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February 27, 1978

Behind the Wall of Respect: Community Experiments in Heroin Addiction Control

Author Affiliations

University of Kansas Medical Center Kansas City

JAMA. 1978;239(9):866. doi:10.1001/jama.1978.03280360062028

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Dr Hughes' book is an eloquent argument for an epidemiologic and social approach to the problems of heroin addiction. He applies to drug abuse the same technique commonly used by communicable disease centers in identifying and treating cases of venereal disease.

After an introduction reviewing the epidemiologic approach to the identification, treatment, and subsequent prevention of heroin addiction, the author describes the various community experiments in heroin addiction control that he and his staff carried out in Chicago between 1968 and 1974. Dr Hughes' successful use of former addicts in his field teams, his well-documented studies to identify target populations of heroin addicts, his subsequent methods of involving the heroin abuser in treatment, and his sociological methods of prevention are all clearly explained.

The enormous difficulties encountered in this approach are honestly discussed. Community resistance, problems in overcoming the fiscal bureaucracy, difficulties of effecting changes in the life-style of the