believes ours are any different than anyone else's-we have tested in excess of 6,000-roughly one-third of them are really clinically depressed individuals. Roughly 10 percent are schizophrenic. An additional 20 percent are above the normal range on anxiety scores.

These are people who have a number of problems of which drugtaking, which we are addressing as the problem, really is probably only a symptom. I have no question in my mind but a large number of people in New York, in Harlem, and in the Bronx, use narcotic drugs as if they were major tranquilizers.

You and I know that if you build a cage for three rats and you put six in it what happens. You know that if you build a cell for three people and put six people in it what happens. We have built cells with literally thousands and thousands of people in them. We didn't really expect the kinds of reactions that we got. Drugtaking is normal behavior there. The sheer weight of density, the population problems, have brought a number of these things to us. We are not addressing that, we really are not. We are addressing only some of the symptoms.

Until we begin to address the other, until I can move some of my low cost housing into the suburban neighborhoods and split the density down where the "potentials for losing" interactions can be cooled off, I am going to have a drug problem, regardless of money, national priorities, or anything else. If not drugs they will cut one another's throats or something else. There will be some outlet.

We have viewed all drugtaking as if it were an individual pathological kind of a problem. Senator, it is a social problem. I really believe it is.

Senator HUGHES. I agree with you. We look at the individual and try to diagnose the illness without getting behind it to find out what is creating the climate that brings the illness. We can create a place of dignity after we find a man or woman who is willing to look at himself and try to get well. Then what does he find? The illness of the society he is coping with in which he is trying to help himself. Dr. CHAMBERS. Exactly. I don't have any idea what will happen in my social system with one-third of the adult population regularly using tranquilizers, stimulants, and so on, daily.

Senator HUGHES. In relation to that, what do you think the responsibility of the medical profession is?

Dr. CHAMBERS. Some of us have fought for a long time for additional controls on not just the medical profession but the drug profession in toto. Part of the responsibility of profittaking should be returning some of it to the areas of education, to the areas of research, of "cleaning one's own house," and so forth. Our efforts had only a very minor impact. Regardless of how many scientific papers and how many addicts I troop into a drug company and say, "Look, you keep selling this drug as a nonaddictive, harmless compound and I have put it in the professional literature for 5 years that I treat people addicted to them as long as it is a $100 million a year drug item to that company, no one is going to listen to us.

Senator HUGHES. I want to thank both of you gentlemen, Dr. Chambers and Mr. Ellis, for your willingness to testify. You have been helpful to the subcommittee and me as we consider this legislation and this problem. The Committee on Labor and Public Welfare

also has the responsibility for generating legislation that helps to eliminate some of the social ills in our country that help to breed drug abuse. I appreciate this and I know the other members of the committee do though they are not here. We are extremely busy this morning, and the full committee is meeting in executive session in another room on another matter.

I am encouraged that we seem to be willing now to look at the problem at least. For years in the past we have been doing nothing but put people in prison and in jail as a solution to a problem.

Thank you very much.

Dr. CHAMBERS. Thank you.

Mr. ELLIS. Thank you, Senator.

Senator HUGHES. We will recess for about 30 minutes.

(Recess.)

Senator HUGHES. The subcommittee will come to order.

Dr. Mitchell Rosenthal, director, Phoenix House Foundation, New York, N.Y., will be our next witness.

STATEMENT OF DR. MITCHELL ROSENTHAL, PHOENIX HOUSE FOUNDATION DIRECTOR, NEW YORK, N.Y.

Dr. ROSENTHAL. Thank you, Mr. Chairman.

Senator HUGHES. Dr. Rosenthal, I apologize for the delay. Please proceed.

Dr. ROSENTHAL. I would like to say I am very pleased to have been invited, notwithstanding the delay.

New York City's health services administrator now estimates that more than 300,000 narcotic addicts live in New York City. I believe this is a reasonable, if modest, estimate.

However, there is no indication that the number of addicts has increased materially during the past few years. The number has always been high, while previous estimates have been unreasonably low.

Traditionally, New York has been assumed to contain about half of the Nation's addicts. This, I suspect, is no longer the case. The great increase in addiction has been most evident in cities that previously had few, if any, resident addicts. And our national addict count probably runs somewhere between three-quarters of a million to a million.

The number of serious drug abusers, who are not addicts, is most likely five times as great. As many as 5 million Americans are regular users of illegal psychoactive drugs, and a growing proportion of these drug abusers are young.

Present public policy, as it has developed and will continue to develop, virtually insures a total addict population of 2 to 22 million and a drug-abusing population of 12 to 15 million in 10 years time.

If you gentlemen suspect that I am attempting to frighten this committee, that I am playing some grim kind of numbers game, you are absolutely right. The figures are only estimates, and as trustworthy as any estimates, but the reality they represent is irrefutable. Our present approach to addiction and drug abuse can only tragically compound the problem.

This policy, the present Federal encouragement of methadone maintenance treatment, and the provisions of the legislation now before this committee are not designed to solve the drug problem. They

are directed specifically toward the prevention of addict crime, the most politically pressing aspect of the drug dilemma. And I cannot argue with the political realities that give priority to the victims of addicts rather than the victims of drugs.

If the policies now strongly endorsed by the administration, and the programs that must inevitably follow from this philosophic base, could indeed eliminate or materially reduce the amount of addict crime, there might be some reason to discount or ignore their other, undesirable results.

But there is no evidence to support the notion that the Government's current approach will, in fact, have more than a minimal impact on the incidence of crime. What it is certain to do is to vitiate any real efforts to prevent the spread of drug abuse among the young.

At the heart of today's controversy, I believe, is a general failure to comprehend the relationship of addiction and crime and the nature of drug abuse.

Addicts commit crimes, and many criminals are addicts. This holds true throughout Western society. It is difficult to resist the notion that addiction then must cause crime- that the addict must resort to extralegal means to acquire the sizable amounts of money needed to procure illicit drugs. But addict crime is not so simple a cause-andeffect phenomenon.

The reality is that addiction and crime are parallel activities. The same people likely to become addicts are likely to become criminals. Both are classic ways of acting out, both fill the same emotional needs. They are dangerous, exciting, self-destructive and pleasurable experiences. Indeed, most addicts have already engaged in criminality before they become addicted.

Nor do we have any reason to believe that providing addicts with drugs will cause them to abandon their criminal ways. This has not been the experience of Britain's heroin clinics. Criminal addicts continue to support themselves by crime even when receiving free heroin.

I would speculate that some addicts receiving orally administered methadone might well turn to criminal activity or increase their criminal activity once they had been deprived of the emotional rewards of drug taking.

On the other hand, a certain number of addicts with heavy habits would probably restrict their criminality to meet their reduced economic needs. Putting it all together, we would most likely end up with roughly the same amount of addict crime we now have.

Some addicts would steal less, others would steal more, noncriminal addicts might well turn to crime and there would be, as a result of the dominant Federal policy, a larger national addict population and more candidates for criminality.

Using the iceberg cliche, addict crime is the merest tip of the drug problem. Just beneath it, still above the surface, is the general addict population that includes a good many habitual narcotic users who do not engage in crime (placed in a methadone program, these addicts would most likely continue their noncriminal ways and be counted as cured).

Beneath the surface are the great number of Americans dependent upon dangerous and illegally procured psychoactive drugs that are not narcotics and, save for barbiturates, not addicting.

And, at the base is the Nation's great drug-misusing majority: alcoholics and habitual alcohol users, the law-abiding prescription "freaks" (whose amphetamines, barbiturates and antidepressants are legally acquired and consumed) and the nonprescription "heads", who depend upon regular intakes of sleeping pills, relaxants, stomach remedies, and the like.

The abuse of illegally acquired dangerous drugs by young people, particularly adolescents, is a vital national concern. But our efforts to prevent the spread of drug abuse among the young have been woefully short of successful. And our current national posture, our emerg ing drug policies, will make us even less able to prevent widespread drug abuse. There is no difference between legally and illegally acquired psychoactives.

Alcoholism is, by far, the most destructive form of drug abuse. Yong people know all this. They recognize our national acceptance of general drug misuse, even if we do not.

When the Government supplies drugs to some and condones its use by others, it cannot hope to discourage drug use by a third group. We then become the victims of our ambivalence, and our children become the victims of our folly.

Drug abuse is, in many ways, a contagious condition. Quite simply, the more drug abusers in a society, the greater the possibilities of infection. Open and socially sanctioned drug use is more contagious than secret and social condemned drug use. We can no more tolerate a certain amount of drug abuse than we can safely permit a limited amount of cholera.

Our very approach to drugs indicates our inability to perceive the true nature of the problem we are confronting. Young people most often choose drugs to help them deal or avoid dealing with difficult human problems.

Our current encouragement of methadone treatment and our hopes of an improved narcotic antagonist is evidence of a similar faith in chemical or mechanistic solutions to what are essentially complex human problems.

The legislators who now talk optimistically about eventually finding some means to inoculate children against addiction might just as reasonably hope for some way to vaccinate them against poverty, ignorance, or bigotry.

Chemical solutions are simple, quick, and uncomplicated. But the problems of addiction and drug abuse are not. I recognize that the partisans of methadone maintenance and the authors of this legislation have attempted to find a humane solution to a pressing political problem. But I submit that there is no simple solution and what appears to be humane is, in fact, dehumanizing.

For years, conventional wisdom and medical opinion both held that drug addiction was incurable. Yet, drug addicts were cured, almost invariably by their own efforts, and these remissions were written off. Fourteen years ago, therapeutic communities began to cure addicts with drug-free residential treatment that succeeded where traditional general medicines and traditional psychiatry had failed.

Today, we know that only a small percentage of addicts will accept drug free treatment, and a somewhat larger percentage will accept methadone maintenance. But the majority of addicts today will will ingly choose no treatment now available.

Furthermore, a sizable number of those who choose either drug-free or methadone treatment will drop out of treatment after a short period of time. In addition, many methadone patients will continue to use drugs (mostly alcohol, and even heroin) while in treatment.

Faced with the dilemma posed by large numbers of addicts to whom no existing treatment program is acceptable, the inclination of many public officials is to devise more acceptable alternatives, specifically heroin maintenance or some form of heroin lure.

While there are differences between heroin and methadone (methadone can be administered orally, while heroin cannot; heroin effects last 4 hours, while methadone's last 24; orally administered methadoes not produce the high of intravenously administered heroin) the primary difference is in the minds of those officials who perceive methadone as a medicine and heroin as a drug.

Methadone is a potent, addictive drug. Given in what is called blockade dosage (in sufficient quantity to create a cross tolerance to as large an amount of street heroin as the addict can lay hands on) it is a massive daily dose of depressant, many times the size of the patient's previous habit. The advocates of heroin treatment can well argue, "If methadone, why not heroin?"

And, I, too, can ask, "Why not?"

Frankly, I believe some form of heroin treatment is inevitable as long as we approach the problem of drug treatment in the manner we now do devising treatments acceptable to addicts.

We tend to ignore the basic reality of addiction and drug abuse. People who take drugs like to take drugs. They will persist in taking drugs in the face of argument, pleading, and their own best interests.

They will stop taking drugs only when they want to stop taking drugs, and that is when drug taking is sufficiently uncomfortable or unpleasant.

Today, the choice of what society can do about addiction is being made by addicts.

Addicts can now choose to live on the streets, to steal or deal drugs, to cop and shoot. They run the risk of being caught from time to time. But for many reasons, including the shortcomings of our criminal. justice system, addicts are rarely sentenced, and then to only minimal prison terms. The criminal option is viable. Most addicts now choose it. The option of being treated without having to give up drugs (through methadone maintenance) is available. And the option of being treated with their drug of choice (heroin) is a reasonable expectation.

Frankly, it is fairly absurd to consider a treatment for addiction that doles out drugs as a cure. Drug taking is not an isolated activity. Addicts are not normal people who happen to take drugs. There is overwhelming documentation of the addict culture, with its criminality, amorality, and the dehumanization of its members.

While there are a number of addicts who control their own habits and their own behavior, they are not the population from which candidates for methadone maintenance will be selected.

Already the failure of existing methadone programs to control patient behavior, to stop their use of other drugs, to halt their criminality, has caused considerable anxiety among methadone advocates. Many