Some Basic Problems in Drug Addiction and Suggestions for Research*
by MORRIS PLOSCOWE
X. THE RELAPSE AND REHABILITATION OF DRUG ADDICTS
One of the foundations of the present policy for dealing with narcotic addiction, which frowns upon ambulatory treatment by physicians or anyone else, is that narcotic addiction must be treated in an institutional setting. The preference for treatment of drug addiction in hospitals led to the establishment of the Lexington, Kentucky and the Fort Worth, Texas instaIlations maintained by the federal government. It also led to the foundation of the Riverside Hospital for adolescent narcotic addicts in New York City.
Those who established these institutions were undoubtedly buoyed by the hope that the institutional treatment would result in the rehabilitation of a substantial percentage of addicts. The founders of Lexington, Fort Worth and Riverside must have held the opinion that the combination of medical and psychiatric treatment, and social work, educational and vocational treatment could eliminate the curse of addiction to narcotic drugs from the patients admitted to their institutions. We have already noted the limited facilities for drug addicts provided by the aforementioned hospitals. If sound statistical studies were available on the relapse of drug addiction and they showed considerable percentages of success secured by institutional treatment, then the conclusion might well be drawn that better and more extensive hospital facilities were necessary for any rational drug control program. Unfortunately, sound, carefully conceived studies on a broad scale of the success or failure of hospital treatment of drug addicts have simply not been made. Whatever studies have been made present a somewhat discouraging picture of the possibility of preventing narcotic drug use by chronic addicts through current methods of hospital treatment.
In 1941, M. J. Pescor93 made a follow-up study of 4,766 patients released from the Lexington narcotics institution.
He was attempting to determine the present addiction status of these former patients of Lexington. Pescor tried to obtain this information from the F. B. I. which reported the re-arrests of these patients, from their probation officers who may have had them under supervision and from the patients themselves, primarily through letters. Pescor did not make any field studies nor did he have any means for determining the truth of a report by a patient or by a probation officer, that the patient was abstinent and no longer used drugs. Thus, on the one hand, Pescor was unable to obtain replies from a considerable percentage of the patients and, on the other hand, where the reply was favorable, there was some question as to whether it was reliable.
Pescor's conclusion was that the present addiction status could not be determined in 39.6% of the cases; 7% had died following release from the hospital; 39.9% relapsed to the use of drugs; and, 13.5% were reported as still abstinent. Even if we accept Pescor's figures as reliable, it is apparent that of the cases on which Pescor had data (39.9% relapsed and 13.5% abstinent), relapse had occurred in 3/4ths of the cases and only 1/4th of the patients could be deemed cured. More accurate tracing of the unreporting patients and more careful checking of those who reported themselves abstinent (through such devices as the use of Nallymorphine), would undoubtedly show that considerably less than 1/4th of the patients that pass through Lexington remain abstinent for any considerable period of time.
The high percentage of relapse after hospital treatment is experienced by other institutions besides Lexington. A study was made in California on 584 cases treated at the state narcotics hospital between the years 1928-1936. This study showed that only 15% of the cases could be deemed abstinent as of the date of the study and that 85% had relapsed; most of them during the 16 month parole period after release from the hospital.
In 1930, Dr. Alexander Lambert94 reported on 318 addicts voluntarily committed to Bellevue Hospital by a City Magistrate. Of these addicts, 279 or 87%, admitted prior cures as against 39 or 13% who denied any prior cures.
More than half of these 279 addicts had "taken the cure" four or more times .
In 1951, Knight and Prout95 reported on a follow up study of 75 private patients treated at the New York Hospital, Westchester Division. These were, obviously, luxury patients who could pay for hospital treatment. Data as to addiction were available on only 38 of these 75 patients.
Less than half of these 38 patients (15) were reported as "abstaining" from drugs.
One might expect a considerably higher percentage of cures from an institution like Riverside, which attempts to select only promising cases for treatment and which takes only adolescent drug addicts to start with. Yet the N. Y.U.96 study made on the post hospitalization adjustment of 30 adolescent opiate addicts is quite discouraging. Only two of the patients remained abstinent during the period of one year after discharge from the hospital. Twenty-two of the thirty patients were reinstitutionalized one year after discharge, either in a jail or in a hospital.
In the light of the data, it is obvious that more careful studies of the effect of hospital treatment of drug addicts must be made. If it is true that most chronic addicts cannot be cured by present hospital methods, this fact should be known as quickly as possible. It may necessitate the complete revision of present methods of dealing with addicts.