many of the nation's costly industrial problems
which result from drug abuse are increasing
absenteeism, excessive sick leave, accidents,
rising health benefits claims and increased
worker's compensation claims. Legalization will
not stop these costs to industry; it will increase
them.

the workplace is being forced to address the issue
head on. Companies are investing in EAPs, drug
testing and whatever else our so-called experts
recommend. However, the workplace cannot afford
any more drug users. The economic costs and loss
of productivity are too high.

Solutions:

Control of addiction cannot be legislated either through

permissiveness or restriction. Those who contemplate legalization

do so from a position of frustration. More than two-thirds of the

funds for the "war on drugs" are spent on law enforcement,

and

less than one-third on education and treatment. The nation has

taken the posture of "control reduction" rather than "demand re

duction." As a nation the United States needs to concentrate on

the demand side.

We must educate our people to the dangers of drugs as we

have done with the harmfulness of tobacco. Recent studies by Cook

and Harrell presented at the NIDA Conference on the Evaluation of

Industrial Drug Programs in October, 1988 revealed that few com

(2) panies with health promotion programs stress drug education.

IBM Corporation stands as an outstanding exception. th interest of full disclosure, I should state that I had the privilege of designing IBM's drug and alcohol educational program which is offered not only to all its employees, but also to their family

members throughout the country.

Substantive training programs are needed immediately

throughout the nation. It seems unbelievable that schools of

medicine, social work and pyschology rarely require a course in

alcohol and drug addiction. Today, fewer schools of psychology

require a course in drug addiction than in the 1950's. Even the

Council on Social Work Education, the accrediting board for

schools of social work, does not require a single course in ad

diction for Master of Social Work candidates.

All managers and supervisors need training in alcohol and

drug abuse. This is the only sensible way for them to understand

that drug abuse is right there in front of them (and they deny

and cover up as much as the addicted employee).

We need EAPs that concentrate on reaching drug and alcohol

abusing employees early. Companies have to reappraise their EAP contracts, place the emphasis upon alcohol and abuse cases, and require that only counseling staff with a minimum of two years'

training in alcohol and drug abuse be involved in the EAP.

There must be new funds for meaningful treatment, especially

for out-patient programs. At USDHHS we funded with Blue Cross the

out-patient model of treating alcohol and drug addiction at the

worksite. We used DHHS offices for counseling federal employees

at night. Employees could continue to work during the day and

there was no need for their co-workers to know they were being

treated. The average length of treatment with this model was six

months with stringent attendance requirements.

These are but a few examples of what should and can be done.

We have not yet begun to tap into our vast resources to solve

this national problem of addiction.

Finally my strong opposition to legalization stems from the realization that by legalizing illicit drugs we accept the inevitability that use will increase. In my opinion this approach cannot be reconciled with ethical principles because it would be

implemented with recognition of the increased personal and social

destruction connected with drug abuse that would result. We, as a

civilized society, are responsible for preventing disease and

destruction

not spreading them.

1 Masi,D., Drug Free Workplace: A Guide for Supervisors, Buraff Publications, Inc., Washington, D.C., 1987.

2

Cook, R. and Harrell, A., "Drug Abuse Among working Adults: Prevalence Rates and Recommended Strategies," Health Education Research: Theory and Practice, Vol.2, No.4, 1987, pp. 353-59.

TESTIMONY ON THE LEGALIZATION OF DRUGS

SELECT COMMITTEE ON NARCOTICS

SEPTEMBER 30, 1988

LAWRENCE S. BROWN, JR. MD, MPH

DEPARTMENT OF MEDICINE, HARLEM HOSPITAL CENTER AND THE
COLLEGE OF PHYSICIANS AND SURGEONS, COLUMBIA UNIVERSITY

MR. CHAIRMAN:

PLEASE LET ME OFFER MY MOST SINCERE GRATITUDE FOR THE OPPORTUNITY TO

ADDRESS THIS ISSUE FROM THE VANTAGE POINT OF A PRIMARY HEALTH CARE

PROVIDER.

FEW HOSPITALS CAN PROFESS A GREATER EXPERIENCE THAN HARLEM

HOSPITAL WITH MEETING THE CHALLENGES OF ILLICIT OR LICIT PSYCHOTROPHIC

DRUG USE.

BECAUSE OF HARLEM HOSPITAL'S LONG LEGACY OF COMMUNITY SERVICE

TO ITS LARGELY ECONOMICALLY DISENFRANCHISED COMMUNITY, IT IS ESPECIALLY

IMPORTANT THAT WE SHARE WITH YOU, AND THE OTHER MEMBERS OF THE SELECT COMMITTEE, OUR PARTICULAR EXPERIENCES. WHILE DRUG ABUSE KNOWS NO COLOR,

RACIAL, SEXUAL, OR ECONOMIC BARRIERS, ITS PREVALENCE IN THE HARLEM

COMMUNITY IS GREAT AND THE IMPACT OF DRUG ABUSE UPON THE CITIZENS OF

HARLEM REPRESENTS, WITHOUT QUESTION, A MAJOR PUBLIC HEALTH PROBLEM.

DISCUSSIONS OF THE LEGALIZATION OF ONE OR MORE OF THE PRESENTLY

ILLICIT DRUGS ARE STIMULATED, AT LEAST IN PART, BY TWO RELATED FACTS.

ONE

IS THE MOUNTING EVIDENCE THAT THE CURRENT RESPONSE OF THE AMERICAN SOCIETY

I AM GOING TO LIMIT MY REMARKS TO PUBLIC HEALTH OR MEDICAL CARE ISSUES,

NOT BECAUSE THEY ARE NECESSARILY THE MOST CRITICAL AREAS FOR CONSIDERATION

BY THIS HEARING PROCESS, BUT RATHER BECAUSE THERE ARE MANY OTHER

INDIVIDUALS AND PERSONS OF VARIOUS LEVELS OF EXPERTISE WHO ARE ARGUABLY

MORE VERSED IN THE SOCIAL, ECONOMIC, AND CRIMINAL IMPLICATIONS OF DRUG ABUSE. FROM THE PUBLIC HEALTH PERSPECTIVE, ONE CAN MEASURE THE

EFFECTIVENESS OF THE AMERICAN POLICIES DIRECTED AT DRUG ABUSE BASED UPON

THE PREVALENCE OF CONSUMPTION OF THESE PSYCHOTROPHIC SUBSTANCES AND/OR THE

PREVALENCE OF DISEASE AND DEATH DUE TO THE USE OF THESE AGENTS.

I CONTEND

THAT WE DO NOT TRULY KNOW THE EXTENT OF USE OF THESE SUBSTANCES.

CURRENT

DATABASES TO ASCERTAIN THE PREVALENCE OF DRUG ABUSE ARE EITHER BIASED BY

VIRTUE OF THEIR SELECTION METHODOLOGY OR SO ATROPHIED DUE TO INADEQUATE

MAINTENANCE SO AS TO COMPROMISE THE RESULTS THAT MAY BE DERIVED FROM THEM.

FOR EXAMPLE, ANNOUNCEMENTS ABOUT THE PREVALENCE OF DRUG ABUSE BASED UPON

SURVEYS CONDUCTED AMONG HIGH SCHOOL STUDENTS CAN NOT BE TRULY

REPRESENTATIVE AS TO WHAT IS OCCURRING AMONG ADOLESCENTS WHEN IN SOME

URBAN CENTERS HIGH SCHOOL DROPOUTS (WHO ARE NOT SURVEYED) MAY BE THE MOST

PRONED TO USE ILLEGAL OR LEGAL DRUGS.

EVEN SO, IT CAN HARDLY BE SAID THAT

THE UNITED STATES IS MAKING MAJOR GAINS IN RESPONSE TO DRUG ABUSE WHEN ONE

PSYCHOTROPHIC IS BEING MERELY REPLACED BY ANOTHER.

IF ONE WERE ON THE OTHER HAND TO LOOK AT THE PREVALENCE OF SCIENTIFICALLY

DOCUMENTED MEDICAL CONSEQUENCES OF DRUG ADDICTION AS A GAGE OF THIS

SOCIETY'S RESPONSE, THE UNEQUIVOCAL CONCLUSION WOULD REMAIN THAT AMERICAN

POLICY TO ADDRESS DRUG ABUSE IS A FAILED POLICY.

AS MEDICAL PROVIDERS AT

HARLEM HOSPITAL WE SEE A CONTINUOUS PARADE OF PATIENTS ADMITTED FOR SUCH