Recovery Month Kit

Policymakers:  A Guide To Help State and Local Officials Make a Difference in Their Communities

Substance use disorders affect millions of people in every city and state across the country.¹ While treatment for substance use disorders is cost effective, when untreated, these disorders can have a negative impact on state resources, businesses, families, and the entire community. The actions you take as an elected or appointed official or a key staff member can have a positive effect on many issues affected by substance use disorders that you are looked upon to address. These include economic growth and stability, use of taxpayer money, and burdens on the welfare and justice systems.

TREATMENT WORKS. We should be shouting this from the highest rooftops as well as at the halls of legislatures across the country. Time and time again, research shows that for every dollar spent on addiction treatment, $7 is saved in health care and criminal justice costs. What a great investment for our elected officials to make in improving the quality of life for those they serve! Call your elected officials today and demand that they support this life-saving and fiscally prudent course of action. TREATMENT WORKS. Believe me, I know. I have worked in treatment for 29 years!

Mark Sarneso
Recovery Advocate

A substance use disorder* (See Glossary near the end of this page for definitions of bolded and starred terms) involves the dependence on, or abuse of, alcohol and/or drugs, including the nonmedical use of prescription drugs. Substance use disorders can affect people regardless of their age, race, ethnicity, class, employment status, or community.² Therefore, like other chronic physical and mental disorders, substance use disorders are medical conditions that can be treated effectively.^{3, 4}

Officials at the state and local levels can have an enormous impact on their communities’ approach to substance use disorders. More than anyone, officials need to truly understand the benefits of consistently investing in treatment*, as well as the costs to society of neglecting substance use disorders. This document will provide an overview of the prevalence of substance use disorders and the positive influence you can have on your community by helping those with substance use disorders find a path to recovery.

The Value of Investing in Treatment in Your Community

Investing in treatment for substance use disorders has many benefits to the community, and perhaps most importantly, for the person in recovery*. Research shows that substance use disorders are medical conditions that can be effectively treated, just as many illnesses are treatable.^{5, 6} A major study published in 2000 in the Journal of the American Medical Association is one of several that demonstrate the effectiveness of treatment for substance use disorders. The study found that treatments for drug use disorders are just as effective as treatments for other chronic conditions, such as high blood pressure, asthma, and diabetes.⁷

Nationwide, the total expenditure in 2001 for the treatment of substance use disorders in the United States was an estimated $18 billion, and this investment offers numerous benefits to society.⁸ Many studies show a positive return on investment when money is spent on treatment. Research suggests at least a 2:1 benefit-to-cost ratio, with other studies allowing for a return of $7 for every dollar spent on treatment.^{9, 10} Another study discovered as much as a $23 return for every dollar spent on treatment.¹¹ While the return on investment varies from state to state and program to program, evidence supports the overall positive financial gain to society when investing in the treatment of people with substance use disorders. To translate this return on investment into actual taxpayer dollars, the cost to taxpaying citizens of treating approximately 150,000 people is $209 million, while the benefits from treatment are worth about $1.5 billion in taxpayer savings.¹²

Investing in treatment can have significant effects on your region’s employment rates and the viability of employers and businesses in your community. Treatment is associated with a nearly 19-percent increase in employment and almost 11-percent decrease in the number of clients who receive welfare.¹³ Reported job problems, including incomplete work, absenteeism, tardiness, work-related injuries, mistakes, and disagreements with supervisors, are cut by an average of 75 percent among employees who have received treatment for substance use disorders.¹⁴

Businesses in your community should know that employees seeking treatment can do so without interfering with the employee’s ability to perform his or her job. Intensive outpatient programs are effective and allow workers to stay on the job, while seeking treatment outside of work.¹⁵

Recovery begins in the heart! At age 18, I left my parents home and became an alcoholic. That is how I identified myself. I made it my mission to visit alcoholics in their wooded enclaves, buy gallons of alcohol, and sit at their feet. To me, these were the most mistreated and despised people I knew. My father ingrained this spirit of empathy in me. He lugged our family of 10 up and down the East Coast to live and work among migrant laborers. To date, I have logged thousands of hours in addiction and recoveryover 30 yearsacquiring the lessons and pains necessary to achieve the strengths, hope, and faith in a power greater than myself. I am now that disaster evangelist who travels into the beaten paths of active addictions telling the story of salvation and deliverance through Jesus Christ. While I have been clean for over 3 years, I dwell not on that space in time but the spirit of redemption in my heart. I am now absolutely sure I understand what God wants me to do.

Gregory Andrew Williams
Spiritual Evangelist

As rising health care costs continue to plague the country, it also is important to recognize the potential of treatment to reduce these and other costs and improve the health of the community. In addition to reducing alcohol and/or drug use, treatment improves mental and physical health and contributes to fewer family problems. Alcohol- and drug-related medical visits decline 53 percent following treatment.¹⁶ Furthermore, families receiving addiction treatment spent $363 less per month on regular medical care than untreated families.¹⁷

Research has consistently found that people who have untreated substance use disorders typically have high rates of repeated contacts with the justice system and a greater chance of re-incarceration. However, when inmates receive treatment for a substance use disorder, re-arrest rates drop from 75 percent to 27 percent.¹⁸

While the monetary savings to taxpayers and the conservation of state resources are important, perhaps the biggest reward is that people with substance use disorders who receive treatment and begin a path of recovery can enjoy life as productive, self-reliant, taxpaying citizens; responsible parents; and contributing members of their communities.¹⁹

The Cost of Not Investing in Treatment

Despite the positive outcomes that states could receive from encouraging the treatment of substance use disorders, the cost of treatment continues to hinder access for many of those in need. Combined data from 2004 and 2005 state that among people who needed treatment for a substance use disorder, didn’t receive it at a specialty facility*, and felt they needed it, 35 percent said they did not receive it because of cost or insurance barriers.²⁰

Substance use disorders present cost burdens to Americans in every state, city, town, and neighborhood. State governments spent $81.3 billion in 1998 on substance use disorders, most of which is dedicated to the consequences of untreated substance use disorders. This amounts to more than 13 cents of every state budget dollar. Substance use disorders are among the largest costs in state budgets, although their impact is hidden in departments and activities that might not directly be associated with substance use disorders, such as education or Medicaid.²¹

The financial costs of substance use disorders fall on the citizens of every community. In 1998, each American paid $277 in state taxes to address the burden of substance use disorders in their social programs, and only $10 per year for prevention and treatment. Furthermore, of every dollar states spend on substance use disorders:

• The vast majority, 95.8 cents, goes to pay for the burden of substance use disorders on public programs, such as the justice system, elementary and secondary schools, Medicaid, child welfare, juvenile justice system, and mental health system.
• Only 3.7 cents goes to fund prevention, treatment, and research programs aimed at reducing the incidence and consequences of substance use disorders.
• Half a cent covers the cost of collecting alcohol and tobacco taxes and regulating alcohol and tobacco products.²²

Businesses also pay the price. One of the largest components of the cost of substance use disorders is the loss of productivity and its impact on businesses. In 2002, drug use disorders alone contributed to a loss of productivity* amounting to $128.6 billion.²³ Alcohol dependence alone is estimated to cause 500 million lost workdays annually.²⁴

Health care costs increase for people with substance use disorders and contribute to our nation’s ongoing struggle with rising costs in the health care system. States spent $15.2 billion (or 2.4 percent of spending) on health costs relating to not treating or preventing substance use disorders.²⁵ Problem drinkers average four times as many days in the hospital as nondrinkers, mostly due to drinking-related injuries. Moreover, there are substantial health care costs for people who do not have substance use disorders, but are harmed by the behavior of those who do, such as motor vehicle accidents.²⁶

Among the most costly consequences to states are the justice system costs that stem from substance use disorders. States spent $30.7 billion in 1998 on the effects of substance use disorders on the justice system, including incarceration, probation, parole, and criminal and family court costs involving people charged with substance use offenses.²⁷

States also incur costs associated with the many unheard victims of substance use disorders. In 2001, more than 6 million children lived with at least one parent who abused or was dependent on alcohol and/or illicit drugs during the past year.²⁸ Of the $7.6 billion that states spent on child welfare in 1998, at least $5.3 billion (or 70 percent) is linked directly to substance use disorders.²⁹ States also reported spending approximately two and a half times more responding to the problems of substance use disorders in children and families than they do for all prevention, treatment, and research.³⁰

In addition to the financial costs, people with substance use disorders and those close to them can suffer personal costs. Families with parents who have an alcohol and/or drug dependence experience a multitude of other social problems, including a higher risk of having children who misuse alcohol and/or drugs themselves. Children from these families are also more likely to have problems with delinquency, school performance, and emotional development, such as aggressive behavior and instances of hyperactivity.^{31, 32} But state and local governments hold the key to recovery. They can allocate resources to decrease the effect of substance use disorders’ financial hardship on individuals, families, and the community.³³

How to Help Your Community

States can reduce their costs linked to substance use disorders by adopting strategies to prevent and eliminate—not just manage—the consequences of untreated addiction.³⁴ Taxpayers shoulder less of the cost if states require treatment for those who use state-funded programs, such as prisons, probation, parole, welfare, juvenile justice, education, mental health programs, and child welfare.³⁵ Through legislation, investment, and communication, states can help reduce the cost burden on their citizens, while simultaneously improving the morale of communities.

Implement Legislative Tactics

Research shows that mandatory treatment is as effective as voluntary treatment. In fact, a recent study found that people who complete court-ordered treatment have similar rates of success as those who enter treatment voluntarily, ultimately reducing the rate of re-arrests and improving employment and abstinence rates.^{36, 37}

In addition, when incentives and sanctions are offered to families, employers, or the criminal justice system, treatment entry, retention rates, and successful drug treatment interventions can significantly increase.³⁸ States can use legislative tactics to ensure that people with substance use disorders get the treatment they need. Tactics that state legislators can use to help establish solid policies to address substance use disorders include:

• Allocating funds to programs that support the state’s strategy to prevent, reduce, and treat substance use disorders
• Establishing drug courts or supporting those in existence
• Working with elected or appointed officials or other people in the community who are in recovery or who have been affected by substance use disorders to demonstrate that treatment is effective and recovery is possible
• Ensuring that fellow officials understand the true costs and consequences of substance use disorders and participate in the development of standards for treatment
• Establishing substance use committees or caucuses to track performance and provide accountability and oversight of public programs³⁹

Since 1989, growth in the Washington State prison population has far outpaced growth in the state’s total population. Much of this increase is attributed to a staggering growth in people incarcerated for drug offenses. In 2002, the state passed a law that offers nonviolent drug offenders the choice of completing treatment or facing conviction and a prison term, and reduces sentences for certain offenses involving drug manufacture, delivery, or possession. The law also states that those who fail treatment automatically must serve time and converts any resulting prison savings into funds for treatment. In the first ten months under the law, the judicially supervised treatment of more than 2,100 people was either partially or fully funded by money from prison savings.⁴⁰

Develop Advisory Boards and Collaborative Structures

Elected officials can work in tandem with community leaders and people in recovery to educate other state leaders through a state advisory board. This board should include a network of local coalitions and recovery organizations that have the resources and responsibility for monitoring and reporting local problems and progress, and provide guidance and insight into substance use disorders, treatment, and recovery. To underscore the importance of this advisory board, chairs and members should be appointed by high-ranking elected or appointed officials and other stakeholders.⁴¹

Additionally, policymakers can address the fact that states continue to segregate health care, substance use, mental health, and other social service groups into separate agencies. Substance use disorders and their consequences overlap into many of these arenas, and agencies should collaborate to focus on people with multiple needs. To thoroughly address substance use disorders, states should collaborate with:

• The justice system, through diversion programs or drug courts
• Juvenile programs, to offer treatment to youths with substance use disorders
• Child welfare services, to provide assistance to the children and family members who are often the unheard victims of the effects of substance use disorders
• Mental health agencies, to offer well-rounded care to those who need treatment for co-occurring substance use and mental health disorders⁴²

A statute authorizing Ohio’s Department of Alcohol and Drug Addiction Services specifies that it must coordinate the alcohol and other drug services offered by state departments, the justice system, law enforcement, the legislature, local programs, and treatment and prevention professionals. By having this type of legislative authority, the department is better able to coordinate among diverse groups.⁴³

Partners for Recovery, an initiative of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT), engages individuals and organizations across the country, building on input from and serving as a resource to all who are working to improve the quality of treatment and recovery support services. Partners for Recovery also supports and provides technical resources to those who deliver services for the prevention and treatment of substance use and mental health disorders and seeks to improve services and systems of care. For more information about Partners for Recovery, visit http://pfr.samhsa.gov/.

Implement Drug Courts

Through drug courts, state and local governments can help the justice system improve people’s access to treatment. Drug courts represent the coordinated efforts of the judiciary, prosecution, defense bar, probation, law enforcement, mental health, social service, and treatment communities to actively intervene and break the cycle of dependence on alcohol and/or drugs.⁴⁴ They also have proven to be particularly successful in lowering recidivism rates.⁴⁵ There are more than 1,600 planned or existing drug courts in the United States that provide job/skill training, family and group counseling, and other resources that help individuals and their families cope.^{46, 47}

Juvenile drug courts are intensive treatment programs established within and supervised by juvenile courts to provide specialized services for eligible drug-involved youth and their families. They provide intensive and continuous judicial supervision for youth involved in substance use cases, as well as offer coordinated and supervised delivery of the combination of support services necessary, including substance use and mental health treatment, primary care, familial issues, and education.⁴⁸

Oklahoma drug court graduates are two times less likely to return to prison than people on probation and four times less likely to return to prison than released inmates. The cost of this program is $5,000 per person per year, compared to spending $16,000 per person per year for prison costs. Additionally, an evaluation of four Boston drug courts found that graduates of the drug courts are 33 percent less likely to be arrested, have 47 percent fewer convictions, and are 70 percent less likely to be incarcerated.⁴⁹

The memory of my last drink is still vivid. I was attending a class reunion and was handed a glass of beer before I could say no. I raised the glass to my lips and I let it flow. It was like a knee-jerk reaction, but I wanted to escape the momentI had just seen my ex-girlfriend with her new fianc. I have the disease of alcoholism, and getting drunk isnt going to solve anything. Ultimately, I ended a 22-year drinking history that had started when I was 12. Putting down the bottle was a whole lot easier than adjusting to all the changes that came with that decision. Drinking was a part of who we were; it bound our lives together. Every major and minor event was intrinsically linked to alcohol. Giving up the booze meant giving up my identity. It meant letting go of friends, changing the places I went, withstanding the jeers, and developing a new lifestyle I knew nothing about. Those early struggles paved the way to a rewarding and satisfying life. Through education and support, I was able to construct a lifestyle that produced tangible results. I have a great wife, a career I enjoy, and I am involved in my community.

Tom McHale
Recovery Advocate

The National Association of Drug Court Professionals and the National Drug Court Institute promote and advocate for the establishment and funding of drug courts. For more information, contact 703-575-9400 or visit their Web sites at www.nadcp.org and www.ndci.org, respectively.

For more policy suggestions and methods to improve treatment for substance use disorders, please consult the Blueprint for the States, which outlines the findings and recommendations of a national policy panel commissioned by Join Together. This report can be found at www.jointogether.org/aboutus/ourpublications/.

Make a Difference During Recovery Month and Beyond

Whether you are a policymaker, staffer, or aide, you can work toward making a difference in your local area. This September, National Alcohol and Drug Addiction Recovery Month (Recovery Month) will be celebrated by hundreds of organizations and communities around the country to highlight the value of investing in treatment for substance use disorders. As part of Recovery Month 2007’s theme, “Join the Voices for Recovery: Saving Lives, Saving Dollars,” take the following steps as a part of your state or local government:

1. Issue a proclamation. Using the sample proclamation provided in this toolkit and on www.recoverymonth.gov, issue a proclamation recognizing September as Recovery Month and calling attention to some critical drug- and alcohol-related issues that most affect your constituents, such as cost and access to treatment. Use the proclamation as a first step in a new direction to help those in need receive treatment.
2. Plan a public policy forum. Seek out policy experts in the field of substance use disorders and treatment to hold a forum or community roundtable to learn from successful policy initiatives in other cities and/or states.
3. Bridge the gap. Encourage dialogue between all public institutions that are impacted by substance use disorders, such as health agencies, the justice system, and child welfare groups. This will encourage appropriate progress and plans of action and ensure continuous conversation between groups that pay for the ramifications of substance use disorders.
4. Share your experience. If you or someone you know are in recovery, share your experiences with your colleagues and, if you are comfortable doing so, the media, during Recovery Month. Speaking out will help bring attention to the value of investing in treatment in your state, and may even help some of your constituents onto a path of recovery.
5. Set goals. State and local officials should set targets for reducing the impact of substance use disorders on their constituents and budgets. To help get people into treatment and reduce the cost to society, teachers, health care workers, social services, and justice staff should be trained to implement initial screening for substance use disorders, so that they know how and when to intervene effectively and early.

For more resources and organizations that can help policymakers and state groups, please consult the “State and Local Resources” section in the “Additional Resources” document in this planning toolkit, or visit the Recovery Month Web site at www.recoverymonth.gov. For additional Recovery Month materials, visit www.recoverymonth.gov or call 1-800-662-HELP.

Glossary

Much has been written about substance abuse, dependence, and addiction; many studies have used different terminology to explain their findings. To foster a greater understanding and avoid perpetuating any stigma associated with these conditions, the phrase “substance use disorders” is used as an umbrella term to encompass these concepts.

Below you will find extensive definitions of substance use disorders, other terms that are highlighted throughout this document, and additional concepts that you may find useful. Unless otherwise noted, more detailed definitions and criteria can be found in the 2005 National Survey on Drug Use and Health: National Findings at www.oas.samhsa.gov/nsduh.htm.

Substance use disorders – Substance use disorders involve the dependence on or abuse of alcohol and/or drugs. Dependence on and abuse of alcohol and illicit drugs, which include the nonmedical use of prescription drugs, are defined using the American Psychiatric Association’s criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). Dependence indicates a more severe substance problem than abuse; individuals are classified with abuse of a certain substance only if they are not dependent on it.⁵⁰

Treatment – Treatment is a path of recovery that can involve many interventions and attempts at abstinence. It is offered in different settings, and types of treatment greatly depend on the substances misused, as well as a person’s individual needs and characteristics. Treatment is offered in residential and outpatient programs and can include counseling or other behavioral therapy, family therapy, medication, or a combination of services.^{51, 52, 53} For more information, please refer to “A Guide To Treatment: Methods To Help People With Substance Use Disorders” in this planning toolkit.

Recovery – Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. Individuals from the recovery community and treatment-related service providers developed this definition through the National Summit on Recovery process sponsored by the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT).

Specialty facility – Specialty facilities include alcohol or drug rehabilitation facilities (inpatient or outpatient), hospitals (inpatient services only), and mental health centers.⁵⁴

Loss of productivity – This is a loss that represents work in the labor market and household production that was never performed, but could reasonably be expected to be performed if it were not for drug misuse.⁵⁵

SOURCES