By MARY LOU MANNING
A former reporter for the Springfield Bureau
of Copley News Service, she has also done
work in public relations. A native of
St. Louis, she received a degree in journalism
from Southern Illinois University at
Carbondale.
State seeks ways to treat 'new' disease — alcoholism
Responding to a growing awareness of the extent of alcoholism in our society, Illinois has decriminalized simple drunkenness and is now grappling with ways to treat the disease. Problems include lack
of trained personnel and detoxification centers, the reluctance of hospitals to get involved and — the
central problem — money
TRUE OR FALSE?
At least nine million people in the
United States are alcohol abusers.
Based on taxes paid on alcoholic
beverages, the "average" person in this
country consumes three ounces of
whiskey per day.
Individuals with a family history of
alcoholism or a family history of
complete abstinence from alcohol are
more likely to become alcoholics.
The answers to all these questions are
TRUE and this gives a hint of the
breadth and complexity of the disease
called alcoholism. It is an illness that
affects, directly or indirectly, millions of
Americans. And it is a growing concern. "Yes, the problem is increasing," explained Richard Swem, a counselor for
the Springfield Salvation Army's alcoholism program. "As long as our
population increases, the problem will
increase because we are a drinking culture."
The view that alcoholism is a disease
— and therefore a medical problem —
gained official recognition in Illinois in
1974 when the legislature passed a new
Alcoholism and Intoxication Treatment
Act designed, among other things, to
shift the emergency care of the public
inebriate from the jail house to a
medical environment. The act is scheduled to go into effect July 1 of this year.
Alcoholism is a big problem in
Illinois. According to the Department
of Mental Health and Developmental
Disabilities, which has been charged
with implementing the new law, nearly
550,000 residents of Illinois are alcohol
abusers and alcoholics. Other estimates
put the number near a million. And, for
the abuser, four to six persons are directly and personally affected by this
abuse. That's approximately a third of
the state's population. In terms of
dollars and cents, Illinois already pays,
directly or indirectly, $120 million per
year for health and welfare services to
alcoholics and their families. Another
$180 million is directly or indirectly paid
by the taxpayers for property damage,
medical expenses and other related costs
resulting from alcoholic abuses, according to the department. There is already a Division of Alcoholism in the mental
health department which provides
residential treatment for alcoholics in its
own facilities as well as assisting local
organizations in developing community programs.
According to the American Medical Association (AMA), alcoholism
appears to be more prevalent in larger
cities than in less populated and rural
communities, but the differences probably will not be too great. "Alcoholism
is also said to be considerably more
common among men than women, but
our perceptions of the differential quite
likely are distorted by the fact that
females also tend to be more protected
and sometimes less easily or more
reluctantly diagnosed," according to a
publication compiled by the AMA.
Along with the emergence of the
woman alcoholic comes the visibility of
the young ones. Although the exact
number of young alcoholics is not
known, they are seeking treatment at an
earlier age. "More and more people are
coming to Alcoholics Anonymous (AA)
meetings, and they are younger than
ever before," Jim C., a spokesman for
the Springfield AA, explained. "They
now come as young as 18." One theory
to explain the phenomenon of the
younger drinker was offered by Swem. "Alcohol has attained the label of a
'non-drug drug' " he said. "It is much the
same as cigarette smoking. They both
March 1976 / Illinois Issues / 13
Alcohol is an addicting drug.
Approximately 70 per cent of all
adults ingest alcohol in variable
amounts for social, religious, medical or
psychiatric reasons.
result in a physical dependence. Alcohol is popular because it is legal, and the drinking age is lower than it used to be. Alcohol is a cheap 'high.' " It has been estimated that there are approximately 450,000 alcoholics between the ages of nine and nineteen, and Swem says he has heard of alcoholics who "began drinking at seven or eight years of age."
Just as estimates of the number of alcoholic women and young people vary from source to source, so does the definition of alcoholism. The National Council on Alcoholism says an alcoholic is "a person who is powerless to stop drinking and whose drinking seriously alters his normal living pattern." AA believes that alcoholism is "a physical compulsion, coupled with a mental obsession." The AMA defines alcoholism in a more formal manner as a "type of drug dependence of pathological extent and pattern which ordinarily intereferes seriously with the patient's total health and his adaptation to his environment."
What each organization does agree on is that alcoholism is a disease, and that a person who is an alcoholic is just as sick as a person with tuberculosis or diabetes. They also agree that alcoholics are so varied in their backgrounds, physiologies and motivations that all stereotypes of the alcoholic personality leave something to be desired.
"For example," said Swem, "there is the 'situational' alcoholic who has reached this stage because of some overbearing situation like the loss of a loved one, undue stress, etc. Then there is a predisposition to alcoholism which is genetically based; but there again, we get into the thing of culture and morals affecting the drinking patterns." Generally, he concludes, "there is more than one cause of the problem."
The AMA believes that, while there is no "alcoholic personality," it does not seem beyond reason to believe that there may be "some combination of personality traits which are contributive to the development of alcoholism. "They point out that emotional immaturity and strong dependency needs are commonly seen in alcoholics. "The question remains, however, whether common traits pre-exist or are the consequence of the excessive use of alcohol."
"A very minute portion of the situational alcoholics might be 'cured,'" Swem said, "that is, may be able to have a social drink again. But then it can be argued whether this type of person was an alcoholic to begin with."
If the exact cluster of causes of alcoholism remains obscure, there is no mystery about the high cost of the disease. Consider these statistics from a report issued by the Medcom Press:
1. An estimated 4.5 million workers suffer from problems related to alcohol and 240,000 of these work for the U.S. government.
2. Alcohol abuse and alcoholism drain the economy of at least$15 billion per year.
3. Alcoholism has reached epidemic proportions in the military. But, unfortunately, alcoholism costs more than dollars and cents. It results in uncalculated human emotional and physical suffering.
4. Alcohol plays a major role in highway accidents with at least 300,000 deaths resulting each year.
5. Alcoholics have a life expectancy some 12 years shorter than the average person.
It has taken a long time for society to be persuaded that alcoholism is more of a disease than a crime, but this recognition is growing. Organizations like the AMA believe that such an awareness is an essential prerequisite to any concerted attack on the problem. This awareness is manifested in legislation passed by several states, including Illinois, which decriminalizes simple drunkenness. But now that states have taken this step, they have found that their existing social and medical institutions are ill-prepared to handle the thousands of inebriated individuals whose only previous treatment was a night in the lockup. The Illinois situation illuminates this problem.
Well over a year ago — on December 30, 1974 — Gov. Dan Walker certified a bill which — when it finally becomes effective — stands to provide services for a large chunk of Illinois' population. It's called the Alcoholism and Intoxication Treatment Act (P.A. 78-1270; Illinois Revised Statutes, Ch. 91½, sec. 501ff) and its date of implementation has been twice delayed.
With adoption of this law, Illinois became the 23rd state to legally recognize that alcoholism is a "health problem rather than an enforcement one," explained Garrit DenHartog, executive director of the Illinois Alcoholism and Drug Dependence Association (IADDA).
The Illinois legislation
The law works this way: When a law
enforcement officer finds a person
intoxicated on the street — and no other
charges are involved — the officer will
"take him into protective custody,
which is not arrest." This explanation
comes from Roalda J. Alderman,
director of the Division of Alcoholism
of the Department of Mental Health
and Developmental Disabilities. "He or
she will be taken either home, if this is
feasible, or to a detoxification facility,"
she continued. "As things stand now
. . . intake for this activity is expected to
be a general hospital, primarily because
this state has not yet developed a broad-scope system of detoxification centers." According to DenHartog, there is no
non-hospital based detox center in
Chicago. However, several are operating in downstate Illinois. Law enforcement officers in many communities, he
says, are already making use of them
when it comes to the public inebriate. Once the inebriate reaches a treatment center, the law requires he or she
be examined by a physician immediately. The physician will then determine
whether or not he or she needs hospital
admittance or whether the person can be
referred to a social setting detox center.
During a recent survey, it was indicated
that only five per cent of those persons
in need of detoxification also require
medical attention. 14 / March 1976 / Illinois Issues
"Nearly 20 years ago, both the
American Medical Association and the
World Health Organization recognized
alcoholism as a disease," he continued.
This premise was used in preparing a
Uniform Alcoholism and Intoxification
Treatment Act upon which Illinois' new
statute is based.
"One point — admission to a detox center is strictly voluntary," Mrs. Alderman stressed. "If a person consents to treatment, he or she will spend from two to ten days, with an average of three to five days, in a detoxification setting. The next step is referral to either a transitional residence (a halfway house) or into out-patient follow-up care," the Chicago-based director said. "That means an intensive program that lasts a year or longer."
Besides decriminalization and continued treatment, the law also provides for a series of somewhat vaguely defined educational and preventive measures:
1. Cooperation with the Department of Corrections in establishing programs for treating alcoholics and intoxicated persons in or on parole from penal institutions.
2. Cooperation with the Illinois Office of Education and other educational facilities in setting up programs for the prevention of alcoholism as well as preparing curriculum materials.
3. Providing educational programs for persons engaged in the treatment of alcoholics as well as setting up training programs for those engaged in the actual treatment.
The central problem with implementing the law is not connected with these provisions, however, but with the cost and complexity of treatment and facilities. Because of these problems, the effective date of the law has been twice postponed: once, in 1974, via the governor's amendatory veto; and once, last summer, via S.B. 822 sponsored by Sen. Daniel Dougherty (D., Chicago). In signing the bill(now P.A.79-59), which sets implementation at July 1, 1976, Walker said: "Health and law enforcement officials agree that a year of intensive planning will allow a smoother transition from the old system of punishing alcoholics to a new system of treating them."
To help speed up the process of implementation, House Resolution 269 last summer called for the formation of a subcommittee to study the legislation. "The subcommittee gathered information that will be used to plug the loopholes in the law," explained Robert Carter, a member of the House Democratic staff. The subcommittee, which was composed of members of the Executive and Human Resources Committees, held a series of public hearings throughout the state last year. "One of the problems in the program is cost identification," Carter stated. "We just don't know the number of people who will actually use the treatment network." Although many states have adopted this law, none are in effect, according to Carter. "We must turn to vague statistical reporting by taking the national averages and applying them to Illinois."
"Money was budgeted in this fiscal year's budget for the law," explained Jim Dolian of the Bureau of the Budget. "The legislature appropriated $5 million for this purpose, but the governor, with a reduction veto, trimmed this to $1.7 million. This reduction was based on the fact that, concurrently, the legislature voted to postpone implementation until July of 1976," he continued. "However, a portion of that money will be spent preparing for the implementation."
Hopes that the federal government will come up with substantial aid appear to be dim. Mrs. Alderman explained that "the federal government has provided seed money, impetus and a whole range of regulations." But, she continued, "it is not going to provide, in the foreseeable future, any extensive amount of funding."
The establishment of detoxification centers is even more problematic. A summary of the first subcommittee hearing held in Chicago states: "Due to a low percentage of persons needing emergency room medical services and the disruption sometimes created by a public intoxicant, all but one witness favored separation of detox procedures and facilities from normal emergency room facilities."
"Many witnesses believe that a hospital emergency room is just not a good place to bring someone who is inebriated," Carter said. "This may also bring about a liability issue for the hospital." Many hospitals are, sometimes understandably, reluctant to take on the job. "Concern was also expressed over the potentiality for law suits found within the act," according to testimony. "More than one witness suggested that there be no liability for medical and hospital personnel who treat public intoxicants in good faith."
The response to the legislation from law enforcement agencies, especially those in Chicago, has been negative. Some of the complaints center around the fact that the law requires law enforcement personnel to determine whether or not the person is actually a public inebriate and in need of services provided by this act. "The law calls for discretion on the part of the law enforcement officers," DenHartog said. "However, in some rural areas, law enforcement officials are already doing this and supporting it."
DenHartog stressed the fact that the law does not apply to any other law covering drunken driving or driving under the influence of alcohol. "This law has to do with public drunkenness, not drunken driving."
Other problems holding up implementation include setting up licensing and certification standards which affect third-party payments. According to testimony, "the lack of non-medical licensing and certification standards prohibit community agencies from receiving third-party payments. Thus, agencies are forced to divert time from treatment operations to fund soliciting. Additionally, these community agencies cannot receive health insurance reimbursements. Hence, the lack of licensing standards prevents the intent of the General Assembly's passage of the law requiring health insurance companies to include alcohol treatment as a reimbursable service."
Immediate medical examination by a physician is also a concern. "Several witnesses recommended striking the term 'immediately' because of the low percentage of those needing immediate medical treatment, the availability of on-duty versus on-call physicians, especially in some rural areas; and the unclear meaning of the term itself."
Carter points out, "Confidentiality is also a minor problem." The law permits the client to deny identification of his family; and fails to delegate the responsibility for contacting relatives if the client does desire notification.
The problems are many, and time is short. Although the implementation date has been twice delayed and Illinoisans are now looking toward a July 1 deadline, one question remains: is ever this date attainable? "It's not going to be possible to set up this type of ideal network throughout the state by the time the law is in effect," Mrs. Alderman predicted. "It will be possible to take a large bite out of the very worst part of the problem; it will also be possible to develop the planning that will lead to concrete results later. It is unrealistic to expect to have the entire system up and in place — no state that has gone into this has found it to work that way."
March 1976 / Illinois Issues / 15