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U.S. Department of Health and Human Services,
Substance Abuse - A National Challenge
PREVENTION, TREATMENT AND RESEARCH AT HHSOverview: Each year, drug and alcohol abuse contributes to the death of more than 120,000 Americans. According to the Office of National Drug Control Policy, drugs and alcohol cost taxpayers more than $143 billion annually in preventable health care costs, extra law enforcement, auto crashes, crime and lost productivity. The Department of Health and Human Services (HHS) plays a key role in the administration's substance abuse strategy, leading the federal government's programs in drug abuse research and funding programs and campaigns aimed at prevention and treatment, particularly programs designed for youth. While overall use of drugs in the United States has fallen by 50 percent in the past 20 years, the past 10 years have shown an increase in drug use by adolescents. However, since 1996 drug use by youth has leveled off with the past four years showing a moderating trend in drug use among adolescents. Leading indicators for drug use - including rates of use among the youngest age group and the number of new users - suggest possible future declines.
President Bush's fiscal year 2003 budget includes an increase of $127 million for a five-year drug treatment initiative to reduce the 'treatment gap' in the United States - the difference between the number of people who need treatment for an illicit drug problem and those who receive the treatment and services necessary to rebuild their lives. HHS was appropriated a total of $4.2 billion for all substance abuse-related activities in fiscal year 2002. The President's fiscal year 2003 budget increases that investment to $4.4 billion.
RECENT FINDINGS FROM HHS SUBSTANCE ABUSE SURVEYS
HHS tracks the nation's substance abuse patterns through three major surveys: the National Household Survey on Drug Abuse (NHSDA), the Monitoring the Future Survey (MTF) and the Youth Risk Behavior Survey (YRBS). Information from these surveys helps the nation to identify potential drug problem areas and ensure that resources are targeted to areas of greatest need.
The National Household Survey on Drug Abuse. The NHSDA, directed by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides annual estimates of the prevalence of illicit drug, alcohol and tobacco use in the United States and monitors trends over time. It is based on a representative sample of the U.S. population age 12 and older. Findings of the 2000 NHSDA are available at: http://www.samhsa.gov/oas/oas.html.
Monitoring the Future. The MTF survey, funded by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH), tracks illicit drug use trends and attitudes by 8th, 10th and 12th grade students. The 2001 study surveyed more than 44,000 students in 424 schools across the nation about lifetime use, past year use, past month use and daily use of drugs, alcohol, cigarettes and smokeless tobacco. Findings of the 2001 MTF survey are available at: http://www.drugabuse.gov/DrugPages/MTF.html.
Youth Risk Behavior Survey. The Centers for Disease Control and Prevention's (CDC) National Youth Risk Behavior Survey is a biennial school-based survey that collects data from a representative sample of students in grades 9-12 on health-related risks. In addition to surveying tobacco, alcohol and other drug use, the survey covers other injury-related behaviors such as weapon carrying and attempted suicide, sexual and dietary behaviors, and physical activity. Findings of the 1999 YRBS are available at: http://www.cdc.gov/YRBS.
HHS PROGRAMS AND SERVICES TO PREVENT AND TREAT SUBSTANCE ABUSE
Reducing the Treatment Gap. The President's fiscal year 2003 budget includes an increase of $127 million for SAMHSA under a five-year drug treatment initiative to reduce the drug treatment gap in the United States. According to SAMHSA's 2000 NHSDA, approximately 800,000 people who needed treatment for an illicit drug problem received treatment at a specialty facility. Of the 3.9 million people who needed but did not receive treatment in 2000, an estimated 381,000 reported that they felt they needed treatment for their drug problem, including 129,000 people who reported that they made an effort but were unable to get treatment and 252,000 people who reported making no effort to get treatment. The initiative includes an increase of $60 million for the Substance Abuse Prevention and Treatment Block Grant and an increase of $67 million for competitive drug treatment grants.
President Bush's fiscal year 2003 budget includes $2.3 billion for substance abuse treatment and prevention activities under SAMHSA, including the initiative to close the treatment gap:
Programs Through the Administration for Children and Families (ACF). ACF's Community-Based Resource Centers serve as comprehensive family service centers that can provide referrals to treatment programs for parents and other family members. The Head Start program, also administered by ACF, helps families access substance abuse services and provides training for Head Start workers in substance abuse issues. In addition, ACF provides counseling, education, referral and other services to high-risk, runaway and homeless youth. More information on ACF programs is available at http://www.acf.dhhs.gov.
Programs Serving American Indians and Alaska Natives. Substance abuse continues to be a leading contributor to health problems among American Indians and Alaska Natives. The Indian Health Service (IHS) funds approximately 400 alcoholism and substance abuse programs and establishes cooperative agreements with other federal and private programs to provide a number of treatment and prevention services to rural and urban communities. More information on IHS programs is available at http://www.ihs.gov/medicalprograms/alcohol/.
Inpatient/Outpatient Benefits. The Medicaid program helps thousands of Americans each year overcome drug addiction. Medicaid may cover some emergency treatment of drug-related symptoms, detoxification and rehabilitation as well as some outpatient services. Many states have also used Medicaid waivers to implement managed care programs targeted at substance abuse.
Recovery Community Programs. Twenty-one community-based organizations with new or ongoing involvement in substance abuse treatment activities have received SAMHSA grants - totaling $4.8 million - to foster participation of people in recovery and their family members in the programs' dialogue about addiction, treatment and recovery.
Workplace Programs. Working with private corporations and managed care organizations, SAMHSA works to improve substance abuse prevention programs in the workplace. A SAMHSA-supported Workplace Helpline, 1-800-967-5752 (WORKPLACE), also provides assistance to employers who are developing and implementing substance abuse prevention programs. More information on workplace programs is available at http://www.drugfreeworkplace.gov.
HHS CAMPAIGNS TO PREVENT AND TREAT SUBSTANCE ABUSE
In addition to the programs and services that the department supports, HHS has joined with numerous private and public partners to establish comprehensive prevention campaigns to educate the public about the dangers of illicit drug use, particularly among youth. Following are just a few examples of the department's initiatives:
Marijuana. To reduce marijuana use among American youth, in 1995 HHS launched a comprehensive marijuana initiative including support for new research on the effects of marijuana and the launch of campaigns to help parents educate children about the dangers of drugs. Two campaigns launched are SAMHSA's "Reality Check" campaign and NIDA's "NIDA Goes to School" initiative. Information on SAMHSA's program is available at http://www.samhsa.gov or by calling 1-800-729-6686. Information about NIDA's campaign may be obtained at http://www.nida.nih.gov/ or by calling 1-800-729-6686.
Club Drugs. In 1999, NIDA launched a new national education, prevention and research initiative to combat the increased use of club drugs such as ecstasy, which are often used at all night "raves" or dance parties and have potentially life-threatening effects. More information is available at http://www.clubdrugs.org. SAMHSA is also focusing on the dangers of club drugs in its substance abuse publications and other awareness programs. Information from SAMHSA is available at http://www.samhsa.gov and at http://www.samhsa.gov/oas/dawn.htm.
Steroids. Recognizing from the 1999 MTF data that steroid abuse may be on the rise, NIDA joined with seven national partners in 2000 to launch an initiative to alert the public about the risks associated with anabolic steroid use. The Institute's partners in the initiative include the National Collegiate Athletic Association, American College of Sports Medicine, American Academy of Pediatrics, National Association of School Nurses, National Federation of High Schools, International Students in Action, and Dr. Drew Pinsky, co-host of MTV's Loveline and drDrew.com. More information is available at http://www.nida.nih.gov/.
Alcohol. To combat the major public health problem of drinking by children aged 9 to 15, NIH's National Institute on Alcohol Abuse and Alcoholism (NIAAA) launched "Leadership to Keep Children Alcohol Free," an alliance of 33 governors' spouses and five emeritus spouses with funding from NIAAA, SAMHSA and other organizations. More information about the activities of the initiative is available at http://www.alcoholfreechildren.org. In another campaign, SAMHSA has joined with Scholastic, Inc., to produce and distribute to every 5th grade teacher a package of materials targeted to students, teachers and parents to encourage conversations about underage drinking. Finally, SAMHSA is joining CDC in planning a $3.56 million educational campaign to influence the attitudes of youths aged 9-13 about alcohol use and abuse. It is part of CDC's larger "Youth Media Campaign" to help youth develop habits that foster good health over a lifetime.
National Alcohol and Drug Addiction Recovery Month. This annual September public education campaign celebrates the gains made by people in recovery from alcohol or substance abuse and lauds the benefits of substance abuse treatment. The theme for the 2001 observance was "We Recover Together: Family, Friends, and Community." More information on the observance is available at http://www.samhsa.gov.
National Alcohol Screening Day (NASD). NASD is a national, one-day outreach, education and screening event conducted by hospitals, clinics, treatment centers, colleges and primary care offices. NASD offers screening, education, intervention and referral to treatment when necessary for at-risk drinking and a range of alcohol problems. NASD is the result of a collaboration between NIAAA, SAMHSA and Screening for Mental Health, Inc. More information on the fourth annual NASD observance is available at http://www.mentalhealthscreening.org.
Girl Power! This education campaign was designed to help encourage and motivate 9- to 14-year-old girls to make the most of their lives. Studies show that girls tend to lose self-confidence and self-worth during this pivotal time and may become less physically active, perform less well in school, potentially use drugs, alcohol and tobacco, and neglect their own interests and aspirations. For more information on the campaign, see http://www.girlpower.gov.
Prescription Drug Abuse. To raise awareness about and increase research efforts on the misuse and abuse of prescription drugs, NIDA has launched a Prescription Drug Abuse Initiative. Seven organizations, including AARP, have joined NIDA in this effort to reduce the non-medical use of prescription drugs, which appears to be on the rise. More information on the initiative is available at http://www.drugabuse.gov/DrugPages/Prescription.html.
HHS RESEARCH INTO DRUG ABUSE PREVENTION AND TREATMENT
Drug Abuse Research. NIDA provides more than 85 percent of the support for research on drug abuse and drug addiction in the world, providing the scientific foundation for prevention and treatment programs all across America. Examples of recent and ongoing research include: studying the biological basis of addiction; developing medications to treat drug addiction; assessing and improving behavioral and psychosocial treatments; studying the organization and financing of drug abuse treatment and linkage to primary medical care; studying abused drugs and their health consequences; studying the long-term consequences of prenatal exposure to drugs; and applying state-of-the-art neuroimaging and genetics techniques to advance drug abuse prevention and treatment efforts. NIDA's fiscal year 2002 budget is $891 million. The President's fiscal year 2003 budget increases that investment by $77 million to $968 million. More information about NIDA research is available at http://www.nida.nih.gov/.
Alcohol Research. NIAAA provides leadership and financial support for approximately 90 percent of all alcohol-related research in the United States. NIAAA supports research on the causes, consequences, treatment and prevention of alcohol-related problems. Highlights of NIAAA research include: determining how genetic and environmental factors interact in the development of alcoholism; researching the brain mechanisms involved in alcoholism; developing new treatment approaches and medications; assessing alcohol's effects on the body; studying the risk/benefit tradeoffs of moderate alcohol use; developing and testing prevention strategies; evaluating the effects of alcohol in the development of birth defects and identifying prevention approaches; and assessing alcohol treatment and prevention services. NIAAA's fiscal year 2002 budget is $386 million. The President's fiscal year 2003 budget increases NIAAA's budget by $32 million to more than $418 million. More information on NIAAA research is available at http://www.niaaa.nih.gov/.
HHS RESOURCES FOR CONSUMERS AND PROVIDERS
Treatment Referral Services. SAMHSA's online locator system provides a private, convenient way to find treatment programs for substance abuse problems. Information on nearly 15,000 facilities recognized by states as appropriate sources of care can be found through this database at http://www.findtreatment.samhsa.gov. The service augments the locator services available through SAMHSA's National Drug and Alcohol Treatment Referral Hotline at 1-800-662-HELP.
Hablemos en Confianza. This program built around Latino strengths is helping Hispanic families bring critical anti-drug messages home to their pre-teens and young teens. The materials for this initiative were built upon input from key leaders and focus groups from Latino communities across the country. An intergenerational communications book provides parents clear examples of ways to discuss substance abuse with family members. Supplementary products include both a children's healthy behaviors activity book (designed for ages 4-6) and a community action guide to help community leaders organize, enhance and expand local substance abuse prevention activities. Information is available at SAMHSA's Web site at http://www.samhsa.gov.
Model Programs for Youth Substance Abuse Prevention. SAMHSA makes available a series of proven and promising prevention programs that have produced consistent, replicable results in prevention with high-risk youth populations. To date, 39 model programs have been identified through a rigorous peer review process to build resilience and self-esteem among youth at high risk for substance abuse. The information is available through SAMHSA's Model and Exemplary Programs Web site at http://www.samhsa.gov/centers/csap/modelprograms.
Treatment Improvement Protocol Series Guide for Treatment Providers. The SAMHSA Treatment Improvement Protocol (TIP) series provides substance abuse treatment professionals with "best practices" in treatment. SAMHSA draws on the experience and knowledge of clinical, research and administrative experts to produce each TIP. Copies of the guides are available through the SAMHSA Web site at http://www.samhsa.gov.
National Clearinghouse. SAMHSA maintains the National Clearinghouse for Alcohol and Drug Information, which can be reached at 1-800-729-6686 for assistance in English or Spanish, or at TDD 1-800-487-4889 for hearing-impaired callers. It is estimated that more than 100 million Americans benefit from Clearinghouse services each year. PREVLine (PREVention-on-Line), a 24-hour Web-based prevention information portal and search engine, is maintained by SAMHSA and is accessible at http://www.samhsa.gov.
NIDA Infofax. Callers can access pre-recorded information and request fact sheets on drug abuse and addiction in English and Spanish 24 hours a day by calling NIDA's toll-free Infofax service at 1-888-NIH-NIDA (644-6432). Hearing-impaired callers can access the system at 1-888-TTY-NIDA (889-6432). All fact sheets from NIDA Infofax are also available on the NIDA home page at http://www.nida.nih.gov.
This document is not necessarily endorsed by the Almanac of Policy Issues. It is being preserved in the Policy Archive for historic reasons.