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Treatment Methods Still Primitive

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(Distributed by Copley News Service) (Eighth ot Ten Articlesl "Heroin addiction is one of the worst hurts man has ever invented," says a 40-year-old ex-addict who suffered under its bondage for 25 years. And the chief obstacle to treating the addict is his insatiable desire for heroin - one fix and he forgets the "hurt." "I've always understood why I took'dope," said an exaddict from Chicago: "Because I love dope." Heroin, addicts say, is the ultímate drug in terms of sensual gratification. Just removing an addict I from the supply of heroin is not tantamount to curing his addiction, for he still retains the m e m o r y of heroin's appeal - a memory which somehow overpowers the memory of the suffering that accompanied it. "If you could just remem! ber what it's like to be in those detention centers," said one heroin victim, "to lie there on those dirty blankets from 9 to 6, to suffer attacks from sadistic corrections officers, and to ask yourself, what an I doing here?' and to resolve you'll never come back." But even after 11 years' confinement in a New York state prison, away from the supply of heroin, one man explained how his release merely signaled his return to the slavery of heroin. As soon as he returned to Harlem, "the vultures" - or heroin dealers - descended upon him. Before he knew it, he had exchanged an opportunity for a f ree education at New York University for a frehlf-kilo of heroiiL Some observéis say the only way to escape heroin's slavery is to "grow out" of it. A study by Drs. Lee N. Robins and George B. Murphy suggests that as many as 80 per cent of the addicts who reach t h e i r mid-30s may mature out of their addictions. But other experts point out that these statistics ignore the obvious: Only a s m a 1 1 percentage o f the heroin addicts live that long. These grim statistics, plus the number of addicts, suggest the importance of treatment efforts. Of the 100,000 to 200,000 addicts in New York City alone, only 7,000 are currently enrolled in any treatment program. Many of the addicts in the U.S. have at some time in their "careers" been in prison or in some kind of treatment program. But traditional methods have failed to instill a lasting motivation to "kick" the habit. ' üf thé 'addicts admitted to the U.S. Public Health Service hospitals in Lexington, Ky., and Fort Worth, Tex., 95 per cent return to heroin within six months of their release. "In the 30 years of our existence, we have been primarily used by communities as a central dumping ground for addicts," says Dr. Jimmy D. Hawthorne, deputy chief of the Clinical Research Center at Lexington. The main problem at Lexington is its isolation. "The most effectivel approach to treatment is community based," says Dr. J Hawthorne, who readilyj acknowledges that ' ' t h i sf woüld put us out of bus-l iness." At present, there are twtf major approaches to the treatment of heroin addiction which have demonstrated some success - residential, drug-free therapeutic communities and methadone maintenance programs. Both approaches try to provide a replacement for heroin - in the first case, intense group support; in the latter, a synthetic narcotic. According to the National Institute of Mental Health, there are at least 25 independent residential therapeutic communities for drug addicts in the U.S. today. All of them are basically patterned after Synanon, an 1,100-resident community which began in Cali-, fornia in 1958 as an offshoot of Alcoholics Anonymous. Though each of the communities has its own style and idiosyncracies, a few characteristics seem to be I held in common: 1- An ''open door" or voluntary community. One of the e r e a t e s t strengths, and, in a sense, inherent weaknesses, in therapeutic communities is I that the addict knows he does i not have to stay. One-third of those who enter Synanon leave within 30 days, according to Mrs. Pat Feinsilver, an ex-addict I self who now serves as I t a n t medical director a t I Synanon in Oakland, Calif. But of those addicts who stay, the motiva tion to "kick" heroin seems to be strengthened. 2- A rigid system of punishment and reward. Admission to therapeutic communities is deliberately humiliating - it's something like the entrance requirements for a monastic order minus the lifetime i ment to celibacy. First, the addict has to withdraw from heroin "cold turkey," or without the aid of other drugs. Then he has to agree not to see his family for several weeks. And he has to start at the bottom rung of the community's job ladder. The status system at Phoenix House in New York is e s p e c i a 1 1 y pronounced. Novices start with "dingbat" jobs like cleaning the toilets or washing the dishes. They proceed from dark "cave" rooms to brighter sleeping quarters, from sixman rooms to t w o - m a n rooms, and from the less desirable top bunks to the bóttom ones. House "elders" occupy "Nirvana" on the top floor. Even if a member reaches the top status, he can still be strictly disciplined. At Gateway House in Chicago, several male residents had shaved heads and one girl wore a stocking cap as a sign of punishment; at Phoenix House one young man, who wore a poster board which advertised "I can't be trusted," was demoted to the dish pit for getting into some "stuff" (heroin). 3 - Encounter games for release of anxiety. Three times a week residents get together in groups of 8 to 10 to perform the ritual - the encounter game, which started at Synanon. The purpose is to provide a builtin device for the expression of feelings which used te be submerged with a "fix" oí heroin. Tomorrow: The Quagmire of Drug Abuse Legislation.