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STATEMENT OF WAYNE THACKER
GOOD MORNING, MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE. THANK YOU FOR THE OPPORTUNITY TO APPEAR BEFORE YOU TODAY TO DISCUSS FISCAL YEAR 1992 APPROPRIATIONS FOR FEDERAL ALCOHOL AND OTHER DRUG ABUSE PROGRAMS.
MY NAME IS WAYNE THACKER. I AM DIRECTOR OF THE OFFICE OF SUBSTANCE ABUSE SERVICES WITHIN THE VIRGINIA DEPARTMENT OF MENTAL HEALTH, MENTAL RETARDATION AND SUBSTANCE ABUSE SERVICES AND AM APPEARING BEFORE YOU TODAY AS A MEMBER OF THE BOARD OF DIRECTORS OF THE NATIONAL ASSOCIATION OF STATE ALCOHOL AND DRUG ABUSE DIRECTORS (NASADAD). NASADAD IS A NOT-FOR-PROFIT ORGANIZATION WHOSE MEMBERSHIP IS COMPRISED EXCLUSIVELY OF THE STATE AND TERRITORIAL OFFICIALS DESIGNATED BY THE GOVERNORS TO ADMINISTER THE PUBLICLY FUNDED ALCOHOL AND OTHER DRUG ABUSE SERVICES SYSTEM.
CONTINUING NEED FOR ADDITIONAL FEDERAL RESOURCES FOR ALCOHOL AND OTHER DRUG ABUSE PREVENTION AND TREATMENT
THE STATE AND TERRITORIAL ALCOHOL AND DRUG ABUSE AGENCIES ARE GRATEFUL FOR THE SUPPORT OF CONGRESS OVER THE PAST FEW YEARS IN MAKING AVAILABLE INCREASED FEDERAL MONIES TO FIGHT THE "WAR ON DRUGS. WE APPRECIATE THE ADDITIONAL RESOURCES TO ASSIST STATES AND LOCAL COMMUNITIES IN EXPANDING TREATMENT SERVICES TO MORE ALCOHOL AND OTHER DRUG DEPENDENT PERSONS AND TO INITIATE MORE PROGRAMS TO PREVENT OUR YOUNG PEOPLE FROM BECOMING ALCOHOL OR DRUG DEPENDENT. OUR EFFORTS ARE HAVING A POSITIVE IMPACT ON THE LIVES OF MILLIONS OF AMERICANS.
HOWEVER, MUCH REMAINS TO BE DONE. OUR FEDERAL DRUG ABUSE POLICY WHICH DOESN'T ACKNOWLEDGE THE DEVASTATION CAUSED BY ALCOHOL-STILL PERSISTS IN ALLOCATING SEVENTY (70) PERCENT OF FEDERAL RESOURCES TO LAW ENFORCEMENT AND INTERDICTION ACTIVITIES AND ONLY THIRTY (30) PERCENT TO EDUCATION, PREVENTION AND TREATMENT.
ACROSS OUR NATION ALCOHOL AND OTHER DRUG ABUSE PROBLEMS CONTINUE TO GROW IN MAGNITUDE AND SEVERITY. STATES AND LOCAL COMMUNITIES IN ALL PARTS OF OUR COUNTRY - RURAL AND URBAN - HAVE A SIGNIFICANT AND GROWING NEED FOR ADDITIONAL FEDERAL RESOURCES FOR ALCOHOL AND OTHER DRUG ABUSE PREVENTION, INTERVENTION AND TREATMENT SERVICES. TREATMENT CAPACITY MUST BE EXPANDED; ADDITIONAL PREVENTION AND TREATMENT ACTIVITIES TO REDUCE THE AIDS/HIV CRISIS MUST BE UNDERTAKEN; AND NEW PREVENTION, INTERVENTION AND TREATMENT ACTIVITIES TARGETING SPECIAL POPULATIONS MUST BE INITIATED.
FY 1992 APPROPRIATIONS RECOMMENDATIONS
THE MEMBERS OF NASADAD SUPPORT FUNDING INCREASES FOR THE FEDERAL PREVENTION, TREATMENT AND RESEARCH EFFORTS OF THE ALCOHOL, DRUG ABUSE AND MENTAL HEALTH ADMINISTRATION. SINCE OUR TIME IS BRIEF, WE WOULD LIKE TO HIGHLIGHT THE NEEDS OF ONLY THREE ADAMHA PROGRAMS THE ADMS BLOCK GRANT AND TWO THAT THE ADMINISTRATION HAS TARGETED FOR ELIMINATION - THE COMMUNITY YOUTH ACTIVITY PROGRAM AND THE NIAAA HOMELESS DEMONSTRATION PROJECTS.
1. NASADAD REQUESTS THAT FY 1992 FUNDS FOR THE ALCOHOL. DRUG ABUSE AND MENTAL HEALTH SERVICES (ADMS) BLOCK GRANT BE INCREASED TO $2 BILLION.
SINCE 1981, THE ALCOHOL, DRUG ABUSE AND MENTAL HEALTH SERVICES (ADMS) BLOCK GRANT HAS BEEN THE PRIMARY FEDERAL FUNDING MECHANISM FOR ALCOHOL AND OTHER DRUG ABUSE PREVENTION AND TREATMENT SERVICES AND FOR COMMUNITY MENTAL HEALTH SERVICES. THE ADMS BLOCK GRANT REMAINS THE MOST VIABLE MANNER TO EQUITABLY DISTRIBUTE FEDERAL SERVICE DOLLARS TO ENSURE THE SYSTEMATIC, COORDINATED DELIVERY OF SERVICES TO ALL STATES, TERRITORIES AND LOCAL COMMUNITIES.
DUE TO THE ESCALATING UNMET TREATMENT NEEDS OF ALCOHOL AND OTHER DRUG ABUSERS IN ALL AREAS OF THE COUNTRY - URBAN AND RURAL, INCLUDING THE ALARMING INCREASE OF AIDS AMONG IV AND OTHER DRUG ABUSERS AND THE GROWING CRACK COCAINE EPIDEMIC, GREATLY INCREASED APPROPRIATIONS ARE NEEDED. THE MAGNITUDE OF INCREASE WE RECOMMEND WOULD BEGIN TO ADDRESS THE REAL NEEDS FOR TREATMENT AND PREVENTION AMONG OUR NATION'S CITIZENS.
AS YOU KNOW, THE AUTHORIZATION OF THE ADMS BLOCK GRANT AND OTHER PROGRAMS AND ACTIVITIES OF THE ALCOHOL, DRUG ABUSE AND MENTAL HEALTH ADMINISTRATION EXPIRES THIS YEAR. IT IS OUR HOPE THAT AS REAUTHORIZATION EFFORTS OCCUR THE ROLE OF THE ADMS BLOCK GRANT WILL BE REAFFIRMED AND STRENGTHENED AND THAT ISSUES, SUCH AS THE NEED TO DEVELOP A MORE EQUITABLE DISTRIBUTION FORMULA, WILL BE RESOLVED.
2. NASADAD REQUESTS THAT THE COMMUNITY YOUTH ACTIVITY PROGRAM BE CONTINUED AND EXPANDED FROM THE FY 1991 LEVEL OF $20 MILLION TO $30 MILLION FOR FY 1992.
THE COMMUNITY YOUTH ACTIVITY PROGRAM (CYAP) WAS CREATED BY CONGRESS IN 1988 AND CONSISTS OF THREE PARTS: A BLOCK GRANT PROGRAM THAT PROVIDES EACH STATE AND TERRITORY WITH FUNDS TO ENHANCE PREVENTION EFFORTS, PARTICULARLY AMONG YOUTH WHO ARE SCHOOL DROPOUTS OR INVOLVED WITH GANGS; A COMPETITIVE GRANT PROGRAM TO SUPPORT AND EVALUATE INNOVATIVE APPROACHES TO DEVELOPING COMMUNITY SERVICES AND PARTNERSHIPS; AND PREVENTION PROJECTS OF NATIONAL SIGNIFICANCE.
FOR FISCAL YEAR 1991 A TOTAL OF ALMOST $4.9 MILLION WAS PROVIDED THROUGH THE BLOCK GRANT PORTION WITH EACH STATE RECEIVING $92,000 AND AN ADDITIONAL $15 MILLION EARMARKED FOR COMPETITIVE AND NATIONAL PROJECTS.
PROGRAM SITE VISITS BY THE OFFICE FOR SUBSTANCE ABUSE PREVENTION (OSAP) STAFF HAVE FOUND AN INCREASE IN COMMUNITY INVOLVEMENT; INTENSIFIED TRACKING AND COUNSELING FOR CHILDREN AT RISK AND THEIR FAMILIES; AND MORE TRAINING OF TEENS TO PROVIDE LEADERSHIP TO THEIR PEERS IN LEADING A DRUG-FREE LIFESTYLE.
3. NASADAD REQUESTS THAT THE NIAAA HOMELESS DEMONSTRATION PROJECTS BE CONTINUED AND EXPANDED TO $20 MILLION FOR FY 1992.
IN FY 1991 THIS PROGRAM RECEIVED $16.4 MILLION IN FEDERAL FUNDS TO SUPPORT TWO RESEARCH DEMONSTRATION PROJECTS. THE MISSION OF THE
FIRST PROJECT IS TO PROVIDE AND EVALUATE A VARIETY OF APPROACHES TO COMMUNITY-BASED ALCOHOL AND OTHER DRUG TREATMENT AND REHABILITATION SERVICES FOR HOMELESS PERSONS. EIGHT CITIES RECEIVED GRANT AWARDS: ANCHORAGE, BOSTON, LOS ANGELES, LOUISVILLE, MINNEAPOLIS, NEW YORK, OAKLAND AND PHILADELPHIA (2 PROJECTS).
THE SECOND RESEARCH DEMONSTRATION PROGRAM WILL ASSESS THE EFFICACY OF A VARIETY OF CLIENT CENTERED INTERVENTIONS. IN SEPTEMBER 1990 COOPERATIVE AGREEMENTS WERE AWARDED TO THE FOLLOWING CITIES: LOS ANGELES, SEATTLE, ALBUQUERQUE, CHICAGO, BIRMINGHAM, WASHINGTON, D.C., NEW HAVEN, DENVER, PHILADELPHIA, NEWARK, ST. LOUIS, NEW ORLEANS AND TUCSON.
THESE PROGRAMS are THE ONLY FEDERAL DEMONSTRATION EFFORTS THAT FOCUS EXCLUSIVELY ON HOMELESS INDIVIDUALS WITH ALCOHOL AND OTHER DRUG ABUSE PROBLEMS.
AGAIN, MR. CHAIRMAN, THANK YOU FOR THE OPPORTUNITY TO HIGHLIGHT A FEW OF THE MANY ALCOHOL AND OTHER DRUG ABUSE PREVENTION AND TREATMENT NEEDS.
Senator ADAMS. Mr. Thacker, as we all know, we have limited resources. I state that neither as an excuse or as something that I am happy about or anything else. I state it just as an existing state of life.
Where should we concentrate our limited resources? Which program or programs do you think best serve the different needs of the States, or have I used the wrong word in saying there are different needs of the States?
Mr. THACKER. I think that there are different needs of the States. The block grant program allows the States to reflect their uniqueness in terms of need and in terms of the base support for a variety of community-based programming.
I share with you the difficulty in prioritization. It is research that leads us into a knowledge to apply into the programs through technical assistance and training, and then it is the services funds. that allow us to implement the programs. I would urge a balance in terms of basic applied research and technical assistance training and the services.
I think key for us right now is providing the prevention and treatment services in the local communities.
Senator ADAMS. I ask you that question because on my most recent visit and I visit quite often the Alcohol and Drug Treatment Abuse Centers in Seattle, elsewhere in the State but particularly in Seattle-they have a very good program there, and they were and are faced with the new impact of crack which they were getting out of both Tacoma and Seattle, and they said that it was entirely different. They did not quite know what to do with it.
They could not handle the time periods, in that there was a quick turnover time period on crack. They would go right back out. and be right back, whereas with cocaine and other forms there was a treatment period that they had developed that gave a time period, and they felt a little more success there.
Would you like to comment? I think it goes to the research problem of I do not know whether we have caught up yet with what
to do with this rapid escalation of activity in the crack victim and then the rapid deescalation, and certainly if you release them then in what looks like a normal state, you have them back very rapidly.
Mr. THACKER. I think that we are just beginning to learn all the complexities of the chronic or lapsing disorder of addiction and that crack, I think, has exemplified some of the variation that we see in addiction. It is an extremely
Senator ADAMS. You are absolutely right. I am sorry that I limited it to crack because we are suffering from a series of other chemical substance abuses that have the same kind of effect.
But please go on.
Mr. THACKER. I believe that the crack-cocaine situation has emphasized that variability by virtue of its being such a quickly addictive substance. It also emphasizes the importance of that ongoing treatment contact after the initial treatment experience. Relapse prevention and a number of other areas that combine again, applied research and funding of basic services I think are brought into focus here.
With respect to the addictive process, again, I think crack has stimulated some basic research in terms of the brain functioning and brain chemistry, and again, addiction is such a complex problem for the United States or the Nation and the world in general there is just not one answer. Treatment is not the answer, prevention is not the answer, and research in support of that is not the answer; but collectively-and then I would have to be fair and add law enforcement to that as a component of the answer.
Senator ADAMS. My problem is I am chairman of another subcommittee which happens to be the District of Columbia. Our basic problem right here now is just simply to get the streets back so that we can apply certain things to them. That is a law enforcement problem which we have not figured out how to meet yet.
I am very concerned because I have heard an enormous amount of testimony, not only in this committee but in many of the other committees I chair, about the dopamine ejectors and receptors and the effects that this was having. That was why I asked you the question, because you are in the treatment program. I see the treatment program. I do not want to say I am discouraged, but I am not rapidly encouraged by the fact that once we stabilize these streets—and I just pray that we are going to stabilize them—that we are going to be able to keep the population off of them long enough that they will not immediately return to their original state.
Mr. THACKER. I think we share with you that frustration of dealing with a chronic or lapsing disorder, and we are a young field that is learning quite a bit about the process of addiction and its treatment.
Senator ADAMS. We wish you godspeed.
Mr. THACKER. Thank you.
Senator ADAMS. We thank you very much for your testimony. I do not mean to cut you off. I just have a number of other people, and this is a field that we are operating on in a number of committees and in a number of institutes. I just want you to understand that the shortness of your testimony is not an indication of the shortness of attention span of the Congress or the administration
to this. We are really feeling not helpless, but we just need an awful lot of help in this.
STATEMENT OF BARBARA DUCKETT, PRESIDENT, BEECH HILL HOSPITAL, DUBLIN, NH, ON BEHALF OF NATIONAL ASSOCIATION OF ADDICTION TREATMENT PROVIDERS
Senator ADAMS. Our next witness is Barbara Duckett, president, the Beech Hill Hospital, Dublin, NH, National Association of Addiction Treatment Providers. Ms. Duckett, welcome to the committee. Ms. DUCKETT. Good morning, Senator Adams. Good morning, staff. My name is Barbara Duckett. I am president of Beech Hill Hospital, which is a freestanding center for the treatment of alcohol and drug abuse.
Senator ADAMS. What was the name of the hospital?
Ms. DUCKETT. Beech Hill Hospital.
Senator ADAMS. Thank you.
Ms. DUCKETT. I appear before you this morning as a member of the board of directors of the National Association of Addiction Treatment Providers, which represents more than 600 treatment centers throughout the country.
Like other members of the NAATP, Beech Hill is a private treatment center and, as such, does not receive money from the National Institute of Alcohol Abuse and Alcoholism nor the National Institute of Drug Abuse.
I am here today because we believe that the Federal Government has a great opportunity to lead by example in its effort to reduce alcoholism and drug addiction in society, and thus far that example has been one which emphasized the criminal justice side of the drug problem. We support a policy which regards addiction as a treatable disease. We feel that there are three results of the current approach which are hampering our ability to effectively reduce addiction in our country.
First is the Federal funding emphasis on law enforcement, which has contributed to the overloading of our public funded treatment programs. We believe there is a need for a balanced approach between education and enforcement in order to be truly effective and in that regard call for a higher level of funding for the public alcoholism and drug dependency programs.
By shifting the Federal focus off of treatment, we feel that employers looking for ways to cut their health benefit expenses have been able to follow suit, and this has resulted in a definite cutback in alcohol and drug treatment benefits. This has exacerbated the problem for the public funded programs because we now have a lot of private individuals, individuals who are working, employed with insurance who cannot get into private treatment programs and are overloading the public programs.
Every day in my facility I am every hour talking with individual patients who are trying to get into treatment who are working, have insurance and cannot get in because of the managed care element that is blocking treatment from their insurance company.
I am also dealing on a daily basis with patients who get into treatment and on the second or third day of treatment find that their insurance benefits have been cut and they have to either take the risk of paying that bill themselves or leave treatment.