MONITORING OF
PROGRESS AND PROCEDURES
There were at least two areas in which the AFP
had interesting effects on the DDTC. The first of these concerned the
monitoring of urine reports. Progress and changes in drug taking were a key part of
family therapy. Clear contingencies were
established for -dirty- urines given by
family (and movie) therapy cases—especially in the two -paid-conditions. The treatment was sharply focused on this
behavior. Thus it was essential that
the urinalysis results processed at DDTC be obtained and recorded accurately and efficiently. In the early stages of the program, however, it was discovered that the
DDTC was going through a -slippage
phase'' regarding strict adherence to urine test results: records were sometimes -lost,- patients were able to get away
with denying that dirty urines were their own, and (previously firm) established rules preventing clients with dirty
urines from obtaining certain privileges, or even remaining in the program,
were not being strictly followed. The
AFP attention to, and insistance on, (1) clarity and efficiency of urinalysis results, and (2) adherance to program strictures based on urine results highlighted
areas where slack had set in. As a
result, the DDTC tightened up its urine-monitoring procedure and the total urine-reporting system was improved.*
Paralleling the above, a
number of areas were uncovered by the AFP in which patients were finding it easy to
manipulate the DDTC system. These included
ways of getting around program rules, tricks for obtaining permission from staff for higher methadone dosages, methods for triangulating staff members and
instigating or exacer-bating conflicts
between them, and so forth. Some of these are described in Chapter 16. As they came to light with AFP cases, or within
AFP team meetings, they were responded to and corrected by DDTC staff, thus allowing improvement in the
overall drug-treatment
program.
THE RESEARCH ETHIC
It is important to mention some
significant aspects of the DDTC that
contributed immeasurably to the success of this work. Because the
DDTC (1) was established partly as a research center, (2) was
*This sequence of
clinical research impacting positively on clinical procedures had happened before the AFP and has recurred since. It presents an
interesting example of the interplay between treatment and research.
somewhat less vulnerable to severe viscissitudes
of funding (compared to many other agencies), and (3) incorporated many
treatment modali-ties within its walls, it
was (and is) a very result-oriented institution. The treatment philosophy was not rigid, and there was a sincere interest
in alternatives to methadone (in contrast to the total commit-ment to various forms of pharmacological
substitution—mentioned in Chapters 1
and 6—that sometimes occurs in drug-abuse programs). This pragmatism fostered a kind of "live and
let live- attitude toward new kinds
of treatment, resulting in an atmosphere in which competi-tiveness
between different modalities could be minimized. It is con-ceivable that a program such as the AFP, had it
been established within a different
context, might have encountered much greater difficulty and that resistance could even have increased as it
began to demon-strate effectiveness.
This did not occur in the present case.
CONCLUSION
Given the
inherent problems that occur when two separate institu-tions collaborate, we feel that the relationship
and cooperation that developed
around this work was closer to optimal than one can normally expect. Our task was certainly facilitated
by common ex-periences shared (prior to the study) by several of
the principal figures, and also by the shared
institutional affiliations and research interests. On the other hand, some of the problems we faced
would not occur in situations where
all programmatic components exist within the same administrative, physical, and institutional
structure. No doubt there are areas
in which the PCGC and DDTC philosophies may never reach assimilation.
Nonetheless the marriage seems to have "worked,- and divorce has never been necessary.
JOHN M. VAN DEUSEN/M. DUNCAN
STANTON/
