reflected in the case of the city of St. Louis. This is a manageable problem.

I would like to close by indicating that we who have been involved in the alcoholism movement for the last few years are deeply appreciative of the interest of the Congress of the United States in reference to this particular problem which has been ignored for so long.

Thank you.

(Mr. Pittman's prepared statement follows:)

STATEMENT OF DAVID J. PITTMAN, PH. D., EXECUTIVE VICE CHAIRMAN, GOVERNOR HEARNES' ADVISORY COMMITTEE ON ALCOHOLISM, STATE OF MISSOURI, PAST PRESIDENT, NORTH AMERICAN ASSOCIATION OF ALCOHOLISM PROGRAMS, DIRECTOR, SOCIAL SCIENCE INSTITUTE, AND PROFESSOR OF SOCIOLOGY, WASHINGTON UNIVER

SITY

It is indeed a pleasure to testify in support of HR 15758, Title III, Part A, "The Alcoholism Rehabilitation Act of 1968." The introduction of this Bill by the eminent Chairman of the Committee, Mr. Harley O. Staggers of West Virginia, is indeed a forward looking and progressive step in copying with one of America's most neglected health problems. One of the most neglected areas of health care in American society today is the provision of treatment facilities for the alcoholic. The presence of around six million alcoholics in the United States makes this one of the nation's foremost medical and social problems, but an equally salient fact is that the expansion of treatment facilities and resources has lagged far behind the growth of the alcoholism problem. Title III, Part A, of this Bill would be a major step forward in providing increased resources to meeting this complex problem.

As the former president of the North American Association of Alcoholism Programs and as the Executive Vice Chairman of the Governor's Council on Alcoholism in Missouri, I am keenly aware of the desperate need for increased federal involvement in providing resources for coping with alcoholism to supplement the increasing efforts by state and local authorities, both private and public. The United States remains one of the few countries in the Western world without an enacted legislative program of alcoholism control at the national level. National alcoholism programs now exist in both Western and Eastern European countries and have had a major impact in ameliorating this problem. Therefore, it is a heartening sign to see the Congress of the United States concerned with this major problem.

RECENT COURT DECISIONS

Recent United States Courts of Appeals decisions in Virginia and the District of Columbia have ruled that chronic alcoholism may be used as a positive defense to the charge of public intoxication. This change in legal interpretation must be placed against the backdrop of the fact that in 1966 about one-third of all arrests made by American police was for public intoxication violations.

New Medical and social approaches will have to be mounted in American communities. As the President's Commission of Law Enforcement and Administration of Justice recommended, communities should establish civil detoxification centers to remove the chronic drunkenness offenders from the status degrading process of arrest, jailing, and re-arrest, which in an earlier work I termed the "revolving door process."

It is indeed a source of pride to note that the first Detoxification Center in North America to systematically remove chronic alcoholics (whose only offense is public intoxication) from the jails is in St. Louis, Missouri. The Detoxification Center is an undertaking of the St. Louis Metropolitan Police Department, under the leadership of a most able past president, Col. Edward L. Dowd, along with the cooperation of the Sisters of St. Mary's and the Social Science Institute of Washington University. This Detoxification Center in St. Louis in the 17 months of its operation has become a model for the whole nation, and the results thus far obtained have far surpassed our expectations-approximately 21 per cent of the chronic inebriates being abstinent when interviewed in the community three months after treatment.

In October, 1967, the St. Louis Board of Aldermen unanimously passed a new statute governing public intoxication in our city without any court pressure

being needed. The essence of our new statute is that chronic alcoholism is a positive defense to a charge of public intoxication. However, very few cases of public intoxication involving chronic alcoholics find their way to the court any more as they are handled in the major medical facility or Detoxification Center. This thirty-bed facility is supported in a cooperative endeavor of federal, state, and local agencies. The federal government, through the Office of Law Enforcement Assistance in the Department of Justice, provided the original grant; the Missouri State Legislature in its recent special session just concluded this month appropriated $150,000 for the partial support of detoxification centers in our major urban centers of St. Louis, Kansas City, and Springfield; and the St. Louis Board of Police Commissioners has appropriated municipal funds with the approval of the Board of Apportionment and Estimate. The Detoxification Center now handles approximately 80 per cent of all "drunk on street" cases in St. Louis and graphically demonstrates what a community can do when it is willing to move on this major problem. The goal of our state and municipal agencies and their personnel is the total removal of chronic alcoholics whose only offense is public intoxification from the jail cells of America. I would like to note for the Committee that the support of the press, television, radio, and community organizations has been completely behind these new actions to remove chronic alcoholics from the judicial process to the medical, rehabilitation, and social context.

On March 7, 1968, the Supreme Court of the United States heard arguments on the Powell vs Texas case, and the Court has been asked to rule on the constitutionality of the public intoxication statute's use in cases involving chronic alcoholics. It is expected that the Court will rule that chronic alcoholism is a positive defense to charges of public intoxication and that these individuals are not to be incarcerated but must receive medical and social treatment. Thus, there will be a crisis in treatment resources unless bold and imaginative steps are taken by local communities now.

But the tragedy is that the implementation of court decisions with new programs and facilities has been so difficult to obtain-individuals are still dying in jail cells of America from chronic alcoholism,

FEDERAL GOVERNMENT ACTION

But for local and state initiative to be successful in combatting this major health problem there must be more vigorous leadership shown at the federal level. Past efforts to cope with alcoholism on the national level have been fragmentary and do not represent a national attack on alcoholism.

Last year the Federal Government spent only eleven million dollars on alcoholism control. This miserly expenditure of funds on a national problem of great importance occurs despite the fact that over one-third of the arrests in America are for public intoxication, despite the fact that 40 to 50 per cent of all fatal traffic accidents involve chronic alcoholics or heavy drinkers, and despite the fact that hundreds of Americans die needlessly in jail cells from the effects of chronic alcoholism.

This Bill should be more specific in noting that detoxification facilities or emergency care resources should be eligible for construction grants as well as staff, operation, and maintenance grants. Unless these emergency facilities are provided, we will continue to see a sizeable proportion of alcoholics who do not have full access to medical and social care. Unfortunately, a sizeable proportion of general hospitals and community mental health centers do not provide, or are unwilling to provide, emergency detoxification care for chronic alocholics. This was the case in St. Louis as well as in many other cities, such as Des Moines, Washington, and Denver, where new detoxification centers have been established to care for the homeless, chronic inebriate population. Therefore, I respectfully request that the Subcommittee give consideration to making emergency detoxification facilities eligible for support under this Act.

In the last four years in connection with the North American Association of Alcoholism Programs, I have traveled from coast to coast, from border to border, and I can assure the members of this Committee that there is a ground swell of support for the enactment of systematic federal legislation to aid the states and the municipalities in coping with this major medical and social problem. I am sure that the people of America are wholeheartedly in support of vigorous federal action for alcoholism rehabilitation, control, and eventual prevention of this major health problem.

Mr. ROGERS. Thank you very much, Dr. Pittman. It is a very interesting statement.

Mr. Nelsen?

Mr. NELSEN. No questions, except to comment that the success you have had is outstanding, and it would indicate the merit of the bills before us.

Mr. ROGERS. Dr. Carter?

Mr. CARTER. Certainly we realize the great problem that alcoholics present to our country, and I want to commend you on your efforts in this direction. I support the part of this bill for the treatment of chronic alcoholism.

There is one thing that interests me, of course. As you state, some of the courts have held that chronic alcoholism is a defense against arrest for intoxication.

How are you going to manage acute alcoholics who are on the streets and who are some danger to the public? How will you take care of them?

Mr. PITTMAN. The procedure we have developed in cooperation with the police and the district attorney's office, as in the case of an accident victim, or a coronary case that may collapse on the street, is taking the individual to the medical facility for treatment.

The law as it is revised does not remove the arresting process for public intoxication. The determination comes in a court hearing. But, briefly speaking, anyone brought by the police to the detoxification center has a summons left with him. If he undergoes the treatment, then the summons is canceled, and that is the end of that particular episode.

There is a volunteer program, and the ultimate sanctioning, of course, is in the statute itself. If the individual goes to court, he can plead chronic alcoholism and under the statute certain options are open to the judge, that is, a voluntary referral to a private doctor or a psychiatrist. The compulsory sentence in the workhouse is still there for the nonalcoholic.

Mr. CARTER. A compulsory sentence to the workhouse? I hardly see how that would be possible for such an offense.

But how are you going to handle the intoxicated people on the streets?

Mr. PITTMAN. We have had a training program for 10 years on how to handle the chronic alcoholic. It is not a very difficult matter. The police officers have had intensive experience in terms of handling these individuals, and in our experience it has not resulted in any violent episode.

Mr. CARTER. Describe the method of handling them.

Mr. PITTMAN. Well, actually, the officer, when he sees the intoxicated person on the street, asks him to go along with him to the center. The minimal degree of force is used.

There is no handcuffing, no use of extreme measures. The talking procedure is used first, and it has not been necessary to restrain any of the individuals. It may be necessary very rarely for two officers to take an individual to the center.

Mr. CARTER. Where are they taken, then?

Mr. PITTMAN. They are taken to the St. Mary's Infirmary, which is a 30-bed facility with 24-hour service and a hospital staff.

Mr. CARTER. You have treatment facilities there for one who has delirium tremens?

Mr. PITTMAN. Yes. There have been few cases of delirium tremens. They are brought immediately into treatment, and care is provided so that there is rapid recovery.

Mr. CARTER. Sometimes even with the best treatment we see this. If you see many alcoholics, you will see delirium tremens. There is no question about that, and it does take a great deal of care and attention, and there is the problem of how to apprehend promptly those who are in this state as a result of the ingestion of alcohol. That is a problem.

Mr. PITTMAN. I think your point is well made. It is a matter of training on the part of the police, the nurses, and so forth. This can be reduced to a minimum.

Mr. ROGERS. I am interested in how your detoxification center works. What is your budget, or do you have it here?

Mr. PITTMAN. I would be glad to send the whole exhibit to the committee for the record. But, briefly, approximately $350,000 yearly. (The following information was received by the committee:)

U.S. DEPARTMENT OF JUSTICE, OFFICE OF LAW ENFORCEMENT ASSISTANCE

GRANT ADJUSTMENT NOTICE

Grantee: St. Louis Metropolitan Police Department (Grant No. 284(S-093)). Title of project: St. Louis Detoxification Diagnostic and Evaluation Center (Adjustment No. 1).

Nature of adjustment: Budget Change (Date, 2-20-68).

To grantee: Pursuant to your request of February 19, 1968, the following change, amendment, or adjustment in the above grant project is approved, subject to such conditions or limitations as may be set forth below:

DANIEL L. SKOLER, Deputy Director, Office of Law Enforcement Assistance. Approval of the attached revised project budget for the project, with changes as follows: