DOCUMENT RESUME ED 045 390 SE 010 099 AUTHOR Brotman, Richard; rrpedman, Alfred TITLE A Community Mental Health Approach to Drug Addiction. INSTITUTION Department of Health, Education, and Welfare, Washington, D.C. Social and Rehabilitation Service. REPORT NO JD-Pub-9005 NOTE 1001). AVAILABLE FPCM Superintendent et Documents, U.S. Government Printing Office, Washington, D.C. 20002 (Cat. No. vS-1/.2:D-P4, $1.00) EPRS PPICE EPPS Price MF-$0.1c HC Not Available from UESCRIPTORS *Drug Abuse, *Drug Addiction, *Drug Legislation, Health Education, 4-Mental Pealth, *Public Health ABSTPACT The nature 04 the historical changes in the presumed stereo-types of drug users in the United States, and the associated policy chanaes, are described in this report which takes a community health viewpoint of drug use while concurrently dealing with the individual. right case histories illustrate the community mental health approach in action. Three of these cases are descriptions of programs for school staff, staff of a vocational rehabilitation service, And for hoWtal and community agency offices. The results of one research study using this approach and a bibliography are appended.A glossary of dependence rrod.ucing drugs, classified according to their effect ou the central. nervous system, with brief aescrintions of the legal regulation, form and effect of each class is also appended. (AL) I A tr O k) A MP c 1111 1 SYSTEIC ANALGOS OriAli S SYNT tittit (NON NARCOTICANALGESICS phoacetkieipinn acetanilid meihadone aniteridhle %/IN/Aldine NATURAL opiqis heroin codeine ertiOli Morptil Ile ..."- NARCOnc AN tNS DErRtSCAN1S cYciatocine RARB"URATis nalorphine Amoberblat phenobafbital selbarbitat P ontob atbK*1 hydrate NON RARMTURATC fDACmtpS thlOir ptaidehyde pbamite At cotiot CNC CimnitANIS A kiPto TAymis methamphtta mintdvasoamphetsmote smiltheternine CAFFEINT COCAINE NICONNt IssIC"f"Porics TRANQUIf Inns T cllf P1 Na th$011)Ottenalint RE'`-"Pr/Ms teserpinet- ANT DI PRI scANTs Uc 0406.04S PerOte lostiocybsn ineStehn A COMMUNITY MENTAL HEALTH APPROACH TO DRUG ADDICTION Rlobard Drotman, Ph. D. Alfred Freedmen, M. D. U. S. DEPARTMENT OP HEALTH, EDUCATION. AND WELFARE Social and RehabIlnellon Service officer,. Anron Oa Oo Mots one y and Youth DerolOpenahl 11.. For isle by the trwerlotert4ent et Doeurritotk, Govermoret Print's Oer. R111100.. .C. 40102Frke $1 ACKNOWLEDGMENTS Many staff persons cooperated in the de- We are particularly grateful to the addicts velopment of this document. We are grateful themselves, whose continual effort to help to Stephen Max Allen for his diligent, cre- themselves and others enabled us to gather ative editorial work; to Stanley Einstein for the data for this manual. his case studies; to Martin Livenstein for his Our final thanks are extended to the many thinking on the role of community organi- professionals all over the world who have zation; to Irving Silverman for his develop- visited and trained with us. Our exchanges ment of the screening instrument; to Alan with them are reflected in this discussion. Meyer for the development of the tables on Any obvious errors are to be attributed to life style adaptation; and to all the staff of us, not to them. the Division of Community Mental Health RICIIARD BROTMAN who have continually encouraged us by their ALFRED FREEDMAN dedicated and unceasing effort on behalf of their patients. iv FORE1VORD Although drug addiction is a problem does not imply official endorsement by the of mounting concern, knowledge about Department of Health, Education, and effective methods of prevention and con- Welfare. The document is issued by the trol remains extremely limited. Office ofJuvenileDelinquencyand Among those who have used innovative Youth Development as part of a training methods to learn more about the problem program which ircludes providing cur- and to attempt to deal with it more effec- riculum materials that will stimulate pro- tively are the authors of this publication: vocative discussionintraining courses. Richard Brozman, Ph. D., a professor in The report should also be of interest to the Department of Psychiatry and the di- members of the various professions who rectoroftheDivisionof Community wish to keep informed about new develop- Health of the New York Medical College, ments in the broad field of juvenile delin- and Alfred Freedman, M.D., the chair- quency prevention and control. man of the Department of Psychiatry of the New York Medical College. RALPH M. SUSMAN The views, opinions, and conclusions Deputy Director Office ofjuvenile Delinquency are those of the authors and publication and Youth Development CONTENTS FOREWORD iii THE AMERICAN REACTION TO NARCOTICS USE. 1 II, PHYSICAL, PSYCHOLOGICAL, AND SOCIAL ASPECTS OF ADDICTION 8 III. THE COMMUNITY MENTAL HEALTH APPROACH TO DIAGNOSIS 15 IV. TARGETS, GOALS, AND METHODS FOR INTERVENTION 31 APPENDICES 41 A. Glossary of dependence producing drugs 43 13. Screening instrumcnt 53 C. Case histories 83 D. A research study 117 E. Bibliography 135 I. THE AMERICAN REACTION TO NARCOTICS USE BACKGROUND AND EARLY mates of the rate of addiction ranged from Ito 4 LEGAL POLICIES (1803-1925) percent of the population. Against a background of considerable concern and little scientific under- Inorder to be properly understood, the problem standing, the U.S. participated in the 1912 Hague of drug addiction in the United States should first Opium Convention, called to establish interna- be viewed in an historical perspective. tional control of the production, sale, and use of In the 30 years following 1805, the year that narcotics. Then, in 1914 Congress passed what is morphine was discovered, several other alkaloid still this country's bask narcotics law, the Harrison derivatives of opium, includingcodeine,were Act. found. In the middle of the 19th century the hr podermic syringe was invented. Subsequently the THE HARRISON ACT injection of morphine and other narcotics to re The Harrison Act was a revenue measure, a part Here painas well as the use of opiates in cough of the Internal Revenue Act, and administered by medicines, tonics, and patent medicines became a branch of the Treasury Department (known since common, so common in fact that during the Civil 1930 as the Federal Bureau of Narcotics). In The 1Var morphine addiction came to be called the Addict and the Law, Alfred Lindesmith says of the "Army disease." Meanwhile, the smoking of opium Act: for pleasure had been introduced by immigrants Its ostensible purpose appeared to be sim- from China. Thus, by the end of the 19th century, ply to make the entire process of drug distri- the unregulated use of narcotics was beginning to bution within the country a matter of record. be considered a serious problem, ..Ithough doctors The nominal excise tax (1 cent per ounce), generally did not understand the mechanism of the requirement that persons and firms ham addiction. dling drugs register and pay fees, all seemed In 1898 heroin, another alkaloid derivative of designed to accomplish this purpose. There opium and morphine, and more potent than either, is no indication of a legislative intention to was isolated.It was thought to be nonaddictive, deny addicts access to legal drugs or to inter- and thus was substituted for morphine in !mil- fere in any way with medical practices in this eines and tonics. However, it soon became appar- area)* ent that heroin was even more addicting than the In 1924, the Nat-ccDrugs Import and Export narcotics it Iva% meant to replace, a problem that Au was passed, and in 1924 the domestic manu- has recurred more recently 'vial the synthetic nar- facture of heroin was outlawed.Thus, heroin is in cotics, meperidine (Demerol) and methadone (nolo- a sense uniquely illegal, since permission must be phine). obtained from the Treasury Department to use it By 1910 drug addiction was recogniied as a po- even for legitimate research purposes. In these taws tential social and legal Limbic:1r, although its medi- imported heroin is used (it is legally manufactured cal aspects were not fully understood. Popular esti- and used in other Western countries). However, neither the Harrison Act, nor any other law, makes continued to prescribe narcotics for addicts." How- narcotics illegal in the sense that their use is sim- ever, in the Behrman case, the Court suggested that ply forbidden. had the physician prescribed a smaller dose of nar- The Harrison Act ni.le no direct mention of cotics, he might not have been subject to convic- addicts or addiction. It specifically exempted indi- tion. And in the 1925 Linder case" (Dr. Linder viduals who received narcotics from a registered was accused of having sold a female addict with physician, although it stated that the prescription withdrawal symptoms one tablet of morphine and had to be "for legitimate medicinal purposes" and three tablets of cocaine for selfadministration; she "prescribed in good bath," and that the drugs had was an informer and he was arrested) the ruling to be dispensed or distributed by a physician, den- stated that the Harrison Act tist, or veterinary surgeon "in the course of his says nothing of "addicts" and does not under- professional practice only." The Act did not make take to prescribe methods for their medical addiction illegal(a1962 Supreme Court ruling treatment. They are diseased and proper sub- held that a law which did so would be unconstitti- jects for zuch treatment, and we cannot pos- tional);" nor did itspecifically either allow or sibly conclude that a physician acted improp- forbid a doctor to give drugs to an addict regu- erly or unwisely or forother than medical larly. But unfortunately the term "professional purposes solely because he has dispensed to practice" was not defined, and thus it became the one of them, in the ordinary course and in basis for 50 years of legal problems for the narcotic good faith, four small tablets of morphine or user, the doctor, and the community.