From the 1920s until the 1960s treatment for drug abuse in the United States was practically nonexistent. Following the enforcement of the Harrison Act during the 1920s, few physicians were willing to treat addicts. During the 1930s two Public Health Service prison hospitals were opened, but their patients had a relapse rate of roughly 80%; during the 1970s the federal government closed them down. Since the 1920s the primary treatment program for most addicts has been no treatment at all; until recently, arrest has simply resulted in incarceration and therefore forcible detoxification. The dramatic explosion in the use and abuse of a number of illegal drugs during the 1960s demonstrated the weakness of this approach. As a result, a range of treatment programs, developed largely in the 1960s, have been widely used.
Methadone is an addictive synthetic narcotic used to combat narcotic addiction. A hospital or a clinic administers the drug, usually dissolved in artificial orange juice drink. Taken this way, the addict does not get high. Methadone blocks the action of narcotics so that addicts cannot become high, even if they were to inject heroin. According to the program's rationale, addicts will then stop taking heroin. Although patients remain addicted to methadone, they can live a normal life, since the drug supply is steady and secure. Plus, they are no longer exposed to health risks like AIDS and hepatitis from shared needles used for injecting drugs. Because the program is inexpensive to administer, methadone has become a very popular form of treatment; roughly 100,000 narcotic addicts in the United States are treated in this program.
The drug naltrexone has been approved by the U.S. Food and Drug Administration for treating alcoholism and heroin addiction, in concert with an appropriate counseling program. Naltrexone reduces cravings for alcohol and heroin, thereby decreasing relapse rates.
Therapeutic communities (TCs), such as Daytop Village in New York and Walden House in San Francisco, advocate a completely drug- and alcohol-free existence. Addicts live in the therapeutic communities, and many of the administrators are ex-addicts, who can best understand the addict residents. The view of all TCs is that the addict uses drugs as a crutch. TCs attempt to resocialize the addict by inculcating a value system that is the opposite of what prevailed on the street. Discipline in therapeutic communities is strict, penalties for breaking rules are severe, peer pressure is unrelenting, and the program benevolently dictatorial. Because of the strictness, many residents leave against the advice, and without the permission, of the staff. TCs seem to be effective for a limited segment of the addict populationÑthose who are young, middle-class, and highly motivated to quit drugs. The programs are expensive to administer; there are far fewer patients in them than in methadone-maintenance programs.