2. Statistical methods are not uniform and we have only limited knowledge of the extent of addiction.

3. Our hospital facilities for addicts are insufficient.

4. There is little coordinated research on the medical aspects although physicians - and experience - underscore the fact that present quick "cures" are not permanent.

5. No broad program exists for treating the addicts. Rather, we release these potentially dangerous persons to circulate among our people under generally illusory supervision.

6. The rate of relapse is high- and virtually all addicts are potential criminals while a great many become criminals and a very high ratio exists between criminality and addiction.

IV-OPPORTUNITIES FOR ACTION

1. Compulsory After-Care: A framework exists within the State upon which we can begin immediately to add the timbers of a realistic post-custodial treatment and supervision program for addicts. This framework is made up of our present parole and probation systems. The details of construction must, of course, be drawn by experts in various related fields.

I would recommend the establishment of compulsory after-care clinics under the over-all control of parole and probation officials.

All addict-criminals released from prison should be required to take prolonged courses of treatment upon a regular schedule at these clinics under penalty of reimprisonment. The treatments would have to be devised by medical experts.

Presumably, at the outset, many of the regimens would be experimental in nature. This would be a public asset rather than a stumbling block to the plan. New ventures in treatment are exactly what is needed since present methods are so patently ineffectual.

Within these clinic laboratories, new progress might be made toward the cure of the unfortunate addicts. At the very least, they would provide a means of keeping a far sharper watch on the "hot" addict than is presently practiced.*

Essential requirements at the present time would be enabling legislation setting up the program within present parole and probation systems; a provision for a medical budget; and finally, necessary parole and probation personnel.

Physically, the clinics could use office space of present parole and probation divisions and medical facilities of State and City hospitals. It is my opinion, moreover, that universities, medical schools and non-profit hospitals in the State could be interested in cooperating in such a program, adding some facilities and personnel of their own.

There is a fund of willingness to support this type of clinic set-up.

Even the highly controversial Howe plan might be tested in such clinics on a tightly supervised scale. The plan, briefly, centers around free or low-cost narcotics to be administered to registered addicts by physicians at such clinics on a tapering-off schedule. A form of this plan was tried in the State of New York after World War I with disastrous results. Its advocates allege the conditions of the plan condemned it to failure. It seems to many the spoon-fed addict would take his public dose and then continue to seek out the peddler for additional narcotics. Canada and other nations have rejected such proposals. But it has received new support in a recent report of the New York Academy of Medicine and perhaps modifications might be tried on a handful of addicts, if we had clinics under a compulsion program.

I have raised the point with a number of officials and hospital authorities and obtained favorable response.

The following is from a letter to me by Chairman Mailler of the State Parole Board reviewing his present problem and commenting on the clinic project I outlined to him:

"It is our concept with selected personnel and limited case loads, the needs of the narcotic parolee related to his employment, social life, emotional life, personality makeup, etc., could be met. It is also conceivable that as a result of such close study of individual cases, the Division of Parole would be in a position to gather information about possible sources of supply and thus work closely with the local and Federal authorities in their efforts to eradicate the narcotic problem. However, we have consistently failed to achieve our objective to secure additional funds for personnel to carry through the plan outlined.

"In many instances, the environment to which a man is paroled is necessarily the same as that which contributed to his commitment to a correctional institution. Because of the availability of drugs, associations, etc., the situation was hopeless from the standpoint of rehabilitation. Return of the offender to the institution was the only solution, when renewal of the habit was revealed.

"With funds to provide for specialized case loads, for their hospitalization apart from a concentration of narcotic addicts, for withdrawal purposes, and for placement of parolees in more suitable environments, we could hope for a decided increase in the number of rehabilitations.

"I realize there is no easy solution to the whole problem, but I feel very strongly that the Division of Parole, from its experience over a period of years, is well equipped to make an objective and realistic approach to the problem through the proposed pilot project, if we could secure the necessary appropriation."

Commissioner of Correction Thomas J. McHugh, in expressing his view to me on the over-all problem, wrote:

"For narcotic users there is a specific need for close supervision and psychiatric treatment while the person is on parole. The craving for drugs and the temptation to return to the habit are negligible as long as the person is confined at a State correctional institution, but the problem becomes acute when the former user goes back to the community, frequently to the same environment and to the same problems and contacts which brought about the addiction in the first place."

Implicit and explicit among all the reactions is the conviction that no after-care program will work unless the addict is compelled

to take the treatment under penalty of confinement. It is for this reason that I advance the idea of testing an after-care clinic program only on such addicts as have been picked up either for violation of the Narcotic Laws or for other violations and have been found to be addicts. The handle for control is already upon these addicts, and we ought to use it.

It is unrealistic to believe that, at the present time, we would be able to move swiftly to set up a compulsion clinic system covering self-committed addicts or those who are revealed through private medical examination. Should the addict-criminal respond to real post-custodial treatment, in these test clinics, public investment in clinics for all could then be considered.

Two other states, to my knowledge, California and New Jersey, are considering legislation which in effect would compel addicts to undergo post-custodial care or treatment. The measures have been eyed askance because the pertinent question - "at what facilities?" - confronts the authorities. The clinic system herein proposed would answer the question for us in the State of New York.

2. State "Watchdog" Agency: Local, State and Federal agencies are involved in the fight against narcotics and the treatment of addicts, yet there is no continued or automatic method of liaison. Statistical procedures are at a great variance; witness the different sets of figures on narcotic arrests available at three levels, all supposedly covering the same subject. Identification and reporting of addicts are far from efficient. The shoplifter may not be discovered to be an addict until sometime after she begins serving a term for stealing. The fact of her addiction may subsequently be overlooked, and she may be released on parole with little concern for her tendency to take drugs.

In addition to the uncertainty about information is the lack of coordinated planning on enforcement, treatment, preventive education or public information.

Private agencies as well as public are touched by the narcotic problem. Welfare groups, religious groups, hospitals and schools must have both a well of counsel and a repository for such information as they might gather.

It is for this reason that I advance the idea of establishing within the State government one agency which would at least have the duty of collating information and maintaining liaison. This may be done by a separate board or commission or by a division authorized by law for that purpose in an existing department. In discussing the problem with the State Department of Mental Hygiene, I received

this statement from Acting Commissioner Arthur W. Pense, M.D., which I recommend to the attention of the Legislature:

"It is our view that narcotic addiction, much like alcoholism, is of major concern to the Departments of Correction, Health, Social Welfare, and Education as well as of some concern to Mental Hygiene. It would therefore seem advisable to administer a state program through some interdepartmental agency. The Mental Health Commission is scheduled to go out of existence in 1956, and it might therefore be best to consider setting up the program under some other interdepartmental organization."

A central agency would have been alert to the resurgent trend of addiction before 1954 ended.

It would have developed pilot programs for testing wherever hospital facilities and medical personnel are available in the State. It would have informed the public that the drug menace was not under the kind of restraint it is now generally believed to be.

3. Inter-State Facilities: While there is a shortage of hospital beds and treatment facilities for addicts in the State of New York, the present costs of construction and the many varied demands upon State funds make it idle to suggest rushing into a building program exclusively for narcotic addicts, ideal as such a program might be.

However, a possibility worth exploring is a facility constructed and supported on a pro-rata basis with other States. No State on the East Coast comes even near the magnitude of New York's experience. Only California, nationally, led New York in the number of persons arrested during 1954 on narcotic charges. Illinois was third.

It is true, nevertheless, that New Jersey, Pennsylvania, Massachusetts and California have their own difficulties finding narcotic treatment facilities, and a joint venture under Inter-State compact might provide an answer - nor is contiguity absolutely vital among the states, parties to such a compact. I recommend that the Legislature give consideration to this possibility.

National Narcotics Conference: No State is an island. Any program developed within New York must fall short of achievement unless eventually it is linked to the programs of other States and the Federal government. The narcotics problem lies athwart the entire nation, and only a national effort will bring it under control.

It is for this reason I propose that New York formally urge the convocation of a full-scale national conference under the auspices of the Federal Departments of Justice and Health.

Primary goal of such a conference would be to reorganize the present disjointed fight against drugs. A full, free and detailed ex

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