applications for establishment of multidisciplinary alcohol research centers. To date one such application has been received, and three additional applications are expected by March 1, 1967. These four new applications combined with a renewal application are a promise of the development of five university-based alcohol research centers.

Although the focus of research proposed will differ between the five research centers, all will have the following common general features:

1. Research will be multidisciplinary in character with integration of basic science and clinical science disciplines. Participating disciplines will include psychiatry, social psychology, experimental psychology, biochemistry, neurophysiology, and a variety of medical sub-specialties such as cardiology and gastroenterology.

2. All of the centers will conduct an active program of research training at the post-doctoral level in medicine and the various basic science disciplines. 3. The research centers will be located in geographical areas which have a high endemic incidence of alcoholism. The establishment of centers in these areas should provide more incentive for training, research, and service by virtue of the stimulus they will offer to the university and the community at large.

4. All of the research centers will be associated with universities and medical schools which have demonstrated excellence in carrying out research and treatment for many disease entities.

5. The centers will have wide geographical distribution within the United States.

6. The principal investigators and project directors at the centers will be distinguished scientists who have carried out research of high quality in the field of alcoholism.

During fiscal year 1968, it is anticipated that at least four more requests for establishment of alcohol research centers will be submitted by universities and medical schools in New York City, Chicago, New Orleans, and Dallas. It is likely that additional requests for establishment of university-based multidisciplinary alcohol research centers will be submitted from Los Angeles, and Oklahoma City, during 1968.

The establishment of multidisciplinary research centers is both necessary and appropriate among the disease entities which can be investigated through cooperative and combined efforts of behavioral and biological scientists. Perhaps none has offered so unique a challenge as alcohol addiction. At the experimental research level a variety of new behavioral and biological techniques are available which can be imaginatively applied to alcohol research. Studies which will be carried out at the multidisciplinary alcohol research centers should greatly enhance our fund of information in the field of alcoholism and speed progress toward its prevention and control.

In the Centers' intramural laboratories to be developed in the coming year, alcoholism as a form of addiction will be investigated both clinically an experimentally in a series of studies on the biological, biochemical and behavioral factors which are responsible for it. Metabolic and endocrine processes related to both intoxication and withdrawal will be studied in alcoholic processes along with analysis of the patients' behavior. Drinking patterns of alcoholics will be investigated. Finally, in order to get at some of the biological aspects of alcoholism that cannot be studied in human subjects, an animal preparation which meets the pharmacological criteria of addiction to alcohol will be developed.

Enactment of new health-care legislation doubtless will result in an increased demand for alcoholism related activities. The staff of the Center is prepared to consult and work with state officials to develop such programs. Discussions have already begun with the Department of Justice, the offices of Welfare Administration, the Office of Education, and the Vocational Rehabilitation Administration. Finally, much remains to be done to improve attitudes toward alcoholism. The disease concept of alcoholism has only recently begun to overcome the social stigmatization usually associated with this illness. Attitudes held by both professionals and the general public must be modified further before significant progress can be made in our ability to cope with the national problem of alcoholism.

There are no reliable data on the extent of drug abuse. In 1965, the Federal Bureau of Narcotics knew of approximately 60,000 individuals actively addicted to narcotics. This is believed to be a minimal number however, because it is drawn almost exclusively from reports by law enforcement agencies. Far less is known about the prevalance of non-narcotic drug abuse. One estimate is that between 200,000 and 400,000 people may be physically dependent on or habituated to non-narcotic compounds. Tranquilizers, including several with proven addiction potential, are the largest single category of drugs prescribed today. Because these compounds are readily obtainable through legitimate channels, it is especially difficult to cope with their abuse.

Because of the growth of this problem in recent years, particularly among the young, the Institute programs have reflected the increased need for basic and practical knowledge of the biological, psychological and social factors in addiction. The newly created Center for the Studies of Narcotic and Drug Abuse can be expected to enhance the coordination and programming of needed research in this cruical area. A substantial number of laboratory studies, social surveys, and clinical work on addiction are presently supported, with new efforts to be added in these directions.

In the important area of treatment, considerable effort has been expended in the development of controlled clinical evaluations of methods such as maintenance methadone and cyclazocine, and of urinary monitoring of addicts under treatment. In another area, in a study of factors which lead to psychological dependence on narcotics and other drugs in the monkey, it has been found that monkeys will voluntarily inject the same drug which man is known to abuse and to which man becomes addicted. Thus, investigators have developed an animal model in which problems of addiction and the role of environmental factors in abuse can be studied. Another project is currently directed at determining incidence of use of "mindaltering" drugs among college students, the characteristics of frequent users of these drugs, and the consequences of extensive use of the drugs on the social, mental, and physical functioning of these students. Among the Institute's applied research programs, one is now undergoing field testing-a halfway house providing specialized services to addicts, including group therapy sessions, role-training process, and job assignments. A variation of this approach is under study in the form of a neighborhood center which provides counseling, special education, and supervised and unsupervised recreation facilities.

In addition the amounts provided under research grants for implementation of the Narcotic Addict Rehabilitation Act include $504,000 for the development of field testing programs for the treatment of narcotic addiction.

Suicide, with 20,000 victims each year, represents the tenth leading cause of death in our country. In the 15-19 age group it ranks third as a cause of death, exceeded only by deaths from accidents and cancer; among college students it ranks second. The problem of suicide, however, cannot be measured by statistics alone, for its psychological costs are high to both family and community. In addition to the trauma of death itself, each survivor of a suicide must handle feelings of shame or guilt. No other kind of death in our society carries such stigma, or creates such lasting emotional scars.

The Institute's Center for Studies of Suicide Prevention-now under the direction of the Nation's leading authority in the field-will coordinate an attack on the problem, encompassing support throughout the country of research, training, service, and demonstration activities, as well as direct research programs within the Institute itself. In the interests of a nationwide prevention program, investigators are developing diagnostic and predictive tests to identify those who are high suicide risks-for example, through measurable changes in certain adrenal hormone levels which may serve as a biochemical indicator of suicidal intent in depressed persons. Of special importance is the need to recognize the ways in which potential suicides signal their distress, the warnings they inevitably communicate as they desperately seek support. Two-thirds of those who attempt suicide have recently visited a physician-putting physicians, among others, in a strategic position to identify the suicide's "cry for help" and to respond adequately. Our aim must be not only to improve therapeutic techniques in dealing with the depressed and suicidal patient, but also to develop a large cadre of professionals in the field-physicians, teachers, lawyers, clergymen, nurses, who can respond to the "cry for help."

Work is proceeding on several fronts. The Los Angeles Suicide Prevention Center, in addition to testing methods of providing emergency service, continues to investigate predictors of suicide behavior; one such warning being studied is disturbance of patterns of sleep. In another project, a procedure for providing follow-up care to those who have attempted suicide is being developed and tested at a large hospital. Studies are also designed to obtain patterns of descriptive information regarding experimental factors and interpersonal dynamics which may distinguish the adolescent intent on suicide. In addition, the Institute's work continues to identify possible biochemical indicators of suicidal intent in depressed persons. Increasing research will be stimulated to study the problems of suicidal "equivalents"-that is, social behavior so destructive that it disastrously undermines well-being.

CENTER FOR STUDIES OF CRIME AND DELINQUENCY

Antisocial behavior-ranging from truancy, window-breaking, and petty thievery at one end of the scale to mass murder at the other-is a major problem in our society. Its monetary cost to the Nation has been estimated at more than $20 billion a year. The number of offenders under correctional supervision at any given time is more than one million, close to 30 percent of them in jails, prisons, and reformatories. The number of delinquency cases among youngsters between the ages of 10 and 17 has been increasing considerably faster than the number of youngsters in the group. Recent studies indicate that one out of five boys growing through the age range of 10-17 will appear in juvenile court. This is a nationwide average; in some deteriorated urban areas as many as 9 out of 10 of the juveniles have juvenile court contact.

Criminal and delinquent behavior is symptomatic of troubled individuals and a troubled society. In recognition of the magnitude of the problem, the President has appointed a Commission on Law Enforcement and the Administration of Justice, with which the Institute is working to develop a national program of prevention and control.

Serving as the focal point for the Institute's activities in this field is the Center for Studies of Crime and Delinquency. The Center's efforts to help the Nation control and prevent crime and delinquency include research on the causes of antisocial behavior, the training of professional and non-professional personnel to work with the socially deviant, direct intervention with street-corner gangs and other delinquents, work with offenders in institutions, studies to determine the most effective means of rehabilitation, investigations of the circumstances leading to mass violence, and studies of the factors that combine to produce violence-prone and homicidal individuals.

Current projects include such studies as the examination of distinctive characteristics of delinquent personality types in an effort to define more explicit

treatment and intervention methods; the effect of socially labeling a child as delinquent; factors affecting the capacity to delay gratification and self-control; and the prevention of delinquency by developing predictive measures to identify the pre-delinquent. Community studies are oriented toward the phenomenon of street-corner gangs; direct intervention with delinquent gangs in the community; and adjustment during the post-parole period-a time of crucial importance for recidivism and rehabilitation. One innovative project provides for the development of work opportunities for ex-offenders in programs for crime and delinquency prevention. Studies of the correctional institution deal with its efforts to provide psychotherapeutic intervention-especially through group counseling and mileau therapy. Focus is also placed on the difficulties in changing originally custodial facilities to institutions which are basically treatment oriented. One major function of the Center is to stimulate the communication of information about crime and delinquency.

An important effort in this area is the International Bibliography on Crime and Delinquency, a service of the National Clearinghouse for Mental Health Information. This publication for scientific community provides abstracts of the current professional literature and reports of research, demonstrations, and action programs. Future efforts of the Crime and Delinquency Center will focus on the many unsolved problems in this area-for example, on the need for more accurate information on the extent of crime and delinquency; on the development of theories of socially deviant behavior that account for both psychological and social factors; and on the development of more effective and efficient social action programs.

CENTER FOR STUDIES OF MENTAL HEALTH OF CHILDREN AND YOUTH

Recent surveys reveal that during 1963, about 4,000 Americans under 15 years of age and 27,000 between 15 and 24 years were admitted to mental hospitals, both public and private. At the end of the year, 5,000 children under 15 and 25,000 children between 15 and 24 were living their broken lives in these hospitals. Both the first admission rates and the resident population rates for children have increased at an accelerated pace during the last decade-and the rise cannot be explained altogether by pointing to the relative increase in the number of children in the general population. Take, for example, boys between the ages of 10 and 14: In the general population, this group has increased almost twofold since 1950, but it has increased almost sixfold in the mental hospital. No such contrast exists with regard to the American mental hospital population as a whole; here the resident patient rates have declined.

Projections for the decade 1963-73 show that in the age group 10-14, we can expect an increase of 15 percent in the proportion of 10-14 year olds in the country's population; in the mental hospital, however, these children will increase by 116 percent. For older children between the ages of 15 and 24 we can expect a 36 percent increase in the population as a whole, but a 70 percent increase in the wards of mental hospitals.

In public and private institutions for the mentally retarded, 13,000 children under 20 years were admitted for the first time in 1963, while 78.000 such children were residents at the end of the year. Rates for this age group-for both first admission and resident patients have shown a gradual increase during the last decade.

Data, again from the Institute's Office of Biometry, show that the toll taken by the major mental and emotional disorders is hardly restricted to the adult years. Among public mental hospital resident patients under eighteen, 43 percent were diagnosed as psychotic, 27 percent as retarded or suffering acute and chronic brain syndromes, and the remainder as victims of a variety of personality disorders reflecting both constitutional deficiencies and environmental trauma. Among children outside the hospital, too, disorders may take forms generally associated with the adult, such as psychoses, neuroses, psychosomatic problems. An estimated 10 percent of public school children in the United States are emotionally disturbed and in need of psychiatric guidance, and at least 250.000 with less serious psychiatric disorders receive services each year at mental health clinics.

Despite the needs reflected in these figures, out-patients clinic data point up the paucity of services available to children. Of the Nation's approximately 1,800 mental health clinics, somewhat less than one-fourth are child guidance clinics: moreover, only 32 percent of the 300,000 patients under 18 years seen at out78-317-67-pt. 5- -60

patient clinics in 1963 were treated. A large proportion of all counties in the United States are without mental health clinics altogether, and most of these also lack agencies that substitute in some measure for such services.

Recognition of the terrible human and economic cost of the mental health problems of children led the Institute to establish the Center for Studies of Mental Health of Children and Youth. This Center will support the conduct of research, develop training programs for specialized manpower, and work toward the development of preventive programs and improved patterns for the delivery of services.

In order to prevent, control, and ameliorate emotional disorders in children, the Institute supports studies in genetics, biochemistry, neurophysiology, psychiatry, psychology, sociology, anthropology, epidemiology, and other disciplines. Many of these studies focus on specific psychopathological phenomena. But basic behavioral research—to obtain normative data on the physiological, psychological, and social growth of the normal child-is also an integral part of the Institute's program and in some respects the more important part. For the results of such research provide the baselines from which deviations in the development of the disturbed child can be measured and understood, and the insights by which many of the origins of adult illness can be identified. The Institute's basic research effort also reflects an important feature of the Institute's mission--its emphasis on mental health as well as illness, on work designed to enhance the child's potential-intellectual, emotional, social, cultural-as well as to resolve specific problems of psychopathology.

The Institute's work in child development focuses on three areas: the critical first years of life, the family, and the school. This concentration of effort reflects the fact that parents and teachers are the adults with whom the child spends the largest portion of his time and who are, then, in the main, the dominant influences on his life. To a large extent it is they, through the process of socializing and educating the child, who transmit the best-and the worst-of our culture from one generation to the next.

The work comprises a broad group of studies. Research on the family's contribution to a child's development extends from genetic influences at one end to the impact of social change on family life, and therefore on the child, at the other. Projects dealing with the school and the child include studies of learning, of school problems in deprived areas, and of the relationships between particular personality factors and learning and behavior. It will be seen that much of the research has implications either for improving our present services to children or for instituting new ones.

The campaign against child mental illness and for improved mental health among our youth is best fought and won in the child's natural environment. There are many children, however, who have been failed by these primary preventive resources and for whom special mental health services now become necessary. The latter represent a second line of defense, intended for the most part to help the troubled and troublesome child remain a functioning member of the community while being treated. The aim is to provide early help for the child suffering a mental or emotional disorder, thus forestalling more serious crises and institutionalization, and, hopefully, returning the child to a normal and productive

life.

This range of services is broad. It includes treatment by pediatricians and general practitioners; treatment in general hospitals and at outpatient clinics; and a combination of treatment and education in special classes and special schools. Included also are the services of welfare agencies, whose workers are often the first to detect existing or impending emotional illness and to bring help to the afflicted person and his family. And, in the case of delinquent youngsters, the services encompass the work of court personnel, training school staffs, and probation officers.

Improvement of these services depends both upon advances in knowledge and upon demonstrations of how these advances can be applied.

The goals of prevention, early diagnosis and early treatment continue to guide the work of those in the child mental health field. But these goals are sometimes unattainable. Social and environmental conditions cannot be transformed overnight, the sick child is not always recognized early, treatment comes too late, or it is simply not effective. For such children-those whose problems become exacerbated, whose psychological suffering and social malfunctioning becomes intensethe concerted and intensive care offered in a residential setting is often the only answer. The aim here is to abort chronicity, to reverse the tide of psychopathology, to rehabilitate the child, and return him to normal life as soon as possible.