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the American Indian. He served with the Indian Bureau for a number of years. You should meet him while you are here.

Mr. LOOKOUT. I will do this. Thank you.

Mr. ROGERS. Dr. Carter?

Mr. CARTER. I want to compliment the gentleman on his excellent presentation.

Mr. ROGERS. Our next witness is Richard S. Cook, Chief, Division of Alcoholism, Illinois Department of Mental Health, Springfield, Ill.

STATEMENT OF DR. RICHARD S. COOK, CHIEF, DIVISION OF ALCOHOLISM, ILLINOIS DEPARTMENT OF MENTAL HEALTH; ACCOMPANIED BY WILLIAM N. BECKER, JR., ASSISTANT CHIEF, ALCOHOLISM PROGRAMS

Mr. ROGERS. The committee is delighted to have you here with us this morning. We will make your statement a part of the record following your summary. If you will, just sum it up for us.

Dr. Cook. I would like to introduce to you Mr. William N. Becker, Jr., who is assistant chief of the alcoholic programs in our State. Mr. ROGERS. We are delighted to have you with us, Mr. Becker.

Dr. Cook. Mr. Becker has worked for many years with alcoholics in our State institutions. I have worked an equally long time with emphasis on outpatient care.

I would like to bring to you the wishes of Hon. Gov. Otto Kerner, who yesterday indicated that I should convey his request to you for the passage of this bill.

Also, the director of our department of mental health is in full support of this legislation.

I would like to read part of my statement to you.

The State of Illinois has forged ahead in providing a continuum of services on a statewide basis. We believe that bill, H.R. 15758, is a wise, timely, and urgently needed step in the right direction.

We urge its passage to provide the leverage enabling the delivery of a full range of services to alcoholics at different levels of severity and varying stages of their illness.

In endorsing this bill wholeheartedly we feel it incumbent to remind the committee that at present with the combined facilities available we treat less than 10 percent of the alcoholics in Illinois.

This bill reflects the needs of the Nation and has been hammered out of pooled experience of thousands of people in close cooperation with the legislators here in Washington, D.C. Those of us working in this difficult field believe that this pending legislation shows that you have heard us and have written down pronouncements and rules that go a long way to establish direction with us and to implement our efforts to gain control over this vast public health problem.

I would like to turn to the situation in Illinois to illustrate how well this legislation can fit with the progress in the State with regard to comprehensive community medical centers and comprehensive community mental health centers.

While it is occurring throughout the State, I would like to focus on the metropolitan area of Chicago, where the problem of alcoholism is especially acute.

In Chicago the city has been divided into many areas for medical and mental health planning. Plans are being made as rapidly as possible, translated into actual programs involving construction, assembly of staff, and offering of services.

It is most timely that we in the section on alcoholism programs be enabled to urge the appropriate authorities to include in their planning, programing, and services a complete continuum of care for the alcoholic in Chicago.

We believe that the time is now for reestablishing the alcoholic as a legitimate patient for coverage in every mental health, public health and welfare program. We believe each community throughout the State should provide the entry and some responsibility for the continuum of services for the alcoholic, and that it can be obtained through a program as provided in this bill.

We have been successful in Chicago in persuading some general hospitals to accept alcoholics for treatment during the acute phase of intoxication. We are providing a program of follow-up care designed to meet the need of each particular patient.

This comprehensive service for the alcoholic is in accordance with other welfare programs throughout the State.

To carry out this conception of establishing facilities for alcoholics in all of the newly planned and realized medical, mental health, public health, and welfare programs we need the provisions of this bill which amends the Community Mental Health Centers Act. We have plans, we have ideas for special facilities, and we are eager to carry through with research.

We urge that you make these hopes and visions attainable through enactment of this legislation.

(Dr. Cook's prepared statement follows:)

STATEMENT OF RICHARD S. Cook, M.D., CHIEF, ALCOHOLISM PROGRAMS,
STATE OF ILLINOIS DEPARTMENT OF MENTAL HEALTH

The State of Illinois has forged ahead in providing a continuum of services to alcholics on a statewide basis. We believe that Bill HR-15758 is a wise, timely, and urgently needed step in the right direction. We urge its passage to provide the leverage enabling the delivery of a full range of services to alcoholics at different levels of severity and varying stages of their illness. In endorsing this Bill wholeheartedly we feel it incumbent to remind the Committee that at present with the combined facilities available we treat less than 10% of the alcoholics in Illinois. This Bill reflects the needs of the Nation and has been hammered out of pooled experience of thousands of people in close cooperation with the legislators here in Washington, D.C. Those of us working in this difficult field believe that this pending legislation shows that you have heard us and have written down pronouncements and rules that go a long way to establish direction with us and to implement our efforts to gain control over this vast public health problem.

It is clear that three powerful forces are tied together by this Bill. One force is the combined effort of the 50 states to deal with alcoholism and to find ways and means of coping successfully with its many aspects. This involves highly trained specialists in increasing numbers who have reflected and expended great effort to learn about alcoholism. This force has been substantially aided by grants from such agencies as NIMH, VRA, and other Federal agencies.

The second force which exerts power by accelerating change is that of the Federal courts. The pending decisions by the Supreme Court regarding the status of the chronic alcoholic is setting in motion already many agencies, public and private, which must meet the potential thrust of new conditions. If it comes to pass that the acutely intoxicated man cannot be arrested for public intoxication if he is a chronic alcoholic, then the jail must be replaced by health agencies in

dealing with the chronic alcoholic. It is not news that available facilities are woefully inadequate to measure up to the consequences of the possible Supreme Court decision.

The third force is that of the Congress of the United States which can act to consolidate the power of the national effort thus far and the possible tumultuous consequence of the Supreme Court action. The enactment of favorable legislation could add the greatest impetus to the national effort in the management and rehabilitation of the chronic alcoholic.

Thus, we from Illinois see greatly the immediacy and necessity of the passage of this superbly conceived bill.

I would like at this moment to turn to the situation in Illinois to illustrate how well this legislation could fit with the progress in the State in regard to comprehensive community medical centers and comprehensive community mental health centers. While it is occurring throughout the State, I would like to focus on the metropolitan area of Chicago where the problem of alcoholism is especially acute. In Chicago the city has been divided into many areas for medical and mental health planning. Plans are being made as rapidly as possible, translated into actual programs involving construction, assembling of staff, and the offering of services. It is most timely that we in the Section on Alcoholism Programs be enabled to urge the appropriate authorities to include in their planning, programing, and services a complete continuum of care for the Chicago alcoholic.

We believe that the time is now for re-establishing the alcoholic as a legitimate patient for coverage by every new medical, mental health, public health, and welfare program. We believe sincerely that each community throughout the State should provide the entry and some responsibility for this continuum of services for the alcoholic and that it can be most effectively attained through a comprehensive alcoholism program, as provided in Bill HR-15758. We have been successful in Chicago in persuading some general hospitals to accept intoxicated alcoholics for treatment during the phase of acute intoxication. Following the medical management we are providing a program of follow-up care which will be designed to meet the particular needs of each patient. This comprehensive planning of services for the alcoholic is in accord with other health and welfare planning programs throughout the State.

To carry out this conception of establishing facilities for alcoholics in all of the newly planned and realized medical, mental health, public health, and welfare programs we need the provisions of this Bill which amends the Community Mental Health Centers Act. We have plans, we have ideas for special facilities, and we are eager to carry through with research. We urge that you make these hopes and visions attainable through enactment of this legislation.

Mr. ROGERS. Thank you very much.

Mr. Nelsen?

Mr. NELSEN. No questions.

Mr. ROGERS. Dr. Carter?

Mr. CARTER. No questions.

Mr. ROGERS. I recall the testimony received from the Bureau of Mental Health in operation in Illinois, and from the Governor, too, and the work that you had done there served as a model, somewhat, in drawing this legislation.

Do you anticipate these centers will be run in conjunction with your community mental health centers?

Dr. Cook. We are trying to provide treatment of alcoholics, but we feel we need funds through grants to enable the alcoholic to be treated. Mr. ROGERS. Would you anticipate that perhaps a wing would be built onto the community mental health center?

Dr. Cook. Yes, it could work like that. I talked to Dr. Paul Neilsen, who is head of the Mile Square Area Community Mental Health Center, and in his plans, he envisages a building for, say, the care and treatment of alcoholics after the acute phase. He is willing to treat them in his hospital for acute intoxication and then have an aftercare program in another building less expensive to operate.

Whether this is a new building or he would take over an existing building, he would include the alcoholics.

Mr. ROGERS. Would you have a detoxification center, in effect? Dr. Cook. We don't want a separate, large detoxification center. We would like each medical center to accept and treat the alcoholic. We are providing funds for detoxification. We will pay on a contractual basis, or we could establish a unit with funds from some source in a medical or mental health center.

Mr. ROGERS. Would you let us have a rundown on how you would do the operation of this?

Mr. BECKER. We have recently submitted a proposal for a grant, and approximately $350,000 from the State legislature for this program of buying medical care for the indigent alcoholic. Funds would also come from public aid to purchase medical coverage.

The idea is to contract for these services on a per diem basis. Particularly in the city of Chicago, we have a problem. In any one given day, we would have anywhere from 150 to 200 patients coming in. This could soon inundate a single program, so we are in the process of continuing to develop citywide programs in concurrence with the comprehensive health program services. Each of these programs will utilize the hospital in that area.

We will contract with them for their medical services in any one year.

Mr. ROGERS. What is the estimate of your population of alcoholics? Mr. BECKER. Using the information we have, our public health statistics indicate we have in excess of 500,000 alcoholics in the State of Illinois. Over 80 percent of these reside in the Greater Chicago area. During 1967 we admitted on a voluntary basis something like 7,000 alcoholics, and over 4,500 of these were in the Greater Chicago area. So we have been involved in the detoxification process for a long time. We do need the opportunity for some comprehensive backup support that this comprehensive bill would supply.

Mr. ROGERS. Are you having any success with bringing about abstinence?

Dr. Cook. We are having a good deal of success in our State hospital programs, but what we are trying to do is keep the alcoholic in his local area, in his community for detoxification, and refer him there for followup care, and save our State hospitals for special treatment centers for the alcoholic who needs 30, 60, or more days of continued treatment.

Mr. ROGERS. Do you get into the treatment of narcotics?

Dr. Cook. In our State we have a council on narcotics, which is established by the legislature and appointed by the Governor. Mr. ROGERS. Do you handle this in your program yet?

Dr. Cook. Not yet.

The pilot project is being established to try to determine what would be the best statewide program for narcotics.

Mr. ROGERS. What is your narcotics population?

Dr. Cook. About 60,000 would be an estimate.

Mr. ROGERS. Thank you very much.

If you would, let us have a breakdown on your operation.

Dr. Cook. Yes, sir.

(The following information was received by the committee:)

Hon. PAUL G. ROGERS,

STATE OF ILLINOIS DEPARTMENT OF MENTAL HEALTH,
Springfield, Ill., April 1, 1968.

Committee on Interstate and Foreign Commerce,

U.S. House of Representatives, Washington, D.C.

DEAR CONGRESSMAN ROGERS: First may we extend our appreciation for the privilege of appearing before your Committee. We hope that our contribution may help in some small way to assist you in reaching your decisions.

As you recall, during the Committee Hearings you requested information on our General Hospital Detoxification Program which I am enclosing. Again, our deepest appreciation, and should you feel that we can be of assistanc to you in any way, it will only be necessary for you to so advise. Sincerely yours,

Enclosure.

WILLIAM N. BECKER, Jr., Assistant Chief, Division of Alcoholism.

PROJECT

Section on alcoholic programs, Department of Mental Health, detoxification program

PROPOSAL

To provide emergency care for acutely intoxicated indigeat persons in general hospitals. In this proposal the main emphasis is on a situation which involves the Chicago metropolitan area but it is our intention to include the entire state in our plans to offer care to acutely intoxicated patients.

RATIONALE

During the past five years it has become increasingly apparent to the Section on Alcohol Programs of a need for a program of mass management of the acutely intoxicated person at the community level. It is common knowledge in the field of alcoholism that the federal government, and the Nation as a whole, is becoming vitally aware of the need for more adequate care and treatment of the acutely intoxicated person. It is equally known that (a) the Supreme Court of the United States will issue a decision regarding compulsory care of the inebriate, the acutely intoxicatel, and the chronic alcoholic; (b) that the American Bar Association and the American Medical Association are jointly sponsoring model legislation to assure the appropriate medical management of the alcoholic; (c) that the President of the United States recommended the "Alcoholic and Narcotic Addict Rehabilitation Amendments of 1968" (HR 15281) (Appendix V) to the 90th Congress.

With full knowledge of the above, the Section on Alcohol Programs strongly proposes the immediate establishment of a pilot project for the mass management of the acutely intoxicated and/or inebriated and/or the chronic alcoholic. In addition to preparing for the effect of the inevitable legislative action, this proposal will have a marked effect on the management of our present problem with acute and chronic alcoholics.

During the last nine months of the last fiscal year, 1,830 persons were assigned to the Department of Mental Health facilities through the hospital referral service for chronic alcoholics. (Appendix I) It is estimated that, as of 1967, there are in excess of 500,000 alcoholics in Illinois with the majority of them residing in Cook County. Utilizing 1967 statistics provided for us on February 13, 1968, by the Department of Mental Health Data Processing Division, there were 7,059 admissions to the Department of Mental Health for alcoholism, representing 30.3% of the total admissions to thirteen state hospitals and four zone centers. (Appendixes II and IV)

Our experience with this increasing number of alcoholic patients, particularly in the metropolitan Chicago area, indicate the following: (1) that the majority require medical management; (2) a large number of these patients do not want, will not, or cannot accept or benefit from treatment or rehabilitation in the alcoholism programs provided in our state hospitals; (3) a substanital number of this group could benefit more by being treated for the acute phase of intoxication and then referred to a variety of ancillary programs for appropriate care; (4) a reasonable number require no emergency medical or psychiatric care but do require direction for the above mentioned ancillary programs;

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