Search for mental health; Narcotics addiction

The Forest Hospital located in displaying the Illinois presents the search for mental help and exploration of the newest advances in psychiatry during this series physicians and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed treatment facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism and adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental help. Your host for this series is Mr. Moore Squire administrators of Forest Hospital. But I know this is my Squire my special guest for today is Dr. Alexander a witch who is a psychiatrist in Cincinnati Ohio in the Department of Psychiatry and Division of Child Psychiatry at the

University of Cincinnati and also a member of the Institute of Psychiatry stance. He's also involved with the central psychiatric unit clinic at the University of Cincinnati. His special interest happens to be narcotics and their addiction doctor which what drove you into this area. Why why did you turn your attention to narcotics. Well my contact with narcotic addicts began in 1964 at which time I was not at Cincinnati at that point and I was a staff psychiatrist at the U.S. Public Health Service hospital in Lexington Kentucky this is the one of the two major federal facilities which provides a rehabilitative services to the narcotic addict who surround Kerry facilities and partly actually. I would guess at least

at the time that I was there up to about 70 percent of the patients at the hospital were federal prisoners. 30 percent or so were volunteers. However their admission rate at the hospital was about reverse of that 70 percent volunteers admitted versus about 30 percent of federal prisoners This means that. The. Majority of the volunteers stayed such a short time that any one point the population was mainly prisoners. This part of your training for training for yourself was it. This one is at this time I was a an officer in the United States Public Health Service and this affiliation was a two year one and as was the case for most of the psychiatrists there. A fulfillment of selective service requirement.

What kinds of therapy are available to the prisoners and the volunteers in Lexington and in economics. Let's pose the first therapy which would be pointed mainly towards the volunteers those that were hooked or dependent on narcotics at the time of admissions was the initial withdrawal. Period withdrawal from the cot X which lasted anywheres for a few days up until a week or two. Then our patients who were shuttled to another section of the hospital were for about three to four weeks they were screened extensively. Given a battery of psychological tests Vocational Aptitude the kinds of assessments all of which helped in the later placement of them within the actual rehabilitative portion of the hospital this is only my professional. Yes it's that testing and so forth is done by

professionals but we have a good deal of help from a nonprofessional of personnel working at the hospital trained but trained but it's the training that I would call in service training. Now are these people who you saw who are narcotic and where they help buy individual therapy by medication by group psychotherapy what kinds of Iman theremin that you have or what do you know he was your technique. Well I think you have to keep in mind that the first of all the population at the Lexington hospital patient population is over 90 percent probably over 95 percent actually. Individuals that are lower class and their social economic background. So we viewed rehabilitation largely a an effort of helping these people not just in terms of their emotional problems but in terms of the fact that.

Most of them were underdeveloped in many of the ordinary skills of living in adapting to society or in specially to the middle class. Values of society. So we spent for example a good deal of time. Well I guess what would be called the occasional rehabilitation. We had a school in the hospital where we concentrated efforts largely on helping a number of people learning how to read and write. And you know reading writing have something to do with it coming in that kind of addict. You mean learning to read and write down. You know what what this is going to work what is the kind of thing that. Why does a person become a narcotic addict you know. And why would you teach him to read and write again. And in the process of curing him. Well these people are very ill equipped for responsible adult living learning how

to live independently on their own. The capacity to read and write for example can be very helpful in getting a number of jobs or many jobs which people have that although they don't require clerical skills do require some capacity to be able to read. Why has any study been done to show that a person who is not able to read and write and therefore And I get along and within the norms of society even at the lower lower class level would turn to narcotics or stealing or anything else that would be anti-social. Not that I'm aware of and I don't would not see the lack of these skills as per se causing addiction however when you have an addiction you have a person who's not only having to contend with his own shall we say the the gap in terms of the social adaptation educational level and so forth

but also trying to overcome the temptation to return to narcotics. Any skill which can aid the patient once he's left the hospital to find out an acceptable self respecting role in society is helpful. Of example these people when they leave the hospital tend largely out of feelings of inadequacy feelings of being out of it in terms of the issue of whether or not they're going to be accepted by ordinary people in society. These feelings are tremendous They tend to congregate together. If you have addicts once they leave the hospital congregate together they're apt to also be congregating in a situation where narcotics are available and the temptation to return to drugs is high we want to get these people out into society into a situation where they're

in contact with people who are making. Had acceptable and successful you know adjustment in life and why did people become addicts. Oh well I think there are a number of factors I think you have to do. Perhaps it's best to look at it in two ways. 1 What are the factors which induce a person initially you know to take narcotics. What starts them. And then secondly what sustains another example. We don't know how many people take narcotics and do so. Over a brief period of time perhaps never become addicted give it up and go on and live an ordinary life. We do know there are good many that can't do that as once they've started and repeated it a number of times they eventually get sucked into the addictive cycle and the whole business of being this

is a sickly I said and you are. I think it would be safe. Let me put it this way I think it lends further understanding to view it as a sickness. It is a sickness especially for lower class addicts it of course has lots of social and cultural overtones to it. How about middle class antics. The middle class addict is somewhat different he's often far better equipped individual usually. This is socio economic and people who are within the five to ten thousand dollar. Income range these are middle class addicts is what we're talking about. And I think that would be a fair statement however. My own experience with middle class addicts probably would also include. Not just income level but also occupational level. For example one of the most common variety of middle class addict is a

physician. Middle class addicts who are physicians won't want to patent aquatics who are physicians. Why do they become addicts. Well I first of all I think they have of course at their disposal narcotics which the ordinary middle class person does not and if they are so inclined to use a chemical as an escape for their attentions or that their anxieties they have this chemical of course more readily at hand. So is the anxiety thing that the person is escaping when he's a narcotic Is that why people who are and I say that why they take medications like this this is one of the determinants and I think it's an important one. I frankly would disagree with people who say that lower class addicts have no anxiety that they are simply a product of their culture they've grown up on the streets and

since so-and-so down the street took at they decided to take it and what not. The rest of us just become anxious right. Those are some people who can afford to take their medications they don't have the gun matches or what's bad about that. What's bad about taking something to yes to overcome anxiety. Well I don't think there's anything bad about it in the sense that you know he uses it as a generality lots of people take tranquilizers. Of course when you start taking narcotics. To diminish anxiety if you run the risk of becoming you know not the master of the anxiety but the victim of a much more serious I narcotic so bad. If a person takes marijuana is this a bad medication or are you saying because he takes it he has to take so much of it. So to overcome the anxiety that it that it now becomes a problem.

Well of course you have to distinguish between marijuana LSD substances you know the sort in the so-called hard narcotics such as heroin morphine allowed it what have you. The latter category are not just habituating in the sense that this is a substance people get in the habit of taking. To give them some sort of pleasure or relief from discomfort. But they're physically addicting. And once a person becomes physically addicted or to using common lingo hooked. Then he is no longer the master of a process but often the victim of it and he must continue to take narcotics in order to avoid the withdrawal sickness. Well then then that person ends up in the psychiatrist's office and therefore in your office what do you do about narcotics. Once you get an addict and it comes to it well. I think the first thing that has to be done is to hospitalized a man. It's

rarely possible to remove a person from narcotics in an outpatient setting. The temptation of the patient himself to get narcotics and to take them to relieve his anxieties is too much for him to withstand without being in a hospital. But there is help available in this process. There is help available in the history of this of this century. Most patients I suppose have been sent to Lexington but nowadays more and more patients are being treated in their hometown areas especially in the larger city areas that have the largest problem. Dr. Wilson let's turn to the middle class because that's the vast majority of the people in our world. I think that they are and how you know we got out. We got a small bottom about 7 percent of the people we're trying to push up and we got a pretty good size top in our country we're trying to keep up there and the middle class is trying to grow.

But these are the people who are who many psychiatrists do with today they're not only dealing with with the with the light and the roots are dealing with the middle class as a very large part of their practice. What kind of sickness do they have that drives them into your practice and interest you in not only the narcotic treatment of these people. I think this is an interesting question and it's interesting because over the years the. Concept of the middle class addict. Run something as follows If he isn't a lower class individual and if he doesn't have a lot of people taking heroin just around the corner down the street in other words he's not growing up in a culture in a mill you know which encourages addiction and yet he still INS up an addict.

Then it is argued that this man must be terribly ill and his psychological conflicts his emotional problems what have you. Must be a very serious ones if it if they were to have led him into narcotic addiction. I think furthermore since there is the fact that the addict himself has so many problems once addicted it's assumed that the problems that led him into this situation must be equally strong now in our studies at Lexington. We begin to take a second look at this concept in a series of 25 middle class or comic attics and incidentally. About 14 of the 25 were physicians and all of the rest I had had at least a college education. Fourteen of the 25 were physicians and all the rest had a college education. That's right.

That's a that's a sort of an upper level sampling of even culture isn't it. Well there's one study that estimates this isn't the detailed statistical analysis but analysis but it estimates that the incidence of addiction among physicians and nurses is up to 100 times that of the general population. So it gives you some idea of the occupational hazard of being a physician having drugs at hand. What kind of came out of a sampling or what were you able to determine about the peculiar things that drove these people to take narcotic beside the fact that it was available to them. Well the surprising finding was that for the most part as a group of these individuals did not manifest have emotional difficulties which were really that much different from what a psychiatrist is used to seeing in his ordinary outpatient private

practice. This isn't to say they weren't sick or that they didn't have emotional difficulties they were surely there but for the most part the nature of these difficulties were run of the mill and representative of the kinds of emotional problems that the middle class sometimes fall into. So why didn't they take aspirins or. What's that favorite medication years ago enters your bounds. Antidepressants and said I present the dramatic lies or what have you. Well now this is a good question we had three patients that had gotten introduced to narcotics because of a philosophic physical illness. In another study of strictly physician Addicks 20 the same number 25 done couple of years ago the number of physical illnesses was I think 10. So this was a more prevalent cause for that sample. We found that in 14 of our addicts who were alcoholics and of course the interesting

thing is if you want to have a habit it's much easier to conceal a narcotics habit than it is the hangover. And. Other intoxicated effects of alcoholism so that lots of these people who want to continue to function the physicians who wanted to continue their practices found it much more. Safe too in terms of being revealed revealing the fact that they had a habit to switch over to drugs. If you got to have a habit that's an easy one to have in terms of concealment. That's a tough thing though to live with us. Yes of course then it's it you have to keep in mind that it's not easier in the long run because these people become addicted and are subject then to a much more serious withdrawal illness if they you know try to stop the other. Initiating mechanisms that we are under is well for

example. I think it was about 5 of our sample. I had no contact with other drug users despite the fact that they were middle class. This provided them not only a source of drugs but also a source of peer approval. Why would you take people who are getting sick. And who are sick. And then are finding some sort of way to get along with their sickness Apparently this is an adjustment then you know if they are taking a medication to lower their anxiety then they're adjusting again and they're functioning well in society where they function by the way are these people functioning in society and iconic functioning adequate in society. Rather using. Well I would say that now you're asking this first of all as an overall statement for all addicts not just middle class. Certainly the lower class in the vigils who have difficulty

functioning adapting. Whether they're addicted or not the addiction generally speaking completely or almost complete disrupts their capacity to adapt and to work and so forth. That doesn't help it not only doesn't help I put it more strongly hurt it hurts. OK now are there any addicts who function better because of narcotics. We're in initial stages do they do it. Yes I would probably I would guess and this is a guess because I remind you I was at the other end of the rainbow I was in the hospital once they had fallen one way or another but my guess would be that when people begin their addiction before they're hooked physically that perhaps their anxieties are relieved they're functioning me. Mark meant but I suspect that the increase in functioning is largely a subjective one that is I don't know that you and I

observing these people would feel that they were doing so much better but they felt as though they were doing better. How do you feel about sinner nine and things like that. The treatment of addicts by their by their own sours in the treatment within the community. Well you've covered a lot in that question when you say treatment within the community and sitting on which is a special example of a group of former addicts somewhat like Alcoholics Anonymous that gather together have a kind of residential area within usually a metropolitan area. I think this is a very effective form of treatment. I haven't personally visited a synagogue though I have talked to people that have you know been a part of the program. Like a lot of programs similar to Scn and on their batting average I would imagine is rather high in terms of keeping people off of narcotics. And those that stay within the program they have a high dropout rate of

people who initially come to the program give it a try perhaps for a short while and leave something up I suspect is important but professional help particularly those people who are who have no other way to go. Do people seek you out who or do you need to go and help in our kind. How does the narcotic come to you. Well in general the narcotic addict does not seek help on his own. The first of all a lower class individual is not used to going to doctors to seeking help of this sort. The middle class person is generally do terribly ashamed of his addiction and for example at Lexington many of the middle class individuals that came came unfortunately at extreme pressure from home it might have been a court it might have been if he was a doctor it might have been his local medical board. But

it often was relatives others interested people in the community. Help is available. Thank you very much Dr. Alexander a witch of Cincinnati Ohio. This is more squire for further information regarding this particular program write to the station or to force hospital displays on the right. You have just heard another in the series the search for a mental health produced by Forest Hospital in this plains Illinois in cooperation with this station. During this series the stations and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility will discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior and marital problems problems of the aged and others will be presented on the search for mental health. The host for this series is Mr. Morris Squire administrator of Forest Hospital.

The search for mental health is produced and directed by Jacques Rogge Amr. This program was distributed by national educational radio. This is the national educational radio network.