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U. S. TREASURY DEPARTMENT

Henry Morcentuau, JR., Secretary

PUBLIC HEALTH SERVICE

 

LA 2 OF Tuomas Parran, Surgeon General
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4 16 (Cree
A Statistical Analysis of the
Clinical Records of Hospitalized
Drug Addicts

By

oe MICHAEL J. PESCOR

Passed Assistant Surgeon
United States Public Health Service

~-

SUPPLEMENT No. 143
TO THE

PUBLIC HEALTH REPORTS

 

United States Government Printing Office
Washington ; 1938

For sale by the Superintendent of Documents, Washington, D.C. = - = »*« - - = = = = Price 5 cents
UNITED STATES PUBLIC HEALTH SERVICE
THomas Parran, Surgeon General

DIVISION OF SANITARY REPORTS AND STATISTICS

Asst. Surg. Gen. ROBERT OLESEN, Chief of Division

The Pustic Heauttu Reports, first published in 1878 under authority of an
act of Congress of April 29 of that year, is issued weekly by the United States
Public Health Service through the Division of Sanitary Reports and Statistics,
pursuant to the following authority of law: United States Code, title 42, sections
7, 30, 93; title 44, section 220.

It contains (1) current information regarding the prevalence and geographic
distribution of communicable diseases in the United States insofar as data are
obtainable, and of cholera, plague, smallpox, typhus fever, yellow fever, and other
important communicable diseases throughout the world; (2) articles relating to
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regarding sanitation and the conservation of the public health.

The Pustic Hnautu Reports is published primarily for distribution, in accord-
ance with the law, to health officers, members of boards or departments of health,
and other persons directly or indirectly engaged in public health work. Articles
of special interest are issued as reprints or as supplements, in which forms they
are made available for more economical and general distribution.

Requests for and communications regarding the Pustic HpattnH Reports,
reprints, or supplements should be addressed to the Surgeon General, United
States Public Health Service, Washington, D.C. Subscribers should remit direct
to the Superintendent of Documents, Washington, D. C.

IT
A STATISTICAL ANALYSIS OF THE CLINICAL
RECORDS OF HOSPITALIZED DRUG ADDICTS!

By Micuasru J. Pescor, Passed Assistant Surgeon, United States Public Health
Service

~~

This study presents a statistical analysis of the information con-
tained in the clinical records of 1,036 patients admitted for the treat-
ment of narcotic drug addiction to the United States Public Health
Service Hospital, Lexington, Ky., during the fiscal year, July 1, 1936,
to June 30, 1937. The patients undergoing such treatment are
prisoners, who constitute the majority of the admissions, proba-
tioners, and voluntaries. The latter enter the hospital of their own
volition and may leave whenever they please, but are urged to stay
a minimum of 6 months. Probationers must remain until pronounced
cured of drug addiction by the hospital staff, which period usually is 9
months. Prisoners, of course, have definite sentences to serve. One
voluntary patient admitted during the fiscal year was excluded from
the present study because he left the institution before any history
could be obtained. Likewise, two prisoners were excluded because
they were transferred to another institution, together with all their
records.

The data were condensed and transcribed to Hollerith statistical
punch cards for greater ease in tabulation. This procedure also
permits numerous cross tabulations and a variety of statistical treat-
ments. However, the present investigation will be confined to a
general view of the whole field as a preliminary step to more detailed
analyses in the future, if such analyses are warranted. The findings
are clouded to a certain extent by several sources of error, principally
the subjectivity of some of the information. These errors may in-
validate accurate statistical measurements, but probably do not
obscure directional tendencies.

ADDICTION HISTORY

The statistical details of this phase of the investigation will be found
in the appendix. The history of addiction is accorded such promi-
nence that the patient has to repeat it practically every time he comes
into contact with the institutional officials. It is recorded by the
admitting officer, the ward physician, the psychiatrist, the chief
“1 From U.S. Public Health Service Hospital, Lexington, Ky.
2 A STUDY OF DRUG ADDICTS

supervising guardian, and the social service representative. Thus the
patients have ample opportunity to contradict themselves if they are
not careful. In addition, the verified sources of information usually
contain a history of addiction. As a result marked variations fre-
quently occurred even in the patient’s own story as told to different
officials; hence for the purposes of the present study it was frequently
found necessary to judge which history appeared to be the most
accurate.

“am of the first questions asked in obtaining the addiction history

, “When did you start using drugs?” On an average basis, the
answer is, “When I was 27. 53 years old.” In a comparable study of
119 addicts, Kolb (1) computed the average age of onset of addiction
as 29.33 years. However, when he divided his subjects into those who
became addicted prior to the enactment of the Harrison law and those
who became addicted afterward, the average ages of onset were found
to be 28.09 years and 32.9 years, respectively. His study was pub-
lished in 1928. Approximately 80 percent of the present subjects
were addicted after the enactment of the Harrison law. Still, the
average age of the onset of addiction is even lower than Kolb’s pre-
Harrison Act level. A number of factors may be responsible for this
downward trend. Propaganda about the evils of drug addiction not
only spreads a knowledge of its existence, but may backfire, arousing
curiosity in place of dread. Better organization of drug dealers with
more efficient methods of procuring new habitués may be another
factor. Economic unrest and lack of occupational opportunity, with
its attendant discouragement, is still another possibility. Or it may
be simply another manifestation of the increasing sophistication of the
younger generation.

Addiction may occur at any age. One patient in the present group
claimed that he became addicted in utero because his mother used
opium during the period of gestation. Shortly after birth he dis-
played such severe withdrawal symptoms that the attending phy-
sician was forced to prescribe paregoric to alleviate distress. Al-
though unverified, the story is plausible. Similar instances have been
reported (2). Two individuals began using drugs at the age of 11
and one at the age of 12. At the other extreme, five patients became
/ addicted at the age of 60 or over.
~~~ While no age is exempt from drug addiction, there is, nevertheless,
a heavy concentration of cases in the decade 20 to 29 years, more than
half of the patients being victimized during this period. A substan-
tial percentage of adolescents (19 years of age or less) also yielded to
_the-temptation of using drugs. On the other hand, very few indi-
viduals became addicted after the age of 50. Therefore, drug addic-
tion seems to be a greater potential danger to youthful individuals
than to older men. Youth characteristically seeks adventure, excite-
A STUDY OF DRUG ADDICTS 3

ment, new thrills, anything but settling down with one sexual partner
to the hum-drum business of making a living and rearing a family.
Drugs offer new thrills and an escape from uninteresting reality.
Furthermore, drugs act as a balance for those unfortunate individuals
who, after they are cut adrift from parental protection, are unable to
decide upon a career or to carve a niche for themselves in the social
structure. This state of indecision and dissatisfaction is bound to be
reflected in emotional upsets which are relieved, at least temporarily,
by alcohol or drugs. >

All this speculation brings up the next logical question in’ taking a
case history, ‘“Why did you take drugs?”’ The answer to that ques-
tion has been sought for centuries and still remains unanswered.
The best that addicts can offer is a list of superficial reasons or ration-
alizations. For that matter very few authors who have investigated
the problem can offer anything better, although a good many have
tried. Terry and Pellens (2), in their chapter on etiology, quote from
67 different references, beginning with F. E. Oliver in 1871 and ending
with M. A. Slocum in 1925. From the standpoint of origin, Kolb,
who has given the subject considerable thought, classified drug addicts
into two groups, namely, pure dissipators and medically addicted .
individuals, with the latter showing a gradual decline in numbers (1).
The first group used the drug for the euphoric effect and the second
for the analgesic effect. More will be said about his etiological classi-
fication when the psychiatric diagnoses are considered,

The favorite explanation for addiction in the present group was
curiosity and association with undesirable companions. Here we may
ask the question, ‘“‘Why did they seek out stich companions?” Why
such an abnormal curiosity, the satisfaction of which almost inevitably
leads to social disaster? Why do these people get a ‘“‘kick’’ out of
drugs while others do not?

Next in the order of frequency is the use of drugs for the relief of
pain and physical distress. On the face of it this is a more substantial
excuse than mere curiosity. Nevertheless, there are very few indi-
viduals who have an incurable, painful disease necessitating the con-
tinous administration of narcotic drugs. The majority of thera-
peutically addicted individuals find that the drug supplies something
that has been missing in their lives, so that even when the original
physical cause for addiction has been removed and the patients with-
drawn from drugs, they relapse in order to ‘“‘feel normal.’’ Morphine
must do something more for these individuals than simply relieve
pain; otherwise thousands of new addicts would be turned out from
the numerous hospitals throughout the country.

Another frequent rationalization is using “shots” to sober up after
alcoholic sprees or to relieve “hang-overs.” These “shots” are taken
closer and closer together until finally the drug displaces the alcohol
4 A STUDY OF DRUG ADDICTS

and the patient becomes a drug addict. Ostensibly alcoholism is the
eause of drug addiction in these instances, but what precipitated the
alcoholism?

Relief of fatigue and the use of drugs as an antidote for environ-
mental stress and worry were other excuses offered for addiction.
Two professional pool and billiards players explained that they took
drugs to improve their games. One of them stated that a “shot?
made the pockets look as big as “bushel baskets.” One patient took
drugs to remove a speech impediment. Another explained that he
used cocaine sprays to relieve a nasal malady, then took morphine to
counteract the cocaine effect. Still another stated that he worked
in the narcotics division of a drug manufacturing concern. The air
was heavily laden with opium dust, and as a result he became inno-
cently addicted. The story was disproved in a communication
received from the former employers of the patient, which stated that
narcotics were prepared in closed retorts. Three individuals denied
the use of drugs, stating they had told the court they were addicts in
order to get a lighter sentence.

The first drug used by the majority of patients was morphine. Next
in popularity was opium smoking, closely followed by heroin. Only a
small percentage used cocaine first. Several patients started with
marihuana, one with hashish (genuine Indian hemp), two with pan-
topon, one with codeine, and one with dilaudid. The majority of
patients used more than one narcotic drug. However, one-fourth of
the patients used morphine exclusively, 7.4 percent heroin exclusively,
2.7 percent opium exclusively; one patient used pantopon only, one
dilaudid only, and one confined himself to marihuana. Two individ-
uals boasted that they had used or tried every form of narcotic drug.

A trifle more than half of the patients reported morphine as the last
drug used, 43.3 percent gave heroin as the last drug, and only 3 percent
admitted opium smoking as the last drug used. The majority ex-
pressed a preference for morphine, 23.2 percent for heroin, and 6.9
percent for opium smoking. Morphine is, therefore, most likely to be
the first drug used, the drug of choice, and the last drug used. Heroin
is used chiefly when morphine is. unavailable or when it sells cheaper
than morphine. Opium smoking is considered a “gentleman’s habit,”
at least by those who indulge in this form of addiction. It is not as
popular as it used to be because it takes more time and effort to get
the effect and is harder to keep under concealment. In Kolb’s

study (1) morphine was given even greater importance as the drug of

—.addicti he ratio of morphine addicts to heroin addicts was esti-

mated as at least 6 to 1. In the present study the ratio is almost
équal on the basis of the last drug used.

The average period of addiction at the time of admission was com-
puted as 12.5 years, with the heaviest concentration in the 5 to 10
A STUDY OF DRUG ADDICTS 5

year period and the lightest concentration in the 1 year or less interval.
Five patients had been addicted 40 years or more. One patient had
used drugs continuously for 59 years without a single cure, either volun-
tary or involuntary. He had a steady income which enabled him to
buy drugs without resorting to illegal methods for the support of his
habit.

‘The majority of the patients denied any previous voluntary cures
in hospitals or sanatoria. Of those who had had treatment, a high
proportion stayed off drugs less than 1 month after voluntary treat-
ment. Nevertheless, the average for the longest abstinence period
following voluntary treatment is 2.2 years and 2.5 percent of the
patients remained abstinent for 5 years or longer after voluntary cures.
As for compulsory treatments, 58 percent admitted previous “iron”

‘jail-house” cures. These will be considered in more detail under
the antisocial history. In general enforced cures are not as effective
as voluntary cures, almost half the patients relapsing in less than 1
month after release. It bears out the old adage, ‘“He that complies
against his will is of his own opinion still.” The average for the
longest abstinence period following compulsory treatment is 1.8 years.
However, 2.4 percent of the patients remained off drugs for 5 years or
longer after enforced cures. Roughly three-fourths of the patients
admitted previous attempts at cure of one kind or another, 1.8 percent
had 9 or more voluntary cures, but-no compulsory cures, and 1 percent.
admitted 9 or more enforced cures, but no-voluntary treatments.

Relapses are explained on practically the same basis as the initial
addiction. Return to former associates and the effort to recapture the
beginner’s thrill heads-the list of excuses, relief of physical discomfort.
runs second, and alcoholism a close third. A good many claim that
sociéty will not “give them a break,” practically forcing them to return
to underworld friends and inevitable relapse. They accuse the police
of constantly harassing them, setting stool-pigeons on their trail to
entrap them, and in oneral” making life miserable. Blaming the
environment for personal failure is a distinctly human failing. There-
fore, such statements have to be taken with several grains of salt.

According to Kolb (3), the relapse of drug addicts is due to the
original cause for addiction to which has been added the increasing
dependence upon drugs for the relief of any unpleasantness, the force
of habit, and numerous impelling memory associations. The addict
acquires a bundle of conditioned reflexes so that any stimulus formerly
associated with the act of taking drugs will bring on the old desire.
One patient in the present group explained that after a cure he com-
pletely severed his connections with his old environment. . He secured
a good job, made new friends, and in general was making an excellent
social adjustment. After 3 years abstinence, he felt quite secure.
Yet one day he was sitting in a cafe with a friend. An old addict
6 A STUDY OF DRUG ADDICTS

acquaintance happened in. He could not very well ignore the old
acquaintance, and during the exchange of amenities he could not
help but notice that the old friend was “in high,” i. e., under the
influence of a narcotic drug. It did not make any particular impres-
tion on him at the time, but on the evening of the same day he found
himself strolling in the direction of the hotel where his erstwhile
friend was sojourning. Before he realized what he was doing, he
was in his friend’s room taking a ‘“‘shot.”’

Individuals who relapse through the alcoholic route go through
much the same sort of experience. A chance meeting with an old |
friend leads to dropping in at a tavern for a glass of beer. No harm
in one glass of beer. Next there is no harm in two glasses of beer.
Then it is, “Oh well, might as well get drunk just this once.” But
the trouble is that he gets drunk again and eventually takes a “hang-
over shot,’’ thus completing the cycle.

At the least physical or mental distress the first thought is of drugs.
When the monotony of normal existence becomes unbearable, drugs
offer an escape. They did in the past, therefore they can do it now.
The unpleasant features of drug addiction are forgotten. Many
addicts insist that they can not feel normal unless they use drugs.
Still others maintain that physical dependence may be removed, but
mental dependence never. One patient remained abstinent for 3
years, but the desire at the end of those 3 years was just as strong as
ever. Finally he gave up. He compared the situation to a heavy
smoker who has given up smoking. He still wants to smoke even
though he does not indulge. The only difference is that the desire

for drugs is more intense than that for tobacco.

e
ANTISOCIAL RECORD

The statistical details of the delinquency record will be found in
the appendix. The antisocial history is second only to the addiction
history in prominence. It is obtained by several institutional officials.
Verified information is also secured from the Bureau of Investigation,
court records, police blotters, probation offices, social service agencies,
and to a lesser extent from relatives. Major offenses resulting in
penitentiary sentences are not so likely to escape notice, but minor
offenses punishable by fines or jail terms are likely to be overlooked.
Nevertheless, the data are about as reliable as any other in the
clinical records. |

The widespread popular belief that drug addiction is conducive to
the perpetration of violent crimes has been thoroughly discredited
by Kolb (4). His summary and conclusions are worth quoting in full:

All preparations of opium capable of producing addiction inhibit aggressive
impulses and make psychopaths less likely to commit crimes of violence.
A STUDY OF DRUG ADDICTS 7

The inflation of personality produced by large doses of morphine or heroin is
a state of ease, comfort, and freedom from pathological tensions and strivings
brought about by the soothing narcotic properties of opiates on abnormal persons.

Nervously normal addicts are not inflated and psychopathic criminals are less
dangerous when inflated than when in their normal condition.

The inflating properties of heroin are similar to those of morphine.

The heroin hero is a myth.

Both heroin and morphine in large doses change drunken, fighting psychopaths
into sober, cowardly, nonaggressive idlers.

Cocaine up to a certain point makes criminals more efficient as criminals.
Beyond this point it brings on the state of fear or paranoia, during which the
addict might murder a supposed pursuer.

Habitual criminals are psychopaths, and psychopaths are abnormal individuals
who, because of their abnormality, are especially liable to become addicts. Addic-
tion is only an incident in their delinquent careers, and the crimes they commit
are not precipitated by the drugs they take.

The increased addict prison population is due to the rigid enforcement of laws
enacted within the last 10 years and designed to curb the drug evil by making the
possession or handling of narcotics by unauthorized persons a prison offense.

Heroin owes its reputation as a crime producer to the accident of having been
introduced to the underworld addicts in the largest city of the country shortly
before the new narcotic laws forced these addicts on the public attention. Heroin
is the drug of addiction in only one section of the country, along the eastern
seaboard.

In New York City, the center of heroin addiction, the hornicide rate has de-
creased during the past 12 years in the face of an increase in the rate for the
country as a whole, and the rate for 28 representative cities is nearly double that
of New York.

As far as violation of narcotic laws is concerned, drug addiction is
not a major problem in criminology. For instance, in 1935 such
violations accounted for only 0.9 percent of the total number of
arrests on any charge in cities in the United States (5). The recent
focus of attention upon marihuana smokers will probably increase,
to a certain extent, the number of arrests for narcotic law offenses.

In the present study a trifle more than one-seventh of the patients
gave no history of conflicts with the law. These, of course, were vol-
untary patients whose statements could not be verified through the
usual official channels because their status gives them legal protection
against any effort to pry into their personal affairs without consent.
However, a small percentage of voluntaries freely admitted illegal
activities. The average age at which the first encounter with the law
occurred was computed as 28.2 years, with the heaviest concentration
of cases in the decade, 20 to 29 years, closely paralleling the findings
for the onset of addiction. Primary arrests at the age of 55 or over
are uncommon. Slightly less than one-fourth of the patients with
an antisocial history were arrested for the first time at the age of 19
or less. Listed in the order of frequency of occurrence, the reasons
for the first arrest are as follows: Violation of drug laws, grand lar-
ceny, petty larceny, vice (gambling, intoxication, etc.), vagrancy,

76475—388-——2
8 A STUDY OF DRUG ADDICTS

investigation, juvenile delinquency, and crimes against person (as-
sault, hold-up, etc.). Only three individuals attributed their first
arrest to sexual crimes. As for the disposition of the first arrest, dis-
missal of the case heads the list, with penitentiary sentences a very
close second, and jail sentences third. Probation, reformatory sen-
tences, fines, and restitution combined do not equal the frequency of
jail terms.

If the addict is basically a criminal, it is likely that he would
have committed antisocial acts prior to his addiction; yet three-
fourths of the patients had no delinquency record prior to addiction. In
arriving at this finding, arrests without any subsequent punitive action
were not counted, since presumably the patients were not guilty if the
charges were dropped. About one-fourth of the patients admitted
delinquencies, with misdemeanors heading the list, convictions second,
and juvenile offenses third.

A substantial majority of the patients were not antisocial prior to
addiction, but a large number became antisocial after addiction for
two principal reasons: First, with certain exceptions, the possession
of drugs-in itself constitutes a violation of the law. Second, the high
cost of bootleg drugs practically forces individuals of marginal eco-
nomic status to resort to illegal sources of income, usually through the

ale of narcotié¢s or larceny. In the present study almost two-thirds
of the patients with an antisocial history were guilty of violating drug

/laws only. The remainder were found guilty of violating other laws,
such as those covering petty larceny and grand larceny. The bulk of
the patients with an antisocial record were recidivists of one type or
another, a trifle over half having a history of more than one con-
-viction, and almost two-thirds a history of more than one misdemeanor.
One patient admitted 29 jail sentences, two patients 9 or more peni-
tentiary sentences. During the fiscal year 1935-36, 49.4 percent of
the prisoners admitted to all Federal penal and correctional institu-
tions were reported as recidivists (convictions only) (6). In other
words, drug addicts have approximately the same tendency toward
recidivism as other delinquents have ‘so far as convictions are con-
cerned.

The average total time served in various penal institutions was
computed as 3.3 years. This is not an accurate figure, because it had
to be arrived at indirectly. For example, when a man is given a 3-
year sentence, he does not usually serve 3 years. He may go out on
parole in a third of the time or out on conditional release in two-thirds
of the time, depending upon his good behavior. Therefore, when the
dates of admission and release were not given, it was necessary to
estimate the actual time served. Eight patients served a total of 15
yours or more in ‘Previous sentences.
A STUDY OF DRUG ADDICTS 9

Most of the patients in the present study were prisoners received by
transfer from other institutions. A very small percentage were re-
ceived directly from the courts. The actual distribution according to _.
status is as follows: Prisoners, 71.1 percent; voluntaries, 17.7 percent; |
and probationers, 11.2 percent. Included among the total admis- |
sions were 9.8 percent of the patients who had returned for further
treatment, or were sent back for violation of conditional release, pro-
bation, or parole. Of the last three types of patients, 42.6 percent
had not relapsed to the use of drugs, but were returned for failure to
report, minor arrests, or some similar transgressions. Voluntaries
comprised 32.4 percent of the readmissions; conditional release vio-
lators, 36.3 percent; former prisoners, 19.6 percent; parole violators, 7.8
percent; probation violators and former probationers, combined, 3.9
percent. In proportion to their numbers, voluntary patients are the
most likely to return to the institution for further treatment and the
probationers least likely.

The vast majority of the prisoner and probationary patients were
sentenced currently for violation of drug laws, chiefly for selling nar-
cotics unlawfully or purchasing and possessing illegal narcotics. A
very small minority were charged with illegal acts other than viola-
tion of drug laws. The average sentence for the prisoners was com-
puted as 2.4 years. Probationers and voluntaries do not have defi-
nite sentences, as explained in the introduction.

Patients were received from 40 States, the District of Columbia,
and Puerto Rico. The eight States that were not represented in the
study are Delaware, Idaho, Maine, Nevada, New Hampshire, Rhode
Island, South Dakota, and Wyoming. This, of course, does not mean
there are no addicts in these States. For instance, a drug addict from
Rhode Island might be arrested in Boston, hence he would be com-
mitted from Massachusetts.

OTHER PERSONAL DATA

The statistical details on other personal data will be found in the
appendix. Personal histories are obtained chiefly by the psychia-—
trist and the social service representative. Verified information usu-
ally comes from relatives and from extra-mural social service agencies.
Some of the data are fairly reliable, as, for instance, age, race, na-
tivity, and citizenship. Other data, such as sexual adjustment, are
more or less subjective.

Racial distribution in the present group shows nothing of great

_ significance. The proportion of white patients to colored is almost
~~{0 to 1. Other races, including Mexican, Chinese, American Indian,
and Japanese, in the order of frequency, constitute 2.7 percent of the
total subjects. The racial representation as determined in the present
10 A STUDY OF DRUG ADDICTS

study more or less approximates the distribution in the population at
large. For instance, in 1930 Negroes constituted 8.9 percent of the
male population, 18 years of age or over, in the United States (6).
The proportion of colored patients in the group under investigation
was also found to be 8.9: percent. No comparable figures were avail-
able for the other races. More than three-fourths of the subjects
were native born of native parentage. Only 3.6 percent were foreign-
born, in contrast to 11.6 percent in the population at large (6). There-
fore, as far as this investigation is concerned, drug addiction is practi-
cally confined to our native subjects. All States were represented
from the standpoint of nativity except New Mexico, North Dakota,
South Dakota, Utah, and Vermont.

The chronological age of drug users has been extensively studied by a
number of different authors whose findings are summarized by Terry
and Pellens (2). Considerable variations in the reports occur because
of selection of groups on the basis of etiology. Thus, medically
addicted individuals tend to fall into the higher age brackets, whereas
dissipators tend to be the younger individuals. Kolb (1) gives 45.7
years as the average age for his group including all types of addicts.
In the present study the average age upon admission was computed
as 39.1 years and the median as 38.3 years. The median age for all
male offenders admitted to Federal institutions during the fiscal year
1935-36 was 32.8 years (6).

The majority of the patients had religious training in childhood,
but gave up church attendance as adults. This indifference to religion
is understandable. Religious belief is a source of solace and comfort
to the individual who has faith. When he is beset by troubles he can
console himself by the thought of a more enjoyable existence in the
hereafter. The addict, however, finds his solace in drugs. He has
substituted a material opiate for the spiritual solace of religion. If the
situation can be reversed, then religion has a definite place as a
therapeutic approach to drug addiction.

The childhood adjustment was ostensibly normal in more than half

' the cases. The remainder of the subjects displayed such traits as

incorrigibility, truancy, juvenile delinquency, marked shyness, feelings
of inferiority, and similar characteristics. A few individuals had the
distinction of being considered model children. Childhood adjust-
ment probably has an important bearing on the problem of addiction.
Habits are acquired during this period of life which more or less deter-
mine the individual’s career as an adult and the manner in which he
faces his problems. Therefore, the childhood phase of the personal
history should be studied more intensively than cursory routine
examinations permit. A modified psycho-analytic approach would
probably yield the best results.
A STUDY OF DRUG ADDICTS 11

The educational attainments of the patients are more or less com-
parable to the population at large. The average grade completed
is the eighth, but there is a liberal sprinkling of men who had attended
college. The proportion of graduates of professional schools is greater
than the proportion of graduates of liberal arts colleges. The reason
is probably that physicians, pharmacists, and dentists are in closer
proximity to drugs, hence the greater temptation to use narcotics.
A very small percentage of the subjects claimed illiteracy or no
schooling.

The occupational distribution reveals the highest concentration of
cases in the domestic- and personal-service classification, that is,
waiters, porters, and thelike. The smallest number occurs in the semi-
skilled group. The professional individuals are well represented,
especially by physicians. A small percentage of subjects stated that
they had no occupation, relying upon their parents or relatives for
support. About a third of the patients admitted supporting them-
selves and their habits either by illegitimate means entirely or partially.
A small percentage derived their income from gambling and book-
making or other semilegitimate pursuits. Roughly a seventh of the
group gave a history of steady employment with sufficient income
to keep up addiction and a livelihood. A slightly smaller group gave a
history of steady employment with marginal income usually insufficient
to include drugs in the budget. The proportion of nomadic workers
is rather low, contrary to general expectations.
~ The majority of the individuals came from deteriorated sections of
the more densely populated localities of the country, that is, com-

~~. munities of 10,000 or over. Patients received from the rural and

semirural districts generally came from a more favorable physical
environment than their city brethren. Data concerning the type of
community lived in during the developmental period were too inac-
curate to include in this study.

As previously explained, information about sexual adjustment is
chiefly subjective except for whatever verified data is received from
wives who get a one-sided view of the picture. Practically every
addict admitted that drugs curb sexual desires and delay the appear-
ance of an orgasm, but a very small percentage confessed to a complete
loss of sexual drive as a result of using drugs. Only five individuals
frankly admitted homosexuality and eight patients disclosed conflicts
over homosexual leanings. One patient professed that he kept up his
drug addiction chiefly because it suppressed his homosexual desires,
Three patients stated that they had indulged in sexual perversions
with women (cunnilinguism). A shade over two-thirds of the patients
were either married or had been married. Almost half of these
marriages proved uncongenial, were characterized by frequent
"2 A STUDY OF DRUG ADDICTS

quarreling, and usually ended in separation or divorce. The chief
reason advanced for marital failure was dissension over the subject
of addiction to drugs. Incidentally, divorced drug addicts frequently
remarry women who use narcotics. Such marriages are generally
compatible due to the community of interests. Common-law rela~
tionships, especially among colored patients, are probably more com-
mon than indicated. The single men usually seek a casual hetero-
sexual outlet with prostitutes when they feel so inclined.

The tendency toward marital failures among drug addicts has been
studied by Kolb (7), who says:

» Of the 118 married cases, 46, or 39 percent, were divorced or separated and a
few others were temporarily estranged. That some other factor besides addiction
was responsible for the unsatisfactory marital history of these cases is indicated by
the fact that 17 of 19 married professional-men were still living with their wives.
Excluding these from the larger group, 46.5 percent of married cases were separated
or divorced. One of the separated professional men had been an extreme drunkard
and the other was an extreme psychopath. The high percentage of marital
infelicity in the remaining cases was traced to several factors, the most important
of which was the unusual or unreasonable behavior that naturally flowed from the
psychopathic or neurotic character that was the original basis for the addiction of
so many of them. Failure to provide, due to dissipation with drugs, accounted
for some cases, and in a few others sexual weakness, from the same cause, was a
contributing factor. Sexual weakness may have been more important in some of
these cases than was determined but it was learned from addicts in this series
that potency is not completely abolished until the daily dose of heroin or morphine
is 15-30 grains. Desire is reduced by much smaller doses, but considerable
potency remains. One 35-year addict raised ‘10 children. Others addicted for
years had families of average size, and men beyond 60 who had been addicted

_ 20 years or more reported sexual competency.

Practically half of the married patients in the present study had no
children. Reproduction, therefore, averages less than one child per
couple, scarcely enough to insure racial preservation. If there is a
hereditary predisposition to drug addiction, then that trait should
gradually disappear by virtue of this failure to reproduce. Possibly,
as Kolb explains, the paucity of children is another expression of the
loss of sexual drive attendant upon the continued use of narcotics. A
few individuals do have large families. For instance four patients
gave a history of having nine or more children; but even that is not
enough to make up the general deficiency.

Slightly more than a third of the patients gave a history of chronic

alcoholism antedating addiction and recurring during periods of
abstinence from drugs. About 20 percent professed more than a
Sociable interest in gambling. Only 5.5 percent indulged in all forms
of vice to excess, including consorting with prostitutes, drinking, and
gambling. About half the patients professed a tolerance toward vice,
occasionally indulging in all forms. No straight-laced individuals
were discovered among the addicts. One would hardly expect to find
them. .
A STUDY OF DRUG ADDICTS 13

The majority of the patients made an acceptable social adjustment
prior to addiction, but not after addiction. _ A little more than a third
made an unsatisfactory adjustment both before and after addiction.
About a tenth were apparently socially acceptable despite addiction.
Only three patients gave a history of a better adjustment after addic-
tion than before. As a matter of fact most of the alcoholics are
better off on drugs than they are on alcohol. However, society
condones alcoholism and frowns upon drugs, hence these patients incur
social disapproval despite greater industrial efficiency. A little more
than three-fourths of the patients denied any military service. The
majority of those who had such service were World War veterans.
While the war was responsible for some cases of addiction, particularly
those veterans who were shell-shocked or injured, it is not a major
factor in the addiction problem. Only 1.8 percent of the subjects
could rationalize their addiction on the basis of their World War
experiences.

FAMILY HISTORY AND RELATIONSHIPS

The statistical details of this phase of the investigation will be
found in the appendix. Subjective information regarding the family
history is not at all easy to procure. For some reason an individual
may readily admit that he himself is a blackguard, but he will tend
to conceal any detrimental facts about-his family tree. The subjects
frequently referred to themselves as black sheep, but the rest of the
family were all respectable, law-abiding people. Therefore, most of
the data had to be gleaned from verified sources of information, prin-
cipally letters from relatives. The wives of the patients dig up the
scandal they know about their husbands’ families. The mothers
reveal the skeletons in the paternal closet and the fathers disclose the
secrets in the maternal ancestry. Thus it is possible to piece together
a picture of the family tree when several sources of information are
available.

Analysis of the data revealed that 41.7 percent of the individuals
had no history of familial diseases or psychopathic determinants.
Drug addiction occurred in other members of the family in 8.2 percent
of the cases and alcoholism in 19.1 percent. One patient came from
a whole family of addicts. The father, mother, three brothers, and a
sister were all addicted. Familial diseases such as cancer, diabetes,
tuberculosis, and cardiovascular disease appeared in the family
history of 32.4 percent of the subjects. Such a history is frequently
reflected in phobias. For instance, one patient was certain that he
was doomed to a cardiac death because several members of the family
had died of heart disease.

A family history of major nervous and mental disorders such as
epilepsy and insanity was elicited in 8.6 percent of the cases and:
14 A STUDY OF DRUG ADDICTS

minor disorders such as neuroses, mild depressions, and eccentricities
in 9.4 percent of the cases. Five patients had a history of suicide in
the family, three a history of syphilis, and one a history of a prostitute
mother. One patient was the offspring of a family with a history of
addiction, alcoholism, and criminality covering three generations.
In all probability a tainted heredity was present in a much larger
percentage of the patients, if the truth were known.

Kolb (1) found that more than half of his subjects had blood rela-
tives with nervous difficulties, among which he included nervous
disease, psychoses, neuroses, epilepsy, psychopathic personality, and
a strong tendency toward migraine, asthma, or alcoholism. On that
basis the results of the present investigation indicate a somewhat
lower incidence of tainted heredity, 39.3 percent to be exact. Kolb,
however, made a more intensive study of his cases than is possible in
routine hospital examinations. Therefore, his findings are undoubt-
edly nearer the correct figure.

The majority of the patients came from an intact home, but a sub-
stantial minority gave a history of disruption of the home by the
death of one or both parents or’separation of the parents. Only one
patient admitted that he was born out of wedlock and was deserted
by ‘both parents to be reared in an orphanage. In most instances
when the home was disrupted the mother took the sole responsibility
for the rearing of the children. A small percentage were taken care
of by the father only, some were sent to orphanages, a few were
adopted by foster parents, still others were taken care of by older
siblings, and a fairly large number were reared by one true parent and
one step-parent. A small percentage left home before they were
fully grown. Only eight individuals gave a history of remaining at
home and helping to support the family. This is rather unusual con-
sidering that the majority of the parents were in marginal economic
circumstances. It serves to emphasize the lack of responsibility
among addicts even before addiction.

The majority of the patients gave a history of a congenial home
with average discipline; about 40 percent admitted poor discipline in
the home; and 11.3 percent claimed the home environment was un-
congenial. Almost 90 percent had other siblings in the family. More
than three-fourths claimed the family relationships were normal. A
trifle more than one-tenth of the subjects indicated rather loose family
ties. A small percentage gave a history of mother fixation and only
one professed a dislike for his mother. A small.proportion of.patients
expressed a hatred for the father and seven individuals gave a history
of unusual attachment for the father. About a fifth of the patients
who had step-parents expressed antagonism toward them.

The majority of the parents were in marginal economic circum-
stances and a small percentage dependent upon relatives or the gov-
A STUDY OF DRUG ADDICTS 15

ernment for a living. Slightly more than a third were comfortably
situated from an economic standpoint; 1.9 percent were well-to-do,
and only one individual came from a wealthy family.

PAST MEDICAL HISTORY

The statistical details of the past medical history will be found in
the appendix. These data are chiefly subjective, although some veri-
fied information is available from relatives and other sources. How-
ever, there is no particular reason for concealing information about
diseases except perhaps mental abnormalities. No man likes to
admit that he is ‘‘touched in the head.”

According to the present findings, drug addicts are no more likely
to have a history of serious physical disabilities in childhood than a
comparable nonaddict group. The majority of the subjects gave a
history of the usual diseases of childhood, such as measles, mumps,
and chickenpox without any complications or permanent sequellae.
About 3 percent had infectious diseases with sequellae, such as ante-
rior poliomyelitis with residual paralyses; about 5 percent had chronic
illnesses; and about 2 percent gave a history of trauma with perma-
nent sequellae. Only six individuals had no record of illnesses during
childhood.

However, the majority of the subjects gave a history of chronic
illnesses, infectious diseases with sequellae, or serious injuries during
adult years. Almost half of the patients maintained that they had
heart disease, tuberculosis, asthma, kidney trouble, or some equally
chronic ailment. Approximately 10 percent claimed injuries with
permanent sequellae. Six individuals had no record of adult
illnesses.

More than three-fourths of the patients denied any history of
mental disorders. Frank psychoses, chiefly alcoholic, were admitted
by 3.6 percent of the cases. Another 3.4 percent of the subjects ad-
mitted ‘‘nervous breakdowns,” which were too inadequately described
to permit proper classification. About 10 percent gave a history of
neurotic tendencies or definite diagnosis of neurosis. Unquestionably
mental disorders occur much more frequently than indicated by the
present findings. A history of venereal diseases was obtained in well
over half the cases. Gonorrhea was admitted by 53.4 percent of the
patients and syphilis by 25.1 percent. Two individuals had granu-
loma inguinale. No effort was made to determine whether these
infections occurred before or after addiction. Such a study might be
of some interest. A number of patients began using drugs for the
relief of gonorrheal arthritis and a few individuals took drugs to
relieve tabetic pains. ‘Therefore, venereal disease does play a part in
the etiology of addiction.
16 A STUDY OF DRUG ADDICTS

CLINICAL FINDINGS

The statistical details for this phase of the investigation will be
found in the appendix. These data are objective and therefore should
be fairly reliable. Errors of omission are much more likely to occur
than errors of commission. The wide variety of medical diagnoses
made it necesary to condense the medical findings into several major
categories.

The most extraordinary physical finding is that only eight indi-
viduals in the entire group were considered by the dental department
as having a “clean mouth.” A dental condition peculiar to addicts
is a type of caries which causes a solution of the enamel at the gingival
margin of all teeth. A large number of the patients also have a very
septic pyorrhea. According to Dr. James S. Miller, head of the
dental department at the United States Public Health Service Hos-
pital in Lexington, Ky., no adequate explanation has been offered
for the almost universal poor dentition in addicts coming to his
attention. A possible explanation is that narcotic drugs disturb the
calcium and phosphorus metabolism. Another theory is that addicts
tend to neglect their diet, and therefore avitaminosis may account for
the phenomenon. Defective vision was found in almost half the cases;
diseases of the ear, nose, and throat in slightly less than a third;
diseases of the joints, bones, and cartilages in slightly more than a
fourth; circulatory disturbances in approximately a fourth; and
genitourinary diseases in somewhat less than a fourth of the cases.
Other fairly common conditions include gastrointestinal difficulties,
hernias, respiratory diseases, tuberculosis, diseases of the skin, diseases
of the nervous system, diseases of the muscles, benign tumors, and
endocrine disturbances. Secondary anemia is of frequent occurrence,
but primary diseases of the blood are infrequent. A number of sub-
jects gave a history of malaria, and 2.1 percent were found to have
positive blood smears. Congenital abnormalities occurred in only
two subjects.

The blood serology was negative in over three-fourths of the patients.
Spinal fluid findings were positive in 1.1 percent of the total admissions,
negative in 6 percent. Approximately one-fourth of the patients were
found to have clinically active venereal disease, including 18.8 percent
with latent syphilis, 7.7 percent with acute or chronic gonorrhea, two
cases of granuloma inguinale, and one case of heredosyphilis.

Roughly two-thirds of the patients were found to have minor defects
which did not interfere with normal function or ability to perform
manual labor. Slightly more than 10 percent had defects, such as
hernias, which interfered with normal physical exertion but which
could be corrected, and a trifle over 20 percent were definitely handi-
capped by uncorrectable defects or chronic diseases, e. g., loss of a
A STUDY OF DRUG ADDICTS 17

limb in the first instance, tuberculosis in the second. Death occurred
in 14 cases, a rate of 13.5 per 1,000, whereas the death rate for the
general population, including both sexes of-all ages, was 10.9 per 1,000
in 1935 (8). The specific causes of death for the 14 cases were as
follows: Diseases of the heart 7; suicide 3; cholelithiasis 1; cholecystitis
1; intestinal obstruction, post-operative 1; tuberculosis of the respira-
tory system 1. If these causes of death are converted into rates per
100,000 population, the incidence of each fatal disease in the present
sroup far exceeds comparable rates for the population at large (8).

The majority of the patients were given the Army Alpha and Stan-
ford-Binet psychometric tests. The remainder were given the Army
Beta, Pintner-Patterson, Ferguson Form Board, Grace Arthur Point
Scale, and the Otis tests. However, for the sake of uniformity, scores
were all converted to mental ages, the average mental age being com-
puted as 13 years and 8.months. On the basis of 15 years as the aver-
age adult level of intelligence, the present subjects are subnormal.
Kolb (9), in a study of 100 addicts, found that 10 percent of his
subjects had an I. Q. below 70, which was Terman’s line of demarcation
between the normal and feeble-minded individuals, and 80 percent an
I. Q. above 75. Ona comparable basis, approximately 8.7 percent of
the present subjects have an I. Q. below 70, and 83 percent an I. Q.
above 75. This is a rather remarkable disclosure considering the
number of variables involved, different testers, different authors,
different groups in different parts of the country tested at a different
time by various tests. It speaks well for the reliability of psycho-
metric instruments, whether they measure intelligence or not.

The classification of addicts used in the present study is a modifica-
tion of the one advocated by Kolb (10). It consists of six major
categories as follows: |

1. Normal individuals accidentally addicted, i. e., through medica-
tion in the course of illness.

2. Individuals with a psychopathic diathesis, so-called because the
personality defect is uncrystallized. To this group belong care-free
individuals on the look-out for new excitements, sensations, and
pleasures.

3. Psychoneurotics.

4. Psychopathic personalities, i.-e., habitual criminals, sexual
psychopaths, etc.

5. Inebriate personalities, i. e., individuals who become addicted
through the use of drugs as a means of sobering up after alcoholic
sprees.

"6. Psychotics who become addicted as a result of the psychosis as
distinguished from addicts who become psychotic after addiction.

The majority of the patients in the present investigation were
classified as having psychopathic diathesis, 21.9 percent as inebriate
personality, 11.7 percent as psychopathic personality, 6.3 percent as
18 A STUDY OF DRUG ADDICTS

psychoneurotic, 3.8 percent as normal individuals accidentally ad-
dicted, and one case of psychosis responsible for addiction. A number
of individuals were classified as psychotic, but the mental disorder was
not considered as the etiological factor in addiction. These findings
are essentially in agreement with Kolb’s except that he found more
psychoneurotics than psychopaths in his group. In the present study
the situation is reversed.

Those who were diagnosed as psychotic were distributed as follows:
Dementia praecox, 6; paranoid state, 2; simple senile deterioration, 4;
psychosis with cerebral arteriosclerosis, 1; paresis, 1; and involutional
melancholia, 1. One case of senile deterioration developed his drug
habit during his psychosis.

INSTITUTIONAL ADJUSTMENT AND FINAL EVALUATION

The statistical details for this phase of the investigation will be
found in the appendix. The data were all obtained from institutional
sources, chiefly progress notes compiled from reports submitted by
custodial officers, psychiatrists, ward physicians and personnel, and
social service representatives.

In proportion to their numbers the voluntary patients were the least
cooperative of all the subjects, chiefly because of their insistent de-
mands for release against medical advice. A little over 10 percent of
the patients were brought to the attention of the disciplinary board for
violating institutional rules. About 5 percent had to be segregated
for disciplinary reasons and 2.5 percent were recommended for transfer
as detrimental to the station. Less than 1 percent were punished by
deprivation of good time, a form of punishment reserved for flagrant
offenses such as assaulting another patient. Less than half the sub-
jects appeared anxious to be of service and ungrudgingly willing to
abide by regulations. A trifle more than a fourth showed no resent-
ment against the rules and regulations, but did not go out of their way
to be of service.

Very few individuals flatly refused to work, though able. About 5
percent were unable to do any work because of major physical handi-
caps. As a general rule the better the knowledge of the work, the
more industrious is the individual. Less than 10 percent of the patients
were reported as shirkers, about half were described as willing workers,
and approximately a fourth were praised as doing more than they were
asked to do. More than three-fourths of the individuals displayed an
average or a good comprehension of their occupational assignments
and only 6.6 percent were classified as deficient in their knowledge of
the tasks assigned.

The majority of the subjects liked to work with and were accepted
by their fellow patients. Approximately 5 percent were disliked, but
accepted; and 1.9 percent were not accepted at all, necessitating segre-
A STUDY OF DRUG ADDICTS 19

gation from the rest of the group. These were chiefly informers or
“stool pigeons,” as they are called in the vernacular. About 1.9
percent were considered as leaders and looked up to by the rest of the
patients. Another group, comprising 3.4 percent of the subjects, were
accepted by the rest of the patients, but were ridiculed and made fun
of, frequently to the point of precipitating an emotional upset.

Custodial officers estimated that approximately half the individuals
were normal, pleasant, and agreeable; about 15 percent preferred to
keep to themselves and did not have much to say, but were agreeable;
and about 7 percent were very talkative, but sociable and agreeable.
About 8 percent were described as constant complainers and frequent
sick-line (out-patient) visitors; about 5 percent as suspicious and
irritable; 3 percent as “‘queer’’, suggesting insanity ; 2 percent as escape
problems; a trifle less than 2 percent as noisy, talkative, and disagree-
able; less than 1 percent as unsociable, introverted, and disagreeable;
and less than 1 percent as possibly homosexual.

The majority of the subjects stated that they would abstain from
the future use of drugs because they wanted to keep out of prison.
They realize that itis alosing game. All the cards are stacked against
them. Such individuals, however, have no true insight. They still
believe that drugs are beneficial. A small percentage maintained
that drugs were beneficial, but the benefit was outweighed by the loss
of social esteem and the respect of relatives. Only a trifle more than a
fourth of the patients professed that drugs were harmful from every
standpoint.

It is obvious that the effect of a cure is influenced by the type of
plans which the patient is making preparatory to his release. About
half the patients in the present. study planned to live with relatives,
but had no employment in view; 12.4 percent had both a home and a
job to return to; 8.4 percent planned to live with friends while looking
for a job; 7 percent had no home to go to, but expected to get employ-
ment; 4.6 percent had no plans at all; 1 percent had no home to go to,
but did have offer of employment; less than 1 percent expected to
appeal to the Salvation Army or some other charitable agency for help;
and four individuals planned to return to an extremely poor environ-
ment, but had offers of employment.

Approximately 4 percent were transferred to other institutions
either before or after expiration of sentence or period of treatment,
and roughly 12 percent of the patients (voluntaries only) were dis-
charged against medical advice. Two-thirds of the voluntary patients
failed to stay the required length of time for an optimal cure. .Four-
teen patients died.

The prognosis for eventual rehabilitation was considered good or
above the average in 8.6 percent of the cases, average in 41.9 percent,
guarded in 6.5 percent, below the average in 2.4 percent, and poor in
20 - A STUDY OF DRUG ADDICTS

37.1 percent. Only 1.2 percent were considered as hopeless addicts.
Three patients denied addiction, and the prognosis in six cases was
considered as conditioned by specific environmental factors.

As a part of the rehabilitation program, all individuals with active
habits are first withdrawn from narcotic drugs. Following that they
are absorbed into the regular regime of the institution, i. e., are assigned
to quarters, given a work assignment, get three square meals a day,
are provided with entertainment, and so on. All this, of course, is
part of the routine treatment. However, some patients need more
than minimal rehabilitative measures. For instance, 87.2 percent of
the present group received more than the minimal rehabilitative
attention, principally for physical defects. Practically all the patients
were sorely in need of dental attention and had either received it or
were waiting their turn at the time this study was inaugurated.
Slightly under 20 percent received psychiatric attention above the
routine requirements of the hospital. Approximately 10 percent
were given occupational assignments primarily for the purpose of
vocational training.

REMARKS

The present investigation may be likened to an examination of a
section of pathological tissue with the aid of a magnifying glass. It is
better than simply looking at the specimen with the naked eye, but
certainly inferior to a microscopic scrutiny. We may turn a low-
powered microscopic lens on the data by using such statistical tech-
niques as correlations, critical ratios, and the like. This may point
out the sections of the field which deserve a more detailed examination
under a high-powered lens. However, the latter procedure entails a
more careful preparation of the specimen, in the present instance
clinical data. More detailed information is necessary. For example,
it is not enough to know that the patient began using drugs at the age
of 24 through association and curiosity. We must know when he
first heard about drugs. Who told him about drugs? What made
him think he would like to try them? Did some one urge him to take
the fatal step? Was he reluctant or eager? Was he alone or in
company when he took his first dose? Was he depressed or elated
before he took the drug? What were his reactions to the first “shot?”
Did he get sick? When did he realize he was “hooked?” Was he
frightened at the prospect or pleased? An endless stream of similar
questions may be propounded.

Obviously such an intensive study cannot be made routinely; nor
can it be made in one session with the patient. Therefore, a small
representative group should be selected for special attention, the object
being to see the subjects at frequent intervals, daily if possible, using
every trick of the trade to pump them dry of information. Some-
A STUDY OF DRUG ADDICTS — OT

where in the lives of addicts there must be a fork in the road when
they had the choice of going to the left or right. This fork in the road
was probably reached before they even thought of using drugs. If
this crucial point and the factors which influenced the choice of direc-
tion can be uncovered, then we may be in a better position to recom-
mend preventive measures even though we may not be able to do any-
thing for the individuals already addicted.

- However, coming back to the present data it might be profitable to
make at least two comparative studies, namely, the status and the
psychiatric classification of the patients. Statistically significant
differences should be found between the various subgroups. It might
‘also be of interest to analyze the data from the standpoint of prognosis
for eventual rehabilitation, determining, if possible, factors which
influence the prognosis.

SUMMARY

The present investigation consists of a general statistical analysis of
the clinical records of 1,036 drug addicted patients admitted to the
United States Public Health Service Hospital at Lexington, Ky., dur-
ing the fiscal year July 1, 1936, to June 30, 19387.

The easiest way to summarize the findings is to describe a “‘statisti-
cal”? addict composed of averages and highest frequencies. Such a
hybrid individual would be a white male prisoner, 38 years of age,
given a 2-year sentence for the illegal sale of narcotics by a Federal
court. His family history would be positive for such familial diseases
as cardiac disease, tuberculosis, or cancer, and if any psychopathic
determinants existed they would most likely be alcoholism or drug
addiction. His parents would be in marginal economic circumstances,
average disciplinarians, and the family relationships would be con-
genial. The patient would be one of several children, a native of
native parentage, the parental home would be intact up to the age of 18
years, and the childhood adjustment would apparently be normal.
He would be brought up in religious faith, but would discontinue
church affiliations as an adult. He would graduate from the eighth
grade, taking up an occupation classified in the domestic and personal
service. As an adult he would live in a deteriorated metropolitan
section. More than likely he would have to resort to illegal means of
earning the additional income required to support his drug habit.
He would marry, but his marriage would probably terminate in separa-
tion or divorce. He would have no children, possibly because drugs
deprived him of a normal sexual urge. He would probably make a
satisfactory social adjustment prior to addiction, but not after addic-
tion. He would be tolerant toward all forms of vice, occasionally
indulging in all forms. He would not give a history of military
service. |
29, A STUDY OF DRUG ADDICTS

He would become addicted to morphine at the age of 27 through the
influence of associates and curiosity. He would use more than one
narcotic drug, but would prefer morphine when it was obtainable.
The last drug used. would, therefore, most likely be morphine. He
would be addicted about 10 years. He would probably give no
history of voluntary attempts at cure, would admit at least one en-
forced treatment in a jail or penitentiary, but would not remain
abstinent any longer than 2 years at the most, relapsing because of
association and desire to recapture the pleasant sensations produced
by drugs.

His first arrest would occur at the age of 28 for violation of drug
laws for which he would have an equal chance of being acquitted or
sent to the penitentiary. He would not have a delinquency record
prior to addiction. After addiction his offenses would more than
likely be confined to violation of drug laws for which he would be
given at least one penitentiary sentence and at least one jail sentence.
He would probably have spent a total of 3 years behind bars on
previous sentences.

He would give a history of the usual childhood diseases without
complications, but as an adult he would be subject to some chronic
disease such as heart trouble, arthritis, tuberculosis, or asthma. He
would deny any mental disorders, but if he did admit any it would be
a tendency toward neurosis. However, he would readily admit a
history of gonorrhea. Ninety-nine chances to one he would have poor
dentition, either caries or pyorrhea alveolaris; there would be a strong
possibility of defective vision also. However, his physical defects
would not prevent him from doing manual labor. The psychologist
would probably give him the Army Alpha test, which would disclose
that the hypothetical patient had a mental age of 13 years, 8 months.
The psychiatrist would give him a classification of psychopathic
diathesis, which means that the patient has an uncrystallized person-
ality defect and that he became addicted through the desire to seek
new thrills.

During his stay in the institution he would abide by the regulations,
show a good knowledge of his occupational assignment, and would be
a willing worker. He would be accepted by his fellow patients and
would like to work with them. The custodial officers would find him
pleasant and agreeable. As the time for his release approached he
would maintain that he was through with drugs forever because he
did not want to spend the rest of his life in jail, indicating that he still
thought drugs were beneficial, but the penalty outweighed the benefit.
He would plan to live with responsible relatives largely at the in-
sistence of the hospital officials. However, he would have no offer of
employment to look forward to. He would be given an average
A STUDY OF DRUG ADDICTS 23

prognosis for permanent cure, which is a vague way of stating that he
will probably relapse.

ACKNOWLEDGMENT

The author wishes to express his appreciation to Senior Statistician
Selwyn D. Collins for his helpful suggestions in tabulating the data.

(1)
(2)

(3)

(4)
(6)
(6)
(7)
(8)
(9)
(70)

REFERENCES

Kolb, Lawrence: Drug addiction. A study of some medical cases. Arch.
Neurol. and Psychiat., 20: 171-183 (July 1928).

Terry, Charles E., and Pellens, Mildred: The opium problem. The Com-
mittee on Drug Addictions in Collaboration with The Bureau of Social
Hygiene, Inc., 370 Seventh Ave., New York, 1928.

Kolb, Lawrence: Clinical contribution to drug addiction: The struggle for
cure and the conscious reasons for relapse. J. Nerv. and Ment. Dis., 66:
22-43 (July 1927).

Kolb, Lawrence: Drug addiction in its relation to crime. Ment. Hyg., 9:
74-89 (January 1925).

U. 8. Census figures taken from The World Almanac and Book of Facts.

New York World-Telegram, New York, 1987, pp. 281, 248, 247.

Federal Offenders, 1985-36. U.S. Dept. of Justice, Bureau of Prisons, Wash-
ington, D. C., pp. 250, 149.

Kolb, Lawrence: Pleasure and deterioration from narcotic addiction.
Ment. Hyg., 9: 699-724 (October 1925).

Vital Statistics—Special Reports. Dept. of Commerce, Bureau of the
Census, 2: 711 (Aug. 3, 1937).

Kolb, Lawrence: The relation of intelligence to the etiology of drug addic-
tion. Am, J. Psychiat., 5: 163-167 (July 1925).

Kolb, Lawrence: Types and characteristics of drug addicts. Ment. Hyg.,
9: 300-313 (April 1925).
APPENDIX

The following tabulations are based on the clinical records of 1,036 patients
admitted to the United States Public Health Service Hospital, Lexington, Ky.,
during the fiscal year July 1, 1936, to June 30, 1987.

TaBLe 1.—History of addiction

 

 

 

4. Drugs used during addiction:
Morphine only
Morphine and heroin
Opium, morphine, and heroin
Cocaine, morphine, and heroin
Opium and morphine
Heroin only
Cocaine, morphine, opium, and heroin...
Cocaine and morphine
Opium only_..._..----------------------
Opium and heroin... 222222
Cocaine and heroin__._.-.-_------ 2...
Cocaine, opium, and morphine_________-
Other combinations or no record

§. Drug preferred:

Morphine
Heroin

Per- Per-
Data cent- Data cent-
ages ages
1. Age at onset of addiction: 7. Duration of addiction:
19 years or less_.-_.-.----.---.--------- 16.5 1 year or less.__-.--..--.---------------- 4.1
20-24 years..-..-2---.---------.--- eee 28, 1 Over 1 year, under 2_-.----2-.---------- 4.5
25-29 years.__...-....-------------- ee 25.1 Over 2 years, under 3._...-.--..--------- 6.4
30-34 years. _...--.-...--------.------.-- 14, 2 Over 3 years, under 4__...----.---------- 5.3
35-39 years._...--.--.-------- eee 6.9 Over 4 years, under 5...-.----. 2 ee 5.3
40-44 years__...--.--.2-- ene eee 5.4 Over 5 years, under 10_..--.---.--------- 24.7
45-49 years... 0-22 --e-eeee 17 Over 10 years, under 15.__--_--...-------- 15.3
50-54 years.__-..2--_-. 2 --eeeee 8 Over 15 years, under 20._-..--._.--------. 13.7
55-59 years._.-..-.--.------- ae eee rm) Over 20 years, under 25._....-._-----2--- 9.9
60 years or over__..-._--------.----- - .5 Over 25 years...__...--------.------.--- 10.4
No record or no drug used._._....----.-- .3 No record or no drugs used__...-...----. 4
Average age: 27.53 years. Average: 12.5 years.
2. Rationalization for addiction: 8. Number of voluntary cures:
Curiosity and association__......---_-.- 45,8 None.__.-..------ ee nen eee ese 56.4
Therapeutic, for relief of pain or physical Le cia deb ele acne pen ciel ple bn pewegeeetne 15.8
distress..._--.-.-.-.------.-------- eee 31.1 Does cnn ne diene Son eeee renew eeenenowene 7.3
Alcoholism (sobering up after sprees)___.|_ 17.8 en 6. 7.
Environmental stress and worry. -__-._-- 3.2 Ash ssp cb seid 2.3
Relief of fatigue. __...------ eee i - 9 Bone wind hat! dees ode ge cecdtacnee fone 2.5
Accidental (taking patent medicines con- 6. wenn nnn nen nee eee ne ttceneee ewes 1.8
taining narcotic drugs, ete.)..-.-..-..- 7 Von ee ne eee eee 9
Other reasons. _.___-._.-------.--------- 2 8_-8 een een een eee wl
No record or no drug used....-.-.-.--.-- .3 9 or Moré..__-__--.-------------------~--- 3.6
3. Drug first used: No record or no drugs used__--------.--- 2.1
orphine_.__... 2-2 63.1 || 9. Longest time off drugs after voluntary
Opium smoking__..-2-2-22 2-2 eee 14.7 cure:
Heroin_._.._.-.2-. eee 12.3 No attempt at voluntary cure.........-- 5
Cocaine__.....-2- eee ene 4.8 Under 1 month____--.--._-.---------.--- 1
Opium, orally (e. g. paregoric).._._.-..- 2.5 Over 1 month, under 3_._.-.---------.--- ,
Marihuana and other narcotic drugs. .._- 2.0 Over 3 months, under 6_._..---------.---
No record or no drug used____.--_-..-.-- .6 Over 6 months, under 1 year
0
1
7
5
5
4

ete.
Opium orally (e. g., paregoric)
Marihuana__._..-2 2-2 e eee ene
No record or no drugs used
6. Last drug used:
Morphine
Heroin... eee
Opium smoking
Opium orally..._-.-..-------------------
Other nonopium derivatives
Other opium derivatives
Cocaine

24

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Over 1 year, under 2 years. _--
Over 2 years, under 3.--..-.------
Over 3 years, under 4__...-.---------.---
Over 4 years, under 5
Over 5 years
No record or no drugs used
Average: 2.2 years.
10. Number of involuntary cures:
Vone

 

9 or MOre_.__-__-.------~----------------
No record or no drugs used._--._-..--_.-
11. Longest time off drugs after involuntary
eure:
Never off involuntarily
Under 1 month
Over 1 month, under 3..__-
Over 3 months, under 6.__-.------------
Over 6 months, under 1 year
Over 1 year, under 2._.._------2-.------
Over 2 years, under 3
Over 3 years, under 4_....--.---.-----.--
Over 4 years, under 5_....-..--..-.------
Over 5 years.._--_.--_-.----------------
No record or no drugs used._...--..-----
Average: 1.8 years.

  

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A STUDY OF DRUG ADDICTS

TaBLE 1.—History of addiction—Continued

25

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

Per- Per-
Data cent- Data eent-
ages ages

12. Total cures: 12. Total cures—Continued.

'No previous cures.__.---.--------------- 22.0 3 involuntary, no voluntary_-----.-____- 1.4
1 involuntary, no voluntary_.._.-------- 11.4 2 involuntary, 2 voluntary---------_._.. 1.2
2 involuntary, no voluntary._.._.-.-...- 8.5 9 or more involuntary, no voluntary... 1.0
No involuntary, 1 voluntary. ....._-___- 7.0 Other combinations___.-..-----------__- 13.9
3 involuntary, 1 voluntary.-..-..--.-.--- 5.0 No record or no drugs used__..-.---_-__. 2.5
No involuntary, 3 voluntary.-..-__-...- 3.8 || 138. Rationalization for relapses:
linvoluntary, 1 voluntary_.....-.--..-- 3.4 Association and to recapture thrill____._. 30.9
4 involuntary, no voluntary__.--.-.----- 3. 2 Therapeutic for relief of pain and dis-
No involuntary, 2 voluntary.......----- 2.4 comfort. ..___..._.--.--_-------------- 17.8
5 involuntary, no voluntary 2.3 Alcoholism (sobering up after sprees)...| 16.5
2 involuntary, 1 voluntary_..-..-._.--_- 2.2 Environmental stress___._.--.-..------- 6.1
§ involuntary, no voluntary__-__-._-___- 2.0 Other. eee ee amarencneucee 8
No involuntary, 4 voluntary.._.....-_._- 1.9 Never off drugs...__.._._.--.----------- 23.0
No involuntary, 9 or more voluntary___- 1.8 No relapse.__._..___..____.------------- 2.8
1 involuntary, 2 voluntary...-..-.-..__- 1.7 No record or no drugs used____...-.----- 2.1
No involuntary, 5 voluntary. -_..._.-.-- 14
TABLE 2.—Delinquency record
Per- f Per-
Data cent- Data cent-
ages ages

1, Age at first arrest: 5. Delinquency record after addiction—Con.

Under 15 years.__-...- 2-2 4,2 Misdemeanors only, all types..--..-.-___ 3.0

15-19__-..2-_-_----- eee ---- 13.8 Convictions, misdemeanors, juvenile

20-24__-2 eee eee eee 19,1 delinquency, all types___------..------ .4

25-29 2 te Sti ecti eit irri 171 Juvenile delinquency only-_----_----L---- .2

80-34__ 2 eee eee 12.3 No record of arrests or delinquency--_-_- 14.4

35-89__-._ eee eee 8.2 |) 6. Recidivism:

40-44_ 22 ose 5.0 A. No record of arrests or delinquency..| 14.4

45-49_ eee eee eee 2.9 B. Convictions:

§0-54_ 2 eee eee eee - 16 No previous-convictions 36. 7

55 or over_._------------------- 14 1 previous conviction.-_..-__.-.--- 24.0

No record of arrest_.-...._-..-.--------- 14.4 2 previous convictions.__.....-.------- 11.6
Average: 28.18. 3 previous convictions_._._..-----.---- 6.4

2. Reason for first arrest: 4 previous convictions_..._-.---------- 3.6

Violation of drug laws__.__...------.---- 29.7 5 previous convictions......_..---.---- 1.8
Grand larceny___-..---..----------.---- 16.1 Over 5 previous convictions...--.----- 1.5
Petty larceny... ..---..---.-------------- 8.5 C. Misdemeanors: :
Vice, i. e., gambling, drunkenness, ete. 7.8 No previous misdemeanors__.._...---- 29.8
Vagrancy. pe ee ne ee em eee we ene 71 1 previous misdemeanor__._.--.-.----- 21.0
Investigation__._._.--.--..--..--_------- 6.7 2 previous misdemeanors_...--. .------ 12.5
Juvenile delinquency-..-..--.----------- 2.6 3 previous misdemeanors_-_---..------- 8.1
Crimes against person (assault, ete.). ---| 2.4 4 previous misdemeanors_--_---- 2.7
Traffic violations._._...--.-..---.------- 4 5 to 9 previous misdemeanors 8.8
Sexual crimes..__...-.------------------ .2 10 to 14 previous misdemeanors.-__--.- 165
Other offenses_....-..------------------- 4.1 15 or more previous misdemeanors..... 1.2
No record of arrests_--_.-.-------------- 14.4 || 7, Total time served in previous sentences:

3. Disposition of first offense: : Less than 1 year_......__---------------- 14.9
Dismissal_....-_--._-- eee 26.1 1 year, under 2.__._.---___--- eee 14.3
Penitentiary sentence__...-.-.-..------- 26.0 2 years, under 3._-_..-._-..--.--_--..--- 9.6
Jail sentence__..2___-__---..-- _--_- ee 17.1 3 years, under 4__.-_---.--_----- eee 7.4
Probationary sentence__..-_.....-_------- 6.9 4 years, under 5__--_.-__-..--.---------- 6.2
Reformatory .._.....-------------------- 4,6 5 years, under 7___-.-_--_---.------------ 6.9
Fined___...__..-.-----1----------------- 4.8 7 years, under 10_.........----..-------- 4.5
Restitution __-..-.-...------------------ 1 10 years, under 15___-_-._--.------------ 2.0
No record of arrest. __:.-...-.------.---- 14, 4 15 years and over_____.------------------ 8

4, Delinquency record prior to addiction: No record or no time served........----- 33. 4
Misdemeanors only__.....-------------- 10.0 Average total time served, 3.3 years.
Convictions only_.._.--.-..------------- 4.8 || 8. Present status:

7 ie moo delinquency. wore gerastectonens . : A. Total admissions:
isdemeanors and CoOnVICtLOnS- .---.--~- . Prisoners received by transfer. _....--- 63. 8
Juvenile delinquency and. convictions--_- 13 : aa - -
Juvenile delinquency and misdemeanors. “9 Prisoners received directly from courts. 2.5
Juvenile delinquency, convictions, and Prisoners returned from escape..-...-- 4
misdemeanors._.._--.------_------2_-_- 9 Conditional release violators....--..-- 3.6
No history of delinquency_-_-_.-..-.-..-- 75.3 Parole violators....-.--..------------. .7

5. Delinquency record after addiction; Ex-prisoner_....---------------------- 1
Violation of drug laws only..--- aeepeweens 64,1 Probationers 11.0
ee . ‘Plus : CONV ICHONSy 7 a 93,2 Probationers returned for further treat-
Convictions other than violation of drug ment...----------------------------- .

laws only......--.-------------------- 4.7 Voluntary patients_...--.--.-...--.--- 17.7

 

 
26

A STUDY OF DRUG ADDICTS

TABLE 2.—Delinquency record—-Continued

 

 

 

 

Per- Per-
Data cent- Data cent-
ages ages
8. Present status—Continued. 10. Sentence—Continued.

B. Readmissions (total).-.-..----------- 9.8 4 years, under 5 2.1
Conditional release violators.....----. 3.6 5 years or over....---------------------- 3.8
Parole violators_.---.----...---------- .7 Average sentence: 2.4 years.

Former prisoners_.-.---.-...---.------ 1.9 || 11. State from which received:
Former probationers and probation TexaS 20-2 ee enn eee eee eee 15.3
violators..__...-----.--..---.------- 4 Louisiana..._.....--.---..------------e- 9.1
Former voluntary patients__....._.-.. 3.2 THlinois__...2 20.2 e eee 7.3
C. Addiction status of readmissions: New York_._.-..---..----------.--- eee 6.5
V.,1 parole violators, probation Kentucky..._.-.-2--------------- nee 6.4
violators, relapsing to use of drugs.--| 2.6 Missouri_____.-..--------.---------- +. 4,2
V.,! parole violators, probation Michigan_.__...---------.-----------e-e 4.1
violators, not relapsing’ to use of Georgia___.___-.-----.------------- ee ne 3.8
drugs (no data obtained for other re- Oklahoma_.._....--------.------------.- 3.5
admissions) _....--.----._-.------.-- 1.9 Tennessee__._.-...-------------------- ee 3.4
9, Offense: Ohio__-_.. 02 ------ eee 3.4

Illegal sale of narcotics.............-..--- 37.5 Cajlifornia_.__......--.-.-.------------~- 2.5

Illegal purchase or possession......------ 26.0 North Carolina_......-.--..---2------ee 2.4

Forging narcotic prescriptions....._._--- 4.6 Massachusetts. ...-.-------------.------ 2.4

Violation of other drug laws._....__-_--- 5.4 Virginia... eee 2.3

Violation of other laws____.._-.-._-._--- 4.3 Alabama__._._- 2.3

Conditional release, parole and proba- Arkansas_____- 2.1
tion violators__.....-....-..___.------- 4.5 Florida__..._...------- 2.1

Voluntary patient, not a law violator-_.| 17.7 New Jersey 18

10. Sentence: South Carolina___.._..-.-.--------.---~- 15

No sentence (voluntaries)........._-_--- 17.7 District of Columbia..........----_---.- 1.5

Probationers.......--.----...----------- 11.2 Mississippi_._......------..----.------.- 1.4

1 year or less...-..----..--.------------ 5 Washington___....--------.-------- 2+. 1.4

1 year, 1 day_.__...--------.2.---------- 9.8 West Virginia....----...-.------2---- 2. Li

Over 1 year, 1 day, under 2____._....--.. 18.5 Indiana____. eee 1.0

2 years, under 8____-----.--.---------.-- 24.6 All others..._.-..----.-.---------------- 7.2

3 years, under 4__._.-...-.-._.--..-.---- 11.8

 

 

 

 

 

1 Conditional release violators.

TasLeE 3.—Personal history

 

 

 

 

 

 

 

 

 

Per- Per-
Data cent- Data cent-
ages ages
1. Race: 3. Nativity ~Goniianeds
White... 22. eee 88.4 Indiana.-_.........-------.------2-.----- 1.6
Colored......-.....--.-----.------------ 8.9 Minnesota. __.....----.--.-------------- 1.4
Mexican... ..--2.-.2.---.---.-- eee 1.2 OW8...----- eee eee eee 1.2
Chinese...._-._...-.-------.------------ .9 Florida........-..--.- 2.22 eee eee 1.2
Indian. _...2- 2.1 --- eee 15 Other States_._..-......-...------------ 7.2
Japanese _-.......---------------- ee el - U.S. possessions_...-..-....------------ .6
2. Citizenship: U.S., State not given_...._-------.---.. (5
Native of native born parents_......---- 78.8 Foreign countries.........-------------- 3.6
Native of foreign born parents__.....---- 12.9 No record__._..-...-.----.-------------- .3
Native of mixed parentage (1 foreign, 1 4. Chronological age:
native)_...--...-_-----_--.---- eee 4,4 19 or less_____.-_---------.-------------- 14
Foreign born, naturalized.....-.....---- 1.7 20 to 24 years_____-....-...-------------- 7.0
Foreign born, alien.......--.....-.--..-- 1.9 25 to 29 years __...-------.-------------- 11.3
No record_......----.-----+.------------ .3 30 to 34 years 15.7
3. Nativity: 35 to 39 years 22.1
Texas.....-...---.---------------- een ne 12.0 40 to 44 years. 15.7
Louisiana_...._- 9.1 45 to 49 years 11.9:
Kentucky_-_.-_. 6.8 50 to 54 years 6.8
New York 5.0 55 to 59 years 4.3
Tennessee___...---..-------------------- 4.6 60 and over__...__--------...--.--..---.- 3.8
Georgia. _....._....--------.-----.------ 4,4 Average age: 39.1 years.
Missouri__......-..--------.------------ 4.3 Median age: 38.3 years.
Tllinois.........2..--..-...-.------------ 3.8 || 5. Religious training:
Oklahoma__....-..--.----.-.---.-.------ 3.4 Protestant___....----.--._----.---------- 45,2
Pennsylvania.......-.-.---.---.-..--.-- 3.2 Catholic. ........--.----..-------------- 25. 4
North Carolina......------.------------ 3.2 No preference....-.-.-.-..-------------- 24.8
Massachusetts_.._--..-----.------------ 3.1 ebrew___.._-...-------..-------------- 4.1
Alabama_.........-.-------2------nen-e 3.0 oi Catholic__..........---------.--.- 2
Ohio____.- 22 --eeenee ee 2.8 }|  Other_..--..---------------------------- wl
Virginia_......._--..--------_---------- ee 2.6 No record mutica wencdaeeenceneunwennenoene 2
Arkansas__......-.---------------------- 2.5 |} 6. Childhood adjustment:
Mississippi__......---.---.-.------------ 2.5 Apparently -normal........------------- 57.2
California__.......------.--.------------ 2.4 Incorrigible, i. e., truant, runaway, ete._| 21.4
8. Carolina_.......---------.------------ 1.9 Antisocial—juvenile delinquency eoeeeee 7.8
Michigan.........----------.----------- 1.8 Shut-in type with feelings ofinferiority..{ 5.4
A STUDY OF DRUG ADDICTS 27

TABLE 3.—Personal history—Continued

 

 

   

Per- Per-
Data cent- Data cent-
ages ages
6. Childhood adjustment—Continued. 11. Sexual adjustment—Continued.

Antisocial with feelings of inferiority __.- 1,4 Married, apparently normal adjustment-| 26.

Considered a model child. ..------------ -9 Total loss of sexual desire due to drugs_.} 1.

Model child with feelings of inferiority-- 5 Conflicts over homosexuality_......____.

Model child with shut-in type person- Overtly homosexual.._..--...---.-____
ality......-...------..---------------- 2 Sexual perversions_.--......-...-----._- 7

No record.....-.-...---..--------------- 5. 2 Conflicts over masturbation.-......-___. .

7. Education: No record.__--.-.----------------- eee .

No schooling. _---...----.--------------- 3.1 || 12, Marital status:

Primary grades (1 to 4)_____----- 2-2. 13.0 Single._.-_--...._------------. 2 33.

Secondary grades (5 to 8)...------------- 48.8 Married, congenial.--......--.--------_- 26.

High school and business school__._...-- 23. 5 Married, noncongenial__---.------.-...- 3.

College__-.------------------------------ 4.3 Separated__..--.---------.-------------- 8,

Graduate, medical school___......-___-- 3.6 Divorceed._..---------------------~------ 14,

Graduate, other professional colleges_.--} 2.4 Widower, not remarried_....--.-.-..--.. 6.

Post-graduate college work_----------_-- .2 Divorced and remarried, congenial sec-

No record.......--------.----.---- eee li ond marriage____...------..-.-------_- 3.
Average grade: 8.0. Divorced, remarried, uncongenial sec-
Median grade: 8.3. ond marriage............__-------- 8. 2.

8. Occupation: Widower, remarried, congenial second

Domestic and personal service___.-_... 30.9 marriage__.....-----------------------

Manufacturing and mechanical indus- Widower, remarried, noncongenial sec-
tries_.......__--.--------------------- 21.7 ond marriage._..-.------.------------- .

Trade (merchandise, stores, etc.) - 12.9 Common law wife ---} 1.

Professional and semiprofessional No record______--------.--..------------

Transportation_-..----------.----------- 13. Number of children:

Clerical. __......--------------------.--- Single__-___-.-...--.-------------------- 33.

Agriculture. _.-------------------------- Married, no children__-----.------..--.- 36.
ining______._---------w------- Married, 1 child_.._.--....-------------- 15.

Publie service_.......--...-------------- Married, 2 children__...--..-----.----_- 8.

Semiskilled.__.--.-.-.-.-.--------------- Married, 3 children____-.-_.--.---.._..- 3.

No occupation or no record.--.---------- Married, 4 children ._---._.----.-...--- 1.

9, Adult environment: Married, 5 or more children_...-.-_._--. 1.

Metropolitan deteriorated section_____.-
Urban deteriorated section_...----------
Semirural good neighborhood- -_------.-
Urban good neighborhood_-_.------------
Surburban good neighborhood-.-_-----.-
Surburban deteriorated neighborhood_--
Rural good neighborhood. _.---.--------
Metropolitan good neighborhood-_--._-.-
Semirural poor environment..-___-.-__-.

No record
14. Social adjustment:
Acceptable before addiction, poor after __
Poor both before and after addiction____-
Acceptable despite addiction_...-.-..__-
Poor before, good after addiction___..._-
Not an addict, but poor adjustment
No history.......-------.-.-------------
15. Reaction toward vice:

ett
~ PNIAMRODHONDO IR Bl Pe BNO}

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NWN POMATTR ER MOTH wo

Rural poor environment. -__-----.------- Strongly alcoholic__..........---.------_- 26.
No record___...__---------.------------- Gambler__..___-.-----.--------.-------- 8.
10. Economic adjustment: Engages in all forms of vice to excess,
Supported wholly or partially by illegal including prostitution__._....---.-.__- 5.
means__..._-__----.------------------- 34.3 Alcoholic and gambler___...-.-..2-.. 22. 5.
Shifting occupational adjustment. ____-- 23.4 Social drinker only__-..-....-.---------- 1.
Steady employment, moderate circum- Social drinker and gambler_.....______._. .
stances..._.-..------------------------ 14.3 Tolerant toward vice, moderate drinker,
Steady employment, marginal circum- gambler, etc_...-.-.------------------- 50.
stancesS__..____------------------------ 12,2 No record. ____...-------.-..------------ 1.
Nomadic worker__.--_------------------ 6.0 || 16. Military history:
Dependent (completely or partially)_..} 5,2 No military history...-...-----------._- 76.
Semilegitimate means of support (gam- United States World War___---.-----..- 17.
bling, book-making, etc.)_--.---------- 4,2 United States Spanish American War... .
No record:_.....------------------------ 4 United States peacetime__-------------- 5.
ll. Sexual adjustment: Foreign military service.-....--------..-
Casual heterosexual experiences. ...-.--- 38.3 No record...-....-------.--.---2--------
Marital discord__-.-..------------------ 31.6

 

 

 

 

 

Tasie 4.—Family history and relationships

 

 

 

 

 

 

: Per- Per-
Data cent- Data cent-
ages ages
1. Familial diseases and psychopathic deter- 1. Familial diseases and psychopathic deter-
minants: minants—Continued.
Physical diseases such as cancer, dia- Drug addiction or alcoholism, and sub-
betes, ete., only ----...------------ 16.3 psychotic disorders._......------....-- 2.6
Drug addiction or alcoholism only_____.- 7.4 Subpsychotic mental] disorders only__.__ 2.4
Drug addiction or alcoholism, and phys- Criminality only._...._--...---.-.---2_. 2.3
ical disease_...---------------.-------- 71 Drug addiction or alcoholism, and in-
Apparently excellent family background.| 2.7 sanity.--......------------------------ 19
28

A STUDY OF DRUG ADDICTS

TaBLE 4.—Family history and relationships—Continued

 

 

Remained home, worked for self-support_
Foster parents. .....--------------------
Reared by sister or brother_-_.___.-____-

  

Per-
Data ‘eent- Data
ages
1. Familial diseases and psychopathic deter- 4, Family relationships:
minants—Continued. Other siblings, congenial, average dis-
Drug addiction or alcoholism, and crim- elpline__ eee leee
inality.......-_------------2-- eee 1.5 Other siblings, congenial, poor discipline
Insanity only_._.--.---.---------------- 15 Only child, congenial, poor discipline__
Physical disease and subpsychotic dis- Other siblings, noncongenial, poor dis-
orders... .,-- ci Piste see 14 cipline_.._..___..- ue e-
Insanity and physical disease_-_._..___ 14 Other siblings, congenial, strict disci-
Physical disease, drug addiction or alco-| © =+(|| —_pline_____...-.............___....___-
holism and criminality............-_-- 11 Other siblings, noncongenial, strict dis-
All other combinations____........--_-_- 8.7 cipline.._..--__-- eee
No history___..----.---------2-- ee 41.7 Only child, congenial, average discipline.
2. Continuity of home: Only child, noncongenial, poor discipline.
Home intact up to age of 18 years______. 55. 8 Only child, nonecongenial, strict disci-
Death of father...-....-.---.---.-------- 15. 3. pline___.-- 0-2
Death of mother......-.---.---.-.------ 9.2 No record.._..-. 2-2 eee eee
Death of both parents._.-.-.-...-.....- 6.0 || 5. Family attachments:
Separation of parents_--.-__..-.--------- 2.5 Apparently normal___-.------_-__---- ee.
Divorce of parents_.__------------------ 7.4 Loose family ties__......-.--..--.-.-----
Discord of parents with occasional sepa- Mother fixation. _..__.-.--------_--- ee
ration___.---..-----.-----.-----2--- ee 1.9 Hatrad for stepparent.........---2----_-
Otherwise unsatisfactory home condi- Hatred for father____.__---_.-----.------
tions____.._..__.-------------- eee 4 Unusual attachment for father__...__._-.
Born out of wedlock, parents unknown_- wl Mother fixation plus hatred for father-_-
No record.......------------------------ 14 Dislike for mother___....-.....-..-------
3. Rearing of inmate: Dislike for siblings____..........-...--_-
Reared by both parents (normal]).--_-__._ 54.6 No information. __...._------..---------
Reared by mother only_-.-------------- 14.5 || 6. Economic status of parents:
Reared by father only_.._.-.-.-.---.-.-- 2.4 Dependent______._- 2-2. ---e--eeee ee
Reared by father and stepmother_-_-__.-- 3.7 Marginal._.--.-----.- 2 --------- eee
Reared by mother and stepfather. ___.__ 5.8 Comfortable. ......-._.---------- 2. ee
Reared by relatives.....-.-----.-------- 7.4 Well-to-do_._... 202 ee --- eee
Reared in an institution___.._._-_.--_.-. 1.4 Wealthy. __._-.-...-.-----.------------
Ran away from home at an early age.___| 5.3 No record_..-.-.__-.-.------------------
8
3
4
4

No record_.....-.-----------------------

 

bot et ee

 

 

Per-
cent-
ages

 

Ne
PS PAN

_Pre

mn
Pre WRN

ooo
PANE &. :
DWH OWND Dee PAYWRDWE HD RR ROR RB A ODMH

-

 

 

TaBuyE 5.—Past medical history

 

 

Per- Per-
Data cent- Data cent-
ages ages
1, Childhood diseases: 3. Mental diseases:
Ordinary-diseases with no sequellae.____ 88.5 ||. No history of mental disorders. _......_- 82.4
Chronic diseases. -..-------------------- 5.3 Neurotic tendencies__.._-.--.----------- 8.4
Infectious diseases with sequellae_____--- 3. 4 Neuroses, not requiring hospital care-_.. 4
Trauma with sequellae_..._.-.-----.--.. 2.2 Neuroses’ requiring hospitalization ._..._. .9
No record__....-.--.-------------------- .6 Alcoholic psychoses. ._.---.------------- 2.0
2. Adult diseases: . Other psychoses__......----------------- 1.6
Ordinary diseases with no sequellae-_--_- 42.9 Nervous breakdowns, unspecified ----._. 3. 4
Chronic diseases. ----------------------- 44,5 No record_...-..-.--.------------------- 9
Trauma with sequellae_.__.....--------. 6.6 || 4. Venereal diseases:
Chronic diseases and trauma__....-....- 2.9 No history or no record_...---.------.-- 41.3
Infectious diseases with sequellae....._._ 2, 2 Gonorrhea..._.-.----------------------- 33. 4
Other combinations of the above cate- Syphilis..............--.---------------- 5.1
gories_.....-..-------------------2---- .3 Gonorrhea and syphilis. ...-..-.-.-....- 20.0
No record._......----------------------- 6 ther__.....-..------.------------------! .2

 

 

 

 

 
A STUDY OF DRUG ADDICTS

TABLE 6.—Clinical findings

29

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

Per- Per-
Data cent- Data cent-
ages ages
1. Medical ndings: 4, Physical summary—C ontinued.
Abnormalities and congenital malforma- Combination of the above 2 categories.._| 0.2
tions__...__-_------------------------- 0.2 Partially correctable defects interfering
Diseases of the blood and lymphatic with normal function..-._....----..---- 2.2
system.___.-_------------------------- <7 ‘Uncormpamble defects, partially compen-
Digeades of the bones and cartilage__._.. 16.5 ||  — gable__..--_-_.------------------------ 8.1
Diseases of the circulation._--...-------- 25.9 Chronig diseases, not requiring hospital
Dental diseases....---------------------- 99. 2 Care__...---.-------------------------- 15.6
Diseases of digestive tract.....---------- 11.3 Chronic diseases, requiring hospital care.| 1.8
Diseases of ears, nose, and throat__._---- 29.4 Death__._....-..------------------------ 14
Endocrine disturbances_._---.---------- 1.9 || 5. Basie intelligence test used:
Defective vision and diseases of the eye_.} 46.5 Army Alpha. ....----------------------- 55. 4
Diseases of the genitourinary system_..-| 21.5 Army Beta__.....-.--------------------- 3.1
Hernias....--.-------------------------- 8.4 Stanford-Binet_..._..------------------- 21,2
Diseases of the joints....-.-------------- 10. 5 Pintner-Patterson_.._..---.------------- 5.9
Diseases of the muscles._.._-..--.------- 3.6 Ferguson form boards____-..---.-------- 1,2
Diseases of the nervous system-.._...---- 5.8 Grace Arthur point scale__..----.------- 2
Parasitic diseases._...-..-.-------------- 2.1 OS Bn 2 as dc cecicicippenenaneeenercnaee-see al
Diseases of the respiratory tract._--.---- 7.7 Not examined_._.....---.---2----------e 12.9
Diseases of the skin._._------------------ 6.1 || 6. Mental ages:
Tuberculosis.....------.---------------- 5.4 8 years 11 months or less___---.--------- 1.4
Tumors (benign and malignant) --__-.-- 3.7 9 years to 9 years 11 months___...-._-.-- 14
2. Blood and spinal fluid serology: 10 years to 10 years 11 months_......-__- 3.4
Blood, Wassermann and Kahn negative | 76.9 11 years to 11 years 11 months__...._---- 8.6
Blood, Wassermann and Kahn positive_| 14.1 12 years to 12 years 11 months_......--- 14,2
Blood’ negative, spinal fluid negative. -_- 2.7 13 years to 13 years 11 months____.__-_.- 15.2
Blood positive, spinal fluid positive. -._-- 9 14 years to 14 years 11 months_._..-_.-_- 14.6
Blood negative, spinal fluid positive____- 2 15 years to 15 years 11 months____.-_-__- 10.3
Blood positive, spinal fluid negative ___- 3.3 16 years to 16 years 11 months_ 10,1
No record______.------------------------ 1.9 17 years to 17 years 11 months_ 5.2
3. Venereal diseases (active): 18 years or Over____-..------------------ 2.7
No disease or clinically inactive..-..--.- 73.7 Not examined.._-_.-..----- 2-2 --.---- 12.9
Gonorrhea, acute and chronic_-_-.------- 5.8 Average: 13 years 8 months.
Latent syphilis_._.--.-.---.------------- 16.9 || 7. Psychiatric classification:
Gonorrhea and latent syphilis_...-_.--.- 1.9 Psychopathic diathesis_....--....-..-.-- 54.5
Heredosyphilis_......----.-------------- wl Inebriate personality._......-.--..-.--_- 21.9
Other__...------------------------------ .2 Psychopathic personality__...--..-_.-.. 11.7
No record____--.--.--------------------- 1.4 Psychoneurotic..._.....------.--.------ 6.3
4, Physical summary: Normal individual accidentally addicted. 3.8
Minor defects, able for manual labor.._.| 66.4 Psychosis associated with addiction. .__- 1,4
Cosmetic defects, correctable_..-_-..--.- 9 Addiction due to psychosis_.......-_...- wl
Correctable defects interfering with nor- Not an addiet (?)_-.-.--------2- 2-8. .3
mal exertion......---.----------------- 8.4
TABLE 7.—Institutional adjustment and evaluation of individual
Per- Per-
Data cent- Data cent-
ages ages
1. Attitude toward institution and officials: 2, Attitude toward work—Continued.
Anxious to be of service, abides by regu- Good knowledge, willing_.___-..-_2. 222. 18.1
lations. .....-------------------------- 42, 6 Good knowledge, does more than asked.| 21.7
Shows no resentment_._.....-.---------- 27.6 Refuses to work, though able__-._-__.._. 4
Violates rules if he thinks he won’t be Unebie _ work.__.--.------------------ 5.3
eaught..........---------------------+ 3.3 No report.__.--.--------------------.--- 10.8
Disciplinary action—reprimanded_._-__- 4,6 || 3. Rolationship with fellow patients:
Disciplinary action—segregated__-..-._- 5. 4 Likes to work with others, accepted by
Disciplinary action—loss of good time._- .2 the group.-_-.-.-.--------------2-- eee 71.9
Recommended for transfer as detrimen- Fits in well, thinks for himself_...-..-_. 6.5
tal to station._.__...-..-.-_.--.------- 2.5 Grudgingly accepted, disliked__...__.._- 4.6
Recommended for transfer plus loss of Ridiculed and made fun of, but aecepted.| 3.4
good time._.__._....-..-.--_---------- 4 Considered 4 leader, looked up to..._..- 1,9
Voluntary patient, uncooperative.._--.- 12.8 Outlawed by the group—stool pigeon__.- 1.9
Insane, unable to cooperate. _....-...--- 6 No report.._.-.------------------------- 9.8
2, Attitude toward work: 4, Custodian’s-estimate of individual:
Poor: knowledge, shirks work_....-..---- 4,4 Pleasant, agreeable, normal_.__....._... 48,1
Poor knowledge, but willing. _....__---. 1.38 Keeps by himself, talks little, but
Poor knowledge, does more “than asked_. 4 equable.__....--.--.--.----- 2 Lee 15,2
Average knowledge, shirks work_.....-- 4.8 Constant complainer, frequent sick line
Average knowledge, but willing._.__...- 28. 8 visitor...-..-..-----.------------------ 7.8
NS knowledge, does more than a8 ee talkative, but sociable and agree-
Odie ened sen cm ern neen nn ewenipeeannn . able__._.--..-.------------------------ 71
Good naiowisdes, shirks work_....----.- 7 Suspicious, irritable, paranoid_.......... 4.6

 

 

 

 

 
30

A STUDY OF DRUG ADDICTS

Taste 7.—Institutional adjustment and evaluation of individual—Continued

 

 

 

Per- Per-
Data cent- | Data cent-
ages ages
4, Custodian’s estimate of individual—Con. 6. Future plans—Continued.
Queer behavior, suggesting insanity_.--- 2.9 Discharged against medical advice----.- 11.8
Escape problem_..._...-----------~----- 2.1 Death.__----. ewe ee 14
Very talkative, noisy, disagreeable. ___.. 1.8 No record wane 2
Keeps to himself, surly, disagreeable. ..- .9 || 7. Prognosis:
Suspected of homosexuality......-..---- .7 AvVeYrage....------------- eens 41.9
No report__...-.-.--...----------------- 8.8 OOF. _---------- eee eee eee 37.1
5. Insight: Above average.....--.------------------ 7.9
Believe drugs are beneficial, but will Guarded___.-.--..----_----------------- 6.5
stay off because of legal] risk_..--.----- 65. 3 Below average_._-.-...----------------- 2.4
Believe drugs are beneficial, but loss of Hopeless......-------------------.------ 1.2
social esteem outweighs benefit._._._-- 5.6 Good_._...-----_------------------ +--+ 7
Believe drugs harmful from every stand- Dependent upon specific environmental
- point....-.-----------------.---------- 27.4 factors_....-------.-.----------------- 6
No record_.....---.------.-------------- 14 eath.__...---------------- 2 - eee 14
No drugs used_.-.....---...------------ 03 Not an addict (?).-----.--.--.----.----- .3
Future plans: 8. Rehabilitative measures:
Live at home with relatives, but no job_]| - 48.4 Physical accentuated__.....--...-------- 61.0
Live at home with relatives, has a job..| 12.4 Physical and psychiatric accentuated__.| 14.1
No home to go to, no job, but hasfriends_| 8.4 Minimum measures._....----.---------- 12.8
No home to go to, expects a job_--_----- 7.0 Physical and vocational accentuated....| 6.8
No home to go to, no job, no friends____- 4.6 Psychiatric accentuated____--.---------- 2.7
Transferred to another institution_.___-- 3.9 Physical, psychiatric, and vocational
No home, but has a job_-...--.-----__-- 1.0 accentuated__..-.-.....-.-----------.-| 14
Expects to seek help from charitable Vocational accentuated__...--...-.------ 1.0
agency.._...--------------------------- 5 Vocational and psychiatric accentuated - 72
Home in poor environment, no job_._-.- 4