RD423 - 2009 Biennial Report on Substance Abuse Services


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 Behavioral Health and Developmental Services 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. Information from the National Household Survey on Drug Use and Health (NSDUH) provides estimates for the nation, the state in its entirety and by region.

Although the state as a whole generally experiences lower rates of use, abuse of and dependence on alcohol and illicit drugs, there are several instances in which specific areas of the state exceed the national rate. Region 3 has higher rates of illicit drug dependence and nonmedical use of pain relievers than the national rates and, according to the Virginia Department of Health Office of the Chief Medical Examiner, a significant rate of Drug Caused Deaths. Problems with alcohol use and dependence are also higher in that region (and also in Region 1).

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. In recent years, both federal Block Grant and State General Fund appropriations have remained relatively flat. In 2001, the expended SAPT BG award was $39,245, 298 and General Funds expended were $38,503,482. In 2009, the SAPT BG expended was $42,910,273 and $47,629,972 in General Funds were expended. When inflation is considered, this has resulted in an overall reduction in capacity. This downward trend has significant implications for both the prevention and the treatment of substance use disorders in the Commonwealth. In 2005, 53,845 consumers were served, but this number declined to 48,156 in 2009. Meanwhile, significant numbers of Virginians are unable to receive timely treatment. DBHDS’ Comprehensive Plan for 2010-2016 indicates that 1,272 individuals waited for between 1 to 3 months to receive treatment for substance use disorders. NSDUH data on unmet need for treatment indicate that residents of Virginia, as a whole, have better access to treatment than the nation at large; however, residents of Region 3 have less access.

DBHDS is involved in several special projects designed to improve access to quality prevention and treatment services. Prevention efforts focus on improving access to evidence-based programs (EBPs) that are designed to strengthen families, and are often provided in elementary, middle and high schools. Strong prevention emphasis is placed on supporting community-prevention leadership by providing training and mentorship.

Many people who have mental health challenge also experience issues with substance use which threatens their stability, and many people with substance use disorders also experience mental health problems – referred to as ‘co-occurring’ issues. In spite of this overlap of challenges, the system of care is segregated, imposing a barrier to effective treatment. To help the service system improve its treatment, DBHDS sought and received a five-year federal grant for $3.5 million to improve the service system infrastructure. The result is the Virginia Service Integration Project (VASIP), which has worked extensively with CSBs to address systems issues that hamper access to services for persons with co-occurring mental health and substance use issues. The grant period is coming to a close, and DBHDS is working to ensure that VASIP will continue.

The General Assembly focused several activities on substance use disorders. A study by the Joint Legislative Audit and Review Commission resulted in a report, Mitigating the Cost of Substance Abuse in Virginia, which determined that untreated substance abuse conservatively costs the commonwealth $613 million in 2006. The study found that “populations that completed substance abuse programs… imposed lower net costs… and experienced better recidivism and employment outcomes than similar groups who either did not enter or complete treatment. (*1) The report also documented the lack of access to treatment and commented on the need for ongoing evaluation. The report made recommendations specific to state agencies and one of those recommended that DBHDS:

• strengthen its capacity to evaluate programs and provide evidence-based services;
• assure that CSB fee structures do not impede access to services; and
• provide training to the judiciary about the benefits of treatment.

On the heels of this report, the General Assembly enacted legislation to support a legislative study (SJR 77 – 2008; SJR 318 – 2009, Hanger) to identify policy and resource remedies. The subcommittee includes representatives from several state agencies involved in or affected by substance use, as well as private providers, consumer advocates and legislators. The subcommittee has not yet completed its work at this time, but recommendations will likely address prevention, treatment and recovery, and abuse of prescription medications.

Meanwhile, DBHDS continues to work closely with CSBs to address issues related to abuse of prescription medication, especially in the far southwestern region of the state. The 2006 Session of the General Assembly allocated $534,000 to improve access to medication assisted treatment, half of which went to this area. Also in 2006, DBHDS was awarded a three-year grant for $.5 million to design and implement a program for persons addicted to opiate-based prescription pain medication. Project REMOTE provided treatment to 229 individuals and trained over 600 community members (including physicians and other health care providers) about pain management, addiction and treatment. Persons who completed Project REMOTE were four times more likely to be abstinent from substances six months after treatment initiation or at discharge than before participating in the program. In addition, 65 percent had increases in employment. This grant ended November 30, 2009. To continue the work, DBHDS received $306,414 from the Office of the Attorney General (OAG) as a part of a civil settlement with the manufacturer of OxyContin, one of the frequently abused pain medications. In addition, the Substance Abuse and Mental Health Services Administration awarded DBHDS $285,000 to provide treatment to 82 miners who have lost their certification to mine due to prescription drug abuse. This program will be implemented in the far southwestern region of the state in collaboration with three CSBs providing services to these communities and the Department of Mines, Minerals and Energy (DMME).

As an ongoing efforts to assure the people with substance use disorders receive treatment in the least restrictive and most clinically appropriate environment, DBHDS has, for several years, implemented a process to divert admissions from state mental health facilities for people with primary substance use disorders. The diversion project also works to assure that persons with co-occurring mental illness and substance use disorders who are appropriately admitted get a timely discharge to an appropriate community treatment setting. Currently six state psychiatric facilities are actively participating in this project, supported with a combination of State General Funds and SAPT Block Grant funds. This project is a component of the DBHDS System Transformation and Restructuring Initiative.
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(*1) Joint Legislative Audit and Review Commission, Mitigating the Cost of Substance Abuse in Virginia, 2008, p. i.