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many of the nation's costly industrial problems
the workplace is being forced to address the issue
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,
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
not spreading them.
1 Masi,D., Drug Free Workplace: A Guide for Supervisors, Buraff Publications, Inc., Washington, D.C., 1987.
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
PLEASE LET ME OFFER MY MOST SINCERE GRATITUDE FOR THE OPPORTUNITY TO
ADDRESS THIS ISSUE FROM THE VANTAGE POINT OF A PRIMARY HEALTH CARE
FEW HOSPITALS CAN PROFESS A GREATER EXPERIENCE THAN HARLEM
HOSPITAL WITH MEETING THE CHALLENGES OF ILLICIT OR LICIT PSYCHOTROPHIC
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.
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.
THAT WE DO NOT TRULY KNOW THE EXTENT OF USE OF THESE SUBSTANCES.
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