On March 31, the House Government Reform Subcommittee on Criminal Justice, Drug Policy and Human Resources heard testimony on the effectiveness of drug treatment programs.
In his opening statement, Chair Mark Souder (R-IN) praised the administration’s Access to Recovery Initiative, which provides individuals with vouchers to pay for substance abuse clinical treatment and recovery support services. Noting that $100 million was allocated for the initiative in FY2004, he stated, “If fully funded at $200 million per year as requested by the President it could help up to 100,000 more addicts get treatment.” Rep. Souder also contended that the initiative “has enormous potential to open up federal assistance to a much broader range of treatment providers than are used today.”
Ranking Member Elijah Cummings (D-MD) underscored the need for a careful examination of drug treatment programs, insisting that just treating an individual is not enough; the treatment also must be effective. “Taxpayer money must be spent effectively and efficiently,” he argued.
Charles Curie of the Substance Abuse and Mental Health Services Administration (SAMHSA) said that federal investments in substance abuse prevention and treatment “are a cost effective and beneficial response to substance abuse.” He cited the SAMHSA National Treatment Improvement Evaluation Study that found a 50 percent reduction in drug use among clients one year after treatment, a nearly 80 percent reduction in criminal activity, a 43 percent decrease in homelessness, and a nearly 20 percent increase in employment. Mr. Curie explained that the congressionally mandated five-year evaluation examined clients “from underserved populations and included minorities, pregnant and at-risk women, youth, public housing residents, welfare recipients, and those in the criminal justice system.”
Mr. Curie said that programs at SAMHSA are centered on three principles: accountability, capacity, and effectiveness. “To measure our effectiveness and be accountable,” he stated, “we must have the capacity to gather and analyze data about our programs. We are continuing to build on our national surveys, such as the National Survey of Drug Use and Health, the Drug Abuse Warning Network and the Drug and Alcohol Services Information System, to measure our program’s effectiveness, and, at the same time, we are working with States to build the infrastructure to capture and evaluate these measures.” Mr. Curie explained that SAMHSA would utilize seven “domains” to assess the effectiveness of drug treatment programs, including abstinence from drug use and alcohol abuse, employment or school attendance, criminal justice involvement, stable family and living conditions, access to treatment services, retention in treatment services, and social support and connectedness.
Testifying on behalf of the National Institute on Drug Abuse at the National Institutes of Health, Dr. Nora Valkow said that substance abuse, which includes smoking, illegal drugs, and alcohol, costs the United States more than $484 billion per year. She also noted that drug abuse “is inextricably linked with the spread of infectious diseases such as HIV/AIDS, STDs, tuberculosis, and hepatitis C, and is also associated with domestic violence, child abuse, and other violent behavior.” Dr. Valkow explained that drug addiction “is similar to other chronic diseases such as type II diabetes, hypertension, cardiovascular disease, and many forms of cancer with respect to its onset, course, and response to treatment.” She also noted that as with other chronic illnesses, it is difficult to encourage patients to maintain long-term treatments and lifestyle changes. According to one study, she stated, “The factors that led to rehospitalization for chronic diseases were the same factors implicated in relapse to drug use.”
Dr. Valkow stressed the difficulty of completely eliminating drug use, stating, “Because of the heterogeneity in patients, such as age, gender, types and severities of substance abuse problems, and mental and medical health problems, eliminating drug dependence is difficult and moreover it is imperative that treatment providers have an array of science-based treatments to offer patients, in addition to access to services, and resources to address the complex problems that patients bring to treatment.” For a treatment to be effective, she argued, “A continuum of care is crucial.”
Hendree Jones of the Center for Addiction and Pregnancy (CAP) at the Johns Hopkins Bayview Medical Center said that CAP “is an outpatient and residential program that provides a comprehensive, coordinated and multi-disciplinary approach to treating drug-dependent mothers and their drug-affected babies.” Dr. Jones explained that women spend 60-90 days at CAP after only having waited 2-4 days for treatment because Maryland requires pregnant women to be treated for substance abuse. In addition to inpatient and outpatient care, CAP “has a range of support services that include on-site child care, transportation to and from treatment, and intensive outreach services for clients who miss one or more days of treatment…Patients also receive exit planning, parenting training, and nutritional support. Children receive a host of services as well, including well and sick care, pediatric care during and after their mother’s treatment is completed, case management, developmental assessment and tracking.” Dr. Jones highlighted the success of CAP, offering a number of statistics:
Dr. Jones offered a number of suggestions for Congress to improve drug treatment programs, including an appropriation of $1.905 billion for the Substance Abuse Prevention and Treatment Block Grant and full funding for the Access to Recovery Initiative. Explaining that CAP receives 90 percent of its funding from Medicaid, Dr. Jones encouraged Congress to expand Medicaid coverage for alcohol and drug treatment and allow Medicaid to cover mental health services for pregnant and postpartum women.
