AFTER THE PARTIAL TEST BAN TREATY

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CIA-RDP66B00403R000100180002-8
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RIFPUB
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K
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4
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December 19, 2016
Document Release Date: 
December 29, 2005
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2
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Publication Date: 
May 21, 1964
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OPEN
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For 9 BPA6 f, 000100180pm12;8 the social pressure of groups; and, third, drug therapy. In working with addicts, however, he is sharply limited with respect to the tools he can currently utilize. He can and does use interpersonal relationships on a 1-to-1 basis, but this approach has. in general, failed to produce the desired change in addicts. As for group approaches, the professional in and out of the hospital has seldom learned to harness for reha- bilitative work the social pressures existing in the patient group on the ward and on the street, and in family, friendship, and organizational groups in the neighborhood and in the larger community. In contrast, the addict has been successful in utilizing the ward group and most neighborlriood and community groups in which he participates to support his struggle against change. Even when he is struggling to change, these groups frequently apply pressures which pre- vent his progress. Finally the question arises whether the most potent tool denied the physician is not medically indicated drug therapy. Unlike the situation in mental illness where the doctor may use his discretion in prescribing drugs he considers appropriate, the physician does not, feel legally free to prescribe nar- cotics as he sees fit in the course of medically treating an addict. At the same time that the physician's hands are tied in treating the addict, the addict himself is able to utilize narcotics at will in defensive efforts to maintain his deviance and to resist change. The proscription against flexible drug therapy appears on the surface to be ac- cepted by staff members without question. It is seldom discussed except inferentially. Yet it is such, a basic question that, regard- less of what the answers might be, avoidance of the question is one of the more conspicu- nus features of staff reaction. There is an interesting contrast between the constant imaginative discussion among patients about drug use in addictive behavior and the con- stant avoidance of imaginative discussion among staff members about drug use for therapeutic purposes. Despite the self-imposed restrictions on ex- ploring alternative approaches to treating ad- dicts, staff members have spent considerable time discussing both with patients and at staff meetings questions involving hospital medication. Such matters include metha- done reduction procedures, proper sleeping medication, the effects of certain drugs ad- ministered on the ward, methods of admin- istering drugs (i.e., parenterally or orally), manipulation of staff members by patients to get drugs, and the like. These are almost exclusively discussed as problems of manage- ment rather than of therapy. The closest the staff has come to consider- ing a broader view of the therapeutic use of drugs was in the establishment of a drug clinic in which nonnarcotic drugs were dis- pensed to outpatients. Although this clinic has been discontinued as such, medication of various sorts is sometimes prescribed by team leaders and after-care therapists to those awaiting admission and to outpatients. These procedures have been questioned and changed from time to time and remarks jocularly passed by staff members about doc- tors becoming pushers. The truth of the matter would seem to be that the staff is indeed trying hard to push the hospital, its service, and its various treatment views, but that the community has stacked the cards in favor of the nonmedical pusher on the street. CONCLUSION We have outlined a theoretical continuum for the treatment of narcotic addiction in a community-based program and elaborated some of the difficulties such a program faces from community attitudes patient attitudes and idiosyncrasies, professional attitudes, and legal limitations. How then, can addic- tion as a public health problem be ap- proached under existing knowledge? We must repeat our original statement that, in the light of all these hindrances to thera- peutic progress, the basic approach must be preventive. This does not preclude the simultaneous effort at development of a more successful treatment program for those already addicted, but it does recognize the reality that reshuffling or elaborating upon our present procedures in the manage- ment of this disease may continue to meet with the apparent failure that has charac- terized treatment efforts to such a degree in the past. It must be recognized that the problems presented to the medical profession and, in fact, to our society as a whole by present-day narcotic addiction are essentially problems of social deviation and disorganization.- Since those who are recruited into the ranks of the addict population are young people, mostly adolescents, this deviation can be seen primarily as a problem of youth. It has been found, incidentally, that a certain pro- portion of addicts do give up their use of drugs either with or without medical help, when they grow older-in-their S0's or 40's. We do not know precisely why; perhaps some maturational factor is at work. Our con- cern must be with the prevention of those wasted 20 years or so in the lives of those who succumb to a chronic disease at the age of 15 or 16. A new kind of environmental sanitation is called for. Those things which need to be eliminated from the narcotogenic environ- ment are the breeders of frustration, aliena- tion, rootlessness, and aimlessness. We can- not, unfortunately, isolate the disease-carry- Ing bacillus or in the traditional way immunize the growing child in the environ- ment to prevent his succumbing to addic- tion, but we can effect environmental changes that may provide a kind of psy- chiatric vaccination for those children we know will be exposed to the addiction-carry- ing agents. Two kinds 'of attack through environmental change are indicated: first, a general strengthening of population resist- ance to the disease of drug addiction, and, second, amelioration or elimination of the contributory environmental factors. This brings us to a consideration of those environmental factors that are contributing to the present increase in addiction in the United States. What is there in the struc- ture of our present-day society that drives young people into drug addiction or that makes addiction necessary as a way of life? We have been discussing narcotic-primarily heroin-addiction, but we must not lose sight of the fact that or present-day culture is characterized also by the tremendous problem of addiction to alcohol and that many professionals are concerned about cigarette smoking which is so universal and, in some senses, addictive. Smoking, gam- bling, particularly in the stock market, or Hi-Fi addiction are respectable forms of ad- dictive behavior, but they suggest that the present structure of our society fosters the development of such activities as defenses against its assaults. What is it that makes society so relentless and vindictive in its attitudes toward the narcotic addict as compared with the alco- holic? Actually persons under the influence of alcohol may cause more damage to them- selves and to others than under the influence of narcotic drugs, However, the fact that alcohol is cheaply and legally available, while heroin is not, means that the average drug addict must turn 4r theft,to support his habit. Does this threat to our property have some influence on our attitudes? Does the historical association of opium with Eastern cultures arouse hidden fears and prejudices? Interesting but fruitless as such specula- tion may be, the fact remains that a neces- sary first step in the management of the narcotic addict as a patient is a fundamental change in the classification of his disease. Like other public health problems, addiction must be seen as a civil, not a criminal matter, and the criminal behavior that may result from the addiction must not be confused with the disease itself. With this funda- mental change in approach, there must be a creative and industrious application to narcotic addiction of all that is presently known and applied to other public health problems about epidemiology, laboratory technics, and clinical medical management. It is to be hoped that such an attack on this "communicable disease" will yield some of the success that has resulted in the elimination of other major public health problems. Mr. JAVITS. Mr. President, I pointed out that this question ties directly into the bill which was passed, and which Is now law, providing for community mental health centers.. This has opened a new era in the treatment of the men- tally ill, and, with the fine cooperation of the Senator from Alabama [Mr. HILL], the chairman of our committee, it allows hospital treatment also for narcotics addicts who are mentally ill. AFTER THE PARTIAL TEST BAN TREATY Mr. JAVITS. Mr. President, a very interesting article appeared in the Bul- letin of Atomic Scientists on what fol- lows the test ban treaty and what open- ings It makes for further efforts In the same direction. Though I do not agree with some of the thesis involved in that article, it is nonetheless such a penetrat- ing study that I think it should be made available to Senators. The signing of a partial nuclear test ban treaty by the major powers last year was a notable advance along the road to effective disarmament. The recent agreement between the United States and the Soviet Union to freeze production of nuclear materials marks another step in this direction. However worthwhile these measures are, they should serve as a spur to more intensive efforts for agree- ments that will reduce the dangers to the world of general war. Continuing efforts must be made especially on verifi- cation and veto-free international ma- chinery for inspection of compliance with disarmament agreements and peacekeeping. Ways in which the partial test ban treaty can be followed up are discussed by Bernhard G. Bechhoefer, author of "Postwar Negotiations for Arms Control," who is a consultant on arms control at the Brookings Institution, a research as- sociate at the Johns Hopkins University School of Advanced International Stud- ies, and a former officer in the Depart- ment of State. There are certain aspects of this article with which I do not agree-as for example an effort to establish a modified republic plan in central Europe-but it is as a whole per- ceptive enough to be worth the attention of my colleagues. I ask unanimous consent to have printed in the RECORD the article by Bernhard G. Bechhoefer entitled, "The Test Ban Treaty: Some Further Consid- erations," which appeared in the Bulle- Approved For Release 2006/02/09 : CIA-RDP66B00403R0001001-80002-8 Approved for 66 00100180002-8 196. ' JygP&R? : - ? X 99 The airbase development, involving the purchase of costly equipment in France, was the latest reported effort to attain party with the Moroccans or better. During the fighting last October, the Algerian National People's Army was severely dealt with by the better equipped, better staffed 'Moroccan force, About 110 Soviet-made tanks have come into Algeria from Egypt or Cuba since the frontier crisis. Cuban and Soviet instruc- tors are operating a tank school fvr the Al- gerians at Bebeau, south of Sidi Biel Abbes, in western Algeria. A total' of 8,000 Egyptian technicians, In- structors and other military personnel are In Algeria, according to reliable sources. DRUG ADDICTION AS A HEALTH PROBLEM Mr. JAVITS. Mr. President, for a very long time I. have taken a great' interest in the problem of drug addiction as a health problem and have sponsored pro posed legislation to bring that about in The enactment into law of the Com- munity Mental Health Centers Act of 1963 opens up a new era in the treat- ment of the mentally ill and apportuni- ties for new approaches to the treat- ment of narcotic addiction. This leg- islation is based on the belief that most- mentally ill persons can be treated suc- cessfully in their own commulties and restored to a useful role with their fam- ilies without first being subject to pro- longed custodial hospitalization. At my initiative, provision was made for the community health centers to treat drug addicts who are mentally ill, a problem which is especially concentrated in metropolitan areas. Three