To the memory of FRANCIS E. CAMPS

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1 Drug Dependence

2 To the memory of FRANCIS E. CAMPS Late Professor of Forensic Medicine, the London Hospital Medical College; Ex-President, Society for the Study of Addiction; First Chairman, Medical Council on Alcoholism; First President, Association for the Prevention of Addiction A source of inspiration and a pioneer of scientific research in the field of dependency as well as in legal medicine

3 Drug Dependence Current Problems and Issues Edited by M. M. Glatt Consultant Psychiatrist and Member of WHO Expert Advisory Panel, Drug Dependence MTP

4 Published in the UK by MTP Press Limited, St. Leonard's House, Lancaster, England Copyright 1977 MTP Press Limited Softcover reprint of the hardcover 1 st edition 1977 No part of this book may be reproduced, in any form, without the permission from the publishers, except for the quotation of brief passages for the purposes of review. ISBN -13: DOl: / e-isbn-13:

5 Contents LIST OF CONTRIBUTORS vii INTRODUCTION PART I: NATURE, AETIOLOGY, EPIDEMIOLOGY 31 ALCOHOL AND DRUG MISUSE TREATMENT: PROBLEMS AND ISSUES S. Einstein 33 2 THE NATURE OF ADDICTION 69 N. Bejerot 3 VICIOUS CIRCLES IN ALCOHOLISM AND DRUG DEPENDENCE 97 W. K. van Dijk 4 THE EPIDEMIOLOGY OF DRUG ABUSE AND DRUG ABUSE REHABILITATION D. Louria THE INTERACTION BETWEEN ALCOHOL AND OTHER FORMS OF DRUG TAKING E. B. Ritson and M. A. Plant 119 P ART II: MEDICAL COMPLICATIONS 6 THE MEDICAL COMPLICATIONS OF DRUG ABUSE D. Louria

6 VI Contents PART III: TREATMENT 7 PSYCHOTHERAPY OF DRUG DEPENDENTS AND ALCOHOLICS 169 R. Battegay 8 NEW AND INNOVATIVE TECHNIQUES IN THE TREATMENT OF DRUG ABUSE P. G. Bourne A THERAPEUTIC COMMUNITY FOR DEPENDENT INDIVIDUALS ('ADDICTS') IN PRISON M. M. Glatt 223 P ART IV: PREVENTION SOCIAL POLICY AND THE PREVENTION OF DRUG ABUSE: PERSPECTIVE ON THE UNIMODAL APPROACH R. G. Smart II AN ENFORCEMENT-PREVENTION PERSPECTIVE ON DRUG ABUSE J. H. Langer 281 PART V: THE LABORATORY'S CONTRIBUTION DETECTION AND MEASUREMENT OF DRUGS IN BIOLOGICAL FLUIDS: THEIR RELEVANCE TO THE PROBLEM OF DRUG ABUSE V. Marks and D. E. Fry 295 INDEX 329

7 List of Contributors R. Battegay, MD Professor Ordinarius of Psychiatry of the Medical Faculty at the University of Basel, Psychiatric Unil1ersity Out-Patient Clinic Petersgraben 1, CH-4051 Basel, Switzerland Nils Bejerot Socialmedicinska Institutionen, Karolinska Institutet, Industrivagen 13, Stockholm 60, Sweden Peter G. Bourne Special Assistant to the President for Health Issues, The White House, Washington, D.C , USA. w. K. van Dijk, MD Professor of Psychiatry, Psychiatrische Kliniek; State Croningen, Oostersingel 59, Croningen, The Netherlands University of Stanley Einstein Executive Director, Institute for the Study of Drug Addiction, 680 West End Avenue, New York, NY , USA; Director, Jerusalem Centre for Drug Misuse Intervention, Jerusalem; Associate Professor, Department of Criminology, Barilan University, Ramat Can, Israel. Denys E. Fry, DE, BSc Epsom Hospital Laboratories at West Park Hospital, Horton Lane, Epsom, Surrey, England Max M. Glatt, MD, FRCP, FRC Psych, DPM Consultant-in-Charge, Alcoholism and Drug Dependence Unit, St. Bernard's Hospital, Southall, Middlesex, England; Hon. Consultant, Department of Psychological Medicine, University College Hospital; Hon. Senior Lecturer, Medical School, University College Hospital, London. John H. Langer, PhB, MA, EdD Chief, Preventive Programs Section, Office of Public Affairs, Drug Enforcement Administration, US Department of Justice, Washington DC, USA

8 Vlll List of contributors Donald B. Louria, MD Professor and Chairman, Department of Preventive Medicine and Community Health, New Jersey Medical School, College of Medicine and Dentistry of New Jersey, 100 Bergen Street, Newark, New Jersey 07102, USA Vincent Marks MA, DM, FRCP Professor of Clinical Biochemistry, Department of Biochemistry, Unillersityof Surrey, Guilclford, Surrey, England Martin A. Plant, BSc, MA, PhD MRC Unit of Epidemiological Studies in Psychiatry, University Department of Psychiatry, Royal Edinburgh Hospital, Morningside Hospital, Edinburgh, Scotland E. Bruce Ritson, MD MRC Psych Consultant Psychiatrist, Department of Psychiatry, University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh, Scotland Reginald G. Smart, MA, PhD Associate Research Director, Department of Evaluation Studies, Addiction Research Foundation, 33 Russell Street, Toronto 4, Ontario, Canada

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