We propose to establish this program in the Office for Substance Abuse Prevention because residential treatment has the potential to prevent alcohol and drug-related birth defects and improve the ability of families to stay together and function successfully. OSAP has already developed a growing expertise regarding the special needs of pregnant women through its implementation of the model projects for pregnant and postpartum women and their infants. That program mainly provides funding for outpatient treatment services, but OSAP has tried to take a comprehensive approach to the issue that would apply very well to a residential treatment grant program.

ACTION IS NEEDED

Mr. Chairman, the programs already in place to help addicted women are important, but they are not sufficient. In addition to what is already being done, we need a new focus on residential treatment for pregnant women.

Our legislation can dramatically reduce the financial and human costs associated with maternal addiction. Every day that we delay in addressing this issue, more drug and alcohol-affected infants are born, many permanently damaged by fetal exposure to these substances. The cost of our legislation is far less than the cost of health care, foster care, special education, juvenile justice, and other social services associated with perinatal drug exposure. We cannot afford not to act to provide these vital services, and to provide them in the residential setting that is essential to success.

I urge you and all of the members of this committee to give careful attention to our proposal, and I hope that, as you develop legislation in the coming months, you will add a residential treatment grant program for pregnant women to the mix of substance abuse programs funded by the federal government.

Again, thank you for giving me this opportunity to testify.

STATEMENT OF THE HONORABLE MARY ROSE OAKAR
MEMBER OF CONGRESS FROM OHIO

BEFORE THE ENERGY AND COMMERCE COMMITTEE
SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT
JUNE 20, 1991

I WOULD LIKE TO THANK THE CHAIRMAN AND THE MEMBERS OF THE COMMITTEE

THE OPPORTUNITY TO OFFER THIS STATEMENT BEFORE THIS VERY IMPORTANT A FEW WEEKS AGO, THE SURGEON GENERAL, DR. NOVELLO, ISSUED THE RESULTS OF AN ALARMING REPORT ON THE DRINKING HABITS OF

SUBCOMMITTEE.

AMERICAN HIGH SCHOOL STUDENTS. A NATIONAL SURVEY CONDUCTED BY HHS

DETERMINED THAT MORE THAN HALF OF OUR JUNIOR AND SENIOR HIGH SCHOOL

STUDENTS DRINK ALCOHOL, AND ALMOST HALF A MILLION OF THESE STUDENTS GO ON ALCOHOLIC DRINKING SPREES AT LEAST ONCE EACH WEEK. THE SAME

SURVEY REPORTED THAT 10.6 MILLION OF THIS NATION'S 20.7 MILLION

STUDENTS IN GRADES 7 THROUGH 12 DRINK ALCOHOL. EIGHT MILLION OF

THESE STUDENTS DRINK WEEKLY, AND 454,000 DRINK AT A MINIMUM OF ONE TIME PER WEEK ILLEGALLY OF COURSE, SINCE THE DRINKING AGE IN ALL

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FIFTY STATES IS NOW ESTABLISHED AT TWENTY-ONE YEARS OF AGE. MORE

THAN 3 MILLION STUDENTS DRINK ALONE TO RELIEVE STRESS OF PAIN, AND 7 MILLION UNDERAGE ADOLESCENTS ARE ABLE TO WALK INTO ANY STORE AND

PURCHASE ALCOHOL.

I THINK THESE FIGURES REPRESENT AN ALARMING PATTERN OF ALCOHOL

ABUSE AND POTENTIAL ADDICTION THAT IS OCCURRING IN THE NATION AMONG OUR YOUTH. IT ALSO VIVIDLY ILLUSTRATES THE DANGER INHERENT IN EXCLUDING ALCOHOL FROM OUR WAR ON DRUGS, SUPPOSEDLY A WAR THAT COMBATS ILLEGAL DRUG USE. BUT IN THE HANDS OF TEENAGERS, ALCOHOL IS THE SINGULAR MOST ABUSED AND EASILY ACCESSED DRUG OF ALL. WE

ARE NOT WINNING THIS WAR BY LOSING OUR TEENAGERS, OR BY IGNORING THIS COUNTRY'S MOST DANGEROUS DRUG OF ALL:

ALCOHOL.

WE CONTINUE TO GO BACKWARDS IN OUR EFFORTS TO REDUCE ALCOHOL AND

DRUG PROBLEMS.

ALCOHOLISM IS A DEADLY, INSIDIOUS DISEASE CHARACTERIZED BY DENIAL OF ITS SYMPTOMS AND ITS VERY EXISTENCE.

DRUG ADDICTION IS THE SAME.

THESE ARE SPECIFIC ILLNESSES HAVING

SPECIFIC SYMPTOMS AND ETIOLOGIES, AND THEY HAVE BEEN TREATABLE PRIMARY DISEASES FOR MANY YEARS.

IT IS OFTEN MISTAKENLY BELIEVED THAT ALCOHOLISM AND DRUG DEPENDENCY

PROBLEMS.

OF UNDERLYING PSYCHOLOGICAL OR PSYCHIATRIC

AND YET RESEARCH HAS REPEATEDLY PROVEN THAT ALCOHOLISM

AND DRUG DEPENDENCY ARE DISTINCT DISORDERS WITH BIOLOGICAL, PSYCHOLOGICAL, AND SOCIOLOGICAL COMPONENTS. IN ADDITION, THE MAJORITY OF PSYCHOLOGICAL SYMPTOMS WHICH ALCOHOLIC AND DRUG

DEPENDENT PERSONS MAY DISPLAY AT THE ONSET OF TREATMENT ARE ALMOST

IMMEDIATELY AMELIORATED WITH THE ONSET OF ABSTINENCE FROM ADDICTIVE

CHEMICALS.

CONGRESS HAS THE

RESPONSIBILITY

то CAST THE PUBLIC TONE FOR

NATIONAL ALCOHOL AND DRUG POLICY. IF CONGRESS DOES NOT AFFORD

PUBLIC VISIBILITY TO ALCOHOL AND DRUGS AS DISTINCT HEALTH PROBLEMS HAVING TRIED AND PROVEN PHILOSOPHICAL AND TREATMENT METHODOLOGIES

THAT DIFFER FROM THOSE UTILIZED IN THE TREATMENT OF MENTAL HEALTH

PROBLEMS, THEN WE ARE IGNORING THE NUMBER ONE HEALTH PROBLEM IN OUR NATION, AND BURYING IT, ALONG WITH OUR CHILDREN.

BOB SMITH AND MR. BILL WILSON COFOUNDED AA IN AKRON IN 1935. TREATMENT OF ALCOHOL AND DRUG ADDICTION WAS PIONEERED IN AKRON BY

SISTER IGNATIA AND DR. SMITH IN 1939.

THEIR WORK OVER FIFTY YEARS AGO DETERMINED THAT MOST EFFECTIVE WAY TO TREAT ADDICTION. ALCOHOL

AND DRUG ADDICTION HAVE BEEN VIEWED FROM THAT TIME FORWARD AS PRIMARY ILLNESSES, SOMETIMES HAVING A SECONDARY DIAGNOSIS OF MENTAL HEALTH PROBLEMS. TODAY, FOR INSURANCE PURPOSES, IT IS SOMETIMES POPULAR TO REVERSE THIS STRATEGY, AND TREAT ALCOHOLISM AS A MENTAL ILLNESS. THE PROFESSIONALS WHO WORK IN THE ADDICTION FIELD ARE

UNDERSTANDABLY ALARMED BY THIS TREND BECAUSE IT BURIES THE

DIAGNOSIS OF A DISEASE THAT IS ALREADY CHARACTERIZED BY DENIAL.

THEREFORE, MR. CHAIRMAN, BEFORE ANY MAJOR OVERHAUL OF ADAMHA, AND BEFORE ANY ELIMINATION OF DISTINCT ENTITIES AND THE LANGUAGE WHICH

DIFFERENTIATES THEM, ONE FROM THE OTHER, I URGE YOU TO LISTEN TO THE CONCERNS OF THOSE PROFESSIONALS ENGAGED IN THE TREATMENT AND PREVENTION OF ALCOHOL AND DRUG DEPENDENCY. WE MUST CONSIDER THE

REAUTHORIZATION PROCESS FOR ADAMHA SLOWLY AND WITH THE PROFESSIONAL ADVICE OF THOSE ENGAGED IN THE DIRECT SERVE DELIVERY TO THIS SPECIALIZED POPULATION, AS CHANGES MADE TODAY WILL IMPACT MILLIONS OF LIVES FOR MANY YEARS TO COME. ALCOHOL, DRUGS, AND MENTAL HEALTH

RESOURCES MUST WORK TOGETHER TO RESOLVE THE ADDICTION EPIDEMIC IN

THIS COUNTRY. THIS IS CRUCIAL, FOR IN SOME CASES OF ADDICTION,

DUAL DIAGNOSTIC PROBLEMS OF ADDICTION AND MENTAL ILLNESS DO EXIST. HOWEVER, MOST OFTEN, THIS IS NOT THE CASE. WE NEED TO RESPECT THE

CONTRIBUTIONS OF ALL PROFESSIONS WHEN ATTEMPTING TO RESOLVE ALCOHOL AND DRUG DEPENDENCY AND WE NEED TO MAINTAIN A SEPARATE FOCUS IN TREATING THE VICTIMS OF ADDICTION VERSES THE VICTIMS OF MENTAL ILLNESS, WHILE STILL MAINTAINING THE ABILITY TO WORK TOGETHER. THERE IS GREAT WISDOM IN KNOWING THE DIFFERENCE BETWEEN THESE

ILLNESSES.

STATEMENT OF LEGAL ACTION CENTER

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Thank you for the opportunity to submit testimony for authorization of programs within the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA). The following testimony is submitted by the Legal Action Center, a not-for-profit law and public policy office that specializes in alcohol, drugs and AIDS related issues, and fourteen state treatment and prevention associations from across the country. These associations represent the individuals on the front lines of treatment and prevention activities who confront on a daily basis the dramatic need to expand drug and alcohol prevention and treatment services.

Mr. Waxman, we thank you and the Subcommittee for your ongoing leadership and dedication to improving alcohol and drug prevention and treatment efforts for families and communities in our nation. We wish to express Our concern, however, that there was no opportunity for public witnesses to testify on the reauthorization of these critical programs and urge you to open the process in future Subcommittee hearings. In our view, public witnesses

provide the field's perspective on the appropriate direction of public policy and innovative

treatment and research efforts.

ideas for improving prevention,

We strongly recommend an increase in the authorization levels for the drug and alcohol prevention, treatment and research efforts that provide the foundation for community based services. We urge the Subcommittee to increase the block grant authorization level to $2 billion for FY 1992

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or at least increase the block grant by