RD9 - Annual Report and Comprehensive Interagency State Plan for Substance Abuse Services


Executive Summary:
[Report was modified by adding a cover on 3/8/05]

Virginians, like other Americans, are seriously affected by abuse of and dependence on alcohol and other drugs. Based on national estimates, 544,608 Virginians aged 12 or older meet criteria for a substance abuse disorder or substance dependence, but only 5.5% received treatment. Substance Abuse and Mental Health Services Administration, 2002 Substance use and misuse is a serious problem among Virginia's youth. According to the Virginia Community Youth Survey conducted in 2000, more than half of Virginia high school seniors reported recent use of alcohol, more than one-third report smoking cigarettes, and nearly as many reported using marijuana. These facts have an impact on the economy, health, welfare and personal safety of all Virginians.

Providing treatment, however, is highly cost-effective. Studies done in other states demonstrate significant cost savings in health, welfare and criminal justice systems, ranging from $5 to $7 for every $1 spent on treatment. Similarly, the cost of not treating substance use disorders also costs the Commonwealth money. A national study that utilized state budget information determined that the cost of untreated substance abuse in Virginia exceeded $1.7 billion, or approximately $260 per person per year. In contrast, only $4.20 is spent on treatment, prevention and research. In 2004, Virginia spent slightly more than $150,000,000 to treat substance abuse, including federal resources.

Modern medical technology has facilitated considerable advances in knowledge about the nature of addiction, specifically, the mechanisms of addiction in the brain. The scientific evidence overwhelmingly supports the conclusion that addiction is a brain disease with considerable psychological, biological and social consequences. Like many other chronic and disabling diseases, substance use disorders have strong genetic components that put whole families at risk.

These advances have also provided scientific knowledge about what treatment works. Researchers consistently agree that the complex nature of substance use disorders requires that treatment be individually tailored to meet the specific and unique needs of each individual. Medical, psychological, social, vocational and legal issues must be assessed, and treatment must be designed to help the individual address these issues. For some, pharmacological interventions are critical, in addition to specific types of psychological counseling and social supports. Others may need an intensive psychological approach with concrete supports, such as childcare and assistance with housing or transportation. Most will need multiple episodes of treatment, and support services to sustain recovery. In addition, people in recovery need advocacy and support to help them overcome the shame and fear associated with these disorders.

In addition to national data, the findings of this report relied on survey data collected from key state agencies and focus groups conducted throughout the Commonwealth. The overarching issue raised is the lack of capacity for treatment, both in the public and private sectors. Unstable funding and lack of insurance coverage for treatment have exacerbated the capacity issue. Recent reductions in General Fund spending on substance abuse treatment have been estimated to exceed $28,000,000, resulting in a lack of access to treatment for the general public as well as special populations, such as offenders and youth.

One option that has been the subject of considerable study is the use of Medicaid to support treatment services. The advantage of using Medicaid is that the federal government will match dollar for dollar the nonfederal funds that are expended for approved health services, including substance abuse treatment. Although a relatively small proportion of those receiving treatment qualifies for Medicaid, use of these funds would permit existing resources to be used to expand the treatment system. A recent study estimated that the entire array of services could be available to every Medicaid eligible person who needed them for less than $6,000,000 per year in General Funds.

Another potential resource is improved use of private health insurance. Currently many private insurers place unrealistic restrictions on duration of treatment, or reimbursement rates are too low to cover actual costs. The impact is that these individuals turn to public sector services, resulting in an additional burden to the taxpayer and further crowding an already overloaded public system.

Substance abuse and dependence are obviously harmful to families. Parental substance abuse accounts for at least one-third of all children in Virginia's foster care system. In addition to the obvious personal damage to the child, the cost to Virginia taxpayers is significant.

In addition, these children are at serious risk of developing addiction themselves. Among Virginia's youth in general, a recent survey indicated that children begin using tobacco at age 12, followed soon after by marijuana. Yet, nearly 50,000 Virginians between the ages of 12 and 25 need treatment every year but don't receive it, due to lack of treatment capacity.

Just as in the treatment realm, knowledge about effective prevention services is increasingly sophisticated. Youth who do not use tobacco, alcohol or other drugs before the age of 21 are virtually inoculated against addiction as adults. Yet all current prevention programs are funded by either federal funds or local dollars; no General Funds are designated for prevention efforts.

In the criminal justice system, over half of adult felons screened warranted additional assessment and of those, over 85% needed treatment. The Department of Corrections reports that more than three-fourths of its inmates report the use of alcohol and other drugs, and the Department of Juvenile Justice reports that 64% of youth in its custody require treatment. Meanwhile, Virginia's prison population may reach nearly 45,000 by 2009, with the majority of inmates needing treatment. An obvious approach, substantiated by research, is to provide treatment to those under supervision, including community diversion programs (such as drug courts), service while in custody, and supervised aftercare programs. Yet the previously discussed budget constraints have seriously impacted the availability of services for this population.

In addition, there is a growing awareness among treatment professionals that many people who abuse or who are dependent upon alcohol and other drugs are also suffering from some form of mental illness. Similarly, between 40 to 60 % of those suffering from severe mental illness are abusing alcohol or other drugs, compromising their ability to live stable lives. In order for the person to recover from either disorder, he or she must be treated for both. Unfortunately, few mental health professionals are trained to recognize or treat substance use disorders, and few addiction treatment professionals are knowledgeable about mental illness. In addition, funding streams for mental illness and addiction are quite distinct from one another, even though both are brain diseases. The net result is that there are few programs providing integrated treatment for mental illness and substance use disorders. The impact is that people with co-occurring mental illness and substance use disorders have considerable difficulty accessing the specialized types of care needed to achieve sober, stable lives.

Underscoring all of these issues is the growing awareness that suffering from an addiction is terribly stigmatizing. Although many people successfully recover, fear of job loss, social humiliation and loss of friends keeps them from sharing their recovery stories to educate and inspire others, as they would if they were recovering from another disease, such as cancer or heart disease. And they are almost never celebrated in a manner similar to those who recover from other relapsing diseases.

These findings resulted in the development of six major recommendations, which are detailed in the Recommendations section of this report. These six recommendations are summarized as follows:

Recommendation 1:

Expand capacity for the treatment of substance use disorders for all citizens in need of those services throughout the Commonwealth.

Action steps for this recommendation focus on obtaining $5.8 million in General Funds beginning in 2006 to match Medicaid funding to support reimbursement of the full range of treatment services for the entire eligible population; addition of a representative from the Department of Medical Assistance Services to the Council; reinvestment of funds to support community-based substance abuse services; and a study of insurance coverage for substance abuse treatment, to be conducted by the Council.

Recommendation 2:

Expand the scope of substance use disorder prevention activities for youth and families of Virginia.

Action steps for this recommendation include raising user fees on tobacco products as a source of revenue for prevention programs; sponsorship of a summit on underage drinking; adding representatives from four (4) agencies and organizations (Department of Alcoholic Beverage Control, Department of Motor Vehicles, Governor's Office for Substance Abuse Prevention, and the Virginia Tobacco Settlement Foundation) to Council membership; and integration of the Governor's Office for Substance Abuse Prevention "Substance Abuse Prevention Plan for Virginia's Youth: Gaining Traction" into the Council's plan; integration of assigned tasks of the Governor's Task Force to Combat Driving Under the Influence of Drugs and Alcohol into the Council's plan.

Recommendation 3:

Expand the availability of substance use disorder treatment for youth and families throughout the Commonwealth.

Action steps for this recommendation include seeking funding for Family Drug Courts from the General Assembly; evaluating and identifying model programs; identifying funding to support treatment for youth; and collaboration with the Department of Social Services to identify screening tools and training for child welfare services staff.

Recommendation 4:

Expand treatment opportunities for adults in the criminal justice system, both within institutions and in community-based settings.

Action steps include seeking funding from the General Assembly to support services, community-based and institutional, for offenders with substance-use related problems, including drug courts; and the addition of a representative of the Virginia Drug Court Association to the membership of the Council.

Recommendation 5:

Advocate and market recovery from substance use disorders and reduce stigma throughout the Commonwealth.

Action steps include collaboration with the Substance Abuse and Addiction Recovery Alliance (SAARA) to educate the public about addiction, treatment efficacy, recovery, and recovery-related economic benefits for the community; development of a campaign to emphasize that "Recovery Works"; and involvement of public officials throughout the Commonwealth in training about addiction, treatment and recovery.

Recommendation 6:

Improve the quality and effectiveness of existing services.

Action steps address the development of standards; implementation of requirements set-forth in § 37.1-207.1, which requires the Council to assess the capacity of state agencies to evaluate publicly-funded treatment services; close collaboration with the Commission on Virginia Alcohol Safety Action Programs to standardize and improve the quality of local services; and expansion of professional staff training opportunities and treatment services for people with both mental illness and substance use disorders.