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Pharmacotherap)' and psychotherapy
wri_tte� in 19�7 in the United States.* About 17% of all pre scnpt1ons written were for drug1- of this type. 'rhe patient cost was $692,000,000. Chlordiazepoxide proved to be the single most popular prescription, with patient costs of almost $150,000,000. �f drug combinations in which psychotropic drugs are combmed with antispasmodics or vasodilators and t�e like are. added to this .total, probably 25% of all prescrip tions contam psychotropic drugs. The distribution of pre scriptions is as follows: Major tranquilizers (phenothiazines) Min.or tranquilizers (anti-anxiety agents) . Antidepressants (tricyclics) · Amphetamines Sedatives (barbiturates) Hypnotics (for insomnia)
9.5% 34.4% 8.6% 15.4% 12.9% 19.2%,
Other �ata pertinent to usage reveal that the heaviest drug user� are m the age group 40-59 and that 70% of all psycho tropic dru? pr�scriptions are written by general practitioners, gynecologists, _mternists and surgeons, although psychiatrists and neurologists as a specialty group prescribe them at a greater rate than any other M.D. specialty. A smv�y of the use of psychotropic drugs in California 2 . gives similar results. Frequent use of psychotropic drugs is reported by 17% of the aduks sampled and is al most twice as high in women as in men. Among men, stimulants are used most commonly in the 30-year age group, tranq uilizcrs in the 40's and S0's, and sedatives from age 60 on. About 30% of a :andom sample had used a psychotropic drug in the preced mg 12 months. Figures such as these are impressive because they indicate a * See H. C. Lenna:.d et al. MYSTIFI<:ATlON AND DRl:G Mrsus,,: (New York: Harper & Row, 1971) pag e v11. Lennard. and co-workers reported that the figure was �02,000,000 m 1970, and there 1s every reason to believe that this figure has co 11 tmued to escalate.
Introduction: Problems of integration
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very high incidence of emotional distress in the population at large. They also suggest that there is a low tolerance of this type of distress and that other solutions for it leave much to be desired, because they arc either unavailable or relatively inef fective. Of course, it is also possible that a substantial portion of this high use rate does, in fact, represent transient use of drugs. A proper estimate of the incidence of drug use for the solution of emotional problems should add to the figures cited here nonprescription items like the antihistamines, which are sold for relief of insomnia and tension states, and drugs like alcohol, marijuana and opiates, the use of which is also rapidly increasing. It is difficult to obtain adequate data on the inci dence of usage of nonprescription and illegal drugs in the population, but the evidence is quite clear that it is high and is not declining. Although the use of psychotropic drugs is astonishingly great and the industry certainly a major one, so too is what might be called "the psychotherapy industry." Here it is dif ficult to obtain precise data, but there are approximately 2,000 mental health clinics in ,,.,,·hich full-time psychiatrists represent about 5% of the professional personnel, and full and part-time psychiatrists represent about 25% of total per sonnel. About 15,000 mental health workers employed in these clinics are clinical psychologists, social workers or other types of professionals wbo are unable to prescribe drugs and have little or no training in their use and utility. In addition, ·we may estimate that about 15,000 psychiatrists in the C nited States are performing psychotherapy about half the time. Simple calculation reveals that this professional time amounts to approximately 300,000 psychotberapeutic hours a week, or more than 10,000,000 hours per year performed hy psychia trists. At a conservative estimate, this would represent an in dustry of about $250,000,000 annually. If one adds to this psychotherapy by clinical psychologists, social workers, mar-
