Federal Drug and Alcohol Policy Recommendations

Memorandum

Date:
January 14, 2009

To: Karen Richardson, Obama Administration Transition Team

From: Becky Vaughn (Executive Director of the State Associations of Addiction Services) and Gabrielle de la Gueronniere (Director for National Policy at the Legal Action Center)

Subject: Federal Drug and Alcohol Policy Recommendations

Thanks to you and your colleagues for taking the time to meet with all of us yesterday to discuss national drug and alcohol policy. We all felt it was a very good discussion and look forward to working with each of you as the transition moves forward. We really appreciate your willingness to consider our recommendations to the transition team, which are highlighted below.

By way of background, the State Associations of Addiction Services (SAAS) is the leading national organization that advocates on behalf of state associations of addiction prevention, treatment, and recovery providers. We represent thousands of providers in 42 states around the country. The Legal Action Center (LAC) is a non-profit law and policy organization whose sole mission is to fight discrimination against people with histories of addiction, HIV/AIDS, and criminal records, and to advocate for sound public policies in these areas.

Attached are three publications we hope will be helpful to you and the rest of the transition team. These documents, which include our detailed recommendations on improving policies for people with drug and alcohol addiction histories, are:

  • “Health Policy Reform: A Roadmap for Smarter and More Effective National and State Drug and Alcohol Policies,” which contains our recommendations to expand the health responses to drug and alcohol addiction, and to eliminate policies that discriminate against people in recovery from addiction and those with criminal histories.
  • “Statement by the State Associations of Addiction Services and Legal Action Center on Underage Drinking,” which details our unequivocal opposition to lowering the drinking age and our support for an informed dialogue about the harmful and lasting consequences of underage drinking.
  • “Stopping the Revolving Prison Door: An Addiction Treatment Toolkit to Prevent Drug Use and Crime, Promote Successful Reentry into Society, and Save Lives,” which explains the relationship between untreated addiction and crime, and the need to expand access to addiction treatment services for people in the criminal justice system.

In addition, below we have highlighted five of our top policy recommendations for the Department of Health and Human Services transition team:

  1. Ensure that the individuals selected for key drug policy leadership positions in the Obama Administration are committed to expanding the health responses to drug and alcohol addiction.
    Addiction to alcohol and other drugs is a chronic health condition that can be effectively prevented and treated.
    We ask that the individuals who are selected to shape our nation’s drug policy, including those chosen to lead the Office of National Drug Control Policy (ONDCP) and the Substance Abuse and Mental Health Services Administration (SAMHSA), be committed to changing our nation’s drug policies to expand the health responses to addiction through an increased investment in drug and alcohol prevention, treatment and recovery services, and research.
  2. Ensure that any national healthcare reform proposals include equitable and adequate drug and alcohol addiction treatment and recovery support requirements, and promote prevention, early intervention, recovery, and research. Alcohol and other drug addiction is a preventable and treatable chronic disease – just like cancer, diabetes, and heart disease. Adequate funding for addiction treatment yields results and returns similar or greater to the treatment of other chronic diseases. Research shows that a healthcare approach is the most effective means to reduce drug and alcohol addiction and the damaging consequences of untreated addiction. By expanding and improving the health response to addiction, healthcare reform can save tens of thousands of lives and billions of dollars in decreased crime, increased employment and improved health, while strengthening families and communities across the country.
  3. Encourage full funding of drug and alcohol prevention, treatment, and recovery services, and research. Alcohol and drug prevention, treatment, recovery and research programs in the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Education (DOE), and the National Institutes of Health (NIH) must be fully funded to provide desperately needed services in communities across the country. This includes funding the following programs at the highest possible levels:
    • SAMHSA’s Substance Abuse Prevention and Treatment (SAPT) Block Grant program, the foundation of the publicly supported prevention and treatment system in this country, which serves two million people annually andaccounts for approximately 42 percent of public funds spent at the State and local level on substance abuse prevention activities and addiction treatment services.
    • SAMHSA’s Center for Substance Abuse Treatment (CSAT), which supports effective treatment through the adoption of evidence-based practice, and supports services that are tailored to address specific and emerging drug epidemics and/or underserved populations.
    • SAMHSA’s Center for Substance Abuse Prevention (CSAP),which, through its Strategic Prevention Framework, helps communities to promote youth development, reduce risk-taking behaviors, build assets and resilience, and prevent problem behaviors across the life span.
    • DOE’s Safe and Drug Free Schools and Communities State Grants program, the backbone of school-based prevention efforts in the United States, which serves over 37 million youth annually and supports community-based prevention programming throughout this country.
    • NIH’s National Institute on Drug Abuse (NIDA), whose research has made extraordinary scientific advances in understanding the nature of addiction, such as those made through the use of imaging technologies and the development of new treatment technologies and medications.
    • NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), whose research has expanded knowledge about how to best prevent and treat addiction to alcohol, which is the third leading cause of preventable death in the United States.
  4. Expand access to drug and alcohol treatment services by removing limitations in the Medicaid program. While financing very little drug and alcohol treatment in most States, Medicaid provides other important healthcare services for low-income parents, children and adolescents, and pregnant women. However, Medicaid coverage for alcohol and drug treatment services is unnecessarily limited and should be enhanced by:
    • Making alcohol and drug treatment a required, not optional, service under the Medicaid program. Because it is an optional service for States, 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. Making drug treatment a required service under Medicaid would establish a more stable source of funding for treatment that is not discretionary and subject to the annual appropriations process. Such stability would increase access to treatment for low-income individuals and families who presently rely on limited Substance Abuse Prevention and Treatment Block Grant dollars and scarce discretionary funds to support treatment services.
    • Lifting the “IMD exclusion” for 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 intent 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, the federal government has nonetheless applied it to deny those programs access to Medicaid funding. Excluding residential drug and alcohol treatment programs from the definition of Institutions for Mental Diseases under the Medicaid program would eliminate a significant barrier to funding for critical residential programs that treat both individuals and families.
  5. Support removing discriminatory legal and policy barriers for people in recovery. People in recovery or still suffering from addiction encounter widespread discrimination based on their addiction history. Discrimination in education, public benefits, housing, employment, and other areas not only impedes recovery, but because of the manner in which many laws are written also has a disproportionate impact on communities of color.
    We ask that the incoming Obama Administration works to:
    • Lift barriers to educational assistance. 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. In February of 2006, the President signed a law that partially repealed this ban 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. Education should be encouraged as an effective means of supporting an individual’s recovery, reducing recidivism and promoting successful reentry, not discouraged. We ask that this ban be repealed completely and that the drug conviction question on the FAFSA financial aid form be removed.
    • Repeal the ban on TANF/Welfare assistance to people with certain drug offenses. Section 115 of the Personal Responsibility and Work Opportunity Reconciliation Act (the welfare reform law) 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. Although a number of States have opted out or modified this ban, millions of women and children are still unable to secure necessary food stamps and cash assistance due to the federal ban.
    • Lift restrictions on obtaining a driver’s license for people with certain drug convictions. Federal law (Department of Transportation and Related Agencies Appropriation Act (P.L. 102-388)) requires states to revoke or suspend the driver’s licenses of anyone convicted of a violation of the Controlled Substance Act or any drug offense. States can “opt out” of this requirement by certifying that it has a statement by the Governor opposing enactment or enforcement of the law and a resolution by the State legislature expressing opposition to such a law. Ten states passed resolutions in opposition to the Act, however, many states modified their laws to allow for restrictive licenses. However, this legislation created another opportunity for people with addiction histories to suffer an additional collateral consequence of their conviction. The drug offense ban causes an additional hardship on individuals with these records, particularly on those living in rural and other areas with limited public transportation.

Again, thank you for taking the time to consider our recommendations to improve policies for people with drug and alcohol addiction histories. SAAS and the Legal Action Center are eager to continue working with you and the transition team during this exciting time, and are happy to serve as a resource as the team moves forward. Please do not hesitate to contact us if you have any questions or would like additional information.

Becky Vaughn (bvaughn@saasnet.org)
Executive Director
State Associations of Addiction Services

Gabrielle de la Gueronniere, JD (gdelagueronniere@lac-dc.org)
Director for National Policy
Legal Action Center/National HIRE Network