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Chairman SIMPSON. Now, Ms. Hill.

Ms. HILL. Thank you, Mr. Chairman. My testimony today concerns the experience of the Baltimore Alcoholism Treatment Center in its efforts to provide services to a large population of alcoholics over the past 12 years. It is my hope that through our experience, you will better be able to address the concerns that now confront you in providing services for veterans.

The Baltimore Public Inebrian Program was the original name for the Baltimore Alcoholism Treatment Center. It consisted of a screening and evaluation unit, a small detoxification unit and a therapeutic community, originally funded by an NIAAA public inebriate grant. In addition, there was funding through a State grant. Like most such programs, this program was designed to provide warmth, safety, and a level of personal comfort, and an access to public welfare and health services to alcoholics who were chronic, recidivist and therefore not expected to show much improvement. Our clientele then consisted largely of alcoholics whom others might regard as hopeless.

Also like most such programs, ours provided little structure or formalized plan for making actual changes in patient behavior, lifestyle and attitude. Relapse rates were high and few achieved any lasting recovery.

In the midseventies, however, our approach to treatment began to change. We established guidelines which prevented use of our facility as a flophouse to sleep off intoxication. We instituted an education program designed to teach the patient about his illness. We changed our philosophy substantially. Rather than focusing on the social consequences of alcoholism, we began to focus on getting the alcoholic to do something about his drinking.

In 1980, all services were consolidated under central management. The name and focus of the shelter was changed to reflect its new emphasis on initiating effective treatment of alcoholism, now seen as a chronic, progressive disease.

This component is now referred to as Baltimore Alcoholism Treatment Center Residential Treatment Services. Residents who relapsed or used alcohol again, were required to reenter the detox unit for 7 days. When they returned, they revised their treatment plans to prevent further relapse.

The treatment program is based on the chronic disease model set out to accomplish four simple but essential objectives: To teach the alcoholic patients what alcoholism was and how their disease worked; to get patients to self-diagnose, that is to recognize their own illness; to teach them how to use AA and other self-help groups; having learned this, to take personal responsibility for their own sobriety on an ongoing basis.

The program required attendance at all activities. If the resident failed to comply with treatment or showed no effort toward recovery, other living arrangements were found. Residents were told that though they had made no conscious choice to become alcoholic, they nonetheless were now responsible for treating their illness. AA had shown that even indigent, poorly functioning, debilitated alcoholics can recover, if they followed a few simple directions.

The treatment program took the position that the residents were there to get better, not simply to keep relapsing, and that AA and treatment were the way out.

The effectiveness of the model becomes clear in light of the incidents of relapse in the resident population. Before the change in the treatment approach, there was an average 89 referrals which was made up of 34 individuals a month to the screening unit for drinking. In fiscal 1983 there was an average of 10 referrals, made up of 10 individuals a month, to the screening and detoxification unit for drinking. There has been a 890-percent decrease in the number of incidents of relapse and a 340-percent decrease in the number of individuals who relapse.

We attribute our success entirely to the adoption of structured, chronic disease model treatment.

We also believe that your population, like other alcoholics, would benefit dramatically from the adoption of a similar structured treatment format.

Thank you very much.

[The prepared statement of Sandra K. Hill, R.N., C.A.C, M.B.A., director, Suburban Hospital's Alcoholism Treatment Services, Bethesda, MD, and president, board of trustees, Baltimore Alcoholism Treatment Center, Baltimore, MD, follows:]

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PREPARED STATEMENT OF SANDRA K. HILL, R.N., C.A.C., M.B.A., DIRECTOR, SUBURBAN
HOSPITAL'S ALCOHOLISM TREATMENT SERVICES, BETHESDA, MD, AND PRESIDENT, BOARD
OF TRUSTEES, BALTIMORE ALCOHOLISM TREATMENT CENTER, BALTIMORE, MD

Distinguished Committee Members:

My testimony today concerns the experience of the Baltimore Alcoholism Treatment Center in its' efforts to provide services to a large population of alcoholics over the past 12 years. It is my hope that through our experience, you will better be able to address the concerns that now confront you in your own

sector.

B.A.T.C. originally consisted of an Evaluation/Screening Unit, a Detoxification Unit, a Shelter, and a Therapeutic community, and was originally funded by an N.I.A.A.A. public inebriate grant. Like most such programs, B.A.T.C. was designed to provide warmth, safety, a modicum of personal comfort, and access to public welfare and health services to alcoholics who were chronic, recidivist, and therefore not expected to show much consisted largely of

"improvement". Our clientele, then,
alcoholics whom others might regard as "hopeless".

Also like most such programs, ours provided little structure or formalized plan for making actual changes in patient behavior, lifestyle, and attitude. Relapse rates were high, and few achieved any lasting recovery.

In the mid' 70's, however, our approach to treatment began to change. We established guidelines which prevented use of our facility as a "flophouse" to sleep off intoxication. We instituted an education program designed to teach the patient about his illness. We changed Our philosophy substantially: rather than focusing on the social consequences of alcoholism, we

began to focus on getting the alcoholic to do something about his drinking.

We initiated a "street rescue" program, which enabled us to identify and intervene with alcoholics before they managed to wander into our facility. This meant that we were able to find and treat patients before they became So 111 that they were beyond medical help. After they were treated medically, we arranged to pick them up at the hospital and transport them to appropriate treatment. This service now operates on Friday and Saturday nights. At one time, CETA positions provided more extensive coverage.

In 1980, all services were consolidated under central management. The name (and focus) of the Shelter was changed to reflect its' new emphasis on initiating effective treatment of alcoholism, now seen as a chronic, progressive disease.

This component is now referred to as B.A.T.C. Residential Treatment Services. Beds were reduced in number from 83 to 74, and staff increased. Residents who relapsed (used alcohol again) were required to re-enteer the Detox Unit for 7 days. When they returned, they revised their treatment plans to prevent further relapse.

A Treatment Program based on the chronic disease model set out to accomplish four simple but essential objectives:

1. To teach alcoholic patients what alcoholism their disease worked.

was, and how

2. To get these patients to "self-diagnose": that is, to recognize their own illness.

3. To teach them how to use AA and other self-help groups.

4. Having learned this, to take personal responsibility for their own sobriety, on an ongoing basis.

The Program required attendance at all activities. If the resident failed to comply with treatment, or showed no effort toward recovery, other living arrangements were found. Residents were told that though they had made no conscious choice to become alcoholic, they nonetheless were now responsible for treating their illness. functioning, debilitated alcoholics could recover, if they followed a few simple directions. The Treatment Program took the position that the residents were there to get better--not simply to keep relapsing--and that AA and treatment were the "way out" for any sick alcoholic.

AA had shown that even indigent, poorly

As a result of these changes, the climate at B.A.T.C. has become completely different. Even this "hopeless" population has responded to these simple expectations. Patients who would previously have relapsed often stay sober. As a result, they make more consistent gains in treatment. Their health is better, a result of the disease model's emphasis on health care. The local AA community has responded favorably to these changes and has worked hard to assist indigents in achieving sobriety.

as

As patients get better, they become less dependent on the facility and on the public welfare system. Many become employed in both private and public sectors. Others volunteer to help newcomers. Everyone, not matter how impaired, finds something he can do.

This would not be surprising result in any middle-class area, but it is unusual to find any method So effective with this population.

The effectiveness of the model becomes clear in light of the incidents of relapse in the resident population. Before the change in the treatment approach there was an average of 89 referrals (34 individuals) a month to the screening unit for drinking; in fiscal 83 there were an average of 10 referrals (10 individuals) a month to the detoxification unit for drinking. There was been a 890% decrease in the number of incidents of relapes and a 340 % decrease in the number of individuals who relapes.

We attribute Our

Success entirely to our adoption of

structured, chronic disease model treatment.

We also believe that your population, like other alcoholics, would benefit dramatically from the adoption of similar philosophy and methods.

Our conclusion: many alcoholic treatment "failures" Occur because the patient was not treated effectively in the first place. Most alcoholics, no matter how deprived of family, friends, or fortune, will respond to effective, ongoing treatment.

We believe the veteran population would respond positively, as well.

The choice is yours.

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