centers, and this is the kind of figure that we are using on the average length of stay and the outpatient visit costs.

Senator HUGHES. That is what I was going to get to, whether you have any idea what it is costing.

Mr. JOHNSON. It becomes complicated because of the individual who comes in with hepatitis, and we must treat and keep for 60 days before moving him to the drug center clinic or the drug outpatient clinic. On those who come only for drug addiction, and that is the only medical problem, we are estimating the cost of inpatient/outpatient visits, on an annual basis, to be about $2,500 per year.

Senator HUGHES. I believe you all read General Tate's estimate yesterday in the paper, in which he estimated that probably 10 percent of the men in Vietnam were dependent on heroin; 5 percent, according to his estimates, were heavily addicted to heroin. That would mean somewhere in the neighborhood of 15,000 men in Vietnam, plus the fact your own estimates were somewhere around 50,000-somewhere in the structure of the country, 65,000. If we were to assume that even one-fourth of those men were to come to the VA for treatmen-let us say, 12,000 or 13,000 men-what that $14 million represents is probably $500 or $600 per patient, on that basis. I understand you do not approach it from a standing broad jump. You get fully into a program all at once. I suppose you are going to get into a program where 75 percent of this $14 million will be spent in the last 6 months and 25 percent in the first 6 months-personnel and facilities and everything that you are using.

You do not have to give it to me now, but if you can furnish for the record your best estimates of what you can judge, doctor, whoever is responsible for it, and what the total cost would be on the basis of an appropriation cost coming in for addiction, I think it might be helpful in future funding recommendations.

Mr. JOHNSON. We will do that. I do want to point out that those who are active duty servicemen will be coming to the VA under an arrangement with DOD and they will be reimbursing us, as part of their overall cost which was reflected in the President's message.

(Subsequently the Veterans' Administration submitted the following information):

When the planned 32 units are fully operational, there will be a total of 480 beds (15 beds per unit) at an average annual unit cost of $517,000.

We estimate that the average cost for treatment of each drug dependent veteran or ex-serviceman for the first 3 years will be as follows:

Senator HUGHES. They have estimated a very minimal amount of money. I got their estimates yesterday in a hearing. It did not look like a very adequate amount to me to face the problem.

Mr. JOHNSON. I think I can assure you that if the workload presents itself in the magnitude that you indicate, there will be no problems, insofar as funding is concerned, from either the Executive or the Congress itself.

Senator HUGHES. I assure you there will be no problems in the Senate, and I do not believe in the House. I think whatever you can logically use, we are more than willing to provide, and we are ready to fight for it, if it needs fighting. I do not think it will.

The one thing I do want to bring out at this point is that we are very much determined to maintain the quality, so that we can keep our very limited experience that we have had to this day at that high

success rate.

You estimate a 20 percent fall-out rate for your program. I have never heard anything like this in my life: 80 percent-success in treating heroin addiction.

Mr. JOHNSON. On those that are in the methadone treatment and maintenance program. Again, I want to underscore with you that our experience has been limited. But I think it indicates not only the quality of the personnel, but the quality of the rehabilitation program. Senator HUGHES. I think it also indicates, depending on how you are getting your figures, that you are really not getting those who you are going to be getting in the future.

Dr. Musser, would you care to hazard a guess at some sort of success rate and I realize how dangerous that is.

Dr. MUSSER. I think, over time, if we were fortunate enough to be able to rehabilitate 50 percent of those who apply to our centers for treatment, we would be remarkably fortunate.

Senator HUGHES. That would be a remarkable success, according to the information that I have been able to gather in the last 2 years from all over the country.

Dr. MUSSER. I think we should recognize this rather remarkable experience we have had so far with the dropout rate of only 20 percent is probably due to the fact that the patients who have sought care in our centers have been remarkably well motivated.

Senator HUGHES. What would you say of the cured? That is another hazard.

Dr. MUSSER. I would not talk of cured; I would say a person is rehabilitated.

Senator HUGHES. How do you describe a person who is rehabilitated? Dr. MUSSER. I think he is rehabilitated when he is no longer taking drugs and he is an active, functioning member of society.

Senator HUGHES. You would not expect to use methadone maintenance?

Dr. MUSSER. I would, yes, sir, but I would like to think that as a patient continues he eventually can have his methadone withdrawn, but even then I am not sure you can say he is absolutely cured.

Mr. JOHNSON. I think that there are some possible developments on the horizon that will allow us to move away from methadone, and we will be working with some of those people who are in that field; for example, Dr. Fink, who, I think, is familiar to you as a consultant of ours in New York City, and we will be working with him in the development of some of these other drugs, so that we can separate the terms of drugs.

Senator HUGHES. Antagonist, primarily?

Mr. JOHNSON. Yes.

Senator HUGHES. He is dealing in the magic book area, total, almost instantaneous remission, which is an unknown quantity right now.

Dr. MUSSER. One of our problems right now: We have not yet in our country had experience with large enough groups of veterans or of addicts over a period of time to get any meaningful statistics. There is only one group that has reported on this, and this is Dale Center in New York City. They have been treating addicts with methadone maintenance for some 7 years now and they report 80-percent success rate in terms of restoring these people to active civilian life.

Senator HUGHES. You are also aware of the fact that in the type of men who have been in Vietnam for 1 year, they may have a duration of over 6 months to fix this guy on methadone, when he is a short duration addict. You may have fixed him for life, on the basis of what we know, and some other method might have withdrawn him completely.

Dr. MUSSER. We agree with you. We think that research of this total program is so essential.

Senator HUGHES. You are aware, are you not, Don, that committee figures show that approximately 5,000 drug dependent men who are now eligible for VA treatment were released from Vietnam alone in the period covered on the chart you gave us?

Mr. JOHNSON. I am not aware that you had made the determination. Senator HUGHES. My staff has gone over that on the statistical information of discharge and the reasons. There are approximately 5,000 drug dependent men who are now eligible for VA treatment, now under the President's program, who were released from Vietnam-covering the charts you gave us this morning. In addition to these, there will be those found in the process of identification as they return home who will be assigned to you. I have talked to Jaffe about it twice myself, and I realize the tremendous struggle he is having in gearing up with personnel and everything else. I think it is incumbent upon all of us right now to exhibit some patience rather than have a lot of things going that are not going to work. But we are going to have a tremendous number of men, and I know you want to meet those numbers adequately. I know you think you are presenting a program that will do that adequately on the basis of what is occurring now. I want to ask the chairman if, on the basis of what is happening, in the period of 60 days we could ask these gentlemen to come back for review of what has happened in the first 60 days and what their experience has been. They would probably be much better able at that point to give us all some more realistic estimates of what sort of an influx, identification, and feed-in we are getting in this process. We may all want to revise our approach at that point as to what is happening.

Senator CRANSTON. I would totally agree, and I hope that we can move on legislation to expand the authority.

Before I forget it, Don, do you have copies of these maps that could go in the record? Could you produce them for that purpose, or if you could leave these with us?

Mr. JOHNSON. We will leave these with you, but perhaps our visual aids could do something that would reproduce better. I am not an expert in that field, but we will have our Director of Administrative Services contact Mr. Steinberg-whomever you say-and see what we can get to you.

(The following was subsequently supplied for the record:)

Senator CRANSTON. I would appreciate it if you could do that. On that matter we were discussing in the delay of getting military records, I would like to point out that when it does happen that there is a 6 months' delay, that means that the veteran, who may be found eligible for treatment, has to wait 6 months for treatment before he gets it, which can be a rather tortuous situation.

Mr. JOHNSON. It is, indeed, and this is the problem of the transfer of the military record itself. We have worked diligently with them; in fact, at just another conference at St. Louis within the last 2 weeks. Again, I say we have shown a real improvement. Over 85 percent of those records are very prompt, and things have worked much better in this regard.

I would also say that under the authority that is granted to me for the humanitarian aspect, we can admit Vietnam veterans on an emergency basis pending determination of eligibility.

Senator CRANSTON. You still have the problem of treating people with less than honorable discharges prior to adjudication?

Mr. JOHNSON. Yes. This is why we favor the proposed legislation, to allow treatment for drug abuse regardless of the nature of the discharge.

Senator CRANSTON. My bill, S. 2108, would do this, along with many other things. I want to strongly associate myself with what Harold Hughes said about the methadone treatment. I also have serious reservations about that, if other approaches can be found to work.

Senator HUGHES. I support methadone and methadone withdrawal and methadone maintenance, but I support it on the basis of great exercise of care and judgment. I have heard the testimony from the witnesses you have described, Dr. Musser; they have been quite successful, but I am worried about the short-term basis.

Mr. JOHNSON. This is one of the reasons why we like, in the VA, a hospital stay. It gives us an opportunity to do a much closer screen of the patient and we can use either treatment or psychotherapy rather than maintenance.

Senator HUGHES. If the chairman would yield just for one supplementary question in relation to what he was talking about. A concern came to my mind, as you were questioning here, about the degree of discharge. Is it presumed that a man with an honorable discharge could not have attained his heroin addiction in the service, and therefore would not be eligible for treatment in VA? I am assuming if he was a known heroin addict in the service, he would not have been discharged honorably, would he?

Mr. JOHNSON. I am not sure about that, Senator. I think there have been addicts-maybe not heroin addicts-who have received honorable discharges.

Senator HUGHES. We have heard half a dozen of them testify here in the same way last week that they went through the service on heroin, were discharged honorably, and no one knew they were an addict. You could not prove service-connected disability?

Mr. JOHNSON. No, but we could under the needs test. Most of the addicts are in the needs category, and can seek hospitalization and receive it.

Senator HUGHES. What would that entitle them to outpatient care?