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Narcotic Drug Control in New York State.New York State Legislature, Albany.7 Apr 71144p.New York State ERIC Service, Room 468 EBA, StateEducation Department, Albany, New York 12224.(Microfiche available at no cost to educators)

EDRS Price MF-$0.65 HC-$6.58Cost Effectiveness, Drug Abuse, *Drug Addiction,*Drug Legislation, Health Educati-n, *Narcotics,Program Costs, Program Descriptions, *ProgramEffectiveness, *Program Evaluation, ProgramImprovement

ABSTRACTThis report concentrates on the analysis and

evaluation of programs utilized by New York State's NarcoticsAddiction Control Commission (NACC) and concerned with control ofnarcotic drugs and with those individuals who abuse then. The threekey premises, basic to the'narcotic drug control programs approved bythe state legislature, are: (1) there exists an effective criminaljustice system to insure either compulsory commitment to NACC fortreatment or the imposition of legal penalties as a sufficientdeterrent to the sale or use of narcotics; (2) there aredemonstrated, reasonably effective treatment procedures for narcoticaddiction; and (3) there exists a tested, satisfactory curriculumplan upon which to base preventive education. This audit, whichexamines current efforts in these three areas, shows that none hasyet been accomplished. It is concluded, however, that the New YorkState Prograw is worthy of continuance, that more time is needed toindicate what performance standards might be achievable, and thatmore funds are needed. (TL)

MEAT Of NI ALIN EDUCATIONI WELFARE

OFFICE OP EDUCATIONTNIS DOCUMENT HAS SUN REPROOL)CEDEXACTLY AS itEctrvic FROMINIEPERSON ORORGANIZATION ORIGINATING IT POINTS OFVIEW OR OPINIONS STATED DC NOT NECESSANKT REPRESENT OFFICIAL OFF ICE OF tOuCATION POSITION OR PCN.ICy

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PROGRAM AUDIT HIGHLIGHTSNARCOTIC DRUG CONTROL IN NEW YORK STATE

New York State's annual operating expendituresto control narcotics and drug abuse have increasedfrom $1.7 million in 1963-64 (under the Metcalf-Volker Act) to an appropriation over $91.7 millionfor the Narcotic Addiction Control Commission(NACC) during 1971-72. The total State operatingexpenditures since 1967 are almost $190 million,and in the same period there have been capitalexpenditures of almost $124 million.

The New York State effort to control the use ofnarcotics attacks the problem on three majorfronts: increased law enforcement to reduce crimeand support compulsory treatment, an extensiveand expensive treatment program to rehabilitatepresent addicts, and a widespread education pro-gram to prevent addiction.

Three key premises were basic to the narcoticdrug control programs approved by the Legislaturein 1966 and thereafter: (1) there exists an effectivecriminal justice system to insure either compulsorycommitment to NACC for treatment or the imposi-tion of legal penalties sufficient to discourage thesale or use of narcotics, (2) there exist demon-strated, reasonably effective treatment proceduresfor narcotics addiction, and (3) there exists atested, satisfactory curriculum plan upon which tobase preventive education. This audit has shownthat none of these important elements are ac-complished facts even today.

The civil certification of addicts, whereby theaddict is certified on his own petition or is certifiedon the petition of another, is working reasonablywell.

The criminal certification of addicts on theother hand, is not working as intended in NewYork City, ,

When addicts contest the question of addictionand request * jury trial, t r is their right, the districtattorneys often doncede non-addiction, either be-cause they do not have the personnel and resourcesto litigate the question of addiction or because theevidence of addiction is insufficient. The evidence

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of addiction is insufficient sometimes because ofdelayed or inadequate medical examinations orweak medical witnesses. From a total of 15,876misdemeanor arraignments reaching disposition inthe New York City Criminal Courts in 1969 over10,000 (66 percent) were dismissed outright, andonly 3,598 resulted in direct sentences; 2,415 ofthese sentences (again 66 percent) were for 90 daysor less, and only 194 were assigned to NACC.

The Narcotics Bureau of the New York CityPolice Department has followed up on 2,218felony arrests made since July 1969 that have beendisposed of in Supreme Court. There were 938dismissals (42 percent) and not more than 827direct sentences. Of the recorded direct sentences,616 were for one year or less; presumably many ofthese were cases of "copping a plea" to a mis-demeanor. Only 172 of the original 2,218 arrestsreceived terms of more than one year; thus, onlyeight percent of those arrez,ted were ultimatelyconvicted and sentenced for felonies.

Thousands of alleged addicts are being arrested,but only a small percentage of these are certified toNACC or receive severe jail sentences. Addicts arenot being taken out of circulation, and the State'sefforts to strengthen deterrence are thereby under-mined. These shortcomings are due to failings inthe system of criminal justice that extend beyondthe ability of the police to apprehend criminals.

NACC currently (January 31,1971) has morethan 10,700 addicts in treatment, aftercare, andcontract programs. An additional 10,400 non-certified volunteers are receiving some form oftreatment in NACC supported private agencies.

The principal problem encountered in trying toevaluate treatment programs provided by the pri-vate agencies and the facilities operated or fundedby NACC directly is the singular lack of whatmight be considered hard data. Most of theprograms have been able to generate some basicdemographic statistics which are highly descriptive

but are not evaluative in nature.Private and public agencies, except for the Beth

Israel Methadone Program, have not done the kindsof follow-up studies that are necessary for programevaluation. The private agencies, even those fundedas long-term demonstration projects, have not beenevaluated on any sort of rational basis by NACC.

Residential treatment is the most expensive partof the NACC program. For the 1970 budget year,almost $21 million was spent for operating e.apen-clitures to treat un average resident population of2,246 addicts an average expenditure of $9,250per patient per year. Operating costs almost tripledbetween the first and third year for the residencefacilities operated directly by NACC or undercontract. However, the number of subjects inresidence only increased by 62 percent betweenthe end of the first and third years.

A basic deficiency of the NACC program oftreatment and rehabilitation and supervised after-care results at the interface or transition pointbetween the two phases where more than 20percent of assigned addicts abscond from NACCcustody.

There are few major differences between treat-ment programs at NACC and other State institu-tions housing NACC certificants. There appears tobe little justification for the interdisciplinary treat-ment programs funded by NACC, except for theutilization of excess space.

One of the principal efforts in the rehabilitationand treatment of drug addicts is the funding ofprivate voluntary agencies located mainly in theNew York City metropolitan area.

NACC has expanded the funding and the num-ber of patients under treatment in the privateprograms almost as fast as the certificants in theregular NACC program.

Methadone maintenance offers the only newtreatment approach. Methadone is a highly addic-tive drug that treats only the symptoms rather thanthe causes of heroin addiction.

Recent evaluative reports of the methadoneprogram suggest that 20 percent of the addicts inthe program either withdraw voluntarily or areadministratively discharged for behavior problemsand other drug abuse; of those who remain in theprogram, 85 percent are claimed to function in asocially acceptable manner as measured by arrest-free records and participation In educational pro-grams or employment.

The State has de sided to greately expand the useof methadone programming in the treatment ofopiate addiction. Governor Rockefeller has stated

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his intent to have 20,000 addicts in methadoneprograms by the end of the 1971 fiscal year.

It is questionele, however, whether the highlyselective criteria which were originally used in theselection of patients in the Beth Israel program calbe maintained with the addition of several thou-sand addicts to methadone programs.

The cost of the Beth Israel program to the Statehas been $159.16 per patient per month for the1969.70 year. This is slightly higher than the$146.08 average monthly cost per patient toNACC for all voluntary agencies, and is not the"pennies a day" cost quoted by some enthusiasticsupporters of methadone maintenance. The main-tenance cost, however, is substantially less than the$771 per patient month cost in the average NACCresidential facility.

The Legislature in 1970 appropriated $65 mil-lion for NACC to provide State aid for drug abusetreatment programs that are designed primarily for16 year olds and younger and that provide ambula-tory and/or in-patient services. The initial applica-tion guidelines distributed by NACC in May didnot allow eligibility for education programs. Thesecond version of the guidelines has for all pur-poses set aside the treatment component specifedin the law and considers educational programssingularly eligible for funding. (Approved by Legis-lature, March 1971.)

Urgent programsand narcotics is an exampleoften must be initiated before all the prerequisitesare available. Such programs should continue to beregarded at experimental in that controls, records,research and evaluation must be maintained continually to document the most advantageous meth-ods and programs. In programs of this type,substantial initial outlays might be necessary toassure that fair and full tests will be available. Atthe same time, the continuation or extension ofsuch outlays should be clerendent upon demonstra-tion that careful controls are being applied andthat some criteria have been established and arebeing utilized to distinguish and select the morepromising approaches.

Since the dimensions of the narcotics problemare still .inknown, It does make a significantdifference in a State hard pressed for revenue as towhether the same essential results can be ac-complished in an outpatient program costing $56or $146 per patient per month or a residentialprogram costing $440 or $969 per patient monthand, more importantly, if any of them are doingthe job.

The New York State Program to control nar-

cotic abuse is a worthy experiment. This experi-ment has not yet had sufficient time to indicatewhat performance standards might be achievable,and it should therefore be continued. There is noevidence, however, that this experiment thus far

has been hindered for lack of funds, and furtherincreases should be conditioned upon NACC, andother departments and agencies supplying plansfounded on documented performance reccrd9.

PROGRAM AUDIT SUMMARYNARCOTIC DRUG CONTROL IN NEW YORK STATE

One of the most frustrating problems thatconfronts the nation and particularly New YorkState today is the control of narcotics and otherdangerous drugs. This State is currently engaged inan extensive and expensive program to meet thisproblem and while it may be too early to judge the

'eventual results, there is nothing to data to indicatethat an acceptable solution is in sight.

Reliable figures concerning narcotics use andabuse are not available. Information that is avail-able indicate° that more than half the narcoticsaddicts in the country are residents of New YorkState and that 85 to 90 percent of the New YorkState addicts reside in New YorkYork City.

The State efforts to control the use of narcoticshas been concentrated in the Narcotics AddictionControl Commission (NACC). Figures compiledduring the four years of NACC operation give someindication of the scope of the State program.

Summary Statistics, NACC

1967-68

1968-69

1959-70

1970-71

Addicted' N.Y.C. 5,910 5,768 9,409 11,1512Bal. N.Y.S. 649 952 1,687 1,8352

NACC Cerlificants 3,164under Care

4,408 7,075 10,7642

Under Treatment - 3,158 6,257 6,704 10,4192Accredited Agen-cies

' Positive Examination by NACC

' To January 81, 1971

SOURCE: NACC Annual and Monthly StatisticalReports

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To meet the narotics problem the State hasrapidly increased its expenditure in this area.

State Narcotics Expenditures

Year

1963-641964-651965-661966-671967-681968-691969.701970-71 (Budget)1971.72 (Appro-

priation)

Metcalf-Volker NACC

$1,731,6172,090,7403,492,4554,673,964

$20,739,39333,216,30949,535,39085,146,12491,739,000

In addition the State has expended almost$124,000,000 in capital construction funds sinceNACC was created.

The New York State effort to ddal with narcoticaddicts began with a Special Narcotic Projectconducted by the Division of Parole in 1956. Itprovided dose supportive parole supervision forapproximately 600 parolee-addicts, and it has beenregarded as valuable enough to be continued to thepresent.

The 1962 Legislature passed the Metcalf-VolkerAct, which provided that as of January 1, 1963arrested narcotic addicts who show a potential forrehabilitation and whose crimes are not seriousmay elect to receive specialized treatment at aState mental hospital rather then be committed toa penal institution. That session also affirmed alarger commitment by the State to treament andaftercare support for voluntary patients.

The impact of these new State programs wasreviewed by the New York State Commission ofInvestigation in 1965. This Commission found theMetcalf-Volker program was disappointing since

follow-up study revealed 80 percent of the treatedaddicts as rearrested, most of them more thanonce, and concluded that "no program of rehabili-tation which relies principally on the voluntaryapplication of the addict for treatment can besufficiently broad and comprehensive to dealeffectively with the total problem of addiction."'The revamped drug control program proposed byGovernor Nelson A. Rockefeller and enacted bythe Legislature in April 1966 accordingly featuredprovisions requiring compulsory commitment ofproven addicts, even when they were not chargedwith a crime.

The Creation of NACCThe 1966 Legislation, comprising Article 9 of

the Mental Hygiene Law, focuses almost ex-clusively on narcotic drugs. This focus is under-standable. Narcotics use is the one drug abuseproblem that is known to be widespread, and tofeed and breed crime extensively. Planning officialswithin the Narcotic Addiction Control Commissionare aware of non-narcotic drug use problems, andthey assume their mandate includes dealing withthis area. For the time being. however, they havemore than they can handle just in attempting tobring heroin under control.

The basic premise of the NACC program, fromthe "Declaration of Purpose" in Article 9, is asfollows:

The narcotic addict needs help before he iscompelled to resort to crime to support hishabit. The narcotic addict who commits acrime needs help to break his addiction. Acomprehensive program of treatment, rehabil-itation, and aftercare for narcotic addicts canflu the needs.

Contrast this assertion with the following ad-mission offered by a proponent of the bill iu theSenate.

We are talking about a problem for whichwe know no cure, about which no data tellsus there is a cure and yet we must dosomething.

The intent of the Legislature thus appears tohave been twofold: first, the expktation that the

New York State Temporary Commission of Investigation,Ninth Annual Report, February 1967, p. 49.

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vasc majority of addicts who were convicted ofmisdemeanors, and who had previously been re-leased from confinement after four-month-averagesentences and no parole, would now be supervisedfor three years; and second, the hope that whatevercompulsory treatment and rehabilitation servicesthese addicts received would equip them to turn(or return) to socially acceptable life styles.

Rehabilitation alone was never presumed to bethe only solution to these problems. The fact thatthe emphasis in the 1966 Legislation was ontreatment did not change the overall picture thatincluded enforcement as a critical component.Enforcement resources are necessary both to ap-prehend the narcotics violator and to assure thatpotential and actual absconders and repeat viola-tors are subjected to continuing pressure.

There is, in addition to rehabilitative treatmentand enforcement, a third significant dimension inNew York State's drug control planning. It ispreventive education.

The 1966 Act charged the Narcotic AddictionControl Commission to:

Provide public education on the nature andresults of narcotic addiction end on thepotentialities ol ,:vention and rehabilitationin order to promote public understanding,interest, and support.

The rationale supperting this aspect of theprogram again was formulated, among other places,in the report of the Commission of Investiga-tion. The Commission proposed the creation of a"comprehensive public education program" in lightof its claim to have found that:

... the education of the public to the perilsof narcotic abuse can be effeetive in prevent-ing addiction. This is especially true in thecase of young people who are particularlyvulnerable and susceptible to contagion. Edu-cation of parents, teachers, and others whohave contact with children in methods ofrecognizing narcotics and symptoms of nar-cotic abuse is also of prime importance.

Since 1966, not only NACC, but also the StateDepartments of Education, Mental Hygiene andHealth have received appropriations to supportdrug education activities.

Thus the New York State effort to control theuse of narcotic attacks the problem on three

major fronts: increased law enforcement to reducecrime and support compulsory treatment, anextensive and expensive treatment program torehabilitate present addicts, and a widespreadeducation program to prevent addiction.

STATE ENFORCEMENT EFFORTS

Law enforcement officials largely agree that,since drug traffic is international and interstate innature, the primary enforcement effort must be bythe Federal government. They also agree, however,that the State must play an imrortant role innarcotics and drug law enforcement, and that theState's proper role is an intermediate one betweenthe Federal and local levels, especially in thosecommunities where Federal presence is least feltand local polite are not equipped to deal with theproblem.

Consequently, the State has taken several stepsin recent years to strengthen ite enforcementeffort:

Criminal penalties have been increased forlarge -scale pushers or dealers in "harddrugs." The 19(9 Legislature imposea 3mandatory maximum life sentence for pos-sessing or selling 16 ounces or mere oiheroin, morphine, cocaine, or opium.

A Special Narcotics Plait was created in theDivision or State Police.

Members of the Narcotics Unit were as-signed in 1970 to participate with Federaland New York City police officers in theNew York Joint Task Force on Narcotics.

The 1970 Legislature established an Or-ganized Crime Task Force within the De-partment of Law headed by a statewideprosecutor with the rank of DeputyAttorney General, who is appointed jointlyby the Governor and Attorney General.

It is crucial to recognize that the combinedefforts of enforcement agencies at all levels havenot yet significantly reduced the supply of nar-cotics available in New York State, and theprospects for a significant reduction in the foresee-able future are not encouraging. These agencieshave succeeded, however, in bringing large numbersof addicts into court, thereby subjecting them tothe possibility of either compulsory commitmentto NACC or lengthy imprisonment.

New York State police recorded 2,081 arrestsand $41 million in chugs seized in 19( 3, and 3,594arrests and $47 million in drugs seized in 1969. Inmany of these arrests the drug involved wasmarihuana.

Local police are far more active in arrests fornarcotics violations. The New York City policemade over 127,000 narcotics arrests between Jan-uary 1967 and December 1970, and in more than85,000 of these the drug involved was heroin ormorphine:

New York City 1967 1968 1963 1970

Total Narcotice,Arrests 17,591 22,440 35,178 62,479

Heroin andMorphineArrests 9,722 13,461 23,698 38,790

The 1969 Annual Report of the Criminal Courtof the City of New York shows the followingdisposition of that year's misdemeanor cases:

Total raisdc-neanor arraignments 20,560Dispositions to date 15,876Outright dismissals 10,301Convictions 5,210Direct Sentences 3,508

Sentences for 90 daysor less 2,415

Commitments to NACC 194

These figures show that about two-thirds of allcases are dismissed outright, and that only 23percent of all diaps4itions result in direct sen-tences. Furthermore, 66 percent of these directsentences are for 90-or-less days.

The actual threat of punishment under felonyprosecution for narcotics violations is not propor-tionately stronger. There were 13,374 felonyarraignments in New York City in 1969, and 7,090reached disposition. Of these over 2,500 (3Gpercent) were dismissed outright. The SupremeCourt records on the disposition of the rest ofthese cases have not been compiled, but representa-tive figures on disposition of felony cases areavailable from the records of the Narcotics Bureauof the New York City Police Department.

The Bureau has followed up 2,218 felony arrestssince July 1969 that have been disposed of inSupreme Court. There were 938 dismissals (42percent), end not more than 827 direct sentences.

ITVtit'IMANItes,

Of the direct sentences, 616 were for one year orless; presumably many of these were cases of"copping a plea" to a misdemenanor. Only 172 ofthe original 2,218 arrests received terms of morethan one year; thus, only eight percent of thosearrested were ultimately convicted and sentencedfor felonies.

Thousands of alleged addicts are being arrested,but only a small percentage of these are beingcertified to NACC or receiving severe jail sentences.Addicts are not being taken out of circulation, andthe State's efforts to strengthen deterrence arethereby undermined. These shortcomings are dueto failings in the system of criminal justice thatextend beyond the ability of the police to appre-hend criminals.

CERTIFICATIONA major characteristic of the NACC program is

the compulsory requirement whereby all ceitifica-tions for treatment are made by a court orderwhich certifies the addict to NACC for treatmentfor a period of up to three years or, in more seriouscriminal cases, for as long as five years. Thelegislation provides several procedures by which anaddict can be certified by the courts to NACC:

Civil Certification1. The addict himself may volunteer for

certification.2. The addict may be involuntarily certi-

fied on the petition of any personbelieving him to be an addict.

3. An addict arrested on a lesser criminalcharge may "volunteer" for the NACCprogram in lieu of a possible penalsentence.

Criminal Certification4. The court must certify an addict con-

victed of a misdemeanor or prostitution.6. The court may certify an addict con-

victed of a felony.

In any of these procedures, ate court cannotcertify unless addiction is shown, usually by meansof a medical examination conducted by NACCdoctors.

Certification FindingsProgram execution falters beginning with the

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certification process. "A comprehensive programof compulsory treatment" was a key provision ofthe 1966 legislation. As one proponent of theleOslatiort stated, "Hk. (the addict) does not wantto be cured so we have to force him to be cured."

The civil certification of addicts is workingreasonably well, despite a heavy caseload in Man-hattan, Brooklyn, and the Bronx. Relatively fewarrested addicts, however, have "volunteered" forNACC tinder the provision which permits addictswith minor criminal charges to ci,00se a NACCtreatment program.

The criminal certification of addicts, on theother hand, is not working as intended in NewYork City. DI-ring the first year of NACC'sexistence, arrested or convicted addicts comprised59 percent of NACC catficants. For the thirdyear and the first six months of 1970.71 only 40percent of the cedificants carne by way of arrest.In the main, this is simply a part of the generaladministrative problem of the criminal courts ofNew York City caused primarily by the tre-mendous volume of cases and the consequentshortage of judges, lawyers, and other court per-sonnel to handle the workload. This load factor,plus a generally negative attitude toward the NACCprogram by the addicts, their attorneys (mostlyfrom the Legal Aid Society), and lawyers fzer.-n thedistrict attorneys' offices combine to produce fewcertifications to NACC. When addicts contest thequestion of addiction and request a jury trial, as istheir right, district attorneys often concede non-addiction, either because they do not have thepersonnel and resources to litigate or becauseevidence of addiction is insufficient. The evidenceof addiction is insufficient sometimes' because ofdelayed or inadequate medical examinations orweak medical witnesses. Rather than being certi-fied to NACC, therefore, most addicts are referredto private agencies or giver short penal senteme.

The negative attitude towards NTACC mentionedabove has come about for several reasons:

1. The belief that commitment to Ni.CCis simply a substitute form of imprison-ment;

2. The long wait in jail awaiting admissionto NACC facilities following certifica-tion;

3. The advantage to the addict of a shortjail sentence over a 3 or 6 year certifica-tion to a NACC treatment program.

TREATMENT ANDREHABILITATION

For many years, the principal treatment fornarcotic addiction has been a combination ofdetoxification, psychotherapy, and counselling.While drugs are slowly withdrawn from addicts,professional staff (primarily psychologists andpsychiatrists) tried to come to grips with thecomplex behavioral factors believed to have causedaddiction. This traditional method of treatment isstill prevalent in most drug treatment centers in thenation. Although statistics indicate that the long-term success rate (patient i-ot becoming readdictedto narcotics) has been very low, no other treatmentprogram has proven more successful.

From the beginning, NACC's approach to re-habilitation end treatment was ,based on theconcept tha no single treatment program wouldbe adequate and that it would be necessary toprovide several programs to meet the needs ofaddicts. Accordingly, a number of approacheswere chosen for the New York State overallprogram:

The principal NACC treatment approach isinterdisciplinary and offers a mix of indi-vidual and group counselling and therapy,education and vocational training, and rec-reation.

NACC offers its commission operated pro-gram of rehabilitation and treatment inthirteen residential facilities followed by asupervised period of aftercare which, hope-fully, prepares the addict for communityliving on a drug free basis.

NACC executed agreements with 14 otherappropriate State and New York Cityagencies to utilize their expertise in thdevelopment of special treatment programs.

The Department of Mental Hygiene em-ployed a "psychiatric" approach. The"correctional" approach of the Departmentof Correction offers treatment in the settingof a correctional institution for addictsconvicted of serious crimes.' A contract withthe 'Department of Social Services offers aprogram for "youthful" addicts.

Separate contracts with the City of NewYork through its Addiction Services Agency

provide primarily for support of the "thera-peutic community" concept in the PhoenixHouses which utilize ex-addicts in the treat-ment program.

NACC funds a number of private voluntaryagencies located mainly in the New YorkCity metropolitan area. When NACC wasfounded, it elected to fund (on a demonstra-tion grant basis) a number of agencies whoseexistence preceded that of NACC. A total of19 private progr-uns are funded.

A "chemotherapeutic" approach is suppliedprimarily by methadone maintenance.Methadone is a synthetic opiate which,given under proper medical supervision,blocks the narcotic effect of heroinwithout inducing euphoria or necess'tatingan increase in the dosage once a mainte-nance level has been attained. Once anaddict has been stablilized, it is asserted thathe is more amenable to treatment for thecauses of his addiction.

In the first three years of its existence, NACCspent $98 million of its $103 million total opera-ting expenditure for treatment and rehabilitation,and $124 million in capital expenditures forfacilib _ 3.

As of January 31, 1971 NACC has more than10,700 certifier: addias in treatment, aftercare,and contract programs. An additional 10,400non-certified volunteers are receiving some form oftreatment in NACC supported private agencies.

There is every indication that NACC knows itsprincipal assignment and has tried to execute ft.

ScreeningOnce a person has been criminally or civilly

certified to NACC, he is given a screening inter-view. The , interview is an attempt e a broadcharacter evaluation to determine his most appro-priate treatment and rehabilitation facility orprogram. However, with the continuing shortage oftreatment beds, actual assignment to residentialfacilities usually takes place on the basis ofavailable bed space.

Some addicts may be recommended kr metha-done maintenance, private agency, or "instantaftercare" programs (short-term residential pro-gram in a community based center). Most certifi-

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Addicts Under Treatment

Residence Aftercare

TotalTotal NACC in Accred-Certificants ited Agencies Total

1968 2,976 188 3,164 3,158 6,3221969 3,405 1,003 4,408 6,267 10,6651970 4,828 2,247 7,075 6,704 13,7791971 (Jan.) 6,141 4,323 10,764 10,419 21,183

SOURCE: NACC Annual Reports and Monthly Census Reports

cants begin their treatment in P. residential programoperated by NACC or one of its contract facilities.

Residential TreatmentThe NACC residential program as of October 31,

1970 provides treatment for some 3,800 patientsin 13 residential facilities with approximately1,400 patients in contract facilities of other StateDepartments. Another 1,000 beds are expected tobe available in the near future as the Ridge Hill andBrooklyn Central facilities become fully operation-

In addition to those under treatment, as ofNovember 1, 1970 the waiting list showed:

425 certified and not admitted;

444 detained for examination with certifica-tion probable for at least half thisnumber (based on past experience);

300 in police custody and chargedwith new offenses who may be returnedto NACC;

27 In policy custody pending return toNACC

The fact is that NACC has not yet had facilities tofully meet the demand.

For a period'that now averages from 6 to 9months, the patient is exposed to a program ofindividual and group counselling and therapy,education and vocational training, and recreation.When it is decidedethat sufficient progrec:: has beenmade, the certificant is rt rortunendeci !or transferto an aftercare center. ..

The residential phase is he meet expensive partof the treatment program. For the 1970 budget

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year, almost $21 million was spent to treat anaverage resident population of 2,246 addicts. Thisis an average annual expenditure of $9,250 perresident patient.

Residential Treatment FindingsThere are few major differences in the treatment

and rehabilitation services offered for narcoticaddicts by NACC and other state agencies. Pro-grams do vary in the "mix" of counselling,vocational and educational training, recreation, andsecurity but only the extremes in this treatmentcontinuum show significant differences. It must berecognized there are two or three individual treat-ment facilities that have established programs thatdiffer slightly in philosophy from the averageprogram.These differences are often based on operatingpremises developed by the program directors ratherthan NACC.

ProCram evaluation depends in part on theassumtion that a full program is being offered.With due respect to the fact that the NACCprogram is only three years old, there are severalcenters with inoperative program components. Thereasons for this inactivity are several.

Some facilities are still not usable: the wiring ofshop equipment was incompatible with the wiringat the facility; in other facilities Out have beenopen for a year or more, equipment has not yetbeea delivered; and in still others, equipment liesidle because essential renovations in shop areashave not b,..-en completed.

The NACC operated programs are also plaguedwith a variety of personnel problems. Professionalsare simply not available in some critical classifica-tions: medical personnel, counsellors (especiallySpanish-speaking), vocational, and educationalstaff.

Contract Treatment FindingsNACC's claim that special interdisciplinary pro-

grams have been developed for certain types ofaddicts does not appear valid.

The psychiatric treatment approach, utilizingprofessional psychiatrists in the therapy process, issupposed to be employed in the Department ofMental Hygiene's program at Manhattan StateHospital. In fact, Manhattan State's program nowfocuses on a team concept of psychologists andsocial workers while psychiatrists have been"phased out."

The Department of Correction, with NACCfunds, operates a treatment program in its facilitiesat Greenhaven and Great Meadow. However, crimi-nal certificants assigned to these institutuions areintegrated with the regular prison population inevery way except that they participate in groupcounselling sessions conducted jointly by correc-tion officers and ex-addicts of the Reality Housestaffa treatment program operated by formeraddicts that performs out-reach work in someprisons.

The arrangement with the Department of 81:-cial Services was established on the basis ti,4tNACC offered no special program for yout..ixicertificants. These young addicts (i.e., under 17years of age) are assigned to the Department ofSocial Services for treatment. However, there areno distinctions made between NACC certificantsand others in the program. Addicts are intermixedand receive the same programming as other youth-ful offenders.

The findings of this study indicate there are fewmajor differences from treatment program totreatment program at NACC and other Stateagency institutions housing NACC certificants.There appears to be little justification for theinterdisciplinary treatment programs funded byNACC, except for the utilization of excess space inthe contract facilities. At a minimum, this jointadministration is causing problems among staffwho are operating under NACC program guide-lines, yet looking to other departments for pro-motions and other benefits.

Treatment CostsRapidly rising costs make establishment of

contrc.ls- ..adequate records, and follow-up to deter-mine results imperative. For example, operating

' costs almost tripled between the first and thirdyear for the residence facilities operated by NACCor under contract. However, the number of sub-

jects in residence only increased by 62 percentbetween the end of the first and third years.

% of1967-68 1969-70 Increase

Subjects in Residence(as ofMarch Fl) 2,976 4,828 62

Operating Expenditures(Resident TreatmentCenters) $10,373,958 $29,298,293 188

Of equal concern must be the rising cost offacilities. The average construction cost per bedhad been about $20,000. The cost of the lastfacility constructed at Ridge Hill was more than$36,000 per bed.

In addition to the sharp rise in overall treatmentcosts, there are wide variations between unit costsin NACC facilities, and between NACC costs andthose of the contract agencies.

Average Cost Per Patient, NACCResidence Facilities

Monthly Annual

High (Queensboro) $ 1,164 $ 13,966Low (Woodbourne) 658 6,691Average 771 9,249

The data indicate a difference of more than 100percent between the lowest and highest cost perpatient in NACC facilities.

NACC current operating costs per resident arealso 75 percent higher than those of Correctionand 30 percent higher than Mental Hygiene.

Average Resident CostsMonthly Annual

NACC $ 771 $ 9,249Mental Hygiene 688 7,068Correction 440 5,275

Until there are demonstrable differences inprogram results, such wide variations do not appearjustified.

AftercareThe NACC aftercare program consists of a

continuing emphasis on the same essentials as

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1,Iworwwwwww...

treatment: counselling, educational and vocationaltraining, and recreation. This continuing aftercareis aimed at preparing addicts for life in thecommunity. Aftercare centers consist of ReportingCenters with virtually no supportive services otherthan supervision, and Community Based Centers(CBC) which provide supervision and supportivecounselling, educational and vocational, and recre-ational services.

There are two Reporting Centers (Albany,Syracuse) that provide counselling and supervisionfor certificants in most of the upstate area. Five ofthe six Community Based Centers are in New YorkCity and one is located in Buffalo.

The typical Community Based Center providesprogramming for 800 addicts: 50 in residence, 160on day care, and 600 on field service. Certificantsare assigned to one of these programs dependir.3 onhome and family situation, progress in program-ming, employment and educational potential, andamount of supportive services required. Minimumrequirements during this phase of programmingconsist of mandatory periodic meetings with pro-fessional staff and regular urinalysis. At the end ofOctober 1970 there were 3,691 patients in after-care programs: 3,236 in field service, 210 in daycare, and 246 in residence.

Number inYear Aftercare

1967-68 (March 31) 1881968-69 (March 31) 1,0031969-70 (March 31) 2,2471970-71 (Oct. 1970) 3,691

SOURCE: NACC Annual Report andMonthly Census Reports.

Operating Costsof CBC's

$ 160,0841,038,0663,192,7976,502,090(Budget)

Aftercare FindingsIt is the so-called "aftercare" resources of NACC

that are most directly involved in getting addictsback into the community and providing them withwhatever support they might need in "returning touseful lives." Most centers actually offer little insupportive services to the people assigned them.Too often, elements of the program are inoperativebecause of a shortage of professional personnel andbecause of a breakdown In supervision resultingfrom hnge caseloads. As a result, it is in thaaftercare phase of treatment that the vast majorityof abscondences from NACC facilities take place.

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13

As of October 1970, there were 1,894 people whowere on abscondence from aftercare programs. Alarge number of certificants have been transferredto aftercare who were apparently not ready whenthey were released from the security of theresidential program, and without adequate sup-porting services they absconded in large numbers.

Private Agency ProgramsOne of the principal elements in the rehabilita-

tion and treatment of drug addicts is the fundingof private voluntary agencies located mainly in theNew York City metropolitan area. When NACCbegan operating, it elected to fund a number ofthese agencies already in existence. In addition, ithas funded new programs that claim to offersomething "unique" in the treatment and rehabili-tation of addicts.

The essential difference between programs oper-ated by private agencks and those operated byNACC is the voluntary nature of the former.NACC exerts legal control over people certified toit and can issue warrants for those who escape. Inthe private agencies people enter programs of theirown "free will" and leave when they choose to doso. Every program has a high "split sate" (i.e.,people who have entered the program but wholeave before they are judged to be "cured").

Private agencies indicate they do not screenpeople out of their programs, but the voluntarynature of the program acts as a selection process .Those who are unhappy with a particular programleave it. The result is that only a small percentageof the people who enter ever graduate from aprogram. According to an unpublished study cover-ing a period from mid-1967 to February 1970,there were 2,110 cumulative admissions to thePhoenix - A.S.A. (NYC) programs. Of this total,only 79 persons (3.7 percent) completed theprogram.

The programs run by the private agencies can bedivided into three basic types: residential, out-patient, and methadone. There is an apparentdifference in the operating philosophies of thedirectors of residential and out-patient programs.The directors of the latter maintain that residentialprograms create an unreal environment for theaddicts and that transition from the secure worldof the treatment facility to the unstructuredoutside world is very difficult. These directorsmaintain that people la out-patient programs avoidthese unnecessary stresses and are forced to dealwith reality by going home and remaining drug

free in the community.The program components employed in the

treatment process differ almost as much as theagencies that emply them. In general, programsfall somewhere along a continuum with therapeuticcommunities that focus almost entirely on grouptherapy at one end and programs with interdis-ciplinary "mixes" that combine therapy witheducation and vocational training in varying pro-portions at the other end.

Out-patient programs, such as Greenwich HomeCounseling Center and the Lower Eastside ServiceCenter, do not have residential facilities. Thespecific mix of services offered in out-patientprograms veries as much as in residential programs.Some stress intensive group therapy while othersemphasize educational and vocational achieve-ments as well. Participants come in as frequently asrequired to receive services and then return to thecommunity. Additionally, these programs are lesscostly since they serve more people with the samestaff and are less intense in nature.

NACC has expanded the funding and the num-ber of patients under treatment in the privateprograms almost as fast as the numbers in theregular NACC rrogram.

Volunteer Private Agency Programs

Year No. of Patients NACC Funding

1968 (March 31) 3,158 $ 3,252,0001969 (March 31) 6,257 8,979,0001970 (March 31) 6,704 9,158,0001971 (January 31) 10,419 10,654,000'

NACC Allocation

SOURCE: NACC Annual Reports and MonthlyCensus Reports

There is a wide range in the direct cost 17 NACCfor the services of these private agencies, from aslow as $56.73 per month for a program that isexclusively outpatient, to as high as $471.78 permonth for a program that is predominantly res-idential.

The operating costs of the private agencies areless than those of facilities operated by NACC.This is due in part to NACC security needs, but canalso be attributed to differences in programmingmethods and staffing. However, the direct cost toNACC which ts used in this report may, in some

cases, be only part of the actual cost. Additionaloperating costs that are financed from othersources are not reflected in NACC cost figures. Forinstance, many of the private agencies insist theirpatients apply for welfare. They are required toturn their checks over to a central fund to payoperating expenses. Additionally, private agenciesoften have several sources of financing. Mostreceive private contributions and several receivefunds from other government agencies.

The private agencies have grown considerably insize since their original contracts with NACC weredrawn. This growth has been permitted without acorresponding evalution of treatment results. Someagencies have doubled their budgets since theirassociation with NACC, a growth that in manycases would not have been possible if they had torely on their previous funding sources. Since thereis no demonstrated "cure" for addiction, thefunding of these private agencies with their variedapproaches to treatment can be justified only ifadequate controls, records and follow-up to citer-mine results are included.

New York City Addiction Services AgencyThe Addiction Service Agency (ASA), establish-

ed in 1966, operates one of the largest municipallyrun anti-drug programs in the country. ASAprovides a variety of services for addicts and drugusers in Phoenix Houses, in other therapeuticcommunity facilities, in neighborhood CommunityCenters, in Youth Centers, in Day Centers, andother programs. The State has authorized about$19 million for ASA since 1967. For fiscal1970-71 the appropriation is $7.4 million.

The ASA funded treatment and rehabilitationprograms are run on the Phoenix House therapeuticcommunity concept, with most of the programsoperated by the Phoenix House Foundation. TheFoundation operates five Phoenix Houses on Hartisland for some 400 addicts, nearly three-quartersof whom are NACC certificants. Funding for thisprogram is provided by NACC through ASA whichis responsible for the coordination of the entirerehabilitation program on the island.

Methodone Maintenance Treatment ProgramsThe most controversial treatment concept for

narcotic addiction developed in recent years is theuse of Methadone Maintenance which has beenfunded by NACC since October 1967. The meth-adone treatment concept is still controversial be-cause methadone is a highly addictive drug thattreats only the symptoms rather than the causes of

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herion addiction. To be successful in the long-termtreatment and rehabilitation of addicts, the pro-gram must rely on the utilization of other suppor-tive and therapeutic services.

Most methadone programs are based on theresearch work and model developed by Drs. Doleand Nyswander at Rockefeller University and locat-ed at Beth Israel Medical Center since 1964.

The general operating concept of the model isthat under proper medical supervision, a highlevel daily dose of methadone will block thenarcotic effects of opiate drugs without inducingeuphoria or necessitating an increase in dosageonce a maintenance level has been established.Once an addict has been stabilized, it is assertedthat he may be more amenable to. treatment forthe causes of his addiction.

The largest program currently operates throughthe Beth Israel Medical Center and its satellitefacilities. Beth Israel works on both an in-patientand ambulatory basis. There were 2,153 people inthe program as of October 31, 1970.

The second largest methadone program in thestate is operated by NACC at the Cross BayRehabilitation Center. This program is essentially aresearch project composed of three research pro-tocols, differentiated by several criteria includingage, criminal background, and prior treatment foraddiction. Patients, alter having been stablilized onmethadone during a six-week period, are thenassigned to one of the NACC aftercare methadoneprograms at community based centers. In addition,NACC operates several methadone maintenanceprograms for a small number of certificants atseveral of its rehabilitation centers. Certificants inthe latter program are stabilized on methadone andare then transferred to aftemare programs atcommunity based centers. There were some 700under treatment In NACC facilities and severalhundred in other private programs.

New York City is now in the process ofestablishing twenty centers operated by its Depart-ment of Health with Sate funding for the treat-ment of an additional 2,500 addicts.

Methadone 1 indingsMost of the public acceptance of methadone

maintenance programs is based on the researchdata and analysis of the methadone treatmentprogram at Beth Israel, Recent evaluative reportsof that program suggest that 20 percent cA thepeople in the program either withdraw voluntarilyor are administratively discharged for behaviorproblems and other drug abuse; of those who

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remain in the program, 85 percent are claimed tofunction in a socially acceptable manner as mea-sured by arrest-free records and participation ineducational programs or employment.

New methadone programs are being rapidlyestablished, usually with few supportive servicesand frequently without the evaluation and follow-up that are necessary in large-scale research pro-grams. Further, it is clear that existing ancillarysupportive services are not heavily utilized inseveral programs.

The State has decided to greatly expand the useof methadone programming in the treatment ofopiate addiction. Governor Rockefeller has statedhis intent to have 20,000 people in methadoneprograms by the end of the 1971 fiscal year.

As of September 8, 1970 10 contracts had beenawarded to provide for treatment for up to 11,875persons under the state's $15 million methadoneprogram. "This combined with the program fortreating up to 2,488 persons, carried out by theNarcotics Commission itself at their centers, a--counts for a total services level of 14,363 persons."

The question must be asked, however, whetherthe highly selective criteria which were originallyused in the selection of patients in the the originalBeth Israel program can be maintained with theaddition of several thousand addicts to methadoneprograms. If not, can it be assumed that the successrate obtained and widely publicized by Beth Israelcan be maintained? There am strong indicationsbased on observations end results obtained fromprograms operated by several private agencies thatsuccess rates are substantially lower when addictsare admitted on the basis of less selective criteria.

The cost of the Beth Israel program to the statehas been $159.16 per patient per month for the1969 and 1970 fiscal years. This is slightly higherthan the $146.08 average monthly cost per patientto NACC for all voluntary agencies, and is not the"pennies a day" cost quoted by some enthusiasticsupporters of methadone maintenance. The main-tenance cost, however, is substantially less than the$771 per patient month cost in the average NACCresidential facility. It must be pointed out that themethadone cost figure is based on a program that islargely outpatient in nature whereas the NACCcost is for a residential program.

In summary, the State pioneered and is nowfunding the rapid expansion of methadone main-tenance because:

It was the only "new" concept that has beenoffered recently;

Follow-up records are being kept and treat-ment results can be documented by the pro-gram's statistics;

It appears to offer an alternative for an as yetunknown segment of the addict population;

It does not require long periods of moreexpensive residential care.

Statistics and Follow-UpThe principal problem encountered in trying to

evaluate both the private agencies and the facilitiesoperated or funded by NACC is the singular lack ofhard data except for the Beth Israel methadoneprogram. Most of the programs have been able togenerate some basic demographic statistics whichare highly descriptive but are not evaluative innature.

The statistics from private agencies are probablyless reliable and more subject to question thanthose .generated by NACC. However, even NACCfollow-up data have been limited. NACC directorsdo not know how their programs compare to otherfacilities, or whether individuals who participatedin their programs are still abstaining from drug useor have become re-addicted to narcotics.

In most cases, the private agencies have not hadeither the resources or the inclination to gathereven the most basic evaluative data. Instead, theyhave relied on their service orientation to justifytheir operations. The statistics that have beenissued are often highly colored and in many casescannot be verified.

Private and public agencies have not done thekinds of follow-up studies that are necessary forprogram evaluation. Tpe private agencies, eventhose funded on a long-term demonstration basis,with exception of the P Ah Israel methadoneprogram have not been evaluated on any sort ofrational basis by NACC, but have been allowed toincrease the size of their programs. Therefore, atthe present time, there is no way in whichtreatment programs can be compared in anymeaningful attempt to determine which, if any, aremore successful the, treatment and control ofnarcotics addiction.

More attention should be directed to acquiringfollow-up information about all known addictsover a given period of time. This information hasbeen restricted for the most part to those personswho have been discharged from programs asdrug-free. It must be expanded to include thosewho have absconded and are now dismissed assimply "lost-to-contact," or who have left treat-ment programs for other reasons. Records of these

"missing" addicts are essential to the orderlyanalysis and development of an overall Statetreatment program.

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EDUCATION

The NACC ProgramsOf NACC's total budget, less than three percent

is spent on "education" efforts. NACC was givenresponsibility for providing public education onthe potentialities of prevention; it was also chargedwith disseminating "information relating to publicand private services and facilities in the stateavailable for the assistance of narcotic addicts andpotential narcotics addicts," and it was essentiallythis latter drug awareness function that NACCunderstandably concentrated on in its first years.Most of this effort has been carried out by thestaffs of the community narcotic education cen-ters, of which there are presently 16nine in NewYork City and Long Island and seven upstate. Theeducation Centers have also served as the principalvehicle assisting applicants for civil certification.

NACC's second element for "prevention" is theNarcotic Guidance Council (NGC), which wasauthorized by legislation in 1968 to "develop aprogram of community participation regarding thecontrol of the use of narcotics and dangerous drugsat the local level." NGCs were to "make immedi-ately available to the community basic knowledgeacquired in the field of drug use ... and create aclimate in which persons seeking assistance... canmeet ... with responsible individuals or agen-cies ....". Approximately 250 NGCs have alreadybeen established, and an additional 140 have beenproposed. These organizations thus far have barelyhad time to go into action.

The Mate Department of Education ProgramsThe Laws of 1967, amended in 1970, authorize

the Commissioner of Education to establish acontinuing program for critical health problems inwhich:

educational requirements regarding cigarettesmoking, drugs, and narcotics and excessiveuse of alcohol become the basis for broad,mandatory health curricula in all elementaryand secondary schools.The basis of this new program was originally

intended to be a curriculum on SociologicalHealth, Drug, and Narcotic Education (Strand II)that was completed in 1967 and available forgrades 4-12. Strand 11 was conceived along tradi-tional lines information, presumably "authorita-

16'

tive," was to be given to students in lectures byteachers. Strand II has been applied minimally,with a current budget of $30,000 to cover thepreparation of new curriculum materials. Strand His currently being revised to allow more studentparticipation in material dealing with drug abuse.

The Education Department in 1970 launched anextensive set of programs to prepare teachers,administrators and students for involvement infuture drug education classes in which the utiliza-tion of innovative materials and student participa-tion would be stressed. During the summer of1970, 89 teachers received two weeks of training inone program, and 189 others completed the firstcourse in a part-time Master's Degree sequence.Other future community teachers are supposed tocome from College Volunteer and School-Community-Team programs. With the exception ofpilot projects, as of January 1, 1971 there has beenalmost no feedback into schools from speciallytrained leaders.

The size and scope of the programs of the StateEducation Department were relatively small scaleand experimental through 1969.70. The Depart-ment has proceeded slowly, apparently recognizingthat it had to develop and substantiate a drugprevention curriculum, and prepare teachers to usesuch a curriculum before any large-scale programcould be launched.

Youthful Drug Abuse Treatment ProgramThe Legislature in 1970 appropriated $65 mil-

lion for NACC to provide State aid for drug abusetreatment programs that are designed primarily for16 year olds and younger and that provide ambula-tory and/or in-patient services. The initial applica-tion guidelines distributed by NACC in May didnot allow eligibility for education programs. Thesecond version of the guidelines has for all pur-poses set aside the treatment component specifiedin the law and considers educational programssingularly eligible for funding.2

Education FindingsNACC's Education Centers and Guidance Coun-

cils have provided a sense cf community presenceand it is reaching some of the addict populationthrough the petitioning assistance even in theEducation Centers.

Impact of the extensive public relations pro-gram lectures, publications, etc. is always diffi-

.

2 Section 213-a of the Mental Hygiene Law was amended byChapter 49, Laws of 1971, to permit these changes.

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cult to judge. However, there is evidence of muchcontinuing skepticism among judges, lawyers, andaddicts themselves about NACC's ability to helpthe addict.

Underlying the spirit of the NGC legislation isthe idea that the Councils would be able tocommunicate with the youth in the communitywho face the perils of drug abuse. NGCs often havea difficult time relating to individuals with drugproblems because they lack youth membership andback-up treatment facilities. Both these short-comings were items covered by amending legisla-tion in 1970. Persons under 21 were specificallyauthorized as Council members, and the $65million Youthful Drug Abuse Treatment moneywas originally authorized for a 50.50 state-localsharing of financing for youth treatment centers.

The preventive education efforts of the State areall so new that evaluation in terms of the relation-ship between costs and results is impossible;indeed, there are presently no results in terras ofprogram implementation. Educational programsdesigned to influence the behavior of students overa period of years are almost always difficult toevaluate even when comprehensive records aremaintained. School programs focused on drugabuse are particularly difficult to measure consider-ing the numerous problems involved. Careful doc-umentation and extensive use of control or pilotstudy groups involving a comparatively small num-ber of students is a ,method frequently employedwhich, among other things, reduces the possibilityof extensive adverse effects. It is expected that alleducational programs devoted to drug abuse willhave been authenticated before they are offered tolarge numbers of students and before sizeableamounts of money will be needed.

There is ample evidence of insistent publicdemand for "something to be done" in educatingstudents regarding the perils of drug abuse. But theextent of the educational programs that GUI beimmediately generated throughout the State andthe amounts of money that can be used withappropriate effectiveness for drug abuse classes arenot readily discernible.

CONCLUSION

Three key premises were basic to the narcoticdrug control programs approved by the Legislaturein 1966 and thereafter: (1) there exist demon-strated, reasonably effective treatment proceduresfor narcotics addiction, (2) there exists an effectivecriminal Wee system to insure either compulsory

17.

commitment to NACC for treatment or the imposi-tion_ of legal penalties sufficient to discourage thesale or use of narcotics, and (3) there exists atested, satisfactory curriculum plan upon which tobase preventive education. This audit has shownthat none of these important elements are accom-plished facts even today.

Urgent programs and narcotics is anexample often must be initiated before all theprerequisites are available. Such programs shouldcontinue to be regarded as experimental in thatcontrols, records, research and evaluation must bemaintained continually to document the mostadvantageous methods and programs. In programsof this type, substantial initial outlays might benecessary to assure that fair and full tests will beavailable. At the same time, the continuation orextension 02 such outlays should be dependentupon demonstration that careful controls are beingapplied and that some criteria have been estsblish-

ed and are being utilized to distinguish and selectthe more promising approaches.

Since the dimensions of the narcotics problemare still unknown, it does make a significantdifference in a State hard pressed for revenue as towhether the same essential results can be accom-plished in an outpatient program costing $56 or$146 per patient per month or a residentialprogram costing $440 or $969 per patient permonth and, more importantly, if any of them aredoing the job.

The New York State program to control nar-cotic abuse is a worthy experiment. This experi-ment has not yet had sufficient time to indicatewhat performance standards might be achievable,and it should therefore be continued. There is noevidence, however, that this experiment thus farhas been hindered for lack of funds, and furtherincreases should be conditioned upon NACC andother departments and agencies supplying plansfounded on documented performance records.

NOTE

These "Highlights" and "Summary" are from aProgram Audit of Narcotic Drug Control in NewYork State which may be obtained from theLegislative Corquission on Expenditure Review,111 Washington Avenue, Albany, New York12210.

The report concentrates on analysis and evalua-tion of programs concerned with control of nar-cotic drum and with those individuals who abusethem. Recommendations are excluded from thereport since they are outside the scope of theCommission's mandate. Also to be noted is thatagency responses to the preliminary draft of theaudit may be found only in the complete report.

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TABLE OF CONTENTS

Chapter Page

Foreword iiNarcotic Drug Control in New York State Introduction and General Findings iiiI. Dimensions of the Drug Problem 1

II. Evolution of Narcotics Control Programs 5III. New York Enforcement Efforts 9IV. Certification of Addicts 15V. Treatment and Rehabilitation 29

NACC Intramural Facilities 33NACC Contracts with Other State Agencies 40Private Agencies Treatment and Rehabilitation Programs 42Methadone Maintenance Programs 49Program Costs 55

VI. Preventive Education 58VII. Summary and Findings 66

List of Exhibits 73

AppendicesA. Capital Construction 87B. New York State Drug Control Laws and Criminal Offenses 93C. Agency Response 105

Department of Education 108Narcotic Addiction Control Commission 109

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FOREWORD

The Legislative Commission on ExpenditureReview was established by Chapter 176 of theLaws of 1969 as a permanent legislative agency for,among other duties, "the purpose of determiningwhether any such department or agency hasefficiently and effectively expended the fundsappropriated by the Legislature for specificprograms, and whether such departments oragencies in the actual implementation of suchprograms have failed to fulfill the Legislativeintent, purpose, and authorization." This programaudit of Narcotic Drug Control is the second staffreport accepted by the Commission.

It concentrates on the analysis and evaluation ofprograms concerned with control of narcotic drugsand with those individuals who abuse them.Recommendations in regard to program or policyare not included in this audit. Policy formulationis, of course, the prerogative of the Legislature andthe programs which implement policy are properlywithin the Executive branch. The responsibility ofthe Legislative Commission on Expenditure Reviewis to aid the Legislature by providing factualinformation concerning State programs whichotherwise would not be readily available.

A word about procedure may be helpful. Afterthe preliminary draft of each audit is completed,copies are delivered to the agencies engaged incarrying out the particular legislative policies underscrutiny. The comments which agencies wish tomake in regard to the preliminary draft aresubsequently either included in the body of thereport or presented in the Appendix. In this way, itis hoped that any possible errors are corrected

before the report is printed, and that should thenagencies involved feel that additional material isessential for an equitable presentation, it will bereadily available. This is not designed to be adebate but rather an attempt to be of utmostassistance to all those concerned with State govern-ment.

The law mandates that the Chairmanship of theLegislative Commission on Expenditure Reviewalternate in successive years between the Chairman,Assembly Ways and Means Committee and theChairman, Senate Finance Committee. SenatorWarren M. Anderson is the chairman for 1971having succeeded Assemblyman Willis H. Stephens.

The professional staff members who conductedthe audit and prepared the report consisted of NeilBlanton (program director), Donald Bisesti, TravisBoggs, William Brooks, Anthony Esposito, BernardGeizer, and Michael Moss.

On behalf of the commission staff, 1 wish toexpress thanks to each of the twelve commissionmembers for assistance and understanding duringthe development of the report. Appreciation isnoted also to Commissioner Milton L. Luger,Chairman of the New York State NarcoticAddiction Control Commission and CommissionerEwald B. Nyquist of the State EducationDepartment and their respwtive staffs for theircooperation during the course of the audit.

April 7, 1971 Troy R. WestmeyerDirector

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NARCOTIC DRUG CONTROL IN NEW YORK STATEINTRODUCTION

This audit is designed to provide information asto the status and progress of New York State'sexisting programs dealing with narcotics and otherdangerous drugs.

The information is organized into the followingcategories: 1) the nature and extent of the narcoticdrug "problem"; 2) the New York State effort todeal with the narcotic drug problem, and therelationship between these efforts and those ofFederal and local governments; 3) assessment ofNew York State programs, in terms of legislativeintent, costs and results.

General FindingsOne of the most frustrating problems that

confronts New York State today is the control ofnarcotics and dangerous drugs. While it may be tooearly to judge the eventual results of the New Yorkdrug control effort, there is little evidence thisprogram his made a significant impact towardcontrolling drug abuse. Even though demonstrableresults have been few, there appears little reason tofault the scope of the program; as the NarcoticAddiction Control Commission (NACC) representsthe most ambitious program of any government tomeet the problem.

The State effort to control the use of narcoticsattacks the problem on three major fronts:increased law enforcement to reduce crime andsupport compulsory treatment, an extensive (andexpensive) treatment program to rehabilitatepresent addicts, and a widespread educationprogram to prevent new addicts.

In the legal. area, penalties for pushers wereincreased and compulsory treatment legislated forarrested users. Detection forces have beenIncreased. A special Narcotics Unit was created inthe Division of State Police and the Stateparticipated with Federal officers and the NewYork Qty Police Department in establishing a NewYork Joint Task Force on Narcotics. Local policeefforts have also been stepped upin New York

iii

`,11,9111,11.11M1.14714.6.-

City arrests for opium and morphine offensesincreased from 9,722 in 1967 to 38,790 in 1970.

The effectiveness of a law enforcement system,however, does not ultimately depend on an abilityto arrest offenders. A swift and fair trial andadequate punishment are also considered essentialsfor deterrent effect. This has not occurred withenough frequency. Of the misdemeanor arrests fornarcotics violations in 1969 in New York City two-thirds were dismissed, and the median sentence ofthose convicted was less than 90 days. The mostserious threat of punishment under felonyarraignments is apparently not much greater. Inone sample only 172 (eight percent) of an original2,218 felony cases were given terms of more thanone year.

Certification to NACC for compulsorytreatment of arrested and convicted addicts hasalso declined. During the first year of NACC'sexistence, arrested or convicted addicts comprised69 percent of total NACC certificants. For thethird year and the first six months of 1970.71,only 40 perceht of the certificants came by way ofcertification in criminal courts.

The arrested addict has been quick to discoverthat the legal requirement for a jury trial todetermine addiction, combined with an ineffectivemedical examining system and a crowded courtcalendar, make plea bargaining relatively easy andreturn to the street quicker than the three year"compulsory" treatment will permit.

In treatment and rehabilitation, NACC estab-lished a multifaceted approach utilizing their ownresidential and aftercare facilities and those ofother State agencies. It also funded almost anyreputable private agency that claimed to offersomething "different" in treatment and rehabilita-tion. To date, inadequate controls, monitoring andrecord keeping have made evaluation virtuallyimpossible, and there appear to be few majordifferences in the programs.

Rapidly rising costs make the establishment of

21

controls, adequate records, and follow up todetermine results imperative. NACC operatingcosts have risen approximately 60 percent per yearfrom an initial expenditure of $21 million in1967.68 to just under $50 million in 1963-70 andan adjusted budget appropriation of $85 millionfor 1970-71. Capital expenditures have totalledsome $124 million.

With rapidly increasing costs and little to showin demonstrable results from its variation oftraditional treatment programs, the State hasturned to a rapidly expanded program of metha-done maintenance. The methadone maintenanceprogram gained in acceptance because it main-tained records, control, and follow up. Evidencesuggests, however; that a great deal more objectiveresearch and evaluation are necessary before appli-cability of methadone for a more general segmentof the addict population can be determined.

The informative and preventive education pro-grams of the State are all so new that evaluation of

the relationship between costs and results is im-possible; indeed, there are presently few results inprogram implementation. Evaluation will remaindifficult even after many years of experience withthese programs because the outputs in educationalsystems are usually complex and strung out.Narcotics education as conceived and practiced byNACC is essentially a drug awareness effort. NACCuses its 16 Narcotics Education Centers and themore than 250 Narcotic Guidance Councils toencourages community action approach to drugeducation. Of N .ACC's total operating budget, lessthan three percent was spent over the first threeyears for preventive education. The State Educa-tion Department has been concerned with de-veloping a curriculum and teacher training programin narcotics education. With the $65 millionappropriation originally made to finance a Youth-ful Drug Abuse Treatment Program now redirectedto education, it becomes even more essential thatan effective program be developed.

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I DIMENSIONS OF THE DRUG PROBLEM

One of the most direct, most basic measures ofthe overall New York State effort to controlnarcotic drug abuse would be evidence that thenumber of narcotic addicts either is declining, or isincreasing at a progressively slower rate. The plainfact is that trend data necessary to make such anevaluation have never been, and are not now,available.

Information on the prevalence and incidence ofmost serious illnesses in the United States has beencomprehensively collected and accurately tabu-lated for a long time. Most people with communi-cable diseases receive some medical treatment, andthe doctors providing treatment normally complywith the law requiring these diseases be reported toPublic Health authorities. It is useful to think ofnarcotic addiction as a communicable disease inthe sense that a person almost always first injectsdrugs under the guidance of an experienced user.Addiction differs from other communicablediseases, however, in that the majority of thoseafflicted with it do not seek medical treatment,and many of those who do happen to receiveprivate medical attention are not reported (due tothe ambiguous status of private treatment underFederal regulations). Statistical information onaddiction is therefore not easy to gather.

Federal EstimatesThe primary datatabulating agency in the

Place

period since 1914 has been the Federal Bureau ofNarcotics (since 1968 the Bureau of Narcotics andDangerous Drugs (BNDIA ), the organizationcreated to implement the original and subsequentdrug control laws, The Bureau from its inceptionhas tried to develop some accounting of narcoticuse, and since 1953 has maintained a File of ActiveAddicts, on which it issues an annual summary.The File is a recor' of addicts known to local,State, and Federal authorities. Most of the reportsincluded in the File come from local policedepartments. The comprehensiveness of informa-tion in the File is limited to the extent that addictsdo not come in contact with, or are at least notrecognized by local police, and that police re-porting of addicts is uneven.

A Bureau report on Traffic in Opium and Othe-Dangerous Drugs listed 62,045 active narcoticaddicts in the United States as of December 31,1967. Of these, 30,543 lived in New York City and1,804 lived in the rest of New York State, givingthe City 49.2 percent of the national total and theentire State 52.1 percent.

The statistics for 1969 are the most up-to-datethat the Bureau can now supply. They indicate nosignificant change between 1967 and 1969 in NewYork City where over 90 percent of the State'saddicts reside, but substantial (percentage) in-creases outside New York City.

Table 1

Active Narcotic Addicts in New York State andNew York City, 1967.1969

Amount1967 1969 Change % Change

New York State 32,347 33,341 +994 +.3New York City 30,543 30,119 -424 -1.3Outside NYC 1,804 3,222 +1,418 +78.6

SOURCE: Federal Bureau of Narcotics and Dangerous Drugs

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The New York City Narcotics RegisterGovernment officials in New York recognized

some time ago the need for better informationthan that developed by the Bureau of Narcotics.The State Legislature in 1952 mandated tl itphysicians report "habitual users" of narcoticdrugs to the State Department of Health.

In 1963, the New York City Health Code addedthe stipulation that habitual users be reported notonly by medical sources, but also by correctionalinstitutions, social agencies, or any other personwho has given care to or has knowledge of anarcotic addict. New York City provided clericalstaff to collect these reports, and a grant from theNational Institutes of Mental Health in 1966enabled a research and analysis unit to be added asa function of the Narcotics Register. The first andthus far the only formal estimate of addiction inNew York City published by the Register (inconjunction with NACC) appeared in 1969, andcovers the period from January 1, 1964 throughDecember 31, 1967.

The New York City Narcotics Register, as ofDecember 31, 1967, had records on 38,751 heroinusers (who constituted 87 percent of their totalknown opiate users). From their data, they con-cluded that this number represented about 65percent of the regular heroin users in the City, sotheir final estimates for the same date as that ofthe Bureau were 65,000 regular opiate users ofwhich 58,500 were regular hero;n users. Since boththe Register and the File claim to record knownaddicts, the two figures should be aligned just byaccepting the higher one.

Not until the NYC Narcotics Register tabulatesand releases its data for 1968, 1969, and 1970 willit be possible to supply a meaningful update on theDecember 31, 1967 figure. (These NarcoticsRegister reports are scheduled for completion byMarch 1971.) The sketchy data that do exist canbe cited to support either the conclusion thatoverall narcotic addiction has about stabilized or

that it has increased; there is little to suggest it hasdecreased.

While they may only be used as indicators, dataon narcotic users provided in the Annual StatisticalReports of the New York City Police Departmentmay give some trends.

This would indicate a rise in both Narcoticsarrests and users, but the percent of admitted usersis declining. When compered with total arrests, thepercent of admitted narcotics users is almoststable.

Even when some alloWance is made for themultiple arrests of some users, 22,000 admittedusers is a significant number. (See Exhibit XIV forfurther detail.) However, the almost constantpercentage of admitted users to total arrests mightseem to indicate a leveling off.Youthful Drug Abuse

There is also substantial documentation of along-term trend toward lowering the age of firstexperimentation with drugs and the onset ofaddiction. This trend is probably understandable interms of two factors the rise in the number oflow-income youths, and the generally more rapidintellectual development (i.e., in terms of schoolcurricula, at least) and consequent social awarenessof today's children as compared with their parents.Special concern has recently developed, however,over an apparent -^pid escalation in the trendtoward earlier drug use. For example, if the dataavailable from the BNDD are broken down, someaspects of the State situation, including that inNYC, appear less favorable than the overall totalssuggest. The change over just a two-year period,from 1968 to 1969, in the number of activeaddicts under 21 years old is striking:

Another indicator is the number of teen-ageheroin deaths reported in NYC.

This increasing number of deaths would seem toimply at least more experimentation with narcoticsamong younger people, although the number ofnew addicts may not be proportional to these rates

Narcotics Users Among Narcotics Arrests NYC

Total AdmittedNarcotics Arrests Users % of Users

1967 17,580 9,413 53.51968 22,428 8,786 39.21969 35,178 11,784 33.6

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Admitted Narcotics Users in Total Arrests NYC

Total Arrests Admitted Users % of Users

1967 163,324 16,779 10.31968 187,613 ,039 9.11969 228,175 21,786 9.5

of death, which may represent inexperience andnot addiction.

The arrest figures for admitted youthful nar-cotics users have also risen sharply, as the followingNYC Police data show:

Nonnarcotic Drug AbuseThe New York State Legislature, following the

lead provided in 1965 by the Congress of theUnited States, filed its own bill providing for thecontrol of "depressant and stimulant drugs," which

Table 2

Active Narcotic Addicts Under 21 Years of Age, 1968.69

NumberIncrease % Increase

Place 1968 1969 1968-69 1968-69

New York State 1,290 2,551 1,261 97.7New York City 1,063 2,160 1,097 103.1Outside NYC 227 391 164 72.2

SOURCE: Federal Bureau of Narcot'es and Dangerous Drugs

Heroin Deaths NYC Age 15.19

1966 - 331967 - 791968 721969 -255*

*Includes 11 under 15 years.SOURCE: Mich, 1 M. Baden, M.D., "Heroin Deaths in

New York City During the 1960's"

Arrests Youthful Narcotics UsersNYC

Year Under 16% of

Increase 16-20% of

Increase Total% of

Increase

1966 190 3,105 3,2951967 293 54 3,270 6 3,563 81968 348 19 4,581 40 4,929 381969 631 52.5 6,721 44 7,252 47

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were defined to include drugs with "hallucinatoryeffect." These control provisions closely paralleledthe existing Public Health statute regulating nar-cotic drugs, and they were added to the PublicHealth Law as Article 33-A by the signature of theGovernor on May 28,1965.

Despite the fact that this action by the Legisla-ture in 1965 demonstrated a sensitivity to growingconcern about misuse of stimulant, depressant, andhallucinatory drugs, the new programs created bythe 1966 drug legislation were focused almostexclusively on narcotic drugs. There were severalreasons for this concentration of effort. It was thenarcotic drug habit that was known to be the "lostexpensive to maintain, and therefore the greatestinducer of crime to support a drug habit. It was thenarcotic thug traffic that was known to be largelyunder the control of organized crime. It wasnarcotic drug abuse that was then believed to bemost extensive.

Since 1966, there has been a tremendous in-crease in parental and official anxiety over theabuse by younger people of non-narcotic drugs,especially the hallucinating agents (e.g., marihuana,ISD) and to a lesser degree, the amphetamines.This recent uneasiness is reflected significantly inthe fact that the Federal Comprehensive DrugAbuse Prevention and Control Act of 1970 passedby Congress in October provides for CommunityMental Health Centers to extend their 1968authority to treat "narcotic addicts" to the treat-ment of "other persons with drug abuse and drugdependence problems."

Available data on the extensiveness of the use ofvarious non-narcotic thugs are sketchy and spottyat best. Whatever assertions might be made aboutrecent and rapid increases in the use of these drugscan therefore only be impressionistic. One of themost careful collections of information on drugabuse is the annual publication of the DrugSciences Division of the BNDD entitled "Illicit Useof Dangeefous Drugs in the United States: ACompilation of Studies, Surveys, and Polls," andthe evidence ins this report does not refute the

4

conclusion that as of now there are no conclusivedata. It is true that arrest figures for non-narcoticdrug offenses have increased considerably in manylocalities, but these figures by themselves do notenable one to distinguish between increased enforcement activity and increased drug use.

While it is still true that a person cannot beadmitted to a NACC facility for treatment of anon-narcotic drug problem (even if he desirestreatment), it would be incorrect to conclude thatthe State has made no response to the growingconcern about non-narcotic drugs. The law creatingNACC, for example, empowers this Commission to"provide public education...on the potentialitiesof prevention..." and the matter of preventiveeducation on narcotic use cannot be isolated frompreventive education on drug use in general.

There is a very serious impediment holding upLarger scale, government-sponsored, education andtreatment programs dealing with non-narcotic drugabuse. This barrier, which no longer exists as aninhibiting factor in the area of narcotic drugs, isthe unavailability of scientifically established andgenerally acknowledged (i.e., publicly accepted)information on either the implications of differentlevels of use of various types of non-narcotic drugsby various types of people in various circum-stances, or proper "treatment" for any type ofabuse that might be confronted.

The limited "knowledge" that officials now haveupon which to base their actions appears to justifythe current focus of the New York State programon narcotic addicts and Narcotic Law violators.Narcotic use is the only drug abuse problem ofknown epidemic proportions, and the drug abuseproblem known both to feed and breed crimeextensively. Planning officials within the NACC arenot aware of non-narcotic drug use problems, norare they assuming that their name and mandatepreclude their dealing with this area. For the timebeing, ho...,:,er, they have more ti an they canhandle just in attempting to bring heroin undercontrol.

II EVOLUTION OF NARCOTICS CONTROL PROGRAMS

Federal BackgroundThe program to control the use of narcotics in

this country dates from the Federal HarrisonNarcotic Act in 1914. The premises underpinningthe Harrison Act, and virtually all other lawsenacted at the Federal and State level until 1960,were (1) that the taking of narcotics so endangersthe health of the individual and the communitythat there is no acceptable justification for thisindulgence except in strictly medical circum-stances, and (2) that the application of severepenalties (made increasingly more severe over theyears) could satisfactorily regulate the level of use.

There is indication that this enforcement ap-proach has had some effectthe tenuous dataavailable suggest that approximately 1 in 500Americans were addicted in 1920 as compared to 1in 1,500 today. But the increase in the number ofillicit addicts from about 20,000 at the end ofWorld War II to around 60,000 in the early 1950'sgenerated a high level of public concern and thefeeling that prevailing reliance on enforcement wasnot, in-and-ofitself, sufficient to cope with theproblem. Some people had come to view addictionas a health deficiency to be cured rather than as acriminal condition to be confined.

The first governmental manifestation of thisconception was the establishment of the PublicHealth Service Hospitals in Lexington, Kentucky,and Fort Worth, Texas, in 1935 and 1938, respec-tively, where treatment was provided for somefederal prisoners addicted to narcotics, and tovoluntary patients admitted on a s ,ce-availablebasis. Ultimately the social attitude that addictionis a disease had a direct impact on legislativeleaders and produced entirely new types of pro-grams, which still had to take into account the factthat addicts more often than not enjoyed theirillness and perpetrated crimes to support theirhabits.The Civil Commitment Program in California

Innovation first ax neared in the Civil Addict

Program established by the California legislature in1961. It provides for "civil commitment" by astate court to a special facility for rehabilitativetreatment through any of the following procedures: (1) petition to the court initiated by theaddict, a relative, or some other responsibleperson, (2) adjournment of proceedings or suspen-sion of the imposition of sentence for a personwho has been convicted of any crime in amunicipal court of justice and whom the judgebelieves to be an addict, or (3) suspension ofproceedings against a person who has been con-victed for a felony and whom the judge believes tobe an addict, so the suspected addict can bereferred to another Superior Court to determinethe issue of his addiction. The revolutionaryimpact of these statutes was that addicts could becommitted for treatment against their will, notonly when they were indicted for a criminaloffense, but also when they faced no crirninalcharge at all. This legislation was the model for theNew York State and Federal approaches adoptedin 1966.The MetcalfVolker Act in New York State

The New York State efforts in the control ofnarcotics began with a Special Narcotic Projectconducted by the Division of Parole in 1956. Itprovided close, supportive parole supervision forapproximately 600 parolee-addicts, and it has beenregarded as valuable enough to be continued to thepresent.

The 1962 Legislature passed the Metcalf-Volkerbill, which provided that as of January 1, 1963,arrested narcotic addicts who show a potential forrehabilitation and whose crimes are not seriousmay elect to receive specialized treatment at a statemental hospital rather than be committed to apenal institution. This session also affirmed a largercommitment by the State to treatment and after-care support for voluntary patients.

The impact of these new State programs wasdisappointing. The New York State Commission of

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Investigation in 1965 began a review of the existingState programs. Among their findings, published ina report in March 1966, were the following:

1. The vast majority of addicts who wereafforded an opportunity to elect treatment(for one to three years of supervised care,only a small portion of which would bein-hospital) preferred to take their prisonsentence (since the average jail sentenceimposed for a group of chronic offendersstudied by the Commission was less than fourmonths).

2. The Commission's survey of the case historiesof 1600 of the 1742 arrested addicts ad-mitted to the program from January 1964through June 1965 revealed that 80 percentwere rearrested subsequent to hospitalization, most more than once.

3. From January 1964 through June 1965,1207 persons absconded and disappearedfrom the program.

4. Of the relatively small number of addictswho completed the program, 52 percent wererearrested shortly thereafter.'

The conclusion of the Commission was that "noprogram of rehabilitation which relies principallyon the voluntary application of the addict fortreatment can be sufficiently broad and compre-hensive to deal effectively with the total problemof addiction."

Creation of the Narcotic Addiction Control Con-i-mission

During the time the Commission's investigationwas proceeding, and presumably with the benefitof its preliminary findings, Governor Rockefeller,in cooperation with legislative leaders and otherpublic officials, was preparing a revamped narcoticcontrol program for presentation to the Legisla-ture. The following three "Recommendations" ofthe Commission turn out to be key innovations inthe State program that was outlined by theGovernor in his Message to the Legislature ofFebruary 23, 1966:

1. "The Metcalf-Volker Act be amended toprovide that persons convicted of crimes, onproof of addiction, be committed to acompulsory program of rehabilitation andtreatment."

2. The Narcotic Rehabilitation Centers andafter-care programs providing close super-vision be operated by the State, ale), c vithexisting private programs that shoulu befinancially assisted by the State.

3. "A State agency be created with the capacityand broad powers to develop, conduct andcoordinate an anti-addiction program whichshould include those concepts of treatment,rehabilitation, education, training, after-care,research and evaluation." 2

The legislation that was enacted in April 1966 asArticle 9 of the Mental Hygiene Law includes alengthy "Declaration of Purpose." This "Declara-tion" provides some insight into the goals andexpectations of the Legislature that is, intolegislative intent. Further elaborations of theshort-term and long-term objectives of the Stateprogram as they existed at that time are indicatedin the legislative debates. Since the Legislature'swork on narcotics at this session was devotedprimarily to the civil and criminal commitmentprograms, and since the Executive had perceivedthe problem in even broader terms, a truly compre-hensive picture of the State program must takeinto account the Executive as well as the legislativedeclarations.

Emphasis on TreatmentThe basic premise of the program, if one were to

take it directly from the "Declaration of Purpose."would appear to be as follows:

The narcotic addict needs help before he iscompelled to resort to crime to support hishabit. The narcotic addict who commits acrime needs help to break his addiction. Acomprehensive program of treatment, rehabil-itation and aftercare for narcotic addicts canfill these needs.3The debate in the Legislature suggest: that at the

time this basic premise was not, in fact, wellestablished. Ore proponent of the bill made theknowing statement, which appears rather re-vealing:

We are talking about a problem for which weknow no cure, about which no data tells usthere is a cure and yet we must do something.It was on this same point, in fact, that one of

the few critics of the legislation based his argu-ment. His response to the speech just cited was:

You admit that there is no cure, yet thestatement on intent says "Experience hasdemonstrated that narcotic addicts can berehabilitated and returned to useful lives onlythrough extended periods of treatment in acontrolled environment followed by super-vision in an aftercare program."...I wouldsuggest that this philosophy pervades the billbut I think this is where we disagree.

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The intent of the legislature appeared to havebeen two-fold: first, the expectation that the vastmajority of addicts who were convicted of mis-demeanors, and who had previously been gettingoff with four-month-average sentences and noparole, would now be supervised for three yearsand, second, the hope that whatever compulsorytreatment and rehabilitation services criminally andcivilly certified addicts received would ec_uip themto turn (or return) to socially acceptable life styles.

This "comprehensive program of compulsorytreatment of narcotic addicts" ultimately wassupposed to eliminate the threat that addict crimeposes to the "peace and safety of the inhabitantsof the state," and to "protect society against thesccial contagion of narcotic addiction."

The threat of addict crime to the peace andsafety of the inhabitants of the state and the threatof the social contagion of narcotic addiction areproblems that can be attacked thro-agh efforts torehabilitate the addict. Rehabilitation alone, how-ever, cannot be presumed and never was presumedto bo the solution to these problems.

Continued Enforcement PressureThe fact that the emphasis in the 1966 legisla-

tion was on treatment did not change the overallpicture that included enforcement as a criticalcomponent. Enforcement resources were necessaryboth to apprehend the Narcotic Law violator in thefirst place and to assure that potential and actualabsconder and repeat violators would be subjectedto continuing pressure. The integral relationshipbetween narcotic control and enforcement isrepresented in the title of Governor Rockefeiler'sSpecial Message to the Legislature in February1966, "War on Crime and Narcotic Addiction: ACampaign for Human Renewal."

The Governor, in first outlining the proposednew program to the Legislature on January 5, drewan important distinction between the "addict" andthe "narcotics pusher":

We must remove narcotics pushers from thestreets, the parks, and the schoolyards of ourcities and suburbs.

I shall propose stiffer, mandatory prisonsentences for these men without consciencewho wreck the lives of innocent youngstersfor profit....

In addition, we must deal decisively withthe addicts themselves to break them of thedope habit and rehabilitate them for useful

This distinction cannot, in reality, a; is be

maintained, for it is generally agreed that morethan half the pushers are themselves addicted, andsell to others to maintain their own habit. It isnevertheless important to remember that the streetpusher is, like the tip of an iceberg, only theevident part of a large and :nuch more menacingsupportive structure. The supplying of heroin isnow a most lucrative activity, and organizedcriminal elements are known to be the keyoperatives and primary beneficiaries. Obviously theabuse of narcotic drugs which we now confrontcould be virtually eliminated even without rehabili-tation programs if the supply of heroin could beshut off.

The Governor's Special Message and the reportof the Commission of Investigation both clearlpointed up the necessity that enforcement provideall practicable support for the total environmentwithin which rehabilitative programs must operate.While the Governor in his Message of January 5,1966 envisioned New York State creating "legisla-tion to act decisively in removing pushers from thestreets and placing addicts in new and expandedState facilities for effective treatment, rehabilita-tion and after-care," he also recognized that "theFederal government has the moral and financial aswell as the legal responsibility to protect theAmerican people from the havoc caused by theillegal importation of these drugs." The Governordrew the conclusion that "we have every rightunder the circumstances to expect the Federalgovernment to shoulder a major portion of thecost," and in his Message to the Legislature a yearlater, he urged these Honorable Bodies "tomemoralize Congress to recognize the magnitudeof the addiction problem and the Federal govern-ment's primary responsibility in this field with amuch greater financial contribution."

As the federal government began to respond, theState's enforcement activities branched out. Therehave been three noteworthy developments. Aspecial Narcotics Unit was created within theBureau of Investigation of the State Police in 1968,and in 1970 State Police personnel joined withnarcotic officers fom the New York City Policeand agents of the Federal Bureau of Narcotics andDangerous Drugs in staffing an innovative type ofenforcement organization, the New York JointTask Force on Narcotics. There was also estab-lished during 1970 an Organized Crime Task Forcewithin the Department of Law.

Preventive EducationThere is, in addition to rehabilitative treatment

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and enforcement, a third significant dimension inNew York State's drug control planning. It ispreventive education.

The 1966 Act charged NACC with the power to:1. Provide public education on the nature and

results of narcotic addiction and on thepotentialities of prevention and rehabilitationit order to promote public understanding,in est and support.

2. Pros le education and training in prevention,diagnosis, treatment, rehabilitation and con-trol of narcotic addiction for medicalstudents, physicians, nurses, social workersand others with responsibilities for narcoticaddicts either alone or in conjunction withother agencies, public or private.5

The rationale supporting this aspect of theprogram again was formulated, among other places,in the "Recommendations" of the Commission ofInvestigation.

The Commission proposed the creation of a"Comprehensive public education program" in lightof its claim to have

found that the education of the public to theperils of narcotic abuse can be effective inpreventing addiction. This is especially true inthe case of young people who are particularlyvulnerable and susceptible to contagion.Education of parents, teachers, and otherswho have contact with children in methods ofrecognizing narcotics and symptoms of nar-cotic abuse is also of prime impor.tance.6 [Emphasis added.]Since 1966, not only NACC, but the State

Department of Education and the Depaitrhents ofMental Hygiene and Health have been appropthtedfunds to support drug education activities.

The New York State effort to contro! the use ofnarcotics is concentrated in three major areas: lawenforcement, to support compulsory treatmentand to reduce crime; an extensive treatmentprogram to rehabilitate present addicts; a wide-spread education program to prevent new addic-tion. The major sections of this report whichfollow review the State program in each of theseareas.

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III NEW YORK ENFORCEMENT EFFORTS

The Federal and State legislation enactedbetween 1914 and 1960/ with the objective ofkeeping narcotic drugs out of the hands of poten-tial users had a dual thrust. The primary objectivewas to put suppliers out of business either by thethreat or the reality of imprisoning them. Thisapproach was supplemented with the applicationof pressures to discourage users; again there werethe direct pressures of the risk of arrest andpunishment, and there was also the indirect pres-sure of higher prices for scarcer supplies wheneverdistributors might be squeezed.

The Impact of Enforcement on SuppliersSince virtually all nonsynthetic narcotic drugs

originate as opium poppies grown and refinedoutside the United States, it is clearly the Federalgovernment that has the primary responsibility forcontrolling the illicit supply. The limited successachieved thus far and the difficulties inherent inthis task are related in the Task lorce Re.port: Narcotics and Drug Abuse completed in1967 by the President's Commission on LawEnforcement and the Administration of Justice.8

The prospects for substantially reducing thesupply of heroin available on the streets ofAmerica have not been good in the recent past, anddo not appear ciuch more ~romising for theforeseeable fuo.u- . The main reason for this situa-tion is that the higher levels of the heroindistribution system are operated by the men andmoney of organized crime cartels; United Statesauthorities know of thirteen major heroin smuggl-ing rings in the world.9 Very few of these membersof the upper levels of the distribution system haveever been convicted, because these members ofcrime syndicates are protected from exposure byfear of retribution, which can be swift and final,and a code of silence.

The people at the lower levels of the distributionsystem the "street peddlers" and "re-tailers" are not members of crime syndicates and

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are very vulnerable to arrest; yet the risks thatconfront these suppliers are obviously not de-terring enough people from engaging in this activi-ty to produce a significant limitation on thesupply. Detailed data on drug arrests and disposi-tions are readily available only for New York City,but these figures can be taken as representative ofdrug control efforts in the State since such a largeportion of this activity is concentrated in NewYork City. All felony offenses under New YorkState narcotic laws involve the at,;, of selling drugsor the possession of larger amounts. The New YorkCity police made 15,431 narcotic felony arrestsduring 1969.

What is especially revealing, however, is thedisposition of these arrests. The court records showthere were 13,374 felony arraignments in NewYork City in 1969, and that 7,090 reacheddisposition. Of this 7,090, over thirtysix percent(i.e., over 2,500) were dismissed outright )0

The Supreme Court records on the dispositionof the rest of these cases have not been compiled,but representative figures on the disposition offelony cases are available from the records kept bythe Narcotic Bureau of the New York City PoliceDepartment. They have followed up on 2,214felony arrests made since July 1969 that have beendisposed of in Supreme Court. The Bureau'sfindings are as follows:

Dismissals 938Direct Sentences 789

15 years or more 3more than 1-10 3- ors 1691 year or less 617

Probation 106Discharged 86Committed to NACC 159Miscellaneous Sentences 97Convicted, sentence unknown 39

Total 2,214

These figures reveal that forty-six percent (1,024of 2,214) of the cases ended in dismissal ordischarge, and that only eight percent (172 of2,214) resulted in direct sentences of more thanone year. It is roughly only this eight percent,then, who were ultimately convicted and sentencedfor felony offenses, since it can be presumed thatmany of the 617 sentences for one-year-or-lesswere instances of "copping a plea" to a mis-demeanor.

The conclusion that is suggested by this data ondispositions is that the relatively small scale nar-cotic suppliers are not in practice being verysevei.ely'riunished.

The Impact of Enforcement on Narcotic UsersThe supply of narcotics was not the primary

target of the New York State program launched in1966. The program's objective was rather to reducethe demand for illicit narcotics by treating andrehabilitating the people already afflicted with thedisease of addiction, and preventing other peoplefrom contracting this sickness.

Enforcement agencies still were a crucial ele-ment in this new approach of 1966. Many addictswere expected to come into treatment facilitiesthrough the criminal courts, so obviously thepolice had to be able to apprehend these people. Itwas also assumed that many of the addicts whowould volunteer for treatment or otherwise cometo NACC through the civil courts would do so atleast partly because police anti-narcotic activitieswere making their lives more difficult. Any in-crease in efficiency on the part of enforcementagencies could also help deter potential drug usersfrom ever beginning.

In light of the documentation above of thedisposition of arrested felons, one would notexpect that strong pressures are actually exerted ondrug users. On the other hand, it might requiremore of a threat to deter a pusher than a user,especially if the pusher happends also to be anaddict, which often occurs:

In cases handled by the Bureau of Nar-cotics ... more than 40 percent of t'.,e defen-dants prosecuted are addicts. However, theseaddicts almost invariably are also peddlers,who are charged with sale rather than merepossession. It is fair to assume that thepercentage of addicts among the defendantsprosecuted by State and local drug enforce-ment agencies is even higher. The enforce-ment emphasis on the addict is due to hisconstant exposure to surveill-nce and arrestand his potential value as an informant.' I

The New York City police have also madeincreasing numbers of arrests on the lesser chargeof possession of smaller amounts of narcoticswhich is a misdemeanor. There were 20,560arraignments in the Criminal Court of the City ofNew York in 1969. (For the figures from1960-1969 see Exhibit XIII.)

The disposition of these misdemeanor arraign-ments for narcotic violations in New York City in1969 is as follows:

Total misdemeanor arrests 20,560Dispositions to date 15,876Outright dismissals 10,301Convictions 5,210Direct Sentences 3,598

Sentences for 90 daysor less 2,415

Commitments to NACC' 2 194

These figures show that about two-thirds(10,301 of 15,876) of all cases are 'dismissedoutright, and that only 23 percent (3,598 of15,876) of all dispositions result in direct sen-tences. Furthermore, 66 percent (2,415 of 3,598)of these direct sentences are for 90-or-less days.

The evidence is cleat that the prosecution ofnarcotics violators today carries no more punchthan was found by the State Commission ofInvestigation in 1965. And at that time thisCommission concluded that addict criminals muchpreferred to take their chances with a regularsentence, which they expected would be light, thanwith some kind of compulsory treatment.' 3

The Failure of the Criminal Justice SystemNew York State law fixes stiff penalties for

offenses involving the sale or possession of narcoticdrugs. All felony convictions for sale go so far as tocarry mandatory minimum sentences. Yet thisreport has shown that only a small percentage ofthose who are arrested and charged on felonygrounds are ever convicted and sentenced as felons,and a majority of defendants charged with mis-demeanors have their charges dismissed outright.

There is a generally accepted explanation forthese phenomena. Obviously there are some in-stances where police arrest addicts on insufficientevidence. For the most part, however, it is the nowwell-recognized overcrowding of the criminaldocket that operates to undermine the deterrenteffect of the criminal laws penalizing drug of-fenders, and to reduce greatly the number ofarrested addicts who are convicted. Overcrowdingplaces an overwhelming workload upon the parties

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involved judges, district attorneys, defensecounsels, and other court personnel and pro-duces great pressures to dispose of cases withoutgoing through the entire trial procedure.

The primary technique for disposing of cases is"plea bargaining" between prosecutors and defensecounsel, sometimes with the active participation ofthe judge. By this process a defendant usually isenabled to "cop a plea" to a lesser offense thanthat charged. Authorities estimate, for example,that about 90 percent of all criminal cases in NewYork City are disposed of in this fashion.' Thedata presented on the disposition of felony andmisdemeanc.r. narcotic 'cases in New York Cityconform t-, this general pattern.

Overcrowding weakens the deterrent effect ofthe criminal laws not only because many defen-dants know that usually they will be able to "cop aplea" to a offense, but also in other ways. Itleads to serious trial delays, during which witnesscsmay die or disappear and memories may becomeindistinct. Overcrowded prisons and detentionfacilities produce great pressures upon judges torelieve the situation by dismissing cases, releasingdefendants on bail or on their own recognizance,and imposing lighter sentences. Several law en-forcement officials commented that drug pushersor dealers released on bail or on their ownrecognizance often take up selling again whileawaiting trial, believing that the police probablywill not bother them at that point.

Eeveral conclusions with regard to enforcementpractice are generally accepted today, even in lightof tie limited success of enforcement activities justdocumented. First, the enforcement of narcoticcontrol laws has made it much more difficult forv2ople who might still want to use narcotics fromactually doing so. Second, despite this pressure,illicit suppliers have been willing and able to absorbthe increased costs of operating and to remain inbusiness, and users have been willing and able toafford the resultant higher prices for the drugs thatfeed their habits. Third, it is desirable to have asubstantial commitment of manpower to maintainand increase whatever pressure practicable on boththe suppliers on all levels of the illegal distributionsystem and the users and potential users.

New York State Police Narcotics UnitNew York State, accordingly, has increased its

enforcement resources committed to Limiting thedistribution of narcotic drugs during the past fewyears. There is a consensus among enforcementofficials at all levels of government that the State

has an important responsibility in this area. Theproper role for New York State agencies is viewedas an intermediate one between and sometimeslinking Federal and local operations. State ef-forts are thought to be particularly necessary inthose communities, mainly upstate, where theFederal presence is least felt and the local policeare least equipped to deal with narcotic and otherdangerous drug violators.

The State Police in 1968 established a NarcoticsUnit in the Bureau of Criminal Investigation. Theprincipal activities of the Narcotics Unit includeconducting criminal investigations and undercoverwork, and making al-rests and seizing drugs. Inthese operations, the State Police often workclosely with officers of the Federal Bureau ofNarcotics and Dangerous Drugs and with localpolice.

The State Police also have a special responsi-bility to enforce those provisions of both Articles33 and 33-A of the Pu'olic Health Law. Thus theNarcotics Unit is concerned not only with controlof the manufacturing, distributing, and dispensingof narcotic drugs (Art. 331, but also depressant andstimulant drugs (Art. 33-A). Suspected violationsof these articles usually are referred to the StatePolice for investigation and possible arrest by theBureau of Narcotic Control in the Department ofHealth, which administers the regulatory provisionsof Articles 33 and 33-A. In November 1970 theNarcotics Unit consisted of approximately 85-90men. Almost half of these were located in NewYork City: 29 were working closely with theBNDD in the U.S. Department of Justice doingmainly surveillance work directed at organizedcrime, and 13 were assigned to the special taskforce on narcotics composed of Federal, State, andlocal policemen. The remainder of the unit wasdistributed throughout the State, wit', two or threenarcotics men assigned to each of the regulartrooper units.

In the New York City area the main enforce-ment effort is directed toward the heroin and"hard drug" traffic. In areas of the State outside ofthe larger cities the heroin problem assertedly isless critical; therefore the main effort is directedtoward the "soft drug" traffic marihuana, bar-biturates, and amphetamines. In these areas theNarcotics Unit devotes the most man-hours to themarihuana traffic, which is often concentrated atcolleges and schools.

Drug arrests and seizures by all State Police,regular troopers as well as narcotics officers, show2,081 arrests and $41 million in drugs seized in

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1968, and 3,594 arrests and $47 million worth ofdrugs seized in 1969. In the year prior to thecreation of the Narcotic Unit, 1967, only 858 drugarrests were made.

New York Joint Task Force on NarcoticsOne of the most itheresting recent developments

in law enforcement is the joint federal-state-local"task force" which is an attempt to formalizecooperation among the different levels of go-wern-ment. This concept has been applied especially tocope with criminal activities which cross jurisdic-tional boundaries, such as organized crime and thedrug traffic. The Organized Crime Task Force justcreated in New York is an application of thisconcept at the State level.

The New York Joint Task Force on Narcotics,which began its operations in February 1970, is apilot project applying the above concept to thedrug traffic in the New York City area. The unit iscomposed of Federal, State, and New York Citynarcotics enforcement officers working together intire same operational groups. Except for thesalaries of the participating State and city officers,the Task Force is funded entirely by the UnitedStates Government through the BNDD in theDepartment of Justice.

The Task Force was established to direct itsprimary effort against middle echelon dealers inthe heroin distribution networks, i.e., those whosell Lora an ounce to as much as a kilo (2.2 lbs.) ormore at a time. The middle echelon of dealers wasbelieved to be a neglected target of the lawenforcement efforts because the BNDD concentrated on the importers and large-scale distributorswhile the State and local efforts were focused onthe small-scale street trade.

In late November 1970 the Task Force wascomposed of the following narcotics enforcementofficers: 10 from BNDD, 11 from New York StatePolice Narcotics Unit, and 22 from NarcoticsBureau of New York City Police Department. Itappears that these men were carefully selected andcomprised a "crack" police unit. In addit+on to theState mid local officers participating full time inthe Task Force, both the State Police and the NewYork City Police maintained a liaison man betweentheir forces and the Task Force. A considerableexpansion of the unit was anticipated within thenear future to 170 investigators.

The leaders of the Task Force have consciouslyadopted a so-called "systems" approach to drugarrests rather than the "numbers" approach whichperhaps characterizes some narcotics enforcement

12

units. Briefly, a systems approach is an attempt toget away from the numbers game of arresting asmany possessors and sellers as possible withoutregard to their status in the drug traffic, and toconcentrate instead on selective enforcement byArresting those who play a more significant role inthe distribution network. But various pres-sures public, political, administrative, or

seem to cause some units to place undueemphasis on the sheer number of drug arrests. Itremains to be seen whether the Task Force will beable to resist the kinds of pressures which producesuch an emphasis.

One of the advantages of the Joint Task Force'soperation is the flexibility it has in choosing theforum in which to prosecute the cases it makes.Criminal charges based on the unlawful possessionand sale of narcotics and other dangerous drugsgenerally constitute both a State offense and aFederal offense, thus offering enforcement author-ities a choice of where to prosecute the case.Normally, a case is prosecuted in the jurisdiction inwhich the case is made; that is to say, if theinvestigation and arrest are made by State or localofficers, the case normally is prosecuted in Statecourts and likewise with a Federal case. The headsof the Task Force stated that they prosecute bothways, the choice depending upon a variety offactors.

Among the factors which deter, ,ceof a forum are the following:(1) Criminal caseload in the cow

of the Task Force stated thtaker to the Federal courtcriminal calendar is less do.;cases can therefore be pro- ,epromptly and justice adn, r-swiftly.

(2) Differences between Feder('Among the differences betv.ekState law cited by law enfo-,,as possibly affecting the C110are the following:(a) Statc conspiracy statute ,!,

the Federal conspiracy statutlaw requires proof of z r b.,.

one of the conspirat,:t r, e,of the conspiracy in oru,person of conspiracy.105.20. Consequently.lacking good proof ct suis lilzely to be pro edited d 1

court. Several law cawurged that the State l'ol)cr 1,,.

I t'

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Ir

Elli

be amended to resemble the Federalstatute.

(b) Differences in penalties. A number ofdifferences in penalties exist betweenthe Federal and State laws, which mayaffect the choice of a forum. It shouldbe borne in mind that a new Federalpenalty structure becomes effective onMay 1, 1971 under the recently-enactedcomprehensive drug legislation. PublicLaw 91-513, 84 Stat. 1236. t.'nlikeFederal law, State penalties dependupon the quantity of the drug possessedor sold. One present difference cited byenforcement officials as a possiblereason for choosing a State prosecutionis the new mandatory maximum lifesentence imposed for heroin, morphine,cocaine, or opium. Penal Law, Sections220.23, 220.44. The new Federal law,however, provides for imposition of alife sentence upon professional crim-inals engaged in the daugerous drugtrade in a major way for profit. Sec.408. The new law also provides for stiffsentences against persons defined as"dangerous special drug offenders."Sec. 409.

(c) Differences in proof requirements. Illus-tra,ive of proof differences is the cur-rent treatment of marihuana offenses.Since the Leary case, U.S. v. Leary, 395U.S. 6, 89 S.Ct. 1532, 23 L. Ed.2nd 57(1969), was decided in May 1969,Federal prosecutors have had to proveimportation of marihuana under theMarihuana Tax Act of 1937 withoutbeing able to rely on a presumption ofimportation based on mere possession.'Inc United , totes Supreme Court in theLeary case held that it was unconstitu-tional to presume importation from thefact of possession. Consequently, manymarihuana cases have been prosecutedin State courts where proof of importa-tion is not required. The new Federallaw, however, dispenses with the re-quirement that importation be proved.Sections 401 et. seq.

Organized Crime Task ForceIn discusElog State law enforcement agencies

concerned with enforcing the State drug 12ws,mention should be made of the Organized Crime

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Task Force established within the Department ofLaw by Ch. 1003 of the Laws of 1970. ExecutiveLaw, Sec. 70-a. That law provides for the jointappointmcmt by the Governor and the AttorneyGeneral of a Statewide Prosecutor with the rank ofDeputy Attorney General, who will be in charge ofthe statewide Organized Crime Task Force.

The Task Force is empowered to investigate andprosecute multi-county organizea crime activitiesincluding, among others, trafficking in dangerousdrugs. The Task Force has the duty and power tocooperate with and assist district attorneys andother local law enforcement officials in theirefforts against organized crime. The Task Forcewill include several experienced prosecutors, whowill be aided by accountants and by investigatorsprovided by the Division of State Police. TheDeputy Attorney General in charge will obtainassistance from various other named State agencies.The act also details various powers to enable himto carry out his statewide activities.

At the present time the Statewide Prosecutor orDeputy Attorney General has been appointed andis in the process of building his staff.

Evaluation of New York State's EnforcementEfforts

It is difficult to evaluate the effectiveness of theperformance of the special Narcotics Unit in theState Police. Drug arrests by all state troopers morethan doubled during the unit's first year ofexistence, but these statistics are an unreliablegauge of police effectiveness for several reasons:

(1) Increased arrests may indicate simply thatadditional men were assigned to drug lawenforcement.

(2) The State Police statistics of drug arrestsand seizures do not indicate how manyarrests and seizures were made by regularstate troopers and how many by the Nar-cotics Unit.These statistics do not indicate the type orquality of arrest or seizure because they arenot broken down according to the type ofdrug -4 offense.Increased arrests and amounts of drugsseized do not necessarily show a reductionin the supply, since the supply may haveincreased even more rapidly. It is difficult, ifnot impossible, to measure the availablesupply, although experienced observers atthe street level probably can detect trendsfrom pricy, purity, availability, and the like.

Reliable standards to measure the effectiveness

(3)

(4)

of drug law enforcement are yet to be perfected.For example, the BNDD, an experienced enforce-ment unit, has itself only recently begun todevelop some comparatively refined measures ofpolice performance.

Ihe Joint Task Force has been in existence tooshort a time to evaluate the effectiveness of its

performance and the validity of the "task force"concept as applied to narcotics law enforcement.Given the alleged neglect of the middle echelondealers in the heroin distribution networks as atarget of a law enforcement efforts. the creation ofa special unit to aim at that target seems of ---priate.

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IV CERTIFICATION OF ADDICTS

"A comprehensive program of compulsory treat-ment," is a key provision of the 1966 legislationestablishing NACC. This compulsion is provided inevery case by a court order certifying the addict tothe custody of NACC. Because court certification,is the means by which the Commission obtainsjurisdiction of a narcotic addict for treatment andrehabilitation purposes, this is a critical step inevaluating the treatment and rehabilitation pro-gram. The number and types of addicts assigned tothe Commission for treatment the input int) thesystem is determined through the certificationprocess. If certification does not function accord-ing to the statutory mandate, then legislative intentmay be thwarted. Addicts whom the legislatureintended to be certified to the Commission maynot be certified; persons who are not narcoticaddicts as defined in the law may be certifiederroneously; constitutional or other legal rights ofalleged addits or other parties may be violated.

Statutory Provisions Concerning Types of Certi-fication

Three different methods of certifying a na- .oticaddict to the care and custody of NACC are setforth in Article 9 of the Mental Hygiene Law:

(1) Civil certification of non-arrested addictUnder Sec. 206 an addict himself or

anyone believing him to be an addict maypetition a supreme court justice or a countycourt judge for certification to the care andcustody of NACC. A person is not eligiblefor such certification if he is participating ina narcotic addict rehabilitation program infacilities or services approved by NACC, orif he has a criminal action pending againsthim. Certification may be voluntary orinvoluntary depending upon whether thepetition is brought by the addict himself orby another. Even if the petition is broughtby another, the addict may or may not

contest it. The statute sets forth an elabo-rate procedure for adjudicating the questionof addiction, largely in order to protect thealleged addict's constitutional right to dueprocess of law. Upon satisfactory proof ofaddiction and compliance with the otherstatutory requirements, the court is requiredto certify the addict to NACC for a periodof unspecified duration which cannot last inany event more than 36 months.

(2) Civil certification of arrested addictAn addict charged with a felony, mis-

demeanor, or the offense of prostitution hasthe choice under Sec. 210 of applying forcivil certification to the care and custody ofNACC rather than submitting to the crim-inal charge, if he satisfies the followingeligibility requirements: no previous felonyconviction; not previously certified toNACC; criminal charge against him notpunishable by death sentence or life im-prisonment; consent of district attorneyobtained if the criminal charge is a felony.An eligible criminal defendant applies forcivil certification by filing a petition withthe court in which tlie criminal action is

pending. If the defendant is eligible for civilcertification and his addiction is established,the court has cretion to certify him toNACC for a period of unspecified durationwhich cannot last in any event more than 36months and to dismiss the criminal charge.If the application for civil certification isdenied, the court proceeds with the criminalaction including possible criminal certifica-tion .,o NACC following conviction as pro-vided in (3) below.

(3) Criminal certification of convicted addictSec. 208 distinguishes between addicts

convicted of a misdemeanor or the offenseof prostitution and addicts convicted of afelony. The criminal court is required, in

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sentencing the defendant, to certify him tothe care and custody of NACC if he haspleaded guilty to or has been found guiltyof a misdemeanor or the offense of prostitu-tion and is also found to be a narcoticaddict. This certification is for an indefiniteperiod of time with a maximum of 36months. In sentencing a person who isfound to be a narcotic addict and who haspleaded guilty to or has been found guiltyof a felony, on the other hand, the court hasdiscretion either to impose a sentence underthe penal law or to certify the defendant tothe care and custody of NACC for anindefinite period of not more than 60months. Certification to NACC whether fora misdemeanor, prostitution, or a felony, isdeemed to be a judgment of conviction.

To complete the statutory picture concerningthe types of certification to NACC, mentionshould be made of youthful offenders who arenarcotic addicts. Minors between the ages of 16and 19 who are charged with criminal offenses maybe entitled to a special "youthful offender" treat-ment under the penal law.15 The certificationprovisions do not deprive a youthful addict of theright to apply for and receive youthful offendertreatment, but they do require that a minoradjudicated as a youthful offender who is found tobe a narcotic addict be certified by the court to thecare s:',d custody of NACC for an indefinite periodof time but not more than 36 months.

Sec. 210-a provides that notwithstanding theprovisions of Secs. 207-210 which deal with thecertification of arrested or convicted addicts nocertification order is effective unless NACC con-sents to it. The language of this section wastightened by Ch. 126 of the Laws of 1970 to makeclear that an arrested addict seeking civil certifica-tion remains subject to the criminal charge untilNACC consents to the certification. One judge hascharged publicly that the 1970 amendment was forthe purpose of enabling NACC to turn awayhard-core addicts in order to improve its record,but NACC officials insist that the amendment wassimply for the purpose stated above. NACC offi-dais state that the power to refuse consent to acertification has never been exercised, either indi-vidually or on a group basis, although civil certifi-cations were closed in the summer and fall monthsof 1968 because of overcrowded facilities.

To summarize, there are several ways in Nv-richcertifications are significantly differentiated. Onthe one hand, certifications can be distinguished

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according to whether they are authorized in a civilcourt or in a criminal court. Civil courts grantcertifications only under Sec. 206, and all othercertifications originate in criminal courts. On theother hand, the statute itself refers to commit-ments to NACC under Sec. 210 as well as Sec. 206[See (1) and (2) above] as "civil certification";"criminal certification" in the language of thestatute refers to Sec. 208 [See (3) above] and Sec.209.

Certifications are also often distinguished interms of "voluntary" and "involuntary." Applyingthe voluntary-involuntary classification to the threetypes of certification stated above, the only trulyvoluntary certification is that resulting from apetition by the addict himself under Sec. 206, andeven such a self-petition might be filed for motivesother than a desire to be cured. A decision by anarrested addict under Sec. 210 to choose "civilcertification" rather than remain subject to crim-inal punishment can hardly be said to be a freechoice.

Constitutional QuestionsSeveral constitutional objections were made to

those certification provisions compelling the com-mitment of narcotic addicts, especially to theprovisions compelling the civil commitment ofaddicts who have not been arrested for any crime.The New York Court of Appeals in NarcoticAddiction Control Commission v. James' 6 heldthat the compulsory civil commitment of addicts isconstitutional. The court relied upon the followingdictum in the leading case of Robinson v. Califor-nia:i 9

The broad power of a State to regulate thenarcotic drugs traffic within its borders is nothere in issue.

****Such regulation, it can be assumed, could

take a variety of valid forms. A State mightimpose criminal sanctions, for example,against the unauthorized manufacture, pre-scription, sale, purchase, or possession ofnarcotics within its borders. In the interest ofdiscouraging the violation of such laws, or inthe interest of the general health or welfare ofits inhabitants, a State might establish aprogram of compulsory treatment for thoseaddicted to narcotics. Such a program oftreatment might require periods of involun-tary confinement. And penal sanctions mightbe imposed for failure to comply with estab-lished compulsory treatment procedures. 370U.S. at pp. 664-5.

Although the United States Supreme Court hasnot specifically decided whether compulsory civilcommitment is constitutional, presumably theabove dictum in the Robinson case indicates whatits position would be. The holding in the Robinsoncase was that a California statute making it a crimeto be an addict was a violation of the prohibitionagainst cruel and unusual punishment in the EighthAmendment of the U. S. Constitution. The courtdist: tguished between simply being an tddict andth a.ts of using or possessing narcotics.

Although compulsory civil commitment washeld constitutional in the James case, the NewYork Court in that case held that compulsorytemporary detention of an alleged addict for threedays on an ex parte order, as was permitted underthe previous wording of Sec. 206, is a violation ofthe due process clause of the Fourteenth Amend-ment of the U. S. Constitution. This section wasamended by Ch. 772, Laws of 1968, to require acourt hearing on notice before an alleged addictcan be detained for medical examination.

In anether leading case construing the 1966 Actcreating NACC, People v. FullerIg , the New YorkCourt of Appeals held that, since compulsorycommitment to NACC is for the purposes oftreatment and rehabilitation rather than criminalpunPunent or incarceration, the procedural safe-guards applicable to a criminal trial do not apply toan addiction hearing. Hence, the court held thatthe following procedures did not violate theconstitutional rights of the convicted addicts cer-tified to NACC in that case: admission in evidenceat addiction trial of statements made in theabsence of counsel to the arresting police officerand to NACC's examining physician during thecourt-ordered medical examinatio-; requiringproof of addiction by only a preponderance of theevidence (civil test) rather than beyond a reason-able doubt (criminal test).

The court left the door open, however, for proofthat the NACC program does not actually treat orcure addicts, but is simply a disguised form ofimprisonment.

If compulsory commitment turns out infact to be a veneer for an extended jail termand is not a fully developed, comprehensiveand effective scheme, it will have lost its claimto be a project devoted solely to curativeends. It will then take on the characteristicsof normal jail sentence, with a side order ofspecial help. The moment that the programbegins to serve the traditional purposes ofcriminal punishment, such as deterrence, pre-

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ventive detention, or retribution, then theextended denial of liberty is simply no dif-ferent from a prison sentence ....

The record is barren, however, of anyevidence that the detention compelled underthe statute is in effect punitive punishment,+..A there is no chance of cure and that thisprogram is a sham and a cover up for theputting away of addicts for a few more years.If it were, society would have to find someother means of dealing with the problem. Thesubstantive aspect of the program is entitledto a presumption of constitutionality, at leastand until a record is established otherwise.For these reasons, we conclude that tteappellants' privilege against self incriminationand right to counsel were not violated whenevidence was received of admissions of addic-tion made to examining physicians during thecourse of court ordered examinations. 24N.Y.2d at 302-303.The court also decided in the Fuller case,

however, that a convicted addict certified underSec. 208 is entitled to a jury trial on the questionof addiction because a non-arrested addict certifiedunder Sec. 206 is granted a jury trial by thestatute. To deny the convicted addict a jury trial,the court held, would deny him equal protectionof the law in violation of the Fourteenth Amend-ment of the U. S. Constitution. The statute wasamended in 1969 to grant a jury trial to convictedaddicts. A closely related question which has notyet been decided by either the New York Court ofAppeals or the United States Supreme Court iswhether, under the state and federal constitutions,a jury trial can be eliminated altogether for bothnon-arrested and convicted addicts. Elimination ofa jury trial for both groups would avoid the equalprotection objection, but would create a substan-tive due process constitutional question regardingdeprivation of liberty.

noof of Narcotic AddictionThe term "narcotic addict" is defined in Article

9 of the Mental Hygiene Law to mean:a person who is at the time of examinationdependent upon opium, heroin, morphine orany derivative or synthetic drug of that groupor who by reason of the repeated use of anysuch drug is in imminent danger of becomingdependent upon opium, heroin, morphine, orany derivative or synthetic drug of that group;provided, however, that no person shall be

deemed a narcotic addict solely by virtue ofhis taking of any of such drugs pursuant to alawful prescription issued by a physician inthe course of professional treatment for legiti-mate medical purposes. Sec. 201 (2).The Court of Appeals has not conclusively

interpreted this definition as yet, but it has givensome indication of its views in Narcotic AddictionControl Commission v. James and People v. Fuller .In the Jcmes decision the court stated:

Persons "dependent upon" narcotic drugs, asthe language and purpose of the statute makeclear, vre persons who, through the repeateduse of rarcotic drugs, have developed so greata physical and/or emotional dependence thatthey are no longer able to control craving fornarcotics. 22 N.V. 2d at 551.

In the Fuller decision the court stated that:There are three characteristic mental andphysical responses which physicians look forin determining whether a person is an addict:(1) physical dependence (as evidenced by theoccurrence of withdrawal sickness upon thetermination of the use of narcotics); (2)tolerance (as evidenced by the requirement ofever increasing doses of narcotics to achievethe same euphoric effect or "high"); (3)emotional dependence or habituation. 24N.Y. 2d at 307.

But the court declared that these three criteriado not have the force of law and do not constitutethe statutory definition. In other words, the courtseemed unwilling to state categorically that one,two, or all three of these criteria must be presentto pro% e addiction.

The court also mentioned the kinds of evidenceconsidered:

In determining whether a patient is an addict,the court considers evidence as to the person'shistory of drug use, ability to cope withpersonal problems by socially acceptablemethods, general mental situation and, ofcourse, medical symptomology. ..lbid. at308.This last passage from the Fuller opinion

indicates that the court wants stronger evidenceof addiction than the findings made during aroutine medical examination. Two recent decisionsby intermediate appellate courts have held thatevidence obtained during a cursory medical ex-amination is not sufficient proof of addiction. TheAppellate Division, Second Department, held inPeople v. Medina" that the "mere discovery ofhypodermic needle scars on one's arms, coupled

with an admission of prior addiction," is notsufficient proof of addiction at the time of themedical examination when the alleged addict hasbeen in custody for eight months prior to theexamination.

In the second case, Negron v. Narcotic Addic-tion Control Cemmission,2° the court held onOctober 20,1970 that the discovery by a doctor offourteen fresh needle marks or "track marks"along the basilic Wins, without a urinalysis or othermedical evidence, did not exclude the possibilitythat the alleged addict was using amphetamines or"speed," as he claimed, rather than heroin.

The Medina and Negron decisions and otherlower court cases point up a major complaint madeby judges and lawyers who have participated inproceedings to determine addiction, namely, thatthe evidence of addiction, both medical andnon-medical, often is insufficient. Medical evidencemay be insufficient because ;A' delayed or incom-plete medical examinations, or poor medical wit-nesses. Non-medical evidence may be insufficientbecause of failure or inability to prepare suchevidence.

Unquestionably the adequacy of the proof ofaddiction is a critical element in the certification ofnarcotic addicts. No person should be involuntarilycommitted to the NACC program for a potentialthree or five-year period without sufficient proofof addiction. At the present time, however, thisproblem is diminished somewhat because the over-whelminl majority of persons currently beingadmitted by NACC are certified without contestingthe question of addiction. Most new admissions arebeing certified either volteiarily on their ownpetitions under Secs. 206 (non-arrested) or 210(arrested,)or "involuntarily" on the petitions ofother persons, mostly parents and close relatives,under Sec. 206. Most alleged addicts do notcontest the question of their addiction in these"involuntary" proceedings. Hence, rek-tively fewfull-blown trials on the question of addiction arebeing held at the present time.

The definition of "narcotic addict" quotedabove includes not only a person who is dependentupon opium, heroin, morphine, or any derivati'or synthetic drug of that group at the time ofexamination, but also a person "who by reason ofthe repeated use of any such drug is in imminentdanger of becoming dependent." Two constitu-tional objections to this language have been made.One, it sets up an unconstitutionally vague stan-dard in violation of the due process clause of theFourteenth Amendment of the U. S. Constitution,

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Two, the State has no power to commit a personwho is not yet dependent upon narcotic drugs.Several lower New York courts have considered thequoted language, but the Court of Appeals as yethas not specifically interpreted this language orruled upon its constitutionality.

Some guidance might be obtained, however,from the California Supreme Court's decision inPeople v. Victor. 2 I The court upheld theconstitutionality of similar language in response tothe two objections mentioned above, and fullydiscussed the meaning of the language. The courtdeclared that narcotic addiction is not so much anevent as a process, and went on to list eightindentifiable stages in this process. The court alsodiscussed in detail what it called the "threecharacteristic mental and physical responses of theaddiction process; i.e., emotional dependence,tolerance, and physical dependence," which werementioned also in the passage from the Fullerdecision quoted above. And finally the courtexplained who is includible in the category ofpersons "in imminent danger of addiction":

It is not enough that the individual be"addiction-prone," or associate with addicts,or even have begun to experiment with drugs;he must have subjected himself to "repeateduse of narcotics."... Nor is it enough that theindividual have thus "repeatedly used" nar-cotics, or even be "accustomed or habitu-ated" to their use, unless such repeated use orhabituation has reached the point that he is inimminent danger in the common-sensemeaning of that phrase discussed above ofoecoming emotionally or physically depend-ent on their use. 398 P.2d at 406 407.Although the New York Court of Appeals has

not specifically interpreted the "imminent danger"language as yet, the Appellate Division0 SecondDepartment, in People v. Medina, cited above,expressed the view that "expert testimony as tothe subject person's mental condition must beintroduced" to show that the person "is inimminent danger of becoming dependent" uponnarcotic drugs. Whether the Court of Appeals alsowill insist upon such psychological or psychiatrictestimony remains to be seen.

THE CERTIFICATION PROCESSIN PRACTICE

The following description of the certificationprocess is based on a study conducted in thesummer and fall of 1970, which concentrated uponthe situation in New York City. Based on inter-

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views and observations outside New York City, itseems safe to generalize that in most places thecertification process is functioning more smoothlythan in New York City.

The main sources of information were actualobservation of certification proceedings and nu-merous discussions with judges, lawyers, and theother principals involved. Several judges and law-yers stated that different judges may vary widely intheir conduct of certification proceedings. One ofthe problems, indeed, has been the lack of auniform procedure. Because of the impossibility,therefore, of talking to every judge and of at-tending all certification proceedings, some excep-tions may be unaccounted for.

Another possible problem is the frequent mod-ification of court practices. This is particularlyrelevant with respect to the certification process inNew York City at the present time because of thecontroversy currently surrounding the handling ofnarcotic cases. As a matter of fact, both the StateSupreme Court and the Criminal Court of the Cityof New York recently instituted, or are in theprocess of instituting, administratiie changes in-tended to improve the handling of narcotic certifi-cations.

The description of the certification process isorganized according to the nature of thecourt i.e., civil or criminal in which theproceeding take place. This means in New YorkCity that proceedings for the civil certification of anon-arrested narcotic addict are conducted in theState Supreme Court, and that proceedings for theso-called "civil certification" of an arrested addictand for the criminal certification of a convictedaddict are conducted either in the Criminal Courtof the City of New York (misdemeanor or offenseof prostitution) or the State Supreme Court(felony). Certification proceedings elsewhere in thestate are conducted in those courts having com-p^rable civil and criminal jurisdiction.

CERTIFICATION IN THECIVIL COURTS

Sec. 206 of the Mental Hygiene Law sets forthin great detail the procedure for civil certificationof a non-arrested narcotic addict. These detailedsafeguards are spelled out to protect the constitu-tional rights of the alleged addicts and to guaranteedue process of law since compulsory commitmentof an addict is a serious deprivation of personalliberty which requires stringent legal safeguards.

Briefly, the procedural steps for civil certifica-tion are as follows: petition by addict himself or

by another; custody or non-custody of allegedaddict; medical examination; court hearing or jurytrial.

An alleged addict is entitled to be informed ofhis legal rights, including his right to counsel. Withfew exceptions the alleged addicts are representedby court-appointed counsel. A representative fromthe State Attorney General's office represents theState and acts on the relation of the petitioner, asrequired by the statute.

Petition By Addict Himself Or By AnotherA certification proceeding is commenced by a

petition either by the addict himself or by anyonebelieving him to be an addict. NACC has preparedblank petition forms and distributed them to itslocal educational centers and to clerks of court.Many of these petitions are filled out with theassistance of NACC personnel at their educationalcenters.

Who are the petitioners? NACC's statistics en-able some conclusions to be drawn. During the firstyear of its operation, April 1, 1967 March 31,1968, NACC admitted 657 self-petitioners and 820addicts on petitions brought by others.22 Thecomparable figures for the second year of opera-tion were 526 and 538 respectively, virtuallyequal.23 Provisional figures for the third yearending March 31, 1970 show 747 self-petitionersadmitted and almost twice as many addicts, 1,525admitted on the petitions of others.

Statistics showing the identity of petitionersother than the addicts themselves help to dispel thefears of some critics that the category of otherpetitioners is too broad in the statute, i.e., "anyonewho believes that a person is a narcotic addict."Sec. 206 (2) (a). During the first two years ofNACC's operation, out of an approximate total of1,350 addicts certified on the petition of anotherperson, approximately 98% of the petitioners wereeither members of the immediate family or otherrelatives." Parents accounted for approximately80 percent of petitioners, and other relatives forapproximately 10 percent. Petitioners other thanfamily or relatives accounted for only 18 (2.4%)and 10 (1.5%) petitions respectively for the firsttwo years. Provisional figures for the third yearshown very similar figures. In other words, theoverwhelming number of addicts being certified onthe petition of another person are being certifiedon the petitions of their parents or other relativesclose to them, rather than by outsiders who maywish to "put them away."

Custody Of An Alleged AddictThe court has broad power to detain an alleged

addict under the following provision:The court may, in an appropriate case,

direct the detention of an alleged addict inany detention facility designated by the com-mission pending proceedings pursuant to thissection. Sec. 206(8).

Similarly the court has power, if an alleged addictfails to appear or would be unlikely to appear for ascheduled court appearance or medical examina-tion, to issue a warrant directed to any peaceofficer or police officer commanding him to takethe alleged addict into custody and deliver him atthe appointed time and place.

In New York City the principal detention centerfor alleged addicts pending certification proceed-ings is the Edgecombe Rehabilitation Center inHarlem, where an average of 75 detainees permonth were maintained during the first six monthsof fiscal 1970. Additional detention facilities willbe available when a new center in downtownBrooklyn is completed, hopefully by the end of1970. At the present tim?, detainees from Brooklynmust be transported from Edgecombe to Brooklynfor court appearances. NACC does not have juris-diction over an addict prior to certification forpurposes of rehabilitation or treatment, but it canadminister methadone to relieve withdrawalsymptoms.

In a study of civil certifications prepared for thePresiding Justice of the Appellate Division, FirstDepartment, one of the criticisms made of theproceedings at Edgecombe was the lack of asufficient number of warrant officers attached tothe court to serve warrants upon alleged addictswho failed to show up for medical examinations orcourt hearings. Brooklyn was reported to be betterstaffed with such personnel.

Medical ExaminationThe court is required to order an alleged addict

to appear at a facility designated by NACC for amedical examination if, after the petition has beenpresented to the court and the alleged addict hasappeared before the court, th' court is satisfiedthat there are reasonable grounds to believe thatsuch person is a narcotic addict. Sec. 206(2)(e,i).The statute further provides that

The commission shall designate facilitiesand establish procedures for the conduct ofmedical examinations pursuant to this sectionand shall provide for the use of acceptedmedical procedures, tests and treatment

20

4 2

which may include but are not limited tonarcotic antagonists and thin layer chromo-tography. Sec 206(3).

The medical examination is a crucial stage of theproceedings since the medical report in most casesis the single most important item of evidence onthe question of addiction.

The Edgecombe Rehabilitation Center is theprincipal medical examination facility designatedby NACC in New York City for processing civilcertifications. In addition to examining allegedaddicts from New York City and surrounding areasthe NACC doctors at Edgecombe also examinesome alleged addicts from nearby areas such asNassau County who have been arrested and aresubject to certification in the criminal courts.

One of the examining doctors at Edgecombedescribed the usual medical examination as con-sisting of: urinalysis, statements by alleged addicthimself, check for evidence of withdrawalsymptoms, check for recent needle or track markson arm, and response of alleged addict to admin-istration of methadone (in constrast to addicts,non-addicts were said to react unfavorably to

hadone).In a study conducted for the Presiding Justice of

the Appellate Division, First Department, however,the court records revealed that the medical reportsoften were inadequate that many did notinclude a urinalysis or were incomplete in otherrepects, and that many were based solely onstatements by the alleged addicts themselves. Anumber of well informed persons stated that thestatements of narcotic addicts regarding their ownaddiction are unreliable.

A number of lawyers and judges familiar withthe certification process complained about theadequacy of medical testimony and personnel.Comparatively low salaries for both doctors andnurses are a principal handicap which NACC hasattempted to offset by hiring part-time medicalpersonnel.

A continuing problem concerning NACC doctorshas been the time lost in testifying as expertwitnesses at addiction hearings. One of the reasonsfor the establishment of special courtroom facil-ities at Edgecombe was the time lost I;y NACCdoctors in travelling from Edgecombe to theregular Bronx and Manhattan courtrooms to testi-fy, and then sometimes, after waiting all or most ofthe day to testify, having the case adjournedbecause the alleged addict failed to show up. Thelawyers from the Attorney General's Office haveattempted with some success to minimize this

21

problem by requiring the doctor's pr sence onlywhen all the necessary parties were fairly certain tobe present. The centralization of certificationproceedings at Edgecombe and the new Brooklyndowntown center should alleviate much of thisproblem. The doctor at Edgecombe stated that lowwitness fees are an additional hindrance to re-cruiting well qualified part-time doctors to performmedical examinations.

Special Court Facilities For Certification Proceed-ings

In New York City, cases from Bronx and NewYork (Manhattan) Counties are heard by the StateSupreme Court in special courtroom facilities setup at the Edgecombe Rehabilitation Center. Casesfrom Queens, Kings, and Richmond Counties, onthe other hand, are heard at present in the regularSupreme Court courtrooms in each of thosecounties. The Brooklyn Detention Center, likeEdgecombe, will include special courtroom facili-ties for hearing certification cases from Kings,Queens, and Richmond Counties, and, when it iscompleted, all civil certifications in New York Citywill be centralized at the Edgecombe and Brooklyncenters. Cases from Nassau, Albany, Erie, and,presumably, other counties in the state are heard inregular Supreme Court or County Court facilities.

Although habeas corpus proceedings have beenheld for some time at state correctional and mentalinstitutions, it is unusual to hold the commitmentproceedings themselves at institutions such asEdgecombe as is now the case. Several reasons weregiven for this innovation: problem of transportingalleged addicts detained at Edgecombe for medicalexaminations to regular courtrooms in Manhattanand Bronx; frequent abscondence of alleged ad-dicts during such transit, leaving judges, lawyers,medical witnesses, and others with lost time; andunruly scenes in regular courthouses resulting fromlarge gatherings of alleged addicts, their relatives,and others. To relieve this situation, NACC, withthe cooperation of the Appellate Division, FirstDepartment (Manhattan and Bronx), set up specialcourtroom facilities at Edgecombe. These facilitiesare cramped, but practical.

Court ProceedingsCertification proceedings are held four days a

week at Edgecombe, two days to hear Bronx casesand two days to hear Manhattan cases. Thecaseload has a daily calendar running from 30 to40 cases or more, which leaves little time for eachcase. Relatively few of the cases, however, are

actual trials of the question of addiction. The casesrun the gamut of the several stages of the certifica-tion procedure already discussed e.g., order totake medical examination, issuance of warrant totake alleged addict into custody, and order certi-fying addict to care and custody of NACC. Most ofthe alleged addicts do not contest the question ofaddiction even when the petition is brought byanother person.

One of the very real problems observed atEdgecombe was the heavy caseload thrust upon therespective lawyers, both the Attorney General'srepresentative and the two court-appointed coun-selors who represent all but a few of the allegedaddicts. Closely connected was the lack of oppor-tunity by the lawyers in most cases to preparebeforehand by examining the papers or interview-ing the parties. This produces a rather hectic sceneat the court proceedings as the lawyers quicklyperuse the papers in each file and briefly interviewtheir new clients. The pressure of time results inthe summary disposition of many items on thecalendar, and this sometimes appears to leave thealleged addicts and their famine:: feeling ratherbewildered as to what actually happened.

Certification proceedings observed in a Brooklyncourthouse annex before Judge Miles F. McDonald,Administrative Judge of the State Supreme Court,appeared to be essentially similar to those atEdgecombe.

A number of alleged addicts at both theEdgecombe and Brooklyn hearings had criminalcharges pending against them. Since a person whohas a criminal action pending against him is noteligible for civil certification under Sec. 206, thecourt adjourned the case until the court-appointedlawyer could obtain a dismissal of the criminalcharge from the district attorney's office. This hasbecome a fairly common arrangement, at least inthe Bronx, Manhattan, and Brooklyn, particularlyin the case of lesser criminal offenses.

Summary Evaluation Of Certification In CivilCourts

The certification process in the civil courts isworking in general as the Legislature intended.Some difficulties exist, at least in New York City,with the main problems brought about by thevolume of cases which must be handled in limitedfacilities by small numbers of personnel. Someeasing may be expected when the new Brooklyncourt facilities are opened, and through someadministrative changes by the courts. Increasingvolume, however, may require additional facilities

and personnel. A study made for the PresidingJustice of the Appellate Division, First Department(Manhattan and Bronx) made the following criti-cisms and recommendations concerning the ceri.ifi-cation proceedings at Edgecombe. The court isnow in the process of attempting administrativelyto institute some of these recommendations.

(1) Medical examination, All medical reportsshould include a urinalysis and a completemedical examination. The urinalysis shouldinclude a thin layer chromotography test, asindicated in Sec. 206(3), and such othertests as will reveal, if possible, the natureand amount of the drug used.

(2) Full-time coordinator. A clerk, law assistant,or other court official should devote fulltime to coordinating the multifarious activ-ities connected with the certification pro-ceedings. Given the heavy caseload and thecomplex procedure, central coordination isneeded to make the system operatesmoothly.Prior availability of papers to court andlawyers. The coordinating official should seeto it that the court and all lawyers have thecourt papers at least one day in advance ofthe court hearings. As mentioned above,both the Attorney General's representativeand the court-appointed counsel come intomost cases "cold", having only the briefesttime to acquaint themselves with theirclients and the facts.

(4) Adequate staff of warrant officers.In addition, the court is studying the feasibility

of a panel of doctors to serve, as an adjunct tothe court, as medical referees on the issue ofaddiction.

CERTIFICATION IN THECRIMINAL COURTS

There is general agreement that in the criminalcourts of New York City certification of narcoticaddicts to NACC is not working as intended by theLegislature in Article 9 of the Mental Hygiene Law.The Legislature intended that all criminal defen-dants convicted of a misdemeanor or the offense ofprostitution and found to be narcotic addictsmust be certified to NACC by the criminal courts.Sec. 208(4) (a). This is not being done.

The Legislature also authorized criminal courtjudges, in their discretion, to certify criminaldefendants who are convicted of a felony and whoare found to be narcotic addicts. Sec. 208 (4) (b).Few felons are being certified to NACC.

(3)

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41

The Legislature intended further to encouragecertain arrested narcotic addicts to choose civilcertification to NACC rather than a possiblecriminal sentence. Sec. 210. Relatively few arrestedaddicts are choosing civil certification to NACC.

Why is certification not working in the criminalcourts of New York City? There are several reasonsfor this, but the main ones are: a general logjam inthe entire criminal justice system, and an appar-ently negative attitude towards NACC's programby the addicts themselves, the Legal Aid Societywhich represents more than 90 percent of thedefendants, and lawyers from the district attor-neys' offices. The general breakdown in the crimi-nal justice system is caused in large part by thehuge volume of cases on the calendar, which inturn is caused in large part by the tremendousnumber of narcotic offenses and narcotic-relatedoffenses. New York City judges and others esti-mate that narcotic offenses and narcotic-relatedoffenses constitute 60 percent of the criminalcaseload in New York City.

Other factors which contribute to the inade-quacies of certification in the criminal courts arethe insufficiency of the proof of addiction inmany cases and the cumbersomeness of the certifi-cation process. These points will be developedmore fully below, but briefly, the proof ofaddiction is insufficient in many cases because ofdelayed or poor medical examinations, inadequatetestimony, medical and otherwise, and inadequatepreparation of cases.

This study of certification in the criminal courtshas centered in New York City, but discussion withofficials in Nassau, Albany, Schenectady, and ErieCounties indicates that the certification process inthe criminal courts outside New York City, whileexperiencing some of the same difficulties, isworking better.

Attention should be called to the lack of goodstatistical data on narcotic-related cases in thecriminal court system, particularly with respect tothe actual dispositions of such cases. The availabletime and staff did not permit the kind of extendedempirical search of court records which coulddocument such dispositions. Consequently, thisdescription of the handling of narcotic-relatedcases in the criminal courts is based mainly onnumerous interviews with judges, lawyers, courtofficials, and city employees, and observation ofcourt proceedings. Some helpful statistical infor-mation is contained in a report on drug addictionand the administration of justice prepared recentlyby the New York City Comptroller's Office. At

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4J

least one potentially significant empirical study ofpurported narcotic-related cases in the New YorkCity criminal courts is presently being prepared byNACC's Division of Research and should be com-pleted in the near future. In that study, approxi-mately 1,100 cases selected at random are beingfollowed through the criminal court system. Atpresent record keeping is difficult since the courtsdo not employ a modern data processing system.Failure of Certification Process in Criminal Courts

The failure of the certification process in thecriminal courts to certify the number of addictsintended by the Legislature can be shown in severalways.

Initially NACC estimated that 75 percent of thecertifications would be criminal (Secs. 208, 209)rather than civil (Secs. 206, 210).25 Presumablythis estimate was based in large part on thestatutory requirement that all addicts convicted ofa misdemeanor or prostitution be certified toNACC. Even if one includes civil certificationsunder Sec. 210, the number of arrested or con-victed addicts certified by the criminal courts hasnever reached 75 percent of the total number ofcertifications, and the percentage has declined overthe life of the program. During the first three yearsof NACC's existence, arrested or convicted addictscomprised 58.7 percent, 54.4 percent, and 39.8percent respectively of the total number of addictscertified.2 6 The actual numbers of arrested orconvicted addicts certified were 2,092, 1,271, and1,501 respectively. Comparable figures for the firstsix mrn+lis of NACC's fourth year, April throughSepW lb( , 1970, are 40.4 percent and 1,308arrest& d ul convicted addicts certified.

The most flagrant violation of legislative intentis the failure to certify all addicts convicted of amisdemeanor, as required by Sec. 208(4) (a). Someindication if this failure appears in the followingfigures compiled by the Criminal Court of the Cityof Ne.v York, which show for several recent years

he number of persons convicted in that courton narcotic misdemeanor charges, and (b) thenumber of such convicted misdemeanants certifiedto NACC.` 7

Year

MisdemeanorConvictions forNarcoticOffenses

NarcoticMisciemeanantsCertified toNACC

1967 3,590 2281968 3,619 1851969 5,210 1941970 9,139 412

Because of the terminology employed by theCriminal Court in compiling these statistics, theconviction totals in the first column includenonnarcotic drug offenses as well as narcoticoffenses, but this qualification is minimized bydrug arrest statistics prepared by the New YorkCity Police Department which show that arrests onnarcotic offenses comprised about 60 percent ofall drug arrests in 1967 and that this percentagesteadily rose to about 80 percent by 1970.2 8 Evenallowing, therefore, for nonnarcotic offenses andfor non-addicted narcotic users in the first-columntotals, it seems clear that the number of narcoticmisdemeanants certified to NACC as shown in thesecond column fell far short of the statutorymandate.

Auother indicatioci of the lack of certification toNACC in the criminal courts is the number ofarrested and convicted persons certified to NACCas a percentage of those who are examined foraddiction by NACC physicians and found to beaddicted. A report prepared by the Office of theComptroller of the City of New York, ("DrugAddiction and the Adminirtration of Justice"),shows a small percent of p, sitive medical certifi-cations certified to NACC from New York County.These percentages in New York County were 21percent for 1968, six percent for 1969, and fivepercent for the first three months of 1970.

Dispositions of CasesThe following summary of actual dispositions of

criminal cases involving narcotic addicts includesthe prevalent dispositions, statutory and extra-statutory, which were apparent in the fall of 1970.As mentioned earlier, some dispositions may notbe accounted for because the practices of individ-ual judges in this area vary considerably, and it wasimpossible to interview every judge. This summaryis divided into pre-trial dispositions and post-trialdispositions, that is, dispositions before and afterthe trial on the criminal charge. This classificationleaves out those who plead guilty without a trial,but those defendants are included in posttrialdispositions here.

Pre trial dispositions encompass the following:(1) certification under Sec. 210.(2) Civil certification under Sec. 206.(3) Referral to private agency for rehabilitation

and treatment.(4) Dismissal of criminal charge for lack of

evidence or other reason.Disposition (1) needs no further explanation

than it has already received, and disposition (4) is

21

self-explanatory. Dispositions (2) and (3), however,are not within the legislative intent, and, thereforeare explained below.

Pre-Trial Dispositions Civil CertificationSome arrested narcotic addicts in New York

City and elsewhere are being civilly certified toNACC, not under Sec. 210 as contemplated in thestatutory scheme, but under Sec. 206, either by apetition brought by the addict himself or byanother person, usually a parent or another mem-ber of the immediate family. Civil certificationunder Sec. 206 is not available to an addict whohas a criminal action pending against him, but thisdifficulty is surmounted by having the districtattorney dismiss the criminal charge. The StateSupreme Court in Brooklyn, for example, has evenestablished administrative procedures for facili-tating this arrangement. This procedure, of course,depends upon the cooperation of the districtattorney, but generally the district attorneys seemwilling to cooperate by dismissing the criminalcharge if the offense is not a serious one and thereare not other limiting circumstances.

One objection to this practice might be that itcontravenes legislative intent by circumventing thecivil certification procedures set forth in Sec. 210.The end result, however, is the same, i.e., civilcertification to NACC, whether it is done throughSec. 206 or Sec. 210. But the eligibility require-ments imposed by Sec. 210 could be bypassed ifthe criminal charge were dismissed without regardto such requirements.

The exact number of arrested addicts beingcivilly certified under Sec. 206 by this procedure isdifficult to ascertain without empirically searchingthe court records. NACC's census figures do notshow how many of its Sec. 206 certifications hadpending criminal charges against them which weredischarged.

Pre-Trial Dispositions Referral to Private AgencyOne of the common pre-trial dispositions of

cases involving addicts in the Criminal Court of theCity of New Yo:k (misdemeanors), particularly inManhattan, has been to adjourn the case and referthe addict to a private agency for rehabilitationand treatment. Approximately every three monthsthe addict, accompanied by a representative of theprivate agency, had to appear before the court fora progress report. If the addict was doing well inthe program, the court would continue the ad-journment of the criminal charge for another threemonths or so. If the addict, in the %iew of thecourt, successfully completed the private agency's

program over the course of a year or so, then thecourt would discharge the addict from the criminalcharge. if the addict were not doing well, or if hehad skipped the program entirely, as some of themdid, often within a few days, then he would bereturned to stand for the criminal charge.

This referral arrangement depends, of course,upon an addict being willing to rehabilitate himselfand upon the cooperation of the judges, lawyersfrom the district attorney's office and the LegalAid Society (which represents most addicts), andthe private agencies. Why referral to a privateagency rather than certification to NACC? Thebasic answer lies in the apparently negative attitudetowards NACC held by some addict-defendantsand the Legal Aid Society. Most addicts do notwish to be certified to NACC for one or more ofthe following reasons: potential length of commit-ment period (three years); belief that NACCcustody is simply a substitute form of imprison-ment; the lengthy waiting period in city jails beforeNACC facilities become available; NACC institu-tion may be upstate, a long way from home andfriends; and some Legal Aid Society lawyers advisetheir clients against the NACC program.

Several serious objections have been made to theprivate agency referral arrangement:

(1) Supervision of private treatment programs isnot a proper function of Criminal Courtjudges.

(2) Pre-trial referral of addicts to privateagencies violates legislative intent by circum-venting certification to NACC and therebyundercutting the authority of NACC.

(3) The Legal Aid Society exceeds its properauthority as a legal advisor if its representa-tives counsel disregard for the obvious legis-lative intent of a duly enacted statute.

The court system itself has taken several stepsrecently to abandon the referral arrangement as ithas previously existed. The Presiding Justice of theAppellate Division, First Department, has morethan once instructed Criminal Court ji r s not toengage in the practice described. Near the end ofAugust, 1970 the Criminal Court of the City ofNew York distributed a memorandum to all of itsjudges detailing a new plan for referral of addictsto private agencies with the concurrence of NACC.This plan contemplates a plea of guilty by thedefendant and certification to NACC for thestatutory period of three years, but imikediatereferral to a private agency accredited by NACCwith the prior agreement of NACC. If the addictleaves or fails to cooperate with the private agency,

25

then NACC has authority to assume jurisdictionover him.

The plan provides for an adjournment periodwhile the defendant's attorney, the private agency,and NACC try to reach agreement. The memoran-dum also lists all of the private agencies accreditedby NACC and sets forth criteria to guide the judgesin passing on each application. It remains to beseen whether this memorandum will be imple-mented by the judges and the other parties. Theaddicts and representatives of the Legal Aid Soci-ety might still object to the NACC certificationand NACC's potential three-year jurisdiction.

Post-trial Dispositions(1) Acquittal of criminal charge. The statute

does not expressly provide for a defendantwho has been medically determined to be anaddict but is then freed of the criminalcharge by dismissal or acquittal. NACC hasfollowed the policy, therefore, of allowingthe defendant to go free without trying tohave him civilly certified. Apparentlynothing would prevent any person believingthe defendant to be an addict, however,from filing a petition under Sec. 206 to havehim civilly certified.

(2) Sentence of convicted addict under penallaw.

(3) Certification of convicted addict to NACC.None of these dispositions on its face seems to

need explanation, but what is discussed below iswhy so many convicted addicts, contrary to thelegislative intent, are sentenced under the penal lawrather than certified to NACC, especially misde-meanants and prostitutes who are required by lawto be certified.

Post-Trial Dispositions Failure to Certify Con-victed Addicts

The most extensive violation of the clear legisla-tive intent is the failure of the criminal courts tocertify convicted misdemeanants and prostituteswho are also narcotic addicts to NACC, as re-quired. This failure is shown by the data previouslyreferred to. The main reasons for this failure arethe overwhelming caseload in the criminal courts,the negative attitude towards the NACC programoften held by the parties involved, and the insuffi-cient medical evidence of addiction caused bydelayed or inadequate medical examirations andpoor medical witnesses.

'I he combination of a huge criminal caseloadand the negative attitude towards NACC producesa common sequence of F'vents, particularly in

Manhattan and Bronx. When the defendant haspleaded guilty to or has been found guilty of amisdemeanor or the offense of prostitution and themedical report and other information indicateaddiction, then the defendant is given the opportu-nity to admit, deny, or stand mute on the questionof narcotic addiction and t..) request a jury trial ifhe wishes to contest the issue. Because mostaddicts do not want to go to NACC, they generallydeny or stand mute on the question of addictionand request a jury trial, which means that thematter must be set over from the Criminal Court ofthe City of New York to the State Supreme Court,since the Criminal Court does not have theauthority to conduct the required type of jurytrial.

With its tremendous backlog of felony chargesand other more serious cases, the district attorney'soffice often is unwilling and unable to expend thetime and effort needed to prepare for and conducta jury trial on the issue of addiction. Consequentlythe district attorney's office, despite a positivemedical report and other evidence of addiction,concedes non-addiction, and the defendant issentenced to a correctional institution rather thancertified to NACC. An almost classical set ofpractical circumstances seemingly conspires tothwart the legislative intent!

Another reason given by representatives ofdistrict attorneys' offices for not wanting to go totrial on the issue of addiction is that many medicalreports are inadequate and incomplete. A majorc'ntributing factor is the frequent delay betweenthe time of arrest and the time of the examination.A urinalysis should be conducted within 48 hoursfrom the time drugs are taken to detect theirpresence. In many cases, however, the arrestedaddicts are not examined that soon, especially ifthey are taken into custody at night or on theweekend. All male addicts who are arrested andconfined in one of New York City's detentionfacilities are transported to the Riker's Islanddetention center to be examined at ,the NACCmedical facility there. All female addicts who arearrested and detained are detained at the Women'sHouse of Detention in Greenwich Village andexamined there. Medical examinations for maleand female addicts who are arrested but releasedon bail or on their own recognizan'e arc scheduledat the Edgecomb Rehabilitation Center or Women's House of Detention respectively.

26

Both the Bronx and Manhattan District Attor-ney's offices readily agreed that, for the reasonsstated above, they usually concede noaddictionwhen confronted with the necessity of a jury trialon the question of addiction. A representative ofthe Brooklyn District Attorney's office stated thathis office did not follow that practice, but at leastone judge stated the contrary. In any event, even ifthe Brooklyn office does concede non-addiction itseems less prevalent than in Manhattan and theBronx because the proportion of criminal certifica-tions is higher in Brooklyn. It is highly doubtfulthat the district attorney's office has the authorityto concede non-addiction when there is reasonablecause to believe that the defendant is a narcoticaddict. The statute appears to require either acourt or jury trial on the issue of addiction whenthe defendant denies or stands mute on that issue.

Waiting Period for Admission to NACC FacilitiesOne of the major criticisms made against NACC

and one of the main causes of disaffection forNACC on the part of addict-defendants is theperiod of time which must be spent in city jailseven after certification waiting for admission toNACC facilities. New York City has been urgingNACC at least since June, 1970 to remove morerapidly the prisoners in city jails who have alreadybeen certified to NACC and are simply awaitingadmission to a NACC facility. The followingfigures compiled by the New York City Depart-ment of Corrections for the Mayor's CriminalJustice Coordinating Council show the number ofaddicts in city jails already certified to NACC andawaiting admission to NACC facilities for eachweek since June 10, 1970. As these figures reveal,the number of addicts awaiting admission to NACCremained mostly in the range of 225-250 until themiddle of October when the situation rapidlyworsened to hit a high point of 444 addictsawaiting admission at the end of November. NewYork City officials made a strong representation toNACC to remove these addicts from the city jails,and an arrangement was reached in which NACCagreed to reduce the number with a view tophasing them out entirely.

The longest individual waiting periods werereduced between July 3 and September 25. Thenumber of addicts held for more than two monthsdeclined from 43 on July 3 to 34 on September25. On July 3 the longest period of detention wasseven months; on September 25 it was just oerthree months.

Table 3

Addicts in New York City Department of Correctionfacilities certifies to NACC and waiting for admission."

Totalno. ofaddicts

Date waiting

No.admittedby NACC Date

June 10 24517 25525 267

July 3 240 3110 223 4217 225 3724 229 38

Aug. 7 214 4814 188 5221 216 1628 229 32

Sept. 4111825

Oct. 29

162330

Nov. 6132027

Totalno. ofaddictswaiting

230230237244269169242275296316375406444

No.admittedby NACC

542239482099225049

(Figuresnot

available)

SOURCE: Figures compiled by New York City Department of Corrections for theMayor's Criminal Justice Coordinating Council.

For a complete picture of the number of addictswho have been certified to NACC and are awaitingadmission to NACC facilities, one would have toadd the number of addicts civilly certified underSec. 206 who are awaiting admission, and thenumber of addicts certified by criminal courts andwaiting in jails outside of New York City. Forinstance, on November 19, 22 addicts were in jailin Buffalo awaiting admission to NACC facilities.Few matters have done more to sour addicts onNACC than the wait in jail to get into its facilities.

SUMMARY AND FINDINGS

A narcotic addict is not subject to the control ofNACC unless he is certified to NACC by a court.Certification, therefore, is the court procedure bywhich an addict is assigned to the care and custodyof NACC. To determine whether the Legislature's1966 program for the treatment end rehabilitationof addicts is being properly carried out, therefore,one must begin by looking at this first step in theprogram to see whether the persons intended bythe Legislature, and only those, are being certified

to NACC as fairly and efficiently as possible.The Legislature set forth several ways in which

an addict can be certified. A non-arrested addictcan be civilly certified either (1) voluntarily on hisown petition or (2) involuntarily on the petition ofany person believing him to be an addict. (3) Anaddict arrested for a lesser criminal offense can becivilly certified on his own petition rather thanstand for the criminal charge. An addict convictedof a criminal offense (4) must be criminally certi-fied if convicted of a misdemeanor or prostitution,or (5) may be criminally certified if convicted of afelony.

The distinctive feature of the certification pro-visions in the 1966 legislation is the compulsorycommitment of addicts for treatment. The compul-sory civil commitment of nonarrested addicts in

404particui....- drew the objections of civil libertarians,but the New York Court of Appeals has upheld itsconstitutionality in N.A.C.C. v. James.

Are the certification procedures working acc, ,rd-ing to the legislative intent? A mixed picture ispresented. Civil certification is working reasonablywell but criminal certification is not working inNew York City.

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Civil certification procedures 1 and 2 above areworking reasonably well, although a heavy caseloadin Manhattan, Brooklyn, and the Bronx presentsseveral serious problems. Among the problemsrelated to the heavy volume of cases are the lack ofprior availability of court papers to the court andlawyers, the brief period of time which the judgesand lawyers can devote to each case, and the lackof overall coordination of the complex proceed-ings. Some easing may be expected through admin-istrative changes by the courts and the opening ofnew court facilities in Brooklyn, but the increasingvolume of cases may require additional facilitiesand personnel. A problem of inadequate medicalevidence of addiction is similar to that experiencedin criminal certification proceedings.

Relatively few arrested addicts have "volun-teered" for NACC under the third civil certifica-tion procedure described above.

The most serious violation of legislative intentoccurs in the criminal certification process. Thecertification of arrested and convicted addicts bythe New York City criminal courts is not working

28

as intended. The violation of legislative intent isparticularly evident in the failure of the courts tocertify addicts convicted of a misdemeanor or theoffense of prostitution, as required by the fourthstatutory procedure mentioned above.

The principal explanation for this lack of crim-inal certification is the general breakdown in thecriminal courts of New York City caused primarilyby the tremendous volume of cases and theconsequent shortage of judges, lawyers, and othercourt personnel to handle the workload. This loadfactor, plus a generally negative attitude towardsthe NACC program by the addicts, their attorneys,and lawyers from the district attorneys' offices,combine to produce few certifications to NACCbecause the addicts contest the question of addic-tion and request a jury trial, as is their right,whereupon the district attorneys often concedenon-addiction either because they do not have thepersonnel and resources to litigate the question ofaddiction or because the evidence of addiction isinsufficient.

V TREATMENT AND REHABILITATION

The declared intent of the legislation as finallyenacted, indicates the initial emphasis of theState's narcotic control program was placed ontreatment and rehabilitation.

The purpose...is to provide a comprehen-sive program of human renewal of narcoticaddicts in rehabilitation centers and aftercareprograms."The principal treatment for narcotic addiction

has been a combination of detoxification, psycho-therapy, and counselling. While drugs were slowlywithdrawn from the addict, professional staff(primarily psychologists and psychiatrists) tried tocome to grips with the complex behavioral factorsbelieved to have caused the addiction. This tradi-tional method of treatment, subject to a variety ofmodifications, is still prevalent in most drugtreatment centers in the nation. Although statisticsindicate the long-term success rate (patient notbecoming readdicted to using narcotics) has beenvery low, no more effective treatment has beendemonstrated.

From the beginning, NACC's approach to reha-bilitation and treatment was based on the conceptthat no single treatment program would be ade-quate and that it would be necessary to provideseveral programs to meet the needs of addicts.Accordingly, a number of major approaches werechosen for the New York State program:

1. The principal NACC treatment approach isinterdisciplinary and offers a mix of individual andgroup counselling and therapy, education andvocational training, and recreation.

NACC offers its commission operated programof rehabilitation and treatment in a dozen residen-tial facilities followed by a supervised period ofaftercare which, hopefully, prepares the addict forcommunity living on a drug free basis.

2. NACC executed agreements with other ap-propriate state agencies to utilize their expertise inthe development of special programs of treatmentfor certain groups of addicts.

The Department of Mental Hygiene employed a"psychiatric" approach. The "correctional" ap-proach of the Depa4tment of Correction offers thesame essential treatment mix in the setting of acorrectional institution for addicts convicted ofserious crimes. A contract with the Department ofSocial Services offers a program for "youthful"addicts.

Separate contracts with the City of New Yorkthrough its Addiction Services Agency provideprimarily for support of the "therapeutic commun-ity" concept in the Phoenix Houses which utilizethe ex-addict in the treatment program.

3. In another approach, NACC funded (on ademonstration grant basis) a number of privatevoluntary agencies located mainly in the New YorkCity metropolitan area.

4. A "chemotherapeutic" approach is suppliedprimarily by methadone maintenance, which isused in both NACC operated and private programs.

This was the principal as ignment of NACC andit has devoted its primary effort to setting up abroad based program of treatment and rehabilita-tion.

NACC has developed and operates its owntreatment centers (13 to date), which employ aninterdisciplinary approach; it has provided fundsfor almost any reputable private treatment pro-gram (19 to date), and has contracted with theState Departments of Correction, Mental Hygiene,and Social Services, as well as 14 public agenciesincluding New York City's programs. (See Maps 1and 2.) Since October 1967. it has funded the onlymajor new treatment concept methadone ituin-tenance.

In the first three years of its existence, NACCspent $98 million of its $103 million total operat-ing expenditure for treatment and rehabilitationand $124 million in capital expenditures ft,tfacilities.

As of January 31, 1971. NACC has 10.761ccrtific-I addicts in trcatmcid, aftcr,iirc, and con-

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31

tract programs. An additional 10,419 non-certifiedvolunteers are receiving some form of treatment inNACC supported private agencies.

There is every indication that NACC under-stands its principal assignment and has tried toexecute it.

ScreeningOnce a person has been certified to NACC, his

first step usually consists of a screening interview.This interview is an attempt at a broad characterevaluation to determine the most appropriatetreatment modality. The interview also presentsinformation on the operations of NACC to newlycertified addicts. There appears to be much nega-tive information about NACC programs in thecourts, in the prisons, and on the streets.

Conducted by a member of NACC's screeningunit, the interview usually lasts an hour, and takesplace at rehabilitation centers for civil certificantsand at jails for criminal certificants. The primarysource of information is the certificant himself,with additional court, medical, historical records,and other documents when available. Often thisbackground information, necessary for a meaning.ful character evaluation is unavailable, and asystematic means for assembling such documents isabsent. Members of the screening unit resort topersonal contacts to assemble as much informationas possible about a new certificant. Since addictshave been described as highly manipulative indi-viduals, such background information would clear-ly be useful to screening personnel in their eval-uations.

Tie screening unit evaluation attempts to selecta suitable treatment modality for a new certificant.

InResidence

(or onleave)

Among the criteria used are: certificant needs,program availability and degree of security re-quired. Personal traits are taken into consideration,and an initial decision is made of the mostappropriate treatment modality (and one alterna-tive). These modalities include: NACC rehabilita-tion centers, "'nstant" aftercare, private accreditedprograms, methadone, and other programs in Stateagencies under contract with NACC.

The screening unit is composed of eight counsel-ors (SG-18), two supervisors (SG-21) and the unithead (SG-23). An average of five people arescreened per day per interviewer; this workloadplus staff meetings and conferences, left littleopportunity for the screening unit staff to visitNACC facilities and other agencies to developfirsthand knowledge of the treatment modalities.They rely on information from other staff mem-bers or representatives of private agencies. Certifi-cants referred to private agencies have been as-signed on the basis of formal requests made by theprivate agency.

Evaluation of ScreeningWhile the screening interview should be con-

sidered an important first step in the treatment ofaddicts, many screening counselors have had rela-tively little experience. Virtually all members ofthe unit are on the beginning level as counselors(SG-18). They may have received on-the-job train-ing with NACC or have passed the civil serviceexamination for counselor, but they have littleacademic or formal training in the social orbehavioral sciences. Thus, important decisions ba-sic to successful treatment and rehabilitationtheheart of NACC's programare being made byinexperienced counselors. Screening interviews

Subjects Under Treatment

InAftercare

UnderTotal Cer- Treatment bytificants AccreditedUnder Care Agencies Total

1968* 2,976 188 3,164 3,158 6,3221969* 3,405 1,003 4,408 6,257 10,6651970* 4,828 2,247 7,075 6,704 13,7791971** 6,141 4,623 10,764 10,419 21,183

*March 31**January 31

SOURCE: NACC Annual & Monthly Reports

32

might be more meal 'n,(,,,u1 If b ',ereadministered, interviews conducted, alundertaken by a group of more experiencedcounselors with relevant backgrounds.

RESIDENT MOVEMENT ANDCENSUS CONTROL SECTION

The Resident Movement and Census ControlSection (RMCC) of NACC is a depository forrecords of persons certified to NACC. RMCCrecords the location of certificants and continuallyupdates this information. RMCC also operates asan information colter handling some 150 to 200telephone calls and inquiries a day from parents,courts, attorneys and others.

When a certificant is assigned to a treatmentfacility, his file is sent to that facility andtreatment records and evaluations are added. If acertificant is transferred, his file is sent to the newfacility. When a certificant absconds, is lost tocontact, is discharged from NACC or dies, therecords are returned to the RMCC depository.Patient information is also forwarded to a centraloffice in Albany, where many reports are processedand added to a computer file of NACC certificants.

The screening unit informs RMCC of preferredtreatment assignments for new certificants. WhileRMCC tries to follow this recommendation, it hasbeen suggested that the availability of bed spacebecomes the primary criterion by which assign-ments are made. RMCC is informed daily bytreatment facilities of available beds. RMCC be-lieves that the reports from facility directors art.reasonably accurate. However, beds may remainempty because a facility director might do so forcause, or, for logistical reasons.

RMCC is also responsible for issuing warrants forcertificants who have escaped from residentialfacilities or have absconded. The unit issues recallsand cancels warrants when certificants have beenreturned to custody.

Evaluation of RMCCRMCC has as its major operational problem the

unavailability of bed space. For example, onNovember 2, 1970, according to RMCC, sources,there were at least 366 persons in jail awaitingassignment to facilities, some of whom had beenwaiting since August. It was further estimated thatapproximately 1,000 beds would be required toeliminate overcrowding in jails, NACC facilities,and the Edgecombe Reception ('enter. A number

33

of iiiese L.cis also w,,uld be used by al ,scuridtwho are being icturned to treatment

Another aspect of the record-keeping functionwhich poses a potential problem area is personnel.RMCC is presently staffed largely by provisionalappointees, many of whom live in the area. WhenRMCC moved from Manhattan to Long IslandCity, many experienced staff transferred to otherNACC units or other State agencies. RMCCclaimed that Civil Service has not been successfulin recruiting people for these permanent positions,and the unit has come to rely primarily on a localemployment office for personnel. The lack ofexperienced personnel has serious implications forrecord-keeping accuracy.

NACC INTRAMURAL FACILITIESThe NACC approach to compulsory treatment is

spelled out in Article 9, Section 200 of the MentalHygiene Law. This section states, in part, that:

Experience has demonstrated that narcoticaddicts can be rehabilitated and returned touseful lives only through extended periods oftreatment in a controlled environment fol-lowed by supervision in an aftercare program.The purpose of this article is to provide acomprehensive program of human renewal ofnarcotic addicts in rehabilitation centers andaftercare programs....The NACC intramural program provides resi-

dential treatment for certificants in its facilitiesand in facilities operated by State agencies undercontract with NACC. The principal objective ofintramural treatment is to prepare certificants toreturn to their communities to live on a supervisedIrug-free basis.

NACC's treatment program is interdisciplinaryin approach, and emphasizes individual and grouptherapy, counselling, education, vocational rehabil-itation, recreation, and security.

Individual and Group Therapy and CounsellingIndividual and group therapy and counselling is

included in programming to improve the certifi-cant's attitude toward himself and society and toenable him to cope with the underlying problemswhich led to the use of drugs. Primary emphasS ison group therapy sessions with counselors andother professional support. In some cases, groupsessions are conducted by counselors; in othercases, Narcotic Correction Officers (NCOs) mayparticipate in group sessions. Individual therapy isprovided, but, for the most part, it only supple.

ments the bate group session. Some facilitiesemphasize group and individual counselling; otherfacilities, such as Iroquois, place less emphasis onformalized counselling but stress participation inwork programs. Bayview Rehabilitation Center alsoprovides family counselling where addicts partici-pate with members of their families.

It must be recognized that the quality of thesecounselling sessions is an important element in thetreatment process. Since counselling is a highlysubjective input, counselors with differing methodsmay be equally effective with certain types ofindividuals. In the most positive cases, counselorsmay cause major changes in an addict's behaviorand life style; in the most negative cases, counsel-ors have little or no impact upon an addict'sbehavior and adjustment. In the great majority ofcases, the quality of counselling services fallssomewhere between these two extremes.

EducationThe educational component of NACC's treat-

ment program focuses on remedial courses inreading, writing, and arithmetic, and secondaryeducation courses leading to a high school diploma.In cases where addicts have graduated from highschool, college level courses may be offered byparttime instructors from local educational insti-tutions.

Vocational RehabilitationNACC's vocational rehabilitation training pro-

gram offers workshops and instruction in variousindustrial and business vocations and techniquesincluding pre-vocational work habits. Special em-phasis is placed on the development of pre-voca-tional work habits including punctuality, organization, cooperation with peers and supervisors, andcare of tools. The most numerous vocational shopsare woodworking, metal working, arts and crafts,electrical, office machinery and typing. Othervocational shops are devoted to auto mechanics,barbering, and tailoring. Facilities for female ad-dicts offer courses in cosmetology, dressmaking,homemaking and office machinery.

While residents may sometimes be awardedcertificates of achievement in vocational courses,more often they develop only a familiarity withthe concepts of the trade and its tools. Hopefully,they also discover whether or not they wish topursue it further. Additional training in localvocational training programs may lead to employ-ment opportunities after they return to the com-munity. Facility directors pointed out that the

3t

continuing emphasis on vocational training hasbeen directed toward the cultivation of positivework experiences.

RecreationNACC proviaes recreational programming at all

rehabilitation centers. Recreational activity devel-ops cooperative attitudes and team efforts besidesproviding entertainment, relaxation, and increasingphysical fitness. The types cf recreational activitiesat intramural facilities depend upon site limita-tions. For example, rehabilitation centers such asSheridan or Bayview have minimal areas devoted torecreational activity while centers like Arthur Killor Iroquois in open settings devote large areas toboth indoor and outdoor recreation. All facilitieshave some areas for recreation. Active recreationconsists of baseball, basketball and other "team"sports, weight lifting and similar activities, whilepassive recreation consists of movies, TV, cardplaying, libraries, music and lounge areas. While theexact 'mix' of these activities varies considerably, itis determined by the limitations of physical spaceand availability of equipment.

SecuritySince intramural facilities provide treatment for

people who have been criminally or civilly certifiedby the courts, security is an important element atNACC facilities. NACC rehabilitation centers runthe gamut in security from the relatively opensetting at Iroquois Rehabilitation Center, a formerJob Corps camp, which does not have any physicalconstraining devices, to the highly secure environ-ment and highly structured programs at Wood.bourne Rehabilitation Center. Woodbourne, a for-mer correctional institution for boys, is still staffedby correction officers who wear uniforms andcarry night sticks. Many of the Woodbourneresidents have been transferred from other NACCfacilities becanse it was determined that they hadbehavior problems. It was felt they would benefitfrom the highly structured and secure setting atWoodbourne to which civil and criminal certifi-cants are assigned.

An of the NACC rehabilitation centers range insecurity between these two. With the exception ofWoodbourne, security is provided by NCOs, few ofwhom have correctional backgrounds, who wearcivilian clothes to minimize the security aspect oftheir jobs. At some NACC intramural facilities,NCOs play more important roles in the treatmentprocess by participating in group therapy sessionsand providing counselling service. Some NCOs with

proper educational background have elected tobecome counselors after serving as NCOs.

NACC COMMUNITY EASED CENTERS

In accordance with Article 9 Section 200 of theMental Hygiene Law, NACC's comprehensive pro-gram of compulsory treatment for narcotic addictscalls for "...extended periods of treatment in acontrolled environment followed by supervision inan aftercare program." The major objective of theCommunity Based (Aftercare) Treatment programis to prepare addicts for independent communityliving, free of psychological and physical depend-ence on drugs.3 1

Community based centers (CBC) are geared toproviding services for 800 certificants: 50 in resi-dential programs, 150 in day-care programs, and600 on field service. Certificants in residential andday-care programs receive services similar to thosein intramural facilities, including education, voca-tional training and rehabilitation, counselling, andrecreational activities, The largest number of certi-ficants, those on field service, live in the com-mu nity.

In addition to the five CBCs in New York Cityand the one in Buffalo, there are two AftercareReporting Centers in the upstate area (Albany,Syracuse). These centers do not have the full arrayof services found in community based centers, andprovide only field service for addicts on aftercarestatus who reside in the upstate area.

In view of the rapid expansion of NACC'smethadone treatment program, four of the CBCs(Fulton, Bushwick, Cooper in New York andMasten Park in Buffalo) have initiated outpatientdepartments for methadone maintenance pro-grams. In those cases, the CBC model serving 1500persons has been modified for an additional 200 to300 persons in methadone programs.

Transfer to AftercareAfter a certificant has been in treatment at a

rehabilitation center for a period of time, and thestaff has decided that satisfactory progress hasbeen made, a recommendation for aftercare is

made. The aftercare center nearest the certificant'shome is notified of the proposed transfer andcontact with the certificant is made by a NarcoticsAftercare Offier (NM)). He checks the certificant'sbackground and treatment history, evaluates thecertificant's family status through a visit to hishome, assesses his employment opportunities, andmakes a preliminary determination of the preferred

35

aftercare servlces (residential, day care or fieldservice) This preliminary decision is discussed withthe certificant, and a request for transfer toaftercare is submitted to NACC. Upon NACCapproval, the certificant is released from thetreatment center and is told to report to hiscommunity based center. Aftercare supervision ofthe addict is essentially the same whether an addicthas been in a NACC intramural program or in aprogram run by a contract agency.

Community Based Center Residential Programcertificant is assigned to a CBC residential

program if it is felt that his home life is notconducive to continued rehabilitation, or if theCBC staff feels he requires closer supervision thancan be expected on either the daycare or fieldservice program. In a residential program, thecertificant is encouraged to participate in theactivities available at the CBC. The primary em-phasis of CBC programming is to help the certifi-cant re-enter the community by seeking employ-ment and attending school or training programs.

Variations of the CRC residential program aremade available to certificants as required. Oneprogram, designated "instant aftercare", is a con-cept of treatment for addicts with marginal drugproblems, some positive signs of social responsi-bility (academic achievement, good employmentrecord, gook.: family relationships,) and minor or nocriminal history. Certificants are admitted to in-stant aftercare programs as a result of the deter-mination that they do not require the moreintensive residential treatment. However, "instantaftercare" certificants live in the facility andreceive more intensive programming than residentsin regular residential CBC programs. If "instantaftercare" does not help, certificants can be transferred to regular intramural treatment facilities.The "instant altercate" program at CBCs is c:e-

signed to run for three or four months.The residential program at CBCs also helps

those certificants on aftercare status who may haveresumed using narcotics. When this occurs, somemay be returned to rehabilitation centers whileothers, who do not require the greater security orsupervision, may be admitted for detoxification atone of the CBCs. Detoxification may take fromthree to five days, but certificants also receiveadditional supportive services, including group andindividual counselling, during the twoweek periodwhich they remain in the CBCs.

Community Based Center Day-Care ProgramCertificants in CBC Day-Care prop,rram: livc in

the community and participate in CBC activitiesduring the day. Addicts in this program usuallypossess few skills, are not able to compete in thejob market, -ind require a wide variety of support-ive services. However, they may live at home sincetheir family ties are good and serve as a positivefactor in rehabilitation and readjustment. Theday -care program is geared to an eight-hour day,although it appears difficult to keep them busy.

People in this program participate in shopprograms to strengthen work habits and otherpre-vocational attitudes, participate in group andindividual counselling sessions as needed, attendclasses and avail themselves of employment andplacement counselling.

Community Based Center Field Service ProgramThe field service program, offered at the six

CBCs and two upstate reporting centers, requiresthe least programming and supervision of all NACCoperated programs. Under NACC's conceptualmodel of treatment and rehabilitation, the fieldservice program is the last step in the rehabilitationand treatment process and the fi'al point prior tothe termination of certification.

Certificants on field service repoi. initially to aNAO weekly. If they Function well, they may berecuired to report only bi-weekly or monthly.Certificants are spot checked for narcotics use byurinalysis and may have to submit to a visualexamination for needle marks. NAOs also functionin a supportive role by providing guidance andadvice for certificants, by referring them to appro-priate staff members for specialized help. A certifi-cant's visit is supposed to be more than just"checking-in'' with the NAO. The addicts shouldreceive counselling, job placement and other supportive services. However, some field service pro-grams have become little more than a "checking-inprocess" because of the large number of casesNAOs are now supervising. NAOs may not visit theaddict's family once a month as required, and thisfurther dilutes the quality of supervision.

According to NACC statistics for October, 1970,only about 31 percent of the certificants inaftercare programs were employed full-time, with24 percent working part-time or counted as stu-dents or housewives. Another 45 percent wereclassified as either not employed or not reported(See Exhibit XV).

If a person certified to NACC begins to abusenarcotics while on aftercare, he may be returned toresidential treatment. NACC issues warrants for thearrest of people who abscond from facilities or

36

who become lost-to-contact w hilc on aftercare.Time spent on abscondence from the program isadded to the certification period if the absconder isfound and returred.

EVALUATION OF NACCTREATMENT PROGRAMS

In recognition of the fact "that not all narcoticaddicts can or should be treated in exactly thesame manner," there are several distinct treatmentmodalities used in intramural treatment pro-grams.32 These are conducted by NACC in its ownfacilities and in those under contraA with theDepartments of Correction, Mental Hygiene andSocial Services. The principal objective of intra-mural treatment is to prepare certificants to returnto their communities to live on a superviseddrug-free basis.

It is difficult to consider the NACC treatmentand rehabilitation program as composed of severalseparate and distinct treatment modalities. Itwould be more accurate to think of it as a broadcontinuum ranging from the highly structured andvery secure setting of the NACC-Department ofCorrection interdisciplinary approach in operationet several correctional institutions, to the relativelyopen and work-oriented program at the IroquoisRehabilitation Center at Medina. All other treat-ment programs conducted at intramural facilitiesare located along this continuum and vary in the'mix' of counselling, vocational and educationaltraining, recreational activities and in security.

The programming 'mix' varies from center tocenter with respect to the proportion of the aboveactivities. At some intramural facilities residentsare programmed for the whole day and have aminimum of free time; at others residents appearedto have little to do during the day. Some directorsexplained that residents "were not yet fully pro-grammed" or that some of the planned activities"still weren't operational."

Many treatment facilities have been opened withcomponents of the treatment program missing. Itwas recognized that NACC had been operating fotlittle more than three years when this study wasundertaken and that some treatment and aftercarefacilities had only recently opened. Many shopsand classrca;ns are still in planning, while othersare inoperative because of a wide variety oftechnical problems (i.e., inadequate wiring, incom,patible equipment and electrical outlets) whileothers stand idle for want of qualified instructors.

The NACC vocational instruction shops arebased on plans which have been modified in lightof space limitations and other considerations ateach of the facilities. As of mid-September 1970,there were 150 to 160 planned shops in all NACCfacilities of which approximately one-third werefully operational, one-third were marginally openatioral, and one-third were in the planning stage. Itshould be noted that some of the operational shopswere incorporated in facilities that had been set upby other state agencies (i.e., Woodboume vocation-al training areas originally designed and operatedby the Department of Correction).

Several community based centers have beenopen for less than a year. Nearly all the structuresconverted to CBCs have undergone extensive reno-vation. Where renovation work is still going on,certificants and instructors try to make the best ofthe situation. In other cases, facilities have beenopen for many months before receiving shopequipment. For example, Fulton CRC has beenopen for six months and, when visited, it's shopswere still not operational.

The vocational training component which isespecially important for those certificants thatrequire day-care services, is either absent or limitedin many CBCs. In the few cases where shops areoperational, there appears to be a gap in NACC'sability to provide continuing vocational trainingand services that smooth the transition fromintramural facilities to CBCs.

A question can be raised concerning the goal ofNACC's vocational training program. It is statedthat vocational training places emphasis on pre-vo-cational skill development, but it appears thatsome shops have been equipped with new, elabor-ate and expensive equipment which could be usedfor much more than the development of positiveattitudes and work habits. It is doubtful whethermore than positive work attitudes can be devel-oped in a limited daycare program. Additionalvocational skills might be developed by the estab-lishment of closer ties with existing vocationaltraining services and programs when available inthe con.munity. There are indications that some ofthe vocational courses offered by NACC areproviding training in skills for which there may belittle market in the near future. Barbering, tailor-ing, and key punching are among the vocationalcourses offered where future employment oppor-tunities may not be especially promising. In lightof these findings, one Pan conclude that manycertificants who have completed, or who arecurrently in treatment, save not had adequate

37

opportunity to develop pre-vocational work atti-tudes, habits, or fundamental shop skills. Thedevelopment of these are of critical importance inthe long -teen rehabilitation of certificants.

For many subjects, the transfer from intramuralto aftercare programs is quite difficult. Addictswho have done reasonably well during the intra-mt,ral phase report they were unable to handle theless structured aftercare situation, and thus re-verted to drugs. This claim by addicts is consistentwith the conclusion of medical researchers that theaddict's return to community life often will be aneven more trying experience than first getting offdrugs, especially because the returning addict maywell have lost both his friends in "straight" societyand his ability to form new social relationships(other than in structured treatment circumstances).

NACC claims to make special efforts to help theaddict through this transition stage. A NAO alwaysineets with a certificant who is scheduled for-Tease to aftercare while he is still in intramuralresidence. While the purpose of such meetings is toassure the addict of continued support, thesepromises are sometimes not fulfilled. The addictoften expects continued close supervision, but theNAOs have 40 to 60 cases per officer instead of the30 called for in the program design. The addictexpects continuity between phases of treatment,but frequently finds that aftercare fails to buildupon intramural treatment.

An addict's progress in rehabilitation may be setback not only by actual aftercare performancedenciencies, but also by the delays bet,kreen therequest and transfer to afters re. These delays,which range up to two or three months, have theeffect both of increasing the addict's insecurity andapprehension, and of keeping residential bed spacetied up that would better serve new certificants.

Average Certification PeriodUnder the certification procedure, addicts are

under NACC supervision for a pe.-iod up to threeyears for civil certificants and criminal certificantssentenced for misdemeanors, and up to five yearsfor criminal certificants charged with felonies.

In most cases, rertificants spend part of theircertification an intramural treatment centerfollowed by a period of supervision on aftercare.However, a certificInt may be discharged fromcertification if NACC finds that he has remainedfree from drugs for an appropriate period of time.

It has been determined that the typi021 addictnow spends between six and nine munths in hisinitial exposure to treatment at an intramural

facility. A year ago, the typical addict was in anintramural facility for nine to fifteen monti's. In atleast one center, the stay has been shortened toabout three months.

Many NACC stall persons attribute the shorterinitial treatment time, in part, to a change intreatment philosophy. NACC now prefers to haveaddicts undergo a short period of treatment andreturn to "the street" to observe how well they do.If certificants start using drugs, NACC can provideadditional supportive services. Another suggestedreason for the cut in treatment time is that NACC'sprogram has improved and less time is now neededto achieve positive result;.

While NACC's changes in the concept of treat-ment time may be acceptable to some observers,there is no evidence to indicate the treatmentprogram has proeressed since there is a lack ofmeaningful statistical data on program results.Since the treatment time dropped rather abruptlyearly in 1970, one must question how this im-provement in prcgramming could have occurred ir_such a relatively short period of time.

Increasing pressure for bed space at treatmentcenters was probably the principal reason for thedecrease in treatment time. NACC facility directorsnow must provide information to headquarterswhen a certificant is in residence more than ninemonths. It appears that facility directors and staffmust now justify more than nine months ofintramural treatment for residents. It is suggestedthat, administratively, this requirement may mini-mize the number of residents who stay in intra-mural treatment for periods exceeding eight ornine months. Yet most facility directors stated thatthey were not sending people to aftercare unlessthey were ready.

While NACC recognizes that the initial screeningprocess provides a broad evaluation used to selectan appropriate treatment modality for new certifi-cants, it was stated that additional screening ozcumif residents are reassigted to other treatmentcenters. Little reassignment now takes place be-cause of the shorter treatment period, except foraddicts who require more secure environments orfor those who apply and are accepted by IroquoisRehabilitation Center.

UrinalysisThe spot checking of addicts' urine is the

principal means for the detection of illicit drug use.There is considerable variation in the spot checkingof urine. Se% eral highly secure facilities do no urinetesting. Others, however, collect urine several times

a week and analyze a sample of those collected.Urinalysis is provided by a California laboratory

under contract to NACC although some samplesare tested locally. Most facilities have been satisfiedwith the laboratory's work. However, criticism hasbeen directed at the length of time required toreceive reports from the laboratory. While this lagmay not be important when residents are inintramural facilities, staff in aftercare centers andprivate agencies commented that it did not help intheir supervision of addicts. This problem mayclear up in the near future when the NACClaboratory in Brooklyn opens.

Abscondences from NACC ProgramsAll of the NACC operated facilities and con-

tractual agreements have as their goal the treat-ment and rehabilitation of addicts so that they canbe returned to the community where they can leaddrug-free lives. The question that must be raisedand answered is "how successful &re these pro-grams in achieving that goal?"

It seems clear that many of the persons certifiedto the NACC program have not adjusted toNACC's programming, nor have they displayedwhat might be even termed positive o.itlook ormotivation to deal with their addiction. As ofSeptember 30, 1970, there were a total of 13,420certifications to NACC. Of this total, 7,582 ab-scondences occurred between April 1, 1967 andSeptember 30, 1970. However, this does not mear.that 7,582 different individuals escaped fromprogramming, since a single certificant nay haveabsconded more than once. Nevertheless, 2,641certificants were counted as absconders as ofSeptember 30th: this figure indicates that no lessthan 20 percent of all people who have beencertified to NACC for treatment have escaped. Itwould seem reasonable tc conclude that th. largemajority of these absconders have probably re-verted to the use of opiates. Even for thosecertificants who have completed the NACC treatment program and have been certified as drug-free,there is still INIe information on how long aperson remains off drugs. Some people probablydo not 'evert to heroin use, others may only useheroin or other drugs from time to time, and somemay become re-addicted to heroin. At the presenttime, only if a certificatA is rearrested is there anyindication as to whether he has again become'caught up in the drug culture."

In order to obtain improved information on thesuccess of NACC's treatment programs, more

38

60

complete statisticai information on programmingand information from follow-up studies should begathered. Systematic follow-up studies, perhapsbased on a reliable random sampling of personswho have been through NACC programming, aresorely needed. Furthermore, information is neededon program deficiencies so that NACC ca.ci providemore meaningful treatment for certificants and forgroups of people that escape from NACC facilitiesand revert to drug use.

Besides these primary considerations for im-woved information and follow-up statistics, thereis the concern for the esprit de corps of the NACCtreatment staff, Because of the nature of NACC'sprogram, professionals in treatment and rehabilita-tion have little indication how people who havebeen through their facilities' programs are doing.These staff people are patient-oriented and com-mitted to the successful rehabilitation of theirclients, ealci they want to know how well they areachieving that goal.

PROBLEMS OF PERSONNELFacility Directors

Facility directors enjoyed good relations withthe senior NACC officials responsible for theirprograms. NACC officials have indicated an aware-ness of the need for closer supervision and aremoving to improve contact.

NACC has issued broad guidelines for theoperation of intramural facilities, but many direc-tors have considerable flexibility "filling in" theseguidelines and in the day-to-day operation of thecenters. All facility directors and high echelonofficials connected with intramural treatment feltthat variations in treatment approach resultingfrom directors' innovations were a positive elementof the program.

Narcotic Rehabilitation CounselorsThe Narcotic Renabilitation Counselors (NRCs)

play prominent roles in the rehabilitation program.NRCs serve as the primary link between NACC andthe residents in treatment. NRCs participate ingroup and individual counselling, provide informa-tion to residents, arrange for educational andvocational programming, keep records of the resi-dents' progress, note changes in behavior patterns,meet with other members of staff to discuss thestatus of residents, and the residents' existing andpotential problem areas.

Rehabilitation facilities in the metropolitanareas have recruiting problems. While they may

39

benefit from a metropolitan location, they sufferfrom a salary stfucture which is not competitivebecause of higher living costs and competitionfrom other programs. This higher cost of living isrecognized by the New York State Department ofCivil Service which has authorized a pay differen-tial of $200 for virtually all state employees in theNew York City metropolitan area. However, ac-cording to facility directors, this salary adjustmentstill does not provide an adequate differentia:.

It was the opinion of facility directors and headcounselors that counselling staffs were overworkedand v, ere unable to spend adequate amounts oftime on each resident. Some facilities are operatingwithout a full complement of counselors. Sincecounselling services are deemed to be an importantcomponent in the treatment and rehabilitation ofaddicts, limited quantities of such services areundermining the rehabilitative aspects of the pro-gram.

Medical PersonnelThere was general agreement among facility

directors that professional psychiatric and psycho-logical services were limited because of a shortageof qualified personnel. Psychiatrists were difficultto recruit since State salaries were not competitivewith salaries in the private sector. However, somefacility directors have had success in providingps3chiatric and psychological services by fillingpositions with several part-time professionals.

one centers hate had difficulty in recruitingnurse; and doctors. Several facilities have filledpositions with part-time medical personnel. Mostfacility directors felt that the situation neededimprovement. They attributed the problems inrecruiting to time principal reasons: (1) generalshortage in the professional fields; (2) non-com-petitive State salaries and (3) remoteness of facili-ties.

Institutional Teachers and Vocational InstructorsInstitutional teachers' primary re5ronsibility in

the NACC program is to provide educationalservices for residents. Since many addicts have notattained more than grade school educations there isa focus on developing basic reading, writing andarithmetic skills. For residents with these basicskills, emphasis is placed on the achievement ofhigh school equivalency.

It is reasonable to expect individual differencesin teaching quality from teacher to teacher. It hasbeer suggested that the low grade at whichinstructors are hired does little to promote teach-

ing excellence. Until early in November 1970,beginning institutional teachers with provisionalcertification were classified at salary grade 12which has since been raised to salary grade 13. Toindicate the relative inequity of this salary gradefor a teacher with a minimum requitement of abaccalaureate degree, it should be noted thatbeginning Narcotic Correction Officers ale also atsalary grade 13. (NCOs under current civil servicestandards are not required to have more than ahigh school education.) Eventually, with perma-nent certification and two years of experience,institutional teachers may attain salary grade 17.Even with this recent salary adjustment, institu-tional teachers remain at a salary disadvantagewhen compared to teachers in the educationalsystems of municipalities in metropolitan areas.Consequently, there has been a high rate ofturnover of institutional teachers which varies fromfacility to facility.

Many of these same problems also pertain toinstitutional vocational instructors.

NACC CONTRACTS WITHOTHER STATE AGENCIES

Article 9, Section 204 (2) charges NACC with..the responsibility for interdepartmental coop-

eration and program development in drug addic-tion, promote, develop, establish, coordinate andconduct unified programs for education, preven-tion, diagnosis, treatment, aftercare, community,referral, rehabilitation and control in the field ofnarcotic addiction, in cooperation with such otherFederal, State, local and private agencies as arenecessary and...implement and administer suchprograms."

NACC's philosophy of treatment is based on therecognition that not all addicts should be treated inthe same manner, and, therefore, provision hasbeen made for joint, interdisciplinary treatmentprograms with the Department of Correction, theDepartment of Social Services, the Department ofMental Hygiene, and, under new legislation passedearlier this year, with the Division of Youth.

The interdisciplinary treatment programs forcertified addicts operated under contractual agree-ments with these Departments, are designed speci-fically for the types of addicts assigned to thosedepartments.

Department of Social ServicesNACC has found that the number of yo ithful

addicts (i.e., 17 years of age or less) has accounted

40

for approximately iive percent of total certifica-tions. In view of the fact that youthful offendersusually require expanded education and counsel-ling programs, NACC's contract with the Depart-ment of Social Services (DSS) focuses on theDepartment's program designed specifically foryouthful addicts.

DSS' stated goal is to improve the socialfunctioning of children when they return to thecommunity. To achieve this result, programs havebeen developed which focus on education, training,and guidance activities which operate throughoutthe period of institutionalization. Part of therehabilitative effort is centered on activities in theliving units, where residents are encouraged tolearn and practice socially acceptable modes ofbehavior within a family setting. Organized recrea-tional activities focus on the development of"team" cooperation. Social services are providedboth on a group and individual counselling basis.Psychiatric and psychological counselling is avail-able for residents to aid in their adjustment tocommunity living.

An education program with emphasis on morepersonalized attention through smaller classes isoperated at DSS institutions. Academic subjectsare taught to the majority of residents, and there isspecial emphasis upon the development of basicreading and writing skills. Vocational courses arealso available.

The NACC-DSS agreement during fiscal year1970-71 calls for the provision of treatment for anestimated one hundred civilly certified addictsunder 17 years of age at a recommended cost toNACC through a budget apportionment of$951,200. Between May and November 17, 1970the census of NACC certificants being treated inDSS facilities has ranged between seven and fifty-six persons.

Department of CorrectionThe purpose of the joint NACCDepartment of

Correction program is to afford society protectionby maintaining continuing supervision of offenderscommitted to correctional institutions and byproviding the offenders with appropriate care. Theprogram is aimed at modifying the anti-socialbehavior and attitudes of offenders by humanecorrection treatment, and appropriate disciplineand supervision.

The rehabilitative program operated by theDepartment of C:or7ection includes educational andvocational training, individual and group counsel-ling, recreation, and correctional industry workactivities.

The NACC-Department of Correction interdisci-plinary treatment program contract calls for theprovision of bed space for some 800 criminallycertified addicts during fiscal year 1970-71 at atotal recommended cost to NACC through abudget apportionment of $4,085,000. BetweenMay and mid-November of 1970, the number ofcertificants assigned by NACC to Department ofCorrection institutions has been between 872 and979 persons.

An average of 600 narcotic certificants havebeen and are being supervised and treated in GreatMeadow and Green Haven Correctional Instqu-tions. In addition, the Department of Correctionsupplies custodial and security services for NACCoperated facilities at Woodbourne, Green Haven,Matteawan, and Albion.

Department of Mental Hygiene (DMH)The principal aim of the NACC Department

of Mental Hygiene program is to provide treatmentfor persons addicted to narcotic drugs. This pro-gram consists of supportive psychiatric counselling,educational and vocational training, recreationalactivity and social case work counselling. Since thisjoint program is referred to as the "psychiatricapproach" by NACC, it is implicit that theprogramming emphasis centers on more intensivepsychiatric counselling than in NACC operatedfacilities or under contracts with other stateagencies.

During fiscal year 1970.71, the NACC contractwith the DMH calls for the provision of bed spacefor some 240 civilly certified addicts at a total costto NACC through a budget apportionment of$1,773,500. The Department of Mental Hygienemaintains bed space for NACC certificants at twofacilities, Manhattan State Hospital with some 200beds for mate civil certificants, and MiddletownState Hospital with some 45 treatment beds forfemale civil certificants.

Since May 1970 the number of NACC certifi-cants assigned to DMH for treatment has rangedbetween 137 and 226.

Evaluation of Contract Agency ProgramsNACC does not provide separate and distinct

treatment modalities for certificants. Instead,NACC treatment and rehabilitation programs rangealong a continuum and there are few, if any,meaningful distinctions in the programming of-fered by NACC at its intramural treatment centersand at those facilities operated by other Stateagencies. While there are criteria for assignment to

41

the programs of DSS (i.e., 17 years of age or less)and to the Department of Correction programs(NACC criminal certification), the components oftreatment have the same kinds of variations as atNACC intramural facilities.

The psychiatric treatment approach claimed forthe NACCDepartment of Mental Hygiene inter-disciplinary program did not appear to be incorpor-ated in the treatment program at Manhattan StateHospital, the largest of the two NACCDMHprograms. In fact, Manhattan State's program nowfocuses on a team concept of psyrihologists andsocial workers, and the psychiatrists are being"phased out" of programming. There is littledifference in the programs offered by DMH andthose offered at NA' treatment centers.

Programs conducted jointly by NACC and otheragencies may, in fact, dilute the effectiveness oftreatment for certificants. For example, criminalcertificants assigned to correctional institutions areintegrated with the regular prison population inevery way except that they are required toparticipate in group counselling sessions conductedby correction officers trained by the ex-addict staffof Reality House. At one correctional institution, asupervising officer stated that the exaddicts hadrelatively little input once they had helped set upthe program and had provided the correctionofficer counselors with some basic counsellinginsight and training.

Criticism of the NACCDSS program appearswarranted on the basis that there is no specialprogram being offered to youthful certificants. Theyoungest certified addicts (i.e., 17 years of age) areassigned to DSS facilities for treatment. No distinc-tions are made between certificants and the rest ofthe population, and addicts are intermixed withother youthful offenders and receive the sameprogramming.

The director of a DSS facility stated that nooperating problems had occurred as a result of thejoint relationship between DSS and NACC. Heelaborated on this by stating that NACC wascontent to let DSS do it because it had experiencewith young people.

Since there are no major differences fromtreatment program to treatment program at NACCand other state agency institutions housing NACCcertificants, there appears to be little or nojustification for the intndisciplinary treatmentprograms funded by NACC. At a minimum, thisjoint administration appears to be causing prob-lems among senior staff who are not certain oftheir lines of responsibility or of their channels of

communication. Furthermore, in some programs,staff operating under NACC program guidelines arelooking to other departments for promotions andother benefits. This tends to split their allegiances.

Of more importance is the as,;.:ssment thatcontractual programs are probably providing lessintensive, rather than more intensive, programmingdesigned to treat and rehabilitate addicts. Certifi-cants might receive more in the way of treatmentand rehabilitation services at NACC treatmentcenters.

PRIVATE AGENCIES TREATMENTAND REHABILITATION PROGRAMS

A principal approach of NACC in the area oftreatment and rehabilitation has been the fundingof private agencies located primarily in the NewYork City metropolitan area. Many of these privateagencies pre-date the founding of NACC. WhenNACC was created, several of the private agencieswere receiving funds ftom the City of New York aswell as from other sources. However, other agen-cies which have proposed additional approaches forthe treatment of drug addiction also have beenfunded by NACC. Dr. Donald B. Louria, presidentof the New York State Council of Drug Addiction,stated, "Currently virtually every voluntary pro-gram with the capacity to help in the anti-addic-tion fight is funded through the Narcotic Addic-tion Control Commission, and any other respon-sible organization not so funded undoubtedly canbe by proper application to the Commission."3 9

NACC, charged in part with accrediVng andfunding some privately operated narcotic addictioncontrol programs in the State, took over the partialfunding of some and the total funding of themajority of private agencies on "three to five yeardemonstration grants." Demonstration grants wereselected because NACC was aware there was nosingle appropriate treatment modality in narcoticsaddiction, and the programs of the private agenciesrepresented a variety of treatment approaches.NACC decided to pIs.ce few restrictions on theagencies during the demonstration period so theycould manifest the effec 'veness of their treatmentapproaches and not accuse NACC of adverselyaffecting programs.

As a result of this ciecision, there has been little,if any, evaluation of private programs. NACCsources have stated it would be inappropriate toconduct such an evaluation until the end of the

42

demonstration period. However, the demonstrationmodels of most programs have been broken, sinceprivate agencies have expanded in size. In manycases, original project designs and treatment ap-proaches have undergone change and a vigorotrevaluative study may be extremely difficult to do.

An examination of the funding provided byNACC indicates the increase which took place. Forexample, four private agencies (Exodus House,Greenwich House, Lower Eastside Service Centerand Quaker Committee) in the 1967-68 fiscal yearwere authorized a total of $939,100. In fiscal year1970-71 these same agencies were authorized$1,656,000. In addition, the Beth Israel MedicalCenter methadone program was authorized$889,000 in fiscal year 1967.68 for the five-monthperiod, between October 1967 and March 1968; infiscal year 1970-71, the program was authorized$6,000,000 as shown in Table 4.

These agencies were chosen as examples primar-ily because they have been among those funded forthe longest period of time, yet if one looks at anyof the other programs funded by NACC, it isapparent that the majority of these agencies haveexpanded also. This increase in funding, except forBeth Israel, appears to have taken place withoutrigorous evaluation by NACC and without sub-mission of supporting evaluative data other thanstandard demographic characteristics.

Private Agency ProgramsThe programs of private agencies can be divided

into three categories: residential, outpatient, andmethadone maintenance. In addition to differentprogram concepts, there are differences in programemphasis in each category.

The residential facilities operated by privateagencies are generally smaller (25-75 residents)than those operated by NACC. Most operate onthe concept that die addict, in order for treatmentto be successful, should be removed from societyand the addict world for a specified period of time,usually from nine months to two years, so thatanti-social behavior or personality traits can bemodified.

The residential settings are voluntary. Residentsmay leave the facility whenever they desire, wheth-er or not they have completed the prescribedtreatment program. In fact, many clients do leavebefore they are deemed ready for "graduation."Virtually all of the programs directors admittedtheir "split rate" varied between 30 and 80percent.

Table 4

Authorized Funding for Selected Private Agencies

Agency 1967-68 1970-71 Percent IncreaFe

Exodus House $294,800 $395,000 34

Greenwich House 241,300 422,500 75

Lower Eastside 791,600 447,500 14Service Center

Quaker Committee 191,400 391,000 104

Sub-Total 939,100 1,656,000 76

Beth Israel 689,000* 6,000,000 575Medical Center

Total $1,828,100 $7,656,000 319

*Period 10/1/67 - 3/31/68

SOURCE: NAf,'C Budget Office, Contract Agency Funding (Unpublished)

Most people who leave a program do so in theearly stage of involvement. Because of a lack offollow-up data, there is virtually no way todetermine how many "splitees" either return tothe original program or enter another for treat-ment. It is generally agreed, however, that asubstantial number of people do, in fact, re-enter.The treatment approaches of the residential pro-grams range from the intensive therapeutic com-munities (especially those based on the peer groupconfrontation methods of the Synanon model) tothe more highly diversified interdisciplinary ap-proaches incorporating both educational and voca-tional training, therapy and counselling.

In the therapeutic communities (i.e., DaytopVillage, Odyssey House) a resident spends most ofIns time in group sessions. These may totaleighteen hours a day. There is little time left forformal academic or vocational training. It is feltthese skills may not be important until theex-addict has come to grips with his fundamentalpersonality problem.

At the other end of the spectrum, are programsthat have vocational shops which emphasize thedevelopment of job skills in order to prepare aperson to take a productive place in society. One

program requires that residents learn two ifferentskills for greater em'oyment flexibility. Otherprograms emphasize educational goals such as highschool equivalency. Another program does notpermit graduation unless the resident has passed ahigh school equivalency examination.

The primary goal of these programs is tocultivate and reinforce acceptable social behaviorand discourage anti-social attitudes. One or moreof the following components, in various degrees,are utilized: group, therapy, individual therapy,educational and vocatior&I programs. There isminimal individual therapy in most privateagencies' programs. The therapeutic communityapproach may be difficult for residents who do notrelate well in groups or who cannot learn to do so.Most programs use incentive systems in whichpositive behavior changes, considered important tothe maturation pro,:ess of residents, are rewardedwith privileges or increased responsibilities. Theseprivileges include visits with family and friends,phone calls, escorted or unescorted passes, endbetter living accommodations.

Some programs require that a person begin atthe bottom of a well defined job ladder working inthe kitchen or cleaning house. The resident must

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6J

demonstrate honesty and an acceptable pattern ofbehavior before he moves up to a better job. Aperson breaking one of the important programrules may be punished by loss of status and may berequired to repeat the whole treatment process.Some smaller programs, especially those housing25 to 30 addicts, try to impart a feeling of familylife and responsibility as compared to the moretraditional institutional settings of larger facilities.

Some residential facilities are coupled withday-care centers which serve as clearing houses andinduction units for the program. A person may berequired to attend the day-care facility daily whileremaining drug free, to demonstrate motivationand willingness to participate in the programbefore being allowed into the facility. In this waythe houses avoid overcrowding, program dilution,and excessive waiting lists. People in the day-careprogram frequently are expected to come to thefacility eight hours daily and participate in thevarious programs. When a vacancy occurs, a personwho has demonstrated the proper "motivation" isthen admitted.

Outpatient ProgramsIn addition to residential and associated day-care

facilities, there are some programs funded byNACC that function strictly on an outpatient basis.In outpatient programs, clients report on a dailybasis and return home each night.

Lower Eastside Service Center and GreenwichHouse reported that 295 and 424 addicts, respec-tively, were being treated as of the end ofSeptember 1970. This compares to an average ofabout 100 persons in treatment at each of eightresidential facilities of six private agencies. NACCreported that its cost for operation of LowerEastside Service Center was $140 per patientmonth and Greenwich House was $56 per patientmonth for the period April 1, 1968 to March 31,1970. This compares to an average cost of $326per patient month for the six residential programsduring the same period.

It is important to note that philosophies guidingthe residential and the outpatient programs aredifferent. Directors of outpatient programs con-tend that residential facilities create an environ-ment that bears little resemblance to the "realworld," and while it may be well and good to treatan addict in a protected environment he may beunprepared to meet the challenges of normal livingwhen released. This may be one reason so manyreturn to drug use. Some directors believe out-patient programs are the only ones which provide

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L

realistic experiences as the addict faces the dailytest of avoiding drug use when he returns home.

Program content at outpatient facilities varies asmuch as in residential programs. Common compo-nents are: group and individual therapy, educa-tional and vocational classes, job placement and thelike. Some programs have workshops while othersrely on traditional social service agencies to providethe services which they do not or cannot provide.

The essential differences between residential andoutpatient programs. aside from philosophy, areintensity and size. The outpatient programs accom-modate more people per staff person than residen-tial programs, but therapy is less intensive becauseof non-residency. While there are almost no reliabledata, the estimated "split rate" for outpatientprograms appears similar to that of residentialprograms.

Evaluation of Private AgenciesOne fundamental difference between the pre

grams run by NACC and those of private agenciesis the voluntary nature of the latter. NACC,because of the certification process, has stringentcontrols over certificants. Addicts who elect to goto private agencies, on the other hand, often do soout of desire to "kick" their drug habit, even ifonly temporarily.

Private agencies, because of their voluntarynature, became appropriate only for those people,often referred to as "motivated" addicts, who havedecided to do something about the problem ofaddiction. Some observers point out that addictsenter private agencies as a condition of theirparole, when there is a "panic" in the streets andtheir source of supply is threatened, when they aretrying to avoid certification to NACC, when theyfeel that their heroin dosage is approaching adangerous level, or when their habit becomes toocostly. When these outward pressures or conditionsare removed, the addict often returns to drug use.These same observers maintain that the pleasuresderived from injecting heroin are too great to begiven up easily.

Legal requirements and the nature of the Stateprogram are such that NACC takes virtually all ofthe people certified to it for treatment. Privateagencies, on the other hand, have the option ofscreening out people they consider undesirable andtaking only those they want into their programs.This screening process may be more passive thanactive. Most agencies say they never turn awayanyone who tries to enter the program, but thevery nature of the program may be such that only

these who feel comfortable with the treatment willstay. The others will leave. This kind of freedom isnot possible in NACC facilities.

The population served by NACC and privateagencies differ in other aspects as well. The State iscommitted to treating only opiate addicts. Privateagencies, on the other hand, are not so restrictedbut are free to deal with other forms of drugaddiction including drug abuse problems that maybe easier to deal with. A major problem hinderingany meaningful attempt to analyze the operationsof private agencies is the lack of hard data otherthan basic demographic statistics. Many programshave been operating for a number of years, but theservice philosophy has taken precedence over theacquisition and analysis of pertinent evaluativedata. However, this data must be collected andanalyzed to determine the effectiveness of varioustreatment modalities.

As Charles Winick pointed out in a researchpaper prepared for the New York Association ofVoluntary Agencies on Narcotic Addiction andSubstance Abuse (now AVANT), "Each researchdirector has been collecting data that appeared toflow naturally from the special historical back-ground, clientele, and treatment philosophy of theagency. 'Because of the idiosyncratic developmentof the data collection enterprise and the varyingsaliency of research at each agency, there has beenno uniform collection of research statistics. Thedata collected are non-comparable.'"

The agencies suggested they are now in theprocess of obtaining some of the necessary infor-mation. Unfortunately, they have not yet agreedon what pertinent data should be and NACC hasnot, to date, made evaluative information collec-tion a condition of funding (or if they have, itclearly has not been enforced).

One result of this paucity of data is that manyagency directors have made unchallengeable state-ments in public and to the media about their"fantastic" success rates. One director stated thathis program had a "67.5 percent success rate."When questioned further, however, he admittedthat he did not know how many people hadgraduated from his program nor had he or his staffdone any follow-up studies to determine howgraduates were doing.

There is a great need for followup studies todetermine not only how well graduates of pro-grams are doing but also how people are doing whohave left the programs before graduation. It hasbeen suggested that there are many who havecompleted some part of a program, who have not

45

graduated, who may be leading drug free lives.Comparable statistical data frmn the private

agencies is needed so their programs can beevaluated, and determinations made as to whichprograms are the n,ost successful as a condition offuture funding. Spot checks of the collection ofdata and evaluative techniques in order co ensurethe validity of the statistics have not been made.Furthermore, follow-up interviews art) essential butlacking.

Comparison of Program CostsAnother difference between private agencrs and

facilities operated by NACC is operating costs.NACC facilities, because of security aspects, em-ploy security personnel around the clock. Ingeneral, when the staff of NACC residential facil-ities is taken into account. the ratio between staffand residents approaches 1:1. This ratio is lowerfor community based aftercare facilities.

Private agencies, on the other hand, do not havesecurity personnel. Many therapeutic communitiesemploy few professional staff relying instead onpara-professional ex-addicts.

According to NACC statistics, the average costper person per month for all NACC operatedresidential facilities for fiscal year 1969-70 was$770.72. (See Exhibit VIII) When the per personcosts of contracts with other agencies are addedthe monthly per person cost drops to $713.21.

The average monthly cost to NACC per personin a private agency is $146.08. Several pointsregarding this figure must br, kept in mind. First,the average cost figure reflects the cost of out-patient programs as well as residential ones.Second, not all operating costs of private agenciesare included since NACC counts only its directcosts. In other words, welfare costs, private contri-butions and funding from other local, state andfederal government agencies are not included inNACC's tabulations. However, it should be notedthat when these other costs &re taken irlo consid-eration, it i^ still less expensive to run one of theprivate agenoies than the NACC program becauseof differences in staffing patterns, security require-ments and underlying program concepts.

It is apparent that many renovations in privatefacilities have been made with materials andsupplies obtained from people in the community.It is rare to find a private residential facility thathas net had considerable improvements made byits residents, a free source of labor the use of whichhas been justified as being part of the treatmentprogram.

Detoxification FacilitiesA major problem faced by private agencies is the

lack of beds available fox detoxification in the Cityof New York. Major Mary C. Davis, Director ofWomen's Correctional Services Bureau of the Salva-tion Army, pointed wit in a paper for AVANT,that there are only 562 detoxification beds in theCity of New York. Of that total, 314 ire in theMorris J. Bernstein Institute with an averagewaiting period of from tear to six weeks; 2-3 bedsare available in Manhattan S';ate Hospital with athree to four-week waiting period; 20 beds are inMetropolitan Hospital Centee with a two-monthwait; and Bronx State Hospital has, "beds only forthose who are going to participate in the metha-done program." In addition, there are 28 beds inSt. Luke's Hospital that are restricted to adoles-cents from two programs. Interfaith Hospital has10.50 beds, but they have been unavailable sinceFebruary 1970 because of building renovations.

Presently, there are only 337 beds available on aregular basis, and all have long waiting periods. Inreflecting on the seriousness of the situation, oneprogram director pointed out it took the betterpart of a day to find a bed for an emergency case,

For many private programs the lack of detoxifi-cation beds means that they lose addicts who areeither unwilling or unable to wait for a bed. It isclaimed that the addict is, at best, an irepuleiveperson with e low "frustration tolerance" who isunable to wait for long pericds of time. As MajorDavis points out, "The ciesire to change is oftenonly a frail spark and is all too easily snuffed outby adverse circumstances."

Longer Treatment PeriodsAnother difference between private agency pro-

grams and those run by the State is the duration oftreatment. Most NACC facilities formerly kepttheir residents some nine to fifteen months. Lately,this period of time has decreased. The averagetreatment in most NACC facilities is now sixmonths. This reduction in treatment time mayresult from an increase in knov,leclge on the part ofstaff and an increased understanding of ai;d experi-ence v..-ith the treatment process. It appears, how-ever, that the NACC program is under very realpressure generated by numbers. There ate manymore addicts trying to begin treatment than thereare treatment beds.

The resulting backlog has caused two things tohappen. First, some court judges are more willingto send prisoners to other prcgrams or to let themplead to terser charges so they will not have to go

into the NACC program. Second, many facilitiesseem to be reacting to pressure for beds by turningpeople over to aftercare facilities in a shorterperiod of time.

Employmmt of Ex-AddictsThe private programs cal! for residents to be in

treatment a minimum of one year, and in manycases the staff of these agencies believe two yearsof intensive treatment are essential to make thepersonality changes believed iecess,try.

Many private agencies depend on ex-addicts fora great deal of their staffin, . Some programs areoperated almost exclus, ex addicts. Theseagencies claim the ex.addi, ys a role in thetreatment process that cannot ue eeiplicated bysomeone who has not been addi, 'ed and who hasnot "kicked the habit." It is also claimed: theex-addict is more likely to know when an addict islying and manipulating staff members; the ex-addict is an important role modol, a living prooffor the addict that a drugfree productive life ispossible; and the ex-acidicc is better able toestablish meaningful commiinie.dions with theaddict than personnel who I c ri,,t been part ofthe drug scene. This viewpoint has resulted in arapid increase in demand for ex-addicts to establishprograms. The programs are usually therapeuticcommunities based on the California Synanonmodel or on one of its variations.

Directors of existing programs commented thatseveral ex-addicts who have taken jobs with otherprograrAs are, in fact, "splitees" who never gradu-ated. These directors point out that, in many cases,they do not consider these people qualified forwork in their own program much less as directorsof other agencies. But, they add there is "bigmoney" in the field.

Many observers feel an ex addict subculture isbeing perpetuated. It is not denied that ex-addictscan play an important role in treatment, but howeffective a role is debated. Some programs haveelected to use ex-addicts extensively as co-ther-apists along side professional psyLholcgists andpsychiatrists; others do not use professionals untilthe addict is on his feet and in need of traditionalservices such as edu -'ation, vocational assistance,job placement, etc.; Jill others have used ex-addicts, and have conclu'fed they do not workwell, or do not fit their particular needs.

The role of the ex-addict in treatment antrehabilitation is questioned by some who are notcertain what qualifications ex-addicts bring to thejob ase)e from former addiction and treatment

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experiences. It has been suggested that the ex-addict would be more useful and his role clearer if,in addition to his experience, he had formaltraining in counselling, vocational training, or inthe social and behavioral sciences.

It is further argued that the ex-addict cannot beconsidered successful as long as he is in thenarcotics treatment field, because he has not leftthe program. The supportive services provided toresidents arc still available to the ex-addict staff.Critics maintain that in order to be successful, theaddict must seek a job outside the narcoticsrehabilitation profession, if only for a few years.

Program ExpansionOther than basic accounting and some data

collection, few controls have been exerted on theprivate agencies by NACC. Agencies have beenallowed to expand and have received additionalfunding from NACC for their programs. Substan-tial changes in the size of a prog- am may effect itsoperations and the concepts on which it operates

In light of the original demonstration grantrationale, it is diffirailt to see how increasedfunding can be justified. Some program costs havemore than doubled without being subjected tomeaningful evaluation. There have been no indica-tions that these programs represent successfultreatment modalities in the field of drug rehabilita-tion. New programs have been funded solely on thebasis that they provide a unique approach to theproblem of drug addiction, yet NACC officialshave been unable to explain the criteria used indetermining the uniqueness of new programs. Itappears that programs have L.,,er, able to expandsimply by playing on demonstrated concern:shown by the public rather than documentedevidence of successful rehabilitation.

One rapidly growing program has made an issueover the lack of adolescent drug addiction treat-ment programs. The importance of this problemhas been disputed by the director of anotherprogram who maintains that although there is agrowing problem of teenage drug abuse, it is besthandled by existing social agencies rather than bycreation of new adolescent residential treatmentfacilities. Yet, there is no reliable data to substan-tiate either claim.

Supportive ServicesNACC facilities are designed to provide, when

fully operational, a range of services that aregenerally similar. This is not the case with privateagencies, some of which offer a full corr.plemeat of

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services while others rely on those provided bysocial service agencies in the community.

Many of the private therapeutic programs pro-ide few services besides therapy. Hart Island isbeginning to offer educational programs and has aneducational research project to determine specialeducational needs of addicts. Daytop and OdysseyHouse employ certified public sahooi teachers.

Some programs insist that addicts attain a highschool equiva: ncy diploma before graduating. Yetothers stress development of vocational skills andassume people must possess specific skills beforereentering society. Unfortunately, skills which arein demand in the job market are not alwaysknown.

SalariesThe private agencies indicate they have diffi-

culty locating qualified people at salaries established by NACC, especially medical and nursingpersonnel.

Agencies not funded by the State hale indicatedthat one reason they have nct contracted witnNACC is directly related to NACC hiring policiesand salaries. In addition, they want to avoid thekind of administrative rigitiity they felt would beimposed. They fear their role as program inno-vators would be lost if they t.ccepted public funds.They are reluctant to try new treatment conceptsfor fear of failure and 3 resulting loss of funds.What is not mentioned is that private egencies,since the inception of NACC grants, have criticizedNACC and have competed among themselves to geta larger share of the NACC financial pie. To date,the spirit of cooperation between involved partieshas not been good. This is unfortunate consideringthe present stat., of the art and the concomitantlack of knowledge. As Miss Judy Calof of theCommunity Service Society pointed out in anarticle in the Antidote, a newsletter of AVANT,"Honest efforts have been made but effectivetreatment remains elusive...Knowledge of whatprograms are appropriate for different addictseludes us. There is no system to help the addictedinto the most suitable program."

The Association of Voluntary Agencies on Nar-cotics Treatment AVANT

AVANT is an association of 11 private agenciesfunded by NACC who joined together to provide acommon front in the treatment of drug addictionin New York City. AVANT is the successor of asimilar organization that began in 1958.

The member agencies were initially unhappy

with the State's program which they viewed aslittle more than incarceration. The agenciesthought they could develop better solutions if theypooled their knowledge and experience and im-proved their own programs. AVANT establishesstandards of admission for member agencies, pro-vides a forum for the exchange cf meaningfulinformation, and has begun to explore the possibil-ities of standardized data collection and evaluation.In addition, AVANT prints and distributes theAntidote, a newsletter detailing the operations ofits member agencies and also publishes articlesrelated to narcotics addiction.

In March 196C the Association hired an execu-tive director, who has been successful in promotingan improved spirit of cooperation among themembers and a more positive attitude towardsNACC.

NEW YORK CITY ADDICTIONSERVICES AGENCY

The Addiction Servioes Agency (ASA) wasestablished in 1966. Originally it was called theOffice of the Coordinator of Addiction Programs(OCAP) and was located in the Office of theMayor. OCA? established information centers butdid not beet :ne directly involved in treatment andrehabilitation. In 1966, there were no p'iblicprograms in operation and a hap lful of smallprivate agencies were trying to provide help for anincreasing number of addicts-

Dr Ephren Ramirez, was recruited to establishtreatment programs based on drug abstinence. Thubasic concept of the Ramirez program was that anaddict should be willing to accept responsibility fr.),his on rehabilitation, and this responsibilityshould increase as the addict progressed throughthe program. Dr. Ramirez developed the PhoenixHouse program 'awed on a threefold treatment andrehabilitation concept induction, treatment, andreentry. At the preaent time, the Phoenix Houseapproach to treatment is still the mainstay of ASAsupported treatment progaama.

ASA contracts with the 2hoenix House Founda-tion to provide treatment services in some 15facilities. in addition, ASA also funds treatmentfacilities not associated with the Phoenix HouseFoundation but based on similar ccncepts. ASAfunds programs in local neighborhoods Day rareCenters, Community Centers, and Youth Centerstihich are primarily educational and informationa:units but which do provide some counseling help

for addicts on an outpatient basis.In October i570, the City Comptroller issued a

manage. aent analysis cf the Phoenix House ASAprogram. The report stated, in part, that PhoenixHouse was "so closely identified with the cityagency as to be inseparable." The report also saidthat as a result of the lack of distinction betweenthe two agencies, the city paid bills that shouldhave been charged to the Phoenix House.,, orderedsupplies for them, and used city employees towork for the Phoenix Foundation.

Among the other findings of the N.Y.C. Com-ptroller were that the Foundation's books andrecords were chaotic and inadequate; that theFoundation. an unincorporated association(Friends of Phoenix); and the Foundation's instru-mentalities in its various real estate ventures(Harness I ealty) may have violated a wide vari-ety of "Aderal, State and local laws concerningfund raising and taxation.

There are indications that the Phoenix HouseASA relationship will be changed with the man-

agement of the Phoenix House program goingentirely to the Foundation. In view of recentorganizational changes in the city's administrativestructure, ASA. is to become more closely asso-ciated vrith the Office of the Mayor and will againbecome principally a staff rather than an operatingagency.

Phoenix House ProgramPhoenix House is a "therapeutic community"

programs, staffed by ex-addicts for the treatmentand rehabilitation of heroin addicts and other drugabusers. The program is voluntary and designed forpeoplepie who have problems with any drug (not justopiates) and even includes people whose problemsare non-drug related. The staff claims the onlycriterion for admission is a sincere desire andcommitment on the part of the individual to dealwith the emotional and social problems that haveled to the use of drugs.

The Phoenix House progra_m began in May 1967and by August 1970 there were over 1,000residents in 15 separate facilities. As of mid-September 1970 about 43 percent of ..ac residentswere under 21 years of age.

There are approximately 200 Phoenix Housestar members. Over 76 percent of the staff areex-addicts and former drug abusers, and the re-maining 40 to 50 persons are doetora, nurses, socialworkers, teachers, and other professionals.

Residents generally remain in the program fortwo to three years, while they learn to face and

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deal effectively with the realities of their lives."Encounter" group sessions several times a weekhelp residents cope with their feelings and theirbehavior. The staff claims that seminars and a fullprogram of informal and formal education providesadditional skills for residents. Household workassignments provide a "sense of community" ,.ndhelp residents take responsibility for the chores ofdaily living.

Most people join the program after 'warning of itat one of the six Phoenix Centers. The inductionperiod provides a watered down program wherenew residents beco:ne oriented to the concepts andmethods of Pi-oenix House. The treatment phaseof the program lasts the longest and consists of allcomponents of Phoenix House programs. Finally,residents move into the re-entry phase of theprogram during which they may work as staff atone of the Phoenix House centers or seek employ-ment or educational opportunities outside theprogram.

NACC Phoenix Hot se (Hart Island)The five Phoenix Houses on Hart Island are

funded by a contract with NACC through ASA.The City of New Yu;k leases Hart Island to theState for use as a rehabilitation mter.

As of the end. of October 1970 there were some375 residents in the program. According toPhoenix staff, all but 50 residents were NACCcertificants. NACC certificants are selected for theprogram by a Phoerix House screening group.

Evaluation of Phoenix House ProgramAn t npublished study of the ASA Phoenix

House program indicates that there were 2,110cumulative admissions between May 2, 1967 andFebruary 11, 1970. Of this total, there were 1,113withdrawals from program (62.7 percent) end 918people remaining in program (45.5 percent). Thestudy found there were 79 residents who hadcompleted the program (3.7 percent). Many ofthose who left the treatment program beforegraduation may have stayed drug free. However, ofthe 79 -esidento who completed the pfogam, twopeople had returned to drpg use, one of whom hadreturned voluntarily. Of the 77 people who gradu-ated from treatment and who reputedly were drugfree, 42 were salaried and working within Phoenixprograms, 17 were working for other voluntaryaddiction programs, and the remaining 18 areworking in other fields, unrelated to thP treatmentand rehabilitation of addicts.

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METHADONE MAINTENANCEPROGRAMS

Methadorw is a synthetic opiate that was de-veloped by the Germans during World War II. It iscalled a synthetic opiate because, although synthe-sized in the laboratory, its chemical propertiesresemble those of morphine. The Germans used thedrug as a pain killer because of the difficulty inobtaining morphine during the war. Methadone hasbeen used at the U. S. Public Health Service facklityin Lexington, Kentucky and at other facilities todetoxify narcotic addicts.

In the early 1960's, another use for methadonewas discovered by Drs. Vincent Dole and MarieNyswander (at Rockefeller University) who foundthat if methadone was administe_ed orally toheroin addicts, it had the capability of blocking theheroin high. In ether words, addicts who tookmethadone and later took one of the opiate drugs,heroin or morphine, reported that they received no'kick" from it.

Research indicates that methadone when admin-istered orally produces none of the unpleasantattributes of heroin. It is longer lasting andtherefore requites only one dose daily; it does notcause debilitation, euphoria, and its side effectsswetsting and constipation are relatively minorproblems. Additionally, methadone does not createa demand for an escalation of dosage as do other°pin thugs. Once a patient has been placed on amaintenance dose (generally 80-110 rigs. daily), itremains stable and can be reduced if required,

methadone programs were established, theprincipal treatment for narcotic addicticn had beena combination of detoxification and psycho-therapy. This traditional method of treatmentsubject to a variety of modifications is still beingused in many of the drug treatment programs inthe country, though statistics to date indicate thatthe long term success rate (patients not returningto the use of narcotics) has been low.

Methadone maintenance programs have been setup within federal guidelines related to the use ofmethadone established by the Food and DrugAdministration of the Department of Health,Education and Welfare and the Bureau of Narcoticsand Dangerous Drugs of the Department of Justice.The criteria and guidelines for conducting researchin this area were announced in June 1970, and areexpects(' to be further modified and amendedearly in 1971.

The oldest ar.d largest methadone program is in

operation at the Beth Israel Medical Center. Theprogram is predicated on the mode, based on theresearch of Dole and Nyswander. Their researchwas originally funded by a grant from the NewYork City Department of Hospitals, but sinceOctober 1, 1967 it has been funded by NACC.

The current budget of Beth Israel provides forthe care and treatment of about 2,100 people at acost of some $4.2 million, out of a total budget of$6,000,000. The remaining funds are allocated forprogram development, supplies and contingencies.

The Beth Israel program has three phases. In thefirst phase the patient enters the program, is givena complete physical exam, and begins his doses ofmethadone. The doses are increased until anappropriate maintenance level has been establishedwhich, in general, is around 80 to 110 milligrams aday. This process takes abort six weeks after whichthe patient takes his established dose of methadonedaily.

Most of the patients initially were handled on anin-patient basis. In the last year, however, most ofthe people have been handled on an ambulatorybasis. Nearly 80 percent of the new patients do nothave to be admitted as in-patients. If necessary,they can be admitted to selected hospitals for anymedical problems that exist or occur.

Once stabilization has been achieved, the patiententers the second phase or out-patient part of theprogram. During this period he comes to the clinicdaily for his oral dose of methadone. He is requiredto leave a urine sample which is tested for drug use.If he remains "clean," the number of visits perweek is reduced until the patient comes only oncea week to pick up his methadore and leave a urinesample.

The third phase of the program begins when thepatient has led a "productive", heroin-free life forone year. At this point he is supposed to be afunctioning member of society. Clinic visits andcontact with the staff become less frequent.However, he must report to the clinic weekly toleave a urine specimen and to be observed takingone dose of methadone.

The Be .;1 Israei program currently consists offive in take facilities and 22 ambuls tory andoutpatient clinics. Admissions to the program arevoluntary but are subject to the approval of thefacility director. The following criteria have beenestablished for admission:

1. A person must volunteer for the program.2. He roust be 18 years of age or older; parental

consent is necessary for those under 21.3. The patients must have a heroin addiction of

at least two years and generally rot have ahistory of mixed drug abuse.

4. The patients must be free of severe psychi-atric disorders.

5 If a patient's spouse is also an addict, both ofthem must participate in the program.

It is claimed that once the patient has beenrelieved of the need to support a heroin habit, hebecomes more amenable to rehabilitation. Hereceives personal counselling and referrals to theappropriate community agencies for additionalassistance in vocational training, job placement, orschooling.

Data Bank for Methadone ProgramA data system for evaluating the operations of

the methadone program at Beth Israel and itsaffiliated facilities has been established atRockefeller University. The system was designed tomonitor a large number of patients and provideanalyses of clinical, laboratory, research and ad-ministrative information. This information is keptin computer data files for immediate access.Currently the system stores information on some4,000 individuals, and its designers claim it canhandle information on 25,000 patients withoutmajor changes. As additional clinics at otherhospitals are set up under contract with BethIsrael, they will be required to collect data whichwill be added to the files of the RockefellerUniversity Data Bank.

Methadone Program NACCIn Fiscal Year 1969-70, NACC began operating

methadone programs for some 300 certificants intwo facilities Cooper Community Based Centerand Masten Park Rehabilitation Cei.`er. In1970-71, largely basing its justification on theclinical findings of Dole and Nyswander and BethIsrael experience, NACC received increased appro-priations to expand its methadone programs totreat an additional 400 certified addicts. Thisbrings to about 700 the number of certificantsprovided with methadone in NACC

As of November 10, 1970 there were 31certificants being stabilized on methadone at intra-mural facilities. An additional 669 persons were incommunity based methadone programs. Another193 certificants were being stabilized on met:ia-done at the Cross Bay Rehabilitation Center.

The NACC methadone program is a two-phaseoperation: a residential sk-week period for stabili-zation and ancillary medical care; and a supervised

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period of aftercare during which the addict reportsfor methadone and additional services as required.

If the certificant does welt on methadone, hisrequired visits per week to the community basedfacility decrease until he reports oily weekly. If,on the other hand, a person does poorly, he maybe required to report to the facility daily. Further,if a person's behavior is poor enough, he may bewithdrawn from methadone and sent to an intra-mural facility for residential rehabititation.

During aftercare, certificants in the methadoneprogram are expected to avail themselves of thesupportive se.-vices offered by the CBC's. The"taporting in" requirement is based on the ce:cant's apparent adjustment to community livingand is tempered by work, schooling, family respon-sibilities and other considerations.

The Cross Bay Methadone Treatment Centerwhich opened in March 1970, is considered blNACC to be primarily a research facility. It wasestablished to obtain data, gain experience andexamine the potential uses of methadone fordifferent sub-groups of narcotic addicts. Cross Byalso houses the NACC central pharmacy whichprepares methadone doses for all NACC patients.Methadone is received in bulk, prepared in indi-vidual dosages, as required. and distributed to thevarious NACC methadone programs several times aweek.

The program at Cross Bay operates on a six-week cycle for a maximum of 225 male and femalepatients per cycle. During the residential periodeach patient is given a complete medical examina-tion and is gradually stabilized on methadone,while under observation of the medical staff. Inaddition to its primary function as a researchfacility. Cross Bay also provides supportive servicesfor patients: group counselling, aptitude develop-ment programming (prevocational training), recre-ation, and work assignments in and around thefacility.

Three research protocols have been establishedat Cross Bay and only people who meet the criteriaare eligible. Patients in the first control group mustsatisfy the following criteria: (1) between 21 and40 years of age; (2) no prior involvement inprograms at other NACC facilities; (3) no chronicphysical illness; (4) no history of assaultive be-havior; (6) no mixed drug use (6) addicted tonarco;ics a minimum of four years.

The criteria for the second research groupare: (1) a minimum of 21 years of age; (2)addicted for at least two years; (3) less importanceplaced on as.)aultive history; (4) fewer 'estrictions

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on behavioral characteristics; (5) prior involvementin NACC treatment; (6) possible mixed drug use.

The third research design is the newest and is inthe process of being set up. The criteria for thisprogram are: (1) over 21 years of age; (2) criminalcertification; (3) recent certification; (4) no specialattention to patient's history.

Once the six-week cycle at Cross Bay is com-pleted, the patients are assigned to a CBC metha-done outpatient facility. The period of aftercaretreatment and supervision is similar to that ofother certificants being treated in the NACCmethadone program.

Private Agency Methadone ProgramsIn addition to the programs already mentioned,

two private agencies, Lower Eastside Service Cen-ter and Greenwich House Counseling Center, oper-ate outpatient methadone programs.

The Lower Eastside Service Center has some 50people in its methadone program. Recently it had acGntract with the New York City Llea Ith ServicesAdministration approved for 125 people and it willbecome one of twenty methadone .clinics nowbeing set up by the city and funded by NACC.

Greenwich House Counseling Center operates amethadone program for some 110 people inconjunction with Et. VLicent's Hospital. The staffestablished the following criteria for admis-sion: (1) a person must request methadone; (2) hemust have first tried abstinence programs; (3) apsychiatrist must determine his mental fitness; (4)a medical doctor must determine his physicalfitness for this program.

At present the staff said there ar3 some 800people on a wai`ing list for the program whichprovides methadone en a five day-a-week basis to"avoid abuses." The participants are given a week-end supply of the drug when the clinic is closed.

Evaluation of Methadone MaintenanceThe Methadone program is probably the most

controversial approach to the problem of narcoticsaddiction currently being tried in this country. Thecontroversial nature of methadone treatment stemsprimarily from the fact that methadone is itself anaddictive drug.

Proponents of methadone treatment point outthat under proper medical supervision, a singledaily dose of methadone blocks the narcoticeffects of heroin without necessitating the escala-tion of the dosage. It is claimed that a person onmethadone will generally be unable to "overshoot"the methadone blockade with heroin. There are

several other positive aspects of methadone treat-ment. It a longacting narcotic whose effects lastfrom 24 to 36 hours. Proponents say that metha-done is relatively safe when taken orally. Researchindicates a high degree of tolerance to methadoneitself with patients who had received double dosesshowing no signs of adverse rAaction. This isimportant since a substantial tolerance to thetreatment drug is needed for success with theblockade treatment. Methadone research to dateseems to indicate no major medical problemsattributed to its use, although research in this areais still continuing. The principal medical complications aro increased sweating and constipation.Finally, methadone does not create a demand forincreased amounts, as do other narcotic drugs.

On the other hand, the proponents of metha-done consistently fail to make clear the conse-quences of making patients dependent on largedoses of methadone, and the withdrawal syndromethat will occur if the drug is not received.

It is readily apparent that, "Methadone is adangerous drug and the doses used for maintenanceare highly toxic to the non-tolerant individual. "3 s

A few deaths resulting from accidental swallowingof methadone doses already have been noted bythe Medical Examiner's Office in New York City.

"Methadone is a narcotic and produces innontolerant patients a type of euphoria: regardlessof whether it is injected or administered orally inorange juice, that is qualitatively similar to heroin.Further, it produces a type of tolerance andphysical dependence that is indistinguishable fromthat of heroin or morphine. It has high abusepotentiality."36

"Patients' acceptance of the methadone main-tenance or continuing in the program should not initself he taken as a measure of its success Thedependence - producing proptnty of methadone dic-tates this result, for it must be remembered thatphysical dependence forces them to remain in theprogram just as physical dependence on heroincauses them to seek illicit narcotics."37

The methadone program in operation under theaegis of the Beth Israel Medical Center is the onlyone that has produced substantial statistical infor-mation. Frances R. Gearing, M. D., of theColumbia University School of Public Health andAdministrative Medicine has headed an indepen-dent evaluation team since the program's inixp-Hon.

Atcording to reports released periodicaly by theevaluation unit twenty percent of the peopleadmitted to the program have been adrninistra-

tively discharged often for drug or alcohol abuse.The staff of Beth Israel commented that of the 80percent who remain in the program, 85 percent areleading "productive and socially acceptable lives."This state is measured by an addict's involvementwith employment and educational activities and hisarrest free record.

Onc of the methods used by the evaluation unitto dramatize the "success" of people on mel,ha-done, as compared to addicts who are not, is tocompare groups of people in the program with,whet the reports refer to as a "contrast group."The contrast group is composed of a selectedn.:mber of addicts, who have been detoxified atBeth Israel. These addicts are then matched by ageand ethnicity to people in the methadone programWhen the arrest records of the two groups arecompared, the group on methadone shows fewerarrests.

The evaluation report, however, fails to note thedifferences between the two groups. There aremany differences in motivational levels. People inthe methadone program are volunteers who oftenhad to wait a year or more to get in. The addictswho have been detoxified were hospitalized forshort periods of time to withdraw from heroinbecause, in general, the amount used each day wasapproaching the danger level or because the cost ofthe habit was Lecoming impossible to maintain.

In addition, people in the methadone programare screened be..ore they are allowed to participate.Even the most minimal screening would eliminate asubstantial number of addicts with mixed drugusage and behavioral problems; addicts who wouldnormally be included in the detoxification group.

Another dissimilarity is that people on methadone continually report to a center to receive theirsupply of the drug and their behavior is observedand checked. The people in the detoxificationgrcup, hovievee, are not followed actively. Instead,they become known only when they becomereap ested.

As one observer noted, "One cannot be certainto what degree the results obtained thus far withmethadone can be extrapolated to the addictpopulation at large. It is quite clear from Dr.Gearing'q data that at this time the patients whohave been accepted for methadone treatment arenot representative of the addict population. Thiswould be expected to some degree, since theselection criteria themselves lead to a nonrepresen-tative sample of the addict population. This bias initself does not detract from the merits of thetreatment; however, it is obvious that one cannot

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generalize the results to the addict population.Further, one cannot comparP samples from differ-ent populations an attribute differences in out-come to treatment effect (e.g., methadone main-tenance).""

The evaluation reports state that people onmethadone have fewer arrests than addicts in thecontrast group. Yet, the reports fail to point outthat the people on methadone had fewer arrestsbefore the./ entered the program than the detoxifi-cation group. The people on methadone do havefewer arrests, but it is hard to determine how muchof the decrease is directly attributable to metha-done maintenance.

It must be recognized that methadone mainten-ance in and of itself deals only with the symptomsof the problem of addiction rather than withunderlying causes of the problem.

Staff at Beth Israel said they utilize counselorsto help the addict get back on his feet and theappropriate community resources are called on,when necessary, for those services that are unavail-able at the hospital. In addition to counseiringservices, the hospital provides necessary back-upmedical and dental services. Hence, educationaland vocational programs are not carried on by BethIsrael but are obtained from social service agenciesin the community. It is difficu:t to determine thedegree of utilization of these services. All too oftenit appears that a patient enters the clinic, leaves asample of urine and receives his dose of metha-done. In fact, it has been noted that patients in theBeth Israel pro2,Tam are inquired to see counselorsonly once a month.

One reason for questioning the existence and thenature of supportive services in a methadoneprogram is the percentage of people who areadministratively uischarged. Reports of the evalua-tion team indicate that same 20 percent of thepeople in the Beth Israel program are dischargedeither voluntarily or because of behavioral prob-lems. According to the %test Gearing report,"Reasons for leaving thy program continue to bethe same as in previous reports. Voluntary with-drawals, and discharge for medical and behavioralreasons have accounted for the majority of drop-outs in the early months. Abuse of alcohol andchronic abuse of amphetamines or barbiturateswere the major causes of discharge in the second orthird year. Alcohol was the major reason fordischarge among the white and Puerto Ricanpatients."3 9

The future for people who leave the program isgrim. In a study of 350 people withdrawn from

methadone, Dr. Dole pointed out that heroinhunger returned in almost all the individualsimmediately after the withdrawal of methadone.He concludes that 'Individuals who have stoppedheroin use with methadone treatment but continueto steal, drink excessively or abuse non-rcircoticdrugs, or are otherwise antisocial, are failures ofthe rehabilitation program but not of the medica-tion."'"

Interestingly, although the Beth Israel programmaintains that it has selection criteria for participa-tion in the program and that each patient iscarefully interviewed by one of their experiencedintake workers, nevertheless the directors of thevarious neighborhood facilities where methadone isdispensed have a veto over the selection of peopleto be served by their facility. Why this veto isallowed after the patient has been screened is notclear.

One of the major problems inherent in amethadone dispensing system is security. Sincemethadone is an addictive and therefore dangerousdrug, most programs insist on security measures totry and prevent the illicit leakage and use ofmethadone. Additionally, it is desirable by meansof urinalysis to determine whether a person in theprogram is abusing drugs.

Some programs observe the urine giving processin order to be sure the sampit was given by thedonor. The staff at Beth Israel does not observe theurine giving process. They claim the staff has been"in this business for a long lime," and thus candetermine visually if someone in the program isusing drugs.

Concern has been expressed by some observersthat it is too easy for addicts to get into amethadone program where they can continue touse drugs and obtain methadone which they cantake, sell, or give away on the street.

Evaluation of Data BankOne of the uses of the data bank at Rocl.efeller

University is to hopefully guard against patientsjoining more than one methadone program. Thestaff at. Beth Israel said that a patient's file wouldconsist of standardized data obtained from per-sonal interviews as well as any pertinent informa-tion from other social service agencies. The staffsaid that the patient, for instance, would berequired to give his mother's maiden name, socialsecurity number, and other information to helpavoid the problem of duplication. However, oneadministrator noted thlt although the patientswould be asked to leave a urine sample after every

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visit, they would not be required to have theirfinger prints taken once, because, as he put it, "itdestroys the relationship between the staff and thepatient."

Methadone Maintenance Program NACCThe study team observed only two of the three

methadone )utpatient programs in operation at theCBCs. The certificant presents an identificationcard to the dispensing nurse, leaves a sample ofurine which is later spot checked for drug use, andreceives his methadone. The oral ingestion issupposed to be observed by the attending nursewho is *equired to engage him in conversation toverify that the methadone has been swallowed andnot mouthed.

Many people ass through these methadoneclinics daily, and the same process is repeatedTon tin uously. There was an inadequate amount ofsecurity in effect to prevent the leakage of metha-done to the street. Nurses frequently did notobserve the ingestion of the liquid and urinespecimens were usually not given in the presence ofa NACC employee who cruld attest to the validityof the sample.

The NACC methadone program design, els, callsfor the reduction of the number of visits requiredif the, patient demonstrates acceptable behavior. Asmore and more patients are permitted weeklyrather than daily visits, increased vigilance will berequired to make certain that patients provide validurine specimens and that they are not enrolled inmore than one program. If safeguards are notprovided, serious methadone abuses may occur.

Private Agency Methadone ProgramsTwo private agency methadone programs aro

operated by the Lower Eastcide Service Center andGreenwich House Counseling Center. The staff ofthe LESC program was critical of certain aspects ofthe methadone program. They said that it was theiiexperience that many of their people, once theybecame stabilized on methadone, were no longerInterested in treatment and rehabilitation. Thestaff said there was still some strong opposition inthe Black community to the use of methadone. Inaddition, they felt that methadone programs werewidely dispersed, and this could be used to theaddicts' advantage. They were especially concernedabout the apparent ease by which adc:ids canbecome enrolled in more than one methadonemaintenance program.

The staff of the Greenwich House CounselingCente' ,aid that most people in methadone pro-

grams did stop using heroin, but many of themturned to other substances-- pills, liquor. In addi-tion, they pointed out that they experienced a verydifferent success rate from the Beth Israel experi-ence. The staff estimated that their current successrate ran between 50-60 percent. They attributedthis to the fact that their participants were not asexclusively screened as at other programs. Theyalso have had some cases of people wh I have beenwithdrawn from methadone without data to showhow this group is doing.

Expanding the Methadone ProgramThe State has decided to greatly expand the use

of methadone in the treatment of opiate addiction.Governor Rockefeller on :nany occasions hasstated his intent to have 20.000 people in methadone programs by the end of the current fiscalyear.

New methadone programs are being establishedand rapidly expanded, usually with few supportiveservices and frequently without the types ofevaluation and follow up necessary in large scaleresearch programs. Further, it is clear that ancillarysupportive services are not heavily utilized inseveral programs.

As of September 8, 1970, according to a pressrelease from the Governor's office, 1r1 contractshave been awarded to provide for treatment fer upto 11,875 persons under the $15 million n.etha-done program. "This combined with the programfor treating up to 2,488 persons, carried out by theNarcotics Commission itself at their centers, ac-counts for a total services level of 14,S63 persons."

The question must be asked, however, whetherthe highly selective criteria originally used for theselection of patients in the Beth Israel program canbe maintained with the addition of several thou-sand new addicts to methadone programs. If not,can it be assumed that the success rate obtainedand widely publicized by Beth Israel can bemaintained? There are strong indications based onresults from other programs operated by privateagencies that success rates may be substantiallylower when addicts are chosen on the basis of lessselective criteria. One observer stated that thesuccess rate will go down as more and more addictsenter the program,

In the final analysis it is virtually impossible topredict how successful methadone may be intreating opiate addiction. To date the evidencesuggests that a great deal more objective researchand evaluation are necessary before any judge-ment can be made about the applicability of

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methadone maintenance programs to more of thegeneral addict population than just a carefullyEcreened group.

PROGRAM COSTSPerhaps as an indication of the importance

attached to the narcotics control problem, therehas been generous funding provided. The NACCappropriation in the first year, 1967-68, was

almost six times as much for its operating budgetas had been appropriated for the predecessorprogram-under the Metcalf-Volker Act in its lastyear of operation-$35 million for NACC comparedwith $6 million for Metcalf-Volker.

In its first year NACC utilized only $21 millionof its $35 million appropriation, and in succeedingyears has operated well within its hudgeted appro-priations.

NACC Budget and Expenditure Comparisons

1967-68 1968-69 1969.70 1970.71

Budget Request $45,880,000 $65,543,000 $5&,830,000 $85,000,000Appropriation , 35,000,000 38,443,000 52,773,003 85,146,000Total Expenditures 20,739,000 33,216,000 49,535,000 22,662,000*Unused Appropriations 14,261,000 5,227,000 3,238,000

*As of September 30, 1970.SOVF CE: NACC Budget and Audit and Control Report, September 30, 1970

The overall operating expenditures have increased at an average rate of approximately 60 percent per year.

OperatingExpenditures

% t.:Incr

Subjects UnderTreatment(March 31)

Number % Incr

Patient Monthsof Care

(March 31)Number % Incr

1967-68 $20,739,000 6,322 9,6171968.69 33,216.000 60 10,605 69 25,300 163%1969.70 49,535,4100 49 13,779 29 41,963 65%1970-71 85,1,4.6,0002 72 17,2511 25 60,107 43%

'As of October 312Appropriations

SOURCE: NACC Financial Reports and Monthly Census

This increase in operating expenditures has treatment program in the NACC residential facili-nearly paralleled the increased in subjects under ties and those contracted with other State depart-treatment. merits. This item constituted more than half of the

total NACC budget in the first three years and hasOperating Expenditures for Intramural Facilities been the item of largest increase. This expenditure

The largest portion of the NACC budget, 60 has been increasing t.t a substantially faster ratepercent in the 1969.70 year, is open', for the than the nuff.ber of patients treated.Operating

ExpendituresNo. of Subjects (Residentialin residence % of Treatment % of Resident Months % of

(As of Mar. 31) Increase Centers Increase of Care Increase(000)

1967-68 2,976 $1,S14 9,6171968-69 3,405 14 18,141 76 25,300 1631969.70 4,828 45 29,928 65 41,963 65

OOURCE: NACC Financial Reports md Monthly Census

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The greatest contrast is between the first andthird years when expenditures increased by 188per-ent while subjects under treatment rose byonly 62 percent.

In addition to the sharp rise in overall treatmentcosts, there are wide variations between unit costsin the various NACC facilities.

This would indicate a difference of more than100 percent between the lowest and highest per

patient cost in NACC facilities. As a general rule,average costs for similar institutional care varydirectly with the size of the population, with thelarger institutions showing lower per capita costs.NACC facilities follow this pattern. (See ExhibitVIII.)

This factor of size may account in pazt f$ thewide difference between the costs in NACC facili-ties and those of the contract departments. NACC

Average Cost peg PatientNACC Residential Facilities

Monthly Per DiemHigh (Queensbcro) $1,164 $38.16Low (Woodboume) 558 18.28Average (All NACC) 771 25.27

current operating costs per resident are 75 percenthigher than those in facilities operated by theDepartment of Correction and 30 percent higherthan the operating costs in facilities operated bythe Department of Mental Hygiene.

Average Cost Per Patient

Monthly Per Diem

NACC $771 $25.27Dept. of Mental Hygiene 588 19.28Dept. of Correction 440 14.41

The average per diem costs in regular MentalHospital facilities is $15.80 a day, reflecting in partlarger institutions, but the differnces are greatenough to warrant careful review.

Capital ExpendituresBecause of the urgency of its assignment, NACC

acquired a number of existing public and privateinstitutional facilities: a convent, a hospital, aYMCA, a Job Corp Training Center, and someexcess facilities from the Department of Correction. Most of these were old and required extensiverenovation.

The acquisition and adaptation cost per bedranged from a few hundred dollars at MidHudson

and Iroquois to an expenditure in excess of$35,000 per bed at the newly constructed IV .geHill facility. The average cost to date 's slightlymore than $2.0,000 per bed. (See Appendix A.)

NACC has indicated a halt in the construction oftreatment centers at the present time as moreemphasis is shifted to the aftercare program, andmethadone maintenance with construction, em-phasis shifting to Community Based Centers.NACC has expended $124 million of its current$159 million authorization for capital [edit',

Costs of AftercareA substantial reduction in treatment cost c( es

when the subject is transferred to aftercare, sithis is primarily an outpatient program. Expen, -

tures to date indicate a cost to NACC abotone-sixth that of intramural treatment.

As an increasingly large percentage of NACC'spatient load is shifted to aftercare, average costsfor treatment should drop correspondingly.

Costs of Private ProgramsNACC has expanded the funding and the num-

ber of volunteer patients under treatment in theprivate programs almost as fast as the number ofcertificants in the regular NACC program whichincreased from 3,164 in :1,967-68 to 9,039 inOctober 1970.

There is a wide variation in the direct cost toNACC for the services of these private agencies,

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2,44.nownwor.avo.

Year

Cost

Number of Subjectsin Aftercare

f Aftercare

Client Monthsof care

Operatinj Costs ofCommunity Based Centers

1967-68 (March 31) 188 $ 160,0841908-69 (March 31) 1,003 15,802 1,038.0561969-70 (March 31) 2,247 18,498 3,192,7971970-71 (Oct. 1970) 3,691 42,641 6,502,090 (Budget)

SOURCE: NACC Financial Report and Monthly Census

Volunteer Private Agency Programs

No. ofPeienb,-

NACCFunding

1968 (Mar. 31) 3,158 $ 2,252,0001969 (Mar. 31) 6,257 8,979,0001970 (Mar. 31) 6,704 9,158,0001970 (Oct. 31) 8,212 10,554,000*

NACC Budget Allocation

from as low as $55.73 per month at GreenwichHouse for a program that is exclusively outpatient,to as high as $471.78 per month at Exodus Housefor a program that includes both residential andoutpatient services. (See Exhibit VII.) Tilt averagemonthly cost per patient to NACC in those privateprograms is $14,;. However, the direct cost toNACC which is used in this report may, in somecases, be only part of the actual costs. Additionaloperating costs that are financed from othersources are not reflected in NACC cost figures. Forinstance, some of the private agencies insist thattheir people get on welfare and turn their checksover to a centre] fund to pay opera, g expenses.Additionally, the private agencies often have in-come from" private contributions. and several re-ceive funds from other government agencies.

Costs of MethadoneThe cost of the Beth Israel methadone program

to the State was $169.16 per patient per month fortie 1969-70 year. This is slightly higher ti.an the$146.08 average cost per patient, to NACC direct-ly, Tier month for the voluntary agencies, and is notthe "pennies a day" cost quoted by some enthusiastic supporters of methadone maintenance. Themaintenance cost is substantially less than theaverage $771 per patient month cost in NACCresidential facilities. It must be pointed out,however, that the methadone cost figure is basedon a program that is largely outpatient in naturewhereas the NACC cost is for a residential programwitn a large security component.

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VI PREVENTIVE EDUCATION

The report of the State Investigation Commis-sion which led to the creation of NACC encour-aged the inclusion of an educational component inlight of findings "that the education of the publicto the perils of narcotic abuse can be effective inpreventing addiction." This conclusion appears tobe largely an expression of faith, for there do notexist even today well-documented studies on theeffectiveness of any large scale drug educationprojects (partly because few such projects havebeen undertaken).

THE NACC EDUCATIONASSIGNMENT

NACC, was given broad responsibility in the lawwhich created it. It was directed to:

provide education and training and preven-tion, diagnosis, treatment, rehabilitation andcontrol of narcotic addiction for medicalstudents, physicians, nurses, social workers,and others with responsibility for narcoticaddicts either gone or in conjunction withresponsible agencies, public or private.

Provide a public education on the natureand result of narcotic addiction and on thepotentialities of prevention and rehabilitationin order to promote public understanding,interest and support.

Disseminate information relati v to publicand private services and facilities in the Stateavailable for the assistance of narcotic addictsand potential narcotic addi.:ts. 41in order to implement its mission and legislative

mandate, NACC has organized a Provision of Pre-vention headed by an Assistant Commissioner. Thisdivision has the following bureaus: ProfessionalRelations, Community Prevention Centers, Com-munity Assistance, and College Relations. Thisformulation is a result of a reorganization studyconducted by the Division of the Budget, datedDecember 1968. Two of these bureaus, Com-munity Assistance and College Relatio-ir, havebeen staffed.

The principal NACC education e ,rts have beenmade through its Narcotic Education Centers andthe Narcotic Guidance Councils.

Narcotic. Education CentersIn terms of staff and activity ti: .our..an of

Community Prevention Centers is responsible forthe Education 0:titers, of which there are pre-sently si, men statewidenine in the New Yorkmetropolitan area and seven upstate. The centersdisseminam information about drugs and drugabuse and promote activities to carry out drugeducation. Staff members have visited over 3,500schools and organizations since 1968, lecturing intotal to over a quarter of a million people. NACChas produced and distributed more than tenmillion pamphlets and newsletters since 1967. Theeducation (enters are estimated to have reachedmore than 8,000 people in their local communities,many of whom have been assisted in preparingapplications for civil certification.

The New York City Centers devote most of theirtime to assisting addicts and their families in thepreparation and presentation of commitment peti-tions. This petitioning load has increased in manyeducation centers concurrent with NACC's expan-sion of its program and reaction to requests fromvarious local groups. The staff complement in thelarger downstate centers is usually about sevenprofessionals, operating virtually a s-icial referralagency. The centers outside Yew York City areengaged more in the dissemination of informationover a much wider base of operations. They are notas involved in the direct petitioning process ar theirdownstate counterparts because of less prevalenceof hard drug addiction. Usually two professionalscomprise the staff of such centers.

The Narcotic Guidance CouucilsNACC's other approach to "prevention" is the

Narcotic Guidance Council, which was authorizedby legislatl an in 1968 to "develop a program of

8)

community participation regarding the control ofthe use of narcotics and dangerous drugs at thelocal level." NGCs were to:

make immrdiately available to the com-munity basic knowledge acquired in the fieldc: drug use . .. and create a climate in whichpersons seeking assistance ... can meet ...with responsible individuals or agencies ... 41N ACC has promoted the growth of these coun-

cils, and has available for newly formulated NGCs aworkshop training course to help orient members.The Bureau of Professional Education is heavilyutilized in this area.

As of Oc' )ber 30, 1970, approximately 250councils were established with 140 proposed. Theoriginal legislation .1968) contained no provisionfor funding. However, an initial $250,000 wasprovided in the 1969-70 supplemental budget forNarcotic Guidance Councils. These funds were tobe utilized on youth related drug programs. Thisamlunt was increa ed by NACC's approved requestfor $700,000 in the 1970-71 budget, and anadditional $200,000 provided for New York CityNGCs and helping services.

NGC ExpendituresNACC reimburses 100 percent of the administra-

tive expenses of an NGC in its first year up to$1,000. NACC also shares in 50 percent of theprogram costs of an NGC; up to a maximum of$10,000. As of October 30, 1970, 29 councils hadrequested funding for the 1970-71 fiscal year. Ofthese, approximately half have requested $1,000 orless. Sixteen councils have executed contracts withNACC but only two have expended money, a totalof less than $2,500 to date.

Expenditures for al! of NACC's education ef-forts have been less than three percent of theCommission's total budget to date. Annual expen-ditures have ranged from $1,058,141 in 1968-69 to$572,180 in 1969-70 with $2,134,800 budgetedfor 1970-71.

Evaluation of NACC Education ProgramsPreventive education as conceptualized and prac-

ticed by NACC is essentially a drug awarenessprogram. Films, pamphlets, lectures bearing theseal of "authority" aie presented with the assump-tion that providing information on dangers willinfluence behavior in a socially acceptable direc-tion.

NACC's Education Centers and Guidance Coun-cils have provided a sense of community presence,and it is reechlne some of the addict populationthrough the petitioning assistance given in the

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701P.1173060Nr1.4,.........-

,education centers. Impact of the extensive publicrelations progamlectures, publications, etc.isalways difficult to judge. However, there is evi-dence of much continuing skepticism amongjudges, lawyers and addicts themselves aboutNACC's ability to help the addict.

Underlying the spirit of the NGC legislation isti,e idea that the Narcotic Guidance Councilswould be able to communicate with the youth inthe community who face the perils of drug abuse.NGCs often have a difficult time relating toindividuals with drug problems because they lackyouth membership and treatment back-up facilities. Both these shortcomings were items coveredby amending legislation in 1970. Persons under 21v ere specifically authorized as Council membersand a $65 million appropriation was authorized fora 50.50 st.Ate-local sharing of financing for youthtreatment centers. Local reaction to both theseprovisions has been slow in developing and avail-ability of this $65 million has been extended toinclude educational purposes.

STATE EDUCATION DEPARTMENTPROGRAMS

Major responsibility for developing preventiveeducation programs in the State in shared by theState Education Department. Chapter 787 of theLaws of 1967 authorizes the Commissioner ofEducation to establish a continuing program forcritical health problems in which

educational requirements regarding cigarettesmoking, drags and narcotics, and excessiveuse of alcohol become the basis for broad,mandatory health curricula in all elementaryand secondary schools.

The education of school age children is emphasizedin the act, but the legislation indicates that all"citizens" of the State are to be educated (Ch. 674of the Laws of 1970). It is noted that theEducation Law, Section 804a (1952) has requiredthat instruction be provided to students withregard to the nature and effects of drugs andalcohol.

The 1970 Legislature in the Supplemental Bud-get Bill (Chapter 157) appropriated a $., millionlump sum from the State Purposes Fund towarddrug education. The legislative language reads:

for services and expenses for the dissemina-tion of information relative to the treatmentand prevention of drug addiction and useaimed at youth a 'd their parents. Activities toachieve sue!' jissernination shall include butnot bo limited to mass media campaigns,

college volunteer programs, in-service teachertraining, local assistance for narcotic educa-tion programs, school community pilot pro-jects and the provision of additional depart-mental staff.

A Division of the Budget certificate of approvaldated June 30, 1970, allocated $1.175 million tothe State Department of Education for this pur-pose.

The basis of this new program was originallyintended to be a curriculum on SociologicalHealth, Drugs and Narcotic Education ("St.andII") that was completed in 1967 and available forgrades 4-12. Strand II was conceived along conven-tional linesinformation, presumably "authorita-tive," was to be given students in lectures byteachers who needed limited special training in thisarea. Strand 11 has been applied minimally, with acurrent budget of $30,000 to cover the preparationof curriculum materials. The little experience withStrand IF has revealed it is seriously inadequate.Effort is therefore now being directed toward whatis believed to be an effective method for dealingwith the subject of drug abuse, peer group involve-ment. This technique relies on student participa-tion in planning and conducting activities. StrandH is thus currently being revised so it will be moreprocess oriented.

The education Department launched in 1970 anextensive set of programs to prepare teachers,administrators and students for involvement infuture drug education classes in which the utiliza-tion of innovative materials and student participation would be stressed. The following programshave been set up: in depth drug training for healthteachers, training of trainers, school-communityteams, and the college volunteer program.

In-Depth Drug Training for Health EducatorsExperienced professional health educators fru n

six colleges and universities in the State wereselected to offer intensive teacher training pro-grams to prepare instructors to teach new drughealth materials as par' of a Master's Degreeprogram Li health edt,cation. Teachers eligible forthis program included not only hygiene instructors,but ins° those from other disciplines. By retrainingteachers holding other certificates, the programwas to set an important precedent, demonstratingthat schools can meet new priorities by retrainingexisting staff rather than hiring additional person-nel.

This past summer, 189 teachers were involved inthe prowam and plans are underway to begin the

training of additional teachers during the 3970-71school year. The ultimate objective is to place ineach school a person with the expertise of theeducator and the content background of a healthorofessional. The State, after September, intro-duced the requirement that money continue tothose teachers who began only if that teacher isinvolved in two or more health courses a week athis school. Because of this action, the originalobject':., of the program has seen a major reversal.In excluding the teacher not meeting the newrequirements, the eflbrt is now one characterizedby providing the health instructor a graduatedegree and not cross training the history or mathteacher.

The Training of TrainersThe training of trainees program has been

funded with $100,000 of State money and anadditional $200,000 of federal money. This drugeducation program is being conducted principallyat Adelphi University, which is offering a series la°workshop sessions in drug education for schoolhealth education personnel. The purpose is to trainteachers to conduct local in-service training pro-grams for teachers in their own and neighboringschool districts. The program is divided into twphases. Phase one consists of the training ofappro:Arnately 150 teachers to teach in-servicecourses on drug abuse to elementary and secondaryschool teachers in the State. Two groups of 50each were to attend a two-week training session atAdelphi University in the summer of 1970, butonly 81 completed the program. An additional 50teachers are now being trained.

Phase two involves these trained teachers return-ing to their local districts to teach in-servicecourses to their peers. For each in-service coursetaught, the teacher receives a $600 stipend fromthe State. The teachers already trained :re nothaving the impact that was originally projected.Districts sending a teacher to Adelphi contractedto make time available for the trained teacher toconduct in-service courses for other teachers in thedistrict. According to educators on th. Adelphiteam who have made follow-up visits to assist andevaluate local efforts, some local school districtshave not promoted in-service courses,

School-Community Team ProjectThe allocation for the school-community team

project is $270,000. This program sponsors work-shoo conducted for school-community teamsmade up of school administrators, guidance coun-

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selors, teachers, students, and colamunity leaders.The objectives in these workshops are: (1) toprovide facteA data concerning drug use andabuse; (2) to provide an opportunity to discuss andbecome involved with effective new techniques incombatting drug misuse; (3) to enable each partici-pating team to develop its own school-communityattion plan; and, finally, (4) to begin a collectionof data providing a base for research and evaluationto determine the effectiveness of the new ap-proaches and techniques.

The first of these workshops was held in July, atthe end of the school year. Since most teachers andstudents had left for vacations, there was a gooddeal of difficulty in recruitment. This school-community workshop program was handled by aconsultant group (Education Dynamics) whichlacked the comprehensive drug-related expertiseassociated with this type program. There was littleor no follow up or evaluation.

College Volunteer ProgramThe college volunteer program is designed to

train and equip college student volunteers through-out the State to work with their peer groups andprovide a trained volunteer contingent whichwould be available to elementary and secondaryschools in caning out drug education programs.They would be able, further, to assist in counselingprospective drug users, providing a dialogue amongstudents regarding their concerns about the drugsituation. Assistance would also be furnished tohelp secondary school students organize and de-velop their own groups to counter, or deter, druguse. As of early October 19'0 proposals weresubmitted from ten schools to conduct collegevolunteer programs. Of these ten proposals, nonehas been funded nor have contracts been signed.No contracted program activity is under way at thepresent time.

Another element of this program is a proposalwith Xicom Development Corporation whichwould develop a series of audiovisual tapes to bemade available to the college councils. Of the tencolleges that currently have submitted proposals, itshould be noted that only one of these schools is inthe New York City area in Staten Island.

Many questions may Oe raised regarding thefunding procedure that will be implemented forthese ten colleges. Basically it consists of thestudents proposing a program which they in turnsubmit to the unit of the college that will handlethe legal contract. The college submits the programto the State Education Department for review and

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approval. When approval is granted and the con-tracts are signed, the funding channels beckthrough the college to the students conducting theprogram. In terms of target numbers of studentsinvolved, it was originally hoped that approxi-mately 250 college students would participate on15 campuses throughout the State. At the presenttime it appears that there will be only ten collegesconducting programs with approximately 20 stu-dents in each program. Therefore the effect of thisprogram in quantitative terms has somewhat dimin-ished.

Local Pilot ProjectsThe local pilot raojects, funded at $120,000,

attempt to identify innovative and exemplaryprograms or program proposals of drug education.The objective is to stimulate the development ofnew aspects in drug education that may be utilizedby all school districts. It would appear that thisarea is one of discussion principally, as funds werenever made t.veilable in the department for itsimplementation.

Evaluation of th,, State Education DepartmentPrograms

The size and scope of the programs of the StateEducation Department were relatively small scaleand experimental through 1969-70. The Depart-ment has proceeded slowly, apparently recognizingthat it had to develop and substantiate a drugprevention curriculum, and prepare teachers to usesuch a curriculum before any large-scale programcould be launched.

In its attempt to stress peer group involvementand teacher training efforts, the Department ofEducation makes crucia assumptions. The preva-lent assumption here is that individuals differ inthe reasons for drug use and that varying ap-proaches are indicated for particular individuals.Involving the peer groop and providing them wVhthe responsibility of combatting drug use is thegoal of the peer group educational effort. Teachertraining, on the other hand, is vital because theelement of overriding importance in drug educa-tion i3 the teacher. His tale '3 not only that of aconduit of knowledge; he must, indeed, personifyan active force in molding student actions.

During fiscal 1970.71, however, monies becamesvailable through the evolution of education as acomponent of the Youthful Drug Abuse TreatmentProgram.

With a prospective 25-fold increase in funding, itbecomes even more essential that n ny educational

program be caref illy planned and tested before itis implemented statewide.

YOUTHFUL DRUG ABUSETREATMENT PROGRAMS

Chapters 607 and G08 of the Laws of 1970authorize NACC co provide State aid for theconduct of a drug abuse treatment program provid-ing ambulatory or in-patient services, or both,designed primarily for persons 16 years of age orless, as prescribed in Section 213-A of the MentalHygiene Law. The Legislature, in its declaratio- ofpurpose, stated:

it is hereby declared to be the policy of theState to act in partnership with local govern-ments to provide improved programs for thecare and treatment of youthful addicts andother regular thug abusers which should beconducted in facilities located close to thoseserved and which should speed rehabilitationand restoration by involving families andcommunity resources to the greatest extentpossible ... the conduct of drug abuse treat-ment programs and the construction,, acquisi-tion, reconstruction and rehabilitation of suchfacilities are hereby declared to be publicpurposes for which public monies may beexpended.The initial guidelines for State aid to local

agencies for the operation of drug abuse treatmentprograms for treatment of youthful addicts weredistributed by the Narcotic Addiction ControlCommission on May 29, 1970. These guidelines, inan attempt to implement the above legislativereferences, defined program eligibility require-ments and the procedures involved in the applica-tion for State aid. Once again, a drug abusetreatment program in this context wa.; defined asan "ambulatory or in-patient program for thetreatment, including but not limited to counselingof addicts or regular drug abusers, or both,designed primarily for persons 16 years of age orless."

The initial Commission guidelines allocatedfunds on a geographic basis in accordance withsuch factors as need and likelihood of utilization.Fifteen million dollars of the total appropriationwas to be reserved for matching the cost of loanamortization, including rental payments, for facili-ties utilized in the treatment program. Of theremainder, it was planned that approximately $40million would be earmarked for matching theoperating costs to be incurred in the New YorkCaty and adjoining connties of Nassau, Suffolk,Westchester, and Rockland. The. balance of the

appropriation was to be allocated for matching thecosts to be incurred by the local agencies in theremainder of the State. Any balances allocated fora particular geographical area which were uncom-mitted by October 31, 1970 were to be .:orisideredavailable for use by other areas.

The initial guidelines further discussed the defi-nition of operating costs to include personnel,maintenance, debt service and capital costs, andother expenses which qualified for reimbursement.In this line gifts, grants, and contributions (in-cluding possible federal grant) were to be con-sidered eligible for State aid under the matchingformula. State aid in the form of financial supportwas to be available, according to the appropriationand the legislation authorizing the program, to theextent of 50 percent of the operating costa of thelocal agency.

Further elaboration of the above guidelinesfound NACC suggesting a treatment program at thecounty government level with a county agencyresponsible for the treatment program. It wassuggested that the treatment and rehabilitationprogram might be administered either by thecommunity mental health board, the Departmentof Mental Health, a specially constituted narcoticand drug abuse commission, or a county NGC.

The original guidelines for this program havebeen changed significantly. NACC, in August 1970,issued revised State aid guidelines for local agenciesoperating youthful drug abuse treatment programs.The revised guidelines include the followi:Ig modi-fications of the initial guidelines.

1. Specialized preventive education services conducted in conjunction with a treatment andrehabilitative program are eligible.

2. Eligible programs are not restricted to those"designed primarily for persons 16 or less";school-age groups in general are appropriate.

3. Matching funds considered eligible includelocal expenses made from a direct federalgrant to a private agency which has acontract to conduct the drug abuse programwith the local agency, and federal funds, suchas 0E0 and model cities funds, received by acounty or the City of New York, which arepassed through to a private agency conduct-ing a drug abuse program pursuant to acontract with the local agency.

4. All private cash grants or gifts received by alocal governmental agency and given by it tosupport an approved program will be eligiblefor State aid.

5. The reiml,nrsable costs for which State aid

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may be obtained may include the value ofin-kind contributions of personal property,such as furniture, equipment, and supplies,and a volunteer's services.

6. A local agency whose budget was adoptedprior to the enactment of the law mayrequest an advance of State aid to cover thecost of its approved program for a period notgreater than six months.43

There is no doubt that these changes constitutean extension or reinterpretation of the originalintent of the Youthful Drug Abuse Treatmentlegislation. The Commissioner of Education re-leased the following statement on September 25,1970:

... it is extremely important to note devel-opments in another part of GovernorRockefeiler's a.,el the Legislature's drug Abuseprogram. The Legislature last session enacteda $65 million, 50-50 matching program ortreatment of youthful dr,..g addicts. Under theor,g,inal guidelines for this program, . . edu-cation programs were not eligible for Statefunding. The guidelines have been changednow to the effect that education programspreve:tion and referral where related to treat-mentare now eligible for funding on a 50.50matching basis."Although this statement of the Commissioner

emphasized education "related to treatment," thetreatment component subsequently was detached.The Education Department, in conjunction withNACC, held a meeting for administrators from allschool districts in the State on October 22, 1970.It was explained to this gathering that a school'sexpenditures for health and drug education couldbe utilized as a part of a community's contributionin the application for funds: in other words, theeducation program itself did not need to have anintegral treatment component; it would be suffi.cient that treatment resources existed or wereplanned for the community.

The message of this conference is clear. Thestrong treatment component of the Youthful DrugAbuse Treatment program has been displaced by astandard educational component. There exists con-sid. able pressure to commit these funds under therevised guidelines. School districts have had hur-riedly to prepare applications under the incentiveof impending deadlines. There has been a flurry ofactivity accompanied by little meaningful planning(e.g., ASA models distributed to all city schooldistricts). This undertaking may result in theexpenditure of a substantial amount of money on

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projects which have not even been tested experi-mentally.

This new approach will perhaps also have theeffect of penalizing schools and school districtsthat have reacted to the educational mandate ofChapter 787 of the Laws of 1967, which called forthe instruction of drug-related subjects as part ofthe total health curriculum. Few school districtshave implemented this mandate in a thoroughmanner. Districts that have sp,:nt considerable timeand money in attempting to develop a program donot qualify for support under the revised guide-lines, which do not fund an on-going program ofdrug education. To receive funding, a programmust be expanded or represent a new or innovativeeffort on the part of the school district. Thoseschool districts, therefore, that have failed tocommence activities in this area might be rewardedby the receipt of financial support to begin drugeducation efforts that were mandated approxi-mately three years ago. In some cases, these fundsmight even be financing curriculum development.

NEW YORK CITY PREVENTIVEEDUCATION PROGRAMS

New York State, through NACC and otheragencies, contributes several millions of dollars (theNew York City budget indicates almost $10million) a year to support programs of the Addic-tion Services Agency, whiet is the organizationresponsible for handling the City's drug controlactivities. ASA has only recently undertaken size-able efforts in preventive education. Its majorprojects, like those of the State, encompass teachertraining, and ten people were assigned to thisactivity by November 1970. The total schoolprogram budget of ASA is presently less than$100,000.

At the first level of ASA action are orientationprograms. Groups of teachers receive approxi-mately ten lectures covering basic informationalaspects of drug use control, usually includingcomponents on ASA and NACC operations. ASAestimates that approximately 4,060 teerhers havethus far participated.

People are selected from this orientation groupfor more complete preparation in a regular, orsummer institute, intensive training course, andonly the people who complete this advancedcourse are considered by ASA to be trainedteachers in the field of drug education. There areseventy-two of these graduates.

The regular intensive courses are normally con-ducted in the tea,:hers' school, and the summerinstitute is run through several units of City

University of New York. In the regular intensivecourse, the objective is to involve teachers in thedrug situation and drug scene of their schools.Problem-solving, rap encounter sessions, and othertypes of attitudinal training are utilized. Thesummer institute is designed as a graduate levelcourse with academic credit granted upon comple-Von. This course represents an experimental effortto probe behavioral modification, inculcate teach-ing and educational skills, and help the teachersolve particular situations. ASA also provides afollow-up training course for those who completethe intensive courses. This entails a four-hoursession held every other week at ASA head-quarters.

ASA's school program also consists of studentrap sessions within the schools. Tnis generallyinvolves a member of the ASA educational staffvisiting a particular school and spending a day ortwo at the school working with the principal,guidance counselors and other teachers of theschool. The ASA representative announcesthroughout the school that a rap session will beheld that day following normal school hours.ASA's experience with this type of activity hasbeen that more students sign up and want toparticipate in such sessions than trained groupdiscussion leaders are available to accommodate.

ASA's other activities include sponsoring theteaching at Lehman College of a regular creditundergraduate course in both semesters of the1970-71 academic year, and the training of truantofficers in the Bureau of Attendance.

The most significant development for the ASAschool program staff has been !..4 involvement withthe Youthful Drug Abuse Program. ASA has beendesignated contractor for this program in NewYork City and therefore has the responsibility forreviewing, monitoring, and accounting of fundsfrom NACC to the various school districts. Theirhope is to get every school district involved in drugeducation by providing them with "inns vativemodels" for their program applications. Any re-sults of their effo-ts will not be evident untilsometime after the first projects are launched inearly 1971.

The New York City Board of Educatior also hasconducted a serious review of what contribution itmight make in the area of drug education. ItsDivision of Health and Physical Education hasproposed that the position of "Narcotics Coordi-nator" L' created in each junior and senior highschool as a focal point for all the school's drugcontrol activities. No action on the implementation

of this proposal has yet been taken.The description of the New York City program:

reveals that no carefully controlled preventiveeducation pilot projects have been launched thatare likely to produce findings soon that could beled back into the larger effort of the StateEducation Department to develop a comprehensivecurriculum, with adequate material and personnelresources.

OTHER STATE PROGRAMSThe Legislature in 1970 involved two additional

state agencies in a campaign for "the dissemi,iationof information relative to the treatment andprevention of drug addiction anr'. use aimed atyouth and their parents." The Department ofMental Hygiene has been assigned $400,000 forthis purpose in fiscal 1971 and the Department ofHealth, $200,000.

The Department of Mental Hygiene is attempt-ing to involve in a more meaningful way the localCommunity Mental Health Boards. At the start, asurvey was conducted to locate throughout theState the highest areas of drug use as shownprincipally through drug death statistics, and engagewith indigenous mental health related operationsassociated with the Community Mental HealthBoard. As a result of this preliminary screening,seven agencies, concentrated in the New York Cityarea, were selected. These sponsoring agencies areconducting a wide range of preventive information,education, and counselling services through localindividuals and groups. The sponsoring agenciesand local partners are to incorporate their work aspart of a comprehensive action to improve thegeneral quality of life in the local area. The peergroup approach characterizes this work. It is feltthat only through individual contact will anyimpact be made.

Of the $400,000 involved, $390,000 representscontracted work which will be spent in the localityby the local sponsoring agency. The remaining$10,000 has been set aside for Hygiene's ownadministrative evaluative expenses. The first ap-proved contract with an agency was consummatedonly on October 16, 1970. While Hygiene's insis-ten..: upon, and supervision of, evaluation on thepart of contractor is noteworthy f. r its inclusion,the first set of final report. s on the success ofactivities is not due until December 1971.

The Department. of Health views its role in termsof drug education as supportive to the roles of themajor departments. Approximately one half of thefunds are being expended on educational mate-

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rialse.g., films, brochures, pamphlets. The re-mainder is being utilized on professional educationwhich atterniits to instruct doctors on such thing':,as emergency treatment involving tile addict. Thefeeling is that physicians are reluctant..to treataddicts in their offices and, as a rc.1.11t, havegenerally fallen behind in the area of narcoticaddiction treatment. The effort is to keep doctorsinformed and up to date on medical treatment ofthe addict. The drug abuse program of the Depaic-

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'8 7

ment of Health therefore involves three majoractivities all directed toward the doctor: the devel-opment and distribution of films, the formulationand presentation of slides, and the utilization ofpublications. Health is printing new l -'aflets and.1.rug charts, along with a specific bibliography andother literature, fo' wide distribution and is devel-oping a desk reference for physicians. Health iscoordinating its publication projects with those ofNACC to eliminate duplication.

VII. SUM:.'.1ARY AND FINDINGS

EnforcementThe combined efforts of enforcement agencies

at all levels have not yet significantly reduced thesupply of narcotic drugs available in New YorkState, and the prospects for a significant reductionin the foreseeable future are not encouraging.These agencies have succeeded, however, in bring-ing large numbers of addicts into court.

The New York City police alone made over100,000 narcotics arrests between April 1967 andOctober 1970, and in more than 70,000 of thesethe drug involved was heroin. The New York Citypolice also identified more than 21,000 "admittedusers" of narcotics among the arrests recorded in1969. The records of the Federal Bureau ofNarcotics and Dangerous Drugs, which are basedentirely on police reports, show 30,119 activenarcotic addicts in New York City in 1969, alongwith 3,222 in the rest of the State, for a total of33,341.

Many of these alleged narcotic addicts have beenarrested and examined for addiction by NACCdoctors. Between April 1967 and October 31,

NACC ct.)nduAed almost 66,000 examina-tions. The results are as follows:

Total PositiveResidence Examinations Exarnmations

New York City 55,416 28,826Long Island 5,280 1,431Upstate New York 3,606 2,174Other 1,730 735

Total 65,931 33,166

SOURCE: NACC Monthly Census Report October 1970

The arrest and medical r:xamin ation statistics,token together, clearly indicate that a substantialproportion of the estimated addict population hasbeen apprehended by enforcement officials duringthe period since NACC's inception.

Thousands of alleged addicts P-P. being arrested,but only a small percentage of these people arecertified to NACC or receiving severe jail sentences.Addicts are not being taken out of circulation, andthe State's efforts to strengthen deterrence arethereby undermined. These shortcomings are dueto failings in the system of criminal justice beyondthe ability of the police to apprehend criminals.

Compulsory CertificationThe objective of returning addicts to useful lives

in numbers that exceed the appearance of newaddicts is, according to the legislat'on creatingNACC, to be accomplished largely by forcing asubstantial percentage of addicts into treatmentthrough compulsory certification by a court oflaw.

The certification of addicts in the civil courts isworking reasonably well. This finding holds even inManhattan, Brooklyn and the Bronx, where aheavy caseload presents certain problems. Rela-tively few arrested addicts, however, have "volun-teered" for NACC under the provision whichpermits addicts with minor criminal charges tochoose a NACC treatment program.

The certification of addicts in criminal courts,on the other hand, is not working as intended inthe area of greatest activity, New York City. Thi.,development is a part of the general administrativeproblem of the criminal courts of New York Citycaused primarily by the tremendous volume ofcases end the consequent shortage of judges,lawyers, and other court personnel to handle theworkload. This load factor, plus a generally nega-tive attitude toward the NACC program by theaddicts, their attorneys, and lawyers from thedistrict attorneys' offices combine to produce fewcertifications to NACC, contrary to the expecta-tion of the Legislature in 1966 that all addictsconvicted of a misdemeanor or prostitution wouldbe certified. This expectation has been thwartedbecause of the problem of proving addiction.

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Addicts are advised to contest the question ofaddiction and request a jury trial, as is their right.At this point the district attorneys often concedenon-addiction, either because they do not have thepersonnel and resources t litigate the question ofaddiction or because the evidence of addiction isinsufficient. Th.:. evidence )f addiction is insuffi-cient sometimes because of delayed or inadequatemedical examinations or weak medical witnesses.Rather than being ,.ertified to NACC, therefore,most addicts are referred to private agencies orgiven a penal sentence.

It follows that there are several changes which, ifintroduced, could bring the process of certifyingaddicts more in line with the original intent of thelaw. First, NACC might persuade more people thatit does have an effective treatment program.Second, proof of addiction might be made lessstringent. Third, the suggestion has been made by anumber of public officials that special courts areneeded for the processing of narcotics cases.

It would not make sense, of course, to improvethe State's ability to get addicts committed toNACC unless there is a demonstrated ability toprovide effective treatment.

T70.atment and LehabilitationIn carrying out its assignment, NACC has ac-

quired and staffed enough facilities so that it cannow deliver "extended periods of treatment in acontrolled environment"that is, intramural servicesto more than 6,500 subjects at atime: 4,500 in 13 residential facilities of its ownand 2,000 under contracts.

This is a program with almost three times thecapacity of the Federal facilities at Lexington andFort Worth.

NACC has developed six Community BasedCenters and two Reporting Centers from which toprovide "supervision in an aftercare program" formore than 6,000 people.

NACC supports outpatient services for 3,400more addicts through contracts with tour addi-tional public agencies including Nassau County andNew York City's ASA.

Finally, NACC currently funds 19 privatetreatment r rums, which divide into the follow-ing three cat, 'es: a limited residential program,outpatient and methadone. These private agenciesare serving 10,400 noncertified subjects.

As of January 31, 1971 a total of 16,210 addictshad been certified to NACC since it began opera-tions In April 1967. The point of greatest interestis the subjects who "complete" the treatment and

aftercare phases and are discharged, and the subse-ouent behavior of these people. Since most sub-j is are kept under control for three years, thefirst large number of discharges was not until April1970. From April 1 through December 31, 1970 atotal of 925 people have been discharged. Of these,717 were discharged because of the three-year timelimit, an additional 28 were discharged as rehabili-tated before the three-year limit, and 180 weredischarged for other reasons.

Information is not yet available on the behaviorof these subjects since their release, althoughNACC is currently planning a follow-up programon a sample basis to determine to what extent theobjective of "returning people to useful lives" hasbeen achieved.

The most crucial issue in an assessment of theNew York State narcotic control program is thecapability to deliver effective treatment. The 1966legislation creating NACC confidently stated that"narcotic addicts can be rehabilitated and returnedto useful lives," although "only through extendedperiods of treatment in a controlled environmentfollowed by supervision in an aftercare program."However, even the supporters of this legislationacknowledged in debate that this reference toeffective treatment relying on strong aftercare wasmuch more theory than fact. They recognized thatthere was to demonstrated medical procedure thathad a high probability of working on the greatmajority of addicts who were to be brought intothe planned treatment facilities. The first impor-tant operating achievement that might have beenexpect,d from the New York program was eitherdemonstration of a treatment of potentially wideapplicability or documentation of procedures thathad limited or no effectiveness.

This study found few significant differencesamong programs and services included in NACC'sinterdisciplinary approach or the special ap-proaches of other public agencies, and no meaning-ful records to provide a basis for evaluating oneform of treatment against another.

There is also no reliable information available onthe results of the treatment administered by theprivate agencies. In most cases, the private agencieshave not had either the resources or the inclinationto gather even the most basic evaluative dataInstead, they have relied on their service orienta-tion to justify their operations, and NACC has notinsisted upon fulfillment of its contract by requir-ing a record-keeping system that would assurecomparable evaluative data on results.

This deficiency ought to be corrected where it

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89

exists in any NACC or NACC-supported operation.If this remedial action is not taken, it will never bepossible to make reasoned calculations aboutwhich treatment and rehabilitation approaches, ifany, are good investments. The ranking administra-tive and research offi-ials in NACC now recognizethe crucial importance of developing plans on thebasis of input from follow-up studies, but they arejust beginning.

The Beth Israel Methadone Maintenance pro-gram is the only treatment approach for narcoticaddiction that has been operated under careful (ifstill imperfect) controls from inception throughfollow-up; it is the only approach which can showmeaningful data about results.

The attrat.tiveriess of the methadone approachstems from several factors. It is the only "new"concept that has been offered recently and datahave been supplied to indicate this approach issuccessful for some portion (not yet well-defined)of the addict populatio.i. Methadone maintenancealso does not require the longer periods of moreexpensive residential care that are required byother treatment programs.

NACC currently has underway a research pro-gram that is designed to provide clarification of thecrucial matter of methadone maintenance's rangeof applicability using NACC's methadone programat the Cross Bay Rehabilitation Center.

It is the "aftercare" resources of NACC that aremost directly involved in getting addicts back intothe community and providing them with whateversupport they might need in "returning to usefullives." Most centers actually offer little in suppor-tive services to the people assigned to aftercare.Too often, elements of the program are inoperztivebecause of a shortage of profe:sional personnel Indbecause of a breakdown in supervision resultingfrom the large caseloads. As a result, it is in thisaftercare phase of treatment that the vast mi.jorityof abscondences from NACC facilities take place.From April 1967 through January 1971, therewere 1,676 abscondences from intramural facilitiesand 4,937 abscondences from ritercare programs.Because of the pressure for NACC residentialtreatment beds, a large number of certificants havebeen transferred to aftercare who were apparentlynot ready when they were released from thesecurity of the residential program, and withoutadequate supporting services they abscond in largenumbers.

Preventive EducationPreventive education as conceptualized and prac-

ticed by NACC is essentially a drug awarenessprogram. NACC was given responsibility for pro-viding public education on the potentialities ofprevention; it was also charged with disseminating"information relating to public and private servicesand facilities in the state available for the assistanceof narcotic addicts and potential narcotic addicts,"and it was essentially this latter drug awarenessfunction that NACC understandably concentratedon in its first years. Most of this effort has beencarried out by the staffs of the sixteen communityNarcotic Education Centers, and the NarcoticsGuidance Councils. As of October 30, 1970,approximately 250 councils were established, with140 more proposed. NACC reimburses 100 percentof the administrative expenses of an NGC in itsfirst year up to $1,000 and shares in 50 percent ofthe program costs of an NGC up to a maximum of$10,000.

NACC's Education Centers and Guidance Coun-cils have provided a sense of community presenceand they are reaching some of the addict popula-tion through the petitioning assistance given in theEducation Centers.

Impact of the extensive public relations pro-gramlectures, puhlications, etc.is always diffi-cult to judge. However, there is evidence of muchcontinuing skepticism among judges, lawyers, andaddicts themselves about NAr',C's ability to helpthe addict.

Underlying the spirit of the NGC legislation isthe idea that the Narcotic Guidance Councilswould be able to communicate with the youth inthe community who face the perils of drug abuse.NGCs often have a difficult time relating toindividuals with drug problems because they lackyouth membership and back-up treatment facili-ties.

Both these shortcomings were items covered byamending legislation in 1970. Persons under 21were specifically authorized as council membersand a $65 million appropriation was authorized fora 50-50 state-local sharing of financing for youthtreatment centers. Local reaction to both theseprovisions has been slow in developing.

The Laws of 1967, amended in 1970, authorizethe Commissioner of Education to establish acontinuing program for critical health problems.The basis of this new program was originallyinterded to be a curriculum on SociologicalHealth, Drugs and Narcotic Education ("StrandII") that was completed in 1967 and available forgrades 4.12. Strand H was conceived along tradi-tional linesinformation, presumably "authorita-

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tive," was to be given students in lectures byteachers. Strand II ha., been applied minimally andis being reed to allow more student participationin the presentation of material dealing with drugabuse.

The Education Department in 1970 launched anex' ensive set of programs to prepa,e teachers,administrators and students for involvement infuture drug education classes in which the utiliza-tion of innovative materials and student participa-tion would be stressed. During the summer of1970, 89 teachers received two weeks of training inone program, and 189 others completed the firstcourse in a part-time Master's Degree sequence.Other future community teachers are supposed tocome from a College Volunteer and School-Com-munity Team program. With the exception of pilotprojects, as of January 1, 1971 there has beenalmost no feedback into schools from speciallytrained leaders.

The size and scope of the programs of the StateEducation Department were relatively small scaleand experimental through 1969-70. The Depart-ment has proceeded slowly, apparently recognizingthat it had to develop and substantiate a drugprevention curriculum, and prepare teachers to usesuch a curriculum before any large-scale programcould be launched.

Funding Preventive EducationThe Legislature in 1970 appropriated $65 mil-

lion for NACC to provide State aid for drug abusetreatment programs that are designed primarily for16 year olds and younger and that provide in-patient services. The initial application guidelinesdistributed by NACC in May 1970 did not allowexpenditures for education programs. The originalconception of this program was in terms oftreatment projects at the county government levelwith a county agency responsible for the program.It was suggested that the treatment and rehabilita-tion program might be administered either by thecommunity mental health board, the Departmentof Mental Health, a specially constituted narcoticand drug abuse commission, or a county narcoticguidance c luncil. This cone; -pt was well-directed,but the people and resources necessary for itsimplementation could not be mobilized.

The original guidelines for this program werechanged in August 1970 so significantly that theserevisions constitute an extension or reinterpreta-tion of the original intent of the Youthful DrugAbuse Treatment legislation. On the basis of theserevised guidelines, the State Education Depart-

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ment, in conjunction with NACC, explained that aschool's expenditure:. for health and drug educa-tion could be utilized as a part of a community'scontribution in the application for funds; in otherwords, the education program itself did not needto have an integi treatment component; it wouldbe sufficient that treatment resources existed orwere planned for the community. The message ofthese revised guidelines is clear. The strong treat-ment component of the Youthful Drug AbuseTreatment program has been extended to include astandard educational component.

There exists considerable pressue to use thesefunds under revised Youthful Drug Abuse Treat-ment program guidelines. School districts havehurriedly prepared applications under the threat ofimpending deadlines. There has been a flurry ofactivity accompanied by little meaningful planning(e.g., ASA models distributed to all city schooldistricts). This dramatic increaso in available fundsmakes it even more essential that any educationalprogram he carefully tested before it is imple-mented statew:,ie.

SummaryThree key premises were basic to the narcotic

drug control programs approved by the Legislaturein 1966 and thereafter: (1) there exist demon-strated, reasonably effective treatment proceduresfor narcotics addiction, (2) there exists an effectivecriminal justice system to insure either compulsorycommitment to NACC for treatment or the imposi-tion of legal penalties sufficient to discourage thesale or use of narcotics, and (3) there exists atested, satisfactory curriculum plan upon which tobase preventive eclucaJon. This study has shownthat none of these important elements are accom-plished facts even today. In fact, the New YorkState narcotic drug control program as it is nowconstituted is sill basically an experimental pro-gram.

Urgent programsand narcotics is an exampleoften must be initiated before all the prerequisitesare available. Such programs should continue to beregarded as experimentalin that controls, records,research and ev:Juation must be carried out con-tinually to document the most advantageous meth-ods and programs. In programs of this type,substantial initial outlays might be necessary toassure that fair ane "till tests will be available.

At the salrle time, the continuation extensionof such outlays should be dependent upon demon-stration that careful controls are being applied and

that some criteria have been established and arebeing utilized to distinguish and select the morepromising approaches.

Since the dimensions of the narcotics problemare still unknown, it does make a significartdifference in a State hard pressed for revenue as towhether the same essential results can be accom-plished in an outpatient program costing $56 or$146 per patient per month 1 r a residentialprogram costing $440 or $969 per patient monthand more importantly, if any of them are doing the

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job.The New York State program to control nar-

cotic abuse is a worthy experiment. This experi-ment has not yet hnd sufficient time to indicatewhat performance Standards might be achievable,and it should therefore be continued. There is noevidence, however, that this experiment thus tarhas been hindered for lack of funds, and furtherincreases should be conditioned upon NACC andother departments and agencies supplying plansfounded on documented performance records.

FOOTNOTES

CHAPTER II

'New York State, Temporary Commission of Investiga-tion, Ninth Annual Report, February 1967, p. 50.

2Ibid , pp. 53-55.

3 Laws of 1966, Ch. 192, Sec. 1.

4 New York State, Governor, Message to the Legislature,January 5, 1966, p. 6.

' Laws of 1966, Ch. 192, Sec. 4.

'Temporary Commission of Investigatio.., pp. 54-55.

CHAPTER III

'For a summary of the New York State laws, seeAppendix B.

8 United States, President's Commission on Law Enforce-ment and dministration of Justice, Task Force Report:Narcotics and Drug Abuse (Washington, D.C.: Govern-ment Printing Office, 1967).

9Albany (N.Y.) Knickerbocker News-Union Star, Decem-ber 8, 1970, p. 5A.

1°See Exhibit X.

11 President's Commission, p. 219.

1 2See Exhibit X.

1'See above, Chap. II, p.

14 The New York Times, December 13, 1970, p. 26.

CHAPTER IV

1 8See section 913-e to 913-r of present Code of CriminalProcedure. The comparable provisions In the new Crlm-ins., Procedure Law, vhlch will become effective Septem-ber 1, 1971, are contained in svrtions 720.05 to 720.70.

1622 N.Y.2d 545, 293 N.Y.8.2d 531, 240 N.E.2d 29(1968).

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ONA1.111.0.101,0=111. 0114a,

17370 U.S. 660 (1962).

1824 N.Y.2d 292, 300 N.Y.S.2d 102 248 N.E.2d 17(1969).

1 932 A.D.2d 969, 303 N.Y.S.2d 7S9 (1969).

2035 A.D.2d 703, 314 N.Y.S.2d 815 (1st Dept. 1970).2162 Ca1.2d 280, 42 Cat.Rptr. 199, 398 P. 1 391 (1965).

12 First Annual Statistical Report of NACC, Albany, 1968,Table 7, p. 7.

23Second Annual Statistical Report of NACC, Albany,1969, Table 8, p. 8.

24Second Annual Statistical Report of NACC, Albany,1969, Table 45, p. 76.

25Executive Budget, Stai:. of New York, 1968.1969, p.722.

"See Exhibit XII.

=Similar figures on narcotic misdemeanor convictions inthe State Supreme Court in New York City apparentlyare not available. Con..equently the table shown does motpresent a complete picture of the number of convictednarcotic misdemeanants certified to NACC in New YorkCity. Indeed a comparison of figures in the table withthe total number of convicted narcotic misdemeanantscertified in New York City reveals that more are certifiedby the Supreme Court than by the Criminal Court, whichmeans that most certified misdemeanants were arrestedand charged for a felony but "copped a plea" to amisdemeanor in Sursremr Court.

2 8 See Exhibit IX.

29See table in NACC Response pp.00 for updated figures.

CHAPTER V

3 °Laws of 19°6, Ch. 192, Sec. 2.

3 IState of New York Eaecu five Budget for the Fiscal YearApril 1, 1970 to March 31, 1971, p. 560.

32/bid., p. 553.

33 Donald B. Louria, The Role of Voluntary Agencies, 'The Antidote April 1970.

"Charles Wineck, "Research Planning at the New YorkAssociation of Voluntary Agencies on Narcotic Addic-tion and Substance Abuse", mimeo, p. 1.

"William R. Martin, M.D., "Commentary on the SecondNational Conference on Methadone Treatment," TheInternational Journal of the Addictions, September1970.

3 6I bid.

"Ibid.

"Ibid.

39"tiethadone Maintenance Treatment Program ProgressReport of Evaluation through March 31, 1970", p. 3.

40Vincent Dole, The International Journal of the Addic-tions, September 1970, p. 362.

CHAPTER VI

41Mental Hygiene Law, Sec. 204 (4) (5) (6).

42 General Municipal Law, Sec. 239-u.

43Section 113-a of the Mental Hygiene Lsa was amender.by Chapter 49, Laws of 1971 to permit those changes.

"New York State Commissioner of Education, "ProgressReport Stationwide Program For Drug Education,"September 25, 1970, pp. 6-7.

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LIST OF EXHIBITS

Exhibit I NACC ExpendituresAnnual Totals by Major Purpose

Exhibit II NACC Budget & Expenditure Comparisons, 1967-1971

Exhibit III NACC Census Statistics by Legal Status, 1968-1971

Exhibit IV Medical Examinations and Certifications by Area of Residence

Exhibit V Expenditures by Fa-..iiity (1967-1970)NACC Resident Treatment Facilities

Exhibit VI Expenditures by Facility (1967-1970)Community Based Facilities

Exhibit VII Average Monthly Costs, Voluntary Agencies 1:68-1970

Exhibit VIII

Exhibit IX

EN cubit X

Exhibit XI

Exhibit XII

Exhibit XIII

Exhibit YIV

Exhibit XV

Average Monthly and Per Diem CostsNACC Operated and Contract Facilities 1969-'70

Narcotic Arrests by Drug TypeNew York City - 1966-1970

Narcotic Arraignments - 1969Criminal Court of the City of New York

Comparison of Arrests for Opium and Derivatives to TotalNarcotic and Drug Arrests 1967-1970

Legal Status of Person Certified to NACC 1968.1970 (Sept.)

Tots: Narcotics ArraignmentsCriminal Court of t%e City of New York 1960.1969

Trends in Narcotic Use: Persons Arrestedby New York City Police Who Admit ULing Narcotics

Employment of Individnals in AftercareJanuary and July 1970

73

Exhibit 1

NACC Annual Expenditures by Purpose

Purpose 1967-68 1968-70 1059-70

TotalAuthorized

1970

ExpendedSept. 301970-71

Administration and SupportServices $6,335,919 $3,083,1E4 $4,731,072 $7,174,800 $2,550,470

. .

Scientific Research 1,580 916,730 1,952,207 1,297,350 227,607

Methadone MaintenanceTreatment 1 12,375,000 2,216,021

Treatment and Rehabili-tation Centers 2 10,372,958 18,141,235 29,928,293 45,593,134 12,965,223

Community Based Centers 160,084 1,038,056 3.192,797 6,502,090 2,235,472

Treatment and Rehabili-tation ContractedServices 3,252,092 8,978,963 9,158,841 10,533,600 2,111,365

Education and Prevention 616,760 1,058,141 572,180 1,669,800 355,502

Total $20,739,393 $33,216,309 $49,535,390 $85,146,124 $ 22,661,660

lExpenditures for Beth Israll Methadone Program budgeted under Contract Services through 1965 -70.2lncludes Centers operated by the Department of Correction, Mental Hygiene and Social St:vices.

SOURCE: NACC Budget Reports, Audit and Control Report, September 30, 1970

Exhibit II

NACC Budget and Expenditure Comparisons (1967.1971)

1967.68 1968.69 1969-70 1970.71

Original Budget Request(Executive Recommendation) $45,879,841 $55,542,500 $58,830,413 $85,000,000

Total Available(Adjusted Appropriation) 35,0003000 38,,! 42,500 52,368,207 85,146,124

Total Expenditures 20,739,393 33,216,309 49,535,3901 22,551,6592

'includes expenditures of the Departmeat of Mental Hygiene

2As of September 30, 1970

SOURCE: Executive BudgetsNACC Budget ReportsAudit and Controt Report, September 30, 1970

74

:

G

Exhibit III

NACC Census Statistics')by Legal Status

Legal Status of Subjects on the Books

1968 1969 1970 19714

Section 206 (self) 354 1147 1867 3124Section 206 (other) 793 1101 2605 4062Section 210 . 1171 1382 1566 1579Section 208.4 (a) 810 1700 2344 3408Section 208.4 (b) 91 335 639 1423Sectior. 209 17 66 174 289Detained 87 73 291 700

TOTAL 3623 6804 9486 14,585

NACC Status of Subjects on the Books

In Residence or on leave 2976 3405 4944 6141Abscondence 4293 992 1899 3299Police Custody Charged 30 129 276 311Police Custody Pending Return 2 1 25Transfer Out 103 146 159Certified Admission Pending 29 170 108 27In Aftercare Programs 188 1003 2332 4623--- --TOTAL 3652 5804 97062 14,585

'From: NACC Monthly Report Figures are Cumulative totals, i.e., each year includes prior years.

2Includes April 1970

3Includes Transfers Out for 19E8

4Report to January 31,1971

SOURCE: Annual Statistical Reports, NACC, 1963 and 1969Monthly Census Reports, NACC, April January 1971

75

97

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Exhibit V

NACC Operated Resident Treatment FacilitiesTotal Expenditures by Facility

Facility 1967-68 1968-69 1969-70

Arthurkill $ 22,024 $ 2,050,104Bayview $ 1,109,657 1,664,911 2,068,784Edgecombe 1,855,533 2,109,508 2,841,174Iroquois 316,065 990,488Manhattan 1,649,211 2,272,585 2,858,493Masten irk 245,900 . 867,191 1,193,820Mid-Hudson l 1,245,453 2,338,199 2,610,513Queensboro 10,240 15,897 1,295,331Sheridan 26,692 107,624 2,683,620Woodbournel 1,501,894 3,733,913 4,228,705Cross Bay 626,351 785,288 401,751Ridge hill 1,013,811 688,112 237,355Brooklyn Central 212,519. 115,507Cooper2 137,308 823,114

'Includes expenditures by Department of Correction.

2Converted to CBC - September 1%8.

SOURCE: NACC Financial Reports.

Exhibit VI

Community-Based FacilitiesTotal Expenditures per Facility

NACC CBC 1967-68 1968-69 1969-701970-'71

AppropriationExpended asof Sept. 1970

Brunswick $ 10,133 $ 5,001 $ 420,911 $ 1,258,068 $ 402,641Cooper* 269,177 977,903 1,870,149 657,373Fulton 41,713 33,549 69,957 752,097 165,332Melrose 70,229 409,499 937,590 1,479,563 554,262Mt. Morris 38,009 312,670 570,899 953,366 364,837Masten Park 3,r,71 314,141 43,934

Converted from IMS September 1968

SOURCE: NACC Financial Reports

77

99

Exh

ibit

VII

AG

EN

CY

Ave

rage

Mon

thly

Cos

ts, V

olun

tary

Age

ncie

s

Tot

al P

aym

ents

App

licab

leP

erio

dto

Per

iod

Cen

sus*

App

licab

leto

Per

iod

Cos

t per

Pat

ient

Mon

th

Add

icts

Reh

abili

tatio

n4/

1/6t

;.3/3

1/70

$42

3,51

4.47

1,48

5.0

$285

.19

Civ

ic C

ente

r C

linic

7/1/

68-3

/31/

7090

,533

.20

393.

523

0.07

Exo

dus

Hou

se7/

1/68

-3/3

1/70

533,

345.

461,

130.

547

1.78

Gre

enw

ich

Hou

se4/

1/C

8-3/

31/7

059

8,34

6.68

10,7

37.0

55.7

3Lo

wer

Eas

tsid

e S

.C.

7/1

/68-

3/31

/70

660,

490.

254,

718.

013

9.99

Van

Ette

n4/

1/68

-4/3

0/70

351,

950.

971,

707.

020

6.18

Bet

h Ls

rael

4/1/

68-3

/31/

703,

896,

250.

8424

,479

.515

9.16

Rea

lity

Hou

se10

/1/6

3-3/

31/7

015

2,86

7.21

2,14

3.5

71.3

2O

dyss

ey H

ouse

10/1

/68-

3/31

/70

453,

664.

111,

197.

537

8.84

Qua

ker

Com

mitt

ee7/

1/68

-3/3

1/70

529,

957.

995,

390.

598

.31

Sam

arita

n (D

ay)

4/1/

68-3

/31/

6948

.719

.74

274.

022

7.66

Sam

arita

n (N

ight

)8/

1/68

-3/3

1/70

273,

851.

1390

5.5

302.

43D

ayto

p V

illag

e4/

1/68

-3/3

1/70

1,54

7,63

7.46

5,43

2.0

284.

01S

alva

tion

Arm

y7/

1/68

-4/3

0/70

342,

715.

741,

660.

020

7.71

Vill

age

Hav

en10

/1/6

8-3/

31/7

019

4,61

9.28

582.

533

4.11

Nas

sau

Cou

nty

1/1/

69-1

2/31

/69

319,

232.

409,

022.

535

.38

Wes

tche

ster

Cou

nty

1/1/

69-1

2/31

/69

80,0

03.0

866

6.5

120.

03H

ope

Hou

se12

/1/6

9-3/

31/7

04,

004.

0023

.012

1.33

TO

TA

L:$1

0,50

1,70

5.01

71,8

88.0

Tot

al A

vera

ge M

onth

ly C

ost

$146

.08

Patie

nt m

onth

s

SOU

RC

E: N

AC

C B

udge

t Off

ice

Tot

al A

nnua

l Ave

rage

Cos

t$1

,752

.95

Exhibit VIIIAverage Monthly and Per Diem Costs for Commission and Contract Facilities

Aprl 1, 1969 - March 31, 1970

NACC FacilityAppropriation

Charge

ResidentMonths

Of Care

AverageMonthly

Cost

AveragePer

Diem

Masten Park $ 1,193,820 1,431 $ 834.26 $27.35Bayview 2,068,784 2,541 814.16 26.69Edgecombe 2,841,174 2,931 969.35 31.78Manhattan 2,858,493 3,096 923.29 30.27Sheridan 2,681,620 2,785 963.60 31.59MidHudson 2,610,513 4,183 624,08 20.46Woodbourne 4,228,705 7,584 557.58 18.28Queensboro 1,295,331 1,113 1,163.82 38.16Iroquois 990,488 1,286 770.21 25.25

NACC TOTAL AND AVERAGE $20,770,928 26,950 $ 770.72 $25.27Correction Facility

Albion 328,206 329 997.59 32.71Great Meadow 2,155,429 5,875 366.88 12.03Green Haven (NACC) 1,188,247 2,096 566.91 18.59Green Haven (Prison) 246,683 1,573 156.16 5.14Matteawan 858,767 1,251 686.46 22.51Reality reuse 112,462 (7,448) 15.10 .50

CORRECTION TOTAL ANDAVERAGE $ 4,889,694 11,124 $ 439.56 $14.41

TOTAL AND AVERAGENACC AND CORRECTION $25,660,622 38,074 673.97 $22.10

FACILITIES WITH REDUCEDOPERATION PENDING PHASEH DEVELOPMENT

Cross BayArthur killRidge Hill

TOTAL

401,7512,050,104

237,465$2,689,310

141,149

-0-1,163

TOTAL AND AVERAGE $28,349,932 39,237 $ 722.53 23.69

ALLOCATED TO OTHERSTATE AGENCIES

Social Services 21,500 79 272.16 8.92Mental Hygiene $ 1,656,861 2,647 588.16 19.28

GRAND TOTAL $29,928,293 41,963 $ 713.21 23,38

SOURCE: NACC Budget Office

79

101

Exh

ibit

IXN

arco

tic A

rres

ts b

y D

rug

Typ

e Fo

r N

ew Y

ork

City

Com

pari

son

of T

otal

Nar

cotic

Arr

ests

(In

clud

es F

elon

y an

d M

isde

mea

nor

Arr

ests

) 19

66-1

970

Dru

g T

ype

1966

1967

1968

1969

1970

Tot

alPe

r C

ent

Nar

cotic

ofA

rres

tsT

otal

Tot

alPe

r C

ent

Nar

cotic

ofA

rres

tsT

otal

Tot

alPe

r C

ent

Nar

cotic

ofA

rres

tsT

otal

Tot

alN

arco

ticA

rres

ts

Per

Cen

tof

Tot

al

Tot

alPe

r C

ent

Nar

cotic

ofA

rres

tsT

otal

Opi

um &

Der

ivat

ives

(Her

oin

& M

orph

ine)

9,05

559

.49,

722

55.3

13,4

6160

.023

,698

67.4

38,7

9073

.9

Coc

aine

143

0.9

285

1.6

391

1.8

660

1.9

884

1.7

Can

nabi

sM

ariju

ana

& H

ashi

sh3,

944

25.9

5,22

229

.74,

695

20.9

5,23

614

.95,

743

11.0

Synt

hetic

Opi

at,e

s22

0.2

5:3

0.3

650.

317

-27

Dep

ress

ant &

Stim

ulan

t 11,

095

7.2

1,04

45.

91,

197

5.3

1,92

65.

52,

482

4.7

Hal

luci

noge

. ,ic

s2

230.

248

0.3

143

0.6

490.

151

0.1

Hyp

o Sy

ring

e, N

eedl

es95

06.

21,

206

6.8

2,47

611

.03,

592

10.2

4,50

28.

6

Glu

e (O

ffen

se)

611

0.1

120.

1

TO

TA

L15

,238

100.

017

,591

100.

022

,440

100.

035

,178

100.

052

,479

100.

0

'Eff

ectiv

e 1/

1/66

2 Eff

ectiv

e 7/

1/65

SOU

RC

E: C

ity o

f N

ew Y

r.k

Polic

e, S

tatis

tical

Rep

ort,

Cri

me

Ana

lysi

s Se

ctio

r., A

nnua

l Rep

ort;.

Exhibit XNarcotics Arraignments) (1969)

Criminal Court of the City of New York

Total ArraignmentsGeneral Disposition

(a) Dis-harged(b) Transferred(el Feld for Grand Jury(d) ConvictedTotals

Acquitted after trialDismissedDismissed on motion of D.A.Certified tc NACCTotals

Breakdown of (d)Misdemeanor Convictions

(1) Fined(2) Workhouse and

Straight Sentences(3) Reformatory(4) Certified to NACC(5) Discharged -

unconditional(6) Discharged -

conditional(7) ProbationTotal

Misdemeanors

20,560

10,301149216

5,21015,876

2,58739

4,464

7,090

Breakdown of (a) - Discharged Cases

Misdemeanors679

5,7893,761

7210,301

Breakdown of (2)and Straight Sentences for

153 1 - 30 days3,598 31 - 60 days

61 - 90 days11 over 3 months - 6

194 cver 6 months - 1

178 suspendedTotal

660

4165,210

Felonies 2

13,374

Felonies

1,599.984

42,587

- WorkhouseMisdemeanors

777646992

months P23year 353

73,598

1Term "narcotics arraignments" includes arraignments for non narcotic dangerous thug offenses as well as narcoticoffenses.

2Brenkdown of felony convictions not compiled by State Supreme Court.

SOURCE: Annual Reports for 1969.Criminal Court of the City of N.Y.

81

103

Exhibit XI

Narcotic Arrest Statistics for New York Cityl

Comparison of Arrests for Opium and Derivativesto Total Narcotic Arrests 1966-1970

TotalNarcoticArrests 1965 1966 1967 1968 1969 1970

Total

Heroin

Heroin arrestsas a % of total

Percent of in-crease: (overprior year)

Total Arrests

Heroin Arrests

13,880 15,238 17,591 22,440 35,178 52,479

(2)

9,055

59.4

10.0

9,722

55.3

15.4

7.4

13,461

60.0

27.6

38.5

23,698

67.4

56.8

76.0

38,790

73.9

49.0

64.5

1 Term "narcotic arrest" includes arrests for non-narcotic dangerous drug offenses as well as arrests for narcoticoffenses.

2 Figures not available.

SOURCE; City of New York, Police Statistical Report, Crime Analysis Section, Anr

82

104

"........1.1911*.-,1,11/111MIRROSIMIN+511111.817.....R.,

Exhibit XII

Legal Status of Persons Certified to NACC

19A,... 1970 1970*No. ofCertifi- % of

No. ofCertifi- % of

No. ofCertifi- % of

No. ofCertifi- % of

Status cants Total cants Total cants Total cants Total

Total Certificants 3569 100 2335 100 3773 100 3238 100

206 (self) 657 18.4 526 22.5 747 19.8 864 26,7206 (other) 820 22.9 538 23.1 1525 40.4 1066 32,9

Total Certified inthe Civil Courts 1477 41.3 1064 45.6 2272 60,2 1930 59.6

208 (4) (a) 812 22.8 817 35.0 798 21,2 751 23,2208 (4) (b) 91 2.6 204 8.7 296 7.8 327 10,1209 17 .5 33 1.4 107 2.8 66 2.0210 1172 32.8 217 9,3 300 8.0 164 4.1

Total Certified inthe Criminal Courts 2092 58.7 1271 54.4 1501 39.8 1308 40.4

Includes only certifications from April 1-September 30, 1970

SOURCE: NACC Annual Statistical Reports Table 18Monthly Census reports AprilSeptember 1970

83

10 5

Exhibit XIII

Total Narcotics Arraignments'Criminal Court of the City of New York

Year

19604969

Misdemeanors Felonies Total

1960 5,696 1,719 7,4151961 4,734 1,559 6,2931962 5,088 2,127 ; .2151963 5,766 2,301 8,0671964 10,557 3,302 13,8591965 10,137 3,682 13,8191966 10,538 5,326 15,8641967 11,510 7,313 18,9831968 13,456 8,409 21,8651969 20,560 13,374 33,934

* Term "narcotics arraignments" includes arraignments for non-narcotic dangerous drug offenses as well asarraignments for narcotic offenses.

SOURCE: Annual Report for 1969Criminal Court of the City of N.Y.

84

10C

Exh

ibit

XIV

Tre

nds

in N

arco

tic U

se: P

erso

ns A

rres

ted

by N

evy

y, Y

ork

City

Pol

ice

Who

Adm

it to

Usi

ng]

Nar

cotic

s

i967

Tot

al

1968

Tot

ai

1969

%A

rres

tT

otal

Tot

al%

Arr

ests

,T

otal

%A

rres

ts,

Tot

alT

ype

af A

rres

tA

rres

tsU

sers

Use

rsA

rres

tsU

sers

Use

rsA

rres

ts _U

sers

Use

rs

Felo

ny, D

ange

rous

-D

rugs

7,19

93,

892

54.1

9,62

63,

732

38.8

15,4

315,

099

33.0

Mis

dem

eano

r,D

ange

rous

Dru

gs10

,381

5,52

153

.212

,802

5,05

439

.519

,747

6,6°

33.9

Felo

ny p

lus

Mis

-de

mea

nor,

Dan

ger-

ous

Dru

gs17

,580

9,41

353

.522

,428

8,78

639

.235

,178

11,7

9433

.5

All

Rec

orde

dA

rres

ts16

3,32

416

,779

10.3

187,

613

17,0

399.

122

8,17

521

,78o

9.5

lAn

adm

issi

on o

f "u

se is

aot

equ

ival

ent t

o an

adm

issi

on o

f "a

ddic

tion,

" bu

t dat

a in

t!-.

e St

atis

tical

Rep

orts

(C

f. 1

969-

1968

, p. 1

3) in

dica

tes

that

78%

of a

sam

ple

of 2

,425

adm

itted

her

oin

user

s ha

d a

habi

t of

mor

e th

an o

ne y

ear.

2Opi

ates

are

the

drug

- A

sed

by 8

5-90

% o

f th

ose

who

adm

it to

use

(i.e

., St

atis

tical

Rep

orts

em

ploy

"na

rcot

ic"

as a

gen

eric

term

for

ill d

ange

rous

drug

s).

SOU

RC

E: P

lann

ing

Div

isio

n, C

ity o

f N

ew Y

ork

Polic

e, S

tatis

tical

Rep

ort:

Nar

cotic

s 1)

69-1

968

(n.d

.); a

lso,

Sta

tistic

al R

epor

t: N

arco

tics

1968

-196

7an

d St

atis

tical

Rep

ort:

1967

-196

6.

Exhibit XV

Employment of Individuals in Aftercare, January and October, 1970

January October Change January to October

Number Per-Cent Number- Per-Cent NumberChange in

Relative Share

Employed Full-Time(more than 3u hours)

793 39.2 958 31.3 +165 -7.9

Employed Part-Time 67 3.3 546 17.8 +479 +14.5(30 hours or less)

Housewives or 108 5.3 457 5.6 +349 4-3

Students

Not Employed 749 37.0 762 33.1 +13 -3.9

Not Repotted 307 15.2 338 12.2 +31 -3.0

TOTAL 2,024 100.0 3,061 100.0 +1,037

SOURCE: NACC Monthly Statistical Reports

86

108

APPENDIX ACAPITAL CONSTRUCTION

The legislative beginning of NACC constructionis found in Chapter 192, Section 26 of the Laws of1966. This legislation appropriated $75 million outof the general fund to the Mental Hygiene Facili-ties Improvement Fund for the costs of esta-blishing narcotic addiction rehabilitation centers atthe request of NACC. These costs were to includeconstruction, rehabilitation and alteration of build-ings, purchase of furnishings and equipment, acqui-sition of property by purchase, lease, or transfer,and engineering or architectural costs. NACC facili-ties could include hospitals, withdrawal centers,aftercare clinics, vocational training schools, em-ployment and guidance centers, halfway houses,special housing, vocational training summer camps,research facilities, and automotive equipment cen-ters.

The above legislation was augmented by Chapter90, Sections 4 and 13, 1967, for $34.7 million and$87.5 million respectively. (Chapter 90, Section 13was a first instance appropriation.) Consideringamounts repealed, the total sum of money appro-priated for NACC Capital Construction is presently$159,353,000. Of this approximately $35 millionis unallocated.

NACC obtains facilities in the followingways: (1) purchase and renovation or rehabilita-tion of an existing structure; (2) new construction;(3) operating agreement (e.g., Hart Island, IroquoisCenter); and (4) use of other State agency build-ings (e.g., Woodbourne Correction, Green Haven).The majority of facilities operated by NACC wereobtained by the first two methods of acquisition.A building was either rehabilitated or new con-struction was completed and that facility was thenturned over to NACC for operation.

Playing a crucial role in this area is the Healthand Mental .Hygiene Facilities Improvement Cor-poration (HMHFIC), Indeed, it operates as NACC'sbuilder; a rtzponsibility given to it in Chapter 192,Section 26, 1966. Commencing in 1966, theCorporation was faced with deadlines in terms of

87

10D

providing facilities for NACC's use. (Initial facili-ties were to be ready in October, 1966.) Thebeginning of the program found little specified interms of building type: design architecture for aNACC facility was indefinite. Little organizeddesign information was available for facilities tohouse narcotics treatment programs. Given thissituation, HMHFIC turned to under utilized exist-ing facilities for quick renovation and rehabilita-tion. Construction guidelines were general, incor-porating the major areas that were to be provided.

NACC's physical requirements stem basicallyfrom the intramural and community based (after-care) treatment programs. Under the intramuraltreatment program, NACC provides residentialtreatment care for certified addicts in its ownfacilities and others operated by State agenciesunder contract. An interdisciplinary approach isfollowed by NACC which finds a physical need forthe following activities:

1. Education (classrooms);2. Vocational rehabilitation (workshops) and

work techniques;3. Individual and group counselling (counselling

facilities);4. Recreation (gymnasium facilities).

The intramural facility, in certain cases, has a bedcapacity of 650. The resident population in intra-mural facilities as of November 1, 1970, was 3,889.

The community based (aftercare) treatmentprogram attempts to prepare addicts for indepen-dent community living The aftercare center isgenerally design-A to provide service for 800addicts; 50 on a residential basis, 150 on a day-carebasis, and 600 on field service status. Addicts inresidence at a community based center are involvedin the same activities as those in treatment facili-ties; namely education, vocational rehabilitation,counselling, and recreation. Addicts on field Se-vicestatus live at home and either have jobs or t rAinvolved in educational or vocationai programs in

the community. Without detailed architecturaltreatment, many facilities were established withphysical areas "roughed out," anticipating specifi-cation and completion as .,he addiction programrecreired. Many physical difficulties had their originin this early :.:story.

The realities of operating relationships amongorganizations involved find NACC working in closepartnership with the Division of Budget andHMHFIC. Once the initial decision to esti:blish afacility is made by the NACC chairman, a verydetailed procedure for the acquisition and con-struction of NACC facilities commences. Thisprocedure involves various Division of Budgetauthorizations, Department of Mental Hygieneacquisition of any real property, and HMHFICengaging an architect and constructing the facility.

Throughout this process, NACC is involved inapprovals of the various steps being taken byothers and the requests for continuation. Duringthe design phase of a facility, the policy ofHMHFIC is to meet every two weeks at corpora-tion offices in Manhattan to iron out designproblems and discuss progress. These meetings havein attendance a NACC representative, generallyfrom the Bureau of Facilities Development. Thearchitect develops a space programming conftruc-don co ostimate. NACC and Division budgetapproval of the space program and estimate follow.NACC, on the Divisio:i of Budget approval of thespace program estimate, requests HMHFIC to issuea construction budget and proceed with the designof the facility. Approval of the final design, madeby NACC, results in - IW-IFIC's bidding on theproject. A request of the Division of Budget forallocation for construction of the facility is made

by HMHFIC.The construction is completed by HMHFIC and

the facility is then turned over to NACC foroperation. Throughout this entire process NACCrelies on the Division of Budget and HMHFICcooperation and involvement to accomplish itsown objectives. NACC's facilities developmentstaff ser ,es principally as a monitoring componentand coordinator between the three agencies in-volved in the planning, design and construction ofa facility. Upon completion of new construction orrehabilitation of an existing structure, HMHFIC'sinvolvement ceases. The operation and continuedmaintenance of the facility becomes the responsi-bility of NACC.

With respect to HMHFIC's involvement regard-ing the $200 million capital appropriation for drugabuse program, an administrative difficulty isapparent. (Chapter 607, Laws of 1970.) Themechanics of the financing find HFA requiring thatcapital projects from first instance funds be linedout in the budget. (HMHFIC, Chapter 359, Section

Though no specific projects have been re-quested utilizing these funds, NACC intends toproceed in its regular manner dealing withHIV HFIC when such a request is made. It isanticipated that HMHFIC would carry the projectwith capital that had been appropriated on a lumpsum basis. Any problem that might result, wouldthen be negotiated with the Division of Budget fordeferred payment. NACC, to satisfy the HFArequirement, would lira out the project in thedeficiency budget. (The youthful drug abuse pro-gram is more fully discussed in the preventiveeducation section of this audit.)

88

119

- .

Table INACC Capital Construction Appropriations

Chapter 192/26/66repealed -6,802,000

$ 75,000,000(68,198,000)

Chapter 90/4/67 21,315,000

Chapter 90(4/37 13,440,000

Chapter 90/13/67 87,500,000repealed -22,500,000

-16,500,000 (56,400,000)added + 7,900,000

Total NACC fundsavailable for capital construction $159,353,000

Unallocated:Chapter 90 (line 047) $ 9,245,581Chapter 90 (line 048) 110,648Chapter 90/13 25,905,951Chapter 192 164,237TOTAL $35,426,447

SOURCE: NACC Memorandum, October 22,1970, "Capital Construction Fund Expenditures."

89

111

Tab

le I

IN

AC

C F

acili

ties

- C

osts

- C

apac

ity

Faci

lity

Aut

hori

tyPu

rpos

eC

ost

Bed

Cap

acity

Tre

atm

ent S

peci

al

Alb

ion

Reh

abili

tatio

n C

ente

rC

hapt

er 1

92C

onst

ruct

ion

1,17

2,11

195

5C

hapt

er 9

0D

esig

n/C

onst

307,

822

1,47

9,93

3

Art

hur

Kill

Reh

abili

tatio

nC

hapt

er 1

92C

onst

ruct

ion

12,0

46,8

0360

050

Cen

ter

Cha

pter

90

Equ

ip/C

onst

1,94

2,80

2C

hapt

er 9

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APPENDIX BNEW YORK STATE DRUG CONTROL LAWS

AND CRIMINAL OFFENSES

Principal StatutesThe statutory provisions controlling dangerous

drugs in New York State and setting forth criminaloffenses and penalties are contained, with a fewexceptions, in two main bodies of law, Articles 33,33-A, and 33-B of the Public Health Law andArticle 220 of the Penal Law. Articles 33 and 33-Aof the Public Health Law contain closely parallelprovisions regulating the manufacturers, distribu-tors, and dispensers of narcotic drugs (Art. 33) anddepressant and stimulant drugs (Art. 33-A).Articles 33 and 33-A are further implemented byextensive administrative rules and regulations pro-mulgated by the Commissioner of Health pursuantto authority granted to him by Secs. 3302 and3372 of the Public Health Law.' Article 33 isbased on the Uniform Narcotic Drug Act approvedin 1932 by the National Conference of Com-missioners or Uniform State Laws, and wasadopted by New York in 1933. All except twostates have adopted the Uniform Act in one formor another. Article 33-A dealing with depressantand stimulant drugs is patterned closely atterArticle 33, and was enacted in 1965. Article 33-1i,enacted in 1967, deals with two relatively minordrug offenses.

The other main body of law controlling dan-gerous drugs is Article 220 of the Penal Law, whichsets forth the rather complex structure of criminalpenalties for the unlawful possession and sale ofdangerous drugs. The complete revision ofPenal Law in 1965, which became effective onSeptember 1, 1967 and resulted in the consolidation of most drug offenses in Article 220, didnot substantially change the penalties for drugoffenses although it did reorganize the peniiesinto a uniform, but complicated, structure.

Besides the two main bodies of law mention 1,

miscellaneous thug offenses are included elsewherin the statutes such as in the Mental Hygiene Lawand Article 240 of the Penal Law.

The principal bodies of law mentioned, the

I

Public Health Law and the Penal Law, althoughlargely independent, duplicate one another to someextent and are dependent upon one another inimportant respects. For instance, the illegal pos-session or sale of dangerous drugs can be and oftenis prosecuted as an offense under both the PublicHealth Law and the Penal Law. Both articlescontain the same general statement that a violationof a provision in the article shall be punishable asprovided in the Penal Law.'

The New York State statutory provisions con-trolling dangerous drugs should be consideredtogether with the comparable federal statutoryprovisions, because of the interstate and inter-national character of the dangerous drug trafficand the extensive cooperation among federal, state,and local law enforcement officials.

Administrative and Enforcement AgenciesThe agency primarily responsible for admini-

stering the regulatory provisions of Articles 33 and33-A 01 the Public Health Law is the Bureall ofNarcotic Control in the Ncw York State Depart-ment of Health. This agency promulgates theadministrative rules and regulations on behalf ofthe Commissioner of Health, as authorized bystatute, and processes the applications for licensesand certificates of approval to manufacture, dis-tribute, and dispense narcotic drugs under Article31 and depressant and stimulant drugs underArticle 33-A. Suspected violations of these articlesare referred to the special Narcotics Unit in theNew York State Police for investigation andpossible arrest.

Prior to 1968, the Bureau of Narcotic Control inthe Department of Health exercised full enforce-

nt powers by in .stigating suspected violationsand making arrests. In that year, however, acontroversy arose over the exercise of full police

,wers by the Bureau's employees, whereupon theGovernor, through a reorganization and budgetary

transfer, shifted enforcement powers to the StatePolice, even though he was unsuccessful in re-pealing t statutory provision granting the fullpowers of a peace officer to representatives of theCommissioner of Health.' So the employees of theBureau of Narcotic Control in the Department ofHealth still possess nominally the powers of policeofficers, but the actual investigations and arrestsfor violations of Articles 33 and 33-A are carriedout by the State Police, usually after suspectedviolations are referred to them by the Bureau ofNarcotic Control.

As indicated above, the law enforcement agencyat the State level which is primarily responsible forenforcing the criminal laws re!ating to drug of-fenses is the New York State Police, especially thespecial Narcotics Unit in the Bureau of CriminalInvestigation.

CONTROL OF NARCOTIC,DEPRESSANT AND

STIMULANT DRUGS

The term "narcotic drugs" is defined in Article33 to include, among others, opium, coca leaves,marihuana, pethadine, and opiates or their com-pound, manufacture, salt, alkaloid, or derivative.4The statue goes on broadly to include everysubstance, however prepared, which is neitherchemically nor physically distinguishable from thenamed substances. The definition sums up the term"narcotic drugs" as being those designated in thefederal narcotic laws and specified in the adminis-trative rules and regulations promulgated by theCommissioner of Health. The classification ofdrugs comprises a major part of the administrativerules and regulations, and the Commissioner relieson the federal designations in performing thisfunction. Among the well-known drugs classified asnarcotic drugs in the rules and regulations aremorphine, heroin, cocaine, Demerol, and metha-done.s

The most controversial inclusion in the abovedefinition of "narcotic drugs" is marihuana. Itsclassification as a narcotic drug is responsible inlarge part, of course, for the present severe criminalpenalties for its possession and use in Article 220of the Penal Law.

The term "depressant or stimulant drug" isdefined as including the barbiturates, ampheta-mines, or

any drug which contains any quantity of asubstance which the commissioner, after in-vestigation, ha! round to have, and by regula-

tion designates as I: ing, a potential for abusebecause of its depressant or stimulant effecton the central nervous system or its hallucina-tory effect; except that the commissionershall not designate any substance that is anarcotic drug as defined in article thirty-threeof the public health law.6

hs can be seen, this definition goes beyond tl ecommonly accepted meaning of the term "depres-sant or stimulant drug", especially insofar as itincludes the hallucinogens which are usually classi-fied separately. In effect, the definition is acatch-all for dangerous drugs not controlled byArticle 33. Further evidence of this is apparent inchecking the classification of depressant and stimu-lant drugs in the rules and regulations, where onefinds, besides the common barbiturates ("downs")and amphetamines ("ups") such well-known hallu-cinogens as LSD, DMT, mescelire, any peyote.

The Commissioner is authorized to exempt byregulation any depressant or stimulant drug fromthe application of all or part of Article 33-A if itsregulation is not necessary for the protection ofthe public health'

Basic Statutory ProhibitionAll of the controls in Articles 33 and 33-A can

be summed up in the following general statutoryprohibition which appears in each statute inidentical language, except for the kind of drug:

It shall be unlawful for any person topossess, have under his control, sell, prescribe,administer, dispense or compound any nar-cotic (depressant or stimulant) drug, except asauthorized in this article.9

This prohibition encompasses practically all of thepotential violations in each statute, covering all theprincipals who participate in the life of a drug fromthe manufacturer through the wholesaler or distributor and pharmacist to the physician or hospitaland, finally, the individual consumer.

This statutory prohibition ties in directly withthe dangerous drug offenses of possession and salein Article ?20 of the Penal Law since the unlawful-ness of those offenses is defined in part byreference to Articles 33 and 33-A.1°

Manufacture and Distribution of DrugsIn order to produce or prepare narcotic, depres-

sant, or stimulant drugs, or to possess of supplythem as a manufacturer or wholesaler, a personmust obtain a license from the Department ofHealth.' I An applicant must furnish satisfactoryproof that he is of good moral character and that

he is equipped to carry on properly the businessdescribed in his application." Once he has ob-tained the license and paid the original fee of$25.00, he must register biennially with the De-partment of Health and pay a fee of $10.00.Licenses may be suspended or revoked for cause bythe C,oinmissioner."

A duly licensed manufacturer or wholesaler maysell narcotic, depressant, or stimulant drugs only tothose persons who are qualified bg law to possessthem in connection with a business or professiondefined in Article 33 or 33-A, and then only if awritten record of the sale is made) A manufac-turer who sells or dispenses a narcotic, depressant,or stimulant drug must clearly label the package toshow the name and address of the endor and thequantity, kind, and form of drug contained there-in. A wholesaler must do the same if he preparesthe pa-,kage.1 s

Sales of Drugs by Pharmat fistsA pharmacist may, in good faith, seP and

dispense narcotic, depressant, or stimulant drugs toany person upon a prescription) 6 If the drug is anarcotic, the prescription must be written, al-though the administrative rules and regulationsallow for a telephone order by a physician or otherpractitioner in an emergency provided that awritten prescription is supplied before deliverymade." The statutes impose certain filing,labelling, and other requirements upon the pharma-cist) 8 In addition, the rules and regulations spellout in considerable detail various other require-ments concerning prescriptions such as who mayissue and fill them, manner of filling, restrictionsupon refilling and partial filling. 9 Understand-ably, the requirements concerning narcotic drugsare somewhat more stringent than those for depres-sant and stimulant drugs.

Article 33 authorizes pharmacists to sell at retailwithout a physician's prescription certain specifiedmedicinal preparations containing small quantitiesof narcotics, such as codeine cough syrup, providedthat no more than four fluid ounces is sold to anyone person on any one day.20 Several conditionsare imposed upon such sales to protect againstabuse of the exception.

Violation of Articles 33 or 33-A may begrounds, not only for criminal prosecution underthe Penal Law, eut also for suspensicci of revocationof a pharmacist's license to praciie his profession.Narcotic addiction by a pharmacist himself is arelated ground for suspension or revocation of hislicense.2

Professional Use of Drugs

The extent to which physicians and otherprofessional tedical personnel can "treat" nar-cotic addicts by prescribing narcotic drugs has for along time been a source of controversy amongpersons holding different views concerning how todeal with narcotic addiction. Some have contendedthat narcotic addiction is primarily a medicalproblem, and, therefore, that doctors should have arelatively free hand in treating addicts according totheir honest professional judgement, even if thatincludes maintaining a confirmed addict on aregular dosage o7 narcotics. Others have contendedthat narcotic addiction is primarily a legal ornon-medical problem, and, therefore, that main-taining an aldict on a regular dosage of narcotics isnot propel medical practice, but may constituteinstead a violation of the narcotic laws.

Historically, the chief proponent of the latterview was the federal Bureau of Narcotics (now theBureau of Narcotics and Dangerous Drugs in theU.S. Department of Justice), and its interpretationof the Harrison Anti-Narcotic Act of 1914 throl'ghits administrative rules and regulations prevailed tothe extent that few doctors ventured to treataddiction by administering narcotics for fear offederal prosecution. The federal Bureau's positionremains essentially the same in its current regula-tion2 2 which, under the new federal dreg law,continues in effect until modified, superseded, orrepealed.23

Nonetheless, continuing pressure from membersof the medical profession and others appears to becausing stirrings of change at the federal level.Explicit provision is made in the new federal lawfor the Secretary of Health, Education, and Wel-fare, after consultation with the Attorney Generaland national organizations, to determine appropri-ate methods of professional practice in the medicaltreatment of narcotic addiction of various classesof narcotic addicts, and to report thereon fromtime to time to Congress.' Moreover, somerelaxation of the Bureau's former position isevident in the proposed guidelines for methadonemaintenance programs, which were published inJune 1970.2s Reportedly the final version of theserules and regulations will be published soon.

Article 33 of the Public Health Law of NewYork State is relatively non-comn ittal on thequestion whether physicians can prescribe narcot-ics for addicts.

A physician or a dentist, in good faith andin the course of his professional pra, fire only,

may prescribe, administer and dispense nar-cotic drugs, or he may cause the same to beadministered by a nurse or intern under hisdirection and supervision.26

The Department of Health, however, in rules andregulations promulgated in April 1970, is notnon-committal in its interpretation of Sec. 3330.27These rules provide that the administration ofnarcotic drugs to narcotic addicts or habitual usersof narcotics is prohibited, except in the followingcircumstances:

(1) for bona fide patients suffering from incur-able diseases;

(2) for aged and infirm, or severely ill, addictsfor whom withdrawal of narcotics would bedangerous to life;to relieve acute withdrawal symptomsseparate rules detail requirements for bothinstitutional withdrawal treatment and forambulatory withdrawal treatment;

(4) for interim treatment of an aidict on awaiting list for admission to a narcoticfacility; andfor treatment of addicts certified for anauthorized methadone maintenance pro-gramrequirements for methadone mainte-nance programs are set forth in a separaterule.28

Both Sec. 3330 and the rules and regulationsmake clear that a physician or other authorizedpractitioner, by virtue of his professional license,may prescribe narcotic drugs to non-addicts in thenormal course of his practice. Article 33-A con-tains similar general authority to prescribe depress-ant or stimulant drugs.2 9

Various housekeeping requirements are imposedupon physicians and other practitioners by thestatutes and regulations: using written order formsto order narcotic drugs;3° labelling container whendispensing drugs;31 and reporting names and ad-dresses of habitual users of narcotic drugs toCommissioner of Health.3 2

Similar to pharmacists and other professionallicensees, physicians risk suspension or revocationof their licenses to practice when they viclate theprovisions of Articles 33 and 33-A. Also similar topharmacists and other professionals, physiciansmay lose their licenses if they are narcotic ad-dicts.'

(3)

(5)

Possession and Use of Drugs by InstitutionsA hospital, laboratory, maternity home, mater-

nity hospital, nursing home, convalescent home, orhome for the aged may apply to the Department of

96

Health for a certificate of approval for the posses-sion and use of narcotic, depressant, or stimulantdrugs." To qualify an applicant must furnishsatisfactory proof that he is of good moral charac-ter and is equipped to carry on properly thebusiness described in his application." The orig-inal fee for the certificate of approval is $10.00,and the fee for biennial registration with theDepartment is $5.00. The Commissioner mayrevoke or suspend the certificate of approval forcause. 3 6

Possession of Drugs by IndividualsArticles 33 and 33-A. each contain relatively

brief provisions stating that an individual who haslawfully received a narcotic, depressant, or stimu-lant drug from a physician or other authorizedperson may lawfully possess it only in the con-tainer in which it was delivered to him by theperson selling or dispensing it.' 7

Provisions in each article restricting the posses-sion and control of drugs do not apply to thefollowing categories of persons: common carriersor warehousemen lawfully engaged in transportingor storing Jrugs; public officers or employeeswhose official duties require possession or controlof drugs; employees or agents of persons lawfullyentitled to possession.' 8

Record-Keeping RequirementsExtensive record-keeping requirements are im-

posed upon virtually all of the persons authorizedto handle narcotic, depressant, or stimulantdrugs.' 9 Such records are required to be kept for aperiod of two years from the date of the transac-tion, and to be open to inspection only to federal,state, county, and municipal officers whose duty itis to enforce drt.,:; laws .° ° Records of drugsreceived and disposed play a key role in enforce-ment of the drug laws, often providing the onlyevidence or indication of wrongdoing. The inter-relationship between state and federal laws isshown by the provision in Articles 33 and 33-Athat compliance with federal laws requiring thesame information as the state laws constitutescompliance with the state laws.41

Enforcement and PenaltiesIt has already been pointed out that the regula

tory provisions of Articles 33 and 33-A areadministered and enforced by the Department ofHealth through its Bureau of Narcotic Control; andthat, even though representatives of the HealthDepartment still possess by statute all the powers

of peace officers, such powers are actually exer-cised by state and lucal police in enforcing criminalviolations of these statutes. Of course, the HealthDepartment employees render assistance to thestate and local police in the course of criminalinvestigations which usually originate with infor-mation supplied by the Health Department.

With minor exceptions, neither Article 33 norArticle 33-A sets forth a specific penalty forviolation of the article. Each article, however,contains a provision that a violation of the article ispunishable as provided in the Penal Law.4 2 Thisprovision presents no problem in ascertaining thepenalty when the charge is unlawful possession orsale, since the penalties for these charges arespelled out in Article 220 of the Penal Law interms defined by reference to Articles 33 cad33-A. Criminal possession and sale are the mostprevalent drug offenses. If, however, the violationof Articles 33 or 33-A is not criminal possession orsale, then neither the Penal Law nor Articles 33 or33-A seems to answer the question as to what thepenalty is. The complete revision of the Penal Lawin 1965 deleted a section in the old Penal Lawwhich established a general penalty for all viola-tions of the Public Health La.", for which nospecific punishment was prescribed.4 3

The statutes authorize the seizure, forfeiture,and destruction of narcotic, depressant, or stimu-lant drugs when their lawful possession cannot beestablished, or when they have been received orobtained from or by an unauthorized source ormeans, or their title cannot be ascertained."Article 33 also authorizes the seizure and forfeiturea vehicles, vessels, or aircraft used unlawfully toconceal or transport narcotic drugs.45

The interrelationship between state and federallaws, already commented upon, is further illustra-ted by a provision in each state statute that noperson shall be prosecuted for violation of the statelaw if he has already been prosecuted under thefederal laws for an act or omission which wouldconstitute a violation of the state law."

Department of Health's Administraive FunctionsThere follows a brief summary of the New York

State Department of Health's administrative dutiesand activities under Articles 33 and 33-A, Most ofthese functions have been mentioned previously,but it may be of some assistance to consolidatethem.

(1) promulgate rules and regulations, includingthe ?lassification of narcotic, depressant,and stimulant drugs, relying almost entirely

97

on the federal classifications;process applications for licenses and certifi-cates of approval;police licenses and certificate holders forcompliance with statute;suspension, revocation, and reinstatement oflicenses and certificates of approval;inspect records and premises to in3ure com-pliance with statute;refer suspected criminal violations of statuteto state and local police for investigationand possible arrest.

CRIMINAL PENALTIES FORUNLAWFUL POSSESSION AND SALE

The criminal penalties for the unlawful posses-sion and sale of dangerous drugs are set forthalmost entirely in Article 220 of the Penal LaW.4 7Statutes fixing penalties for the possession and saleof apparatus used in taking drugs, such as hypoder-mic needles, are considered latter. With a fewrelatively minor exceptions, the use of a dangerousdrug by itself is not a criminal offense. Thecriminal law reaches the user and others bypunishing for the unlawful possession and sale ofdangerous drugs.

In the complete revision of the Penal Lawaccomplished in 1965, the formerly separate anddisorganized statutes on criminal possession andsale were brought together in Article 220 andrestructured into a unified but complex scheme.4 8Several changes of substance were no.de, but themain accomplishment was the reorganization ofthe offenses into two principal ones, each presented in a degree structure: "criminal possession of adangerous drug" and "criminally selling a danger-ous drug." With the 1969 amendments" whichadded two new offenses at the top of each degreestructure, there are now six degrees of criminalpossession and four degrees of criminal sale. Thefirst degree offense in each structure is the mostserious crime and curies the most severe penalty.The degree of the offense in most cases dependsupon the kind of drug and the quantity possessedor sold.

The offenses range from criminal possession inthe sixth degree (any quantity of any dangerousdrug):.° which is a class A misdemeanor (one yearmaximum term), to criminal possession or sale inthe first degree (16 ounces or more of heroin,morphine, cocaine, or opium),` i each of Ahich is a

class A felony (mandatory maximum term of lifeimprisonment). The 1969 amendments for the firsttime made the most serious drug offenses class Afelonies with the mandatory maximum life term.This exactly doubled the total number of class Afelonies, since the only ones previously weremurder' 2 and kidnapping in the first degree."Although the 1969 amendments became effectivein September 1, 1969, reportedly no one vv,ssentenced to the mandatory maximum life termfor a drug offense until November 1970. TheGovernor's message approving the 1969 amend-ments stressed that they were aimed at thelarge-scale sellers or pushers.'4

"Dangerous drug" is defined in Article 220 tomean any narcotic drug, depressant or stimulantdrug, or hallucinogenic drug.' 5 "Narcotic drug"and "depressant or stimulant drug" in turn aredefined in terms of their definitions in Sections3301 and 3371 respectively of the Public HealthLaw.' 6 "Hallucinogenic drug" is defined in termsof its definition in Section 229 (See 429) of theMental Hygiene Law." There appears to be aninadvertent duplication or overlap with respect tothe definition of "hallucinogenic drug" since theterm "depressant or stimulant drug" is definedbroadly enough in Section 3371 of the PublicHealth Law to include hallucinogenic drugs. Mari-huana is included in the definition of "narcoticdrug" in the Public Health Law. The definitionsshow the interdependence between Article k20 ofthe Penal Law and Articles i3 and 33-A of thePublic Health Law and how the Department ofHealth's classification of new drugs in its rules and

I)egree

Sixth degrec(Sec. 220.05)

Fifth degree(Sec. 220.10)

Fourth degree(Sec. 220.15)

regulations affects the criminal penalties for unlaw-ful possession and sale.

This interdependence is further evident in thedefinition of "unlawfully" ia Article 220. "Unlaw-fully" is defined to mean in violation of Articles33, 33-A, or 33-B of the Public Health aw orSection 229 (See 429) of the Mental Hygiene1_,Lw.' a A person is not guilty of any possession orsale offense in Article 220 unless he "knowinglyand unlawfully" possesses or seils the dangerousdrug in question.

In those offenses in Article 220 in which thedegree of the crime depends upon the quantity ofthe drug possessed or cold, it is worth noting thatno minimum percentage of the pure dangerousdrug is required. These sections only require thatthe total matter or substance in question satisfythe quantity requirement and that it contain someof the dangerous drug. One of the provisions in theformer Penal Law 5 9 required that the substancecontain at least one per centum of the dangerousdrug. This requirement was eliminated in therevision because of the time-consuming quantita-tive analysis needed in addition to the usualqualitative analysis made to determine the presenceof the narcotic drug. Moreover, a study showedthat only a small percentage of samples containedless than one per centum of the narcotic drug.' °

Offenses For Unlawful PossessionFollowing are the six degrees of criminal posses-

sion set forth in Article 220 of the Penal Lawarranged from least serious to most serious:61

Quantity and Other Requirements

any quantity of any dangerous drug

any quantity of any dangerous drugplus intent to sell the same

(a) any quantity of any narcoticdrug plus intent to sell the same; or(b) following quantities of differentnarcotic drugs: marihuana(cannabis, sativa) 25 cigarettesor more or it ounce or more;heroin, morphine, or cocaine 1(8ounce or more; opium '/2 ounceor more: other narcotic drugsounce or more

98

Classificationof Crime

class A misde-meanor (oneyear maximum)

class E felony(four yearsmaximum)

class D felony(seven yearsmaximum)

Degree

Third degree(Sec. 220.20)

Second degree(Sec. 220.22)

First degree(Sec. 220.23)

Quantity and Other Requirements

following quantities of different nar-cotic drugs: marihuana (cannabis,sativa) 100 or more cigarettes or1 or more ounces; heroin, morphine,or cocaine 1 or more ounces;opium 2 or more ounces; othernarcotic drugs 2 or more ounces

8 ounces or more of heroin, mor-phine, cocaine, or opium

16 ounces or more of heroin, mor-phine, cocaine, or opium

As stated before, all of the foregoing quantityrequirements are satisfied if the substance pos-sessed contains any of the dangerous drugs men-tioned.

The unlawful possession of all dangerous drugsother than narcotic drugs i.e., depressant, stimu-lant, or hallucinogenic drugs is punishable onlyunder Section 220.0i; (sixth degree) or 220.10(fifth degree) since the first four degrees applyonly to rv.r,otic drugs. Hence a four-year prisonsentence is the maximum possible punishment forunlawful possession of any non-narcotic drug, nomatter what the quantity.

Although a person unlawfully possessing anyquantity cf any narcotic drug with an intent to sellit normally is charged at least with a fourth degreeoffense (Sec. 220.15) carrying a possible maximumsentence of seven years imprisonment, the fifthand sixth degree offenses are worded broadlyenough to be convenient lesser offenses for purposes of plea bargaining which is extensive in thisarea of the criminal law.

The only statutory presumption in Article 220provides that every person in an automobilecontaining a dangerous drug is presumed to knowingly possess it, except that the presumption doesnot apply: (a) to a duly licensed operator for hire;(b) when one person, who is not under duress,lawfully possesses the drug; or (c) when the drug isconcealed upon the person of one of the occu-pants. 6 2

Offenses For Unlawful Sale of Dangerous DrugsThe definition of "sell" goes well beyond the

ordinary meaning of the word.

99

Classificationof Crime

class C felony(fifteen yearsmaximum)

class B felony(twenty-fiveyears maximum)

class A felony(mandatory max-imum of life im-prisonment)

"Sell" means to sell, exchange, give or disposeof to another, or to offer or agree to do thesame. 6 3

Practically any transfer qualifies as a sale under thisdefinition.

On the following page are the four degrees ofcriminal sale of dangerous drugs set forth in Article220 of the Penal Law arranged from least seriousto most serious.64

As stated before, both of the foregoing quantityrequirements are satisfied if the substance soldcontains some of the drug mentioned.

It is quickly evident that the unlawful sale ofsmall quantities of any dangerous drug is moreseverely punished than the unlawful possession ofsimilar or even larger quantities. Similarly, theunlawful sale of a small quantity of any narcoticdrug (Sec. 220.35) carries a potential penalty morethan twice as severe as the intent to sell the samequantity of the same narcotic drug (Sec. 220.15).At the first and second degree levels, however, thequantity requirements and the potential penaltiesare the same.

Criminal Penalties for Unlawful Possession and Saleof Marihuana

Perhaps the greatest controversy concerning thecriminal penalty structure of Article 220 relates tothe penalties for the unlawful possession and saleof marihuana. No extensive discussion of the Statelaws relating to marihuana is undertaken here asthis subject has been studied and reported on bythe Temporary State Commission to Evaluate theState Drug Laws.

Degree

Fourth degree(Sec. 220.30)

Third degree(Sec. 2k.0.35)

Second degree(Sec. 220.40)

First degree(Sec. 220.44)

Quantity and Other Requirements

any quantity of any

any quantity of any

dangerous drug

narcotic drug

(a) sells any quantity of any nar-cotic drug to a person under 21; or(b) sells S ounces or more of heroin,morphine, cocaine, or opium16 ounces or more of heroin, mor-phine, cocaine, or opium

As noted above, marihuana is included in thedefinition of "narcotic drug" in Article 33 of thePublic Health Law, which, of course, means thatthe unlawful possession and sale of marihuanasubjects the offender to the more serious penaltiesattaching to narcotic offenses generally. For ex-ample, the possession of even a small quantity ofmarihuana with the intent to sell, give, exchange,etc., bears a potential prison sentence of sevenyears.65 If a person acts on that intent and gives orotherwise transfers even a single marihuana ciga-rette to another person, he becomes subject to apossible prison sentence of fifteen yearsl6 6 It isnot difficult to understand why these offenses arenot being enforced in many areas.

Another perspective on the marihuana penaltiesis to compare them with penalties imposed for theunlawful possession and sale of depressant, stimu-lant, and hallucinogenic drugs. Most drug expertsconsider potent hallucinogenic drugs such as LSD,and even many of the so-called "soft drugs" suchas the barbiturates and amphetamines, more dan-gerous than marihuana. Yet the sale of onemarihuana cigarette risks a prison sentence offifteen years,67 whereas the sale of a large quantityof LSD or one of the "soft drugs" is punishable bya maximum prison sentence of seven yearsI66Whether or not one believes that the marihuanapenalties are too high, one must agree that therelative penalties for marihuana and some of themore potent depressant, stimulant, and hallucino-genic drugs are out of balance.

The classification of marihuana as a narcoticdrug in the Public Health Law steins from earlierfederal laws which lumped marihuana together

Classificationof Crime

class D felony(seven yearsmaximum)

class C felony(fifteen yearsmaximum)class B felony(twenty-fiveyears maximum)

class A felony(mandatory maxi-mum of life im-prisonment)

with the narcotic drugs. The new comprehensivefederal drug legislation still classifies marihuana inSchedule I of the controlled substances togetherwith narcotic drugs such as heroin, but it reducesconsiderably the penalties for possession and saleby treating it as a non-narcotic drug for punish-ment purposes.69 Moreover, the new law estab-lishes a commission to study the marihuana lawsand to make a report with recommendations in oneyear.7 0 the last two or three years, many states,Inincluding New Jersey, have reduced the penaltiesfor possession and sale of marihuana, particularlyfor first offenders.7I

Miscellaneous Drug OffensesIn addition to the main control scheme in

Articles 33 and 33-A of the Public Health Law andthe basic penalty structure for the unlawful posses-sion and sale of dangerous drugs in Article 220 ofthe Penal Law, there are a number of miscellaneousdrug offenses located in those articles and else-where in the statutes. Some of these provisionsduplicate or overlap one another or the provisionsin the Public Health Law or the Penal Law alreadydiscussed; others are distinct. Most of these miscel-laneous offenses are narrow in scope and do notneed further explanation. Hence, only a couple ofthese offenses will be discussed at any length.

These miscellaneous drug offenses include thefollowing:

(1) Smoking or inhaling opium, or possessingopium pipe or other apparatus for smokingor inhaling opium. 7 2 Punishable as providedin th(- Penal Law.' This is one of the rare

statutes making use of a dangerous drug byitself a criminal offense. As stated above,most statutes penalize only the possessionor sale of the drug.

(2) Unlawful possession or sale of hypodermicsyringe or needle; or unlawful possession ofother instrument for administering narcoticdrugs." Punishable as a class A misde-meanor (one year maximum)." Accordingto drug arrest figures prepared by the NewYork City Police Department, arrests forthis offense during the last three years(1968, 1969, and first 9 months of 1970)amount to approximately 10% of the totaldrug arrests and rank third behind arrestsfor the possession and sale of heroin andmarihuana.76 Of course, many arrests forthe possession or sale of hypodermic instru-ments probably occur at the same time asarrests for the possession or sale of heroin."Glue sniffing" statute unlawful inhala-tion, use, possession, or sale of glue contain-ing a solvent having the property of releas-ing toxic vapors or fumes.77 Sale is punish-able as a class A misdemeanor (one yearmaximum); other offenses are punishable asviolations, with a maximum imprisonmentof five days and/or a $50.00 fine.7 8Growing marihuana without a license:9Punishable as a class A misdemeanor (oneyear maximum)."Operation of motor vehicle while ability isimpaired by use of a drug," "Drug" isdefined in the Vehicle and Traffic Law toinclude a depressant, hallucinogenic, narcot-ic, or stimulant drug essentially as thesedrugs are designated by the Commissionerof Health under Article. 33 and 33-A of thePublic Health Law.82 First offense punish-able as unclassified misdemeanor,83 with amaximum imprisonment of one year and/or$500.00 fine. Second offense punishable asclass E felony (four years maximum)."Any person who operates a motor vehicle inthe State is deemed by law to have given hisconsent to a chemical test of his breath,blood, urine, or saliva for the purpose ofdetermining the alcoholic or drug content ofhis blood." If a person is convicted ofoperating a motor vehicle while his ability isimpaired by the use of a drug, his driver'slicense must be revoked and his certificateof registration as an owner may be re-voked.8 6

(3)

(4)

(5)

a

101

(6) Piloting an aircraft, or serving as a memberof the crew, while under the influence ofdrugs!' 7 This statute also prohibits carryingany person in an aircraft who is obviouslyunder the influence of drugs, except amedical patient under proper care or in caseof emergency. Punishable as an unclassifiedmisdemeanor,88 with a maximum sentenceof 90 days and/or a fine of $100.00.Operation of a snowmobile while under theinfluence of narcotics or drugs.89 Punish-able as a violation with a fine of not lessthan $5.0f, and not more than $100.00."

(8) Knowingly permitting a child less than 18years old to ei'ter or remain in a place whereillegal narcotics activity is maintained orconducted." Punishable as a class B misde-meanor (three months maximum imprison-ment).Loitering for purpose of unlawfully using orpossessing a dangerous drug.9 2 Punishableas a class B misdemeanor (three monthsmaximum sentence). This offense is dis-cussed below.

(7)

(9)

'mitering for Purpose of Using or PossessingDangerous Drug

The offense of loitering for the purpose of usingor possessing a dangerous drug deserves furtherdiscussion because arrests for this offense consti-tute such a large proportion of narcotics and drugarrests in New York City, and the overwhelmingnumber of arrests for this offense are dismissed bythe district attorneys. On September 1, 1968 theclassification of the loitering offense was raisedfrom a violation (15 days maximum) to a class Bmisdemeanor (three months maximum). Arrestfigures compiled by the New York City PoliceDepartment show that there were 33,078 drugarrests on misdemeanor charges in 1969, including13,304 arrests for loitering. Arrest statistics for thefirst nine months of 1970 show that both of thesefigures had already been exceeded.' 3 It is estimatedthat 85-90 percent of the loitering charges aredismi ssed.94

Why do the police make so many arrests forloitering, and why are so many of the chargesdismissed? Several reasons have been given. Tounderstand better the position of the police, oneshould realize the extent of public pressurebrought upon them to remove the pushers andaddicts from the streets and public places. Policeofficials stated that the principal and continuing

complaint of the public relates to the publicpresence of pushers and addicts on the streetcorners, sidewalks, and public portions of build-ings. Charges for unlawful possession and salebased simply on observance of the presence andtransfer of drugs from a distance have beendifficult to prove in court, and many of such caseshave been dismissed. The best way to make suchcases is by undercover work in which the police-man or undercover agent makes a purchase from apusher of drugs. But, undercover work takes timeand does not really cope with the public scenedescribed. Under the circumstances, a loiteringcharge is a natural temptation to the police. Even ifthe charges are dismissed, the immediate objectiveof clearing the streets is accomplished.

Whatever the reasons for the vast number ofloitering arrests, the New York City Police Depart-ment apparently has become convinced that theloitering law was being misapplied, and has issuednew guidelines advising the police on how to applythe law.95 The three-page departmental directivesent to all police commanders stated that the City'sprosecutors had reported that

the vast majority of arrests under Section240.36 of the Penal Law do not meet theminimum requirements of the statute andconsequently do not make out a prima faciecase.

Arrests not meeting such standards havebeen characterized as unwarranted and unlaw-ful by the District Attorneys.96

The order stated that the new guidelines werebeing issued

to assure the protection of the rights ofcitizens, to avoid court congestion by elimin-ating arrests which do not make a prima faciecase, to fully cooperate with the DistrictAttorneys of New York City and to conservePolice Department man-hours.97The directive went on to specify the elements

102

1J4

that must be present before a policeman can makean arrest for loitering for the purpose of using orpossessing a dangerous drug.

Intention may be inferred only from thepresence of dangerous drugs or paraphernaliacommonly associated with dangerous drugs,such as a bottle cap, eye dropper, emptyglassine envelope, etc., and accompanyingcircumstances excluding every possibility ex-cept intent to use or possess a dangerous drug.

No person should be arrested unless thecircumstances are such to exclude every pos-sible reason for his presence except suchintent.9 8

Addiction or Excessive Drug Use As Grounds forRevocation or Suspension of Professional Licenses

Closely akin to the criminal penalties consid-ered above is the civil penalty of having one's stateor local license to practice a particular professionor business revoked or suspended on account ofnarcotic addiction or excessive drug use. Althoughcivil in nature, such penalty can be as severe ormore severe than a criminal penalty. Severalstatutes make narcotic addiction or habitual use ofa habit-forming drug grounds for revocation orsuspension of a license to practice a particularprofession or to conduct a particular business.

(a) narcotic addiction as grounds for revocationor suspension:(1) physician, osteopath, or physiothera-

pisti9 9(2) pharmacy;' °°(3) nursing;' °I(4) podiatrist.' ° 2

(b) habitual use of a habit-forming drug asRounds for revocation or suspension:(1) hairdressing and cosmetology or con

` =''.; ducting a beauty parlor,' °J(2) barbering or conducting a barber

o 4shop.

FOOTNOTES FOR APPENDIXON N. Y. STATE DRUG LAWS

'N. Y. Codes, Auks and Regulations, Title 10, Secs.80.1-80.72 (narcotic control); 81.181.92 (depressantand stimulant drug control).

2Public Health Law, Secs. 3354(2), 3393(2).

3Public Health Law, Sec. 3350(3).

4Sec. 3301(38).

s N. Y. Codes, Rules and Regulations, Title 10, Sec. 80.48.

6Sec. 3371(1).

1N. Y. Codes, Rules and Regulations, Title 10, Sec. 81.48,

8Sec. 3374.

9Secs. 3305, 3373.

I °Penal Law, Sec. 220.00(6).

I 'Secs. 3310, 3375.

I2Secs. 3312, 3377.

3Secs. 3313, 3378.

"Secs. 3320, 3380.

I sSecs. 3325(1), 3383(1).

16Secs. 3322, 3381.

2N, Y. Codes, Rules and Regulations, Title 10, Sec. 80.31.

Jo` 18Secs 3322, 3325(2), 3381, 3383(2).rr19N. Y. Codes, Rules and Regulations, Title 10, Secs,

80.2580.33 (narcotics), 8125-8132 (depressants andstimulants).

2°Sec. 3324

21Education Law, Sec. 6804(1)

22Code of Federal Regulations, Title 26, Sec. 151 392.

"Pub Law 91513, Sec 705.

103

.411. As:owe:wt.., WC+ r

24Pub. Law 91.513, Sec. 4.

25Federal Register, Vol. 35, No. 113 Thurs., June 11,1970, p. 9015.

26Sec. 3330.

21N. Y. Codes, Rules and Regulations, Title 10, Secs.80.17-80.23.

28/bid., Sec. 80,19.

29Sec. 3385.

30N. Y. Codes, Rules and Regulations, Title 10, Sec. 80.15.

3ISecs. 3325(3), 3383(3).

32Sec. 3344.

33Education Law, Sec. 6514(2) (b), (c).

"Secs. 3311, 3376.

35Secs. 3312, 3377.

36Secs. 3313, 3378.

37Secs. 3331, 3386.

"Secs. 3332, 3387.

39Secs. 3333, 3388; N. Y. Codes, Rules and Regulations,Title 10, Secs. 81.80.81.87.

40Secs. 3334, 3389.

"Secs. 3333(9), 3868(7)

2Secs. 3354(2), 3393(2).

43Penal Law of 1909, Sec. 1740.

"Secs. 3352, 3392

4s Sec 3353.

"Secs. 3354(3). 3393(3) See Peop?e ex ret Liss t'Superintendent of Wornen's Prison 2s2 N. Y 115. 25 NE 2d 869 (1940)

4 'For two exceptions, see Public Health Law, Sec. 3396("glue sniffing") and Mental Hygiene Law, Sec. 229 (See429) (hallucinogenic drugs).

8See Practice Commentary for Article 220 in McKinney'sConsolidated Laws.

49Chs. 787 and 7813, .,aws of 1969.

5 °Penal Law, Sec. 220.05.

51Penal Law, Secs. 220.23, 220.44.

52Pena1 Law, Sec. 125.25.

53Penal Law, Sec. 135.25.

54For the Governor's message, see McKinney's SessionLaws, 1969, Vol. 2, p. 2560.

55Penal Law, Sec. 220.00(4).

s6Penal Law, Sec. 220.00(1), (2). See discussion above.

5 "Penal Law, Sec. 220.00(3).

54Penal Law, Sec. 200.00(6).

59Penal Law of 1909, Sec. 1751(3).

"See Practice Commentary for Sec. 220.15 of the PenalLaw in McKinney's Consolidated Laws.

"For a complete table of drug offenses arranged by drugand quantity, see Sentence Chart VI in McKinney'sConsolidated Laws of New York Annotated, Book 39,Penal Law, 1970-1971 Cumulative Annual Pocket Part,pp. 21-22.

62Penal Law, Sec. 220.25.

63Penal Law, Sec. 220,00(5).

64See complete table of drug offenses referred to in note61 supra

75See Penal Law, Sec. 55.10(2)(b).

76See Exhibit IX.

'Public Health Law, Sec. 3396.

78See Penal Law, Sec. 55.10.

"Public Health Law, Sec. 3315.

8 °See Penal Law, Sec. 55.10(2)(b).

81 Vehicle and Traffic Law, Sec. 1192(4).

82Vehicle and Traffic Law, Sec. 114-a.

83See Penal Law, Sec. 55.10(2)(c).

84 See Penal Law, Sec. 55.10(1).

85 Vehicle and Traffic Law, Sec. 1194.

86 Vehicle and Traffic Law, Sec. 510(2) (a) (iii).

8 General Business Law, Sec. 245(7).

84See Penal Law, Sec. 55.10(2)(c).

89Conservation Law, Sec. 8-0303(1)(c). This statute refersto Sec. 114-a of the Vehicle and Traffic Law for thedefinition of "drug."

9 °Conservation Law, Sec. 8.0409.

91 Pens ._,aw, Sec. 260.20(2).

92Penal Law, Sec. 240.36.

93See Statistical Reports prepared by Planning Division ofCrime Analysis Section of New York City Police Depart.ment.

94See N. Y. Times, November 2, 1970, p. 43.

65 Penal Law, Sec. 220.15. 951d

66Penal Law, Sec, 220.35. 961d.

67fd. "Id.

68 Penal Law, Sec. 220.30. 981d

69Pub Law 91-513. 84 Stat. 1136, Secs. 202, 401, 99 Education Law, Sec. 6514(2)(c).

"ibid., Sec. 601. 199Education Law, Sec. 6804(1).

I See N. Y. Times, November 1, 1970. 101 Education Law, Sec 6911(1)W.

72Public Health Law, Sec. 3343. 102 Education Law, Sec. 7011(1)(c)

"Public Health Law. Sec 3353(2). 193General Business Law, Sec. 109(a)

74Public Health Law. Sec. 3395; Penal Law, Sec 220.45. 194General Business Law. Sec 441(a)(3)

101

APPENDIX CAGENCY RESPONSE

Preliminary draft copies of the program audit,Narcotic Drug Control in New York State, weresent to the agencies primarily involved, the Narcot-ic Addiction Control Commission and the StateEducation Department with the request that theymake whatever corrections or comments theyconsiderei appropriate. Subsequent to the receiptof this information, either changes were made inthe text of the report or the comments areincluded in the pages which follow. This assistancefrom the agencies involved is indeed appreciated.

105

No attempt has been made to carry on a debatewith the agencies concerning the merits of all thecomments. The objective of the audit is to providematerial which will be of most assistance in thelegislati:te process. Differences in analysis of ma-terials or degrees of emphasis are frequent whereindividuals are involved and occasional decisionsmay be based on "facts" which are not weightedequally by all who view them. This is indigenous tothe dynamics of government.

THE UNIVERSITY OF THE STATE OF NEW YORKTHE StATE EDUCATION DEPARTMENT

OFFICE OF THE PRESIDENT OE THE UNIVERSITY

ANU COMMISSIONER OF EDUCATION

ALBANY, NEW YORK 12224

FridayMarch 519 71

The Honorable Warren M. AndersonChairman, Legislative Commission

on Expenditure Review111 Washington AvenueAlbany, New York 12210

Dear Senator Anderson:

COPY

In mid-February, Mr. Troy R. Westmeyer, Director of the Legis-lative Commission, sent me a draft copy of the report on narcotics con-trol. We thank you for the opportunity to make the following commentson the draft copy.

We have commented in three ways. First, in the main body ofthis letter, I summarize the accomplishments of the State EducationDepartment's Drug Education Program and comment on the overallquality of this study. No summary appears in the study and I believe itis important to have a short statement relating the resources availableto the accomplishments. In Attachment A to the letter, we have commentson those pOrtions of the report which deal explicitly with programs admin-istered by this Department. In Attachment B to the letter, we commentbriefly on other portions of the report which do not involve our Departmentas the primary administrator. It is our understanding that you will wantto publish the comments of the agencies as part of the final report. Wesuggest that the letter and both Attachments A and B be published.

We are pleased to report progress in implementing our five-partDrug Education Program. These accomplishments have been made withina very difficult time frame. Even though a lump sum appropriation of$2 million for The Interagency Drug Information Program was made inApril of 1970, the allocation to our Department of $1. 1 million was notreceived Lntil June 25, 1970. This made it extremely difficult to launchsummer training programs.

106

128

The Honorable Warren M. Anderson -2- March 5, 1971

Our programs are reaching these targets: (1) 875 individuals weretrained in Summer School-Community Team Workshops; (2) InserviceTraining of 7500 elementary and secondary teachers is being accomplishedthis school year through 150 trainers whom we have trained; (3) In-depthTraining for 189 health educators was completed last summer and 100additional individuals are presently in training; (4/ College VolunteerPrograms are operating on 11 campuses with 300 volunteers participating;and, (5) guidelines and curricular materials are being provided to theelementary and secondary schools of the state. In addition, this same staffhas been and is now offering technical assistance and reviewing projectapplications for educational projects as part of the $65 million programfor Youthful Drug Abuse. These programs have been administered bya full-time staff of six persons in the Department.

WE commend the Commissio,1 staff for its second report. Thenarrative is clear and understandable. We would suggest that you includea summary section at the close of each chapter as you did in the ManpowerReport. In addition, as we suggested in our previous response, it wouldbe useful if the report included recommendations.

Again, thank you for the opportunity to review and comment on yourstudy.

Attachments

cc: Troy R. Westmeyer

107

129

Fait ully yours,

wald B. Nyquist

ATTACHMENT ACOMMENTS ON PROGRAMS

ADMINISTERED BY THE STATEEDUCATION DEPARTMENT

1. On page 60 regarding an erroneous descriptionof "Strand II", we suggest the following substi-tute: "At the outset the State Education De-partment was concerned with the developmentof curriculum for Sociological Health Problems(Strand II) with substrands on alcohol, tobaccoand drugs. The curriculum utilized a conceptualframework and espoused a student-centeredclassroom orientation and peer approach. TheNational Clearinghouse on Drugs has selectedStrand II of the New York State curriculum asone of two outstanding state curricula that theyare disseminating nationally. The selection ofthe New York State materials was made for theNational Clearinghouse by an inter-disciplinarygroup of nationally recognized professionals inthe drug area. Current efforts to update StrandH are budgeted at $30,000 and are aimed atimproving a good piece of curriculum to makeit even better."

2. On page 60, there is a statement that we havereversed our objectives regarding the teachingprogram for health educators; we feel that thefollowing clarification is necessary. There hasbeen no reversal of the original intent in thetraining programs for non-health teachers. Theretraining of certified teachers is an importantinitial step in the task of preparing an adequatesupply of qualified health instructors. The Staterequirement that subsiuizPrl teachers wouldhave to be involved in two or more healthcourses in the school was for the purpose ofallowing the schools to utilize the services ofthe newly trained personnel as quickly aspossible in a much needed curriculum area.Because of limitations of staff availability at theinstitutions that conducted the program, andthe fact that other institutions which mighthave participated were not prepared to do so,the summer training of the original number ofteachers was not possible. The 81 that weretrained plus the 60 currently in training wasvery close to the original number planned.

Therefore, the fourth paragraph on page 60 shouldread: "This past summer, 189 teachers were in-volved in the program and plans are underway tobegin the training of additional teachers during the

108

1970.71 school year. The ultimate objective is toplace in each school a person with the expertise ofthe educator and the content background of ahealth professional. The State, after September,introduced the additional stipulation that moneyfor the training courses continue to be paid toteachers who had begun their training only if theywere involved in two or more health courses aweek in their particular school. Requests byteachers to be included in this program have beenrapidly increasing, and the State Education Depart-ment is seekirg to expand the current program byadding six more institutions of higher education tothe current six institutions so that there would be atotal of 12 institutions of higher education in-volved with this program. Budget permitting, thisprogram can be easily doubled if not tripled andconsiderably augment the ranks of qualified healthinstructors."3. On page 60, there is a statement "The teachers

already trained are not having the impact thatwas originally projected." Based on uur follow-up, we feel that the number of school districtsthat have not promoted local inservice programshas been minimal. A follow-up is being done todetermine why the school administrators madea commitment to send someone fu: suchtraining and then inhibit the use of suchpersonnel. On the other hand, in the majorityof school districts the grant for the use of thetrainers is such that the number of teachers tobe reached by this program may exceed originalestimates.

4. On page 61, the following is provided forclarification purpoo.es regarding the section onschool-community workshops.The school-community workshop program wasnot handled by just; one organization (Educa-tional Dynamics) as indicated in the report. Thevarious workshops were handles by SyracuseUniversity, the State University College atPlattsburgh, the Title III Unit in New YorkCity, as well as tae Educational DynamicsCorporation.

As far as attempting to evaluate the exact effectand impact of the trained school-communityteams on their particular communities, there areno instantaneous cures in drug abuse preven-tion. However, observations expressed in thesubmitted workshop reports include the state-ment that programs developed in the variouscommunities represented were a direct result ofworkshop inputs. Wotkshop participants wereutilized in many ways such as consultants fororganizing and implementing drug abuse preve

130

tion programs and panel members for inserviceworkshops.

5. On page 61 of the draft report, the Commis-sion staff imply a criticism in that the CollegeVolunteer Program has only funded one pro-gram in New York City. We are presentlysupporting one program in Staten Island Com-munity College and anticipate contracting withPace College in the coming year. The reason fornot having more programs is that colleges inthat environment are more concerned withrehabilitation and treatment programs thanwith prevention. Since their interest is suchprograms, we have centered our efforts onassisting them in getting projects approvedthrough the $65 million program for YouthfulDrug Abuse.

6. Page 61 of the.he report indicates that theCollege Volunteer Program is limited. It mustbe understood that at the time we began thisprogram there were only ten campuses thatwere either effectively organized or ready toorganize such a program. The development ofthe programs has been very careful and deliber-ate. We estimated that we would have 10-20campuses and 300+ volunteers. In fact, thereare 11 campuses with 200 volunteers.

7. On page 61, the staff appears to be question-ing the assumptions underlying local projects. Itis extremely difficult to establish an easilyidentifiable pattern or profile of a potentialdrug user. There is little doubt that the need forpeer acceptance and for socialization are im-portant contributing factors in drug use. It isalso understandable that youngsters feel moreable to communicate with their peers to discussthe problems that trouble them, such as war,poverty, marriage, etc., that are germane to theproblem of drug abuse. The peer group tech-nique is effective because students can relate toone another and not have the emotional tensions of the parent/child or teacher/studentsituation.If teaching were simply a matter of impartinginformation, the educator's task vi ould berelatively simple. Teachers today must be awareof "their students" needs, fears, expectations,capabilities and acquire, through training, avariety of student-centered approaches that willhelp their youngsters develop positive attitudesand effective modes of behavior for solvingtheir problems in today's complex society.

8. Under the section on Evaluation of the StateEducation Department Programs, in the lastparagraph there is the indication of a prospec-

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tive 25 -fold increase in funding. While thisDepartment hopes this is true, the only indica-tion it has thus far is that the program will bemaintained at the previous year's funding levelof $1.1 million. The statement, "that anyeducational program be carefully planned andtested before it is implemented statewide",implies that education programs of this kindhave never been in practice in New York State.We have, in fact, had some 25 years ofexperience with various programs around theState serving as models. This would seem to besufficient basis for the extension of this pro-gram to all schools in the State.

9. On page 8 of the draft report, it is suggestedthat the following be added for clarificationpurposes: Second from last paragraph begin-ning "Since 1966, not only NACC... "add"The Critical Health Problems Law, Chapter 737of the Laws of 1967 allocated only $200,000 tothe State Education Department to supportdrug education activities, an inadequate sum fora vast undertaking. In 1970.71 the s-pn of $1.1million was allocated to the State EducationDepartment, indication of the growing aware-ness that preventive education for youth shouldbe a major thrust of the total State program."

ATTACHMENT BCOMMENTS ON PROGRAMS NOTADMINISTERED BY THE STATE

EDUCATION DEPARTMENT

1. Vocational Rehabilitation Portion of NACC'sProgram

On page 34 of the draft report, mention is madeof the vocational rehabilitation portion of theNACC's Program. Since the Education Dcpartmenthas had such a successful program in this area,NACC has been in touch with us regarding theirefforts. They indicate that they lack the capacityto offer a full range of occupational trainingactivities and also the ability to follow up with theindividual after he is released from their institu-tions. Presently, the Education Department iscooperating with NACC in two areas by offering aprogram for approximately 60 individuals. Wewould like to expand our programs in this area byhousing our counselors in their facilities as we arebeginning to do with the Department of MentalHygiene. The main problem prohibiting us frommoving faster is the lack of State funds.

2. NACC's Education ProgramOn page 58 of the draft report the NACC's

educational program is discussed. Since their pro-gram is prevention oriented as is ours, naturaloverlap is bound to occur with the State EducationDepartment's program which has the same objec-tive. There is a need, we feel, for a well-focused,comprehensive, and singularly administrated pro-gram that addresses the needs of all individuals bethey school age, college, adults or parents. Sincewe already deal with all of these groups and theevidence in the draft report seems to indicate aneed for such a comprehensive program, we feelthat a consolidation of programs should be con-sidered at this time.

3. Youthful Drug Abuse Treatment Programa. On page iv of the report, the last paragraph is

erroneous. It should read: The changes inguidelines to permit a portion of the $65million NACC appropriation for YouthfulDrug Abuse Treatment Program for prevP.-Dive educational programs in the schools havenow, by agreement with NACC, given theDepartment added responsibility in cooperat-ing with NACC in providing assistance in the

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development of effective school - communityeducation programs for prevention of drugabuse and in review of applications for suchprograms. The State Education Departmentprograms have been directed primarily atelementary and secondary school students,and parent and adult education. The focus ison curriculum development, teaching tech-nique development and teacher-training pro-grams in narcotics education.

b. On page 62, the report criticizes the qualityof the local educational programs beingfunded from the $65 million. By agreementwith NACC all school drug abuse preventionprograms included in proposals submitted toNACC for funding under the $65 millionallocation are meant to be reviewed by theState Education Department. Of the pro-posals are found wanting in any way, theState Education Department notifies NACCand confers with local schools and assiststhem in developing acceptable proposals. Noproposal is recommended by the Depart-ment to NACC unless it is well conceived.The Department role is advisory. Decisionsare made by NACC.

MILTON LUGERCHAIRMAN

STATE 07 NEW YORK

NARCOTIC ADDICTION CONTROL COMMISSION

EXKUTEIE PARK SOUTH

ALBANY, NEW YORK 12203

Ne. Tray R. WestmeyerDirectorLegislative Ccunissicn on

Expenditure Review111 Washington AvenueAlbany, ti-L.York 12210

Dear Mr. S)(!isers er:

March 5, 19 71

COPY

Enclosed is a preliminary response to the ProgramAudit prepared by the Legislative Commission onExpenditure Review. It is preliminary in the sensethat it does not represent a "finished" typing job,nor does it represent a oomplete reaction to thedocumnt. It is expected that additiina1 commentswith regard to law enforcement and the courts, wellas specific clarifications and comments on fiscal andother statistical data will be forwarded to you onMonday, March 8, 1971.

It was decided to forward this preliminary responseto you today in order that your staff could initiate thereview of our reactions as soon as possible.

IV roc

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Sincerely,

Li(Milton LugerChaim en

MILTON LUGER

F TERRENCE M

3ANTIA30 GREVI

ARTHUR J ROGERS

HCNARD A JONES

STATE OF NEW YORK

NARCOTIC ADDICTION CONTROL COMMISSIONEXECUTIVE PARK SOUTH

ALBANY. NEW YORK 12203

Mr. Troy R. WestmeyerDirectorLegislative Commission on

Expenditure Review111 Washington AvenueAlbany, New York 12210

Dear Mr. Westmeyer:

March 8, 1971

RAYMOND 'WICKHAM

COPY

As indicated in Milton Luger's letter to you datedMarch 5, I am forwarding additional materials relativeto your Carrission's report on the Narcotic AddictionControl Commission.

Because of public interest engendered by repotsby the New York County District Attorney and Mayor Lindsay'sCoordinating Council on Criminal Justice; which focusedon the certification process, Mr. Luger requested theCamussion's Counsel to prepare an in-depth cartmntary onChapter IV of your report, "Certification of Addicts."This carrientary and a detailed statement on fiscal andstatistical data are enclosed.

Staff members of this Carmission are prepared tomeet with mothers of your staff to furnish any additionalcarment and clarification which you my require.

144, /pmt

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Sincerely,

ymind WickhamEir4t Deputy Caardssioner

REACTIONS TO THE REPORT OFTHE LEGISLATIVE COMMISSION ON

EXPENDITURE REVIEW

The Report of the Legislative Commission onExpenditure Review is by and large, a fair andbalanced summary which makes for informativeand interesting reading. Since the Preface indicatesthat the report is designed to provide the Legisla-tive Commission with information as to the currentstatus and progress of New York State's existingprograms dealing with narcotics and other danger-ous drugs," it is essential that some of the pointsmade by the report be clarified if it is to representan accurate and up-to-date description of whatNACC is doing today.

The positions taker: represent several differentorders of inaccuracy. Spnifically:

1) Some sections of the report reflect theoperation of NACC as of a year ago or evenas recently as a half year ago, but do notadequately convey the "current status ofactivity." It would be important, therefore,for the report to be updated so that itdescribes what is, in fact, operational today.

2) C.ner areas do not adequately present therationale under which NACC is operating.This is expecially true in relation to the kindsof treatment services encompassed by theprogram: the impression conveyed, for ex-ample, is that it is largely a matter of levelsof security, that there is only slight variationfrom facility to facility. The fact is that avery different rationale is being pursued --namely that of the multi-modality, comprehensive approach to treatment, which wouldencompass the NACC components, as well asa wide range of funded and accreditedagencies in the community, a point whichwill be clarified in the material which fol-lows.

3) A motif which recurs throughout the reportpertains to the lark of knowledge whichprevails in the addiction field. While this lackof knowledge reflects the "state of the art"everywhere - it is at times presented a if itwere an individual shortcoming of the NACCprogram. NACC is well aware of the knowl-edge gaps which exist and is 'abating to fill inthese lacunae as expeditiously as possible.

4) There are sections which present a verydistorted picture and need to be corrected.This is especially true of the discussion ofMethadone maintenance.

Need for Updating of the ReportThe impression conveyed by the report is that

no provision has been built into the NACCtreatment progom for evaluation both of its ownprogram and those of the funded agencies. Nothingcould be further from the truth at this point sincethe basis for very careful evaluation and follow-uphas been laid. In fact, neither the primary datasystem nor the required reports from the privateagencies can be characterized as providing a lack of"hard data other than basic demographic statis-tics."

The following is a description of the Commission's statistical system which has unique com-ponents far exceeding typical demographic sys-tems:

1) NACC Primary Data System - The currentNACC data system has four interrelatedcomponents which characterize the addic-tion-rehabilitation-outcome process. Thesefour components... the intake personal his-tory, the intramural involvement/ adjustmenthistory permit the Commission to describeits program participants, its interventions andthe outcomes of these efforts more fullythan any other large scale system. Models forsuch a system did not exist in 1966 norcould one have been constructed without theaccumulation of experience servicing clientsin a compulsory civil commitment programand without the r,equisition and wedding ofmature systems developers and professionaldrug researchers/clinicians. The significantelements within each of the four componentsare as follows:

a) Personal History (Intake)Age; sex; ethnicity, place of birth;

permanent residence; occupation; socialsecurity number; marital status; educa-tion; religion; previous treatment history;arrest history; drug use history; mtdicalhistory; etc.

b) Intramural Involvement AdjustmentDuration and extent of individual

counseling and group counseling; indicesof emotional state and psychiatric dis-order; assessments of interpersonal rela-tions, ability to work with others andreactions to adverse situations: historiesof behavior on passes and wadm releaseprograms; assessments of the level ofunderstanding of past behaviors; assess-ments of various psychosexual factors;results from educational and vocationaltestings; I.Q.; pre-release plans; any un-

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usual incidents; prognosis; etc.c) Aftercare Adjustment

Every three months, reports are for-warded for each rehabilitant which in-clude the amount and types of contacts;the reporting schedule and record; anindication of involvement in NACC spon-sored programs; current residence; resi-dential situation; employment situation;drug usage (suspected, reported and/orconfirmed); arrest situation; etc.

d) Follow-upThe NACC system has been defined to

include a follow-up of oil decertifiedclients through the major data systems inthe state, i.e., NYSIIS; Mental Hygiene;etc. In addition, all decertified individualswill be "at risk" for a physical follow-uowhich will assess the client's major roleconstellations: work, family, criminality,drugs, peers, etc.

At the present time, five scientists and foursupport staff (cut of 25 1/2 positions in theNarcotic Control Commission's research bureau)have the maintenance of these systems and theanalyses of the data which has been outlined, astheir primary tasks. While not all of the fourcomponents were fully operational at the time ofthe Legislative Commission on Expenditure Reviewsurvey, components "a" and "b" were operational,"c" was in a pretest phase and "d" was designedand discussed with the legislative commission'sinvestigators.

Standardized psychological testing for all new-ly-certified addicts began 3/1/71 and will be asignificant addition to component "b". A socialpsychological battery is undeigoing a pretest whichincludes aspiration and motivation scales for pos-sible use as future screening discriminators.

2) Funded Agency Data Inputs - The currentreporting forms required of all privateagencies receiving monies from NACC reflectmajor tevisioas instituted more than sixmonths ago. These revisions were made incollaboration with research directors fromsome of the larger agencies specifically to getbeyond the collection of bookkeeping statis-tics.

In addition to the standard demographic attri-butes (age, sex,race, etc.), the revised intake formspursue with some depth the drug history, treat-ment history and criminal involvement of theclients. At the time of termination, the agenciesprepare a form indicating the various types andextent o1 services provided the client.

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3)

a)

b)

These two data inputs provide the basefor the statistical evaluation of eachagency's efforts. These two new inputsbecame necessary when an initial statistical evaluation was attempted and foundlacking.

It would appear appropriate to indicatethat the Commission's evaluation of theseagencies shortly will include three addi-tional components: the completion of astandardized questionnaire by eachagency wherein they can indicate theirperceptions of their service, any unique-nesses which it may contain and thesuccesses/problems they have encoun-Ored; the physical follow-up of a sampleof their successes/failures by bureau ofresearch scientists (its standard follow-upprocedures and instruments will be uti-lized); and a team of independent non-aligned observors will asslst in the reviewof all three sets of data and in determin-ing levels and types of outcomes.

Multi-modality RationaleIn evaluating pro-grams a major NACC mission is the devel-opment of a comprehensive treatment ap-proach with a variety of modalities and adetermination of which individuals will havethe highest probability of success in whichprogram. The primary data system institutedwill provide a basis for the eventual realiza-tion of this goal and the development ofobjective effective criteria for the screeningand referral of patients. This mission hasbeen reinforced by placing clients withindefinable cohorts by comparable exposures.Thus, the Commission's research bureau iscurrently following the careers of rehabili-tants in a number of cohorts such as thosedescribed below, which will be comparedwith all other cohorts:All rehabilitants released to the aftercarephase during each six month period be-come a cohort, and each cohort is com-pared with all others.Rehabilitants have been randomly placedin the intramural program, the half-wayhouse program and directly to aftercarethereby becoming cohorts who receivedinitial exposure at various places on the"continuum of care" provided by theCommission.

c) Individuals have been placed in theMethadone maintenance modality with ahighly selective protocol and with noselection criteria.

d) All age, sex, race and types of drug usergroups be,nne standardized cohorts.

e) Rehabilitants have been placed in cohortsdefined by treatment attributes; length oftime in the intramural phase, amount offormal therapy/counseling, etc.

Analytic techniques include multivarient,factor, configural, correlational and processanalyses. In brief, an appropriate data systemhas been defined and isolated comparativecohorts established as a basis for accumulat-ing the analytical skills to accomplish themission of delineating the appropriatemodalities for different kinds of clients.

Areas Requiring Further ClarificationOn Page 36, the report mentions that "it is

difficult to consider the NACC treatment andrehabilitation programs as composed of severalseparate and distinct treatment modalities. Itwould be more accurate to think of NACC'streatment improvements as a broad continuumranging from the highly structured and very securesetting of a NACCDepartment of Correctioninterdisciplinary approach in operation, in severalcorrectional institutions to the relatively open andwork-oriented program at the Iroquois Rehabilita-tion Center at Medina. All other treatment pro-grams conducted at intramural facilities are locatedalong this continuum and vary in the "mix" ofcounseling, vocational and educational training andrecreational activities and in the security of thefacility."

While a treatment continuum does exist, thereport's emphasis misrepresents the actual rationaleby which NACC is being guided. As indicatedearlier, the goal being pursued is that of acomprehensive, multi-modality approach to treat-merit increasingly being accepted by various pro-grams throughout the countryincluding thoseoperated or funded by the NIMH, the State ofCalifornia, the cities of Chicago and New Havenand othersas the "model" approach to treatmenttoday. In brief, this rationale derives from theconcept that there is no such universal as "theaddict", but rather a variety of addicts withdiffering social and psychological characteristicsand varying ages, ethnic and class backgrounds,stages of involvement in the addiction system andstates of readiness for help. The evaluation strategyis to determine what characteristics, psychologicaland social, lend thern.selves to Help under thedifferent treatment approaches, and to developobjective criteria for the eventual screening andreferral of all patients. After an initial interview, apatient would be referred to the treatment

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modality best equipped to help himwhether aresidential center, religious approach, narcoticsantagonist, Methadone maintenance or any othertechnique or combination of techniques, depend-ing on the patient's needs. This rationale insuresthe development of a comprehensive approachwhich draws upon the entire range of treatmentprograms. It also ensures that the various ap-proaches can end the internecine struggle whichhas existed in the past.

NACC is implementing this approach todaysince it encompasses a variety of modalities notonly within the State program itself, but byfunding other modalities such as ex-addict-directedtherapeutic communities, day centers, semi-reli-gious approaches, cyclazocine and other wreoticsantagonists, programs for youthful drug abusers,Methadone maintenance and various oLtpatientcenters.

The report suggests that effective programs fortreating addicts do not exist. Tnis is not true, tostart with, and the issue is more complex. Underthe multi-modality approach, it is apparent thatnot esery treatment modality will be of equalweight: that is, patients will find certain modalitiesmore acceptable than others. This has indeed beentrue in the case of Methadone maintenance and lessso in the case of therapeutic communities whichentail a long commitment to communal living awayfrom the community. This need not interfere withour schema for developing screening criteria nowundermine our rationale since, even if an approachis effective with only 5-10% of the addict popula-tion, it may still be the treatment of choice forsome and should be continued. This was true, forexample, of the Christian Damascus Church in theSouth Bronx several years ago, which proved to beparticularlyaefiective with lower class or lo wer-mid-dle class Puerto Rican patients amenable to aFundamentalist Pentecostal religious approach.Cyclazocine was effective with "hidden drugabusers", i.e. middle-class, motivated patients; andwe need to learn how to extend its effectiveness toother segments of the addict population. Somemodalities with limited application might be ap-propriate to sustain even if its costly to do so on aunit basis.Areas Reflective of the General "State of the Art"Rather Than of Specific Individual NACC Prob.!ems

As the report indicates, the primary puhliconcern for many years was with the narcoticsproblem aloneperhaps because it constituted aprimary social problem contributing to the inner-city decay and "crime in the streets." It in only

13"1'

very recently, in 1965, that the Federal Govern-ment enacted control legislation regulating softdrugs; and that we began to address ourselves tothe question of devising creative and innovativeprograms for such users. It would be helpful if thereport stressed that the number of programs in thecountry specifically directed to these "new areas"of soft drug abuse and the problem of youngerdrug abusers can be counted on the fingers of onehand.

Another aspect to be stressed is the fact thatnew problems are emerging continually; apart fromthe abuse of newer drugs such as doriden, valmid,darvon, etc. new species of drug abusers emergecontinuouslysuch as the multiple drug user whois abusing a variety of drugs including heroin.Although the original mandate for the State"Narcotics Additction Control Commission" wasprimarily for narcotics, room was left open foreducational and preventive approaches in relationto the soft drugs. The NACC has moved svonglyinto the area of soft drug abuse and has beenencouraging, through education and funding, thedevelopment of innovative programs, with evalua-tion built in to determine their effectiveness andgain experience and knowledge. The field ofprevention and education reflects the same lack ofunderstanding Jf how to develop effective educa-tional programs. Until very recently, the emphasiswas largely on scare techniques, which it is nowagreed do not act as a deterrent and often have a"boomerang effect."

The Commission's bureau of program planninghas been actively engaged in preparing positionstatements in the areas of soft drug and youthfuldrug abuse as well as preventive education andthinking through a range of programs to deal withthem. Through a variety of publications by variousstaff members, public attention is being directed tothe seriousness of these problems and how thedevelopment of needed programs might be facili-tated.

Another area in which blame seems to bedirected to NACC, but which reflects the prevailingdate of knowledge nationally is that of incidenceand prevalence data. Unfortunately, little attentionwas devote'? to accumulating such data untilrecently, and we are only now beginning to cometo closer grips with this. NACC has been aware ofthe need to obtain this data for the State and hasjus;, completed a major epidemiological assessmentof all types of drug use within the generalpopulation. The data from this survey are beinganalyzed and will be available very shortly forpublic dissemination.

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Accuracy of PresentationThere are positions assumed i, 0 e report with

which the Commission would ciu feras in thediscussion of Methadone maint( nz,nce; a, i we shalloutline our questions seriatim:

1) On page 51, it is stated that he NI, O-to:loneprogram is probably the mast c antoersialapproach to the problem of n3r,otic , addic-tion currently being tried 11 is country.The controversial nature of the MethadoneTreatment stems primarily from the fact thatMethadone itself is an addictive drug.. ."This statement, as it stands. s misleadingsince there are aspects of N:etha()one pro-gramming which are still controversial orbetter a matter for further res., arch; andothers which are well este 1-1;ed, and itwould be important to rmke th,se distinc-tions. In terms of a bro:' t public healthapproach, for example, we helieve it can besaid that Methadone maiptcilayi e is by farthe most effective trk li)proachdevised for hard-core, I( narcoticaddicts since it has helped .[ ' rcentageto give up their heroin add I returnto productive social funct i sayingthis, an attempt is not being made torepresent Methadone maintenance as an"ideal" program since it is questionable thatthere are any ideal programs. The importanceof Methadone maintenance neverthelesslooms large, the more so, perhaps, becausethe thcrepeutic communities, as the reportitself indicates, have not fulfilied th hopesheld out for them and have returned onlyvery small ntnnbers of rehabilitated patientsto the community.

2) On page 62, the report confuses the issuesby failing to distinguish sufficiently betweennon-tolerant individuals and addicts stabi-lized on Methadone. It stresses the danger ofmaking individuals dependent on large dosesof Methadone and deplores the withdrawalsyndrome which occurs if the drug is notreceived. The report does not specify thatevery Methalone program explains to pa-tients that Methadone is, in itself, a syntheticnarcotic and that when used for maintenancepurposes it creates a state of narcotic de-pendence. Further, the withdrawal syndromefrom Methadone does not constitute a seri-ovs problem, particularly if compared tobarbiturate or alcohol withdrawal. Indeed,since 1953, the Public Health Service Hospi-tals and every other reputable detoxification

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facility have used Methadone as the drug ofchoice to withdraw addicts from opiatessince it is the most moderate and mildestdrug available for this purpose.

3) On page 52, it is stated that the "depen-dence producing property of Methadonedictates this result (patients continuing in theprogram). It must be remembered that physi-cal dependence forces them to remain in theprogram just as physical dependence onheroin causes them to seek illicit narcotics."This represents a misunderstanding and falseemphasis in that one of the primary prob-lems in treating addicts has been retainingthem in program. Methadone does indeedbecome a powerful structuring dc ice forkeeping patients in treatment to the pointwhere they become fully engaged and areable to function satisfactorily. Indeed, theuse of "rational authority", a concept im-plicit in the application of civil commitmentprocedures, constitutes a recognition of the"lack of motivation" and apathy of manyaddicts and the need to provide powerfulincentives and structuring to help them comeinto ana :emain in treatment. In short, whatis a plus in Methadone treatment emerges asa negative in the report.

4) Re toxicity, etc. the report does not mentionthat part of the research of every Methadoneprogram calls for periodic liver and bloodstudies to insure that there are no long-termphysical or toxic effects from the drug. Itmight be added that addicts are known whoused Methadone as their exclusive drug ofchoice for from 10 to 15 years with no toxicor other untoward tong -term effects ob-served.

5) Regarding the role of ancillary treatmentservices, the Beth Israel complex and otherprograms following thiP model, on the basisof their clinical experience, are aware of atleast three categories of patients in Metha-done who require different kinds of service.Up to a third may respond to Methadonealone with a small assist; the large middlesection, probably the majority, need moreintensive individual counseling and grouptherapy; and some 20% as the report in-dicates, seem to represent the sociopathichard core who require more intensive help.NACC staff have conceptualized a "multi-modality" approach to Methadone treatment

which more flexible use may be made of

Methadone, ranging from a first step ofambulatory or in-patient detoxification, tolow-dose, to high-dose Methadone, to acombined therapeutic community-Metha-done maintenance facility, and approacheswhich build in rational authority if required.Such programs already exist both in Chicagoand at the Bronx State Hospital. By buildingin evaluation, it is hoped to learn whatMethadone approach can be most helpful forparticular kinds of patients and what ancil-lary services need to be provided for thesedifferent categories.

6) The report states"It has been suggestedthat the ex-addict would be more useful andhis role cler-xer if, in addition to his expeii-ence, he had formal training in counseling,vocational training, or in the social aadbehavioral sciences." And further "Still otherpeople have suggested that the ex-addict isnot a proven success so long as he is in thenarcotics treatment field because he has notleft the program...The critics maintain that,in order to be successful, the addict mustseed a job outside the narcotics rehabilitationprofession even if only for a few years."

To comment on this question: the NACCprogram does not have any guit'ed belief in the"ex-addict mystique". Ex-addicts, like other staff,need to be screened and used very carefully inrelation to the particular setting and programwhere they will be used in terms of the individualqualifications they bring to treatment. For ex-ample, we have questions about the role ex-addictsare playing in education and prevention; greatselectivity is required to ensure that erroneousinformation is not being imparted and that they donot serve as a model of having led a dangerous andglamorous life.

However, there is fairly general agreement thatex-addicts can play an import role in treatment.The need for ex-addicts is abetted by the fact thatmiddle-class professionals often do not know howto talk to lower class, minority groups and havedifferent concepts of time, goals, and standards.Exaddicts who are graduates of particular pro-grams represent these programs ably since theyhave been through it themselves and offer visableevidence of its effectiveness. In the Beth Israelcomplex, the "Ras" (Research Assistants) serve asrole models but are also felt to have specialantennae and sensitivity to patients which profes-sionals, especially those without experience, canlean on and use effectively until they themselves

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acquire more expertise. They are also "bridges"between professionals and patients. Graduates ofex-addict directed therapeutic communities carryout the "concept" and may also be experienced asleaders of "encounters" as well as in the overallmanagement of a therapeutic community program.While it is important to help addicts find their wayout of the "addiction system" and back to theconventional world, it is important to understandthe benefits inherent in their remaining in thesystem and helping others. The sociological con-cept of differential association stresses that in theprocess of helping others, you may be helpingyourself as well. It thus becomes an essentialingredient of the addict's own rehabilitation. It isour feeling that this is a valid concept and that ithelps reinforce the rehabilitation of addicts in thelater phases of treatment. This idea is built into thetherapeutic community "concept." The directlyoperated NACC program provides similar opportu-niLn to qualified former narcotic abusers.

7) On page iv it is stated that "Methadonemaintenance gained acceptance because itmaintained records, control and follow-up".This is a surprising statement and hardly areason for its widespread acceptance. Histori-cally, the Methadone program evolved grad-ually, starting with a small group of carefullyobserved and controlled patients, then ex-panding and by now proliferating greatly asindicated earlier. It has become an importanttreatment of choice for many hard core drugaddicts and seems to be most acceptable tothem for a variety of reasons, including thefact that it does not involve any long-termcommitment to a residential center for twoyears or more. The patient can be stabilizedvery quickly within a six week period.Increasingly, this is being accomplished on anambulatory basis so that he can remainwithin the community. The real reasons forMethadone success, therefore, have to dowith the programs' effectiveness and accept-ability rather than with records, control andfollow-up, which are alien to the understand-ing and interest of most addicts.

8) Some of the statistics which the reportutilizes are erroneous. They apparently werebased on the NACC monthly statistical re-port which is a preliminary document, isnever current, and must be used with thatunderstanding. For example, the legislativecommission on expenditure review cites that,during the first six months of 1970, the rate

of criminal certifications was 5.5% of thetotal. More complete statistics reveal that itactually ran from 30-43% which is fairlyconstant and consistent with the previousyear. Other statistical statements are in error.It is indicated on page 37 that there are 2-3month delays before patients are movedfrom intramural facilities to aftercare. 'thishas rarely been the case, unless we ccnsiderthe point where staff first initiated a,requestfor pre-release information. There is no suchdelay in actual movement. Elsewhere, theaverage intramural stay formerly is cited asfrom 9-15 months. Rarely has a stay reached15 months. The average intramural stayformerly was 10.2 months. The NACC em-ployment statistics used in the report areincomplete and do not reflect the actualsituation in July 31, 1970. At that time 61%of NACC rehabilitants were constructivelyoccupied or employed full-time.

9) The report, in addressing vocational issues,fails to include a discussion of aftercareplacement services and on-going relationshipswith NYSES, MDTA, MCDA, DVR,etc.

10) The report indicates that the fundedagencies have had their money allocationsincreased without adequate evaluation oftheir programs, and lists the budget of theBeth Israel Methadone Maintenance Program,along with others, to help make the point.Demonstration grant increases mostly reflectincreased operational costs for maintainingthe progra'n at its prior level. The largeexpansion of Beth Israel funds reflects acommitment to expand Methadone servicesin response to data accumulated. In addition,the funded agencies have been under con-tinuous review although it is conceded thatthe rapid expansion of Methadone mainten-ance and the youthful drug abuser programduring the period which coincided with thelegislative commission review greatly taxedNACC field staff and limited the intensity oftheir contact with the agencies they oversee.

ConclusionThis discussion has attempted to delineate a

number of areas in which it was felt the report tothe Legislative Commission on Expenditure Reviewwas misleading or else failed to reflect what isactually operational or projected in the NarcoticCommission today. It is hoped that the variouspoints discussed will allow for a more accurate

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picture of the current status and progress of theNACC program to be presented.

COMMENTS ON CHAPTER IV"CERTIFICATION OF ADDICTS" OFTHE PROGRAM AUDIT REPORT OF

LEGISLATIVE COMMISSION ONEXPENDITURE REVIEW.

General Commentssically, the report writers have accepted the

po,uon, which is broadly about, that NACC ispart of thi. Criminal Justice System. By so doingthe failuree of that system attorn to the Commis-sion as though it were a cause of its failures. Wecan only be characterized as part of the CriminalJustice System if we are considered a dispositionalresource of the system. However, such a character-ization is improper. NACC is a treatment agencyand not a dispositional resource, for, if we were thelatter, then the caveat spelled out by the Court ofAppeals in the Fuller decision, to wit:

"If compulsory commitment turns out in factto be a veneer for an extended jail term and isnot fully a developed and comprAensiveeffective scheme, it will have lost its cle,:m tobe a project devoted solely to curative ends. Itwill take on the characteristics of normal jailsentence, with a side order of special help.The moment that the program begins to servethe traditional purposes of criminal punish-ment, such as deterrence, preventive deten-tion, or retribi'tion, then the extended denialof liberty is simply no different from a prisonsentence..." People v. Fuller 24 N.Y. 2d 292,pp 302-303

would become operative, and the stringent require-ment applicable to a criminal will be applicable tothe certification process. It is the fact that we arenot part of the Criminal Justice System whichpermits the certification process to be less stringentthan the criminal trial process.

Specific CommentsPar Iv.

The comparison of the initial expenditure$21,000,000 to the $50,000,000 in 1'969-70,without a corresponding statement as to thenumber of addicts under care between the years inquestion tends to create the unfortunate impres-sion that costa have increased without acorresponding increase in services.

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Pages 20 through top of 21 concerning MedicalExaminations.

This entire section of the report should bemodified in order to again provide certain neededbackground by which the statements therein,though sometimes attributed to others, can beplaced in proper perspective. The adequacy orinacequacy of medical examinations does notdepend, as the impression is created, solely uponthe quality or the number of doctors available. Thedeficiency of the medical examination process arestated to be: (a) insufficiency of the medicalreport because it does not include urinalysis:and (b) reliance upon the statements of the al-leged addict. What the report should state is that,except in those rare instances where a physiciancar observe withdrawal, there is practically noother absolute proof of addiction. Urinalysis,unless the sample is taken within 48 hours ofingestion of an opiate drug, will not providesupporting evidence. A positive finding is merelyproof of use within the past 48 hours. As noted atpage 6 of the report of the Mayor's CriminalJustice Coordinating Council "(a) about a third ofthe people who died trom overdose last year, someof them immediately upon injecting heroin, hadnegative urinalysis." Granted that the presence of apositive finding coupled with the physical examina-tion evidence of track marks and perhaps anadmission by the addict would provide adequateevidence for determining addiction, the point to bemade is that the absence of a positive urinalysis isnot conclusive evidence of non-addiction. There-fore, the question to be raised is: should aurinalysis be made for all persons examined eventhough we can predict, with reasonable certainty,that in a great number of cases the urinalysis willbe negative?.We can have such certainty wheneverthe sample would be taken more than 48 hoursafter possiole injte.ion. This is particularly truewith respect to the individual who has beendetained after arrest and whose order for a medicalexamination is made more than 48 hours after thestart of detention.

On the issue of whether the doctors should placereliance upon the statements of the alleged addict,the question to be raised is what else is available? Ifwithdrawal is not observed by the physician, thenthe remaining potential sources of evidence are:the addict himself; a positive urinalysis; track-marks; and testimony of those including correctionofficers who my have observed the alleged addictundergo withdrawal. For the arrested alleged ad-dict the testimony of others, relatives, friends, orcorrection officers is usually not sought. This lack

may explain why civil certification proceedings,where such testimony, usually from the petitionerexists, has a better success rate. The observationscontained in the report may be engendered by thediscrepancy between accepted common knowledgeof widespread addiction, and the failure of proof ina particular situation.

In other sections of the report a contrast is madebetween those arrested for dangerous drug offensesand those who are admitted users. Necessarily sincethe report also talks about the number of personswho are certified as addict the comparison orgrounds for comparison is thereby planted. It is anunfortunate ground for comparison. For admittedusers are not admitted addicts; nor are admittedusers all admitted heroin users. A factor whichshould be pointed out concerning the physiciansemployed by NACC to conduct medical examina-tion is that they have more than one year on thejob experience, and as indicated in the tableattached to the Mayor's Criminal Justice Coordi-nating Council's report, during the first ninemonths of 1970 the percentage of those examinedand found addicted by the doctors rose from a lowof 35.2% to 62.9% in September whereas thehighest rate during the entire year of 1968 was

Pages 23 through top of 24This section contains certain major data errors.

The conclusions and characterizations drawn fromthe erroneous data are of course regrettable. If thedata used by the report writers was derived fromthe monthly statistical reports prepared by theCommission, especially the old ones, then we mustshare part of th, blame for the errors. It is to thecredit of the Expenditure Review Commissiontherefore that it has submitted its draft report tous for comment.

Page 26, Waiting Period For Admission to NACCFacilities.

This section with its reliance upon the datadeveloped by the Mayor's Coordinating Councilalmost refutes the information and the data used inother sections to demonstrate the alleged break-down of the criminal certification process. Further-more, since the Coordinating Council was making acase, reliance upon its data will carry the selectivitybias of that group. The presence of a large numberof certified addicts in the Houses of Detentiondoes not necessarily mean that they have beenthere for months and months as the CoordinatingCouncil would like people to believe. A study of

the subjects in the Houses of Detention from April1 through December 31, 1970, indicates thatwhereas the average stay after certification was 50days in the April-June quarter it dropped to 25days in the October-December quarter despite anincrease in the number of persons certified. Fur-ther, whereas 7.5% were moved within the first 15days during the April-June quarter, 32.1% weremoved within the first 15 days of certification inOctober-December quarter. It should also be notedthat not only did the percentage rise but the rawnumber also went up from 22 in the April-Junequarter to 172 in the October-December quarter.Furthermore, the average stay developed throughthis analysis did not exclude the period betweenthe date of certification and the actual date wewere notified that an individual was certified,which averaged 4 daysit took 80 days before wewere notified for one individualnor did thecomputation of average stay exclude those periodsduring which a certified individual was held be-cause he was recovered in the infirmary, or becauseanother commitment order was outstanding whichprecluded a NACC pick-up. Attached hereto is atable showing the average stay in days of thosecertified addicts who were held by the New YorkCity Correction Department during the periodApril through December 1970.

Page 26This item indicates that NACC agreed to reduce

the number of those detained with a view to"phasing them out entirely". NACC never agreedto a complete phase-out because no substitutedetention facility is available for NACC to use. Itshould also be pointed out that for the days theindividuals are cared for by the City CorrectionDepartment we have agreed to pay at the usual$5.00 per day rate. Furthermore we have esta-blished an orientation program through our ownteam of counsellors to provide services to personsbeing detained pending their assignment to fulltreatment placement. We have done so at Rikers'Island and have suggested to CommissionerMcGrath that, if it can be arranged, we will do thesame for the individuals held at the various Housesof Detention, even though we would prefer onelocation. We are informed that adequate space maybe available at Rikers.

Page 27Table 3 should be amended to include figures

for December and January which would reflectNACC's effort to alleviate the situation as pre.sented.

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Page 36It should be noted that Ance the time when

visits were made to facilities, practically all shopsare substantially comoleteti and equipped.

Page 37It should be noted that the reasons for variations

in caseloads include large numbers of unfilled

vacancies and assignment of personnel to otherthan directed aftercare facilities.

Page 38It should be noted that since the preparation of

the report, NACC has established a sampling policyfor urine testing.

New York StateNarcotic Addiction Control Commission

LENGTH OF STAY FOR CERTIFIED SUBJECTS IN NEW YORK CITYHOUSES OF DETENTION FROM DATE OF CERTIFICATION TO

DATE OF ADMISSION TO NACC PROGRAM*

For the Period April 1,1970 thru December 31, 1970

TOTAL SUBJECTSFOR THE PERIOD

DATE OF CERTIFICATION1970 1970 1970

April 1 - June 30 July 1 Sept 30 Oct. 1 - Dec. 31NUMBER OF Number Percent Number Percent Number Percent Number PercentDAYSTotal Subjects 1212 100.0 294 100.0 382 100.0 536 100.0

15 Days or Less 274 22.6 22 7.5 80 21.0 172 32.1

16 Days or More 938 77.4 272 92.5 302 79.0 364 67.9

Average Stay in Days 34 50 35 25

* Information contained in this report does not: (1) exclude the periods between dates ofcertification and actual dates of noticeto NACC that subjects were certified.

(2) exclude periods during which certifiedsubjects were being held for other courtactions which precluded pick-up by NACC.

PREPARED BY NACC Bureau of Management Information Services Date: March 3, 1971

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