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represents all forms of cash income including pensions, disability payments, welfare, etc. Fifteen percent reported no income in the intake rating. The same was true of only 10 percent on the after-treatment measure. At the time of the follow-up interview the average weekly income for the study group had risen to $53.27 for a net average gain of $4.52 per week. Sixteen of the study group are responsible for this increase. These, who showed improvement, averaged a rise in weekly income amounting to $21.62. Seventy-two percent remained at approximately the same level with 8 percent having decreased income. The remaining 4 percent were not scored as was the case with employment.

HEALTH

At the outset it was felt that the most immediate and marked effects of treatment were to be found in the areas of health. None of the evaluation team can claim competency in the area of medicine; hense, this measure proved to be unscaleable. In an attempt to achieve some assessment, this evaluation is based on gross factors which are readily available during the interview process. In order to achieve a rating of "improved," the patient must display a significant change evidenced by such things as weight gains, increased appetite, cessation of or a decrease of polyneuritic pains, or the disappearance of other complicating symptomatology (DT's, blackouts, etc.). Fifty-six of the study group showed marked improved in their physical well-being based on the above factors. Thirtyfive percent displayed no significant improvement and 9 percent showed a decline in overall health.

For half of these individuals, the Center represented the first medical treatment they had received for alcoholism. Almost all subjects indicated during the follow-up interview that the care they received at the Center was the first sign, in a long time, that "somebody cared about me." The interviewers expressed the opinion that perhaps the therapeutic effects were even greater for the individual's mental health than upon his physical self. The mere fact that a seven-day program of nutrition, sanitation and mental hygiene would leave its effects on such large numbers of these individuals three months after the treatment period is evidence of the accomplishments which can be made with this group of "hopeless people."

DRINKING

The area of drinking is the most crucial test to be applied to the treatment program. Rehabilitative gains in any other area must be seen as temporary unless a concommitant improvement is displayed in the individual's drinking patterns. The question is not simply a matter of sobriety or insobriety so much as how well the individual copes with his problem. Primarily, this scale measures the frequency and duration of the drinking bouts in ratio to the periods of sobriety as representative of one's ability or inability to deal with his dependency on alcohol.

At the time of admission the medical rating was category I. This rating represents a prolonged drinking pattern wehre the individual would have to be drinking steadily (daily) for more than two months prior to rating and the quantity of alcohol consumed would have to exceed approximately two fifths of wine or one fifth of whiskey, gin, vodka, etc. per day. The average rating on intake was 2.9. On the basis of our experience with these scales it would appear that a rating of four or lower negates the maintenance of any semblance of adequate functioning in the areas of familial or employment roles or a stable residential setting over any appreciable length of time. Seventy-six percent of the paitents admitted were rated four or below. The remaining 24 percent were marginal in their capacity to function with any degree of normalcy. No one achieved a rating of seven at the time of admission.

The after-treatment ratings showed 51 percent of the patients studied displaying some significant improvements in their ability to control their consumption of alcohol. Approximately 46 percent demonstrated no significant improved control, while only 3 percent actually deteriorated in their drinking pattern. The average rating achieved at the time of the follow-up interview was 4.1 for an average increase of 1.2 in the study group ratings. The frequency distribution of ratings was bi-modal being equally distributed with 21 individuals in both categories 1 and 7. For the categories of 5 through 7 which could permit some degree of stability or normalcy to prevail in the individual's life style we now find 51 percent after treatment as opposed to only 24 percent prior to treatment.

These results greatly exceeded those anticipated by all concerned. Fully 21 percent of the study group had been for all practical purposes dry since discharge until the time of the follow-up interview (see category 7). This time averaged a lapse of approximately 120 days of total sobriety. Certainly, by any standards, this 21 percent would represent unqualified success in treatment outcome. Below is a table of the ratings for the before and after treatment measures.

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Following are two histograms which graphically illustrate the transitions in ratings achieved from the before-admission drinking patterns to the after-treatment drinking patterns displayed at the time of the follow-up interview.

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One of the unusual findings during this study was that Negroes were disproportionately represented in this 21 percent who achieved what might be termed total success. Seventeen percent of the entire treatment population were Negroes. Eighteen percent of the study group were Negroes while 25 percent of the "drys" were Negroes. Of the possible alternative hypotheses, two are most reasonable and complementary. First, that the treatment they received initiated by a police contact was totally dissonant with all their expectations. In all cases the Negroes found themselves better clothed, better fed and more well cared for than they could ever remember. Somewhere in the treatment process their initial disorientation was turned into a positive motivational attitude. Although in retrospect the same process was noted with the white patients it was perhaps not of the same degree. Another very plausible explanation of this finding is that perhaps the Negro subculture has not imposed quite the same rigid value structure upon these individuals as one would find in the more middle class oriented whites. This would mean that the Negro offender would not experience the same degree of guilt over his drinking problem and hence, as a result, have one less problem to deal with at the time of discharge.

In all discernible characteristics the stdy group was representative of the total patient population, i.e., age, race, marital status, years of alcoholism, etc. One qualification exists; whereas females compose 9 percent of the patient population none was included in the follow-up study. Further, it was found that those achieving a rating of 7 after treatment on the average had slightly higher ratings in the other scales before admission. The significance of this has been demonstrated in other studies of this type, namely, that the type of treatment administered is not the determining factor for prognosis so much as the social setting the individual is taken out of and the setting into which he is placed after treatment. The implications of this finding are even more crucial in a program designed to handle the "revolving door" clientele. A strong referral network and an intensive after-care program is essential.

ARRESTS

The area of arrests has been left until this point because of the scant data available. The seasonal nature of this type of arrest rules out comparing equal time periods before and after treatment. Further, a significant percentage of the patients had been residents of this area for less than one year; hence, any measure based on a comparison of specific months for the year prior to opening the Center or since its opening could be grossly misleading due to incomplete data. It is hoped that by the time of the final report this dilemma can be resolved satisfactorily. Earlier in the report the arrest figures for the City of St. Louis were cited showing a tremendous decrease. Even after adding the number of admissions to the current arrest rate there would still be a total decrease of 28 percent in police contacts with drunkenness offenders. The findings on our study group were an average of 1.6 arrests for 12 months prior to treatment as compared to an average of 0.4 after treatment. This latter figure is arrests plus readmissions over an average period of six months. This should be interpreted cau tiously as the parameters of these figures have not been fully explored. However, it is safe to say that a significant decrease in police intervention can be noted after treatment.

The following table is presented in summary. The interpretation of these figures should be unequivocal. Where improvement is reported, it must be of a significant magnitude to the extent that the individual has, at least in some areas of his life, reversed this deterioration process. Many individuals who have received ratings of "remained the same" may well be in the process of establishing a new claim on life. It may prove to be unrealistic for this evaluation to demand significant demonstrable change in such areas as housing and employment in a three or four month period. This idea would seem to be supported by the findings in the area of drinking which would indicate more improvement than shown in the other scales. Further, improved control over one's drinking pattern is certainly a precondition to improvement in the other areas of life.

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Aside from this clinical picture one might ask the question "What has the impact of the Center been on the police?" Other than arrest figures, man-hours, and increased efficiency, this question may never be answered fully. The impact on the patrol officers has been as remarkable as in any other area under study. Many who were openly skeptical of the treatment program have expressed unqualified enthusiasm as a result of some of the Center's success cases whom they have known. Some have even gone so far as to volunteer their services both on and off duty in any way that they might further the treatment program.

St. Louis has always had a non-punitive approach to the problem of public intoxication. At the individual level officers are so sensitized to this problem that they have donated clothing and other useful articles to the Center. The acceptance of the treatment program on the part of the line officers could not help but be recognized when investigators in this research began to hear of informal shuttling procedures being conducted so that an individual would be found in one of the districts being served by the Center.

Mr. ROGERS. And any suggestion you have as to how this could best be incorporated into the community health centers that we already have authorized.

This is most helpful, and this is what we need, some specific information.

Mr. PITTMAN. Thank you, sir.

Mr. ROGERS. Thank you.

The next witness is Mr. F. Morris Lookout, industrial representative, Tulsa Council on Alcoholism.

We appreciate your presence here.

STATEMENT OF F. MORRIS LOOKOUT, INDUSTRIAL REPRESENTATIVE, TULSA COUNCIL ON ALCOHOLISM

Mr. LOOKOUT. Mr. Chairman and members of the committee, my name is F. Morris Lookout, and I represent the Tulsa Council on Alcoholism, Tulsa, Okla., for which I serve as industrial representative.

It is indeed an honor and a privilege to appear before this distinguished committee and I thank you, Mr. Chairman, for the opportunity to testify in support of the Alcoholism Rehabilitation Act of

1968.

In my position with the Tulsa Council on Alcoholism, I am presently working with 30 business firms in the Tulsa area. Each of these firms now recognizes the significant impact of alcoholism on their company productivity. They also know by experience that it is much more profitable for them to treat their alcoholic employees and to rehabilitate them than it is to deny that the problem exists and to discharge summarily those employees with drinking problems.

This enlightened concept is now implemented by many firms of the Nation's business community. Eastman Kodak, North AmericanRockwell, Western Electric, Pittsburgh Plate Glass, and many other major firms across the country have recognized the economic feasibility of rehabilitating alcoholic employees who, aside from drinking problems, have proven to be productive employees.

I deal primarily in education, yet I know only too well there must be a balance between education and treatment. I know that before an alcoholism rehabilitation program can work for a company, it must have therapeutic resources to which the alcoholic employee can be referred. In Tulsa, and throughout Oklahoma, such facilities are rare and, in terms of the need, totally inɛdequate.

Thus, in view of the Supreme Court decision to be handed down within the next 2 months, which is likely to make it unlawful to hold alcoholics criminally liable for public drunkenness charges, the very limited number of facilities now available for treatment of company employees and others with less complicated cases of alcoholism will be overwhelmed with caseloads found by the courts to be alcoholics.

The provisions of title III, part A, of H.R. 15758 would make possible, immediately, the implementation of a much-needed alcoholism treatment program within the Tulsa Community Mental Health Center and other community mental health centers throughout Oklahoma. Without new facilities we face the same grave situation as was the case here in the Nation's Capital following the Easter decision.

Comprehensive programs of alcoholism care and control must become a part of the pivotal, basic institutions of our society. The provisions of title III, part A, of H.R. 15758 will provide a very constructive beginning to such needed comprehensive programs. It will provide a stimulus to legislators and to a broad spectrum of allied professional disciplines. And, as more and more of these key persons become interested and involved, more professionals will seek the training provided by title III, part A, of H.R. 15758.

That industry is vitally concerned throughout Oklahoma, not only in their own obvious stake in the problem of alcoholism but in the broader social and cultural implications, is evidenced by the fact that I am an ex officio member of the Tulsa County Bar Association, serving as technical adviser to its grievance committee, and I also serve as technical adviser to the Tulsa Division of the State Department of Corrections. These extra activities resulted from my industrial contacts. I am a full-blooded American Indian and have a great interest in the problems of the Indians in this country, and I know that alcoholism is one of the most serious of those problems. I also know that, in those municipalities with a significant Indian population, the Indian continues to be jailed for public drunkenness on the slightest provocation. Yet the major proportion of these Indians are suffering from the illness of alcoholism. They should be treated as sick people and not as criminals.

I am therefore doubly pleased with the provisions of the alcoholism bill, title III, part A, H.R. 15758. It will serve a longstanding need from the business community standpoint, it will provide congressional intent that all alcoholics should be treated medically and not as criminals, and it will provide Federal resources to help accomplish a more humane and effective method of dealing with this tremendous problem in all communities.

Thank you, Mr. Chairman.

Mr. ROGERS. Thank you very much. We appreciate the testimony you have given.

Mr. Nelsen?

Mr. NELSEN. I have no questions. I wish to compliment the gentleman for his appearance. I wondered, are you acquainted with Congressman Reifel from South Dakota?

Mr. LOOKOUT. No, I am not.

Mr. NELSEN. He is a Sioux Indian, and he speaks the Sioux language. He is a competent Member of Congress, and he is very concerned about

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