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Examination of the report and its appendices reveals one characteristic which should be
borne in mind by individuals who may be interested in narcotics problems. The report
differs from the papers of most scientific and judicial committees in that it is not an
impartial enquiry into a problem, with an assembly of evidence from all sides of a
question. On the contrary, the report is a polemic for a radical revision of the present
methods for handling narcotics addiction in the United States. Such evidence as is
presented consists largely of selected quotations from individuals and from the
literature. The remainder of the report consists of opinions.
The position of the committee may be summarized as follows: If addicts were treated
medically by physicians and if the instances of failed treatment were managed by provision
of narcotic drugs at a minimal cost, the incidence of addiction would decrease and the
illegal traffic in drugs would be priced out of existence. The English experience is cited
as an example of the successful application of this approach. An experimental clinic to
study 100 cases is proposed.
Our first comment on the report and its recommendations deals with the nature of the
criminal addict population. On pages 33-39 of his appendix Judge Ploscowe quotes several
studies which indicate that the United States addict population consists of a very small
proportion of normal individuals; the rest are persons with psychopathic personalities,
inebriates, habitual criminals, and persons with chronic psychoses. Those designated as
normal or psychoneurotic constitute less than 12 per cent.
General psychiatric experience indicates that various psychiatric syndromes which
comprise the vast majority of addicts have in common the fact that they are remarkably
unresponsive to any form of treatment. Irrespective of whether or not they are addicted,
these individuals characteristically get into all kinds of difticulties. When rescued from
one problem they are almost magnetically attracted to another.
My own experience is limited to the treatment of a relatively small number of cases
which I chose because they appear to have exceptionally good personality resources. We
have never had much difficulty in getting these individuals free of narcotics during a
3-week hospitalization. We have applied some new pharmacological devices which are of
assistance in separating addicts from their drugs. After hospitalization we have continued
to see patients and to assist them in such ways as are feasible. It is after
hospitalization that the trouble is likely to start. Almost all of these selected
patients, freed of addiction, have turned or returned to another variety of antisocial
behavior-barbiturate addiction, dexedrine excesses, severe alcoholism, and all kinds of
bouts with the law and with society. rather than remunerative, and so were
not disappointed when they almost never paid their bills. The experience which these
patients indicates, however, that the physician in private practice is not likely to find
that his income will be augmented by treating persons who correspond to the various
psychiatric categories which are characteristic of addicts in the United States. Even when
there is no experience of addiction, patients in these categories tend to be culled out of
private practice, and if they are treated at all, it is within the framework of public
clinics or institutions.
It should be pointed out that in England medicine is socialized, and the physician's
income is not dependent on fees for service. The British physician is not concerned with
the ability of the individual patient to pay. He can treat an indigent addict with the
same office routine as a medical case. Our experience suggests that if the American form
of medical practice is not to be transformed into one of socialized medicine, then the
management of addicts would have to be a public responsibility.
The varieties of psychopathology which are found in the addict population raise several
practical and statistical problems with regard to the experiment with 100 cases which is
proposed by the committee.
If it is hoped that the study will lead to generalizations regarding addicts, then the
experimental population must be a random sample of addicts. This means, according to Dr.
Pescor's figures quoted by the committee, that in the sample of 100 cases there would be
about 4 individuals with normal personalities, 6 with psychoneuroses, 55 with psychopathic
diathesis, 12 with psychopathic personality, 22 inebriates, and 12 psychotics. The study
would certainly be inadequate unless data on the differential prognosis of these
categories were obtained. Except for the psychopaths, the number of cases are much too
small for predictive value. A three- to five-fold increase might be necessary.
The proposed "experiment" lacks the sine qua non of research, a controlgroup.
This would again double the number of cases. Without a control group, carefully equated
with the experimental or treated group, no conclusion of scientific acceptability could be
reached by the study.
It is pertinent to examine what is implied in dollar-cost of the proposed study. It is
suggested that 100 addicts be taken off their drug for 90 days in a hospital. Before,
during, and after their release there would be extensive medical and social studies,
together with considerable psychiatric guidance. The study would have to carry on for at
least 2 years. Our conservative estimates of cost run to a half-million dollars. But if
the study were expanded to the point that real comparisons, predictions, and
generalizations regarding addicts could be made, increased numbers of experimental and
control patients could easily run the cost to several million dollars.
The costs which have been mentioned relate only to the conduct of a
scientifically-valid experiment. An all-out effort to rehabilitate 50,000 addicts would
run into astronomical figures. It may be pertinent to question the wisdom of selecting