SD42 - Mandated Substance Abuse Treatment Programs
Executive Summary: AUTHORITY FOR STUDY The Joint Subcommittee Studying Mandated Substance Abuse Treatment Programs was created in 1987 by Senate Joint Resolution No. 171 (Senate Document 28, 1988) and continued in 1988 (SJR 65, Senate Document 22, 1988) and 1989 (SJR 169). The scope of the study was broad and directed the joint subcommittee to review legislatively mandated substance abuse programs, determine the need for coordination of rehabilitative and preventive 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. Since the nature of and solutions to these problems are complex and provide no simplistic answers, the joint subcommittee has been continued for two years to provide the General Assembly continued input on the issue of treatment for substance abuse. BRIEF HISTORY OF JOINT SUBCOMMITTEE A number of issues have been raised during the course of this study including funding for treatment and research; organizational placement of substance abuse services and resultant philosophy about priorities; adequacy of staff providing services on the state level; coordination of drug treatment and education endeavors between state agencies; insurance coverage, including Medicaid, for more appropriate levels of care for substance abusers; drug interdiction efforts by the Commonwealth; adequacy of provision of services on the local level through the community services boards structure; and life skills training as· a practical prevention and treatment effort. Debate continues among members of the joint subcommittee, as well as the population at large, about the grouping of all mood-altering drugs into one category under the generic term "substance" and the lack of prioritization in terms of treatment and funding. Many individuals feel that certain drugs, such as alcohol, are tolerated and even promoted by our society. Other drugs are perceived to be used without apparent addiction, while some drugs, such as cocaine and heroin, are truly addictive. Suggestions have been offered which would differentiate between drugs and funds for control, education, and regulation. (See Appendix 1.) In response to these issues, the joint subcommittee recognizes that continual review and evaluation of substance abuse treatment and prevention efforts are essential. The cost of substance abuse, in both human and economic terms, is staggering. Alcohol is the most widely used intoxicant in the United States today, and abuse costs an average of $117 billion per year in lost productivity and medical bills. According to the National Institute of Drug Abuse, 14 to 18 percent of workers abuse alcohol or other drugs or both and that percentage translates to 16.5 to 21.2 million impaired workers. Lost productivity, absenteeism, medical expense, disability claims, and theft due to the abuse of drugs other than alcohol cost businesses about $16 billion annually. Not included in these figures are the family members who are affected by the member who abuses substances. Costs of substance abuse are generally underestimated due to the hidden nature of the disease, the tendency toward denial among users, and inadequate treatment for the primary diagnosis of substance abuse. As of October 1989, community services boards have implemented 93 percent of all new projects funded during the past biennium. These funds have enabled a significant increase in substance abuse services to occur. By the end of fiscal year 1989, these funds had provided for the following additional services: 57,624 service hours; 23,369 bed days; 3,235 days of service; and 13,876 new clients. During the course of the past three years of study, the joint subcommittee has offered a number of comments or legislative solutions which have been directed at the improvement of substance abuse treatment in the Commonwealth. The joint subcommittee has: • Provided in § 37.1-205.1 for the annual report to the General Assembly by the Department of Mental Health, Mental Retardation and Substance Abuse Services on its activities in administering, planning, and regulating substance abuse services. The provision requires a specific statement of the extent to which the Department's duties, as specified, have been performed. Constant oversight allows the continual update of activities and opportunity to provide immediate legislative remedy if practical. • Directed and encouraged the development of an Interagency Comprehensive Substance Abuse Plan for the Commonwealth by the Department of Mental Health, Mental Retardation and Substance Abuse Services in conjunction with the Department of Criminal Justice Services. The plan was formulated under the power of the DMHMRSAS as the sale agency for planning, coordination, and evaluation of the state comprehensive plan for substance abuse services, the authority to formulate such a comprehensive plan for the development of adequate and coordinated programs for research, prevention, and control of substance abuse, and the authority to effect such a plan in cooperation with other federal, state, local, and private agencies. The plan is reviewed by the Governor's Council on Alcohol and Drug Abuse Problems, and recommendations offered are reviewed by the joint subcommittee. A copy of the executive summary of the Comprehensive Plan is attached, but, as a result of its volume and detail, the entire Plan is not included. For information on the availability of the complete version of the Plan, please contact the Office of Substance Abuse Services in the Department of Mental Health, Mental Retardation and Substance Abuse Services. • Endorsed various proposals for the development of clinical research through the combined efforts of the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Medical College of Virginia. Virginia Commonwealth University received state support for the Commonwealth Center for Drug Abuse in 1988. This research focused effort is based in the Department of Pharmacology. However, the Division of Substance Abuse Medicine is part of the Center, and approximately $50,000 of the $500,000 awarded to the Center went to the Division to support a part-time research assistant and small pilot studies. These efforts resulted in a successful application for federal funding ($9 million over five years) by the Division of Substance Abuse Medicine for services to and research for pregnant addicted women and their children. Further, the Department of Pharmacology has been awarded a major grant ($3 million) by the Alcohol, Drug and Mental Health Administration to study drug development in the areas of substance abuse and mental health treatment. The Office of Substance Abuse Services, through the Department of Health, has received federal funding from the Center for Disease Control to identify intravenous users of drugs who test positive for AIDS as well as tuberculosis. • Established a two-year task force of various professionals involved in the treatment delivery system for substance abuse to evaluate the 30-day insurance mandate currently provided in the Code. A copy of their findings and recommendations is included in this document. • Endorsed the addition of crucial personnel to the staff of the Office of Substance Abuse Services within the Department. The joint subcommittee and various individuals who testified before the committee were not critical of the quality of the current staff but found the original size of the Office of Substance Abuse Services, which was seven individuals, to be inadequate for the massive size of the problem with which they were dealing. As a result, positions to manage the interagency planning process and to coordinate efforts by agencies serving youth have been filled. The previously cited funding from the Center for Disease Control, obtained through interagency collaboration with the Virginia Department of Health, netted approximately $250,000 to fund an AIDS specialist in the Office of Substance Abuse Services as well as funding for AIDS counselors in five communities. Also, the Department recently obtained funding from the National Institute on Drug Abuse (NIDA) for two data analysts. • Directed the Division of Youth Services to thoroughly evaluate and consider the concept of substance abuse treatment and education for juveniles housed in their facilities in the Commonwealth. The Office of Substance Abuse Services continues to work with the Division, soon to be the independent Department of Youth Services, and its new director. Funding for an assessment of the substance abuse education and treatment needs of the youth served in DYS institutions was provided by a grant from the Governor's Council via the federal Drug Free Schools and Communities Act. The completed report of this activity forms the basis for parts of the Department of Youth Services' biennium budget. In addition, DYS has also requested support from the Governor's Council on Alcohol and Drug Abuse to implement a new substance abuse curriculum and provide training for cottage counselors. • Directed the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Medical Assistance Services, pursuant to SJR 196, 1989, to 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 cost of providing the required treatment services. A copy of the report of that study as presented to the joint subcommittee is included. • Endorsed additional funding, within current budget restraints, for support of pilot public/private employee assistance programs. Funding for pilot employee assistance programs was included in the budget and the Department provided staff assistance in a request for proposals offering. As of December 1989, the process was virtually complete with awards to be made in the immediate future. The Department also provides current literature on drug-free workplace activities but is unable to provide developmental or technical assistance to businesses and industry due to staffing limitations. EXECUTIVE SUMMARY The Joint Subcommittee Studying Mandated Substance Abuse Treatment and Prevention Programs was continued by the 1989 Session of the General Assembly expressly to provide oversight to a number of task forces studying a variety of designated topics. These topics included the interagency plan for substance abuse services, Medicaid coverage for substance abuse treatment, the adequacy of insurance coverage for psychiatric illnesses, and insurance coverage for substance abuse treatment. |
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