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I

I

74*27,425
IVES, William Robert, 1945AN EVALUATION OF TWO DRUG ABUSE TREATMENT
PROGRAMS IN LANSING, MICHIGAN.
Michigan State University, Ph.D., 1974
Psychology, clinical

University Microfilms, A XEROX Com pany, A nn Arbor, M ichigan

AN EVALUATION OF TWO DRUG ABUSE
TREATMENT PROGRAMS
IN
LANSING, MICHIGAN

By

William Robert Ives

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Department of Psychology
1973

ABSTRACT

AN EVALUATION OF TWO DRUG ABUSE
TREATMENT PROGRAMS IN LANSING, MICHIGAN
By
WILLIAM ROBERT IVES

The major problem in the treatment of addiction has
been the relative inability to find an effective treatment
(i.e. one that reduces the probability of the addict re­
turning to crime*institutional care, and the abuse of
addicting drugs).

In addition, there have been very few

studies seeking to evaluate the effectiveness of alternative
treatment approaches.

Because of the lack of such data the

present study has undertaken an evaluation of the relative
treatment efficacy of two disparate treatment approaches; a
traditional halfway house and an innovative program, the
lodge.

The halfway house provided a highly structured living

environment designed to provide a gradual transition between
addiction and normal community life.

Conversely, the lodge

was designed as a loosely structured, member-governed,
residential community.

The operation of a lodge business

was intended to provide both employment and a source of
support for the lodge program.

A series of problems though,

occurred in the implementation of the lodge program.

Because

of these problems, the lodge program was modified such that
it was actually run as less-authoritarian halfway house.

William Robert Ives
Drug abusers from the local community who voluntarily sought
treatment were randomly assigned to one of the two programs
at intake.

During this initial interview information was

collected on personal characteristics! treatment expecta­
tions and drug attitudes.

At the end of 90 days in a given

program follow-up information is collected on a number of
new arrests, reinstitutionalizations, length of stay in the
program, and use of drugs while in the program.

Chi square

analysis of the outcome variables revealed no significant
differences between the halfway house and lodge.

The find­

ing of no differences between the two approaches seriously
weakens the arguments for the need for highly structured
programs for the treatment of chronic drug abusers.

Data

on personal characteristics of addicts was cluster analyzed.
The factors that were found to be related to outcome generally
supported the hypothesis that increased assimilation into
the "drug culture" (i.e. longer time spent mainlining heroin,
greater habit cost.. illegal support of the habit, and more
time spent in jail after beginning illegal drug use) leads
to unfavorable treatment outcomes.

No evidence was found

that related treatment outcomes to social class, age, educa­
tion, employment history, marital status, or drug use history,
as had been reported by several other investigators.

Three

critical elements were also discussed which are necessary
for the implementation of community research:
administrative agreements;
treatment programs; and 3-)

2.)

1.)

Written

Researcher control of

The necessity to leave unwilling

programs out of the research design.

ACKNOWLEDGMENTS

I had originally Intended to create a pool-pah but
better judgment has overcome my social motives.
you Lou for all your support.

ii

Thank

TABLE OF CONTENTS
LIST OF T A B L E S .................................

iv

LIST OF F I G U R E S ...............................

▼

CHAPTER I* INTRODUCTION .......................
A Brief History of Opiate Use ..............
Legal H i s t o r y ...............................
History of T r e a t m e n t .......................
Rationale of the Present S t u d y ............

1
1
4
6
12

CHAPTER II. METHODS
....................
Social Subsystems...........................
S u b j e c t s ...................................
Instruments
..................
Experimental Design and P r o c e d u r e s ........

17
17
lo
19
21

CHAPTER III. R E S U L T S .........................
The Environment . . . . . . . ..............
Outcome Variables ...........................
Cluster Analysis ...........................
O - A n a l y s i s .................................
Limitations.................................

22
22
24
25
30
34

CHAPTER IV.
D I S C U S S I O N ......................
Comparison of Programs
............
Correlates of Treatment O u t c o m e .......... .
Problems in Implementation of Community
R e s e a r c h .................................
S u m m a r y .....................................

35
35
39
43
4o

APPENDIX A.

The Intake Q u e s t i o n n a i r e ........

46

APPENDIX B.

The Expectancy Questionnaire

61

...

LIST OF REFERENCES.............................

ill

66

I

LIST OF TABLES

TABLE 1. A comparison of the halfway house
an<f lodge in demographic data from four
geographical subdivisions of their
environment............................. 23
TABLE 2« Comparison of the halfway house
and lodge on the four outcomes variables;
reinstitution zation, rejailing, length
of stay, and percentage of cleanurines
. . 25
TABLE 3 . Comparison of non-heroin and heroin
users on the four outcome variables; rein­
stitutionalization, rejailing, length of
stay, and percentage of clean urines . . .
TABLE 4 .

The Three Preset C l u s t e r s ....... 27

TABLE 5 « Correlations between the oblique
—
cluster D o m a i n s ......................... 26
TABLE 6 . Means, standard deviations, N and
homogenity of the O-Types derived from
the a n a l y s i s ............................33

iv

26

LIST OF FIGURES

FIGURE 1 . A schematic representation of
................... 21
the experimental design
FIGURE 2*
0=Types

Graphical representation of the
. . . . . . .

........................

v

32

CHAPTER I
INTRODUCTION

A Brief History of Opiate Uae
The problem of narcotic addiction is not a new one.
The use of opium was known to the Sumerians, where mention
of the collection of opium from poppies (Papaver somniferum)
was made in the seventh century B.C.

Opium was used in

remedies by the early Egyptians, Persians, and later by
the Greeks and Romans (Hess, 1971).

Hippocrates (460-

357 B.C.) recommended a preparation of opium for the treat­
ment of leukorhea.

The writer Virgil (70-19 B.C.) mentions

the sleep-inducing properties of opium in two of his works.
Galen (130-200 B.C.), the Greek physician, saw opium as a
virtual panacea and recommended its use for the cure of
diseases such as epilepsy and melancholy (Terry and Pellens,
192B).
Opium was introduced into Europe during the Middle
Ages by the Chinese, where its use grew rapidly.
"The famous physician . . . Paracelsus (14901540) owed much of his success to the bold way
in which he administered opium to his patients.
He is said to have carried opium in the pommel
of his saddle and called it the •stone of immor­
tality. ' His followers were as enthusiastic as
himself over the virtue of opium. Platerus of
Basle in 1600 strongly recommended it and
Sylvius de la Boe, a famous Dutch physician
declared that without opium he could not
1

2
practice. The celebrated chemist and physician,
Van Helmont, about 1640, used it so frequently
that he was called Dr. Opiatus, and Sydenham
about I6 4 O writes that among the remedies which
it has pleased Almighty God to give to man to
relieve his sufferings, none is so universal and
so efficacious as opium" (Terry and Pellens,
192S, p. 57).
The use of opium during the eighteenth and nineteenth cen­
turies followed a similar course.

De Quincie*s description

of his personal use of opium in Confessions of an English
Opium Eater (1#21) did much to popularize the use of opium.
In 1S03 the chemist, Serturner, isolated morphine from
opium and with the development of the hypodermic method of
injection by Wood in 1#43» the addiction problem increased
in severity.
1.)

The hypodermic method had two influences;

It provided a more efficacious means of administration

of drugs and

2.)

It led to the belief that hypodermic

injection of morphine was a cure for opium addiction and
non—addicting.

Unfortunately the first victim of an over­

dose was Wood's own wife.
The American Civil War provided the first opportunity
for physicians to use the hypodermic method of injection of
morphine on a large scale.

The disastrous consequences of

this wide spread morphine use were reflected in the large
number of addicts seen after the hostilities were concluded.
Opium based preparations found their way into the con­
sumer market during the late 1300's and early 1900*s as
tonics, elixirs, cough syrups, and pain killers.

Opium

smoking was introduced in the 1^50's by the Chinese immi­
grants to the U. S.

It is instructive to note that while

3
the dangers or opium addiction had been known since 1563*
the use of opium had been widespread.

It wasn't until

gamblers, prostitutes, and underworld figures began to
smoke opium that the public was aroused.
"It was due to the shady character of the first
white opium smokers that first the smoking habit,
and later all narcotics use became to be con­
sidered as disreputable and associated in popular
opinion with crime . . . .
This new spirit
(i.e. regarding opium use as criminal) is aptly
expressed by the new, specifically American term
'dope fiend* the first known usage of which
occurred in the New York Sun in 1396 (Hess, 1971,
-----------p. 593)."
At the same time as public awareness was increasing
with respect to the problems of opiate addiction heroin
was synthesized from morphine by the German chemist
Dresser.

The Bayer Company took over the development of

this derivative terming their new product heroin and placed
it on the market as a cure for morphine addiction.

In

commenting on the use of heroin Terry and Pellens (1923)
state:
"In reviewing the very remarkable history of the
rapid increase in the use of this drug, its wide
popularity as a therapeutic agent, the acclaim
with which it was received by the medical profes­
sion, and the perslstance with which manufacturers
advertised its virtues in both technical and lay
publications, it is astonishing that physicians
were so slow to recognize its dangers and that
for the first six or eight years of its employment
there were only a few among the large number who
proposed its employment in an ever increasing
number of conditions who appreciated the harm that
was being done. One wonders why during this period
members of the profession, to whom cases of chronic
heroin intoxication must have appealed for treat­
ment and who scarcely could be unaware of the grow­
ing popularity of the drug among the laity, did not
come forward in greater numbers with appropriate
warnings. The fact remains however that for 12 or

4
14 years after Its Introduction current medical
literature Included constant references to Its
value as a therapeutic agent In almost every
variety of complaint . . . .
Heroin was quickly
seized upon by the underground market subsequent
to the passage of state regulatory laws and the
Harrison Act (because It was particularly adapted)
to the purposes of vendors of Illicit drugs inas­
much as its morphology permitted easily of
adulteration with sugar of milk (i.e. lactose) or
certain coal tar products (i.e. quinnine) while
morphln (sic) could be so treated only with great
difficulty (p. £6)."

Legal History
Increase in the public's awareness of addiction conse­
quent to opium smoking and the use of over-the-counter
preparations containing opium or opiates (e.g. heroin)
resulted in the Pure Food and Drug Act of 1906, the banning
of the importation of opium for smoking in 1909» and the
Harrison Act of 1914*

The passage of this latter act sig­

nalled the beginning of the increasing criminalization of
the addict status.

Its passage represented a tacit admission

of the failure of the medical community to find an effective
cure for addiction.

The Harrison Act and subsequent Supreme

Court decisions engendered by its enforcement effectively
removed the problem of addiction from the medical profession
and gave it over to the law enforcement officials.
The Harrison Act was passed, ostensibly as a revenue
measure, imposing a tax of one cent per ounce on opiates and
making trade in opium a matter of public record.
stated nothing about treatment of addicts.

The act

Several subse­

quent Supreme Court decisions effectively altered the intent
of this act.

In Webb vs. U. S. (1919) the court ruled that

5
prescription of drugs for the treatment of an addict "not
in the course of professional treatment in the attempted
cure of the habit but being issued for the purpose of pro­
viding the user with morphine sufficient to keep him com­
fortable by maintaining his customary use" was not a legal
prescription under the act (Lindsmith, 1 9 6 5 ).

In the U. S.

vs. Behrman (1922) the court ruled that prescriptions for
morphine given to addicts were illegal regardless of the
purpose.
During the period from 1919-1921, 44 clinics were
operated which dispensed morphine on an outpatient basis to
registered addicts.

Practices were quite variable from

clinic to clinic and the fact that they were generally oper­
ated by persons who were naive with respect to the problems
of narcotic addiction were probably contributing factors to
their closing by the Federal government.

Lindsmith (1965)

states:
"in view of the wide differences between the clinics
and the short period of their operation (some were
only open a few months before they were closed) it
is inconceivable that the Washington authorities
who ordered them closed acted on the basis of
knowledge of how the individual clinics were
operated (p. 5 2 )."
In 1925 the Supreme Court apparently reversed itself in
Linder vs. U. S. by ruling that prescription of drugs to
relieve withdrawal distress by physicians acting in good
faith and fair medical practices, is not a violation of the
law (Lindsmith, 1 9 6 5 ).

This case notwithstanding, doctors

gave up the practice of dealing with addicts because of the

6
possibility of prosecution.

The addict thus had to turn to

Illegal sources in order to supply his habit.

Terry and

Pellens (192#) quote a report of the Committee on Traffic
in Narcotic Drugs published in June 1919:
"In recent years especially since the enactment of
the Harrison Law, the traffic by 'underground'
channels has increased enormously and the present
time it is believed to be equally as extensive
that carried on in a legitimate manner. This
traffic is chiefly in the hands of so-called
'dope peddlers' who obtain their supplies by
smuggling from Canada, Mexico, and along the
Atlantic and Pacific coasts (p. #7)*”
Thus by the 1920's the criminalization of the addict status
was complete.
History of Treatment
Treatment for addicts was usually accomplished in hos­
pital settings until the 1950*8.

The Federal government

has established two such hospital treatment programs, one
in Lexington, Kentucky, and the other in Fort Worth, Texas.
These two facilities were developed in the 1930's in the
belief that addict prisoners shouldn't be mixed with other
types of offenders.

Addicts were at first withdrawn through

the use of morphine but in 1 9 4 # methadone was substituted
for morphine.

By 1970 these two facilities had treated more

than 50,000 addicts with a fairly low degree of success.
The results of a number of investigations of addiction statUB
subsequent to treatment at the Lexington facility are quite
variable.

The results vary from a low of 39-99^ relapsed

(Pescor, 1943) to a high of 90.1# relapsed (Hunt, 1962).
O ’Donnel in discussing the variability of the "Lexington

Studies" points out that the disparate findings could be
explained by the fact that relapse rates vary considerably
depending on the age, volunteer-non-volunteer status,
length of stay, and social status of the addicts (1965)*
In 195## Synanon was established in Ocean Park, Cali­
fornia by Charles Dederich, an ex-member of Alcoholics
Anonymous.

For several reasons Synanon has effectively

resisted evaluation by outside professionals.

One of the

reasons is that Synanon has a strong anti-profeBsional bias.
Professional people and particularly those who profess to be
experts in the area of addiction treatment are therefore not
encouraged to undertake an evaluation of the program.
Secondly, Dederich believes that if the addict population
seeking treatment knew what the success rate was they would
use it as an excuse and a rationalization for failure
(Yablonsky, 1965).

Volkman and Cressey (1966) have come the

closest to evaluating Synanon.

From May 1953 to May 1961,

263 people were admitted to Synanon.

Of these, 190 left

without the advice of the program giving an attrition rate
of 72#.

Ninety percent of the dropouts from the program

occurred within the first three months of the program.

By

the seventh month only 75 out of the original sample of 263
were totally abstinent.

Thus, the relapse rate appears to

be approximately 7 1 *59t.
Deissler (1972) cites several factors that he feels are
important determinants of the success of Synanon:
(1)

Environment - Diessler feels that an addict cannot

be rehabilitated if he is kept in his usual environment.

8
Therefore addicts coming to treatment in Synanon are usually
moved far away from their original neighborhoods#
(2)

Learning from Peers - All work at Synanon is done

by ex-addicts who reside there.

The author feels that this

instills the belief in the if-he— can—do-it-I— can-do-it
philosophy.
(3)

Interaction with the Community — Synanon encourages

its people to interact with the community which fosters some­
thing other than ”junkie" behavior.
(4)

Self-Support - Synanon is almost totally self-

supporting deriving most of its support from its advertising
business.

Diessler feels that this leads to cooperation

among participants and therefore fosters group spirit.
(5)

The Synanon Game - Deissler and most other advo­

cates of the Synanon treatment approach usually place the
greatest emphasis on this aspect of Synanon.

The "game"

amounts to a no-holds-barred, confrontative encounter group.
Deissler feels that this "game" allows the addict to grow
personally and emotionally.
To most Synanon detractors this latter aspect of
Synanon is the most offensive.

Many feel that the game is

inhumane treatment for an addict and that it does more damage
than good.

Perhaps what the critics are reacting to is the

fact that Synanon does not pretend to be a non-directive
program interested only in keeping the addict off heroin.
The employment of a non-directive approach would be in direct
contradiction to their values.

9
Synanon has given rise to several similar programs in
other parts of the country.

A few of the more well known

are DAYTOP Village (an acronym for Drug Addicts Treated On
Parole),

Phoenix House in New York City, and Gaudenzia

House, in Philadelphia.

Most of these therapeutic communities

have lacked evaluative research, although DAYTOP has been
studied in a survey by ftlasscote, et al. (1972).

In terms

of outcome the authors state that out of approximately 1000
participants (records were rarely kept in the early years)
over a period of six years only 137 participants have
reached "graduate status."

For these 137r 14 had returned

to drug use, 29 were on the staff of DAYTOP, 6l were on the
staff of other drug treatment programs, and 32 were employed
at other jobs.

It should be noted that this information was

gained on hearsay rather than through more reliable methods
of data collection.
Treatment of narcotic addicts has also been accomplished
by use of the halfway house concept.

The basic idea of the

halfway house is borrowed from the area of corrections where
it was first originated by William Roscoe in 1&19*

Roscoe

contended that prisoners leaving the Massachusetts State
Prison should be returned via a transitional residential
program*
"The convicts who are discharged are often en­
tirely destitute. The natural prejudice against
them is so strong that they find great difficulty
in obtaining employment. They are forced to seek
shelter in the lowest receptacles if they wish to
lead a new course of life are easily persuaded
out of it, and perhaps driven by necessity to the
commission of fresh crimes. It is intended to

10
afford a temporary shelter In this building, if
they choose to accept it, to such discharged con­
victs as may have conducted themselves well in
prison, subject to such regulations as the direc­
tors may see fit to provide. They will have here
a lodging, rations from the prison at a cheap
rate, and a chance to occupy themselves where
they can gain an honest livelihood in society. A
refuge of this kind to this destitute class, would
be found perhaps, humane and politic (Roscoe, 1819
quoted in Gels, 1966, p. 165)•"
Evaluations have been reported in the literature on three
such facilities.

Geiss (1966) randomly assigned felons

with a previous record of narcotics use to one of two con­
ditions:

either a halfway house or regular parole.

The

house population (2 4 ) turned over about every four months.
Commenting on this high turnover rate Gels (1966) states:
"The rapid shift of residential population was
seen by the treatment staff as seriously in­
hibiting any continuity in attempts to establish
a certain ethos in the house and vitiating thera­
peutic advances by rapidly removing centers of
stability from the house and intruding a large
number of uninitiated entrants each month. The
aim of this rapid turnover was to determine whether
a facility such as the East Los Angeles Halfway
House could in fact produce a positive result
without the rather high cost associated with long­
term residence in the facility and without the
allegedly debilitating influence of extended
dependence upon the house (p. 129)*"
Follow-up was conducted at 12 months.

There were no statis­

tically significant differences found between experimental
and control conditions in terms of return to use of nar­
cotics, drug free weeks, and number of new criminal
convictions.
Berecochea and Bing (1972) report on an evaluation of a
halfway house similar to that described by Geis (1966).
Subjects were civily committed addicts assigned to the

11
halfway house as a part of their treatment, following in­
patient detoxification at the California Rehabilitation
Center.

A sample of 44 clients turned away because of over­

crowding served as the control group.

Follow-up was con­

ducted at 12 months after an individual was released from
the house.

The authors reported no significant differences

between experimental and control programs, with respect to
new convictions and detected drug use during a follow—up
period.
Kaplan and Meyerowitz (1969) studied a halfway house
facility designed as a transitional residence for narcotic
addicts coming out of prisons and hospitals.
randomly assigned to the treatment condition.

Subjects were
One hundred

seventy-seven individuals who were Institutionalized and
scheduled for release served as the control group.

Follow-

up was conducted at anywhere from 9-22 months after release
from the treatment program in which they participated.

The

results shewed that those in the experimental program did
not differ significantly from the controls in return to the
use of narcotics.

Those participants in the halfway house

that did not leave against program advice significantly
differed from controls on employment (greater likelihood of
employment for experimentals who left early) and new convic­
tions (greater likelihood of no new arrests for experi­
mentals who stayed in the program).

Experimental early

leavers were significantly more likely to be unemployed
than those in the control condition and were more likely to
have become readdicted.

12
Rationale of the Present Study
A major problem in the treatment of addiction has been
the relative inability to find an effective treatment fi.e.
one that reduces the probability of the addict returning to
crime, Institutional care, and the abuse of addicting drugs).
Treatment methods, with the exception of methadone, have
usually been predicated upon intervention involving some
version of verbal therapy,

Fyen the Synanon approach, with

its apparant reliance on the social community and getting
jobs, places a heavy emphasis on the Importance of the
synanon game.

This assumption does not appear to be tenable

in light of all the studies reviewed by Bandura (1971^ on
treatment of the mentally ill.

Bandura points out that when

considered in the light of treatment outcomes determined
under experimental conditions, the "so— called conversa­
tional therapies" are an ineffective treatment modality
for the treatment of the mentally ill.
Tit contrast to much of the traditional approaches to
treatment has been the work of Fairweather and his associates
(Fairweather, et al., i 9 6 0 , Fairweather, 1 9 6 4 » Fairweather,
1 9 6 7 » Fairweather, 19^9» Fairweather, et al., 1973)*

In

1 9 6 4 f Fairweather found that with mental patients, length

of stay in the community was related to the degree of
supportiveness of the living situation and the frequency
of employment in a low Btatus job.

These findings led to

the development of the community lodge (Fairweather, 1969).
This program is a member-governed residential program which
is entirely self-supporting through the operation of the

13
lodge business.

The staff serves in the program as con­

sultants to the residents rather than playing the traditional
roles of psychologist or psychiatrist.

As a whole the intent

of the program is to provide meaningful occupational and
social roles for the residents.

This program has been shown

to be highly effective in the treatment of the mentally ill
(Fairweather, et al., 1969).

The program*s emphasis on a

social system approach with a task orientation (selfgovernment and business) rather than a verbal therapy
orientation is somewhat similar to Synanon.
The contrast between the lodge approach and the halfway
house approach is obvious.

One involves the creation of a

coherent social system with autonomy and meaningful social
and occupational roles for its members; the other continues
the medical model treatment approach with an adjunct
emphasis on traditional or neo-traditional psychotherapy.
In a review of the existing treatment literature there is
no direct comparison involving the relative effectiveness
of these two disparate treatment approaches.

It is there­

fore the first major purpose of the present experiment to
evaluate treatment of chronic drug abusers in one of two
settings; a traditional halfway house or a lodge type
program.
The failure of many of these programs to prevent
relapse to the use of narcotics may be that they do not
match the addict to the program best suited for him.
(1966) has spoken out about this in the following way:

Geis

14
" . . . The house can serve as a useful thera­
peutic weapon . . . If Initial screening Is
undertaken to admit only Individuals who are
apt to be most responsive to the things which
It offers (p. 185)."
Some social and/or psychological characteristics have been
found to be correlated with an addict's degree of success
in a given program.

The most commonly studied variables

have been demographic.

Variables of this type are easy to

measure and are not influenced by the reactive technique
of most experiments.

In addition they are relatively in­

expensive to obtain because they are usually kept in
institutional records.

A number of demographic charac­

teristics have been shown to be related to relapse rate or
attrition from a treatment program including age (Duvall,
Brill, and Locke, 1963; Hunt and Odoroff, 1962; Winick,
1962; Zahn and Ball, 1972), education (Chambers, Cuskey,
and tfieland, 1970; Geiss, 1966; Vaillant, 1966), employment
history (DeFleur, Ball and Snarr, 1969; Vaillant, 1966;
Zahn and Ball, 1972), marital status (Vaillant, 1966; Zahn
and Ball, 1972), race (Geiss, 1966; Hunt and Odoroff, 1962),
time spent in treatment (Hunt and Odoroff, 1962; Volkman and
Cressey, 1966; Zahn and Ball, 1972), volunteer-non-volunteer
status (Hunt and Odoroff, 1962; Vaillant, 1966), social
class (Jones, 1958), and family background (Geis, 1966).
These variables are related to relapse such that favorable
treatment outcomes are expected when the client is an older,
married, white, non-volunteer, who has a higher education,
better family background, a better employment record, and
who spends a longer time in treatment.

15
Personality variables have also been looked at by
several Investigators.

Gendreau and Gendreau (1971) Btudied

differences between addicts and non-addicts on the MMPI.
They found that if criminality is controlled for by equating
groups on criminal behavior (time in jail) there are no
differences on MMPI scores between addicts and criminal non­
addicts.

Carroll (1968) failed to find relationships

between Rotter's internal-external control and an addicts
age at first heroin use, number of times arrested, age at
first arrest, or race.

DeMeritt (1970) found that there

was no difference in self-concept of non-drug users and
abusers while former users seemed to have a better selfconcept than abusers and non-abusers as a class.
One of the major problems with the studies cited above
has been the lack of multivariate statistical analyses of
data on addict characteristics and treatment outcomes.

One

of the major purposes of the present study is to subject
data on treatment outcomes and abuser characteristics to
analysis using the BCTRY system (Tryon and Bailey, 1970).
This analysis will not only allow us to determine the
dimensionality of the data but also, through O-Analysis,
will allow us to look at data on individuals who are suc­
cesses and failures.

Through the use of the latter tech­

nique it is hoped that we can discover what type of people
do best in what type of program.

Demographic variables

will be used in this analysis because of their previously
demonstrated relationships to relapse and attrition.

The purpose of the present experiment is two-folds
1.)

To examine the relative efficacy of two treatment

approaches (halfway house and lodge) in the treatment of
chronic drug abusers; and 2.)

To examine the charac­

teristics of drug abusers employing the technique of cluster
analysis (Tryon and Bailey, 1970) and relate these
characteristics to degree of success within a given program.

CHAPTER II
METHODS

Social Subsystems
The halfway house.

The halfway house studied in this

research provides its residents with a structured living
situation.

The facility is located on the predominately

black, west side of Lansing in an old house.
capacity is 15.

The total

During the course of the study the program

was structured to keep drug abusers there a minimum of six
months.

During this time the residents are supposed to

find a legitimate job and complete any educational deficien­
cies that they might possess.

On-going group therapy is

used to aid the client in discovering personal attributes
or problems that have maintained his drug taking behavior*
At the end of the six month period the individual client
would take up residence in the place of his choice.
The lodge.

Fairweather, et al.

(1 9 6 9 ) have charac­

terized a lodge as a "special kind of social organization
in the community which differs radically from other, more
traditional forms of residence (p. 3)."

The main dif­

ferentiating characteristics of the lodge are:

1.)

It

depends on the clients themselves to keep its members in
the community rather than the support of other personnel;

17

16
and 2.)

Members, as a group, are responsible for the con­

trol of the living and working aspects of the lodge opera­
tions.

Like the halfway house, the facility is located on

the west side of Lansing in an old house.
capacity is 24.

The total

Unlike the halfway house there is no set

time limit on length of stay of Individual clients.

It was

also expected that within the first several months of opera­
tion that the members would decide upon the nature of the
business operation they were to set up.
Subjects
All subjects, except one, were volunteers from one of
several sources.

Of the 43 subjects, 13 came from the

streets, 14 were referred from the Ingham County Jail, 6
were referred from local crisis centers, 3 were referred
from the methadone and detoxification program, and 7 were
referred from local community mental health center.

One of

the referrals from the jail was assigned to the lodge as a
condition of his parole.

Of the 24 people assigned to the

halfway house, one had been assigned to the outpatient
condition and later returned for reassignment, one was hired
as a staff counselor, one was refused admission, one was
assigned to the lodge and then was reassigned to the halfway
house, and one never showed after being assigned.

Twenty

persons stayed in the house for some period of time after
their assignment.

Of the 25 persons assigned to the lodge,

one was not accepted, six left before they moved in, one
was assigned to the lodge and didn't show up until several

19
months later, and one was assigned to the lodge as a con­
dition of his parole.

Seventeen clients lived in the

program for some period of time after their assignment.
Instruments
Four sources of information were utilized in the present
study} an intake questionnaire, administered by the inter­
viewer, an expentancy questionnaire, which was self­
administered, lnstutltional records from the Ingham County
Jail and local community mental health centers, and program
records from the individual treatment programs.

These lat­

ter two sources of information allowed calculation of
rejallings and reinstitutionalizations, dirty urines, and
length of stay in the program.
Intake questionnaire.

The intake questionnaire

(Appendix A) was designed to measure certain demographic
characteristics of the participants including employment
history, arrest record, family history, military history,
treatment history (i.e. for drug and mental health problems),
education, marital status, race, sex, and age.

In addition

a detailed drug history inventory was included which
assessed past and present use of seven categories of drugs;
marijuana/hash, alcohol, CNS depressants, CNS stimulants,
cocaine, hallucinogens, and narcotics.

This section was

scored as follows:
1 = never used or used once or twice
2 = used less than once a month but not currently using

20
3 3 used greater than once a month but not currently
using
4 - used greater than once a month and currently using
A score for each specific drug used was calculated and a
mean derived for each class.

In addition to this drug

section, each addict completed a special section of the
questionnaire which was designed to measure certain charac­
teristics of the heroin habit such as cost, age at first
use, length of time spent mainlining heroin, and the means
used to support the habit.
Expectancy questionnaire.

This questionnaire (see

Appendix B) was a modification of that used by Fairweather,
et al. (1969)*

It was designed as a series of statements

of behavioral intentions or guesses about how well the client
thought he would be satisfied in the program.
Program and instutitional records.

These records pro­

vided information for the determination of program outcomes.
The outcome variables utilized in the present study were
number of reinstitutionalizations, number of rejailings,
time spent in the program, and percentage of clean urines.
Urines were analyzed for amphetamines, barbiturates, opiates
(as morphine), and quaaludes by United Medical Laboratories
using paper chromatography.

Percentage of clean urines was

calculated by dividing the total number of clean urines by
the total number of urines taken and multiplying the result
by 100.

All four of the outcome variables were assessed at

a three month interval after a person entered the program.

Experimental Design and Procedure
The experiment was designed as a 2 X 2 analysis of
variance design (heroin-non-heroin X halfway house-lodge)
and is pictured in Figure 1.

Upon admission to the drug

program each client was referred to the central intake

Heroin Users

Non-Heroin Users

Halfway House

N=16

N=4

Lodge

N=12

N=5

Figure 1.

A schematic representation of the experimental
design.

coordinator for an initial intake interview.

These inter­

views were conducted at either the point of initial
referral, the central office of the drug program, or any
place of mutual convenience.

During the initial interview

the Intake and Expectancy questionnaires were administered
Participants were then randomly assigned to one of the two
treatment conditions.

After a client had been in the

program for 90 days, Program and Institutional Record
outcome data were gathered.

CHAPTER III
RESULTS

The Environment
The raileu in which these subsystems were implanted
can be described by looking at census data.

Table 1

presents data on population, percentage of white and
black residents, number of housing units, percentage of
the population in the labor force, percentage of the popu­
lation in the educational and professional services, and
median family income for four geographical subdivisions
of the subsystem's environment; the metropolitan region,
the urban region, the local area, and the neighborhood
(Fairweather, et al., 1969).
The metropolitan region is taken as the standard
metropolitan statistical area (SMSA).

The urban area is

defined as the city of Lansing, Michigan.

The neighborhood

is defined as the census tract of which the subsystem is a
part and all of the bordering census tracts.

The local

area is taken as the census tract in which the subsystem
is located.

As can be seen from the data presented in

Table 1 the environments of the halfway house and lodge
are dramatically different.

The neighborhoods of the two

subsystems differ in terms of percentage of blacks,
22

23
Table 1. A comparison of the halfway house and lodge on
demographic data from four geographical subdivisions of
their environment. HOC=Halfway house.

Subdivision

Population
* Black

Metro

Urban

373,423

131,546

3.9*

Housing Units
(All Housing
Vacant or Not| 116,039

Local
Lodge
HOC

Neighborhood
r o d f r .TOC

2 1 ,2 1 1

2,399

4,153

7 .0 *

73.0 *

1 5 ,6 6 0

9.0*

45,300

7,230

6,343

1,531

1,643

* Population
in Labor Force

42*

42*

46*

46*

5656

41*

* Labor Force
in Education
and Profes­
sional
Services

16 *

13*

11*

13*

23*

11 *

Median Family
Income

$11,213

$10,339

----

$10,064 $7,369

percentage of the total labor force in education and pro­
fessional services, and median family income.

The neighbor­

hood of the halfway house is predominately black with a
median family income well below that of either the SMSA or
the urban area.

The neighborhood of the lodge has a median

income which is comparable to that of the SMSA and the
urban area has a population composed of 7 * blacks compared
with the 73* black population of the halfway house neigh­
borhood.

These differences are all the more dramatic if

it is considered that the two programs are only separated

24
by six city blocks (the halfway house is located at 402
S. Walnut while the lodge is located at 517 N. Walnut).
Outcome Variables
During the three month follow-up period a total of
five persons were reinstitutionalized and three persons
were sent to jail.

Comparison of the halfway house and

lodge on these two variables revealed chi-square values of
1.35 (1 df, .20 < p <*.30) and .02 (1 df, .80 < p <*90) for
reinstitutionalization and rejailing, respectively (see
Table 2).

The median time persons spent in the program

during this three month period was 73-5 days.

A comparison

of the halfway house and lodge on median length of stay
revealed a chi-square of 1.37 (1 df, .20 < p <.30).
Median percentage of clean urines was calculated to be
92.2#.

Comparison of the two programs on this variable

revealed a chi-square of .04 (1 df, .80 < p C.90).

The

analyses for these latter two variables are presented in
Table 2.

Thus in terms of these outcomes at 90 days there

are no statistically significant differences between the
two programs.
In order to determine differences between heroin and
non-heroin users on the outcome variables, comparisons
were conducted using chi-square (see Table 3)«

As can be

seen only one test reached significance (i.e. percentage
of clean urines).

Thus, persons who have used heroin in

the past, not surprisingly, exhibit more dirty urines
than do non-heroin users.

25
Table 2. Comparison of the halfway house and lodge on the
four outcome variables; reinstitutionalization, reJailing,
length of stay, and percentage of clean urines.

Outcome Variable
Reinstitutionalization
In treatment some
time
Remained out of
treatment

Halfway
House
N
£

Lodge
N

%

1

3

4

11

19

51

13

35

ReJailing
In Jail some time
Remained out of
Jail

2

5

1

3

Id

49

16

43

Length of stay
Above median
Below median

12
6

32
22

6
11

16

Percentage clean urines
Above median
Below mbdian

11
9

30
24

9
6

24
22

df

£

1

1.35

1

.02

1

1.37

1

.04

30

Cluster Analysis
An empirical V analysis (Tryon and Bailey, 1970) was
conducted on the data from both programs.

In order to

form an outcome cluster percentage of clean urines and
other cluster deflners derived from the empirical V analysis
were preset (Preset Key Cluster Analysis, Tryon and Bailey,
1970).

In this way it was possible to examine outcome

variables and related measures.

In addition variables

found to be independent of outcome could also be defined.
The three preset

clusters derived from the present analysis

26
Table 3* Comparison of non-heroin and heroin users on the
four outcome variables, reinstltutlonalizatlon, rejailing,
length of stay, and percentage of clean urines.

Outcome Variable

Reinstltutlonalizatlon
In treatment some
time
Remained out of
treatment

Heroin
Users
N
%

Non-Heroin
Users
N
£

3

3

2

5

25

63

7

19

df

£

1

.10

1

.10

Rejailing
In jail some time
Remained out of
Jail

2

5

1

3

26

70

8

22

Length of stay
Above median
Below median

14
18

33
43

4
1

11
3

1

.01

Percentage clean urines
Above median
Below median

10
14

27
33

8
5

22
13

1

5-73*

* P <.05

are presented In Table 4.

The correlations between the

oblique cluster domains are presented In Table 5*

27
Table 4 .

The three preset clusters.

Cluster
Cluster 1.
Outcome
1.
Greater number of dirty urines
2.
Shorter time in the program
3 . Heroin
a.
Greater time mainlining heroin
b.
Longer time spent clean
c.
Greater cost of habit
d.
Tendency to support habit illegally
4.
Less optimistic expectations for
treatment
5*
Greater amount of time spent in jail
after beginning illegal drug use
Cluster 2. Drug Behavior
1. Greater number of drugs used
2. Drugs
a. More frequent use of marijuana/hash
b. More frequent use of hallucinogens
c. More frequent use of narcotics
d. More frequent use of CNS depressants
e. More frequent use of CNS stimulants
f. More frequent use of cocaine
g. More frequent use of alcohol
3. Tendency to be younger
Cluster 3 . Institutionalization
1.
Institutional history
a. Older at first institutionalization
b. Greater number of institutionali­
zations
c.
Higher probability of being
reinstitutionalized
2. Greater number of residencechanges
3. Tendency to be female
4. "Middle class”
a. Tendency to be white
b. Parents have a higher occupational
code
5. Older at first illegal drug use
6. Tendency to be married
7*
Tendency to have been born and raised
in the same town

Loading

.6 9

.33
.62
.6 9

.3$
.4 6

.77
.44

.91
.76
,63
.6 7
.6 3

.75
.53
*42
.43

.43
.56
.4 1

.42
.42
.32
.5 4

.45
.3#
.3 3

23
Table 5* Correlations between the oblique cluster domains.
Cluster 1 is outcome, Cluster 2 is Drug Behavior, and
Cluster 3 is Institutionalization.

Cluster 1
Cluster 1

Cluster 2
.09

Cluster 2

.09

Cluster 3

-.09

Cluster 1 (outcome).

Cluster 3
-.09
-.01

-.01

----

This cluster was termed outcome

because its primary definers were the percentage of clean
urines and length of stay as well as other variables found
to be related to those outcomes in the initial empirical V
analysis.

The cluster haB a relatively high reliability

(.30) and high domain validity (.90).

As can be seen in

Table 5 it is relatively uncorrelated with the other two
clusters.

It is correlated .09 with cluster 2 and -.09

with cluster 3»
ables.

In all this cluster contains eight vari­

The first two variables, percentage of clean

urines and length of stay in the program are inversely
related to one another.

Four variables related to the use

of heroin are also found in this cluster; time spent main­
lining heroin, longest time spent free of heroin, cost of
the habit, and the nature of habit support (legal vs.
illegal).

These variables were all negatively related to

the percentage of clean urines and length of stay in the
program.

The score on the Expectancy Questionnaire and

29
the amount of time spent in jail after beginning Illegal
drug use also were Included In this cluster.

Taken together

these variables give a picture of a short-time Intensive
user of heroin, with limited extra-legal Involvement, and
an optimistic view of treatment, as having a good treatment
prognosis.
Cluster 2 (drug behavior).

This was the most reliable

cluster discovered in the analysis (reliability - .&7).
It seems to represent a highly colinear subset of variables
related to drug usage or behavior.
found in this cluster.

Nine variables are

The first variable, total number

of drugs used, has a loading of .91 on the cluster and
correlates positively with all other variables in the clus­
ter except age.

The next seven variables measure the use

of drugs in the following seven classess
hash;

2.) cocaine;

5.) CNS depressants;

3*) hallucinogens;

1.) marijuana/
4.) narcotics;

6.) CNS stimulants; and 7*) alcohol.

The usage pattern (i.e. frequency of use) is highly posi­
tively correlated with the total number of drugs used and
negatively correlated with age.

Age has a loading of .4#

on this cluster and was found to be negatively correlated
with the other variables.

Thus, a greater number of drugs

used and a greater frequency of the use of drugs was found
in the younger members of the sample.

This cluster was

essentially unrelated to the other two clusters.
Cluster 3 (institutionalization).
most difficult cluster to interpret.

This has been the
The relatively low

30
reliability (.6 9 ) coupled with the relatively low loadings
(seven out of ten at or below the .40 level) seem to limit
its generality.

Ten variables are found in this cluster.

The first three (age at first institutionalization, number
of institutionalizations, and number of reinstitutionali­
zations) form a group of variables that might be termed
institutional history.

Two other variables, race and

parents occupational code, formed a second group termed
"middle class."

The five other variables which are found

in this cluster were number of residence changes, sex, age
at first use of illegal drugs, marital status, and whether
or not the person was born and raised in the same town.
Taken as multiple predictors of reinstitutionalization it
would be predicted that the probability of being reinstltutionalized is greatest when the person is a white
middle class female who began illegal drug use at a later
age, who was or is currently married, has changed residences
a greater number of times, has had a history of past insti­
tutionalization, was institutionalized at a later age, and
who was born and raised in the same town.

These variables

seem also to be descriptive of the non-heroin using popu­
lation which is heavily white and has generally been
institutionalized in the course of treatment.
0-Analysis
0-Analysis (Tryon and Bailey, 1970) was conducted in
order to determine individual profiles with respect to the
scores on the three clusters.

Nine O-Types were defined

31
which accounted for 35 out of the 37 subjects*

These

0-Types are presented graphically in Figure 2.

Means,

standard deviations, number of persons in each 0-Type,
and homogeneity are presented in Table 6.
In the discussion below only those 0-Types will be
discussed which had at least one mean cluster composite
score greater than 1 one standard deviation from the
standardized mean.

Of the nine 0-Types only one, 0-Type 5>

had all three cluster scores within the range of expected
values.

The other eight had at least one cluster com­

posite score outside this range.
0-Types 1 and 4— low institutionalization non-whites.
Both these 0-Types scored low on cluster 3 and both are
formed of non-white males with little or no history of
Institutionalization.

The two are differentiable on the

basis of length of stay in the program with 0-Type 1
remaining in the program the full 90 days and the individuals
of 0-Type 4 remaining in the program for the firBt month
before leaving.
0-Types 7 and 6— drug experienced whites.

Both these

0-Types are composed of white individuals who had had a
considerable background of drug use.

In terms of outcome

and institutionalization they are within the range of
expected values.
0-Type 6— institutional white female.

This O-Type is

composed of three white women with a past history of insti­
tutionalization.

They generally stayed in the program less

32

80i
70
60
50

SCORE

40

A
3

80i

4

70

6
A

60
50
40

MEAN

CLUSTER

2

2

A
■I1

2

3

1

*

■

I

3

2

I

80
"7

i

70

w

\

60

50

A

40

2

3

2

3

I

CLUSTER
Figure 2.

A Graphical Representation of the 0-Types.
Cluster number is represented on the
abscissa while mean cluster score is on
the ordinate.

Table 6. Means, standard deviations, N, and Homogeneity
of the 0-Types derived from the analysis. The first num­
ber in each tetrad is the mean followed by the standard
deviation, N, and homogeneity.

O-Types

0-Type 1

0-Type 2

Cluster 1

Cluster 2

Cluster 3

40.3642
2.3955
4
.9709

45.5933
2.9646
4
.9544

35.7641
2.9396
4
.9543

50.3975
4.9940

3 4 .1 1 0 6

49.1679
5.3652

2

0-Type 3

0-Type 4

0-Type 5

0-Type 6

0-Type 7

0-Type 3

0-Type 9

3.1796
2

2

•3661

.9461

.3439

47.7706
7.6192
4 ,
.6477

32.7034
4.6921
4
.3331

6 2 .4 1 2 0

55.3129
3-2777
4
.9446

46.2659
4.0470
4
.9144

37.1533
3.5526
4
.9343

44.2772
2.1994
9
.9755

54.0009
3.7429
9
.9273

46.9769

43.4392
1.6393

43.7336
2.6613

64.2297
1.3637

.9365

.9639

.9907

50.2543
4.3390
2
.9010

64.9256
1.0040
2
.9949

4 3 .0 4 6 3
.3427
2
.9994

50.6029
3.5547

60.9317
1.6440

59.4552
2.6425

.9336

.9664

.9645

30.4095
11.4177
2
-.5510

51.7634
3.9264
2
.9197

47.5050
1.0226
2
.9946

3.6437
4
.9313

4 .6 6 7 1

9
.6344

34
than the full 90 days.

They were average with respect to

scores on the other two clusters.
0»Type 9— high risk.

This 0-Type is formed of two

individuals who used heroin for over 5 years (i.e. main­
lined).

Both were rejailed and left the program within

the first month.
0-Types 2 and 3— drug naive.

These two 0-Types

represent Individuals who scored low on cluster 2, drug
behavior.

0-Type 2 is composed of two individuals, both

non-white, who have had little history of use of drugs
other than heroin.

0-Type 3 is composed of four indi­

viduals, all white, who have used very few different types
of drugs but had a relatively high composite score on the
institutionalisation cluster (cluster 3).
Limitations
The major problem in the interpretation of the results
of both the preset analysis and the 0-Analysis is that only
37 individuals were studied.

In the latter analysis 0-Types

generally contained only two or three individuals which
makes it difficult to determine the meaning of the group­
ings.

While the use of this technique is a viable one for

studies seeking to determins types of persons who do best
in treatment the small sample size of the present study
limits the generalizations which could be derived from
such an analysis.

CHAPTER IV
DISCUSSION

Comparison of Programs
The major results of the study seem disappointing at
first examination.

No statistically significant differences

were found between the halfway house and lodge in terms of
length of stay, percentage of clean urines, reinstitu­
tionalisations, and rejailings.

Our major hypothesis,

that the lodge would be superior to the halfway house in
terms of outcomes in treating drug abusers, is not supported
by these findings.

Several factors, though, inveigh against

a consideration of this study as an actual comparison of the
two different systems.
While the subsystems were intended to be radically dif­
ferent approaches to the treatment of drug abusers many of
these differences existed on paper only.

Thus, while the

lodge had intended to start its own business, such a business
has not yet materialized because the director has felt that a
stable population of clients was a necessary precondition to
its formation.

Also, group autonomy is not like that of the

original lodge developed by Fairweather, et al. (1969)-

At

both the lodge and the halfway house terminations of persons
from the program are made by the respective directors of the
program and their staff.

At the lodge, in distinction to
35

the halfway house, there are no restrictions placed on new
entrants to the program.

In the halfway house clients are

placed on a 30 day restriction during which time they cannot
leave the program without being accompanied by another resi­
dent.

Both programs seek to find employment for their

clients on an informal basis.

Clients in both programs are

encouraged to make use of the job placement services offered
by the community action work center, another component of
the comprehensive drug treatment program.

While residents

of the halfway house are not permitted to have any drugs
including alcohol, lodge residents are permitted to have
alcohol.

Residents of both programs are charged with the

responsibility of physical maintenance of the structures in
which they reside; residents of the lodge are required to do
their own cooking while the members of the halfway house
have a part-time cook.

In the halfway house the resident

with the least senority is required to cook breakfast.
In general the halfway house is marked by a greater
reliance on staff decision making and chain-of-command than
is the lodge.

In the halfway house problems are communi­

cated to an expeditor rather than going to the director as
in the lodge.

Visiting privileges are set by the staff at

the halfway house while at the lodge they are set by the
residents.

In terms of staffing, the lodge has two co­

directors and one staff person while the halfway house has
a director, three counselor aides and a half-time consulting
psychologist.

The latter staff function on an around-the-

clock basis while the lodge staff are physically present

37
from 6s00 A.M. to 5:00 P.M. after which time they serve on
an on-call basis.
As can be seen from the above description the lodge is
a much less authoritarian program than the halfway house
but does not completely have the two characteristics which
were evidenced in the prototype lodge with mental patients;
autonomous self-government and economic self-support.

From

the present findings it would seem, though, that the less
authoritarian approach evidenced by this "lodge" is at least
as effective as the more structured approach taken by the
I
halfway house.
Another feature of the lodge as it was operated in
Lansing which distinguishes it from the prototype lodge (but
not subsequent lodges) was that it housed both male and
i

female residents.

This seemed to represent a major source

of problems for the lodge program.

In one incident a male

resident accosted a female resident and in the ensuing
struggle was stabbed to death.

This tragic occurrence,

coming as it did in the infancy of the program, resulted in
an entire change in structure.

Now, instead of the staff

serving on a consulting basis, there is 24 hour staffing.
It is hard to determine the causes of the incident (i.e.
whether or not it was due to lack of program structure) but
as a result the program is moving away from the original
concept toward a more structured program.
The finding that it seems to make little difference in
outcomes whether the program is loosely or highly structured
and staff dominated is important for several reasons.

In

3#
any treatment program of a residential nature the greatest
costs are generally for staff.

The halfway house expended

approximately 70# of their budget for staff salaries.

The

lodge, on the other hand, expended only 26# of its budget
on staff salaries.

This represents a savings of 44#»

Coupled with the fact that the lodge ultimately becomes
self-supporting, through the operation of the lodge business,
the economic advantages of the lodge program represent a
substantial improvement over the halfway house.
In addition to the economic arguments the finding of
no difference between the two programs, seriously argues
against current conceptions of the treatment of drug abusers.
It has generally been assumed that in order to cure an addict
either methadone or a highly controlling treatment program
was needed.

Advocates of the therapeutic community approach

generally stress the need for a confrontative therapeutic
game as a critical element of treatment (Yablonsky, 1965).
The findings of the present study show that a therapuetic
game, as was practiced in the halfway house, did not produce
superior treatment outcomes.

The fact that Synanon has a

business as well as a confrontative game is of special
significance here.

While advocates of the Synanon approach

argue that the game is the critical element of treatment it
would seem as if the game and the effects of owning and
operating a business are confounded.

In looking at the

principles of Synanon operation cited by Diessler (1972) and
discussed in the introduction, only one of his five prin­
ciples of operation is not a principle that was operative

39
in the* prototype lodge, the therapeutic game.

Thus in the

lodge members learn from their peers, interact frequently
with the community, support themselves, and are generally
away from their original neighborhoods.

The present experi­

ment has allowed an investigation of the operation of a
therapeutic game independent of a member owned and operated
business.

These findings argue for an interpretation of

the "success of Synanon" in terms of the operation of a
i

task oriented community rather than a verbal confrontative
one as the necessary component of success.
The finding that the median percentage of clean urines
was 92.9# and the overall attrition rate was 59.5^ was quite
surprising.

The programs were well below the national

attrition rate of 70#-fi0^ (Glasscote, et al., 1972).

The

fact that the Lansing programs seem to be doing better than
the national average could be due to the fact that the popu­
lation of drug abusers in Lansing is radically different
from the "big city" users usually studied.
Correlates of Treatment Outcomes
No evidence was found that related treatment outcomes
to social class, age, education, employment history, marital
status, or drug use history.

Several investigators (see

Chapter I) have reported such relationships.

The majority

of factors related to outcome were factors descriptive of
the heroin habit such as cost of habit, length of time spent
mainlining heroin, illegal vs. legal support of the habit,
and longest time spent clean.

The Expectancy Questionnaire

had u cluster loading of .77 on the outcome cluster indi­
cating that statements of behavioral intention may be useful
in multivariate prediction of treatment outcomes.

Involve­

ment in criminal activities subsequent to beginning illegal
drug use was also found to be related to outcome.

These

characteristics seem to represent an individual^ degree of
assimilation into the "heroin culture."

The longer an

individual has been mainlining heroin, the greater the cost
of the habit, and use of illegal means to support the habit
all indicate that an Individual is involved in behaviors
which are peculiar to the "heroin culture."

Thus the indi­

vidual effectively becomes "marginalized" at the periphery
of a society which does not sanction drug use.

Involvement

in criminal acts subsequent to beginning illegal drug use
also results in increasing "marginalization."

It is

interesting in this respect to note that addicts who had
"kicked the habit" for a longer period of time and then
returned to heroin use were less likely to have favorable
treatment outcomes than those who had "kicked" for shorter
periods of time.

This relationship could possibly be due

to the fact that addicts who had "kicked" the habit for a
relatively long period of time and then returned to it had
more of a failure set than others who had not been able to
"kick" for such longer periods of time.

The correlation

between a pessimistic expectancy and longer time spent clean
was .4 2 which adds some strength to this interpretation.
Table 4 shows that there are two classes of variables related
to treatment outcomes.

One class, those which measure

41
amount of criminal activity subsequent to beginning illegal
drug use and characteristics of the heroin habit, seem to
measure assimilation into the role of an addict.

The more

assimilation into this role the more unfavorable will be
the treatment outcome.

The second class of factors, those

which measure the behavioral intentions of persons entering
treatment (llxpectancy Questionnaire), may measure past
experience with particular emphasis on failing to "kick"
the habit.

The likelihood of favorable treatment outcomes

seems to be related to success of past treatments.
It was found that drug behavior was highly independent
of outcome.

The only drug class which was loaded highly on

the outcome cluster was narcotics.

This is expected since

the outcome cluster contained a number of factors directly
related to heroin abuse.

Thus, drug naive or drug experi­

enced persons are equally as likely to succeed in treatment.
In terms of the assimilation notion discussed above it would
seem as if there should be a relationship between number of
drugs used and involvement or assimilation into the ”drug
culture.”

Chambers, et al. (1970) reported that poly-drug

users had a higher attrition rate from a methadone program
than heroin-only users.

It was found, though, that there

was a strong negative correlation between the number of drugs
used and the amount of time spent in jail after beginning
illegal drug use (r = -.4&).

In view of this strong negative

relationship it seems that the number of drugs used is not a
measure of assimilation into the "heroin or drug culture.”
It would seem necessary that in order to reach such

U2
conclusions variables indicating drug taking patterns should
be used, not number alone.

A measure was derived from the

analysis which was utilized in an attempt to quantitatively
describe drug taking patterns.

The measure, HILO, resulted

from subtracting the lowest score obtained for any one of
the seven drug classes from the highest score obtained.

It

was felt that if an individual had utilized all the drugs
about evenly then the HILO score would be low and the person
would be drug experienced but with little involvement in
just one drug type.
HILO score.

The converse would apply for a high

It would not be expected that individuals who

experimented with a large variety of drugs would be more
assimilated into the "drug culture" than those who had used
just one or two types of drugs more heavily.

The relatively

high correlation between jail after beginning illegal drug
use and HILO (r = .30) would seem to support this
interpretation.
The factors found in cluster 3» which are termed insti­
tutionalization, appear to be the non-heroin counterpart of
those factors found in the outcome cluster (cluster 1).
Thus non-heroin users tend to be white, middle class adults
who entered into illegal drug use at a relatively older age
than heroin users.

The fact that none of these characteris­

tics correlated with percentage of clean urines is due to
I
the virtual absence of dirty urines in the non-heroin using
clients of the present study.
The results of the 0-Analysis tend to confirm the pre­
dictions made concerning the degree of assimilation and

43
outcome.

0-Type 9, composed of two individuals in the sam­

ple who had been mainlining heroin for over five years did
the poorest.

In terms of length of stay in the program

those persons in 0-Type 1 did the best.

In terms of

assimilation characteristics of the members of this 0-Type
it was formed of two non-white males who had never abused
any narcotic and two that had mainlined heroin for less
than one year.

While O-Type 9 seems to represent a clear-

cut failure typology there was no clear success typology.
Problems in Implementation of Community Research
This study was designed to include a comparison group,
outpatient aftercare, so that drug abusers would be assigned
to one of three different treatment conditions (halfway
house, lodge, and outpatient aftercare).

Early in the study

this condition had to be dropprd because of pressure from
the community mental health board.

It was the board's

feeling that assignment of drug abusers to a counselling
condition represented ineffective and inadequate treatment.
While the board had initially agreed to the empirical
approach advocated by the investigators, they soon reversed
their approval.

This reversal in their attitude towards

the research was probably attributable to the fact that
during the first few months of the residential programs*
operation very few clients applied for entry to the program.
The board expressed their dissatisfaction with the small
number of clients in treatment on several occasions.

Con­

cern centered around the fact that while the programs were

44
budgeted Tor $100,000 each, both programs had only about
four clients each.

They felt that the lack of clients was

due to the fact that some were being assigned to outpatient
aftercare at the local community mental health centers.

In

addition there has always been some disagreement between
the drug program in Lansing and the local community mental
health centers and community mental health board.

This

conflict has arisen both because of differing treatment
philosophies and because of the fact that drug programs
have received large amounts of federal and state monies to
the exclusion of community mental health programs.

These

factors resulted in the eventual removal of the outpatient
condition from the study.

The study had also originally

included instruments designed to measure internal processes
in both of the residential programs.

Both because of delay

in the construction of the instruments and lack of coopera­
tion on the part of certain program personnel these instru­
ments were never administered to the treatment populations.
These two problems illustrate two recurring problems in
the implementation of community research;
written administrative agreements; and 2.)
researcher control of treatment programs.

1.)

The need for

The need for
If written adminis­

trative agreements had been required initially the board
would have probably been more reticent to not fulfill its
committments.

Written agreements would have also provided

a better incentive for the Lansing drug program director to
stand behind the researchers.

As it was the director did

not staunchly ally himself with the research efforts.

The

need for researcher control of the treatment programs was
also a problem in the present study.

Instruments designed

for use within the programs would have been easily adminis­
tered with a researcher running the program or had a
researcher been in a position of authority over the treat­
ment directors.

As it was, one of the directors was quite

hostile to the whole concept of research.

To him the notion

of random assignment to treatment programs was a severe
impediment to treatment.

Random assignment was cited as

the cause of the relatively slow growth of the client popu­
lation in the treatment programs.

He also felt that random

assignment was in fact biased assignment.

This director

saw the researcher as assigning all bad people to him.
Even when all these criticisms were met and explained he
was still antagonistic toward the research and the re­
searcher.

This points out an important principle of commu­

nity research.

In evaluating existing programs it is

necessary to allow programs the option to not be a part of
the study.

The present research design was imposed on the

treatment programs which, it was felt, promoted antogonism.
Another problem which made the research more difficult was
the fact that programs were intended to become an integral
part of the Lansing drug treatment program rather than being
designed as models to be tested empirically.

Thus the need

for research was seen as academic rather than the means for
finding the "best" treatment modality.

The imposition of

the research design was consequently seen as more of an
impediment to treatment than as an aid to discovering the

46
most efficacious means of treatment.

Researcher control

of the treatment programs would have partially insured the
success of the original design.

In addition it would have

insured the committment to model testing rather than the
perpetuation of a particular treatment modality because of
its political popularity.
Three critical elements have emerged which are neces­
sary for conducting community research;

1.)

Written,

formal administrative agreements which clearly specify the
obligations of all parties concerned with or affected by
the research;

2.)

The researcher must be in control of

the treatment program; this control could be exercised in
the formal directorship of the program or having researchers
in supervisory control of treatment program directors; and
3.)

Research designs cannot be imposed on unwilling pro­

grams; a trial period could be established during which,
the programs could decide whether or not they wished to
remain a part of the research design.
Summary

The present study originally had been intended to be
a comparison of two disparate treatment modalities, the half­
way house and the lodge.

Instead, because of modification of

the lodge structure, the comparison that was actually con­
ducted was between an authoritarian program (halfway house)
and a less-authoritarian program (lodge).

The finding of no

differences between the two approaches seriously weakens the
arguments for the need for highly structured programs for
the treatment of chronic drug abusers.

hi
The factors that, wore found to bo related to outcome
genera I Ly supported the hypothesis th«*it Increased assimi­

lation Into the "drug culture" as measured by longer time
spent mainlining heroin, greater habit cost, illegal support
of the habit, and more time spent in jail after beginning
illegal drug use, leads to unfavorable treatment outcomes.
No evidence was found that related treatment outcomes to
social class, age, education, employment history, marital
status, or drug use history, as had been reported by several
other Investigators.
Three critical elements were also discussed which are
necessary for the implementation of community research;
.1.)

Written administrative agreements;

control of treatment programs; and 3.)

2.)

Researcher

The necessity to

leave unwilling programs out of the research design.

APPENDICES

APPENDIX A

TIIK INTAKE QUESTIONNAIRE
Pat. iout *s Name
Address

Tel. Number

___________________

Social Security Number _ _ _ _ _
Admission Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Termination Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name of parent or next of kin to be contacted in case of
emergency:
Name _____________________________ Relationship _ _ _ _ _ _ _ _
Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Tel. Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
How often do you see this person? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
When was the last time you saw this person?
Program Assignment:

Multi-Lodge _ _ _ Half-way House ____

Outpatient aftercare (specify facility) _______________
IF NON-VOLUNTEER:

Specify program recommendation ______

Who referred you to us?
DEC

Mason CMH

North Side Crisis

Lansing CMH

West Side Crisis

Charlotte CMH

Listening Ear

St. John's CMH

Ingham County Jail Program

Sparrow Hospital

Kalamazoo State Hospital

Ingham Medical

Methadone Program

Other (specify):
4*

49
Patient'r. propram number _____
L.

Date of admission

/

/

day
2.

Date of birth

/

/

day
3*

Ape at admission

4*

Sex:

5*

Race:

6.

Marital Status:

7-

1. M

year

month

year

month

2. F

1. B

2. W

3* Mex-Am

4* Other

1.

Single (never married)

3*

Separated

5*

2.

Married

4*

Divorced

6.

IF MARRIED:

Does your spouse work?

Widow or
Widower
Remarried

If so t what

does he or she do?
6.

What was the highest grade in school completed by your
spouse?

9*

What is the highest grade you completed? ____________

OMIT THK H M ' QUESTI'OH AT CENTRAL TMTATCF,
10.

Why did you

1.

leave school*

Voluntary reasons

W a s it Tors

2.

Involuntary reasons

11.

How many children do you have? __________________

12.

What are their ages and where are they living?

50
13.

With whom are you living now?

14-

1.

Parents only or parents and other family

2.

Spouse

3.

Other family

4.

Friends

5.

Alone

How many times have you changed residence in the last
year?

tm t

Tmn ra rr

A rsa rcm i i ntake

15.

What is the name of the last school you attended?

Address

-

.16. Would you beinterested in completinghigh school?
1.
17.

Yes

2.

No

What subjects did you like best

inschool?

What is your present religion?
1.

None

4.

Jewish

2.

Protestant

5.

Muslim

3.

Catholic

6.

Other

FAMILY BACKGROUND
1.

Where were you born?

City
Country

State

51
2.

Whore did you grow up?

3.

When you were growing up, who were the adults you w€*re
living with?

_ _ _ _ _ . _ _

I would llko to know their agen und marital

status also:

(IN ANSWERING THE FOLLOWING QUESTIONS, IF IDENTITY OF MOTHER
AND FATHER ARE UNKNOWN, USE THE OCCUPATIONS OF THE ADULTS IN
QUESTION #3)
4.

While you were growing up, what was the highest grade
completed by your:

5.

Father

2. Mother_________

While you were growing up, what were the occupations of
your:

6.

1.

1,

Father

____________— —

—_ _ _ _ _ _ _ _ _

2.

Mother

_ _ _ _ _ _ _ _____________ ______

While you were growing up, what language was spoken at
home?

___________________________—________________

7.

What language do you prefer to speak? _______________

3.

How many brothers and sisters do you have? ________________
For each, what is their sex, age, marital status, and
number of children?

T m r ym
9.

h m

mm k

questions" at’1c W r a l intake

What is your feeling towards your family at present?
1.

Distant

3. Close

2.

Warm

4* Family deceased

52
10.

IF MARRIED:

What is your feeling towards your spouse

and children (if any)?
1.
11.

Distant

Warm

3.

Do you have any close friends now?
IF YES:

12.

2.

1.

Close

Yes

2.

No

How many?_______________

What was the economic status of your household while
you were growing up?
1.

Mostly on welfare

3. Average

2.

Poor

4. Above average

EMPLOYMENT BACKGROUND
1.

Are you presently employed?

1.

Yes

2.

No

2. IF YES:
Who is your employer?
What do you do there? _ _ _ _ _ _ _ _ _ _ _ _
How long have you been employed there? ________________
What is your gross income?
3-

4.

TP NO:

What is your source of income?

1.

Welfare

3» Veteran's Disability

2.

ADC

4- Other

FOR THOSE WORKING:
from your job?
If so, what

5.

_____

1.

type?

_

Doyou receive
Yes

2.

any income other
No

(use categories from question #3)

Do you support anyone else?

1.

Yes

2.

No

If so, how many (include yourself)? _____________

than

53
6.

How many

jobs have you held in the past 10 years? _ _ _ _ _

For each

job, I want you

to tell me thenature of the

job, how

long you worked

there, and thereason for

leaving (were

you fired,

laid off, or did you Just

change jobs?):
DURATION OF
_______ TYPE OF_JOB_______ EMPLOYMENT

FIRED

LAID OFF

QUIT

54

OMIT TH'Jj NUTT QTC3TTOM AT
7.

INTAKE

What kind of work would you like to do?

MILITARY HISTORY
1.

Have you ever served in the armed forces?

2 . IF YES:

1. Yes

2. No

How long? ______________________

3.

Rank _____________________________________

4.

Date and type of discharge __________________________

5.

Any specialized training?

6.

IF YES:

1. Yes

2. No

What type?

ARREST RECORD (USE TABLE ON NEXT PAGE)
1.

Have you ever been arrested?

1. Yes

2. No

IF YES:
2.

How many times were you in jail before you started using
drugs, and afterwards?

3.

BEFORE ________

How much time did you spend in jail before you started
using drugs, and afterwards?

4.

AFTER ________

BEFORE _____ AFTER ______

How many arrests and convictions have you had for each
of the crimes listed below before you started using
drugs?

After?

(See table on next page.)

55
CRIME

arrests

BEFORE
WILLFUL HOMICIDE
FORCIBLE RAPE
ROBBERY
AGGRAVATED ASSAULT
BURGLARY
LARCENY ($50 AND OVER)
MOTOR VEHICLE THEFT

AFTER

convictions

BEFORE

AFTER

2.

Did you ever
use: (check
if yes)

Are )rou
curresntly
usingj?
no
yes

t

3.

IF NO:
When did
you stop?
(months;

Wine, beer,
whiskey^
Amphetamines
Barbiturates
Minor l
rranquilizers
Marijuana
Hashish
Heroij^
OpiunL^
Morphine2
Methadone2
Codeine
LSD
Mescaline
Psilocybin
Cocaine
Glue
Major Tran­
quilizers
Other
1.
2.

If yes go to question #$.
If yes go to question #9.

4.
How oft,en
do (die0
you use drug?
< 1 mo > 1 mo

5.
If >1 mo.
how often
did you
use it?
(per mo.)

6.
How long
have you
been using
it? (months)

7.
How many
people dc
(did) you
do it
with?

57
tf.

IF PATIENT HAS USED ALCOHOL:
.1.

How many times a week do you drink? _____________

2.

How many glasses of beer or wine, or shots of*
whiskey do you usually drink at one sitting? ____

3.

9.

What is the maximum you drink at any one sitting?

IF PATIENT HAS USED AN OPIATE:
1.

Do you use it currently?

IF NO:

2.

When was the

Her

1. Yes

2. No

last time you used?

Op

1. Yes

2. No

Her

Morph

1. Yes

2. No

Op

Dem

1. Yes

2. No

Morph

Meth

1. Yes

2. No

Dem
Meth

3.

4-. Who first introduced

When you last used, was

you to the drug?

it to get straight or high?

5.

Her

1. S

2. H

Her

On

1. S

2. H

Op

Morph

1. S

2. H

Morph

Dem

1. S

2. H

Dem

Meth

1. S

2. H

Meth

How old were you when

6

.

How did you first do it up?

you first tried it?

Her

Her _________________

Op

Op __________________

Morph

Morph

Dem

____________

Dem ____________________
Meth

Meth

snort
smoke
snort
smoke
snort
smoke
snort
smoke
snort
smoke

pop shoot
other
pop shoot
other
pop shoot
other
pop shoot
other
pop shoot
other

58
7.

How long did you spend skin-popping, snorting, and
mainlining each drug?
Her

pop

Op

pop _________

Morphpop __________

8

.

snort

shoot _____

snort _ _ _ _ _ _

snort

______

pop _________

snort___________

shoot ____

Meth

pop _________

snort

shoot ____

Do you mainline?

9.

Op

How long?

______________

Morph

Morph

Dem _

Dem

Meth

Meth

Ever use any other route?
Her

1. yes

2.

no

Op

1. yes

2.

no

Morph

1. yes

2.

no

Dem

1. yes

2.

no

Meth

1. yes

2.

no

11 . How long have you been

12 . How much per day do you use?

13.

IF YES:

Her _ _ _ _ _ _ _ _ _

________________

op

.

shoot _____

Dem

Her _____________

10

shoot_____

addicted?

Cost:

in dollars per day

Her ____________________

Her ____________________

Op

O p ____________________

____________________

Morph _____________________

Morph __________________

Dem ______________________

Dem _____________________

Meth

Meth

How do you support your habit?

59
14.

Have you over tried to kick the habit on your own?
1.

15.

Yes

IF YES:

2.

No

How many times?

________________________

How?

.

16.

What was the longest time you stayed clean?

17-

What was the shortest time you stayed clean?

10. What was the

first drug you used? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

11. How old were

you when you first used it? ________________

12.

Has anyone in your immediate family, or with whom you are
living, ever used any of the drugs listed in question #1?
1.

13.

Yes

2.

No

IF YES:
1.

Person

2.

Drugs

60
1.

Have you ever been treated for personal problems or drug
use?

2.

1.

Yes

2.

No

IF YES:

REASON FOR
SEEKING
TREATMENT

* TYPES:

TYPE*

Hospital
Out-Patient
Transitional

AGE AT
TREATMENT

REASON FOR
TERMINATION
(voluntary or
involuntary)
LENGTH VOL
INVOL

APPENDIX B

APPENDIX B
THE EXPECTANCY QUESTIONNAIRE
Name

__ D a t e _______________
Onployed ______ yes

no

Below are several statements in which you are asked to guess
how you will like some aspects of your living situation.
Read each statement carefully and choose the one phrase that
most accurately reflects your guess about the future.

An

example is given below:
Example:

I will like the food where I will live.

X

A great deal
Quite a bit
_______ Somewhat
Only slightly
_____ Not at all
Please complete the following statements by choosing the one
phrase which most accurately reflects your guess about the
future.
U

I will like the place where I live.
A great deal
Quite a bit
Somewhat
Only slightly
Not at all

2.

I will like the people with whom I live.
A great deal
_______ Quite a bit
_____ Somewhat
_____ Only slightly
Not at all

61

I will like the sleeping arrangements.
A great deal
_____ Quite a bit
Somewhat
Only slightly
Not at all
The place where I live will make it easy for me to stay
off drugs.
Strongly agree
_____ Agree
______ Undecided
_____ Disagree
Strongly disagree
I will like the food.
A great deal
Quite a bit
Somewhat
______ Only slightly
Not at all
I will like my room.
_____ A great deal
Quite a bit
_____ Somewhat
Only slightly
Not at all
I will like to get out of the house and go to the movies
or a party, or do something else.
A great deal
_____ Quite a bit
Somewhat
Only slightly
Not at all
I will like the recreational facilities in or near the
place where I live.
A great deal
Quite a bit
_____ Somewhat
_______ Only slightly
Not at all

63
9.

I will like to see my friends.
A great deal
_____ Quite a bit
Somewhat
__ Only slightly
Not at all

10.

The program that I am going to will help me get myself
together.
Strongly agree
Agree
Undecided
Disagree
Strongly disagree

11.

I will like the way I will spend my free time.
A great deal
Quite a bit
_____ Somewhat
Only slightly
Not at all

12.

I will like to spend my spare time with other people.
_____ A great deal
Quite a bit
_
Somewhat
Only slightly
Not at all

13*

The staff in the program will help me with my problems,
A great deal
_____ Quite a bit
Somewhat
Only slightly
Not at all

14.

I will like the job I find.
Strongly agree
Agree
Undecided
________ Disagree
_____ Strongly disagree

64
15.

I will earn every cent of my salary.
Strongly agree
______ Agree
Undecided
_____ Disagree
_____ Strongly disagree

16.

I will be able to go as far as I would like to in the
job I get.
Strongly agree
_____ Agree
Undecided
Disagree
Strongly disagree

17.

I will be doing the kind of job I want to do.
_____ Strongly agree
Agree
Undecided
______ Disagree
_____ Strongly disagree

1$.

I will remain on the job I find.
_____ Strongly agree
_______ Agree
Undecided
Disagree
_____ Strongly disagree

19.

Compared with the way X now live, I will be well satisfied
with my living conditions.
_____ Strongly agree
_ Agree
Undecided
_____ Disagree
Strongly disagree

20.

I will feel very proud of my living quarters.
______
______
_____
_____

Strongly agree
Agree
Undecided
Disagree
Strongly disagree

65
21.

I will want to live in the house where I go for a long
time.
Strongly agree
Agree
Undecided
_____ Disagree
_____ Strongly disagree

22.

I will be happy to leave where I fm living now to live in
the halfway house or lodge.
_____ Strongly agree
_____ Agree
Undecided
_____ Disagree
Strongly disagree

LIST OF REFERENCES

LIST OF REFERENCES

Bandura, A. Principles of Behavior Modification.
Holt, Rinehart, and Winston, inc. I9t>9«

New Yorks

Berecochea, J. E. and Sing, G. E., Jr. The Effectiveness of
a Halfway House for Civilly Committed Addicts. International Journal of the Addictions, 1972, 7 (1), 123-

TJTl

Carroll, L. T. An Investigation of the Internal-External
Control Construct In a Population of Addicts Addicted
to Narcotic Drugs. Dissertation Abstracts Inter­
-----------national, 1 9 6 9 , 3o cc-gr,
Chambers, C. D., Cuskey, W. R., and Wieland, W. F. Predictors
of Attrition During the Outpatient Detoxification of
Opiate Addicts. Bulletin on Narcotics, 1970, 23 (4),
43-46.
DeFleur, L. B., Ball, J. C., and Snarr, R. W. The LongTerm Social Correlates of Opiate Addiction. Social
Problems, 1969, 17 (2), 225-234.
DcMeritt, M. W. Differences in the Self-Concept of Drug
Abusers, Non-Users, and Former Users of Narcotics and/
or NcnNarcctic Drugs. Dissertation Abstracts Inter—
national, 1970, 31 (3-A)7 IPPg.
DeQulncey, T. Confessions of aun English Opium Eater.
Middlesex, Jilngiand: Penguin hooks,
Deissler, K. J. Synanon: How It Works, Why It Works, in
Blachly, P., (ed.) Progress in Drug Abuse. Spring­
field: C. C. Thomas'; 1972"
---Duvall, H. J., Coche, B. Z., and Brill, L. Follow-up Study
of Narcotic Drug Addicts After Five Years Hospitalization.
Public Health Reports, 1963, 76 (3), 165-194.
Fairweather, G. W., Simon, R., Gebhard, M. E., Weingarten, E.,
Holland, J. L., Sanders, R.f Stone,G. B . , and Reahl, G.E.
Relative Effectiveness of Psychotherapeutic Programs: a
Multicriteria Comparison of Four Programs for Three
Different Groups. Psychological Monographs, I960, 74 (5).
66

67
Fairweather, G. W. (Ed.), Social Psychology in Treating
M e n t a l Illness: An Experimental Approach. N e w York:
John Wiley and ^ons, Inc., l % 4 .
Fairweather, G. W. Methods for Experimental Social Inno­
vation . New York* John Wiley ancl Sons, Inc., iyt>7»
Fairweather, G. W., Sanders, D. H., Cressler, D. L., and
Maynard, H . Community Life for the Mentally 111,
Chicago: Aldine, i9fc>9Fairweather, G. W . , Sanders, D. H., Maynard, H., Cressler,
D. L., and Jennings, R. D. A Manual for Developing a
Community Treatment Program, Portland, Oregon: Institute
for the Psychological Study of Living Systems, 1969.
Fairweather, G. W., Sanders, D. H., and Tornatzky, L.
Creating Change in Mental Health Organizations (in press)

W /'f.

Geis, G. The East Los Angeles Halfway House for Narcotics
Addicts. Sacremenio, California: Institute for the
Study of Crime and Delinquency, 1966.
Gendreau, P. and Gendreau, L. P. Research Design and Narcotic
Addiction Proneness. Canadian Psychiatric Association
Journal, 1971» 16, 265-Z&7.
Hess, A. G., Deviance Theory and the History of Opiates.
International Journal of the Addictions, 1971* 6 (4),
W t t W . ------------------------------------------

Glasscote, R., Sussex, J. N., Jaffe, J. H., Ball, J., and
Brill, L. The Treatment of Drug Abuse, Washington, D. C.:
The Joint IniVmation Service of the American Psychiatri c
Association, 1972.
Hunt, G. H. and Odoroff, M. E. Follow-Up Study of Narcotics
Drug Addicts After Hospitalization. Public Health
Reports, 1962, 77 (1), 41-54.
Jones, J. E. How 92$ Beat the Dope Habit. Bulletin of the
Los Angeles County Medical Association, 1 ^ 8 , 19, 37.
Kaplan, H. and Meyerowitz, J. Evaluation of a Halfway House:
Integrated Community Approach in the Rehabilitation of
Narcotic Addicts. International Journal of the Addictions,
1969, 4 (1)» 65-76.
Lindsmith, A. R. The Addict and the Law.
House, 1965.

New York:

Random

O'Donnel, J. A. The Relapse Rate in Narcotic Addiction: A
Critique of Follow-Up Studies, in Wilnor and Kassenbaum
(eds.) Narcotics, New York: McGraw Hill, 1970.
Pescor, M. J,.
Addicts.
1-ia.

Follow-Up Study of Treated Narcotic Drug
Public Health Reports, 1943, Supplement 170,

C. E. and Pellens, M. The Opium Problem.
Social Hygiene, Inc., 1928.

Terry,

R. C. and Bailey, D. E.
McGraw Hill, 1970.

Tryon,

Cluster Analysis.

Bureau of
New York:

Vaillant, G. E. Twelve Year Follow-Up of New York Narcotic
Addicts: I. Relation of Treatment to Outcome. American
Journal of Psychiatry, 1966, 122, 727-737.
Volkman, R. and Cressey, D. R. Differential Association and
Rehabilitation of Drug Addicts, in O'Donne1, J. A. and
Ball, J. C. (eds.) Narcotics Addiction. New York:
Harper and Row. 1966,
Winick, C. Maturing Out of Addiction. United Nations
Bulletin on Narcotics, 1962, 14 (1), 1-fe.
Yablonsky, L. Synanon: The Tunnel Back.
Penguin Books, 1965*

Baltimore, Maryland:

Zahn, M. and Ball, J. C. Factors Related to Cure of Opiate
Addiction Among Puerto Rican Adults. International
Journal of the Addictions. 1972, 2