Various procedures in themselves, however, are not to be utterly discredited and condemned. They have performed a function in a transitional stage of education and progress. They can all bring evidence in support of some “cures.” In their origin and inception they represent honest effort, study and original thought. In analysis of them can be seen, in the minds of those who first evolved them, recognition and application of one or another of the basic elements, reactions or facts of addiction-disease. Each generation builds upon and adds to the work of the previous one, discards or adopts according to its more complete knowledge. We are building upon the various procedures of the past just as our successors will build upon our work of the present and will discard or adopt our various instruments and theories.
We are nearing the end of consideration of routinely applied procedures, in all diseases. In addiction we are entering upon a stage of attitude and handling in which there shall be in each case comprehension of intrinsic elements and appreciation of their relative importance, and in which there shall be competent interpretation of symptomatology and competent selection and application of therapeutic measures, placing our efforts on a rational basis and adapting handling and treatment to the needs of the individual.
Our stumbling-block in the past has been that our minds have been too much focused upon the mere use of narcotic drug and upon the stopping of drug use and too little upon the individual we were treating and the mechanism of his disease. We have tended to apply our remedial efforts to narcotic use instead of to narcotic drug addiction-disease.
This may explain the paucity of clinical and scientific information as to addiction-disease coming from the institutions in which these cases are gathered. It seems to be the fact that the narcotic wards of our great charity hospitals and institutions of custody and correction still in great measure proceed with their handling of narcotic addicts on the basis of mental or moral degeneracy or deficiency or weakness of will, or morbid appetite, etc., or apply one or another of the various remedies or combinations of remedies. Their internes and nurses do not seem to graduate with a conception of addiction as a definite physical disease, with clinically significant symptomatology and constant physical reactions and phenomena. That these institutions have after many years given us so little information as to the definite physical symptoms and phenomena which their patients constantly manifest is in large measure the result of attention directed to control of drug use instead of to alleviation of physical addiction-disease. There has been much discussion over various methods of treatment and over measures for the control of patient and of narcotic drug, and there has been insufficient study and analysis of the clinical details of addiction-disease manifestations and their possible therapeutic significance.
There has been of late, however, signs of change in this situation, and in this change lies one of the greatest hopes of solution of the narcotic drug problem. The attitude towards addiction is beginning to follow the trend of modern medicine in getting away from special or routine treatments, and the search for specifics and panaceas, and in aiming at and devoting great effort to the searching out, consideration of, and treatment of fundamental cause and underlying condition. When this method of approach is applied widely to addiction-disease, and the facilities of our great hospitals and institutions of research properly directed to its furtherance, there will come a re-arrangement of conception of opiate addiction. Restraint and custodial care, and psychologic and psychiatric classification will be applied more sparingly. Many worthy sick people will—instead of being refused treatment, or turned back upon their own resources after inadequate treatment—thus adding to the public and private burden of the care of the unfit—be rationally treated as sick people and returned to health and self-supporting competency.
The one great point to be kept in mind is that narcotic addicts are sick; sick of a definite and now demonstrable disease. This disease is variously complicated and widely variable as it occurs in individual patients. Although some individuals, afflicted with this disease, may require custodial or correctional handling—the fundamental physical disease cannot be properly arrested nor handled successfully by mental, moral, sociological or penological methods only. Any toxic, worried, fear-ridden or suffering sick man may show psychological or even psychiatrical manifestations or complications, but observing and attempting to control complications only will not cure basic disease.
Even if it should some day develop that a serum can be produced against the underlying toxins of addiction-disease; and this is not beyond the bounds of possibility; its usefulness and application must remain for the present matters of academic speculation. Other than this possibility, there seems practically no hope of a properly called “specific medication” in narcotic drug addiction-disease. Even with its discovery, it is highly improbable that a routine treatment applicable to all cases could ever be successfully adopted. In the very few disease conditions in which we can properly be said to have “specific” medication, routine handling and treatment of all cases is inadvisable and unsatisfactory.
There is not and probably never will be any specific routine treatment successfully applicable to all cases of any complex and variable disease condition. We shall save much public money, and personal effort and time, and shall save the narcotic addict much suffering and discouragement, and shall add much to human health, competency and happiness when we realize these facts as applied to addiction-disease, and proceed upon them in a spirit of broad humanity and of rational clinical study and remedy of obvious disease symptomatology. Narcotic drug addiction-disease is a definite, and in most cases arrestable disease. It should be widely so regarded and studied and treated.
CHAPTER VI
THE RATIONAL HANDLING OF NARCOTIC DRUG ADDICTION-DISEASE
If anything has been demonstrated conclusively concerning narcotics it is that the methods of the past, legal, administrative, and medical, have not solved the narcotic drug problem, nor controlled the narcotic drug situation, nor been successful in the handling of the narcotic drug addict.