H is for joy; Treatment programs, part 1

The following program is produced as a public service feature by the radio division of the Moody Bible Institute of Chicago. With cooperation from the Federal Bureau of Narcotics and Illinois Division of Narcotic Control, we present H is for joy. The physical and psychological dependency of a human upon chemicals produced by a weed. A weed is defined as a plant out of place, a drug addict, a human being out of place. But must he stay there, lost, depended upon the euphoric effect of a chemical?

True he should never have reached this point, but nevertheless he has. Now what does he do? As we see it, he has only two choices, one to continue his off-again, on-again life, or two to seek some sort of cure, some way to strangle the monkey on his back, some way to choke off the shadow of hell that clings to his every move. Cure? Is there such a thing? Some say impossible, others possible but not probable, and a few simply say, yes, there is a cure. We've already mentioned about the topic of cause and effect, prevention and education. Now we enter the highly controversial area of treatment. In the whole of the United States, there are only three medical hospitals that specialize in the treatment of those addicted to narcotics.

Two of these are operated by the Federal Government, Fort Worth, Texas, and Lexington, Kentucky. The third is operated by the City of New York, its Riverside Hospital. Like those at treats, it is alone, separated from the mainstream of life by the currents of the East River that flow around the island on which it rests. There are other factors that separate Riverside from the other hospitals, but before we get to them, here's Dr. Afield Gamsoe whom you've heard before. Dr. Gamsoe is the medical superintendent of Riverside. We ask him if Riverside is really different from Fort Worth or Lexington. Riverside Hospital is unique. It is the only hospital in the United States, and probably in the world, which is evoked to the treatment of the young drug addict. It is operated by the Department of Hospitals of the City of New York, with financial assistance by the state of New York, and it can accept patients who are under 21 years of age and

who are narcotic users if they reside in New York State. It was established in July of 1952 to meet the great increase in drug use among young persons. Up to that time, there had been no special institution. Bellevue and Kings County psychiatric units had accepted young drug addicts during the previous year for detoxification and evaluation, but knowing to their type of organization, they could not keep patients beyond one or two months. It was felt that what was needed was an institution which could give a medically long term period of institutional care, plus follow-up in an aftercare clinic. Accordingly, this hospital was open in July of 1952 since that time. As we see it over 2,000 patients, many of them have been to the hospital a number of times. In fact, we have had actually over 5,000 missions of these 2,000 individuals. Their care is for a period not to exceed three years.

They are received as a commitment from a special court, not as convicted individuals, but for public health reasons. The public health law has provision that interested parents or guardians can petition the court requesting treatment for their young child or person whom they are interested in. After hearing, they judge orders them into the hospital and they can always refer to this as hospital treatment. It would not be held against them for criminal purposes or as something which they have to be worried about and seek a job later. Later, after the monkey on his back is dead, but how was it killed? How was the overpowering desire for narcotic strangled so that the addict desires to live a more normal life?

Or is that monkey still there? There's a point of beginning to everything. In the treatment of youthful addicts at Riverside, there's a program, a process, an evolution toward a goal. The goal of freedom from drugs, a normal life. Dr. Gamso explains the process of admission to Riverside and the program that follows. The young drug addict appears first at the court where the parent or guardian signs petition requesting treatment after a brief hearing. The judge signs the order or any of the person into the hospital. They arrive there the same day and receive immediate attention. For the purpose of being able to maintain a drug-free environment and continue the hospital program in the best circumstances, all patients have to be searched on admission. It is a non-fact that many persons, even though they certainly want to go off drugs, will never let us attempt to bring drugs with them.

Patients where they come to us may be in acute withdrawal, not having had any narcotics for the past 10, 12 or more hours. On the other hand, some have had drugs needed before they came to us, knowing that they would not get enough. They came to the hospital in the form of their most interest in receiving it, namely as heroin. After the search, they are placed on a medical ward where they will be observed to determine where they need medication immediately. The medication which we use is methadone. This is synthetic narcotic. It too is addicting a few of the long pairs of time, however, in the method used at the hospital, we are able to take the person off their narcotics within a week. And they are able then to maintain themselves without further narcotic medication, although for a few days beyond that, they may need to set it to help them sleep at night, since they are still somewhat irritable and somewhat restless.

When the medical phase of the withdrawal is completed, the psychiatric phase of care and treatment begins, namely, the evaluation by the psychiatric staff, including psychological testing, interviews of the patient and the parents by the psychiatric social worker, aptitude testing, and, of course, psychiatric evaluation by the psychiatrist. This with other observations enables the staff to maintain knowledge about the patient's potential, about their personality and about their motivation. So at the end of one month, the conference was held at which more definitive programs outlined for further care of the patient, these definitive programs include school from nine to three, work program, which may be used in conjunction with the school, or as an alternative to the school, therapy on the part of one of the professional persons, for a few individuals that may be intensive psychotherapy by the psychiatrist or psychologist, for other patients that may be case-worked by the social worker or by the vocational

counselor, and in some case, be the supervision by other staff members. One of the three o'clock period comes, as school closes, the recreation staff maintains the program activities from then until nine o'clock the evening, also on Saturday, Sundays, and holidays. The patients return to the ward at nine p.m., at which time the ward personnel of the nursing supervision are responsible for their continued care until the next morning. Is there any specific length of time during which you have jurisdiction over these patients? The New York State Public Health Law provides, as the judge may order the hospital into the hospital for a period not to exceed three years. This may be terminated at any time at the discretion of the hospital, however our practice is to retain jurisdiction over the patients the entire three a period. There is a period of hospital care and patient care, in most cases, about six months following which the transfer to clinic supervision, and the same patient, too, to get them in the

hospital. We'll see them in the evening clinic, which is meeting in Manhattan at this clinic. They will have weekly appointments and a template made to assist them by a further supervision, casting guidance, help in trying to plan their work situation, use their leisure time, the involvement of other community agencies for the patient and for the family, and whatever ways we can to sustain them, try to help them refrain from returning to drug use. They can't return to the hospital since they are still under the hospital's jurisdiction and syndicated before, and I said that we had 5,000 missions, experience is that they will average about two and a half admissions for each patient, this varies anyway from just one admission for an individual up to many admissions for others. What is the average length of time that a person would stay here in any single admission? Well, this will vary greatly. In some cases, it may be as little as one month, and our policy at the present time is that

for all first admissions, you'll stay a minimum of six months, however we have had some patients who stay a year and a half, they are rare but they have a card. If a person stays that long, there are many reasons why this might be. They might be making intensive, maybe receiving intensive psychotherapy, which couldn't be given as intensively on the outside, possibly the home environment is so poor that they would not say to let them go out of the hospital at this time, and the reasons for a continued care of that length of time are varied, but in most cases, the stay would vary between six to eight months. What is the youngest age of persons who are admitted here? You mentioned it under 21, what is your youngest age? We have, in the course of the seven years of in operation, received about five persons under 14 years of age. The average age of admission is 18, usually patients come to us about two years after they

start using drugs, although that may vary anywhere from three months to six years. The average age of starting to use drugs upon our patients has been little under 16 years of age. What is your capacity here in terms of number? Our rate of bed capacity is 140. We usually have more than that in the way of patients, and there is a continuous need for inpatient services as it happens. We are able to accept all the individuals who apply to us. This doesn't mean that we treat all the addicts in the city because many people don't apply for treatment. As we know, even though it's a con, the average comes two years after they start using drugs. And as probably many others never do reach us either because they are sent to jail or because they manage to avoid detection and therefore do not feel the urgency of coming in for some treatment.

No desire for treatment. No desire to lead a normal life. What does this indicate? To us, it shows the addict, even though he can be taken off drugs physically, can never make a go of it in a day-to-day existence with the pushing, shoving world. He's not ready. He's still seeking an escape from the reality of an uncaring world. As Dr. Gamso said, he has not felt the urgency of his illness. But in reality, how can a society create within an individual a sense of urgency about his own personal fate if the society itself continues to escape from reality in ways other than addiction? If society cannot teach itself the importance of proper values, how then can that same society hope to teach an addict that age is not for joy? Construction by Bill Oberg, this is Ted Seely speaking.

The preceding tape-recorded program was made available to this station by the National Association of Educational Broadcasters. This is the N-A-E-B radio network.