Unstable motivation has represented a major problem in the treatment of opioid dependence. Early followup studies at the two Public Health Service Hospitals found that legally coerced treatment, especially when combined with compulsory posthospital care, led to better outcomes than did voluntary treatment. During the years 1967–1973, over 10,000 patients were admitted to the two hospitals under the NARA for evaluation of their suitability for treatment under civil commitment. Over one-third were found not suitable. Followup studies suggested that the outcomes of committed patients were somewhat better than those of voluntary patients. While civil commitment may bring some opioid users into treatment who would not voluntarily enter, it cannot overcome deficits in services, and it cannot insure that patients will participate in treatment.
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References
1.
ConradH. T.1977Psychiatric treatment of narcotic addiction. In MartinW. R. (ed.) Drug Addiction. New York: Springer-Veriag Handbook of Experimental Pharmacology, New Series, Vol. 45:249–278.
2.
CooperJ. R.AltmanF.BrownB. S.CzechowiczD. (eds.) 1983Research on the Treatment of Narcotic Addiction. Treatment Research Monograph Series. Rockville, MD: National Institute on Drug Abuse, Department of Health and Human Services.
3.
DeitchD. A.ZwebenJ. E.1981Synanon: A pioneering response in drug abuse treatment and a signal for caution. In LowinsonJ. H.RuizP.P. (eds.) Substance Abuse: Clinical Problems and Perspectives. New York: Williams and Wilkins.
4.
DesmondD. P.MadduxJ. F.1977The effect of probation on behavior of chronic opioid users. Contemporary Drug Problems6:41–58.
5.
DuvallH. J.LockeB. Z.BrillL.1963Followup study of narcotic drug addicts five years after hospitalization. Pub Health Rep78:185–193.
6.
HarneyM. L.1962Current provisions and practices in the United States of America relating to the commitment of opiate addicts. Bulletin on Narcotics14:11–23.
7.
HubbardR. L.RachaelJ. V.CraddockS. G.CavanaughE. R.1984Treatment outcome prospective study (TOPS): Client characteristics and behaviors before, during, and after treatment. In TimsF. M.LudfordJ. P. (eds.) Drug Abuse Treatment Evaluation: Strategies, Progress, and Prospects. NIDA Research Monograph 51:42–68Rockville, MD: Department of Health and Human Services.
8.
HughesP. H.FloydC. M.NorrisG.SilvaG. E.1970Organizing the therapeutic potential of an addict prisoner community. Int J Addict5:205–223.
9.
HuntG. H.OdoroffM. E.1962Followup study of narcotic drug addicts after hospitalization. Pub Health Rep77:41–54.
10.
JonesM.1953The Therapeutic Community. New York: Basic Books.
11.
KayD. C.1974Civil commitment in the Federal Medical program for opiate addicts. In BrillL.HarmsE. (eds.) Yearbook of Drug Abuse. New York: Behavioral Publications.
12.
KolbL.1939Drug addiction as a public health problem. The Scientific Monthly48:391–400.
13.
KolbL.HimmelsbachC. K.1938Clinical studies of drug addiction III. A critical review of the withdrawal treatments with method of evaluating abstinence syndrome. Pub Health Rep Suppl128.
14.
KolbL.OssenfortW. F.1938The treatment of drug addicts at the Lexington hospital. Southern Medicine31:914–922.
15.
LangenauerB. J.BowdenC. L.1971A followup study of narcotic addicts in the NARA program. Am J Psychiatry128:41–46.
16.
LevineJ.MonroeJ. J.1964Discharge of narcotic addicts against medical advice. Pub Health Rep79:13–18.
17.
LewisJ. M.OsbergJ. W.1958Observations on institutional treatment of character disorders. Am J Orthopsychiatry28:730–744.
18.
LondonR. (ed.) 1972Civil commitment of heroin addicts, a panel discussion. Contemporary Drug Problems1:561–592.
19.
LowryJ. V.1956Hospital treatment of the narcotic addict. Federal Probation20:42–51.
20.
MadduxJ. F.1965Hospital management of the narcotic addict. In WilnerD. M.KassebaumG. G. (eds.) Narcotics: 159–176New York: McGraw-Hill.
21.
MadduxJ. F.1966Treatment of narcotic addiction: Issues and problems. In SellsH. F. (eds.) Rehabilitating the Narcotic Addicts: 11–22Washington, D.C.: U.S. Department of Health, Education, and Welfare.
22.
MadduxJ. F.1978History of the hospital treatment programs, 1935–74. In MartinW. R.IsbellH. (eds.) Drug Addiction and the U.S. Public Health Service:217–250Rockville, MD: U.S. Department of Health, Education, and Welfare.
23.
MadduxJ. F.BerlinerA.BatesW. F.1971Engaging Opioid Addicts in a Continuum of Services. Behavioral Science Monographs. Fort Worth: Texas Christian University Press.
24.
MadduxJ. F.DesmondD. P.1981Careers of Opioid Users. New York: Praeger.
25.
MadduxJ. F.HoppeS. K.CostelloR. M.1986Psychoactive substance use among medical students. Am J. Psychiatry143:187–191.
26.
MandellW.AmselZ.1973Status of Addicts Treated under the NARA Program. Baltimore: School of Hygiene and Public Health, The Johns Hopkins University.
27.
McLellanA. T.1983Patient characteristics associated with outcome. In CooperJ. R.AltmanF.BrownB. S.CzechowiczD. (eds.) Research on the Treatment of Narcotic Addiction. Treatment Research Monograph Series. Rockville, MD: National Institute on Drug Abuse, Department of Health and Human Services.
28.
NewmanR. G.1974Involuntary treatment of drug addiction. In BourneP. G., (eds.) Addiction:113–127New York: Academic Press.
29.
O'DonnellJ. A.1969Narcotic Addicts in Kentucky. Chevy Chase, MD: U.S. Department of Health, Education, and Welfare.
30.
PescorM. J.1943Followup study of treated narcotic drug addicts. Pub Health Rep Suppl170.
31.
President's Advisory Commission on Narcotic and Drug Abuse, Final Report. U.S. Government Printing Office, 1963.
32.
Proceedings White House Conference on Narcotic and Drug Abuse. U.S. Government Printing Office, 1963.
33.
RasorR. W.MadduxJ. F.1966Institutional treatment of narcotic addiction by the U.S. Public Health Service. Health, Education, and Welfare Indicators (March).
34.
SimpsonD. D.SellsS. B., 1982Effectiveness of treatment for drug abuse: An overview of the DARP research program. Advances in Alcohol and Substance Abuse2:7–29.
35.
SimpsonD. D.JoeG. W.LehmanW. E. K.1986Addiction Careers: Summary of Studies Based on the DARP 12-Year Followup. NIDA Treatment Research Report. Washington, D.C.: U.S. Department of Health and Human Services.
36.
StephensR.CottrellE.1972A followup study of 200 narcotic addicts committed for treatment under the Narcotic Addict Rehabilitation Act (NARA). Brit J Addict67:45–53.
37.
StrombergC. D.1982Developments concerning the legal criteria for civil commitment: Who are we looking for? In GrinspoonL., (ed.) Psychiatry 1982 Annual Review:334–350Washington, D.C.: American Psychiatric Press.
38.
SzaszT. S.1972The ethics of addiction. Harper's Magazine244:74–79.
39.
VaillantG. E.1966aA twelve-year followup of New York Addicts: I. The relation of treatment to outcome. Am J Psychiatry122:727–737.
40.
VaillantG. E.1966bThe role of compulsory supervision in the treatment of addiction. Federal Probation30:53–59.
41.
VaillantG. E.1973A 20-year followup of New York addicts. Arch Gen Psychiatry29:237–241.
42.
YablonskyL.DederichC. E.1965Synanon: An analysis of some dimensions of the social structure of an antiaddiction society. In WilnerD. N.KassebaumG. G., (eds.) Narcotics:193–216New York: Graw-Hill.
43.
ZahnM. A.BallJ. C.1972Factors related to cure of opiate addiction among Puerto Rican addicts. Int J Addict7:237–245.
