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groups in several of our large cities experiment with drugs. The Children's Bureau estimates that 500,000 children age 10 to 17 come to the attention of the juvenile courts each year. During 1953 and 1954 fewer than 400 addicts of school age come to the attention of the authorities. According to the Department of Education there are 38,149,000 school children in grades from kindergarten through the eighth grade in the United States and 7,919,000 in grades 9 through 12. The total number of addicts under 21 that came to the attention of the authorities in 1953 and 1954 was 3,125. Nearly 88 percent of these were 18 or over. Juvenile delinquency as expressed by narcotic indulgence is in practically all cases evidence of an unstable personality. In the deprived groups this expression occurs in insecure individuals seeking to express themselves in ways that promise excitement, unusual sensations, and the thrill of defying authority. In the group that become addicts there are a few who have a normal personality.
There is no problem about curing these normal persons. They become frightened. They want to be cured and get cured with or without hospital assistance and as a rule do not relapse. The mildly unstable juveniles as well as older persons of this type who become addicted also get panicky, seek cure and achieve it as they always have but more of these relapse. The most unstable become chronic addicts and are extremely difficult to cure. It is this unstable group, many but not all of whom were delinquent before they became addicts, who give some people the impression that drug addicts are never cured.
The chronic addict to the opium drugs, including morphine and heroin, and to the synthetic drugs, methadone and demerol, is in the same situation as to cure as the chronic compulsive alcoholic who is extremely prone to relapse. Nevertheless, I have seen cure of an alcoholic who had been in jail 167 times for drunkenness. I have also seen an addict cured after 40 years of morphine indulgence. Therefore, hope of cure should not be abandoned in either condition. The juveniles who become chronic addicts are always decidedly unstable and are usually delinquent before they become addicts. The impulse to commit delinquent acts is not increased by morphine, heroin, or other opiate drugs or by methadone and demerol. The direct effect of these drugs is to decrease aggressive crime, but addicts to these drugs do commit crimes in order to get drugs to ward off the suffering that follows forced abstinence. The crimes are violations of narcotic laws, stealing, forging prescriptions, etc., and more serious crimes in the case of original aggressively inclined criminals.
Rape, a common crime among juveniles, is less likely to be committed by a juvenile morphine or heroin addict, both during sustained addiction and the distressing withdrawal period. During sustained addiction the sex impulse is decreased by the drugs and during withdrawal the physical distress siphons his attention away from sex.
Heroin is no more harmful as an addicting drug than morphine. There is no reliable medical evidence to sustain the popular conception about the special sinister effect if this drug. Heroin is more toxic; however, like morphine and some other opiates, it quickly causes physical addiction if used daily.
The physical addiction caused by opiates and related drugs is the only effect of these drugs that justifies special measures to control their use beyond the usual measures applied to other dangerous drugs, such as forbidding purchase except on prescriptions and forbidding the refilling of prescriptions. The opiates are usually more effective tranquilizers and always less harmful to the physical and mental well-being of patients than the tons of tranquilizing drugs now being taken all over the United States. This is the reason why the Public Health Service should continue its efforts to develop a pain relieving, tranquilizing opiate that does not cause physical addiction.
The physical addiction to opiates causes such a severe and distressing type of slavery that every effort should be made to cure it at an early stage before developing habit patterns intensify and add to the original psychological reason for the addiction. Hospitalization with adequate followup, not by police, but by social workers and mental-health clinics to which addicts can go both before and after hospitalization is the answer. Hospitalization for voluntary patients especially juveniles is important. Hospitalization for addicts caught violating a narcotic law should be on a commitment or probation basis. The recidivist criminal who is an addict because he is a criminal may as well be sent to jail. Very few persons under 21 fall in this class.
Marihuana addiction is more serious from the mental, physical, and social standpoint than opiate addiction, but less serious in that there is no physical
addiction. Marihuana addiction does not lead to heroin addiction because of the marihuana, but most members of the unstable sidewalk juvenile groups who experiment with both marihuana and heroin are apt to become heroin addicts because of the physical dependence that heroin produces. One marihuana cigarette produces about the same degree of intoxication as 1 ounce of whisky. Juveniles should therefore be protected from it especially as like alcohol intoxication, marihuana intoxication may lead aggressively inclined persons to commit aggressive crimes. However there are fewer than 5,000 marihuana addicts in the United States as against the 68 million drinkers. Well known authorities have estimated that there are 200 million marihuana users in the world.
In summary, drug addiction is of only slight importance in juvenile delinquency. It is believed that most of the addiction proceeds from delinquency and that most juveniles who experiment with narcotics will discontinue the experiment before they become seriously addicted. Treatment divested as far as possible from police action should be provided for them.
In the event that the United States should adopt a policy of dealing with addicts based on the British method of giving maintenance doses of opiates to chronic addicts so that they can continue at work and in good health and not commit crimes, the method adopted should not result in giving maintenance doses to juveniles. Several efforts should be made to cure juveniles before maintenace doses are thought of as a remedy. They would then be beyond age 21.
The British method is explained in the Home Office Regulations DD101 (6th edition) February 1956 entitled "The Duties of Doctors and Dentists Under the Dangerous Drugs Act and Regulations."
Dr. KOLB. Now, drug addiction is a very minor factor in juvenile delinquency. For instance, I get from the children's bureau they have 500,000 children each year before the juvenile courts.
Now, the President's Committee on Drug Addiction found out that over a 2-year period, 1953 and 1954, there were only 400 addicts of school age in the United States-this was up to age 18-and according to the Department of Education, there are 38 million schoolchildren of that age; and from there on, from the 9th to the 12th grade, there are 7,919,000 additional schoolchildren.
Well, in that entire age group, the President's Committee found that there were 3,125 addicts, and that makes over 40 million children, so you can see really how small the problem is. But there is a problem, and it should be attended to.
Now, juvenile delinquency as expressed by these children who become chronic addicts, is a problem of an emotional disturbance. I have found, and other researchers in this field have found, that with practically all of these children, there is some sort of an emotional disorder to begin with. It is not an absolute rule in all cases.
In our large cities at the present time there are some addicts among the juveniles who probably are normal and near-normal, and I want to say about those addicts you needn't worry about them, they are going to get cured, because along with other addicts they get panicky as soon as they become addicted to a thing like heroin, they ask for a cure, and a lot of them get cured, even without going to a hospital. They get cured just by stopping the drug themselves or by a private doctor who doesn't give them any drug or, if they go to a hospital like Lexington, that group will remain cured.
We had from Dr. Lowry yesterday the fact that 61 percent of the people who came to Lexington, you never heard of them before. One reason why, I found out, you don't hear of those people through the years any more, is that they don't go out and advertise the fact they were addicts, because addiction is a thing that is looked upon with such extreme disfavor by all strata of our society.
Now, the chronic addict to all-whether he is an adult or whether he is a juvenile, the chronic addict to such things as morphine and heroin, and the synthetic drugs, methadone and demerol, is always a disturbed person emotionally.
We don't have any more in the country, chronic addicts, who are normal from a nervous standpoint.
I would point up that in the United States we have 9 million people who are somewhere mentally disturbed. It doesn't mean we need to be in a mental hospital or jail or anything like that. We are just distressed about some emotional problem, but we probably never tell anybody about it.
But that is the group of people from which the chronic addict is recruited. Those persons who, unfortunately, get started onto this thing and who, because of the magnitude of their emotional problems, get so much relief from it, when they get cured and they meet another distressful situation they go back to solve it the same way; and I always explain this matter, in order that the layman might understand it, in terms of chronic alcoholism.
The chronic drug addict is exactly the same thing, emotionally, as the chronic alcoholic. That is the problem alcoholic who can't be cured; who swears off from drinking and who goes home, and gets drunk on the way home.
That same thing happens to the chronic drug addict. But even these people, some of them, are cured. I have seen a chronic alcoholic of this kind cured after 167 times in jail; and I have seen a drug addict cured, of this type, after 40 years of addiction. So it isn't absolutely a hopeless thing.
Now, what we hear about people saying drug addicts can't be cured just comes from this situation: We are constantly curing those that are curable, that is, easily curable, and they never advertise any more, and we get left over a type that are like the "skid row" alcoholics, the cure of them is extremely difficult because of emotional problems, not because of any particular thing that the drug itself has done for them to make them deteriorated, or anything like that.
The fact is that there is no deterioration associated with the taking of morphine or heroin or any other opiate, unless you get into very large doses. All of this stuff you read in the public newspapers about the terrible effect of heroin is just pure hogwash. There is nothing to it, and there is no medical opinion anywhere to support it.
I have studied this thing carefully, and other people in this country have studied it carefully, and it has been studied carefully abroad. There is no deterioration from the taking of morphine or heroin within, but some of these people appear to be deteriorated, for the reason they appear to be deteriorated from the emotional standpoint,
criminals and addicts.
And the association these addicts have to keep to continue the habit, the secrecy of the habit, does have a deteriorating effect on personalities, in being arrested and being associated with criminals; but the drugs themselves, morphine and heroin, never cause any deterioration. There is an interesting thing that I might mention right here. Mr. MITLER. Are they violent people?
Dr. KOLB. How is that?
Mr. MITLER. Are drug addicts violent people?
Dr. KOLB. No.
Mr. MITLER. You always hear about that. What is the fact?
Dr. KOLB. No. I will stop now and say during the 5,000 years that opium has been used, that there hasn't been one violent crime committed by anybody because of the effect of this drug. The exact effect of all types of opiates is to soothe people and make them less likely to commit crime.
But drug addicts do commit crimes; they commit crimes if they were criminals before; the addiction doesn't quite cure them, and of course they commit crimes to get the drug for this reason: The opiate drugs, and the two synthetic drugs, have an effect that no other drugs have to the same degree. They create a dependence. You get tolerant.
One can take as much after they get well-they can take enough at 1 does that will ordinarily kill 5 or 6 people who are not addicted, and they won't feel anything special from it. In fact, it is almost impossible to poison with morphine or heroin a well-addicted addict.
Well, when you take that drug away from them, they suffer intensely. They even-they get extensively sick, and some of them die unless they are properly treated, just from the withdrawal symptoms, and I have seen that happen, and it happened due to the enforcement of these laws, because doctors get scared off, and I can cite cases where the doctor could have given drugs and has been scared off by narcotics inspectors, and let the people go, and you have got a death, and they are fine people.
But there is a lot of crime in drug addiction, and 90 percent is not due to the drugs they have taken, but to the impulse they have to keep up this habit, to keep from being intensely sick, and so they violate narcotic laws and they get-lots of them, to begin with, are unstable people, and they get to committing these petty crimes like stealing, and things of that kind, forging prescriptions, and those who were criminals before then will occasionally commit a violent crime like an armed robbery, and they even might commit murder. But it is not because of the drug in them, but it is because of their original state, and it is because they are suffering intensely from this thing, and will do most anything to get this drug.
Chairman KEFAUVER. Doctor, isn't your testimony contradictory to the great mass of professional evidence on this subject?
Dr. KOLB. It is not contradictory to the great mass of professional evidence on this subject.
Chairman KEFAUVER. I had always understood
Dr. KOLB. Let me say what I mean by "professional evidence." I mean informed professional evidence. You can talk to physicians throughout the country now, and they have absorbed their ideas on drug addiction from newspapers through inflammatory articles, and magazine inflammatory articles, because they won't handle drug addicts and don't handle them. And when they hear in the newspaper that heroin is the atomic bomb type of thing, they believe it.
I have talked to doctors who believe it. I think if you ask the Lexington people about it, and if you ask Dr. Chapman about it, and any other person who has treated drug addiction, you will find, just as I say, it is a soothing drug.
I want to come to the English situation here.
Chairman KEFAUVER. Let me ask you another question.
I suppose, like alcohol, that if you drink a certain amount of alcohol, basically that does not ruin your body, but it is generally believed that it might deaden your senses or lessen your responsibilities so that you do things that you would not otherwise do, and commit crimes that you would not otherwise commit.
So I always understood it was, to a greater degree, with heroin and drugs.
Dr. KOLB. It is just exactly the other way around, and I will show you why.
Heroin and morphine give the soothing effect that people get from alcohol, and why they become drunkards through alcohol. But the person who takes heroin and morphine does not get intoxicated in that sense. He maintains his judgment in perfectly good form. That is very well known.
Now, alcohol, as I have written about in that article, does, I think, a couple of thousand times more harm in the United States in a year than the narcotics do, because thousands of people do become insane, 18,000 are in our hospitals every year from alcohol, and I would guess right now not one enters from narcotic drugs. And that is the difference.
Chairman KEFAUVER. Well, all of these police officials couldn't be wrong in saying that things happen at marihuana parties and heroin parties that certainly normal people would not do.
Dr. KOLB. No; they wouldn't be wrong when they are talking about marihuana, but the police have got this police attitude. The thing has been turned over to them, and they know these drug addicts commit crimes to get their drugs, and they testify to that effect. But it is not because of the effect of the drug, morphine or heroin, on them; it is because they cannot get it, and they are suffering, and because, as I said before, they were recruited from an unstable type of people.
I am absolutely sure if you made every violent criminal in the United States an addict, and they wouldn't like it, I am sure, and would give them the drug that they needed, that violent crime would be decreased tremendously.
It is different with alcohol. Alcohol is one of the most important causes of crime-that is very well authenticated-and also of disease, insanity. I have only seen two cases of insanity due to drug addiction. These people had been addicted for about 40 years. They tried to get cured. They had been taking 5 or 6 treatments. When they got off, they got hypomania; that is, having been compelled to do without that sedative, they got excited, talked too much, some foolish action, and when they got back on the drug again they were cured in less than half a day. They needed that sedative that they had gotten used to throughout the period of years.
Now, alcohol, as you said, there are millions of people, there are about 55 million people in the United States who drink alcohol without any harm. But-there is a total of 68 million people who drink alcohol, and from that 68 million people we have got 4,500,000 alcoholics who are marching on their road to the grave or to the insane asylum or to the gallows for killing somebody.
And, of course, among that number are a certain number of persons who get drunk and irresponsible and have all these automobile accidents. Automobile accidents don't go along with morphine or heroin