The Relevancy of Some Newer American Treatment Approaches for England *

SUMMARY As indicated in this paper, we believe that the three approaches discussed in this paper represent some of the most important treatment modalities being studied in the United States. As described, our assumption is that there is no single universal solution for all addicts, be it a Synanon‐type organization, probation or chemotherapy. We therefore need to learn what approaches will work with particular kinds of addicts. Cyclazocine was first indicated for patients still new in the “addiction system”, in the sense of primary or secondary prevention; whereas methadone seemed prescribed for patients only after they had been “through the mill” after 4 or 5 years when everything else had been tried and nothing had worked, in the sense of tertiary prevention. Although we have not discussed the Synanon or therapeutic community approaches using ex‐addicts in detail, we do not mean to imply that this is not a most important development in America, or that it may not be far more appropriate for many patients than the approaches we have described here. How much of this work is applicable to the British problem remains to be determined. On the surface, it appears that each of the modalities described would require considerable modifications to adapt them to the different English situation. For example, the doses of cyclazocine which block the usual doses of diluted heroin available in New York might need to be doubled or tripled to be effective against the pure heroin tablets available in England. The same uncertainties apply to the use of methodone. Similarly, Synanon‐type organizations which rely heavily on severe external pressure from police and social attitudes might have to modify their stance and perhaps adopt induction techniques such as those used at the Addiction Research Center in Puerto Rico. Here, ex‐addicts return to the community as workers to induce, entice, and persuade their former associates who are still active narcotic users to enter the treatment program. This report has stressed that the various approaches being explored in the United States need not be mutually exclusive, but could rather serve to reinforce each other as in our use of probationary supervision and “rational authority” with chemotherapy to hold patients in treatment, help them brake their acting‐out behavior and remain in a program until they have been rehabilitated. We believe that we in the United States need to understand better the dimensions of the addiction problem—its chronicity and multi‐causation. We must stop thinking of simplistic overall solutions and setting up unrealistic demands for immediate total abstinence for every addict which is frequently beyond the capacity of most and based on a misconception of the nature of addiction. By insisting on this, we reinforce the addict's feelings of hopelessness and further involve him in the “addiction system”. A typology, further, needs to be developed which can encompass various discrete categories of addicts. Eventually it should be possible to develop suitable criteria for screening and treatment so that given addicts can be directed to the program best suited to help them resolve their particular problems of living. Résumé Dans cet article nous allons discuter ce que nous considérons comme les trois des plus prometteurs rapprochements au problème de l'intoxication avec des narcotiques. Ce n'est pas une coincidence que nous avons déjà expérimenté ces modalités de traitement: (1) l'utilisation de l'autorité rationnelle, (2) cyclazocine, antagoniste de narcotiques qui bloque les effets de l'heroine et d'autres opiacés; et (3) le traitement d'entretien avec methadone, ça veut dire traitement des intoxiqués avec methadone comme substitut de la drogue narcotique. En considérant la possibilité d'appliquer ces modalités de traitement en Angleterre, nous devons avoir en vue la situation spécifique Anglaise; l'environnement socio‐culturel différent, la manière beaucoup plus tolérante de traiter les adonnés, le manque de contrainte ou punition, et la rélative purité des narcotiques disponibles. zusammenfassung In dieser Abhandlung werden wir besprechen, was wir als die drei vielversprechendsten Annäherungen an das Problem der Rauschgiftsucht erachten. Es ist kein Zufall, dass diese Behandlungsarten, mit welchen wir direkte Erfahrung hatten, sind: Die Verwendung von (1) vernünftiger Autorität; (2) Cyclazocin, ein gegen Rauschgift antagonistisch wirkender Stoff, der die Effekte von Heroin und anderen Opiaten blockiert; und (3) Methadon‐Behandlung, d.h. die Rauschgiftsüchtigen einer Ersatznarkotischen Drogenbehandlung mit Methadon zu unterziehen. In Erwägung der Relevanz dieser Behandlungsarten auf England werden wir die spezifisch englische Situation im Sinne halten müssen: die verschiedenartige, sozial‐kulturelle Umgebung, die weitaus zulässigere Art in der Behandlung von Rauschgiftsüchtigen, das Nichtvorhandensein von Zwangsbedingungen, Beschränkung oder strafweisen Vorgehen und die relative Unvermischtheit der zugänglichen Rauschgifte.