NASADAD’s Robert Morrison: State Substance Abuse Agencies and Adolescent Services

On behalf of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), and our component groups the National Prevention Network and National Treatment Network, I am pleased to offer the first in what I hope will be periodic articles regarding our nation’s publicly funded substance abuse prevention, treatment and recovery system. We look forward to sharing information from both our Association and members regarding key issues impacting addiction policy.

As we all know, addiction is a devastating public health problem. The data tell us that more than 23 million Americans could benefit from specialty treatment for a substance use disorder. Yet we also know that of the people who could benefit from treatment, only a fraction – approximately three million – actually receive these lifesaving services.

Our first goal should be to reduce the demand for needing these services in the first place. Therefore, NASADAD promotes increased and sustained investments in substance abuse prevention services. A key pillar in supporting our state substance abuse prevention system is the federal Substance Abuse Prevention and Treatment (SAPT) Block Grant. By statute, at least 20 percent of the SAPT Block Grant must be allocated to prevention activities. For state substance abuse agencies, the set-aside is critical. On average, the SAPT Block Grant represents approximately 65 percent of state substance abuse agencies’ prevention budget. In 21 states, the SAPT Block Grant set-aside represents at least 75 percent or more of the state substance abuse agency’s prevention budget. As a result, we hope to educate the public on the fact that a strong commitment to substance abuse prevention includes a strong commitment to the SAPT Block Grant.

Ultimately, state agencies work to develop their systems to provide services along the continuum, including substance abuse treatment and recovery services. As I speak with state directors, I am hearing more and more about the treatment and recovery needs of adolescents – and the data help explain why this is so.

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2009 National Survey on Drug Use and Health, of the 1.8 million youths aged 12 to 17 who needed treatment for an illicit drug or alcohol use problem, approximately 150,000 received treatment at a specialty facility (or about 8.4 percent). As a result, 1.6 million youths needed – but did not receive – treatment for a substance use problem at a specialty facility.

Overall, the drug of choice of adolescents is alcohol. Specifically, alcohol is the substance with the highest rate of abuse or dependence among both adolescents and young adults (4.6 and 16 percent, respectively). Statistics also show us that marijuana use continues to rise – with approximately one in sixteen high school seniors using marijuana daily or almost every day (Monitoring the Future (MTF), 2010). MTF also found that perceived risk of marijuana has been falling – a trend that could lead to a future spike in use. Finally, a number of states are seeing an increase in adolescent mis-use, abuse and dependence on prescription drugs.

In addition to the sheer number of adolescents impacted by substance use disorders, it must be recognized that our treatment system evolved around services for adults. But over time, more attention has been focused on the unique needs of adolescents. As a result, work is steadily moving forward to build more capacity for adolescent programs.

One critical initiative that helped a number of state substance abuse agencies develop much-needed infrastructure for adolescent services was SAMHSA’s State Adolescent Substance Abuse Treatment Coordination Grant Program (SAC). The SAC program allocated resources to develop state-level service delivery infrastructure focused on adolescent treatment. In turn, the grant helped establish or improve agency collaboration, assisted with financing coordination, supported the involvement of families and more. In all, 48 states applied for the funds – while 16 won the three-year award of $400,000 per year.  Support for state infrastructure is critical given the difficult fiscal situation of many states. This infrastructure generated a number of activities, including:

• The SAC Grant in Washington helped create the momentum for an extensive set of consultations and meetings that ultimately led to the development and release of a strategic plan for improving adolescent treatment services.

• The state of Illinois worked with a provider organization to develop a handbook in both English and Spanish to guide parents through the adolescent treatment process.

• In Wisconsin, the SAC grant supported Project Fresh Light, which created a framework for adolescent treatment services along with practice guidelines that were then shared with providers.

There are other innovative actions by states seeking to address issues related to linkages with primary care or criminal justice. The state director from Massachusetts, for example, recently teamed with Children’s Hospital and Massachusetts Behavioral Health Partnership to develop a toolkit that was sent to pediatric health providers to help them (1) incorporate screening protocols; (2) become educated on brief advice; (3) referrals for further evaluation or treatment; and (4) share information on reimbursement strategies. North Carolina, led by Flo Stein, who serves as NASADAD President, developed the Juvenile Justice Substance Abuse Mental Health Partnerships to promote a multi-disciplinary, family approach at the local level to juvenile justice-involved youth with substance use and mental health problems.

Recently, the federal government has taken a lead role in promoting discussions regarding adolescent services. For example, SAMHSA’s Center for Substance Abuse Treatment (CSAT) sponsored meeting in March 2009 titled, “Families of Youth with Substance Use Disorders: A National Dialogue” had family members from 34 states gather to discuss family involvement in youth services. During last year’s Recovery Month celebration in September, the Office of National Drug Control Policy, the Department of Education’s Office of Safe and Drug Free Schools and SAMHSA organized an emerging issues meeting to discuss ways in which the K-12 educational system could better support youth in recovery from substance use disorders. These same federal agencies have taken an interest in recovery schools that are opening up around the country to help students.

In addition, other organizations such as Reclaiming Futures have helped a number of states work to address treatment needs for teens in the justice system.

NASADAD and our members recognize that we face many challenges – including the need to address the many unique needs of adolescents with substance abuse problems. As we work to navigate the many changes brought on by health reform, during these tough economic times, it will be important for us all to ensure we do not allow these recent gains fall by the wayside. We look forward to working with the Partnership for Drug-Free Kids on these and other important issues.

Robert Morrison, Executive Director
National Association of State Alcohol and Drug Abuse Directors

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    Barbara Wybrecht

    June 3, 2011 at 4:17 PM

    No where in your article did I see any mention of Fetal Alcohol Spectrum Disorders. Approximately one in a hundred teens suffer the life long results of their mother’s use of alcohol while pregnant. Due to their brain differences caused by the alcohol, they are at high risk for being in trouble with the law.
    They are often the scapegoat, are extremely naieve and gullible. Please include these individuals in your plans for helping communities work with high risk youth.

    Barbara Wybrecht RN
    FASD Clinical Nurse Specialist
    Member of NIAAA FASD Juvenile Justice Work Group but not speaking for the group, speaking as an adoptive parent of two adult sons with an FASD

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    Jamie Ware-Jondreau

    May 31, 2011 at 8:48 PM

    All are useful tools for motivating and rethinking change for our youth.

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    May 31, 2011 at 8:19 PM

    I can still remember back when drug abuse among teens was a new phenomenon. Treatment often consisted of “rap centers” and drop in centers in store fronts. Adolescent treatment has come a long way since then. However, as Rob notes, it still has a way to go. I am afraid we will never meet the needs for treatment by trying to conduct business as usual. Passage of the Affordable Care Act was a game changer for the substance abuse treatment system as we know it. It expands eligibility for insurance to tens of millions, and cements the guarantee of parity coverage for substance abuse treatment. It also creates medical homes, and supports the creation of shared electronic medical records systems. All of these create an opportunity to transform substance abuse treatment from services delivered by an isolated specialty system into an integrated component of primary medical care. NASADAD and the states should focus their energies on ensuring that the primary care system is prepared to offer excellent care for substance abusers. Efforts such as those in North Carolina are laudable, but they are predicated on the continued existence of a separate specialty treatment system which is “in charge” of substance abuse treatment, and which uses other care systems as an outreach system to identify clients. I propose a different mind set, one in which states and providers use their expertise and resources to empower the primary care system to gear up to provide substance abuse treatment within the core health care system. I propose that states begin contracting with rural health care centers and other federally qualified health care centers, providing them with technical assistance, and certifying their staff, in order to ensure that they have the capacity to provide the amount of treatment services necessary. If necessary the funds for these contracts could come from eliminating funding to struggling free standing treatment providers, perhaps under the condition that the health centers hire the counselors working in those programs.
    I doubt the mainstream health care system will ever adequately serve those in the criminal justice system, or homeless persons, and perhaps some other special populations. A publically funded specialty treatment system needs to exist to provide them the care they need. But millions of substance abusers and others with behavioral health problems, can, and should be, treated in the mainstream health care system. Before funding streams dedicated to substance abuse treatment are further eroded, the field should make sure that the torch is passed to a health care system that is trained and ready to take on this task.

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