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r C C A A Choirman of the Board of Din •ctms Vice Chairman MRS . RHODES L. PERDUE, Secrerwy w . L. CALLOWAY. As .. ocrare ,S'ecrerary A. B. PADGETT, Treasurer JAMES P. FURNISS ommunity ouncil o:f the tlanta rea inc. CECIL ALEXANDER . DUANE W . BEC K. ONE THOUSAN D G LE NN BUILDING, 120 MARIETT A ST., N. W. Exenuhe Director ATLANTA, GEORGIA 30303 TELEPHONE 577-2250 Report 67-1 March, 1967 TREATMENT PLAN FOR THE CHRONIC ALCOHOLIC COURT OFFENDER This report is the result of the work of the Advisory Committee on Alcoholism of the Community Council of the Atlanta Area, Inc., and was compiled and written by staff of the Council. Approved by the Executive Committee of the Community Council on March 2, 1967. Paul Cadenhead, Chairman Mrs. Marian Glustrom, Staff, CCAA Eugene Branch, Chm., Permanent Conferenc e Mrs. Inez B. Tillison, Assoc. Dir., CCAA Committee Members Asa Barnard, Division of Vocational Rehabilitation Paul Cadenhead, Atlanta Bar Association Chaplain Joseph Caldwell, Candler School of Theology T. A. Carroll, Alcoholics Anonymous Grover Causby, Georgia Department Family & Children Services Dr. Sheldon Cohen, Fulton County Medical Society Mrs. Marian J. Ford, Travelers Aid Dr. Vernelle Fox, Georgian Clinic s. C. Griffith, Jr., Atlanta Hospital Council Bruce Herrin, Emory Univ, Alcohol Vocational Rehabilitation Pr oject Dr . Sidney Isenberg, Fulton County Medical Society Henry Jackson, St. Jude's House, Inc. Wilbu r Stanley, Georgia Department of Education Mrs . Nita Stephens, Fulton County Dept. Family & Child r en Se rv ices Ma jo r John St ra ng , Salvation Army Reve r end Russell St r ange, Atl a nt a Union Mission Ernest Wr i ght , Geo r g i a De pa rtmen t of Labor �• TREATMENT PLAN for THE CHRONIC ALCOHOLIC COURT OFrENDER I. Background The problem of the chronic alcoholic court offender is not a new one in Atlanta. The courts and many other agencies have been aware of it for many years, and attempts have been made to meet it. Over 10 years ago, Municipal Court judges became concerned with the problem because it was occupying an increasing amount of the court's time. It became increasingly evident that repeatedly arresting these individuals, trying them, sentencing them, and having them pay fines, serve time or both, was not allev iating the problem. Even turning these individuals over to a higher court as habitual drunkards helped only to the extent that men spe nding 12 months in prison could no t be rearrested and appear in court during that time. A large percentage of those who did serve 12 months in prison were back in jail for "plain drunk" within days and sometimes even hours after being released from prison. At a bout this time, the judge s were approached by several individual s , some o f whom were ex-alcoholics, who volunt e ered their services a s a Helping Hand Society to do wha t they could to help t hese individuals c a ught in what is regarded as the "revolving door of drunkenness"--arrest-jail-release-drunkenne s s-arrest, etc. At this same time, Mr. He nry Jackson, who had 18 years of e x tensive e x p e rience working with alcoholics, was added to the Municipa l Court staff as the Director of the Alcohol i c Rehabilitation Prog ram. Jud ge J a mes E. Webb a cce pt e d the offers o f h e lp a nd se t up a sys tem where b y ind i v iduals who were brought to court for pla in public intoxication could, by request , be probated to the Helping -Hand Soci e ty. At the discretion o f the judge and r e pre sentatives of the Helping Hand Society, a n individual wa s acce pte d on the p r og ram, and for a probation per iod o f 60 d a ys h e was e x p ected t o coope r a t e with the Soci e ty. The program cons i sted o f t h ree e s sentia l things: 1) b ei ng a friend to t h e i n d i v i du a l wi t h a d r inking p rob l em; 2 ) he l ping him find f ood, clo t h i ng a nd s h e l ter ; 3 ) p rovid ing fe l lowship for the ind i vidual in a new envi r onment away from drinking establishment s. Because o f the l ack of p r oper f a c i l i t ies to carry out the f u nction s of the Helping Hand Society, t he pro gram, a l thou gh s u c c es s f u l with s ome, was u nab l e to reach the majori t y o f the chro nic court offenders, a n d t h e Municipal Court caseload continued to grow at an a l arming rate. In 1961, Ju dge Webb and the lea d er s of th~ Helping Ha n d Society decided that if an increase in facil it ie s for the treatme nt of alc o holism we re at their disposal, they could do a better j ob of rehabilitating larger numbers of chronic alcoholic court offenders. They approached the Community Council of the Atlanta Area, Inc. The Council re~ommended that further study be done. The City of Atlanta, Fulton County, and a group of business leaders agreed to provide the funds for a one year study to be made by the Department of Psychiatry of Emory University. The study was designed to gather data, �Page 2 analyze the data, and make recommendations based on this data to better deal with the problem of the chronic alcoholic court offender and his family. The study began on July 1, 1962 and ended June 30, 1963. The following is a summary of the committee's recommendations: 1. That a new facility, an Intensive Treatment Center, be established with City and County funds to provide inpatient and outpat i ent services using a multi-discipline approach. That these services be coordinated with all other treatment and rehabilitation services for alcoholism. 2. To continue the present Helping Hand Halfway House, with some City and County funds made available for this facility, as a model for the establishment and development of other halfway houses in the community. 3. That at least one Alcoholic Information and Referral Center be established on an experimenta l basis, in one of the neighborhood areas of particularl y heavy drinking, this Center to be staffed primarily with volunteers. 4. To provide better training to policemen in the recognition of "intox icatio~' and its various causes. 5. That there be medical screening in the City Jail of all intox icated p r i s oners immediately following the arrest of these persons. That t hose in need of any medical attention be immed i atel y transferred to Grad y Memorial Hospital for this medical ca r e. 6. Tha t the lega l procedures now e x isting be r evised so that an individual can be processed from the time o f his arrest un t il disposition o f hi s case h a s been mad e by the multi-Qiscipline team previousl y mentioned . 7. Tha t some of t h e approaches to alcoholics at the Cit y Pri s on Fa rm be mod i f ied so that trea t ment and rehabilitation can be c a rried out in this setting. Tha t an effort be made in the Ci ty P r ison Fa r m to eva lu a t e the mental a nd phy sic a l condition of the alcoholic prisoners and a p r og ra m o f re h a b i li tat ion be ins t ituted for e a ch of these pe r sons. Some st ride s have bee n made in implementing these r e c omme nd a tio n s , bu t we s t ill have a l o ng way to g o a s wi l l be s e en i n ot h e r sectio n s o f this repo rt. Lack o f funds , s hortage o f sta f f a nd publ i c apa thy have combine d to hi n der pro gre ss. Recent events, ho wever, have mad e it i mperative t ha t we deve l o p and carry o ut plans f o r the chronic alc o h ol ic c ourt offender. There have been two court case s c o ncerning the chronic alcoholic which have grave implications for Atlanta. On e decision, in the Easter Case, was handed down by the U. s. Court of Appeal s in Washington, D. C., and the other, t!~e Driver Case, by the Fourth U. S. Circuit Court of Appeals in Richmond, Virginia . Both decisions were similar and indicative of what path other courts will take. �-- - - - - -- Page 3 The decisions stated that chronic alcoholics could not be charg ed with drunkenness because they have lost the power of self-control in the use of intox icating beverages. In Washington, the judge said that a 1947 federal law on rehabilitation of alcoholics described chronic drinkers as sick people who needed proper medical and other treatment. However, commi t ment for treatment of chronic alcoholics as contemplated b y Congress was not mandatory. The accused may be released but he may not be punished. It was a l s o the judge's decision tha t chronic alcoholism is a "defense t o a cha rge of public intoxication and, therefore, is not a crime, however, this does not absolve the voluntarily intoxicated person of criminal responsibility for crime in general under applicable law." The case is now coming up bef o r e the Supreme Court a nd there is every reason to _b e liev e that the deci sion will be upheld. Therefore, it is o n ly a matt e r o f t i me b efore At l a nt a is fa c e d wi t h t he p r oblem a nd some planni ng mu s t be done so that facilities for rehabilitative services for the chronic alcoholic will be available, otherwise, there will be chaos and confusion with wa sted effort, time and money . The p r oblem is a compli ca ted one. Trea tment of the a lcoholic--to b e effec t ive and l ast ing --requ ire s coordinat ion of se rvic es a nd a combi n ation o f many resources and practices. A multi-disciplinary, as well a s a f a mily centered and reaching out approach, must be used. Trea tment should be dire cte d to thr ee mai n g oals : 1. Pe rma n e n t sep ara tion o f t h e a lcoho l i c f rom alcohol. 2. Repa iring the physical and emotional d a mage a nd preventing f u rt her d a ma ge . r 3. Chang i ng c o mmu nity institu t ion s, p rog rams and services t o meet the s pecial n e e ds a nd p robl e ms o f t h e a l coholic. Communi ty r e sou r c e s shou ld b e ma d e as r e adi l y a vailabl e a nd easi l y accessibl e as ot h ers . In a ddition, a n y pla nning f o r the chronic a lcoholic cou r t be integrat e d wi th the pl anni ng b ei ng done f o r a l l o the r f o r other phases of mental h ea l th and physica l i l lness . p art o f the s a me problem and should not b e s egme nt e d, i f II. o ffe nd er shou ld a lcoholics and They are a ll a at a ll po ssibl e . Target Populati on in Atlanta A. Ove r half o f t he arre sts ma de b y the At l a nta Polic e De pa r tme n t i n 1 9 6 6 for non-traff ic o ffe nses i n v olve d pu b l ic i ntoxi cation. 1. Total non-traffic arrests - 79 , 092 ( does not include juveniles) 2. Arre s ts involving dru nken ness - 47,305. These consist of approximately 1 2,000 ind ividua ls and that about one-half, or 6,000, of these individuals were arrested on this charge from 2 to 20 times �Page 4 during the year. It is difficult to say how many of these can be rehabilitated fully or t o some e xtent. From the experience of the staff of the Emory University Alcohol Project in their three and a half years of operation, it is their belief tha t with the proper a pproaches, facilities and staff, a conside r able number of these persons might be at least partially rehabilitated. They a r e not willing to dismiss the poss i bility of assisting even t he mos t ha r d-core chronic alcoholic. It is sometimes extremely difficult to determine accur~tely in advance just who can be helped or how long it might take. They . believe that it is essential to at least make a sincere effort to treat each one of these individuals. It is rea lly only through giving e a ch of them an opportunity for t reatment and rehabilitation t hat we c a n determ i n e whether or not they can be helped. I t is conceivable that approximat ely 10,000 of thi s g roup o f 12,000 alco hol i c off ende rs can be as sisted to improve their total well-being significantly. B. Characteristics of the Chronic Alcoholic Court Offender 1. 2. Gene r al Characteristics: a. Produc t o f a limited social envi r onment who has never a t ta ine d more than a minimum of integration within the community. b. Depe ndent p e rsonali t y without much individua l r esourc e f ulness . c. Ind i vidu a l who has di ffi cul ty in communicati ng with others . The following specific data has b e en taken from the original s t udy { done by Emory Universit y : a. Average age of white ma l e - 48. 0 year s Negro ma l e - 42.9 years b. Ra t e o f t u b e r c ulo s i s in thi s group was fou nd t o b e t e n times g reat er than the ra te i n the genera l popula tion . c. 1 0 % of the white males and 3 . 6 % of t h e Ne gro ma l es had been hospita l ized in a me nta l ho s pita l p reviou sly. d. 50 % o f the whi t e mal es we n t b eyond the eigh t h grad e in schoo l. In t hi s grou p, there wa s no corre l a tion b e tween the number of court appearances and l e vels of education . e. The Negro ma l es did d e mo nst rate a c or re l ation of the lev e l of e ducation with the numb er o f court appearances. 1) 50% of the Negro males in the 1-2 court appearance group went throu gh the n i nth grade. �Page 5 f. 2) 50% in the 3-6 court appearance group went through the eighth grade. 3) 50% in the 7 or more court appearance group went only through the seventh grade. Employment 1) 77% of the Negro males were classified as unskilled labor; while 32% of the white males were in this gr.map. 2) 40.9% of the white males had had special job training; while only 24.8% of the Negroes had. 3) 52% of both races were unemployed. 4) 26% of the white males and 14% of the Negro males were receiving some type of financial assistance. 5) At the time of arrest, 42% of the white males and only 6% of the Negro males had money available to pay a fine. r III. Elements to be considered in a Treatment Plan for the Chronic Alcoholic Court Offender A. Legal and Legislative 1. Legislation to give city authority to spend funds for local alcoholic rehabilitative measure s. The city of Atlanta is in a peculiar position. Under the Reorganization Plan of 1951, health functions were made the responsibility of the county and police functions were made the responsibility of the city. Therefore, city police can arrest an alcoholic for public drunkenness, but the city cannot spend tax money to rehabilitate him, since rehabilitation is a health function. The FultonDeKalb County Hospital Authority says alcoholism is a chronic illness and it assumes no responsibility for chronically ill. The Fulton and DeKalb County Health Departments have no outpatient clinics for the alcoholic. The State Health Department feels that it has no responsibility for the alcoholic until reasonable rehabilitative measures have been made at the local level. 2. There must be a change in the police handling of chronic inebriate offenders. The following quotation from Peter Barton Hutt, the attorney who presented the appeal in the Easter Case in the Distric of Columbia, gives an indication of some of the problems involved: �Page 6 "With regard to the police handling of chronic inebriate off enders , it is my opinion that it is not a false arrest for a pol i ceman to charge an unknown inebriate with public intoxication, even after the Easter and Driver decisions. The police should not be required, at their peril, to make a judgment on the street as to whether an intoxicated individual is or is not a chronic alcoholic. "In the case of known chronic alcoholics, however, this problem raises a far more difficult legal issue. To some, the a vailability of the defense of chronic alcoholism still seems more properly an issue for the courts than for the police . "But more impor ta nt, the community should not place the police in j eopard y in thi s way. There is no reason why the police should be bu r dened with the ignominious task o f swee pi ng chronic inebria tes off the public streets. I was recently called upon in the District of Columbia to assist a man who had been arrested 38 times since the Easter decision. When you take into consideration the amount of time he spent incarcerated in jail and in various hospitals, this amounted to 1 arrest for every 2 days that he appeared on public streets. Certainly, the a nswer to the Easter and Dri ver decisions is not just to arre st dere lict alcoholics every day, duly bring them to trial and then immediately release them back on the streets without assistance, only to repeat the process over and over again. This succeeds only in speeding up the "revolvi ng door," a nd in further pe rsecution a nd deg rada t ion of chr onic inebriates . It c a nnot contribute to the elimi na tion o f these a bu ses , a s the Easte r a nd Dr iver de c i sions de ma nd . "In my opinion, the police can .and should take t wo immedi a te steps to end the revolving door process, pe nding de velopment of a br oad er community p r og r a m tha t I will d iscu s s l a ter in this t a lk. Fi rst, they should assi s t a ny d r unken person t o hi s home , whe ne ver that i s possible . Se cond, where a n indi vidua l i s u nable to take care o f himself , the poli ce s hould as.sist hi m to an appr opriate public heal th faci l ity where he can r ec eive the ne c e s s ary a tte n t ion. Under no cir cumsta nces should they arre st known a lcohol i c s time a nd time again . "The question arises, o f c ourse, whether the police may properly assume responsibility f or intoxi cated individuals and escort them to an appropriate public health facility to receive proper medical attention. If t he ineb riat e does not consent , would the police incur liability for a fal s e arrest? I have l ong been o f the view that the police have duties o f a civil nature, in addition to their responsibility for enforcing the criminal law. ~hen a policeman escorts a heart attack victim to the hospital, he certainly is not arresting him. Thus, in my opinion, the police have both a right and a duty to take unwilling intoxicated citizens who appear to be unable to take care of themselves, whether or not they are alcoholics, to appropriate public health facilities. And I might �Page 7 add that, in the oral argument in the Easter case, all 8 of the judges indicated agreement with this proposition. Nevertheless, law enforcement officers have expressed considerable apprehension about the possible liability of policemen for false arrest under these circumstances. Certainly, this question should be resolved immediately, preferably by enactment of state statutes, in order to lay the necessary legal foundation for the proper medical handling of alcoholics." 3. The court procedure must also be modified. Peter Barton Hutt: Again, the quotes are "With regard to the judicial handling of chronic court inebriate s , once a judge becomes aware, through any information of any kind, from any source, that a defendant charged with public intoxication may have available to him the defense of chro_nic alcoholism, he is, in my opinion, clearly obligated to make certain that the defense is adequately presented. Cases in the District of Columbia, involving the analogous defense of mental illness, hold that even if the defendant protests, the judge is required to inject the defense into the case sua sponte, which means of his own motion, to make certain that an innocent man is not convicted. Failure to do so is reversible error, as an abuse of the judge's discretion. And a decision handed down by the United States Supreme Court in March of this year is wholly consistent with this position. There is no reason why these precedents should not be equally applicable to the defense of chronic alcoholism. "This means, of course, increased responsibility for the judicia ry . Under the Easter and Driver d~cisions, each trial judge is obligated to take affirmative action to bring an immediate end to the traditional "revolving door" handling of the chronic court inebriate in his court. No judge, in my opinion, may properly remain neut r al, simply waiting for a defendant to raise the defense of alcoholism. "Indeed, statistics I have reviewed suggest that, throughout the cou nt r y, a ppr oximately 90-95 per cent of the drunkenness o f fende r s who appear before the courts have serious d r inking problems . In my judgment, this statistic in itself places upon trial judges an obliga tion to inquire into the possibility of the defense of chronic a lcoholism fo r virtually eve r y dr unkenness offender who a ppear s i n the courts . A fa i lu r e to u nderta ke this inqu i ry amount s , in my vi ew, to a de r ogat i on of judic ial r espon sibi lity. "Thi s al so me an s t he d emi se o f t he so- cal l e d court honor or probationary programs f o r al coholics which have s prung up all over the country as the judiciary 's ad hoc answe r t o the failure of public health officials t o treat alcoholism as a disea s e. If a defendant is found t o be elig ible f or a court alcoholic program, then obviously he should not be convicted in the first place. The Easter �Page 8 and Driver decisions are, in my judgment, fundamentally in conflict with any type of judicially-sponsored post-conviction program for the treatment of alcoholism. However benevolent such programs may be, constitutionally they are a thing of the past. For my part, I shall be very happy to see the courts step aside in this area, and to see public health officials take over problems which the y should have taken over many years ago." B. 4. Legislation to provide for involuntary commitment of alcoholic until rehabilitation process is complete. Should be on a health and treatment basis rather than through courts with penal approa ch . 5. The responsibilities of the state and local communities must be defined and clarified. 6. The responsibility of after-care when the patient has been rele a sed from the hospital should be determined. Who follows-up--the state or local community? Treatment Facilities 1. Intake Center and Detoxification Unit Before any kind of evaluation, diagnosis or therapy can beg in , it is necessary that the individual be detox ified as quickl y a nd as safely as possible so that the effects of acute intox ific a tion are no longer present. There is no doubt that the hospital is t he best setting f or such treatment. Eme r genc y measures a re a t h a nd , the staff is av ailable a nd all necess a r y equipment is the re . In Fulton and DeKalb County, Grady Memorial Hospital seems to be the logical place for a Detox ification Cente r . It is authorized to t a ke care of e me r gencie s , it has spa ce and is convenientl y l oc at ed . I t does t ake c a re of alcoholics in i ts emergency clinic. Ex pe r i ence h a s shown that there is v ery little difficult y encoun tered i n t r ea ting a lcoholics . Recor ds of hospitals that h a v e a dmi t t e d the s e pa t i ents wi ll con fi r m t he re port that most of t h e se p a tients of fer no mo r e d i f fi culty t han an y o t her s i ck pe r son . I t is d i ffic u l t to es tima t e how many b e ds At l a nt a would need t o take c are of the probl em to a f a i r l y adequ a t e d e g ree. St. Lou is , Mis souri, o pened a 30 - bed unit t o s erve the en t i r e c ity. Officia ls r e p o rted t h a t in the fir st two mo n t hs o f op e r ati on , the s t a t ion ope rated a t or near capa c i t y wi th o n l y the al coh o lics fr om t wo p olic e districts. It i s o b vi ous t h at if fa c i l ities e x i st the y will be used. Based o n the St. Louis experience, which was c o ncerne d with a lower rate of arre sts than Atlanta has, it is felt that approximately 100 beds would be needed. Staff f o r 24 hour duty would be required. This would mean: 9 regist e red nurses, 9 licensed practical nurses, 15 attendants (nurses aides or orderlies) . Exact plans would have to be worked out in detail with Grady Mem- ori al Hospital and other professional people who are concerned and working with the problem. I �Page 9 2. Inpatient Diagnostic-Evaluation Center Following the individual's detoxification, he could be transferred to an inpatient diagnostic-evaluation center where a complete work-up could be prepared on his medical, social, occupational, family and other personal history. This could conceivably be the present City Prison Farm, which, when alcoholics can no longer be incarcerated there, would have room. Alterations and modifications in the structure would have to be made, but this would not present much of a problem. The Center should have a multi-disciplinary team approach . Its staff should consist of medical, psychiatric, psychologica l, soci a l work, vocationa l, and rehabilita tion personnel. The individual would stay approximately 5 or 6 days or until plans were complete for future treatment. It is hoped that as much as possible treatment would be on a voluntary basis and that commitment would be only used when absolutely necessary. Full coopera tion a nd willingness of the individ~al to under go treatment would f a cil i tate the rehabili t ative process. 3. Outpatient Rehabilitative Treatment The s u c c es s o f the Emory Universi ty Voca tiona l Rehabilitat i on Alcohol Proj e c t d emonst r ates tha t these me n can be tre a t ed s uccessf ully in an outpa t ient setting. Even those who will become only partially self-sustaining should be treated as those who eventually wi ll be fully rehabili t ated. The most i mpor t a nt a nd unique f eatu re o f t he p r oposed method o f treating t he chronic a lcohol ic cou rt o ffend er is based on the recogniti on that t hese i nd i vi duals are to ta l l y d e pe nd e nt upon o t her s to ta ke care of them. Knowing a nd accepting this ma kes the t ask o f r e ha bil ita t i on l ess d iffi cult a nd more cer t a i n. Any outpatient service should be based on t he Emory Pro j ect and its experience should be f ull y ut i lized. The servi c e should use a multi-disciplinary approach. Represented on the staff should be vocational re habilitation counselors, social workers, clinical psyc hol ogists, chapl ains, physicians and psychiatrists. The main emphasis in rehabi litation should be on "reaching out" for the clients rather than the traditional waiting for the client to request services. This reaching out is necessary because of the passive, dependent nature of the alcoholic. Once he is involved in the rehabilitation process, he must be continuously supported until his total dependency can be changed so that he is sufficiently independent to function in society and to maintain employment. �Page 10 4. Inpatient Extended Care Program-Rehabilitative Service The Georgia Health Code Act No. 936 (H.B. 162) 1964 session of the General Assembly, 88-403, states: "The administrative responsibility for alcoholic rehabilitatio~ as provided herein shall be vested in the Department of Health. The Department of Health shall study the problem of alcoholism, including methods and facilities available for the care, custody, detention, treatment, employment, and rehabilitation of alcoholics. The Department of Health shall promote meetings for the discussion of the problems confronting clinics and agencies engaged in the treatment of alcoholics and shall disseminate information on subject of alcoholism for the assistance and guidance of residents and courts of the State. The Department of Health is hereby authorized to establish and maintain hospitals, clinics, institutions, outpatient stations, farms, or other facilities for the care, custody, control, detention, treatment, employment, and rehabilitation of alcoholics, and is further authorized to accept for care and custody alcoholics voluntarily applying for treatment or or dered hospitalized by court order as hereinafter provided, and is further authorized to confine and detain such alcoholics for treatment and rehabilitation," This, then, definitely places the responsibility on public heal t h and any planning should be done with this in mind. Also, as with all othe r phases of the plan, this should be inte grated and coo r dina ted with the state and local plans for me ntal he alth . In a conference Community Councilr staff had with the State Mental· Health Di vision, it was pointed out that it was the policy of the Menta l Health Division to require that all local mental health pr ogra ms should include some provision for the care o r ha ndl i ng o f chronic alcoholic s . The e xact me thods to be uti lized are no t s pecifi ed , but t hi s proble m must be considered a nd pr o vided for in some manner in any mental health program at the local l e ve l, Dr. Donald Spille, Executive Director of the Metropolitan Atlanta Me ntal Health Associa tion, Inc., is a member of t he Community Counc il's Committee on Alcohol i sm a nd wi ll help keep the Committe e advi s ed on me ntal hea l t h program p lans. The inpatient extended care rehabi l itative service could be part of a reg i onal ho spi t a l or a center by itself. The s t re ss s hould be o n rehabilita t i on t o prepare t he individua l to be a selfsustaining member of soci e ty . Treatment techniques should include: a. b. c. d. Counseling and e valuation Physical therapy Work therapy Group therapy �Page 11 e. f. g. h. i. Self government Lectures and films Drug therapy Recreation therapy Pastoral counseling Specific plans should be developed by experts in the field. At present, we have the Georgian Clinic located in Atlanta and supported by the Georgia Department of Public Health. Fees charged to the patient are based on income. It is a 50-bed resident patient hospital and also provides day care and night care, This serves all residents of Georgia and the patient must be free of alcohol for 24 to 48 hours, There are also a few private · hospitals or sanatoriums that accept chronic alcoholics but facilities are extremely limited and almost nonexistent for those who cannot pay. C. Supportive Services 1. Housing - a great many of these individuals have no place to live. Some need temporary shelter while undergoing treatment. Some place must be provided for them which will give them support and keep them from drinking. Others will need more permanent arrangements if they cannot return to their own homes or live independently. The following are some of the kinds of housing that are recommended: a. Hostel - a semi-institution preferably in town. Should have a structured program with some medical personnel in attendance. Can be large, serving several hundred individuals. There is nothing like this in Atlanta. b. Halfway homes - smaller , more individual, less structured. St. Jude's Hou s e, Inc,, is at present the only halfway house i n Atlanta. It is supported by r ents from residents, contr ibutions from churches, individuals and foundations . I t has b eds fo r 40 r esidents and provides meals fo r an i ndefini te pe r iod of time in a protective setting . The men must be 20 year s a nd older , must ha ve an a rrest r ecor d fo r drunke nnes s , mu s t be s creened psychologically a nd phy sical l y by the Emory Univer s i t y Alcoho l Pr oject , The y mu s t also be sui t a b le for employmen t . c. Shelters for homele ss men that include alcoholics. The Atlanta Union Mission which i s supported by individual c ontributions and f e e s . The Mi s sion provides shelter , food, �Page 12 clothes, Christian counsel and employment for indig~nt men. On the average, 200 men are taken care of per night. Approximately 85% of these are alcoholics. The Salvation Army provides over 700 men with shelter a week. About 90% of these are alcoholic. It does not accept anyone in a severe drunken state since no medication or special treatment is available. These are sent by cab to Grady Hospital or turned over to the police. The men from the Emory Project will occupy a special section. The Army staff is responsible for giving the medication prescribed and will see that the men cooperate with treatment. Women alcoholics are housed at 242 Boulevard, N.E. Since August, 1966, there have been 4. Women are always referred to Grady Hospital, the Emory Project or the Georgian Clinic. d. Individual rooming houses or hotels. The Emory University Alcohol, Project now has a staff member developing these facilities. With help and supervision, many of these places could be made acceptable, kept from deteriorating and provide pleasant places to live. In most of the "flop houses" and cheap hotels, the man is exposed to other drinkers and the atmosphere is not conducive to a healthy state of mind. e. Social clubs where individual can go when not in treatment or when not working. A.A. meetings provide a form of this. f. Facility for individual who cannot be rehabilitated but will always remain partially depend~nt on treatment. Social improvement, even if it implies dependency upon the hospital, is perhaps the most that can be expected as a goal of therapy for this group. 1) Farm where he c an be self-sup porting. 2) Work outside of facilities with aid of treatmen t, but return to facility f o r night a nd free time. Atlanta Union Mission Rehabilitation Farm for alcoholics and the aged will open in May. It will house 32 alcoholics to begin with and the master plan calls f or 64. In order to be accepted , the client must be without a d rink for at least 48 hours, sign a statement of his own free will of intent to stay a minimum of 60 days, to cooperate with the staff and i ts program of worship, work and education. The client will not be permitted to leave the mission farm for the first 2 weeks and afterwards only when accompanied by Mission Farm personnel~ There will be a charge of $62.50 per month for every man. However, his ability to pay will not determine his acceptance. �Page 13 2. Financial Assistance - part of society's basic obligation is to provide for the destitute. This allows them income while undergoing treatment and supplements income of those who need permanent care. The Fulton County Department of Family & Children Services cooperate completely with the existing facilities for treatment of the chronic alcoholic. The individual receives temporary financial assistance as long as he is cooperating and undergoing treatment. The Special Service Section, which carries a reduced caseload, takes care of most of the alcoholics so that they can be given more intensive case work. When an individual applies for financial help and is an alcoholic, every attempt is made to get him to treatment. D_ Public · Educa tion Public apathy ha s been one of the most severe obstacles in working with the chronic alcoholic court offender. As a rule, he is a forgotten man, relegated to a flop house or prison and given up as a hopeless case. He remains a burden to society a nd is one of the most important contribut ors to the rese rvoir of poverty in this country. Once the public underst a nds and its intere s t is arou s ed, the resul t ing action c an become a powerful force in accomplishing a constructive objective. A public education program should concern i tself with the following aspects: 1. Deve lop community leade rship to alert people to the need s and pot e nt ial of a n a dequa t e a nd sympa thet i c a ppr oa ch to the pr oblem. 2. Ac knowledging that alcoholism is a public health problem and, the r ef o r e, a public r e sponsibility . 3, Showing t hat the penal appr oa ch t o the publ i c alco holi c is expensive and inhumane. I t has only perpe tuated t he pr oblem and in no way eased it. 4. Demons t rating t ha t the re is no s i mple so l ut i on. That t rea t ment o f the public alcoholic to be effec tive and lasting requires c oordination of s e rvices and a comb ina t i o n of many resou rces and programs. 5. Unde r stand i ng of the pub lic alcoholic and home l e ss i nd i vidu al. 6. Expl aining of problems a r ising in developing programs and service . a. b. c. 7, Legal and l egi s l ative Economics or fu nd ing Facilities and services tha t have t o be developed Describing and explaini ng kind of comprehensive plan Atlanta needs, element s involved and how we go a bout implementing such a pl an. �Page 14 A public education program should be directed at public officials, special interest groups, as well as the general public. The Metropolitan Atlanta Council on Alcoholism, working with the Community Council, could be the motivating force behind an education program. E. Central Registry and Information Retrieval The full extent of Atlanta's alcoholic problems is not known. The United States Public Health Service considers alcoholism the fourth most serious health problem in the country and the picture in Atlanta is most likely no different than that in any other city. According to the national average, it is estimated that there are from 20,000 to 25,000 alcoholics in Metropolitan Atlanta. This is far from a complete number for statistics are not available for those using private facilities and for those that never come to the attention of the public. We know that in 1965, 48,783 arrests were made in Atlanta involving drunkenness. We have these isolated figures but nothing complete , and some agency should be charged with the responsibility of keeping accurate statistics on alcoholics and facilities available for rehabilitation. In addition, the need for a central clearing house has been felt by many agencies. Alcoholics seek help in many places and often at the same time, and there is no way of knowing where they have been or what treatment they have received. A central clearing house or central registry cannot succeed, however, unless it rec e ives the full cooperation of all participating agencies. The Metropolitan Atlant a Council on Alcohol i s m might be a ble to orga nize one under a special grant so that mone y would be available for trained staff. { F. Staff Training Befor e a ny k ind o f servic e o r program c an be i n s tituted, personnel on a ll levels must be available. At the prese nt, the r e is a sever e short age of staff and there is a pressing need for training in the field. Inducements must be made so tha t individuals will be interested in working i n the are a o f a lcohol ism. All facil i t ies and p r ograms conc erned with t he t reatment o f the a lcoholic s hou ld be i nvolved with the training program and this should ag~i n be coor d inated wi t h the St ate ' s comprehensive plan for ment al il l ness o f which training is an i mpor t a n t part . The Geor g i a n Clini c ha s a n extensive training program which could be e xpanded. The Clinic cou ld po s sibly act a s t he c oor d ina t ing agency for a training program. G. Evaluation For a program of this kind, there should be a built-in system of evaluation of services. Only on the basis of such an evaluation would we be �Page 15 able to strengthen and develop the program, accomplish any worthwhile long-range planning, and establish accurate guidelines for the further development of the program. The Research Division of the Community Council will help develop the evaluation and the plan for it will be incorporated in the final report, Community Council of the Atlanta Area, Inc. �