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Substance Abuse and Mental Health Services Administration,
On Solutions to Problems Posed by Crime
and Substance Abuse
Before a Ft. Wayne, Indiana Field Hearing of the House
Government Reform Subcommittee on Criminal Justice, Drug
Policy, and Human Resources
March 22, 2002
Mr. Chairman, my name is Charles Curie, and I am the Administrator
of the Substance Abuse and Mental Health Services Administration
(SAMHSA or the Agency). I am deeply honored to have been
chosen to lead this agency, which I believe should be and
will be the focus of Federal efforts to support and improve
substance abuse prevention and treatment services and community-based
mental health services.
I am also deeply honored to be here today for two reasons.
First, this is the community that I grew up in. I am a native
of Noble County. It is here that I developed my sense of
community and my interest in mental health and substance
abuse services. My parents still live in this community;
so do many of my friends, neighbors, and relatives.
Second, it gives me an opportunity to express my personal
as well as professional appreciation for the work that you
have done in the short 7 years that you have served this
district and the country. As Chairman of the Subcommittee
on Criminal Justice, Drug Policy and Human Resources, you
oversee Federal efforts to address both demand- and supply-side
efforts to reduce drug abuse in the country. I look forward
to working with you to achieve our shared goal of improving
access to quality care for those in need of substance abuse
Mr. Cummings, if I might, I would also like to note your
continued efforts to reduce the availability of drugs and
to increase access to care for those who need it. I apologize
for not being available to testify at the hearing earlier
this month in Baltimore. I was otherwise preoccupied with
preparing for appropriations hearings.
Our mission, as envisioned by Congress 10 years ago when
SAMHSA was created, is to "fully develop the Federal government's
ability to target effectively substance abuse and mental
health services to the people most in need and to translate
research in these areas more effectively and more rapidly
into the general health care system." Over the years SAMHSA
has worked with State and local governments, consumers,
families, service providers, professional organizations,
our colleagues in HHS and the Office of National Drug Control
Policy, and Congress to achieve this mission. The Agency's
work has shown that prevention, early intervention, and
treatment for mental and substance use disorders pay off
in terms of reduced HIV/AIDS, crime, violence, suicide,
homelessness, injuries, and health care costs; and increased
productivity, employment and community participation. Data
confirms that the human and economic cost is much lower
when we prevent or intervene early with the best research-based
tools available. SAMHSA is working towards achieving the
President's goal of reducing current drug use in the U.S.
by 10 percent over two years and 25 percent over five years
in line with the National Drug Control Strategy released
by the President in February 2002.
Our budget proposal, recently released to the Congress
and the general public by the President, proposes an increase
of $127 million to help build substance abuse treatment
capacity and increase access to services that promote recovery
and help people rebuild their lives. Included in this proposed
increase is $50 million for a new grant competition, which
will be structured to reserve funding for state-level competitions,
based upon each states' need for treatment services. The
proposed funding will allow States and local communities
to provide treatment services to approximately 546,000 individuals,
an increase of 52,000 over FY 2002.
SAMHSA's National Household Survey on Drug Abuse
found in 2000 that approximately 800,000 people needing
treatment for an illicit drug problem received treatment.
However, of the 3.9 million people who needed but did not
receive treatment in 2000, only 381,000 recognized their
need for drug treatment. This estimate includes 129,000
people who reported that they had made an effort but were
unable to get treatment and 252,000 who reported making
no effort to get treatment. While this analysis gives us
a better picture of what the true treatment gap is, it also
tells us that we need to do a better job of outreach.
To help build treatment capacity beginning with services
for those who are trying but unable to receive treatment,
the President has proposed a $60 million increase for the
Substance Abuse Prevention and Treatment Block Grant. This
will raise the direct Federal contribution to States for
prevention and treatment services to $1.785 billion. The
Substance Abuse Block Grant is the cornerstone of States'
substance abuse programs, providing approximately 51 percent
of all public funds expended for substance abuse treatment.
It supports some 10,500 community-based organizations. Before
leaving Washington, I looked up a list of treatment facilities
right here in Fort Wayne, and I counted 22. It is very likely
that most of these facilities, if not all, are receiving
some assistance under the block grant program. If the President's
proposal is approved by Congress, Indiana will receive $33,632,240
for substance abuse prevention and treatment services through
the Block Grant in FY 2003. States have considerable flexibility
in the use of these funds. For the best information on how
these funds are being used, you should contact Janet Corson,
the Director of Indiana's Division of Mental Health, Family
and Social Services, whom we work with very closely.
In addition, the President has proposed an additional $67
million for competitive drug treatment grants to address
urgent and emerging drug treatment needs in States and communities,
such as treatment for OxyContin abuse, methamphetamine use,
or individuals with co-occurring addictive and mental disorders.
This year $4,721,759, in addition to the block grant funds,
are coming into Indiana for substance abuse prevention and
treatment services in the form of competitive grants.
The most well-received competitive treatment program SAMHSA
supports is the Targeted Capacity Expansion (TCE) grants.
Applications for the next wave of grants have to be submitted
by May 10 and for the wave after that by September 10. These
TCE grants are intended to expand substance abuse treatment
capacity to achieve a targeted response to treatment needs
in local communities. I recommend that programs in Indiana
interested in funding for treatment for methamphetamine
or oxycotin abuse or wanting to focus attention on treatment
services for adolescents, especially adolescents involved
with the criminal justice system, consult our web site at
www.samhsa.gov for grant
To support the delivery of effective substance abuse prevention
services at the community level, SAMHSA is proposing to
expand its State Incentive Grant Program in FY 2003. Indiana
is currently receiving $2,500,000 from SAMHSA under this
program to promote the development of State/city-wide strategies
to make optimal use of science-based prevention resources.
At least 85 percent of these funds are required to go to
community-level prevention programs. In FY 2002, the State
Incentive Grant Program is providing resources to approximately
2,700 community-based and faith-based organizations, community
anti-drug partnerships and coalitions, local governments,
schools, and school districts.
SAMHSA is assisting States and local communities in other
ways. SAMHSA is dedicated to the identification of and the
dissemination of best practices in both prevention and treatment
services. As stated earlier, this is part of our mission,
and one of my goals as Administrator will be to work with
our sister agencies in NIH to identify best practices and
to recognize good programs in the field that should be replicated
in other communities and with other populations. SAMHSA
publishes Treatment and Prevention improvement protocols;
we sponsor conferences on ways to improve services for vulnerable
populations; and we fund technical assistance centers that
can help States and local communities in further improving
their system of care. Yet it takes some 15 years for the
best practices that we have identified today to become common
practice. This is unacceptable, and I am dedicated to changing
We have had a prolonged discussion in this nation as to
whether treatment works. As a result of that discussion,
it is generally accepted that it does work, but its efficiency
and effectiveness need to be improved. I believe we need
to change the discussion from treatment to recovery, then
ask ourselves whether we are providing what the individual
needs to recover from drug use. This is not a question of
semantics. We cannot expect an individual who has successfully
completed treatment to return to a life situation where
they are not working, have no positive social involvement,
have no home to return or go to, and no support system.
So when we start asking whether a person has successfully
recovered from drug use, we ask not just whether they are
free from drugs or free from criminal activity. We need
to ask whether they have substantive employment, a safe
and stable living situation, positive social involvement,
and the support systems needed to recover.
When athletes tear their anterior cruciate ligament (ACL),
we do not judge the success of the treatment by whether
the operation was successful or the individual is free of
pain. We ask whether they are recovered. Are they walking,
climbing stairs, carrying out activities of daily living?
The same is true if people have had open heart surgery.
Then it should be the question we ask about individuals
returning from a life of drugs. This may mean that we have
to take another look at the way we are providing treatment
and the services we provide as part of our treatment system.
My firm belief is that if we do, the results will be much
better. The associated costs involved will be well worth
Mr. Chairman, I have touched on only a few subjects in
the areas of substance abuse prevention and treatment. There
is so much more that we can discuss today. I can only hope
that I will have more opportunities in the future to discuss
them in public forums like this with you, Mr. Cummings,
and the other members of the Subcommittee.
Again, I appreciate the opportunity to be here, and I am
ready to answer any questions you may have.
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revised: March 25, 2002