2008-2009 BUDGET RECOMMENDATIONS
Over the last decade, chemical dependence prevention and treatment programs have weathered numerous cuts to baseline funding. Required to do more with less, providers of services have suffered from an increase in unfunded mandates, dramatic increases in energy and health insurance costs, and a workforce crisis caused by an inability to attract and retain a qualified workforce. New York State has failed to maintain adequate support for chemical dependence services in spite of increasing evidence that treatment and prevention are cost saving services. According to a report by Join Together1: State governments . . . spend over thirteen percent of their budgets on problems related to drug and alcohol use. Less than four percent of this is spent on prevention and treatment, while more than 96 percent pays for the social, health and criminal consequences that result from our failure to apply what we know about how to prevent and treat substance use problems.2 In New York State, similar percentages apply. If the State truly wants to address addiction, the root cause of so many social and health concerns, then it will require thinking differently about how the State invests in preventing and treating addiction and supporting recovery. As we learn more about addiction and how to address it, public policy should reflect this research. With an emphasis on the needs of individuals, families, and communities and the use of science-based practice, the New York Association of Alcoholism and Substance Abuse Providers, Inc. (ASAP) advocates for a NYS budget that includes funding to strengthen existing services and develop new capacity to address unmet needs. Understanding that a significant investment is needed, ASAP recommends a multi-year investment strategy in NYS treatment, prevention, and recovery services. Workforce Infrastructure Cross-Systems Collaboration Education Children and Family Services Resource Recommendations 2 Summary of “Blueprint for the States: Policies to Improve the Ways States Organize and Deliver Alcohol and Drug Prevention and Treatment.” A copy of the Summary is attached. 3 “Evidence-Based Treatment of Alcohol, Drug, and Mental Health Disorders: Potential Benefits, Costs, and Fiscal Impacts for Washington State” (June 2006) Washington State Institute for Policy found that evidenced-based treatment of these disorders can achieve about $3.77 in benefits per dollar of treatment cost, a 56 percent rate of return on investment. From a narrower taxpayer’s-only perspective, the ratio is roughly $2.05 in benefits per dollar of cost.
Resources for the chemical dependence workforce have not kept pace with those in the mental health and developmental disability services arenas. As noted in an OASAS workforce report published in 2003, the resultant workforce crisis threatens the quality and availability of services. Immediate action is needed to adequately compensate our workforce to ensure we are able to retain staff and not lose them to other fields where they would receive significantly higher salaries.
• The 2008-09 budget should include the third year of a three year COLA tied to the Consumer Price Index and elimination of budget language that would sunset the COLA.
• $20 million is needed for salary upgrades to retain entry level/direct service staff.
• $10 million is needed to address dramatic increases in the cost of employee health benefits. Funds are needed to prevent further erosion of employee health coverage.
The State has recognized that energy costs have risen dramatically and has included funding for such increased costs in their state operations budgets. Community-based providers are faced with the same costs but have not received funding to meet those costs.
• $10 million is needed to offset dramatic increases in the cost associated with gas and utilities
• $5million in local assistance is needed for information technology upgrades. ASAP recommends making DOH HEAL Funds available to treatment programs.
Prevention/Treatment
Blueprint for the States: Policies to Improve the Ways States Organize and Deliver Alcohol and Drug Prevention and Treatment points out that 70% of child welfare expenditures are related to chemical dependence as well as 77% of state criminal justice, 66% of juvenile justice, 51% of mental health, between 16% and 37% of social services, 25% of health care, and 9% of developmental disabilities expenses in state budgets. To help reduce these costs and to improve the health status of individuals and families, ASAP recommends:
• $10 million in the OASAS community prevention (aid to localities) budget to address the underage drinking crisis.
• $5 million to support implementation of treatment for tobacco dependence in treatment programs. With an estimated 80% of treatment consumers smoking, programs need training, staff specialists and other resources to accomplish OASAS/DOH tobacco-free goals.
• $1.875 million for adolescent treatment. Continue support contained in the 2007-08 budget that addresses the need to compensate programs serving the uninsured and working poor.
• $1 million for OASAS state operations to support re-engineering of the treatment system. Creation of community-based detox, addressing structural issues in medication assisted treatment, and the need for new treatment models warrants strengthening of OASAS staff capacity and funding to develop a treatment model that puts consumers first.
• $5 million for specialized treatment and prevention for underserved/high risk groups: $1 million for geriatric chemical dependence services, $ 2 million for problem gambling treatment and prevention, $1 million for veteran’s treatment, and $1 million for specialized services for persons with brain trauma.
Chemical dependence treatment and prevention programs can be instrumental in driving down the costs associated with other systems of care. Blueprint for the States asserts that increasing prevention and treatment services will decrease the need for foster care placement for children of addicted parents, reduce re-arrest rates for persons in the criminal justice system (drop from 75% to 27% with treatment), decrease adolescent re-arrest rates from 64.5% to 35.5% after a year of residential chemical dependence treatment, reduce the average family’s healthcare spending by $363 per month, increase employment 19% and decrease dependence on public assistance by 11%, reduce the prevalence of Fetal Alcohol Syndrome (the number one cause of developmental disabilities), and reduce the cost associated with co-occurring mental health disorders. ASAP recommends the following cross-systems collaborations to improve outcomes and lower expenses in other systems of care:
Criminal Justice
• $25 million to implement recommendations of the Commission on Sentencing Reform to help close the treatment gap and to provide prevention services to re-entry families
• $5 million for treatment as an alternative to incarceration and prevention for families of CJ involved youth
• $1.875 million of treatment of persons involved with drug courts and the criminal justice system for uncompensated care to uninsured persons. Continue support contained in the 2007-08 budget to relieve the fiscal strain on treatment programs caused by uncompensated care for persons involved in the criminal justice system.
• $10 million for a Youth-At-Risk School/ Community Partnership Grants Program. An OASAS/SED collaboration could help the Governor and legislature achieve their goals of helping high-risk children in high-risk districts to increase their grade point averages, increase their involvement in extra-curricular activities, and decrease truancy and drop-out rates.
• $2,000,000 for implementation of a statewide school survey/needs assessment in collaboration with SED and other state agencies that need school based data. Survey results will help NYS to access federal funding.
• $5 million for child welfare/chemical dependence collaboration. Research is showing that this collaboration significantly decreases the need for out-of-home placement, significantly decreases the length of stay where placement is deemed necessary, and dramatically reduces repeat calls to the hotline for abuse and neglect when parents receive treatment
• $2 million for treatment of adolescents with co-occurring disorders. Services for this population are almost non-existent in NYS. The prevalence and severity of co-occurring chemical dependence and mental health disorders is increasing. Funding is needed to strengthen and develop appropriate service models.
• $3 million for treatment of women with children. Programs that are able to accommodate women with children have proven to be effective in addressing both addiction and child welfare concerns. Additional capacity is needed to make services more accessible.
1. Increasing the availability of gambling options in New York has created more risk for problem gambling, increased the need for problem gambling prevention, and increased the need for treatment services for individuals with gambling addictions. To address this increasing need, ASAP recommends that 1% of all revenues from new gambling initiatives be set aside for problem gambling prevention and treatment services throughout the state.
2. According to Join Together’s Blueprint for the States, “if additional funds are needed, states should consider raising alcohol taxes.” In New York State, alcohol taxes have been consistently reduced since 1997. Currently, a six-pack of beer costs less than a six-pack of soda. ASAP recommends restoring the tax on alcohol beverages to 1997 levels.
3. Putting people first, will result in a re-engineering of healthcare and creation of a service delivery system that offers a more comprehensive and efficient range of services. ASAP recommends reinvestment of the savings that will occur with the development of new, less costly detoxification services and case management of Medicaid recipients3.
4. Funding should be transferred from DMV to OASAS to offset the transfer of responsibility for monitoring assessments of drinking drivers. OASAS was recently given responsibility for compiling the list of eligible assessment professionals and monitoring the quality of their services, but was not given any resources to do so.
Endnotes
Join Together, founded in 1991, works to advance effective alcohol and drug policy, prevention, and treatment. They recently published a report titled, “Blueprint for the States: Policies to Improve the Ways States Organize and Deliver Alcohol and Drug Prevention and Treatment”, which provides recommendations to the states.
