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Mr. EATON. So it has been a long time, but I still have friends and watch and care a lot about things back there.
We are very grateful for the leadership that you provide as a reult of your representing them in the United States Senate. Your ontributions to the areas of jurisdiction in this subcommittee have een really outstanding.
I would like to focus on a few issues related to the ADAMHA udget, most particularly alcohol and drug prevention and treatnent. Before I do, I would like to join several of my colleagues in upporting a recommendation that the research budgets of NIDA and NIAAA be increased by at least 15 percent. This is roughly to ommensurate with the increase of the NIH research programs, and we feel it is quite appropriate. Others have elaborated on that, o I will not do the same.
Several years ago, Mr. Chairman, the AIDS Commission recmmended an unequivocal commitment to providing drug treatnent on demand. This, we believe, is still valid and should not be orgotten. The tragic situation with respect to cocaine, the ongoing ut unfortunately seldom recognized epidemic of alcoholism, and he overwhelming burden placed on our criminal justice system nd other factors add much to the urgency for more readily accesible substance abuse treatment.
A few important points. Very much tied to alcohol-and drug-reated crime, America has now achieved the No. 1 status in the world in its incarceration rate. In the last 10 years this rate has nore than doubled. Of every 100,000 Americans today, 426 are beind bars. To provide a frame of reference, South Africa, who used o be ahead of us, incarcerates only 333 out of 100,000, the Soviet Jnion 268 out of 100,000, Great Britain, a society very much like s, incarcerates only at the rate of 97 per 100,000, Spain 76, Italy 50, the Netherlands 40.
We need to be concerned about this, especially if we look at subpopulations; that is, young black males. It is even more alarming. ully, 25 percent, one-fourth of all young black males are either beind bars or on probation or on parole.
I noticed an article this morning in the Washington Post which eported that the number of drug offenders serving time in Federal risons has more than doubled just in the past 2 years and now omprises more than one-half of the inmate population of the Fedral prison system.
The same thing is occurring at State and local levels. The simple natter of fact is that our criminal justice system has simply beome overwhelmed by drug-related crimes. If crimes related to alcool abuse were included, the proportions would even be larger. We propose that a more frequent use of treatment for selected ofenders is needed to make our criminal justice system more effecive and in some cases to prevent the need for incarceration. This eed, combined with the well-established need to provide treatment and prevention of the spread of AIDS and other human tragedies neans, in our view, that we cannot relax our efforts to provide reatment for all who need it.
I think the evidence is now clear, Mr. Chairman. Treatment or reatment combined with criminal justice sanctions for those who ave committed crimes is the best alternative for breaking the
cycle which is jamming our jails and prisons. Treatment is the best strategy for disrupting the epidemic of alcohol and drug dependency which threatens to consume a young generation of people.
In this respect, we are somewhat encouraged to see the administration request $100 million for new treatment expansions. We must point out, however, that this proposed $100 million is not actually new funding. It is merely a shifting of funds previously used for services under a special one-time waiting list grant program. These waiting list grant programs are left hanging in the air.
I presume there is an assumption that the States are going to pick up the waiting list grant services with block grant funds. Ironically, there is no increase recommended in the block grant to enable this. The States are already under great pressure to provide increased resources just to meet their individual needs. It is not something that the States possibly can cope with in a productive fashion. We propose that while we do not oppose a categorical approach and a targeting, that depending exclusively upon categorical grants as the administration proposes would undermine the important and effective Federal-State partnership which has evolved during the past decade. This cannot be jeopardized.
Even if the $100 million represented new treatment funding, it would be quite insufficient. In reality, though we will not recommend this, an additional $1 billion is probably needed for treatment to create a better balance between demand reduction and supply reduction initiatives and to constrain the flow of new inmates into our jails and prisons.
We are aware of the very tight financial situation you must face and the great competition you have and would offer a more practical recommendation for the current year, which would be to provide $200 million a year to add it to the $100 million proposed by the administration and, further, to recommend that $150 million of this be added to the block grant to help meet the States' needs and to help some of them pick up the waiting glass programs, and to add another $50 million to the initiative the administration has proposed for a total of $150 million. That would give us a balanced approach between categorical programs and strengthening the block grant program and the Federal-State partnership.
Whatever amounts might be possible in the treatment expansion area, we would urge that the committee insist that it be divided roughly evenly between categorical programs and between the block grant.
We have some other recommendations in our written testimony, and I will not repeat it.
I would like to make one point about prevention. We have recently established a new prevention agency, the Office of Substance Abuse Prevention. Thus far it is doing a good job. It has captured the attention and the imagination of American communities all over the country. Many grant proposals are being submitted.
One thing we need with this program now is stability. Prevention is a long-term affair. Our commitment has to be firm. The resources we provide must be stable. That means we have to be able to provide enough new grants to sustain and nourish community interests and leadership to be certain that we have adequate training, adequate management resources, and that we evaluate what
ve are doing. In all candor, the administration's proposal will not lo this.
In brief, we would recommend that the very modest 3.7 percent ncreased proposed by the administration be upgraded to about 100 million. This would be a little bit over one-third increase, but ve feel it is important in the new prevention programs to go that ar and further recommend that $3 to $5 million be made available o initiate a national evaluation effort so we all know where we are going and how we are getting there.
The last point that I would make has to do with the management esources of two new agencies that we are depending on to lead our lemand reduction efforts in communities; that is, the Office of Subtance Abuse Prevention and the Office of Treatment Improvement. One has been established by statute, the other by administrative ct. I suspect that Congress will follow suit.
Both of these are new agencies. They are competing for staff, for pace, for management resources with well-established institutes. OSAP, for example, is expected to function at only about 46 percent of the staff budget ratio as the three primary research institutes, OTI only about 13 percent of this level. While some disparity is probably justified, we feel this is not nearly adequate, and we are ormally not at all excited about recommending additional money For administrative costs.
We have to count on these agencies. They have to be accountable, and if we are going to expect that of them we need to provide the management resources. We would recommend an additional $10 million for each of them to serve that purpose.
The last point, please consider forward funding the block grant. Many other block grants are already forward funded. It would not cost more money, but it would provide all the States and the communities that depend on the block grant funds with some addiional planning time so that they could be ready to use the money hat is provided by the Federal Government in a more efficient
We are ready to continue working with the staff. Thank you for he opportunity and the leadership of this committee. [The statement follows:]
STATEMENT OF KENNETH L. EATON
“*** Temporarily ameliorating the health effects of aids can cost as much as $100,000 per person, and imprisonment has an average annual cost of $14,500
“*** What is needed is a clear federal, state and local government policy, in ther words a national comprehensive policy, unequivocally committed to providing creatment on demand' ** **
Mr. Chairman, these recommendations were included in the AIDS Commission report a few years ago. They are still valid and should not be forgotten. The tragic ituation with respect to cocaine, the ongoing but seldom recognized epidemic of aloholism, the overwhelming burden placed on our criminal justice system and other actors add to the urgency for more readily accessible substance abuse treatment. Some important points:
America's incarceration rate is now No. 1 in the world!
In the last ten years, our incarceration rate has more than doubled. Of every 00,000 Americans today, 426 are behind bars. Some comparisons:
South Africa-333; The Soviet Union=268; Great Britain=97; Spain=76; Italy=60; the Netherlands-40!
Our incarceration rate among black males is nothing short of astonishing and should be a cause for particularly serious alarm. Reportedly, America is incarcerating young black males at a "mind-shattering" rate of 3,109 per 100,000! 25 percent; one-fourth; one out of every four young black men in America is behind bars, on probation or on parole. We are painfully aware that drug-related crimes are playing a major role in the escalating numbers of people who are becoming involved with our criminal justice system.
Indeed, our criminal justice system has become overwhelmed by drug-related crimes. This, has become an urgent problem, especially in state prisons, local jails and local law enforcement systems. A more frequent use of treatment for selected offenders is needed to make our criminal justice system more effective and, in some cases, to prevent the need for incarceration. This need, combined with the well established need to provide treatment to prevent the spread of AIDS and other human tragedies, means that we cannot relax our efforts to provide treatment for all who need it.
Before making some specific recommendations about treatment and prevention, I would like to urge that the research programs of NIAAA and NIDA be increased by at least 15 percent and be much more sharply focused on services related research. This research will yield long-term benefits and should not be slighted in the heat of our alarm about today's problems.
In recent years the Administration and the Congress has focused almost exclusively upon illicit drug control. Our success will be seriously limited unless we deal more generically with the illnesses of alcohol and drug dependency and realize that we must also deal with the problems of alcoholism and prescription drug depend ency. We urge that the Committee insist that treatment funds not be restricted to providing treatment only for illicit drug abuse. This is not good strategy and clinically, it is not realistic. It is common for people to become dependent upon more than one drug; most often one of them is alcohol. We should be paying more attention to alcoholism, alcohol abuse and prescription drug abuse as a part of the National Drug Control Strategy.
Mr. Chairman, the evidence is now clear. Treatment or treatment combined with criminal justice sanctions for those who have committed crimes is the best alternative for breaking the cycle which is "jamming" our jails and prisons. Readily accessible treatment is the best strategy for disrupting the epidemic of alcohol and drug dependency which threatens to consume a generation of young people. In that respect, we are encouraged to see the Administration request a $100 million for new treatment expansion grants. Actually, this proposed $100 million is not new funding. It is merely a shifting of funds previously used for services under the waiting list grants. These services are left "hanging in the air". There seems to be an assumption that the states will pick up the "Waiting list" grants with block grant funds. Ironically, no increase is recommended in the block grant to enable this. The states are already under great pressure to provide increased resources to meet the individual needs of each state. It is impossible for the states to cope productively with a situation like this. It is wise for the Office of Treatment Improvement to plan upon administering these categorical grants through the states as this will help encourage the states later to use block grant funds to continue these services if the categorical federal funding is discontinued. However, the states will be completely unable to do this if we embark upon a policy of withholding block grant increases as the Administration currently proposes. Depending exclusively upon categorical grants would undermine the important and effective federal-state partnership which has evolved during the past decade. We cannot jeopardize that! Even if the $100 million represented new treatment funding, it is quite insufficient to make a significant dent in the burgeoning demand.
In reality, an additional $1 billion is needed for treatment to create a better balance between demand reduction and supply reduction initiatives and to constrain the flow of inmates into our jails and prisons. We are aware, however, that the committee faces a very tight fiscal situation and would offer a more practical recommendation for the current year.
We recommend that $200 million dollars be added to the Administration's proposal for treatment funding.
We further recommend that $150 million be added to the block grant for substance abuse treatment and that an additional $50 million be included for the proposed treatment expansion grants.
We also recommend that the Committee look very closely at the use of the roughly O million which is set-aside from the block grant. We do not question the imporce of this set-aside. We believe, however, that there should be a 5 percent ceiling 1 that these funds should be used solely for data collection, evaluation and techal assistance activities which are directly related to enhancing the federal-state tnership created by the block grant. We do not support using these funds for acities which could appropriately be funded through other parts of the ADAMHA lget.
Despite the vital importance of expanded treatment to deal with today's emeracy, treatment alone will not permanently resolve our problems. treatment will ways be needed just as it is for other chronic disease; but we can reduce this need h thoughtful and determined prevention strategies such as the ones now being tiated by the newly created Office of Substance Abuse Prevention. We are pleased -h the progress of OSAP. It's programs have captured the attention and interest large numbers of community based organizations and professionals throughout e nation. The resources of talent and concern are being mobilized and have the ential to make great progress. However, we face the danger that the focus of ese resources will not be sustained because our federal program cannot respond the needs and opportunities which have been identified. While the Administration 3 proposed modest increases in funds for prevention grants, we face an ironic blem. Perhaps no one imagined that community interest in prevention would be great and develop so quickly. However, the sad fact is that the vast majority of h quality proposals developed by communities will go unfunded if funds for new jects are limited to those proposed by the Administration.
t is possible that proposals submitted after the 1st quarter of next year would ve no prospect of funding. This instability of new grant opportunities would npen community enthusiasm and we would loose important opportunities. We not afford to suggest that our new prevention initiative was a false promise by rting and stopping new programs in the rapid succession suggested by the Adnistration's proposal. Neither can we afford to loose community interest by preturely halting the growth of our efforts. Preventing alcohol and drug problems a long term affair. Our commitment must be firm and the resources we provide st be stable. Stability means that each year we must provide enough new grants sustain and nourish community interest and leadership; that we must be certain at adequate training is available; and, that we conduct an on going evaluation of - programs. The proposed budget for OSAP will not accomplish this. There is m only for modest growth, mostly at the expense of curtailing or eliminating ne programs, failing to initiate evaluation and understaffing the agency. In const to the Administrations modest $10 million (3.7 percent) increase, we recmend an increase of at least $100 million (36.9 percent). We further recommend at $3 to 5 million be made available to initiate a national evaluation effort. On another matter, we must be painfully candid. Neither The Office of Treatment provement nor the Office of Substance Abuse Prevention have adequate managent resources to administer the complex and large programs for which it is responle. It is never pleasant to face the need for more administrative costs, but the ed for accountability and proficient management is urgent.
OSAP is now expected to function at only 46 percent of.the staff/budget ratio of e 3 research institutes. OTI will be at only about 13 percent of this level. Alugh OTI might do with somewhat less because such a large portion of its budget in the block grant, these staffing levels are clearly inadequate. Mr. Chairman the ngress and the nation are counting on these agencies to lead our community sed demand reduction efforts. We expect them to be effective and accountable. We not afford to stifle their capacity to manage the public funds and responsibilities have delegated to them. Stronger management capacities are needed and we recmend that an additional $10 million be provided each to OTI and OSAP for this rpose.
Our final suggestion is that the Committee consider "forward funding” the block ant appropriation. This would not increase costs but would generate much more ective planning. Most other block grants are already"forward funded".
Thank you again for this opportunity. We appreciate the Committee's attention these issues and stand ready to assist in any way as you proceed.
Senator HARKIN. Mr. Eaton, thank you very much for your fine stimony. I am going to keep that testimony. There is some good formation in there that I need to use.