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whom we hope to educate to want adequate medical care, but there may be just as many medically deprived people totally unrelated to economic circumstances. Included in this group are many of our most talented and capable citizens who simply do not seek medical care that could be classified as adequate.

Finally, Mr. Chairman, we believe that the key to the success of the regional medical program in Georgia is the involvement of community hospitals. This, no doubt, is true in every region in the country to a greater or lesser extent. Very early in the development of plans for the Georgia program, the regional advisory group recognized that the vast majority of physicians, nurses and others involved in the regional program relate themselves to one or more hospitals. Therefore, each hospital in the region has a vital role in the program and in the future of medicine. This includes the large hospital, the small hospital, and the hospital in the medical center, and the hospital remote to the medical center. At the present time there are about 19,500 hospital beds in Georgia distributed among 178 general and limited services hospitals of all sizes. Over 3,000 physicians serve on the staffs of these hospitals. To emphasize the role of hospitals in the program, it is planned that each hospital will become a central focal point through which the objectives of the regional medical program will be carried out. Every hospital will become a teaching hospital. This does not imply that medical students and house staff need to be present; but, it does imply that physicians, nurses, dentists, pharmacists, administrators, members of the public, and all of the allied health professionals shall organize themselves into an educational program. Each hospital has been asked to submit the names of a group of persons to serve as a local advisory group to the regional medical program. It was suggested that a physician (as chairman), a hospital administrator, a nurse, and a member of the public be the minimum number to comprise each designated

group.

This local advisory group may be as large as the local hospital or community desires, but it must be named by and through acceptable administrative mechanisms.

These groups of local hospital representatives are functioning well. Of Georgia's 178 hospitals, 121 have appointed local advisory groups. This represents approximately 90 percent of the general hospital beds in the region. It is pertinent to this presentation that the chairman of the local advisory groups met in Atlanta on Sunday, March 24, 1968, for a day of planning and discussion. According to the registration, 87 hospital representatives were present. Similar meetings, as approved in the program plans for Georgia region, will be held at least twice during each calendar year. This method of affiliating local direction at the grassroots with the overall program of health planning is, in our opinion, a sound and effective approach.

Although health planning has been going on in our region for many years, this is the first time that representatives from all interested groups have deliberated together in an attempt to coordinate their health care planning into a unified plan for progress. Both interest and participation of the practicing physicians, local hospitals, and medical schools have been excellent. Close communication with other agencies, organizations, institutions, and Government programs is

assuring complete coordination of all activities in the area of health in the Georgia region, and the purposes of Public Law 89-239 are being achieved.

Thank you again, Mr. Chairman, for this opportunity.

Mr. ROGERS. Thank you for an excellent statement.

I notice that you say 87 hospital representatives were present at your last meeting out of what? Some 178?

Dr. CHAMBERS. Potentially 178. Of that number 121 have already set up the local advisory groups. The ones who have not are primarily the extremely small hospitals, Mr. Chairman, maybe as few as 15 to 20 beds.

Mr. ROGERS. But you feel the major hospitals in the State have?
Dr. CHAMBERS. We have 90 percent of the beds covered.

Mr. ROGERS. Even though they don't attend the meeting, they have signed up for this?

Dr. CHAMBERS. Yes. These same ones are not the ones who were at previous meetings, necessarily, but this percentage is a pretty good attendance, for a region our size.

Mr. ROGERS. Is the region too large?

Dr. CHAMBERS. No, we do not think so. We are beginning to get subregionalization now. This is what we hope to accomplish.

Mr. ROGERS. How long have you actually had the region formed? Dr. CHAMBERS. Our program, Mr. Chairman, actually began January 1, 1967, so we are only about 15 months old.

Mr. ROGERS. You present a very encouraging picture.

Dr. CHAMBERS. We feel we have accomplished a lot in 15 months, sir. If the committee would be interested, sir, I would be glad to leave a copy of the operating rules and regulations of our programs.

Mr. ROGERS. I would like very much to have that for the committee files.

Thank you very much, Dr. Chambers.

Our next witness will be Thomas Carpenter, president of the National Council of Alcoholism, Inc., New York.

STATEMENT OF THOMAS P. CARPENTER, PRESIDENT, NATIONAL COUNCIL ON ALCOHOLISM, INC.; ACCOMPANIED BY WILLIAM MOORE, EXECUTIVE DIRECTOR

Mr. CARPENTER. I have with me Mr. William Moore. He comes to us after a distinguished executive career with the Heart Association. I know the previous testimony has covered many aspects of the problem. We have a brief statement identifying ourselves and our particular interests.

Mr. ROGERS. You may proceed.

Mr. CARPENTER. The National Council on Alcoholism is the voluntary health agency concerned with alcoholism. It has 82 affiliates serving the major cities, plus 11 group members in smaller communities throughout the United States. Each affiliate has a volunteer board of directors and a citizen constituency. These boards, like the national board of directors, are representatives of the legal, medical, educational, civic, religious, business, and industrial interests which are concerned with the disease of alcoholism.

The National Council on Alcoholism directly speaks for nearly 11,000 U.S. citizens who are involved in its programs and vitally concerned about the prevention and control of alcoholism. The council represents a unique citizen response to this problem, and has been leading the attack against this disease for 23 years.

This national voluntary health organization, concerned as it is with the third largest public health problem of modern times, also seeks to change community attitudes toward alcoholism and the alcoholic. Long regarded as a personal and moral problem, alcoholism has only in recent times been recognized as a major medical and social problem affecting a broad spectrum of health, welfare and social areas of con

cern.

The National Council on Alcoholism, through its programs of public and professional education, attempts to bring a message of hope and help to the community regarding alcoholism. The basic points of this message are: alcoholism is a disease; it can be treated successfully; it is a public health problem and a public responsibility.

The affiliates of the National Council on Alcoholism have ongoing programs of public education which are reaching increasing numbers of citizens where they live. Affiliates also sponsor professional seminars for physicians, nurses, social workers, and other professional persons to enable them to deal more effectively with alcoholics whom they see in the course of their regular work. These activities comprise the portion of the National Council on Alcoholism's program which is intended to transform public and professional attitudes toward alcoholism, thus making it easier for the alcoholic to seek and accept treatment.

In addition, each affiliate of the National Council on Alcoholism maintains an alcoholism information center which serves as neutral ground for alcoholics and their families to obtain information concerning alcoholism, and which makes referral to treatment resources and facilities. Because our local voluntary councils on alcoholism have of necessity, in some places, had to fill the vacuum created by a lack of community facilities for the treatment and rehabilitation of alcoholics, we are particularly concerned that this legislation be approved by the Congress.

The establishment of specialized facilities for alcoholics as provided in title III, part A, H.R. 15758 is a major contribution toward creation of a comprehensive community attack on the problem of alcoholism.

As president of the National Council on Alcoholism, I commend the members of this subcommittee and the leaders of the House of Representatives for their concern for the health and social welfare of their constituents who suffer from, and are threatened by, alcoholism. I am happy to testify in favor of title III, part A, H.R. 15758, which, if passed, will insure that specialized facilities for alcoholics will be included in the Community Mental Health Centers Act. By this wise and humane gesture, facilities will be provided which will help advance the control of alcoholism in the United States of America.

I pledge to you anything that the National Council on Alcoholism can do in the way of support or the furnishing of any additional information which may be helpful to you.

Thank you very much.

Mr. ROGERS. Thank you, Mr. Carpenter and Mr. Moore, for being here.

I think it would be helpful to the committee if you could give us the number of alcoholics, the number which you have made studies of in major cities, or by State, and those areas where the problem of the homeless alcoholic is greatest, and any facts like that.

Also, I would like to have some memorandum from your organization as to how they feel these emergency rooms or facilities would operate, how the domiciliary care would work as proposed in the bill. If you have any experience that we could go on, I think it would be helpful, because I think the committee is going to want to know more facts about this, rather than to get into the beginning of a large building program.

Can't this be integrated within the community health center, in this program we have already done, as an adjunct there? Must it be separate and apart, or how much is it supposed to be tied together? If you could let us have your thinking on this for the record, we would appreciate it.

Mr. CARPENTER. I will be happy to supply that information. (The following supplemental statement was subsequently submitted by Mr. Carpenter:)

SUPPLEMENTAL STATEMENT OF THE NATIONAL COUNCIL ON ALCOHOLISM, INC.

ALCOHOLISM STATISTICS

Statistics on the incidence of alcoholism are necessarily rough estimates, based on inferences derived largely from the prevalence of cirrhosis of the liver in communities. Obviously, it is not possible to use routine questionnaires and sampling techniques in determining the number of alcoholics in a given state. It has been noted that denial of the condition of alcoholism is a symptom of the disease. Because of the effects of social stigma, those who have alcoholism are not likely to state that they do.

Efron and Keller have published a state-by-state breakdown for 1960 of the number of male and female alcoholics, the rates of alcoholism and the rank order of the states by rate. It should be noted that these figures are unquestionably a conservative estimate. For example, the California Department of Public Health in March 1965 estimated 850,000 alcoholics in the State of California, while Efron and Keller estimate a total of 623,400. Similarly, Colorado's State Department of Health in October 1967 declared that there were 275,000 alcoholics in the state; Efron and Keller estimated there were 42,500. Other states have also estimated that they have many more alcoholics than the Efron and Keller study would indicate. Hence it may be said that the statistical analysis presented here probably represents the least number of alcoholics, rather than the opposite. The viewpoint of the National Council on Alcoholism is that regardless of whether estimates of the number of alcoholics in the United States are 5 million or 8 million, the basic fact is that alcoholism is a health and social problem of immense magnitude. When it is considered that every active alcoholic affects at least four other persons, the significance of the problem is apparent. One of the principal objectives of the National Council on Alcoholism is to make community leaders and the general public aware of the very large number of Americans whose lives are blighted by alcoholism. The statistical data follows as Appendix A.

DETOXIFICATION CENTERS AND HALF-WAY HOUSES

A detoxification center is generally understood to be a short-term treatment facility for the acute symptoms of withdrawal from alcoholism, i.e., delirium tremens, alcoholic convulsions, etc. The usual duration of emergency treatment is approximately 5 days, although some have reported adequate detoxification in 72 hours.

Essentially, detoxification centers provide withdrawal from alcoholism under medical supervision and with minimum risk of death to the patient during the withdrawal period. They are designed to replace the hit or miss searching by concerned friends and relatives for a health facility which will accept alcoholics or the potentially dangerous "drunk tank" in jails, which may or may not provide any medical supervision, and invariably has minimal facilities for treatment of the physical symptoms of alcoholic withdrawal. Although a few detoxification centers in the United States and abroad have reported some effort at beginning rehabilitation of patients, their prime function is not long-term treatment of alcoholism. They are a way of returning the patient to a physical condition which allows him to be free from the dangers of withdrawal from acute alcoholism.

Half-way houses, on the other hand, are temporary residential facilities which provide a "substitute family for the person in the course of his treatment. . ." This "... transitional facility provides a peer group experience for the individual to learn how to live without the help of chemical crutches." See Appendix B for description of a model half-way house.

After a detoxification period, some patients with alcoholism find they are unable to benefit from treatment unless their environment is conducive to it. Since they may have failed to develop a sense of community orientation, or through their alcoholism may have lost this sense, they need the reassurance of an orderly existence among congenial persons who have the same problems.

A half-way house can serve as a bridge between the disorienttaion of latestage alcoholism, and the ability to lead a normal life characteristic of the majority of Americans. A half-way house is not usually thought of as a custodial institution. Its residents are encouraged to find work as soon as they are able to do so, and they henceforth pay for their room and board. The goal of the half-way house is to enable its residents to take their place in the community as self-respecting and self-supporting individuals, free of their disease.

Half-way houses are heartily endorsed by the National Council on Alcoholism as a means of providing help to homeless alcoholics. It should be pointed out, however, that the homeless alcoholic represents no more than 10% of the total number of alcoholics in the United States. Hence the provision of half-way houses, while eminently desirable, does not in any sense deal with the entire population affected by alcoholism.

Detoxification centers also are endorsed without qualification by the National Council on Alcoholism. These facilities would provide emergency treatment for alcoholics in the acute stages of withdrawal from alcoholism regardless of economic status. They will do much to close the gap which exists between emergency facilities available to alcoholics and the number of alcoholics requiring such facilities. We would find it highly desirable for the legislation to specifically mention the construction, maintenance, staffing and operation of detoxification facilities under the provision of HR 15758 Title III, Part A.

ALCOHOLISM AND COMMUNITY MENTAL HEALTH CENTERS

The U.S. Department of Health, Education and Welfare, National Institute of Mental Health, has published an excellent pamphlet entitled "The Community Mental Health Center and Alcoholism Programs." It is felt that this pamphlet is so concise and well presented that an appropriate quotation will be adequate to cover this question of the Committee. There follows a section of the pamphlet which sketches the various ways that alcoholism programs may be meshed into the community mental health centers:

"Complete integration' of alcoholism services with other activities of the mental health center. Under such an arrangement all services of the center are open to problem drinkers with no special arrangements made for their care. This presupposes that staff are adequately trained and well motivated to work effectively with these patients.

"Special alcoholism services or ‘units' within the mental health center. Under this arrangement services for persons with drinking problems are physically located within the center's facilities and the alcoholism staff is administratively responsible to the director of the center.

"Special alcoholism services or ‘units' as an administrative part of the mental health center program but not physically located in the center's facilities. Under this plan, overall program direction is the responsibility of the center's director.

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