RD110 - Substance Abuse Services Council Annual Report and Plan - January 1, 2009

Executive Summary:
This report was replaced in its entirety on March 23, 2009 by the Substance Abuse Services Council.

JLARC Report and SJR 77 Can Attention to the Impact of Substance Use Disorders

After two years of study, the Joint Legislative Audit and Review Commission issued its findings in a report, Mitigating the Cost of Substance Abuse in Virginia (House Document No. 19 - 2008). Concluding that substance use disorders cost the Commonwealth $613 million in 2006, the study also found that only $102 million were spent on the prevention and treatment of substance use disorders. The study found that people who completed treatment had less involvement with the criminal justice system and higher rates of employment than those who did not. The study identified substantial systemic barriers to obtaining treatment. These obstacles include not recognizing the need for help, cost or logistical barriers, inability to access the appropriate level of care due to lack of capacity, or receiving services that are less effective because they do not follow proven practices. In addition, the report indicates that prevention services need improved evaluation, coordination and direction, and better monitoring to assure that proven practices are appropriately implemented. The report concludes that the State should improve program evaluation, assure that proven practices are implemented properly and focus attention on the transition of inmates back to the community, financing these initiatives with additional revenues from the Department of Alcoholic Beverage Control.

As a means of applying the report's findings to policy, legislation and budget, the 2008 Session of the General Assembly established the Joint Subcommittee to Study Strategies and Models for Substance Abuse Prevention and Treatment. The subcommittee met four times and worked closely with the Substance Abuse Services Council. In spite of intensive effort, the Subcommittee has only begun to address its mandate.


The General Assembly should enact legislation continuing the Joint Subcommittee to Study Strategies and Models for Substance Abuse Prevention and Treatment for at least an additional year.

Drug Caused Deaths Related to Abuse of Prescription Drugs

In four years, according to the Office of the Chief Medical Examiner, the Commonwealth has experienced a 27 percent increase in the number of drug-caused deaths, from 564 in 2003 to 717 in 2007. Many of these deaths were related to the misuse of opiate-based prescription pain medicine. Although the highest number of deaths occurred in the western region of the state, the number of deaths increased in other regions. Figure 1 displays this information. (see full Report for Figure 1)

The increase of abuse of prescription drugs is also occurring at the national level. Alarmingly, prescription drugs are replacing marijuana as the initiation to drug abuse for youth. Several initiatives have been implemented to address this issue. The Department of Health Professions has established the Prescription Monitoring Program to assist pharmacists and physicians with identifying patients who may be misusing prescription drugs, and has also partnered with the Virginia Commonwealth University School of Medicine to provide training in pain management to healthcare providers.

To address the need for treatment for substance use disorders related to prescription drug abuse, the Department of Mental Health, Mental Retardation and Substance Abuse Services allocated $350,000 from the federal Substance Abuse Prevention and Treatment Block Grant in 2002 to four community services boards serving the far southwestern portion of the state, where the death rates are the highest. These funds continue to be dedicated for this purpose. In 2006, the General Assembly appropriated $534,000 in ongoing general funds to support medication assisted treatment for opiate dependence, and half of these funds were allocated to these four community services boards. In October 2006, the federal Substance Abuse and Mental Health Services Administration awarded a three-year grant in the amount of $500,000 per year to the Department of Mental Health, Mental Retardation and Substance Abuse Services, in conjunction with three community services boards, to address the problem of prescription drug abuse in southwest Virginia. Working closely with the Prescription Monitoring Program, this federally funded effort has promoted physician education about addiction and pain management, and will have provided intensive treatment services to more than 200 individuals by the time the grant ends in 2009.

Meanwhile, at the state level, the Department of Mental Health, Mental Retardation and Substance Abuse Services/Office of Substance Abuse Services, the Office of the Chief Medical Examiner in the Department of Health, and the Prescription Monitoring Program are collaborating to share data to closely monitor trends, as drug caused deaths appear to be spreading across the Commonwealth.


The Department of Mental Health, Mental Retardation and Substance Abuse Services/Office of Substance Abuse Services, the Department of Health/Office of the Chief Medical Examiner and the Department of Health Professions/Prescription Monitoring Program should continue to work collaboratively to monitor trends in prescription drug abuse, and should present their findings to the Council.

Uniform Youth Survey Needed to Assist Planning and Evaluation of Prevention Efforts

In order for substance abuse prevention and early intervention to be effective, data are needed to guide decision-making for communities, local agencies and state agencies to assist in identifying need, targeting resources, designing programs and evaluating the impact. This survey would collect information about factors and characteristics that indicate that youth are engaged in high-risk behaviors, including substance use. Ideally, a survey using nationally standardized questions would collect data from every student in every school, so that information could be compared across school districts and with national data. This data would not include any personally identifying information, so subject confidentiality would be protected. Virginia, however, does not utilize a uniform survey instrument across the state, so data collected from various survey instruments cannot produce reliable information about specific regional needs, nor can it be used to measure or compare the impact of prevention programming across the state.

Conducting a survey of all school districts using a uniform instrument would produce an economy of scale that would reduce the cost of compiling and disseminating the results, and would produce information useful for schools and communities to use in local planning. Several state entities have indicated support for implementation of a standard youth survey, including the Governor's Health Reform Commission, the Governor's Commission on Sexual Violence, and the Joint Legislative Audit and Review Commission. Currently, the Department of Health, in conjunction with the Department of Education, is implementing a five year grant in the amount of $42,000 from the federal Centers for Disease Control and Prevention (2009-2013) to collect data from youth about risk behaviors and attitudes using a standardized survey instrument. The initial survey, to be conducted in the spring of2009, will collect information from a random sample of students in grades 9-12 in 26 school districts. In 2011, this effort will be expanded to collect data that will be valid for each city and county in Virginia.


The General Assembly should require all public school divisions to participate in youth surveys designed to assess youth-risks and attitudes towards risk behavior sponsored by the Department of Education or the Department of Health, using such funds as are available for this purpose.

Substance Abuse and Older Adults

As the population in general gets older, and the demographic bubble referred to as the Boomer generation moves into older age, the need for substance abuse prevention and treatment services designed to address the issues of older adults increases. Of the 35 million people in this group, about 5 million will need assistance in addressing a substance use disorder, and half of these will have a problem specific to alcohol use. In addition to alcohol, the Boomer generation in its youth incorporated other drugs into recreational use, and has sustained attitudes that are highly tolerant of drug use. Problems associated with these attitudes and past use may emerge or continue as this group ages.

For a variety of reasons, substance abuse and dependence are harder to detect among older people, and are often more tolerated than for a younger generation, especially if the person is no longer employed. Psychosocial stressors triggered by bereavement, retirement, loneliness, marital problems, or economic hardship may increase susceptibility to dependence on alcohol or other drugs, and may affect other health issues as well.

In Virginia, while community services boards can expect to see increased demand for services from this age group, relatively little is known about best practices for treating these older citizens. Currently, in response to an initiative of Governor Kaine, twenty agencies and organizations have collaborated to form the Alcohol and Aging Awareness Group (AAAG). The goals of AAAG include dissemination of information and training by using the Internet, conducting media campaigns, collecting data, developing a resource guide, and training service providers. The AAAG sponsored a conference this year and has scheduled a follow-up conference for 2009.


The Department of Mental Health, Mental Retardation and Substance Abuse Services should identify evidence-based treatment and prevention practices and programs especially effective with older adults and disseminate information about them to community services boards and other service providers.

Drug Treatment Courts

Drug treatment courts administer specialized dockets within Virginia's existing court system, and provide comprehensive substance abuse treatment, as well as intensive supervision and frequent judicial monitoring. Drug treatment courts require collaboration and coordination among the judiciary, Commonwealth's Attorneys, defense attorneys, drug court case managers, drug court administrators, addiction treatment professionals, probation officers, and law enforcement. Only nonviolent offenders are eligible to participate. Although participants receive treatment and intensive court supervision instead of incarceration, they are still subject to legal consequences as determined by the court. In Virginia, 27 drug treatment courts are currently in operation. Four models of drug treatment courts have been implemented in Virginia: adult, juvenile, family and driving under the influence.

Drug treatment courts arose in response to the escalating number of persons arrested and incarcerated for drug offenses, which has increased 41 percent from 2000 to 2006. During the same period, the number of new court commitments to the Department of Corrections ranged between 23 percent and 26 percent. The Drug Treatment Court Act (§ 18.2-254.1 Code of Virginia) directs the Supreme Court to provide administrative oversight for Drug Treatment Courts, including distribution of funds, technical assistance, program evaluation, and reporting to the General Assembly. The statute requires the establishment of an advisory body to establish standards and develop and implement planning, evaluate efficiency and effectiveness, and encourage interagency collaboration. In addition, the Code requires legislative action for localities to establish drug treatment courts, regardless of the source of funding. Local courts are also required to establish advisory committees.

The Code outlines five goals for drug treatment courts:
1. Reducing drug addiction and drug dependency among offenders;
2. Reducing recidivism;
3. Reducing drug-related court workloads;
4. Increasing personal, familial, and societal accountability; and
5. Promoting effective planning and use of resources among criminal justice system and community agencies.

Drug treatment courts are supported with a variety of funds. Fourteen courts receive state funds: three are funded entirely by state funds and eleven are supported by additional resources. Thirteen courts are supported with nonstate funding. Because funding for drug treatment courts is not secure, their operational stability and effectiveness are undermined.

National data indicate that successful participation in a drug court reduces recidivism and drug related crime (as much as 30 percent) and that the savings associated with these benefits more than compensate for the additional expense involved in operating a drug treatment court. A study recently published by the Joint Legislative Audit and Review Commission (Mitigating the Cost of Substance Abuse in Virginia, House Document No. 19 - 2008) included a review of two drug treatment courts in Virginia, and concluded that persons who completed drug treatment courts imposed lower daily costs after completing treatment than offenders who did not complete treatment in a drug treatment court.


The Governor and the General Assembly should support the continuation and expansion of Virginia drug treatment court programs that meet the guidelines and approval of the Supreme Court of Virginia and the State Drug Treatment Court Advisory Committee.

Medicaid Funded Substance Abuse Services

The 2007 Session of the General Assembly appropriated $10.5 million (general fund and non-general fund), available July 1, 2007, for Medicaid reimbursement of substance abuse treatment services for children and adults. Community services boards have encountered several barriers to implementation and are collaborating with the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Medical Assistance Services to address them. These efforts include conducting training seminars to acquaint providers with the regulations pertaining to the newly covered services, eligibility and billing. The Department of Medical Assistance Services has also responded to concern about the reimbursement rates by adjusting its calculations and continuing to explore the feasibility of additional increases. The Department of Mental Health, Mental Retardation and Substance Abuse Services has been working with the community services boards to address operational concerns regarding implementation. Finally, both agencies are working to increase effective communication with providers.


The Department of Medical Assistance Services, the Department of Mental Health, Mental Retardation and Substance Abuse Services, and the Virginia Association of Community Services Boards should continue to collaborate to maximize the utilization of Medicaid reimbursement for the provision of substance abuse services.