small social service staff. Following the full course of treatment, the patient usually returns to the community where his addiction developed, back among his old associates, without a job, and sometimes without a suitable place to live. He still has most of his old problems, plus, perhaps a few new ones. For such a person relapse is all too easy. Studies of Lexington and Fort Worth releasees show that as few as one out of ten or twelve has remained off drugs.

The use of methadone and similar easing drugs, special diets, and other medical therapy has long been standard practice at the federal hospitals. But, in many city and county jails into which addicts are put after arrest, the so-called "cold turkey" treatment (cutting off the addicting drug immediately and completely) is still practiced. Such a procedure is considered barbaric and dangerous by many in the medical profession. It involves great suffer

ing for the addict, extreme exhaustion, often physical and mental illness, and, rarely, death.

state and local governments

Some state hospitals for the mentally ill accept narcotic addicts but most of them are so overcrowded, understaffed, and financially impoverished that they can give such patients little help. State prisons and local jails ordinarily provide no special treatment at all. In conjunction with their pioneering in law enforcement, both California and New York have also pioneered in treatment. California has set up medically-oriented treatment centers to which its addicts are sent, voluntarily or under compulsion. The atmosphere is as non-punitive as possible; even an addict who did not willingly enter the center can become an outpatient in little over a year and may be completely discharged following three years of aftercarein this case, supervision to encourage his staying off drugs. Among the patients paroled to their home communities after completion of compulsory treatment, one out of five has remained drug-free for at least two years.

new york's programs

New York's present program, begun in 1962, is operated by the State Department of Mental Hygiene, which has established eight treatment units in state hospitals. The program is wholly voluntary, and uses the civil commitment procedure. Non-criminal addicts may volunteer for treatment,. and those who are arrested and charged with a crime may be permitted by the courts to choose commitment for treatment instead of a criminal conviction and imprisonment. Committed addicts can be held in the program as long as three years; the average stay in the hospital varies from six weeks to several months. There is little or no control over those released from the hospitals to outpatient status, and most of them disregard the requirements that they report regularly to clinics for counseling and therapy. A large percentage of the addicts under arrest choose the short term of imprisonment usually imposed on them in preference to commitment for treatment.

In 1966, New York adopted a law which places responsibility for the care and treatment of the narcotic addict in a Narcotic Control Commission appointed by the Governor. It is no longer a

wholly voluntary program, but follows the California pattern of compulsory commitment, when the courts consider it necessary, and provides for strict control of addicts released from the hospitals to outpatient status. The new law, as it relates to voluntary commitments, becomes effective in April, 1967, and with respect to involuntary commitments in October, 1967.

A small but promising program for addicts paroled from New York state prisons is run by the State Division of Parole. Carefully selected and specially trained parole officers are assigned small caseloads of addicts for strict but helpful supervision and aftercare, including emotional support, counseling, and vocational guidance. After six years of operation, a 37 per cent abstinence rate is claimed for this program.

New York City, which recently appointed a Narcotics Coordinator (a doctor), cooperates in many of the addiction-treatment activities of the state and those supported in part by federal funds. It also has detoxification and treatment facilities of its own in several of the municipal hospitals.

Voluntary as opposed to compulsory treatment at the hands of legal authority is still being debated. On the one hand, it is said that voluntary programs can never work because addicts are not motivated to stay in them when the going gets tough. What's more, only a small portion of the addict population ever volunteer, for it seems that few addicts have sufficient stability and stamina to fight their addiction. On the other hand, opponents of compulsion claim that confinement whether in jail or hospital is something that addicts cannot endure or benefit from. More may go through it, because of its compulsory nature, but that in itself is not likely to give them the drug-fighting urge that they lack. One recent study of addicts in psychiatric hospitals in New York indicated that only 4 per cent of voluntary patients succeeded in staying off drugs, while 67 per cent of the addicts receiving long sentences, with parole, appeared cured.

A major contribution of government to the solution of the problem can be in research. Studies of the physical and other attributes of patients are going on at Lexington and elsewhere under government auspices. Still other tax-supported searches for answers to the question "How?" are being planned for in the proposed

new federal legislation, among other places.

private efforts

While the agencies of government have moved only recently and tentatively toward voluntary commitment and aftercare, the private agencies (some partly supported by public funds) have applied such ideas from the beginning. They, too, have seen considerable growth in numbers and size, although both public and private facilities are still far too few for the need.

Methods being tried differ widely, of course, including notions of just what constitutes aftercare. Where doctors are involved, as in the hospitals and hospital clinics, the tendency is to regard drug abuse as an illness, largely physical, perhaps having to do with body chemistry, and to use chemicals not only to help overcome the hardships of withdrawal but also as a method of treatment. An experimental program at Manhattan General Hospital, New York City, conducted by Dr. Marie Nyswander in collaboration with Dr. Vincent Dole of Rockefeller University, has produced some interesting and hopeful, though preliminary, results.

This experiment has pioneered in using maintenance doses of the synthetic methadone for ambulatory patients addicts not confined to a hospital but free to come and go at will. The drug apparently blocks off their desire for heroin. They also receive social guidance. Out of 101 selected patients, none had been lost by the third year, and 80 were gainfully employed. But they must come in regularly for doses of methadone, with little likelihood of ever being able to give it up, for methadone is itself an addictive drug.

the synanon approach

An entirely different approach is taken by the many non-medical workers, particularly former addicts. Synanon, established by a recovered alcoholic with experience in Alcoholics Anonymous, is the leading example. The basic principle of treatment in a Synanon establishment-there are now five on the West Coast and one in New York City-is "No chemicals!" and a raw facing up to the truth. An entering addict is exposed to the Synanon form of “attack therapy": an understanding but scathing analysis of his weaknesses by other addicts and former addicts. If he can face up to it, work out his emotional problems, and endure the discipline

plus-self-discipline of the group - who themselves have lived they believe he has a

through every aspect of his experience — good chance of staying off drugs.

Synanon, which has been credited with one of the best current success records with narcotic addicts, is now attempting to apply its methods to help persons who are not addicts achieve a productive place in society. They hope that the self-knowledge gained through their methods will lead an individual to a better understanding of his problems and that he can then do what he must to become a better person.

The two Daytop houses on Staten Island, New York, differ from Synanon in several ways- although they are headed by an exSynanon resident. Unlike Synanon, they accept local and federal funds toward their support. While they are run chiefly by former patients, the Daytops have a medical director as well. Like Synanon, however, they believe strongly in "no chemicals," and in facing up to the truth with group support. The Daytops are halfway houses, places where an addict on his way toward cure can make the transition to ordinary living under sympathetic care, with his routine needs taken care of, and without the pressures that an abrupt return to "the street" would entail.

Neighborhood projects in the heart of "the street" - New York's Harlem, particularly offer emotional support, some professional service (medical, psychiatric, and social), and practical aid to addicts who have no other resource. Some are related to the organized "war against poverty." Many are sponsored by church groups, such as that of the East Harlem Protestant Parish, an operation carried on with limited funds in a store-front "clinic" which has distinguished itself by its stubborn persistence for many years against great odds. Other church-backed efforts range from Catholic retreats and Protestant minister-led clinics to Teen Challenge, an evangelist-minded organization that maintains nine. centers in Harlem, Pittsburgh, and elsewhere. The last relies entirely on "prayers and work" to cure the "moral disease" of addiction.

Narcotics Anonymous (patterned after Alcoholics Anonymous) has 29 chapters in most of the large cities and stresses the necessity of admitting illness, surrender to something greater than oneself, followed by action to bring about recovery.