The Department has been advised by the Office of Management and Budget that there is no objection to the submission of this report to your Committee and that enactment of H.R. 9264 would be in accord with the program of the President. Sincerely yours, SAMUEL R. PIERCE, General Counsel. VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: This will respond to your request for a report by the Veterans Administration on H.R. 9264, 92nd Congress, the "Special Action Office for Drug Abuse Prevention Act." H.R. 9264, which would implement the President's message to the Congress on June 17th, is intended to focus the comprehensive resources of the Federal Government and bring them to bear on drug addiction and drug abuse with the immediate objective of promptly and significantly reducing the incidence of such conditions in the Nation within the shortest possible time. To accomplish these objectives, all Federal drug abuse prevention, treatment, rehabilitation, training, education, and research activities would be placed under the direction of a new Special Action Office for Drug Abuse Prevention established in the Executive Office of the President. That Office would be charged with developing, funding, managing and evaluating all major Federal drug abuse programs (exclusive of law enforcement activities and legal proceedings) in order to achieve maximum effectiveness. Section 5(c) of H.R. 9264 provides authority for the Director of the Special Action Office to exercise all or part of many Federal Acts as they relate to drug abuse prevention. This includes the Narcotic Addict Rehabilitation Act of 1966, the Comprehensive Drug Abuse Prevention and Control Act of 1970, the Drug Abuse Education Act of 1970, the Community Mental Health Centers Act, the Omnibus Crime Control and Safe Streets Act of 1968, the Economic Opportunity Act of 1964, the Manpower Development and Training Act of 1962, the Public Health Service Act, and title 38 of the United States Code dealing with the authorities of the Veterans Administration. Dr. Jerome H. Jaffe, who has been named by the President as Special Consultant to the President for Narcotics and Dangerous Drugs, in his statement to the Subcommittee on Public Health and Environment of your Committee on June 28, 1971, following a recitation of the above-noted statutory provisions, set out the proposed exercise of this authority by his office as follows: "In most cases, however, the Special Action Office will not implement programs under these authorities itself, with its own staff. Instead, it will arrange for implementing operations to be carried out by other Federal agencies through carefully defined working agreements. In the case of activities now in operation, the Office is authorized to take over direct responsibility for all significant, identifiable programs. The Director will prepare the Federal budget for funds for all programs for which he assumes responsibility and justify this consolidated budget before Congress. He will also develop and introduce new programs where necessary and include these in the consolidated office budget. "In many agencies, however, activities relating to some portion of the drug abuse problem may be part of some broader program where the drug abuse portion cannot be managed and funded separately by the Special Action Office. In these cases, the Special Action Office will provide policy and program guidance based on direct research and on evaluation of programs carried out by other agencies, to assist those agencies in making their programs more effective." It is my sincere belief that the Veterans Administration, working with the Special Action Office for Drug Abuse Prevention proposed in H.R. 9264, can make a significant contribution to the solution of the national drug problem in view of the fact that we have been in the forefront in this highly specialized medical treatment and rehabilitation area. Although in recent times the drug abuse problem has reached alarming proportions in our society, it is not a new problem to the Veterans Administra tion. For years, we have taken care of veterans with drug abuse problems in our hospitals. In 1968 the VA commenced making statistical studies as to the dimensions of this problem among its patient load, and data on the incidence of veterans discharged from our hospitals with principal or associated diagnosis of dependency on a number of addictive drugs was included in our Automated Medical Information System. In 1969 the Alcoholism and Related Disorders Staff (more recently redesignated as the Alcohol and Drug Dependency Service) which had been established as a separate staff within the VA's Department of Medicine and Surgery in 1967, was given additional emphasis. Also, as we were then planning the VA's budget for fiscal year 1971, it was a logical next to provide in that budget for the opening of specialized drug abuse treatment centers. Five of these centers have now been opened as pilot models for the exploration and development of the best possible techniques for the care and rehabilitation of veterans suffering with drug addiction problems. Before outlining our present plans and future capabilities, it is important to dentify the existing limitations on our authority to provide medical care and treatment for veterans, because these limitations significantly influenced our original estimates of the magnitude of our drug abuse treatment responsibility. Hospital and outpatient treatment by the VA, except on a humanitarian basis, is limited to those who are eligible for such treatment under the provisions of chapter 17, title 38, United States Code. Moreover, an individual must have been discharged from military service under conditions other than dishonorable. Furthermore, section 3103 of title 38 bars any benefits to an individual discharged or released from service by reason of a sentence of a general court. This means that any serviceman who receives a dishonorable discharge for drug abuse problems cannot now be treated in VA facilities. However, to implement the President's proposal to provide treatment for servicemen legislation has been submitted to the Speaker of the House, by the Department of Defense (H.R. 9503) which would eliminate this problem insofar as care and treatment for drug abuse problems is concerned, by providing that servicemen shall not be discharged under other than honorable conditions solely on a drug abuse problem. Furthermore, H.R. 9264 would permit the Director of the Special Action Office for Drug Abuse Prevention to make agreements with Federal agencies, including the Veterans Administration, to treat those not notherwise eligible. These additional authorities would permit the Veterans Administration to treat a larger segment of those drug abuse patients who require treatment. Therefore, contingent on our obtaining the extra $14 million requested by the President, we plan to be operating 32 specialized drug treatment units by October 1971. These centers will provide approximately 500 additional beds for inpatient treatment, with an annual capacity of approximately 6,000 patients. Our total capacity to treat eligible cases will be much greater than the planned capability of these units. As heretofore, veterans with drug abuse and related disorders will continue to be accepted into our regular general medical and neuropsychiatric wards, regardless of location. Moreover, the drug abuse program of the Veterans Administration is only part of our overall care and treatment program for eligible veterans. As such, institutional facilities and resources which the agency uses in our drug abuse treatment program cannot be totally separated from the facilities and resources utilized in our total treatment program. Our plans for future expansion of the drug abuse treatment program will be based upon our experience during the next year-not only in relation to workload but also in regard to the appropriate geographic location of specialized treatment centers. And, of course, we intend to participate wholeheartedly in the coordinated drug abuse treatment program which will be conducted under the direction of the Special Action Office. Therefore, in view of the foregoing, I recommend early and favorable consideration of H.R. 9264 by your Committee. We are advised by the Office of Management and Budget that there is no objection to the presentation of this report and that enactment of H.R. 9264 would be in accord with the program of the President. Sincerely, DONALD E. JOHNSON, Mr. ROGERS. Our first witness today is Dr. Jerome H. Jaffe, who at present is director of the drug abuse program, department of mental health in the State of Illinois, and the President has indicated that he will, and has announced that he will appoint, subject to confirmation as soon as this legislation is acted upon, if such a program is approved, he wuold appoint Dr. Jaffe to head this program of drug abuse control for the Federal Government. Dr. Jaffe, we welcome you, and will be pleased to receive your testimony at this time. STATEMENT OF DR. JEROME H. JAFFE, DIRECTOR, DRUG ABUSE PROGRAM, DEPARTMENT OF MENTAL HEALTH, STATE OF ILLINOIS, APPOINTED SPECIAL CONSULTANT TO THE PRESIDENT FOR NARCOTICS AND DANGEROUS DRUGS; ACCOMPANIED BY ARNOLD R. WEBER, ASSOCIATE DIRECTOR, OFFICE OF MANAGEMENT AND BUDGET, AND JAMES LAWRENCE, EXECUTIVE OFFICER, NATIONAL INSTITUTE OF MENTAL HEALTH, NATIONAL INSTITUTES OF HEALTH, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Dr. JAFFE. Mr. Chairman. Mr. ROGERS. You might introduce your colleagues, sir. Dr. JAFFE. I am pleased to appear before this committee this morning. I am accompanied here this morning by Mr. Arnold Weber, Associate Director of Management and Budget, on my right, and Mr. James Lawrence, executive officer of the National Institute of Mental Health. Mr. ROGERS. We welcome you, Mr. Weber and Mr. Lawrence. Dr. JAFFE. I am pleased to appear before the subcommittee this morning to testify on the new Special Action Office for Drug Abuse Prevention which has been proposed by the President. I especially appreciate the willingness of this committee to hold hearings so quickly after submission of the bill. I know that this is a reflection of the concern of this subcommittee to find the best means for combatting drug abuse and shaping the Federal response to the drug problem. In his message of June 17, 1971, the President outlined the need for the Special Action Office to develop an overall Federal strategy for drug abuse programs to respond to the emergency situation in which we find ourselves. The President defined the role of the Special Action Office as follows: This Office would provide strengthened Federal leadership in finding solutions to drug abuse problems. It would establish priorities and instill a sense of urgency in Federal and federally supported drug abuse programs, and it would increase coordination between Federal, State, and local rehabilitation efforts. The problems of drug abuse and drug addiction are human problems. We do not yet have total insight into the causes of drug addiction among different groups of people, particularly young people, but we know Americans in ever-increasing numbers are experimenting with an ever-increasing variety of pharmacological substances. In some cases, the experimentation is a transient behavior motivated by curiosity and peer pressure. Often it is a phase that passes and leaves no scars. But tragically, for too many Americans the kinds of drugs used and the patterns of use lead to the breakup of their personalities, the destruction of personal and family ties, and the commission of crimes to obtain the money to buy the drugs. As a society we pay for this in many ways-the diversion of energy and talent from socially useful to socially detrimental channels, the cost to curb and root out the suppliers of illicit drugs; the crimes committed by the drug users, and the anguish of thousands of families who must watch helplessly as one of their members gets caught up in a drug dependence problem. It is clear that one of our first priorities must be the prevention of additional victims. Once drug dependence is established, it is immensely difficult to reverse. Many drug users simply do not want treatment. Even for those who seek treatment, extraordinary effort is required by both the individual himself, and by society, to make that treatment successful. Our best strategy at this time, therefore, is to prevent it in the first instance. We do know that for many individuals there is a terrible progression from experimental testing of a drug to the state of compulsive use or true addiction. Yet, not every person moves inexorably down this roadway. But, who will do so and who will not still eludes us. We must develop ways to discover why some users progress, then identify them, and halt that progression. The second great need is for treatment of those who have already moved on to addiction but have not yet entirely destroyed their lives— to shorten the journey before it reaches its tragic end. The message of the President is a crucial "turning of the corner" in this regard. It represents a determination to give new emphasis to the treatment of drug abuse, and adopts the realistic and more humane attitude that every addict in need of treatment should be able to obtain it. It recognized further that treatment must be adapted to the individual and that this means a number of alternatives will have to be made available. Just as there are individual addicts who do not seek out any treatment, there are those who seek treatment, but do poorly in specific treatment programs. Over the past several years many Federal agencies, each responsive to its own limited responsibilities, have developed and operated programs dealing with one piece of the drug abuse problem. There are nine Federal agencies now involved in some facet of the drug abuse problem, including six offering some form of treatment program and five engaged in education and training activity. It is clear that this piecemeal approach is inadequate to the task. We no longer can afford the luxury of having each Federal agency respond to one part of the drug problem without linking its efforts to others underway. Such discontinuities are not only inefficient but they make it difficult for the public to know which agency it should seek out first, and it dooms the drug user seeking treatment to wander through a bureaucratic maze hoping to find the treatment best suited to his needs. There are a number of things which we can do to build on existing activities and programs. Our first priority is to make better use of the resources already committed to pieces of the problem. We must bring them together in a coordinated attack upon the total problem. We must, in fact, develop a national strategy for responding to this national crisis. To do this, we must take the following steps: 1. We must identify and define the total problem, and its parts, more precisely. 2. We must state clearly and definitively our immediate and longer range objectives. 3. We must examine the range and variety of programs which will be needed to meet these objectives, take steps to get the most out of current programs and using new programs to fill in the gaps. 4. We must examine the utility of existing programs, measure their impact and effectiveness and be prepared to redirect their resources where their usefulness cannot be clearly seen. We must view our mission with a clear sense of urgency, and with a recognition that we intend, in a few short years, to leave the scene with a better range of programs than we found. A first step is to establish a new administrative entity to respond to this emergency directly and specifically. This agency is intended to achieve very specific objectives in a limited period of time. Such an approach is not new in responding to questions of great national concern, but it is the first time it has been applied to this kind of program. In effect, we are setting up a project office in the Executive Office of the President which will be equipped to develop a national strategy, to set forth very clear objectives to insure coordinated program management, and to measure the progress of the Federal Government against those objectives. In his June 17 message, the President set forth the mission as follows: ... The Special Action Office would develop overall Federal strategy for drug abuse prevention programs, set program goals, objectives and priorities, carry out programs through other Federal agencies, develop guidance and standards for operating agencies, and evaluate performance of all programs to determine where success is being achieved. It would extend its efforts into research, prevention, training, education, treatment, rehabilitation, and the development of necessary reports, statistics, and social indicators for use by all public and private groups. ... it would concentrate on the "demand" side of the drug equation-the rise and uses of drugs. Within its mission, the Director would set specific objectives for accomplishment on a time-phased basis, during the 3 years of the Office's intended existence. These objectives would include, among others Reduction in the increasing national rate of drug addiction; Reduction of drug use in schools; Increase in the number of individuals treated by methods proven to be effective; and Increase in the number of rehabilitated addicts placed in jobs. A major objective of the Office will be the development of a reliable set of social indicators which will show clearly the nature, extent, and trends in the drug abuse problem, and the kinds of workload measures which will tell us what kinds of progress we are making. We already have such indicators in other medical problem areas, and we know that they can be provided for drug abuse as well, so that we can look at patterns of drug use and the rate of change and gage our effectiveness in reducing the growing numbers of addicts. The Special Action Office will have special tools for carrying out its mission. It will have strong directive authority and funding control |