able to keep, maintain contact, and deal successfully, apparently successfully, with a number of patients. Now, at the present point in time I cannot tell you how many they have dealt with successfully. They made a study of some 200, and they felt that about 50 percent of those that they were able to contact, and about 19 percent of the 200 at the interval, I think, of a 3-year period, so far as they could determine, I think, were off drugs, so far as they could determine. Sometimes they could not be sure. So I think Chairman KEFAUVER. In fairness, let us get this correctly. They only contacted about 50 percent? Dr. CHAPMAN. They were only able to find 50 percent. Chairman KEFAUVER. And of the 50 percent they found about 19 percent of the total were off drugs? Dr. CHAPMAN. No, sir; 19 percent of the 200. Chairman KEFAUVER. Of the 200? Dr. CHAPMAN. Yes. Chairman KEFAUVER. All right. Mr. MITLER. Now, that is not a maximum security institution at all, is it? Dr. CHAPMAN. No, sir, and it was not meant to be. I think one should, in studying Riverside, look into all of the ramifications of the circumstances of establishing the hospital. J It is stated specifically in the original discussions of proposing the setup, this should not be a matter of a maximum security institution, and should not have a penal atmosphere. It should not be like Lexington. These points are specifically made. The patients should not feel that they are under the kind of penal coercion for this reason: One has to then expect to have a number of things happen in such a place which would not happen in an institution which was more tightly controlled from a security standpoint. Mr. MITLER. There were some mistakes at first, and there were a lot of attacks on Riverside. Dr. CHAPMAN. They were starting from zero. Mr. MITLER. They started from the beginning, but they are developing. Dr. CHAPMAN. That is right. Chairman KEFAUVER. Who pays the cost of this operation? Dr. CHAPMAN. Almost all of it is borne by the city of New York. At the time of my survey-I can give you a breakdown. Chairman KEFAUVER. Partly by contribution by the city and partly by charitable contributions? Dr. CHAPMAN. No, sir; by the State; the State Health Department in its division of chronic diseases, I think it is. Chairman KEFAUVER. That is all right; by the city and by the State. Dr. CHAPMAN. Yes. Chairman KEFAUVER. Let us get on with the rest of your testimony. Mr. MITLER. All right. Now, could you just briefly summarize what your recommendations are with respect to developing a good program in the United States for the treatment of drug addiction? That is a big question, but could you hit the highlights of your recommendations? Chairman KEFAUVER. Before you do that, I would like to get clear Dr. CHAPMAN. Yes, sir. Chairman KEFAUVER. Just what do you do for patients leaving Lexington and Fort Worth? It has been testified here that you give them a railroad ticket back home and $3. Dr. CHAPMAN. Well, it would vary, depending upon whether or not he was a discharged prisoner. If he is a discharged prisoner, I forgot what the going rate is, I think it is somewhere around $25 he is given, and a suit of clothes and his ticket back home. Voluntary patients, if they stay for the complete period of treatment of 412 months, are given a railroad ticket back home, and the funds for subsistence while on the train-I think it is around $3— and if he is in need of suitable clothes to go out and be in society, he is given those clothes, not usually new, usually used clothes. He gets nothing else, and by law he cannot. Now, the patient who leaves against advice gets nothing, not even a railroad ticket. Chairman KEFAUVER. He just leaves and he is on his own? Chairman KEFAUVER. In addition to that is there any effort to have anybody meet him or try to locate a job for the person or are they in contact with the State or social agency to alert them or get their cooperation? Dr. CHAPMAN. Only in the case Chairman KEFAUVER. With this dischargee? Dr. CHAPMAN. Only in the case of prison patients, Federal Prison patients, is there any concerted constant program in that regard. This is required. The average almost all of the voluntary patients leaving the hospital with the advice of the medical staff, those we don't-I did when I was there, I do not think they do now-concern themselves with what happens to them. But for those who stay for the full period of recommended treatment, efforts are made, and I do not know in what percentage of the cases, a very small percentage of the cases, to provide contacts for them in the community, give them the names of the vocational rehabilitation personnel or some social agency that may give them some advice or assistance of that nature. Occasionally, and this is almost rare, letters are actually written to the respective agencies advising of the arrival of such an individual. I do not think it is ever-this would really be rare-happen that an individual is being planned to be met at the train and escorted through the throes of getting adjusted back to his community, except by his family. Chairman KEFAUVER. Please refer to Mr. Mitler's previous question, and go ahead; that is, what do you recommend for a treatment followthrough program that would be most beneficial to the unfortunate addicts. Dr. CHAPMAN. In the broad, in the main, I feel that the circumstances, if I may use that, the circumstances of the operation of this program are the first and most important considerations before we get down to the details, because this affects the actual details. By circumstances, I mean, the legal circumstances of this general program, and I feel for the bulk, for the great bulk, as I said in my letter, of addicts as we know them in the United States today and as we see them and as they pose problems to us and to themselves, there is a need for a kind of involuntary commitment procedure to insure that they receive adequate medical care over a long period of time. Now, I am not specifying the length of time because in the cases of the kind of civil commitment that I have in mind, time is not specified. It is left to the judgment of the medical personnel operating that program. Now, I could go on at length giving you ifs, ands, and buts of such a commitment program. I can give you the highlights of what it should contain. It should contain provisions whereby it would be possible to provide a graded or graduated series of steps in security of the patient in treatment. The maximum of those steps of security would be hospital commitment; the next, perhaps, would be one which was suggested by one of the people here either yesterday or today, the halfway house—I think Dr. Schultz mentioned this place where they could go as an intermediate point where they could work from, so to speak, and they would be there 12 hours a day, 16 hours a day, and the other 8 they would be out working somewhere; or, there might be circumstances in which you might wish to provide this general program of treatment out of an outpatient service clinic or something like that or even a doctor's office. But there ought to be a provision for a graduation of kinds of treatment determined occording to the individual needs of the patient. Now, in the United States I feel under the presentday situation most of the addicts would require at least for some part of their program the maximum kind of security in their treatment such as could be supplied at Lexington or any hospital of a similar nature, or at Riverside, a place where they can be kept free from drugs and can be withdrawn and given adequate medical care and treatment. Then I feel they should be followed within the framework of this commitment procedure the same as you would follow a mental patient who is discharged from a psychiatric, any psychiatric, hospital, into the community where he is paroled, if you will, by the director of the hospital to the community, to the aegis of an agency or an individual such as a mental health clinic or something of that nature, with the understanding that he be under their specific control, and receive the kind of treatment and guidance that is needed. He would be sent to vocational rehabilitation; he would be sent to a job program; he would be given family advice and guidance, and so forth, all of the things we now provide in our best organized communities for the care and treatment of our mentally ill discharged patients. If at any time it became apparent to the local supervisory person that he was in immediate need of further treatment, he could be returned to the next higher step or to the institutions for further treatment. This might be in the case of anticipated failure, it might be in the actual case of failure in treatment. Hopefully, it would be before failure occurred. To revert back to Riverside, they are gaining experience and, perhaps, almost predicting "Next week this guy is going to fall off the wagon," and at that point to suddenly say, "This is the end; you need to go back for more closely supervised treatment." This should be over a period of years, again to be determined by the medical staff involved. I think in broad and in general that would provide the best answers we know at this time for dealing with this kind of drug addict in the main that we are dealing with in the present day. Mr. MITLER. You have here your report on Riverside? Dr. CHAPMAN. Yes. Would you like to have a copy of that for the record? Mr. MITLER. Yes. Chairman KEFAUVER. We will just make this an exhibit without being printed in the record. (The document referred to was received as exhibit 12, and is on file with the subcommittee.) Mr. MITLER. You have touched the highlights of the program, Dr. Chapman? Dr. CHAPMAN. Yes; I think in the main I have. Mr. MITLER. I have no further questions. Chairman KEFAUVER. Dr. Chapman, the Public Health Service in the various States, of course, contributed to by the Federal Government, could they not be used substantially in connection with this followthrough treatment? Dr. CHAPMAN. Yes; they could, Senator, if-and the "if" is a mechanism, and the machinery would do it. It may be of interest to you to know that we are in the process of, at the current moment, laying the groundwork for the kind of a followup demonstration community program, demonstration followup community program, which we feel should be developed all around the country, in New York City. We have a very small staff, and, incidentally, I want to emphasize that point-this is one of the keynotes, just as Dr. Lowry emphasized yesterday, in thinking of any program, and that is getting the personnel to operate it. We are starting with a very small staff in New York City right after the first of the year in working through the problems connected with the operation of such a followup aftercare program. They are many. We are very reluctant and very hesitant to plunge into a program just because it is good. We want to work solidly; we want to build solidly, so that we can go back 1 year or 5 years from now, and when you ask, "What are the results?" we can give them to you unequivocally without saying, "We ran through a hundred thousand, and we don't know what happened," which is the kind of thing that happens too many times, and for that reason we want to build it solidly. We want to have a good records system; we want to have good contacts in the community; we want to have adequate built-in controls so that we can run research out of this and find out what we have been doing, and change the methods and techniques of treatment so that we can really make it a good sound demonstration. This takes time and people to get the right kind of people to operate it. We do not lack in money; we lack in people, and I think that we can enlist and recruit people, and gardually as we build and develop something which we can put before the country and say, "This is the kind of program which should be used," within the modifications, of course, of what the local community needs. Now, mind you, and this is going to be just about a half of what I would like to see ultimately, because as yet we do not have these laws, the legal circumstances of treatment which would make it possible for a more adequate followup. We have no commitment procedures that authorize us to involuntarily, as far as the patient is concerned, follow him and see what happens to him, whether he moves from 42d Street to 33d Street. We have no way of doing that. We have to depend upon his cooperation to do this, and until such a time as we do have techniques of legal controls over these individuals, by whatever method, we are going to be faced with the continuing problem of operating so that we can get their assistance. I might say that, of course, with the Federal probationers we will have no difficulty during the length of time of their Federal probation. But again, it is a sentence. The average Federal prisoner gets out and has a third of his sentence, which gives 1, 2, 3 years, perhaps; no more. We work very closely with the probation officers in this regard, but for the voluntary patients it is going to be just that question, Is he going to cooperate with us? I might say in passing we have been sort of counting noses on Lexington discharges in New York City for the past 3 or 4 years, and have been surprise at the cooperation we have gotten from the patients in letting them be counted. We have been able to contact, I think, some 90 percent of the patients, at least one time, since their discharge which, much to our surprise, we thought they would disappear. Mr. MITLER. Just one question: To wrap three questions up in one, I have asked you before about why couldn't they have a facility on the west coast, and why couldn't they segregate 17- and 18-year-olds from the prisoners; why couldn't they segregate the volunteers from the prisoners; that all comes back, then, to the question of staff? Dr. CHAPMAN. No; not entirely, Mr. Mitler. The west coast-well, even if I had people I would hesitate moving into a program on the west coast until we have gone through the mill, the same kind of problems they went through in Riverside; we are going to have to go through that in a different way with this, even if I had the people, which I haven't. This other question, the matter of mixing volunteers and juveniles with so-called hardened criminals, you remember Dr. Lowry's figures yesterday Mr. MITLER. They were small. Dr. CHAPMAN. The number of people who make up 25 percent of the admissions are only 3 percent of the people that have ever been in the hospital. So at any one time there are not many of these recidivistic hardened criminals at the hospital. As a matter of fact, 50 percent of the admissions have been-I do not know what it is today |