L I T E R A T U R E ABSTRACTS
Observations on Some Community Mental Health Programs in Europe. Sylvan S. Furman. American Journal oj Public Health. 1966, 56, 202209. The European systems observed were those of England, Scotland, Holland, Denmark, and Sweden. The information derived is from personal observation and the stated opinions of those operating, working in, or evaluating the programs. From these observations, the following impressions and convictions were developed: (a) The most ingenious, comprehensive, and creative attempts to achieve comprehensive community mental health services appear to have occurred where the least amount of new construction was available and in the most complex society; namely, in Great Britain and Holland. (b) Personnel shortages continue in all nations studied, but the handicapping effects have been met partly by emphasizing flexibility and cooperation among the professions to provide at least "coping" services to people in times of stress. (c) Both in the use of personnel and in the organization of programs there has been a minimum of overspeeialization, so that the systems tend to fit patients and community needs, rather than narrow professional interests. (d) To varying degrees, the advantages of decentralization and closeness to the community have been demonstrated. Local health departments generally play a more important part in these systems than in the United States. (e) There doubtless are many inadequacies in the actual performance of these systems of care, but they do not stem from fragmentation, selectivity, rigidity, or the isolation of community facilities from community need, and they are governed by public health principles. Mental Health Systems and the Solution o f Community Problems. David J. Vail and Arthur S. Funke. Mental Hygiene. 1966, 50, 2733. The authors examine the concepts of the public and the public language in their application to the mental health field in general and more specifically to community psychiatry. They attempt to develop terms to encompass newly defined problems and new solutions to them. They suggest that a prime need is continuity of responsibility for the solutions of these problems--a new kind of authority in the public mental health field. They feel that the planning-prevention-service view is inadequate and suggest a broader based view that continuity of care will follow continuity of responsibility. The deliberate use of reason will enable planning for the prevention and solution of public problems to enhance the public service motif aimed toward the good society. Ten Papers Related to Community Mental Health. Special Section, American Journal o] Psychiatry. 1966, 122, 977-1020. This series of ten brief theoretical papers appears as a special section
covering many different aspects of community mental health. The discussions include commentary from varying perspectives: the federal government, the state government, the urban community, the general hospital, the community mental health center, social factors in adjustment, private practice, manpower, etc. Together they constitute a comprehensive discussion of central issues in the area of community mental health. Epidemiology of Psychiatric Disorders as a Contribution to Medical Ecology. H. Warren Dunham. Archives o/ General Psychiatry. 1966, 14, 1-17. . This paper explores the extent to which epidemiological studies of psychiatric disorder have made a contribution to the field of ecology. Distinguishing differences between epidemiology and medical ecology are noted. Epidemiology is primarily a method for the study of disease and medical ecology is a field that attempts to develop positive knowledge concerning the impact of the total environment upon the organism. The paper then examines the central findings of several epidemiological studies and points to some of the hypotheses that have been advanced for interpreting their findings. Further, the possibility of the limitations and advantages of experimental epidemiolog. ical studies are touched upon. Finally, an attempt is made to view some of the problems and the contributions that these studies have made to the field of medical ecology. Schizophrenia and the Protestant Ethic. Robert E. Kantor. Mental Hygiene. 1966, 50, 18-23. Evidence of the significant social prejudice that operates against the schizophrenic is presented. The tentative hypothesis offered to account for this is that the schizophrenic encounters prejudiced treat. merit when he is unable to work and thus violates a basic element in the Protestant Ethic, namely work as a mandatory social virtue. Treatment of Alcoholic Families with Nurse H o m e Visits. E. Mansell Pattison. Family Process. 1965, 4, 7 5 - 9 4 . A program for the treatment of "multiple problem" families with whom alcoholism was a major factor in family dysequilibrinm is described. A public health nurse made regular home visits to families who had refused or dropped from outpatient psychotherapy. In each of seven families under study the nurse was able to catalyze the resolution of acute family crisis. There was alleviation of the alcoholism and reestablishment of an effective family equilibrium. The public health nurse is discussed in terms of her mental health role, which has both role advantages and role conflicts. Counseling Engaged Couples in Small Groups. Dorothy R. Freeman. Social Work. 1965,
269
270
THE COMMUNITYMENTAL HEALTH JOVaNAL
10, 36.42. Short term counseling of engaged couples in small groups has proved to be a worthwhile method of educating couples for marriage and preparing them for its stresses and satisfactions. References are made to the Marriage Counselling Centre of Montreal, set up in 1955 as a community mental health service in primary prevention. The Centre distinguishes between counseling and therapy and focuses on current reality in counseling engaged couples. They have found that this counseling provides a constructive learning experience and fulfills a useful function. The Public Health Nurse in Aftercare Programs for the Mentally Ill: The Present Status. Eleanor Joan Collard. American Journal o/ Public Health. 1966, 53, 210-217. A wide variety of patterns of public health nursing participation in aftercare programs for the mentally ill exist throughout the country today. The author feels the public health nurse can and does play a definite role in providing aftercare services. Specific activities in which the nurse engages are being continually evaluated and reported in the literature. There is need for continued demonstration and evaluation of the most appropriate and effective administrative systems for provision of aftercare services. Each state and agency must define for itself the most effective mechanism based upon individual patient and family need and other available community resources. Where resources are lacking, public health nursing has a responsibility to stimulate community action for the development of needed resources and to cooperate in the coordination of the services thus developed. Then, perhaps, the full potential of joint planning, agreement on common goals and methods, discriminate use of services, and individualization of each patient will be realized. Social Status and Psychological Disorder: An Issue of Substance and an Issue o f Method. Bruce P. Dohrenwend. American Sociological Review. 1966, 31, 14-33. It would seem that the major substantive issue, the issue of the relative importance of social causation vs. social selection factors in class differences in rates of psychological disorder, must yield precedence to resolution of the central unsolved problem of psychiatric epidemiology--the measurement of untreated psychological disorder. For, while the results of field studies of psychological symptomatology make it clear that there are group differences in modes of expressing distress, including some that are apparently stylistic, the studies are far from clear about the relation of these modes to the underlying psychiatric condition of individuals. Two major questions confront further work in this field. First, what are the cultural and situational factors that lead to different modes of expressing psychological symptoms? Second, under what conditions does symptomatic expression of psychological distress become evidence of underlying personality defect? When these questions can be answered, it will be possible to measure psychological disorder
in different groups with some hope of resolving the crucial etiological issues. A Nationwide Survey of Outpatient Psyehiatrie Clinic Functions, Intake Policies and Practices. Beatrice M. Rosen, Jack Wiener, Catherine L. Hench, Shirley G. Willner, and Anita K. Bahu. American Journal of Psychiatry. 1966, 122, 908-915. Ninety-three per cent or 1,573 of 1,695 clinics in the United States reported in this survey. All clinics provided direct services to patients (the definition would exclude any who did not), with 94% ranking it as the primary function; consultation was most frequently rated as second in importance, training third, and research last. More than four-fifths of the clinics reported an "open admission" policy; 12% accepted 0nly other agency or professional referrals and seven per cent accepted referrals within the agency only. Three-quarters of the clinics in the country accepted psychotics and sex deviates while relatively few accepted drug addicts and homicidal cases. A wider range of problems was accepted more often in the children's clinics than in adult clinics and in the part time clinics than in the full time clinics. Sixty-four per cent of the clinics reported a waiting list of patients with whom they had made contact in the previous three months. Waiting lists ~r more prevalent in children's clinics than in adult clinics, in clinics that had an "open admission" policy than in clinics that accepted referral only within the agency and in clinics with a large staff as compared with clinics with a small staff. Eight per cent of the patients served during the year were on waiting lists. Two-thirds of the persons on waiting lists were children, even though they constituted only slightly more than one-third of the total patients served. Private Hospitals in Community Planning. Lucy D. Ozarin, Melvin Herman, Jerry Osterweil. Mental Hygiene. 1966, SO, 24-26. Private psychiatric hospitals are an important and integral part of the mental health resources in this country. A questionnaire has shown that these hospitals have actively participated in the comprehensive mental health planning effort of the various states. The private hospitals report that they can offer a wide range of mental health services, and they are eager to collaborate with public and private institutions and agencies to provide better service to their communities. Manpower, financing, lack of facilities, and interagency collaboration are seen as the major problems. Consideration must be given to the role and responsibilities of the private psychiatric hospital in every community mental health program. These hospitals offer needed resources and have capabilities for growth and development. Cultural Exclusion, Character and Illness. Eugene B. Brody. American Journal o/Psychiatry. 1966, 122, 852-858. Cultural exclusion leads to a sense of alienation, loss of sense of identity, self hatred and an increased vulnerability to mental illness. The problems raised by the rejection of society of certain minority elements constitute a
LITERATURE ABSTRACTS challenge to the psychiatrist as applied social scientist and responsible citizen. The Mental Health of the Unmarried. Genevieve Knupfer, Walter Clark, and Robin Room. American Journal o/ Psychiatry. 1966, 122, 841851. Data from 785 interviews of married and never married respondents in a sample of the adult population of San Francisco are presented by marital status. On most of the indices of adjustment, it was found that more single men are maladjusted than single women, and more single men are maladjusted than married men, thus confirming and enlarging on the results of other studies. These findings were discussed in terms of two general types of explanatory factors: selective factors and reactive factors. Because of the greater freedom of choice men have in the marriage market, it seems likely that those among them who are either unable or unwilling to get married were more psychologically impaired to begin with. Evidence from the data for this argument is the higher proportion of childhood stress among single men than among any other group. Explanations in terms of reactive factors suggest that without marriage, men, more than women, have a tendency to become socially isolated and antisocial. While the data show that single men are in fact more socially isolated and more antisocial than single women (and than married men), it is not possible to say whether this is due to reaction or to selection. Some Thoughts on the Formation of Personality Disorder: Study of an Indian Boarding School Population. Thaddeus P. Krush, J0hn W. Bjork, Peter S. Sindell, and Joanne Nelle. American Journal o/Psychiatry. 1966, 122, 868.876. The authors contend that frequency of movement and the necessity to conform to changing standards can only lead to confusion and disorganization of the child's personality. Frequency of movement further interferes with and discourages the development of lasting relations in which love and concern can permit adequate maturation. This is approached as though it were an Indian problem. But it begins to appear that these are problems common to individuals who are dependent and/or neglected. It is their contention that "psycho-social nomadism" and shifting value systems result in inward disturbance. These findings are applicable to groups other than the population being studied as the patterns are similar to youngsters of different and deprived cultures. Thus, the dilemma in approaching individuals who have disordered homes and disordered behavior is how to get them to relinquish the dependency that we, ourselves, create in trying to get them well or educated. It is evident that if the authors' findings are substantially correct, there will be serious logistical problems in altering ignorance and poverty. Problems Referred to Children's O u t p a t i e n t Psychiatric Clinics. Jacob Tnckman and Richard A. Regan. Journal o/Health and Human Behavior. 1966, 7, 54-58. The relation of referral problems to several personal and social characteris-
271
ties of 1,813 children admitted to outpatient psychiatric clinics was studied. Problems included anxiety and neurotic symptoms, severe psychiatric symptoms, withdrawal behavior, school problems, problems of mental retardation, aggression, antisocial behavior, ditficulties in interpersonal relations, somatic symptoms, problems of habit formation, sexual, and miscellaneous problems. Differences in referral problems were found for sex, race, age, religious affiliation, occupational level of father, source of referral, and outcome of clinic contact (at intake, diagnostic evaluation, and treatment phases). Alcoholism (Conceptual Models for the Treatment of Alcoholism). E. Manse]] Pattis0n. Psychiatric Opinion. 1965, 1, 39-42. The effective treatment of alcoholism continues to elude us due to the paucity of scientifically conceived programs. A general epidemiological model is presented as a framework for systematic treatment formulations. Three common assumptions are questioned in the light of recent research: (a) Is abstinence a criterion of successful treatment? (b) Is Alcoholics Anonymous an adequate resource or is it a middle class phenomenon? (c) Can alcoholics be treated without regard to social class, or does treatment need to be geared to the population? Finally, the relevance of primary, secondary, and tertiary treatment models is applied to the problem of alcoholism.
MENTAL HEALTH Quarterly Journal of THE NATIONAL ASSOCIATION FOR MENTAL HEALTH 39 Queen Anne Street, London, W.1., England. Features on all aspects of mental health, mental illness and subnormality. Book reviews; surveys of press, Parliament, radio and television coverage of mental health matters; conference reports; notes on research and enquiries; correspondence. Autumn number features Addiction: Drugs and Alcohol Annual subseription: $3.40; ,~l.ls. Single copies 5/6 D (post free) Orders to: Publications Manager, N.A.M.H., 39 Queen Anne Street, London, W.I., England.
Observations on Some Community Mental Health Programs in Europe. Sylvan S. Furman. American Journal oj Public Health. 1966, 56, 202209. The European systems observed were those of England, Scotland, Holland, Denmark, and Sweden. The information derived is from personal observation and the stated opinions of those operating, working in, or evaluating the programs. From these observations, the following impressions and convictions were developed: (a) The most ingenious, comprehensive, and creative attempts to achieve comprehensive community mental health services appear to have occurred where the least amount of new construction was available and in the most complex society; namely, in Great Britain and Holland. (b) Personnel shortages continue in all nations studied, but the handicapping effects have been met partly by emphasizing flexibility and cooperation among the professions to provide at least "coping" services to people in times of stress. (c) Both in the use of personnel and in the organization of programs there has been a minimum of overspeeialization, so that the systems tend to fit patients and community needs, rather than narrow professional interests. (d) To varying degrees, the advantages of decentralization and closeness to the community have been demonstrated. Local health departments generally play a more important part in these systems than in the United States. (e) There doubtless are many inadequacies in the actual performance of these systems of care, but they do not stem from fragmentation, selectivity, rigidity, or the isolation of community facilities from community need, and they are governed by public health principles. Mental Health Systems and the Solution o f Community Problems. David J. Vail and Arthur S. Funke. Mental Hygiene. 1966, 50, 2733. The authors examine the concepts of the public and the public language in their application to the mental health field in general and more specifically to community psychiatry. They attempt to develop terms to encompass newly defined problems and new solutions to them. They suggest that a prime need is continuity of responsibility for the solutions of these problems--a new kind of authority in the public mental health field. They feel that the planning-prevention-service view is inadequate and suggest a broader based view that continuity of care will follow continuity of responsibility. The deliberate use of reason will enable planning for the prevention and solution of public problems to enhance the public service motif aimed toward the good society. Ten Papers Related to Community Mental Health. Special Section, American Journal o] Psychiatry. 1966, 122, 977-1020. This series of ten brief theoretical papers appears as a special section
covering many different aspects of community mental health. The discussions include commentary from varying perspectives: the federal government, the state government, the urban community, the general hospital, the community mental health center, social factors in adjustment, private practice, manpower, etc. Together they constitute a comprehensive discussion of central issues in the area of community mental health. Epidemiology of Psychiatric Disorders as a Contribution to Medical Ecology. H. Warren Dunham. Archives o/ General Psychiatry. 1966, 14, 1-17. . This paper explores the extent to which epidemiological studies of psychiatric disorder have made a contribution to the field of ecology. Distinguishing differences between epidemiology and medical ecology are noted. Epidemiology is primarily a method for the study of disease and medical ecology is a field that attempts to develop positive knowledge concerning the impact of the total environment upon the organism. The paper then examines the central findings of several epidemiological studies and points to some of the hypotheses that have been advanced for interpreting their findings. Further, the possibility of the limitations and advantages of experimental epidemiolog. ical studies are touched upon. Finally, an attempt is made to view some of the problems and the contributions that these studies have made to the field of medical ecology. Schizophrenia and the Protestant Ethic. Robert E. Kantor. Mental Hygiene. 1966, 50, 18-23. Evidence of the significant social prejudice that operates against the schizophrenic is presented. The tentative hypothesis offered to account for this is that the schizophrenic encounters prejudiced treat. merit when he is unable to work and thus violates a basic element in the Protestant Ethic, namely work as a mandatory social virtue. Treatment of Alcoholic Families with Nurse H o m e Visits. E. Mansell Pattison. Family Process. 1965, 4, 7 5 - 9 4 . A program for the treatment of "multiple problem" families with whom alcoholism was a major factor in family dysequilibrinm is described. A public health nurse made regular home visits to families who had refused or dropped from outpatient psychotherapy. In each of seven families under study the nurse was able to catalyze the resolution of acute family crisis. There was alleviation of the alcoholism and reestablishment of an effective family equilibrium. The public health nurse is discussed in terms of her mental health role, which has both role advantages and role conflicts. Counseling Engaged Couples in Small Groups. Dorothy R. Freeman. Social Work. 1965,
269
270
THE COMMUNITYMENTAL HEALTH JOVaNAL
10, 36.42. Short term counseling of engaged couples in small groups has proved to be a worthwhile method of educating couples for marriage and preparing them for its stresses and satisfactions. References are made to the Marriage Counselling Centre of Montreal, set up in 1955 as a community mental health service in primary prevention. The Centre distinguishes between counseling and therapy and focuses on current reality in counseling engaged couples. They have found that this counseling provides a constructive learning experience and fulfills a useful function. The Public Health Nurse in Aftercare Programs for the Mentally Ill: The Present Status. Eleanor Joan Collard. American Journal o/ Public Health. 1966, 53, 210-217. A wide variety of patterns of public health nursing participation in aftercare programs for the mentally ill exist throughout the country today. The author feels the public health nurse can and does play a definite role in providing aftercare services. Specific activities in which the nurse engages are being continually evaluated and reported in the literature. There is need for continued demonstration and evaluation of the most appropriate and effective administrative systems for provision of aftercare services. Each state and agency must define for itself the most effective mechanism based upon individual patient and family need and other available community resources. Where resources are lacking, public health nursing has a responsibility to stimulate community action for the development of needed resources and to cooperate in the coordination of the services thus developed. Then, perhaps, the full potential of joint planning, agreement on common goals and methods, discriminate use of services, and individualization of each patient will be realized. Social Status and Psychological Disorder: An Issue of Substance and an Issue o f Method. Bruce P. Dohrenwend. American Sociological Review. 1966, 31, 14-33. It would seem that the major substantive issue, the issue of the relative importance of social causation vs. social selection factors in class differences in rates of psychological disorder, must yield precedence to resolution of the central unsolved problem of psychiatric epidemiology--the measurement of untreated psychological disorder. For, while the results of field studies of psychological symptomatology make it clear that there are group differences in modes of expressing distress, including some that are apparently stylistic, the studies are far from clear about the relation of these modes to the underlying psychiatric condition of individuals. Two major questions confront further work in this field. First, what are the cultural and situational factors that lead to different modes of expressing psychological symptoms? Second, under what conditions does symptomatic expression of psychological distress become evidence of underlying personality defect? When these questions can be answered, it will be possible to measure psychological disorder
in different groups with some hope of resolving the crucial etiological issues. A Nationwide Survey of Outpatient Psyehiatrie Clinic Functions, Intake Policies and Practices. Beatrice M. Rosen, Jack Wiener, Catherine L. Hench, Shirley G. Willner, and Anita K. Bahu. American Journal of Psychiatry. 1966, 122, 908-915. Ninety-three per cent or 1,573 of 1,695 clinics in the United States reported in this survey. All clinics provided direct services to patients (the definition would exclude any who did not), with 94% ranking it as the primary function; consultation was most frequently rated as second in importance, training third, and research last. More than four-fifths of the clinics reported an "open admission" policy; 12% accepted 0nly other agency or professional referrals and seven per cent accepted referrals within the agency only. Three-quarters of the clinics in the country accepted psychotics and sex deviates while relatively few accepted drug addicts and homicidal cases. A wider range of problems was accepted more often in the children's clinics than in adult clinics and in the part time clinics than in the full time clinics. Sixty-four per cent of the clinics reported a waiting list of patients with whom they had made contact in the previous three months. Waiting lists ~r more prevalent in children's clinics than in adult clinics, in clinics that had an "open admission" policy than in clinics that accepted referral only within the agency and in clinics with a large staff as compared with clinics with a small staff. Eight per cent of the patients served during the year were on waiting lists. Two-thirds of the persons on waiting lists were children, even though they constituted only slightly more than one-third of the total patients served. Private Hospitals in Community Planning. Lucy D. Ozarin, Melvin Herman, Jerry Osterweil. Mental Hygiene. 1966, SO, 24-26. Private psychiatric hospitals are an important and integral part of the mental health resources in this country. A questionnaire has shown that these hospitals have actively participated in the comprehensive mental health planning effort of the various states. The private hospitals report that they can offer a wide range of mental health services, and they are eager to collaborate with public and private institutions and agencies to provide better service to their communities. Manpower, financing, lack of facilities, and interagency collaboration are seen as the major problems. Consideration must be given to the role and responsibilities of the private psychiatric hospital in every community mental health program. These hospitals offer needed resources and have capabilities for growth and development. Cultural Exclusion, Character and Illness. Eugene B. Brody. American Journal o/Psychiatry. 1966, 122, 852-858. Cultural exclusion leads to a sense of alienation, loss of sense of identity, self hatred and an increased vulnerability to mental illness. The problems raised by the rejection of society of certain minority elements constitute a
LITERATURE ABSTRACTS challenge to the psychiatrist as applied social scientist and responsible citizen. The Mental Health of the Unmarried. Genevieve Knupfer, Walter Clark, and Robin Room. American Journal o/ Psychiatry. 1966, 122, 841851. Data from 785 interviews of married and never married respondents in a sample of the adult population of San Francisco are presented by marital status. On most of the indices of adjustment, it was found that more single men are maladjusted than single women, and more single men are maladjusted than married men, thus confirming and enlarging on the results of other studies. These findings were discussed in terms of two general types of explanatory factors: selective factors and reactive factors. Because of the greater freedom of choice men have in the marriage market, it seems likely that those among them who are either unable or unwilling to get married were more psychologically impaired to begin with. Evidence from the data for this argument is the higher proportion of childhood stress among single men than among any other group. Explanations in terms of reactive factors suggest that without marriage, men, more than women, have a tendency to become socially isolated and antisocial. While the data show that single men are in fact more socially isolated and more antisocial than single women (and than married men), it is not possible to say whether this is due to reaction or to selection. Some Thoughts on the Formation of Personality Disorder: Study of an Indian Boarding School Population. Thaddeus P. Krush, J0hn W. Bjork, Peter S. Sindell, and Joanne Nelle. American Journal o/Psychiatry. 1966, 122, 868.876. The authors contend that frequency of movement and the necessity to conform to changing standards can only lead to confusion and disorganization of the child's personality. Frequency of movement further interferes with and discourages the development of lasting relations in which love and concern can permit adequate maturation. This is approached as though it were an Indian problem. But it begins to appear that these are problems common to individuals who are dependent and/or neglected. It is their contention that "psycho-social nomadism" and shifting value systems result in inward disturbance. These findings are applicable to groups other than the population being studied as the patterns are similar to youngsters of different and deprived cultures. Thus, the dilemma in approaching individuals who have disordered homes and disordered behavior is how to get them to relinquish the dependency that we, ourselves, create in trying to get them well or educated. It is evident that if the authors' findings are substantially correct, there will be serious logistical problems in altering ignorance and poverty. Problems Referred to Children's O u t p a t i e n t Psychiatric Clinics. Jacob Tnckman and Richard A. Regan. Journal o/Health and Human Behavior. 1966, 7, 54-58. The relation of referral problems to several personal and social characteris-
271
ties of 1,813 children admitted to outpatient psychiatric clinics was studied. Problems included anxiety and neurotic symptoms, severe psychiatric symptoms, withdrawal behavior, school problems, problems of mental retardation, aggression, antisocial behavior, ditficulties in interpersonal relations, somatic symptoms, problems of habit formation, sexual, and miscellaneous problems. Differences in referral problems were found for sex, race, age, religious affiliation, occupational level of father, source of referral, and outcome of clinic contact (at intake, diagnostic evaluation, and treatment phases). Alcoholism (Conceptual Models for the Treatment of Alcoholism). E. Manse]] Pattis0n. Psychiatric Opinion. 1965, 1, 39-42. The effective treatment of alcoholism continues to elude us due to the paucity of scientifically conceived programs. A general epidemiological model is presented as a framework for systematic treatment formulations. Three common assumptions are questioned in the light of recent research: (a) Is abstinence a criterion of successful treatment? (b) Is Alcoholics Anonymous an adequate resource or is it a middle class phenomenon? (c) Can alcoholics be treated without regard to social class, or does treatment need to be geared to the population? Finally, the relevance of primary, secondary, and tertiary treatment models is applied to the problem of alcoholism.
MENTAL HEALTH Quarterly Journal of THE NATIONAL ASSOCIATION FOR MENTAL HEALTH 39 Queen Anne Street, London, W.1., England. Features on all aspects of mental health, mental illness and subnormality. Book reviews; surveys of press, Parliament, radio and television coverage of mental health matters; conference reports; notes on research and enquiries; correspondence. Autumn number features Addiction: Drugs and Alcohol Annual subseription: $3.40; ,~l.ls. Single copies 5/6 D (post free) Orders to: Publications Manager, N.A.M.H., 39 Queen Anne Street, London, W.I., England.
