p r i s o n s e t t i n g .  been recognized  a d d i c t s was v i r t u a l l y Legal  and M e d i c a l It  ities  turkey"  The  i n this setting.  that, generally,  t h e l e g a l and m e d i c a l  t h a t e x i s t i n g l e g i s l a t i o n and l a w  argument i s p r e s e n t e d  (48)  author-  enforcement a r e un-  and t h a t d r u g a d d i c t i o n i s a c o n d i t i o n p r o p e r l y  that drug a d d i c t i o n i s a disease  sustain  Rehabilitation,  as the key problem i n the t r e a t m e n t o f  a r e a o f m e d i c a l c o n c e r n and j u r i s d i c t i o n . is  method.  mainly of  Views  c a n be s t a t e d  are agreed  satisfactory  ignored  has b e e n done f o r t h e  Treatment e f f o r t s c o n s i s t e d  a b r u p t w i t h d r a w a l known a s " t h e c o l d which has long  little  The b a s i c  w i t h i n the  premise  here  f o r which punishment i s i n a p p r o p r i a t e .  t h a t many a d d i c t s  become c r i m i n a l s i n o r d e r  to  t h e i r h a b i t a n d , i n f a c t , h a v e no a l t e r n a t i v e t o a c r i m i n a l  existence.  ( 1 4 , p. 2 4 )  Dr. H a l l i d a y , p a s t d i r e c t o r o f the N a r c o t i c  Addiction Foundation of B r i t i s h  Columbia has s t a t e d :  " I t i s more and more r e c o g n i z e d a n d a c c e p t e d t h a t the n a r c o t i c a d d i c t i s a s i c k p e r s o n , and t h a t h i s a d d i c t i o n i s a symptom o f some d i s t u r b a n c e o r c o n f l i c t w h i c h he c a n n o t r e s o l v e o r c o p e w i t h i n a n a d e q u a t e way." ( 2 5 , p. 8 5 ) Some a u t h o r i t i e s i n t h e f i e l d  believe  that  the kinds  o f people  who  are  addicts  narcotics life.  they f i n d  relief  p.  social  As  sciences  i n recent  treated  is d i f f i c u l t  as  t h a t most o f  formative  social  i s a part of  sympathy w i t h  may  a discrepancy the  of being  treated  t h e way  as  of  addicts  later.  the  aims of  (60)  between the themselves.  treatment of  the  which  i t would  objectives  C l e a r l y , the  addict  history  he appear  treatment i f that  of  i s under  appear  treat-  recognition  i s o f p a r a m o u n t i m p o r t a n c e when t h e p r o b l e m o f  or d i s c o n t i n u i n g of  and  treat-  I t would  From t h i s  a i m s and  the  a s i c k person  life  a r e s u l t of h i s a s s o c i a t i o n s .  that  ment p e r s o n n e l and  notion  .Addiction  them h a v e l i t t l e  be  psychological  experienced a long  a d d i c t who  to  depression.  has  the  in  to  to a d j u s t  For  f a l l e n i n t o as  such d i s p a r i t i e s  and  years  approaches to the  w i t h o u t drugs sooner or  tinuing  their  new  means l i f e there  for  y e a r s have d e v i s e d  a c r i m i n a l the  to accept.  chosen or  f o r drug use,  a consequence, w o r k e r s i n the m e d i c a l ,  ment o f d r u g a d d i c t i o n .  has  since  problems of economic, p s y c h o l o g i c a l  404)  of being  subjects  from t h e i r m u l t i p l e , problems i n a d j u s t i n g  These p e o p l e have t r i e d  formidable (15,  appear to have been f e r t i l e  the  of  con-  consideration.  TREATMENT METHODS United  States:  I t has divided  generally  may  be  and  mefttal r e h a b i l i t a t i o n , The  Lexington,  i n t o three  first  Kentucky  T e x a s i n 1938. a d d i c t s , do  phases: (3)  concerted i n 1935,  T h e s e two  research  been accepted  on  (1)  treatment of  the w i t h d r a w a l of d r u g s ,  f o l l o w up effort  t h a t the  t r e a t m e n t . ( 5 2 , p.  (2)  t o t r e a t , d r u g a d d i c t i o n was  followed  by  a d d i c t i o n , and  Physical  72) made i n  a federal hospital i n Fort  p s y c h i a t r i c h o s p i t a l s were intended  to  Worth,  treat  t o make a v a i l a b l e t o s t a t e and  agencies  the knowledge g a i n e d  from t h e i r  They had  some s u c c e s s and  problem of withdrawal  the  addiction  e x p e r i e n c e and  r e s e a r c h . (52,  local p.174)  from n a r c o t i c s , once  12.  r e g a r d e d as that  the  a m a j o r p r o b l e m , was  p r o b l e m was  not  Unfortunately research  to get not  solved.. the  lems t o b r i n g  this  has  t o pay  continued  I n the mented w i t h  b e e n done i n the  treatment of  the  s i t u a t i o n under c o n t r o l , w i t h a very  high  1950's the  s t a t e s o f New  ment o f c o m p u l s i o n .  the  Y o r k and  treatment of  could  be  required  r e s u l t that  the  compulsory a f t e r - c a r e f o r p a t i e n t s  h o u s e s on sition  I t has  also contributed  an e x p e r i m e n t a l  from the  basis  institution  her  out  of  the  sub-culture  done. ( 2 8 ) on  According  addicts  their  treatment.  getting  i n the  s u c h as  a s s o c i a t e s , were e s t a b l i s h e d  for voluntary  establishment  as  one  outpatient  the  i n her  t h e i r drugs l e g a l l y  i n order  way  two  to p l a n  of  federal  p.  the  tran-  177)  Nyswander  to  and  come  get;addicts  experiment,  will  of  concept  were a d d i c t s  only  t o N y s w a n d e r , much more r e s e a r c h  released  Metha-  h a v e t o be  done  intelligently  for  rehabilitation.  pioneered.in addicts  with  clinics  them d r u g s and,  Synanon, a u n i q u e e x p e r i m e n t i n the  by  o p e r a t e d by  Nyswander f e e l s t h a t  i s to g i v e  (52,  ele-  half-way  treated addict  community.  the  the of  an  success  s u p p o r t f o r the  to ease f o r the  to l i f e  Experimental c l i n i c s ,  to the  The  at  (47)  experi-  for parolees  civil  hospitals.  society  addict with  led recently  of prob-  i n this regard.  t h e s e programmes has c o m m i t m e n t and  off.  p a s t i n t h e way  to c o - o p e r a t e .  to i n c r e a s e d  start  to keep him  California  T h e s e p r o g r a m m e s w e r e s e t up who  from the  addict's manifold  price for i t s failure  programmes t h a t combined  from s t a t e p r i s o n s  recognized  a d d i c t o f f drugs but  e n o u g h has  i n t o a n u n d e r s t a n d i n g and  I t was  California themselves.  a strong  c o n c e r n and  who  i n 1 9 5 8 . ( 7 1 , 76) The  aim  f a t h e r - f i g u r e who  g r o u p l i v i n g method  This  centre  i s s t a f f e d and  i s to attempt to c r e a t e dispenses  was  an  extended  f i r m j u s t i c e combined w i t h  extols inner-directed convictions  about the v i r t u e s  run family warm of  13.  h o n e s t y , s o b r i e t y , l e a r n i n g and h a r d w o r k . wide a c c l a i m  a s a more p o s i t i v e a p p r o a c h  e n j o y e d some s u c c e s s .  was  a t t e m p t has  received  t o a d d i c t i o n t r e a t m e n t and h a s  I t i s i n t e r e s t i n g to note  o n t h e S y n a n o n programme ment o f t h e Supreme  This  that a project  i n s t i g a t e d i n 1964 b y t h e P r o b a t i o n  C o u r t o f New Y o r k .  patterned Depart-  (67)  Canada: Approaches  t o t r e a t m e n t i n Canada i n c l u d e  ( h o s p i t a l s , p r i s o n e t c . ) and N a r c o t i c T o r o n t o and V a n c o u v e r .  In British  M a t s q u i f o r the compulsory  Addiction Foundations located i n  Columbia the f e d e r a l i n s t i t u t i o n at  t r e a t m e n t o f d r u g a d d i c t s was o p e n e d i n 1966.  Treatment methods i n c l u d e group s e s s i o n s , ing  a n d a n i n t e n s i v e w o r k programme.  this  a p p r o a c h by. v a r i o u s  institutionalization  educational  and v o c a t i o n a l  train-  Much c r i t i c i s m h a s b e e n l e v e l l e d  a u t h o r i t i e s i n the f i e l d .  (9)  , A u s u b e l has  at  stated  that: " F e d e r a l drug a d d i c t i o n h o s p i t a l s a c q u i r e an unmistakable p r i s o n atmosphere which not only s u b t l y i n f l u e n c e s t h e a t t i t u d e s o f p h y s i c i a n s and a t t e n d a n t s toward t h e p a t i e n t s , b u t a l s o f o c u s e s undue a t t e n t i o n upon t h e s e c u r i t y and c u s t o d i a l a s p e c t s of treatment. L i t t l e hope f o r a t t i t u d i n a l i m p r o v e ment c a n be a n t i c i p a t e d when s o c i e t y a d o p t s a p u n i t i v e approach toward v i c t i m s o f a behaviour d i s o r d e r and t r e a t s them.as c r i m i n a l s . " ( 5 2 , p . 197) Some v o l u n t a r y essentially programme selves in  programmes  have emerged, s u c h as Teen C h a l l e n g e ,  a r e l i g i o u s approach to the problem.  i s , basically,  The H a l f - W a y House  a s e l f - h e l p method where a d d i c t s  w i t h o u t the a i d of p r o f e s s i o n a l s .  Canada i s t h e N a r c o t i c  (73)  which i s  t r y to help  One o f t h e t r e a t m e n t  Addiction Foundation of B r i t i s h  themcentres  Columbia i n  V a n c o u v e r , founded i n 1955. (48) I t w o u l d seem addicts  will  community.  continue According  that  that c r u c i a l  t o be how  problem i n the treatment of  to e f f e c t t h e i r  to O'Donnell  r e h a b i l i t a t i o n i n the  ( 5 2 , p. 1 9 7 ) , t h e p r o b l e m i s s i m i l a r  to  that which e x i s t s f o r the p r o s t i t u t e or c r i m i n a l .  a behavioral  p a t t e r n has been e s t a b l i s h e d  in.an. a n t i s o c i a l  subculture  s u p p o r t and f r e q u e n t l y  I t also resembles  alcoholics  and m e n t a l l y  i l l i n their  many c a s e s  the deviant  n e v e r was a p e r i o d  of reasonably  tially  person could not  the problems faced  b y some  r e j e c t i o n by t h e w i d e r s o c i e t y .  p a t t e r n , was e s t a b l i s h e d  t h e p e r s o n m i g h t be r e t u r n e d . returns  some s a t i s f a c t i o n s , g r o u p  the deviant  achieve l e g i t i m a t e l y .  instance  a n d t h e p e r s o n i s enmeshed  which supplies  an income l e v e l  I n each  so e a r l y . i n - l i f e  that  I t i s n o t k n o w n why a n a d d i c t Presumably  produced h i s a d d i c t i o n r e t a i n t h e i r  frequently  the f a c t o r s which  effect.  ini-  Other f a c t o r s  u c e d o r a c c e n t u a t e d b y t h e a d d i c t i o n may h a v e c o n d i t i o n e d  prod-  him to relapse.  • T h e r e h a s b e e n . a n i n c r e a s i n g a w a r e n e s s among t r e a t m e n t  personnel  i n t h e t r e a t m e n t may i n c l u d e more t h a n t h e  apparent motivation  of the p a t i e n t ,  of  the t h e r a p i s t .  What h a p p e n s i n t r e a t m e n t may, t o a s i g n i f i c a n t  be  a f u n c t i o n of the patient's  Individuals different  t h e d e g r e e o f t h e p a t h o l o g y and  from d i f f e r e n t c l a s s e s undergo d i f f e r e n t experiences,  frames o f r e f e r e n c e  t h e way o f l i f e  others.  ( 2 7 , p. 1 6 3 )  and g o a l s  helping  (26,  socio-economic  blocked  ( 3 0 ) and  an impediment t o treatment.  p. 186) One u s e f u l way o f s h e d d i n g l i g h t o n t h i s  u n d e r s t o o d a r e a i s to examine the a d d i c t the  The c o n v e r s e o f  o f persons from lower  judgmental a t t i t u d e s which create  kinds  p e r s o n who f a i l s t o  g r o u p s s o t h a t c o m m u n i c a t i o n b e t w e e n them i s f r e q u e n t l y who m a n i f e s t s  degree,  have  f o r human r e l a t i o n s h i p s o r d i f f e r i n g  t h i s problem e x i s t s f o r the m i d d l e - c l a s s  understand  skill  s o c i a l c l a s s p o s i t i o n i n t h e community.  or o r i e n t a t i o n s f o r a c t i n g w i t h of  there  s a t i s f a c t o r y a d u l t adjustment to which  to drug use a f t e r a 'cure'.  that success or f a i l u r e  In  i m p o r t a n t and  i n treatment;  little  to t r y to d i s c e r n  f a c t o r s w h i c h l e a d p e o p l e i n t o d r u g a d d i c t i o n a n d , more  specifically,  15.  the  f a c t o r s w h i c h k e e p some a d d i c t s  which impel is  to g i v e  ment as given  others  consideration  c o n c e i v e d and  to t h i s  THE  The  Annual Report states  research  t h i s p u r p o s e , had  the  p.  t h a t i t was  A d d i c t i o n Foundation should and  education,  for help,  39)  The  Paulus study (1)  aim  be  treatis  The  of medication,  with  of  the  Narcotic  the  intention  project  t r e a t m e n t and f r o m whom t h e  i n view of  primrehab-  professional  Foundation, although  role  and  B R I T I S H COLUMBIA  a pilot  from the m e d i c a l p r o f e s s i o n  designed  increasing  for advice  from the p u b l i c  for  A d d i c t i o n F o u n d a t i o n as  and  appeals assist-  information. outlined  by  i s to:  Detoxify  the  w i t h o u t the (2)  to a f f e c t  initially  to those a d d i c t s  to abandon t h i s  ance i n the d i s p e n s i n g (48,  study  t h e N.A.F., s p e c i a l c o n s i d e r a t i o n  obtain meaningful data.  from a d d i c t s  purpose of our  to f a c t o r s which would appear  i l i t a t i o n programmes r e s t r i c t e d  for  the  those  setting.  concerned with  s t a f f could  I n a s m u c h as  NARCOTIC ADDICTION FOUNDATION OF  the N a r c o t i c  arily  i t .  p r a c t i c e d by  agency  E X P E R I E N C E OF  that  to leave  i n a t r e a t m e n t s i t u a t i o n and  E n a b l e him  a d d i c t and a i d of  teach  him  to f u n c t i o n  properly  drugs.  to secure or m a i n t a i n  work i n an  desist in his criminal  activities.  appropriate  occupation. (3)  Have h i m  (4)  Change h i s a s s o c i a t i o n s  (5)  Teach him  to a c t r e s p o n s i b l y  t a t i o n or p r o c r e a t i o n - o r (55, "The a self-induced  p.  i n his  to  non-users.  family of  orien-  b o t h , where a p p l i c a b l e .  14)  philosophy and  from drug users  of  the F o u n d a t i o n i s t h a t a change can  self-perpetuated  d e s t r u c t i v e p r o c e s s once the  occur  in  patient  knows t h e u n d e r l y i n g c a u s e s a symptom". ( 4 9 , p. iatrists,  8)  The  of the d i s e a s e f o r which clinic  team, c o m b i n i n g  p h y s i c i a n s , s o c i a l workers  t r e a t these causes.  The  and  the use  the s k i l l s  psychiatric  aims o f t r e a t m e n t a r e  nurses,  since  1963:  (1)  t h e t r e a t m e n t programme h a s  R e g u l a r w i t h d r a w a l and  e s p e c i a l l y , f o r the o l d e r a d d i c t . voluntary note  and  offers  ambulatory  i s t h a t i n 1960  Methadone i n . i t s  (2)  (73) and  The own  environment,  dition,  and  tenance.  in-patient  this,  regard.  i n North America.  r e c o g n i z e d the need  to d i s c o v e r something  literature  Outside  of empirical  two  withdrawal,  treatment.  Worthy  r e s e a r c h on  1963  was  study  of  narcotic  a l o n g w i t h the  to study  initiation  a. ' f i r s t '  o f the e p i d e m i o l o g y lead  (55)  little  of h i s  t o a d d i c t i o n and  has  con-  i t s main-  studies i n this  b e e n done i n the  the a d d i c t p o p u l a t i o n of Vancouver which  zation  total.  f o r Youth  ( 4 8 , p.  (61)  and  5)  D e s c r i p t i v e r e p o r t s such as  empirical  s t u d i e s such  d e a l w i t h a d d i c t i o n among N e g r o e s and l a r g e American s t u d y as  cities.  The  t h o s e by  P u e r t o R i c a n s i n New  v a l u e o f t h i s r e s e a r c h has  i t i s q u e s t i o n a b l e whether these  Vancouver scene  as  native born,  49 p e r c e n t f r o m o t h e r p r o v i n c e s and  countries.  Many had  of  Mobili-  Chein  York  limits  other  f o r our  o f 45 p e r  6 per c e n t from  w i t h , or were a d d i c t e d to a  (9)  and  f i n d i n g s are a p p l i c a b l e  where the a d d i c t p o p u l a t i o n i s comprised  experimented  the  area  contains  the l a r g e s t p r o p o r t i o n o f a d d i c t s i n Canada namely, 53.34 p e r c e n t the n a t i o n a l  in  the a d d i c t i n h i s  r e v e a l s a p a u c i t y of r e l i a b l e  the Paulus  groups  (49)  the sequence o f events which The  m i g h t have  t h e N.A.F. commenced u s i n g t h e s y n t h e t i c  N.A.F. h a s  to  Treatment a t the F o u n d a t i o n i s  t r e a t m e n t programme and  field  psych-  tries  fallen into  Prolonged  o f a p r o l o n g e d w i t h d r a w a l programme i n F e b r u a r y , the treatment  of  is  t h e same f o r a l l a d d i c t s .  H o w e v e r , f o r some o l d e r a d d i c t s f u n c t i o n i n g w i t h o u t d r u g s become i m p o s s i b l e and  of drugs  to  the  cent other  narcotic  drug b e f o r e moving to t h i s a r e a . i s one  of the c e n t r e s which  ( 4 8 , p.  attracts  6)  This suggests  ' f r i n g e ' members o f s o c i e t y  t h e r e i s an e s t a b l i s h e d ' s u b - c u l t u r e ' w h i c h to  flourish.  ( 4 8 , p.  The  in  principles  and  a i m s o f t h e N.A.F. a r e i n the  According  to the Paulus  t a t i o n a r e n o t a f f e c t e d by receives.  ( 5 5 , p.  treatment  approaches such  settings.  72)  Both use  of  This finding  the  in institutions  intention.  submit  and  As  succeed  t h e y c a n be  proud.  f r i n g e members  i n line with current  of drug  addiction.  The  success w i t h a d d i c t s c o n t i n u i n g  study  overall  rates i n rehabili-  the k i n d s o f w i t h d r a w a l m e d i c a t i o n a p a t i e n t  as  i s supported  by  r e s u l t s of  t h o s e u s e d i n S y n a n o n and  'cold  other  in institutional  t u r k e y ' m e t h o d o f w i t h d r a w a l but. S y n a n o n  claims a h i g h e r degree of success. drawal  field  i s however e x p e r i e n c i n g l i m i t e d  treatment.  allows these  because  22)  thinking of leading a u t h o r i t i e s Foundation  t h a t Vancouver  i s compulsory,  One  d i f f e r e n c e i s t h a t where w i t h -  Synanon uses  t h i s method f o r p r o o f  H o l z i n g e r ( 3 2 ) p o i n t s o u t a d d i c t s who  are w i l l i n g  i n t h i s m e t h o d make a p s y c h o l o g i c a l i n v e s t m e n t One  the method o f w i t h d r a w a l  c o u l d s p e c u l a t e as  of  to whether f a c t o r s o t h e r  i n f l u e n c e the outcome o f  to which than  treatment.  SUMMARY A n a t t e m p t has drug  addiction reflected  the a d d i c t . and in  T h i s was  b e e n made t o show how i n the  laws  compounded by  attitudes  toward  c e p t i o n of s e l f criminal  argot  the p u n i t i v e  s p e c i f i c meaning which  The he  as a c r i m i n a l becomes i n t e r n a l i z e d and  treatment  institutional  of  approaches  addict's incarceration  finds reflected  h i m b y members o f t h e n o n - a d d i c t  to h i s a c t i v i t i e s  toward  l e d to the u l t i m a t e d e g r a d a t i o n  a t t i t u d e s o f law enforcement o f f i c i a l s . i n s t i t u t i o n s had  society's attitude  society.  i n the This  as he b e g i n s experiences.  to  conapply  (59)  It  i s only  i n recent years  that the notion  somehow p s y c h o l o g i c a l l y i n a d e q u a t e h a s g a i n e d new k n o w l e d g e o f t h e s o c i a l appear  to i n d i c a t e that  deprived.  I t was f o u n d  was c o m p r i s e d istic before  regarding study  agency.  \  This, along  environment o f the a d d i c t ,  with would  they a r e s o c i a l l y , a s w e l l as p s y c h o l o g i c a l l y that the l i t e r a t u r e which supports  More e m p i r i c a l r e s e a r c h  c o u l d be a n i n i t i a l  as w e l l as  i n t h i s area  t h i s e v i d e n c e as c o n c l u s i v e . effort  f a c t o r s w h i c h may a f f e c t t h e c o n t i n u i n g treatment  support.  largely of theoretical discussions  analyses.  exploratory  and c u l t u r a l  that the addict i s  these views impression-  seems w a r r a n t e d  Perhaps our p r o j e c t e d t o w a r d d e f i n i n g some o f t h e  contact  o f the a d d i c t with h i s  19.  CHAPTER I I  PROBLEM I D E N T I F I C A T I O N AND  The  impressions  perplexing.  no  conclusive  of c o n t r i b u t o r y  i t .  As  with  symptoms b e c a u s e o f  factors.  source of  the  any  their  dealt v.with :  1  :  that as  social  i l l n e s s we  immediacy b e f o r e  the  the w i d e l y  addict  i s used a d v i s e d l y  as  a s i c k p e r s o n and  a d d i c t i o n as  residing within society Despite  the  population:  not  likely  the  area of  approximately  l e g i s l a t i o n and  a social  can,  with  attitudes  exception.  The  The  expression recently  of viewing the  casual  the  what  comparatively  illness,  the  diffi-  concepts of  dealt with.  until  deal-  treating  to determine  rising  .0007, ( 4 8 )  only  and  incidence a small  the  addict  factors  t o a c c o m m o d a t e them o t h e r the  c o n t r o l of drugs.  hopefully,  in  s o c i e t y more r e w a r d i n g  to  the  faced be  to h i m s e l f  with  helped and  the  f r a c t i o n of reform i s  than, perhaps,  in  f a c t remains  that  The  0  are  in  massive s o c i a l  laws, themselves a r e f l e c t i o n of  i n e f f e c t , we  a manner t h a t he  are  itself.  to ensue i n order  a t t i t u d e s , are  faced  possibility  i n Canada, they r e p r e s e n t  u n t i l more e n l i g h t e n e d  are  be  i n d i c a t i o n s of a s l i g h t l y  numbers o f a d d i c t s  are  c o n f l i c t i n g modes o f  differing  should  the  in social  attempting  i t i s only  a t t i t u d e s have p e r m i t t e d  literature  s p e c u l a t i v e and  differences  D r u g a d d i c t i o n i s no  how  the  than that i n d i c a t i n g a m u l t i -  c o r o l l a r y i n the  c u l t i e s h a v e b e e n compounded by  1  The  social  infection.  d r u g a d d i c t i o n i s and  are mainly  evidence other  toward the p r o b l e m have t h e i r ing with  a f t e r reviewing  Theories of c a u s a t i o n  s u p p o r t e d by plicity  retained  FORMULATION  t r e a t i n g the  the  public's  addict  to occupy a s t a t u s  i n such  and  consequently of greater  function benefit  community. It  i s to  the  terms of  t r e a t m e n t t h a t we  narrow the purpose  of  20.  this  study  i n t h e h o p e t h a t an  possible causal may  be  exploratory  f a c t o r s which a f f e c t the  c o n s i d e r a t i o n o f some o f  addict's  the  Problem  Embodied i n our  i n t r o d u c t o r y remarks i s the  the problem under c o n s i d e r a t i o n i s the h i g h from treatment. personnel  at  illuminated  The  i n their  10th  Annual Report  treatment  report  i n t e r e s t i n g comparison appropos continuance i n  treat-  stages  (1965).  when m e d i c a t i o n by  (48)  Columbia i s  In this  the d i s t r e s s o c c a s i o n e d  i s being  the w i t h d r a w a l  prescribed  syndrome.  s t a g e t h e d r o p p i n g f r o m t r e a t m e n t a v e r a g e s 32.25 p e r  p a t i e n t s and (48,  the  pp.  46.75 p e r  43-44)  treatment,  that  drop-outs  the N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h  a r i s e s an  alleviate  statement  percentage of  d e g r e e o f c o n c e r n e x p r e s s e d by  ment i n the p r e l i m i n a r y  this  involvement  determined.  Statement of  there  treatment  the  cent of  There are  those i n r e s i d e n t i a l  i n d i c a t i o n s here that  i.e. residential  or o u t p a t i e n t ,  and  Even  cent of  at  the  out-  treatment.  the  not  to  'conditions'  t r e a t m e n t per  of  se  may  h a v e some s i g n i f i c a n c e . This both during has  expressed concern regarding  and  a f t e r the m e d i c a t i o n a l  been a c o n t r i b u t o r y  f a c t o r i n the  the p r o b l e m under s t u d y . infers  phase of  the  Recent research  by  realized  The  goals  of  the  therapeutic  i f t h e p a t i e n t makes h i m s e l f  o f a d d i c t i o n may c o n t r o l s are  lend  required  what i s n e c e s s a r y  itself to help  i s broad  t o m e n t a l and  to the the  (55,  and,  likely  i n fact,  that strong  r e v i s i o n comparable to  public health disorders.  (48,  p.6)  p.  11)  to the  be nature  external  a d d i c t r e m a i n i n t r e a t m e n t and  legislative  of  t h e programme i s  team a r e h a r d l y  suggestion  contact  formulation  Ingeborg Paulus  unavailable  of  t r e a t m e n t programme  i d e n t i f i c a t i o n and  t h a t a l l p a t i e n t s drop from treatment b e f o r e  completed.  related  the d i s c o n t i n u a n c e  that  that  Our s i t u a t i o n as selves for  immediate c o n c e r n however, i s a c o n s i d e r a t i o n i t presently  to the p r o b l e m of  treatment but  for  as  long  as  therapeutic span f o r the  the  of  the  addict  that  the  the  goals  agency o r , peutic the  of  that  The  this  and  p a t i e n t who only  presents  i n the  study w i l l  be  discussed  the  the  under  meditherapy  assessment of  the  consideration agency  the  of  the  treatment  the  opera-  possible disparity  through i t s instrument of be  a relatively  simple  agency under r e v i e w i t i s f e a s i b l e p a t i e n t are  not  consonant with  though they i n i t i a l l y  matter  to  the  have w i t h i n i t elements w h i c h d i s t o r t or  the b r e a c h of c o n t r a c t  by  the  addict which  is giving rise  to  propose  those of  which  in  service,  h a v e much i n common, t h e  o r i g i n a l p u r p o s e s o f b o t h c o n t r a c t i n g p a r t i e s and  present  himself  stages of psycho-social the  our-  initial,  p r e c i s e boundaries of  W h i l e i t may  the  e n c o u n t e r any  i n t e n t i o n i s to apply  n e c e s s a r y on  11)  to the  team.  aims o f  later  the  terms.  leads  therapeutic  define  p.  purpose of  This goals  the  i s considered  t i o n a l d e f i n i t i o n of  the  to pursue i t , not  also at  team. ( 4 8 ,  and  the v o l u n t a r y  fails  c a t i o n a l phase but  exists  of  theranegate  lead  to  to  our  concern.  Assumptions A p r o p o s i t i o n which presents that  the  patient's  confused with is him  by  treatment involvement  or considered  d e t e r m i n e d by  t o be  his motivation,  b o t h h i s e n v i r o n m e n t and Casework theory and  are  supplied  and  and  capacity  bears examination i s  (longitudinally,  synonomous w i t h  and  a c t u a l use  not  to  be  of  service)  opportunities  afforded  and  the  the  c l i e n t with  agency.  postulates  adequate m o t i v a t i o n appropriate  itself  that  adequate c a p a c i t y i n an  t o whom t h e  appropriate  services  a d e q u a t e manner makes u s e  of  offered case-  and  •22. work h e l p p r o v i d e d f o r c e s o u t s i d e o f agency or c l i e n t are not restrictive continuum  and  unmodifiable.  i t i s suggested  p r i a t e l y m o t i v a t e d , who  At  the o t h e r extreme a l o n g  t h a t t h e c l i e n t who  use  As  continuance  It  to which  seems v a l i d  s t u d y , he  i n treatment  o f t r e a t m e n t our e f f o r t s w i l l  f a c t o r s or elements  be  t h a t , as  reason  t o assume t h a t i t i s h i s i n i t i a l  t r e a t m e n t made a v a i l a b l e .  Similarly,  t h e s e same a d d i c t s f o r m u l a t e s p o l i c y  the-addict s 1  i t c a n be  those ends. one  I f such e f f o r t s  and  on b o t h  antecedent  the f a c t o r s which  of  treatment,  a p p e a r t o be  s t e p s c o u l d be  initial  voluntary basis there to pursue  the  assumed t h a t the  t o meet the needs o f  treatment designed  sides f a i l  to  t o come t o  attain  fruition  the a d d i c t ' s continuance  some  s i g n i f i c a n t o b s t a c l e s to the  taken to modify  them i n o r d e r  to  pursuance facilitate  i n treatment.  Hypotheses It themselves A.  appears  at this  t h e r e f o r e , t h a t three major hypotheses  present  stage:  There are f a c t o r s d i s c e r n i b l e  i n the a d d i c t a t the  presents h i m s e l f f o r treatment which  affect his  time  he  treatment  involvement. B.  There are f a c t o r s treatment  i n the agency which  involvement.  the  those  c o u l d f u r t h e r assume t h a t i f t h e a g e n c y i s a b l e t o i d e n t i f y  of  to  subject.  intention  i n s t i t u t i o n o f a s e r v i c e or an agency.designed  treatment  to s p e c i f y  the a d d i c t appears  to propose  the  i s a necessary  to attempt  are  of casework h e l p .  severs  c o n t a c t w i t h the agency i s n o r m a l l y on an e n t i r e l y is  inappro-  l a c k s c a p a c i t y , a n d t o whom t h e s e r v i c e s  o t h e r words, i n the terms o f our  contract.  the  i s p o o r l y and  i n a p p r o p r i a t e o r p o o r l y s u p p l i e d d o e s n o t make u s e In  too  affect  the a d d i c t ' s  C.  There a r e f a c t o r s addict's In  if  treatment  which  a f f e c t the  involvement.  p u r s u i t of this reasoning i ti s l o g i c a l  hypotheses  A, B & C a r e s u p p o r t e d  f a c t o r s which treatment  i n the treatment  to hypothesize  that  a n d any o r a l l o f t h e d e t r i m e n t a l  are subject to m o d i f i c a t i o n are modified, the addict's  involvement  w o u l d be e n h a n c e d .  At this  stage of the study,  h o w e v e r , i t i s c o n s i d e r e d i m p e r a t i v e t o c o n f i n e o u r s e l v e s t o a n exami n a t i o n o f those  factors referred  to i n hypotheses  A, B & C.  Dependent and I n d e p e n d e n t V a r i a b l e s Since the purpose o f t h i s itself  to the q u e s t i o n o f the a d d i c t ' s continuance  treatment, be v i e w e d  hereafter referred as the dependent  t o as ' t r e a t m e n t  of infinite variety  or discontinuance i n  involvement',  influencing  variables  delineating  them.  will  the addict's contact could  and e n d l e s s p e r m u t a t i o n ,  b u t those which a r e  s e p a r a b l e and m e a s u r a b l e and o f seeming s i g n i f i c a n c e w i l l independent  this  variable.  Those f a c t o r s p o s s i b l y be  e x p l o r a t o r y research i s t o address  and o u r e f f o r t s w i l l  be t o w a r d  be t e r m e d t h e  r e c o g n i z i n g and  We h a v e a l r e a d y made r e f e r e n c e t o t h e c u l t u r a l d i f f e r e n c e s a t t e n d a n t upon n a r c o t i c of  a d d i c t i o n i n t h e U.S.A. a n d C a n a d a .  t h e s t u d i e s we h a v e d i s c u s s e d h a v e b e e n p u r s u e d  they have l i t t l e  S i n c e many  i n the United  States  d i r e c t reference to the Canadian n a r c o t i c a d d i c t ' s  s u b c u l t u r a l environment.  Undeniably,  existence fraught with misery  and h a z a r d  the Canadian a d d i c t pursues b u t he i s f r e e r  an  from the  a d d i t i o n a l p r e s s u r e s o f e t h n i c a n d t h e more e x t r e m e a n d c o m p l e x e c o n o m i c deprivations that  than h i s American counterpart.  the area of concern o f t h i s p a r t i c u l a r  geographic  I t c a n be r e i t e r a t e d study  then,  i s confined to the  l o c a l e o f Greater Vancouver - the r e s i d e n t i a l m i l i e u o f the  m a j o r i t y of Canadian  addicts  - and  i t c a n be  speculated that  main consumers o f the p o s s i b l e outcome o f t h e s e p a r t i c u l a r e f f o r t s . w o u l d be  the a d d i c t p r e s e n t s h i m s e l f f o r t r e a t m e n t which treatment involvement a s s o c i a t i o n of such  to the problem  a d d i c t i o n f r o m m e d i c a l and  itself,  appear  d e v e l o p m e n t and  of B r i t i s h  the  materially narcotic  to the b r o a d e r  i t s interpretation.  aims  This, i n  f o r the p u r s u i t of those  have d i r e c t o r i n d i r e c t b e a r i n g on.the  t h e i r p l a n n i n g and  when  to a f f e c t h i s  of the treatment of  p s y c h o - s o c i a l therapy  is sufficient justification  w h i c h may  are d i s c e r n i b l e  f a c t o r s w i t h treatment involvement would  and  Columbia.  i t i s c o n c e i v a b l e t h a t the d e m o n s t r a t i o n of  the whole approach  of agency p o l i c y  research  the N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h  I n summary, i f t h e r e a r e f a c t o r s w h i c h  affect  the  factors  t r e a t m e n t aims  i m p l e m e n t a t i o n a t the N a r c o t i c A d d i c t i o n  and  Foundation  Columbia.  OPERATIONAL D E F I N I T I O N S As varied  i n the r e v i e w of the l i t e r a t u r e  stated definitions  addiction, terms  noted  o f the terms u s e d  treatment, e t c .  as s t a t e d  For  i n the hypotheses  t h e r e a r e many  i n discussing  the purposes  of t h i s  are defined.as  and  addicts,  study the  key  follows:  Addict A p e r s o n , who,  not r e q u i r i n g  for  o f t h e symptoms o f a n o r g a n i c d i s e a s e , h a s  the r e l i e f  the c o n t i n u e d use  of a  drug  acquired  as a r e s u l t o f r e p e a t e d a d m i n i s t r a t i o n s , a n  powering  desire  of  the drug  mental  f o r i t s c o n t i n u a n c e , and  leads to d e f i n i t e  d i s t r e s s or d i s o r d e r .  i n whom w i t h d r a w a l  symptoms o f p h y s i c a l ( 6 6 , p.  2)  over-  and  Addiction No  truly  c o m p r e h e n s i v e d e f i n i t i o n o f a d d i c t i o n has  been formulated. full  The  d e f i n i t i o n put  i z a t i o n and addict  The  p h y s i c a l and  described  "will  by  f o r w a r d by  Stevenson Report questions  f o r w a r d by  specifically  the  obtain  (22,  the Organ-  that p o r t i o n which states i t by  a reformulation  Organization.  the W o r l d H e a l t h  any  psychological  Goodman and  properties  of  the  G i l m a n and  supply,  the  and  are  best  definitions  the World  put  Health  69)  consumption of a drug,  a high  tendency  It's  characteristics  need  to continue  the  d o s e , and  taking  a psychic  and  qualitative  sense to  pervades  the  the  an  after  e f f e c t of an  withdrawal.  and  the  to  sometimes  extreme along  activity  of  the  a  drug. the  continuum than  the degree to w h i c h the d r u g  life  or  increase  refers i n a quantitative rather  total  of i t s  overpowering d e s i r e  (psychological) the  involve-  securing  drug, a tendency  i f t h u s v i e w e d as  o f d r u g use  the  to r e l a p s e  include  p h y s i c a l d e p e n d e n c e on Addiction  that  means".  Drug a d d i c t i o n i s a s t a t e o f p e r i o d i c or c h r o n i c ment w i t h  yet  use  user.  Treatment Throughout the  literature  much c o n f l i c t r e g a r d i n g treating  the  T h o s e who only by  t o be  the  i t i s apparent  the  l e g a l methods f e e l  f r e e of drugs w h i l e  courts.  Others  there  the most e f f e c t i v e methods  a d d i c t , d e p e n d i n g on how  favor  that  feel  serving  the  the  addict  the  addict  a sentence  a d d i c t can  be  is of  i s seen. needs imposed  treated  only  i n an i n s t i t u t i o n a l  staff  administering  i n g and/or of  s e t t i n g but u t i l i z i n g  psycho-therapy  vocational retraining.  There  t r e a t m e n t s u c h as M a r i e N y s w a n d e r , who  c a t i o n s u c h as m e t h a d o n e m u s t be c a n b e s t be The  treated  included  on an o u t p a t i e n t  philosophy underlying  f o r s e r v i c e a t the N a r c o t i c  British  Columbia  to a l l e v i a t e  drawal  symptom." In  this  Narcotic  a r e some  advocates  feel and  that that  the  who  f o r which with  the  physical  patient with-  to t r e a t  the t a k i n g of drugs  i s but  a  (56)  study  t h e d e f i n i t i o n o f t r e a t m e n t as e m p l o y e d by  A d d i c t i o n Foundation of B r i t i s h  Columbia  will  be  The F o u n d a t i o n e m p l o y s t h e f o l l o w i n g t r e a t m e n t p r o c e d u r e s an o u t p a t i e n t  basis:  1.  S o c i a l work  2.  Medical examination  3.  P s y c h i a t r i c assessment  4.  Community, p h y s i c i a n s  5.  Social  I n a broad  sense  u n d e r two m a i n i.  of  self-induced  t h e t r e a t m e n t team s e e k s  f o r which  addict  Addiction Foundation  the p a i n s a s s o c i a t e d  causes  medi-  basis.  destructive^process  from drugs, w h i l e  the u n d e r l y i n g  counsell-  i s t h a t "change can occur i n a  self-perpetuated  seeks  casework  the treatment of the a d d i c t  applies  and  and/or  professional  The by  counselling  and and  counselling other resources  casework the treatment approach  c a n be  classified  headings: a l l e v i a t i o n of p h y s i c a l d i s t r e s s occasioned  the o n s e t o f the w i t h d r a w a l  syndrome.  the used. on  2.  R e h a b i l i t a t i v e measures i m p l i c i t psycho-social  Treatment  therapy  i n the  offered.  Involvement  This w i l l  be d e f i n e d a s h a v i n g h a d , o n a n o u t p a t i e n t  more t h a n 10 s o c i a l whether  casework  and/or p s y c h i a t r i c  interviews,  o r n o t t h e w i t h d r a w a l p e r i o d was c o m p l e t e d .  the d e f i n i t i o n used  basis,  This i s  i n t h e P a u l u s s t u d y and i s u t i l i z e d  to ensure c o r r e l a t i o n w i t h  the agency's  drop-out  here  statistics.  Agency The a g e n c y  referred  to i n t h i s  Foundation of B r i t i s h British  Columbia.  Columbia,  study i s the N a r c o t i c  Addiction  2524 C y p r e s s S t . , V a n c o u v e r  9,  CHAPTER I I I  RESEARCH DESIGN  The  t a s k o f d e t e r m i n i n g some o f t h e v a r i a b l e s w h i c h  to  be o f s i g n i f i c a n c e  in  two p h a s e s .  delineating of  to the-addict's  I n the f i r s t  phase  those-factors which  a retrospective  study.  further  specified used  period  as t o o l s  of time.  those v a r i a b l e s  which  s t u d y -as s i g n i f i c a n t a n d m e a s u r a b l e  i n a longitudinal  a p p l i c a t i o n of the v a r i a b l e s  be c o n c e n t r a t e d upon  t h e m s e l v e s t o e x a m i n a t i o n by means  I n the second phase  emerge f r o m t h e r e t r o s p e c t i v e be u s e d  treatment involvement i s v i s u a l i z e d  attention will  lend  appear  study.  will  T h i s would n e c e s s i t a t e the  t o c u r r e n t and p r o j e c t e d  treatment over a  V a r i a b l e s o f proven v a l i d i t y  could  t h e n be  f o r prognostication.  F I R S T PHASE - THE RETROSPECTIVE STUDY  We h a v e a l r e a d y d e t e r m i n e d will  be t h e N a r c o t i c A d d i c t i o n . F o u n d a t i o n o f B r i t i s h  data available  f o r c o l l e c t i o n and a n a l y s i s  addict's propensity transient nature. 1959  that the l o c a l e of our research Columbia.  are limited  t o p u r s u e -an e x i s t e n c e w h i c h  because  to assemble  a sample  of the  i s o f a n e r r a t i c and  R e c o r d s a t t h e F o u n d a t i o n go n o . f u r t h e r b a c k  and- t h e o p p o r t u n i t i e s  The  f o r study which  than i s large  e n o u g h t o b e c o n s i d e r e d r e p r e s e n t a t i v e - a r e - c i r c u m s c r i b e d by t h e s e Fortunately,  the Paulus Study,  though pursued  f o r reasons  from o u r s , provides- us n o t o n l y w i t h a s t u d y sample tions, the  (105 a d d i c t s ,  majority  50 m a l e s  facts.  different  of reasonable propor-  a n d 55 f e m a l e s ) , f r o m w h i c h we c a n s e l e c t  o f o u r s u b j e c t s , b u t a l s o w i t h a c o l l e c t i o n o f d a t a some o f  which a r e o f immediate "this stage that  relationship  to our factors.  I t s h o u l d be e x p l a i n e d  t h e P a u l u s S t u d y was d e s i g n e d t o e x a m i n e t h e d i f f e r e n c e i n  29.  c h a n g e b e t w e e n two g r o u p s o f a d d i c t s , dosage o f m e d i c a t i o n , concern  i s directed  one g r o u p o n t h e r e g u l a r w i t h d r a w a l  the o t h e r on p r o l o n g e d  solely  toward  those  only  It at  this  the i n f o r m a t i o n which  Study  will  be s e p a r a t e d , e x -  i s p e r t i n e n t to the r e g u l a r group.  h a s t o be c o n s t a n t l y b o r n e i n m i n d stage i s a composite  Our  a d d i c t s on r e g u l a r dosage o f medi-  c a t i o n and t h e d a t a a s s e m b l e d by t h e P a u l u s tracting  o r maintenance dosage.  t h a t w h a t we a r e d e t e r m i n i n g  d i a g n o s i s or assessment o f the a d d i c t a t the  t i m e he p r e s e n t s h i m s e l f f o r t r e a t m e n t .  The i m m e d i a t e -aim i s t o s e p a r a t e  certain  t h i s p o i n t and t e s t  f a c t o r s which  determine  i f they  Factors  as  i n f l u e n c e h i s treatment  them t o  involvement.  - The R a t i o n a l e  The general,  are discernible-at  following  the Paulus  f a c t o r s were d e v e l o p e d  Study  i n particular  from  the l i t e r a t u r e i n  a n d f r o m N.A.F. r e c o r d s a s w e l l  t h e p e r s o n a l e x p e r i e n c e s o f members o f t h e r e s e a r c h team who  been i n v o l v e d i n the treatment  No. .1.  addicts.  Drug Use P a t t e r n By  drugs.  of narcotic  have  drug use p a t t e r n i s meant.the c h a r a c t e r i s t i c s  The t y p e s o r f o r m s o f d r u g s  (alcohol, barbiturates,  o f the use o f o p i a t e s ) , the  v a r y i n g p e r i o d s o f a d d i c t i o n -and t h e c o r r e s p o n d i n g p e r i o d s o f b e i n g the a c t i v i t i e s All  will  engaged i n t o s u p p o r t  be u s e d  f o r abstinence.  to d e f i n e a p a t t e r n of drug use,-a continuum along which the  a d d i c t ' s p o s i t i o n may b e - r e l a t e d  No. 2.  t h e h a b i t and r e a s o n s  iclean';  to treatment  involvement.  Work P a t t e r n  In he. a t t e m p t s reasonable  view o f the f o r m i d a b l e - d i f f i c u l t i e s which t o resume h i s p o s i t i o n - a s . a w o r k i n g  f a c e t h e a d d i c t when  member o f t h e c o m m u n i t y i t i s  t o assume t h a t h i s p r e v i o u s w o r k e x p e r i e n c e s  directly influence  -30.  his e f f o r t s at r e h a b i l i t a t i o n . training  and - a b i l i t i e s  to the  The  appropriateness  jobs  of h i s  a v a i l a b l e , ,and  the  education,  lengths  or unemployment a r e - i m p o r t a n t elements o f  the  m e a s u r e m e n t o f h i s s u c c e s s :and  p r i o r to t r e a t m e n t  p r o v i d e - an  i n d i c a t i o n of h i s chances of  taking of  No.  3.  difficulty  seeking  abstinence-and  Delinquency  the c r i m i n a l a c t i v i t i e s  of  conclusions the  v i c t i o n s p r i o r to t h e i r c o n t a c t 57,per c e n t of Paulus'  drawn from s t u d i e s  that, " p r a c t i c a l l y - a l l  with  n a r c o t i c drugs".  r e g u l a r group are  i n t h i s area coupled with  are  a v a i l a b l e f o r i n s p e c t i o n adds c o n f u s i o n t h a t i f the. a d d i c t was  chances of p o s i t i v e change are are  important considerations  " b e c a u s e , as we  have-already  n e c e s s a r y . a n t e c e d e n t to use  addicted better  intimated,  the  to  addicts  had  (55,p.53)  to the  issue.  cononly The records  I t i s further  criminal activity  than I f v i c e versa. with  The  fact that j u v e n i l e  p r i o r t o any  i n connection  of  pertaining  In contrast,  so d e s i g n a t e d .  of  believed  under-  functioning.  paucity not  A  would.probably  a d d i c t p r i o r to.and a f t e r a d d i c t i o n .  (69,p.21) s t a t e s  studies  rehabilitative-process.  s u c c e s s i n the p r o j e c t e d  independent  employment  Pattern  There are v a r y i n g  Stevenson Report  of  treatment  (55,p.52)  his  These  involvement  continuance i n treatment i s a  t r e a t m e n t , by w h i c h , p r e s u m a b l y , c h a n g e i s  effected.  No.  4.  Family  ,We and  his  the  addict  network.  assume t h a t  total  discomfort  History  life  the  addict's  discomfort  s i t u a t i o n m o t i v a t e s him  i s present-oriented  arising  toward  i t i s reasonable  treatment.  (78)  i n her  s t u d y on  problem  Further,  ,as  to suppose t h a t most of  a r i s e s from h i s immediate-and c o n t i n u i n g Ripple  from h i s  close  family  and  continuance i n casework s e r v i c e  his  social found  that and  t h e p a t i e n t who i n his  forcing  life  I f i t can  (not m e r e l y . l e g a l )  w i d e r network the could  be.applied  having  low  discomfort  s i t u a t i o n r a r e l y continues.  thesis.  actual  i s r a t e d - as  be  the  at  - F i n l a y (77)  problem  posits a  the o u t s e t - w h a t the  rein-  addict's  s i t u a t i o n i n r e l a t i o n s h i p to spouse, f a m i l y  conclusions to  determined  about h i s  drawn from the  specific  Ripple  and  Finlay  and  studies  nature of a p a r t i c u l a r problem;  namely,  addiction.  No.  5  Male - Female The  ratio  treatment at -females. continue ting  No.  (55,p.12)*  I f i t can  be  that d i f f e r i n g  differences  to her  tative.  In  proportions  factor-for  the-addict's  prognostica-  for narcotics i s  Charles  older  Winick  (75)  closely parallels  the  ; t h e - D i v i s i o n of N a r c o t i c  addicts  a p p e a r t o be  suggests  that a  (55,p.12)  f o r 1964.  (72% M  age  groups,  more - r e h a b i l i -  'maturing-out'  of  figures for criminal addicts  Control  that  P a u l u s comments ( 5 5 , p . 4 7 ) u p o n  i n response to treatment of d i f f e r i n g  f i n d i n g s t h a t the  t h e U.S.  desire  n a r c o t i c s a d d i c t i o n takes p l a c e - f o r perhaps two-thirds  :  cent  involvement.  important aspect of  striking  This  per  for  Age  alluding  *  themselves  c e n t m a l e s t o 30  a significant  appears to undergo change w i t h ^ a g e .  the  presenting  established  i n t r e a t m e n t t h i s w o u l d be  An it  of male to f e m a l e - a d d i c t s  t h e N a r c o t i c F o u n d a t i o n i s 70 p e r  treatment  6.  Comparisons.  the  addicts.  reported  to 28%  F).  by  of He  32.  speculates  t h a t as  t h e s t r e s s e s o f a d o l e s c e n c e become l e s s  the drug u s e r f e e l s he  tends  less  t h r e a t e n e d by  to stop taking n a r c o t i c s .  i n v o l v e m e n t c a n be d e t e r m i n e d  i n s i s t e n t rand  the need to r e s p o n d t o 1  I f t h e r e l a t i o n s h i p o f age  i t w o u l d be a c l e a r - c u t  factor  such  stresses  to  treatment  to a i d prog-  nostication.  No.  7.  S t a t e d Reasons f o r S e e k i n g  Treatment.  A s s e s s m e n t o f m o t i v a t i o n , e s p e c i a l l y when one account  i t s unconscious  aspects i s , at best, u n r e l i a b l e .  w o r k i n g on a c o n s c i o u s l e v e l truthful), ment.  may  be  also  the a d d i c t ' s  a measurable  stated reasons  factor relative  takes  Nevertheless, (presuming  attendance  o f h i s a n x i e t y or h i s discomfort.whlchl.he states- p r o p e l s him  to h i s treatment  No.  8.  itself be  have i n d i c a t i o n s  toward  directly  over a p e r i o d of time to determine  some a d d i c t s  i n the Paulus Study  range  as h i g h as  i f a definite pattern  I f i t c a n be d e t e r m i n e d  that a  s u c c e s s f u l c o m p l e t i o n o f t h e t r e a t m e n t programme i t may  Symbols used  Sought  T2 = Time R e s e a r c h  exists. by  relationand  o r may  the n o t "be  a t t h e time an a d d i c t p r e s e n t s h i m s e l f f o r  i n the Paulus Study  T l = Time F i r s t  lends  t h e number o f c o n t a c t s f o r w i t h d r a w a l  10+.  a s i g n i f i c a n t "factor d i s c e r n i b l e  *  related  i f i t can  s h i p e x i s t s between the n u m b e r a n d d u r a t i o n of treatment attempts final  seeking  r e p e t i t i v e - c o m p u l s i v e n a t u r e of the a d d i c t ' s b e h a v i o u r  From T l t o T2*  source  w i t h N..A..F.  to e x a m i n a t i o n i n c o n n e c t i o n w i t h t r e a t m e n t i n v o l v e m e n t  studied  the  involvement.  P r e v i o u s Treatment Involvement  The  he i s  to h i s c o n t i n u a n c e i n t r e a t -  C o n s i d e r i n g the v o l u n t a r y n a t u r e o f h i s i n i t i a l  some - a m e l i o r a t i o n o f h i s c o n d i t i o n may  into  to d e f i n e p o i n t s i n time.  Treatment.  I n t e r v i e w took p l a c e .  (55,p.ll)  33,  treatment.  No. .9.  Agency  In training,  Staff.  the t h e r a p e u t i c r e l a t i o n s h i p  are,  selves  sex., p r o f e s s i o n ,  experience, attitudes, personality-and associated:traits  •important elements. which  the t h e r a p i s t ' s  Some-are d i f f i c u l t  (sex., p r o f e s s i o n , t r a i n i n g ,  for testing  for their  are  o r i m p o s s i b l e -to m e a s u r e b u t experience  relationship  for. i n s t a n c e ) ,  -those  lend  to the a d d i c t ' s treatment  them-  involve-  ment.  Data  Collection.  At  t h e o u t s e t i t m u s t be - r e a l i z e d  ment d e s c r i b e d i n t h e P a u l u s Each has  t o be  remembered  Study  cannot, .for our purposes,  examined f o r v a l i d i t y  t h a t h e r e n q u i r y was  and  directed  p a r a t i v e g r o u p s o f a d d i c t s d u r i n g and prolonged  toward  factors at a specific  be m a i n l y  taining only As  extracting  illustration  Treatment Involvement  Our  detailed  discussed,  such  As  to  ' i n toto'. be  as  com-  treatment, i . e .  i s focussed  upon  p o i n t i n t i m e n a m e l y , when t h e  Consequently,  our use  of  the  Paulus per-  the r e g u l a r s .  o f - t h i s , when p u r s u i n g . f a c t o r No. ..8.  w i t h t h e N.A.F.).we w i l l  therein.  - I t has  types of  concern  collect  d a t a c o n f i n e d t o t h e number o f N.A.F. w i t h d r a w a l s , mation  used  i n f o r m a t i o n r e l e v a n t t o o u r e n q u i r y and  to the group d e s i g n a t e d an  be  of measure-  e v a l u a t i n g c h a n g e i n two  after- d i f f e r e n t  addict presents himself f o r treatment. data w i l l  appropriateness.  o r r e g u l a r .dosages o f m e d i c a t i o n .  discerning particular  that the instruments  from  Table  (Previous 22  ignoring a l l other  the method o f d a t a c o l l e c t i o n  a d a p t a t i o n s , w h e r e n e c e s s a r y , . w i l l be  (55,p,58) infor-  f o r each f a c t o r i s  indicated.  .34.  The  primary  source o f our i n f o r m a t i o n w i l l  be t h e i n t e r v i e w  s c h e d u l e , q u e s t i o n n a i r e i t e m s a n d r a t i n g s d e v i s e d by M i s s P a u l u s t h e s o u r c e m a t e r i a l by w h i c h parative study.  There w i l l  she a r r i v e d  (Tl  t o T2) w i l l  be u t i l i z e d .  P o l i c e Records;, tured  a t t h e T l a s s e s s m e n t f o r h e r com^  be one e x c e p t i o n .  (Previous Treatment Involvement  When c o n s i d e r i n g f a c t o r No. 9.  w i t h t h e N.A.F.), t h e , p e r i o d o f h e r e n q u i r y  Miss  Paulus  1  s o u r c e s o f i n f o r m a t i o n were  The D i v i s i o n o f N a r c o t i c C o n t r o l , N.A.F. R e c o r d s  i n t e r v i e w s w i t h the Other  elicit  and s t r u c -  addicts.  sources o f data f o r our study w i l l  be agency r e c o r d s  i n t e r v i e w s c h e d u l e s e t c . ) . as w e l l a s , where i n d i c a t e d , to  to provide  (files,  questionnaires designed  i n f o r m a t i o n f r o m p r e s e n t s t a f f o r p a s t members o f t h e s t a f f i f  they c a n be l o c a t e d .  F a c t o r No*. 1.  Drug Use P a t t e r n .  Source used  to assess  F a c t o r No. .2.  of data w i l l  0 7 4 a n d 075 u s e d  Source were used  -pattern.  i t e m s 0 4 1 a n d 042  Work P a t t e r n .  will  be t h e i n t e r v i e w s c h e d u l e  to assess  F a c t o r No. 3. D e l i n q u e n c y  which  be t h e i n t e r v i e w s c h e d u l e  the a d d i c t ' s drug use p a t t e r n a t T l .  Source 073,  of data w i l l  t h e addict-'s work p a t t e r n a t T l .  Pattern.  be t h e s t a t i s t i c s  to support  items 071, 072,  determined  from o f f i c i a l  sources  the T l assessment o f the a d d i c t ' s delinquency  F a c t o r No.  4.  Family;History.  •Source  of data w i l l  be  t h e i n t e r v i e w s c h e d u l e i t e m 148  assess the-addict's family h i s t o r y  F a c t o r No.  5.  Male-Female  •Source will  be u t i l i z e d  treatment  by  6.  be  t h e i n t e r v i e w s c h e d u l e i t e m 007  simply dividing  t h e s e x e s and  comparing  which  them w i t h  Age.  Source  of data w i l l  the s i m p l e s t a t i s t i c s  F a c t o r No.  7.  and  be  t h e i n t e r v i e w s c h e d u l e i t e m 008  instituting  by P a u l u s  of data w i l l  (55,p.54) w i l l  t h e q u e s t i o n n a i r e and  be  be u t i l i z e d  8.  Treatment.  to group  the s p e c i f i c s  of data w i l l  be  will  be u s e d  table  determined  of  Drugs,  Other.  Involvement  w i t h t h e N.A.F.  i n t e r v i e w s c h e d u l e i t e m 017  numbers o f c o n t a c t s f o r w i t h d r a w a l d u r i n g the p e r i o d agency f i l e s  The  subsumed u n d e r t h e s i x b x o a d h e a d i n g s  P r e v i o u s Treatment  Source  extracting  indicated.  i n t e r v i e w s c h e d u l e i t e m 036.  L e g a l , - H e a l t h , Work, F a m i l y - a n d  Factor/No.  . ' c u t t i n g p o i n t s ' where  S t a t e d Reasons f o r Seeking  Source  by  at T l .  involvement.  F a c t o r No.  used  to  Comparisons.  of data w i l l 1  used  to i d e n t i f y  t h o s e who,  which  gives  f r o m T l t o T2.  while i n regular  The  treatment  eventually•completed  t h e programme ( b y t h e s t u d y d e f i n i t i o n o f c o m p l e t i o n ) .  Thus two  groups  to  comparative  illustrate  will  the r e l a t i o n s h i p ,  e v o l v e and i f any,  a simple graph w i l l  be d e v i s e d  b e t w e e n t h e number o f t i m e s  an  36.  addict presents ting  himself  f o r treatment before  No. 9.  Agency S t a f f .  Sources o f i n f o r m a t i o n selected  addicts  to d e t e r m i n e - t h e  p e r t a i n i n g to the therapists involved  would be-derived  from, . i n i t i a l l y ,  i nrelation  of a d d i c t s . the  expert  attitudes,  the addict's  t h e r a p i s t and t h e n from t h e t h e r a p i s t ' s p e r s o n a l  t o a s c e r t a i n t h e d e t a i l s t o be c o n s i d e r e d age  comple-  t h e programme.  Factor  the  he s u c c e e d s i n f i n a l l y  i . e . sex, profession,  to patient's marital status  We w i l l  also devise  (from permissive  t h e y -can b e c r o s s - e x a m i n e d w i t h involvement of the addict  file training,  rating scale  and a v a i l a b l e p e r s o n n e l  t o a u t h o r i t a r i a n ) and c a p c i t y  r e l a t i o n s h i p s o f the - t r e a t m e n t -staff:.  file  and e x p e r i e n c e i n t h e t r e a t m e n t  a questionnaire;and  judgment o f the a p p r o p r i a t e  with  to e l i c i t  regarding  f o r casework  Once t h e p e r t i n e n t d e t a i l s a r e l i s t e d  t h e s e x , a g e , m a r i t a l s t a t u s , and t r e a t m e n t  to determine  the c o - r e l a t i o n s h i p s .  Data A n a l y s i s . The concerning -addicts'  data w i l l  those addicts  be a n a l y z e d i n regular  treatment involvement.  those which s u r v i v e w i l l  by s e p a r a t i n g  the appropriate  t r e a t m e n t and r e l a t i n g  Thus, t h e f a c t o r s w i l l  be f u r t h e r t e s t e d  -factors  them t o t h e  b e p r - e — t e s t e d : and  i n a l o n g i t u d i n a l study.  SECOND PHASE - THE LONGITUDINAL STUDY  Emerging from t h e : r e t r o s p e c t i v e d i s c e r n i b l e a t the time the a d d i c t presents  study w i l l himself  be s p e c i f i c  factors  f o r treatment,  which,  j u d g e d by e v i d e n c e p r o d u c e d by t h e p r e - t e s t i n g a p p e a r t o be - s i g n i f i c a n t l y re-lated  to h i s treatment involvement.  f u r t h e r prove the v a l i d i t y  The n e x t l o g i c a l  step w i l l  o f e a c h f a c t o r w h i c h h a s emerged i n a  be t o fashion  which w i l l  r e i n f o r c e , modify or d i s c o u n t  longitudinal  period  the -addict p r e s e n t s be made t o t h e  and  of t e s t i n g w i l l himself  time the  the  be  f o r twelve  for treatment,  review  a  months-, f r o m t h e  when t h e  assessment w i l l  P a u l u s S t u d y -these p o i n t s  initial  t a k e .-place.  i n time w i l l  be  time  assessment To  avoid  will  con-  symbolized  by  Fl  F2.  Fl  =  Factors  used  F2  =  Factors  evaluated- a f t e r  All  a d d i c t s who  in initial  present  Foundation for a period questionnaires  and  cutting-off point commencement o f place  months.  o f s i x months f r o m F l w i l l  be  study,  t o be  Fl +  of eighteen  6.  so  f o r the  be  months:  Fl  be  twelve  commence-at F 2  months p e r i o d  using  the  6  ( F l +12)  The  s i x months a f t e r  longitudinal +  Addiction  r e t r o s p e c t i v e study.  studied w i l l  Thus, the  Narcotic  assessed,  +  study  will  the take  12.*  seen, however, t h a t e v a l u a t i o n of  treatment i n v o l v e m e n t can e x a m i n e d as h i s  12  themselves f o r treatment a t the  for addicts  the  will  assessment.  r a t i n g ;scales d e v i s e d  over a period It  *  f i n d i n g s - by means o f  study.  The  fusion with  the  as  the  factors  and  each s u b j e c t w i l l  expires.  Code f o r S y m b o l s . Fl  =  F2  !  Fl  +  Factors  =  Factors 6  =  used i n i n i t i a l evaluated  +  6 +12.  12  months.  S i x month -period d u r i n g selves  Fl  after  assessment.  which a l l addicts presenting  for treatment w i l l  Total period  of study  be  included  i n the  for a l l addicts.  study.  -them-  be  .38.  •Thus, t h o s e f a c t o r s w h i c h o r i g i n a l l y in  the  r e t r o s p e c t i v e s t u d y w i l l be - a d d i t i o n a l l y  of current of value  treatment.  not  indications the  emerged as  only of  Those w h i c h s u r v i v e - t h e  prognosticative  f a c t o r s t o be  probabilities  of the  t e s t e d under  conditions  l o n g i t u d i n a l study w i l l  be  t o o l s f o r treatment -involvement but  modified,  addict's  significant  where-possible,  i n order  to  as  enhance  continuance i n treatment.  *  SUMMARY  The seeking  p r i m a r y and  voluntary  treatment at the N a r c o t i c  drawal medication. offered and  to the  often admittedly; only  self-perpetuated  alleviate  the p a i n s  while  t r e a t m e n t team s e e k s t o  for  the  which  the At  the  associated  withdrawal help, patient  t r e a t the u n d e r l y i n g  attend vided.  f u n c t i o n of  i n t r e a t m e n t beyond the  the c l i n i c  more f r e q u e n t l y  H o w e v e r , ,as  completed  s o o n as  the m a j o r i t y  -degree o f c o n c e r n f e l t  the  by  the  in a  self-induced  patient  seeks  to  causes of  the  drugs, disease  clinical  approach<to psychiatrists,  When a p a t i e n t f i r s t a r r i v e s the  for  t r e a t m e n t team t o i n v o l v e of w i t h d r a w a l  the  discomfort.  A d d i c t i o n F o u n d a t i o n show t h a t m o s t during  period  of a d d i c t s  addict  the-treatment  s k i l l s of p h y s i c i a n s ,  immediate r e l i e f  Narcotic  narcotic  symptom.•  A d d i c t i o n F o u n d a t i o n the  i t i s the  the  p h y s i c a l w i t h d r a w a l from n a r c o t i c  p s y c h i a t r i c nurses.  R e c o r d s - a t the  occur  f o r w h i c h the  treatment or drug a d d i c t i o n combines the  s o c i a l w o r k e r s and  high  with  t a k i n g of drugs, i s a the N a r c o t i c  underlying  i s t h a t change can  d e s t r u c t i v e process  of  Addiction Foundation i s with-  However, the p h i l o s o p h y  narcotic addict  goal  the  period  patients  that medication i s  pro-  of w i t h d r a w a l under m e d i c a t i o n i s  drop out  of  the  treatment process.  t r e a t m e n t p e r s o n n e l about the  p e r c e n t a g e of p a t i e n t s d r o p p i n g from the  The  proportionately  t r e a t m e n t p r o c e s s has  led  to  39.  the  i d e n t i f i c a t i o n and  therapist's goals,are unavailable is  formulation hardly  for continuing  t o be  himself  the problem f o r t h i s  are  study.  r e a l i z e d i f t h e p a t i e n t makes  treatment.  to d e t e r m i n e whether t h e r e  presents  of  The  primary concern of  f a c t o r s discernab.le at  f o r treatment which.are "associated with  the  The himself  this  study  t i m e an  addict  treatment i n v o l v e -  ment. I t became c l e a r l y  evident  from the r e v i e w  of  the  literature  on  d r u g a d d i c t i o n t h a t t h e r e were c o n f l i c t i n g v i e w s o f n a r c o t i c a d d i c t i o n treatment. reliable  T h i s - i s i n d e e d a most c o n t r o v e r s i a l f i e l d studies.  Most of  the  literature  theoretical material reflecting little  reliable  a u t h o r s .and  reflect One by  two  there  approach considers the  law  l e g a l and  points  which should  the  t r e a t m e n t and The plexity the  of  few  of view  author  d e a l t w i t h by the  with  expressed.  main approaches  other  taken  dealt  drug 'addiction.a medical  the m e d i c a l  literature  these  of drug a d d i c t i o n .  approach, entertained  authorities.  indicates a shift,  d e c a d e s , f r o m - a n e m p h a s i s on  law  by  with the  problem While  over  enforcement,  both  the to  rehabilitation. wide range of  t r e a t m e n t approaches i n d i c a t e s the  the d r u g a d d i c t i o n p r o b l e m .  l i t e r a t u r e w h i c h may  t h i s area  The  of  t h e - p r o b l e m s o f a d d i c t i o n and  a u t h o r i t i e s , considers  p r o p e r l y be  last  the  drug a d d i c t i o n a s o c i a l problem p r o p e r l y  views c o - e x i s t inoour.;.society course of  a paucity  i m p r e s s i o n i s t i c or  of v i e w about the n a t u r e  e n f o r c e m e n t agencies;. medical  the p o i n t s  a p p e a r t o h a v e b e e n two  individuals dealing with  divergent  i s based on  the b i a s or o r i e n t a t i o n of  evidence to s u b s t a n t i a t e  Basically, by  with  1  and  of research  has  a f f e c t the no  A . v a r i e t y of  addict's  specific  e x t r e m e com-  f a c t o r s emerge  treatment involvement.  d o c u m e n t a t i o n to  date.  from However,  .40.  Since  our study  i s p r i m a r i l y concerned with  the treatment of  a d d i c t s :at t h e N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h necessarily  circumscribed  countered which required  by t h a t agency.  Several  Columbia i t i s '  difficulties  a r e f o c u s i n g o f the study.  While  the Narcotic  A d d i c t i o n F o u n d a t i o n o p e n e d i n December o f .1958 i t was o n l y any.systematic year  approach to data  the agency p u b l i s h e d  of drug a d d i c t i o n u s i n g  c o l l e c t i o n was d e v i s e d .  t h e f i n d i n g s o f :a r e s e a r c h  a pre-coded  them t o g e t " s t a t i s t i c a l l y  speaking"  to u t i l i z e of  the pre-coded - intake  of  treatment  enabled  population.  c o l l e c t i o n of  regard  to the N a r c o t i c  f o r the present  i n the Paulus  r e t r o s p e c t i v e study  t e s t i n g and*a l o n g i t u d i n a l study  the study  on the problem  research  u s i n g ;some o f t h e f a c t o r s a n d c a t e g o r i e s  i n t e r v i e w schedule used  Thus, an e x p l o r a t o r y instrument  systematic  i t was n e c e s s a r y  a retrospective design  I n the f o l l o w i n g  study  a picture of their  on the epidemiology o f drug a d d i c t i o n w i t h  Addiction Foundation population  i n 1965 t h a t  intake i n t e r v i e w schedule which  • B e c a u s e o f t h e l a c k o f any e a r l i e r statistics  were en-  Study.  was f o r m u l a t e d f o r  was p r e p a r e d  f o r the t e s t i n g  hypothesis.  Recommendations  It  i s recommended'that t h e f a c t o r s and t h e i r measurement be  f u r t h e r developed"and It  t e s t e d by t h e N a r c o t i c A d d i c t i o n F o u n d a t i o n . 1  i s f u r t h e r recommended  a d d i c t i o n be c o n s i d e r e d a paucity  of reliable  unsuitable  that research f o r student  s t u d i e s and t h e f i e l d  research  i t ' s many  aspects.  of narcotic  because there i s  of narcotic addiction'is^bb'tih  c o m p l e x and c o n t r o v e r s i a l r e q u i r i n g c o n s i d e r a b l e become f a m i l i a r w i t h  i n the f i e l d  t i m e f o r s t u d e n t s ;to  41.  BIBLIOGRAPHY  1.  Ausubel, David, "Cause and Types o f N a r c o t i c A d d i c t i o n : A Psychos o c i a l View", P s y c h i a t r i c Q u a r t e r l y , V o l . . 3 5 , No. 1, 1 9 6 1 , pp. 523-531  2.  , Drug A d d i c t i o n , Physiological, Psychological and S o c i o l o g i c a l A s p e c t s , New Y o r k , Random H o u s e , ( p a p e r b a c k ) 1 9 5 8 .  3.  B e e c h , G.E. & G r e g e r s e n , A . I . , " T h r e e Y e a r F o l l o w - u p S t u d y : Drug A d d i c t i o n C l i n i c , M i m i c o " , The C a n a d i a n J o u r n a l o f C o r r e c t i o n s , Vol. 6, No.. .2, A p r i l , 1 9 6 4 , p p . 2 1 1 - 2 2 4 .  4.  Bill  5.  B r i l l , L., "Agency T r e a t m e n t " , Problems i n A d d i c t i o n : A l c o h o l and Drug A d d i c t i o n . B i e r , W. ( e d . ) , New Y o r k , F o r d h a m U n i v e r s i t y P r e s s , .1962.  6..  Canada Food and Drug Law.  7.  Casriel, Daniel, So F a i r A H o u s e : C l i f f s , N. J . .1963.  8.  Chein, I .& Rosenfield,  100 - A s s e n t e d t o J u n e 2 2 , 1 9 6 1 . of N a r c o t i c Drugs i n Canada.  Narcotics  E..,  An A c t to Provide  Control The S t o r y  A c t , .1961. o f Synanon,.Englewood  "Juvenile Narcotics  Use",  t e m p o r a r y P r o b l e m s , ,1957. ( f u r t h e r i n f o r m a t i o n 9.  Chein, I .e t a l ,  The Road  f o r the Control  t o H, New Y o r k , B a s i c  L a w a n d Con-  not.available.)  Books,  1964.  10.  Curran, Robert, "Canada and C o n t r o l l e d D r u g s " , M e d i c a l J o u r n a l o f C a n a d a , V o l . .18, No. 6, J u n e , ,1962, p p . 4 1 5 - 4 3 0 .  11.  De Ropp, R o b e r t , 1957.  12.  D i e t h e l m , 0., " B a s i c C o n s i d e r a t i o n s o f t h e C o n c e p t o f t h e P s y c h o p a t h i c P e r s o n a l i t y " i n . E n c y c l o p a e d i a o f A b e r r a t i o n s , P o d o l s k y , E. ( e d . ) . New Y o r k , P h i l o s o p h i c a l L i b r a r y , 1 9 5 3 , p p . 4 5 2 - 4 5 6 .  .13.  D r u g s a n d t h e M i n d , New Y o r k , G r o v e P r e s s ,  (paperback)  D u v a l l , H. J . e t - a l . , ; " F o l l o w - u p S t u d y o f N a r c o t i c D r u g A d d i c t s F i v e Y e a r s A f t e r H o s p i t a l i z a t i o n " , P u b l i c H e a l t h R e p o r t s , U.S. D e p t . o f H..-E..W. - P u b l i c H e a l t h S e r v i c e , V o l . 7 8 , No. .3, M a r c h , ,1963, pp. 185-193.  14.  E l d r i d g e , W.B.., N a r c o t i c s t i o n , 1962.  a n d t h e Law, New Y o r k , A m e r i c a n B a r F o u n d a -  15.  E n c y c l o p a e d i a o f S o c i a l Work, 1 9 6 5 , L u r i e , H. L . ( e d . ) , New Y o r k , N a t i o n a l A s s o c i a t i o n o f S o c i a l Workers.  16.  F e d e r a l H e a l t h and W e l f a r e Dept. R e p o r t, D o m i n i o n . S t a t i s t i c s - T o t a l A d d i c t P o p u l a t i o n i n C a n a d a , .1966, . ( M i m e o g r a p h e d ) , N.A.F.  42.  17.  . F l i n t , . M a u r i c e S ., " N a r c o t i c A d d i c t i o n i n Women O f f e n d e r s " , C a n a d i a n J o u r n a l o f C o r r e c t i o n s , V o l . 6, No. .2, A p r i l , ,1964. pp. 2 4 6 - 2 6 5 .  18.  Frankau, I . , "Treatment i n . E n g l a n d of Canadian P a t i e n t s A d d i c t e d to N a r c o t i c D r u g s " , C a n a d i a n M e d i c a l A s s o c i a t i o n J o u r n a l , V o l . 90, No. 6, F e b r u a r y , 1964, pp. 4 2 1 - 4 2 4 .  19.  F r a z i e r , Thomas, " T r e a t i n g Y o u n g D r u g U s e r s - A C a s e w o r k A p p r o a c h " , S o c i a l Work, V o l . 7, No. .3, J u l y , 1 9 6 2 , pp. 9 4 - 1 0 1 .  20.  G e r a r d , D. and K o r n e t s k y , C , "Adolescent Opiate Addiction: o f C o n t r o l and A d d i c t S u b j e c t s " , Psychiatric Quarterly, No. 1, 1955, pp. 4 5 5 - 4 8 6 . J.., A f t e r - C o n d u c t o f & Co. L t d . , 1946.  Discharged  A Study V o l . 29,  .21.  G l u e c k , -S. & G l u e c k , E. London: M a c M i l l a n  .22-.  Goodman, L.S. & G i l l m a n , A.,, New Y o r k , The M a c M i l l a n  .23.  H a l l i d a y , R., The E t i o l o g y a n d - E p i d e m i o l o g y o f D r u g A d d i c t i o n , V a n c o u v e r . The N a r c o t i c A d d i c t i o n . F o u n d a t i o n of B r i t i s h Columbia, (Unpublished) Nov. 1966.  24.  ._  The P h a r m a c o l o g i c a l Co., .1965.  Basis  Offenders,  of  Therapeutics,  :  . •Narcotic  , M a j o r Treatment Approaches to the Problem of Drug A d d i c t i o n , Vancouver, ( U n p u b l i s h e d ) , 'March, 1963.  25.  ' Counsellors  , "The N a r c o t i c A d d i c t J o u r n a l , May, .1962.  26.  H a r m s , E. ( e d . ) , ,1965.  .27.  Hellenbrand, Shirley, " C l i e n t Value Orientations: Implications for D i a g n o s i s and T r e a t m e n t " , S o c i a l Casework. V o l . 42, No. 4, A p r i l , ,1961, pp. 1 6 3 - 1 6 9 .  .28.  Hentoff, pp.  .2-9.  H o c k a , P-. "Comments on N a r c o t i c A d d i c t i o n " , V o l . -4, No. 3, J u n e , 1963, p p . .140-144.  30.  Hollingshead,  Nat, "The 32-77.  Drug A d d i c t i o n  i n Y o u t h , New  Treatment of P a t i e n t s " ,  .A.B., & R e d l i c h , ,F..C., S o c i a l  A -Community S t u d y , New  York:  and  the Community",  B.C.  York,.Pergamon.Press,  The  New  Yorker,  Comprehensive  Class  and  Mental  J u n e , .1965,  Psychiatry,  Illness:  ^ W i l e y & S o n s , .1958.  31.  H o l m e s , S.  J . , ' . C h e m i c a l C o m f o r t s and. Man,  . Ottawa, Canada,  32.  Holzinger, tion,  R., " V i s i t to Synanon", The V o l . .16, No. .3,.pp. 1 4 - 1 6 .  33.  I n t e r i m R e p o r t o f the J o i n t Committee of the A m e r i c a n Bar A s s o c i a t i o n and t h e A m e r i c a n M e d i c a l A s s o c i a t i o n on N a r c o t i c D r u g s , Drug Addiction: Crime or Disease? Bloomington, Ind. Univ. Press, 1961.  Journal  of  1964.  C o r r e c t i o n a l Educa-  .43.  34.  K i n g , D. E., "Some Comments o n t h e N a r c o t i c • P o l i c e , V o l . 10, No. .1, .1965.  35.  K o l b , L . a n d H i m m e l s b a c h , .C. K.., " C l i n i c a l S t u d i e s o f D r u g A d d i c t i o n III. A C r i t i c a l Review o f W i t h d r a w a l T r e a t m e n t s w i t h Method f o r E v a l u a t i n g A b s t i n e n c e Syndromes", A m e r i c a n J o u r n a l o f P s y c h i a t r y , V o l . 9 4 , No. ,4, Jan.., 1 9 3 8 , p p . 7 5 9 - 7 9 9 .  36.  K o l b , L a w r e n c e , -Drug A d d i c t i o n . C. -C. T h o m a s , .1962:.  37.  K r o n , Y. J . & B r o w n , E . M., M a i n l i n e t o N o w h e r e , A d d i c t , New Y o r k , P a n t h e o n B o o k s , 1 9 6 5 .  38.  L a r i m o r e , G.W. .& B r i l l , H., .On t h e S i t e S t u d y o f t h e B r i t i s h N a r c o t i c System, R e p o r t t o G o v e r n o r N e l s o n R o c k e f e l l e r , New Y o r k , 1 9 5 9 .  39.  Lindesmith, Alfred P r e s s , 1965.  40. N a t i o n , March  .A M e d i c a l  P r o b l e m i n t h e U^S.",  Problem, - S p r i n g f i e l d ,  R., T h e A d d i c t a n d t h e Law,  Illinois,  The M a k i n g o f a H e r o i n  B l o o m i n g t o n , ,Ind. U n i v .  , "Dope: Congress Encourages the T r a f f i c " , 1947, p p . .228-231.  The  41.  M a u r e r , D. W. & V o g e l , V. H., N a r c o t i c s a n d N a r c o t i c A d d i c t i o n , f i e l d , I l l i n o i s , C. C. T h o m a s , , 1 9 6 2 .  42.  M c M o r r i s , S,. C., " N a r c o t i c C l i n i c s : An American Viewpoint", -Criminal Law Q u a r t e r l y , V o l . 8, No. .2, .1965.  43.  M e n t a l H e a l t h , M o n o g r a p h , No. .2. N a r c o t i c D r u g A d d i c t i o n , U.S. D e p t . o f H.E.W.., W a s h i n g t o n , D. C , U.S. G o v e r n m e n t P r i n t i n g O f f i c e , 1 9 6 3 .  44.  M e n t a l H e a l t h M o n o g r a p h 3. R e h a b i l i t a t i o n i n D r u g A d d i c t i o n . A Report o n a f i v e - y e a r Community E x p e r i m e n t o f t h e New Y o r k D e m o n s t r a t i o n Center. U.S. D e p t . o f H.E.W., .1963.  45-.  M e y e r s o n , P., " F i n d i n g C a u s e s : . S e e k i n g C u r e s " . New Y o r k , T i m e - L i f e B o o k s , .1965.  46.  "Narcotics", S y m p o s i u m i n . L a w - and C o n t e m p o r a r y - P r o b l e m s , V o l . 2 2 , No. .1, W i n t e r 1957. (Issues devoted t o n a r c o t i c s w i t h r e s p e c t t o the law).  47.  The N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h V a n c o u v e r , May,  48.  C o l u m b i a , Drug  in.British  Takers,  Addiction,  .1964.. , .10th A n n u a l R e p o r t , V a n c o u v e r ,  49. 50.  -The D r u g  Spring-  1965.  , 'A S h o r t H i s t o r y o f D r u g A d d i c t i o n a n d T r e a t m e n t C o l u m b i a , V a n c o u v e r , M a r c h , .1966.  N y s w a n d e r , M., The -Drug A d d i c t a s ^a P a t i e n t , New Y o r k , G r u n e •Inc., 1956.  & Stratton  44.  51.  O ' D o n n e l l , J o h n A.., "A F o l l o w - u p o f N a r c o t i c l a p s e and A b s t i n e n c e " , A m e r i c a n J o u r n a l 34,.No. 5, O c t . 1964, ,pp. 9 4 8 - 9 5 4 .  52.  O ' D o n n e l l , J o h n A.. & B a l l , J o h n C , & L o n d o n , H a r p e r & Row, 1966.  53.  O ' D o n n e l l , J o h n A., " N a r c o t i c A d d i c t i o n and V o l . 13, No.. 4, S p r i n g 1966.  54.  Parsons, T a l c o t t , " R o l e C o n f l i c t and t h e G e n e s i s o f D e v i a n c e " i n S o c i a l P e r s p e c t i v e s on B e h a v i o u r , S t e i n , H. & C l o w a r d , R. A. ( e d s . ) I l l i n o i s , The F r e e P r e s s o f G l e n c o e , .1963.  -55.  (ed.)  Addicts: M o r t a l i t y , Reof Orthopsychiatry, V o l .  Narcotic  A d d i c t i o n , New  Crime",  Social  York  Problems,  P a u l u s , I . , A C o m p a r a t i v e - S t u d y o f L o n g - T e r m and S h o r t - T e r m W i t h d r a w a l of N a r c o t i c A d d i c t s V o l u n t a r i l y S e e k i n g Comprehensive Treatment, Vancouver, The N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h C o l u m b i a , 1966.  56.  , H i s t o r y o f Drug A d d i c t i o n and L e g i s l a t i o n i n C a n a d a , V a n c o u v e r , The N a r c o t i c A d d i c t i o n F o u n d a t i o n o f B r i t i s h C o l u m b i a , Nov., ,1966.  57.  P i n e s , Maya, "The O c t . , 1965.  58.  P r i c e , H. F., "The C r i m i n a l Addict'-', No. .2, O c t . , .1946., p p . .149-158.  59.  Ray, M. B., "The C y c l e o f A b s t i n e n c e and R e l a p s e , Among H e r o i n A d d i c t s " i n The O t h e r S i d e : P e r s p e c t i v e s o n D e v i a n c e , B e c k e r , H.S. (ed.) C o l l i e r - M a c M i l l a n L t d . , L o n d o n , The F r e e P r e s s o f G l e n c o e , 1964.  60.  A R e p o r t p r e p a r e d by a S p e c i a l C o m m i t t e e a p p o i n t e d by t h e E x e c u t i v e C o m m i t t e e o f t h e C a n a d i a n M e d i c a l A s s o c i a t i o n , The C a n a d i a n M e d i c a l A s s o c i a t i o n . J o u r n a l , ..Vol. 92, N o . . 1 9 , May, , 1 9 6 5 , p p . 1 0 4 0 - 1 0 4 3 . R.,  "Junk",  Coming U p h e a v a l  P. Q u a r t e r l y ,  Y o r k e r , M a r c h , ,1965, p p .  Vol..12,  Rice,  62.  R i c h m a n , A., "Follow-up - Study of C r i m i n a l N a r c o t i c A d d i c t s " , d i a n N a t i o n a l H e a l t h G r a n t Program, 1962-5, pp. 107-115.  63.  R i c h m a n , A. e t a l , " N a t u r a l H i s t o r y o f N a r c o t i c A d d i c t i o n " , C a n a d i a n P s y c h i a t r i c A s s o c i a t i o n J o u r n a l , V o l . .9, No. 5, O c t . , 1964, p p . . 431-438.  64.  R.C.M.P.  65.  S.abath, G., "The T r e a t m e n t o f H a r d - c o r e V o l u n t a r y .Drug A d d i c t P a t i e n t s " , I n t e r n a t i o n a l J o u r n a l o f G r o u p P s y c h o t h e r a p y , V o l . 14, N o s . ,1-4, J a n . , 1964, pp. .307-317.  •66.  S c h u r , E. M.,. N a r c o t i c D r u g . A d d i c t i o n i n B r i t a i n t o n , . I n d . U n i v . P r e s s , T962.  and O r d e r  New  R. C. M.  Harpers.Magazine,  •61.  Law  The  i n Psychiatry",  50-142.  i n C a n a d i a n Democracy, Ottawa,  i n Cana-  1952.  and A m e r i c a ,  I  Blooming-  45.  67.  S h e l l y , J . & B a s s i n , A.., ,"Day-Top L o d g e : H a l f - W a y .House f o r D r u g A d d i c t s " , f e d e r a l P r o b a t i o n , V o l . 28, No. 4, D e c , 1964, pp. 46-54.  68.  T e r r y , C. E. & P e l l e n s , M., of S o c i a l Hygiene Inc.,  69.  T r a s o v , G. E., (The " S t e v e n s o n R e p o r t ) A Summary o f t h e F i n d i n g s and R e c o m m e n d a t i o n s o f t h e N a r c o t i c D r u g R e s e a r c h Team on ''Drug A d d i c t i o n i n B r i t i s h C o l u m b i a " , ( M i m e o g r a p h e d ) , V a n c o u v e r , The N a r c o t i c A d d i c t i o n Foundation of B r i t i s h Columbia, (undated).  70.  V a l i a n t , G. E., "A T w e l v e Y e a r F o l l o w - u p o f New Y o r k N a r c o t i c A d d i c t s I. The R e l a t i o n o f T r e a t m e n t t o O u t c o m e " , A m e r i c a n J o u r n a l o f P s y c h i a t r y , V o l . 122, No. 7, J a n . , 1966, pp. 7 2 7 - 7 3 7 .  71.  W i k l e r , A., Opiate.-Addiction, l i s h e r ) . , .1953.  72.  W i k l e r , A. •& R a s o r , R., " P s y c h i a t r i c A s p e c t s o f D r u g A d d i c t i o n " , ..Americ a n J o u r n a l o f M e d i c i n e , V o l . 14, No. 5, May, 1953, p p . 5 6 6 - 5 7 1 .  73.  W i l l i a m s , H. R., T r e a t m e n t and R e h a b i l i t a t i o n o f D r u g U s e r s , V a n c o u v e r , The N a r c o t i c F o u n d a t i o n o f B r i t i s h C o l u m b i a , ( U n p u b l i s h e d ) , Nov,, 1966.  74.  Winick, Charles, "The L i f e C y c l e o f t h e N a r c o t i c A d d i c t and o f A d d i c t i o n " , B u l l e t i n o n N a r c o t i c s , ( U n i t e d N a t i o n s ) , V o l . 16, No. -1, J a n . - M a r . , 1964, p p . 1-11.  75.  The Opium P r o b l e m , New 1928.  S p r i n g f i e l d , 111.,  C.  Y o r k , The  C.  Thomas  Bureau  (Pub-  , "Maturing-out.of Narcotic Addiction", •on N a r c o t i c s , V o l . 14, No. .1, J a n . - M a r . , 1962, pp. .1-7. The  Tunnel Back:  :Synanon, New  -  Bulletin  76.  Yablonsky, Lewis, 1965.  York, MacMillan  Co.,  77.  F i n l a y , D. G., R o l e N e t w o r k P r e s s u r e a n d t h e A p p r o a c h t o T r e a t m e n t by A l c o h o l i c P a t i e n t s , A D e s e r t a t i o n S u b m i t t e d to t h e ' F a c u l t y of the S c h o o l of S o c i a l S e r v i c e A d m i n i s t r a t i o n i n Candidacy f o r the Degree of Doctor of .Philosophy, U n i v e r s i t y of Chicago, Chicago, I l l i n o i s , M a r c h , .1963.  78.  R i p p l e , L., " F a c t o r s A s s o c i a t e d w i t h C o n t i n u a n c e i n Casework S o c i a l Work, V o l . 2, No. 1, J a n . , 1957, pp.,87-94.  Service",  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0104513/manifest

Comment

Related Items