Box 3, Folder 15, Document 12

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Box 3, Folder 15, Document 12

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C
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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.
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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.

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