2008 Candidate Survey
SAMPLE SURVEY
State Associations of Addiction Services (SAAS) is a national organization representing state provider associations and community-based alcohol and drug abuse prevention and addiction treatment programs in forty-one states. The mission of SAAS is to ensure the availability and accessibility of quality drug and alcohol treatment, prevention, education, and research.
The Legal Action Center is a leading non-profit law and policy organization whose mission is to advocate for expanding effective addiction treatment, prevention, recovery supports and research, and for the elimination of discrimination against people in recovery, or still suffering from alcohol and drug dependence, as well as people with criminal records or HIV/AIDS.
As a candidate for public office, SAAS and Legal Action Center ask you to complete this Candidate Survey on issues important to the alcohol and drug treatment and prevention and criminal justice fields, as well as to individuals in recovery from addiction and individuals with criminal records.
Legal Action Center and SAAS represent providers, programs and individuals affected by these issues in all 50 states and will make the answers to this survey available to its members and on its website to inform constituents about your views.
Please note that we have provided significant background material to correspond with each question to reduce the time it will take to complete this survey and to minimize the research required to answer each question.
Thank you so much for time and consideration of this request. Please complete and return the survey by February 4, 2008 to info@lac-dc.org.
Legal Action Center & State Associations of Addiction Services
Substance Abuse Directors Association of Alaska * Arizona Council of Human Service Providers* Arkansas Association of Substance Abuse Treatment Programs * California Association of Addiction Recovery Services * California Association of Alcohol and Drug Program Executives * County Alcohol and Drug Program Administrators Association of California * Colorado Association of Alcohol and Drug Service Providers * Connecticut Association of Substance Abuse Agencies * Delaware Association of Rehabilitation Facilities * Florida Alcohol and Drug Abuse Association * Georgia Council on Substance Abuse * Illinois Alcoholism & Drug Dependence Association * Iowa Substance Abuse Program Directors’ Association * Coalition of Louisiana Prevention and Service Providers * Maine Association of Substance Abuse Programs * Maryland Addictions Director’s Council * Mental Health and Substance Abuse Corporations of Massachusetts * Michigan Association of Licensed Substance Abuse Organizations * Minnesota Association of Resources for Recovery & Chemical Health * Mississippi Association of Addiction Services * Missouri Association of Alcohol & Drug Abuse Programs * Montana Addiction Service Providers * Nebraska Association of Behavioral Health Organizations * Nevada Alliance for Addictive Disorders Advocacy, Prevention and Treatment Services * New Hampshire Alcohol and Other Drug Service Providers Association * Addiction Treatment Providers of New Jersey * Alcoholism and Substance Abuse Providers of New York State * North Carolina Association for Behavioral Health Care * North Dakota Addiction Treatment Providers Coalition * Ohio Council of Behavioral Healthcare Providers * Oklahoma Substance Abuse Services Alliance * Oregon Prevention, Recovery and Education Association * Drug and Alcohol Service Providers Organization of Pennsylvania * Drug and Alcohol Treatment Association of Rhode Island * Behavioral Health Services Association of South Carolina * South Dakota Council of Substance Abuse Providers * Tennessee Association of Alcohol, Drug & Other Addiction Services * Association of Substance Abuse Programs of Texas * Utah Behavioral Healthcare Network * Vermont Association of Drug and Alcohol Programs * Virginia Association of Drug and Alcohol Programs * Washington Association of Alcoholism and Addiction Programs
Candidate Questions:
- Do you support dramatically expanding the availability of drug and alcohol addiction prevention and treatment services in the United States?
Strongly support___ Support___ Oppose_
- Do you support an investment of $4 billion a year, phased in over five years, to help another one million Americans access drug and alcohol treatment services annually?
Strongly support___ Support___ Oppose_
- Do you support investing another $1 billion per year to build an infrastructure of proven prevention initiatives that serve youth, families, communities and schools?
Strongly support___ Support___ Oppose_
- Do you agree that any national health care reform initiatives must include meaningful coverage of drug and alcohol addiction treatment services?
Strongly agree___ Agree___ Disagree__
- Do you support the Paul Wellstone Mental Health and Addiction Equity Act, federal legislation to require group health plans offering coverage for drug and alcohol addiction and mental illness to provide those benefits in the same way as all other medical and surgical procedures covered by the plan?
Strongly support___ Support___ Oppose_
- Do you support changing the Medicaid program to: a) make alcohol and drug treatment a required service, and b) lift the IMD exclusion so that it would no longer apply to community-based residential drug and alcohol treatment services?
6a. Strongly support___ Support___ Oppose_
6b. Strongly support___ Support___ Oppose_
- Do you support expanding access to housing, education, employment and other services for people reentering the community from the criminal justice system, and the removal of discriminatory legal and policy barriers to reentry?
Strongly support___ Support___ Oppose_
- Do you support the repeal or removal of a) the ban on TANF/welfare assistance and food stamps for people with felony drug convictions, and b) the federal student financial aid ban for people with drug convictions?
8a. Strongly support___ Support___ Oppose_
8b. Strongly support___ Support___ Oppose_
- Do you support eliminating mandatory incarceration and mandatory minimum sentences for lower-level drug crimes in order to give courts flexibility in sentencing addicted individuals to alcohol and drug treatment and other successful alternatives to incarceration?
Strongly support___ Support___ Oppose_
- Do you support eliminating the disparity in sentencing for crack and powder cocaine?
Strongly support___ Support___ Oppose_
Background for Questions 1, 2, 3 and 4: Funding for alcohol and drug treatment and prevention services:
For over a decade, addiction treatment has been shown to cut alcohol and drug use in half, reduce crime by 80 percent and arrests by up to 64 percent, and has a demonstrated impact on HIV risk behaviors and incidence of HIV infection. Addiction treatment results also are sustainable -- studies have found that, one year after completion of treatment, there is a 67% reduction in weekly cocaine use, a 65% reduction in weekly heroin use, a 52% decrease in heavy alcohol use, a 61% reduction in illegal activity, and a 46% decrease in suicidal ideation. Moreover, these outcomes are generally stable for the same clients five years post treatment.1 And taxpayers
save $7 for every $1 spent on treatment and $5.60 for every $1 spent on prevention, as a result of increased productivity, and reduced health care, criminal justice, welfare and social costs. When adding the savings to healthcare, for every $1 dollar spent on addiction treatment, society benefits by more than $12.2
And despite the fact that addiction afflicts one in ten Americans and affects one of every four children, an extremely small percentage of overall health care spending is used for drug and alcohol treatment and recovery services. In 2001, of the $1.4 trillion spent on health care, it is estimated that only $18 billion was devoted to treatment of alcohol and drug addiction -- just 1.3 percent of all health care spending and a fraction of the economic and social costs of substance use and addiction, estimated in 1998 to total $328 billion. These costs include medical consequences, lost earnings linked to premature death, lost productivity, motor vehicle crashes, crime, and other social consequences. Given these expenditures, it is not surprising that in 2006 21.1 million (89%) of the 23.6 million Americans in need of alcohol and drug services did not receive any care.
Finally, millions of young people never benefit from proven prevention strategies that are successful and cost-effective -- a Washington state study of school-based prevention programs found that a number of prevention programs resulted in a $70.34 benefit for each dollar of programming
spent for each participating young person.
Background for Question 5: Parity in private insurance coverage for addiction treatment services:
Addiction is a chronic disease, like diabetes, asthma or hypertension, and paying for its treatment yields as good a return as paying for treatment for other chronic illnesses. In 2004, of the 20.3 million adults classified with substance dependence or abuse, 77.6 percent (15.7 million) were employed either full or part time. Yet the number of Americans with employer-provided insurance coverage for alcohol and drug addiction is restricted by day and visit limits, annual and lifetime expenditure limits, and cost-sharing requirements not imposed on other illnesses. These limits -- combined with the reality that alcohol and drug addiction is a chronic, relapsing condition -- mean that individuals quickly exhaust their insurance coverage for treatment.
When individuals do have benefits, many cannot obtain access to the type, level, or duration of care they need because of inappropriate managed care practices that deny that access to necessary services. Almost half (44.4 percent) of the individuals who made an effort to receive treatment but were unable to, reported that the cost and/or health insurance barriers prevented them from gaining access to treatment.
When privately insured individuals exhaust or are unable to access their benefits, they turn to the public sector for treatment, which increases costs to federal, state, and local governments. Given the lack of funding for treatment and the extent of the addiction problem, achieving parity in insurance coverage for alcohol, drug and mental health treatment is imperative.
H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, current federal legislation would provide:
- Meaningful equity with medical and surgical benefits in the provision of alcohol/drug and mental health benefits for both in- and out-of-network benefits;
- Parity for benefits for treatment of the full range of substance use disorders and mental health conditions in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV);
- The provision of medical necessity criteria and reasons for any denials of reimbursement to participants and beneficiaries upon request;
- The protection that state laws which provide better insurance and consumer protections remain in effect and are not preempted by new federal laws or policies; and
- The requirement that managed care companies make fair and medically appropriate decisions in terms of approving the types and duration of treatment covered.
Background for Question 6: Medicaid coverage of alcohol and drug treatment services
The Medicaid program finances very little drug and alcohol treatment in most states, despite the fact that it provides many other important health care services for eligible populations, including low–income women and children. Medicaid coverage for alcohol and drug treatment services is limited by two policies:
- Alcohol and drug treatment is not a required service under the Medicaid program.
Medicaid finances some drug and alcohol treatment, subject to state limits on amount, duration, and scope, but alcohol and drug treatment is not a required service under the program. Because it is an optional service, only about 25 States have opted to cover drug and alcohol treatment services under their Medicaid benefit, and the level and amount of that coverage varies widely.
- The “IMD exclusion” applies to residential drug and alcohol treatment programs.
One of the most serious roadblocks preventing individuals receiving Medicaid from obtaining residential alcohol and drug treatment has been the “Institution for Mental Diseases (IMD) exclusion.” The IMD exclusion is a statutory provision that prohibits Medicaid from paying for institutional treatment for individuals between 22 and 64 who are diagnosed with mental diseases and receiving treatment in programs with more than 16 treatment beds. While the purpose of the IMD exclusion -- to prevent Medicaid funds from going to expensive mental hospitals -- is wholly unrelated to cost-effective, community-based alcohol and drug residential programs, nonetheless the federal government has applied it to deny those programs access to Medicaid funding. For drug and alcohol treatment programs to receive Medicaid reimbursement, they must keep their residential programs at 16 beds or less.
Background for Question 7: Reentry into society of people with criminal records:
In 2002, two million people were incarcerated in federal or state prisons or in local jails.3 Nearly 650,000 people are released from state and federal prison, and many more from county jails, back into communities nationwide each year4
In the past twenty years, the federal government and many states have dramatically increased the number, range, and severity of civil penalties for people with criminal records. As a result of this increase in legal roadblocks, successful reentry into society is much more difficult for people with criminal records, many of whom are fully qualified to work and participate in society. Criminal records create barriers to reentry: over 59 million Americans - and probably many more -- have a criminal history on file with state or federal governments. This means that about 27 percent -- or more than 1 out of 4 -- of the nation's adults have a criminal record, thus making it more difficult for them to gain employment, housing and access to public benefits.5
Here are some additional facts about existing legal barriers:
- Most states allow employers to deny jobs to people who were arrested but never convicted of a crime. The majority of states have laws permitting all employers and occupational licensing agencies to ask about and consider arrests that never led to conviction in making employment decisions.
- Most states allow employers to deny jobs to anyone with a criminal record, regardless of how long ago or the individual’s work history and personal circumstances. These states lack any standards governing the relevance of conviction records of applicants for occupational licenses, such as those requiring a direct, rational or reasonable relationship between the license sought and the applicant’s criminal history to justify the agency’s denial of license.
- All but two states restrict the right to vote in some way for people with criminal convictions. Twelve states have lifetime bans on voting for some or all people convicted of crimes.
In addition to the removal of these legal and policy barriers, a strong reentry/transition process -- through which individuals are prepared for release, leave prison, return to communities, and adjust to free living -- is needed to enhance public safety.6 Ninety-seven percent of the individuals now in prison eventually will be released and will return to communities,7 often without assistance or services. Many men and women leave prison and jail with substance use disorders, chronic health issues, low levels of education and job training, and a lack of resources to help them truly reintegrate.8 Research confirms that these services – education, job training, job placement, job retention, and alcohol and drug treatment – are essential to help formerly incarcerated individuals obtain work, housing, and avoid recidivism.
Background for Question 8: Federal barriers to food stamps, public benefits, and student loans
Over the last two decades, several public benefits programs and some laws have adopted discriminatory policies that reduce or eliminate access to support for individuals with criminal records, especially records for crimes involving alcohol or drugs. Repealing this discriminatory laws and policies would increase access to these important programs and protections, and help individuals with criminal records better re-integrate into society and help those with addiction histories attain and maintain recovery and lead law-abiding and productive lives.
Two current federal bans for people with drug conviction histories are:
- The ban on Temporary Assistance for Needy Families (TANF/welfare) and food stamp benefits for individuals with drug felony convictions.
Section 115 of the 1996 welfare law, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), prohibits anyone convicted of a drug-related felony from receiving both federally-funded cash assistance through the TANF program and food stamps unless States opt out of or modify the ban. Under the ban, individuals are barred for life from obtaining cash assistance and food stamps even after completing their sentence, and overcoming an addiction. Currently, sixteen States completely deny benefits on the basis of this ban and eleven States partially deny benefits. Almost 100,000 women and nearly 150,000 children in the States that are enforcing the ban have been affected due to ineligibility for cash assistance or food stamps.
- The student financial aid ban for individuals with drug convictions.
In 1998, Congress reauthorized the Higher Education Act (HEA), which funds educational financial aid for students. During consideration of the HEA, Congress approved an amendment to the legislation that delayed or denied federal financial aid for students convicted of a drug offense. Students applying for federal financial aid are asked on the FAFSA (Free Application for Federal Student Aid) form whether they have ever been convicted of “possessing or selling illegal drugs.” If an applicant answers anything other than “no,” the applicant is required to fill out a worksheet to determine if and when the applicant will resume eligibility for federal student financial aid. It is estimated that over 128,000 students applying for federal financial aid have been denied assistance because of this provision.
In February of 2006, legislation was approved by both chambers of Congress and signed into law by the President that partially repeals this student aid provision. Public Law 109-171 partially repeals the ban on student federal financial aid for persons convicted of drug crimes so that only students who are convicted of a drug offense while they are in school and receiving federal financial assistance will be affected by the ban. However, research has shown that thousands of individuals who might be eligible for student financial aid are deterred from applying for this federal assistance because of the drug question on the FAFSA form.
In addition, although the law also provides that a student can resume eligibility for aid if that student satisfactorily completes a drug rehabilitation program, accessing treatment services can be extremely difficult. Waiting lists for these services can be up to six months long. Treatment delays can prevent students who lose financial aid eligibility from returning to school.
Background for Questions 9 and 10: Mandatory minimum sentences for lower-level drug crimes and alternatives to incarceration:
There is a clear link between crime and the use of alcohol and drugs, and drug and alcohol treatment services repeatedly have been shown to effectively reduce crime and drug use and help ensure the individual’s successful reentry into society. Many jurisdictions nationwide have implemented alternative to incarceration programs, such as drug courts, to better address the issue of drugs and crime. Eliminating mandatory incarceration and mandatory minimum sentences for lower-level drug crimes gives courts flexibility in sentencing addicted individuals to drug treatment and/or successful alternative to incarceration programs.
In addition, alternatives to incarceration that utilize mandated addiction treatment, where appropriate, would save taxpayer dollars as the cost of addictions treatment is 15 times less than the cost of incarcerating a person for a drug-related crime and would reduce recidivism. Numerous studies have demonstrated that treatment is as effective when the individual is required to participate as a condition of deferred prosecution, sentence, or other criminal justice disposition as when the individual enters treatment voluntarily. Research has shown that combining criminal justice sanctions with drug treatment is effective in decreasing drug use and related crime, and that treatment retention rates for individuals under legal coercion are higher than for others not under legal pressure.
One federal mandatory sentencing policy that is long-standing is the sentencing disparity for crack and powder cocaine. The science has demonstrated that both drugs derive from the same substance, therefore there is no scientific basis for the differing sentences for these offenses. In addition, research has shown that a mandatory minimum sentencing structure has a particularly harsh and disparate impact on communities of color and urban communities.
