Mr. ROGERS. That is, if you can get all of the people you need and so on?

Mr. JOHNSON. We are confident we can recruit at these locations. The choice of location involved a variety of factors: one, as I mentioned a while ago, the demograpihc studies of where the numbers of veterans are; some applied judgment as to where we think the major addiction problems are; and finally, of course, the physical plant available and the recruitability of personnel.

Mr. ROGERS. I think if you could let us have for the record a breakdown of each one and when it is anticipated it will be activated, and a general description of services to be rendered, it would be helpful. (The following information was received for the record:)

VA'S DRUG DEPENDENCE TREATMENT UNITS OPERATION

The VA's Drug Dependence Treatment Units will offer a wide variety of services. The inpatient period will provide detoxification and ensuing period of stabilization. Following this period, patients will be transferred to outpatient status. All patients will be exposed to intensive group and individual psychotherapeutic approaches including confrontation therapy. Each unit will utilize a urine surveillance program during in and out patient treatment periods. Vocational counseling and assistance will also be stressed in these units. Adjunctive approaches, such as recreation and occupational therapy will supplement more traditional forms of treatment. Most units will utilize methadone on a maintenance basis.

Mr. ROGERS. I notice that you plan for 28 more, and I presume that is within the next year?

Mr. JOHNSON. Yes, sir; that is the current plan. Here again, I think that as we learn, as we have the experience, and as we further identify the magnitude of the problem, which is really one of the hangups that we all have today, if it is demonstrated that we can have the physical plant, that we can find the personnel and there is the workload there to justify it, that the President made it very clear he would not be reluctant to come back to the Congress and ask for additional moneys for the VA or any other portion of the Government treating people. Mr. ROGERS. You propose satellite drug clinics, also, I understand? Mr. JOHNSON. The satellite clinics are what we call these outpatient clinics,

Mr. ROGERS. Ninety-one?

Mr. JOHNSON. Yes, sir.

Mr. ROGERS. Psychiatric hospitals with drug capabilities-are you using those?

Mr. JOHNSON. Yes, sir; and in fact are using those now.

Mr. ROGERS. How many of those?

Dr. MUSSER. We have 33 psychiatric hospitals. Also, we have psychiatric services in most of our general hospitals. We operate a total of 45,000 psychiatric beds throughout the system.

Mr. ROGERS. Now, let me ask you, what will the drug abuse burden do to the bed shortage in VA hospitals?

Mr. JOHNSON. Here again, Mr. Chairman, we have to define the magnitude of this problem, but we believe we have the capability to handle the anticipated workload and we do have the physical plant to handle it.

Mr. ROGERS. I think if you would fill that in for us in the record, because, as I understand it, you asked for 79,000 beds in the budget and you actually had a bed load of 85,000.

(The following statement was received for the record:)

The data available to us at this time are much too sketchy and, therefore, we cannot make a meaningful judgment.

Mr. JOHNSON. Mr. Chairman, we asked and presented to the Congress a budget based on a 79,000 average daily patient census in our hospitals. This does not include those that are in nursing care and so on, because we take care of about 112,000 patients every day in some kind of medical facility.

The addition of active duty servicemen and the formalization now of these additional drug centers, which has come about since the preparation and presentation of the budget, will be over and above the 79,000 figure. So there is no inhibition.

Mr. ROGERS. You are estimating 6,000?

Mr. JOHNSON. Yes; but not all inpatients. We are only talking about 500 to 600 here in the formalized units on a daily basis, because it is a short hospital stay. As they move into the outpatient phase, they do not affect the average daily patient census in the hospital.

Mr. ROGERS. And you are counting on about 500 or 600 per day?

Mr. JOHNSON. Yes. If there are 32, at 15 beds, you have 480. These will be running at nearly capacity, or we anticipate they will, each day. So we are talking about between 450 to 500 additional patients in the formalized centers.

Then, those that are clearly identifiable as addicts being treated in the NP hospitals will be over and above that figure. And, of course, the third factor to be added is the active duty servicemen whom we may be asked to treat on behalf of the Department of Defense.

All three of these factors will be on top of the 79,000 figure to which you referred.

Mr. ROGERS. What would be the overall figure for the year you would anticipate treating?

Mr. JOHNSON. We anticipate treating, excluding the active duty servicemen, just veterans, somewhere between 5,000 and 6,000.

Mr. ROGERS. That is what you anticipate you will be able to treat within a year's time?

Mr. JOHNSON. Yes.

Mr. ROGERS. How are you outlining treatment? What happens if he comes in and says, "I am an addict"? What happens to him? Is he hospitalized?

Mr. JOHNSON. Let me turn you back to the professionals, sir.

Dr. LEE. The man is admitted to a hospital claiming he is an addict, and put in a hospital bed. At that point, a full round of medical, surgical, psychiatric, and psychologic groups assay his particular case in its total aspect. All of the various bits and pieces that add up to his being a patient in a VA hospital.

A part of that has to do with the estimate as to whether or not he is addicted to drugs.

There are three techniques by which various urine components can be tested to determine whether this man is in fact a drug user. The grossest of these will outline whether he has recently used any drug of the narcotic type, the amphetamines, or barbiturates.

If the man is on a drug or his urine shows that he has recently had a dosage, then the issue is whether he is a casual or occasional user or whether he is truly addicted to the drug. If addicted, by the removal of any drugs the man will in a short period of time show a very typical withdrawal syndrome with all the symptoms.

Mr. ROGERS. What is the period of time you will keep him in the hospital?

Dr. LEE. We think that the man can be in the hospital up to 1 or 2 months as a usual thing.

On the other hand, a man in good general condition who has a mild drug habit and who is to be detoxified, after an initial survey of 2 or 3 days, will be detoxified in another 7, which makes a total of 10 days, so perhaps 14 days in the hospital wil be ample for that individual. Mr. ROGERS. So you anticipate probably a minimum time would be 14 days and a maximum probably of a month, as an average run? Dr. LEE. The average, Mr. Chairman, would probably be 30 days, while the minimum could be 2 or 3 days if we find he is already detoxified and in good physical shape.

Mr. ROGERS. Two or three days?

Dr. LEE. Yes, sir. If we don't need to keep him in a hospital bed, and he has been detoxified previously, simply the business of taking him off his drugs, if he is a user, takes no time at all. If there is no other physical reason for the man being in the hospital, we can treat him as an outpatient.

Mr. ROGERS. Even though he turns himself in as an addict?
Dr. LEE. Yes, sir.

Mr. ROGERS. Would you have time within that period to go through withdrawal?

Dr. LEE. Again, this is a minimum of time, and the issue I raise is the intensity of his addiction, If he is a user instead of an addict, he can be withdrawn within a very short period of time and moved out as an outpatient, where he can function as an outpatient.

Mr. ROGERS. Now, during this time of hospitalization, is he kept in somewhat of a security position where people cannot get drugs to him?

Dr. LEE. From that standpoint of security, yes. From the standpoint of custodial care, no.

Mr. ROGERS. I am not sure I understand the difference. Is anyone allowed to come in and visit him so he can get drugs, or not?

Dr. LEE. No, sir; folks are not allowed to come and bring him drugs. However, we in the VA are not in a position of retaining him in a posture of custodial or prison care.

Mr. ROGERS. In other words, if he doesn't like the way you treat him, he can just walk out?

Dr. LEE. That is true of any veteran in the VA hospital system; yes, sir.

Mr. ROGERS. Should we have civil commitments?

Dr. LEE. We have not had that as yet.

Mr. ROGERS. I understand that. What I am saying, should we write in the law a provision that someone who is really addicted should have treatment?

Dr. LEE. True motivation in that patient would bring him into the hospital. If he is certain he doesn't want to stay in the hospital, I don't

think that civil commitment is going to help him in his therapy. He might just as well be discharged, as far as he is medically concerned. Mr. ROGERS. To go back to the community and carry on his addition?

Dr. LEE. As far as the medical side is concerned, yes.

Mr. 'ROGERS. Now, that is interesting, because we have heard other experts of course, I realize there is a variety of opinion-who would differ very greatly from that.

Mr. JOHNSON. Mr. Chairman, I think in regard to this problem of civil commitment, we in the VA, and I think, respectfully I say this, the Congress must address themselves to it, it is one of those areas that would require not only extensive hearings but a considerable amount of thought, and there is some time element here in which we can do this. We can generate sufficient workload with the legislation that is before us, and make a massive onslaught in meeting the crisis of the moment with the enactment of this legislation.

And as we know more and learn more about it, then I think we in this Nation, will sometime, have to face this whole problem of civil commitment. I know that we have started to turn our minds to this, because we can kind of sense the mood that there must be some of this, and how do we handle civil commitment in the atmosphere that has been historical in the VA?

We don't have answers to give you today on that.

Mr. ROGERS. Well, I think it has been proposed that you have civil commitment when you release men from the armed services, has it not, and that you give them a treatment for 1 week, detoxification, and then 21 days of treatment?

I understood that was the approach to be used by the Defense Department on discharge. I don't understand.

Mr. JOHNSON. I am not aware of it.

Mr. ROGERS. You don't know what they plan to do?

Mr. JOHNSON. In that regard, I don't know what hold they or the VA would have on a man, once he receives his discharge.

Mr. ROGERS. I thought the President had just submitted legislation to the Armed Services Committee that it be done. You are not aware of this legislation?

Mr. BRONAUGH. Chairman Rogers, we have the bill from the Armed Services, H.R. 9503. It does have a provision where the military can hold persons in the service.

Mr. ROGERS. Then they are talking about turning them over to you, aren't they?

Mr. BRONAUGH. Not as civilians. It would be as active duty personnel, and any control would be on that basis.

Mr. ROGERS. I understand that, but you are talking about working out some arrangement where you can provide that arrangement, isn't that true?

Mr. JOHNSON. That is true, Mr. Chairman.

Mr. ROGERS. If that is so, that is a civil commitment.

Mr. BRONAUGH. We misunderstood you.

Mr. ROGERS. Because he cannot, on his own volition, as the Doctor said he might, just walk off. He would have to stay there.

Mr. JOHNSON. That is true because he is still in the military. We were addressing ourselves to the veteran.