Alcohol Abuse Prev Strategies
ALCOHOL ABUS(=
PREVENTION
STRATEGIES
A Profile of One City - San Francisco
United States
Conference of Mayors
1620 Eye Street, Northwest
Washington, D,C, 20006
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United States
Conference of Mayors
Helen G, Boosalis, President
Mayor of Lincoln, Nebraska
John J, Gunther
Executive Director
Acknowledgement
This publication was written by Elizabeth
Campbell, Staff Associate, in consultation with
Carol Moody Becker, Staff Director for the
Alcohol Abuse Prevention Project. Pat Troll-
inger, Office Associate, assisted in the
preparation, The alcohol abuse prevention
strategies of the Conference fall under the
Office of Employment, Education and Human
Resources, which is directed by James L,
Parsons,
The U,S, Conference of Mayors prepared this publica-
tion under contract number ADM 281-80-0017 from the
National Institute on Alcohol i6,buse and Alcoholism
(N IAAA) The findings and conclusions do not neces-
sarily reflect the policies of NIAAA
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Contents
Preface, ,
I. Overview,
II. Alcohol Abuse in San Francisco
Costs to the Criminal Justice
and Health Systems, "
Community Substance Abuse
Services"", '"
Community Involverlent '" "
Coordinated Approach to Alcohol
Abuse Prevention,
Role of the Mayor
III. San Francisco's Alcohol Abuse
Prevention Strategies
The Mayor's Blue Ribbon
Committee,
Bartender Training
Sobriety Hotels, ,
Media Campaign, "
Healthy Youth Project, , ,
Employee Assistance Program
IV. Resources
Use of Student Volunteers,
Special Liquor Tax, " '
Organizations and f\gencies,
Footnotes,
Page
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4
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6
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11
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Special Acknowledgement
The Conference of Mayors would like to
express its appreciation to Mayor Feinstein and
to the San Francisco city officials who offered
both information and valuable insights on the
alcohol abuse prevention program in their city,
Special thanks is given to Larry Meredith, Ph,O"
Program Chief, Community Substance Abuse
Services, City and County of San Francisco, for
his time and the assistance he has provided to
the Conference of Mayors' Alcohol Abuse
Prevention Program,
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IV
The U ,S, Conference of Mayors, in coop-
eration with the National Institute on Alcohol
Abuse and Alcoholism (N lAM), has explored
over the past eighteen months innovative city
approaches in alcohol abuse treatment and
prevention, Special attention has been focused
on prevention efforts involving city policy in
areas such as criminal justice, civil service, and
health, Through the publication of the issue
paper Alcohol Abuse Prevention Strategies in
Cities and presentations at three Mayors Lead-
ership Institutes the Conference has brought ex-
emplary city approaches to the attention of the
Mayors,
Preface
After reviewing various city alcohol abuse
prevention strategies in the kst issue paper,
the Conference felt that it would be useful to
concentrate on one city's approach, Through
such a focus, other cities could analyze the
various components necessary to develop,
organize, and implement prevention strategies,
as well as learn effective ways to involve the
community and the private sector, Conse-
quently, this report provides an in-depth presen-
tation of the comprehensive alcohol abuse
prevention program in San Francisco, San
Francisco is one of the cities which has done
extensive work in the alcohol abuse field and
has always had a focus on prevention, The
city's prevention effort addresses alcohol abuse
through model programs anc policy ap-
proaches, It is hoped that this description of
one city's experience in prevention will provide
guidance to Mayors and oHler local officials in
impacting upon alcohol abuse and alcoholism
in their cities,
v
Alcohol abuse and alcoholism cost the na-
tion billions of dollars annually and much of the
financial burden is borne by local governments,
Cities are faced with the costs and conse-
quences of: public inebriates and their impact
on the health and criminal justice systems and
on downtown revitalization: drunken drivers who
cause half of all traffic fatalities;; and alcohol
abusing and alcoholic employees, 25 percent of
whose salary is lost due to absenteeism, ineffi-
ciency, and other factors,2 Increasingly, Mayors
are looking to alcohol abuse prevention pro-
grams to address these costs,
San Francisco's coordinated approach to
alcohol abuse prevention can provide a model
for other cities wishing to impact on their
alcohol problems, With the strong support of
Mayor Dianne Feinstein, the city has developed
a multifaceted approach to the prevention
issue, This approach-involving the criminal
justice system, the schools, and the civil service
system-includes an ambitious public informa-
tion/media campaign and an innovative seven
year plan for housing public inebriates,
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I.
OvelVi ew
Following a description of the nature of the
alcohol abuse problem in San Francisco, this
report describes the operation of the city's Divi-
sion of Alcohol Programs, A subsequent
chapter provides detailed information on the
various strategies, both traditional and in-
novative, which San Francisco has employed to
impact on alcohol abuse,
It is recognized that cities are not identical
and that programs and approaches are
adapted to differing urban needs, Therefore,
this profile of San Francisco is presented to
stimulate thought and discussion and to offer a
new framework for planning alcohol abuse
prevention strategies,
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San Francisco often has been character-
ized as a "hard drinking town," For many years
the city has led the nation in the incidence of
alcohol related problems among its citizens,
with the highest per capita level of alcohol con-
sumption and alcohol cirrhosis in the United
States,3 However, since 1970, with the im-
plementation of an effective service delivery
system for alcohol abuse and alcoholism, the
cirrhotic death rate has declined 47 percent.
Costs to the Criminal Justice
and Health Systems
As in cities across the country, alcohol
abuse has a major impact on San Francisco's
criminal justice and health systems, Alcohol
related arrestees crowd the jails and overload
the court system, Most of the arrests are for
public drunkeness-16, 167 arrests in 1979,4
Studies show that housing the public inebriate
in jail is a costly and ineffective way of dealing
with the problem, Compared with a cost of $90
for processing and jailing; the cost for housing
the public inebriate in a city funded detoxifica-
tion facility averages $33-one third the cost."
II. Alcohol Abiuse In
San Francisco
It is more difficult to measure the impact
of alcohol abuse on San Fra lcisco's health
facilities, However, it is well known that chronic
inebriates repeatedly utilize hospital emergency
rooms, San Francisco General Hospital serves
a large number of public inebriates, "Normally
between 35 percent and 45 percent of
emergency room patients seen by the Medical
Staff Worker are diagnosed as alcoholics or
problem drinkers," 6
Community Substance j~buse Services
To respond to the wide range of alcohol
related problems in the community, San Fran-
cisco's Division of Alcohol Programs, Commun-
ity Substance Abuse Services (CSAS), maintains
a comprehensive service system, Currently,
CSAS funds 25 different treatment and referral
agencies which provide a variety of alcohol
related services,
The fiscal year 1981 budget to support
these programs totalled $4 million with the
largest percentage from state general
funds-$2,6 million, Federal formula grants
comprised $651,000 of the total.
3
Community Involvement
The community is an active participant in
the planning of the city's alcohol programs
through the Citywide Alcoholism Advisory Board
(CMB), This 15-member board, established in
1971, provides the Division of Alcohol Programs
with community input regarding programs,
policies, and priorities, The CMB reviews the
program budget and the community's
alcoholism prevention, treatment, and rehabilita-
tion needs, In addition, the CMB promotes
public understanding of the problems of
alcoholism and encourages public support for
the development and implementation of effec-
tive alcoholism programs,
A prevention task force of the CMS has
been active in pursuing means through which
the community can be more effective in ad-
dressing problems created by drunk drivers.
Representatives of the Police Department, the
judicial system, the American Automobile
Association, and concerned citizens are par-
ticipating in this forum,
Coordinated Approach to Alcohol
Abuse Prevention
One of the keys to the comprehensive
alcohol abuse prevention program in San Fran-
cisco is a coordinated approach, Community
Substance Abuse Services (CSAS) emphasizes
the importance of good working relationships
with other health and human service agencies
in the city, The Director of CSAS promotes this
community coordination of alcohol related serv-
ices by his involvement in a range of health and
human service organizations.
The Division of Alcohol Programs has
established linkages with the criminal justice,
welfare, mental health, and public health
systems, enabling them to stretch their
resources, These relationships help to bridge
gaps in care and have provided productive
cross referral opportunities, In addition, the
Director of CSAS feels that because of this in-
4
teragency involvement and communication, the
services of law enforcement, public and mental
health, and employers are more sensitive to the
needs of those with alcohol problems,
Since the major share of the city's alcohol
abuse services are provided under contract ar-
rangements, the Division of Alcohol Programs
also requires that providers develop effective
working relationships with the entire alcohol
service delivery system, In addition, the Division
holds a monthly providers meeting so that all
the units providing services can share informa-
tion and troubleshoot problems, This service
delivery system, with its network of interdepen-
dent linkages, permits the city to more effec-
tively serve the community.
Role of the Mayor
Mayor Dianne Feinstein, a strong advocate
of the city's alcohol abuse prevention activities,
has provided leadership and ~lelped to raise
community awareness of alcohol problems in
San Francisco. With the Mayor's support, and
in some cases active participation, the city: ap-
pointed a committee to study the public in-
ebriate problem, conducted a training session
for bartenders, began planning for low cost
housing for public inebriates, developed a
public information campaign on 'alcohol abuse,
instituted an alcohol risk reduction program in
the schools, and has plans to broaden its
alcohol assistance program for municipal
employees, These approaches are described in
the following section,
By employing a comprehensive broad-
based approach to the alcohol abuse issue, the
Mayor has been able to minimize the costs to
the city of San Francisco which result from
alcohol abuse.
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The Mayor's Blue Ribbon Committee
As in cities across the country, San Fran-
cisco was faced with mounting concerns over
the impact of public inebriates on businesses
and neighborhoods, In addition, the processing
of public inebriates in the criminal justice
system was costly, largely ineffective, and a
misdirected approach for dealing with the prob-
lem, In response to these problems and to a
study analyzing the impact of alcohol abuse on
the criminal justice system, Mayor Dianne
Feinstein appointed a 25 member "Blue Ribbon
Committee on Public Inebriates,"
Recognizing the need for broad based
support in the resolution of the problem, the
Mayor appointed representatives from all sec-
tors of the community including: alcohol treat-
ment service organizations, the criminal justice
and health systems, the corporate sector, and
neighborhood organizations, Professional sup-
port was provided by the Mayor's office, as well
as the Division of Alcohol Programs of Com-
munity Substance Abuse Services,
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III. San Francisco's
Alcohol Abuse
Prevention
Strategies
The committee's function was to explore
the public inebriate problem and to suggest
solutions addressing criminal justice, health,
and residential issues, Testimony was received
from a wide range of sources-including the
Department of Public Health, the Police Depart-
ment, the Salvation Army, the business sector,
concerned citizens, and public inebriates-in
an effort to determine the size and nature of
the problem, current local responses, and what
should be done, In order to receive community
input and recommendations, two well attended
public hearings were held, The committee's
final recommendations were then submitted to
the Mayor,
Findings and Recommendations
The findings and recommendations of the
Blue Ribbon Committee deal with the alcohol
abuse problems in San Frarcisco, However, as
many cities face these same problems, the
committee's recommendations (some of which
have already been implemented) may have a
broad applicability, Among the findings and
recommendations were the following: 7
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. Sober Residences: San Francisco's alcohol
recovery system should be expanded to meet
the need for sober residences, Due to lack of
these facilities many persons become re-
involved in the criminal justice system
because they have no place to go upon com-
pletion of the detoxification program, (For fur-
ther information on sober residences see the
description of sobriety hotels in this report on
page 6,)
. Reception Centers: Public inebriates should
be diverted from the criminal justice system
which is a costly and inappropriate response
to the problem, The committee recommends
that the police transport public inebriates to
reception centers rather than to jail and that
there be increased communication and coor-
dination between the police and reception
centers,
. Public Awareness: A media campaign
should be developed to promote public
awareness of the size and cost of the public
inebriate problem and the resources
necessary to place those who need help into
the alcohol recovery system, (The city media
campaign will begin in mid-March, See the
description of this effort on page 7,)
. Alcohol Tax: The Mayor should support
passage of state legislation increasing the
alcohol excise tax, The additional funds would
be earmarked for increased alcoholism serv-
ices,
For further information on the Mayor's
Blue Ribbon Committee contact:
Jim Buick
Office of Criminal Justice
City Hall
San Francisco, California 94102
Bartender Training
A special seminar on alcohol abuse was
given to San Francisco bartenders, restaurant
and bar owners, and waiters and waitresses in
December, The seminar was sponsored by the
city's Community Substance Abuse Services as
one of a number of positive steps toward
preventing problems, particularly during the holi-
day season (with its usual increase in alcohol
related fatalities and accidents), Techniques for
cutting off bar service to intoxicated patrons,
how to recognize when a person is becoming
intoxicated, myths about alcohol, and drinking
capacity of people by weight were among the
topics discussed,
The training was deviseel by the State of
California's Department of Alcoholic Beverage
Control-the state regulatory agency that
licenses all sales of alcohol. F'reviously training
was given to all restaurant ard bar owners at
each establishment and was considered to be
very effective, However, this practice was
discontinued due to lack of funds,
The training seminar emphasizes the
responsibility of the servers toward intoxicated
and near intoxicated persons, and manage-
ment's responsibility for supporting a server's
decision to refuse further service to a patron,
The seminar is an excellent example of how
government and industry can work together to
solve common problems, The participation of
bartenders in this training program can help to
prevent injuries and save lives, as well as
reduce one of the major headaches associated
with running a bar or restaurant.
For further information on bartender train-
ing contact:
Mara Mugford
State of California
Department of Alcoholic Beverage Control
1215 0 Street
Sacramento, California 95,314
Sobriety Hotels
The Mayor's Blue Ribbon Committee, as
previously described, identified the need for
sober environments for those public inebriates
who wish to maintain sobriety, Recovery from
alcohol abuse is significantly improved when a
person can live in a controlled, alcohol free en-
6
vironment. Sober residences minimize the
"revolving door" syndrome in treatment set-
tings and the criminal justice system, Currently,
the demand for residential services in San Fran-
cisco is high due to, among other factors, the
housing shortage which leaves few low cost
housing alternatives,
Bridgeway Project
The Bridgeway Project, a sober hotel
which has been in existence for eight years, of-
fers the chronic alcoholic an alcohol free living
environment. This successful program provides
referral links to health and other services
available in the community, as well as providing
round-the-clock counseling, Of the 100 beds in
the hotel, 40 are for long term alcoholics who
are sober, The goal is for the problem drinker
to "graduate" and remain in the hotel.
Island of Sobriety Project
Using the Bridgeway Project as a pro-
totype, the Division of Alcohol Programs "Island
of Sobriety Project" has as its seven year goal
the establishment of ten sober hotels in San
Francisco, To respond to the need for addi-
tional sober environments, these hotels will pro-
vide long term residence to chronic alcoholics,
In addition to reducing the costs to the public,
the project will enhance the personal and social
conditions of these individuals,
The first phase of the project calls for a
funding strategy to raise the money necessary
to set up and begin operation of ten 1 OO-bed
hotels, This money will come from a mix of
private investment, public monies, and capital
fund raising, After identifying potential investors
and arranging real estate and banking transac-
tions, the Division of Alcohol Programs will
oversee the purchase and renovation of the
facility and then select and administer the facili-
ty management team,
In addition to providing stable, low cost
housing, the hotels will include job training and
rehabilitation services so that individuals can
become productive citizens, Cost savings are
foreseen in the criminal justice and health
systems,
For further information on the Island of
Sobriety Project contact:
Wayne Clark, Ph,D,
Division of Alcohol Programs
Community Substance Abuse Services
170 Fell Street
San Francisco, California 94102
Media Campaign
The San Francisco Department of Public
Health, Division of Alcohol Programs, has
developed a media-based alcoholism informa-
tion and prevention program, Under a contract
with Cole Communications (a private advertising
firm), the campaign will increase community
awareness about the nature and effects of
"atypical" alcohol use and the resources
available to assist the alcohol abuser, The cam-
paign strategy is based on the premise that
alcohol abuse affects not only the problem
drinker, but all members of the community,
Therefore, alcohol abuse will be presented as a
community problem requirinç a community
response,
The information dissemination campaign
will be targeted to reach specific population
groups including Blacks, youth, women, men,
and the elderly, Recognized and respected com-
munity leaders, role models jar each specific
audience, will appear in ads declaring
themselves as "typical" drinkers but not pro-
blem drinkers, They then will outline the symp-
toms of problem drinking and state the help
available, The focus will be en all citizens as
"significant influences" on al1 alcohol abuser
and stress that they are in a position to in-
tervene on behalf of the problem drinker, Media
use will include television, radio, newspapers
and magazines, special community events,
posters, and yellow pages advertising,
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Funding Strategy
The campaign has looked to all segments
of the community to share in sponsorship,
Foundations have been approached and cor-
porate sponsors are being sought. As a means
of securing private sector support, a Sponsor
Participation Book has been sent to businesses
in San Francisco, A company can choose to
sponsor one particular item in a certain media,
such as a radio ad or a poster, donating the
amount listed as the production cost of that
item only, The advertisement would then depict
the firm as the corporate sponsor,
The campaign has received positive
responses from the media in San Francisco,
One station has already donated the production
of a videotape session on alcohol problem
prevention with a group of local notables-a
contribution valued at $35,000, This will be a
central component in the overall media-based
prevention effort.
Citizen Participation
Prior to the development of the advertising
strategy, a community survey regarding at-
titudes on alcohol was conducted, The survey
measured the public's level of awareness in
order to gear the campaign to community
needs,
, A public meeting was held for community
!nout on campaign goals as well as the major
Issues and needs to be addressed, In addition
the city's health service providers were inter- '
viewed to ascertain their needs in a community
outreach campaign,
Goals
The primary goal of the public information
campaign is prevention-a reduction in the in-
cidence of alcohol related problems, The city is
also seeking to achieve an increased communi-
ty awareness that:
. the misuse of alcohol is a serious problem for
everyone, not just the abuser:
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. an extensive network of services exists to
help the problem drinker: and
. all citizens are significant influences on the
alcohol abuser and can help to relieve this
problem,
For further information on the media cam-
paign contact:
Art Cole
Cole Communications
1700 Union Street
San Francisco, California 94123
The Healthy Youth ProjE~ct
The Healthy Youth Project is a risk reduc-
tion program established threugh a joint effort
of the San Francisco Department of Public
Health and the San Francisco Unified School
District. The aim of this peer teaching, parent,
and teacher health promotion program is to
deter the onset of smoking and alcohol abuse
among youth.
The abuse of alcohol and tobacco can
lead to illness, disability, and (jeath, However
prevention programs can help to minimize'
these risk factors, Since it is during
adolescence that experimentation with alcohol
and tobacco usually begins, it is an optimal time
to educate youngsters in the responsible use of
these products,
As in other San Francisco prevention ef-
forts, community involvement is an integral
component of the program, The community and
parents are involved in all phases of planning
and Implementation, The project has a com-
munity advisory group with representatives from
the public and private sectors, This group
assists in mobilizing the suppert of concerned
citizens, transmitting information to the com-
munity, and advising on policy matters,
The project addresses the use of alcohol
and tobacco on three levels: parental influence
on children's smoking and drinking behavior,
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teachers and other school staff influence on
this behaviorl and peer pressure to smoke and
drink, The curriculum focuses on learning social
skills such as building a positive self image and
includes facts and dispels myths about smoking
and drinking,
By January, 1983, the project hopes to
have delivered risk reduction programs at three
schools, providing students with the necessary
life skills training to resist social pressures to
smoke and drink,
For further information on the Healthy
Youth Project contact:
Larry Meredith, Ph.D,
Comllunity Substance Abuse Services
170 Fell Street
San Francisco, California 94102
Employee Assistance Program
The National Council on Alcoholism
estimates that up to ten percent of the nation's
workforce are problem drinkers, and that as
much as 25 percent of a problem drinker's
salary is lost due to absenteeism, excessive
sick leave, and low productivity, Mayors are
particularly concerned with this problem as
fiscal constraints lead to a shrinking municipal
workforce,
In order to address this problem and in-
crease the effectiveness of the city's workforce,
San Francisco's Division of Alcohol Programs
instituted an Employee Assistance Prog ram
(EAP), The program provides information and
referral services to employees who are ex-
. periencing job performance problems due to
alcohol abuse and other personal problems,
which can cause stress and lead to substance
abuse, The EAP is designed to help in the early
identification of employees when their problems
first impair job performance, There is ongoing
training of supervisors to assist them in the
early detection of possible troubled employees,
The program aims to motivate the employee to
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receive the necessary treatment to resolve their
problem, Treatment occurs outside the EAP
after diagnosis, pre-treatment counseling, and
referral have been made, Employees are
assured that their job and future will not be
jeopardized by utilizing this service.
Many cities administer their employee
assistance programs through the personnel
department. However, San Francisco's ap-
proach is for each department to design and
budget for their own EAP, with the city's public
health department providing technical
assistance in establishing the program, In this
way, the program can be structured to conform
to the needs of individual departments and con-
fidentiality is assured,
As in their other successful alcohol abuse
prevention programs, San Francisco stresses
the importance of communication and coopera-
tion in their EAP, Therefore, the city's effective
Employee Assistance Program involves both
management and unions from the planning
stages,
For further information en San Francisco's
EAP contact:
Larry Meredith, Ph.D,
Community Substance Abuse Services
170 Fell Street
San Francisco, California 94102
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Use of Student Volunteers
San Francisco's Community Substance
Abuse Services enlists the aid of graduate
students in the Bay Area in their alcohol abuse
prevention efforts, Across the country, colleges
and universities, particularly those with graduate
schools of medicine, public health, or social
work, often have capable students who are anx-
ious to find opportunities for field research,
Graduate students can be especially helpful in
gathering and analyzing data and writing case
studies on alcohol abuse for a city's needs
assessment
Special Liquor Tax
Mayor Feinstein's Blue Ribbon Committee
on Public Inebriates recommended that in lieu
of passage of state legislation to increase the
alcohol excise tax, the Mayor should explore
the feasibility of instituting a local alcohol tax,
Several local governments have enacted
designated liquor taxes,S and many other cities
and states are considering taking similar action,
The revenue generated by the tax would be
.._-~-
IV.
Resources
used specifically for alcohol prevention and
treatment programs,
Organizations and Agencies
. The National Institute on Alcohol Abuse
and Alcoholism, 5600 Fisher's Lane,
Rockville, Maryland 20857, NIAM is an
agency of the U ,S, Department of Health and
Human Services.
. The National Clearinghouse for Alcohol In.
formation, P.O, Box 2345, Rockville, Maryland
20852, The Clearinghouse, part of N lAM,
provides publications, literature searches,
and other services regarding alcohol
related subjects. Requests may be sub-
mitted to the Clearinghouse by mail or by
telephone, (301) 468-2600,
. The State Alcoholism Authority in each
state supports a range of alcohol services, in-
cluding prevention programs,
. The National Council on Alcoholism, 733
Third Avenue, New York, ~~Y 10017, NCA a
private, nonprofit organization, has local af-
filiates in many cities whicll can be of
assistance in planning prevention efforts,
11
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Ernest p, Noble, ed" Third Special Report to
the US, Congress on Alcohol and Health
from the Secretary of Health, Education,
and Welfare (Washington, D,c.: Government
Printing Office, 1978), p, xi.
2 National Council on Alcoholism estimate,
3 Larry Meredith, Alcohol and Drug Services
in San Francisco,' Current Status, Future
Prospects (San Francisco: Community
Substance Abuse Services, 1981), p, 1,
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Footnotes
4 Jenny White, Executive Summary-Alcohol
Abuse and Alcohol-Related Problems in San
Francisco,' A Needs Assessment for
Alcoholism Treatment anÔ Prevention Serv-
ices (San Francisco: Community Substance
Abuse Services, 1980), p, 5,
5 Ibid" p, 6,
6 Ibid" p, 7,
7 The Blue Ribbon Committee on Public
Inebriates, Report to the Mayor, October 22,
1981. pp, 8-14
8 John R, Deluca, ed" Fourth Special Report
to the US, Congress on Alcohol and Health
from the Secretary of Health and Human
Services (Washington, D,C,: Government
Printing Office, 1981), p,172,
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