Healthy People 2000 Consortium Meeting November 7, 1997

Summary of the Breakout Group Discussion Concerning Priority Area 4: Substance Abuse: Alcohol and Other Drugs

I. Structure of HP 2010

Recommendations

Use of "Achieve Health Parity" Instead of "Eliminate Health Disparities," for a more positive statement.

Removal of substance abuse from the "Promote Healthy Behaviors" goal.

Substance abuse "must be removed" from the "Promote Healthy Behaviors" goal—this association stigmatizes addiction as bad behavior; implies it's a bad choice; fails to address the stigma aspect; equates it to nutrition. One member felt prevention did fit in that area, while treatment fit in "Protect Health" or "Assure Access." Another member felt prevention and treatment should be seen as part of a single continuum and that both belonged somewhere other than "Promote Healthy Behaviors." The State agency perspective sees prevention and treatment as part of a single thing.

Revision of the Fan.

The group felt the fan is attractive and eye-catching, but they weren't satisfied with it and felt it is static. One mentioned a wagon wheel; another, a tree. After discussion, the group agreed that nearly all the enabling goals apply to nearly all the focus areas, and that the inner circle should not be fixed, as it is, but should conceptually rotate among all the focus areas, showing this broad relevance.

The group said the fan doesn't show how connected the various objectives/focus areas are. For example, substance abuse people relate to many focus areas and fields.

The family is missing from the structure and the objectives.

The net for objectives should be wide and inclusive throughout the development process; the final product, however, should be more selective.

Use cross-referencing or some way to find all the objectives on a given topic.

Do not separate tobacco from substance abuse; it's unrealistic.

II. Objectives

4.1 should be expanded to include drugged driving.

4.11 may have been met by 2000; is anabolic steroid use still an issue?

The group is dismayed by the rise in alcohol and drug testing in schools and workplaces, without availability of treatment. Testing is no substitute for treatment. Perhaps 4.13 (and 4.19?) could be revised to discourage screening without treatment.

EAPs are valuable—if confidentiality is possible. EAP offices for State of Ohio employees are not housed in the workplace, where colleagues can see people going to them, but are outside referrals. The group recommended an EAP objective. 4.14 seems related, but less specific. The group noted that HP developed in an era that preferred "user responsibility" to the EAP approach.

The group recommended adding, to 4.19's list of professionals, those who practice in schools—people like school counselors, school psychologists, school nurses....

In different States, the entities that carry out the function of 4.20's "Hospitality Resource Panels" may be different. Liquor control agencies, restaurant associations, etc., may do this.

To eliminate disparities, money, access, and culturally appropriate programs are necessities. Programs are needed for women, dually diagnosed people, and outpatients... People need not only SA treatment, but also job training, parenting training, etc.

The group noted that HP goals reflect values—possibly not always the values of the people they're about.

Educating the public about stigma is a most important need.

Binge drinking, especially on college campuses, is the subject of Ohio and New York initiatives. The group recommended that HP address binge drinking.

Inhalants are a rising problem in various States. The group recommended considering an objective on inhalants.

The group has noticed a rise in heroin use, with some young people thinking heroin use is all right as long as the drug is not injected.

The group recommended that HP address fetal alcohol syndrome, fetal alcohol effects, crack babies, and other substance exposure in infants.

The group noted the important linkages of alcohol with driving and driving without a seat belt; sex, pregnancy, date rape; violence; accidents on public transportation (trains, metros) and other unintentional injuries.... The group noted that more than half of Maine fire deaths are alcohol related. HP 2000 is silent on these links.

III. Related Issues

The group noted that the Congress may act outside HP, with its own differently developed goals, such as in the case of the Synar amendment.

Collecting trackable data under the block grant poses problems of many kinds. One is that on moving from a cost-reimbursement system to capitation, and from an eligibility requirement of 100% of poverty to one of 200% of poverty, makes the old and new data difficult to compare.

The group felt SAMHSA and HHS should support States' data collection efforts and that performance partnership ideas should be considered for HP. They felt funding and achievement of goals should NOT be linked.

People felt HP had done a good job in that States have adopted/adapted HP objectives for their own goals, that some substance use is down, that there's a synergy among the HP 2000 objectives. Lack of enough money is a major problem. Another is that for some objectives, including those for substance abuse, data and action fall under different departments and under departments other than the single State agency.

Another problem of coordination (not related to Healthy People) is that different funding streams with different requirements can make programming very difficult. The different offices must coordinate and collaborate—both within each State, and among the Federal agencies and offices that fund a given State program. When different agencies fund one project and impose different reporting and data requirements, things can become difficult.

Participants

Ann Mahony, Facilitator, Substance Abuse and Mental Health Services Administration
Dorita Sewell, Recorder, Substance Abuse and Mental Health Services Administration
Deborah Chambers, Ohio Department of Alcohol and Drug Addiction Services
Howard Greene, Salvation Army, Indiana Division
Terrence Jackson, New York State Office of Alcoholism and Substance Abuse
Phyllis Lewis, National Association of State School Nurse Consultants

Breakout Session List