Discussion

I think that Dr. Levy has done us a great service in presenting his experience in the treatment of patients addicted to various drugs. This is a problem that is increasing, and the likelihood is that it will continue to increase for some time. Not only is this true in the United States, but also in England which theoretically had the ideal system for the treatment of drug addiction. The English are now finding that the incidence of drug addiction is rising at an alarming rate and they are beginning to re-evaluate their approach to the entire problem.

Dr. Levy has given us an accurate picture of what the drug-dependent person is like as a patient. He has also given us some conception of the vicissitudes entailed in attempting to deal with such patients. However, I would like to raise some questions about a few of his comments.

First of all, I would question his statement that, like all other people suffering from neurotic problems, addicts turn to therapy when their solutions fail. Addicts do not turn to therapy but come to it only under coercion. This has been my experience in dealing with addicts in city hospitals as well as the type of patient to which Dr. Levy has referred, that is, the addict seen in private practice. Dr. Levy has very vividly described how he came to see the young man whom he discussed first. The mother made the call and the patient complied only after repeated threats and cajoling on her part. This factor has to be taken into account when we consider therapy for addicts. Dr. Levy hasn't mentioned under what circumstances the other patients come, but I would be inclined to believe, in view of my own experience, that most of them came under this type of duress. Dr. Levy has subsequently reported to me that all of his patients came to therapy under