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Eventually, proven methods could then be disseminated to other areas of the United States.

Such a comprehensive program must be provided and where better might this be done than in our Nation's Capital? The size of the problem in the District of Columbia warrants such an approach. The Circuit Court of Appeals of the District of Columbia has prepared the way for such an approach. There are knowledgeable, dedicated people in the field of alcoholism in the District to implement such a program.

I think I speak for others who are active in the field of alcoholism when I say that we probably lend our technical assistance, if it were requested, to those who were responsible for providing the District of Columbia with the best possible program for alcoholism care and control.

If we are to make the necessary strides forward in the field of alcoholism, which now ranks as one of the major health problems in the United States, we must act now. We have the knowledge and the methods to make progress. H.R. 6143 would provide the media to activate this progress.

Mr. DowDY. Mr. Hagan, do you have any questions?

Mr. HAGAN. No. I just want to say this, Mr. Chairman, that is it not true that one of the very reasons for a need for legislation in this field-and by the way that's one of my reasons for subsequent nationwide legislation that we have plans for-and that is to provide for research into this field of alcoholism so we will have all the answers that the Chairman was just talking about awhile ago. I don't think we actually have had enough research on this subject to really know exactly-well to put it in simple terms-why is it, some of us can go out, if we desire to, and take a few drinks and be at work the next morning, we can. But, as Mr. Chairman pointed out, the alcoholic takes one drink and he'll be gone for weeks until somebody gets him to an intoxication place and gets him back on his feet again. I think that's one of the great needs for legislation in this field, is to provide for research which can help us someday to find out exactly what is the cause of a man becoming a confirmed alcoholic.

Dr. ALFORD. I agree.

Mr. HAGAN. Thank you for your testimony.

Dr. Alford, I think this field, the research area, is definitely needed. I think there is another area which we might emphasize, and is emphasized by your Bill, and that is that we already have considerable knowledge, if we just had the facilities to put this into action.

Mr. HAGAN. Through a pilot program like this in the District research will come.

Dr. ALFORD. Yes.

Mr. HAGAN. All of this will have to be trial and error.

Dr. ALFORD. I can say this. We in our program are certainly looking toward this as a kind of a guideline and a model which we can follow, and I can speak for the Director of our State program, Mr. Charles B. Metford, who will say the same thing.

Mr. Dowdy. Mr. Steiger, do you have any questions?

Mr. STEIGER. Thank you, Doctor, for a very fine statement. I gather that you, under your program, at Emory, are conducting at least a pilot program for rehabilitation; is that correct?

Dr. ALFORD. Yes.

Mr. STEIGER. How long have you done this?

Dr. ALFORD. We have been in the field, in terms of study and demonstration projects. We have been on full scale less than a year, but the demonstration project, three years prior to that.

Mr. STEIGER. Have you any feeling for what percentage of success you had in your rehabilitation? I'm not interested in gross numbers, just percentages.

Dr. ALFORD. I would say-now we are taking the real hard-core group. We take only those who have showed up in chronic drunkenness two or more times in the past year. In the city of Atlanta this means that a man has to be at the very bottom of the list because he can repeatedly pay out and never show up in drunk court. It is only when he doesn't have anything that he finally shows up in drunk court. Of this group, this hard-core group we feel that about a third of them can really be put back into the mainstream of society, keeping in mind, of course, their original abilities. They are not middle-class citizens for the most part.

Mr. STEIGER. Yes, I understand.

Dr. ALFORD. Another third can be kept fairly productive in the kind of stable facilities that are provided in this bill, such as half-way houses and controlled living situations. Another third probably are going to have to be institutionalized in the traditional sense of the word.

Mr. STEIGER. That's really remarkable. From my own knowledge of the present situation. Have you developed any cost figures per patient?

Dr. ALFORD. No, I couldn't-I would not be able to give any thing that would be very stable.

Mr. STEIGER. In those cases where you have been successful is there an average term in which you have been able to treat them, a matter of months, a matter of weeks?

Dr. ALFORD. Let me say this, we have seen many of these people who have a long history of repeated arrests; they have spent the last 10 years in prison on the installment plan; and many of these people, approximately a third of them, once we start them on a program and put them in a stable environment, can, within a matter of a week or two, start supporting themselves considerably.

Mr. STEIGER. Do you retain possession of them, as it were, or let them go out and function, and return?

Dr. ALFORD. They go out and work and they pay room and board. Mr. STEIGER. That has been a successful program?

Dr. ALFORD. Yes.

Mr. STEIGER. What is the mean period of time that you have to retain this custodian possession of these people?

Dr. ALFORD. I would estimate now-and we haven't been in existence very long-I would estimate within the period of a year, on the mean, in terms of half-way houses facilities and such.

Mr. STEIGER. So a successful program by your experience, and recognizing you have not had sufficient time to establish a hard figure, you would say you would reasonably expect a year's treatment of the confirmed hard-core alcoholic in order to have a 30 percent chance of restoring him successfully?

Dr. ALFORD. Yes.

Mr. STEIGER. Thank you, Doctor, it is very helpful.

Mr. DowDY. I have one question. With regard to compulsion beyond perhaps a 30-day period proposed in this bill, do you feel that 30 days is enough time to have any success with an alcoholic? The

point I'm getting at is whether we should have some compulsion in the bill for more than 30 days of treatment.

Dr. ALFORD. No. I am personally an advocate of minimal inpatient treatment facilities, with a maximum amount of time getting the person to readapt to the social environment in which he is going to have to live from that day on. This is part of the treatment

process.

Mr. Dowdy. For instance, the illustration I gave earlier, about the man who was kept under a restriction for a year and it didn't do any good. You have to have some compulsion, or some hold over a man of that character to ever have any results with him, do you not? Dr. ALFORD. It depends what happened to him in that year of compulsive confinement.

Mr. Dowdy. He had been in confinement for a year or more and then was out for a year under parole, and as long as he was under parole, not reporting in or anything, just paroled to a friend he did not drink. So at least that much compulsion is all right. Don't you feel, or do you, that this is effective?

Dr. ALFORD. I think this type of individual, if he can identify himself with any authority, even someone like myself who has no legal authority-but he had the feeling of my authority, and I say, "You have to stop drinking." Sometimes an individual case can be helped considerably by this kind of interest.

Mr. DowDY. Thank you, Doctor Alford, we appreciate your coming. You have been very helpful.

Dr. ALFORD. Thank you.

Mr. Dowdy. Colonel Edward Dowd, President, Board of Police Commissioners of St. Louis. Colonel, we are glad to have you.

STATEMENT OF COL. EDWARD DOWD, PRESIDENT, BOARD OF POLICE COMMISSIONERS, ST. LOUIS, MISSOURI

Col. Dowd. Mr. Chairman, members of the committee, the St. Louis Police Department has substantially the same problem and the same history as described to you by the previous witness from Atlanta. The process of sending persons through City Court, down to the workhouse for 30 or 60 days, or assessing a fine that was never collected, was found to be a dismal failure with a lot of people that were human beings but were treated really more like animals than people.

We established a Detoxification Center in November of 1966, with the aid of the Federal Government, by a grant of the sum of $158,000, supplemented by police department funds of approximately $100,000, which is mainly in the form of personnel, vehicles, and such things as that. We took a lease on St. Mary's Infirmary, an old hospital in Downtown St. Louis, and the public alcoholic now is picked up off skid row, he is taken directly to the detoxification center, he is given drugs to avoid withdrawal symptoms of alcoholism, he is given intramuscular injections, he is given vitamin shots, he is given a high protein diet, he is cleaned up, he is de-loused, and he is given a clean bed and a clean room to sleep in.

That process goes on from 7 to 10 days, both on an intensive basis; the first 48 hours he is watched intensively because St. Louis has had the same experience that other cities have had of these people dying,

and in the custody of the city hospital, dying in a police station. So they watch very closely during the original 48 hours, and after that they are put into self-care units where they take their own meals in a cafeteria, they start performing small services around the hospital, and at the end of the 7 to 10 day period they are released to halfway houses, Salvation Army, and other social agencies.

We have processed approximately 275 people through the Detoxification Center. We have had a follow-up study made on the first 25 and we are indicating a rate of recovery of something like 50 percent that are not coming back or not resorting to alcoholism.

Mr. Dowdy. That's remarkable.

Colonel Down. Yes, it is a high figure and we know it is a high figure, because we are early in the program. Undoubtedly some of those that haven't come back since they were released in December will come back to us next year, and the succeeding months. We have received a side benefit from this in that many of the alcoholics that have been recovered have been a source of good community relations. Some of them belong to the police community relations organizations in the districts now. The attitude of many of the, let's say the hardened police officer of many years ago is improving, because they are not burdened with the time consuming procedures that we had previously. Our procedure required an alcoholic to be taken to the city hospital, examined by a physician and determine whether or not he was intoxicated or ill or suffering from some other difficulty, or injury, and then taken to city court where they went through the process. This took three to four hours of the police officer's time. Now, he disposes of the public alcoholic in something like 30 to 40 minutes. He writes a very brief report and takes them directly to the Detoxification Center, does not go to a police station, and the police officer is immediately available for other duty. This has increased the efficiency of the districts that are involved. We are doing this in four districts out of nine, and it has worked to such an extent-it is almost—we are reluctant to believe our own figures, but we are having a drop in arrests for public alcoholism of 66 percent. It has ranged in some months as high as 85 percent. By that I just mean we are not finding that many drunks on the street being picked up by the police and taken in. If they are becoming intoxicated in other places, we are still missing some of them, there is that possibility. But the fact remains we are having a lot less of a problem on the street with the public alcoholic than we were having this time last year.

We are sadly in need of real close followup care of the place for these men to live for the year period that the doctor spoke of. That seems like a very good estimate to me, and I would endorse that suggestion and suggest further that there is need of an employment. program. These people will drift back into alcoholism unless they are given a way to earn their own living and make their own way. We have received the full subsistence of Washington University in St. Louis, and of many of the social agencies in the State Employment Office and some of them are employed, some are back with their families, actual count on this is something in the area of 15. It is not a high number of almost 300 that have gone through, but many of them have not been run down. We are still in the process of doing that. When they were first set up they were checked out at the end of this

period and the follow-up procedures were not instituted immediately. But we do need this follow up care, of employment, of a better place to live.

Mr. Dowdy. I notice in your statement that you say that the patients stay at treatment facilities on a voluntary basis. But if the patient doesn't volunteer to stay, then you declare him under a drunk charge. It is a little bit of a compulsion and I think you need it. That's the way you handle it.

Colonel Dowd. That's right. That's the way we handle it. We call it voluntary.

Mr. DowDY. I was just describing that a little while ago when Dr. Alfrod was on the stand. We are going to make your full statement part of the record.

(The complete statement of Colonel Dowd follows:)

STATEMENT OF COLONEL EDWARD L. DOWD, PRESIDENT, BOARD OF POLICE COMMISSIONERS, ST. LOUIS, Mo.-"OUR NEW APPROACH TO THE CHRONIC POLICE CASE INEBRIATE, OR THE PUBLIC ALCOHOLIC"

ST. LOUIS DETOXIFICATION CENTER

The St. Louis Detoxification Center is the first "Sobering-Up" Station in the Western Hemisphere sponsored by a Metropolitan Police Department. It is funded by a federal grant from the Office of Law Enforcement Assistance, United States Department of Justice. The Center is located in St. Mary's Infirmary, 1536 Papon Street, St. Louis, Missouri.

In October, 1966, a grant of $158,000 was awarded to the St. Louis Metropolitan Police Department and the Center became operational on November 18, 1966, when the first patients were admitted. It is significant that a metropolitan police department took the initiative in establishing a "Sobering-Up" facility for the "revolving door alcoholic" rather than a local health or welfare agency. It is unique in the history of our country to have a police department take the lead in helping to render a service to the public intoxicant.

The St. Louis Detoxification Center uses a variety of therapeutic techniques, including medical diagnosis, treatment, counseling and evaluation (social, vocational, employment); group therapy; task (work) therapy; self-government; didactic lectures and films; and socio-drama. The purpose of the Detoxification Center is not one of extended treatment but to sober-up the public intoxicant, attempting to build him up physically and begin the process of his rehabilitation by appropriate referral for aftercare to the community agencies.

PROCEDURES FOR ADMITTANCE

In the City of St. Louis, a person being intoxicated in public is in violation of a city ordinance, as in many other communities in the United States. To be admitted to the Center, the intoxicated individual is picked up by the police and issued a City Court Summons for "public drunkenness", after he is transported to the Center-rather than being taken to a City Hospital for a physical examination and then being forwarded to the police department's "drunk tank", located in the Holdover in Headquarters Building, where he would normally be booked on the charge of "drunk on the street" (D.O.S.). He is admitted to the Center only if there is no other criminal violation involved and he is not wanted for any other offense. It is to be noted that the patient's stay at the treatment facility is on a voluntary basis. If the patient remains for treatment, the City Court Summons for the charge of "public drunkenness" is voided by the Police Department. However, if the patient refuses to accept the treatment at the Center and leaves against medical advice (AMA), the City Court Summons is processed and the individual must appear in court to answer for the “public drunkenness" charge. This procedure was established by the City Court Judges with the approval of the St. Louis City Counselor. Upon entering the Center, the intoxicant is brought into the Intensive Care Unit where is he is given a physical examination, a shower, placed in hospital clothing, and put into a bed. During his stay in the Intensive Care Unit, which averages 1.7 days, the patient

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