couple of weeks and then he goes to an orientation ward. While he is there if he stays in the hospital, he is interviewed by a psychiatric social worker, vocational rehabilitation officer, and a psychiatrist, and then a report is compiled on this patient and the psychiatrist, the administrative physician discusses this with the senior psychiatrist and the treatment program for that patient is discussed and the patient is brought in and his program outlined for him.

This program will vary from one patient to another. It depends on a number of factors. The motivation of the ptiaent, the staff available, the treatment facilities available, but the patient may be offered individual psychotherapy, group psychotherapy. He is also given vocational therapy and social casework is done. With some it is more and with some it is less. I think it is only fair to point out to you that what I said this morning, we had 1,178 patients in the hospital, but 125 of those are nonaddicts, psychotic patients, and that leaves about 1,050 patients.

We have a limited staff. With physicians, we have a limited staff of social workers and psychologists, and I think if every physician on the staff worked 50 hours a week and spent all of his time working with patients that he would be able to devote-each patient would get less than 1 hour per week.

When I say physicians, I include all of them in the hospital, even those that devote all their time to the medical and surgical services. Mr. MITLER. Dr. Lowry, you do have some of the 18- and 19-yearold group at the hospital.

Dr. LowRY. Yes; we have 18 years old, 19 and 20.

Mr. MITLER. What is your opinion about the feasibility, the problem of having those youngsters who are volunteers in the same group and commingling with some older Federal narcotic prisoners?

Do you think that is any kind of a problem?

Dr. LowRY. I think there are advantages and disadvantages to this situation. If you ask whether it would be practical to separate them I would have to say no. If you only admit 25 such persons a year at any one time there wouldn't be more than 10 in the hospital. As I pointed out earlier today to someone we have more physicians in the hospital than we have juvenile addicts in the hospital. From a practical standpoint this could not be done. I will say this, the 18-, 19-, and 20-year-old addict is a much more difficult patient to handle than an older person. We know what the normal adolescent is like. We have lived through it ourselves, and we have had children. They are in a difficult period, and added onto that they are disturbed people. I think while we often think of what happens to the younger person, I think we should not forget the impact of these younger people in their behavior on the older person in the hospital.

Mr. MITLER. Do you think that some of the volunteers who might potentially or some people who might be addicts who might want to come as volunteers would be reluctant to go because they might be apprehensive of being commingled with Federal prisoners?

Dr. LowRY. I think this might be a problem with some people. However, I think it might be worth pointing out, each year we admit 2,500 voluntary patients and 500 prisoners, and it certainly has not deterred the 2,500 from coming in.

Mr. MITLER. Could you tell us about the question of the followup or aftercare program what your opinion is of the existing facilities on that score?

Dr. LOWRY. I can tell you what we do.

Our vocational training and our social work services and our physicians attempt to help the patient develop a posthospital plan. We have no facilities and no authority to work with the patient after they leave the hospital. They are in a sense temporary residents with us. They come from a community, they stay with us and they go back to a community. We try and prepare them for going back to the community. We correspond with employment agencies, we try to get them a place to live, and we can do this with the Federal prisoners through the probation officers, but I think this is one of the areas where we are unable to do as much as should be done.

Frankly, there is a provision in the law that says that the record of voluntary patients is confidential, and shall not be divulged. We do divulge their presence in the hospital if they will sign a request that we correspond with persons in order to be of help to them. We do this and we try and work out a plan for every patient that we can.

Mr. MITLER. Dr. Lowry, do you have available, is there any study of fitness to indicate the degree of success at Lexington that they have had with respect to the patients.

Dr. LowRY. I can tell you that there is a study that has been made on the followup patients that left Lexington. I heard someone say this morning that some percentage of patients did or did not relapse from the use of narcotics drugs. I would like to know what the basis is for those figures. I don't know of any such figures. Pescor made a study back in 1935 and his results have been published. Let me see here, he studies 4,766 patients who were discharged from 1936 to 1940. He did this in various ways. He felt this method which he used, he used the FBI records, probation officers, also anyway to make contact with them. He felt this method was crude and I am inclined to agree with him, since he could only obtain information on 60 percent of the group. He did determine that 39.9 percent had relapsed in periods varying from 6 months to 6 years. And he found that the parole prisoners made the best record.

The parole prisoners are a selected group. He has to have a plan, he has to have a job, he has to have a place to live and he has to have a parole adviser. It is not surprising that this was the group that did the best.

All we can really tell from our standpoint at the hospital is whether a patient returns to the hospital. I can tell you what our experience is with that.

The fact that he does not return to the hospital does not mean that he is not using narcotic drugs.

Mr. MITLER. Dr. Lowry, apart from Lexington, would you mind if I asked you about your reaction to what Dr. Brown had to say while I was there or do you feel that was not in accord with the testimony? You remember the man from Singapore.

Dr. LowRY. Oh, the visitor from Singapore.

Mr. MITLER. I was going to ask your reaction to that if that would be beyond the purview of your testimony. He stated in Singapore he was a director of the medical center there and that the opium, the

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distribution of opium was made unlawful and narcotic squads were set up in Singapore and before that there had been no racketeering and gangsterism. Prior to that the drug addicts were able to get a card which permitted them to go to a center and get the opium. And after the opium was made unlawful there was gangsterism and heavy trafficking in drugs.

I thought you might have some reaction to that.

I thought it was rather interesting.

Dr. LowRY. I feel perfectly free to say that the information that Dr. Brown gave was very interesting but I find that I don't have any need to comment on it, because I don't know the facts about the real situation. This is not a medical problem.

Mr. MITLER. I see.

Just one other question, I would like to ask, that was the question of it, you have been also to Fort Worth and to Lexington.

Dr. LowRY. Yes, I have been at both places on two different details. Mr. MITLER. Do you feel there is any difference in atmosphere between the fact that Fort Worth seems to be more oriented toward a mental hospital, that there is any greater value to that? In other words there are not the same number of bars?

Dr. LowRY. I think you will have to remember this, that both of them are prison hospitals, because there are prisoners there. Both have Federal prisons. The tradition at Lexington is a little different. It was started in 1935 and it was opened by having a number of prisoner addicts transferred from Federal penitentiaries and there were a lot of custody features that were set up then that we no longer utilize. I am sure a person who had not been there in 20 years would be very surprised. All through the years there have been prisoners.

When Fort Worth was opened in 1938, the same thing occurred but it was a little different. The patients came from Lexington, the first group to Fort Worth and in the few years that Lexington had been opened a good deal was learned about the discipline and treatment of addicts. Then the population of addicts didn't get very large at Fort Worth before World War II broke out and if you will recall during the war the hospital at Fort Worth treated patients who were psychiatric casualties from the Navy and Marine Corps in the Pacific so there were relatively few addicts at the end of the war and that the number of addicts in the hospital-and by the way the figure at present is about 300-has increased gradually over the past few years.

This does bring a somewhat different orientation. Here you have a large number of nonaddict patients and a small number of patients. At our hospital we have a large number of addicts and a small number of nonaddict patients.

People have attitudes about the mentally ill and they have attitudes about narcotic programs. There is a difference I am sure in appearance. Fort Worth is a fine white brick hospital sitting on top of a hill. Lexington is sort of a darker brick, red, and it looks a little bit formidable.

I will say this, I think our staff at Lexington is as well qualifiedalthough I wouldn't want this repeated, I think just a little better than they have at Fort Worth.

Mr. MITLER. I interrupted you while you were going through the statement. Are there additional things you want to bring out about the program at Lexington?

Dr. Lowry. I think it might be important to repeat something I said before. There are a good many illusions about the number of times patients are treated at Lexington. We made a study last year of the patients who had been in the hospital from 1935 to 1952, that is about 17,000 different patients, and we found that 64 percent of these 17,000 were treated in the hospital once and have not returned, that is they had from 3 to 20 years to return and had never returned. Another 2 percent came back a second time and did not come back a third time and so you see that there are 86 percent that have come into the hospital once or twice and have not come back.

There is a small segment that constitutes 32 percent of the 17,000 that accounts for over 23 percent of the admissions to the hospital. These are the people that create the illusion like the small army that is in the theater; it consists of 6 men coming out in front and going behind the scenery and coming out again and this is where the impression comes that everybody is a repeater, when actually the number that come more than twice is relatively small.

Mr. CHUMBRIS. Let me get that figure correct. Three and a half percent constitutes approximately 25 percent or about 4,200 of 17,000; is that about right?

Dr. LowRY. Three and a half percent of the patients account for 25 percent of the admissions.

Mr. CHUMBRIS. That's right. That would mean of the 17,000 admissions?

Dr. LOWRY. No, I am talking about 17,000 different patients. The actual number of admissions I think runs up to close to 40,000. I can give you that figure. I don't have it at my fingertips.

Mr. CHUMBRIS. How much does it cost the patient per year at Lexington, would you say?

Dr. LowRY. It costs about $6.70 per day.

Mr. CHUMBRIS. How much?

Dr. LowRY. $6.70 per day.

Mr. CHUMBRIS. And how do you fare as far as appropriations are concerned? Do you feel that your appropriations meet the particular problem that you have at Lexington?

Dr. LOWRY. We have limitations that I think are important; however, I feel that it is, well, somewhat unfair to ask me to comment on this particular question. I think this is something that you should ask of the persons in the headquarters at the service.

Mr. CHUMBRIS. If you don't feel like you want to answer the question. The reason is this: There was a suggestion made earlier that we have more regional clinics or hospitals to take care of these addicts where the Federal Government and the States can coordinate their activity and send the boys and men to these various institutions. I just wanted to get a line on the cost of such a program if we had more regional institutions for the care of the addicts.

Dr. LowRY. You will find the cost at Riverside is approximately $30 a day.

Mr. CHUMBRIS. How about Fort Worth? Do you know what the cost is there?

Dr. LowRY. There it would be about the same as ours.

Senator LANGER. How do you arrange about these volunteers? How do they pay?

Dr. LOWRY. The voluntary patients fill out an application and he has to list his income and assets on the application and the determination is made as to whether they can pay for their care. We collect a few thousands of dollars a year and most of the money that is collected comes from the physicians who are pay patients and their wives, some of the women come in and their husbands pay for their care in the hospital.

Senator LANGER. Any further questions?

Mr. CHUMBRIS. Mr. Winick testified as to the advantages of psychotherapy in the treatment of an addict. Now, first what is your impression of his testimony as to the psychotherapeutic treatment in his rehabilitation?

Dr. LowRY. All I can say is that I listened with a great deal of interest to the results of the program that they have started and he gave some figures that a certain number came to the clinic, I believe it was 70, and of those 35 remained in treatment or initiated treatment and he then went on to say that 80 percent of those that continued in treatment appeared to be moving toward recovery.

I find this a very interesting experiment and I am glad to know that someone is dealing with this group on this basis and will come up with some results that can be examined.

Mr. CHIUMBRIS. If funds were made available to your institution, do you think such a plan could be inaugurated at Lexington?

Dr. LowRY. We already have a good deal of psychotherapy, both group and individual, going on, but the limiting factor there is the availability of trained staff to do this. At the present time we have vacancies for psychiatrists, we have vacancies for social workers and they are very difficult to find.

If somebody talks about setting up a regional hospital, they are going to have to remember they will need a staff to be in that hospital and they are very difficult to come by. Especially at this time.

Mr. CHUMBRIS. Then you have the same problem we find in many of our Federal institutions, that it is not so much the limitation of funds as it is the limitation of qualified personnel.

Dr. LOWRY. I didn't say we didn't have any limitation on funds. I said we had a limitation on personnel.

Mr. CHUMBRIS. That is what I say. In many institutions we found throughout the country like the Federal prisons and correctional institutions that they can't find a sufficient number of psychologists and mental hygienists and psychiatrists and so forth to fill the necessary positions if the funds were made available to them. Dr. LowRY. I understand that is a universal difficulty. Senator LANGER. Any further questions.

Mr. MITLER. I want to incorporate in the record the statement and material that Dr. Lowry has. It is subcommittee exhibit No. 8. Senator LANGER. That will be made part of the record.

(The document referred to was marked "Subcommittee Exhibit No. 8" and is as follows:)