We can investigate the success rates of addiction treatment methods used over the past century, see what worked, and what didn’t work. We can use programs of proven benefit or we can continue to spend money on programs repeatedly shown to have little benefit.
From 1935 until 1962, drug addicts were treated at a unique facility, part jail and part treatment hospital. Initially named the United States Narcotic Farm, it was later changed to the U.S. Public Health Service Narcotics Hospital. Even after this name change, most people still called it the Narcotic Farm.
This facility was located on twelve acres of Kentucky farmland. The facility was created by the Public Health Service and the Bureau of Prisons, meant to serve a dual purpose. It was a treatment hospital, where drug addicts could voluntarily be admitted for treatment of their addiction, and it was also a federal prison, where drug offenders were sent to serve their sentences. About two thirds of the inpatients were prisoners and the other third were addicts, voluntarily seeking help for opioid addiction. Both types of patients were treated side by side. For over forty years, it was the main drug addiction treatment center in the United States, along with a similar facility in Ft. Worth, Texas, which opened in 1937.
The Narcotic Farm was a massive institution for its time. It had fifteen-hundred beds, and housed tens of thousands of patients over its forty years of operation. It was located in a rural area of Kentucky, which gave it space for numerous operations to engage the prisoners – now called patients – in all types of job training. (1)
The Narcotic Farm really was a farm. Besides growing many types of vegetables, there was a working dairy, and livestock including pigs and chickens. These operations provided food for the patients and staff of the facility and provided work for the patients. The patients provided the labor to keep the farm going and it was hoped they would simultaneously learn useful trades. In addition to farming, they learned skills in sewing, auto repair, carpentry, and other trades. Besides teaching new job skills, it was hoped that fresh air, sunshine, and wholesome work would be beneficial to the addicts. (1)
For its time, the Narcotic Farm was surprisingly progressive in its willingness to try multiple new treatments. For the forty years it operated, many different treatments were tried for opioid addicts. It offered individual and group talk therapies, job training, psychiatric analysis, treatment for physical medical issues, Alcoholics Anonymous meetings, art therapy, shock therapy, music therapy, and even hydrotherapy, with flow baths to soothe the nerves. Despite these options, the Farm apparently retained many of the characteristics of a prison, with barred windows and strict security procedures. (1)
The Narcotic Farm had its own research division, the Addiction Research Center (ARC), which became the forerunner of today’s National Institute on Drug Abuse (NIDA). The Narcotic Farm did pioneering work, using methadone to assist patients through withdrawal, and helped establish the doses used to treat opioid addiction. Methadone was used only short term, for the management of withdrawal symptoms, and not for maintenance dosing at the Narcotic Farm. The Farm also trained a dedicated group of doctors and nurses, who were pioneers in the field of addiction treatment. It provided new information on the nature of addiction.
Admission to the Narcotic Farm allowed an opioid addict some time to go through opioid withdrawal, eat regular meals, work in one of the farm’s many industries, and have some form of counseling. However, after leaving the hospital, the addicts were entirely released from care and supervision, with no assistance to help re-enter their communities. Most times, they returned to their same living situation and old circumstances encouraged relapse back to drug use and addiction. As a result, two follow up studies of the addicts treated at the Narcotic Farm showed a ninety-three percent and ninety-seven percent relapse rate within six months, with most of the relapses occurring almost immediately upon returning home. Many addicts cycled through the Public Health Hospital multiple times. (1)
The Narcotic Farm was eventually turned over to the Bureau of Prisons in 1974, as the treatment for addiction was de-centralized. Since the studies found high relapse rates for addicts returning to their previous communities, it was hoped by moving treatment centers into communities, these addicts could have ongoing support after they left inpatient treatment.
- Nancy P. Campbell, The Narcotic Farm: The rise and fall of America’s first prison for drug addicts, (New York, Abrams, 2008)