Charles Curie, SAMHSA

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Statement of
Charles Curie,
Administrator,
Substance Abuse and Mental Health Services Administration, HHS
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 services.

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 opportunities.

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 that.

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 the expense.

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.

Last revised: March 25, 2002