on

drug abuse

robert I.dupont,m.d.

institute for behavior and health

avram goldstein,m.d.

stanford university and

addiction research foundation

john o'donnell,ph.d.

university of kentucky

editors

barry brown, ph.d.

national institute on drug abuse

managing editor

Social Work Gift 7/15/77

Foreword

Today, when drug abuse professionals attempt to update their knowledge of the field, they confront a situation unknown to us 10 years ago-an abundance of solid research available in a wide variety of journals and monographs. The issue then becomes one of choice. Which articles are most relevant to planning prevention programing or managing local treatment units, and just as critical, which materials are the policymaker, clinician, or community organizer most likely to find both useful and understandable?

The second question is particularly important because as the field has both developed new techniques and utilized effective strategies from long established disciplines, its vocabulary has expanded and become more complex. While undeniably useful to the field as a whole, this new eclecticism does pose a special problem for the concerned professional who may not share a common knowledge base or research tradition with a published colleague. Thus, although goals are shared, the vital language to communicate findings-and the clinical implications of findings-may not be. As a result of this diffusion of effort, much relevant research is apparently not being disseminated to the field in a concise, understandable form, and research findings are not having an effect on clinical practice as rapidly as would seem desirable. When I discussed this problem with Dr. Barry S. Brown, Chief of the Services Research Branch of NIDA in late 1977, we decided that a compilation of recent research findings written in a style understandable to planners, clinicians, and policymakers was badly needed.

It was agreed that the Office of Drug Abuse Policy in the Executive Office of the President and the National Institute on Drug Abuse of the Department of Health, Education, and Welfare, would jointly sponsor such a publication with the Office of Drug Abuse Policy providing the needed financial support. Chapters would be commissioned from researchers and clinicians recognized by their peers as experts in one or another aspect of drug abuse. Our goal was to make available to the field a concise compilation of major developments of recent years and their implications for treatment and research.

We contracted with over 40 authors, all well known and respected in their fields, and I believe we have met that goal. During the drafting process, the editors commented on the interpretations of the research, but each author was free to incorporate as much or as little of the editors' comments as the individual author chose. Thus, the authors were free to express their viewpoints and interpretations of issues. In addition, many authors included recommendations for the future, including policy recommendations, and these too reflect the authors' thinking.

The handbook is organized into nine sections which cover issues ranging from the history of the field by Dr. Jaffe, to innovative treatment for drug addiction by Dr. O'Brien and Dr. Ng. Special attention has been given to the issue of treatment, which is discussed in chapters on the established modalities of treatment for narcotic addicts and studies of their effectiveness; in those describing ancillary treatment programs; and in chapters on specific populations such as youth, women, the elderly, and minority communities.

A separate section of the book is devoted to specific drugs or classes of drugs, such as PCP and amphetamines, which have aroused public concern in the past few years. One section looks at drug use from a psychosocial perspective, while another assumes an epidemiological viewpoint. Management, training, and prevention are discussed as special issues. The final section discusses research prospects and concludes with an assessment of the future direction of the drug abuse field.

Taken together, these chapters present a comprehensive understanding of our research and treatment efforts and, perhaps more important, propose new directions in which we can proceed. I believe that this book will fill a critical need among professionals in the field of drug abuse prevention and treatment and that it will be widely acclaimed for years to come.

Preface

Lee Dogoloff's foreword describes the concept and design of this handbook. A word should be added on how it came to fruition.

Authors had been told that the intention was to make available to those in the drug abuse field a concise compilation of major developments of recent years, and their implications. Each chapter was to review briefly highlights from the past 5 years (more if indicated) of research and program initiative. Each was to be only 5 to 10 printed pages in length and was to include brief sections on implications for further research, for treatment, for prevention, and for training, unless one or more of these was not relevant. The original timetable called for first drafts of the chapters by the end of 1977 and publication in the spring of 1978.

This timetable was not kept, as the date of publication indicates. As is usual in any project, there were many unforeseen difficulties. Gaps in coverage were identified and new chapters commissioned. Some authors, because of prior commitments of time or other problems, could not meet their deadlines. Some chapters, in the judgment of the editors, required extensive revision, in several instances because the first draft was seen as too technical and not properly designed for the intended general audience.

Two types of editorial decisions deserve comment. First is the point made by Lee Dogoloff on interpretation of data and policy recommendations. The second type of decision relates to the content and depth of the chapters. Some authors held themselves to the original instructions, for example, with regard to length, and therefore had limited space to cover their assignments, necessarily omitting details. Others aimed at fuller coverage, regardless of restrictions, and exceeded the requested length. In a few cases, there was so little firmly established information in an assigned area that the authors could not say much even in a brief chapter. Aside from cutting extraneous material and material covered in other chapters, the editors chose to let chapters stand as written or as revised.

For this reason, and probably for other reasons too, the substantive coverage contained in the chapters in this handbook is somewhat uneven in the opinion of the editors. Many of the chapters are clearly superb-masterly reviews of what is known, judicious evaluations of research, with wise and practical suggestions for future directions in research, treatment, and prevention. We agree with Dogoloff that they will be widely cited for years to come. Most of the other chapters are at least competent and useful overviews of their areas, and thus achieve the original goal of the handbook. A few, in the frank opinion of the editors, are included with some misgivings, on the grounds that partial coverage of an area is preferable to omitting it entirely, and that seeking replacement authors would have delayed publication too long.

Readers will probably find that their major interests center on only a few of the sections, but most will find material of value throughout the book.