the basis of direct arrest or on the basis of a special, new, legal provision for voluntary self-commitment, individuals would be placed in the situation of being compelled to continue the treatment supervision. From a psychological viewpoint it was felt wise to refer to the followup outpatient treatment not as probation but as treatment supervision. In both the initial as well as the outpatient phase of addict management, the time element purposely is left indeterminate. The suggestion is made for the consideration of a new kind of approach, namely, the formation of a disposition tribunal-a group of individuals experienced broadly in the field of human relations who would act as the ones to evaluate the disposition of cases, would determine how long a person should remain in an institution for the initial phase, would regulate the time the patient should be kept in outpatient treatment and control. In association with the element of outpatient treatment there is one recent development in the field of pharmacology which can be of enormous help in getting around a great problem in the procedure of diagnosis of narcotic addiction. Thus far physical examination of the patient for evidence of needle injection or the restraint of the individual for 24 to 48 hours for the production of withdrawal symptoms have been the only techniques available for diagnosis. At the present time, however, there is in existence a drug called Nalline which within a matter of minutes can produce withdrawal reactions within an individual who is addicted. This could be a very potent instrument in the outpatient clinic because it is an objective technique for determining whether an individual who is in outpatient treatment has returned to the use of narcotics. If the Nalline showed that the individual had withdrawal reactions and that he once more was addicted, the disposition tribunal would have the privilege of determining what might be done with him and he might then be returned to the primary institution. There probably would be individuals who would go through this procedure 2, 3, or 4 times. When direct evidence of that would be gathered, the issue that would arise at that time then would be, "Is this a person who can be helped?" or "Is he an individual who might be characterized as incurable?" This issue of what to do with the incurable individual provoked some degree of dispute in the subcommittee since one group felt that individuals of this sort should in some sense be certified or registered and then through some governmental agency be given narcotic drugs in a regulated manner so as to remove the addicts as a potential market for criminally or illegally secured narcotics. Because of the subcommittee's disagreement on this particular point it was finally resolved that instead of committing itself to a definite recommendation we would be able within a year or two after the institution of the overall management program to have gained direct experience as to whether the residue of incurables would be around 5 percent or 95 percent. At that time, when the problem could be a more direct and concrete one, the issue of certification or registration could be considered more realistically. In association with the problem of marihuana and barbiturate addiction, the former could be integrated into the outpatient treatment program since there are no withdrawal reactions associated with marihuana, while barbiturate addicts who showed withdrawal reactions to barbitals could go through the same procedure as the regular narcotic addicts. Several members expressed the particular opinion that any kind of a program of this sort will inevitably cost a certain amount of money, but that if research were instituted to show how much could be saved by not having the individuals brought up for trial, imprisoned, and their families in a variety of ways affected, the cost actually would be no more than at the present time. CHAPTER VII. REPORT ON PREVENTION The most serious aspect of the increase in the use of narcotic drugs is the reported number of young persons involved. Consequently this chapter is concerned principally with our youth. The data presented to the committee failed to substantiate the somewhat sensationalized statements reported in certain areas to the effect that there has been a marked increase in the number of juveniles who are using narcotics (see appendix for arrest data). The effects of narcotics is so ravaging, however, that even if we had only a few youthful addicts, steps must be taken to stamp out the menace. Law enforcement alone cannot accomplish this. Drug addiction has two main factors, availability of the drugs and predisposition to addiction. Law enforcement can control the first but not the second. Prevention must include education and understanding of the causation of addiction. Education The education code of California states: "SECTION 8253. Instruction shall be given in all grades of schools and in all classes during the entire school course, in manners and morals, and upon the nature of alcohol and narcotics and their effect upon the human system as determined by science." "SECTION 20456. In all teachers' training classes in the State colleges, adequate time and attention shall be given to instruction in the best methods in teaching the nature of alcohol and narcotics and their effect upon the human system." The reported increase in the number of youthful addicts in the last few years has realerted many school systems in the State to the importance of these sections, with the result that they have reevaluated and revised their curriculum material. Most schools incorporate this teaching in health, physical education, science, senior problems, social science and/or family life classes. Narcotics should not be dramatized nor “glamorized" by special assemblies. The committee feels that the revised curriculum material is good but we recommend that the State board of education urge all school systems in the State to see that sections 8253 and 20456 of the education code are constantly carried out. It is not only youth, however, who must be taught about the effects of narcotics. There is need for education of parents, teachers, law-enforcement officers, and other community youth leaders. In considering the problem of narcotics the importance of marihuana should not be minimized. The consensus of doctors is that marihuana causes a mental habituation without the physical dependency brought about by the overuse of opiates; it leads to a breakdown in the fundamental social and moral principles and the transfer to heroin is easy. This is its chief danger, particularly to our youth. Only those persons become addicts who have addictive personalities, the addiction having developed from some basic emotional maladjustment or insecurity. Narcotic addiction, representing one form of antisocial behavior, centers primarily in urban communities which previously have had a high delinquency record, but addicts are found in all economic brackets of society. Drug addiction is a result of human weakness, and may result from cultural conflicts, family tensions, insecurity, lack of parental training, or personality maladjustment. While it is true that the narcotic habit is adopted by some adolescents who are looking for a thrill, the majority of juvenile users of narcotics are those who have somehow missed the satisfactions of normal social life and work, youngsters from slum areas, or from inadequate homes, or from communities which provide no wholesome youth activities or interests. The committee believes that consideration should be given to a new type of counseling agency for young people intended to serve individuals who have already violated the criminal law by experimentation with narcotics. There are unfortunately very few places where such a person may now go to, should he become concerned about the drugs he has been offered or has already taken or has seen his friends use, the exceptions being that the department of mental hygiene maintains mental outpatient clinics in Berkeley, Fresno, Long Beach, Los Angeles, Marysville, Riverside, San Francisco, and San Diego, and in connection with some of the State hospitals they are developing some degree of outpatient clinic work. Unfortunately these are so overcrowded that they cannot meet the demands for service with the present complement of personnel. You must also have a community environment which satisfies their needs for normal, wholesale social and work experiences. It will take large sums of money to equip a community with adequate recreational, welfare, and cultural services, but the providing of these resources will not in the long run be so costly as the present staggering sums spent on law enforcement and judicial agencies, prisons, and mental hospitals. Our concept in law enforcement has rightfully changed from punishment of the offender to treatment of the offender, for we believe that treatment is less wasteful than punishment, but even treatment is inferior to prevention. CHAPTER VIII. PENALTIES The consensus of experts heard was almost unanimous that the punitive approach to the narcotic problem has been a failure. Case histories studied, together with the recidivist records of convicted addicts who have served sentences for addiction, show that very few remain free of addiction for any ap preciable period of time following release from incarceration. Commissioner Anslinger and other Federal narcotic officers point out with some degree of force that whenever and wherever the penalties become more severe and more strictly enforced the incidence of addiction in that area decreases proportionally. There is no evidence, however, that these addicts were cured or diminished their intake of narcotics. On the contrary it would appear that the addict merely moved to another climate. Insofar as the basic problem of addiction is concerned it would appear that stiffer penalties merely result in brushing the problem under the carpet; the problem remains in spite of our complacency in wearing blinders. On the State level, the philosophy toward penalties may be summed up in the statement that "It is not the severity of punishment that acts as a deterrent to crime but rather, the certainty of punishment." This statement was voiced by such experts as Austin MacCormick, Walter Creighton, George Maloney, A. V. Beckner, Orville Hawkins, John Misterly and others. While the experts and the committee abhor the purely commercial peddler of narcotics, on the other hand they recognize that the great majority of addicts and a large percentage of addict-peddlers should be regarded as mental-health problems and that penalties meted out to these two groups should be on a mental-health approach. The records are replete with case histories of addicts who might have been helped medically had they received treatment during the early stages of their addiction. Almost every addict interviewed revealed that his first commitments to city or county jails had no beneficial effect on him but instead merely served to introduce him to other addicts and peddlers who were likewise serving sentences. Through mutual exchange of experiences among these addicts and peddlers they became further indoctrinated in the use, source of supply, names of users and peddlers throughout the State. This information was used by them in the furtherance of their addiction upon release. The studies of the committee brought into focus the realization that its studies on penalties should be considered in three separate phases: 1. The addict. 2. The addict who peddles to support himself. 3. The professional nonaddict peddler. It was agreed that the addict who has found that he is addicted should be able to surrender himself to a proper institution and admit his addiction without the necessity of being charged with a felony for which he may be incarcerated. Such person should be able to voluntarily surrender to any superior court by petition and may, without arrest, appear in court and upon determination that he is an addict, the court shall place such person on probation and as a condition thereof shall send such person to a State medical institution for care and treatment. Through the courtesy and cooperation of Mr. Ronald H. Beattie, chief of the Bureau of Criminal Statistics, Department of Justice, State of California, the following data is submitted: Comparative figures of the United States district courts in California and the superior courts of this State, showing the disposition of narcotic cases together with the sentences imposed on those convicted for the fiscal years 1952 and 1953. It is interesting to note that over 92 percent of all the prosecutions in the State of California for narcotic felonies occurred in the State courts. The fact that most of the prosecutions occurred as a result of enforcement activities by State and local agencies, and that many cases involving Federal enforcement activities 86525-57- -3 are turned over to State courts illustrates the need for wider sentencing discretion on the part of the State courts as compared with the Federal courts to take care of a relatively large number of minor violations. The legislature gave further recognition to this need in its action last year by returning to the State courts the judicial discretion to use probation in cases of first narcotic offenders. This change became effective in September 1953, and accounts for the greater use of probation shown in 1953 in the above figures relating to California superior court sentences. The following table shows sentences set for narcotic cases by the Federal courts throughout the United States, and sentences set by the Federal district courts in California, as compared with the sentences set by the California State Adult Authority in narcotic cases committed to prison. In studying these comparative figures it should be remembered that the adult authority in these cases does not generally hear and set sentences until after the prisoner has been incarcerated and has been in prison for approximately 1 year. Consequently those of the sentences referred to in the following table, as set by the adult authority in 1953, involve defendants who had been committed under legislation passed in 1953 which extended the penalties for narcotic addiction. It is interesting to note that the California Federal sentences in 1953 were less in narcotics cases than they were in 1952, and that despite the fact that the State sentences set in 1953 involve persons committed before the 1953 changes in the California law, the State average sentence in 1953 of 53.8 months is 56 percent greater than the average Federal sentence of 34.4 months set in 1953. It would seem to be apparent from these facts that State and local operations account for over nine-tenths of the enforcement activities in the narcotics field, and that the State penalties invoked for those sentenced to prison are at present more than one and one-half times as great as the Federal imprisonment penalties. Supply CHAPTER IX. RECOMMENDATIONS 1. That in view of the critical lack of adequate enforcement personnel in all Federal agencies that deal with traffic in narcotics for the proper investigation and inspection of persons, vehicles, ships, and aircraft coming into the United States from other countries, and the lack of funds to support proper investigation and undercover work in foreign countries, Congress be strongly urged to increase appropriations for these purposes to a level more nearly consistent with the enormity of the problem and the menace to the public welfare which it represents. 2. That a new Federal agency or bureau, with adequate enforcement personnel, be created to deal specifically with the problem of preventing the smuggling of narcotics across our border, and that the Customs Bureau be relieved from primary responsibility for this function; consideration should obviously be given to the feasibility of authorizing the Federal Bureau of Narcotes to exercise the function suggested for the new agency or bureau. 3. That a central clearinghouse, through which all information of value to narcotic-law enforcement officials on the local, State, and Federal level can be channeled, be created jointly by the Federal Government and by the several States. 4. That the armed services be urged to set up special narcotics control units to protect our overseas military personnel against the danger of becoming addicted in countries where narcotics are readily available, and to prevent the smuggling of narcotics into this country by returning military personnel. 5. That the attorney general of the State of California address to the Secretary of the Treasury of the United States a resolution expressing the deep concern which the members of the attorney general's committee feel, and which is shared by all informed and public-spirited citizens, that the personnel of the Customs Bureau are so inadequate in numbers that it is impossible for them to prevent the entrance into this country of more than a small percentage of the huge quantities of narcotics smuggled over our borders by land, sea, and air. The resolutin should make it clear that the committee recognizes the enormity of the problem, but believes that a wealthy and powerful Nation such as ours must staff its protective forces more adequately than we are now doing, and that the reductions recently made in the appropriations for the Customs Bureau are indefensible. The Secretary of the Treasury should be urged to bring this resolution to the attention of the Director of the Budget and appropriate congressional committees. It is recommended that a similar resolution with reference to the Federal Bureau of Narcotics be addressed to the Secretary of the Treasury, and that it refer to internal law enforcement as well as to the international traffic. Enforcement 6. That the Federal Government increase the appropriation for the pay, training, and staffing of its narcotic enforcement agency. 7. That the appropriations available to the attorney general of the State of California for the operation of this bureau of narcotic enforcement be increased to the same end. 8. That provision be made for the regular conduct of in-service training schools conducted under the supervision of appropriately trained Federal and State narcotic officers for the more thorough indoctrination of local police and deputy sheriffs. Treatment 9. Upon a medical determination that a person is an addict, he shall be institutionalized for a period of at least 90 days, during which time the patient will be withdrawn from narcotics and exposed to an overall educational and psychiatric program. 10. On release from this institutional treatment, the patient will be assisted by outpatient supervision. Here the patient will receive benefit of all reasonable conceivable therapy. It will include phychological, sociological, economic, cultural, and other elements in an effort to determine the narcotic-proneness of the individual. 11. Treatment should be on either a voluntary self-commitment basis or involuntary. The patient must be required legally to continue the treatment supervision in the outpatient clinic. This phase shall be known as treatment supervision. 12. It is recommended that a disposition board be established consisting of individuals experienced in the field of human relations who shall evaluate the disposition of cases and the duration of treatment and control. 13. If during outpatient treatment it is ascertained by administration of Nalline or other means that the patient is again using narcotics as indicated by his withdrawal symptoms, then the disposition board would have the responsibility of determining the further disposition of the case. 14. Should the disposition board conclude, after repeated failures, that the patient is incurable, he might then be certified or registered so that thereafter he shall receive indicated dosages of narcotic drugs from a determined governmental agency and thereby remove said addict as a potential market for criminally or illegally secured narcotics. The establishment of this phase of the program should be deferred until 2 years after the institution of the overall management program. 15. Barbiturate and marihuana addicts should be integrated into the outpatient-treatment program. Barbiturate addicts evidencing withdrawal reactions could be subjected to the same procedure as the regular narcotic addicts. Prevention 16. It is recommended that greater emphasis be placed in all schools on the importance of moral and spiritual influences. |