Wallace RehabilitationDrugAddict 1931

The Rehabilitation of the Drug Addict
Author(s): George B. Wallace

Source: The Journal of Educational Sociology, Vol. 4, No. 6, Narcotic Education (Feb., 1931),
pp. 347-357
Published by: American Sociological Association
Stable URL: https://www.jstor.org/stable/2961616
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THE REHABILITATION OF THE DRUG ADDICT
GEORGE B. WALLACE
The intensive experimental and clinical studies on drug

addiction which have been made in recent years have estab-
lished a number of facts of fundamental importance. In
addition, they have had an effect in defining more clearly
the directions which attempts to solve the problem of
addiction may profitably take. In the past, knowledge on
the subject has been uncoordinated and largely empirical.
At present facts brought out by the more exact methods
of statistics, experimentation, and by thorough clinical
study are available and are brought together as coordi-
natedc parts of a whole. There are indeed innumerable
gaps remaining, but on the whole it may be said with some
confidence that the problem of drug addiction is better
understood than that of any other one of comparable na-
ture and importance.
In the carefully planned and carried-out studies made
at the Philadelphia General Hospital, and repeated in part
at Bellevue Hospital, it was shown that continued taking
of opium or any of its derivatives resulted in no measurable
organic damage. The addict, when not deprived of his
opium, showed no abnormal behavior which distinguished
him from a nonaddict. Further, the most careful exam-
ination of his body functions failed to show any damage
which could be directly attributed to the narcotics. In
animal experiments, which allow of complete control of all
steps, it has also been demonstrated that morphine addic-
tion is not accompanied by organic damage. The experi-
ments, which are supplementary to the clinical studies, are of
importance in that the animals used were studied not only
during the addiction period but in the pre- and post-periods
as well. These studies, carried out independently and agree-
ing in conclusions, are very convincing and, contrary to
347
348 The Journal of Educational Sociology
older beliefs, establish that an addict is not an irrevocably
diseased person.
The clinical studies have further thrown more light on
the mental make-up of the drug addict. This is a phase
of the problem much more difficult of approach, and for
which methods for accurate measurements have not been
developed. In both the Philadelphia and New York
studies, the addicts under observation belonged to the lower
social order and in fact many had criminal records. It was
found that about half of the entire number could be classed
as constitutionally psychopathic types. This term should
not be confused with the term insanity, in the sense in
which this latter is commonly used. It includes a complex
mental make-up which prevents a reasonable adjustment
to surrounding conditions. That basic changes in charac-
ter occur during addiction was not established. The traits
of lying, irritability, unscrupulousness, cowardice, disregard
for others, and a lowering of the whole moral tone which
characterize the behavior of the addict have long been
recognized. It is not improbable, however, that these are
all in a way part of a long existent defense mechanism.
Since the addict can never be assured of the continuity of
his drug supply, and, further, since there is a dread of the
knowledge of his habit becoming spread, he adopts any
method available to forestall these calamities. Whether
a group of addicts in better worldly circumstances and of a
higher social order would contain a proportionate number
of psychopaths is unknown. It is quite probable, however,
that such would be the case. In any event, the fact that
so many drug addicts are of this abnormal type emphasizes
the difficulties in any rehabilitation plan.
In practically all studies on drug addicts, efforts are
made to determine the reason for the starting of the ad-
diction. The results are sometimes given a statistical sig-
nificance. While they are not sufficiently dependable for
this, they still afford useful information. In general, it
has been found that the addiction began in one of two
The Rehabilitation of the Drug Addict 349
ways: first, through association with other addicts and,
second, through the drug's being given by a physician in
treatment of disease. In the latter instance, if the disease
is of some duration and the narcotic administration con-
tinued throughout its course, the habit may be firmly estab-
lished; or the knowledge of the great relief afforded by
the drug may prompt the person to make use of it for en-
tirely different conditions, mental as well as physical. The
real distinction from the practical standpoint is that the
individual who has taken the drug only for the purpose of
relieving suffering caused by a continued physical disease
offers a far better chance of complete and permanent cure
than do the others.
The inability of the drug addict to rid himself of his
habit is well known. In the Bellevue Hospital study where
some three hundred addicts were under observation, it
was shown that each addict had undergone at least one
withdrawal treatment. Most of them had undergone sev-
eral such treatments and some had passed through ten or
more withdrawals. But in all of these it was unusual to
find an abstinence period of longer than one year. The many
so-called cures for drug addiction therefore have in them-
selves no permanency of effect. It is indeed hardly sur-
prising that an addict, free for a time of his habit, but
remembering clearly the pleasure and relief the narcotic
affords, returns to its employment when his environment
favors this or when he sees in it a relief from conditions
he feels unable to face.
The facts which have been presented in the preceding
paragraphs have a direct bearing on the problem of re-
habilitation. They offer promise in that narcotic addic-
tion produces no permanent organic damage, and hence
on the physical side no bar to complete recovery. They
are discouraging on the other hand in showing that a very
considerable proportion of drug addicts are, if not actually
psychopathic, at least significantly unstable mentally and
unadapted for suitable adjustment to conditions which they
inevitably must face. It is discouraging also to know that
in spite of a full recognition of the evils of drug addiction
and the best intention to remain free of it, a permanent
riddance of the habit has been in the past the exception
and not the rule. But while these discouraging aspects
emphasize the difficulties confronting any rehabilitation
scheme, they are in no way overwhelming, and there seems
no reason to doubt that a workable plan can be evolved
through which those addicts whose habit is curable may be
brought to a condition of permanent abstinence and those
who are incurable placed in a position where they are no
longer a social burden or menace.
Except for the passing of prohibitory laws there have
been very few organized efforts made for ridding the drug
addict of his habit. In 1919 the New York City Health
Department opened a clinic for the care of drug addicts,
at which over seven thousand were registered. Similar
ones were established at about the same time at Shreve-
port, Louisiana, Los Angeles, and many other cities. At
this time enforcement of the Harrison Act had materially
shut off the ordinary sources of drug supply, and the addict
could obtain his drug only from peddlers at an exorbitant
price. The purpose of the clinics was to supply morphine
at a moderate cost over a period during which efforts were
made to gradually free the addict of his habit. The clinics
seem to have performed a useful service in that in many
instances the addicts, through being regularly and inexpen-
sively supplied with their drugs, were able to work steadily
and maintain their families. In addition they put an end
to drug peddlers. After a rather short existence these
clinics came to an end, either voluntarily or through order
of the Commissioner of Internal Revenue.
Aside from these short-lived clinics, very little of a public
nature has been attempted. New York C'ity established
a colony for inebriates and drug addicts in 1915 at War-
wick, and in 1919 Riverside Hospital was set aside for
those addicts, registered at the Health Department Clinic,
The Rehabilitation of the Drug J1ddict 351
who were in need of hospital treatment. At both places
the chief aim was to carry out a short convalescent treat-
ment.
In the past two or three years, institutional work on
rehabilitation, along well-planned and comprehensive lines,
has been started in Michigan and California. The Cali-
fornia experiment, begun in 1928, will be described later.
The general features of a rehabilitation plan, omitting
for the present details of execution, are as follows: The
addicts would be kept under legal commitment for an inde-
terminate period in an isolated locality. At the outset
there would be a complete withdrawal of the drug of addic-
tion. A comprehensive study of each addict would be made
by which would be determined his physical condition, his
mental make-up, the reasons for beginning addiction, and
his training and fitness for some work affording a liveli-
hood. The defects noted, a therapeutic schedule-mental,
physical, and occupational-would be instituted. When a
satisfactory degree of improvement had resulted, the
addict would be provisionally discharged and a place se-
cured for him through which he would become self-support-
ing and in which any former injurious environmental fac-
tors were absent. He would not, however, be a free agent,
but on parole, which again would be indeterminate. The
parole system would be such that the former addict would
be helped when difficulties in his adjustment arose, and a
return to addiction promptly recognized. If addiction
recurred, he would be returned to the rehabilitation center
and if deemed worth while the whole process would be
repeated.
In the plan outlined, many difficulties may be seen. Its
carrying out necessitates long-continued effort and large
expense, and the ultimate results are by no means certain.
It may indeed be asked whether the attempt is worth while.
In this connection certain considerations may be stated.
There is no accurate estimate of the number of drug addicts
in the United States or in any of its localities. The reason
for this is that an unknown number of addicts obtain their
drug supply from peddlers. Such traffic being illegal, there
is no known method for determining its extent. When the
clinic in New York City was opened, as already stated,
over seven thousand addicts were registered, but it would
not be proper to apply this figure in estimates for other com-
munities in this State nor for the country at large. Re-
liable studies, however, give a national figure of approxi-
mately ninety thousand addicts who obtain their drugs in
a legal manner, that is from pharmacists through physi-
cians' prescriptions. If, in connection with this figure, is
considered the extent of illegal addiction, it seems reason-
able to believe that addiction is present in excess of .1 per
cent of the population.
In the second place, through association and encourage-
ment many addicts introduce drug taking to acquaintances.
Again, the extent to which this occurs cannot be estimated,
but it is considered a definite factor in the etiology of drug
addiction. Removal of the drug addict and his rehabili-
tation does away with this factor.
Finally, an intensive study of drug addicts, carried
through in accordance with the plan would not only give
definite information concerning this particular group, but
would also bring out facts which might have a very general
application. The make-up of the drug addict is probably
not unlike that of the great number of individuals who are
unable to make their own adjustments and receive no real
help in their difficulties. Drug addiction is an expression
of this and comparable to other expressions of unsocial
behavior in those of similar make-up. In spite of the gen-
eral interest in this subject, there is no clear-cut agreement
as to the proper handling of these unfortunates. The
results of the rehabilitation plan should be a real and prac-
tical contribution to the more general problem. It should
also emphasize and strengthen the widespread feeling that
the problem of the adult unfit has its beginning in childhood.
Another matter which should be considered has to do
with the control of the rehabilitation experiment. It may be
accepted that a government assumes responsibility for the
welfare of its people, whether these are fit or unfit. Gov-
ernment control, however, deals commonly with established,
practical procedures and is not given to carrying on by
itself ventures which are experimental in character and
therefore uncertain as to results. What exceptions there
are to this have not always won universal approval. Fur-
ther, in a political system, the appointment of those en-
trusted with carrying out a measure, whose success is as
dependent as this on its personnel, does not usually result
in the selection of those best suited for the purpose. It
would be far better then if the plan were carried out by
some outside organization, with private funds for the pur-
pose, and its own carefully selected groups for planning,
supervision, and management. Government aid, however,
would be essential in the matter of legal commitments and
an enforceable parole system. It might well furnish the
land, and perhaps buildings, required and help in many
other less tangible ways.
If such a plan as the one outlined is considered feasible
in principle, the details must be worked out with great care.
It should be recognized, however, that no rigid rules of
procedure can be laid down, and that such changes as ex-
perience warrants may be made without undue delay.
In selecting a location and arranging suitable quarters
a number of factors have to be considered. From the
standpoint of the convalescent period, of some out-of-door
life for general health improvement, and of complete re-
moval from former environment, a locality away from the
city is essential. With this, there is also less likelihood of
the addicts' obtaining drugs from outside sources and no
greater opportunity for their escape from the institution.
In view of the different types of addicts who would be
gathered, it would seem advisable to have a unit system of
housing rather than large common dormitories. In this
way small and selected groups could be arranged for, which
would make easier the handling and reeducation problems.
Special quarters are desirable for withdrawal treatment.
Of great importance would be proper arrangements for
occupational therapy since this is designed particularly for
the purpose of preparation for positions after discharge.
To an institution of the kind contemplated, there would
come all types and classes of addicts. If State or city aid
were rendered, many of those would be of the type seen in
workhouses. Others would apply, however, who have
never been under police jurisdiction. But in all instances,
there can be no hope of success unless legal commitment is
made. This must obviously be for an indefinite period,
the termination of which rests with the director of the insti-
tute. If after discharge and while on parole, readdiction
occurs, there should be a return to the institution under the
original terms.
It must be emphasized that the success or failure of
the undertaking will depend upon those in direct charge,
and particularly upon the director. The director should
be a physician of sound judgment and experience, with a
broad and sympathetic knowledge of human nature. He
should also have the keenest interest in the problem at
hand, an enthusiasm and perseverance to carry through
work until such time as the results are thoroughly estab-
lished. He would make clear that the institution was not
a prison but a combination of hospital and training school.
While men of the kind described are not commonly met
with, there is little doubt that one could be obtained.
Closely associated with the director in his professional
work should be a second physician, trained in psychological
or psychiatric work. It will be largely through his efforts
that an understanding of the mental make-up of each ad-
dict is obtained, and proper measures for adjustment and
training carried out. There are younger men available
for this work who would welcome its opportunities.
Among other members of the staff would be those hav-
ing charge of the occupational therapy divisions, selected
because of their character and special training, and em-
ployees for the usual routine work. It is quite probable,
as time went on, that many of the positions could be filled
by those who have been inmates of the institution, and
preferred life there to struggles with the outside world.
The procedure in regard to addicts committed to the
institute should be uniform in principle. A withdrawal
treatment can be carried through according to methods
advised by the committee in charge of the Bellevue Hospital
study. After the withdrawal, convalescent treatment is
given for such time as is necessary. During this time an
idea of the mental state and capacity of the addict can be
obtained. The necessary steps are then taken for reeduca-
tion and training. No stated time for this can be given.
In rare cases a few weeks may be sufficient, in others many
months and in some a year or more. Those who have had
experience with drug addicts will agree with the statement
that during this period a fairly sharp differentiation can be
made of curable, incurable, and doubtful cases. The dispo-
sition of those eventually pronounced incurable is not dis-
cussed here, as this is entirely a government problem.
Finally, some description of the parole system may be
given. To be effective there must be provisions for a
legally enforced parole period. Laws passed for this pur-
pose are to be considered a continuation, and therefore a
part of the original commitment laws. The period of
parole, like that of commitment, must by the nature of
things be indefinite, but two years would appear to be a
minimum time.
The parole system in rehabilitation has many aspects.
It is first necessary to create a sentiment in favor of giving
positions to former addicts. The positions available, the
nature of the work, and the environmental factors should
be especially investigated. Knowledge of the addict, of
his make-up, his aptitude, his training, and his own desires,
would be available from the institute records. With these
facts at hand it may be possible intelligently to place the
former addict in a position suitable to his capabilities.
Once placed, his subsequent career for any time desired can
be followed, and help offered when difficulties arise. There
is, of course, a great difference between an ideal and its
practical accomplishment and it would be unreasonable to
expect that these features of the system would be uniformly
successful. The actual facts, however, can be. determined.
To offer real promise of success, it goes without saying
that the parole officer must be an unusual individual. He
must establish a standing with employers, and form and
maintain friendly relations with the addicts. Above all
he should have a deep interest in the problem itself and a
confidence in the possibility of solution.
It is a relatively simple matter to draw up a plan for
rehabilitation. How successfully it may be carried out,
however, is another matter and can be determined only
after the attempt is made and the results become evident.
But that the idea is not Utopian is shown by the fact that
a plan of similar purpose is at present in operation in Cali-
fornia.
In 1927, the California legislature appropriated a sum
of money for the establishment and operation of a colony
for the rehabilitation of drug addicts. A large tract of
land with buildings previously used for State purposes
was set aside for the colony. It is situated outside of
Spadra, a small town in Los Angeles County. The insti-
tution as at present arranged can take care of about one
hundred inmates, who are committed by the superior court
judges for an indeterminate period of from eight months
to two years. The main effort in handling the addicts is
directed towards physical restoration by means of
graded exercises and outdoor farm work, but an indus.
trial building is planned by means of which useful trades
can be taught. There is a legal parole period with active
supervision by the parole officer, who has had no great
difficulty in finding places for those under parole. The
director of the colony is Dr. Thomas F. Joyce, who has
had a large experience with drug addicts in New York
City. He has taken up his work with enthusiasm and faith
in the outcome. While it seems evident that the staff,
equipment, and facilities for the work are far from what
is desirable, nevertheless it is hopeful that such an experi-
ment has been started. Its future course will be watched
with much interest.
It is unfortunate that corrective measures for wide-
spread evils are exercised only when these become notorious
or intolerable. And when measures for relief are proposed,
they usually take the form of prohibitory or punitive legis-
lation. It is hardly believable, however, that this offers
any permanent solutions, or that it is more than a useful
adjunct to broader corrective aims. The aim in a study
of rehabilitation is to determine the peculiar mental states
and the conditions that give rise to this expression of mal-
adjustment, to find out to what extent these may be re-
moved, and to suggest the steps that may be taken for
their prevention. An experiment carried out in accord-
ance with the suggested plan and continued over a period
of five years or more would be almost without precedent.
It would conform to the requirements for any scientific
study; namely, intelligent direction, adequate facilities, con-
trol of its subjects, and recording and evaluation of facts.
Finally, the practical application of the knowledge obtained
would be made clear.

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The Rehabilitation of the Drug Addict

Author(s): George B. Wallace

American Sociological Association is collaborating with JSTOR to digitize, preserve and

The intensive experimental and clinical studies on drug

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