Home > Encyclopedia of Drugs, Alcohol, and Addictive Behavior > Narcotic Addict Rehabilitation Act (Nara)

Public Law 89-793, the Narcotic Addict Rehabilitation Act (NARA), was passed by Congress in 1966. This legislation was designed to allow the use of the federal courts and criminal-justice system to compel drug addicts to participate in treatment. Several developments provided the context for this legislation. In the early 1960s, the problem of NARCOTIC drug use and ADDICTION were perceived to be increasing. There was also a perception that treatment was not particularly effective and that the RELAPSE rate was high. In response, California, in 1961, and New York, in 1962, passed legislation permitting the CIVIL COMMITMENT of narcotic addicts; that is, they could be compelled to accept treatment even if they had committed no crime but could be shown to be using illicit narcotic drugs. In both of these states the legislatures also provided substantial funds to establish residential facilities where addicts could be treated initially as well as aftercare programs to provide supervision following their release from the residential facilities. Several other states, including Illinois, passed similar civil commitment legislation, but only New York and California launched massive programs to implement compulsory treatment and civil commitment.

In January 1963, the Presidential Advisory COMMISSION ON NARCOTIC AND DRUG ABUSE appointed by President John F. Kennedy made a number of recommendations, including the enactment of a federal civil commitment statute that could provide an alternative to prison for confirmed narcotic or marijuana abusers convicted of federal crimes. The advisory commission also recommended increased assistance to states and municipalities to develop and strengthen their own treatment programs.

As passed by Congress, NARA had four titles, or main parts: Title I provided that eligible addicts charged with a federal offense could choose civil commitment or treatment instead of prosecution. After being examined by clinicians at a treatment center, an addict, if found suitable, could be committed to the custody of the surgeon general for thirty-six months of institutional treatment and aftercare. Title II provided for civil commitment after conviction. Title III stated that even if no federal crime had been committed, an addict or a related individual could petition the U.S. attorney in the district of residence and, if local facilities were unavailable, the U.S. District Court could commit the person to custody of the surgeon general for treatment. Title IV provided for funding to states and localities to establish or expand treatment for addicts.

Treatment under NARA began to be provided in 1967. The two U.S. PUBLIC HEALTH SERVICE HOSPITALS—in Lexington. Kentucky, and Fort Worth, Texas—which had been treating both addicted federal prisoners and voluntary patients, were redesignated "Clinical Research Centers" and became the sites for the institutional phase of treatment for addicts committed to the Surgeon General under NARA. Aftercare was provided by local programs supported by contracts with the NARA program administered by the Division of Narcotics within the National Institute of Mental Health (NIMH).

From 1967 through 1973, the two clinical centers admitted more than 10,000 NARA patients, 5 percent under Title I, 2 percent under Title II, and 93 percent under Title III. Women made up 15 percent of admissions. Race and ethnicity were noted for admissions between 1970 and 1973, during which time the designations and distribution were as follows: Anglo 43 percent, black 47 percent, Puerto Rican 1 percent, Mexican American 9 percent.

Many of the patients referred were found "not suitable for treatment" (38% at Fort Worth and 51% at Lexington), a designation that generally meant they were too disruptive or antagonistic. Some of this unsuitability was deliberate. Many of those under Title III, while not being charged with a federal crime, were under court pressure because of state or local crimes; as part of plea bargaining with local courts, they agreed to accept commitment under NARA Title III. They quickly learned that the centers would not require them to stay in residence, nor would NARA officials compel them to stay in aftercare. Once released from the centers as "not suitable," they would find ways to convey to the local courts how motivated for treatment they still were and how puzzled they were not to be offered treatment.

The general approach to treatment during the residential phase was based on THERAPEUTIC COMMUNITY principles, which delegate many responsibilities to former addicts and to patients participating in the program. The average duration of the residential phase of treatment was intended to be about 6 months, but of those admitted for examination, only about 35 percent were discharged to aftercare as having completed the residential phase. A number of studies have been conducted on the effectiveness of the NARA program, including aftercare. One study found that only 38 percent of the 35 percent that completed the residential phase remained in aftercare for the full six months after discharge from residential treatment. Reasons for attrition included death, disappearance, recommitment, conviction, and incarceration. One study by Gold and Chatham in 1971 found that 46 percent of addicts in aftercare had used an illegal drug during the month preceding the interview; about 50 percent were working. Another study found that 87 percent had used narcotics during the first six months after the residential phase; 65 percent had become readdicted.

While this rate of readdiction did not seem as bleak as that seen after the discharge of the early cohorts from Lexington, it was not seen as particularly successful—given the high cost of the six-month residential phase and the high attrition rates. Because of the attrition, the readdiction rate, while not inevitable, was occurring among only the better candidates. Another study by Mandell and Amsel (1973) compared the outcome of those treated compared to those found "not suitable" for treatment. The difference in outcome between the two groups was not significant.

While the legal authority for federal civil commitment remained in effect through the early 1990s, the actual application of NARA felt into disuse in the mid-1970s as more federal prisons developed programs for Title II offenders and as more communities developed their own treatment programs. The use of treatment under civil commitment also declined, because the involvement of courts and expensive legal procedures made it far more expensive than voluntary treatment. In 1971, the Fort Worth facility was closed and turned over to the Bureau of Prisons. The Lexington facility experienced the same fate in 1974.