RD1 - Biennial Report on Substance Abuse Services (2004 and 2005)


Executive Summary:
Substance use disorders—the dependence on or abuse of alcohol and illicit drugs—affect virtually every citizen of the Commonwealth. As the state agency charged with the administration, planning and regulation of substance abuse services in Virginia, the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) works to provide cost effective, professionally appropriate services to citizens with the most serious substance abuse disorders.

Alcohol and drug use pose significant economic and social costs to the Commonwealth. The rate of use of alcohol and other drugs among Virginians exceeds the national rate in several categories, and the proportion of Virginia’s population dependent upon illicit drugs is also higher than that of the nation. One of the most significant trends in Virginia is the percentage of the population age 12 and older using pain relievers for nonmedical purposes. Although research indicates that youth who do not use tobacco, alcohol or other drugs before the age of 21 are virtually certain never to do so, no General Funds are designated for prevention efforts in Virginia. Federal funds or local dollars fund any prevention programs currently offered in the Commonwealth.

The Substance Abuse Prevention and Treatment Block Grant (SAPT BG) provides approximately half of the funding for community based treatment, and nearly all prevention in Virginia. As health care costs and competition for limited government resources increase, federal Block Grant funds are declining and State General Fund appropriations have remained relatively flat, when inflation is considered, resulting in fewer real dollars for statewide programs. The difference between Virginia’s 2005 SAPT BG allocation ($43,461,008) and its 2007 allocation ($42,930,418) represents a loss to the Commonwealth of more than half a million dollars ($530,590). This downward trend has significant implications for both the prevention and the treatment of substance use disorders in the Commonwealth.

DMHMRSAS and the forty community services boards (CSBs) plan and execute comprehensive prevention programs that strengthen communities and support healthy environments for all people. Strategies that strengthen the family have long been noted as being an effective method to reduce risk factors and enhance protective factors in communities. The Department intends to maintain its support for these initiatives and to increase the number of evidence-based prevention programs in Virginia.

The Department and the CSBs have long recognized the need to integrate and improve services to persons with co-occurring mental illness and substance use disorders (co-occurring disorders). Currently in Virginia, there are approximately 191,210 adults with co-occurring disorders (CODs). CODs are associated with increased costs of health services, mainly due to an increase in the use of acute psychiatric services, longer average lengths of stay, and higher readmission rates. A Diversion Project was implemented to redirect admissions from state mental health facilities for persons with primary substance use disorders to appropriate clinical care in the communities through the CSBs. Due to its success, the Diversion Project has now evolved into a census management project. DMHMRSAS is committed to providing safe detoxification that protects the client’s dignity; crisis stabilization, as needed; an alternative to temporary detention or hospitalization in a state psychiatric facility; and facilitating the client’s transition into the appropriate level of care for ongoing treatment of his or her dependence on alcohol or other drugs and of any serious mental health problem.

To assist the Commonwealth in addressing these issues, DMHMRSAS applied for and was awarded a five-year, $3.5 million grant from SAMHSA under its Co-Occurring State Infrastructure Grant (COSIG) program in October 2004. COSIG enhances Virginia’s public mental health system’s ability to screen, assess and treat co-occurring mental illness and substance abuse. COSIG goals include: improvement in screening, assessment and treatment of CODs; maximization of Medicaid resources for treatment of CODs; and improvement of Virginia’s ability to serve persons with CODs through Workforce Development. The project will also improve infrastructure and enhance supporting services using evidence-based practices. COSIG is one of Virginia’s most significant initiatives to improve services for persons with co-occurring mental illness and substance use disorders.

Overall, the Department’s vision includes a community-based system of services for persons with or at risk of CODs that promotes self-determination, empowerment, recovery, health, resilience and the highest possible level of participation in work, relationships and all aspects of community life.