October 8, 1975
Page 32253
SENATOR HATHAWAY ON ALCOHOLISM AND DRUG ABUSE
Mr. MUSKIE. Mr. President, my colleague and friend, Senator HATHAWAY, earlier this year was named chairman of the Senate Labor Committee's Subcommittee on Alcoholism and Narcotics. This subcommittee has an awesome responsibility in developing programs which adequately respond to the terrible problems associated with alcoholism and drug abuse. I note with pride that Senator HATHAWAY's first two public statements regarding his intention to meet that responsibility were made in our home State of Maine, addressing the Maine Addiction Professionals Association in Bangor and the Task Force for Responsible Decisions About Drinking of the Education Commission of the States in Boothbay Harbor. In both cases, Senator HATHAWAY made forceful statements regarding the prevention and treatment of alcoholism and drug abuse. I commend them to my colleagues so they might know that Senate leadership in this area has passed from our truly dedicated former colleague, Senator Harold Hughes, into the strong legislative hands of our colleague from Maine.
Mr. President, I ask unanimous consent that the two speeches by Senator HATHAWAY be printed in the RECORD.
There being no objection, the speeches were ordered to be printed in the RECORD, as follows:
MAINE ADDICTION PROFESSIONALS
Alcoholic beverages and concerns about their effects have been a part of American life for as long as there has been an American life. Debate over issues of temperance raged from the moment our founding fathers set foot on American soil,
The Massachusetts Bay Colony, for example, forbade excessive drinking at an extremely early date. Of course, "excess" was defined as "more than half a pint of whiskey at one time." But those who persisted in what the law called "the swinish sin of drunkenness" were variously fined, whipped, thrown into stocks, or sentenced to wear a big red "D" around their necks. Connecticut assessed anybody found drunk in a private dwelling 20 shillings and fined the host 10 shillings.
New Hampshire posted the name of drunkards. The Plymouth Colony took away their right to vote, and General James Oglethorpe, who founded the Colony of Georgia, became, in 1733, the first governor to banish spirits altogether.
Three weeks later the residents of South Carolina invented bootlegging.
Even in those early years there was a great public policy ambivalence over alcohol.
One life insurance company of the time, for example, actually increased its premiums by 10 percent for the abstainer, whom it considered "thin and watery, and mentally cranked, in that he repudiated the good creatures of God as found in alcoholic drinks."
George Washington was so publicly pious on the subject that an early teetotaler's society, the "Washingtonians," was named after him. Nevertheless, in the first three months of his Presidency, Washington spent almost one fourth of his household budget — some 750 pounds — for liquor. Washington also violated an early Virginia campaign law in one local election when he distributed among the voters of his county 180 gallons of beer, wine, cider, punch and rum.
He won by a vote of 310 to 15.
He later wrote to his campaign manager, saying "I hope no exception was taken to any that voted against me, but all were alike treated, and all had enough."
Then there was John Adams, who once claimed that for the "last 53 years of his life, I've been fired with a zeal, amounting to enthusiasm, against ardent spirits, the multiplication of taverns, retailers, dram-shops and tippling houses ..." — but who had an invariable habit of downing a large tankard of hard cider every morning before breakfast.
All this is by way of saying that alcohol has been a part of American life for a very long time.
What is new, then, about our current federal efforts in the field? Why are we entitled to consider them exciting and perhaps even revolutionary? I think the answer is that we recognize and accept a number of concepts today that were never previously accepted by most observers. We now accept that alcoholism is a disease, like any other — a disease that can be cured and even prevented. We now accept, without casting moral aspersions, that alcoholics and alcohol abusers can be restored to healthy, productive lives just like the person who has been afflicted with pneumonia — and that significant federal funds can be committed to that process. And finally, we have come to accept the premise that the two-thirds of adult Americans who drink can be aided whether they are alcohol abusers or not — and that they can be educated in how to avoid burdening themselves, their families and society with the potential costs associated with this drug they have chosen to use.
While our alcoholic history dates back centuries, then, our modern approach to alcohol dates back just a few short years. The first real breakthrough probably occurred with a number of court decisions in the mid nineteen-sixties. In these cases, Federal and state courts held that alcoholism is an illness, and that a homeless alcoholic could not avoid being drunk in public and therefore could not be punished solely on the basis of his public intoxication. In the famous 1968 case of Powell vs. Texas, the U.S. Supreme Court agreed with that theory, finding that such punishment would violate the Constitutional prohibition against "cruel and unusual punishment."
The court in the Powell case wanted to know what else could be done for alcoholic people. But when they examined the alternatives, it was to conclude unanimously (and angrily) that no facilities, procedures or legislative responses then available were adequate — at a time when Americans were already being landed on the moon!
By then, a number of commissions studying the problem had begun to recommend the substitution of a public health approach for the typical criminal approach. Even the American Bar Association and the American Medical Association, neither of them noted for being in the vanguard of change, collaborated on a "Joint Statement of Principles Concerning Alcoholism". In it, they urged the adoption of comprehensive new legislation in which alcoholism would be viewed as an illness, rather than a criminal offense.
The federal government responded to the Supreme Court by passing the Alcoholic Rehabilitation Act of 1968, the first law dealing specifically with the treatment of alcoholism on a national basis.
Congress declared that treating alcoholism as a health problem "permits early detection and prevention of alcoholism and effective treatment and rehabilitation, relieves police and other law enforcement agencies of an inappropriate burden that impedes their important work, and better serves the interests of the public." In 1970, this federal initiative in the field was substantially expanded with the enaction of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970, and the establishment of the National Institute of Alcoholism and Alcohol Abuse.
With the creation of the National Institute, America entered still another era in its approach to this problem: the era of accomplishments.
Federal funding of programs for prevention, treatment, research, training and other elements of the alcoholism problem went from a mere $17 million in 1971 to over $200 million the last fiscal year; and state, local and private occupational efforts have grown in the same way. There has been a ten-fold increase, for example, in the creation of out-reach programs by business to assist employees. Over half of the states, including Maine, have now passed statutes identifying alcoholism as in illness and making it a health, rather than a criminal, issue.
Information and education efforts, including those generated by the Alcohol and Drug Abuse Education Act, have come into being in many different formats.
Increased treatment success, and decreases in costly use of in-patient hospital care, have been generated as a result of increased knowledge and more sophisticated utilization of resources.
But these and other recent gains have not obscured the fact that the job has only begun.
For one thing, the scope of the problem itself shows no real evidence of having abated in the course of the last few years. Alcohol remains far and away the most heavily abused drug in our culture.
The number of alcoholics or alcohol abusers has edged over 9 million, including nearly 10 percent of the work force. The direct and indirect drain on our economy is estimated to be $25 billion a year. And alcohol is still found to be directly related to half of all traffic fatalities and over 40 percent of all non-traffic arrests in the country.
In medical terms, the picture is equally bleak. The incidence of death from cirrhosis of the liver, a statistic which is highly correlated with the incidence of alcoholism, is escalating wildly in the United States. Experts agree that there has been a marked increase in the use and abuse of alcohol among young people, especially teenagers. In fact, a recent random household survey showed that alcohol problems tend to be most severe in the youngest age groups — a fact that may have a grave effect on our highway death toll as age restrictions on the consumption of alcoholic beverages are relaxed.
What must be our goals and challenges for the future, in the face of this unhappy picture?
For one thing, this is no time to relax our federal financial support for the National Institute and the programs it funds. Yet this Administration has proposed cutting back alcoholism funding by more than $50 million dollars for the current fiscal year! As I said when I appeared before the Senate Appropriations Committee on this issue, "the quality of a society may be measured in terms of its attention to its least fortunate members. If judged by this criterion, our society, in terms of the proposed budget for fiscal year 1976, would not be looked upon favorably." I and a majority of my colleagues in Congress intend to oppose these cutbacks, and to try to achieve increased fiscal support for alcoholism programs to the maximum extent possible.
However, we are beyond the state in our nation's history where the best solution to a social problem is simply to throw money at it. Whatever the level of funding for alcoholism and alcohol abuse programs, there are other goals we must keep in mind regarding the way we want that money to be spent.
We must now adopt a cohesive set of goals simultaneously in a number of areas. Those include :
Solving all the needs of alcoholic individuals — including their health, welfare, vocational and social needs;
Reaching out to find and treat the so-called "non-public" alcoholic or alcohol abuser, since only 9 to 5 percent of all alcoholics fall into the category of "public inebriate" and fewer than 10 percent of alcoholics are receiving the treatment they need;
Fostering widespread prevention efforts aimed at reducing the number of future alcoholics, by educating people who drink so they will not develop drinking problems, or getting to others before their problems become severe (recent figures show that the average client of treatment programs today has more than 14 years of heavy drinking under his belt);
Changing our societal values regarding alcohol, including the way we all perceive and communicate facts and myths about the use and abuse of this drug, and getting the media to cooperate in changing the way it presents (and glamorizes or laughs at) the consumption of alcohol;
Promoting the increased cooperation of physicians and hospitals in both identifying and treating the health problem of alcoholism and alcohol abuse, including the assurance of patient confidentiality, the restructuring of health insurance to include alcohol related problems, and rectification of the sad fact that fewer than half the nation's hospitals will even admit patients whose primary diagnosis is alcoholism;
Paying more attention to the needs of specific groups of potential users, such as teenagers, and recognizing and effectively treating other groups among alcohol abusers, such as those with poly-drug problems;
Bringing together all the various constituencies now associated with the problem, so that they might learn from one another's experience.
And finally, training more alcoholism workers — paraprofessionals as well as professionals — in all aspects of prevention and treatment of the problems surrounding alcohol and its abuse.
We must oversee the development of a comprehensive approach to this problem; one that includes education, laws and customs, economic and the relationship between alcohol and other health problems and concerns.
At the federal level, we expect to have a unique opportunity to pursue this approach in the weeks and months ahead; I have secured personal commitments to that effect from the new Secretary of Health, Education and Welfare (David Mathews), and the new Director of the Alcohol, Drug Abuse and Mental Health Administration (James Isbistek) ; and I fully expect to secure a similar commitment from the person chosen to be the new Director of the National Alcoholism Institute.
My subcommittee expects to review and update the 1970 Alcoholism Act and its 1974 amendments in the course of this coming year, and we are going to seek to construct a big picture.
I expect the positive help of those individuals, of my colleagues — and I hope we can expect help from you, the men and women who are dedicating yourselves to this field.
ECS TASK FORCE ON ALCOHOLISM
I'm pleased my schedule allows me to be here today, if only to speak informally for a few minutes at the beginning of your meeting.
You asked me to talk this afternoon about goals and priorities for my subcommittee, but I don't think I'll try to do that in the limited time available today. You already have a brief outline of my previous thoughts in this area, taken from statements made as recently as three weeks ago. Since I intend to continue to educate myself by visiting treatment programs in a number of states in the weeks ahead, I can't add anything to that outline at this time.
Instead, I want to urge you to relate the subject of responsible decisions about alcohol to two phenomena that currently perplex our decision makers:
(1) our drastically changing ideas about health policy; and
(2) the information or stimulus overload that may well be short circuiting the educational process for young people growing up today.
With regard to health policy, we are all observing with alarm the gradual bankruptcy of our current systems — and the potentially traumatic attempts to create new ones.
Doctor's strikes and the malpractice controversy are only small symptoms of the increasing disruptions we can expect in this field.
A much larger problem is the hopelessly unequal distribution of services and facilities. On the one hand, we can't provide even minimally adequate health services to large segments of our urban rural poor. On the other hand, we are told that in many parts of the country we have a surplus of hospital beds
Comprehensive health planning and delivery systems are virtually non-existent in most parts of the country. Some health services are needlessly duplicated in areas where others are totally lacking. No one knows if less expensive non-medical care or careful preventive policies might solve problems currently thought to require a complete hospital-oriented approach.
New laws have been passed to try at least partially to remedy this situation, but no one yet knows whether, or in which aspects of health policy, they will be effective.
Meanwhile, the great debate continues over national health insurance. So far in that crucial process, economics, philosophy and rhetoric seems to prevail over hard thinking about health.
But Congress will ultimately come to some conclusions on this issue, and you simply cannot discuss the prevention of alcohol abuse without taking that into consideration.
The second point you need to keep firmly in mind is the drastic change taking place in the educative process itself. No longer is it easy to point to any one factor in a child's life as the principal "educator", or to an informational or emotional force as the principal instiller of values.
Nor is this the "fault" of any one element in modern American society.
Children are bombarded with confusing new input from many diverse sources today. With increasing violence among their peers, easier availability of drugs (including alcohol), teachers more openly expressing demands and grievances of their own, and society up in arms over swirling, emotionally charged issues like busing to achieve desegregation, schools are no longer the comfortable educating or socializing institutions they have traditionally been in the past.
In addition, our mass media have begun to come of age as a potent force in the formative process, for better or (most likely) for worse. And while arguments rage over the educative effects of sophisticated commercial "messages," or of televised violence or sex, or examples of aberrant behavior, the industry notes that for the first time in history the average American home now has a T.V. set on for more than seven hours a day.
Finally, we have launched into an era of confusing public charges and counter-charges regarding a galaxy of substances, objects and ideas which may or may not be harmful — an era in which over-simplification has become the order of the day.
Take hand guns — on the one hand, they are sources of evil and should be outlawed; on the other hand, if they are outlawed, only outlaws will be able to get them.
Easy catchwords on both sides of this issue obscure important and difficult decisions about violence, law enforcement, and so on. But the easy catchwords are what the child most readily assimilates. To see the effects, you need only witness the pitiful spectacle of youngsters mimicking their parents on the front lines of the busing controversy, or for that matter, on the real front lines of open warfare in Northern Ireland, shouting slogans they don't even understand.
Multiply the effects by a limitless variety of other issues and arguments a child confronts daily: about aerosol sprays, sleeping pills, automobile emissions, abortion, pornography. The list is virtually endless. And it is into this alarming and confusing morass of ideas and warnings and tendencies and beliefs that you people would inject some thoughts about the subject of responsible decisions about alcohol.
I have noticed in the last few months that some people concerned with alcoholism would view their problems in a sort of splendid isolation. But quite simply, the world doesn't permit that anymore.
I don't envy you your task. I agree that alcoholism is one of our important health and social problems. But you will succeed in developing policies to deal with alcoholism only if you approach it with an open mind within its wider societal context.
In closing, I would like to offer a few specific suggestions for the work you will be doing in the course of the next few days.
With regard to health policy, try to develop a firm handle on where education about alcohol will fit into some wider national health policy system. Bear in mind that not all the proposals currently before Congress give a significant role to preventive health policies in general, or alcoholism education and early identification in particular.
Use this opportunity to examine the various proposals and come up with recommendations that will ensure that your actual substantive suggestions about alcohol can be incorporated into whichever scheme Congress adopts. Note with particularity the specific health consequences of not using alcohol, of using alcohol, and of abusing alcohol.
In addition, it stands to reason that no suggestions will be incorporated if they are vague and rhetorical. Be specific, and start out by developing a complete definition of what you mean by prevention of alcohol abuse. What particular "responsible decisions" do you want to encourage? Not to drink alcohol at all? To drink responsibly if you do? Spell it out, and note the social, economic and health consequences of each decision, and delineate the best methods of encouraging it.
Next, in addition to examining new methods for influencing decisions about alcohol, pay careful attention to the messages that are already being sent and received in the marketplace of ideas. Take a tough look at the mass media, and the images it presents.
If alcohol is the most heavily abused drug in America, then television is our number one pusher.
Consider methods of tracking media-induced images about alcohol directly, and about chemical dependency in general. And make sure you devise means of changing those images as an integral part of any program to educate the public about alcohol.
And finally, I strongly urge you to share your assessments and suggestions with me as you proceed. Don't wait for the production of a final report to communicate with me or my subcommittee staff. We expect very soon to begin serious consideration of the alcoholism authorizing legislation.
Don't make the mistake too many other task forces make in ignoring national legislative timetables. A good rough draft or set of working papers this month can be far more valuable than a finished product next June.
Good luck with your efforts — and keep your eyes and your minds open about the entire social context into which responsible decisions about alcohol must fit.