SD22 - Mandated Substance Abuse Treatment and Prevention Programs

  • Published: 1989
  • Author: General Assembly. Joint Subcommittee
  • Enabling Authority: Senate Joint Resolution 65 (Regular Session, 1987)

Executive Summary:
INTRODUCTION

The joint subcommittee was created pursuant to SJR No. 171 in 1987 to review legislatively mandated substance abuse programs, determine the need for coordination of rehabilitative and prevention services provided by various state agencies, determine the efficiency and effectiveness of the administration of substance abuse programs and services delivered by the community services boards, assess the delivery of substance abuse services in light of federal and state cutbacks, and recommend methods of maximizing the utilization of available funds and enhancing service delivery mechanisms.

Due to the multiplicity and complexity of these issues, the joint subcommittee was continued for 1988 by SJR No. 65. (Appendices A and B). The interim report for the joint subcommittee is contained in Senate Document No. 28 of 1988.

As a result of legislation recommended by the joint subcommittee in 1988, the Department of Mental Health, Mental Retardation and Substance Abuse Services has filed its annual report to the General Assembly (Appendix C).

RECOMMENDATIONS

The joint subcommittee has found that the issue of substance abuse treatment and prevention is an extremely complex one with no simplistic solutions. Recognition of substance abuse problems is steadily increasing in our culture and one that is not always a popular issue with which to deal. Treatment modalities are being constantly developed and modified to provide proper treatment for individual needs but public perception and stigma attached to such a malady inhibit clients seeking treatment. Current treatment and insurance coverage are not always necessarily appropriate and many go undiagnosed or untreated for many years. The sheer number of state agencies providing some sort of substance abuse services, whether it be law enforcement, treatment or education, represents a complex approach to the problem of substance abuse. In all, seventeen state entities provide some sort of substance abuse service to citizens of the Commonwealth. The Departments of Mental Health; Mental Retardation and Substance Abuse Services and Criminal Justice have initiated a comprehensive substance abuse plan to address coordination among these agencies.

In light of these considerations, the joint subcommittee recommends:

• That they continue their work for an additional year in order that they might continue to evaluate and make recommendations on several specific issues, including insurance coverage for substance abuse treatment, and recommendations in the interagency comprehensive plan being developed by the Departments of Mental Health, Mental Retardation and Substance Abuse Services and Criminal Justice Services. These efforts are currently under way and the joint subcommittee desires to see them to completion in order to provide a complete evaluation and appropriate recommendations. (Appendix D)

• That they again endorse the appropriation of funds for research at the Medical College of Virginia Department of Substance Abuse Medicine. Research falls into two categories of client treatment models and victims of AIDS who are intravenous drug users. Response to treatment is frequently more due to individual client characteristics than specific treatment approaches. The impact of client characteristics such as familial stability, economic condition, general health, psychiatric complications, sex, age, race, and social stability, in addition to unique responses to substances abused have led investigators to further exploration. Virginia is not currently engaged in applied research, except on a limited basis, directly related to the question of what type of treatment provides the most benefit to what type of client. Significant amounts of applied research grant funds from the federal level are directed at this question, but in order to be able to capture these funds, Virginia must establish a track record for applied substance abuse treatment research. The initial steps in establishing a track record will include the development of a uniform data collection system through questionnaire development, field testing and use of the questionnaire to collect data across the Commonwealth. Once subcategories of substance abusers are clearly defined, treatment protocols could be developed/identified to meet the needs of these categories of abusers. The development of such a model will place Virginia in the forefront of treatment approaches, and place Virginia in a strong position for securing grants to support research in this important area. Estimated cost for this is $200,000.

Intravenous (IV) drug users, including homosexual IV drug users, are reported as victims in approximately 12% of the total known AIDS cases in Virginia. Intravenous drug users are the second highest at risk population to homosexual/bisexual individuals who are reported as victims in approximately 72-73% of the total known AIDS cases. Nearby states such as New Jersey have reported that IV drug users are found among reported AIDS cases in much higher percentages than the national level. The major mechanism of AIDS transmission in IV drug users is the sharing or exchange of needles and this practice, in addition to prostitution, may represent a major source of spreading AIDS among the heterosexual population. Elimination or reduction of IV drug use and associated practices are primary goals of drug treatment. A problem facing the treatment community is motivating potential drug treatment clients to begin and continue a course of drug information that will assist them in motivating IV drug users to participate in treatment. The research effort will include description of actions taken by other states, literature reviews, and a design of specific actions for Virginia drug treatment programs. Failure to focus on this high risk population of AIDS infection will contribute to the general spread of AIDS and increase occurrence in the heterosexual population. The Department will facilitate coordination of this research effort with other activities of the AIDS Office, Department of Health. Estimated cost for this study is $50,000.

• That the Task Force Studying Insurance Coverage for Substance Abuse Treatment, as created under the Joint Subcommittee, be continued to evaluate and make recommendations on this specific, complex issue. The current task force is comprised of individuals representing various interests, including service providers such as medical professionals, community services boards, employee assistance programs, residential programs, hospitals and insurance companies, who volunteered their time and expertise to the study of this issue. There are many fundamental questions which need to be answered with regard to appropriate treatment for various types of clients to ensure that each client is receiving proper care for his particular condition and to provide insurance coverage adequate to do the job. The task force did not begin its deliberations until September, 1988, and therefore did not have sufficient time to make comprehensive recommendations on this issue. Members did outline the general questions which need to be answered and made great headway in reaching consensus on many issues, and they have expressed their desire to continue to meet in order to make a comprehensive presentation of a program of treatment and insurance coverage which would be beneficial to all involved. Specific issues are discussed later in the report.

• That the Office of Substance Abuse Services within the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) in conjunction with the Department of Criminal Justice Services continue with the development of a comprehensive interagency plan. This plan is designed to first find out exactly who is doing what with what resources for substance abuse treatment and prevention services in the Commonwealth. This plan will be ongoing and information will be updated on a regular basis. This planning process provides the mechanism for identifying gaps in services and potential strategies and resources for addressing these gaps. In addition to this plan, the Department is developing a grant monitoring process to keep track of the source and amount of funds being disbursed by which agencies and on what projects. This mechanism will allow the Department to keep track of projects between biennium updates of the plan. A copy of the initial findings of what state agencies are currently doing is found in Appendix E.

• That the $1.8 million which was deleted from the Governor's initiative for community services boards for alcohol programs be reinstated to the budget. This recommendation is made in recognition of the overwhelming demand for treatment services at the local level and would restore funding for this area to the level recommended by the Governor and the House of Delegates.

• That additional staff for the Office of Substance Abuse Services as requested be provided within current, available funds. During the first year of the study by the joint subcommittee testimony expressed much concern about the level of staffing within the Office of Substance Abuse Services. Criticism was not leveled at the quality or expertise of the personnel but at the monumental job which they were being expected to do with a total staff of seven persons. The office has since added one staff position with the specific responsibility for statewide planning and coordination and is in the process of recruiting an additional staff position to focus on youth with emphasis on coordination with youth-serving agencies. Requests for additional staff for the next biennium to address specific issues such as improved access to health care, AIDS, field training, client employment and program evaluation have been submitted through the Departmental comprehensive planning process.

• That the concept of substance abuse treatment and education programs be thoroughly evaluated and given consideration by the Division of Youth Services for the facilities housing juveniles in the Commonwealth. Current legislation in the 1989 Session of the General Assembly calls for the Division of Youth Services to be separated from the Department of Corrections by 1990 but provides for a policy board to begin functioning in 1989 to determine the goals and mission of the new department. It is hoped that substance abuse treatment of these juveniles will receive priority consideration by the new department. Current plans include instituting such a program, but during the course of the current study none were available. Much testimony was received from professionals in the field as to the need for such treatment as well as direct testimony from juveniles incarcerated in the Division of Youth Services who had or continue to have substance abuse problems and who hoped to give some insight and personal meaning to the situation. Eighty percent of the students in the Division of Youth Services have been affected directly or indirectly by substance abuse and over fifty percent have been sexually abused. A great number of children are abused by someone under the influence of drugs or alcohol, and substance abuse education and treatment programs are vitally necessary not only for those juveniles incarcerated in the system but also for the families of those individuals as well.

• That the General Assembly consider legislation which would provide for mandatory suspension of the driver's license of a minor who was convicted of any drug or alcohol offense. This concept has been adopted by at least five other states who have demonstrated its effectiveness in decreasing the numbers of juveniles who were driving under the influence of alcohol or drugs, possessing open containers in vehicles, and general liquor and drug law violations. Rationale for this proposal generally centers on the idea that the state is providing guaranteed punishment for juveniles in an area where the law generally tends not to be enforced, thereby making juveniles more accountable for their actions and also providing a more positive way to reward those who abstain from use as well as providing an easier way for minors to say "no" rather than participate under great peer pressure. More detailed discussion of this proposal is contained in the body of the report. (Appendix F).

• That the Department of Medical Assistance Services and the Department of Mental Health, Mental Retardation and Substance Abuse Services conduct a study to determine the size of the Medicaid-eligible population in need of substance abuse treatment, the services required by that population, and the projected costs of providing the required treatment services. State Medicaid currently does not provide substance abuse treatment services for their clients since federal regulations classify this as a rehabilitative service and therefor an optional service by the state. The state has chosen not to participate in such a program due to the cost, the difficulty of defining the population at risk and the treatment necessary for those individuals, and the fact that Medicaid regulations provide that when a treatment is offered it must be offered to everyone who qualifies, not just those which can be treated vii thin the current budget. The Department of Medical Assistance Services has been working to provide some of this information on a consistent basis and has made a preliminary determination that $12 million would be necessary to provide these services to Medicaid eligibles, of which $6 million would be federal match funds. This is seen to provide services to those who generally have no insurance coverage for treatment and are dependent on public treatment facilities therefor placing a great burden on the local community services boards and other publicly funded services. These individuals, left untreated, are responsible for the expenditure of large numbers of dollars in other programs such as hospitalization for a secondary diagnosis, unemployment, medical assistance, and food and shelter programs, none of which address the primary problem of substance abuse. (Appendix G).

• That an sufficient State Employee Assistance Services (SEAS) offices be established as determined by the Department of Personnel and Training to provide services to state employees and that plans be developed by the Department to provide for the coverage of other state employees who live and work in areas which do not have enough state employees to justify a full-time SEAS office or counselor. SEAS was originally started in 1978 as a pilot program to demonstrate the extent and costs of alcohol and drug problems among the 80,000 employees of state government and it was based on the model of some very successful Employee Assistance Programs (EAP) in private industry in the state which proved to be cost effective when fully implemented. The SEAS office began with one counselor and secretary in the Richmond area, but demand quickly outgrew the capability of the office to provide needed services and the necessary follow-up. In response to requests for additional offices, the 1988-90 Budget Act included provisions for the expansion of this service in Norfolk and Blacksburg opened during the summer of 1988.

• For many years, the Commonwealth, private employers and labor organizations have recognized the problems and costs associated with alcohol abuse among employees and have developed occupational alcoholism programs designed to help workers with these problems. Today, these efforts are known as Employee and/or Workers' Assistance Programs (EAP) (WAP) and have been expanded far beyond the initial concern. They now also include drug abuse, mental health problems, financial difficulty and family/marital crises.

The joint subcommittee believes that EAP's and comprehensive referral services provided by private employers, labor organizations and nonprofit charitable organizations should be continued and expanded so that workplaces, large and small, may be better equipped to deal with the problems associated with chemical dependency.

We believe that early workplace detection and intervention, as well as education and training, are elements crucial to the success of treating substance abuse problems. Full service workers' assistance programs are a wise and prudent investment which return substantial dividends to industry and human capital. Keeping Virginia's workers on the job as productive citizens enhances the Commonwealth's business climate and reduces the burden on state agencies who treat those in need who cannot provide fully their own treatment due to lack of insurance coverage because of loss of employment.

Recognizing the important and crucial services provided by assistance programs within the Commonwealth of Virginia, in the area of workplace treatment and intervention, we recommend to the 1989 Session of The General Assembly that funding be provided to the Department of Mental Health, Mental Retardation and Substance Abuse Services to pilot public/private EAP'S, which, if successful, could be used as a model for statewide implementation.