is medicated for the withdrawal symptom for his acute intoxication. It is to be noted that there has been no case of DTs (delirium tremens) since the Center became operational.

The following routine orders are designated by the medical director of the Center. Appropriate tranquilizing drugs are given IM (intra-muscularly) to maintain the patient during the withdrawal stage. He is under constant nursing supervision and his vital signs are taken every two hours. In addition to the tranqualizing drugs, orange juice with dextri-maltose is given to the patient. It is imperative at this time that fluids be forced because of the severe debilitation of the patient. Under this medical regimen, the patient is manageable and can be roused to be fed his meals.

When the patient is discharged from the Intensive Care Unit, he is moved into the Self-Care Unit where he becomes involved on a daily basis within the therapeutic milieu. During this time, he is exposed to didactic lectures and films about his disease, alcoholism, as well as participation in group therapy, Alcoholics Anonymous meetings and individual counseling with the staff social workers.

The patient is evaluated for his positives rather than his negatives, which are emphasized during the discharge planning to community agencies for after-care and follow up. The individual is urged to maintain contact with the Center, as well as to attend AA meetings in the community. The average stay for the patient at the Center is seven days.

PATIENT ANALYSIS

In the first quarter of operation, October 1, through December 31, 1966, some sixty patients were processed through the Center. Of this number, the majority were male, with 82% being female. The average was white, divorced, with a median age of 47 years. The largest number of males were unskilled laborers, with the next largest being found in the semi-skilled category. Educational attainment was found to be mostly of eighth grade achievement, with only a few patients having finished high school.

During this quarter, 6% (four males) signed out Against Medical Advice (AMA). It is to be noted that one man signed out AMA twice. This demonstrated the voluntary acceptance by the majority of the intoxicants. Fifty-six patients remained at the Center for treatment.

At the present time, the second quarterly progress report, covering the period of January 1, through March 31, 1967, is being prepared. A preliminary report shows that 214 patients were admitted to the Center during this quarter. There were 216 patients discharged, and of that number 24, or only 11%, signed out Against Medical Advice. This figure continues to demonstrate the voluntary acceptance by the intoxicants to the treatment offered at the Center.

Of the 216 patients, 93% were male, with the median age of 48 years; 50% were either divorced or separated; 26% had never married. Again, the predominance of educational achievement was leveled at the eighth grade with only a few having gone beyond this to high school. Occupational background still remained with the predominance, 57%, being found in the unskilled category while 20% were semi-skilled. It is to be noted that a new group came into the Center during this quarter, with 11% being either disabled or elderly.

NEW APPROACH: TREATMENT INSTEAD OF JAIL FOR THE PUBLIC INTOXICANT

For many years, the "revolving door alcoholic", the chronic police case inebriate, or "public intoxicant", has either been abused, punished or neglected in most communities throughout our nation. The problem is by no mean's insignificant since it is estimated that some 6,000,000 persons living in the United States have a problem with alcohol and some 2,000,000 arrests occur annually for public intoxication. The skid row or the "revolving door alcoholic" describes the American public intoxicant offender whose usual habitat is in the skid rows in our larger cities. These public alcoholics are the men who are arrested, convicted, sentenced, jailed and released only to be rearrested, often within hours or days. Furthermore, there is strong evidence that these public alcoholics constitute over 50% of the individuals incarcerated in short-term correctional institutions. A recent study, Man on the Periphery,' shows of the penal population in the Monroe County Penal Institutions, that alcoholic offenders accounted for 62.5% of the prisoners and 73.1% of the total commitments in the year 1962. This is the same type of population studied earlier by Pittman

and Gordon, the findings of which are published in the classic, The Revolving Door Alcoholic."

It is to be noted that for the "revolving door alcoholic", incarceration has never been intrusive in changing his drinking patterns to any marked degree. Unfortunately, public intoxication still remains a reason for arrest in the majority of the states of our country. This has been viewed with grave concern by many people and within the recent past, a different legal opinion has emerged as a result of the Driver and Easter decisions. These cases have set a precedent by declaring that the public intoxicant, the chronic police case inebriate, should be treated not as a criminal but as an ill person who needs medical care.

A report by the President's Commission on Law Enforcement and the Administration of Justice, entitled "The Challenge of Crime in a Free Society", has recommended that treatment facilities be established to replace incarceration. It is the philosophy of the St. Louis Metropolitan Police Department that treatment rather than incarceration will be the most dramatic way of intruding upon the criminal process of the chronic police case inebriate. Treatment in the St. Louis Detoxification Center is based upon the belief that these individuals are salvageable and indicates that the chronic alcoholic and police case inebriate have a potential for rehabilitation. Therefore, we hope to continue to demonstrate that proper medical treatment, good nursing care, individual counseling and therapy for their disease in addition to proper referral for aftercare to the community agencies, will have an impact upon this group of men. We know that sobering-up centers in some of the European countries have been shown to be an effective kind of treatment for the public alcoholic.

The St. Louis Detoxification Center is a needed beginning for the treatment of the public alcoholic. However, suitable facilities such as half-way houses and domiciliary type shelters, as indicated in the President's Crime Commission Report, are desperately needed to supplement the Center if we are to achieve our goals.

REFERENCES

1. Benze, Elizabeth, Man on the Periphery; Rochester, New York, the Bureau of Municipal Research. 1964.

2. Pittman, David J. and Gordon, C. W., The Revolving Door: A Study of the Chronic Police Case Inebriate; the Free Press, Glencoe, Illinois; Yale Center of Alcohol Studies, New Haven, Connecticut. 1958.

Mr. Dowdy. I just noticed, as I glanced through your statement, reference to this intensive care unit-you call it something else, "Detoxification Center." The patient averages 1.7 days of stay. Do you have another place he can go?

Colonel Down. That's in the same building. The original unit they go into is an intensive care unit and they only stay one to two days in there, and then move to another floor, where they go under self-care. But they are under the control and guidance and custody of two police officers.

Now, they are light-duty men who are recovering from some illness, themselves, not intoxication, but recovering from surgery or something. We use officers of that nature in this capacity, as well as medical staff, psychiatrists, social workers, professionals, and some sub-professionals and semiprofessional people at the unit. But we retain them from 7 to 10 days and as you suggest the choice is leaving and then going through court and being processed as a public alcoholic.

Mr. Dowdy. You haven't been in operation but 4 or 5 months.
Colonel DowD. That's right.

Mr. Dowdy. In that time have you been able to develop any costs per patient figures?

Colonel Dowd. We do not have any cost-per-patient figures. We know the annual operation of this facility will be approximately

$300,000. We can accommodate 36 patients, with a turnover every seven days. I've never broken it down, the economics of it we think are quite feasible. If you get some of these people back employed, paying taxes, making a contribution to the community, I have the strong feeling that this money will be very easily recovered.

Mr. DowDY. I think if you can run an operation and get anywhere near as good results as you have indicated that you might have so far, that $300,000 figure, in a town the size of St. Louis, or Washington, D.C., it would be well worth it.

This is something I would like an explanation on. It says the preliminary report shows 214 patients were admitted during the quarter and 216 were discharged. How is that?

Colonel Dowd. The only thing I can think of, it must be a typographical error. I don't see how they could have discharged more than they put in. We are anxious for the program to be a success, but I think that might be overdoing it. [Laughter.]

Mr. Dowdy. Mr. Hagan, have you some questions? You might ask them. I want to review this and I might have more questions.

Mr. HAGAN. Mr. Chairman, I just want to express my appreciation to Colonel Dowd for his fine testimony this morning. People who are interested in this field certainly know of the fine program you have underway out there, in St. Louis, Colonel Dowd.

I want to comment on the fact that you mentioned the necessity for having jobs for these people in St. Louis or Washington, or Atlanta, or wherever it might be, where they are put back on their feet. We've got to continue the job there. So this is all encompassing. It must be a program that will-in any community, if we really want to accomplish a job we must take it from beginning to end. I'm glad you brought out that point there. So we must find jobs for these people or they will fall right back into the same category or the same rut they were in. I just want to thank you for this testimony.

Colonel Down. Thank you.

Mr. DOWDY. Mr. Steiger.

Mr. STEIGER. I just have one question. In your efforts have you used any of these drugs that apparently make alcohol unpalatable to the person who takes the drug? Is that part of your program?

Colonel Down. No, Mr. Steiger, they are not using that type of drug because the psychiatrists on our staff feel this is sort of a superficial way of avoiding it. If they don't take the pill they can immediately return to alcoholism. They are looking for, let's say, a longrange cure, and they haven't used that to my knowledge. Although they sometimes do things there without my knowledge.

Mr. STEIGER. You used the $300,000 figure. Is that the total operational figure? Including the psychiatrists?

Colonel Down. That's right. That includes all the salaries. In cash money, we are spending approximately $200,000; $158,000 of this is Federal money, and the police department is spending about $50,000 to $60,000 in cash money, and then we are spending about $80,000 to $90,000 in personnel that are assigned there that would ordinarily be assigned elsewhere.

But I'll tell you frankly, we are saving well over a half million dollars in police officers' time.

Mr. STEIGER. Yes, I can see that.

Colonel Dowd. We are coming out way ahead on the whole arrangement because our men are back out on the street and they are available for your assaults, and your rapes and your robberies, while otherwise you are standing around the city hospital or standing around the city court testifying this man was drunk the day before or two days before.

So economically we are way ahead just the way the present program is, without any of the humanitarian aspects being considered.

Mr. STEIGER. Using your figure of 36 patients a week, or whatever you call these people, $300,000, the cost per patient per year is only $1600-and-something. So it seems to me this is a very reasonable

figure.

Colonel Down. We have been very fortunate in this particular build ing. This old hospital was almost on the point of being closed and it is down in an area that is idea for our situation, and there were many retired nuns that were maybe a little bit on the shelf themselves that had moved into this program with a great deal of zeal and dedication, and they feel now they are needed, and the patients have responded to this attitude and this atmosphere, and it has kept our cost down, because most of them are working without salary.

Mr. STEIGER. That would explain at least in part the low cost figure. Thany you. That's all I have.

Mr. Dowdy. Do you in St. Louis, keep a charge over a person until such time he is medically discharged from your facility.

Colonel DowD. Not actually. From a practical standpoint, Mr. Chairman, it is only the first 2 or 3 days. Usually, after that time they are quite ready and willing to stay through the period. They are getting the first decent meal and treatment many of them had in years, and further the few of those that said they don't want to stay when they are cold sober and have been cleaned up and have had 3 or 4 days of rest and decent meals, the police have not seen fit to take them to court to try to get them convicted. The psychologists and psychiatrists talk to them, they give them some vocational guidance, and they just let them sign themselves out and walk away. We don't literally enforce that all the way through the entire period.

Mr. DOWDY. You haven't had a long enough experience to know whether it would be helpful to keep it all along.

Colonel Dowd. No, we do not.

Mr. DowDY. I want to say again I appreciate your coming here and giving us the benefit of your experience in St. Louis.

Mr. Dowdy. The next witness, Mr. Jack Donahue of Hope House in Boston, and Peter B. Hutt, attorney, of Washington, D.C.

Mr. Donahue, you might tell us what Hope House is.

Mr. HAGAN. Excuse me, Mr. Chairman, before Mr. Donahue testifies, I would like to read into the record a telegram I just received from the Boston Agency, Action for Boston Community Development. DEAR REPRESENTATIVE HAGAN: Action for Boston Community Development, The Community Action Agency for the City of Boston, wishes to register its support for, and serious interest in, H.R. 6143. The proper treatment of alcoholism as a serious physical and social disease is a very important part of the overal social welfare program to eliminate poverty and social illness in our country." [Signed] George Bennett, Executive Director, Action for Boston Community Development, 18 Tremont Street, Boston, Massachusetts.

Thank you. Mr. Bennett was unable to be here. Thank you for letting me read this into the record.

Mr. DownY. All right, Mr. Donahue, I asked you to tell us about Hope House.

STATEMENT OF JACK DONAHUE, HOPE HOUSE, BOSTON,

MASSACHUSETTS

Mr. DONAHUE. My name is Jack Donahue, and I am Director of Hope House, a half-way house for the rehabilitation of alcoholic men in Boston, Massachusetts, which I have operated since 1961. (Flyer attached.)

This is a recovery house to bridge the gap from hospitals, institutions, broken or disrupted homes, etc., so that the sick alcoholic can be soberly and wisely reintegrated into the community, the home, taken off relief roles, and become again a useful citizen to society, family, and the business and industrial community.

As Director of Hope House, I wish to go on record as totally in favor of passage of H.R. 6143. The bill is carefully thought out, wellwritten, and takes into consideration all possible pitfalls and contingencies which those persons who, either do not believe that Alcoholism is a widespread and serious illness or who are fearful that it will be used as an unjustified defense in the perpetration of major crimes. I urge that there be no delay in passage and implementation of this bill.

Since the inception of Hope House, over 600 men have utilized its facilities; and while I dislike using statistics, over 65% of these men have shown complete recovery that is from total sobriety to marked improvement. There are roughly around 27% who cannot or will not be reached-I prefer to believe the latter is correct in the light of the limited knowledge and facilities now available to these sick individuals. There are another 8% who cannot seem to function in groups at all.

The recividism rate from Hope House to institutions is less than 10%. Individual welfare stipends are greatly reduced, except in rare cases of physical disability. Our men are usually back at work of some kind within two weeks or so after entrance in to Hope House.

It is within the family unit that the area of greatest savings take place whether it be on the town, city or State. It is also too within the family unit that reunification usually recurs, and the entire family can look forward to a secure, sober, and happy future for everyone.

The alcoholic, when living in a half-way house, like ours which is AA. oriented, and uses the miltidiscipline services such as those offered to us by the Massachusetts General Hospital and other agencies, is in a controlled situation during the crucial phase of recovery. There is plenty of freedom, along with the knowledge that everyone with whom he lives has been through the same route. Because the man is again working, staying sober, and contributing to his family's welfare, many of his interior burdens and tensions case enormously. Independence comes as sobriety increases and contributions to the family do likewise. The average alcoholic who comes to Hope House has from two to five children, who prior to his rehabilitation have cost the cities and town, etc., a great deal of money.