A number of studies have suggested that psychiatric syndromes differ in the socio-cultural factors with which they are associated, such as age, race, social class and religion, as well as in the patients' family and personal backgrounds.

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A raised incidence of neurotic personality traits and mental illness has been reported among the first-degree relatives of obsessional neurotics. It has been suggested that genetical factors are involved in determining a predisposition to this condition, but some authors have postulated that similarities in aspects of the environment such as early upbringing and family traditions may account for similarities shown by relatives.

y Tkis study was undertaken mainly to examine the attitudes keroin addicts hold towards themselves in their addiction ; and to compare the addicts' responses with those qf the professional and paraprofessional staff'who work witk them. We consider that the attitudes of the staff play a significant role in treatment, and thai treatment becomes more effective when patients and staff agree closely about the cause and nature of the illness. Conversely, a marked divergence in views could seriously impede treatment.The second aim of this study was to compare the way addicts viewed themselves and their illness and the way they viewed alcoholics and alcoholism. We feel that there are many similarities between these major addictive states even though in most centers they are treated separately. MethodThe population interviewed for the study consisted of a group of 120 heroin addicts treated at the Boston City Hospital Methadone Clinic. At the time of the study (June 1971) the average length of time each patient had been in treatment was 5 months. Patients were approached randomly and asked to participate in the study. The first sixty who agreed were given a questionnaire dealing with drugs and addiction. The second group of sixty patients (15 of whom were also in the first group) were asked similar questions concerning alcohol and alcoholism. Over 80 per cent of those asked agreed to participate. Thirty-seven members of the staff (all of whom had worked with addicts for at least six months) were given identical questions on the subject of drug addiction.The instrument used to measure attitudes was a questionnaire consisting of forty statements to each of which the subject responded by marking one of seven numbered boxes according to his opinion of the correctness of the statement. (These varied from 1 signifying complete disagreement to 7 signifying complete agreement.) The instrument was developed by Marcus^ as the outcome of a factor analytic study. It has been used by several authors to measure the attitudes of professionals working with alcoholics2>3, ji^e original wording of the statements was retained for the study of attitudes towards alcoholics, but w^ altered for the part of the study dealing with drug addicts. In most cases, a simple substitution ofthe words "drugs" for "alcohol"; "addict" for "alcoholic" and "addiction" for "alcoholism" was all that was required. Only a few statements required more extensive alteration. This was done without altering the similarity of meaning between the statements.The statements were read to the respondents and explanations were offered to any respondent who asked for clarification. The questionnaire required about 20 minutes to complete. Each question was grouped into one of nine factors, the definitions of which are given in Table 1. 195

The natural history of alcoholism has been described by Trice and Wahl (1958) and by Glatt (1967). The “average” alcoholic first begins drinking when aged 18, and by the time he is 26 he is drinking heavily and frequently becomes drunk. He begins to experience blackouts between the ages of 30 and 35, and a number of years later he is no longer able to control his intake of alcohol. He begins to lose contact with his family and friends and starts drinking alone. By the middle of the fifth decade he has reached his lowest point and seeks admission to hospital. In a proportion of cases∗ this process is markedly accelerated and patients aged 30 or less are admitted to hospital because of alcohol dependence.