Substance Use Disorder Prevention and Treatment Mark Fontaine Executive Director Florida Alcohol & Drug Abuse Association House Healthy Families Subcommittee February 20, 2013

Treatment is Effective A major review of 600 peer reviewed research articles are conclusive . Drug addiction treatment is very effective and it works as well as other medical treatments for illness such as diabetes, hypertension and asthma. Research that tracks individuals over extended periods reveals that most people who get into treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. Overall treatment of addiction is as successful as treatment of other chronic diseases. Drug treatment reduces drug use by 40% to 60% and significantly reduces criminal activity during and after treatment. Individuals progress through drug addiction treatment at various speeds, so there is no predetermined length of treatment. However, good outcomes are based on adequate lengths of treatment. Those who get more treatment and sooner are indeed likely to do better. Addiction is tenacious. People in recovery remain vulnerable to relapse even after years of abstinence.

Research and Findings Substance abusers have a higher prevalence of co-morbid conditions than other primary care patients. Mertens, J.R., Weisner, C., Ray, G.T., Fireman, B., and Walsh, K. (2005). Hazardous drinkers and drug users in HMO primary care: Prevalence, medical conditions and costs. Alcoholism: Clinical and Experimental Research, 29(6), 989-998.   Providing treatment to individuals in the criminal justice system decreases future criminal behavior – decreases drug use – and improves social functioning. National Institute of Drug Abuse. (2009). Treating Offenders with Drug Problems: Integrating Public Health and Public Safety. NIDA Topics in Brief, March 2009. Drug abusers have increased absenteeism and unstable employment costing businesses $197 billion per year. Treatment improves the prospects for employment, with gains of up to 40% after a single treatment episode. Larson, S.L., Eyerman, J., Foster, M.S., & Gfroerer, J.C. (2007). Worker substance use and workplace policies and programs (DHHS Publication No. SMA 07-4273, Analytic Series A-29). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The George Washington University Medical Center. (2011). The substance use disorder calculator. Washington, DC: The George Washington University Medical Center. http://www.alcoholcostcalculator.org/sub/cost/print-cost.php Simpson, D.D., Joe G.W., and Brown B.S. (1996). Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behavior, 11:294-307.

Research and Findings cont. In Florida, child protective investigations reports alleging substance abuse increased 9% from 2009-2011. Over 1 in 10 children in the U.S. under age 18 lives in homes with a substance-dependent or substance-abusing parent. Retention and completion of treatment have been found to be the strongest predictors of reunification. Florida Department of Children & Families Data. (2011). National Survey on Drug Use and Health Report (2009). Children Living with Substance-Dependence or Substance-Abusing Parents: 2002- 2007. April 16, 2009. Marsh, J., Smith, B. & Bruni, M. (2011). Integrated substance abuse and child welfare services for women: A Progress Review. Children and Youth Services Review, 33, 466-472. Documented economic benefits of treatment include reduced criminal activity, reduced criminal justice and health care costs, and increased employment earnings.

H.R. 6983 – Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 “Parity” refers to fair and equal coverage of mental health and substance use disorders.   Mental health and substance use disorder benefits must by “no more restrictive than the predominant financial requirements applied to substantially all medical and surgical benefits covered by the plan…” and “there are no separate cost sharing requirements than are applicable only with respect to mental health or substance use disorders benefits.” The Act extends equal coverage to all aspects of health insurance plans. Day and visit limits Dollar limits Coinsurance Co-payments Deductibles Out-of-pocket maximums

Profile of Service Delivery for Substance Abuse Disorders Community Substance Abuse Prevention/Treatment Agency Component of Comprehensive Behavioral Health Center Specialty Service Providers (Women, Adolescents) Prevention Agency Criminal Justice Agency Funding Sources Include: DCF Insurance United Way DOC Counties Fundraising DJJ Cities Federal Grants AHCA Juvenile Boards Research

Innovations Diversion/Drug Courts Co-occurring Treatment Evidence-Based Practice Process Improvement Medicated Assisted Treatment Integration with Primary Care Reduction in Residential Bed Stays