STATEMENT OF ALFRED FREEDMAN, M.D., CHAIRMAN, DEPARTMENT OF PSYCHIATRY, NEW YORK MEDICAL COLLEGE, NEW YORK, N.Y.

Dr. FREEDMAN. Thank you, Senator Hughes.

I am very grateful for the opportunity to be here to discuss your very important legislation. I shall make some brief remarks. I think if there had been more time I might have emphasized some further points.

However, I think there are some compelling experiences and observations that I would like to share with you.

During the past 10 years I have been actively engaged in the field of drug abuse in the areas of treatment, preventing, teaching, and research.

Our program has involved a wide sector of the population and a great variety of projects. Our experience includes the rich and poor, urban and suburban, the young and the middle-aged, so-called hard drugs and soft drugs, biological and sociological studies, prevention in the schools and treatment in neighborhood agencies in East Harlem. During these past 10 years several factors have been outstanding to me and if I may I will call them the "Seven Pillars of Wisdom":

(1) The harsh laws characteristic of the law enforcement approach do not serve as a deterrent to the expansion and proliferation of drug abuse.

The past decade has seen the use of marihuana escalate, current estimates range from 10 to 20 million. Younger and younger children are experimenting with all substances, including heroin.

(2) The consequences of this approach may ultimately be as serious as the drug abuse itself. The widespread use of some substances such as marihuana by youngsters in some schools more than 50 percent are by children who are otherwise conventional. To define nondeviant use as criminal is a grave mistake.

It may turn out to be a self-fulfilling prophecy; by defining youngsters as criminals many may become criminal.

Young people thus tagged may find their future careers impaired beyond recall. Much of the enforcement approach has contributed to a loss of respect for laws, authority, and adults in general.

Grouping heroin and marihuana in the same category and statements not based upon fact in regard to marihuana have led to a belief of many youngsters that since they lie to us about marihuana, they are probably doing the same about heroin.

(3) The past decade has seen significant advances in the knowledge concerning drug use. These advances should be encouraged. Legislation such as S. 3246 which clearly will inhibit progress, should be rejected.

Ten years ago, very few scientists or physicians were encouraged to work in the field of drug use. It was neither popular nor respectable, and those of us engaged in it, were considered strange, exotic and isolated from the mainstream. We are now seeing more and more individuals recruited to treatment, taking part in the collection of data, the development of methadone maintenance and opiate antagonists, and the isolation of the active ingredient of marihuana, tetrahydrocannabinol.

The opportunity for research has enabled us to look forward to the development of new agents that will be helpful in our program. It now appears quite feasible to develop a long-acting opiate antagonist that can be of value in the treatment of heroin addiction for weeks or months through one injection.

Such innovations will require further research and continuing support in a variety of fields such as pharmacology, biochemistry, epidemiology, as well as in the social aspects of the addictions.

The National Institute of Mental Health, at the present time, is unable to support a significant number of projects that have high priority. It is regrettable but must be faced that the field of drug abuse, like alcoholism, has been bypassed while the treatment of other disorders has benefited from technical advances and spectacular achievements of the past decade.

(4) A necessary prerequisite for continuing present work, as well ast introducing new developments, is an unfettered climate. Senior researchers have been harassed. There are tedious application forms, multiple agencies, various types of licensure necessary to pursue, for example, marihuana research. It took us over a year and pounds of documents before we obtained permission and supplies to carry on marihuana research. Compared to what may be expected under the proposed new legislation, S. 3246, these hazards will appear ridiculously simple.

I am certain that many now working in the field will become discouraged by new restriction and will turn to other areas. Research will only flourish when there is great encouragement and a free ambiance so that scientists may work with each other and evaluate each other's work without restrictions.

(5) There are no quick answers and easy methods of treatment applicable to all. There is room for a variety of approaches and the involvement of a variety of institutions, agencies, professionals and nonprofessionals. It is important that a variety of programs be set up to try different methods of treating drug abusers.

Treatment should vary with type of drug and the population to be served. The aim must always be to develop a treatment suited for a particular individual. Obviously, treatment should differ for a 16-yearold and a 36-year-old, for a methedrine user, an LSD user, a heroin user, or a multiple-drug user. Modalites of treatment should include outpatient treatment or residential treatment, individual or group therapy, and community organization.

An institution may be specially interested in pursuing certain techniques of intervention. For example, at the New York Medical College we have been especially interested in setting up programs in schools and agencies of the community we serve from our community mental health center, the ideal place from which to carry on such work. This gives us the opportunity to work not only with individuals, families, and groups, but also with the important institutions of society. All treatment programs must be tied in with evaluation.

The importance of evaluation research in determining the effectiveness of any treatment effort cannot be overestimated. It must be part of the design of any such effort from the beginning. Evaluation research is necessary so that the results of various treatment efforts may be compared.

(6) The steady recruitment of younger and younger individuals to drug use makes mandatory development of programs of prevention. Our treatment programs are limited while we are being inundated by new users. The more we learn about how drug abuse develops, what drugs are abused, the better we will be able to set up treatment programs for those who are already involved and prevention programs for the young who are not yet involved with drugs. It is necessary to develop modes of persuasion against involvement in the drug world. Many of us at the present time believe that the most effective form of prevention is through a program of drug education in the schools. The objectives of such education are to effect changes in knowledge about drugs, in attitudes toward drugs, and in drug-using behavior.

Our community mental health center has developed programs of sending teams into various schools to give factual information to students and to faculty. However, the trust is toward developing facultystudent seminars. In this way interchange takes place under the guidance of the staff member so that communication is established, information gained, and attitudes changed.

It is noteworthy that where such engagement between student and faculty takes place, more and more of the discussion moves away from pharmacological facts about drugs toward questions concerning the morality and social values that surround drug use.

(7) One must not forget the setting and the society in which drugs are being taken. There is a reason for the widespread use and expansion of use of drugs. It is at these broader issues that we must also aim. We live in a drug-oriented society. Television commercials urge us to seek surcease from the trials of the day and the restlessness of the night through handy pills obtainable at the corner drugstore, without prescription. New drugs more powerful in their action with widespread effects upon the brain are being developed constantly. The possibility of drugs being developed that will improve memory, accelerate learning, produce forgetfulness, are in the offing. We will have to learn how to live with some drugs and prevent the use of others on some rational basis as society condemns the use of some and condones others.

On the basis of these seven observations, it is clear there is need to coalesce our efforts in regard to substance abuse. We need comprehensive programs under health auspices for treatment, rehabilitation, research, and prevention. As has been emphasized, the future in regard to drug use appears uncertain. We need middle-range plans so that results can be fed back immediately and applied or used to modify existing plans. The complex issues involved must be recognized and the wide range of concerns in regard to drug abuse must be remembered.

S. 3562 is commendable in providing such a comprehensive Federal program. Its constant referral to the need for prevention and rehabilitation is important during this period of search for a gimmick that will cure all.

Inclusion of drug abuse and drug dependence under health and disability insurance, as well as regarding drug dependence among military personnel as a physical disability, are illustrative of enlightened approaches to the problem of drug abuse.

Inclusion of the community mental health centers is of prime importance. I do not feel that providing grants of 90 percent with reduc

tion after 2 years will insure widespread response to such a program. I have been impressed with the expertise and commitment of the National Institute of Mental Health in the area of drug abuse, and would urge strongly that NIMH be legislated a prominent role in this endeavor. Since the civil-commitment sections of the law are not being considered, I will not comment except for one observation. Civil commitment provides an excellent alternative for drug abusers who are involved in serious misdemeanors or criminal action in regard to those involved in possession and use by setting up jails and calling them hospitals and rehabilitation centers.

It is of prime importance that the role of law enforcement be restricted to law enforcement, and that the areas of treatment, prevention, teaching, and research be assigned to those appropriate for these tasks; namely, those involved in health, education, and welfare.

In these brief remarks, I have been able to touch on only a few of the pressing issues of this critical field. In my statement for the record, I shall enlarge upon these bare observations.

In closing, I would like to emphasize two things. One, the study of recruitment of young people to the drug world, accompanied by a rejection of the perturbations of these young people, will result in the loss of this generation to society. The generation gap has narrowed to about 2 years, and the younger children in the sixth and seventh grades are displaying more daring behavior than the eighth and ninth graders.

I am appalled by the consequences of S. 3246, which can be catastrophic. My colleagues have reviewed issues concerning this bill with this group, I am sure. I would like to add my voice to the growing voice of opposition. Its passage would be an error, and its results would set us back decades.

Senator HUGHES. Dr. Freeman, I thank you kindly, and I would welcome your filing with the committee any recommendations you have for improvement in this piece of legislation as you have more time to review it, so that we can consider those when we get to a markup session of the bill.

The bill, as you can undoubtedly see, had hundreds of man-hours put in on it. In trying to cover everything comprehensively, we do need the advice and expertise of those to help after we have this measure put together.

I would like to ask you a few basic questions, also. Do you believe that television can play an effective role in an antidrug campaign, one way or another?

Dr. FREEDMAN. I think it can have a useful aspect both in encouragement and discouragement, in the sense that we can deliver certain messages that would discourage the use-promiscuous use of drugs, or educate youngsters, particularly on the realities of what drugs are, who uses them, and why.

It also can, by implication, indirectly develop both positive and negative images, in the sense that in the ghetto, for example, and in many neighborhoods, it is the drug user and pusher who has a big car, who may be the model, while the fellow who has a job pushing a cart is considered disparagingly.

So that, if you can develop the notion of affirmative models for nondrug users, I think that can also be useful.

There are interesting questions concerning the possibility of using such devices and trying to evaluate them that we have been concerned with. For example, the use of split-cable techniques, in which you can deliver different messages to similar populations, and then compare them, I think that would give us some idea of the effectiveness of such

programs.

However, I do feel that we have to spread our net far, and try a variety of techniques ranging from television, radio, and other

messages.

What we have been impressed with is the necessity of making very direct contact and opening up communication for youngsters with individuals in the adult world. If you talk to high school students, they will very often tell you that they were worried; for example, some of their friends were asking them to experiment, and maybe they tried. and they want to speak to someone, and they choose a teacher.

Very often the response will be, "Don't tell me about it," or the other one will be "I don't know what you are talking about," or they may receive a long lecture that the student knows clearly is distorted. Even trying to hint; for example, we have tried the experiment of a student writing a theme or a poem describing their perturbations under the influence of drugs, trying to get a response from the teacher, and the response would be, "The grammar is very poor; your spelling is terrible."

That is why it is important to try to open up the channels between teachers and students, and that teams do try to work with the teachers in education and then with students, and then set up seminars together with them in order to do that.

I would say that we have to use all these procedures. I have in my presentation emphasized the schools because I think they are a central socializing institution. Almost all we have in ghetto areas are the schools, and certainly in the suburban areas they are the focus. Most of our suburban communities have nothing else. There are practically no stores and you can't get around unless you have a car.

So, I think there is great emphasis there.

Senator HUGHES. What grade level do you think we need to try to reach?

Dr. FREEDMAN. I think at the present time we have to start reaching kids around the fourth and fifth grades. Each year we see a dropping in the age of initiation, so that whereas a couple of years ago I spoke of the eighth grade, now I think we have to get down to the fifth- or sixth-grade level.

Senator HUGHES. The changing drug scene has to be continuous, doesn't it, throughout the educational process?

Dr. FREEDMAN. Yes; that is why I like to emphasize the middle-range plan. I think we get polarized, and someone talks about an immediate program, or long-range planning. I think what we need are middlerange plans, talking in terms of a year or two, with a very rapid feedback of evaluation, so that we can modify in the sense that we modify the path of a rocket to the moon.

You get it started, and then you find it is a little off course and you modify it, and a little later you modify it again, or it may be necessary to abort the trip.