Now, we certainly don't pretend to have any panacea for all the ills, but we have been working on this problem for many years with many people over the nation, and we welcome any ideas and suggestions from anyone so that we can come up with the answer to this problem, we hope, here in the District of Columbia, and subsequently throughout all the States of the Union.

I shall be brief in my remarks this morning, Mr. Chairman, out of deference to the witnesses who have come many miles to appear before us in support of H.R. 6143.

My own position regarding the District's alcoholism care and control problem is best stated by the terms of the legislation itself. I am, however, submitting an analysis of the Bill, section-by-section, as part of my testimony, for the record.

In brief, here is a summary of the situation that led me to introduce this legislation and which, it is my sincere hope, will lead the 90th Congress to enact it into law.

First, The Federal court decision in the case of Easter v. District of Columbia requires that the chronic alcoholic, as the victim of a disease, be transferred from the jurisdiction of our criminal courts and jails to the administration of public health authorities.

Second, the inadequacy of treatment facilities for chronic alcoholics in the District of Columbia has created a serious, if not critical, situation which finds local law enforcement and public health authorities unable to develop such alcoholism care and control programs as can meet the requirements of the court decision.

Third, what is needed to correct this situation is a comprehensive program which includes (a) establishment of facilities and clinics to treat those persons found to be chronic alcoholics, on both an immediate and extended care basis; (b) the expansion of rehabilitation programs and facilities in order, wherever possible, to take the "repeater" alcoholic off the public rolls and return him to a useful role in the community; and (c) the pilot development of long-range research programs into the cause of chronic alcoholism, its possible prevention and cure.

Fourth, far from being a drain on the public treasury, such a program would in fact plug that drain, in terms of both human and material resources, which alcoholism makes on the community. As a ward of society, the "repeater" alcoholic can be more efficiently handled as a public health responsibility. Our law enforcement authorities and courts, already burdened with the effects of an increasing crime rate, will be well relieved of the task of trying to cope with "revolving door" inebriates through criminological and judicial processes which have proven inadequate and futile in the past.

Finally, the situation now confronting the District of Columbia will soon face other communities across the land. Court decisions similar to the Easter case are going force a re-evaluation of public attitudes and community facilities dealing with chronic alcoholism.

Therefore, as I said upon introducing this legislation, what we do here in the Nation's Capital can be an exemplary program for other American communities in the not-too-distant future. On the other hand, our failure to act-and our failure to act soon-will compound an already existing law enforcement and public health crisis in the District.

We will be hearing today from expert witnesses from other communities. As sponsor of this legislation, I want to thank these individuals, Mr. Chairman, and you, and the organizations which they represent, for their interest in this National Capital community problem, and for coming here to give us the benefit of their experience.

In fact, this is not simply a National Capital community problem. It is a national problem, period. The disease of alcoholism knows no community or state boundaries or jurisdictions, nor is it a respecter of class or status in society.

My own interest in this problem is not new, but goes back many years, to the time I served as a Member of the Georgia Legislature. I am gratified, indeed, proud, to count among my accomplishments as a State legislator the enactment of legislation providing for a State Bureau of Alcoholism, an agency specifically created to take up the problem of alcoholism care and control in my home state. And we have a wonderful record of accomplishment in this program in our

state.

My purpose and my hope, this morning, Mr. Chairman, is that H.R. 6143 will provide here in our Nation's Capital an effective, comprehensive, alcoholism program to meet the needs of this community, the Nation's Capital, and to serve as a forerunner of similar programs in communities throughout the country.

Thank you, Mr. Chairman.

Mr. DOWDY. Thank you, Mr. Hagan.

We have on our list of witnesses Dr. James Alford, Emory University, Department of Psychiatry, Atlanta, Georgia.

Dr. Alford, we are pleased to have you with us today to give us the benefit of any experiences, knowledge and studies you have made along this line.

STATEMENT OF DR. JAMES ALFORD, EMORY UNIVERSITY DEPARTMENT OF PSYCHIATRY, ATLANTA, GEORGIA

Dr. ALFORD. Thank you, Mr. Chairman. I am Dr. James A. Alford, M.D., Psychiatrist, an associate with the Department of Psychiatry at Emory University, and Director of the Emory University-Vocational Rehabilitation, Alcoholism Project in the city of Atlanta.

I would like to go on record as saying that, in my opinion, H.R. 6143, introduced by Mr. Hagan of Georgia, is a very timely and exceedingly necessary step forward in the control of drunkenness and in preventing and treating alcoholism in the District of Columbia and would further provide a model for other cities of the United States to follow in coping with similar problems.

I make that statement on the basis of my own experience in the field of alcoholism over the past five years, starting with a study of a similar problem in the city of Atlanta, Georgia, which is comparable in size to the District of Columbia. And interestingly enough the problem itself is very comparable to the problem in the District of Columbia in that we both have approximately 46,000 or 48,000 arrests per year for public drunkenness.

In Atlanta, the problem became so large that it was actually inundating the Atlanta Municipal courts. They were having to handle a caseload of an average of 100 cases per day for plain public drunkenness

and this of course would not allow for very careful evaluation of the cases. We had, as is commonly called, a "revolving door" method of handling the chronic drunkenness offender, alcoholic. In other words, arrest, jail, turn loose and arrest again.

From our study of this problem which was called for by the city court judges in the city of Atlanta, we found for all practical purposes these people that were being handled in this way were a seriously ill portion of our population. Not only did they suffer from chronic alcoholism in a majority of cases, but also they suffered from a great number of other kinds of illnessses including mental illness, physical abnormalities, some of which were resulting from their chronic alcoholism. Many of them were mentally retarded, many were socially and educationally handicapped; somewhat from the very beginning, others as a result of their disease alcoholism.

Mr. DowDY. I am wondering, is alcoholism a mental trouble? Is it a mental disease, or is it something else?

Dr. ALFORD. I think it is something else. Frequently, there is an associated emotional instability, but I feel the disease, alcoholism, is something else besides mental illness.

Mr. DowDY. The reason I asked that question, I had a friend once that was an alcoholic. He is dead now. It killed him. Everything under the sun was done, and finally he was put in an asylum. They dried him out. I considered him a hopeless alcoholic. I thought for his own life he ought to be confined. But he made friends with a man who got him out on parole and kept him out on parole for a year. He stayed sober.

The alcoholic finally persuaded the man he was paroled to that he could go out and get a job, stay sober and behave himself. The man he was staying with--he had taken him into his home-came to me and asked me about it. I told him "You are making a mistake. I would advise never to release him from his parole." But he went ahead and did it anyway, asking the institution to discharge him, which it did, and he celebrated his first night by getting drunk and then went back to the asylum and died there shortly after.

I'm just wondering, as I've wondered for a long time, if it is not a mental problem.

Dr. ALFORD. I think alcoholism is superimposed on all illnesses. I mean, anyone with a mental illness can be an alcoholic.

Mr. Downy. As long as this fellow was on parole and he would have to go back to the asylum if he took a drink, he stayed off of it. But the minute that was removed he took a drink. The only alcoholics I have ever known, their only problem was the first drink. After they took it then they couldn't stop. They did not have the willpower to refuse the first drink. An alcoholic, who knows he is one, realizes this; he wants to stop and does. Such a person who has stopped, you can meet him on the street and ask him how long since he had had a drink and he'll tell you the number of days he hasn't had a drink. I have several such friends, one of whom has not had a drink in more than 15 years. He can tell you how many days. He had been in the gutter all the time. He just decided he wouldn't drink any more. He says, "If I take a drink, I'll be back. Just one." He knows.

I don't know if that's an answer. That's just two illustrations that I have. I could name others. But the same results; if a man wants to quit, he can and if he don't want to quit he won't.

Dr. ALFORD. I think this is a very important point. One of the definitions included in the definition of alcoholism, is this loss of control that person has, either when he is going to drink, or if he starts drinking, that he can't stop.

Mr. Dowdy. It isn't a question of when he drinks. If he drinks he is gone. Taking one drink, he is gone. I have seen a good many, in prosecuting, among my friends, and in the experiences one has in life, observing.

Dr. ALFORD. I think there is a close correlation between what you said earlier, in terms of, is this a mental illness. I think that it is this first kind of loss of control that I mentioned in terms of alcoholicssome alcoholics at least, not being able to control when they take the first drink. It is like the impulsivity of emotional and

Mr. DowDY. When you say "lack of control" when they take the first drink, they can't take the first drink. They flat can't take it. Not any drink. When they realize that then they can cure it. With all the alcoholics I've ever known, that's their problem. That first drink. Anytime they take just one, they are licked. I think if we are going to get a cure for them we've got to try some way to eliminate the first drink.

I'm sorry I interrupted you, but I was hoping you could comment on that, if in your experience you have found any means that you could prevent or persuade a person to use his willpower, not to take the first drink.

Dr. ALFORD. I think this is, as I was saying, the essence of the loss of control is that these people are oftentimes plagued with considerable anxiety which make it impossible to cope with a lot of life's stresses without sometimes resorting to this method of decreasing anxiety, which is to take the first drink, thinking that this will in effect help them. It certainly never does, because as you said, once they take the first drink then, of course, the second kind of loss of control comes in. Our own experience has been that because of the--and I'm talking primarily now about the chronic police case offender who is handicapped in a variety of ways, that this total dependency upon the community to take care of them is the key to the whole thing. And the communities have been taking care of these people whether we like it or not by the "arrest" method, which I feel is certainly not the method of handling a chronically ill individual.

I feel that as a physician, we in the health field have certainly been negligent in handling this illness, partly because of our own ignorance and as a result of our own ignorance heretofore we have been frightened by it and we have avoided it. But I don't think we can continue to do this. And I think if we provide facilities to meet the dependency needs of these people in a healthy sort of way that then they won't have to resort to this unhealthy, unsocial type of behavior that is so distressful to the community economically and otherwise that we could in fact change this whole picture considerably.

Mr. DOWDY. You mentioned that drunks shouldn't be arrested. How are you going-what are you going to do with them?

Dr. ALFORD. I would suggest doing the same as you would with any other sick person, take him to a health agency facility and treat him accordingly.

Mr. DOWDY. You would have to arrest him to do that wouldn't you?

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Dr. ALFORD. Not necessarily. As a physician who has been very comfortable in this field now, I don't see it any different from taking a heart attack case to a medical emergency facility and present him to the physicians and say "take over."

Mr. DOWDY. You would generally think a heart attack case would want to go to the physician. You can generally figure that a drunk wouldn't want to.

Dr. ALFORD. My experience is that is true of the alcoholics. They generally want to go, provided there is something to go to. They don't want to go to what we have now, but if the facilities are available they want to go to a good facility in the majority of cases. Now there are exceptions to this, definitely.

Mr. Dowdy. You may proceed.

Dr. ALFORD. Thank you.

Mr. Dowdy. Were you through?

Dr. ALFORD. I have presented all the material.

(The prepared statement of Dr. Alford, follows:)

STATEMENT OF JAMES A. ALFORD, M.D., DIRECTOR, EMORY UNIVERSITY-VOCATIONAL REHABILITATION ALCOHOLISM PROJECT, ATLANTA, GEORGIA

H.R. 6143, introduced by Mr. Hagan of Georgia, is, in my opinion, a very timely and exceedingly necessary step forward in the control of drunkenness and in preventing and treating alcoholism in the District of Columbia. It would further provide a model for other cities of the United States to follow in coping with similar problems.

It is generally agreed that the current system of repeated arrests and jailing does not alter the drinking behavior of any significant number of problem drinkers. It certainly is not an effective treatment of individuals suffering from alcoholism, nor is it a deterrant of public drunkenness.

It is also generally agreed by people knowledgeable about the subject that alcoholism is a disease of complex origin and with multiple ramifications that touch upon the physiological, psychological, social, educational, and vocatonal well-being of its victims.

The bulk of the information about alcoholism leads to the conclusion that this disease, because of its complexity, calls for a comprehensive approach to its management. This will entail the involvement of multiple professional disciplines and social, health, welfare, education, and rehabilitation agencies.

H.R. 6143 provides this comprehensive program. The program for the District of Columbia as described in this bill would, for the first time, put together in one adequate package the resources deemed necessary by those of us in the helping professions to properly treat and prevent alcoholism. There are many programs in effect in various cities of the United States which have fragments of the comprehensive program provided in H.R. 6143. Each of these programs claims a certain amount of success in the treatment of alcoholism, and the rehabilitation of sufferers of this disease. However, without exception, these programs throughout the United States, are aware of the inadequacies of their program by virtue of the fact that they are not comprehensive enough. One city, St. Louis, Missouri, is demonstrating that a detoxification center has had a very positive effect in improving the medical management of the acutely intoxicated. However, those individuals working with the St. Louis program are aware of their inadequate follow-up facilities beyond detoxification. Atlanta, Georgia, where I am the director of a vocational-rehabilitation oriented program, is having some success with vocational rehabilitation of our recipients. We are greatly handicapped by the lack of a detoxification center and inadequate follow-up housing facilities. And so it goes. Each city recognizes its inadequacy is a result of a lack of comprehensiveness of its program.

H.R. 6143 in providing such a comprehensive program would be eagerly observed by the entire Nation. It would allow, for the first time, observation of a completely equipped rehabilitation process from detoxification to long-term follow-up. In this setting techniques could be tested and improved. Innovations heretofore unable to be tried adequately could be instituted. Areas of research and personnel training could be further pursued and perfected.