Prescription for Wellness

SUBSTANCE ABUSE PRELIMINARY PLANNING

Substance abuse and dependence is a public health concern. Although research has provided many promising opportunities for reducing the impact of substance abuse, our community has not fully embraced these opportunities. Substance abuse continues to be a primary factor in human suffering and loss, crime, loss of workforce productivity, and high costs to the individual, family, employers, tax payers, and society. Substance abuse in Travis County is a reappearing theme in other Community Action Network health and human service issue areas and is identified as a priority issue area that impacts our community's well-being.

Collaborative Efforts of Travis County Substance Abuse Providers

1. There is full participation of service providers and other interested community stakeholders in the Substance Abuse Planning Partnership (SAPP) of the Community Action Network. The SAPP fully participates in the Strategic Assessment and Planning process for substance abuse. The Strategic Planning Process is active, comprehensive, responsive, and representative.
2. The City of Austin and Travis County established a system for provision of substance abuse treatment services utilizing a managed care approach with ATCMHMR serving as the Managed Service Organization (MSO). The purpose of using a MSO approach is to better coordinate and standardize substance abuse treatment services, apply utilization management, quality management, credentialing, etc. processes to the treatment system. The MSO will also identify and measure specific standardized outcomes, prevent duplication of administrative services, and promote a more complete continuum of care for clients.
3. There is an ongoing and meaningful information exchange through the Austin Area Chemical Dependency Alliance.
4. There is the active and successful practice of subcontracting services, in order to avoid administrative and clinical duplication. For example, local providers often contract with ATCMHMR to provide utilization management or quality management. In addition, ATCMHMR's Substance Abuse and Specialized Services may opt not to provide a specialized service, instead contracting with a local provider with specific clinical experience.

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City/County Interlocal Cooperation Agreement

Under an Interlocal Cooperation Agreement executed by the City of Austin and Travis County local governments, the Austin Travis County Mental Health Mental Retardation Center is designated to (City of Austin, 1996):

• Provide the lead in assessment and planning functions relative to mental health, mental retardation, and substance abuse services in support of the Community Action Network (CAN).
• Include community providers and participants in a process of collecting data and input on community needs and strengths.
• Lead CAN mental health, mental retardation, and substance abuse planning activities and identify the critical issue areas to be addressed in the CAN application process.
• Participate in CAN performance review for contracted services.

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Substance Abuse Policy Issues

National Policy Issues

In 1999, the results of the Fourth National Survey on Community Efforts to Reduce Substance Abuse and Gun Violence identified several specific policy concerns. Leaders around the country want to see changes in "long-standing public policies." Specifically, there needs to be a shift in spending priorities of the federal government, and local law enforcement needs to maintain strong enforcement against illicit drugs. Some of the policy issues that leaders around the nation identified as important are as follows (Join Together, 1999):

• A decrease in alcohol and tobacco advertising.
• Support for increased alcohol and tobacco taxes.
• Expansion of treatment services for all who need it.
• Addiction treatment needs to be covered by healthcare benefit plans like other diseases.
• Treatment for those driving under the influence would be mandatory.
• Treatment for addicts in the criminal justice system would be required.
• Treatment alternatives to jail would be available for non-violent offenders
• Policies and laws related to alcohol and other drugs would be enforced at the local level.
• Currently illicit drugs would remain illegal.
• Federal funding for prevention and treatment should increase significantly.

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Local Policy Issues

Locally, similar concerns have been identified. During November 2000, the Substance Abuse Planning Partnership (SAPP) formulated legislative recommendations. The SAPP noted several background issues that led to their recommendations. Travis County has experienced a significant reduction of TCADA resources over the past two years for prevention, treatment and alternative criminal justice treatment services juxtaposed against a 24.6 percent growth in population between 1990 and 2000. Finally, the City and County have relied upon Community Action Network planning partnerships to provide recommendations about resource allocation. The SAPP's legislative recommendations were submitted as follows:

1. Restore substance abuse services funds, in the form of a pilot, to several communities, heavily impacted by TCADA reductions that have allocated local resources to address unmet treatment needs. Provide the state government entity with three match dollars for every dollar from the local government.
2. Mandate any Texas Department of Criminal Justice (TDCJ) funds allocated for substance abuse treatment, but not utilized by TDCJ, be diverted to community substance abuse treatment rather than being returned to the general fund.
3. Increase the allocation of unspent Temporary Aid for Needy Families (TANF) to support substance abuse services.

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Youth Key Findings

• Age of onset of adolescent use of alcohol strongly predicts development of alcohol dependence over the course of the lifespan.
• Forty percent of the youth that begin drinking at age 14 or under develop alcohol dependence, opposed to about 10 percent that begin drinking at age 21 or older.
• Families with a history of alcoholism have a higher prevalence of lifetime dependence among members than those without a history.
• Drug use among adolescents aged 12-17 years doubled from 5.3 percent to 11.4 percent between 1992 and 1997.
• In 1999, seventy-four percent of adolescents admitted for treatment had a primary problem with marijuana. This percentage was 35 percent in 1987. TCADA estimates that 11,555 adolescents in Texas want substance abuse treatment and are medically indigent. In 2000, TCADA met 43 percent of this need.

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Adult Key Findings

• In 1998, there were 367 adult and youth deaths related to substance abuse in Travis County. This represents a slight decrease over 1997.
• It is estimated that between 180,765 to 223,426 Travis County residents smoke and research shows that around 70 percent of smokers would like to quit.
• An increasing problem in Travis County is the rise of deaths due to cocaine overdoses. In 1998, there were nine deaths and this increased to twelve in 1999.
• Heroin addicts are most likely to be Hispanic or Anglo males. In 1998, there were 21 deaths in Travis County and the number of deaths increased to 28 in 1999.
• In Travis County, 3,431 AIDS cases were reported between January 1983 and March 2000. Twenty-six percent or 908 of these reported injecting drug use as a possible factor in their contracting of AIDS. Statewide, there have been 51,707 cases reported in this time period. Twenty-three percent or 11,901 reported injected drug use cases (TDH, 2000, March 31).
• In 1999, there were 106 new adult AIDS cases in Travis County. Of the adult cases, 16 percent or 17 people reported injecting drug use as a possible factor in their contracting of AIDS. Statewide, the rate was 27 percent, which translates to 750 of 3,086 cases (TDH, 2000, March 31).
• TCADA estimates that 195,881 adults in Texas want substance abuse treatment

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Preliminary Recommendations :

The preliminary planning recommendations listed below are based upon literature, data for Austin and Travis County, a community forum, focus groups, and input from the SAPP and other community members. The recommendations target the needs of individuals as well as the community.

• Utilize the SAPP to formulate policy initiatives that will overcome barriers to establishing a more effective delivery system. An improved system will be characterized by preventive and rehabilitative approaches and a financial structure responsive to needs.
• Increase capacity for substance abuse services. Collaborate with the Indigent Care Collaboration and other health care initiatives to identify and implement innovative financing structures for both primary and behavioral health care for uninsured persons. Identify opportunities to utilize approaches for integrating substance abuse screening, prevention/intervention and treatment services with primary care when appropriate.
• Conduct inventory of current efforts and develop a plan for coordination of community-wide prevention/intervention and treatment activities resulting in agreement about common outcome measures to increase accountability, efficiency and effectiveness. Utilize trend and outcome data to align resources and minimize fragmentation within the service delivery system.
• Increase outreach activities to parents, teachers, and physicians, and target to populations likely to be uninsured, at risk of substance experimentation, use, abuse and dependence. Develop new opportunities to meet the needs of those at risk of involvement with the criminal justice system but not yet adjudicated to interrupt patterns of substance abuse and incarceration.
• Implement best practices as well as a system of accountability. Develop uniform outcome measures across providers to identify trends, efficiencies and effective use of resources for youth, adults and special populations thereby ensuring community investments are used most wisely. Incorporate cultural competencies in all best practice activities.
• Develop a focused public education campaign using multiple venues to communicate that substance use disorders are conditions to be treated rather than punished and that economic wisdom supports treatment. Collaborate with local chambers of commerce and other employer organizations to provide substance abuse education about the benefit of treatment. Reduce stigma and denial through use of a web page, forums and public speaking presentations to employers, civic organizations, schools and the general public.

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