ATTACHMENT 4

THE NARCOTIC ADDICT REHABILITATION ACT OF 1966

(Submitted by the National Clearinghouse for Mental Health Information, National Institute of Mental Health)

What is NARA?

NARA is the Narcotic Addict Rehabilitation Act of 1966 (Public Law 89-793), in which Congress established a new national policy for the treatment of narcotic addicts. The Act represents the view that narcotic addiction is symptomatic of an illness that should be treated and not a criminal circumstance in itself. Signed into law November 8, 1966, the Act provides for the civil commitment and treatment of narcotic addicts, including those charged with or convicted of violating certain Federal criminal laws.

NARA emphasizes total treatment of addicts. This means that a patient may receive hospital care followed by continuing supervised treatment and rehabilitation services available in his community.

The program is administered by the National Institute of Mental Health and the Department of Justice.

A new approach

For the first time, Federal law provides that narcotic addicts may apply for treatment in lieu of prosecution for certain crimes and that addicts not charged with a criminal offense may also be committed to the Secretary of Health, Education, and Welfare for treatment and rehabilitation. Under the law, treatment and rehabilitation may include a wide range of services.

The act sets in motion a new nationwide program for the treatment and rehabilitation of addicts in the community. In this way a patient can be treated, supervised and guided in his local environment, where his problems can be best understood and their solution best sought. This long-term support and supervision should lower the high relapse rate of treated addicts.

Who may be eligible?

1. Narcotic addicts who are charged with a certain Federal offense and who desire to be committed for treatment in lieu of prosecution.

2. Narcotic addicts who are convicted of a Federal crime and who may be committed by the court for treatment of their addiction.

3. Narcotic addicts not charged with a criminal offense who may apply for commitment to treatment. Petition for such commitment may also be made by a related individual.

Who is not eligible?

1. Individuals who are charged with or convicted of "crimes of violence," such as voluntary manslaughter, rape, mayhem, kidnaping, robbery, burglary, or housebreaking at night, assault with a dangerous weapon, or assault with intent to commit an offense punishable by imprisonment for more than 1 year. 2. Individuals charged with unlawfully importing, selling, or conspiring to import or sell, a narcotic drug.

3. Individuals who have been convicted of a felony on two or more occasions, or who have been civilly committed under this act on three or more occasions are ineligible for commitment under titles I and II.

4. Individuals with pending prior charges of felonies which have not been finally determined or who are on probation or whose sentences following conviction have not been fully served, including any time on parole or mandatory release. An individual on probation, parole, or mandatory release may become eligible if the authority authorized to require his return to custody consents to his commitment.

Provisions of NARA

Title I authorizes Federal courts to commit for treatment, to the Secretary of Health, Education, and Welfare, certain eligible narcotic addicts who are charged with a Federal offense and who desire to be treated for their addiction. instead of being prosecuted for the criminal charge.

Before a patient can be committed for treatment, he must be examined by two physicians, one of whom is trained in psychiatry, to determine whether he is an addict and is likely to be rehabilitated through treatment. If it is determined that the person is an addict who is likely to be rehabilitated, he is committed to the Secretary, for a period of up to 36 months, during which time he may not voluntarily withdraw from treatment.

Treatment is provided first in a hospital. When the patient improves sufficiently, he may be conditionally released and placed under supervised outpatient care in his own community. If he resumes the use of narcotics, however, he may again be placed in the hospital.

If the patient successfully completes the treatment program, he will be discharged and the criminal charge against him will be dismissed. But if it is decided, at any time, that a patient can no longer be treated effectively, his commitment may be ended and prosecution on the criminal charge resumed. Title II provides for a sentencing procedure to commit for treatment addicts who qualify under the Narcotic Addict Rehabilitation Act of 1966, and who have already been convicted of a crime.

If, in the opinion of the court, an offender is a narcotic addict, the court may place him in the custody of the Attorney General for an examination to determine whether he is an addict and whether he is likely to be rehabilitated through treatment.

The Attorney General has delegated to the U.S. Bureau of Prisons the authority to administer the title II program. A special treatment program has been developed at the Federal Correctional Institution at Danbury, Conn., for male commitments from geographical areas east of the Mississippi River. Female commitments from the eastern portion of the country are designated to the Federal Women's Reformatory, Alderson, W. Va. All male and female title II commitments from geographical areas west of the Mississippi River are committed to special treatment units at the Federal Correctional Institution, Terminal Island, Calif.

After an individual committed under title II has been treated in the institution for a minimum of 6 months, he may be paroled to aftercare. The range of aftercare services may include individual and/or group counseling. psychotherapy, urine testing, educational and vocational training, employment placement, temporary housing, assistance, transportation, et cetera. All title II releases are provided with an aftercare program whenever community resources are available.

Upon release to the community, each individual is supervised by a U.S. Probation Officer. The probation officer is an agent of the U.S. Board of Parole, and he is responsible for seeing that the conditions of release are met as outlined by the Board of Parole. Effective coordination of aftercare services necessitates a close working relationship between the institution treatment staff, probation officer, and the aftercare agency. Considerable freedom and flexibility are encouraged in institution and aftercare program planning and implementation.

Since the aftercare treatment needs of title II releases are generally comparable to the needs of titles I and III cases, the Bureau of Prisons will negotiat contracts with many of the same community agencies with whom the National Institute of Mental Health has contracts.

Title III provides for civil commitment of addicts not charged with an offense. Such commitment must be initiated by petition to the U.S. attorney of the district in which the addict lives. This may be done by the addict himself or by a related individual.

After the U.S. attorney has determined that there is a reasonable cause to believe the person is an addict, the attorney must file a petition with the U.S. district court, who may place the addict in the custody of the Secretary for examination. If the examination indicates that the patient is a narcotic addict who is likely to be rehabilitated through treatment, the court may commit him to the custody of the Secretary for a period of treatment and rehabilitation. The treatment will include an initial period of hospital care not to exceed 6 months, followed by a 36-month period of supervised care within his own community. If the patient refuses to comply, or if he again becomes addicted to narcotic drugs, he may be recommitted for additional in-hospital treatment or he may be discharged from the program.

Title IV; this title originally authorized the Secretary to make grants to State and local governments and private nonprofit organizations for development of field testing and demonstration programs to treat narcotic addicts, and for training people to work in such programs. It also authorized the Secretary to enter into jointly financed cooperative arrangements with State and local governments and with public and private organizations to help develop, construct, operate, staff, and maintain treatment centers and facilities for narcotic addicts within the States.

Title IV of the NARA Act was changed in 1968 by Public Law 90-574 which authorized grants to public or nonprofit private agencies and organizations to assist them in meeting the cost of construction and staffing of treatment facilities for narcotic addicts in conjunction with the national community mental health centers program.

The Secretary was further authorized to make grants for developing specialized training programs or materials relating to the provision of public health services for the prevention and treatment of narcotic addiction; developing in-service training, short-term, and refresher courses with respect to the provision of such services; training personnel to operate, supervise, and administer such services; and conducting surveys and field trials to evaluate the adequacy of the programs for the prevention and treatment of narcotic addiction within the States. Implementing NARA

The National Institute of Mental Health Division of Narcotic Addiction and Drug Abuse has been designated to carry out the responsibilities for the examination and treatment of patients committed under titles I and III. The Bureau of Prisons and Board of Parole within the Department of Justice is responsible for the treatment of patients committed under title II. Both NIMH and the Department of Justice arrange with State and local programs and facilities to provide supervised care in the communities.

Treatment in the community

In keeping with good mental health practices, contractual arrangements with existing community agencies and programs will provide appropriate supervision and care for the narcotic addict.

After suitable State and local facilities have been developed, the NIMH Division of Narcotic Addiction and Drug Abuse plans that all phases of the treatment process, including initial examination, will be provided through contractual arrangements within the patient's community. At the present time the major portion of both the examination and treatment phases are being provided at the National Institute of Mental Health Clinical Research Centers in Lexington, Ky., and Fort Worth, Tex.

The supervised community care following in-hospital treatment is expected to provide each addict with the rehabilitative support he needs. The treatment program must be flexible and adapted to the individual needs of each addict. Among the services that may be contracted for in the patient's community-are vocational training, continuing education, job placement, social casework, individual psychotherapy, and group or family therapy. Halfway houses and day or night hospitals may also be used. Evaluation of the progress of each patient will be made and tests given periodically to determine whether he has returned to the use of narcotic drugs.

Field offices to assist in the operation of this community-based program under titles I and III are being established. The NIMH personnel based in these field offices will provide consultation, stimulate and develop community agency contracts for treatment of the addict, and monitor community programs to assure quality care of the addict committed to their care.

Research components to measure the effectiveness of various treatment modalities will be an important aspect of the on-going treatment and rehabilitation program.

For further information

For additional information concerning titles I and III, and the location of field offices, write to the Director, Division of Narcotic Addiction and Drug Abuse, National Institute of Mental Health, 5454 Wisconsin Avenue, Chevy Chase, Md. 20015.

The Attorney General is responsible for the administration of title II of the Narcotic Addict Rehabilitation Act of 1966 and inquiries regarding this title should be directed to his office.

Further information regarding grants and jointly financed cooperative arrangements under Public Law 90-574 may be obtained by writing to the Director, Division of Narcotic Addiction and Drug Abuse. National Institute of Mental Health, 5454 Wisconsin Avenue, Chevy Chase, Md. 20015.

Information may also be obtained from your Associate Regional Health Direc tor for Mental Health, Regional Office, Department of Health, Education, and Welfare.

DISCRIMINATION PROHIBITED

Title VI of the Civil Rights Act of 1964 states: "No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program receiving Federal financial assistance." Therefore the support programs of the National Institute of Mental Health, like every other program .or activity receiving financial assistance from the Department of Health, Education, and Welfare, must be operated in compliance with this law.

EX-ADDICT CENTER GETS ALLY

They haven't sent the welcome wagon around to the new neighbors in the big white house at 2101 N Street NW., but they might.

The new neighbors are former heroin addicts, all under 18 years of age, who are moving into a rooming house just opened a rehabilitation center by the city's new Narcotics Treatment Agency.

"They," are the members of the neighborhood establishment, who have a big say in what happens in the area just west of Dupont Circle.

Led by William T. Brawner, owner of the expensive, highrise apartment building across the street, and joined by Blackie's House of Beef and other businesses and citizen groups in the area, the "Establishment" ended a similar venture in December, when the Department of Corrections attempted to use the building for a halfway house.

Charging that the halfway house would endanger the neighborhood, they went to court and won a permanent injunction against the city.

But, two weeks ago, the city began moving people into the building again. It would become the first community house for the new drug treatment agency, which first detoxifies addicts in a 200-bed ward it operates at D.C. General Hospital.

According to Paul Woodard, the 35-year-old former Roving Leader who now runs the agency's youth division, the house will be home for its youngest addicts for from 6 months to a year after they are detoxified.

Brawner, who watched them move in from the windows of his St. George Apartments, across the street, was fuming.

"This is too much. They obviously felt they could shift people around and call it a different use of the house," he thought as he called his lawyer.

Threatening to bring an action against the city for disobeying the injunction, Brawner met with District officials last week.

He wasn't satisfied with their answers, but decided to visit the house before going to court. "I want to see this first," he told the worried officials.

Wednesday, Brawner inspected the house and talked with a few of the 12 young ex-addicts who are there now. The drug treatment agency hopes to house as many as 50 there.

"You know, after I talked with some of the kids, I decided that I wasn't going to fight it, I was going to support it," said Brawner afterwards, asked about his visit.

"I decided if they can do their thing, we can do our thing," he added. Now Brawner is trying to convince the other members of the establishment to put some of the youths on their payrolls.

"I think they're going to follow my lead. I told them that I would be taking the primary risks anyway. We own the building behind it as well as the apartment across the street," he said, referring to the Brawner Co.

The house, and two other like it that will soon be opened in Anacostia, is considered crucial to the city's drug program-a way to readjust youths to a regu lar home-like routine, let them work and attend school in the community, and still provide the therapy that they need to remain free of drugs.

DAILY TABS TO BE KEPT

Woodward's assistant, Simon Holliday, explained that the drug agency will check urine samples from the youths in the house daily to assure that each remains "clean" (free of heroin).

He added that two rooms in the building's basement will be soundproofed for use in group therapy sessions, which often get pretty noisy.

"These kids are all volunteers and it made them feel a lot better to know that the neighborhood is going to give them a chance," said Holliday.