Created by Joel Fort, M.D.-the result of his nearly 20 years of experience as a public health innovator, concentrating on all aspects of drug abuse, human sexuality, and youth problems -FORT HELP is a private nonprofit center open to all, irrespective of ability to pay. It is designed to be a warm and supportive environment in which to be helped, bringing together those giving and receiving help in a new kind of relationship that emphasizes a shared responsibility. Its physical surroundings are highly unconventional-bright, bold, and free form-in an attempt to break away from sterile institutional atmospheres. Envisioned as a bridge over the increasing fragmentation of our society, FORT HELP is dedicated to working in a nonhierarchical, nonauthoritarian manner to try to avoid the inefficiencies and dehumanization of traditional organizations.

We believe that FORT HELP- a busy, people-filled, obviously relevant facility from the moment it opened--is a valuable indicator of the future of social health care. It is accessible, human, and oriented to keeping people well. Its staff brings together medical doctors, social workers, psychologists, community workers, interns and residents, teachers, vocational counselors, and a wide variety of other professionals and nonprofessionals-all of whom are selected for their relevance, commitment and maturity rather than for arbitrary certification. The Center stresses a generalist interdisciplinary approach to solving problems, with the greeter problem-solver as the core of its unique services. FORT HELP is a model for the obviously needed helping facility which can provide new solutions to complex societal problems and which now seems certain to replace present mammoth and unresponsive institutions.

Under the guidance of Dr. Fort and a staff selected team of coordinators and activators, FORT HELP is geared not only to help people from all walks of life but also to providing intensive training, public education and research We are convinced that the need for help in our present society has long since outrun any possibility of ' certified," routinized treatment by specialists with professional degrees. People must be brought together to help each other accomplishing this is one of our primary aims. We ask your help in financing this unique facility While we are seeking every poss bie private nongovernmental Source of operating money continuing direct help from concerned individuals is a necessity. We welcome your involvement with our direct and indirect services in addition to your financial contribution (tax deductible)

The Center for Solving Special Social and Health Problems (FORT HELP) is a new, fundamentally different kind of resource

for people seeking aid in dealing with some of today's most pressing problems. Based on the evident need for new ways

of coping with the stresses of modern life, it represents an innovative, eclectic approach to providing immediate and pertinent kinds of help. It assumes that those needing help for drug, sex, and other special problems

should not be labeled, processed or

in any way reacted to as "sick" or "abnormal."

THE PROS AND CONS OF LEGAL HEROIN, METHADONE, AND NON NARCOTIC
WITHDRAWAL AND MAINTENANCE TREATMENTS

(By Joel Fort, M.D. Founder-leader, The Center for Solving Special Social and Health Problems-FORT HELP, San Francisco, and former Consultant on Drug Abuse, World Health Organization and United Nations.)

In general, treatment and rehabilitation have never been available for narcotics addicts in the United States. There has been only token treatment for small numbers in prison hospitals or state mental hospitals. Then there evolved a number of self-help approaches such as the black Muslim movement, Daytop, and Synanon, which have been of significant help in a small minority of addicts, but which often claim to be far more successful than they are: Now comes methadone maintenance treatment, which is being widely promoted not only as the cure for heroin addiction, but also as the answer to the "drug problem." It is falsely and harmfully stated that addiction is an incurable disease, that all heroin addicts have a permanent metabolic disorder, and they must take moderate to large quantities of methadone for the rest of their life.

As more and more new people and programs enter the previously totally neglected field of drug abuse, it is important to remember that there are many pros and cons about all aspects of the drug scene, and it is better to stick with the pros and avoid the cons. Methadone in particular appeals to our craving for over-simplification and for quick, easy chemical "solutions" to problems. It is a convenient cop out for politicians, psychiatrists, and others, who can then claim that they are doing what needs to be done to solve the drug problem by setting up methadone programs.

While attempting to put methadone or any other treatment in perspective, there should be no question that it is better to be on a legal, long-acting, orally administered, inexpensive narcotic, methadone, than to be a street heroin addict forced by our social policies to seek out a very high priced, illegal, short-acting narcotic which must be injected. However, we have a responsibility to see that addicts have available more than this one option. There is absolutely no evidence that heroin addiction or any other form of drug abuse, including alcoholism, tobacco smoking, etc. are genetic, bi-chemical, or metabolic in origin. They are primarily social in origin, and secondarily psychological.

The traditional stigmatization of the addict and his segregation must be ended. Drug abuse is not particularly a mental health or psychiatric problem to be turned over to government mind bureaucrats who have never shown any interest in the problems in the past and have no specific training or experience for dealing with it now. The British concept that it is a medical rather than a criminal problem is a major public policy distinction that is long overdue in the United States and has been proven to prevent the crime and deterioration of the addict seen here.

A wide range of treatment approaches are available for heroin addiction and other drug abuses, and the best program is one that makes fully available all traditional and innovative approaches for long-term out-patient help and allows the affected individual to participate in the decisions as to which combination of methods will be utilized. Methadone should never be presented in isolation or stressed as the best or only treatment available for heroin addiction. When it is presented, hopefully as part of a comprehensive rehabilitative effort, which all addicts are urged to participate in, its benefits should not be overplayed, and its possible deficiencies should be fully discussed. The value should be communicated to the addict of working toward freedom from methadone as well as from heroin, the goal being to become a free and independent person, able to be fully and constructively invovled in this society.

Acceptance, understanding, and moral support, along with self-help approaches, group and individual psychotherapy, social work services, vocational counselling. job finding, cyclazocine, and methadone can all be valuable components of the rehabilitation of heroin addicts. Methadone withdrawal treatment, presently prohibited in California, except under rare circumstances, needs to become fully available to any addict desiring to kick heroin, and more methadone maintenance programs, particularly private, non-governmental ones, are badly needed in this and other urban areas. The best programs will avoid assembly line, indiscrimi nate placement of people on indefinite methadone maintenance; will stress pri vacy and confidentiality; and will seek to estabilize the addict on the lowest possible maintenance dose that enable avoidance of most or all heroin use, i.e.. "social blocking.”

The public health approach to drug abuse which I have advocated for more than 15 years is now coming into wider and wider acceptance, and one component of this, methadone treatment, has gained perhaps the too great acceptance since 1966 when I first attempted to establish a methadone maintenance program in California. Methadone maintenance, even if it were 100% successful, represents only one technique for treating what is in reality the smallest drug abuse problem in America. It doesn't at all help, and in fact, diverts us from the massive drug abuse problems of alcoholism, pills, cigarette smoking, drunk driving, etc. A pilot research project of heroin or morphine maintenance should be carried out with at least 50 addicts to compare with methadone maintenance and probably to reveal the superiority of the latter.

With sufficient knowledge and commitment, outstanding rehabilitation programs can be developed with very little money, and are best created without government funds, which stultify innovation, put everyone in data banks destroying their privacy, and control or manipulate powerless people.

If an individual sees no hope but dope in his life, he is far more likely to use dope. Drugs are always a symptom for the individual and society, rather than existing in a vacuum. These are human problems and social problems which require a provision of numerous positive alternatives to drugs, deep involvement in social change and an awareness that man cannot live on chemicals (or bread) alone.

Methadone maintenance represents only one method for helping heroin addicts; it should be used with discrimination and individualized with the addict participating in the decision; and when used should be as part of a long-term comprehensive services, which have as their goal, moving the former heroin addict toward freedom and independence from drugs, including methadone (which can and should be gradually decreased as soon as the individual on maintenance has achieved a social reorientation), and from government or private programs or psychiatrists.

In summary, a legal heroin or morphine withdrawal and maintenance should be experimented with and is far preferable to street (illegal) addiction; methadone maintenance (or withdrawal) treatment is superior to heroin maintenance; methadone withdrawal needs to be far more widely available and in fact should be provided by all practicing physicians; non-narcotic withdrawal treatment using sedatives, tranquilizers, and anti-spasmodics as provided by so-called "free clinics" is markedly inferior to methadone withdrawal and very unsuccessful; methadone maintenance treatment although an important avenue of help to many heroin addicts, is being oversold and abused by politicians, psychiatrists, and addicts; and finally, narcotics addiction is a social rather than a metabolic disease, and the goal of rehabilitation should be freedom from all drug dependence including heroin, methadone, and alcohol.

MULTIPLE DRUG AND PROGRAM ABUSE AND HOW TO CONTROL IT

(By Joel Fort, M.D.)

(Founder-leader, The Center for Solving Special Social and Health ProblemsFORT HELP, San Francisco and former Consultant on Drug Abuse, World Health Organization and United Nations.)

The usual heroin addict coming into a methadone maintenance program is and has been a multiple drug user beginning with use of alcohol and tobacco in the early teens, and later pills and marijuana. With some of these mind-altering substances there has been abuse meaning objective damage to health or social and vocational functioning, and this abuse may exist concurrently with the heroin addiction and with the subsequent legal methadone addiction in a maintenance program. Programs, sometimes by choice but more commonly because of state and federal laws and regulations, attempt to control or prevent this by collecting frequent urine samples under direct and demeaning observation followed by expensive laboratory analysis of this urine for narcotic, sedative, and stimulant drugs but not for the drug which they are most likely to use and abuse, alcohol. It is probably alcohol and not barbiturates, amphetamines, or heroin which is most likely to lead to the ex-heroin addict's failure on a methadone maintenance program.

As a result of our destructive social policies and the consequent stigmatization and criminalization of addicts each rule in a program becomes a potential symbol or focus for manipulation or conning, for extension of cops and robbers, fuzz and junkies games with elaborate efforts to fool the labor use various drugs without detection. Also if life for the addict continues to be seen as offering no hope but dope, if no alternatives are provided and no services to help change the life style, the individual is likely to continue to turn to chemical pseudosolutions for problems-alcohol, pills, and sometimes heroin despite high dose methadone maintenance.

The best approach to this is a positive one stressing acceptance of the addict as a human being, individual attention, and open communication with mutual trust and respect. Methadone maintenance rather than being presented as a panacea or magic chemical cure for a supposed metabolic illness, should be given as one facet of comprehensive services including group and individual counseling or therapy, vocational counseling and job finding (and development), social work and medical services, self-help approaches, psychodrama, etc. Addiction is a social disease and methadone a transition technique to be presented with the built-in goal of coming off it as soon as important life changes are made.

One of the major program abuses occurring presently is not an abuse by addicts but by psychiatric or other bureaucrats who are placing increasing tens of thousands of heroin addicts on lifelong methadone while telling them they have an otherwise hopeless condition and must remain under government supervision. This sometimes involves an element of racism.

When someone on maintenance tells you about or shows up in the urine as having used a forbidden drug or the approved drug alcohol, this should be interpreted as a sign requiring more or better help and not seen in an all or none way as representing total failure. If any drug abuser has reduced the quantity of drugs used and/or improved their social and vocational functioning this should be seen by the staff and communicated to the addict as progress while working toward the ideal goal of freedom from heroin, methadone, alcohol, etc.

As for other program abuses these include theft and vandalism, mouthing or otherwise stealing single doses of methadone, diversion of take home doses into the black market, failing to pay the modest fees essential in a private non-profit program such as our to cover lab and staff costs-by addicts; and exploitation for publicity or budget building purposes, assemblyline additions of addicts to maintenance programs at too early ages or with inadequate proof of lengthy addiction and failure of other treatments, indefinite maintenance on methadone or excessive doses, failure to provide help for people with other drug problems than heroin, and ignoring the social and political roots of heroin addiction while providing politicians with a convenient cop-out-by professionals and adminis trators.

Senator BAYH. Our next presentation is going to be a panel wit Sheriff Richard Hongisto, the sheriff of San Francisco Count Matthew M. O'Connor, supervising special agent of the Bureau of Narcotic Enforcement of the California Department of Justice, are Mr. Frank Pappas of the Bureau of Narcotics and Dangerous Drugs. who was also with us in Los Angeles.

Mr. Pappas, you must be a roving troubadour.

Gentlemen, would you be so kind as to identify yourselves for us. and, Sheriff, would you be so kind as to tell us how you prononuce you last name-with names like Bayh and Hruska, we're a little sensitive about mispronouncing others.

Sheriff HONGISTO. Sheriff Richard Hongisto.

Senator BAYH. Feel free to proceed, gentlemen.

STATEMENT OF SHERIFF RICHARD HONGISTO

Sheriff HONGISTO. I have some general points I would like make-three points, essentially.

I'm very pleased to be here today and appreciate the invitation.