oversight

Limited Use of Federal Programs To Commit Narcotic Addicts for Treatment and Rehabilitation

Published by the Government Accountability Office on 1971-09-20.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                                        llllllllllllllllllllllllllllllll
                                               LM095518




Limited Use Qf Federal Programs
To Commit Narcotic Addicts For
Treatment       eha bilitation                   a-164037   (2)




Department of Justice
Department of Health, Education,
  and Welfare




BY THE COMPTROLLER GENERAL
OF THE UNITED STATES


                                   SfPf.20J971
                                                                                           I
                                                                                       ,




                           COMPTROUER     GENERAL      OF     THE   UNITEI   STATES
                                        WASHINGTON.     DC.     20343




          B-164031(2)




          To the President  of the Senate and the
    Ef,
    us    Speaker of the House of Representatives
f
                 This is our report     on the limited    use of Federal       programs
          to commit    narcotic   addicts for treatment       and rehabilitation.       The
          programs    are authorized      by the Narcotic     Addict Rehabilitation
          Act of 1966 (28 U.S.C. 2901) and are administered              by the De-            i ,
                                                                                                .
          partments    of Justice   and Health,    Education,    and Welfare.                  3 =-_
                                                                                                  )
                  Our review was made pursuant   to the Budget and Ac-
          counting Act, 192i (31 U.&C.   53), and the Accounting and Au-
          diting Act of 1950 (31 U.S.C. 67).

                 Copies of this report    are being sent to the President   of
          the United States; the Director,      Office of Management   and
          Budget; the Attorney    General    of the United States; and the Sec-
          retary   of Health, Education,   and Welfare.




                                                      Comptroller            General
                                                      of the United          States




                                   50 TH ANNIVERSARY                1921- 1971
*COwT;OLLER GENERAL‘S                         LIMITED USE OF FEDERAL PROGRAMS
REPORT TO THE CONGRESS                        TO COMMIT NARCOTIC ADDICTS FOR
                                              TREATMENT AND REHABILITATION
                                              Department of Justice
                                              Department of Health,  Education, and Welfare
                                              B-164031(2)


DIGEST
------
WHY THE REVIEW WAS MADE

       Because narcotics    addiction     has reached the dimensions of a national emer-
       gency--as defined below in a Presidential         statement--the General Account-
       ing Office   (GAJ&.revi-ewed the manner-in which two Federal agencies were
       implementing   a 1966 law designed to deal more effectively       with drug ad-
       dictionand    addict rehabilitation.

      Dimensions         of the r~~~cotics   addiction       problem

       In a message to the Congress on June 17, 1971, the President              stated,     in
       part,     that:

             --In New York City more people between the ages of 15 and 35 years             die
                 as a result of narcotics than from any other single cause.

             --The cost of supplying a narcotic habit can run from $30 a day to
                $100 a day. This is $210 to $700 a week, or $10,000 to over $36,000               a
                year.

             --Untreated   narcotic   addicts ordinarily do not hold jobs.       Instead,    they
                often turn to shoplifting,    mugging, burglary,    armed robbery,     and so on.
                They also support themselves by starting      other people--young      people--
                on drugs.

             --The financial      costs of addiction are more than $2 billion      every year,
                but at least    these costs can be measured; the human costs       cannot.

       1966 act

       The Congress passed the Narcotic I~-SW
                                            Addict
                                             ._" . __ Rehabilitation        Act (28 U.S.C.
       2901) in 1966. The law wazlgned             primarily*to      enable the courts. to
       deal morP‘effectively  with the narcotic        addiction     rehabilitation   problem.
       ItTXunmary,   the act:

             --Authorizes  pretrial     civil  commitment for treatment,   in lieu of rose-
                cutiong of addicts     charged with certain   Federal crimes (title  I B.

             --Provides  for sentencing   to commitment for treatment       of addicts     con-
                victed of certain  Federal crimes (title   II).




Tear Sheet                                               1
                  l




                                                                                                     c           I



                                                                                                             a

                                                                                                                 I



      --Provides  for civil     commitment for        treatment   of persons   not charged       -       I       1
         with any criminal     offenses  (title       III).
      --Provides    for rehabilitation      and post-hospitalization-care          programs
         for addicts    civilly    committed and for financial         and technical    assis-
         tance to States and municipalities         in the development of treatment
         programs for addicts        (title IV).

FINDINGS AND CONCLUSIONS
    Pretrial  civil commitment (title   I) has not been used to the extent antic-
    ipated during the first   3 years of the program.   Only 179 addicts were
    committed compared with the 900 a year estimated    before the act was passed.




    Although it has been recognized          that the majority       of the crimes committed
    by addicts fall      under the jurisdiction      of State     and local courts,     neither
    the National     Institute   of Mental Health nor the         Department of Justice       (the
    Department)     had directed   its financial     assistance      programs toward the de-
    velopment of close working relationships           between      State or local courts and
    federally    funded State or local narcotic        addict     rehabilitation    programs
    and for the development of State or local civil               commitment programs.        (See
    p. 18.)

    About 57 percent of the persons who voluntarily             applied for examination
    and evaluation      of treatment      potential   during the first  3 years of the civil
    commitment program (title         III) were rejected by the two Public Health Ser-
    vice clinical     research centers on the basis that these applicants          were un-
    suitable   for treatment.        As a result    the court did not commit the rejected
    applicants    for treatment.        At July 31, 1971, about 50 percent of the capa-
    city at the two Federal centers was being used for rehabilitating              narcotic
    addicts.

    U.S. attorneys   generally     indicated     that they did not regard their offices
    as appropriate   intake points for requests from persons seeking treatment
    under the title    III program, except for introducing              commitment petitions
    to the U.S. district     courts.      The attorneys      indicated    also that they did
    not wish to engage in those services            usually associated       with social work
    agencies for those persons who inquired            about the program but did not file
    petitions   or who were found to be unsuitable             for treatment.       (See p* 27.)
    GAO's review indicated     that the administration            of the title    III program
    could be improved and greater         assistance     could be provided to addicts         if
    the Department of Health,        Education,     and*Welfare      (HEW), through its grantees



                                                  2
                  .
    I   .
    I
    I       .         and contractors,    were to assist     the U.S.    attorneys   by performing     certain
    I                 intake functions    and activities     under the program.
    I
    I       RECOJBENDATIONS
                         OR SUGGESTIONS
    I                 The Attcrney    General should emphasize to all U.S. attorneys  the intent    of
    I                 the title    I program and encourage them to give greater consideration    to
    I                 its use.

                      The Attorney   General and the Secretary    of HEW should revise their grant
                      program guidelines     to stress the development of close working relationships
                      between rehabilitation     programs and the courts and to encourage arrange-
                      ments whereby the Department and HEW would participate       jointly   in the de-
                      velopment of State and local civil      commitment programs.     (See p. 20.)

                      The Attorney     General and the Secretary          of HEW should consider having HEW
                      grantees or contractors        involved     in the treatment     and rehabilitation     of
                      narcotic   addicts provide assistance           to U.S. attorneys      by performing the
                      following    nonlegal intake functions:            (1) receiving    the request from a
                      person seeking treatment         and rehabilitation       under the program, (2) deter-
                      mining that there is reasonable           cause to believe that the person is a
                      narcotic   addict,    (3) determining       that appropriate     State or local facili-
                      ties are not available       for the treatment         of the person, and (4) helping
                      the person prepare and file          a petition     for commitment with the U.S. at-
                      torney's   office.      (See p. 29.)

I           AGENCYACTIONSAND UNRESOLVED
                                      ISSUES
                      The Assistant    Attorney  General for Administration stated that the title    I
                      pretrial   civil  commitment procedure had not been used to the extent to
                      which it might have been.      He stated also that the Department was inclined
                      to agree with the reasons for the underuse set forth       in this report.   He
                      cited,   however, other possible   reasons for the underuse of title     I. (See
                      p. 15.)
i                     He gave a number of reasons why any instruction    the Attorney General
I
                      might issue to U.S. attorneys   could be only in the nature of recommenda-
i                     tions and would not be binding.     (See p. 16.)
I

1                     The Assistant    Attorney   General did not agree with GAO's opinion that the
I
I
                      Department had not made a serious effort       to assist   States in developing
I                     close working relationships       between the courts and narcotic      addict re-
I                     habilitation    programs.    Both he and HEW's Assistant    Secretary,     Comptrol-
I
I                     ler, indicated,     however, that grant guidelines    would be used to encour-
I                     age development of State and local civil       commitment programs.        (See
I
I
                      p. 20.)
I
I
I
                      Many of the title       III precommitment functions          assigned to U.S. attorneys,
I                     the Assistant    Attorney    General stated,         were or could be performed by the
                      Surgeon General.       The Assistant        Secretary,    Comptroller,    stated that HEW
I                     had no objection      to expanding its role in determining             the availability  of
I
I                     State and local treatment        facilities       although he advised that additional
I                     resources would be required.
I

I               Tear Sheet
I
MTTERS FOR CONSIDERATIUNBY THE CONGRESS                                                    I   I
                                                                                               I
                                                                                               I
    Because of the congressional       interest in the problem   of narcotic   addiction       ;
    and addict rehabilitation,      this report is being sent    to the Congress to
    point out the results      of GAO's review of the Federal    civil  commitment pro-        i
    grams.                                                                                     I
                                                                                               I




                                                                                               I
                         Contents
                                                            Page

DIGEST                                                        1

CHAPTER

  1        INTRODUCTION                                       5

  2        NEED FOR ENCOURAGING   USE OF CIVIL
           COMMITMENTPROGRAMS                                11
              Actual use of title      I less than
                 expected                                    11
                    Agency comments                          15
                    Recommendation to Attorney General       17
              Need to encourage development of State
                 civil   commitment programs                 18
                    Agency comments                          19
                    Recommendation to Attorney General
                       and to Secretary of Health, Edu-
                       cation, and Welfare                   20
  3        OPPORTUNITIESFOR IMPROVINGADMINISTRATION
           OF TITLE III PROGRAM                              22
               Administration   by National Institute
                  of Mental Health                           23
                    Agency comments                          25
               Administration   by U.S. attorneys'    of-
                 fices                                       27
                    Agency comments                          28
                    Recommendation to Attorney General
                       and to Secretary of Health, Edu-
                       cation, and Welfare                   29

  4        SCOPEOF REVIEW                                    30

APPENDIX

  I        Letter dated July 29, 1971, from the As-
             sistant  Secretary, Comptroller,   Depart-
             ment of Health, Education,    and Welfare,
             to the General Accounting Office               33
                                                                         Page

APPENDIX

  II       Letter dated June 16, 1971, from the Assis-
             tant Attorney General for Administration,
             Department of Justice,  to the General Ac-
             counting Office                                              38

 III       Principal     officials      of the Departments of
              Justice and Health, Education,          and Wel-
              fare responsible         for the administration
              of activities        discussed in this report               43

                                 ABBREVIATIONS

GAO        General Accounting          Office

           Department     of Health,Education,             and Welfare
           Law Enforcement          Assistance       Administration

NARA       Narcotic     Addict      Rehabilitation        Act

NIMH       National     Institute       of Mental Health
~OMPTl?OLLERGENE&IL'S                      LIMITED USE OF FEDERAL PROGRAMS
REPOLRTTO THE CONGRESS                     TO COMMIT   NARCOTIC ADDICTS
                                                                      FOR
                                           TREATMENT AND REHABILITATION
                                           Department of Justice
                                           Department of Health,  Education,   and Welfare
                                           B-164031(2)


DIGEST
------
WHY THE REVIEW WAS M4DE

    Because narcotics    addiction     has reached the dimensions of      a national  emer-
    gency--as defined below in a Presidential         statement--the     General Account-
    ing Office   (GAO) reviewed the manner in which two Federal           agencies were
    implementing   a 1966 law designed to deal more effectively           with drug ad-
    diction   and addict rehabilitation.

    Dimensions         of the narcotics   addicfiion   probZem

     In a messageto the Congress on June 17, 1971, the President              stated,      in
     part,     that:

        --In    New York City      more people between the ages of 15 and 35 years         die
             as a result of narcotics      than from any other single cause.

        --The cost of supplying a narcotic habit can run from $30 a day to
           $100 a day. This is $210 to $700 a week, or $10,000 to over $36,000                    a
           year.

        --Untreated   narcotic   addicts ordinarily do not hold jobs.       Instead, they
           often turn to shoplifting,    mugging, burglary,    armed robbery,    and so on.
           They also support themselves by starting      other people--young    people--
           on drugs.

        --The financial         costs of addiction are more than $2 billion    every year,
           but at least       these costs can be measured; the human costs     cannot.

     1966 act

     The Congress passed the Narcotic  Addict Rehabilitation        Act (28 U.S.C.
     2901) in 1966. The law was designed primarily      to enable the courts to
     deal more effectively  with the narcotic addiction      rehabilitation   problem.
     In summary, the act:
        --Authorizes    pretrial      civil  commitment for treatment,   in lieu of       rose-
           cution,   of addicts      charged with certain   Federal crimes (title       I P.
        --Provides  for sentencing   to commitment for treatment        of addicts       con-
           victed of certain  Federal crimes (title   II).
      --Provides  for civil      commitment for        treatment   of persons   not charged.
         with any criminal      offenses  (title       III).

      --Provides    for rehabilitation      and post-hospitalization-care          programs
         for addicts civilly       committed and for financial         and technical    assis-
         tance to States and municipalities         in the development of treatment
         programs for addicts        (title IV).

FINDINGS AND CONCLUSIONS
    Pretrial  civil commitment (title   I) has not been used to the extent antic-
    ipated during the first   3 years of the program.   Only 17'9 addicts were
    committed compared with the 900 a year estimated    before the act was passed.




    Although it has been recognized           that the majority       of the crimes committed
    by addicts fall       under the jurisdiction      of State     and local courts,     neither
    the National     Institute    of Mental Health nor the         Department of Justice       (the
    Department)     had directed    its financial     assistance      programs toward the de-
    velopment of close working relationships            between     State or local courts and
    federally    funded State or local narcotic         addict     rehabilitation    programs
    and for the development of State or local civil                commitment programs.        (See
    p. 18.)

    About 57 percent of the persons who voluntarily               applied for examination
    and evaluation      of treatment       potential    during the first  3 years of the civil
    commitment program (title         III)     were rejected   by the two Public Health Ser-
    vice clinical     research centers on the basis that these applicants            were un-
    suitable   for treatment.        As a result      the court did not commit the rejected
    applicants    for treatment.        At July 31, 1971, about 50 percent of the capa-
    city at the two Federal centers was being used for rehabilitating                narcotic
    addicts.

    U.S. attorneys   generally     indicated     that they did not regard their          offices
    as appropriate    intake points for requests from persons seeking treatment
    under the title     III program, except for introducing             commitment petitions
    to the U.S. district     courts.      The attorneys      indicated    also that they did
    not wish to engage in those services            usually    associated    with social work
    agencies for those persons who inquired             about the program but did not file
    petitions   or who were found to be unsuitable             for treatment.       (See p. 27.)
    GAO's review indicated      that the administration           of the title    III program
    could be improved and greater         assistance     could be provided to addicts          if
    the Department of Health,        Education,     and.Welfare      (HEW), through its grantees



                                                   2
   ' and contractors,    were to assist     the U.S. attorneys     by performing     certain
     intake functions    and activities     under the program.

RECOMMENDATIONS
             OR SUGGESTIONS
    The Attorney    General should emphasize to all U.S. attorneys    the intent    of
    the title    I program and encourage them to give greater   consideration    to
    its use.

    The Attorney   General and the Secretary    of HEW should revise their grant
    program guidelines     to stress the development of close working relationships
    between rehabilitation     programs and the courts and to encourage arrange-
    ments whereby the Department and HEW would participate       jointly    in the de-
    velopment of State and local civil     commitment programs.      (See p. 20.)

    The Attorney     General and the Secretary          of HEW should consider having HEW
    grantees or contractors        involved in the treatment         and rehabilitation     of
    narcotic   addicts provide assistance to U.S. attorneys                by performing the
    following    nonlegal intake functions:            (1) receiving    the request from a
    person seeking treatment         and rehabilitation       under the program, (2) deter-
    mining that there is reasonable cause to believe that the person is a
    narcotic   addict,    (3) determining       that appropriate     State or local facili-
    ties are not available       for the treatment         of the person, and (4) helping
    the person prepare and file          a petition     for commitment with the U.S. at-
    torney's   office.      (See p. 29.)

AGENCYACTIONSAND UNRESOLVED
                          ISSUES
    The Assistant    Attorney  General for Administration stated that the title     I
    pretrial   civil  commitment procedure had not been used to the extent to
    which it might have been.      He stated also that the Department was inclined
    to agree with the reasons for the underuse set forth       in this report.   He
    cited,   however, other possible reasons for the underuse of title       I. (See
    p. 15.)

    He gave a number of reasons why any instruction    the Attorney General
    might issue to U.S. attorneys   could be only in the nature of recommenda-
    tions and would not be binding.     (See p. 16.)

    The Assistant    Attorney   General did not agree with GAO's opinion that the
    Department had not made a serious effort       to assist States in developing
    close working relationships       between the courts and narcotic     addict re-
    habilitation    programs.    Both he and HEW's Assistant   Secretary,     Comptrol-
    ler, indicated,     however, that grant guidelines    would be used to encour-
    age development of State and local civil       commitment programs.       (See
    p. 20.)

    Many of the title       III precommitment functions          assigned to U.S. attorneys,
    the Assistant    Attorney    General stated,         were or could be performed by the
    Surgeon General.       The Assistant        Secretary,    Comptroller,    stated that HEW
    had no objection      to expanding its role in determining             the availability  of
    State and local treatment        facilities       although he advised that additional
    resources would be required.

                                               3
M4TTERSFOR CONSIDERJTIONBY THE CONGRESS
    Because of the congressional       interest in the problem    of narcotic   addiction
    and addict rehabilitation,      this report   is being sent   to the Congress to
    point out the results      of GAO's review of the Federal     civil  commitment pro-
    grams.
                                CHAPTER1

                             INTRODhsCTION               c
       We reviewed the efforts    of the Departments of Justice
and Health, Education,     and Welfare to administer   narcotic
addict treatment and rehabilitation      services provided under
titles   I and III of the Narcotic Addict Rehabilitation        Act
cm)      of 1966 which authorized    the Federal civil  commitment
programr     This program and the related direct services are
administered     jointly by the U,S. attorneys   of the Department
and by the National Institute      of Mental Health (NIMH) of HEW.

       Drug abuse has been one of the most widely reported
problems in the kited         States in the past few years.           The
relationship      between narcotic    addiction,     crime, the courts,
and the prisons has been highly publicized,               and efforts    have
been intensified      to understand and deal with the problem of
addict rehabilitation       as well as crimes stemming from drug
abuse, The incidence of narcotic           addiction      is increasing,
and conservative      estimates are that there are about 180,000
narcotic     users in the country.      A strictly      legalistic    and
punitive     approach to a problem of this magnitude has been
challenged by professionals         in both the law enforcement and
the medical fields,

       Civil commitment of narcotic         addicts is generally     un-
derstood to mean compulsory confinement in a special narcot-
ics treatment facility       followed by outpatient        treatment un-
der intensive    parole-type      supervision.      The treatment regi-
men consists of withdrawing         the addict from his physical        de-
pendence upon narcotics       and providing      therapy and training
to overcome his psychological          dependence upon drugs.       Com-
mitment is for an indeterminate          period not to exceed the
prescribed    number of years set forth in the applicable            stat-
utes.

      Congress recognized narcotic     addiction  as a problem in
1929 with enactment of legislation      calling  for the establish-
ment of two clinical     research centers for treatment of drug
addicts.    The centers-- at Port Worth, Texas, and Lexington,
Kentucky--were   opened in the mid-193Ols' and are still     in
operation.
       In 1962 the White House Conference on Narcotic and
Drug Abuse was convened because drug traffic            and abuse was
growing and was of critical      national    concern.     The
President's    Advisory Commission on Narcotic and Drug Abuse
was established     in 1963 to recommend a program of action.
The Commission@s final report,       issued on November 1, 1963,
pointed our among other matters,        that the treatment at the
two Federal centers had, in essence, become a revolving-
door process for voluntary      patients who entered and left
treatment as they desired and who were more properly            the
responsibility    of the patients'     States and communities.       Of
the total 87,000 admissions to both centers from 1935
through 1964, 63,600 were voluntary         admissions of addicts
who applied for treatment and the remaining 23,400 were Fed-
eral prisoners.      Most of the voluntary     patients--an    average
of over 70 percent during this period--left           the centers
against medical advice.

       The Commission recommended that voluntary         patients  be
accepted only for purposes of research study and that Federal
financial   and technical    assistance be authorized      for State
and local programs,       The Commission recommended also that a
special treatment program be established          within the Federal
prison system and that a Federal civil          commitment statute
be enacted to provide an alternative        method of handling Fed-
eral prisoners   who were narcotic     addicts.

     In 1966 the Congress passed U     to enable the courts
to deal more effectively with the narcotic  addiction prob-
lem.
       In summary, the main titles,     or parts,   of NARA are as
follows:
     --Title   I authorizes  the pretrial    civil    commitment for
        treatment,   in lieu of prosecution,       of addicts charged
        with certain Federal crimes.

     --Title    II provides for the sentencing to commitment
        for treatment of addicts convicted of certain Federal
        crimes.
     --Title  III provides for the civil       commitment for treat-
        ment of persons not charged with       any criminal  offenses.

                                   6
     --Title     IV provides for rehabilitation      and post-
        hospitalization-care    programs for addicts civilly
        committed and for finaneial       and technical   assistance
        to States and municipalities       in the development of
        treatment programs for addicts.
Eligibility  for civil commitment under titles I and II may
be extended by a U.S. district  court to any narcotic  addict
charged with, or convicted of, an offense against the United
States, but excludes any person

     --charged    with a crime of violence;
     --charged    with unlawfully   importing or selling,      or con-
        spiring   to import or sell, a narcotic   drug;1
     --against    whom there   is pending a prior    charge of a
        felony;
     --convicted   of a felony on two or more occasions (Ti-
        tle II provides-- on two or more prior occasions);   and

     --previously   civilly committed on three or more occa-
        sions (Title II provides --civilly  committed on three
        or more occasions under the title   I program).
        A person eligible    under title     I is committed by a U.S.
district    court to the custody of the Surgeon General for
treatment.      The total period of treatment for any such person
may not exceed 36 months. Generally the person will be con-
fined in an institution        for part of this period and then may
be conditionally      released, at the discretion      of the Surgeon
General, for supervised aftereare          treatment in his community.
If the person successfully        c    letes the treatment program,
the criminal     charge is dismissed; if not, prosecution       of the
charge may be resumeds

1A person convicted for this offense may be offered title              II
 if the court determines that the sale or importation   was            for
 the primary purpose of enabling the offender to obtain a              nar-
 cotic drug which he required for his personal use because               of
 his addiction   to such drug,

                                   9
      A person not given the opportunity    to elect civil com-
mitment, or who does not so elect, if subsequently prose-
cuted and convicted,   may receive sentencing to commitment
for treatment under title   II.   Such a person is committed
to the custody of the Attorney General who provides for his
treatment.
       Under title  III,  any person seeking treatment for nar-
cotic addiction    may voluntarily     file a petition with a U.S,
attorney.    A member of his immediate family or household
also may file a petition.        Title III provides that a U.S.
attorney   has the   responsibility    for   determining   whether   there
is reasonable cause to believe that the person seeking treat-
ment is a narcotic addict and whether appropriate      State or
local treatment facilities     are available.  It is upon these
determinations    that the U.S. Attorney is authorized   by NARA
to petition    a U.S, district  court for commitment.
       Before the court can commit a person for treatments he
must undergo examination and evaluation          by two qualified
physicians      appointed by the court to determine whether he is
a narcotic      addict and is likely    to be rehabilitated     through
treatment,       NARA requires that one of the two physicians         be
a psychiatrist.        Upon completion of the examination and
evaluation,      each physician   is required to file a written       re-
port with the court.

      Most of these examinations and evaluations   for the
courts have been made by either the Fort Worth or the Lex-
ington clinical   research centers of the Public Health Service,
and such examinations and evaluations    at these centers can
take up to 30 days.
       Sara provides also that, if the court determines, after
receiving   the reports of the examining physicians    and after
a hearing, that a person seeking treatment is a narcotic       ad-
dict who is likely     to be rehabilitated through treatment,
the court order him committed to the care and custody of the
Surgeon General for treatment in a hospital      of the Public
Health Service for a period not to exceed 6 months. At the
discretion   of the court, and upon the advice of the Surgeon
General, the person may then be provided with supervised af-
tercare in his home community for as long as 3 years,
      Also the court, acting upon the recommendation of the
Surgeon General, has the authority     to ultimately release a
person from the civil  commitment program; however, in no
ease may the person voluntarily    withdraw from the program
after having been committed for treatment by court order.
       NIGH has been delegated the responsibilities        assigned
to the Surgeon General under NARA and is concerned princi-
pally with the treatment and rehabilitation        aspects of the
program,    The U.S, attorneys are the principal      administrators
involved in formalizing     the narcotic addicts'    entries into
and exits from the civil     commitment program.
         Both title  I and title III persons have been sent for
treatment to the Federal centers in Fort Worth and Lexing-
ton and have been sent for supervised aftercare           to community
facilities      which receive Federal financial    assistance.    Ti-
tle    II persons received treatment at one of three Federal
prisons located in Danbury, Connecticut;        Alderson, West
Virginia;     or Terminal Island, California.
        The principle    that treatment was the primary responsi-
bility    of the State and local communities was established
by title    IV and was expanded by allowing title         III commit-
ments only when appropriate          State or other treatment facil-
ities were not available.           Also, although certain grant pro-
visions    of title    IV were repealed by the Alcoholic      and Nar-
cotic Addict Rehabilitation          Amendments of 1968, the basic
principle    of title     IV--development    of community programs for
addicts--was      insorporated     in the new law and in later amend-
ments which permitted NIGH to make grants for construction
and/or staffing       of narcotic    addict facilities   in communities.
       In February 1967, shortly after passage of NAM, the
President called for enactment of legislation           in the area of
Federal assistance for the control of crime.            The
Presidential     proposal,   introduced   in the Senate as the Safe
Streets and Crime Control Act of 1967, followed the
Presidential     message on crime in        rica.    The message
called for an intensified         attack on the narcotics    and drug
problem by every level of government and included the fol-
lowing statement       on the Federal rehabilitation      effort.
      I'** to carry out the purposes of the Narcotic Ad-
      dict Rehabilitation      Act of 1966, I am instructing
      the Secretary of Health, Education, and Welfare,
      in consultation      with the Attorney General and the
      Secretary of the Treasury, to coordinate         the re-
      habilitation     efforts  of all the Federal agencies
      concerned and to work through local and State fa-
      cilities     to the greatest possible extent.       Fed-
      eral rehabilitation      efforts  will be closely re-
      lated to local programs that may qualify         for fed-
      eral support under the grant provisions        of the
      Safe Streets and Crime Control Act of 1967."
       The legislation     was enacted in June 1968 as the Omnibus
Crime Control and Safe Streets Act of 1968. The act created
the Law Enforcement Assistance Administration,             under the
general authority       of the Attorney General and within the
Department, to administer        the program.     The act, as amended
in 1970, requires the Attorney General to submit to the
President and to the Congress annual reports on the operation
and coordination       of the various Federal assistance programs
relating   to crime prevention       and control,   including   those
authorized    by MR.&
      In his message to the Congress on June 17, 1971, the
President outlined a comprehensive approach to the solution
of the drug abuse problem.        The key element in his recommen-
dation was the creation of the Special Action Office for
Drug Abuse Prevention which would have direct responsibility
for all Federal drug abuse training,          education,    prevention,
treatment,  rehabilitation,      and research programs and activi-
ties.   As an interim measure, the President,            by Executive
Order 11599, established      the Special Action Office for Drug
Abuse Prevention within the Executive Office of the
President to coordinate     the work of all Federal agencies in
their drug abuse prevention       activities.




                                   IO
                               CHAPTER2

                    NEED FOR ENCOURAGING
                                       USE OF

                     CIVIL COMMITMENTPROGRAMS

       NARAwas intended to enable the Federal courts to deal
more effectively    with the problem of narcotic        addiction    and
to bring about a fundamental reemphasis on rehabilitation.
The legislation    was based on the recognition        that narcotic
addiction    was a medical problem.      Title I of NARAwas one of
the most innovative     departures   from past methods of dealing
with narcotic    addicts by permitting      pretrial   civil   commit-
ment, instead of criminal      prosecution,     of arrested addicts
who are charged with nonviolent        Federal crimes and who show
prospect for rehabilitation.

        The title    I provision    of NARA has not been used to the
extent anticipated       at the time it was passed.       During the
first    3 years of the program--July        1967 to June 1970--179
drug addicts were committed, compared with the estimated
900 a year.        As far as we could determine,     expectations        of
anticipated       use of title    I were not met because of (1) the
lack of appropriate        emphasis on implementation     of title      I by
U.S. attorneys       and (2) a preference     by U.S. attorneys      for
the use of posttrial         commitments authorized   by title     II of
NAM. Also the use of the title             I program has been reduced
by the practice       of referring    addicts who were potentially
eligible    for the title      I program to State and local courts
for prosecution       when the crimes also were violations         of State
statutes.

      Our review indicated    also that neither NIMH nor the
Department had directed    its financial     assistance  programs
toward the development of close working relationships          be-
tween State or local courts      and Federally    funded State or
local narcotic  addict rehabilitation      programs or the
development of State or local civil      commitment programs.

ACTUAL USE OF TITLE I LESS THAN EXPECTED

     Our review showed that, despite initial   expectations
that 900 addicts would be eligible   each year under the ti-
tle I pretrial  civil commitment program, only 207 persons had

                                    11
been examined for admission into the program and only 179
had been accepted for treatment during the first     3 years of
the program's operation--July    1967 to June 1970, In con-
trast,    509 addicts had been sentenced for treatment under
the title    II posttrial commitment program.   Whether to use
title   I or II is the decision of the court,

       The small number of addicts accepted under the title               I
provisions    was in striking     contrast    to expectations    prior
to passage of NARA. For example, there was congressional
concern as to whether the 1,800-bed capacity of the two Fed-
eral centers would be sufficient          to handle the expected pa-
tient load,     Officials   from the administrative        agencies alle-
viated the concern4 in part, by pointing           out that they had
the authority    to contract    for facilities     if the patient      load
became a problem.

       Also studies made by the Department and HEW indicated
that a large number of addicts would be charged with crimes
in the Federal courts and therefore          would be eligible      for
the commitment program.        HEN estimated that about 1,300 per-
sons suspected of narcotic        addiction   would be brought before
the Federal courts each year because of criminal            activity
and that about 900 of these persons would be treated under
title    I for narcotic   addiction.      It was estimated that 100
persons would not qualify        and that 300 personsp after exam-
ination,    would not be eligible      for treatment.    HEWcould not
provide us with supporting        data for these estimates,       and we
have no basis for questioning         the estimates or for validating
them. The number of persons expected to be eligible               in
1 year for rehabilitation        under title   I was greater than the
actual number of commitments in 3 years under both title                I
and title     II.

     During our review we attempted to establish          the number
of Federal offenders who were narcotic        addicts,   as well as
the number of such offenders who were denied rehabilitation
because of the eligibility    restrictions      contained in NARA.
Records available   at U,S. attorneys'     offices which we visited
were not sufficient    for making these determinations,
      To determine the reasons for the underuse of title    I,
we solicited,   by questionnaire,  the cements of 22 U.S, at-
torneys in offices   located in those Federal districts  with
indexes of major narcotic     addiction.     Of the 22 replies,1
21 disclosed   that 48 addicts were processed under title        I
during the year ended December 31, 1969. Although these 21
U.S. attorneys    represented  the districts    having the highest
incidence of drug addiction,      10 of them reported no title     I
civil   commitment cases, four reported one civil      commitment
case, and seven reported two or more cases.

       Because 20 cases were reported by the U.S. attorney at
one location--the      District  of Columbia--we inquired     into the
practices    followed at that location.      We were informed that
 (1) the U,S. attorney and Federal judges within the district
court in Washington, D.C., accepted the merits of a civil
commitment program and were willing        to offer the addicts a
chance for rehabilitation       and (2) there were many addicts in
the District      of Columbia who were charged with Federal of-
fenses, such as thefts from mail boxes and check forgeries,
which did not exclude them from eligibility         under title    I,
whereas in other districts       these types of offenses were gen-
erally referred      to State or local courts.

      In response to our questionnaire, one U.S. attorney
merely stated that his office did no% process title    I cases.
The paraphrased comments of two others follow.

     One U.S. attorney     informed us tha% his inquiry within
     his office early in 1970 had disclosed no study, under-
     standing,    or use of title    I and that few, if any, of
     the staff were aware of the existence of the act.            Al-
     -though he indicated     a desire to develop a viable com-
     mitment program, he envisioned       problems in attempting
     delayed prosecution      of those addicts committed for
     treatment who did not successfully        complete rehabilita-
     tion.     The problems would stem from the passage of
     time, which might affect the availability         of witnesses
     or the usefulness     of o%her evidence.
     Another U.S, attorney  stated that his office had not ye%
     developed a program for commitment in lieu of prosecu-
     tion.   He pointed out that suspension of prosecution
     for serious offenses was no% considered appropriate   and


1One reply   was no% responsive.

                                   13
      that, for minor offenses,   his office  favored             dismissal
      of the charges and referral    to the State for             treatment
      and rehabilitation.

      Our review showed that in some districts                the U.S. at-
torneys preferred      criminal     prosecution      to the civil     commit-
ment option.     Also U.S. attorneys          advised us that (1) they
encountered practical       difficulties       in ascertaining      which
persons charged with Federal crimes were narcotic                  addicts
and (2) the difficulties         were compounded by the defendants'
or defense counsels'       lack of cooperation          in disclosing     cases
of narcotic   addiction.        Legislation      currently    being con-
sidered by the Congress addresses the identification                   problem
by requiring   immediate emergency medical treatment for per-
sons who appear to be drug abusers and who are charged with
Federal crimes,      Such emergency treatment would include de-
termination   of addiction,       detoxification,        and identifica-
tion of rehabilitation        potential     prior to determination         of
whether to prosecute.




                                       14
Agency cormnents

        In commenting on our draft report by letter      dated
June 16, 1971, the Assistant      Attorney General for Admin-
istration    informed us that the title    I procedure had not
been used to the fullest     possible extent.     He stated that
the Department was inclined     to agree with our reasons for
the underuse.

      The Assistant   Attorney General pointed out that title          I
did contain a rather detailed       listing of eligibility     re-
quirements and that one major reason for the underuse of
title  I was that, under the eligibility       requirements    as writ-
ten, many addicts who probably would benefit          from treatment
simply were ineligible.       He pointed out also that the de-
cision to use title     I was wholly discretionary       with the
courts and that the courts themselves were under no obliga-
tion to state their reasons when they determined not to use
title  I.

      The Assistant Attorney General also stated that, al-
though the Department was not in a position   to comment on
the frequency with which any one given court declined to
use title  I, he suggested that the underuse of title  I might
have been due to factors other than those which we specified
in the report.

      In our draft report we suggested that HEW, through
NIMH, and the Department jointly    develop and distribute   in-
formation to defense attorneys    and to the courts on the con-
cept of treatment under title    I and stress the importance
of the civil  commitment program.

        HEWS Assistant  Secretary,  Comptroller,     stated that
HEWagreed with our suggestion and would continue to work
with the Attorney General in jointly       developing    and dis-
tributing    additional information   on title   I.
                            r
        The Department, although agreeing that our suggestion
had merit, indicated    that it did not see any way in which the
suggestion could be implemented meaningfully         and cited, as
an exmple,     that it would be a monumental task to contact
all defense attorneys     to advise them of the availability      of
title    I commitments.


                                  15
       We are aware of the problems that would be associated
with informing    all defense attorneys       of the concept of treat-
ment under title      I, but we believe that there is a need for
continued exploration        of ways to publicize    and implement the
provisions   of title     I. We believe also that the Department
should seek opportunities,        such as bar association     meetings
and articles   in professional      legal publications,    to inform
defense attorneys       of the concept of treatment under title        I.

      In our draft report we suggested also that the Attorney
General issue instructions     to U.S. attorneys  that they con-
sider the use of title     I in all cases in which narcotic  ad-
dicts are charged with Federal offenses.

       The Assistant      Attorney General for Administration       ad-
vised us that our suggestion had overlooked two important
considerations:        (1) the offender might not be an eligible
person within the definition           of the statute and (2) there
might be many reasons why the U.S. attorney would not want
to utilize     title   I.    For example, if a U.S. attorney believed
that a person was not likely           to benefit   from the program3
any effort     to ge t the person into the program might be futile.
Also, since the pending charge is held in abeyanee conditioned
upon the person's successful           completion of the program, the
situation    frequently      might arise when the person did not suc-
cessfully    complete the program and, because of the passage
of time, the U.S. attorney would be unable to try the per-
son on the underlying         criminal   charge,    The Assistant  At-
torney General pointed out that, in situations              such as this,
the person was neither rehabilitated             nor made to pay for his
offense and that consequently           neither the goal of rehabili-
tation nor the goal of justice           was served.

       The Assistant  Attorney General advised us that any in-
structions   which the Attorney General might issue could be
only in the nature of an advisory recommendation9 which was
the current policy of the Department, and that he certainly
could not issue any binding instructions,       He emphasized
that any decision of whether to invoke the provisions       of
title   I was a prosecutorial   decision which must be left to
the sound discretion     of the U.S. attorneys.

     We recognize that      title I has eligibility   requirgments,
and we do not question      the merits of such requirements.

                                   16
Also we have no basis for questioning   the Assistant      Attorney
General's statement that any decision of whether or not to
invoke the provisions  of title  I is a prosecutorial      decision
which must be left to the discretion   of U.S. attorneys.         We
believe, however, that the possible application       of title    I
should be considered in all cases in which narcotics         addicts
are charged with Federal crimes.
       With regard to the Assistant        Attorney General's concern
for prosecuting     Federal offenders after substantial           delays
for purposes of treatment,        it should be noted that in 1966
the Senate Committee on the Judiciary,             in considering   the
then-proposed NAM, discussed the possibilities               of the ef-
fect of delays in criminal prosecution             but, on the basis of
the testimony of medical authorities            and the then-Attorney
General, was persuaded that pretrial            civil   commitment of-
fered worthwhile advantages and that the possibility               of re-
suming the.criminal      prosecution     would remain as a sanction
reinforcing    theaddicts'    disposition     to cooperate throughout
their programs of treatment.
Recommendation to Attorney       General
      We recommend that the Attorney General emphasize to
all U.S. attorneys   the intent of the title I program and
encourage them to give greater consideration   to its use.




                                  17
NEED TO ENCOURAGEDEVELOPMENT
                           OF
STATE CIVIL COMMITMENTPROGRAMS

      Although it has been recognized that the majority     of
the crimes committed by addicts fall under the jurisdiction
of State courts, neither NIMH nor the Department has di-
rected its efforts     toward the development of close working
relationships    between State or local courts and federally
funded State or local narcotic     addict rehabilitation   programs
or the development of State or local civil       commitment pro-
grams.

      NARA provided not only for the conrmitment of narcotic
addicts under Federal court jurisdiction           but also for Fed-
eral assistance       to aid State and local agencies in develop-
ing narcotic    addict treatment facilities.         The Qnnibus Crime
Control and Safe Streets Act of 1968 created the Law En-
forcement Assistance Administration        (IX&,      within the De-
partment, to assist State and local governments to improve
their criminal      justice   systems--the police,    the courts, and
institutions     for corrections --as well as to develop narcotic
addict treatment and rehabilitation        programs.

       NIMH's grant programs, which are concerned primarily
with increasing    the availability     of non-Federal   treatment
programs for narcotic     addicts,    have a potential   for assist-
ing the development of State civil        commitment programs.
NIMH's guidelines     for the narcotic    grant programs, however,
do not encourage the development of civil         commitment pro-
grams for the treatment of addicts referred          by State and
local courts.     Our review of 22 NIMH grants awarded through
April 30, 1971, showed that some grantees had been required
to assist the Federal civil        commitment program; however,
none of these grants had included a requirement forthe grantee
to accept commitments or referrals        from State and local
courts.
       The use of title     I generally   was intended to apply to
addicts who committed such Federal crimes as mail theft,
check forgery,    auto theft,    and other nonviolent      crimes.
Many of these Federal crimes are also violations            of State
statutes   and often are prosecuted+in       the State or local
courts under State statutes.          Under the provisions     of NARA,
only U.S. district      courts are empowered to invoke title         I.

                                  18
Therefore,  when addicts who commit Federal crimes are re-
ferred to State or local authorities    for prosecution,   op-
portunities   for pretrial civil   commitment in lieu of pros-
ecution are lost if the State does not have a civil      commit-
ment program,

        An indication    of the number of persons committing cer-
tain types of Federal offenses and who therefore                 may be eli-
gible for title       I commitment but who are tried in State
courts is provided by Post Office Department (now the U.S.
Postal Service> statistics        which show that during fiscal
year 1970, 2,093 persons were convicted             in Federal courts
and 3,225 were convicted        in State or local courtsforthe
theft of mail from letter        boxes.    Post Office Department of-
ficials    estimated that, nationwide,        about 20 percent of the
persons arrested on such mail-theft           charges were addicts.
On this basis, we estimated that about 640 addicts were con-
victed in State or local courts of thefts from letter                  boxes
and thus could not be considered for pretrial               civil   commit-
ment under the title       I program.     Also,   in  New   York   City,
which has the largest estimated narcotic             addiction     problem
in the country, a 3-month study showed that 45 percent of
the persons arrested for thefts         from letter     boxes were nar-
cotic addicts.

        We believe that, because only a few States have active
civil    commitment programs, NIME-Iand LFM should seek, partic-
ularly    through grant program guidelines,    the development of
close working relationships     between State or local courts
and Federally     funded State or local narcotic   addict rehabil-
itation    programs or the development of State or local civil
commitment programs.
_&ency comments

       The Assistant      Attorney General for Administration       did
not agree with our conclusion         that LEAA had not made a se-
rious effort      to assist the States in developing     close work-
ing relationships        between the courts and narcotic     addict
rehabilitation       programs.    We pointed out that LEAA, from
fiscal    year 1969, had provided about $25 million        to a num-
ber of programs concerned with the rehabilitation            of the
narcotic     addict,


                                     19
        The Assistant    Attorney General stated that it was true
that LEAA had not been involved in developing civil         commit-
ment programs for the narcotic        addict (1) because LEAA fund-
ing went to the States which were largely responsible         for
the spending of the money and (2) because changes in State
laws would be needed in most cases to establish         such pro-
grams and because LEAA had not been involved to a great ex-
tent in influencing       changes in State legislation,    The As-
sistant    Attorney General agreed that LEAA had not developed
guidelines     regarding    civil commitment programs for the nar-
cotic addict.

Recommendation to Attorney General and to
Secretary of Health, Education, and Welfare

        We recommend that the Attorney General and the Secre-
tary of HEWrevise their grant program guidelines        to stress
the development of close working relationships      between re-
habilitation      programs and the courts and to encourage ar-
rangements whereby the Department and HEWwould participate
jointly     in the development of State and local civil   commit-
ment programs.

      HEW's Assistant Secretary,   Comptroller,  informed us
that HEW, in its c ommunity assistance   program guidelines,
would stress the need for local treatment agencies to co-
operate with State and local civil    commitment programs.      He
also stated that HEWwould coordinate     its activities    with
LEAA to support the development of local treatment services
which emphasized acceptance of State and local court commit-
ments in the locales in which LEAAwas supporting        the devel-
opment of legislation  for civil   commitment programs.

       The Assistant     Attorney General said that LEAA would
make it a point to develop guidelines           in greater detail
with State planning agencies regarding            civil  commitment pro-
grams.    He said    also   that  NIMH   and LEAA  had  several   commit-
tees with representatives         from both agencies,     including    one
on drug addiction,       which could be assigned the task of
studying and considering         ways in which the two agencies
could stimulate      and promote the development of civil           commit-
ment programs for narcotic          addicts.



                                    20
     We were told that, in the annual report to the President
and to the Congress required under the 1970 amendments to
the Omnibus Crime Control and Safe Streets Act, the Depart-
ment planned to provide data on the programs conducted,
plans developed, and problems discovered in the operation
and coordination  of Federal efforts  to stimulate   the develop-
ment of State and local civil   commitment programs,




                               21
                                               CHAPTER3

                              OPPORTUNITIESFOR IMPROVING

                     ADMINISTRATION OF TITLE III                         PROGRAM
       Our review indicated   that the administration    of the
title   III program could be improved and that greater assis-
tance could be provided to addicts if HEW, through its
grantees and contractors,     were to assist the U.S. attorneys
by performing    certain nonlegal activities    concerned with
helping persons who seek treatment under the program.
      Of the persons who voluntarily      submitted for examina-
tion and evaluation     of treatment potential    under the ti-
tle III program during the first       3 years of its operation,
about 57 percent were rejected      by the two Public Health
Service clinical    research centers.     The rejections  were
made on the basis that the persons were unsuitable         for
treatment,   and therefore    the court did not commit them for
treatment to the Federal centers.        At July 31, 1971, about
50 percent of the available      capacity at the two Federal
centers was being used for rehabilitating        narcotic addicts.

       Following   is a summary of the sta istical      data re-
ceived from 19 U.S. attorneys*       offices E responding to our
questionnaire    regarding   the voluntary   civil  commitment pro-
gram authorized     by title   III.  The data represents    calendar
year 1969 figures only.
1. Narcotic         addicts      in district          (note   a)                                 56,036
2. Narcotic addicts              who contacted U.S. attorneys'   offices
   about commitment              under the NARA title  III program                                3,804
3. Title      III    petitions       filed     with     the courts                                1,123
4. Narcotic   addicts rejected  by HEW after examination    and
   evaluation   as not being suitable  for treatment   under ti-
   tle III                                                                                          596
aObtained       from Bureau        of Narcotics          and Dangerous    Drugs,    Department     of
 Justice.

'Three      U.S. attorneys'                  offices          did not supply       statistical
  data.

                                                        22
laDMINISTRATIONBY NATIONAL INSTITUTE
OF MENTALHEALTH

       During the first  3 years of the title      III program,
2,801 addicts,   or about 57 percent of the 4,889 who volun-
tarily   sought commitment, were rejected       by the Federal
treatment centers during the examination and evaluation
phase of the program,     Rejections were made on the basis of
the persons Q being unsuitable     for treatment.      At July 31,
1971, about 50 percent of the capacity of the two centers
was being used for rehabilitating      narcotic    addicts.
        According to HEW, the addict's         motivation    toward
treatment,     to a high degree, indicates        his relative     suit-
ability    for treatment.     The eligibility       conditions,    in-
cluding suitability       for treatment,      must be met before a
person may be admitted to the program for treatment.

       The Congress gave the Surgeon General broad authority
for treatment of addicts who are likely       to be rehabilitated.
NIMH was delegated the responsibilities       of operating    the
program for the Surgeon General and was authorized         to dele-
gate any of its responsibilities      to other public agencies
or to privat e agencies or to contract with such agencies
for facilities    and services for examining or treating        ad-
dicts.

       Treatment can include,  but is not limited     to, services
in the medical, educational,     social, psychological,     and vo-
cational    fields. It can include also corrective       and pre-
ventive guidance and training     and any other rehabilitation
services designed to protect    the public as well as to bene-
fit the addict by correcting    his antisocial   tendencies and
ending his dependence on, and susceptibility       to, narcotics.
      The Surgeon      General is authorized    by NARA to restrict
commitments under       the program when he certifies    that ade-
quate facilities       or personnel for treatment of patients       un-
der the title    III    program are unavailable.
      HEWbelieves that a higher potential    exists for suc-
cessful rehabilitation    for persons who are highly motivated
for treatment than for those who are not so motivated.       Ac-
cordingly  NIMH has elected to accept those persons who have


                                     23
high motivation  for rehabilitation    and to reject all others
as not being suitable   for treatment.    HEW advised us that:
      "Our experience has borne out the belief         of ex-
      perts in this field that a high degree of motiva-
      tion on the part of addicts is an essential          pre-
      requisite    if treatment and rehabilitation      programs
      are to be successful.      We have found that the in-
      dividuals    who have been most disruptive     and unco-
      operative,     most eager to leave the program prema-
      turely,    and who have profited    least have been
      those with insufficient     motivation    who, fre-
      quently, were in the program only because of pres-
      sures from relatives     and friends.     Our experience
      has also demonstrated that the disruptive         influ-
      ence exerted by such addicts on the other patients
      is extremely detrimental."

        Early in fiscal    year 1970, the chiefs of the clinical
research centers,       in response to an NIMH request,coauthored
a paper on their experiences regarding        the suitability     of
addicts for treatment.         The paper was distributed     to com-
munity agencies as a guide in screening applicants            and to
officials    of courts to promote greater understanding         of the
reasons for rejection.

        The gist of the paper was that the persons being re-
jected required large amounts of medical, nursing,           and so-
cial work time and that additional        resources of trained
personnel would be needed to treat larger numbers of antag-
onistic    patients,  psychotic patients,     mentally retarded
patients,    and others with special problems.        The paper
stated that:
     "It is possible    to retain and treat some patients
     in the hospital    whose behavior is chronically       an-
     tagonistic  and disturbing   to others.       The problem
     is that we have to devote large amounts of medi-
     cal, nursing and social work time to small groups
     of these patients.     With additional     resources of
     trained personnel we could accept and treat
     larger numbers of antagonistic      patients,    psy-
     chotic patients,    mentally retarded patients,       and
     others with special problems.       However, at the

                                  24
         present time, the fiscal    and personnel restraints
         within the Federal Government are very severe,
         and we are forced to limit our program to the
         number of patients    who can be adequately treated
         within our current limitations.         We do not fore-
         see any lifting    of those limitations     at any time
         in the immediate future,      Accordingly,    we will
         try to give the best treatment possible        to those
         patients   who are most highly motivated to benefit
         from itetq

      Formalized guidelines     issued in March 1970 to           the com-
munity agencies which were under contract         and which        were
performing narcotics    addiction    treatment activities           in-
cluded basically   the same criteria      with respect to         motiva-
tion for acceptance of applicants        for treatment.

       Rejections   by the Federal treatment centers during the
examination and evaluation      phase of the program, wb#ch was
made to avoid formal commitment      of persons considered un-
suitable    for treatment,  rose from 56 percent during fiscal
year 1969 to 62 percent during fiscal       year 1970.

Agency     @omments

         The Assistant    Secretary,   Comptroller,    HEW, stated that
court commitments should be restricted            when personnel and
facilities      were not adequate to provide the authorized
treatment and control        services and that the voluntary           civil
commitment program was directed           toward accepting only those
addicts with high motivation          for treatment.       He stated that
to do otherwise would seriously          diminish the overall         reha-
bilitation      potential   of the addicts committed to the pro-
gram and that patients        cannot be considered "likely          to be
rehabilitatedDD      unless they are highly motivated.           He stated
further     that HEW"s experience had borne out the belief of
experts in the field that a high degree of motivation                  on
the part of addicts was an essential            prerequisite     if treat-
ment and rehabilitation         programs were to be successful.
     The Assistant   Secretary,  Comptroller,  acknowledged
that the provisions   of NARA, which direct   that addicts be
committed to treatment only if they are considered likely
to be rehabilitated,   limited  the intake of patients    into

                                     25
         the program.     He stated that HEWbelieved this to be the
         intent of the Congress and considered HEW's practice    of
         weeding out individuals    unlikely to be rehabilitated to be
         consistent   with NARA and with HEW's judgment as to the best
         way to manage the program at that point in time.




I
    ‘:




                                      26
ADMINISTRATlON BY U.S. ATTORNEYS1OFFICES
       We found that many U.S. attorneys       questioned the use
of the title      III program and particularly    their own role in
assisting     program applicants.     Many persons who inquired
about the program did not file petitions         with the U.S. at-
torneys,    and many who did were rejected by the Public
Health Service clinical       research centers as being unsuitable
for treatment,        Comments from U.S. attorneys     generally in-
dicated that they did not wish to take on the type of work
that required following       up on such persons or providing      re-
ferral    services9 which they said was usually associated
with social agencies.
       NAEA requires that an applicant              voluntarily      seeking
treatment for narcotic          addiction    must petition        the U.S.
attorneyOs office        and that the U.S. attorney,            in turn, must
petition     a U.S. district       court.    Following the U.S. attor-
neyss petition       to the U.S. district         court, the court re-
quires an examination and evaluation                of a person to deter-
mine whether he is a narcotic             addict and is likely         to be
rehabilitated       before deciding whether the applicant                should
be committed for treatment.             The examination and evaluation
function     has been performed mostly at the clinical                 research
centers.      We understand that some examinations                and evalua-
tions are being performed in community facilities                     which
have contracted       with HEW to perform such services.
        To gain an insight       into the intake process at the U.S.
attorneys"     offices,    we discussed the process with repre-
 sentatives    of the U.S. attorneys'          offices     in four selected
cities    and obtained,      by questionnaire,         information     from
 22 U.S. attorneyss       offices.
       U.S. attorneys'     comments in response to our question-
naire indicated     that there -appeared to be general agreement
that the U.S. attorneys'       offices   were not appropriate      in-
take points for persons,seeking         treatment under the title
III program because intake involved the type of work usu-
ally associated with soc5al agencies.            There are, however,
certain    legal functions    that must be performed by the U.S.
attorney, such as making eligibility         determinations     and fil-
ing petitions    with the court.       Gee p,. 8.1
       One U.S. attorney,     whose district     had a relatively
high ratio of commitments to the estimated addict


                                      27
population,      expressed one of the most favorable opinions,
i.e.,    that the program was running quite smoothly and that
the purpose of the legislation            was being effectively         rea-
lized.      He went on to explain,        however, that most of the
commitments were referrals           from the State courts and that
some other intake point would, in his opinion,                  be more
successful     in generating voluntary           commitments.
       Other U.S. attorneys        generally      were far less compli-
mentary about the program's effectiveness.                  One deemed the
program ineffective,        stating     that,of    43 persons     submitting
petitions     under the title      III program in his district,            only
one was accepted for treatment.               Another reported that all
the persons sent to clinical            research centers from his dis-
trict    were addicted to narcotic          drugs, yet about 75 percent
were found to be unfit subjects for rehabilitation.                     Still
another, who had a large number of petitioners                   accepted,
emphasized the point that commitments were voluntary                    and
stated that, to his knowledge, no sanctions had been im-
posed on escapees.         He went on to state that use of the
courts for title       III commitments, in his opinion,             was cum-
bersome, constituted        a waste of time and money, delayed
treatment,     and deterred applicants.
        Another U.S. attorney recommended that, at the very
least,     the evaluation    and examination phase of the pro-
gram be done locally        and entirely        on the initiative      of
NIGH and that the person be referred               to a court for commit-
ment only after completion of evaluation               and examination.
      Comnnents which emphasized the view that the U.S. at-
torneys'   offices were not social-work-type       agencies were
most frequently     offered as an explanation    for the lack of
any referral     to available treatment centers or of follow-
up on those persons who had not pursued the steps to com-
mitment or who had been found to be unsuitable         for treat-
ment.
Agency comments
      Because U.S. attorneys      generally agreed that their of-
fices were not appropriate      intake points for persons seek-
ing treatment for narcotic      addiction,  except with respect
to the performance of the required legal functions,         we
suggested in our draft report that the administration          of
the title    III program possibly could be improved if HEW


                                      2s
would assume the responsibility    for certain precommitment
functions  assigned to U,S. attorneys.     These functions in-
clude determining whether there is reasonable cause to
believe that the person seeking treatment is a narcotic
addict and whether appropriate    State or local treatment
facilities  are available.
        The Assistant     Attorney General advised us that many
of the precommitment functions            currently     assigned to U.S.
attorneys were, or could be, performed by the Surgeon Gen-
eral.      He stated that there was no objection             to having a
prescreening      conducted by the Surgeon General to ensure
that a person was suitable          for treatment,         The Assistant      Sec-
retary,      Comptroller,    HEW, had no objection         to expanding
HEWss advisory role to U.S. attorneys               in determining     the
availability      of State and local treatment facilities,               al-
though he advised that additional             resources would be re-
quired.       The Assistant    Secretary,     Comptroller,      stated that
HEWconsidered it inappropriate             to require the Surgeon GenA
eral, acting through NIGH, to perform the legal functions
required of U.S. attorneys,            He stated that it would be un-
wise to mix the legal and therapeutic               functions.
        We did not intend to imply that HEW should take over
any of the legal functions          of the U.S. attorneys.           Our con-
cern was for improving the administration                 of the title    III
program by having nonlegal functions              performed by HEW, in-
stead of by U.S. attorneys.,
Recommendation to Attorney General and to
Secretary of Health, Education, and Welfare

       We recommend that, to provide greater assistance           to
addicts who are seeking treatment and to improve the ad-
ministration    of the title     III program, the Attorney General
and the Secretary of HEWconsider having HEWgrantees or
contractors    involved in the rehabilitation        of narcotic    ad-
dicts provide assistance       to U-S. attorneys     by performing
the following     nonlegal intake functions:        (1) receiving    the
request from a person seeking treatment and rehabilitation
under the program, (2) determining          that there is reasonable
cause to believe that the person is a narcotic            addict,
 (3) determining     that appropriate    State or local facilities
are not available       for the treatment of the person, and
 (4) helping the person prepare and file a petition            for com-
mitment with the U.S. attorney's         office.
                                       29
                             CHAPTER4

                        SCOPEOF REVIEW
       Our review was directed principally       to an examination
of those policies,      procedures, and practices     of the Depart-
ment of Health, Education, and Welfare and the Department
of Justice relating      to the implementation     of the pretrial
commitment and voluntary        commitment programs under NARA.
Our review was made during 1969 and 1970 and covered the
pertinent    activities    of the Department and HEW from the pas-
sage of NARA in November 1966.
      Our work included a review of (1) the legislative    his-
tory of NARA, (2) national and local reports on the problems
of addiction,  crime, and the courts, and (3) records, re-
ports, and the related guidelines    of the Department and HEW.
A significant  part of our fieldwork   was done at program
sites in Albuquerque, New Mexico; Chicago, Illinois;     New
York, N.Y.; and San Antonio, Texas.
       We also contacted NIMH field and regional office staffs,
the offices   of U.S. attorneys,   and operating officials      con-
cerned with State or local programs,including         those programs
assisted with Federal grants.      We supplemented site visits
with questionnaires     and made selective  inquiries     at key of-
fices of several Federal, State, and local agencies,           We
also visited   the NIMH centers at Lexington and Fort Worth,
NIMH headuarters     at Bethesda, Maryland; and the IEAA re-
gional office in Des Plaines, Illinois.
APPENDIXES




 31
                                                                                              APPENDIX I



               DEPARTMENT          OF     HEALTH,         EDUCATION,          AND   WELFARE
                                       OFFICE    OF THE      SECRETARY

                                          WASHINGTON.        D.C.   20201




Mr. Dean K. Crowther
Assistant Director, Civil Division
U. S. General Accounting Off ice
Washington, D. C. 20548

Dear Mr.      Crowther:

            The Secretary has asked that I reply to the draft report of the

General      Accounting       Office      entitled,       “Limited          Impact of Federal Programs

for Treating and Rehabilitating                 Narcotic        Addicts.”        As requested,   we

are enclosing the Department’s                  comments on the findings and recommendations

in your report
                                            [See GAO note.]

            We appreciate        the opportunity           to review and comment on your

draft report.

                                                               Sincerely       yours,




                                                               James 5. Cardwell
                                                               Assistant Secretary,       Camptrol ler

Enclosure

GAO note:   Deleted comments pertain to material presented in the draft report which has been revised or which has
            not been included in the final report.



                                                        33
APPENDIX      I                                                     .



COMMENTS ON THE GENERAL ACCOUNTING       OFFICE DRAFT REPORT
ENTITLED: LlMlTED IMPACT OF FEDERAL PROGRAMS FOR TREATING
AND REHABILITATING   NARCOTIC ADDICTS, DHEW, DEPARTMENT OF
JUSTICE, AND VETERANS ADMINISTRATION


                         [See GAO note.]


GAO     Recommendation:     That the Secretary of Health, Education, and
      Welfare, and the Attorney General jointly develop and distribute
      meaningful information to the defense attorneys and the courts on
      the concept and treatment under Title I, and stress the importance
      of the civil commitment program enabling the courts to deal more
      effectively  with the problem.

HEW Comment:       We concur with this recommendation,   and will continue
to work with the Attorney General in jointly developing and distributing
additional information regarding Title I of the Narcotic Addict Rehabilitation
Act (NARA).




                           [See   GAO   note.]




In the past, we have met with U.S. Attorneys of all the large United
States Court Districts to discuss Title I, and in cooperation with the
Department. of Justice, have conducted training seminars for U.S. Attorneys
at both the Lexington and Fort Worth Clinical Research Centers. Staff
members have also appeared on the programs of Sentencing Institutes
sponsored by the Administrative   Office of the U.S. Courts to present
information regarding Title I to U.S. Judges and, on numerous other
occasions, have discussed the program with the U.S. Judges, who are of
critical importance because they make the final decision regarding commitment.




                                          34
                                                                       APPENDIX I


GAO      Recommendation:     That the Secretary of Health, Education, and
      Welfare and the Attorney General jointly include in each of the
      agencies grant and funding guidelines the importance of meaningful
      linkages between rehabilitation    programs and the courts and encourage
      working arrangements whereby joint funding could be used to develop
        State or local court civil commitment programs.

HEW Comment:       We concur with this recommendation.

We will expand our efforts in this area by stressing in our community
assistance program guidelines the need for local treatment agencies to
cooperate with State and local court civil commitment programs. The
plans of grant applicants to do so can be considered during the evaluation
of applications and subsequently monitored during our administration of
these grants. Al soI we will coordinate our activities with the Law
Enforcement Assistance Administration   (LEAA) through the recently-
established LEAA-NIMH      Liaison Committee so that we support, to the
extent permitted by budget constraints, the development of local treatment
services which emphasize acceptance of State and local court commitments
in the locales in which LEAA is supporting the development of legislation
for civil commitment programs.




                          [See GAO note.]



Provisions of the NARA, which we believe to be sound, state that narcotic
addicts will be committed to treatment if, after a period of examination and
evaluation,   they are considered “likely to be rehabilitated.”   In conformance
with these provisions NIMH has, as stated in the report, “exhibited a
tendency to accept only those addicts with high motivation for treatment.”
To do otherwise would seriously diminish the overall rehabilitation    potential
of the patients committed to the program.

We believe that the patients cannot be considered “likely to be rehabilitated”
unless they are highly motivated.     It is widely recognized that the process of
treatment and rehabilitation  is a difficult   and demanding one for addicts.




                                         35
APPENDIX I
                                                                             .
Our experience has borne out the belief of experts in this field that a high
degree of motivation on the part of addicts is an essential prerequisite if
treatment and rehabilitation     programs are to be successful.      We have
found that the individuals who have been most disruptive and uncooperative,
most eager to leave the program prematurely,          and who have profited least
have been those with insufficient motivation who, frequently,          were in the
program  only because   of pressures   from relatives   and friends,  Our experience
has also demonstrated that the disruptive influence exerted by such addicts
on the other patients is extremely detrimental.




                            [See GAO note.]




We acknowledge that the provisions of the Act which state that addicts
will be committed to treatment only if they are considered likely to be
rehabilitated  limits the intake of patients into the program. We believe
this to be the intent of Congress and consider our practice of “weeding-out”
individuals unlikely to be rehabilitated    consistent with both the NARA and
our judgment as to the best way to manage the program at this point in
time.




                              [See GAO note.]




                                           36
                                                                      APPENDIX I

We consider it inappropriate to require the Surgeon General, acting through
NIMH, to perform the functions now required of U.S. Attorneys.         It would
be unwise to mix legal and therapeutic functions; not only would it be
impractical from a fiscal standpoint (NIMH would need a greatly expanded
staff to cover the District Courts), but our involvement in the legal function
would diminish the confidence of the addict in our therapeutic role and
wow Id tend to destroy the effectiveness of therapeutic relationships.    The
suggestion to have the Surgeon General petition the Courts to commit the
addicts is contrary to long-standing policy to avoid having the Public Health
Service become involved, except by providing medical judgments, in
committing people to mental or other institutions.     To do so would remove
an important “check” from the commitment process. We presently examine
and evaluate potential commitments and, to some extent, determine the
availability  of State and local facilities.   We have no objection to expanding
our role, which is now advisory to the U.S. Attorneys, in assessing the
availability  of facilities although additional resources would be required.




                            [See GAO note.]




                                        37
                     APPENDIX II

                                                 UNITED          STATES         DEPARTMENT                        OF JUSTICE

                                                                        WASHIKGTON,         D.C.          20530


        Address      Reply     LO the                                        June 16,              1971
          Division      Indicated
and   Refer    to Initials     and   Number



                       Mr. Irvine M. Crawford
                       Associate Director,  Civil Division
                       United States General Accounting Office
                       Washington, D.C. 20548
                       Dear Mr. Crawford:
                             This is in response to your request for comments
                       on the draft report titled    "Limited Impact of Federal
                       Programs for Treating and Rehabilitating       Narcotic
                       Addicts."    The report expresses your concern over the
                       need for the Federal Government to more effectively
                       deal with the problem of narcotic     addiction.
                             Although the report covers the activities       of three
                       Federal organizations,     our comments are generally    limited
                       to those areas which deal with the relationship        of the
                       Department of Justice to the Narcotic Addict Rehabilitation
                       Act (NARA) of 1966. Regarding those areas of the report
                       which deal with the National Institute      of Mental Health
                                  [See GAO note.]          we  lack  the requisite
                       expertise    to make meaningful comments.
                              In evaluating    your recommendation that the Attorney
                       General distribute      information   to defense attorneys    and
                       the courts concerning the concept of treatment under Title I
                       of NARA, the fact must be recognized that Title I of NARA
                       has been on the statute books for almost five years.            Pre-
                       sumably, defense counsel seeking some alternative          to prose-
                       cution for their addict-clients        would be aware of the
                       availability    of the program.      Accordingly, while your sug-
                       gestion has merit, we do not see any way in which it can be
                       meaningfully    implemented.      For example, it would be a monu-
                       mental task to require the Attorney General to contact all
                       defense counsel to advise them of the availability           of Title
                       I commitments.       In the same vein, any general announcements,
                       as in the form of a press release, would be of limited
                       impact.

                             GAO note:        Deleted comments pertain to material presented in the draft report which has been revised or which has
                                              not been included in the final report.




                                                                                      38
              .                                               APPENDIX II


        The report recommends that the Attorney General
issue instructions         to United States Attorneys        that they
consider the use of Title I in all cases in which
narcotic    addicts are charged with Federal offenses.                 This
recommendation overlooks two important considerations.
Firstly,     the offender may not be an eligible            person within
the definition        of the statute.       Secondly, there may be
many reasons why the United States Attorney may not want
to utilize      Title I. For example, if he believes              that the
individual      is not likely       to benefit   from the program, any
efforts    to get the individual         into the program may be
futile;    additionally,        since the pending charge is held in
abeyance conditional           on the individual     successfully     com-
pleting    the program, the situation          may frequently      arise
when the individual          does not successfully       complete the
program, but because of the passage of time, the United
States Attorney is unable to try the individual                  on the
underlying      criminal     charge.    Witnesses may disappear or
their memories may fade; evidence may be lost; and any
number of other factors may occur which would prevent a
prosecution.         In a situation     such as this, the addict is
neither rehabilitated           nor is he made to pay for his offense;
neither the goal of rehabilitation             nor of criminal       justice
has been served.          Accordingly,     any instruction     which the
Attorney General might issue could be in the nature of a
recommendation only; certainly             he could not issue any
binding instructions.            And insofar as any advisory rec-
ommendation is concerned, this is no different                 than the
present policy of the Department.               However, it must be
 observed that any decision as to whether or not to invoke
the provisions         of Title I is a prosecutorial        decision which
must be left in the sound discretion               of the United States
Attorneys.
      Of course, there is one overriding     consideration     which
must be taken into account with respect to Title I.          It is
wholly discretionary     with the court as to whether or not
the Title I procedure will be used with any one individual.
Accordingly,    even if both the United States Attorney and
the Surgeon General recommend to the court that Title I be
used, the court is under no compulsion to use this procedure.
See 28 U.S.C. §2902(a).       There is no way in which the United
States Attorney can compel the court to use this procedure.
The court itself     is under no obligation  to state its reasons
when it determines not to use Title I; therefore,         an important




                                      39
 APPENDIX II                                                  .

factor which must be considered in examining the relative
low use of Title I is the court itself.    The GAO report
does not in any way take this into account.    While we are
not in a position  to comment on the frequency with which
any one given court declines to use Title I, we would
simply suggest that the disuse of Title I may be due to
factors other than those which are specified   in the report.
      We do not agree with the comments in the report indicating
that the Law Enforcement Assistance Administration               (LEAA)
has made little       serious effort   to assist the States in
developing     linkages between the courts and narcotic           addict
rehabilitation       programs.    LEAA has funded a varied number
of programs concerned with the rehabilitation              of the narcotic
addict totaling       approximately   $25 million     since fiscal    year
1969.     These   programs   include  prevention/public      education
programs, treatment/rehabilitation          programs and enforcement
and control programs.
       It is true that LEAA has not been involved in developing
adequate civil     commitment programs for the narcotic     addict.
This can be traced to at least two problems.         First,  the
bulk of LEAA funding goes directly       to the States and they
are largely    responsible    for the spending of the money.
Secondly, changes in State laws would be needed in most
cases to establish      such programs, and LEXA has not been
involved to too great a degree in influencing        changes in
State legislative     matters.
        It is also correct to state that LEAA has not developed
guidelines    regarding     civil   commitment programs for narcotic
addicts.     LEAA could certainly         do considerably    more and we will
make it a point to develop this area in greater detail with
our State Planning Agencies.            In this regard, the National
Institute    of Mental Health and LEAA have several committees
with representation       from both agencies, including          one on drug
addiction.     This   committee     could   be assigned   the  task   of
studying and     considering      ways  in  which  the  two  agencies    could
stimulate    and promote the development of civil            commitment
programs for narcotic        addicts.
       As pointed out in the draft report,   an annual report to
the President and the Congress is required under the Omnibus
Crime Control Act of 1970. In preparing      our annual report
pertaining    to this Act, we plan to provide data on the programs
conducted, plans developed, and problems discovered      in the
operation   and coordination  of Federal efforts  to stimulate
the development of State and local court civil      commitment
programs.



                                     40
             .                                              APPENDIX    II


        With respect to having the Surgeon General perform
any of the functions      now performed by the United States
Attorney,     we envision some difficulty.        Certainly     there
is no objection      to having a "pre-screening"       conducted
by the Surgeon General to insure that an individual                is
a suitable     person for treatment.       However, the commit-
ment of an individual       under NARY.is a legal function;
the addict is subjecting        himself to a relatively       long
period of carefully      supervised treatment.        Therefore,
we would object to any proposal which would have the
Surgeon General himself petition          the court for the
commitment of an addict.         Many of the pre-commitment
functions,     e.g., the determination       of whether an
addict is in fact an addict who is likely            to be rehabil-
itated,     can be-- and we  are  advised    are and  will be--
performed by the Surgeon General; however, the actual
commitment proceeding should and must be left in the
control     of the United States Attorney.
       The report notes, quite correctly,         that the Title I
procedure has not been used to the extent to which it
might be. We are inclined          to agree with the reasons for
this disuse set forth in the report.            However, we would
like to point out that Title I does contain a rather
detailed   listing  of eligibility       requirements.    We believe
that one major reason for the disuse of this provision
is the fact that under the eligibility           requirements     as
written,   many addicts who probably would benefit            from
Title I treatment are simply ineligible           under the Act.
        With respect to Title III commitments, the report
indicates     that during the first       3 years of operation,
57 percent of the addicts who sought treatment were
re jetted as unsuitable.         We can offer no concrete explana-
tion for this,       other than the apparent policy of NIMH to
select only those addicts for whom complete recovery is
deemed highly likely.          Coupled with this,   of course, is
the reluctance       of NIMH to accept for treatment those
addicts who appear "intractable"           or who seem to be trouble-
makers.      Within the confines of the program as presently
constituted,      there is a sound basis for this reluctance
on the part of NIMH; indeed, their task is difficult
enough with the 'average'         addict,   without having to
introduce     potential    troublemakers    into the patient
population.




                                   41
APPENDIX II




                      [See GAO note,]




      We appreciate the opportunity afforded     us to comment
 on your proposed report to the Congress.
                                  Sincerely    yoxs,


                                   L. M. Pellerzi
                            Assistant   Attorney General
                                for Administration




                             42
  ‘


                                                           APPENDIX III


                PRINCIPAL OFFICIALS OF THE DEPARTMENTS
                                                     OF

              JUSTICE AND HEALTH, EDUCATION, AND WELFARE

        RESPONSIBLEFOR THE ADMINISTRATION OF ACTIVITIES
                            DISCUSSEDIN THIS REPORT


                                                Tenure of office
                                                From            -To
ATTORNEYGENERALOF THE UNITED
  STATES:
    John N. Mitchell                         Jan.   1969    Present
    Ramsey Clark                             Oct.   1966    Jan.    1969

SECRETARYOF HEALTH, EDUCATION,
  AND WELFARE:
    Elliot L. Richardson                     June   1970    Present
    Robert H. Finch                          Jan.   1969    June 1970
    Wilbur J. Cohen                          Mar.   1968    Jan.    1969
    John W. Gardner                          Aug.   1965    Mar. 1968
DIRECTOR, NATIONAL INSTITUTE OF
  MENTAL HEALTH:
    Dr. Bertram S. Brown                     June   1970    Present
    Dr. Stanley F. Yolles                    Dec.   1964    June 1970




 U.S   GAO.   Wash.. D-C-



                                        43
Copies  of this report are available       from the
U. S. General   Accounting   Office,    Room 6417,
441 G Street, N W., Washington,      D.C., 20548.

Copies    are provided    without        charge      to Mem-
bers of Congress,        congress iona I committee
staff members,    Government        officia Is, members
of the press,    college    libraries,       faculty    mem-
bers and students.       The price to the general
public   is $1 .OO a copy.      Orders should be ac-
companied    by cash or check.