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Testimony on SAMHSA's FY 1998 Budget Request by Nelba Chavez, Ph.D.
Administrator, Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

Before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and Related Agencies
February 12, 1997

Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to present the 1998 budget request for the Substance Abuse and Mental Health Services Administration. Our request for $2.205 billion for 1998 is an increase of $34.4 million or 1.5 percent over the comparable 1997 enacted level of $2.172 billion. I think you will find in developing our budget we have taken into consideration the evolving role of the Federal government, emerging public health trends, fiscal responsibility and the need for SAMHSA to focus on results and program performance - an area I know you have great interest in.

Our programs touch the lives of some of our Nation's most vulnerable populations and have a tremendous impact on the Nation's service systems. For example early findings from SAMHSA's Access to Community Care and Effective Services and Supports (ACCESS) program show that homeless people with mental illnesses who received services through this program had significant improvements in almost all outcome measures. After the first 12 months, ACCESS clients showed a 66% decrease in minor criminal activity, a 52% decrease in total days of drug use, a 46% decrease in reported psychotic symptoms, a 36% increase in the number of days worked, and a 74% reduction in the actual number of days of homelessness. Preliminary findings also show that clients in integrated systems have better housing outcomes than those in less integrated systems.

Just last fall, we released the preliminary findings of the National Treatment Improvement Evaluation Study which was a five-year study on the impact of drug and alcohol treatment on 5,388 clients treated in substance abuse treatment programs funded by SAMHSA. In a comparison of behaviors a year before and a year after drug abuse treatment, the rate of respondents reporting marijuana use declined 50 percent, cocaine use declined 55 percent, crack use declined 51 percent, and heroin use declined 46 percent. The study also noted large reductions in criminal behavior - the rate of respondents selling drugs and committing violent crime declined by 78 percent. The study noted a 19 percent increase in the rate of employment and a 42 percent drop in the rate of respondents who were homeless. I must add, these are results from our most under served and vulnerable populations whose drug problems tend to be more severe and who have few social supports to help in their recovery.

When it is done right, we know addiction treatment and mental health services are effective, they improve lives and save resources across a broad spectrum of public sector programs. However, almost half of the 3.5 million people in serious need, do not receive treatment for drug dependence. And, it is a national tragedy that two-thirds of young people in need of mental health services are not receiving help. Without help, these problems can lead to school failure, alcohol and other drug use, family discord, violence, crime and even suicide.

To help improve services to children SAMHSA has launched our Starting Early-Starting Smart collaborative effort. I say collaborative because beginning this year SAMHSA is collaborating with The Casey Family Program and the Department of Education to develop new knowledge, demonstrate what works, and create collaborative community-based partnerships that will sustain improved health and health care services for children from birth to age 7 and their families or care givers. SAMHSA initiated the Starting Early-Starting Smart program because so many social and economic factors impact children's mental health and their potential for substance abuse. This interagency collaboration will bring all the available resources to bear on providing coordinated, quality services for children and their care givers. I clearly see this collaboration as just the beginning of a much needed effort to improve the lives of children and ultimately as our first offence in preventing drug use.

National social trends are without question undermining our efforts to prevent drug use, especially among youth. Reducing drug abuse in the country is going to require a long-term commitment of leadership, new ideas, and resources. And our past work has shown we cannot focus on just one drug alone. Each new generation of youth needs to be immunized against all forms of substance abuse - from methamphetamine to marijuana and from alcohol to tobacco. And, today's social trends make this generation of youth even more vulnerable. The proponents of legalization are better organized than ever before, kids report drugs are easily obtained, and the perception of harm of drug use is on the decline among youth. And for the first time ever, we're facing a generation of youth, many of whose well-educated parents tried marijuana in their own youth, without any perceived negative consequences. This single factor makes the problem unique and very difficult, because these parents don't know how to tell their own children not to use marijuana, or don't think it's that bad that their kids use marijuana. Given these trends, it is of little wonder that young Americans are abusing drugs at rapidly increasing rates.

The good news is that public and private sector investments in science-based research have developed substance abuse prevention strategies that directly counteract some or all of these national social trends. In short, prevention strategies have been developed that work. Successful programs are comprehensive and take advantage of key opportunities to provide youth, early on in life, with positive messages, role models and opportunities to learn and achieve. A number of programs have employed these principles and have shown positive long-term effects. For example Project Star, developed by the University of Southern California, demonstrated that students who began the program in junior high and whose results were measured in their senior year of high school, showed approximately 30 percent less use of marijuana, about 25 percent less use of cigarettes, and about 20 percent less use of alcohol than children in schools that did not receive the program. The most important factor found to have affected drug use among the students in this program was increased perceptions of their friends' intolerance of drug use. Obviously, parents and other caring adults, peers, schools and other youth-serving institutions, and the media play influential roles in reducing youth substance abuse. And, Federal, State and local governments can help by fostering a supportive environment and providing parents with the tools they need through legislation and strategic investments.

In 1997, SAMHSA initiated a new approach toward youth substance abuse prevention that takes advantage of the unique role the Federal government can play in this nationwide problem. In FY 98 we are proposing to expand on this years work and increase SAMHSA's support to $98 million in order to build a sustained initiative. Our strategies include mobilizing and leveraging Federal and State resources, raising awareness and countering pro-use messages, and measuring outcomes. Approximately $63 million will be dedicated to State Incentive Grants and to developing a regional approach to providing "state of the art" prevention knowledge and technical assistance for implementing effective programs. The State Incentive Grants call upon Governors to develop comprehensive State-wide strategies that identify and take advantage of all available funding streams dedicated to reducing youth substance abuse. States may propose their own programs but they will be offered a menu of effective substance abuse prevention strategies and programs that are based on scientific research. SAMHSA will focus public education efforts on reaching youth and their care givers by integrating and expanding our on-going - Girl Power! and Reality Check - anti drug use campaigns and by coordinating our efforts with the Office of National Drug Control Policy. To measure outcomes SAMHSA is dedicating approximately $28 million to develop State level estimates using SAMHSA's National Household Survey on Drug Abuse. The Household Survey now provides data for making national estimates on the prevalence of substance abuse in the population age 12 years and older as well as information on behavior, attitudes, and household environment. The new investment will enable us to make State-level estimates on these same measures with a focus on youth 12 to 17 and 18 to 25. These State estimates will give Governors and others information about where efforts are succeeding and where improvement is needed.

Clearly, there is a need for continuous Federal leadership in these and other areas of substance abuse prevention, addiction treatment and mental health services. As a long-term partner with States and counties, communities and employers, consumers and families, and health professionals, SAMHSA is well positioned to meet these challenges and continue to push the field forward.

In particular, SAMHSA's new Knowledge Development and Application program is designed to ask and develop answers to critical questions of immediate concern to providers and policy makers, and to ensure that what is learned is used to improve services at the community level. This process includes six phases that begins with problem identification. As each phase is completed it "rolls" into the next, ending ultimately with adoption of improved policies or techniques in State systems, community services and individual practice.

SAMHSA intends to devote more than half of the new 1998 Knowledge Development and Application funds to working with States and counties, communities and employers, consumers and families and health professionals to ensure that new and current knowledge is actually used in ways that improve services and save money. The 1998 budget request proposes $137 million to fund new competitive Knowledge Application grants. I can assure the Committee that these funds represent an outstanding investment, which will lead to documentable improvements in the Nation's health care system.

Another method available for implementing new findings is SAMHSA's block grant programs. The FY 98 budget requests a $10 million increase in the Substance Abuse Prevention and Treatment Block Grants, for a total of $1.320 billion. Our request continues the Community Mental Health Services Block Grant at the FY 97 level, $275 million. In addition, our 1998 request proposes to modify these block grants into Performance Partnership Block Grants. Our proposal will increase States flexibility, ultimately allowing States to set their own priorities for expenditures and management of grant funds. In exchange, States will accept greater accountability for producing results. We are already working with some States through pilot projects to identify performance measures, develop data reporting systems and establish a sound basis for outcome oriented, Federal-State partnerships.

Mr. Chairman, we are committed to continuous improvement in the way SAMHSA does business to ensure that our efforts continue to have a positive impact on the Nation's prevention and treatment systems. Over the years, our work has demonstrated that substance abuse prevention, addiction treatment and mental health services can be highly effective. Yet, just like interventions for heart disease, cancer, and diabetes, these services can and must be improved. SAMHSA's Knowledge Development and Application program is the Federal tool specifically designed to make progress and improve services in our Nation's communities. This is SAMHSA's unique Federal role.

I am both optimistic and enthusiastic about what the future holds for our ability to address some of the Nation's most costly and devastating problems. It is clear that each new generation of American youth will present us with new challenges; each new scientific breakthrough will provide us new options; and each new option will need to be translated to every day, real-life practice if we are to improve the quality and availability of prevention, early intervention, treatment and rehabilitation services for substance abuse and mental illnesses, including co-occurring disorders.

The directions we have outlined for SAMHSA's future positions the Agency to best meet the challenges. We cannot accomplish this alone, Mr. Chairman; we will continue to seek the advice and assistance of the Committee as we improve our programs and our effectiveness as an organization.

Mr. Chairman and Members of the Subcommittee, thank you for the opportunity to present the 1998 budget request for the Substance Abuse and Mental Health Services Administration. We will be pleased to answer any questions you may have.

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