Note: An intensive 28 day Alcoholism Treatment Program is being The cost per day in the ATP is projected to be $35.00 per day. Chairman SIMPSON. Mr. Ruffing please. Mr. RUFFING. As a representative of the Halfway House Association, I appreciate the opportunity to address the issue of utilization of halfway houses and recovery homes by the Veterans' Administration. My involvement with veterans' chemical dependence goes back to 1957 when I did some volunteer work at the veteran's hospital in Biloxi, MS. In graduate school, I was involved in some research with Dr. Mary Ellen Curtin and George English at the veterans' hospitals in Louisville and Lexington, KY. In my doctoral programs, I did some work at the Federal prisons in Lexington, KY, and other places. The impressions I have and the literature that I read and the research I have been involved with show that most of the veterans that we encounter at the halfway houses are the type that Dr. Saxe referred to, those who have been disconnected with families, community-base sources, and things that can enable them to get a support system going to recover. And there are a few issues involved in these things that are being discussed today about halfway houses. One of them is that many of the people we see really do not need an inhospital setting, that the Veterans' Administration or other groups like this would contract with what has been established as a nonmedical or social detox, that a lot of these veterans can go directly from detox units to a halfway house or some facility like that, which is not a hospital. They are quite cost effective in that the rate varies, that I know, from about $16 a day to $28 a day around the country, depending on the location. The ones in the immediate area run pretty close to $17 to $21 a day and a lot of them are $19 a day, as compared to $8,000 to $9,000 a month for inhospital treatment, not counting the physicians services, which very often are not needed. I One of the issues was restricting the service in hospital or in halfway houses to residentials to 60 days and it is not very practical, because a lot of the studies have shown, and in the paper have submitted, Dr. Simpson shows that the treatment of alcoholics or the recovery of alcoholics is interjected by periods of relapse and they are identifiable periods of 5 to 7 weeks. And a lot of people come out of a treatment center right in the middle of or the beginning of a very high risk period, whereby it is indicated that a long-term stay, a longer term of 5 to 7 to 9 months would be indicated in a halfway house and get them over these periods and they stand a better chance of avoiding a relapse. One question that I was asked was about the duplication or the cost duplication by the contracting of VA services. The VA in some places has set up separate licensures and standards and I think they could do a lot of cost saving simply by accepting the State licensure procedure in effect in many places. And I looked around and in some of the States I looked at, the State standards have been adapted to and sometimes exceed the ones set by the Veterans' Administration, they are copied after the Joint Commission on Hospital Accreditation, JCAH. So the standards are pretty high and doing something about the problem of alcoholism, anything that is done is better than nothing. Ken Eaton, when he was working with Dr. Chafitz said in about 1971 or 1972 that if we do not solve the problem of alcoholism, no matter in our veteran population or our general population, we can forget about the rest of the problems that we have, because this is one that has the capacity to destroy the Nation. Thank you very much. Chairman SIMPSON. Rather dramatically said and I tend to believe that. I really do. Everything around here is dramatically said, but that was appropriate. I don't know, I practiced law for 20 years in a little town Coyote, WY, and if there were that many butchered human beings in Coyote, WY, there are that many anywhere in the world and that is what we forget in this place, that there are places where these people are not affected, there are restrictions there, and that is not true as long as there are human beings in other places, child abuse, butchered marriages. [The prepared statement of Leo Ruffing, member of the board of directors, Association of Halfway House Alcoholism Programs of North America, Inc., St. Paul, MN, follows:] PREPARED STATEMENT OF LEO RUFFING, MEMBER OF THE BOARD OF DIRECTORS, The Association of Halfway House Alcoholism Programs of North, Incorporated (AHHAP) came into existance in 1966. The Association comprises 233 full members, individual recovery homes/halfway houses, 26 associate members, and 212 individual members throughout the United States and Canada. In addition, it has a worldwide correspondent's list of 684. We would like to address the following issues in light of proposed legislation: I. II. III. IV. V. Extention of Services to Include Social Detox, Three-Quarter A. B. Cost Effectivess Utilization of Resources Recovery from alcoholism and other drug addictions takes a minimum of two to three years. Recovery involves the whole person; the physical being, the psychological, emotional being, and the spiritual being. Therefore, a multi-disciplined approach is essential in the delivery of service to individuals involved in a recovery process. This process should involve all community resources which provide delivery of health care services In what is termed a "continum of care". This means that a recovering person should have access to and benefit of a therapeutic team approach that encompasses all available community resources. Dr. R. Keith Simpson, former Director of the Harrison Treatment Center in Des Moines, Iowa stated in 1968: "We can now predict with some definite degree of accuracy periods within the two year follow-up, that a person will have difficulties that may trigger relapses. I refer to it as a physiological phenomenon which can be diverted. These periods are: 5 to 7 weeks after the last drink; 5 to 7 months, 11 to 13 months and 18 months after the last drink. Preparing the patient for these periods relieves him of a lot of unnecessary fears and anxieties." Common sense should tell us to keep the man or woman until they are through the crisis periods and then discharge them with encouragement and support; along with complete confidence in their ability to make it. Most residential treatment facilities (Post Detox) are designed for 28 to 45 days. This forces the client to be discharged during the first or most intense crisis period described by Dr. Simpson. A person leaving a residential facility after 28 to 45 days most often returns to the same environment and circumstances from which they come. The recidivism rates and related cost increase (for re-entry into programs) are well documented. Residents in a Halfway House/Recovery Home are most often open ended or developed for a 2 to 9 month stay. They are generally located in an area where all community services are available to their residents. (Employment opportunity, communty health service, educational facilities, AA, NA, and other self-help groups). In half-way houses and three-quarter way houses, between 40 and 75% of the residents are employed and in some instances contribute as much as 60% to the cost of their treatment. Obviously, the cost of social services benefits are markly decreased in these populations as compared with residential treatment populations. |