Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to present the 1998 budget request for the Substance Abuse and
Mental Health Services Administration. Our request for $2.205 billion for
1998 is an increase of $34.4 million or 1.5 percent over the comparable 1997
enacted level of $2.172 billion. I think you will find in developing our budget
we have taken into consideration the evolving role of the Federal government,
emerging public health trends, fiscal responsibility and the need for SAMHSA
to focus on results and program performance - an area I know you have great
interest in.
Our programs touch the lives of some of our Nation's most vulnerable
populations and have a tremendous impact on the Nation's service systems.
For example early findings from SAMHSA's Access to Community Care and
Effective Services and Supports (ACCESS) program show that homeless people
with mental illnesses who received services through this program had
significant improvements in almost all outcome measures. After the first 12
months, ACCESS clients showed a 66% decrease in minor criminal activity, a
52% decrease in total days of drug use, a 46% decrease in reported psychotic
symptoms, a 36% increase in the number of days worked, and a 74% reduction
in the actual number of days of homelessness. Preliminary findings also show
that clients in integrated systems have better housing outcomes than those in
less integrated systems.
Just last fall, we released the preliminary findings of the National
Treatment Improvement Evaluation Study which was a five-year study on the
impact of drug and alcohol treatment on 5,388 clients treated in substance
abuse treatment programs funded by SAMHSA. In a comparison of behaviors
a year before and a year after drug abuse treatment, the rate of respondents
reporting marijuana use declined 50 percent, cocaine use declined 55 percent,
crack use declined 51 percent, and heroin use declined 46 percent. The study
also noted large reductions in criminal behavior - the rate of respondents
selling drugs and committing violent crime declined by 78 percent. The study
noted a 19 percent increase in the rate of employment and a 42 percent drop in
the rate of respondents who were homeless. I must add, these are results from
our most under served and vulnerable populations whose drug problems tend
to be more severe and who have few social supports to help in their recovery.
When it is done right, we know addiction treatment and mental health
services are effective, they improve lives and save resources across a broad
spectrum of public sector programs. However, almost half of the 3.5 million
people in serious need, do not receive treatment for drug dependence. And, it
is a national tragedy that two-thirds of young people in need of mental health
services are not receiving help. Without help, these problems can lead to
school failure, alcohol and other drug use, family discord, violence, crime and
even suicide.
To help improve services to children SAMHSA has launched our
Starting Early-Starting Smart collaborative effort. I say collaborative because
beginning this year SAMHSA is collaborating with The Casey Family
Program and the Department of Education to develop new knowledge,
demonstrate what works, and create collaborative community-based
partnerships that will sustain improved health and health care services for
children from birth to age 7 and their families or care givers. SAMHSA
initiated the Starting Early-Starting Smart program because so many social and
economic factors impact children's mental health and their potential for
substance abuse. This interagency collaboration will bring all the available
resources to bear on providing coordinated, quality services for children and
their care givers. I clearly see this collaboration as just the beginning of a
much needed effort to improve the lives of children and ultimately as our first
offence in preventing drug use.
National social trends are without question undermining our efforts to
prevent drug use, especially among youth. Reducing drug abuse in the country
is going to require a long-term commitment of leadership, new ideas, and
resources. And our past work has shown we cannot focus on just one drug
alone. Each new generation of youth needs to be immunized against all forms
of substance abuse - from methamphetamine to marijuana and from alcohol to
tobacco. And, today's social trends make this generation of youth even more
vulnerable. The proponents of legalization are better organized than ever
before, kids report drugs are easily obtained, and the perception of harm of
drug use is on the decline among youth. And for the first time ever, we're
facing a generation of youth, many of whose well-educated parents tried
marijuana in their own youth, without any perceived negative consequences.
This single factor makes the problem unique and very difficult, because these
parents don't know how to tell their own children not to use marijuana, or don't
think it's that bad that their kids use marijuana. Given these trends, it is of little
wonder that young Americans are abusing drugs at rapidly increasing rates.
The good news is that public and private sector investments in science-based research have developed substance abuse prevention strategies that
directly counteract some or all of these national social trends. In short,
prevention strategies have been developed that work. Successful programs are
comprehensive and take advantage of key opportunities to provide youth, early
on in life, with positive messages, role models and opportunities to learn and
achieve. A number of programs have employed these principles and have
shown positive long-term effects. For example Project Star, developed by the
University of Southern California, demonstrated that students who began the
program in junior high and whose results were measured in their senior year of
high school, showed approximately 30 percent less use of marijuana, about 25
percent less use of cigarettes, and about 20 percent less use of alcohol than
children in schools that did not receive the program. The most important factor
found to have affected drug use among the students in this program was
increased perceptions of their friends' intolerance of drug use. Obviously,
parents and other caring adults, peers, schools and other youth-serving
institutions, and the media play influential roles in reducing youth substance
abuse. And, Federal, State and local governments can help by fostering a
supportive environment and providing parents with the tools they need through
legislation and strategic investments.
In 1997, SAMHSA initiated a new approach toward youth substance
abuse prevention that takes advantage of the unique role the Federal
government can play in this nationwide problem. In FY 98 we are proposing
to expand on this years work and increase SAMHSA's support to $98 million
in order to build a sustained initiative. Our strategies include mobilizing and
leveraging Federal and State resources, raising awareness and countering pro-use messages, and measuring outcomes. Approximately $63 million will be
dedicated to State Incentive Grants and to developing a regional approach to
providing "state of the art" prevention knowledge and technical assistance for
implementing effective programs. The State Incentive Grants call upon
Governors to develop comprehensive State-wide strategies that identify and
take advantage of all available funding streams dedicated to reducing youth
substance abuse. States may propose their own programs but they will be
offered a menu of effective substance abuse prevention strategies and programs
that are based on scientific research. SAMHSA will focus public education
efforts on reaching youth and their care givers by integrating and expanding
our on-going - Girl Power! and Reality Check - anti drug use campaigns and
by coordinating our efforts with the Office of National Drug Control Policy.
To measure outcomes SAMHSA is dedicating approximately $28 million to
develop State level estimates using SAMHSA's National Household Survey on
Drug Abuse. The Household Survey now provides data for making national
estimates on the prevalence of substance abuse in the population age 12 years
and older as well as information on behavior, attitudes, and household
environment. The new investment will enable us to make State-level estimates
on these same measures with a focus on youth 12 to 17 and 18 to 25. These
State estimates will give Governors and others information about where efforts
are succeeding and where improvement is needed.
Clearly, there is a need for continuous Federal leadership in these and
other areas of substance abuse prevention, addiction treatment and mental
health services. As a long-term partner with States and counties, communities
and employers, consumers and families, and health professionals, SAMHSA is
well positioned to meet these challenges and continue to push the field
forward.
In particular, SAMHSA's new Knowledge Development and
Application program is designed to ask and develop answers to critical
questions of immediate concern to providers and policy makers, and to ensure
that what is learned is used to improve services at the community level. This
process includes six phases that begins with problem identification. As each
phase is completed it "rolls" into the next, ending ultimately with adoption of
improved policies or techniques in State systems, community services and
individual practice.
SAMHSA intends to devote more than half of the new 1998
Knowledge Development and Application funds to working with States and
counties, communities and employers, consumers and families and health
professionals to ensure that new and current knowledge is actually used in
ways that improve services and save money. The 1998 budget request
proposes $137 million to fund new competitive Knowledge Application grants.
I can assure the Committee that these funds represent an outstanding
investment, which will lead to documentable improvements in the Nation's
health care system.
Another method available for implementing new findings is
SAMHSA's block grant programs. The FY 98 budget requests a $10 million
increase in the Substance Abuse Prevention and Treatment Block Grants, for a
total of $1.320 billion. Our request continues the Community Mental Health
Services Block Grant at the FY 97 level, $275 million. In addition, our 1998
request proposes to modify these block grants into Performance Partnership
Block Grants. Our proposal will increase States flexibility, ultimately allowing
States to set their own priorities for expenditures and management of grant
funds. In exchange, States will accept greater accountability for producing
results. We are already working with some States through pilot projects to
identify performance measures, develop data reporting systems and establish a
sound basis for outcome oriented, Federal-State partnerships.
Mr. Chairman, we are committed to continuous improvement in the
way SAMHSA does business to ensure that our efforts continue to have a
positive impact on the Nation's prevention and treatment systems. Over the
years, our work has demonstrated that substance abuse prevention, addiction
treatment and mental health services can be highly effective. Yet, just like
interventions for heart disease, cancer, and diabetes, these services can and
must be improved. SAMHSA's Knowledge Development and Application
program is the Federal tool specifically designed to make progress and
improve services in our Nation's communities. This is SAMHSA's unique
Federal role.
I am both optimistic and enthusiastic about what the future holds for
our ability to address some of the Nation's most costly and devastating
problems. It is clear that each new generation of American youth will present
us with new challenges; each new scientific breakthrough will provide us new
options; and each new option will need to be translated to every day, real-life
practice if we are to improve the quality and availability of prevention, early
intervention, treatment and rehabilitation services for substance abuse and
mental illnesses, including co-occurring disorders.
The directions we have outlined for SAMHSA's future positions the
Agency to best meet the challenges. We cannot accomplish this alone, Mr.
Chairman; we will continue to seek the advice and assistance of the Committee
as we improve our programs and our effectiveness as an organization.
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to present the 1998 budget request for the Substance Abuse and
Mental Health Services Administration. We will be pleased to answer any
questions you may have.