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DOCUMENT RESUME ED 272 807 CG 019 290 AUTHOR Butynski, William; And Others TITLE State Resources and Services for Alcohol and Drug Abuse Problems. Fiscal Year 1985. INSTITUTION National Association of State Alcohol and Drug Abuse Directors, Inc. SPONS AGENCY National Inst. on Alcohol Abuse and Alcoholism (DIIIIS), Rockville, Md.; National Inst. on Drug Abuse (DHNS/PHS), Rockville, Md. PUB DATE Jul 86 CONTRACT DIMS -ADN-271 -84 -7314 NOTE 139p. PUB TYPE Reports - Research/Technical (143) EDRS PRICE MF01/PC06 Plus Postage. DESCRIPTORS Alcoholism; *Drinking; *Drug Abuse; *Intervention; Needs Assessment; *Prevention; *State Action; *State Programs IDENTIFIERS *Alcohol Abuse ABSTRACT This report presents and analyzes the results of the State Alcohol and Drug Abuse Profile data for the states' 1985 fiscal year (FY). Included is information from the 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands. Highlights, an executive summary, an introduction, and a section on the study purpose and methodology are included. The section on funding examines financial expenditures by state and funding source sad by type of program activity. The section on client admissions to alcohol and drug treatment services describes client admissions to alcohol treatments, admission to drug abuse treatments, and comparisons of client admissions data for FY 1984 and FY 1985. The next two sections concern the availability of treatment-related data by state and the top three policy issues from a state alcohol and drug agency perspective: (1) prevention and education services; (2) services for children and adolescents; and (3) public and private health insurance issues. A section on major unmet needs in FY 1985 examines the areas of youth and women, other special populations, detoxification services, and staff positions and salaries. The final section identifies significant changes in alcohol and/or drug prevention and treatment services in FY 1985 and in the areas of changes in financial resources, intoxicated driver legislation and services, prevention programs and services, changes in services for women, client and drug use trends, and other significant developments. Appendices include a glossary of terms, and state narrative reports on major unmet needs and on significant changes in services during FY 1985. Twenty-three statistical exhibits are included. (NW *********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. *********************************************************************** STATE RESOURCES For ALCOHOL AND DRUG Fiscal Year Coc, AND SERVICES ABUSE PROBLEMS 1985 A Report for the National Institute on Alcohol Abuse and Alcoholism and the National institute on Drug Abuse U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement E orCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received from the person or organization originating it 0 Minor changes have been made to Improve reproduction quality. Points of %ow or opinions slated In this docu ment do r,cit necessarily represent official OE RI position or policy U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration 2 BEST COPY AVAILABLE ACKNOWLEDGEMENTS The data contained in this report was compiled from alcohol and drug abuse agencies in all 50 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands along with other information on which the document is based. The names of State Alcohol and Drug Abuse Directors and SADAP contact persons who participated voluntarily in the information- gathering process are listed on the inside cover. A number of staff persons from both the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) also served as reviewers, and provided comments on various drafts of the report. Patricia G. Reed, Program Analyst, Division of Biometry and Epidemio- logy, NIAAA, and Ann Blanken, Chief of the Survey Management and Reports Section of the Epidemiologic Research Branch, NIDA, served as co-project officers and coordinated all of the statistical data appearing in the report. They also provided the overall technical review of materials submitted by the National Association of State Alcohol and Drug Abuse Directors, Inc. under contract No. ADM 271-84-7314. Statements appearing in the report do not necessarily reflect the official position of NIAAA or NIDA or any other part of the U.S. Department of Health and Human Services. Printed July 1986. All material appearing in the report is in the public domain and may be reproduced or copied without permission from the Institutes. Citation of the source is appreciated. STATE RESOURCES AND SERVICES For ALCOHOL AND DRUG ABUSE PROBLEMS Fiscal Year 1985 An Analysis of State Alcohol and Drug Abuse Profile Data by William Butynskl, Ph.D. Nancy Record Jo Lynn Yates National Association of State Alcohol and Drug Abuse Directors, Inc. A Report for the National institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse U.S. DEPARTMENT OF HEAETH AND HUMAN SERVICES Pub Ilc Health Servlce Alcohol, Drug Abuse, and Mental Health AdmInIstratIon 5600 Flshers Lane Rocky Ille, Maryland 20857 4 qpinpriqtlimpuipimpIPIPP1111014 woriwillii/R91111i i!iiiiVi$9111111111 I! wily,1,01002010 g " meng911111119191111191wirmillippal TABLE OF CONTENTS HIGHLIGHTS EXECUTIVE SUMMARY I. INTRODUCTION II. STUDY PURPOSE AND METHODOLOGY III. FUNDING OF ALCOHOL AND DRUG SERVICES Page vii ix 1 4 6 1. Financial Expenditures by State and Funding Source 6 2. Financial Expenditures by Type of Program Activity 10 3. Total Number and Percent of Treatment Units Which 10 Received Funds Administered by the State Alcohol/ Drug Agency in FY 1985 IV. CLIENT ADMISSIONS TO ALCOHOL AND DRUG TREATMENT SERVICES 15 1. Client Admissions to Treatment Services for 16 Alcohol Abuse and Alcoholism a. Client admissions data by environment and type of care 16 b. Client admissions data by sex, age and race/ ethnicity 18 c. Availabiiity of client admissions data within treatment units that do not receive any State 23 Alcohol Agency funds 2. Client Admissions to Treatment Services for Drug 23 Abuse mnd Addiction a. Client admissions data by environment and modality 26 b. Client admissions data by sex, age and race/ ethnicity 26 c. Client admissions data by primary drug of abuse 35 d. Availability of client admissions data within treatment units that do not receive any State 35 Drug Agency funds 3. Comparisons of Client Admissions Data for FY 1984 and FY 1985 39 a. Comparisons of alcohol client admissions data 39 b. Comparisons of drug client admissions data 42 V. AVAILABILITY OF TREATMENT RELATED DATA BY STATE 45 6 Page VI. TOP THREE POLICY ISSUES FROM A STATE ALCOHOL AND DRUG 47 AGENCY PERSPECTIVE VII. MAJOR NEEDS FOR WHICH RESOURCES WERE NOT ADEQUATE IN 49 FISCAL YEAR 1985 1. Youth and Women 50 2. Other Special Populations 51 3. Detoxification Services 51 4. Staff Positions and Salaries 52 VIII. SIGNIFICANT CHANGES IN ALCOHOL AND/OR DRUG PREVENTION 53 AND TREATMENT SERVICES IN FISCAL YEAR 1985 1. Changes in Financial Resources 53 2. Intoxicated Driver Legislation and Services 55 3. Prevention Programs and Services 57 4. Changes in Services for Women 60 5. Client and Drug Use Trends 62 6. Other Significant Developments 63 APPENDICES A. STATE ALCOHOL AND DRUG ABUSE PROFILE COVER LETTER, A-1 INFORMATION COLLECTION FORMAT AND GLOSSARY OF TERMS B. STATE-BY-STATE POPULATION, PER CAPITA INCOME, POPULA- B-1 TION DENSITY AND REVENUE FIGURES C. STATE NARRATIVE REPORTS ON MAJOR UNMET NEEDS C-1 D. STATE NARRATIVE REPORTS OF SIGNIFICANT CHANGES IN SER- D-1 VICES DURING FISCAL YEAR 1985 iv LIST OF EXHIBITS EXHI1IT PAGE I. Expenditures for State Supported Alcohol and Drug Abuse Services By State and By Funding Source for Fiscal Year 1985 II. Expenditures for State Supported Alcohol and Drug Abuse Services By State and By Type of Program Activity in Fiscal Year 1985 8 11 III. Number of Alcohol and/or Drug Treatment Units Which 12 Received Funds Administered by the State Alcohol/Drug Agency for FY 1985 IV. Estimate of Percent of Total Alcohol and/or Drug 14 Treatment Units in the State that Received Any Funds Administered by the State Alcohol/Drug Agency in FY 1985 V. Number of Alcohol Client Treatment Admissions By 17 Type of Environment, Type of Care and State for Fiscal Year 1985 VI. Number of Alcohol Client Treatment Admissions By Sex 19 and State for Fiscal Year 1985 VII. Number of Alcohol Client Treatment Admissions By Age 20 and State for Fiscal Year 1985 VIII. Number of Alcohol Client Treatment Admissions By Age, 21 Sex ane State for Fiscal Year 1985 IX. Number of Alcohol Client Treatment Admissions By Race/ 24 Ethnicity and State for Fiscal Year 1985 X. Information Availability and Source for Alcohol Related 25 Client Admissions Within Treatment Units That Do Not Receive Any State Alcohol Agency Funds XI. Number of Drug Client Treatment Admissions By Type 27 of Environment, Type of Modality and State for Fiscal Year 1985 XII. Number of Drug Client Treatment Admissions By Sex and 30 State for Fiscal Year 1985 XIII. Number of Drug Client Treatment Admissions By Age and 31 State for Fiscal Year 1985 XIV. Number of Drug Client Treatment Admissions By Age, Sex 32 and State for Fiscal Year 1985 XV. Number of Drug Client Treatment Admissions By Race/ 34 Ethnicity and State for Fiscal Year 1985 8 PAGE XVI. Number of Drug Client Treatment Admissions In State 36 Supported Facilities By Primary Drug of Abuse and State for Fiscal Year 1985 XVII. Information Availability and Source for Drug Abuse 38 Related Client Admissions Within Treatment Units That Do Not Receive Any State Drug Agency Funds XVIII. Comparison of Number of Alcohol Client Treatment 40 Admissions By State for Fiscal Years 1984 and 1985 XIX. Comparison of Number of Alcohol Client Treatment 41 Admissions By Type of Care and Treatment Environment for Fiscal Years 1984 and 1985 XX. Comparison of Number of Drug Client Treatment 43 Admissions By State for Fiscal Years 1984 and 1985 XXI. Comparison of Number of Drug Client Treatment 44 Admissions By Primary Drug of Abuse for Fiscal Years 1984 and 1985 XXII. Availability of Treatment Outcome and Cost Data by 46 State XXIII. Top Three Policy Issues as Reported By State Alcohol 48 and Drug Agencies HIGHLIGHTS The State Alcohol and Drug Abuse Agencies voluntarily submit a broad spectrum of fiscal, client and other service data on an annual basis to the National Association of State Alcohol and Drug Abuse Directors, Inc. (NASADAD). These data are submitted via the State Alcohol and Drug Abuse Profile (SADAP) data collection effort. With financial support from the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), NASADAD staff have prepared a detailed analysis of these data. Recently, NASADAD analyzed Fiscal Year (FY) 1985 data reported by the States. Selected comparisons were also made with the client data previously submitted for FY 1984. The financial and client data provided by the State Alcohol and Drug Abuse Agencies apply to only those units and programs "which received at least some funds administered by the State Alcohol/Drug Agency". All fifty States, the District of Columbia, Guam, Puerto Rico and the Vizgin Islands participated in the FY 1985 State Alcohol and Drug Abuse Profile (SADAP). Highlights from the FY 1985 SADAP study indicate that: o Expenditures for alcohol and drug abuse treatment and prevention services totaled over $1.3 billion. o Of the total expenditures, States prolyided $718.4 million or 52.7 percent, while Federal sources provided $262.3 million or 19.3 percent, county or local sources contributed $89.3 million or 6.5 percent and other sources (e.g., private health insurance, court fines, client fees or assessments for treatment imposed on intoxicated drivers) contributed $294.6 nillion or 21.6 percent. o Approximately 78.2 percent of the total monies were expended for treatment services, 11.8 percent for prevention services and 9.9 percent for other activities (e.g., training, research, administration). o A total of 5,901 alcohol and/or drug units received funds administered by Alcohol and Drug Abuse Agencies in FY the total units, 2,376 were identified units, 1,410 as drug units and 2 identified as combined alcohol/drug units. treatment the State 1985. Of as alcohol 1115 were treatment o The tota] alcohol client treatment admissions reported by 48 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands were vii 10 over 1.1 million; over 76 percent of the client admissions were to non-hospital treatment units; alcohol client admissions were 79 percent male, 30.9 percent between the ages of 25 - 34 and 71.3 percent White, 16.1 percent Black and 5.5 percent Hispanic. o A total of 46 States, the District of Columbia, Guam, and Puerto Rico reported total drug client admissions of 305,360. Also, 76.2 percent of the client admissions were for outpatient services, 69 percent were male, 11.1 percent under the age of 18, 61.3 percent White, 24.4 percent Black and 11.5 percent Hispanic. o Total alcohol client treatment admissions increased by six percent from FY 1984 to 1985; total drug client admissions increased by 5.6 percent from FY 1984 to 1985. o Heroin was identified in overall reporting as the primary drug of abuse. However, in 26 States, Guam and the Virgin Islands, cocaine and/or marijuana mentions exceeded heroin mentions. The number of cocaine rentions increased by 48.5 percent from last year. o In response to a request for the top three policy issues, States identified prevention and education, services for children and adolescents and public and private health insurance issues. o Forty-nine States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands indicated that major needs were identified through their most recent State planning process for which there were insufficient resources to meet those needs. States identified a need for an increase in funding for services, as well as specific needs for increased services to youth and women, expansion of detoxification services and an increase in program staff positions and salaries. o Significant changes in services that occurred during FY 1985 and were reported by the States related to an increase or decrease in a State's financial resources, the impact of new Stai.e legislation on the service delivery system, prevention program efforts and changes in drug use trends. viii 11 EXECUTIVE SUMMARY In September, 1984 the National Institute on Drug Abuse (NIDA), with support from the National. Institute on Alcohol Abuse and Alcoholism (NIAAA), entered into a three year contractual relationship with the National Association of State Alcohol and Drug Abuse Directors, Inc. (NASADAD) to ensure the continued availability and analysis of data from the States. The contract provides support for the analysis of data voluntarily submitted by the States from existing sources of information on alcohol and drug abuse funding and services. This cooperative Federal-State effort responds to recent Congressional mandates and ensures that the Institutes and the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) have the information necessary to exercise a strong national leadership role with regard to alcohol and drug abuse program needs and services. In the first year of the State Alcohol and Drug Abuse Profile (SADAP) data contract all 50 States, the District of Columbia and Puerto Rico provided at least some information on alcohol and drug abuse resources and services in their States for Fiscal Year (FY) 1984. The information provided was analyzed and a comprehensive report was developed based on that information. With the cooperation of both Federal and State officials, the SADAP data collection format and process have been continually refined and improved. As part of the current report, new data are provided for FY 1985 and appropriate comparisons are presented among States and over time. This report presents and analyzes the results of the State Alcohol and Drug Abuse Profile (SADAP) data for the States' 1985 Fiscal Year (FY). All 50 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands cooperated and contributed information on resources, services and needs related to alcohol and drug abuse problems within their States. The remaining information is categorized into the following six areas: funding levols and sources; client admission characteristics; availability of other treatment related data; top policy issues; major unmet needs; and significant changes in treatment and/or prevention services. Funding Levels and Sources The total reported expenditures within 50 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands for alcohol and drug services in those programs receiving at least some State administered funds during the State's 1985 Fiscal Year (FY) were over $1.3 billion. This total includes $659.1 million (48.3 percent) from State Alcohol and Drug Agency sources, $59.4 million (4.4 percent) ix 1 2 from other State agency sources, $237.0 million (17.4 percent) from the Alcohol, Drug Abuse and Mental Health Servics (ADMS) Block Grant, $25.4 million (1.9 percent) from other Federal government sources, $89.3 million (6.5 peront) from county or local agency sources, and $294.6 million (21.6 percent) from othtr sources (e.g., reimbursements from private health insurance, client fees, court fines or assessments for treatment imposed on intoxicated drivers). See Figure I which follows. It should be emphasized that the data provided do not include information on those programs that did not receive any funding from the State Alcohol and Drug Agencies in FY 1985. These programs would include most, if not all, private for-profit programs; some private not-for-profit programs; some county and local government programs; and most Federal government programs such as the Veterans' Administration. Therefore, the overall fiscal data contained in this report are conservative in nature, and, to some degree, underestimate funding expenditures by other departments of State and Federal government and by private, non-State agency supported acohol and drug abuse treatment and prevention programs. Although the specific levels of fiscal support contributed by ditf.2rent sources vary considerably among the States, the single largest source of funding during FY 1985 for alcohol and drug services was State revenues. In 37 States and Puerto Rico, State Alcohol and Drug Agency monies constituted the largest source of funding, while in two States and the District of Columbia, other State revenues were the largest source of support. The ADMS Block Grant was the largest revenue source in six States, Guam and the Virgin Islands.. Among the remaining five States, other Federal sources constituted the largest source of funds in one State and in four states the largest revenue source was provided by other sources. None of the State Agencies reported county and local monies as the largest revenue source during FY 1985. Approximately 78.2 percent of the funds were expended for treatment services, 11.8 percent for prevention services and 9.9 percent for other activities (e.g., training, research, administration). The State Agencies identified a total of 5,901 alcohol and/or drug treatment units to which they provided at least some funding in FY 1985. In terms of treatment orientation 2,115 of the units provided combined alcohol/drug treatment services, while 2,376 focused on alcoholism services and 1,410 concentrated on drug dependency services. Because major changes were instituted in the FY 1985 SADAP data collection methodology for funding resources, detailed comparisons of FY 1985 expenditures reported by States in this year's SADAP data with SADAP data collected 13 A _21kA A PJ_)4 kk c AIL 4;ll °ALA; II I I is S III . ; ' D ' ; in previous years are not appropriate. However, it is believed that this year's change will ensure the accuracy, precision and completeness of the data and will establish a foundation for future fiscal year comparisons. Client Admission Characteristics The total alcohol client treatment admissions reported by 48 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands exceeded 1.1 million (1,159,588), including 846,081 client admissions to non-hospital treatment units. Hospitals were used by over 42 percent of those clients who required detoxification services. Nearly 73 percent of client admissions for rehabilitation/residential services were to non-hospital facilities. Nearly 95 percent of client admissions to outpatient services were also to non-hospital facilities. In 49 States, the District of Columbia, Guam and Puerto Rico which reported admissions data by sex, over 79 percent of the alcohol client admissions were male. Other alcohol client admissions characteristics in terms of age were as follows: 3.3 percent under age 18; 4.4 percent 18-20; 10.7 percent 21-24; 30.9 percent 25-34; 24.2 percent 35-44; 14.8 percent 45-54; 7.1 percent 55-64; 2.4 percent age 65 and over; with 2.2 percent not reported. In terms of race/ethnicity, alcohol client admissions were as follows: 71.3 percent White, not of Hispanic origin; 16.1 percent Black, not of Hispanic origin; 5.5 percent Hispanic; .2 percent Asian or Pacific Islander; 3.7 percent American Indian or Alaskan Native; .2 percent Other; and 3.1 percent not reported. The total drug client treatment admissions reported by 46 State Agencies, the District of Columbia, Guam and Puerto Rico were 305,360. With regard to 274,861 drug client admissions that could be categorized by environment 46 agencies reported 12,586 admissions to hospitals, 52,925 to residential facilities and 209,350 to outpatient environments. In terms of treatment modality, 41,973 client admissions were for detoxification, 38,460 were for maintenance and 195,187 for drug-free types of treatment services. Of 46 States, the District of Columbia, Guam and Puerto Rico which reported admissions data by sex, 69 percent of the drug client admissions were male. Other drug client admissions characteristics in terms of age were as follows: 11.1 percent under age 18; 9.8 percent 18-20; 17.1 percent 21-24; 43.2 percent 25-34; 14.3 percent 35-44; 2.6 percent 45-54; .8 percent 55-64; .3 percent age 65 and over; and .8 percent not reported. In terms of race/ethnicity, drug client admissions were as follows: 61.3 percent White, not of Hispanic origin; 24.4 percent Black, not of Hispanic origin; 11.5 percent Hispanic; .4 percent Asian or Pacific Islander; 1.0 percent American Indian or Alaskan Native; .6 percent Other; and .8 percent not reported. xii 15 Heroin mentions constituted a large portion of drug client admissions by drug of choice in overall reporting of such information from 39 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands. However, in 26 States, Guam and the Virgin Islands, cocaine and/or marijuana mentions exceeded heroin mentions. Selected comparisons were made between 1984 and 1985 alcohol and drug client SADAP data. The alcohol client treatment admissions data provided by 44 States, the District of Columbia and Puerto Rico for both years revealed a six perccnt rise in those admissions. Forty States, the District of Columbia and Puerto Rico were able to provide information on drug client treatment admissions in both years. Comparisons of those data show an increase of nearly 5.6 percent. Comparisons of drug client admissions over the two years by primary drug of abuse revealed a 69.8 percent increase in the "Other" drug category. A 48.5 percent increase in the cocaine category was also reported. Availability of Other Treatment Related Data In order to determine the availability of treatment related data, the State Alcohol and Drug Agencies were asked whether any data are available on treatment outcome and/or the average costs of treatment by modality. Thirty State Agencies responded that treatment outcome data are available within their States. Forty-one State Agencies indicated the availability of information on the average costs of treatment by modality. Top Policy Issues Fifty States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands identified policy questions and issues currently being considered at the State level. The most frequently mentioned policy issues fell into five categories: prevention and education (19 States); services for children and adolescents (17 States); public and private health insurance issues (14 States); maintenance and measurement of quality control, treatment effectiveness and efficiency (13 States); and the pursuit of alternative sources of funding for treatment and prevention services (11 States). Major Unmet Needs Forty-nine States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands indicated that major needs were identified through their most recent State planning process for which resources were not adequate to meet those needs. Most States submitted narrative responses describing these unmet needs. In addition to the need for a general increase in funds to support treatment 16 and prevention services, the States indicated other specific needs including increased services to youth, women, as well as a variety of special population groups including ethnic minorities: the dual handicapped, intravenous drug abusers diagnosed as having AIDS, indigent persons, individuals in the criminal justice system, the homeless, chronic alcoholics and public inebriates. In addition, many States identified the need to expand detoxification services, increase program staff positions and raise salaries. Significant Changes in Treatment and/or Prevention Services The State Alcohol and Drug Agencies were also asked to provide a narrative description of any significant changes in services that occurred during FY 1985 and the reasons for such changes. A total of 43 States, the District of Columbia, Guam and the Virgin Islands submitted narrative information in response to this request. The scope of the narrative comments related to either increases or decreases in funding support for treatment services, new program initiatives, intoxicated driver legislation and services, prevention programs and services, changes in services for women, and client and drug use trends. xiv ; =. 17 I. INTRODUCTION Alcohol and drug abuse and dependency constitute major public health problems for the nation. During 1983, the most recent year for which cost data are available, the economic costs of these problems totaled over $176 billion. 1/ These enormous problems must be addressed at all levels of government. At a Federal level, the Alcohol, Drug Abuse and Mental Health Administration (ADANHA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) have been authorized to provide national leadership on alcohol and drug issues. A major portion of this responsibility focuses on the task of monitoring various indicators of alcohol and drug abuse, including information on treatment and prevention services and funding resources. At a State level, the State Alcohol and Drug Agencies have administrative responsibility for the allocation and effective utilization of Federal and State revenues specifically targeted for alcohol and drug treatment and prevention services. In order to effectively and efficiently carry out these tasks, each State Agency collects relevant information on needs, services and resources. This information assists the States in their ongoing planning, monitoring and service delivery functions. Prior to 1982 NIAAA and NIDA were the repository for significant amounts of detailed information from States and programs on alcohol and drug treatment and prevention services and clients. These data were often reported v) the Federal level by the States and/or individual programs as a condition of receipt of the Federal alcohol and drug formula and project grant funds. However, when the Alcohol, Drug Abuse and Mental Health Services (ADM8) Block Grant was authorized by Public Law 97-35 in 1981, the requirement for the provision of detailed data from the States and programs was eliminated. As a result of this action a number of different national data reporting systems that had been developed by NIAAA and NIDA were terminated. Nevertheless, the continued importance and need for some national data on alcohol and drug treatment and prevention programs, services and clients was recognized. The Senate Committee on Labor and Human Resources included language in its report on the Alcohol and Drug Abuse Amendments of 1983 which refers to data oollection as "an important national leadership responsibility of the 1/ Economic Costs to Society of Alcohol, Drug Abuse and Mental Illness: 1980. Harwood, Henrick; et.al., Research Triangle Institute. 1 18 Institutes". The Committee specifically encJuraged the Institutes to acquire "alcoholism and drug program data from information systems in each State". The Congress eventually directed the Secretary of. the Department of Health and Human Services, through the Administrator of ADAMHA to: "conduct data collection activities with respect to such programs, including data collection activities concerning the types of alcoholism, alcohol abuse, drug abuse and mental health treatment and prevention activities conducted under such part, the number and types of individuals receiving services under such programs and activities, and the sources of funding (other than funding provided under such part) for such programs and activities". (Section 1920)(42 U.S.C. 300 x) In order to meet the Congressional mandates for continuing data collection activities and to be able to respond knowledgeably to questions regarding the availability of prevention, intervention and treatment resources to deal with alcohol and drug abuse, the Federal government has sought to maintain minimal data which are accurate and updated on a regular basis. Since NASADAD has an established ongoing relationship with all of the State Alcohol and Drug Abuse Agencies, it constitutes the single best source of such data. NASADAD has demonstrated its capability to effectively and efficiently gather, analyze and present uniform information on alcohol and drug abuse treatment and prevention resources and clients from the States. The States' willingness to provide NASADAD with information on alcohol and drug treatment and prevention services, resources and clients is evidenced by the successful outcome of previous contract efforts which included State data from Fiscal Years 1983 and 1984. State-by-State data on funding levels and services, client characteristics and program changes has been collected, analyzed and presented. In addition, data were compiled on State prevention activities, intoxicated driver projects and employee assistance programs. On September 18, 1984, NIDA and NIAAA again entered into a contractual relationship with NASADAD to continue support of a cooperative Federal/State national data strategy (Contract No. ADM 271-84-7314). As a key part of this contract, NASADAD is working with both the Institutes and the States to assess, define and voluntarily provide information on alcohol and drug abuse services, programs, resources, and needs. The data being collected and analyzed by NASADAD are already in existence at the State level. The major tasks being performed by NASADAD are the 2 19 definition and collection of information in a uniform format from its members, the analysis of the data submitted by each State, the development of meaningful comparisons of data across States and over time, and the provision of a comprehensive report on the findings. 3 20 II. STUDY PURPOSE AND METHODOLOGY The overall purpose of this study is to ensure the continued availability of selected service and resource information from already existing State sources throughout the United States and its Territories. The specific data elements include, but are not limited to, financial, program, and client data that States are willing to voluntarily submit to assist NIDA and NIAAA in assessing the type of treatment and prevention resources and services provided to drug and alcohol abusers throughout the country. The major study objectives are: o To provide continued support for the implementation of a joint Federal/State national data strategy, e.g., through collaboration on the State Alcohol and Drug Abuse Profile (SADAP) and the National Alcoholism and Drug Abuse Program Inventory. State representatives are involved by providing consultation, in examining options and developing recommendations for appropriate ohs:wits in the scope and content of existing and future efforts to acquire data from the States on a voluntary basis. o To annually collect secondary data from the States relating to alcohol and drug abuse services, clients and resources. o To automate the editing, storage and analysis of data acquired from the States in prior and current Fiscal Years. o To aggregate and analyze the data that are voluntarily submitted by each State, including the development of bcth within and across State comparisons and anallies. The overall study methodology was defined within a performance plan comprised of four major tasks and related sub-tasks, including the design of data acquisition and analysis plans; development of support materials and procedures; implementation of data acquisition and analysis; and the preparation of numerous project reports. Subsequent to the conduct of a meeting in May, 1985 with State and Institute representatives to solicit input and recommendations for the 1985 SADAP form, NASADAD staff developed all necessary support materials. Data collection procedures were implemented in October, 1985 when those support materials were distributed to the State Alcohol and Drug Agency Directors. Attached as Appendix A is a copy of the cover letter, information collection format, and 4 21 glossary of terms that were sent out to each State Alcohol and Drug Agency Director. This material was followed by written communications to States reminding them of the importance of voluntarily submitting the data. Telephone.., calls also were made to Directors who had not submitted information within the requested time frame. The Directors of the State Alcohol = Drug Agencies from 50 States, the District of Columbia, Juam, Puerto Rico and the Virgin Islands voluntarily submitted information in response to the request from NASADAD. The data received are summarized and analyzed within the remaining sections of this report. Each State Director was provided a draft copy of the report tables to review and verify the accuracy of all data submitted from his/her State. In. FUND/NG OF NLCONOL AND DRUG SERVICES In Octobel, 1985 each State Alcohol and Drug (A/D) Agency was asked to provide data on total expenditures for alcohol and drug services by source of funding and type of program activity within the State for Fiscal Year (FY) 1985. Fifty States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands responded positively to this request. Before presenting and analyzing the findings, it is important to note that, as with any data, these data, have a number of inherent limitations. They should not be utilized without an appreciation of the qualifications that apply to them. One major qualification is that the States were asked to report total expenditures for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". The data presented, therefore, do not include information on those programs that do not receive any funding from the State A/D Agency (e.g., most, if not all, private for-profit programs; some private not-for-profit programs; and some public programs). As a result, the overall fiscal estimates contained herein are conservative in nature and, to varying degrees, underestimate funding expenditures by other departments of State government, by Federal agoncies such as the Veterans' Administration and by private, non-State agency supported alcoholism and drug abuse treatment and prevention programs. The financial and related data collected from States are organized within three major subsections: o Financial Expenditures by State and Funding Source; o Financial Expenditures by Type of Program Activity; and o Total Number and Percent of Treatment Units Which Received Funds Administered by the State Alcohol/Drug Agency in FY 1985. Information on each of these areas follows. 1. Financial ExPenditures by State and Funding Source This subsection provides information on expenditures for alcohol and drug services within each State during that State's 1985 Fiscal Year. It should be noted that only two States (Alabama and Michigan), the District of Columbia, Guam and the Virgin Islands have Fiscal Years directly comparable to the Federal Government (October 1 to September 30), while 46 States and Puerto Rico have Fiscal Years from July 1 to June 30, one State (New York) has a Fiscal Year from April 1 to March 31 and one State (Texas) has a Fiscal Year from September 1 to August 31. The data are categorized and 6 23 presented on both a State-by-State basis and by funding source, including State Alcohol and Drug Agency monies, other State monies, the alcohol and drug portion of the Alcohol, Drug Abuse and Mental Health Services (ADMS) Block Grant, other Federal monies, county and local funds and monies from other sources. Also, total expenditures are reported for each of the 50 States, District of Columbia, Guam, Puerto Rico and the Virgin Islands and for each funding source. See Exhibit I which follows. The total monies expended within all 50 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands for alcohol and drug services in those programs receiving at least some State administered funds during each State's 1985 FY were $1,364,765,441. This total includes $659.1 million (48.3 percent) from State A/D Agency sources, $59.4 million (4.4 percent) from other State agency sources, $237.0 million (17.4 percent) from the ADMS Block Grant, $25.4 million (1.9 percent) from otner Federal government sources, $89.3 million (6.5 percent) from county or local agency sources, and $294.6 million (21.6 percent) from other sources (e.g., reimbursements from private health insurance, client fees, court fines or assessments for treatment imposed on intoxicated drivers). Caution needs to be exercised in the utilization and interpretation of these data. As noted earlier, the data include information only on those programs "which received at least some funds administered by the State A/D Agency during Fiscal Year 1985". Also, in some States complete information is not available on all funding sources even for State A/D Agency supported programs. In most instances where such information is not presented the amount of such funding, if any, is probably minimal. However, since in some instances such funding may be substantial, the percents presented in Exhibit I should be used only as gross estimates of the overall level of funding from various sources. It is likely that the "Other State", "Other Federal", "County or Local" and "Other Sources" categories actually contribute more monies and higher percents than the figures indicate. The specific levels of fiscal support contributed by different sources vary considerably among the States. It is clear, however, that for all States combined and for most States individually the single largest source of funding during FY 1985 for alcohol and drug services was State revenues. In 37 States and Puerto Rico, State A/D Agency funds constituted the single largest source of funding, while in two States and . the District of Columbia other State revenues were the largest source of support. The ADMS Block Grant was the largest revenue source in six States, Guam and the Virgin Islands. Among the remaining five States, other Federal sources was the largest source of funding in one State and other sources of monies provided the most funds in four States. None of the State Agencies reported county and local monies as the largest revenue source during FY 1985. 7 24 EXHIBIT I EXPENDITURES FOR STATE SUPPORTED ALCOHOL AND DRUB ABUSE SERVICES SY STATE AND SY FUNDING SOURCE FOR FISCAL YEAR 1985 STATE OTHER ALCOHOL/ OTHER COUNTY &comma STATE DRUG ABUSE FEDERAL OR LOCAL STATE DRUG ASINCY AGENCY BLOC( GRANT GOVERNMENT AGENCIES eewewlemewa.wesewwwww........ OTHER SOURCES GRAND TOTAL Alabama 1,854,694 0 3,768,355 292,744 N/A N/A 5,915,793 Alaska 14,000,700 1,504,400 0 4,006,763 0 19,511,863 Arisona 9,636,203 N/A 3,793,471 0 N/A 6,788,446 20,218,120 AB Arkansas 19785,517 0 2,111,218 1,179,584 0 327,223 5,403,542 California 75,516,000 435,004 30,547,000 3,531,000 24.033,952 67,567,768 201,933,720 Colorado 4,476,302 1,100,000 3,083,967 0 0 2,558,953 16,219,222 Connecticut 7,192,697 0 4,488,451 2,639,323 0 12,767,264 27,087,735 Delaware 2,444,977 0 1,311,925 0 0 0 3,756,902 District of Col 181,067 16,847,010 1,861,600 0 0 0 18,897,677 Florida 25,786,532 1,493,724 15,511,138 100,041 0 0 42,891,735 Cleorgia 19,092,515 0 2,091,268 0 598,881 2,015,078 23,797,742 Sudo N/A 0 206,092 0 0 0 206,092 A Hawaii 1,339,908 N/A 996,579 36,393 35,225 1,265,019 3,673,124 Idaho 1,795'504 N/A 1,027,071 N/A N/A N/A 2,822,875 Illinois 39,773,570 20,680 7,562,566 0 0 0 47,356,016 Indiana 3,143,592 4,772,872' 2,934,313 21292,680 397,950 4,142,284 17,683,691 Iowa 81464,993 458,670 2,342,473 171,794 1,107,429 35,694 12,281,053 .Kansas 3,175,100 1,445,400 1,469,500 177,000 1,500,000 635,000 8,402,000 Kentucky 967,733 3,325,479 2,546,8011 6,550 1,054,371 0 7,900,941 Louisiana 8,659,523 962 3,937,715 216,739 0 0 12,514,939 Maine 4,025,510 266,000 1,316,304 120,000 480,000 2,425,000 8,632,514 Maryland 21,802,397 N/A 2,950,416 1,062,583 1,247,220 1,087,381 28,149,997 Massachusetta 28,894,667 N/A 6,440,634 . 0 N/A 599,000 35,934,301 Michigan 25,360,748 1,225,000 10,727,884 1,609,796 6,856,306 19,766,141 65,545,875 Minneoeta Miesiesipps 2,333,500 2,661,222 N/A 0 2,665,500 1,098,003 10,500 3,077,075 N/A N/A N/A N/A 5,009,500 6,526,300 AlS444114 6,975,116 0 3,583,769 S40,453 N/A N/A 11,402,338 Montana Nebraska 207,920 3,941,659 1,938,141 0 1,095,187 1,057,490 415,005 0 1,483,350 475,198 2,917,470 709,320 8,060,073 6,153,667 Nevada New Hampshire Nee Jersey 1,446,229 1,029,960 12,204,000 0 0 1,000 2,198,309 1,305,230 9,1704000 0 0 932,000 147,163 0 N/A 2,760,389 0 N/A 6,552,090 2,335,190 22,307,000 New Mexico 9,9111,236 492,300 2,252,950 844,800 0 N/A 13,571,286 Nee York Werth Carolina 136,3299671 2,813,657 704,199 NiA 28,345,055 3,709,862 1,425,901 0 21,448,538 N/A 121,115,117 N/A 309,368,481 C 6,523,519 Werth Dakota 1,017,000 N/A 615,000 N/A N/A 145,000 1,777,000 Ohio 11,273,958 7,881,975 5,635,656 1,389,557 1,525,906 5,253,715 35,960,797 OklahomM 4,054,743 0 1,868,325 0 N/A N/A 5,923,068 Oregon 7,063,378 N/A 3,547,557 304,295 N/A N/A 10,915,230 Pennsylvania 26,902,000 5,272,000 11,546,000 94,000 3,526,000 15,367,000 65,712,000 Puerto Rice 13,426,84, 0 4,076,575 214,720 0 0 17,7.8,444 Rhod Island 5,399,841 0 1,892,243 0 0 0 7,292,084 South Carolina 4,008,065 0 1,891,965 159,572 3,857,694 2,565,000 12,512,296 !Guth Daketa 589,367 295,220 919,298 558,051 6281715 1,025,065 4,015,716 Tennessee 4,933,742 N/A 2,705,434 434,307 244,496 1,782,821 10,100,500 Tomas 59736,367 . 53,539 10,416,354 0 4,196,855 0 20,433,115 Utah 5,534,653 825,304 1,948,541 354,843 2,041,112 2,224,607 12,929,062 Vermont 2,159,067 0 1,322,052 50,572 0 246,450 3,778,941 Virgin Islands 216,559 0 375,000 0 0 0 591,589 Virginia 12,180,45V N/A 4,326,036 N/A 5,845,554 4,675,024 27,027,873 Washington 16,418,630 535,248 4,249,712 462,438 646,311 6,532,186 28,844,525 West Virginia 2,094,977 1,843,680 1,220,531 0 256,417 2,031,976 7,447,581 Wisconsin 39,134,736 5,142,100 4,054,516 0 1,109,626 3,283,576 52,724,554 A Wyoming 2,939,536 0 loswemeow....wwwwwweemewsmemeweemewe. 344,566 N/A 598,351 N/A 3,882,453 .TOTALS 6599050,208 59,408,503 236,969,764 25,372,616 89,349,383 294,614,967 1,364,765,441 mommimminsommsommilmomm 48.3% PERCENT OF TOTAL 4.4% 17.4% 1.9% 6.5% 21.6% 100.0% A Figures represent.allecated funds rather than expenditures. Other Sources Category includes County or Local funds; further breakout not available. C Other State.Agentegory includes alcohol monies only; data on drug monies from this_fundiftlietIrCe is.not available. N/A Cautionary Notes In number 414 States complete information is not available on all funding sources for Stat supported programs. In most instances where such information is not presented the amount of uch .fundingi If any, is probably minimal. However, since in some instances such funding may be substantial, the percents presented at the bottom of this table should be used only as gross estimates of the overall levels of funding from various sources. It is likely that the "Other S tate", "Other Federal", "County or Local" and "Other Sources" categorise actually contribute more monies and higher percentages than the figures shown. State Alcohol and Drug Abuse Profile, FY 1'45; data are included for "only those programs which rece4vsd at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". Sources 8 25 Included as Appendix :3 of this report are State-by-State population, per capita income, population density and State revenue figures to aid in further analyses and interpretations of the financial data. Population data are for Fiscal Year 1985, the population density dcta are for Calendar Year 1983, the per capita income data are for Calendar Year 1984 and the State revenues reflect each State's FY 1984. More recent information was not available for all States. Detailed comparisons of financial expenditures reported by States in this year's State Alcohol and Drug Abuse Profile (SADAP) data with SADAP da'za collected in previous years for FYs 1982, 1983 and 1984 are not appropriate. Such comparisons would be misleading since there have continued to be changes instituted in the specific wording of questions related to States' fiscal resources. In previous years, States were asked to "estimate" their current year's fiscal allocations while they were still in the middle of the fiscal year. Thus the State could only provide estimates of dollar allocations for all alcohol and drug services within their States. Last year, two major refinements were made to the data collection effort: States were asked to report actual allocations for their most recently completed fiscal year (FY 1984) and to provide fiscal information for "only those programs which received at least some funds administered by the State alcohol/drug agency during Fiscal Year 1984". This year a third lefinement was added: States were asked to report actual total "expenditures" for FY 1935 rather than allocations. For purposes of a general comparison, however, it can be reported that the total dollars expended in FY 1985 for alcohol and drug abuse services in those programs which received at least some State A/D Agency monies in the 50 States, District of Columbia and Puerto Rico which also responded to the FY 1984 survey were $1,364,765,441. In FY 1984 the total monies allocated by those same 52 State A/D Agencies were $1,323,748,793. It should be emphasized, however, that total monies "allocated" in a particular fiscal year are not the same as total monies "expended" in that fiscal year. Therefore, such direct comparisons are not statistically valid. For example, one State allocated approximately $25 million more for prevention activities than it expended in FY 1985. This change could easily be misconstrued as a reduction in support for prevention when, in actuality, it is merely a reflection of the change in the reporting format. It is anticipated that the changes in methodology that have continued to be instituted will help to ensure the accuracy, precision and completeness of the data that are provided. Also, a firm base has now been established for comparing FY 1985 data with data collected in future years. 9 2R 2. Financial Expenditures by TYpe of Program Activity Within this subsection information is provided on the amount of monies expended during FY 1985 for different types of alcohol and drug program activities. Data are presented on a State-by-State basis for three program activities including treatment, prevention, and other. Total expenditures are reported for each State and for each program activity category. See Exhibit II which follows. As noted previously, the total monies expended within the 50 States, District of Columbia, Guam, Puerto Rico and the Virgin Islands during FY 1985 in those programs which received at least some State A/D Agency funds were $1,364,765,441. Of this amount, 54 State Agencies were able to report the breakout of $1,332,706,692 into the different types of alcohol and drug program activities. Of this total $1,042,734,615 (78.2 percent) were expended for treatment activities, $157/621/278 (11.8 percent) were expended for prevention activities, and $132,350,799 (9.9 percent) were expended for other activities (e.g., training, research, administration). Over the past few years, many States have substantially increased their commitment to and financial expenditures for prevention programs. However, within every State the expenditures for treatment remain much higher than those for prevention. Overall, the expenditures for treatment are nearly seven times as great as those for prevention. 3. Total NUmber and Percent of Treatment Units Which Received Funds Administered by the State Alcohol/Drug Agency in FY 1985 Within this subsection information is provided on the total number of treatment units which received funds administered by the State A/D Agency in FY 1985. The data are presented by primary orientation of the treatment units: alcohol, drug or combined alcohol/drug. An estimate is also provided indicating the percent of treatment units in the State in FY 1985, that received any funds administered by the State A/D Agency. Fifty States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands identified a total of 5,901 alcohol and/or drug treatment units which received funds administered by the State A/D Agency in FY 1985. With regard to the orientation of the treatment units, 2,376 were identified as alcohol units, 1,410 as drug units and 2,115 were identified as combined alcohol/drug treatment units. Four of the State respondents were unable to identify the total number of units by orientation, i.e., alcohol, drug or combined alcohol/drug treatment units. See Exhibit III. With regard to an estimate of the percent of total alcohol and/or drug treatment units in the State that received any funds administered by the State A/D Agency in FY 1985, 46 10 27 EXHIBIT 12 EXPENDITURES FOR STATE SUPPORTED ALCOHOL AND DRUM ABUSE SERVICES SY STATE AND SY TYPE OF ROMAN ACTIVITY IN FISCAL YEAR 1985 TYPE OF PROGRAM ACTIVITY STATE TREATMENT PREVENTION OTHER TOTAL Alabama 4,458,845 959,197 497,751 5,915,793 Alaska 16,236,314 1,918,211 1,357,338 19,511,863 Arizona 19,118,95S 712,952 386,210 20,218,120 A Arkansas 4,108,707 606,782 638,053 5,403,542 California 142,256,420 25,966,929 33,710,371 201,933,720 Colorado 13,035,797 3,183,425 0 16,219,222 Connecticut 23,832,166 110991069 1,656,000 27,087,735 Delawar 2,619,121 658,409 482,372 3,756,902 District of Col 11,823,494 S451738 6,228,448 18,897,6)7 Florida 39,313,673 2,697,902 880,160 42,091,735 Georgia 23,487,762 , 309,9E0 0 23,797,742 Guam 144,260 41,218 20,609 206,092 A Hawaii 3,403,677 269,447 0 3,673,124 Idaho 2,397,878 155,263 269,734 2,822,875 Illinois 45,908,815 1,440,001 0 47,356,816 Indiana 15,708,007 1,203,632 772,052 17,683,691 Iowa 9,642,022 1,948,915 690,116 12,281,053 Kansas 7,324,460 939,365 138,175 8,402,000 Kentucky 6,424,034 484,044 792,863 7,900,941 Louisiana 91802,720 1,219,640 1,792,579 12,814,939 Maine 7,921,210 711,604 0 8,632,814 Maryland 25,626,668 845,991 1,677,338 20,149,997 Massachusetts 30,593,606 2,899,298 2,441,317 35,934,301 Michigan 49,869,422 8,097,776 7,578,677 65,545,875 Minnesota 2,785,600 1,063,600 1,160,600 5,009,800 Mississippi 5,608,590 219,601 998,109 6,826,300 Missouri 9,746,975 796,715 858,648 11,402,338 Montana 7,260,223 799,850 0 8,060,073 Nebraska 5,109,612 764,847 309,208 6,183,667 Nevada 5,256,349 761,591 534,150 6,552,090 New Hampshire 1,229,700 387,470 718,020 2,335,190 New Jersey 13,913,000 6,783,000 1,611,000 22,307,,00 New Memico 11,723,963 1,515,800 331,523 13,571,286 New York 238,461,935 41,882,077 29,024,469 309,368,481 North Carolina 2,893,692 816,170 2,813,657 6,523,519 North Dakota 1,643,000 134,000 N/A 1,777,000 Ohio 22,815,136 3,793,442 4,321,343 30,929,921 8 Oklahoma 5,058,672 458,074 406,322 5,923,068 Oregon 9,739,245 386,707 789,278 10,915,230 Pennsylvania 48,946,000 9,556,000 7,210,000 65,712,000 Puerto Rico 9,922,643 2,146,832 5,648,969 17,718,444 Rhode Island 6,135,237 459,114 697,733 7,292,084 South Carolina 5,563,313 4,193,014 2,755,969 12,512,296 South Dakota 3,141,134 427,443 447,119 4,015,716 Tennessee 7,739,402 1,327,459 1,033,939 10,100,800 Texas 12,554,207 5,053,577 2,825,331 20,433,115 Utah 10,225,186 2,703,876 0 12,929,062 Vermont 2,325,951 683,388 769,602 3,770,941 Virgin Islands 515,865 75,724 0 591,589 Virginia N/A N/A N/A N/A Washington 27,917,777 865,000 61,748 28,844,525 West Virginia 6,218,870 722,893 505,818 7,447,581 Wisconsin 40,502,795 8,006,023 4,215,734 52,724,554 A Wyoming 2,672,402 917,706 292,345 3,082,453 TOTALS 1,042,734,615 157,621,278 132,350,799 1,332,706,692 PERCENT OF TOTAL 78.2% 11.8% 9.9% 100.0% A Figures represent allocated funds rather thin; empenditures. 8 Ohio was not able to differentiate by program activity the $5,030,876 of the total monies reported in Ewhibit I. C Virginia was not able to differentiate by program activity the $27,027,873 in empenditures reported in Ewhibit I. N/A Information not available. NOTE. "OTHER" category includes other activities beyond treatment or prevention services, e.g., training, research and administration. Sources State Alcohol and Drug Abuse Pro4ile, FY 19851 data are included for "only those programs which received at least some funds administered by the State Alcohol/ Drug Agency during Fiscal Year 1985". 11 EXHIBIT III NUMBER OF ALCOHOL AND/OR DRUG TREATMENT UNITE WHICH RECEIVED FUNDS ADMINISTERED BY THE STATE ALCOHOL/DRUG AGENCY FOR FY MO STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware ALCOHOL TREATMENT UNITE 21 1 32 12 467 31 46 7 DRUB TREATMENT UNITS 4 3 27 6 253 10 49 1 COMBINED ALCOHOL/ DRUB TREATMENT UNITE 23 38 61 14 N/A 0 N/A 7 TOTAL ALCOHOL/ DRUB TREATMENT UNITS 48 42 120 32 720 41 95 A la District of Col a 7 0 12 Florida 24 43 33 102 Georgia 9 3 31 43 Buoy 0 0 1 1 Hawaii 9 3 9 21 Idaho 0 0 13 13 Illinois 135 31 19 115 Indiana 0 0 48 40 Iowa 0 0 29 29 Kansas 0 1 34 35 Kentucky 1 3 126 130 Louisiana 18 11 26 aa Maine 0 0 31 31 Maryland 154 70 20 244 Massachusetts 130 64 0 196 Michigan N/A N/A 237 237 Minnesota 2 2 46 so Mississippi ao l 20 71 Missouri 7 8 57 72 Montana 0 2 30 32 Nebraska 0 0 75 75 Nevada 9 to Is 34 New Hampshire a 5 17 27 New Jersey 105 73 N/A 178 New Mexico 32 31 12 75 New York 263 376 35 674 North Carolina 23 1 13 37 North Dakota 0 0 8 8 Ohio 87 74 29 190 Oklahoma 0 0 32 32 Oregon 68 9 19 96 Pnnsylvania 48 25 415 488 Puerto Rico 8 21 37 66 Rhode Island 21 11 4 36 South Carolina 0 0 37 37 South Dakota 0 0 21 21 Tennessee 0 0 51 al Texas 48 16 17 SI Utah 3 1 55 59 Vermont 0 0 26 26 Virgin Islands 1 0 2 3 Virginia 21 7 94 122 Washington 47 42 40 .129 West Virginia 0 0 26 26 Wisconsin 424 103 67 594 Wyoming 0 1 la 16 TOTALS 2,376 11410 21115 51901 PERCENT OF TOTAL* 40.3% 23.9% sa.ss loo.o% A Connecticut recently classified 24 units as "Combined" units. However, due to difficulties in formatting data into the separate alcohol and drug client matrices, they have been artificially separated as submitted previously for FY 1984. N/A Information not available. Cautionary Notes Since 4 States were not able to identify all treatment units by orientation, i.e., alcohol, drug or combined, the percents shown should be viewed as only gross estimates. Sources State Alcohol and Drug Abuse Profile, FY 19851 data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year mom. 12 29 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands responded to this question. The estimates ranged from a low of 16 percent in Texas to a high of 100 percent in Georgia, Guam, Puerto Rico and the Virgin Islands. See Exhibit IV. 13 30 EXHIBIT IV ESTIMATE OF PERCENT OF TOTAL ALCOHOL AND/OR DRUG TREATMENT UNITS IN THE STATE THAT RECEIVED ANY FUNDS ADMINISTERED BY THE STATE ALCOHOL/DRUG AMENCY IN FY 1985 ESTIMATE OF PERCENT OF TOTAL TREATMENT UNITS STATE FUNDED BY STATE AGENCY Alabama 60 Alaska 90 Arizona/Alcohol 75 Arizona/Drug 70 Arkansas 70 California N/A Colorado 18 Connecticut 62 Delaware 88 District of Col SO Florida 80 Georgia 100 Guam 100 Hawaii 85 Idaho 56 Illinois 67 Indiana 30 Iowa 57 Kansas 32 Kentucky 85 Louisiana 41 Maine 89 Maryland/Alcohol 54 Maryland/Drug 84 Massachusetts N/A Michigan 45 Minnesota 21 Mississippi 75 Missouri 51 Montana 73 Nebraska 88 Nevada 75 New Hampshire 36 New Jersey 60 New Mexico/Alcohol 75 New Mexico/Drug 47 New York/Alcohol 84 New York/Drug N/A North Carolina N/A North Dakota N/A Ohio 57 Oklahoma 60 Oregon 80 Pennsylvania 92 Puerto Rico 100 Rhode Island 88 South Carolina 60 South Dakota 72 Tennessee 60 Texas 16 Utah 74 Vermont 90 Virgin Islands 100 Virginia 75 Washington 56 West Virginia 85 Wisconsin 80 Wyoming 90 N/A Information not available. Sources State Alcohol and Drug Abuse Profile, FY 1985. 14 31 IV. CLIENT ADMISSIONS TO ALCOHOL AND DRUG TREATMENT SERVICES Each State Alcohol and Drug (A/D) Agency was asked to provide information on client admissions to treatment units that received at least some monies administered by the State Agency during Fiscal Year 1985. Most of the States have combined alcohol and drug abuse treatment responsibilities within one agency. Also, a number of these agencies have established combined (e.g., substance abuse, chemical dependency) treatment systems and/or client reporting systems and would prefer to report combined alcohol and drug client data. However, in response to a specific request from the Institutes (i.e., NIAAA and NIDA), each of which have a distinct mandate, NASADAD asked the States separate questions relating to alcohol and drug abuse treatment services. This was done in the interest of obtaining data that would be generally consistent with past data collection efforts and in an attempt to be responsive to those States that have separate alcohol and drug agencies. In reviewing and interpreting the data in this section of the report it is important to recognize that the client admissions figures noted are limited to those treatment units which received "at least some funds administered by the State Alcohol Agency" during Fiscal Year (FY) 1985. However, States reporting client information on those treatment units which received only partial funding from the State Agency were instructed to report data on all client admissions to the program, not just data on those client admissions supported by State A/D Agency funds. The data presented do not include client admissions to treatment units that did not receive any funds administered by the State A/D Agency during FY 1985. It is also important to recognize that the total number of client admissions reported in the following exhibits may not always be equal since in a few cases the State may not have been able to provide client admissions for all of the categories specified (e.g., some States use different age categories). The remainder of this section on client treatment services is organized within subsections including: Client Admissions to Treatment Alcohol Abuse and Alcoholism; admissions to three major Services for Client Admissions to Treatment Services for Drug Abuse and Addiction; and Comparisons of Client Admissions Data for FY 1984 and FY 1985. Information on each of these areas follows. 3.5 32 1. Client Ad:insions to Treatment Services ,for Alcohol Abuse and A CO 0 sm This subsection includes client data organized under three topic headings including: o Client admissions data by environment and type of care; o Client admissions data by sex, age and race/ethnicity; and o Availability of client admissions data within treatment units that do not receive any.State Alcohol Agency funds. Information on each of these areas is presented within the following paragraphs. a. Client Admissions Data by Environment and. Type of Care Each State Alcohol (and combined alcohol and drug) Agency was asked to provide (lat.% on the "number of client admissions during FY 1985 for ALCOHOL related treatment services in all units which received at least some funds administered by the State Alcohol Agency." The information requested included client admissions data organized by environment (hospital or non-hospital) and by type of care (detoxification, rehabilitation/residential, or outpatient). See Exhibit V which follows. A total of 48 State Agencies, the District of Columbia, Guam, Puerto Rico and the Virgin Islands provided at least some data on the number of total alcohol client treatment admissions during FY 1985. See the last column in Exhibit V. The total of reported alcohol client treatment admissions was over 1.1 million (1,159,588). Of these admissions over 76 percent (846,081 admissions) were to non-hospital units. However, seven States which reported admissions to non-hospital units did not have data available on admissions to hospital units and so the actual number and percent of hospital admissions is likely to be higher than indicated. Forty-one States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands reported a total of 255,666 client admissions to hospital based treatment units. Most States also reported data on alcohol client treatment admissions by type of care (detoxification, rehabilitation/residential, or outpatient) and environment (hospital or non-hospital). See the first six columns of Exhibit V. Hospitals were used 16 33 EXHIBIT V NUMSEA OF ALCOHOL TYPE DETOXIFICATION STATE HOSPITAL NON-HOSPITAL CLIENT TREATMENT ADMISSION@ OP CARO, AND @TATE FOR REHAB/RESIDENTIAL HOSPITAL NON-HOSPITAL SY TYPE OF ENVIRONMENT, FISCAL YEAR 19115 OUTPATIENT HOMPITAL NON-HOSPITAL mmmumw.mmm.wmw.mwmomm.m. TOTAL ADMISSIONS SY TYPE OF ENVIRONMENT HOSPITAL NON-HOSPITAL TOTAL ADMISSION@ .mmwmaimmommmwel Alabama 96 0 mummmewm.mmmwmemmwm..wm 0 3,779 mmummmmumwmummmmisommmmwmcc 96 6,106 6,202 2,327 Alaska 223 2,972 0 1,406 5,213 223 9,814 Arisen* 17 496 0 4,365 /6,305 17 21,166 21,153 Arkansas 1,352 44 0 2,830 3,152 1,352 6,026 7,378 California 60,000 0 22,400 0 30,900 82,400 30,900 113,300 AS Colorado 100 30,630 Connecticut 0 5,249 0 3,889 0 3,014 tom 7,844 3,715 100 42,363 1,180 11,978 42,463 13,158 C Delaware 0 2,310 0 362 525 0 3,197 3,197 District of Col 0 3,917 0 1,487 2,1,1 0 7,555 7,595 Florida N/A N/A N/A N/A N/A' N/A N/A N/A 56,221 D orgia 10,430 5,806 0 2,340 1,332 20,604 11,762 28,858 40,620 Guam 4 0 0 0 33 0 37 0 37 Hawaii 0 729 0 489 0 1,344 0 2,562 2,562 Idaho N/A 1,057 N/A 812 N/A 4,285 N/A 6,154 6,154 Illinois N/A 29,200 N/A 4,633 N/A 20,990 N/A 54,823 54,823 E Indiana 0 6,471 52 1,532 0 7,317 52 15,320 15,372 Iowa 0 521 17 1,530 0 3,361 17 5,412 5,429 Kansas 0 2,763 0 1,116 0 4,841 0 5,720 8,720 Kentucky 0 1,997 0 2,5,6 0 5,3,3 0 9,986 'OM Louisiana 36 1,446 N/A 1,145 N/A sown 36 11,242 11,278 Maine 585 1,329 977 535 835 4,316 2,400 6,180 8,580 F Maryland 0 1,594 0 5,988 619 15,981 619 23,563 24,182 Maesachusetts 40,842 0 0 5,841 0 19,718 40,842 25,559 66,401 Michigan N/A 5,470 N/A 6,397 N/A 22,158 N/A 34,725 34,725 Minnesota 0 27,682 3,581 964 0 625 3,581 29,271 32,552 Mississippi 503 1,788 0 4,561 0 2,767 503 9,116 9,619 Missouri 1,1151 8,727 0 4,401 0 4,274 1,851 17,402 19,253 Montana 1,0,3 325 1,369 251 N/A 3,937 2,462 4,513 6,4,75 Nabraska 428 5,627 1,259 1,594 534 7,556 2,221 15,077 17,2,8 F Nevada 0 1,871 0 839 0 559 3,269 3,269 Nem Hampshirm 0 0 0 579 0 1,905 2,484 2,484 New Jersey 2,108 7,018 271 2,853 953 5,143 3,412 15,044 18,456 New Mewico N/A 3,412 N/A 246 N/A 4,816 N/A 8,474 8,474 8 New York 36,208 24,807 3,510 10,333 20,034 29,993 59,752 65,133 124,885 H North Carolina N/A 4,749 4,254 1,803 N/A 11,223 4,254 17,855 22,139 North Dakota 1,300 N/A 1,900 N/A N/A 50600 3,200 5,600 8,800 8 Ohio .0 8,364 0 1,821 0 8,781 0 18,966 15,966 Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A 4,966 N/A 2,590 N/A 23,520 N/A 31,376 31,376 Pennsylvania 10,181 6,469 716 6,632 0 21,645 10,097 34,746 45,643 Puerto A1ce 337 0 0 0 0 3,177 337 3,177 3,514 Rhode Island 3,048 1,710 SO 456 111,5 1,420 3,296 3,626 6,922 South Carolina 0 3,097 0 400 0 14,826 0 19,123 19,123 South Dakota N/A on 364 178 N/A 3,094 364 4,947 5,311 Tennessee 435 1,159 112 1,255 0 5,106 547 7,520 8,067 A8 Tawas 521 662 N/A 4,388 N/A 1,707 521 6,757 7,278 Utah 2,667 975 0 3,573 0 6,742 2,667 11,290 13,957 ; Vermont N/A 856 N/A 501 N/A 2,701 N/A 4,058 4,050 Virgin Islands 0 0 0 32 0 94 0 126 126 Virginia N/A 4,373 N/A 1,581 N/A 18,753 N/A 24,707 26,327 I Washington 575 24,913 N/A 5,703 N/A 24,379 575 55,035 55,610 West Virginia 2,645 310 1,157 383 45 5,628 3,647 6,329 10,176 NisCOnsin 7,930 3,826 2,256 3.276 0 41,932 10,216 49,034 59,250 111 Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A SOMME, ws........wmwmwmm.mmwmmmwmwmwmwm........... TOTALS 185,5,0 253,480 OMOMMOMMOOOMOOSOMOOMOOM 44,335 117,717 25,733 474,084 255,666 846,081 1,159,51111 IIMWMIIM1111NOINIMMISIMMOOMMISONOMMI1110M0 PERCENT OF TOTAL 42.3% 57.7% 27.4% 72.6% 5.1% 94.9% 23.2% 74.5% 100.0% A Environment categories arm residential and non-residential instoad of hospital and non-hospital. 8 These admissions data are estimates. C Number of clients served instad of clients admitted. D State of Florida cannot break out the total admissions figure of 56,221 by type of environment; the grand total admissions figure of 1,151,114 is thus 56,221 admissions higher than the combined total admissions of the two typo of environment figure.. I Includes sanatoriums and/or halfway houses in rehab/residential non-hospital category. P Includes both alcohol and drug admissions. 8 These totals include community contract treatment programs only) they do not include 4 State lodges. H All client information is for CY 1984. I Hospital admissions cannot be broken out by typo of cars. N/A Information not available. NOTE. Grand totals for the client erhibits may differ depending on State ability to respond to specific categories. Source/ State Alcohol and Drug Abuse Profile, FY leas data are included for "only those.pro aaaaa which received some funds admini 000000 by the State Alcohol/Drug Agency during Fiscal Year 1955. 17 by nearly 43 percent of those clients who required detoxification services. However, the proportions of hospital and non-hospital admissions are considerably different for those clients who required rehabilitation/residential or outpatient services. With regard to rehabilitation/residential services, non-hospital facilities were used for nearly 73 percent of the client admissions. Also, with regard to outpatient services, non-hospital facilities were used for nearly 95 percent of the client admissions. b. Client Admissions Data by Sex, Age and Race/EthnicitY Each State Alcohol (and combined alcohol and drug) Agency was asked to provide data on "the number of client admissions during Fiscal Year 1985 in units which received at least some funds administered by the State Alcohol Agency for ALCOHOL related treatment services in each of the age, sex, race/ethnicity categories" specified. Forty-nine States, the District of Columbia, Guam and Puerto Rico reported alcohol client admissions data by sex. See Exhibit VI which follows. Over 79 percent of the alcohol client admissions were male, nearly 20 percent were female and data on sex were not reported on 1.0 percent of the alcohol client admissions. Thirty-three States, the District of Columbia and Guam were able to report data by the age categories requested. See Exhibit VII. The percent of client admissions that fell within categories requested were as Ag.t each of the age range follows: Percent of Admissions Under 18 3.3% 18-20 4.4% 21-24 10.7% 25-34 30.9% 35-44 24.2% 45-54 14.8% 55-64 7.1% 65 and over 2.4% Not Reported 2.2% With regard to alcohol client treatment admissions information by age and by sex, a total of 33 State agencies reported data. See Exhibit VIII which follows. A number of States have established different age range categories and they were not able to retrieve or report client information according to the specific categories requested. 18 35 EXHIBIT VI NUMBER OF ALCOHOL CLIENT TREATMENT ADMISSIONS BY SEX AND STATE FOR FISCAL YEAR 1985 SEX STATE MALE FEMALE NOT REPORTED TOTAL Alabama 3,523 906 0 4,429 Alaska 8,310 2,694 0 11,004 Arizona 15,984 5,199 0 21,183 Arkansas 6,229 1,149 0 7,378 California 92,300 21,000 0 113,300 Colorado 25,157 4,883 0 30,040 Connecticut 10,250 2,900 0 13,158 A Delaware 2,616 581 0 3,197 District of Col 6,378 1,217 0 7,595 Florida 45,049 11,172 0 56,221 Georgia 33,471 7,149 0 40,620 Guam 30 7 0 37 Hawaii 1,823 622 117 2,562 Idaho 4,617 1,537 0 6,154 Illinois 45,341 9,412 70 54,823 Indiana 11,722 3,702 0 15,424 Iowa 4,146 865 424 5,435 Kansas 7,395 1,325 0 8,720 Kentucky 8,184 1,802 0 9,986 Louisiana N/A N/A N/A N/A Maine 9,772 2,802 191 12,765 B Maryland 20,076 4,106 0 24,182 Massachusetts 54,457 11,944 0 66,401 Michigan 27,720 6,890 0 34,610 Minnesota 28,251 4,601 0 32,852 Mississippi 6,262 947 78 7,287 Missouri 15,947 3,306 0 19,253 Montana 5,023 1,952 0 6,975 Nebraska 13,389 3,909 0 17,298 B Nevada 1,018 380 0 1,398 New Hampshire 1,776 708 0 2,484 New Jersey 14,750 3,706 0 18,456 New Mexico 7,644 1,732 0 9,376 C New York 92,164 32,721 0 124,885 DEF North Carolina 14,663 3,192 0 17,855 North Dakota 5,980 2,820 0 8,800 D Ohio 15,029 3,937 0 18,966 Oklahoma 8,531 2,966 0 11,497 8 Oregon 24,888 6,487 0 31,375 Pennsylvania 37,625 8,018 0 45,643 Puerto Rico 3,374 140 0 3,514 Rhode Island 1,536 508 4,878 6,922 South Carolina 16,032 3,091 0 19,123 South Dakota 4,161 1,150 0 5,311 Tennessee 6,301 1,766 0 8,067 Texas 6,090 1,1813 0 7,278 Utah 12,216 1,741 0 13,957 Vermont 2,890 1,168 0 4,058 Virgin Islands N/A N/A N/A N/A Virginia 22,295 4,032 0 26,327 Washington 28,208 6,484 0 34,692 West Virginia 8,667 1,509 0 10,176 Wisconsin 35,704 10,040 5,098 50,842 D Wyoming 5,068 2,482 0 7,550 TOTALS 890,032 220,553 10,856 1,121,441 PERCENT OF TOTAL 79.4% 19.7% 1.0% 100.0% A w Number of clients served instead of number of clients admitted. 8 w Includes both alcohol and drug admissions. C w All these admission totals are for contracted treatment programs only; they do not include 4 State lodges. D w These admissions data are estimates. E All client information is for CY 1984. F w Male and female admissions figures are estxmates. N/A w Information not available. NOTE, Grand totals for the client exh ability to respond to specific Sources State Alcohol and Drug Abuse for "only those programs whi administered by the State Al Year 1985. ibits may differ depending on State categories. Profile, FY 1985; data are included ch received at least some funds cohol/Drug Agency during Fiscal 19 36 STATE EXHIBIT VII NUMBER OF ALCOHOL CLIENT TREATMENT ADMISSIONS BY AGE AND STATE FOR FISCAL YEAR 1985 UNDER ABE 65 NOT AGE IS 18 TO 20 21 TO 24 25 TO 34 35 TO 44 45 TO 54 55 TO 64 AND OVER REPORTED TOTAL Alabama Alaska 38 N/A 101 N/A 460 N/A 1,544 N/A 1,187 N/A 684 N/A 311 N/A 417 N/A 0 4,429 N/A N/A Arizona 813 406 2,338 6,844 5,483 3,003 1,589 600 108 21,183 Arkansas 69 300 742 2,111 1,941 1,236 816 263 0 7,378 California 1,600 2,400 7,500 39,200 33,300 19,200 9,400 1,700 0 113,300 Colorado N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Connecticut N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Delaware WI 111 367 1,036 7116 438 242 128 0 3,197 District of Col 0 227 602 759 2,278 3,048 454 227 N/A 7,595 F:orida N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Georgia 330 1,099 3,007 10,925 11,445 8,110 4,538 1,166 0 40,620 Suas 5 2 2 20 8 0 0 0 0 37 Hawaii N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Indiana 1,162 1,782 3,099 3,874 2,789 1,604 960 154 0 15,424 lows 119 412 965 1,765 947 479 238 86 424 5,435 Kansas 330 692 1,473 3,048 1,674 924 443 127 9 8,720 Kentucky N/A N/A NIA N/A N/A N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A N/A N/A N/A NIA N/A Maryland 625 1,315 3,431 8,573 5,438 2,958 1,491 351 0 24,1112 Massachusetts 1,590 2,271 6,012 21,854 17,056 10,310 5,776 1,529 3 66,401 Michigan 1,521 2,106 4,695 13,209 7,359 3,401 1,608 503 202 34,610 Minnsota 859 1,657 3,278 9,027 7,643 5,304 3,466 1,616 2 32,852 Mississippi 118 425 1,149 2,612 1,467 845 467 126 78 7,287 Missouri 591 854 1,953 5,727 4,842 3,140 1,725 423 8 19,253 Montana 1,018 809 1,263 1,116 1,976 425 349 119 0 6,975 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Nevada N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New Hampshire 186 192 332 892 509 201 101 33 39 2,404 New Jersey 514 817 2,042 6,569 4,716 2,266 1,205 311 16 18,456 New Mexico 468 504 1,280 3,198 2,148 1,106 484 184 4 9,376 C New York 7,491 3,871 10,269 34,710 32,962 23,223 10,238 2,122 0 124,805 AB North Carolina 264 758 1,836 5,393 4,450 3,135 1,593 424 0 17,955 North Dakota N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Ohio 1,232 322 2,063 6,962 3,831 2,201 1,252 303 0 18,966 Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A N/A N/A N/A ,N/A N/A Pennsylvania 229 2,589 6,317 15,757 11,067 5,945 0 3,740 0 45,643 Pusrto Rico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Rhode Island 84 130 287 778 407 220 118 20 4,878 6,922 South Carolina 914 1,195 2,301 5,717 4,496 2,607 1,442 451 0 19,123 South Dakota 431 651 979 1,593 812 472 280 93 0 5,311 Tennessee 240 387 1,014 2,716 1,928 1,091 554 134 3 8,067 Texas 177 285 712 2,292 1,804 1,189 651 140 28 7,278 Utah 97 262 642 2,685 1,683 1,087 537 120 6,844 13,957 Vermont 305 319 600 1,390 829 372 163 51 29 4,058 Virgin Islands N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Virginia 924 1,481 3,565 0,471 5,887 3,523 1,955 521 0 26,327 Washington N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A West Virginia 393 688 1,491 3,301 2,093 1,174 762 274 0 10,176 Wisconsin 2,142 4,270 7,364 15,194 8,796 4,536 2,494 920 5,126 50,842 A WVoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A ...... ................... MMMMMMMMMMMMMMMMMMMM TOTALS 26,967 35,689 86,229 249,861 195,837 119,457 57,708 19,056 17,800 808,604 PERCENT OF TOTAL 3.3% 4.4% 10.7% 30.9% 24.2% 14.8% 7.1% 2.4% 2.2% 100.0% A These admissions data are estimats. II All client information is for CY 1984. C All these admission totals are for contracted treatment programs only; they do not includ 4 Stat loAges. N/A Information not available. NOTE; Grand totals far the client exhibits may differ depending on State ability to respond to specific categories. Source, State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985. 20 EXHIBIT VIII NUMBER OF ALCOHOL CLIENT TREATMENT ADMISSIONS BY AGE, SEX, AND STATE FOR FISCAL YEAR 1985 TO 24 25 TO 34 35 TO 44 UNDER AGE 18 18 TO 20 21 STATE MALE FEMALE MALE FEMALE MALE Alabama 20 10 84 17 345 Alaska N/A N/A N/A N/A N/A Arizona 450 363 276 130 1,770 Arkansas 56 13 242 58 633 California 1,100 500 1,700 700 5,600 Colorado N/A N/A N/A N/A N/A Connecticut N/A N/A N/A N/A N/A Delaware 56 33 92 19 287 District of Col o o 191 36 505 Florida N/A N/A N/A N/A N/A Georgia 262 68 895 204 2,419 Guam 3 2 2 o 1 Hawaii N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A Indiana N/P N/A N/A N/A N/A Iowa 72 47 317 95 823 Kansas 239 91 582 110 1,237 Kentucky N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A Maryland 509 116 1,095 220 2,826 Massachusetts 902 688 1,704 567 4,672 Michigan 958 570 1,739 367 3,860 Minnesota 540 319 1,351 306 2,706 Mississippi 103 15 358 67 1,052 Missouri 286 295 671 183 1,516 Montana 593 425 614 195 956 Nebraska N/A N/A N/A N/A N/A Nevada N/A N/A N/A N/A N/A New Hampshire 115 71 130 62 259 New Jersey 360 154 619 198 1,595 New Mexico 352 116 434 70 1,066 New York 3,603 3,888 2,822 1,049 7,964 North Carolina. 209 57 615 143 1,471 North Dakota N/A N/A N/A N/A N/A Ohio 977 255 255 67 2,269 Oklahoma N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A Pennsylvania N/A N/A N/A N/A N/A Puerto Rico N/A N/A N/A N/A N/A FEMALE MALE FEMALE MALE FEMALE Rhode Island 56 28 98 32 208 South Carolina 656 258 1,023 172 1,968 South Dakota 266 165 499 152 794 Tennessee 182 58 296 91 816 Texas 165 12 226 59 555 Utah 67 30 222 40 531 Vermont 150 155 221 98 442 Virgin Islands N/A N/A N/A N/A N/A Virginia 722 202 1,224 257 2,971 Washington N/A N/A N/A N/A N/A West Virginia 278 115 582 106 1,264 Wisconsin 2,135 2,034 2,440 1,627 6,281 Wyoming N/A N/A N/A W/A N/A TOTALS 16,450 11,153 23,619 7,497 61,662 115 1,186 358 974 213 N/A N/A N/A N/A N/A 568 5,161 1,683 4,066 1,417 109 1,806 305 1,502 339 1,900 30,800 7,400 27,600 5,700 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80 831 205 663 123 97 637 122 11913 365 N/A N/A N/A N/A N/A 588 8,902 2,023 9,447 1,998 1 17 3 7 1 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 142 1,466 299 767 180 236 2,551 497 1,455 219 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 605 7,083 1,490 4,519 919 1,340 17,709 41145 14,394 2,662 835 10,583 2,625 5,919 1,440 572 7,605 1,422 6,655 988 97 2,242 370 1,246 221 437 4,559 1,168 4,121 721 307 788 328 1,388 488 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 73 648 244 365 144 447 5,222 1,347 3,840 876 214 2,560 638 1,770 378 C 2,304 25,651 9,059 23,897 9,065 AB 365 4,338 1,055 3,686 764 N/A N/A N/A N/A N/A 594 5,516 1,446 3,036 795 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 79 587 191 309 98 333 4,830 887 3,747 749 185 1,242 351 640 172 198 2,135 581 1,476 452 157 1,864 428 1,545 259 111 2,336 349 1,465 218 158 997 393 611 218 N/A NiA N/A N/A N/A 594 7,181 1,290 5.050 837 N/A N/A N/A N/A W/A 227 2,820 481 1,797 296 4,135 6,220 4,213 6,101 4,059 A N/A N/A N/A N/A N/A 18,203 178,073 47,396 145,971 37,374 A These admissions data are estimates. B All client information is for CY 1984. C All those admission totals arm for contracted treatment programs only; they do not include 4 State-operated treatment lodges. N/A Information not available. NOTE, Grand totals for the client exhibits may differ depending on State ability to respond to specific categories. Source, State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 21 38 UMW VIII PASS 2 OF 2 NUMBER OF ALCOHOL CLIENT TREATMENT ADMISSIONS BY ASE, SEX, AND STATE FOR FISCAL YEAR 1985 STATE 45 to 54 MALE FEMALE 55 TO 64 MALE FEMALE 65 and OVER MALE FEMALE NOT REPORTED MALE FEMALE MALE TOTALS FEMALE TOTAL Alabama 548 136 272 46 86 11 0 0 3,523 906 4,429 Alaska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Arizona 2,413 590 1,313 275 461 139 74 34 15,984 5,199 21,183 Arkansas 1,040 196 714 102 236 27 0 0 6,229 1,149 7,378 California 16,200 3,000 7,900 1,500 1,400 300 0 0 92,300 21,000 113,300 Colorado N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Connecticut N/A N/A N/A, N/A N/A N/A N/A N/A N/A N/A N/A Delaware 359 79 212 30 116 12 0 0 2,616 581 3,197 District of Col 2,560 480 381 73 191 36 0 0 6,378 1,217 7,595 Florida NJA NJA N/A N/A N/A N/A N/A N/A N/A N/A N/A Oeorgia 6,733 1,377 3,822 716 991 175 0 0 33,471 7,149 40,620 Guam 0 0 0 0 0 0 0 0 30 7 37 Hawaii N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Indiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Iowa 411 68 214 24 76 10 N/A N/A 4,146 865 5,435 C Kansas 811 113 402 41 110 17 0 1 7,395 1,325 8,720 Kentucky N/A N/A N/A N/A WA N/A N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maryland 2,464 494 1,275 216 305 46 0 0 20,076 4,106 24,182 Massachusetts 8,810 1,500 4,980 796 1,284 245 2 1 54,457 11,944 66,401 Michigan 2,821 580 1,300 308 395 108 145 57 27,720 6,890 34,610 Minnesota 4,767 537 3,135 331 1,490 126 2 0 28,251 4,601 32,852 Mississippi 744 101 410 57 107 19 N/A N/A 6,262 947 7,287 D Missouri 2,791 349 1,606 119 391 32 6 2 15,947 3,306 19,253 Montana 314 111 279 70 91 28 0 0 5,023 1,952 6,975 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A NJA Nevada N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New Hampshire 142 59 67 34 21 12 29 9 1,776 708 2,484 New Jersey 1,818 448 1,009 196 275 36 12 4 14,750 3,706 18,456 New Mexico 802 224 414 70 164 20 2 2 7,644 1,732 9,376 E New York 17,092 6,131 7,791 2,447 1,494 628 0 0 90,314 34,571 124,885 AB North Carolina 2,650 485 1,331 262 363 61 0 0 14,663 3,192 17,055 North Dakota N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Ohio 1,744 457 992 260 240 63 0 0 15,029 3,937 18,966 Oklahoma NJA N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Pennsylvania N/A N/A N/A N/A NJA NJA NJA N/A N/A N/A N/A Puerto Rico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Rhode Island 173 47 90 28 15 5 N/A N/A 1,536 508 2,044 South Carolina 2,176 431 1,231 211 401 50 0 0 16,032 3,091 19,123 South Dakota 385 87 251 29 84 9 0 0 4,161 1,150 5,311 Tennessee 842 249 439 115 113 21 2 1 6,301 1,766 8,067 Texas 1,019 170 568 83 122 18 26 2 6,090 1,188 7,278 Utah 1,004 83 497 40 105 15 5,989 855 12,216 1,741 13,957 Vermont 279 93 132 31 41 10 17 12 2,890 1,168 4,058 Virgin Islands N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Virginia 3,037 486 1,653 302 457 64 0 0 22,295 4,032 26,327 Washington NJA N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A West Virginia 1,019 155 667 95 240 34 0 0 8,667 1,509 10,176 Wisconsin 4,270 2,440 618 203 915 203 1,525 1,423 30,505 20,337 50,842 A Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A TOTALS 92,318 21,764 45,965 9,110 12,780 2,580 7,839 2,403 584,677 157,480 742,659 F A These admissions data are estimates. 8 All client information is for CY 1984. C Total figure 5,435 admissions for Iowa includes 424 mlient admissions for which sex was not reported. D Total figure 7,287 admissions for Mississippi includes 78 client admissions for which sex was not reported. E All these admission totals are for contracted treatment programs only; they do not include 4 State-operated treatment lodges. F Grand total admissi figure of 7391559 includes 424 admissions in Iowa and 78 admissions in Mississippi fo. A-11h sex was not reported. N/A Information not r.li Alle. NOTE: Brand totals fr.,- t lent exhibits may differ depending on Stat. Ability to -espond to .egories. Sources State Alec lo *n. Abuse Profile, FY 1985; data are included for "only those progr-m. wAxch received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 22 39 With regard to alcohol client treatment admissions, information by race/ethnicity a total of 46 State Agencies, the District of Columbia, Guam, Puerto Rico and the Virgin Islands provided at least partial data. See Exhibit IX which follows. Overall, among the States reporting data the percent of client admissions that fell within the race/ethnicity categories specified were as follows: Race/Ethnicity Percent of Admissions White, not of Hispanic origin 71.3% Black, not of Hispanic origin 16.1% Hispanic 5.5% Asian or Pacific Islander .2% American Indian or Alaskan Native 3.7% Other .2% Not Reported 3.1% c. Availability, of Client Admissions Data Within Treatment Units that Do Not Receive Any State Alcohol Agency Funds Each State Alcohol Agency was asked to indicate whether information was available from the State Agency or from any other source on "ALCOHOL related client admissions within treatment units that do not receive any State Alcohol Agency funds". A total of 20 State Agencies responded "Yes" indicating that at least some data were available on client admissions to such treatment units that receive no State Agency funding. The sources of such data vary widely. They range from the State A/D Agency or some of its components which were indicated as the source by many States to a number of other sources such as the State Health Planning and Development Agency, a hospital questionnaire and licensing visits. For further information on the individual State Alcohol Agency responses, see Exhibit X which follows. 2. Client Admissions to Treatment Services for Drug Abuse and Addiction This subsection includes client data organized under four topic headings including: o Client admissions data modality; by environment and o Client admissions data by sex, ethnicity; age, and race/ o Client admissions data by primary drug of abuse; and 23 4 0 STAYS Alabama Alaeka AiaSna Arkansas California Colorado Cennectieut & Hamer. Diarist 64 Col Florida lergia S um Hawaii Idaho Illinois Indiana lees 1111119410 Kentucky Leuisiona Maine Maryland Massashmetts Miehigan Minnesota Mississippi Miessuri Montana NObraska Nevada NOw Hampshir Nee Jersey Nee Maoism NOm York N orth Carolina N Orth Dakota O hie O klahoma Orogen Pennsylvania PUert Rise Mode Island uth Carolina Muth Dakota Tennessee Team Utah Vermont Virgin Islands Virginia Washington Met Virginia W isconsin W yomin TOTA1.8 maw OF TOTAL SMISIT IX NUMMI OF ALCOHOL CLIIINT TROATMONT ADM:OS:DNS SY RACS/ITHNICITY AND STATS FON FISCAL YEAR 1985 WHITS, NOT OF HISPANIC 011:111N BLACK AMNI :AN CAN NOT ar on AS INDIAN OR HISPANIC PACIFIC ALASKAN NOT ORISIN HISPANIC ISLANDON NATIVO OTHER MPORTM TOTAL xxxx.................................. 3,864 886 N/A N/A N/A 9 N/A 5,112 220 1041 24 4,913 48 108 11,004 12,834 647 39066 N/A 49734 95 107 21,153 8,626 1,696 24 2 30 0 0 7,375 78,300 189400 12,700 500 3,400 0 0 113,300 210070 1,220 6,873 70 1,000 0 107 30,040 99880 2,160 19118 0 0 30 0 13,158 A 2,326 820 43 0 0 0 0 3,197 649 69729 173 0 0 44 0 7,890 470144 5,595 2,149 23 127 83 0 56,221 28,020 12,466 94 10 31 31 0 40,620 9 0 0 a5 o o o 37 1,220 68 N/A 317 0 706 251 2,562 8,886 38 269 0 275 0 19 6,194 38,927 12,981 2,257 66 405 0 147 54,523 13,264 1,880 307 0 0 3 0 15,424 4,674 138 74 2 129 5 420 5,435 7,115 774 386 9 437 8 21 5,720 9,021 915 21 23 3 0 0 9,986 6,677 4,412 164 6 19 0 0 11,278 N/A N/A N/A N/A 346 N/A 12,419 12,765 8 16,135 7,833 116 30 60 0 5 249182 88,222 59628 19987 ,34 388 142 0 66,401 279801 59670 656 N/A 649 112 117 34,725 23,794 1,442 404 38 69704 50 370 32,882 49720 2,420 0 0 30 117 0 7,257 14,629 49334 123 9 158 0 0 19,253 5,915 28 70 7 949 6 0 6,979 13,267 886 472 11 2,626 33 33 17,295 2 1,231 61 an 6 67 5 0 1,395 C 2,424 11 9 3 6 3 28 2,4114 129342 59090 936 N/A 45 37 6 18,486 D 29162 108 3,212 4 3,890 0 0 9,376 79,177 31,721 12,364 o 874 749 o 124,885 IF 13,006 4,487 15 o 315 29 0 17,595 N/A N/A N/A N/A N/A N/A N/A N/A 15,455 3,243 198 9 04 7 o 189966 10,394 1,103 150 19 1,840 25 o 13,561 8 27,692 876 1,176 141 1,786 5 31,376 31,743 12,833 966 o o aoa o 45,643 O 0 3,514 0 o o o 3,514 1,890 102 20 a 4 27 4,575 6,922 14,125 4,910 45 9 31 o o 19,123 4,175 26 0 o 19070 37 o sou 6,696 1,335 15 a 8 e a 89067 4,629 999 1,840 0 64 3 0 79278 0,961 191 912 32 965 o 5,896 139937 N/A N/A N/A N/A N/A N/A 4,098 4,018 20 35 10 N/A N/A 29 N/A 94 19,481 6,445 278 76 50 0 0 269327 28,129 29095 1,512 182 21500 103 121 34,652 9,761 399 9 3 4 o o 10,176 40,634 3,396 915 34 775 N/A N/A N/A N/A 12 5,110 50,542 2 N/A N/A N/A N/A ........................................ 797,282 179,630 61,243 1,734 419833 2,694 34,227 1,1189643 momenumesommamemmlemossimeommossimansameasamemaloommmoomoseamossummonomanowasomalsonsamemmammese 71.3% 16.1% 5.5% .2% 3.7% .2% A Number of clients served instead of number of client admitted. Includes both almhel and drug adaissions. C Dees not include detoxification Miamians. Asian and Pacific Islander included in "Other" Category. I These adsissions data are estimates. F All client information is for CY 1904. N/A Information net available. NOTSe rand totals for the client exhibits may differ depending en State ability to respond to specific categories. Mures, State Alcohol and Drug Abuse Profile, FY 19850 data are included for "only these prove.. Mich received at least some funds administered by the State Alcehol/Drug Agency during Fiscal Yew 1988". 24 4 3.1% 100.0% EXHIBIT X INFORMATION AVAILABILITY AND SOURCE FOR ALCOHOL RELATED CLIENT ADMISSIONS WITHIN TREATMENT UNITS THAT DO NOT RECEIVE ANY STATE ALCOHOL AGENCY FUNDS STATE INFORMATION AVAILABLE SOURCE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachustts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire Nw Mexico Nw Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennsse Texas Utah Vrmont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming No No No No No Yes Y s No Yes No No No No No Ys Ys No Y. No No Ys No No No Ys No No Ys Ys Ys Ys No Yes Ys No No No No No No No Ys Ys Yes Ys No No No No No Ys No No Y. STATE A/D AGENCY STATE A/D AGENCY STATE HEALTH PLANNING & DEVELOP. AGENCY HOSPITAL QUESTIONNAIRE STATE A/D AGENCY SURVEY STATE A/D AGENCY STATE A/D AGENCY DAANES & CATOR DATA SYSTEM PLANNING SURVEY STATE A/D AGENCY MINI-DAWN ALCOHOL MANAGEMENT INFO SYSTEM LOCAL SERVICES LICENSING VISIT SC DEPT MENTAL HEALTH/REHABILITATION VA HOSPITALS LICENSURE SECTION PRIVATE AGENCY REPORTS STATE HOSPITAL Sourco State Alcohol and Drug Abus Profil, FY 1985. 25 42 o Availability of client admissions data within treatment units that do not receive any State Drug Agency funds. /nformation on each of these areas is presented within the following paragraphs. a. Client Admissions Data by Environment and Modality Each State Drug (and combined alcohol and drug) Agency was asked to provide data on the "number of client admissions during FY 1985 for DRUG related treatment services in all units which received at least some funds administered by the State Drug Agency." The information requested included client admissions data organized by environment (hospital, residential, or outpatient) and by modality (detoxification, maintenance, or drug free). See Exhibit XI which follows. A total of 43 State Agencies, the District of Columbia, Guam and Puerto Rico provided at least partial data on drug client treatment admissions by modality and by environment. The total of drug client treatment admissions during FY 1985 for these State Agencies was 274,861. Of the drug client admissions 12,586 were to hospitals, 52,925 to residential facilities, and 209,350 to outpatient environments. In terms of treatment modality, 41,973 drug client admissions were for detoxification, 38,460 for maintenance and 195,187 for drug-free types of treatment services. Within each of these three types of treatment modalities, the type of environment most often utilized was outpatient. The outpatient environment was utilized for 50.6 percent of the detoxification admissions, 97.1 percent of the maintenance admissions, and 76.5 percent of the drug-free admissions. In interpreting the client admissions data reported above it is important to note that it is limited to only those programs that received some State Drug Agency monies and did not include facilities that received no State Drug Agency administered monies during FY 1985. It is also important to note that some States were not able to report the information in the format requested. b. Client Admissions Data by Sex, Age and Race/Ethnicity Each State Drug (and combined alcohol and drug) Agency was asked to provide data on "the number of client admissions during FY 1985 in units which 26 4 3 EXHISIT XI NUMSER OF DAUS CLIENT TREATMENT ADMISSIONS SY TYPE OF ENVIRONMSNT,' TYPE OF MODALITY AND STATE FOR FISCAL YEAR 1985 STATE mum DETOXIFICATION HOSPITAL RESIDENTIAL OUTPATIENT U. II TOTAL Alabama 11 0 0 11 Alaska 0 0 0 0 Arisona 3 13 74 90 Arkansas o 4 o 4 California 0 2,734 9,785 12,519 Colorado o o o o Connecticut o o 899 899 Delaware o 161 o 161 District of Col 0 0 606 606 Florida N/A N/A N/A N/A Georgia 1,1129 397 461 2,687 Suam 0 0 0 0 Hawaii 0 0 73 73 Idaho o 130 o 130 Illinois 3 46 96 145 Indiana 0 1,251 o 1,251 Iowa 0 63 16 79 Kansas 0 334 0 334 Kentucky o 602 o 602 Louisiana 15 590 o 605 Maine N/A N/A N/A N/A Maryland 306 1 1,016 1,323 Massachusetts o 811 785 1,596 Michigan N/A 1,331 205 1,536 Minnesota o o o o Mississippi 435 0 125 560 Missouri 47 293 e 348 Montana 26 o o 26 Nebraska N/A N/A N/A N/A Nevada o o o o New Hampshire o o o o New Jersey o 344 3,967 4,311 New Mexico N/A N/A N/A N/A New York 406 o 1,371 1,777 North Carolina N/A N/A 545 545 North Dakota N/A N/A N/A N/A Ohio N/A N/A N/A N/A Oklahoma N/A N/A N/A N/A Oregon 19 o o 19 Pennsylvania 3,888 1,308 SO 5,276 Puerto Rico N/A 257 157 414 Rhode Island 216 o 297 513 South Carolina o 695 o 695 South Dakota o 22 o 22 Tennessee 318 301 o 619 Texas 39 1 16 56 Utah 184 51 21 256 Vermont o 223 o 223 Virgin Islands N/A N/A N/A N/A Virginia N/A 55 221 276 Washington 0 0 323 323 West Virginia 371 1 93 465 Wisconsin 546 52 o 598 Wyoming mmememmm.m.. N/A N/A N/A N/A TOTALS 8,662 12,071 21,240 41,973 PERCENT OF TOTAL 20.6% 28.8% 50.6% 100.0% S ee footnotes at the bottom of next page. N/A Information not available. PAM 1 OF 2 HOSPITAL RESIDENTIAL MAINTENANCE OUTPATIENT TOTAL 0 0 197 197 0 0 261 261 0 0 883 883 0 0 0 0 0 20 4,465 4,405 0 0 246 246 0 30 1,8,5 1,925 0 0 89 89 0 0 2,315 2,315 N/A N/A N/A N/A 0 0 110 110 0 0 0 0 0 0 65 65 0 0 0 0 1 290 2,604 2,895 0 0 787 787 0 2 37 39 0 0 0 0 0 0 36 36 0 0 200 200 N/A N/A N/A N/A 17 0 1,566 1,5E3 0 0 . 812 812 N/A N/A 2,193 2,183 0 0 55 55 0 0 0 0 0 0 359 359 0 0 0 0 N/A N/A N/A N/A 0 0 200 200 0 0 0 0 0 0 1,738 1,738 N/A N/A N/A N/A 0 671 9,911 10,582 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 0 0 529 529 0 0 2,026 2,026 N/A N/A 31 31 0 0 95 95 0 0 114 114 0 0 0 0 0 0 187 187 2 3 1,130 1,135 0 21 174 195 0 0 0 0 N/A N/A 80 SO N/A 55 664 719 0 0 804 804 0 0 0 0 0 0 500 500 N/A N/A N/A N/A 20 1,092 37,348 38,460 IMMMIMMOMM .1% 2.8% 97.1% 100.0% NOTE, Grand totals for the client exhibits may differ depending on State ability to respond to specific categories. S ource, State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 27 4 4 EXHIBIT XI STATE NUMBER OF DRUG CLIENT TRIATMENT ADMISSIONS BY TYP1 OF ENVIRONMENT, TYPE OF MODALITY AND STATE FDA FISCAL VRAR 1985 DRUB FREE TOTALS HOSPITAL RESIDENTIAL OUTPATIENT TOTAL I HOSPITAL RESIDENTIAL OUTPATIENT wwwwwwwwwwwwwwww. MMMMM wmwwwwwwwwwwwmwwwwwwwwmwmomme PAIN 2 OF 2 TOTAL 1,615 Alabama 0 236 1,171 1,407 11 236 1,368 Alaska 0 400 741 1,145 0 400 1,009 1,409 Arizona 20 739 3,412 4,171 23 752 4,369 5,144 Arkansas 0 306 1,374 1,760 0 390 1,374 1,764 California 0 5,970 21,053 27,523 0 1,724 35,803 44,527 Colorado 177 117 21295 2,509 177 117 2,541 2,835 Connecticut 0 1,544 2474 4,410 0 1,574 5,668 7,242 A Delaware 0 0 486 486 0 161 575 736 District of Col 0 168 597 765 0 168 3,511 3,686 Florida N/A N/A N/A N/A N/A N/A N/A N/A Georgia 310 713 5,992 7,023 2,147 1,110 6,563 9,820 Guam 0 0 11 11 0 0 11 11 Hawaii 0 102 1,174 1,276 0 102 1,312 1,414 Idaho 0 208 846 1,054 0 330 846 1,184 Illinois 3 1,930 4,738 6,671 7 29266 7,438 9,711 11 Indiana 20 596 29059 2,675 20 1,847 2,846 41713 Iowa 12 652 803 1,467 12 717 1116 11585 Kansas 0 375 910 1,285 0 709 910 1,619 Kentucky 0 369 1,766 2,135 0 971 1,802 2,773 Louisiana 0 772 * 40211 5,053 15 1,362 4,401 5,058 Maine N/A N/A N/A N/A N/A N/A N/A N/A C Maryland 10 377 100108 11,195 333 371 13,390 14,101 Massachusetts 0 MOS 7,722 1,530 0 1,619 9,319 10,938 Michigan N/A 2,638 5,661 8,299 N/A 3,969 8,049 12,018 Minnesota 1,687 1,314 636 3,637 1,687 1,314 691 3,692 Mississippi 0 0 622 622 435 0 747 1,182 Missouri 0 1,073 21846 3,919 47 1,366 3,213 4,626 Montana 0 45 1,149 1,194 26 45 1,149 1,220 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A C Nevada 0 240 374 614 0 240 574 814 New Hampshire 0 115 560 675 0 115 560 675 New Jorsny 0 1,330 4,350 5,680 0 1,674 10,055 11,72, New Mexico N/A N/A N/A N/A 63 140 1,531 1,741 F New York 0 7,749 16,482 24,231 406 8,420 27,764 34,590 North Carolina N/A N/A N/A 2,697 N/A N/A 545 3,242 D North Dakota N/A N/A N/A N/A N/A N/A N/A N/A Ohio N/A N/A N/A' N/A N/A N/A N/A N/A Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A C Orogen 0 209 2,681 2,190 19 209 3,210 3,430 Pennsylvania 708 3,967 9,584 14,259 4,596 5,275 11,690 21,561 Puerto Rico N/A 181 580 761 N/A 438 768 1,206 Rhode Island 0 155 1,578 1,713 216 135 1970 , 2,321 South Carolina 0 12 3,456 3,531 0 777 3,570 4,347 South Dakota 63 0 297 360 63 22 297 382 Tennessee 29 510 2,529 3,068 347 111 2,716 3,874 II Texas 91 19024 4,741 5,856 132 1,021 5,117 7,047 Utah 0 409 936 1,345 184 481 1,131 1,796 Vermont 0 253 572 825 0 476 572 1,048 Virgin Islands N/A N/A N/A N/A N/A N/A SO SO Virginia N/A 553 3,986 4,539 197 663 4,871 5,731 8 Washington 0 658 5,126 5,784 0 651 6,253 6,911 West Virginia 30 103 544 677 401 104 637 1,142 Wisconsin 476 572 4,314 5,362 1,022 624 4,814 6,460 1 Wyoming N/A N/A N/A N/A N/A N/A N/A MIIIMEMOMMOS N/A IMMO MMEMMOMEMMO MMMMMMMMMM MMMMMMMM MONO 12,586 52,925 209,350 ww 274,861 TOTALS 3,644 39,622 149,224 195,187 I MMMMMMMMMMMM MMMMMMMM lumwwwwww MMMMMMM wwwwwwMMMMM 1..wwilm wmumwuwmal 100.0% PERCENT OF TOTAL 1.9% 20.3% 76.5% 91.6% I 4.6% 19.3% 76.2% A Number of clients served instead of clients admitted. I Drug free admissions include clients receiving early intervention services. C See alcohol admissions exhibit; it includes both alcohol and drug data. D North Carolina was not able to provide breakout of 2,697 drug fres admissions by Type of Environment. These admissions data are estimates. F New Mexico was not able to breakout 63 admissions to hospitals, 140 to residential facilities and 1,538 to outpatient environments. O Virginia was not able to break out the 197 hospital admissions by Type of Cars. N/A Information not available. NOTE. Brand totals for the client exhibits may differ depending on Stets ability to respond to specific categories. Sources State Alcohol and Drug Abuse Profile, FY 1985; data are included far "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 28 45 received at least some funds administered by the State Drug Agency for DRUG related treatment services in each of the age, sex, race/ethnicity categories" specified. Forty-six States, the District of Columbia, Guam and Puerto Rico reported drug client admissions data by sex. See Exhibit XII which follows. Overall, 69 percent of the drug client admissions were male, nearly 31 percent were female and data on sex was not reported for .2 percent of the drug client admissions. Thirty-one State Agencies, the District of Columbia and Guam provided information on drug client admissions by age. See Exhibit XIII which follows. The proportions of client admissions that fell within the age-range categories requested were as follows: Age Percent of Admissions Under 18 11.1% 18-20 9.8% 21-24 17.1% 25-34 43.2% 35-44 14.3% 45-54 2.6% 55-64 .8% 65 and over .3% Not Reported .8% In comparing the drug client admissions by age to the alcohol client admissions, it is clear that the drug client admissions tend to be younger (81.2% are under 35 years of age), while the alcohol client admissions tend to be older (a higher proportion of alcohol client admissions - 50.7% - fall in all age categories 35 and over). With regard to drug client treatment admissions by age and by sex, a total of 29 States, the District of Columbia and Guam provided at least partial data according to the age categories specified. See Exhibit XIV which follows. A number of States encountered problems in reporting client admissions data by age and sex combined. With regard to drug client treatment admissions information by race/ethnicity, a total of 42 States plus the District of Columbia, Guam, Puerto Rico and the Virgin Islands provided at least partial data. See Exhibit XV which follows. Overall, among the States reporting data, the percent of clients that fell within the race/ethnicity categories specified were as follows: EXHIBIT XII NUMBER OF DRUID CLIENT TREATMENT ADMISSIONS BY EX AND STATE FOR FISCAL YEAR 1985 SEX STATE MALE FEMALE NOT REPORTED TOTAL Alabama 1,062 450 0 1,512 Alaska 1,058 351 0 1,409 Aritona 3,314 1,830 0 5,144 Arkansas 1,306 458 0 1,764 California 29,195 16,459 0 45,654 Colorado 1,951 814 0 2,765 Connecticut 5,002 2,156 84 7,242 A Delaware 552 184 0 736 District of Col 2,581 1,105 0 3,686 Florida 10,017 3,939 0 13,956 Georgia 6,914 2,906 0 9,020 Guam 10 1 0 11 Hawaii 888 526 0 1,414 Idaho 877 307 0 1,184 Illinois 6,743 2,968 0 9,711 Indiana 3,582 1,131 0 4,713 Iowa 1,059 405 121 1,585 Kansas 1,229 390 0 1,619 Kentucky 1,804 969 0 2,773 Louisiana N/A N/A N/A N/A Maine N/A , N/A N/A N/A 8 Maryland 10,938 3,163 0 14,101 Massachusetts 7,368 3,570 0 10,938 Michigan 8,268 3.1662 0 11,930 Minnesota 2,817 875 0 3,692 Mississippi 830 352 0 1,182 Missouri 3,497 1,129 0 4,626 Montana 746 474 0 1,220 Nebraska N/A N/A N/A N/A B Nevada 529 285 0 814 New Hampshire 475 200 0 675 New Jrsey 8,197 3,532 0 11,729 New Mexico 1,033 505 0 1,538 New York 25,357 11,233 0 36,590 North Carolina 2,296 946 0 3,242 North Dakota 925 475 0 1,400 C Ohio 9,501 5,111 o 14,612 Oklahoma N/A N/A N/A N/A 8 Oregon 2,284 1,154 0 3,438 Pennsylvania 16,440 7,499 0 23,939 Puerto Rico 1,102 104 0 1,206 Rhode Island t,393 712 0 2,105 South Carolina J,134 1,213 C 4,347 South Dakota 274 108 0 382 Tennessee 2,418 1,456 0 3,874 Texas ' 307 1,738 2 7,047 Utah 1 251 545 0 1,796 Vermont 736 312 0 1,048 Virgin Islands N/A N/A N/A N/A Virginia 4,071 1,660 0 5,731 Washington 4,19 2,382 0 6,911 West Virgin:a _5 377 0 1,142 Wisconsin 1918 1,612 402 5,932 C Wyoming ,106 369 0 1,475 . TOTALS 210,649 94,102 609 3051360 PERCENT OF TOTAL 69.0% 30.8% .2% 100.0% A Number of clients served instead of clients admitted. 8 See alcohol admissions exhibit, it includes both alcohol and drug data. C These admissions data are estimates. N/A Information not available. NOTEN Brand totals for the client exhibits may differ depending on State ability to respond to specific categories. Sourcee State Alcohol and Drug Abuse Profile, FY 19851 data are included for °only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985. H 4 7 30 [MINT XIII 'NUMBER OF DRUB CLIENT TREATMENT ADMISOION8 SY ASS AND OTATE FOR FIOCAL YEAR 19O5 UNDER STATE AOC 18 wwwwwwwwwwwwwww. MMMMM wmwswwwwwwwww. le TO 20 21 TO 24 25 TO 34 35 TO 44 43 TO 54 55 TO 64 ASS 65 NOT AND OVER REPORTED TOTAL .wwwwwwww.e. tel Alabama 112 224 650 200 43 19 OO 0 1,512 Alaska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Arizona 1,033 495 661 1,323 1,323 90 99 72 40 5,144 Arkansas 154 289 402 683 170 47 9 2 0 1,764 California 3,269 3,974 1,333 21,O29 6,472 1,415 321 41 0 45,654 Colorado N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Connecticut N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Delaware 136 74 116 314 12 14 0 0 0 736 District of Col 147 291 951 1,101 995 114 0 0 0 3,6O6 Florida N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Seorgia 792 981 1,104 4,432 1,354 310 111 36 0 9,O2O Guam 3 1 2 5 0 0 0 0 O 11 Hawaii N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Indiana 354 542 943 1,178 41 5l8 23 47 0 4,713 Iowa 132 269 375 540 123 21 1 3 121 1,585 Kansas 134 242 412 675 136 15 4 1 0 1,619 Kentucky N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maryland 2,085 1,493 2,778 5,784 1,652 259 44 6 0 14,101 Massachusetts 1,473 1,091 1,843 5,131 1,236 129 27 8 0 10,938 Michigan 1,595 876 1,419 5,711 1,110 278 91 66 77 11,930 Minnesota 159 627 1,06l 1,409 350 53 16 17 0 3,692 Mississippi 66 SO 144 235 64 25 8 0 560 1,112 Missouri 330 597 1,116 1,941 521 84 18 4 1 4,626 Montana 200 155 241 234 2O9 49 36 9 0 1,220 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Nevada N/A N/A N/A. N/A N/A N/A N/A N/A N/A N/A New Hampshire 217 90 106 200 48 4 0 0 10 675 New Jersey 610 790 1,873 6,396 1,800 216 38 5 1 11,729 New Mexico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New York 4,299 3,701 4,955 15,776 6,404 1,043 177 24 131 36,590 North Carolina 375 360 635 1,441 335 69 . 23 4 0 3,242 North Dakota N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Ohio N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Pennsylvania N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Puerto Rico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Rhode Island 377 202 405 O96 119 IS 15 3 0 2,105 South Carolina 1,114 441 568 1,513 484 112 37 O 0 4,347 South Dakota 81 57 13 133 16 B 5 4 0 382 Tenneesse 374 315 712 1,872 421 111 44 21 4 3,174 Texas 538 67O 1,277 3,260 1,021 213 53 5 2 7,047 Utah 149 129 232 637 143 33 13 7 453 1,796 Vermont 125 125 226 408 115 25 17 1 6 1,041 Virgin Islands N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Virginia 1,011 528 965 2,471 621 74 31 18 12 5,731 Washington 1,271 707 1,244 2,644 862 139 32 12 0 6,911 West Virginia 157 157 171 422 142 45 24 24 0 1,142 Wisconsin 1,128 521 830 2,140 680 156 46 16 40O 5,932 A Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A TOTALO 24,070 21,133 37,121 93,4O6 30,921 5,733 11642 552 1,126 216,414 PERCENT OF TOTAL 11.1% 9.8% 17.1% 43.2% 14.3% 2.6% .3% .8% 100.0% A These admissions data are stimates. N/A Information not available. NOTEs Brand totals for the client exhibits may differ depending on State ability to respond to specific categories. Source, State Alcohol and Drug Abuse Profile, FY 19851 data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 31 EXHIBIT XIV PAGE I OF 2 NUMBER OF DRUG CLIENT TREATMENT ADMISSIONS BY AGE, SEX, AND STATE FOR FISCAL YEAR 1985 UNDER AGE 18 18 TO 20 21 TO 24 25 TO 34 35 TO 44 STATE MALE FEMALE MALE FEMALE w MALE FEMALE MALE FEMALE MALE FEMALE Alabama 84 28 139 29 169 55 .458 200 147 53 Alaska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Arizona 674 359 352 143 469 192 831 492 831 492 Arkansas 112 42 239 50 311 91 502 181 124 54 California 2,307 962 2,630 1,344 4,756 3,577 13,483 8,346 4,611 1,861 Colorado N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Connecticut N/A N/A N/A NJA N/A N/A N/A N/A N/A N/A Delaware III 25 61 13 SO 28 228 86 54 28 District of Col 99 48 198 93 651 307 803 378 752 243 Florida N/A NJA N/A N/A N/A N/A N/A N/A N/A N/A Georgia 593 199 718 263 1,290 514 3,100 1,332 960 394 Guam 3 o I o 1 1 5 0 0 0 Hawaii N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Indiana N/A NJA N/A N/A N/A N/A N/A N/A N/A N/A Iowa 85 47 205 64 290 85 383 157 87 36 Kansas 104 30 206 36 329 83 481 194 102 34 Kentucky N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maryland 1,528 557 1,235 258 2,189 589 4,426 1,358 1,307 345 Massachusetts 933 540 798 293 1,246 597 3,400 1,731 892 344 Michigan 1,116 479 692 184 957 462 3,866 1,852 1,303 507 Minnesota 95 64 488 139 836 225 1,058 351 276 74 Mississippi 45 21 64 16 117 27 164 71 37 27 Missouri 228 102 501 96 883 233 1,431 517 382 146 Montana 129 71 104 51 174 .74 142 92 155 134 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Nevada N/A N/A N/A N/A N/A N/A N/A N/A NJA NJA New Hampshire 134 83 70 20 74 32 149 51 39 9 Now Jersey 454 156 579 211 1,255 618 4,341 2,055 1,383 417 New Mexico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New York 2,665 1,634 2,628 1,153 3,293 1,662 10,770 5,006 4,926 1,478 North Carolina 281 94 278 82 455 180 979 462 246 89 North Dakota N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Ohio N/A N/A N/A N/A N/A N/A N/A N/A N/A NJA Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Pennsylvania N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Puerto Rico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Rhode Island 250 127 157 45 260 145 589 307 122 67 South Carolina 895 289 345 96 425 143 1,091 422 308 176 South Dakota 51 30 46 11 69 14 99 34 7 9 Tennessee 280 94 213 102 458 254 1,141 731 253 168 Texas 403 135 538 140 949 328 2,377 883 818 203 Utah 105 44 107 22 161 71 430 207 101 42 Vermont 79 46 93 32 159 67 301 107 77 38 Virgin Islands N/A N/A NJA N/A N/A NJA N/A NJA N/A N/A Virginia 743 268 396 132 673 292 1,727 744 444 177 Washington N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A West Virginia 87 70 114 43 123 48 302 120 90 52 Wisconsin 1,017 503 352 141 717 382 717 376 717 308 A Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A TOTALS 15,690 7,147 14,547 5,302 23,827 11,376 59,774 28,843 21,511 8,005 A These admissions data are estimates. N/A Information not available. NOTE. Grand totals for the client exhibits may differ depending on State ability to respond to specific categories. Sources State Alcohol and Drug Abuse Profile, FY 1985p data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985°. 32 49 EXHIBIT XIV NUMBER OF DRUG CLIENT TREATMENT ADMISSIONS BY AGE, SEX, AND STATE FOR FISCAL YEAR 1985 45 to 54 55 TO 64 65 and OVER NOT REPORTED TOTALS STATE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE TOTAL Alabama 24 19 10 9 31 57 0 0 1,062 450 1,512 Alaska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Arizona 54 44 54 45 24 48 25 15 3,314 1,830 5,144 Arkansas 15 32 2 7 1 1 0 0 1,306 458 1,764 California 1,114 301 258 63 36 5 0 0 29,195 16,459 45,654 Colorado N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Connecticut N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Delaware 10 4 0 0 552 184 736 District of Col 78 36 0 0 2,501 1,105 3,686 Florida N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Georgia 173 137 61 50 19 17 6,914 2,906 9,820 Guam 0 0 10 1 11 HaWaii N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Idaho N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Illinois N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Indiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Iowa 6 15 1 3 1,059 405 1,565 8 Kansas 5 10 3 1 1,229 390 1,619 Kentucky N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Louisiana N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maine N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Maryland 211 48 37 5 1 10,938 3,163 14,101 Massachusetts 75 54 19 5 3 7,360 3,570 10,93S Michigan 194 84 60 31 23 43 57 20 8,261 3,662 11,930 Minnesota 37 16 11 5 16 1 2,817 875 3,692 Mississippi 17 3 5 0 392 168 830 352 1,182 Missouri 63 21 6 12 2 2 1 3,497 1,129 4,626 Montana 24 25 14 22 4 5 746 474 1,220 Nebraska N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Nevada N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New Hampshire 2 2 7 3 475 200 675 New Jersey 155 61 28 10 1 4 1 8,197 3,532 11,729 New Memico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A New York 836 207 131 46 16 92 39 25,357 11,233 36,590 North Carolina 43 26 11 12 3 1 2,296 946 3,242 North Dakota N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Ohio N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oregon N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Pennsylvania N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Puerto Rico N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Rhode Island 7 11 7 a 1 2 1,393 712 2,105 South Carolina 50 62 16 21 4 4 3,134 1,213 4,347 South Dakota 1 2 5 1 3 274 108 382 Tennessee 48 63 18 26 5 16 2 2 2,418 1,456 3,874 Tomas 175 38 42 11 5 5,307 1,738 7,047 C Utah 20 13 5 6 316 137 1,251 545 1,796 Vermont 15 10 a 9 1 3 3 736 312 1,048 Virgin Islands N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Virginia 51 23 20 11 11 7 6 6 4,071 1,660 5,731 Washington N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A West Virginia 24 21 14 10 11 13 765 377 1,142 Wisconsin 78 101 4 21 4 20 313 161 3,919 2,013 5,932 A Wyoming N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A TOTALS 3,596 1,503 840 466 239 262 1,215 554 141,279 63,458 204,860 D A These admissions data are stimates. 8 Total figure 1,706 admissions for Iowa includes 121 client admissions sem was not reported. C Total figure 7,049 admissions sem was not reported. D Brand total admissions figure of 204,983 includes 121 2 admissions in Temas for which sem was not reported. for which for Tomas includes 2 client admissions for which admissions in Iowa and N/A Information not available. NOTE! Grand totals for the client exhibits may differ depending on State ability to respond to specific categories. Source, State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received ot least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 33 50 EXHIBIT XV NUMBER OF DRUG CLIENT TREATMENT ADMISSIONS SY RACE/ETHNICITY AND STATE FOR FISCAL YEAR 1985 WHITE, NOT OF HISPANIC BLACK, NOT OF HISPANIC ASIAN OR PACIFIC AMERICAN INDIAN OR ALASKAN NOT STATE ORIGIN ORIGIN HISPANIC ISLANDER NATIVE OTHER REPORTED TOTAL Alabama 1,199 312 N/A N/A NJA I N/A 1,512 Alaska 783 66 25 12 521 2 0 1,409 Arizona 3,567 262 983 N/A 266 41 25 5,144 Arkansas 1,362 388 5 3 6 0 0 1,764 California 23,217 7,825 13,592 628 373 19 0 45,654 Colorado 2,122 144 436 13 37 0 13 2,765 Connecticut 4,514 1,710 894 0 0 40 84 7,242 C Delaware 423 280 33 0 0 0 0 736 District of Col 288 3,354 35 0 0 9 0 31686 Florida 10,105 2,501 798 0 0 552 0 13,956 Georgia 7,089 2,710 0 5 6 2 0 9,820 Guam 0 0 0 11 0 0 0 11 Hawaii 450 36 0 281 0 584 63 1,414 Idaho 1,075 12 41 0 40 0 16 1,184 Illinois 5,224 3,795 619 24 37 2 11 9,711 D Indiana 4,053 566 94 0 0 0 0 4,713 Iowa 1,332 86 14 3 27 3 120 1,585 Kansas 1,304 243 37 1 27 3 4 1,619 Kentucky 2,451 259 56 7 0 0 0 2,773 Louisiana 3,468 2,292 85 3 10 0 0 5,858 Maine N/A N/A N/A N/A N/A N/A N/A N/A Maryland 6,947 7,059 48 17 30 0 0 14,101 Massachusetts 8,636 1,313 056 22 25 86 0 10,938 Michigan 6,810 4,848 ISO N/A 83 39 58 12,018 Minnesota 2,779 220 51 3 617 20 2 3,692 Mississippi 665 317 0 0 0 0 0 1,182 Missouri 3,024 1,548 36 6 12 0 0 4,626 Montana 1,116 4 12 0 87 1 0 1,220 Nibraska N/A N/A N/A N/A N/A N/A N/A N/A A Nevada 715 47 34 5 7 6 0 814 New Hampshire 640 11 7 1 1 3 12 675 New Jersey 6,711 3,752 1,244 0 0 21 1 11,729 New Mexico N/A N/A N/A N/A N/A N/A N/A N/A New York 17,420 10,925 7,807 N/A N/A 290 148 36,590 North Carolina 2,267 936 4 0 27 8 0 3,242 North Dakota N/A N/A N/A N/A N/A N/A NJA NJA Ohio N/A N/A N/A N/A N/A N/A N/A N/A Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A A Oregon 3,050 156 86 14 132 0 0 3,438 Pennsylvania 14,455 6,203 853 N/A N/A 32 0 21,543 Puerto Rico 0 0 1,206 0 0 0 0 1,206 Rhode Island 1,895 121 42 0 6 ',1 0 2,105 South Carolina 3,177 1,150 11 2 7 0 0 4,347 South Dakota 288 6 0 0 84 4 0 msc. Tennessee 3,199 664 1 0 5 5 0 3,874 Texas 3,554 999 2,641 3 21 0 9 7,227 Utah 1,364 57 142 5 29 0 199 1,796 Vermont N/A N/A N/A N/A N/A NJA 1,048 1,048 Virgin Islalds 21 31 20 N/A N/A 13 0 80 Virginia 3,901 1,756 34 23 17 0 0 5,731 Washington 5,720 746 186 67 184 0 0 6,911 West Virginia 1,070 71 1 0 0 o 0 1,142 Wisconsin 4,276 1,014 186 2 46 2 406 5,932 8 Wyoming N/A N/A N/A N/A N/A N/A N/A N/A TOTALS 177,934 70,795 33,442 1,161 2,770 1,824 2,219 290,145 PERCENT OF TOTAL 61.3% 24.4% 11.5% .4% 1.0% .6% .8% 100.0% A See alcohol admissions exhibit, it includes both alcohol and drug data. B These admissions data are estimates. C Number of clients carved instead of clients admitted. D Drug Free admissions include clients receiving early intervention services. N/A Information not available. NOTE; Grand totals for client exhibits may differ depending on State ability to respond to specific categories. Source; State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 51 34 Race/Ethnicity Percent of Admissions White, not of Hispanic origin 61.3% Black, not of Hispanic origin 24.4% Hispanic 11.5% Asian or Pacific Islander .4% American Indian or Alaskan Native 1.0% Other .6% Not Reported .8% A comparison of the drug client admissions to the alcohol client admissions in terms of race/ethnicity, reveals that the drug client admissions include a higher proportion of Blacks, Hispanics, and Asian or Pacific Islanders, while the alcohol client admissions consist of more Whites (71.3 percent compared to 61.3 percent among drug clients) and American Indians or Alaskan Nazives (3.7 percent as compared to 1.0 percent among drug client admissions). c. client .AdmiSsions Data,bY. PrimarY_Drufl. Of Abuse Each State Drug (and combined alcohol and drug) Agency was asked to provide information on the number of client admissions by the primary drug of abuse. Thirty-nine States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands provided at least partial data in response to this question. See Exhibit XVI. The totals indicate that, overall, heroin mentions constitute the largest portion of drugs of choice. However, a State-by-State analysis indicates that in 26 States, Guam and the Virgin Islands, cocaine or marijuana mentions exceeded the number of heroin mentions. d. vaj,1abiUty of Client Adatia4ons. Data Within Treatment. plats ,that _Do ,Not,Receive_Aay State, Drug Agency Funds Each State Drug Agency was asked to indicate whether information was available from the State Agency or from any other source on "DRUG related client admissions within treatment units that do not receive any State Drug Agency funds". A total of 20 State Agencies responded "Yes", indicating that at least some data were available on client admissions to such treatment units that receive no State Agency funding. The sources of such data vary widely. They range from the State A/D Agency or some of its components to a number of other sources such as the State Health Planning and Development Agency, CODAP or other existing data systems, a methadone registry and licensing visits. For further information on the individual State Drug Agency responses, see Exhibit XVII which follows. 35 52 S TATS EXHIBIT XVI PAM 1 OF 2 NUMBER OF DAUS CLIENT TREATMENT ADMISSIONS IN STATE suppooTau FACILITIES BY PRIMARY DRUG OP ASIAN" AND STATE FOR FISCAL YEAR 1005 OTHER OTHER NON-RX OPIATIS/ SEDATIVES/ HEROIN METHADONE SYNTHETICS SARSITURATES TRANQUILIZERS SYNTHETICS AMPHETAMINES COCAINE Alabama N/A N/A 363 87 N/A N/A 31 131 Alaska 116 6 72 1 9 4 11 419 Arizona 1,282 29 241 42 109 42 280 011 Arkansas 00 2 133 01 66 105 178 180 California 21,943 113 1,214 239 303 190 2,537 0,664 Colorado 292 2 160 24 40 12 191 708 Connecticut 3,649 102 181 36 24 15 49 981 Delawars 184 2 11 6 8 2 127 101 District of Col 2,671 0 0 0 0 0 1 6 Florida 1,575 84 1,128 119 178 189 167 4,280 S eorgia N/A N/A N/A N/A N/A N/A N/A N/A S uam 0 0 0 0 1 0 0 0 Hawaii 134 0 4 0 0 0 0 64 Idaho 37 2 42 14 10 18 07 112 Illinois 4,070 22 307 127 114 69 332 1,494 Indiana 442 10 335 0 0 0 0 0 Iowa 97 1 20 32 35 11 120 164 Kansas N/A N/A N/A N/A N/A N/A N/A N/A Kentucky N/A N/A N/A NtA N/A N/A N/A N/A Louisiana 249 44 1,059 3 2 147 128 1,814 Mains N/A N/A N/A N/A N/A N/A N/A N/A Maryland 51136 120 205 107 201 57 284 1,701 Massachusstts 4,212 41 655 95 214 94 115 1,963 Michigan 4,070 79 876 SO 197 02 312 2,156 Minnesota 149 0 201 0 0 108 289 270 Mississippi 26 5 125 50 26 73 70 108 Mislleurl 890 12 404 101 127 SI 200 271 Montana N/A N/A N/A N/A N/A N/A N/A N/A Nebraska 114 7 70 28 27 60 178 119 Nevada 3:6 2 14 7 10 8 65 110 New Hampshirs 39 1 2 8 9 1 23 218 Now Jersey 7,102 145 386 235 164 130 938 1,738 New Mexico N/A N/A N/A N/A N/A N/A N/A WA New York 16,093 423 830 298 432 175 428 6,339 North Carolina N/A N/A N/A N/A N/A N/A N/A N/A North Dakota N/A N/A N/A N/A N/A N/A N/A N/A Ohio 216 0 521 7 6 32 17 113 Oklahoma N/A N/A N/A N/A N/A N/A N/A N/A Oregon 791 20 205 It 51 22 648 880 Pennsylvania 5,696 219 1,403 574 607 359 4,805 2,603 Puerto Rico 549 0 4 2 11 1 1 28 Rhoda Island 332 27 158 40 167 25 81 730 South Carolina 471 37 222 100 138 68 173 779 South Dakota 8 0 3 10 14 0 24 32 Tennessee 138 12 963 126 134 184 203 314 Texas 2,434 7 327 108 67 51 11180 635 Utah 278 8 177 30 30 44 100 298 Vermont 22 s 16 12 40 la 37 146 Virgin Islands SO N/A 2 N/A N/A N/A N/A 3 Virginia 1,544 11 458 46 86 120 269 711 Washington 1,450 27 443 48 106 48 265 001 West Virginia 6 10 103 511 86 97 148 84 Wisconsin N/A N/A N/A N/A N/A N/A N/A N/A Wyoming NtA N/A N/A N/A N/A N/A N/A N/A ...a TOTALS 89,456 1,637 13,966 21974 2,936 2,772 15,185 39,827 S ee footnotes at bottom of next page. N/A Information not availabls. NOTEI Brand totals for client exhibits may differ depending on State ability to respond to specific categories. S ourcs, State Alcohol and Drug Abuse Profits, FY 19851 data ars included for "only those programs which received at least sans funds administered by the State Alcohol/Drug Agency during Fiscal Year 1905". EXHIBIT XVI NUMBER OF DRUG CLIENT TREATMENT ADMISSIONS IN STATE SUPPORTED FACILITIES BY PRIMARY DRUG OF Amu STATE MARIJUANA/ HASHISH AND STATE FOR FISCAL YEAR 1905 OTHER PCP HALLUCINMENS INHALANTS OVER.. THE COUNTER OTHER TOTAL Alabama 325 724 7 N/A N/A 89 1,757 Alaska 455 o 11 2 2 6 1,114 Arisona 1,680 44 65 105 33 370 5,144 Arkansas 938 9 26 40 8 8 1,164 California 5,339 6,865 210 186 55 716 45,654 Colorado 971 7 67 82 9 231 2,812 Connecticut 727 5 40 9 1 1,423 7,242 AS Delaware 277 6 10 1 2 2 736 District of Col 12 996 o o o 0 3,686 Florida 4,247 22 72 45 12 1,838 13,956 Georgia N/A N/A N/A N/A N/A N/A N/A Guam 9 0 o o 0 1 11 Hawaii 559 0 o o o 653 1,414 Idaho 766 3 18 20 5 45 1,184 Illinois 2,345 173 162 59 35 402 9,711 E Indiana 0 o o o o 3,926 4,713 F Iowa 936 1 28 7 4 10 1,471 Kansas N/A N/A N/A N/A N/A N/A N/A Kentucky N/A N/A N/A N/A N/A N/A N/A Louisiana 1,255' 257 o 78 39 783 5,858 Maine N/A N/A N/A N/A N/A N/A N/A Maryland 4,224 1,066 139 103 36 642 14,101 Massachusetts 2,089 79 122 10 11 1,230 10,938 Michigan 3,406 ft: 101 33 20 564 42,018 Minnesota 1,557 o 30 30 0 43 2,777 Mississippi 591 N/A 13 15 7 65 1,182 Missouri 2,382 128 29 38 15 156 4,626 Montana N/A N/A N/A N/A N/A N/A N/A Nebraska 986 3 36 4 13 192 1,837 Nevada 240 16 10 3 o 13 814 New Hampshire 304 o 21 1 6 42 675 Now Jersey 495 97 179 N/A 40 61 11,729 New Mexico N/A N/A N/A 22 N/A N/A N/A New York 7,224 563 279 41 77 2,888 36,590 North Carolina N/A N/A N/A N/A N/A N/A N/A North Dakota N/A N/A N/A N/A N/A N/A N/A Ohio 364 3 18 3 12 121 1,433 Oklahoma N/A N/A N/A N/A N/A N/A N/A Oregon 1,038 5 33 21 4 5 3,438 Pennsylvania 4,398 N/A 203 123 56 435 21,561 Puerto Rico 492 0 1 19 0 1 1,206 Rhode Island 362 30 114 9 9 21 2,105 South Carolina 2,026 N/A 32 95 19 187 4,347 South Dakota 250 2 3 27 o 9 382 Tennessee 907 13 37 47 8 788 3,874 C Texas 1,793 6 55 323 1 60 7,047 Utah 559 2 22 28 9 21 1,796 Vermont 577 1 13 2 3 159 1,048 D Virgin Islands 16 1 N/A N/A N/A N/A 80 Virginia 2,122 206 63 34 6 35 5,731 Washington 2,598 20 70 12 10 97 6,911 Vest Virginia 384 15 7 39 3 22 1,142 Wisconsin N/A N/A N/A N/A N/A N/A N/A Wyoming N/A N/A N/A N/A N/A N/A N/A TOTALS 62,225 11,432 2,346 1,716 570 18,368 267,615 A Number of clients served instead of clients admitted. B "Other" category includes 880 clients whose primary drug of abuse was alcohol. C "Other" category includes 429 clients whose primary drug of manse was alcohol. D "Other" category includes 104 non drug using family members of drug abusers. E Drug Flee admissions include clients receiving early intervention services. F "Other" category includes admissions for polydrug abuse. N/A Information not available. NOTE. Grand totals for client exhibits may differ depending on State ability to respond to specific categories. Sourcel State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency during Fiscal Year 1985". 37 54 EXHIBIT XVII INFORMATION AVAILABILITY AND SOURCE FOR DRUG ABUSE RELATED CLIENT ADMISSIONS WITHIN TREATMENT UNITS THAT DO NOT RECEIVE ANY STATE DRUG AGENCY FUNDS INFORMATION STATE AVAILABLE SOURCE simmallimusema UUUUU MMMMM MMMMMMMMMMMMMMMMMMM Alabama No Alaska No Arizona No Arkansas No California Yes STATE A/D AGENCY Colorado Yes STATE A/D AGENCY Connecticut Yes STATE A/D AGENCY Delaware No District of Columbia Ysis STATE HEALTH PLANNING AND DEVELOP. AGENCY Florida Yes CODAP Georgia No Guam No Hawaii No Idaho No Illinois Ysis HOSPITAL QUESTIONNAIRE Indiana Yes STATE A/D AGENCY SURVEr Iowa No Kansas Yes STATE A/D AGENCY Kentucky No Louisiana No Maine No Maryland Yes MD DRUG AGENCY Massachusetts No Michigan No Minnesota YOB OAANSS & CATOR Mississippi No Missouri No Montan& Yes STATE DATA SYS4Em Nebraska No Nevada ,res STATE PROGRAMia New Hampshire yes MINI-DAWN New 3ersey 'yes NJ CODAP SYSTEM New Mexico No New York Yes METH/C REGISIR, North Carolina No North Dakota No Ohio No Oklahoma No Oregon No PennsylvanLe4 No r:uerto Rico No Rhode Island Yes LICENSING VISIT South Carolina YOU SC DEPT OF MH South Dakota Yes VA HOSPITALS Tennessee Yes LICENSURE SECTION Texas No Utah No Vermont No Virgin Islands No Virginia No Washington No West Virginia No Wisconsin No Wyoming Yes STATE HOSPITAL N/A Information not available. Source: State Alcohol and Drug Abuse Profile, FY 1985. 38 55 3. Comparisons of . Client Admissions Data for FY 1984 and FY 1985 This subsection includes comparisons of alcohol and drug client admissions data reported for FY 1985 with that reported for the previous year, FY 1984. This material is organized under two topic headings as follows: o Comparisons of alcohol client admissions data; and o Comparisons of drug client admissions data. Information on each of these areas is presented within the following paragraphs. Data analyses are included in this subsection only for those States that provided comparable data for both FY 1984 and FY 1985. a. Comparisons, of Alcohol Client Admissions Data For those State Agencies that provided alcohol client admissions information for both FY 1984 and FY 1985, a nun:I:sr of data comparisons were conducted. Following as Exhibit XVIII is a comparison of total alcohol client treatment admissions by State for FYs 1984 and 1985. Forty-four States, the District of Columbia and Puerto Rico were able to provide information for both years. The total alcohol client admissions figure for these State Agencies rose from 992,067 in FY 1984 to 1,051,892 in FY 1985, an increase of 59,825 admissions or just over six percent. However, as is clear from an inspection of the data, there exists considerable variability across individual States. Alcohol client admissions data were also compared by type of care (detoxification, rehabilitation/ residential or outpatient) and by type of environment (hospital or non-hospital) across FYs 1984 and 1985. Forty-three States, the District of Columbia and Puerto Rico provided comparable data for both years. See Exhibit XIX which follows for summary data. The number of client admissions to rehabilitation/ residential care increased by 8.6 percent while the number of outpatient admissions increased by 11.9 percent. Also, in terms of admissions by type of environment, hospital admissions appeared to grow by 4.4 percent while non-hospital program admissions appeared to decline by 5.8 percent. Since new categories were added to the alcohol client admissions questions relating to sex and to race/ethnicity (e.g., "Not Reported" and "Other") for FY 1985, meaningful comparisons cannot be made between FYs 1984 and 1985. 39 5 6 COMPARISON OF SY STATE STATE EXHIBIT ALCOHOL CLIENT TREATMENT FOR FISCAL YEARS TOTAL ADMISSIONS 1984 XVIII ADMISSIONS 1984 AND 1985 1985 DATA Alabama 5,919 6,202 Alaska 11,302 9,814 Arizona 17,279 21,183 Arkansas 8,837 7,378 California 106,600 113,300 A Colorado 44,176 42,463 Connecticut 12,593 13,158 Delaware 4,345 3,197 District of Col 7,3612 7,595 Georgia 31,417 40,620 Hawaii 1,961 2,562 Idaho 6,549 6,154 Illinois 53,899 54,623 Indiana 11,757 15,372 Iowa 4,541 5,429 Kansas 8.632 8,720 Louisiana 9,322 11,278 Maine 8,337 8,580 Maryland 25,004 24,182 Massachusetts 63,953 66,401 Michigan 34,660 34,725 Mississippi 8,653 9,619 Missouri 17,107 19,253 Montana 11,391 6,975 Nebraska 17,921 17,298 Nevada 3,906 3,269 New Hampshire 2,236 2,484 New Jersey 16,402 18,456 New York 123,345 124,885 North Carolina 16,949 22,139 North Dakota 10,228 8,800 A Ohio 18,471 18,966 Oregon 22,464 31,376 Pennsylvania 42,490 45,643 Puerto Rico 2,711 3,514 Rhode Island 7,891 6,922 South Carolina 17,868 19,123 South Dakota 8,022 5,311 Tennessee 7,381 8,067 A Texas 6,319 7,278 Utah 9,643 13,957 Vermont 3,833 4,058 Virginia 21,607 26,327 Washington 53,225 55,610 West Virginia 12,236 10,176 Wisconsin 51,303 59,250 A TOTALS 992,067 1,051,892 A These admissions data are estimates. 8 Number of clients served instead of clients admitted. C Includes both alcohol and drug admissions. D Client admissions data are for calendar years 1983 and 1984. E Ohio client admissions for FY 1984 have been adjusted to reflect the same client universe as that used for the FY 1985 data. NOTEs Brand totals for the client exhibits may differ depending on State ability to respond to specific categories for both 1984 and 19851 this exhibit includes comparable FY data for 44 States plus the Distric of Columbia and Puerto Rico. Sources State Alcohol and Drug Abuse Profile, FY 19851 data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency". 40 57 ' EXHIBIT XIA COMPARISON OF ALCOHOL CLIENT TREATMENT ADMISSIONS DATA BY TYPE OF CARE AND BY TREATMENT ENVIRONMENT FOR FISCAL YEARS 1984 AND 1985 1984 I 1985 IPERCENT CHANGE I mmommummmummummusammumummommommamommumammummummommummsnummummummummmommummumml TYPE OF CARE; DETOXIFICATION 412,940 401,610 -2.77. REHABILITATION/ RESIDENTIAL 140,882 I 153,052 I 8.6% OUTPATIENT 420,998 I 470,903 I 11.97. TYPE OF ENVIRONMENT; HOSPITAL PROGRAMS 149,049 155,576 I 4.47, NON-HOSPITAL PROGRAMS 847,034 I 798,224 -5.87. mormommummemmumumummemmommumwsommeammummommummumummumwrommeammummommumommul NOTE: Grand totals for the client exhibits may differ depending on State ability to respond to specific categories in both FY 84 and FY 85; this exhibit includes comparable data from 43 States, the District of Columbia and Puerto Rico. Sour:ce; State Alcohol and Drug Abuse Profile, FY 1985; data are included +or "only those programs which received at least some funds administered by the State Alcohol/Drug Agency". 58 59 r,;, b. Comparisons of Drug Client Admissions Data For those State Agencies that provided drug client admissions information for both FY 1984 and FY 1985, a number of data comparisons were conducted. Most of these analyses were similar to the alcohol client comparisons. Following as Exhibit XX is a comparison of total drug client treatment admissions by State for FY 1984 and 1985. Forty States, the District of Columbia and Puerto Rico were able to provide information for both years. The total drug client admissions figure for these State Agencies rose from 255,512 in FY 1984 to 269,711 in FY 1985, an increase of 14,199 admissions or nearly 5.6 percent. However, an inspection of the data reveals that considerable variability exists across States in terms of increases or decreases in drug client admissions. An attempt was made to compare drug client admissions data by type of care (detoxification, maintenance or drug-free) and by type of environment (hospital, residential or outpatient) across FYs 1984 and 1985. However, since directly comparable data were available from less than one-half of the States, these data are not considered to be sufficiently representative and are not presented. Also, since new categories (e.g., "Not Reported" and "Other") were added for FY 1985 to the drug client admissions question relating to sex and to race/ethnicity, meaningful comparisons cannot be made between PlYs 1984 and 1985. Drug client admissions data for FYs 1984 and 1985 were compared by primary drug of abuse. See Exhibit XXI which follows. Thirty-five States, the District of Columbia and Puerto Rico were able to provide comparable information for both years. The category "Other" increased from 8,321 admissions in FY 1984 to 14,128 admissions in FY 1985. The other most significant increase was reflected in the "Cocaine" category. The number of cocaine admissions increased from 26,653 in FY 1984 to 39,592 in FY 1985, an increase of 48.5 percent. Drug categories which were less likely to be noted as the primary drug of abuse for client admissions in FY 1985 included "barbiturates" (a decrease of 25.1 percent), "Other Sedatives and Synthetics" (a decrease of 25.8 percent) and "Other Hallucinogens" (a decrease of 23.1 percent). 42 6 0 EXHIBIT XX COMPARISON OF DRUG CLIENT TREATMENT ADMISSIONS DATA BY STATE FOR FISCAL YEARS 1984 AND TOTAL ADMISSIONS 1985 STATE 1984 I 14e5 Alabama 3,229 I 1,615 Alaska 1,000 I 1,409 Arizona 5,454 I 5,144 Arkansas 1,304 I 1,764 California 42,320 I 44,527 Colorado 2,977 I 2,835 Connecticut 7,459 I 7,242 IA Delaware 793 I 736 District of Columbia I 3,070 I 3,686 Georgia 8,300 I 9,820 Hawaii 815 I 1,414 Idaho 1,169 I 1,184 Illinois 8,192 I 9,711 lB Indiana 6,404 I 4,713 Iowa 1,277 I 1,585 Kansas 1,389 I 1,619 Louisiana 6,624 I 5,858 Maryland 12,957 I 14,101 Massachusetts 5,693 I 10,938 Mi.chigan 12,185 12,018 Minnesota 938 I 3,692 Mississippi 1,112 I 1,182 Missouri 5,736 I 4,626 Montana 1,07 I 1,220 Nevada 1,037 I 814 New Hampshire 502 I Nw Jersey 10,623 I 11,-129 New York 36,549 I 36,590 Oregon 3,217 I 3,438 Pennsylvania 18,089 I 21,561 Puerto Rico 3,586 I 1,206 Rhode Island 2,23 I 2,321 South Carolina 3,674 I 4,347 South Dakota 722 I 382 Tnnessee 3,327 I 3,874 Texas 7,600 I 7,047 Utah 1,547 I 1,796 Vermont 903 I 1,048 Virginia 6,612 I ,731 Washington 7,915 6,911 West Virginia 925 I 1,142 Wisconsin 4,979 I 6,460 IC TOTALS 255,512 I 269,711 A Numbr of clients served instead of clients admitted. B Drug free admissions include clients receiving early intervention ervices C is These admissions data are estimates. NOTE: Grand totals for the client xhibits may differ depending on State ability to respond to specific categories for both 1984 and 1985; this exhibit includes comparable data for 40 States plus the District of Columbia and Puerto Rico. Source: State Alcohol and Drug Abuse Profile, FY 1985; data arc included for "only those programs which received at last some funds administered by the State Alcohol/Drug Agency". 43 61 EXHIBIT XXI COMPARISON OF DRUG CLIENT TREATMENT ADMISSIONS DATA BY PRIMARY DRUG OF ABUSE FOR FISCAL YEARS 1984 AND 1985 1984 1985 1PERCENT CHANGE HEROIN 90,285 I 88,626 I .1.8% NON....RX METHAOONE 1,541 1,620 I 5.1% OTHER OPIATES/SYNTHENTICS 12,865 13,038 I 1.3% BARIBITURATES 3,922 I 2.939 I ..25.1% TRANQUILIZERS 4,193 I 3,902 1 ..6.9% OTHER SEDATIVES tst SYNTHETICS 3,611 2,680 ..25.8% AMPHETAMINES 14,985 I 14,990 .0% COCAINE 26,653 39,592 I 48.5% MARIJUANA/HASHISH 58,757 60,850 3.67. PCP 9,798 11,425 16.6% OTHER HALLUCINOGENS 2,981 2,292 ..23.1% INHALENTS 1,933 1,687 I ...12.7% OVERTHECOUNTER 566 I 545 3.7% OTHER 8,321 I 14,128 69.8% TOTAL 240,711 1 259,541 7.8% NOTE: Grand totals for the client exhibits may differ depending on State ability respond to specific categories for both 1984 and 1985; this exhibit includes a summary of comparable data for 35 States plus the District of Columbia and Puerto Rico. Source: State Alcohol and Drug Abuse Profile, FY 1985; data are included for "only those programs which received at least some funds administered by the State Alcohol/Drug Agency". 44 62 V. AVAILABILITY OF TREATMENT RELATED DATA BY STATE In order to determine the availability of treatment related data among the State Alcohol and Drug (A/D) Agencies, the States were asked whether any data were available on treatment outcome and/or the average costs of treatment by modality within their respective States. Fifty States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands responded to this request. See Exhibit XXI/. Thirty State A/D Agencies responded that treatment outcome data are available within their States. States were not asked to list the source of such data or to describe its contents, findings or limitations. It is anticipated that further analysis of the responses to this question may be undertaken at a later date. Forty-one State A/D Agencies indicated the availability of information on the average costs of treatment by modality within their States. As with the question related to treatment outcome, States were not asked to provide detailed information on the source or extent of the data. EXHIBIT XXII AVAILABILITY OF TREATMENT OUTCOME AND COST DATA BY STATE STATE TREATMENT OUTCOME DATA AVERAGE COSTS OF TREATMENT BY MODALITY Alabama No Yes Alaska No No Arizona Yes Yes Arkansas Yes YeS California Yes* No Colorado Yes YeS Connecticut No Yes Delaware Yes No District of Columbia Yes Yes Florida Yes Yes Georgia No No Guam Yes No Hawaii Yes YeS Idaho Yes YeS Illinois Yes Yes Indiana Yes Yes Iowa Yes Yes Kansas Yes Yes Kentucky No Yes Louisiana No Yes Maine No Yes Maryland/Alcohol No YoS Maryland/Drug Yes YeS Massachusetts Yes Yes Michigan No Yes Minnesota Yes Yes Mississippi No No Missouri Yes Yes Montana Yes Yes Nebraska Yes No Nevada Yes Yoe New Hampshire Yes Yes New Jersey No No New Mexico/Alcohol No Yes New Mexico/Drug Yes Yes New York/Alcohol No Yes New York/Drug Yes Yes North Carolina No No North Dakota No No Ohio No Yes Oklahoma Yes Yes Oregon No Yes Pennsylvania No Yes Puerto Rico Yes No Rhode Island No Yes South Carolina No Yes South Dakota Yes Yes Tennessee Yes Yes Texas Yes Yes Utah Yes No Vermont Yes Yes Virgin Islands No No Virginia No Yes Washington No Yes West Virginia No No Wisconsin Yes Yes Wyoming No No Only drug information is available. N/A Information not available. Sourcel State Alcohol and Drug Abuse Profile, FY 1985. 46 6 4 VI. TOP THREE POLICY ISSUES PROM A STATE ALCOHOL AND DRUG AGENCY PERSPECTIVE In order to identify the policy questions and issues currently being considered at the State level, the State Alcohol and Drug Agencies were asked to list their top three policy issues. Forty-nine States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands responded to this question. See Exhibit XXIII for a summary of the State-by-State responses. States were not asked to rank the policy issues by priority level. However, in compiling the results of the responses, five policy issues were mentioned by at least 11 State agencies and are categorized as: 1) prevention and education; 2) services for children and adolescents; 3) public and private health insurance issues; 4) maintenance and measurement of quality of care in an environment of limited fiscal resources and cost containment efforts; and 5) the need to seek alternative sources of funding for treatment and prevention services. Twenty State Agencies reported prevention and education services as a top policy issue. These responses ranged from the general need to increase prevention services, to the development and implementation of a Statewide prevention policy, to the mandatory provision of a grade X-12 curriculum in the schools. The development of treatment and prevention services for children and adolescents was listed as a top policy issue by 17 State respondents. The responses ranged from the need to develop adolescent services, to the need to provide services to juvenile offenders, to the development of alcohol prevention projects for children. Public and private health insurance issues including mandatory health insurance coverage by private health insurers and the expansion of Medicaid services to indigent clients in non-hospital settings were mentioned by 13 State respondents. Issues of quality control, treatment effectiveness and efficiency were also mentioned by 14 State Agencies with an emphasis on the need to maintain quality control and measure effectiveness and efficiency in an environment of limited resources. The need to seek alternative sources of funding for treatment and prevention services was identified by 11 State respondents. Concerns were expressed about the need to maintain an adequate level of funding for services as well as the need to identify new sources of funding and eliminate barriers to reimbursement. 47 EXHIBIT XXIII TOP THREE POLICY ISSUES AI REPORTED BY STATE ALCOHOL AND DRUG AGENCIES STATE Alabama 1.ACCEPT JCHA ACCREDITATION 2.ADEQUATE LEVEL OF FUNDING AID SERVICES &REVISE HALFWAY HOME STANDARDS Alaska 1.1TABILIZE AND REDUCE PER CAP CONSUMPTION2.REDIRECT INTERV t CABE FINDING EFFORTS 3.INCREASE AND EXPAND PREY EFFORTS Aritone/A 1.EXPAND PROORAMS FOR SPECIAL POPULATIONS &SERVICES TO LESS CHRONIC ALCOHOL ABUSER3.ALC PRIV PROJECTS FOR CHILDREN t YOUTH Arisona/0 1.ANALYZE STATE METHADONE REGULATIONS 2.8110ADEN STATE LEVEL OFFICE 3.EXPAND PROGRAMS FOR SPECIAL POPULATIONS Arkansas 1.ALCOHOL/DRUO EDUCATION IK-121 2.EXPAND REQUIREMENTS FOR INS COVERAGE 3.SERVICEI TO ADOLESCENTS California 1.0RUO AND ALCOHOL PREVENTION 2.A1D8 ISSUES 3.MANDATED FUNDING MT ASIDES Colorado 1.DEVELOP ALTERNATIVE FUNDING MECHANISMS 2.VOLUNTARY COMPLIANCE WITH 1NSUR MODEL 3.DEVELOP PROORAMMINO W/YOUTH SVCS DEPT. Conn. 1.TRANIFER OF DMH AID RESPONSIBILITIES 2.11ALANCED SYSTEM OF SERVICES &SERVICE ALTERNATIVES Delaware 1.DUAL DIAGNOSED CLIENTS 2.11ERVICES TO ADOLESCENTS 3.JOINT FUNCTIONAL PLANNING W/MH AGENCY D.C. I.PROVISION OF INPAT DRUO DITOX/TREATMENT 2.COMMITMENT FOR COMPREHENSIVE PREY STRAT3.1148 FOR CR1M JUSTICE REFERRALS Florida 1.EXPAND PROVISION OF 3 CONTINUA OF CARE 2.1NTERFACE WITH OTHER STATE AGENCIES 3.11ERVICE DELIVERY AND QUALITY OF CARE Georgia 1,1MPLEMINT 4 YEAR A/D SERVICE PLAN 2.EITABLIBH PROORAM FOR REPEAT DUI 3.EDUCATIE BOARD OF HR t COMMUNITY GROUPE Duct 1.PROVISION OF COMPREHENSIVE SERVICES 2.STAFFINO NEEDS 3.FREE STANDING MH FACILITY Hawaii 1.ACCESSIBILITY OF SERVICES 2.PROGRAMS SHOULD SEEK OTHER $ SOURCES 3.PROSRAM ACCRED AND CERTIFIED COUNSELORS Idaho 1.8E1T TREATMENT FOR TYPE OF CLIENT 2.08TAIN HIGH CLIENT OUTCOME RATES &PROVIDE EDUCATION TO CHILDREN OF ALC Illinois l.PRIVENTION AND EDUCATION 2.UPGRADING QUALITY Of CARE 3.ADOLESCENT TREATMENT SVCS Indiana 1.HEALTH INEURAME COVERAGE 2.111R91C1 EFFECTIVENESS 3.1TATE FUNDING FOR SERVICES lows 1.MIET DEMAND FOR TREATMENT SVCS LAPPROPRIATE TREATMENT FOR DWI 3.ADDRES5 THE NEEDS OF JUVENILES Kansas 1.YOUTH 2.A/D ABUSE OUTPATIENT SVCS 3.1ERYICES FOR MINORITY POPULATIONS Kentucky 1.FUNDINS TO IMPLEMENT MANDATED PROGRAMS 2.PREYENTION Of ORM DRIVING 3.INCARCERATION ALTER F/PUBLIC INEBRIATE Louisiana IsSEPARATE ADMINISTRATION OF AtD/MH 2.MANDATE TREATMENT OUTCOME DATA 3,STANDARDIZE SERVICE WIN 11 REPORT SVCS Mains 1.DEVELOP ALTERNATIVES TO REBID REHAB &DEVELOP ADOLESCENT t RURAL SVCS &MORE REALISTIC THIRD PARTY PAYMENT Maryland/A 1.ADOLESCENT TREATMENT SERVICES 2.IMPROVED SERVICES TO DWI OFFENDERS &ENHANCE SERVICES TO WOMEN Mary1and/D 1.EXPAND SERVICES TO JUVENILE OFFENDERS 2.SERVICES TO INDIGENTS VIA MEDICAID 3.nEDISION A/D INFO SYSTEM Mass. 1.DEVELOP STATEWIDE PREVENTION EFFORT &DEVELOP JOINT ADOLESCENT PROGRAMMING 3.COMBAT DRUM( AND DRUGGED DRIVING Michigan 1.ACCEPTANCE OF JCHA ACCREDITATION 2.ADEQUATE LEVEL AND FUNDINO FEA SA OVCS 3.REV1BION OF 1TANDARDS Minnssote 1.FUNDING SYSTEM REFORM/COST CONTAINMT 2.UNIFORM ASSESIMENT/PLACEMENT CRITERIA 3.ROLE IN AIDS PRIV/TREATMENT Miami, 1.IMPLEMENT PRIV ACTIVITIES IN SCHOOLS 2.MAINTENANCE OF TREATMENT SERVICES 3.MANDATORY TREATMENT MULTIPLE DUI OFFE Missouri 1.PROVISION OF SERVICES TO TAROET POP. 2.DEMONSTRATE PROGRAM EFFECTIVENESS 3.DECREASE COSTS TO STATE REVENUES Montana 1.MAINTAIN QUALITY ts CURRENT LEVEL OF SVC112.1ERVICE EFFICIENCY AND EFFECTIVENESS &COMMUNITY DEVELOPMENT OF PREY PROGRAMS Nebraska 1.EQUITABLE REIMBURSEMENT RATES 2.IMPLEMENT SUSS ABUSE SVC SYSTEM PLAN &IDENTIFY QUALITY SERVICES VIA TRT OUTCO Nevada LEON-DISCRIMINATION IN SERVICE PROVISION 2.2UAL1TY OF CARE 3.MAINTAIN AND PREVENT SVCS TO AT RISK PO New Hamp. 1.SUSS ABUSE EDUC IN GRADES K-12 2.DEVEL. OR PSYCH DISABLED SA CLIENT 3.ENCOURA01 HEALTH INSURANCE COVERAGE New Jersey 1.MEDICAREiMIDICAID REIMBURSEMENT 2.MANDATORY DRUO ABUSE INSURANCE LEGIS 3.AIDS AMONG 14 DRUG ASUSERII N.M./A 1.FAMILY ORIENTED COMPREHENSIVE TRT PROO 2.EARLY INTERVENTION SERVICES 3.TREATMENT FOR ADOLESCENTS AND WOMEN N.M./0 1.MOVINS FUNDING INTO PREVENTION SVCS LIMPROVE QUALITY OF SERVICES 3.L1M1T USE Cf MITHADONE/COUNSILING SVCS New York/A 1.DEVELOP STATEWIDE ALCOHOL PREY POLICY UNSURE QUALITY OF ALC TREATMENT 3.MANAOINO GROWTH OF SVC DELIVERY SYSTEM New York/0 1.MAINTAIN EXISTING ESSENTIAL SERVICES 2.ADDRESS THE UNMET NEEDS 3.IMPROVE SERVICE QUALITY AND EFFECTIVENE N.C. 1.ADOLESWAT SERVICES 2.1NVOLUNTARY COMMITMENT FCA TREATMENT 3.PRIMARY OUSE AIME PREY PROGRAMS N.D. 1.COMMUNITY PREVENTION PROGRAMS &OUTPATIENT TREATMENT is OUTREACH SVCS 3.ADOLEBCENT TRT AND RESIDENTIAL CARS Ohio 1.MERGE STATE ALCOHOL AND DRUG AGENCY LADEQUATE CONTINUUM OF CARE 3.RESOURCE DEVELOPMENT Oklahoma 1.0EVELOP ADOLESCENT SERVICES LEXPAND SERVICES TO DUI OFFENDERS 3.DEVELOP WOMEN'S RESIDENTIAL SERVICES Oregon 1.EDUITABILITY OF ALLOCATION OF FUNDS 2.APPROPRIATE UNIT OF REIMBURSEMENT 3.COORDINATE 14 STATE AGENCIES, AMD MON1E Penn. 1.MANDATED K-12 A/D CURRICULUM 2.MANDATORY HEALTH INSURANCE COVERAGE 3.CERT OF NEED F/NON -HOOP, RESIDENTIAL CT P.R. 1.ESTABLISH THERAPEUTIC COMMUNITY CONCEPT 2eCONCEPTUAL FRAMEWORK FOR TRT/PREY 3eDIRECT PREY PROGRAM Role 1.EXPAND FINANCIAL RESOURCES 2.PROMOTE LICENBINS AND PROGRAMMINS 3.PREV PROGRAMMING FOR UNDERSERVED S.C. LINVOLUNTARY COMMITMENT 2.TH1RD PARTY PAYMENTS 3.INCREASE REVENUE FROM ALC BEVERAGE TAX S.D. 1.INCREASE STATE FUNDING BABE 2.ADDRESS INSURANCE COVERAGE ISSUES 3.PRIVATE SECTOR TRT. FOR INDIGENTS Tennessee 1.MANDATORY INSURANCE 2.CRIMINAL JUSTICE/JUVENILE JUSTICE 3,YOUTH SERVICES Texas 1.SIGNIFICANT UNDERFUNDING OF DRUB Al SVCS2.NANDATORY !NSW COVERASE FOR DRUG ABUSELDEDICATE FUNDING FOR ALL SA SERVICES Utah 1.YOUTH 2.WOMEN 3.CONT1NUU1i OF SERVICES Vermont 1.IMPLEMENT EDUC PROORAM IN EVERY SCHOOL 2.L1NKS BETWEEN PROVIDERS 3.STATE SUPPORT FOR PUBLIC PROGRAMS V. Islands 1.TREAIMENT PROGRAMS 2.REHASILITATION/EDUCATION 3.PREYENT1ON/OUTREACH Virginia 1,PROVISION OF CONTINUUM OF CARE 2.REIOURCE ALLOCATION FOR A/D SVCS &EVALUATE EFFECTIVENESS OF LOCAL SVCS Washington 1.PROVIDE TREATMI FOR ALC WELFARE CLIENTS 2.CONTINUUM OF SVCS FOR YOUTH 3.PRIY -FOR -PROFIT METH. CLINICS W. Va. LIMPROVE PROGRAM MONITORING 2.DEVELOP REGIONALIZED CORE SERVICES SYS 3.SEPARATE ACCOUNTASILITY FOR A/D ABUSERS 66 Wisconsin 1.EXPAND CITIZEN PARTICIPATION 2.0011110Mt SERVICE BARRIERS TO SPEC POPS.3.8ARRIERS TO FAMILY TREATMENT Wyoming 1JURVIVAL 2.LIGAL DRINKING AGE 3.11VCI FOR CHILDREN ADOLESCENTS 67 Sowell State Alcohol and Drug Abuse Profile, FY 1115. V/I. MAJOR NEEDS FOR, WHICH RESOURCES WERE NOT ADEQUATE IN FISCAL YEAR 1985 Each State Alcohol and Drug Abuse Agency was asked to indicate whether there were any major needs identified through its most recent State planning process for which resources were not adequate to meet those needs. The States were also asked to provide a brief description of those major needs and the types of resources that would be required to meet them. State-by-State information on major needs and required resources is attached as Appendix C. Responses to the question of major netdt4 ftnd adequate resources were received from 49 States, e District of Columbia, Guam, Puerto Rico, and the Virgin 7alands. Only one State (Nevada) indicated that adequate lesources were available to meet major needs within the State. Narrative responses received from 49 States, the District of Columbia, Guam, Puerto Rico and the Virgin Islands indicate that there were major needs in these States in the areas of prevention and/or treatment for which adequate resources were not available. While the scope of the narrative comments and information retrieved from the States is quite broad, many responded that additional resources must be obtained to support the development of treatment and prevention services for youth and women. In addition, States noted the need to address: the requirements of other special populations such as minorities, dually-diagnosed clients, the elderly and persons with AIDS; a lack of adequate detcxification services; the need for expansion of existing outpatient services; and the need for increased funding of program staff positions and salaries. The major need most frequently identified in both the FY 1984 and the current SADAP effort for FY 1985 was the development of treatment and prevention services for youth and women. For FY 1985, however, other frequently mentioned needs included expansion of detoxification services and increasing staff positions and salaries. For FY 1984, frequently mentioned needs included the provision of services to the criminal justice population and developing programs for driving while intoxicated offenders. The majority of States indicated that resources required to adequately reconcile these unmet needs should be in the form of increased overall funding to compensate for the decrease in Federal support and lack of inflationary increases. However, some States also indicated other needs, including: research into emerging new areas, especially the designer drugs and the intravenous (IV) drug abuse - AIDS connection; additional facilities and staff to service the backlog of clients 49 68 awaiting treatment; and policy mandates that recognize the priorities of the States in providing alcohol and drug abuse services. Highlights from the information submitted by the States have been organized into the following four categories of need: o Youth and Women; o Other Special Populations; o Detoxification Services; and o Staff Positions and Salaries. 1. Youth and Women A total of 41 State Agencies identified a need to expand treatment and/or prevention services for children and adolescents. Fifteen State Agencies reported the need for services specifically geared to women. While States noted various unmet needs in the treatment and prevention of youthful alcohol and drug abuse, the most critical need among States is to expand and/or establish residential treatment facilities for youth. Twenty-two State Agencies noted such a need in their State. Nine States (Alabama, Indiana, New Mexico, Rhode Island, South Dakota, Tennessee, Texas, Utah, and Washington) mentioned the need for new or expanded outpatient services to youth. Three State Agencies (New Mexico, Oregon and Pennsylvania) also reported the need for increased identification and referral of alcohol and drug abusing youth by juvenile courts. A general need to expand adolescent treatment services was identified by 15 State Agencies (Kansas, Kentucky, Maine, Maryland (alcohol and drug), Minnesota, Montana, New Jersey, North Carolina, North Dakota, Oregon, Puerto Rico, Texas, Utah, and Wyoming). Finally, three State Agencies [Maryland (drug), South Dakota, and Washington) identified a need for treatment personnel with expertise in counseling and treatment of chemically dependent adolescents and children. Five State Agencies (California, Illinois, Iowa, Vermont, and the Virgin Islands) noted that resources were inadequate to meet the service needs of women. Alabama cited a specific need for expansion of outpatient and Cay treatment services targeted for women, while the Maryland Drug Agency observed that the need was greatest in the State for counselor/coordinators to provide services in female outpatient programs. Four States (Maine, Oklahoma, Oregon and Puerto Rico) described the need for establishment or expansion of specialized residential treatment programs for women. One State (Alaska) mentioned the need to improve its efforts in the prevention of Fetal Alcohol Syndrome (PAS). In addition to citing a general need for the expansion of services to alcoholic and drug addicted females, New Mexico expressed a specific need for the development of standards for the residential treatment of alcoholic women. And finally, Wisconsin cited a need to provide child care services for women in treatment as well as funding of an American Indian women's treatment center. 2. Other Spooial Populations Twenty-three State Agencies responded that their State lacked adequate services to meet the needs of special populations other than women and children. Seven States (Alabama, California, Iowa, Minnesota, Oregon, Vermont, and Wisconsin) noted that the elderly population did not receive the adequate specialized services needed to prevent, identify and treat drug and alcohol problems among that group. Some States reported an inability to serve the handicapped population. California, Minnesota, New Hampshire, New Jersey, Oregon and Wisconsin identified a need to develop and expand services to substance abusers with physical or mental handicaps. The need to develop a procedure for identifying and referring substance abusers diagnosed as having AIDS was noted by four States (District of Columbia, Florida, New Jersey and New York). Other special populations noted by States as being underserved include: ethnic/racial minorities (California, Illinois, Iowa, Minnesota, and Wisconsin); persons in the criminal justice system (Delaware, Idaho, Kentucky, Oregon, Puerto Rico, and Wisconsin); indigent clients (Kansas, Montana, New Mexico and Virginia); the homeless (New Jersey and Pennsylvania); chronic alcoholics (West Virginia and Wisconsin); public inebriates (Kentucky and Texas) and inhalant abusers (New Mexico). 3. Detoxification Services Twelve State Agencies reported unmet needs in the provision of detoxification services. Arizona, Georgia, Louisiana, Maine, Missouri, and New York (alcohol) identified a need for expanded detoxification services within their State. Oklahoma and Texas noted the need for new detoxification services, while Virginia added that although new detoxification services have been established within the State recently, the need to continue to develop such services remains. California noted a need for social model detoxification services, while the District of Columbia reported that sufficient resources were lacking to provide adequate inpatient drug detoxification, particularly for treatment of PCP use. Also, in analyzing financial accessibility the State of Nebraska found that emergency detoxification services in the State are not offered on an ability to pay basis. 4. Staff. Positions, and Salaries Several States specifically identified the need to increase the number of program staff positions or to increase existing staff salaries. Arizona and Kansas noted a need for more realistic salary structures for treatment personnel. The Kansas State Alcohol and Drug Agency even suggested that excessive turnover in staff positions in the State treatment programs is a direct result of inadequate counselor salaries. Nine States identified a need for additional treatment and/or prevention personnel. Five States mentioned a need for ancillary staff to provide treatment and prevention services to special populations: (Maryland) addiction counselors/coordinators to serve adolescents and females; (South Dakota) full time counselors and referral employees to serve adolescents; (Virgin Islands) treatment personnel to staff a new women's program; (Washington) specially trained youth therapists to provide outpatient and aftercare services; and (Wisconsin) specially trained staff to treat the American Indian population. 52 71 VIII. SIGNIFICANT CHANGES. IN, ALCOHOL AND/OR DRUG PREVENTION AND TREATMENT _swims IN FISCAL ,YEAR 1985 Each State Alcohol and/or Drug Abuse Agency was asked to provide a narrative description of any significant changes in services which occurred during Fiscal Year (FY) 1985 and the reasons for such changes. Agencies from 43 States, the District of Columbia, Guam and the Virgin Islands submitted information in response to this request. The reports provided by the States are attached as Appendix D. The scope of the narrative comments that were provided is quite broad ranging from information on changes in States' financial resources to the impact of new State legislation on the service delivery system, from a discussion of efforts in prevention programming to data on the types of persons served and drug use trends. The information submitted has been organized into the following six categories: o Changes in Financial Resources; o Intoxicated Driver Legislation and Services; o Prevention Programs and Services; o Changes in Services for Women; o Client and Drug Use Trends; and o Other Significant Developments. Summary information from the States is presented within each of the following subsections. 1. Changes in Financial, Resources A total of 19 State Agencies provided comments related to either increases or decreases in funding support for treatment and/or prevention services. These State Agencies include Arizona, the District of Columbia, Guam, Idaho, Iowa, Kentucky, Maryland, Massachusetts: Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, Ohio, South Carolina, Tennessee and Wisconsin. Most of the States' comments on funding appear to be related to decisions by State legislatures to change the level of fiscal support for services. The majority of the State Agencies which provided information in this area discussed new funding and/or program initiatives (12 State Agencies). Some of these changes were major in scope. For example, the comment from the Iowa Agency refers to "landmark State legislation" which increased direct State support for alcohol and drug services from under $3 million in FY 1984 to over $8 million in FY 1985. This change resulted in greater support for both treatment services, including assumption of 100% of the costs for indigent clients at community based programs, and for prevention services at county and community levels. Also, the Iowa State Agency reported that the new law mandates that preliminary client intake and assessment procedures be accomplished before individuals are admitted for treatment to a State Mental Health Institute. Kentucky also indicated a significant increase in the level of services by reporting the allocation of "an additional $1,000,000 for DUI assessment, education and treatment for indigent offenders (and) DU/ prevention programs". Also, the Missouri Agency reported a "27.2% increase in general revenue appropriation for FY 1986". Some of the other State Agencies which reported increases in funding support and/or new program initiatives included the followings o Maryland - A new residential facility for indigent cocaine abusers will be funded in FY 1986. o Massachusetts - Awards were made to support new programs for previously underserved populations, including residential adolescent treatment, services for women, court diversion programs, services for Hispanics and prevention programs, among others. o South Carolina - Substantial additional funding was provided to expand the School Intervention Program. o Tennessee o Wisconsin - A Governor's Task Force on Youth Alcohol and Drugs made recommendations which resulted in increased funding for youth services in 1985-86. - $125,000 was appropriated to support a new program to train and certify minority counselors to provide alcohol and other drug abuse services. With regard to specific funding mechanisms, three State Agencies -- Missouri, Montana and Nevada -- discussed the positive impact on services from laws which mandate health insurance coverage for alcoholism and/or drug treatment services. Also, the State Agencies in Montana and New Jersey indicated that increased State taxes on alcohol were being used to provide additional or 54 73 more stable funding for treatment and prevention services. However, the Ohio Agency indicated that declining per capita consumption of alcohol in the State resulted in some funding cuts for services (since service funding was tied to a percent of gross profits and permit fees), although new DWI license reinstatement fees were being used to reimburse the costs of indigents who attend driver intervention programs and to support treatment services. A number of State Agencies provided narrative reports on reductions in the level of funding and services. These agencies included Arizona, Guam, Idaho, Minnesota, Nebraska and New Mexico. For example, the Arizona Drug Agency indicated that a 14% reduction in funding during FY 1985 resulted in a 3.8% reduction in the number of clients seen. Also, the Idaho Agency reported that "community awareness/community networking" services were being curtailed due to both dollar shortages and the lack of focus of many of those programs. In addition, the :Ante Agency in Minnesota discussed program closures and increased difficulties in serving low-income clients as a result of various cost containment measures. New Mexico noted that excise tax revenues dedicated for alcoholism treatment had declined by $200,000 in FY 1985 due to a decrease in alcohol beverage sales. The State legislature has taken action to increase the percent of excise taxes dedicated to treatment from 49% to 52% effective July 1, 1986. The District of Columbia Agency indicated the difficulties involved in attempting to confront an increased demand for services while having inadequate resources and staff. This State Agency is developing r fee schedule for services rendered which will be implemented in FY 1986. Overall with regard to funding it is cl.tar that each State Agency must continuously deal with tne cYlllenges of changes in the level of fiscal supp from a variety of different sources. For example, due tc. recent reductions in oil prices, overall tax revenues in ma:y States are being adversely affected and State ri:ograms, including alcohol and drug services, are likely to 't$ reduced in those States. 2. Intoxicated Driver Legislation and Sel -ces Seventeen of the State Agencies presented information on changes in intoxicated driver legislation and/or services in their States. These State Agencies include the District of Columbia, Guam, Indiana, Kentucky, Maryland, Montana, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, Texas, Vermont, West Virginia, Wisconsin and Wyoming. It is clear that Driving Under the Influence (DUI) and Driving While Intoxicated (DWI) 55 74 statutes have had and are continuing to have a significant impact on the service delivery systems in many States. For example, the Maryland Alcohol Agency reports that with regard to DW/ drivers, "68% of those assessed are in need of treatment". Also, DWI referrals constitute "more than 50% of the clients in treatment" in the State of Maryland. Similarly, the Wisconsin Agency reports that the DUI laws have resulted in "a dramatic increase in the number of clients assessed and the number entering treatment". The Rhode Island Agency indicates that treatment services for DW/ offenders continue to be expanded. Also, the State Agency in New Jersey reports that by the end of the Fiscal Year at least one intoxicated driver resource center (IDRC) had been established in each county in the State. Other State Agencies, such as that in Indiana, .indicate that although "treatment providers continue to feel the impact of tougher DUX enforcement", it is not significantly different from FY 1984 or previous years. However, most of the State Agencies which raised the issue, such as West Virginia and the others noted above, indicate that "DU/ clients constitute an increasing proportion of client admissions." in Kentucky some treatment centers have indicated that the large numbers of DU/ court referrals have precluded staff outreact, to voluntary clients. Also, specialized treatment programs such as Oklahoma's Alternatives to Incarceration for Drinking Drivers (AIDD) Program have contInucd to expand. Oklahoma's A/DD program has increarlc from 5 beds in October 1981 to 100 beds by the end of FY 1985. Many States also report an expansion in alcohol education programs for the general public and/or for DUI/DW/ offenders. Such increases in educational activity have been indicated by the District of Columbia, Guam, Kentucky, Montana, and Wyoming, amnng others. However, in some States, e.g., Wyoming, questions are being raised about the efficacy of some impaired driver schools. Other State Agencies have reported on the impact of refinements in DUI/DWI statutes and/or in programs. For example, the North Carolina law was changed to require substance abuse assessements for additional populations including second offenders, those who refuse breathalyzer tests and those who have blood alcohol concentrations of .20 or more. Within Pennsylvania there has recently been increased use of group intervention programs for DU/ offenders. Also, the Driver Rehabilitation Schools in Vermont now offer a Multiple Off,rider Course and are more active in attempting to intervene and encourage more first offenders to enter treatment if they need it. Some State Agencies such as Kentucky, Ohio and Texas have reported increased fiscal support for DUI/DWI services. in Kentucky the State Legislature appropriated 56 75 an additional $1,000,000 for these services. In Ohio portions of license reinstatement fees are being used both for treatment services and to reimburse costs for indigents who attend driver intervention programs. In Texas legislation was passed which provided for the diversion of monies from DWI fines to pay for treatment services. 3. Prevent4on Programs and OlerViCee Agencies from a total of 23 States reported on significant changes in their prevention servica systems. These State Agencies include California, Connecticut, the District of Columbia, Hawaii, Idaho, Iowa, Kansas, Louisiana, Maine, Massachusetts, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Pennsylvania, South Carolina, Tennessee, Vermont, Virginia, Washington and Wisconsin. Many State Agencies continue to discuss increases in their prevention services. However, as differentiated from the FY 1984 survey comments that documented increased prevention services as a function of increased fiscal support, the FY 1985 survey comments cited changes in focus or in the type of prevention service being supported. A number of State Agencies reported an increased emphasis on school based prevention programs. These States included Idaho, Montana, North Carolina, Pennsylvanic., Tennessee, Vermont and Virginia. For example, in North Carolina funds were allocated to the Department of Public Instruction for development of a drug education curriculum and the training of personnel in 142 school systems across the State. Also, South Carolina has implemented a major expansion of its School Intervention Program. However, at least one State, North Dakota, has ehifted its emphasis away from school based prevention approaches and to broader community based prevention strategies. Most States, including many of those noted above, attempted to achieve a balance between support for both community based and school based prevention approaches. Those States which specifically mentioned their support of both approaches include California, Kansas, Tennessee, Vermont and Virginia. Beyond greater emphasis on school based prevention approaches, State Agencies which mentioned an increase or continuation of prevention services include the following: o Connecticut - Prevention has been identified as a priority focus area by the State Agency. 57 76 o District of - Increased prevention oriented Columbia activities have been instituted through campaigns such as those on Drunk and Drugged Driving Awareness and Fetal Alcohol Syndrome Awareness. o Hawaii - Community participation in prevention has been fostered through the formation of groups such as Chemical People, Toughlove, Mothers Against Drunk Driving (MADD) and Students Against Driving Drunk (SADD). o Iowa An additional $550,000 was allocated to support increased prevention services; $150,000 was set aside "for prevention programming on a match basis with counties" and 85 mini-grants of $250 each were provided to encourage and support local parent and community group efforts in prevention. o Kansas State funded prevention programs served 135,000 citizens in FY 1985, an increase of 7% over FY 1984; also, school team training activities were expanded to 44 teams, the SADD network grew from 28 to 77 chapters and a new youth hunter safety program was instituted. o Louisiana - The scope of work for some provider agency contracts was changed to emphasize prevention services leading to a 13% decline in the number of drug client related treatment admissions. o Maine - The State Agency supported the implementation of four model prevention programs. o Massachusetts - The separate Alcohol and Drug Agencies in the State cooperated in jointly funding prevencion center programs. o Missouri 58 - The State Agency implemented a comprehensive statewide youth prevention program, the Missouri Institute for Prevention Services. 77 o Few Hampshire - The State Agency implemented its Second Annual Teen Institute which provided an intensive week long training experience for 60 teen leaders. o Tengessee o Texas o Virginia o Washington - A Governor's Task Force on Youth Alcohol and Drugs developed recommendations that resulted in increased fiscal support for youth prevention and treatment services. - A Governor's Task Force led to increased public recognition of the problems associated with juvenile inhalant abuse; also, increased support was provided to peer assistance programs. The State Departments of Education, Mental Health and Mental Retardation (which includes the State Alcohol and Drug Agency) and Motor Vehicles are collaborating on a youth alcohol abuse prevention project. - The State Agency has developed special plans, budgets and contracts to ensure that prevention services do not have to directly compete with community treatment providers for the limited funds which are available. o Wisconsin 7 As a result of increased public awareness State prevention consultants experienced "a dramatic increase in demand for technical assistance from local communities" over the past year. Additional comments from State Agencies which relate to prevention and may be particularly worth noting include the following: o California 59 - Drug abuse prevention in the State are being "to involve more people school and community also, attention is being the "development of standards for programs 78 efforts expanded at the level"; given to minimum offering o Nebraska prevention services", as well as to the process of credentialling and certifying of prevention services. Although there were no signficant changes in prevention services during FY 1985, due to lagging State tax receipts, significant cuts in resources may occur during the current and next year which will lead to difficult decisions as to the types of services that must be reduced. 4. Changes in Services for WOrIn A total of 13 State Agencies volunteered information relating to a significant change in services for women. These State Agencies include Alabama, Arkansas, California, Kentucky, Massachusetts, Mississippi, Missouri, New Hampshire, New Jersey, Nevada, New Mexico, Ohio and Tennessee. Most of the new State initiatives relating to expansion of alcohol and drug services for women appear to be the result of the 5% set aside requirement on the Alcohol, Drug and Mental Health Services Block Grant. Ten of the 13 State Agencies which provided narrative information explicitly mentioned the establishment of women's services in response to the Block Grant. Some of the specific new services mentioned by various States include the following: o Alabama - Four model programs for women were funded. o Arkansas 60 - Since treatment services require a stable funding source, Arkansas fulfilled the Block Grant requirement through requesting and then funding unique and innovative prevention service grants for women; however, this new requirement limited the amount of monies available for prevention services with other populations who also have important needs, e.g., elderly, troubled youth and minority groups. 7 o California - The State Agency established a Women's Advisory Committee, issued Requests for Proposals for innovative women's projects and increased the level of technical assistance and training services for programs serving women. o Kentucky - After a solicitation that resulted in 17 applications, the State Agency funded eight separe women's grants for a total $177,500 and allocated $227,500 for such projects in FY 1986. o Massachusetts - The State Agency provided grant awards for residential drug free services for women. o Mississippi - The State Agency developed new guidelines that contain elements which specifically target resources for "the recruitment and retention of women in treatment programs". o Missouri - As a result of the Block Grant requirement treatment programs specifically designed to serve women were expanded. o New Hampshire - As of January 1, 1985 the State Agency established a halfway house for women. o New Jersey - The State Agency designed and established a strategy for the implementation of women's services during the period from 1985-87. o New Mexico - Four new programs for women with alcohol-related problems were created in response to the Block Grant set-aside for women. However, this was arcomplished only by reducing all other f5ervices and programs by five percent. o Nevada In response to both Block Grant requirements and increased interest demonstrated by volunteer groups, on October 1, 1985 the State Agency funded a Community Addiction Clinic that provides a broad spectrum of prevention, education and related services for pregnant women, high risk female adolescents and other women. o Ohio - In response to the Block Grant requirement the State Agency set aside the sum of 8140,584 from the alcohol portion of the Block Grant in order to support women's services. o Tennessee - The State Agency funded six new outpatient/day treatment programs and one new halfway house for women in response to the Block Grant set-aside requirement. It should be noted that NASADAD did not specifically ask the States to address the Block Grant set aside requirement for women, but rather the State Agencies noted above voluntarily chose to address their increased efforts to serve women. It should also be noted that many States either in their narrative statements and/or in other communications with NASADAD have indicated that although this set-aside may be beneficial for women, it can adversely effect a variety of services for other underserved populations. Particularly for those States that received no increase in the level of their Block Grant awards, it is clear that in order to meet this set-aside requirement other services have to be either reduced and/or eliminated. 5. Client ,and Drug, Use Trends Basic information on changes in the types of clients being served and on trends in drug use is presented in earlier sections of this report, particularly in Chapter IV, Client Admissions to Alcohol and Drug Treatment Services, and in subsection IV.2.c., Client Admissions Data by Primary Drug of Abuse. The narrative information provided by State Agencies on significant changes and trends within their States indicates the following: o Cocaine abuse is continuing to escalate in many States, and cocaine now constitutes the primary drug of abuse for a much higher proportion 62 81 of client admissions to treatment than in previous years. More specifically, within their narrative cnmments seven State Agencies reported on increasing problems and/or greater demands for treatment services related to cocaine. These seven States include Maine, Maryland, Missouri, Rhode Island, South Carolina, the Virgin Islands and Wisconsin. For example, the Maryland Drug Agency discussed its "cocaine epidemic" that has resulted in many clients becoming addicted to cocaine, as well as to both cocaine and heroin. Since FY 1980 Maryland's cocaine related client admissions have increased by 304%; also, during FY 1985 client admissions with cocaine related problems constituted 38% of all client admissions for the year. In response to this problem the State of Maryland will be opening a new residential facility in FY 1986 that is specifically designed to serve indigent cocaine abusers. o The need for and/or implementation of increased prevention and/or treatment services for youth was reported by at least 18 State Agencies including California, Florida, Indiana, Iowa, Kansas, Maryland, Massachusetts, Missouri, Nevada, New Hampshire, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington, and Wyoming. A number of these States indicate that a specific need for more residential alcoholism and drug dependency treatment services for youth exists, but with tight funding and other legislated priorities (e.g., women) it is difficult to locate sufficient fiscal resources to provide such treatment services for youth. o Additional client needs mentioned by various States include services for chronic inebriates, criminal justice referrals, the elderly and for those IV drug abusers who have AIDS. Although the AIDS problem received only one written mention, other correspondence and verbal communication indicate that AIDS already constitutes an epidemic among IV drug abusers in several States and it is likely to continue to spread and increase dramatically over the next few years. 6. Other Significant Developments In addition to the significant changes in services noted above, many State Agencies discussed other important developments. Highlights of some of these developments are as follows: 63 82 o A total of eight State Agencies discussed improvements in their program licensing and/or individual practitioner certification procedures. These States include California, Florida, Iowa, Montana, Nevada, Rhode Island, Texas and Wisconsin. In some instances licensing responsibilities had previously been assumed by different State departments, while in other instances the State Alcohol/Drug Agencies have expanded their existing authority and activities in these areas. State Agencies that reported activity in the certification area include California, Florida, Iowa, Montana, Nevada and Wisconsin. For example, California has initiated efforts related to "credentialing and certification of prevention workers", Montana has initiated the development of certification standards for DUI course instructors and the Wisconsin Legislature "appropriated $125,000 to fund a program which will train and certify minority AODA (alcoholism and other drug abuse) counselors." o At least six State Agencies volunteered narrative information on activities that they have initiated to improve their data collection procedures. These States include Alabama, the District of Columbia, Idaho, Louisiana, New Hampshire and wyoming. For example, Idaho has moved to an outcome oriented system for service delivery by treatment providers. The Idaho State Agancy has funded independent contractors to follow-up and interview clients to determine their condition at six months after admission to treatment. A random 20% sample of clients are followed-up and if the client cannot be found then he/she is counted as a treatment failure. The program treatment outcome rates are then considered as factors in the competitive bidding process as the State funds new or continuing services. o Agencies in at least six States mentioned either specific needs and/or new services for the indigent and/or chronic inebriate population. These State Agencies include Kentucky, Minnesota, Rhode Island, South Dakota, Washington and West Virginia. For example, the Washington State Agency indicates that there has been a recent increase in the number of indigent alcoholics, usually located in urban areas, who receive welfare monies due to their incapacity related to alcoholism which has compounded the problem of a limited treatment capacity for this population. Limited funding for both welfare and treatment 64 means that it is important to more effectively use existing monies to provide both life support and treatment services. o Many other significant developments were also raised by State Agencies. For example. both Ohio and Texas discussed the mergers of the alcohol and drug offices in their States. The merger in Texas was accomplished in FY 1985, while the merger in Ohio has just been proposed by the Governor. However, ven in Ohio the proposal has led to closer working relationships between the two agencies. Another example of a significant development and initiative at the State level includes an emerging interest in intensive outpatient services in the States of Maine and Montana. NASADAD APPENDIX A National Association of State Alcohol and Drug Abuse Directors October 15, 1985 President Anne D. Robenson Mississippi First Vice President Chauncey I... Vutch III California Vice Presidentfor Alcohol Abuse Issues Luceille Fleming Pennsylvania Vice President for Drug Abuse Issues John Gustafson New York Past President Donald J. McConnell Connecticut Secretary R. B. Wilson Missouri Treasurer Jeffrey N. Kushner Oregon Regional Directors William Pimentel . Rhode Island Riley Regan New Jersey Simon Holliday District of Columbia Robert Currie Tennt.ssce Wayne Linustrom Ohio Ross Newby Texas R.B. Wilson Missouri Robert Aukerman Colorado Richard Ham Nevada Jeffrey N. Kushner Oregon Executive Director William Butynski, Ph.D. William J. McCord, Director South Carolina Commission on Alcohol and Drug Abuse 3700 Forest Drive Columbia, South Carolina 29204 Dear Mr. McCords I am writing to request your continued participation in the National Association's information collection activities. As you know, last year our National Association entered into a new three year contract with the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to continue operation of the Sthte Alcohol and Drug Abuse Profile (SADAP). Under the initial N/DA-N/AAA contract awarded in 1982, the State and Territorial Directors unanimously expressed their willingness to participate in a NASADAD voluntary data collection effort. During the following two years an information collection instrument was designed, tested and further refined and resulted in the SADAP data collection effort. All 50 States, the District of Columbia and Puerto Rico participated in both the 1983 anti 1984 SADAP. The informatzon collected on alcohol and drug abuse services through SADAP is of considerable value and interest to the States, the Federal Government and the U. S. Congress. The attached form, which I ask that you complete and submit to the NASADAD office by December 2/ 1985, is the result of many hours of effort by a State consultant group made up of your peers and staff that met in May of this year. The format for the 1985 SADAP has been updated but maintains the key elements from 1984. Responses to the attached form should be gathered from secondary information sources already existing at the State level. As in previous years, a report displaying the information collected through the SADAP effort on 444 North Capitol Street, N.W. Suite 530 Washington, D.C. 20001 (202) 7834868 a national and State-by-State basis will be made available to you once it is completed. Also, in recognition of the substantial contribution that you and your staff make to SADAP, this year as part of the final SADAP report we will include both your name and that of your data person. Although the SADAP format has been designed to be simple and straightforward, a. few brief instructions may assist your staff in completins. the form. mem, a glossary of terms has been included to assist in resolving any questions regarding definitions of terms. I recommend that the glossary of terms be reviewed b.f.a responding to the questions on the SADAP form. 1111n, please no. v.hat when a question asks for information from your most recently completed Fiscal Year (FY 1985) it is to be information based on your State Fiscal Year. /AIM some questions request information only on those programs Ithat received at least some funds administered by the State AlcohOl/Drug Agency. For those programs, please provide information on all alcohol and drug resources and clients in such programs, not just the services or clients which are supported by State Alcohol/Drug Agency administered funds. Also, please note that State Alcohol/Drug Agency administered funds can include State revenues, Federal block grant monies, Medicare or Medicaid funds, earmarked taxes or seized assets specifically targeted for alcohol and/or drug services, or any other monies administered by the State Alcohol/Drug Agency. FOURTH, this year we are requesting information on actual expenditures of funds. However, if you cannot provide actual expenditures in the timeframe given, please note this fact and provide your most recent allocation figures. yINALTA, I urge you to give special attention to the last two questions regarding service needs and significant changes in alcohol and/or drug services. In the past, information derived from the States' responses to these two questions has proved invaluable to NASADAD and the Federal Government in demonstrating to the Congress and the Administration the major needs of the States. If you have any questions or require clarificafion on any of the requested items, please do not hesitate to contact Nancy Record, Project Manager of SADAP. On behalf of the NASADAD Board of Directors and myself, I thank you for your onoing coopere.ion and participation in our information collection efforts. Enclosures Sincerely, Anne D. Robertson President A-2 86 NASADAD STATI ALCOROL AND DRUG ABUSE PROFILE FOR FY 1905 State States Contacts Telephone: Please complete and return this form by December 2, 1985 too MASADA!), 444 North Capitol Street, N.W., Suite 530, Washington, D.C. 20001 ?ENDING INFORMATION 1. Report the total expenditures for alcohol and drug abuse services by source of funding and type of activity for only those orocrams which ieceived at least some funds administred by the State_A1cohol/DrUe Acencv durina Fiscal Year 1985. tum All boxes must be filled in withs (1) a dollar amount; (2) a sero (0) denoting that no funds from that funding source are expended for the particular activity! or (3) an 611/A° indicating that the information is not available.) Funding Source Tvne of Act vitY A. ADMS Block Grant S. Other Federal C. State A/D Agency D. Other State R. County or Looal F. Other Sources O. Total Treatment Prevention Other Total 2. Indicate the total number of treatment units which receive funds administered by the State Alcohol/Drug Agency in FY 1985 Of this total indicate the number that aces A. combined alcohol/drug treatment units B. alcohol only treatment units C. drug only treatment units 3. Of the total number of treatment units in the State in FY 1985, estimate the percent that received any funds administered by the State Alcohol/Drug Agency O. at9.121.S. IkliFORMATION 4. Inter the number of client admissions during FY 1985 for ALCOHOL related treatment services in all units which received at least some funds administered by the State Alcohol Agency, SNVIROMMIINT TYPS OF CARE , Detoxification Rehabilitation/ Residential Outpatient Total Hospital Non..Nosnital 5. Enter the number of client admissions during FY 1905 in units which received at least some funds administered by the State Alcohol Agency for ALCOHOL related treatment services in each of the age, sex, race/ ethnicity categories below. If unable to provide age by sex, provide totals by age and aex categories. 1116....diX CLIENTS bps "---,......_ MA.LE FEMALE Undr 10 Frs. __ZOTAL 18-20 , 21-24 12:1V 35-44 45-54 55-64 , 6.1Aind over soorted T otal _ luo. or CLIENT RACE/ETHNICITY !CLIENTS White, not of Hispanic Origin Black, not of Hispanic Origin Hispanic Asian or Pacific Islander American Indian or Alaskan Native Other Not Reported . otal (Eau, Grand totals in Questions 4. 5? and 511 should agree.) 6. Is any information available (from your State Alcohol/Drug Agency or any other source) on ALCOHOL related client admissions within treatment units that do not receive any State Alcohol Agency funds? Yes No If yes. Ogees; identify the sources DRUG ABUSE CLIENT INFORMATION 7. Enter the number of client admissions during FY 1985 for DRUG related treatment services in all units which received at least some funds administered by the State Drug Agencys ENVIRONMENT TYPE OP CARE Detoxification Mai tenance Dru Free Total Hospital Residential , Outpatient Total 8. Of the DRUG related client admissions noted in item 7 above, provide the number of client admissions that reported the primary drug of abuse ass Heroin Non-RX Methadone Other Opiates and Other Sedatives Othr and Synthetics Hallucinogens Amphetamines Inhalants Over-the- Synthetics Cocaine Counter Barbiturates Tranquilizers Marijuana/ Hashish Other PCP Total 9. ightOr the number of client admissions during FY 1965 in units which received at least some funds administered by the State Drug Agency for DRUG related treatment srzIces in each of the age, sex, raoe/ethnicity categories below. If unable to provide age by sex, provide totals by rge and sex categories. CLIENTS AG11-414--"...4 MALE FEMALE Under 1$ yrs. TOTAL 1;5-20 21-24 25.44 25-44 -4 45-.54 55-64 65 and over Not Reported Toial CLIENT RACE/ETHNICITY NO. OF CLIENTS White, not of Nispani2 Origin Slack, not of Rispanic Origin Hispanic . Amian or Pacific Islander American Indian or Alaskan Native Other Not Reported ,Total (NOTEs Grand totals in Questions 7, il, 9A and 9E should agree.) 10. Is any information available (from your State Alcohol/Drug Agency or any other source) on DRUG related client admissions within treatment units that do not receive any State Drug Agency funds? Yee No If yes, please identify the sources OTHER INFORMATION 11. Are treatment outcome data available within your State? Yes N0 12. /s there any information on the average costs of treatment by modality within your State? Yes No 13. Please identify your State Agency's top three policy issues. A. B. C. ,= PLEAsE BE SURE TO PROVIDE ANSWERS TO QUESTIONS 14 AND LS SINCE THE ANSWERS PROVIDE VITAL INFORMATION. 14. Nero Cters any ajor needs identified through your recent State planning process for Which resources were not adequate to meet those needs? Yes No :f yes. please provide a one-half page narrative description of those ma;or needs and the type of resources required (e.g., staff, funds, facal4ties, technology, etc.) 15. Describe within a one-half page of narrative, any significant changes in alcohol and/or drug prevention and treatment services delivered within your State in FY 1915 and the reasons for these changes (e.g., impact of funding changes; increased intoxicated driver enforcement efforts; voluntary group activities; and/or changes in drug abuse trends). A-6 SADAP - 1985 Glossary of Terms, ADMS Block Grant - Federal funds awarded to the State via the Alcohol, Drug Abuse and Mental Health Services Block Grant program and used to support the provision of alcohol and/or drug treatment or prevention services. Client Admissions - Individuals admitted to and provided services in appropriate treatment settings according to State definitions. County or Local Monies - Funds that are provided by county or local governments to support the provision of alcohol and/or drug treatment or prevention services. Detoxification (Alcohol) - Restoration of client sobriety through medical or non-medical means under the supervision of trained personnel. Includes detoxification services provided in an inpatient or outpatient setting. Detoxification (Drug) - Planned withdrawal from drug dependency supported by use of a prescribed medication. Drug Free, - A treatment regimen that does not include any chemical agent or medication as the primary part of the drug treatment. It is the treatment modality foe withdrawal without medication. Temporary medication may be prescribed in a drug free modality, e.g., short-term use of tranquilizers, but the primary treatment method is counseling, not chemotherapy. Hospital, - An institution that provides 24 hour services for the diagnosis and treatment of patients through an organized medical or professional staff and permanent facilities that Lnclude inpatient beds, medical and nursing services. Clients should be counted if they are receiving detoxification or treatment services primarily for alcoholism and/or other drug abuse. Maintenance - The continued administering and/or dispensing of methadone, L-alpha acetylmethadol (LAAM), or propoxyphene napsylate (Darvon-N), in conjunction with provision of appropriate social and medical services, at relatively stable dosage levels for a period in excess of 21 days as an oral substitute for heroin and other morphine-like drugs, for an individual dependent on heroin. This category also includes those clients who are being withdrawn from maintenance treatment. ather (Type of Activity) - Other activities beyond treatment or prevention services, e.g., training, research, administration. Other Federal - All Federal funds used for support of alcohol and/or drug treatment or prevention services other than the ADMS Block Grant monies. These could include funds provided through Federal programs such as the Social Services Block Grant, Medicare, the Federal share of Medicaid, Veterans Administration and Indian Health Service. A-7 Other Sources - All funds used for support of alcohol and/or drug treatment or prevention services other than monies from the ADMS Block Grant program, Other Federal, State A/D Agency, Other State, County or Local sources. Thesld funds could include reimbursement from private health insurance, client fees, court fines or assessments for treatment imposed on intoxicated drivers. pther State - State revenues appropriated to State governmental units or programs other than the State alcohol and/or drug agency which are used to support alcohol and/or dr- eatment or prevention services. These funds may or may not eventually be administered by the State alcohol and/or drug agency. These funds would include the State share of Medicaid funds provided for treatment services unless the Medicaid share is provided by the State alcohol and/or drug agency's State appropriation. Outpatient (Alcohol - Evaluation and treatment, or assistance services, provided on a short-term basis to clients who reside elsewhere. Outpatient (Drug) - Treatment provided by a unit where the client resides outside the facility. The client participates in a treatment program with or without medication according to a pre-determined schedule that includes counseling and other supportive care services. For the purpose of this effort, day care should be included in this category. Prevention - Those activities that are designed to prevent individuals and groups from becoming dependent on the regular use of alcohol and/or licit or illicit drugs. Available services may vary widely but are generally associated with information, education, alternatives, and primary and early intervention activities, and may also encompass services such as literature distribution, media campaigns, clearinghouse activities, speaker's bureau, and school or peer group situations. These services may be directed at any segment of the population. When reporting allocation of ADMS Block Grant funds, early intervention services may be included within this category. Rehabilitation/Residential (Alcohol) - An approach which provides in a nospital or non-hospital (including a halfway house) setting, a planned program of professionally directed evaluation, treatment or rehabilitation services for alcoholism and alcohol abuse. Residential (Drug) - An environment where the client resides in a treatment unit other than a hospital. Drug treatment halfway houses, inpatient rehabilitation units, sanctuaries and therapeutic communities are included in this environment. state A/D Agency Funds - State revenues, earmarked taxes or seized assets specifically appropriated to the State alcohol and/or drug agency for support of alcohol and/or drug treatment, prevention or other related services. Treatment - Formal organized ervices (including detoxification, treatment and aftercare) for persons who have abused alcohol and/or drugs. These services are designed to alter specific physical, mental or social functions of persons under treatment by reducing client disability or discomfort and ameliorating the signs or symptoms caused by alcohol and/or drug abuse. Treatment Unit - Discrete location, building or stand alone facility where alcohol and/or drug trment ervices are provided by specially trained staff. In the case of outreach services, count only permanent base of opersticns. APPENDIX B STATE -8Y -STATE POPULATION, PER CAPITA INCOME, POPULATION DENSITY AND REVENUE FIGURES 1984 POPULATION 1983 PER CAPITA JULY 1, 1985 POPULATION DENSITY INCOME FY 1984 STATE REVENUES (IN THOUSANDS STATE (IN THOUSANDS) (PER SOUARE MILE) (IN DOLLARS) OF DOLLARS) mom mem Alabama 4,021 761 9,992 6,195 Alaska 521 1 17,407 5,463 Arizona 3,107 26 11,841 4,552 Arkansas 2,339 45 9,805 2,967 California 26,365 161 14,487 50,634 Colorado 3,231 30 13,847 4,87n Connecticut 3,174 644 16,356 5,314 Delaware 622 314 13,685 1,494 District of Col 626 9,891 17,113 - Florida 11,366 197 12,763 11,896 Gmorgia 5,976 99 11,351 7,458 Guam - r - - Hawaii 1,054 159 13,042 J,541 Idaho 1,005 12 10,092 1,478 Illinois 11,533 206 13,802 16,470 Indiana 5,499 /52 11,717 7,163 Iowa 2,884 52 12,160 4,351 Kansas 2,430 30 13,248 3,363 Kentucky 3,726 94 10,300 5,448 Louisiana 4,481 100 10,800 7,201 Maine 1,164 37 10,813 1,873 Maryland 4,392 438 14,464 7,296 Massachusetts 5,822 737 14,784 10,253 Michigan 9,0e8 159 12,607 17,071 Minnesota 4,193 52 13,247 8,826 Mississippi 2,613 55 8,777 3,641 Missouri 5,029 72 12,151 5,964 Montana 826 6 10,346 1,538 Nebraska 1,606 21 12,430 2,047 Nevada 936 8 13,320 1,767 New Hampshire 998 107 13,192 1,276 New Jersey 7,562 1,000 15,440 14.677 New Mmxico 1,450 12 10,262 3,338 New York 17,783 373 14,318 42,412 North Carolina 6,255 125 10,850 8,735 North Dakota 685 10 12,352 1,553 0hl.; 10,744 262 12,255 19,682 Oklahoma 3,301 48 11,655 5,064 Oregon 2,687 28 11,611 4,981 Pennsylvania 11,853 265 12,314 18,985 Puerto Rico - 931 - - Rhode Island 968 906 12,820 1,987 South Carolina 3,347 108 10,116 3,017 South Dakota 708 9 11,069 999 Tennessee 4,762 114 10,419 5,333 Texas 16,370 60 12,372 18,912 Utah 1,643 20 9,733 2,877 Vermont 535 37 10,602 992 Virgin Islands - - -, Virginia 5,706 140 13,254 .- 8,171 Washington 4,409 65 12,792 8,833 West Virginia 1,936 81 9,728 3,547 Wisconsin 4,778 87 12,474 9,572 Wyoming 509 5 12,224 1,802 - Information not available. APPENDIX C STATE NARRATIVE REPORTS ON MAJOR UNMET NEEDS ALABAM: o The planning process has resulted in three major arcas of unmet need. - Increased funding of existing residential services. - Expansion of short term and long term substance abuse residential services. - Expansion of outpatient and day treatment services with emphasis on accessibility to target populations such as working people, women, children and elderly. ALASKA: o Improved efforts in the prevention of Petal Alcohol Syndrome. o Establishment and operation of a residential youth treatment facility. o Thore is an overall need to conduct special prevention efforts on a regular and consistent basis. ARIZONA: o The Office of Community Behavioral Health has identified domestic violence shelter services as under-developed in Arizona. While not specifically supported by drug, alcohol, or mental health funds (domestic violence funds are a separate legislative appropriation) the clients served often have difficulties that grow out of substance abuse problems. We fund shelters and safe homes throughout Arizona and believe this system is in need of expansion. o The capacity to serve clients in need of methadone maintenance services is not sufficient to meet demand. Publicly supporteu programs are having to delay client registration. Additional funding is required. o Expanded residential treatment services are needed for women with dependent children, for clients needing detoxification services, and for drug abusing youth. Various facilities already established need refurbishment and more realistic salary structures. Additional funding is required. C-1 Qc ARKANSAS: o Youth involved, at some level of severity, with alcohol and other drugs, and how to create/design services for this group have gained increasing emphasis in the last year. Data on the number of youth needing treatment are limited. A recent drop-out study has provided considerable new information in this area. The OADAP has made available limited funds for a pilot project designed to provide residential treatment to adolescents. There are not sufficient funds to initiate a new program. It is anticipated that the limited pilot will provide further support for the need for morg services to this group. The current funding situation will prohibit any service expansion. CALIFORNIA (ALCOHOL): o A survey of the critical unmet needs, as defined by the local county alcohol authorities, resulted in an unmet need costing $85 million. o Other data sources, identified in the State Alcohol Plan, indicate that special underserved population groups are inadequately served in California. These groups are made up of women, ethnic minorities, youth, the elderly and the disabled. o A variety of services are needed throughout the State, such as social model detoxification and recovery homes, residential treatment, non-residential and outpatient services, and prevention services. CALIFORNIA (DRUG): o Major needs include: - Treatment facilities for cocaine and fiynthetic drug abusers. Treatment facilities (residential) specifically for AIDS-diagnosed patients and for youth services. - Affordable laboratory tests to detect presence of fentanyl analogs. o Resources required include: - Adequate and timely research on the epidemiology of synthetic and natural drugs to facilitate development of public policy and program funding priorities. C-2 COLORADO: o With increased funds we would be able to provide higher reimbursement rates for services currently provided and expand services to meet the needs of greater percentage of the target population. CONNECTICUT: o A major need identified is the replacement of federal funds due to decreased block grant allocations and lack of inflationary increases. In the first instance, a $410,000 decrease in Social Services Block Grant (SSBG) funds became effective October 1, 1985. These monies are needed to maintain the existing community based treatment and rehabilitation system. The October 1, 1985 decrease in SSBG funds was offset this year by unallocated funds which resulted from the closing of one program. Without an increase in subsequent years, service reductions would be required. In the second instance, CADAC has identified $66,819 needed to replace the amount of Alcohol, Drug Abuse and Mental Health Services (ADMS) block grant funds which will no longer be available due to inflationary costs. The effect of status quo funding is a loss of ability to maintain current positions due to increased costs relating to collective bargaining increases and anniversary increases. o Another major need identified in our planning process is the expansion of the service delivery capability of existing prevention programs. CADAC has identified $100,000 to increase by 50% the nunkber of youth, teachers and other adults to be served by high demand population services. DELAWARE: o Appropriate residential treatment resource for adolescent alcohol/drug abusers.* o Residential treatment alternatives to incarceration for alcohol/drug abusers with significant criminal justice involvement.** o Legally under auspices of separate governmental unit. Need acknowledged but not responsibility of this agency. ** Not sole responsibility of this agency. C-3 9 7 DISTRICT OF COLUMBIA: The following needs were identified, but not provided in the District of Columbia due to inadequate resources: NEEDS INADEQUATE RESOURCES o Inpatient drug detoxification (PCP and other drugs) o Treatment slots for court referral o High risk identification and referral (AIDS, prenatal care) o Communications network (to link treatment programs and compile data) Funds Funds, Staff Funds, Staff Funds, Technology FLORIDA: o There are currently insufficient funds to expand and enhance alcohol and drug abuse services. In addition, with an increase in cocaine use and AIDS clients (Florida currently has the third highest number of confirmed AIDS cases) additional resources will be needed to provide adequate services for these two population groups. ;BORGIA: o During 1985, the Alcoholism and Drug Abuse Services Plan was formulated in order to realign resources to shift the balance more toward a community-based continuum of care. The plan further provided that the size and function of the eight regional hospital alcohol and drug units be reduced to serve only the most problematic patients and the acutely medically involved. Over a four year period, hospital resources are being redirected to develop 24 hour community services to provide for detoxification, 28-day residential treatment and extended residential care in eight regions of Georgia. During FY 1986, three regions will implement a regional system of services for alcohol and drug clients. The implementation of this portion of the plan is supported by the Department of Human Resources FY 1986 improvement funds. The plan projects an increase in all alcohol and drug abuse residential treatment beds from the current number of 646 to a total of 992 at a cost of $6 million over a four year period. C-4 98 GUAM: o Major needs that were identified for which resources were not adequate include the development and implementation of a drug and alcohol unit, a satellite medication and mental health clinic, specific risk reduction services for special populations, the Department's quality assurance program, and the Department's management information system. Many of these needs were not met because of a lack in funds, educational institutions, and coordination among other planning/research agencies. HAWAII: The following table demonstrates the gap in available services and the resources needed to reach a low average level of services: AVAILABLE RESOURCES SUPPORT NEEDED o Prevention $ 430,604 $723,331 + 38.6 F.T.E. o Emergency/Crisis $ 21,926 $495,385 + 19.3 F.T.E. Intervention + 26,055 bed days o Outpatient $ 1,224,335 $11,467,573 + 104.2 F.T.E. o Residential $ 1,122,731 $5.839,915 + 138,400 bed days IDAHO: o Idaho identified the need to establish a residential treatment program for adolescents needing longer term, more structured substance abuse treatment. Estimates were that this would cost $250,000 or more. Also identifled as a need was the development of treatment programs for persons under custody of the State or county - (criminal justice systems - jails, prisons, etc.) or foster homes, youth homes, etc. The need to find cost effective treatments, matching clients and treatments, has contir.-Ad to be a priority for substance abusf: administration. ILLINOIS: o The Illinois Department of Alcoholism and Substance Abuse (DASA) coordinates services and distributes grants to community drug and alcohol prevention and treatment service providers. By far, the largest portion of the DASA budget is grant-in-aid. Based on research conducted by the agency, it appears that the major problem in Illinois is the lack of a full range of services in all areas, as well as the lack cf adequate services to special populations (i.e., C-5 ILLINOIS: (cont'd.) youth, women, minorities) In all parts of the State. This is caused by the fact that federal and State funding is limited, and the State's top priority at this time is to provide continued funding to the existing service system, thereby upgrading the quality of car.l. In a State as geographically large and culturally diverse as Illinois, additional centers throughout the State are necessary to adequately serve the population. INDIANA: o Services, primarily of a non-hospital 24 hour residential nature, were identified as deficient for both youth and adults. Intensive outpatient treatment (day treatment) needs were likewise noted as insufficient. The absence of a statewide prevention strategy was noted. Funding in the areas of $12,000,000 annually was identified as needed to meet the reasonable demands for services. IOWA: o Respondents to a mailed questionnaire identified the following treatment needs: specialized services to ethnic/racial minorities and the elderly; adult in-patient services; halfway house services for men and women; day care services; and adolescent residential services. In prevention, respondents called for increased services to minorities, the elderly, and women. In addition, respondents requested more specialized training for groups outside the network of prevention and treatment programs. Those groups included police officers, volunteers, parents, physicians, clubs and organizations, prison staff, administrators and teachers. o Although there was an increased State appropriation for FY 1985, these funds were not sufficient to address the identified needs. KANSAS: o To enhance and promote community pmgrams furthering youth prevention, intervention and treatment services, a $10.6 million investment is needed over the next 5 years. o To promote and enhance community programs furthering alcohol and other drug abuse outpatient services, with special attention to the needs of both employed and indigent clients, a 5 year $650,000 investment is necessary. C-6 luO KANSAS: (cont'd.) o To enhance and promote community programs furthering prevention, intervention and treatment services for minority populations, a $2,376,000 investment is needed. o More than $5 million in State and community funding is needed for capital improvements in treatment facilities. o Inadequate counselor salaries resulting in excessive turnover is a longstanding problem. KENTUCKY: o Governor's Task Force on Drug and Alcohol Prevention - funds would be allocated to implement the recommendations of the Governor's Task Force. o Treatment Services for Adolescents - through subcontract arrangements with CCC's new services targeted at youth who have alcohol and drug problems would be developed. o A&D Treatment Services for Adults - Expansion of CCC system would include more halfway house and residential treatment programs for adults who abuse alcohol and drugs. o Alternatives to Incarceration - In order to implement the intent of the Decriminalization of Public Intoxication Act, alternative programs need to be established. o Prescription Abuse Data Synthesis (PADS) - One staff position and computer capability would be required to implement this recommended program of the Governor's Task Force on Prescription Drug Abuse. o Criminal Justice Diversion Program - Each CCC would have opportunity to establish court liaison for ME-MR-SA identification and referral. o Capitol Construction of Alcohol and Drug Facilities - The legislature would appropriate funds for a bond issue. Employee Assistance Program for State Government - An EAP program would be established by the Department of Personnel for all State government employees. o Alcohol & Drug Programs in Kentucky Prisons - the Corrections Cabinet would expand programs in 5 prisons in Kentucky. C-7 101 LOUISIANA: o A recently completed needs assessment identified the following major needs and the resources required to meet total needs of those dependent on public sector treatment resources. - To provide 100% of detoxification needs an additional 197 beds would be needed. Existing beds for detox services in the public sector totals 40. - For inpatient (30 day) treatment, unmet need is estimated to be 207 beds. Through existing resources, 310 beds are presently available for a total bed need of 517. - Halfway house/residential services are now provided through 197 beds. Unmet need is estimated to be 557 beds. - For outpatient treatment services, it is estimated that an additional 395 treatment staff positions would be needed to meet 100% of need for services based on a caseload of 1:50. - An additional $10,625,634 would be needed to fund approximately 50% of the unmet need in new or expanded prevention/intervention/treatment programs. MAINE: o Both inflation and increased quality of services have diminished the buying power of existing funds. o Halfway house services for women. o Expansion of rural outpatient services. o Extended care services for late stage population. o Expansion of adolescent treatment. o Shelter/detoxification services. MARYLAND (ALCOHOL): o Services to adolescents - additional funds need to be appropriated to provide expanded assessment and treatment and residential treatment services. These gaps in services have been identified and are priority funding items for this current fiscal year and the next three fiscal years. In addition to 102 MARYLAND (ALCOHOL): (cont'd.) this, increased prevention and intervention efforts have been initiated in conjunction with other human service agencies in the State. It is projected that annually, a need to provide residential placements for 300 adolescents in fiscal year 1986 will outstrip the available resources and additional residential facilities will have to be developed. Projected costs through purchase of service contracts will be around $500,000 to $750,000 annually. MARYLAND (DRUG): o To fund an additional nine addiction counselor positions to serve as adolescent treatment coordinators throughout the State to provide liaison with other juvenile agencies; assessment and referral to residential facilities; outpatient and family counseling ($200,000). o To improve treatment services for an estimated 750 new female clients annually in outpatient programs by providing two counselor/coordinator positions in each of the five regions throughout the State ($225,000). o To provide Group Home Care for approximately 92 adolescents annually who have completed formal treatment for substance abuse, but need extended aftercare and are unable to return to their own homes ($303,000). MASSACHUSETTS o Several major needs were identified through the recent State planning process for which resources were not adequate to meet those needs. First, there has been a need to increase prevention efforts in the schools and to develop resources to train teachers and to support the development of comprehensive drug and alcohol prevention curricula. Second, the need to acquire additional funding to upgrade residential drug programming was identified. Third, the need to expand the availability of methadone services was identified. o For all services, there is a need to maintain the existing level of operations while at the same time providing for cost of living increases. This has become increasingly difficult in that State and federal funding are static. Federal "lag" money is no longer available for alcoholism services, and we are faced with the prospect of service reductions in the State 1986-87 fiscal year. C-9 103 MINNESOTA: o Specialized programs to prevent, identify, and treat drug and alcohol problems among various "special" populations, including the elderly, adolescents, Southeast Asians, Blacks, Hispanics, the handicapped, various dual disability groups (MI/CD. MR/CD, hearing impaired, etc.). etc. While the State can and does provide grants for demonstration projects, on-going funding and dissemination of results to effect permanent system change continue to be problems. o Treatment for those who do not meet public assistance guidelines but have no insurance or other resources. MISSISSIPPI: o Additional treatment beds fur adolescents are needed, especially in the Northern and Southern portions of the State. The required resource is funding. o Prevention activities within the school system are inconsistent both in availability and quality where they exist at all. The required resource is a policy mandate from the State Board of Education for the inclusion of prevention activities in the curriculum requirements. MISSOURI: o The table below summarizes the Missouri Division of Alcohol and Drug Abuse target population and the level of service needed for that population. As can be seen, there is a large gap between existing and desired service level. An additional $76 million would be necessary to reach the desired service level. Target Population Service 46,614 Detoxification Beds Residential Beds Non-Residential Hours MONTANA: Need Identified 1) Lack of inpatient treatment bads for indigents in the Eastern Part of State Existing Services 129 551 151,118 Desired Services 516 2,601 649,514 Resources Required Funding 104 MONTANA: (cont'd.) 2) Need for more transitional living, or extended care facilities 3) Need for adolescent treatment services 4) Increase training for adolescent diagnosis and assessment 5) Maintaining existing services with a continued decrease in public (State and federal) funds Funding Funding, staff & facilities Funding Funding NEBRASKA: o Our most recent plan was published in July, 1985, and proposes a model service system for the six planning regions in the State. It identifies a general lack of public information, education, and prevention services in 3 of the 6 regions. Day Care (Partial Care) is not available in 3 regions nor are youth services available in 4 regions. Detoxification services are available in all but one region. o In an analysis of geographic accessibility three multiregional level services were found not to be accessible (youth halfway house, youth short term residential, and adult extended residential). o Analysis of financial accessibility reveals that five types of services are not offered on an ability to pay basis (emergency detoxification (1 region), youth short-term residential (2 regions), adult short term residential (3 regions), youth halfway (I region) and adult halfway house (I region). o No estimate of resources required to fullfill these needs was made. From the above, I have estimated that there is a need for about 21 new programs (facilities). The programs listed are not of the inexpensive variety. A very rough estimate of cost would be approximately $5 million in additional State funds or about twice as much as we currently provide. NEW HAMPSHIRE: o Although more people than ever have been served, due to tight budgets and limited fiscal resources, OADAP is still only reaching four (4) percent of the identified population in need of treatment. The increasing numbers being identified as a result of 105 NEW HAMPSHIRE: (cont'd.) prevention and awareness efforts have strained resources and created gaps in services. Becaurl of the same constraints, special populations troubled by substance abuse, such as the hearing impaired, blind, or developmentally disabled, have not been served. NEW JERSEY: o The following major programmatic areas are in need of substantial funding resources and represent major categorical underserved populations as well: (1) homeless/chronic debiliated alcoholics and drug addicts in need of residential extended care servicesv (2) teenage substance abusers in need of primary services, and (3) substance abusers who have an additional simultaneous condition including AIDS, mental illness and hearing loss in need of specialized treatment services. o Additional technological resources are necessary to provide more complete, rapidly available drunk driving data and client tracking capability. NEW MEXICO (ALCOHOL): Major needs include: o Early intervention e.g., with both adolescents and adults in collaboration with the courts o Treatment for adolescents - currently there exists only one State funded adolescent program; a gap in services exists Expanded treatment services for women o At least one additional halfway house in certain areas of the State o Development of standards for residential treatment of women o Additional monies for all of the above and creativity in spending and utilizing the monies. NEW MEXICO (DRUG): The New Mexico State planning process identified various needs that are currently not being addressed in the field of drug abuse. The following are those needs currently being identified as most crucial at this time: C-12 NEW MEXICO (DRUG): (cont'd.) o treatment for inhalant abusers o treatment for children and (inpatient and outpatient) o treatment for addicted women o treatment for medically indigent o prevention. New Mexico continues to provide substance without the benefit of adequate resulting in a system of service delivery difficult to expand treatment options needs are identified. their families abuse services funding thereby that finds it when additional The New Mexico Health and Environment Department, Behavioral Health Services Division, Drug Abuse Bureau, finds itself in the unfortunate position of not being able to allocate monies crucial to the development and expansion of current services that will address the needs earlier identified. This translates into a lack of trained staff, facilities and technical guidance. In summary, the lack of adequate funding currently being appropriated for drug abuse services in New Mexico has contributed to a system of service delivery that may soon be identified as deficient and/or incomplete. NEW YORK (ALCOHOL): o The current alcoholism service delivery system reaches approximately eight per cent of the population in need. Almost all existing inpatient and outpatient alcoholism treatment services report excessive waiting time for entry into services. In many communities, the most fundamental services including alcoholism clinics do not exist. o The following chart illustrates immediate and projected needs by program type: Program Type 1985 Inpatient Detox Inpatient Rehab Community Residence Outpatient Alcoholism Rehab 4,004,762 684 beds 421 beds 582 beds C-13 1986 717 beds 479 beds 4,212 beds visits 4,104,542 visits 107 NEW YORK (DRUG): o The Division of Substance Abuse Services oversees a statewide network of programs providing treatment and rehabilitation services to substance abusers in communities throughout the State. Treatment services benefit not only the abusers whose health and personal status are improved, but society at large. However, a great many substance abusers whose problems are serious -- including substantial itambers who are the cause of enormous social and economic costs -- are not in treatment. Overall, there are more than 240,000 narcotic addicts and more than 550,000 heavy non-narcotic abusers in the State -- while only 75,000 - 80,000 substance abusers are known to receive treatment during a year. In order to adequately address the unmet treatment needs problem that currently exists in the State of New York the following directions need to be undertaken: 1) expand treatment capabilities; 2) increase availability of services; 3) assess and design services for nonnarcotic abusers; 4) further increase the quality of service; 5) undertake additional research; 6) increase appropriate services to special populations; 7) continue efforts to impact on public awareness/attitudes; and 6) continue contributions to AIDS research efforts. o New York also supports an extensive network of prevention and early intervention services that include statewide public information/awareness and community volunteer efforts, and local prevention and early intervention programs. While the great majority of the local prevention programs focus on a youthful population, incidence and prevalence data indicates a need to also target other groups. However, prevention services are already severely constrained by recent funding decisions. In order to adequately address the unmet prevention needs problem that currently exists in the State of New York, the following directions need to be undertaken: 1) expand the capabilities of the substance abuse prevention services system, especially for target populations; 2) continue efforts to increase public awareness; 3) increase quality and cost-effectiveness of services; 4) study the future elderly population; 5) develop additional information; 6) develop and implement mechanisms to foster increased coordination of program efforts; and 7) develop mechanisms to access additional funding sources. 12121.212hilis o Irevention - There is a need to have personnel to do prevention full-time and funds for demonstration projects in student intervention and parent education. Adolescents - Although the dimensions of the problem are unclear at present comprehensive early identification and treatment for adolescents with substance abuse problems is being given special :11:Osis in North Carolina. Our legislature has ated $1.2 million for start up funds for new programs in 1985-86 that are designed to demonstrate model services for communities. These resources will also assist in the better assessment of needs for underserved populations in our system and further planning and training. poen DAROTA: o Major resource needs include residential and intermediate care for adolescents which include both facility and operational funds with no specific estimate of the dollars required. Present outpatient programs are adequate in their present locations, but our need is to expand existing treatment programs to include outreach programming in various parts of our State. The major need here is additional addiction counseling staff with estimated budget to be around $500,000 per year including salary and travel expenses. No facilities are necessary. OHIO: o Although Ohio was able to increase funding, fiscal year 1985 again fell dramatically short of its needs for treatment and prevention dollars. As we have described in FY '84, it cost approximately $46.5 million to treat 30,105 Ohio indigents within three levels of care -- inpatient, residential and outpatient. That cost is now approximately $48 million based on a 3 percent inflation factor. This oost takes into consideration all resource areas -- staff, funding, facilities, etc. o The increases in State funds from DWI license reinstatement fees was also certainly a step in the right direction, however, Ohio's need for an adequate continuum of care accessible to all Ohioans, particularly to specific populations, remains a high priority. This will require special attention in the area of resource development and a unified approach, whether it be through the implementation of a generally controlled statewide system, or some other alternative system. C-15 109 OHIO: (contld.) o Prevention remains a priority for Ohio. Again, despite Ohio's efforts to increase State funding for the development of a system to provide training and consultation of Ohio communities on prevntion/intervention, the gap between available resources and existing need is considerable, as previously identified, Ohio plans to implement such a system through essentially three avenues: (1) intervention training; (2) personal resources and (3) community training. OKLAHOMA: o The Department requested $960,559 as expansion funds for PY 86 but did not receive. The increase was to assist ins - developing new adolescent residential service - upgrading the three existing adolescent residential facilities - developing new adolescent/women's residential facility for minorities - developing a new service of detoxification in one residential program - expanding residential services expanding outpatient services. o No additional funds were received to develop or expand the programs. OREGON: o The following needs exist: - Prevention and treatment services for elderly people - Prevention and treatment services for handicapped people - Prevention and treatment services for adolescents - Residential services for women - Treatment services for the most chronic and severe clients, many of whom have organic brain damage - Treatment services for incarcerated individuals -- juveniles and adults. PENNSYLVANIA o Residential treatment capability for the adolescent. o Transitional housing for the homeless. o Treatment alternatives for the youthful criminal justice substance Lbuser. (TASC) o School prevention program. C-16 110 MERTO RICO: o Prevention: - To reestablish the Humacao Prevention Center, thereby increasing services in the Eastern part of the Island, an often reported lacking service at a total cost of $74,568. - To provide additional technicians for Mobile Units and centers to broaden coverage of the Island, at a total cost of $71,850. - To intensify the mass media effort, at a cost of $34,500. - To increase personnel in the Juvenile Restitution Program at a cost of $121,768. o Treatment: - To create a complete treatment center in the Eastern area to service adults, children and adolescents, at a cost of $484,877. - To establish Day Care Centers for Alcoholics in Manati and Caguas at a cost of $75,000. - To increase the DWI Program staff, at a cost of $86,052. - To establish a specialized residential treatment center for adolescent and adult women. - To strengthen the treatment modules prevalent in the penal institutions and to set up new modules in the institutions in need of them. - To expand services at the Industrial School for Girls at Ponce and Boys at Mayaguez, at a cost of $80,000. RHODE ISLAND: o Transitional and long-term care for chronic alcoholics. o Shelter care for alcoholics. o Residential and outpatient treatment programs for adolescents. o Rhode Island - specific drug abuse study/survey. o Methadone maintenance services are inadequate. RHODE ISLAND: (cont'd.) o Inadequate services, across all modalities, to meet the current demand. o Lack of growth/expansion in the treatment/prevention system due to decreased and inadequate funding. o Two catchment areas do not have funded prevention programs. o Inadequate financial resources to implement school substance abuse intervention and student assistance programs. SOUTH CAROLINA: o Needs were identified in treatment, prevention and early intervention, and in several non-programmatic areas. o The principal treatment need is for additional outpatient counselors as a result of increases during the last three years in the demand for outpatient services. For the same reason, a need has been identified for increased funding to support training and technical assistance for treatment providers. o Several needs were identified in the areas of prevention and early intervention, including expansion of primary prevention activities in communities, expansion of the School Intervention Program, expansion of prevention and intervention services for institutionalized youth, a second Teen Institute, and increased information services. o Non-programmatic needs include funding for facility renovation, funding to allow cost-of-living salary adjustments for personnel and funding for improvements in information technology capability. SOUTH DAKOTA: o An assessment of adolescent needs revealed a need for at least 2 more residential treatment programs, 5 structured outpatient treatment programs; 22 FTE's in counseling and referral centers with expertise to deal with chemically dependent adolescents and issues of children of alcoholics and 33,852 days of transitional or group home care. o We are in the process of assessing statewide services and determining systems needs. We should have specific identified need areas by late December. 112 TENNESSEE: o Adolescent Residential TreatmelLt has been a priority. In FY 84-85 the first publicly funded 15-bed program was established. With the impact of the Governor's TLsk Force on Youth Alcohol and Drugs, in FY 85-86 two additional publicly funded 15-bed programs are being established for a total State resource amount of $1,500,000. This gives one program in each grant region of the State. The Statewide Planning Committee recommended one progray per region (six regions), which would require an additional $1,500,000 of state resources. o Adolescent Aftercare and Outpatient Services was also recommended by the Statewide Committee. No identified State resources are available to meet this need in the development of the continuum of care for youth. For the present, we are asking for a percentage (10%) of contracted outpatient slot utilization for adolescents across the State. o The Statewide Planning Committee also made recommendations concerning underfunding for adult services. This addresses unmet needs in regions across the State. The percentage annual increase of State funding does not meet this recommendation. It remains a continuing planning issue for this year to more concretely address the unmet needs and resources required during the next three years to improve adult services. This will require Departmental improvement requests in the budget process and legislative action. TEXAS: o Detoxification, evaluation, and referral centers for public inebriates diverted from the criminal justice system are needed in every region of the State. At present, there are three. At least twenty-four are needed, and the three which are in operation need expansion. o The insufficient number of long-term care facilities for chronic inebriates also comprises a major gap in services. o Adolescent treatment services addition to a need to outpatient services. Texas based residential substance for persons under 18 who for-profit servicPs. C-19 1113 are a major need, in expand the number of has few non-hospital abuse treatment services are unable to access TEXAS (cont'd.) o The Commission also has a priority for establishing at least 24 programs to serve children from chemically dependent families. We need one in each region; at present there are five. o Additional casefinding and referral capabilities and training resources are needed to respond to the divergence of public inebriates. o Services for youthful inhalant abusers are inadequate and need significantly more financial support. o Funding and technology are also needed to respond to the service needs of specific substance abuse trends, such as cocaine and designer drugs. UTAH: o Alcohol and drug abuse problems affect the lives and health of many youth in Utah. A 1983 study by the Utah State Division of Alcohoholism and Drugs shows that 7.4% of Utah teens ages 12-17 (13,067) have either extreme or severe problems with alcohol and drugs and are in need of treatment intervention. Recent increases in State appropriations for alcohol and drug services have been directed at relieving public safety pressures and at prevention. As a result, adequate treatment resources do not exist; treatment programs are filled to capacity and many youth are required to be placed on waiting lists. A survey conducted across the State in 1985 indicates that it would cost 84,961,568 over the next two years to develop and implement an adequate service system to address the needs of our youth who have extreme or severe alcohol or other drug problems. VERMONT: o A major need for the State of Vermont is an instate residential facility for youth. o Currently the existing array of services is having difficulty meeting the client demand. More general outpatient services are required for this purpose. In addition, services to older Vermonters, women and school age youth are needed. We believe that we have the technology to meet these needs. The resource are the primary problem. o Overall the existing system is in financial trouble. With the exception of a few outpatient clinics, most programs are experiencing serious problems. C-20 114 VIRGINIA: o Although new detoxification services have been initiated in Virginia recently, there remains a need to continue development of community-based detoxification especially in areas previously served by state facilities which are now reducing detoxification services. o Progress is continuing in accessing care in local, general hospitals; however, as with the detoxification service need noted above, funding is an issue especially for medical services to the indigent alcoholic under the primary diagnosis of alcoholism. o Employment services are required to deal with the current 50% rate of unemployment among our treatment clientele; connections among local agencies are required. o Virginia has become increasingly aware of the special needs of the dually diagnosed (MH/SA) population -- technology and improved relationships between MH and SA providers is required; then the funding issue can be examined. o Additional funding (with a focus on rural areas) is required to meet current demand as evidenced by waiting lists and to further develop a continuum of services. VIRGIN ISLANDS: o New programs for women's treatment were designed, one in St. Thomas and one in St. Croix. The St. Croix program still lacks a staff member and although women are being served, the program, as designed, will not be implemented until a staff member can be hired. o Increase services to women and youth, cooperative efforts with the school are moving along slower than expected. A new program entitled "Women's Challenges" has been designed and minimally implemented. o Staff person also need to implement this program. WASHINGTON o There are 2,800 alcoholics and drug abusers who are receiving welfare checks on the basis of a substance abuse disability. While State policy requires that these persons be enrolled in a program at residential or outpatient treatment, funds are insufficient to provide the necessary treatment services for this population. C-21 115 WASHINGTON: (cont'd.) o All persons convicted of Driving While Intoxicated (DWI) axe required to undergo an assessment of alcohol dependency. Those considered to be in need of alcoholism treatment are referred to treatment by the courts as a condition of their retaining driving privileges. New DWI statutes have increased the total number of court referrals to primarily outpatient treatment, among than: are a significant number of low income persons. Bureau funding is iasufficient to pay for the cost of treatment of all of these persons. o In the past, most alcohol and drug dependent youth were treated together with adults by regular treatment agencies. During the last two years, the bureau has been funding twenty-eight youth alcohol and drug treatment beds in three special residential facilities for youth, but has not developed a continuum of aftercare outpatient services for youth. There is a need for additional specialized youth treatment beds and for specially trained youth therapists to provide outpatient and aftercare services. o We have only fifty percent of the drug residential treatment capacity which we need to keep up with the service demand generated by court treatment placement. At present, there is a 76 day average waiting period for admission to residential drug treatment agencies. In addition, the quality of treatment is suffering because of attempts by agencies to accommodate the demand by overextending themselves. WEST VIRGINIA.: o Residential treatment for adolescents. o Long-term residential treatment for chronic alcoholics. o Expanded day treatment programs. o Expansion of outpatient services. o Expansion of transitional living services. o All above services could be provided with a sufficient increase in funds to provide staff, and, in the case of the first and second facilities. 'HISCONSIN: The State of Wisconsin, through its biennial planning and budgetary process, prepares proposals to meet the State needs. Proposals in the area of alcohol and other drug abuse programs include the following: In addition to the increase to counties to address women's initiatives, other priorities to be considered if funding allows include: expansion of the Women Reaching Women program to all counties ($235,000). Earmark block grant funds for specific initiatives for women through the community aids process ($360,000). Pool funds with the Domestic Abuse Council and jointly fund new programs ($360,000). Develop procedure to use funding for child care for women in treatment ($75,000). Increase funding for the TRAILS programs to a level that will minimally fund one full-time employee at each reservation with adequate travel and training ($75,000). Support and encourage the development and expansion of services to special populations (i.e., women, minorities, elderly, criminal justice, youth, the chronic, the disabled). (Amount to be determined, $1-2 million approximately.) Fund services for hearing impaired ($720,000). Fund an American center ($350,000). Fund an American ($350,000) treatment Indian residential treatment Indian Women's Treatment Center Provide funding for the State Chronic Alcoholic Community Support program ($3-4 million). WYOM/NG: o Major need is treatment services for children/ adolescents (persons under the age of majority which is 19 in Wyoming). Impetus for this need emerged from an overall examination by the State of all youth services in Wyoming. It became clear that alcohol and drug treatment services for youth in C-23 WYOMING: (cont'd.) Wyoming are not available. Many youth are being sent to special youth treatment facilities in neighboring States. Questions arose as to whether these youth could or should be treated in adult facilities. Currently the State is exploring and searching for appropriate tzeatment alternatives for youth in Wyoming. Although the State is experiencing an economic downtt and new monies are difficult to obtain, the State is committed to improving the adequacy of services for children. APPENDIX D STATE NARRATIVE REPORTS OF SIGNIFICANT CHANGES IN SERVICES DURING FISCAL YEAR 1985 ALABAMA: o The most significant change was in zreatment services due to the 5% set-aside requirement for women under the Block Grant. Four model programs were funded in FY 1985. Services will be expanded in FY 86 based upon the evaluation of the model programs initiated in FY 85. Prevention services remain basically the same. The procedures for application and funding of prevention services were improved so that more measurable objective's were obtained, and reporting was improved. ARKANSAS: o The State of Arkansas has had considerable difficulty with the 5% (now 3% in the first year) set-aside fund requirement for services to women. Of greatest concern was the issue of treatment services which demand a stable funding source. Thus, Arkansas has chosen to place the bulk of these funds into prevention/early intervention services to women. This decision has brought about numerous unique and innovative project applications, none of which will suffer if funds are available for a limited time. The problem this creates is that it severely limits prevention efforts with other populations (i.e., the elderly of which Arkansas has a large percentage; troubled youth; minorities; etc.). ARIZONA (DRUG) o Drug abuse client median income rose considerably from FY 84 to FY 85. In FY 84 drug median income was lowest when compared to alcohol and mental health, while in FY 85 it became the highest of the three! (64,241 .vs. 66,695). o A 14% reduction in all funds in contracts for drug abuse only resulted, during FY 85, in a 3.8% reduction in clients seen (7,292 vs. 7,016). CALIFORNIA (ALCOHOL): o Two major changes have been or are being implemented in California's alcohol delivery system. The first is that the Department has received legislative authority to license alcohol residential facilities. Previously, this activity was performed by another State department that also licensed skilled nursing facilities, Eh9 board-and-care homes, etc. includes the requirement regulations. This will result and realistic requirements residential alcohol services. The new authority to adopt new in more sensitive for providers of o The other major change is the Department's Women's Initiative. This initiative is designed to dramatically increase the number and quality of alcohol programming for women in California. Major features of the initiative include the development of a Women's Advisory Committee, the issuance of RFPs for new and innovative women's programming, and increased technical assistance and training for programs serving women. CALIFORNIA (DRUG): o Because of the increasing incidence of drug abuse by youth, drug prevention services have been expanded to involve more people at the school and community levels. A school-community primary prevention project has been implemented. A statewide network of drug prevention professionals and prevention experts in allied fields has been developed. Efforts have also been directed toward credentialing and certification of prevention workers, the development of minimum standards for programs offering prevention services, and the hosting of a statewide prevention conference in April, 1986. CONNECTICUT: o Significant activity nas continued in the prevention arena. Efforts to develop an effective "network" throughout the State and coordinating the varied organizations and interests have emerged as key system activities. This is in great part due to CADAC's identification of prevention as a priority focus. DISTRICT OF COLUMBIA: o The District continues to confront the challenges of increased demand on public services, inadequate staff and resources for the delivery of prevention and treatment services. In fiscal year 1985, we moved closer to a comprehensive alcohol and drug treatment system with: - An intensive residential alcohol treatment program with a low recidivism rate and a high employment rate; n-2 120 Development of a fee schedule for services rendered, to be implemented in fiscal year 86; Implementation of a policy to limit the continuous use of methadone; - Increased activity in statewide prevention (e.g., Drunk and Drugged Driving Awareness Campaign, Fetal Alcohol Syndrome Awareness Campaign and local networking); and, Development of plan for a computerized data collection and tracking system to link treatment programs. FLORIDA: o To assure quality of services, the department is implementing licensure of alcohol facilities, is requiring accreditation of services to meet at least minimal standards, and is encouraging certification of alcoholism counselors and therapists. These elements are especially important if Florida is to provide specialized treatment services to children, youth, the elderly, the chronically mentally ill, and those who are enmeshed in the criminal justice system. In 1985 and the next decade, new demands will continue to be added to Florida's alcohol and drug abuse service delivery system. GUAM: o In FY 1985, the Department hired a Drug/Alcohol Supervisor from the U.S. mainland with the intentions of dramatically increasing drug/alcohol services to the population. However, lack of manpower on-island and the reduction of federal and local funds to institute such a program forced an indefinite postponement of any plans. o Increased arrests and prosecutions of DUIs coupled with a sustained pattern of alcohol evaluations of probated people, have required the local court's alcohol education program to service more clients. The court program has consequently outlined additional educational services to be delivered to communities on the island free of charge. HAWAII: o In terms of prevention services there has been increased community participation through the formation of Chemical People, Toughlove, MADD and SADD groups. D-3 121 o In terms of treatment services, a crisis response team and crisis beds were added to the available services on the Island of Oahu. The crisis team has been able to divert numerous admissions to the State Hospital and place t'lose clients in a less restrictive setting. IDAHO: o Idaho has focused their prevention program upon three programs: two programs in public schools - one with a curriculum to teach 6th grade children about alcohol/drug abuse; and a K-12 grade curriculum "Here's looking at you, II". This is a comprehensive alcohol/drug curriculum. Then we have begun a program to identify and educate young children of alcoholics between four and 18 years of age that they are at increased risk of developing alcoholism. They also learn other facts about alcoholism. Idaho has essentially stopped the "community awareness/community networking" area because of dollar shortages, and the fact that these programs usually are so poorly focused that no goal is achieved. o Idaho has gone to an outcome oriented provider system for treatment delivery. Contractors have a random 20% sample of clients followed up by independent contractors who interview the client to see if he is sober or improved at six months after admission. Idaho takes the very strict and harsh view that if a client cannot be found, they are counted as a treatment failure. The client relocation rate thus becomes very important to both the independent contractor and the treatment facility. We use our outcome rates as one factor in our competitive bidding process to determine successful bidders. ILLINOIS: On July 1, 1984, the Department of Alcoholism and Substance Abuse began operating in the State of Illinois. Prior to that time, the Dangerous Drugs Commission and the Division of Alcoholism at the Department of Mental Health and Developmental Disabilities operated separately, with each providing its own type of service. These separate agencies often times provided disjointed services and used different standards and procedures. It had long been apparent that a single State agency was needed to coordinate both types of services; therefore, the legislation which combined the two agencies was welcomed by providers and experts in the field. After 17 months of operation, the new agency has made considerable progress in uniting both types of services and is currently working on equalizing reimbursement rates and the quality of service within the drug and alcohol system. D-4 122 IBMs o Treatment providers continue to feel the impact of tougher D.U.I. nforcement, but it is not significantly different from the FY 1984 xperience. A focus on youth treatment has resulted in service growth for this population both in the private and the public sectors. IONA: o Landmark Stat legislation provided the Iowa Department of Substance Abuse (IDSA), with nearly $8 million (supplemented by $3 million federal funds) for strengthening alcohol tnd drug programs in the State during FY 1985 - a substantial increase in the IDSA funding from FY 1984 level of $2.9 million. The measure required the State to assume 1000 of the cost of treatment for indigent clients at community-based programs (approximately $$.5 million), set aside $150,000 for prevention programming on a match basis with counties, and mandated a preliminary intake and assessment of patients before admission to a State mental health institute for substance abuse treatment. In addition, prevention efforts were increased by $550,000. o Additional State funds permitted the development of several new treatment and prevention projects. New treatment programs included two residential, two halfway houses, and two juvenile residential facilities plus expansion of existing services. Seven new and innovative prevention projects were begun besides a prison pilot project at the Iowa Correctional Institutional for Women in Mitchellville and one newly-funded community-based prevention program. Prevention programming was expanded throughout the State. The statewide federation of parent and community groups, the Iowa Network of Drug Information (INDI), sponsored five regional workshops on oommunity group organisation techniques, in cooperation with IDSA. Iowa continued to be a national leader in numbers of parent and community groups, approximately 250. o To encourage their involvement in local prevention efforts, IDSA awarded 85 mini-grants of $250 each to those groups. C1-5 123 o To support the continuing development of qualified substance abuse program staff, IDSA organized 21 workshops for about 1,700 persons and also participated in the formation of the Iowa Board of Substance Abuse Certification (The board certifies substance abuse counselors). KANSAS: o Alcohol and Drug Abuse Prevention. Prevention Programs funded by the State served 135,000 in FY 85, an increase of 7% over FY 84. Funds granted increased by 18%. Seventy percent of the student participants agreed that they were less likely to become intoxicated as a result of the programs. School Team Training, a five day intensive training of prevention skills and plan development for schools, was expanded to serve 44 teams. The expansion resulted from funding provided by Kansas Department of Transportation. Seventy one teams applied. Other significant prevention activities included coordination of the Kansas SADD network, which grew from 28 chapters to 77 in FY 85. "Know Your Limit" a new youth hunter-safety program began with the potential of serving 14,000 yearly. It is a cooperative program with Kansas Fish and Game Commission. o Alcohol and Drug Abuse Treatment Programming. Admissions to treatment increased by 5% for the third consecutive year. Admissions to programs partially funded by the State has increased 43% since FY 82. Grant funds have not kept pace with demands for service. Many programs have waiting lists. Funding was provided in FY 85 to start a residential treatment program for indigent youth. o Information Resources. There was an expanded emphasis in FY 85 on developing greater public awareness and on developing information resources capable of influencing State and local decision makers. KENTUCKY: o The 1984 legislature allocated an additional $1,000,000 for DUI assessment, education and treatment for indigent offenders. Alr., DUI prevention programs could be funded with these funds. All of the Community Mental Health Centers that provide substance abuse services are increasing services to the DUI offender. Some centers complain that staff are unable to reach voluntary clients because of the large numbers of court referred DUI offenders. D-6 124 o The 1985 ADMS Block Grant allows for program expansion in the area of substance abuse services to women. The amount of the ADMS Block Grant allocated for women's initiatives for FY 1986 for substance abuse services is $227.500. Thirteen Comprehensive Care Centers submitted a total of 17 proposals for funding for increased services for women ($614,066 was requested). A committee of Substance Abuse Division staff reviewed all the requests and recommended that 8 receive funding. The Commissioner awarded funds to the 8 following projects: North Central Substance Abuse Prevention ($47,932), Seven Counties Services Substance Abuse Training and Education ($10,887), Seven Counties Services Student Assistance Program ($37,255), Payways, Inc., Lake Cumberland Prevention and Intervention ($48,185), Bluegrass Regional Mental Health/Mental Retardation Board and Chrysalis House ($7,291), Bluegrass Regional Mental Health/Mental Retardation Board and Alternatives for Women ($18,000), and Bluegrass Regional Mental Health/Mental Retardation Board will provide $8,000 to the Human Abuse Council. LOUISIANA: o There has been a 21% increase in reported admissions to alcohol related treatment services during FY 1985. This increase in reported number, of persons served is due to improved data collection procedures and increased emphasis on substance abuse services with the separation of Alcohol & Drug Abuse services from the Office of Mental Health. o There has been a 13% reduction in admissions to drug abuse related treatment services. This reduced level of persons served is due to a change in scope of work from treatment to prevention services for some provider agencies. MAINE: o There is an emerging interest in the intensive outpatient modality. o New demands have been created by cocaine abuse. o There exists limited access to residential rehabilitation/inpatient services for the medically indigent. o Expansion of Medicaid coverage for some forms of outpatient treatment has occurred. o Four Model Prevention Programs have been implemented. D-7 125 MARYLAND (ALCOHOL): o Increases have been noted in the identification of adolescents needing specialized residential treatment i.e., 45 - 60 day intermediate care facility or halfway house services. Planning goals are to develop more programs such as ICF's for adolescents and secure additional funds for expanded residential stay in halfway houses. o DWI treatment continues to be a priority and has been budgeted at constant levels for FY 1985 and FY 1986. The increased apprehension of DWI drivers and the need to assess whether they are problem drinkers, has indicated that 68% of those assessed are in need of treatment. This has created the establishment of private entrepreneur programs to provide services to the DWI client. These programs have assisted the State funded programs by entering into referral agreements to provide treatment to those DWI clients who would have been on a waiting list. Data also indicates that more than 50% of the clients in treatment are DWI referred. MARYLAND (DRUG): o The rapid growth in cocaine use and the increase in cocaine availability have resulted in a cocaine epidemic as well as the emergence of a new poly drug abuser -- a person addicted to both heroin and cocaine. Client admissions with cocaine related problems increased by 304% over FY 1980 and represented 38% of all drug abuse treatment admissions for FY 1985. Intensive staff training was offered to program personnel so that staff would be able to recognize and treat cocaine abusers. In addition, funds were sought and appropriated for a new residential facility for indigent cocaine abusers which will be funded in FY 1986. o The protocol for a pharmacy pilot program for long-term chemotherapy clients was submitted to the Drug Enforcement Administration. This protocol includes dispensing medication to long-term successful clients not in need of continued intensive counseling at a local Baltimore City Hospital pharmacy. D-8 MASSACHUSETTS: o During FY 1985, several changes were made in the delivery of alcohol and drug prevention and treatment services. A mid-year request for proposal resulted in the funding of new programs to serve previously undeserved populations. Awards were made to increase residential adolescent treatment, residential drug free services for women, residential detoxification services, Hispanic services, prevention centers, prevention programs, and court diversion programs. The increased residential adolescent treatment and prevention center programming was done jointly by the Division of Alcoholism and Drug Rehabilitation. MISSISSIPPI: o The only significant change in treatment services in FY 1985 was the development of new guidelines for programs for women in compliance with Federal legislation. The new guidelines contained elements targeted specifically to the recruitment and retention of women in treatment programs. MINNESOTA: o Continued emphasis on cost containment measures by both the public and private sectors have resulted in increased competition, program closures, and increased difficulty in serving low-income clients. Major legislation to consolidate and streamline all public funds for CD treatment did not pass in 1985 session, but received widespread attention and support. MISSOURI: o The Missouri Division of Alcohol and Drug Abuse received a 27.2 percent increase in general revenue appropriations for FY 1986. o The Missouri Division of Alcohol and Drug Abuse implemented the Missouri Institute for Prevention Services, a comprehensive statewide prevention program focused on youth. o Several important pieces of legislation passed the Missouri General Assembly including bills which provide for mandatory insurance coverage for alcohol abuse treatment, involuntary treatment for alcohol and drug abusers who are dangerous to themselves or others and licensure for counselors. These new laws will impact the service delivery system when they go into effect. D-9 127 o The Block Grant requirements resulted in an expansion in treatment programs designed to serve women. o Communications and relations between the Division and volunteers improved as a result of several Division sponsored meetirgs and workshops designed for volunteers and self-help groups. o The Division published a monograph entitled "Model Staffing Patterns and Budgets for Missouri Alcohol and Drug Abuse Programs. o Division personnel presented papers at the National Council on Alcoholism Forum and the International Congress on Alcohol and Drug Dependence describing the Missouri approach to prevention of substance abuse among teenagers. There was an increase in admissions among cocaine abusers. MONTANA: o Development of State standards for educational programs provided to DUI and Minors in Possession offenders; also, certification standards for course instructors. o The State Legislature has increased taxes on wine and beer to provide additional funding for chemical dependency treatment programs. o An increase in programs providing outpatient services as an alternative to treatment has occurred. o There has been an increase in programs' of third party reimbursement due legislation which mandated group coverage. o There has been an increase intervention activities, programs, due to increase DUI and possession laws teacher and parents. intensive inpatient collection to 1983 insurance in prevention and early particularly school based of awareness, stricter and increase training for o An increase in DUI education course admissions has occurred due to stricter DUI laws. NEBRASKA: o There were no significant changes year. We do expect significant changes current and next fiscal year. The reduced State aid to substance abuse D-10 128 during the during the legislature programs by 1% during the regular session and is currently in special session for additional cutback legislation as tax receipts are lagging. These acts and the goal's of the State system plan to emphasize prevention and services to youth will cause some difficult decisions in the future. NEVADA: o The State of Nevada funded a Community Addiction Clinic in October, 1985 for prevention and education for pregnant women and high risk adolescents and women. The additional emphasis on women's treatment is partially due to the Block Grant requirements, but also due to volunteer groups showing dramatic increase in interest. We also participated in the opening of a 26 bed newly constructed drug and alcohol residential facility located in rural Nevada. The opening of this new facility is an attempt to bridge the gap between insurance clients and the publicly subsidized clients. The change in State health insurance legislation triggered this proto-typical treatment center. o The certification procedure was developed, redefined and finalized in October, 1984 with the publication of Nevada Administrative Code 458. The intent was to strengthen .education and experience requirements for counselors and program administrators involved with drug and alcohol programming. Insurance requirements and quality assurance strengthening brought on more stringent regulations for certification of counselors and accreditation of facilities. NEW HAMPSHIRE: o Even though financial constraints do limit the numbers of people that can be reached and makes services to the special populations listed almost virtually non-existent, progress was made during FY 1985. Several gaps in New Hampshire's Comprehensive Continuum of Care were being addressed for the first time. OADAP efforts toward establishing a halfway house for women were realized as of January 1st. So was a pilot project for third party insurance coverage from Blue Cross/Blue Shield for New Hampshire residents who are chemically dependent. In addition, two (2) earlier pilot projects matured nicely. The State's first sobriety maintenance center worked out its role even more meaningfully than originally expected and continues to experience admissions at a higher than anticipated rate. D-11 129 OADAP held its 2nd Annual Teen Institute, an intensive week-long educational program about substance abuse for 60 of New Hampshire's young potential leaders. As in its development edition, this program was funded through scholarships from the private sector and manned by volunteer staff. It has successfully carved itself an important niche in the Statc's overall prevention and education effort. It should also be mentioned that in addition to these newly instituted endeavors, on-going services also increased. Through education, prevention, intervention and treatment, 110,000 New Hampshire citizens were reached by OADAP efforts in the fiscal year just past. OADAP again participated actively in the New England Institute of Alcohol Studies (NESAS), held this time in our sister State of Rhode Island. NESAS provides advanced training for alcohol and drug abuse professionals, has a special track for medical students, and offers introductory courses for those just entering the field. Closer to home, OADAP continued to enhance it's contract monitoring and service evaluation capabilities. Significant advance was made in the area of prevention program evaluation and while a vehicle for such nears realization, the manpower and other resources still necessary for its fullfillment has been committed for the current FY. NEW JERSEY: o FY 85 marked the initial implementation of two significant State legislative alcoholism initiatives, one addressing a stable State funding base and the other targeting drunk driving. Both laws were enacted during State FY 84. The funding initiative resulted in the implementation of a designated beverage tax which provided the first stable State funding base for alcoholism treatment and prevention services. It was subsequently implemented through State health service contracts between the State alcoholism agency and the 21 county government authorities, resulting from State agency approval of the required county plan. o The companion drunk driving legislation resulted in: (1) an increase in the penalties for conviction of an alcohol/drug related motor vehicle offense including fines and detention; and (2) the establishment of county intoxicated drivers resource centers (IDRC) providing client evaluation, treatment referral, and monitoring of treatment services for convicted offenders. By the end of the fiscal year, each of the counties had a functioning IDRC and two residential IDACs serve repeat offenders. D-12 130 o New planning efforts supported by ADMS block grant funds, resulted in the establishment of a strategy for the implementation of the 1985-87 five percent women's set aside requirement. o Implementation of mandatory Medicaid legislation covering eligible substance abusers. NEW MEXICO (ALCOHOL:) o A major problem was created when the conditi ns o the Block Grant required the State to provid services for women, but did not include 1ny increase in monies to provide these services. The State funded four new programs for women, but in order to do so had to cut all other services and programs by five percent. The new programs will provide education, training and awareness related to women and alcohol. o The overall public awareness of needs has increased due to the activities of groups like MADD, etc. o A significant number of new for-profit alcoholism treatment agencies is being initiated in the State. o New Mexico earmarks 49% of its alcohol excise tax revenues for alcoholism treatment services. However, alcohol sales are down and so excise tax revenues are down and less State monies are available for alcoholism treatment services. The shortfall was about $200,000. In July, 1985 the State legislature increased the percent for services from 49% to 52%. If Gramm-Rudman-Hollings cuts occur, New Mexico will also experience large cuts in Title XX. NEW MEXICO (DRUG): o New Mexico did not experience significant changes in the delivery of drug abuse services during FY 1985. However, the Health and Environment Department, Behavioral Health Services Division, and Drug Abuse Bureau has recognized and identified service needs that may result in a realignment of service appropriation. Those newly identified service needs are as follows: substance abuse school-based) prevention (primarily substance abuse treatment for women D-13 131 substance abuse treatment for children and their families substance abuse treatment for those who abuse inhalants. o Another treatment service area currently being examined is methadone counseling. During FY 1985, 24% of the Drug Abuse Bureau Budget was expended on methadono counseling. NORTH CAROLINA: o The DWI law (N.C.G.S. 20-179) was changed to add a provision requiring substance abuse assessments in second offense cases or those individuals who register .20 blood alcohol content or more on the breathalyzer, and those who refuse to take the breathalyzer test. The assessments are to determine if the offender has an alcohol or drug problem and should be referred to treatment. o Funds have been allocated to the Department of Public Instruction to provide alcohol and drug services in 142 State school systems; expansion and training of school support personnel and the development and implementation of an effective drug education curriculum throughout the State. NORTH DAKOTA: o Delivery of treatment services did not change dramatically in 1985; however, prevention services changed dramatically toward community based prevention programs including school and citizen groups developed around a "community chemical health" model. Small grants were provided to communities on the basis of initially stringent grant requirements of an ongoing community task force including representation from schools, school board, law enforcement, parents and students. This is a shift away from school based prevention programs which were largely curriculum based. OHIO: o In December, 1984, the Governor announced his intention to merge the Bureau of Drug Abuse (Mental Health) and the Bureau of Alcohol Abuse and Alcoholism Recovery within the Health Department, and legislation has been drafted to this effect. Meanwhile, both agencies continue to work together and to cooperate as closely as possible in administering and facilitating a statewide drug and alcohol abuse service delivery D-14 132 system. The Governor also announced the establishment of the Governor's Office of Advocacy for Recovery Services and the Council for Recovery Services. These efforts are being made as part of Ohio's attempt to create a more adequate continuum of care for both alcohol and drug clients. o In FY 1985, the State began to utilize funds received in FY 1985 and continued to receive in FY 1985 from DWI license reinstatement fees, the State elected to set aside a small portion of these funds for cost reimbursement to indigents attending driver intervention programs as a result cf DWI convictions. The balance of these funds have been allocated for treatment services. As the State becomes more familiar with the conviction rates and monthly funding levels via receipt of license reinstatement fees, it can more adequately project the availability of funds for planning of treatment services. o The State also receives funds from the Department of Liquor Control - 1.5 percent of the gross profits and 20 percent of the permit fees. In FY 1985, Ohio experienced a reduction in funds from FY 1984 ($5.8 million to $5.4 million). This reduction is the result of a trend in declining per capita consumption over the past six years from 1979 to 1984. In FY 1986, we should experience a greater reduction (perhaps 6.5 percent of gross profits) due to the continuation of this trend and the implementation of a federal excise tax. o It also has been brought to our attention by NASADAD that Congress may, as part of the balanced budget proposal, reduce ADMS Block Grant awards by 8.2 percent. Ohio's share would be a 2.6 percent reduction. Combined with a possible shortfall in State liquor funds, the State could be faced with a total reduction in these, particular sources of about $250,000. Add to this, the $140,584 of alcohol funds set aside for women and a 3 percent inflationary factor and it is easy to see the difficulty in maintaining treatment and prevention services at the FY '85 level. OKLAHOMA: o The Alternatives to Incarceration far Drinkirl Drivers Program which was initiated in October, 1981, with bed capacity for five, has been increased to one hundred beds. Referrals for residential treatment are from the Department of Corrections for residential treatment services. D-15133 o With passage of H.B. 1034 (DUI legislation) last year, more drunken drivers are coming from the Department of Corrections and this program has become a line item in the appropriations bill. o The legislation also provides that prior to sentencing, any person found guilty in violation of DUI, may be referred to an alcoholism program for an evaluation. The Department has formalized this process and established the criteria for evaluation and held training sessions. In the first seven months of the program, 250 persons were evaluated. OREGON: o Additional services for women and adolescents have been funded for 1985 as a result of priorities set by this agency and agreement by the State Legislature. Additionally, new training funds have been added to train employees in the Department of Human Resources, as well as treatment personnel for adolescents across the State. Funds have been made available for a statewide EAP for employees of the Department of Human Resources (one third of all State employees). PENNSYLVANIA: o An increased emphasis has been placed on school based prevention programs rather than on community based programs. o More emphasis has been given to early intervention services, particularly for teenagers, e.g., pregnant and suicidal. Also, there has been increased use of group intervention programs for DUI offenders. RHODE ISLAND: o Increased counselor training and treatment focused on cocaine abusers has occured. o Increased counselor training on AIDS and counseling of clients affected directly or indirectly by AIDS has been implemented. o The State licensed two residential facilities for female alcoholics. o Initial planning was accomplished in order to increase detoxification services, long-term transitional and shelter care for chronic alcoholics. D-16 13 4 o Treatment services for DWI offenders continued to be expanded. o A statewide Parents' Group and central organization representing them, the Rhode Islanders for Drug Free Youth, was developed and supported. SOUTH CAROLINA: o The most significant change was a major expansion of the School Intervention Program resulting from a substantial funding increase for this program. o A second significant change was a continuing increase in the number of clients with a cocaine problem, resulting from increased use of cocaine. o A third major development was the initiation of demonstration projects to provide alcohol and drug counseling services in Family Practice clinics in four locations in the state. o In general, there was a continuing increase in the demand for counseling services, which have increPsed 55% in three years, and an increase in deto.-fication utilization following three years of declines. Precise reasons for this latter change have not been determined. SOUTH DAKOTA: o FY 1985 funding reflected basically a maintenance posture. We are seeing a greater shift to group services in our community based programs. The influx of private for-profits seems to be generating a fierce competition for "bodies" that is hurting the service delivery system. We started funding for a custodial care facility in an attempt to provide appropriate cost effective services for our chronic iclients. We made an initial effort to generate some activity in parent/community group development. We are seeing more and more structured outpatient treatment programs spring up in an attempt to offer cost effective alternatives to inpatient. TENNESSEE: o Six new outpatient/day treatment and one new halfway house for women were opened as a result of incr-ased designated block grant funding. D-17 1 o The Governor's Task Force on Youth Alcohol and Drugs convened, conducted public hearings and made recommendations resulting in increased funding for the 1985-86 Fiscal Year, as well as recommending several other program and policy changes. o The Department of Education mandated a new health curriculum including a K-12 alcohol and drug strand. o The age 21 drinking law was strengthened. o Additional Sta%e funds for FY 1985 resulted in the provision of increased halfway house and early intervention services. TEXAS: o In FY 1985, the separate Alcohol and Drug Abuse State Authorities were combined into a Single State Agency. In addition, group insurance coverage for alcoholism became mandatory, as did the licensure of alcoholism and combined alcohol and drug abuse treatment programs. Laws establishing peer assistance programs and allowing the diversion of fines from DWI offenses to pay for treatment programs were also authorized. In addition, a Governor's Task Force focused public attention on the problems of juvenile inhalant abuse. VERMONT: o We are continuing to integrate prevention, intervention and treatment services. This is crucial in school programming. o The Driver Rehabilitation Schools now offer a Multiple Offender Course and the effort to intervene when necessary has increased for the First Offender Program. The goal is to increase the number of DWI offenders entering treatment. VIRGINIA: o The Departments of Mental Health and Mental Retardation, Motor Vehicles and Education are major collaborators on a youth alcohol abuse prevention project that involves students and treatment/prevention services providers across the Commonwealth. Our first annual conference was held this year and has contributed greatly to enhanced relationships among schools and service providers. A major focus of this project is to support, via a statewide and regional network, local school-based prevention projects. D-18 136 o During FY 1985, additional funds were awarded to localities in support of detoxification and residential services in the community. State facility detoxification services were then phased down, resulting in fewer inappropriate admissions to State facilities and increased utilisation of local, general hospitals. Clients requiring detoxification are now able to receive detoxification services closer to home, in a less restrictive environment, at a less costly rate, and at service more closely integrated into the local continuum; also, those requiring social-setting detoxification can more readily access these services. VIRGIN ISLANDSe o The incidence of alcohol and drug related problems in the community is indicative of the need to continue to make substance abuse treatment services available. Alcoholism continues to be our biggest problem. However, illicit drug use in the islands continues to show an increase. Those found to be abusing drugs are no longer primarily Hispanics age 20-40 (as was the case four (4) years ago); since then illicit drug use has shown an obvious trend toward younger people, more females, an increase in the number of Caucasians and an increase in the use of cocaine and polydrug use. o Substance abuse figures for 1985 for the territory indicate that although alcohol treatment remains the greater problem, decrease since last year is evident, whereas, drug treatment shows an increase over 1984, particularly toward the end of the year. o Laboratory data collected on urinalyses continue to show the most positive results for morphine and cocaine, with an increase in cocaine over 1984. MASHIMOTONs o The bureau contracts for all community based ser*ices through county governments. In order to ensure that prevention services do not have to compete for limited funds with community treatment services, the bureau has written separate prevention contracts with counties, with separate prevention plans, budgets and contract statements of work. State approved prevention activities are occurring in all of the State's counties and are generating a significant amount of local funding to supplement the required block grant funding. TN-19 o A recent increase in the number of indigent (usually urban) alcoholics who receive welfare payments due to alcoholism incapacity has severely compounded the problem of a limited treatment capacity for this population. Because funding for life support (welfare) and alcoholism treatment are legally mandated, it is essential that a means be devised to ensure the most effective use of limited funding in order to effect the best combination of life support and treatment services for this population. o While we have all of the elements of a continuum of treatment services for adults, we only have scattered elements of a continuum of specialized services for youth. Most notably, we have funding for youth in three publicly funded residential treatment facilities and a growing network of intervention services. However, we need additional residential beds, and we have very few specialized outpatient youth programs for either primary treatment or follow-up treatment. We need discrete youth treatment programs in each county. At a minimum, we need at least one person in each county who is specially trained in the identification and treatment of substance abusing youth. WEST VIRGINIA: o Continued emphases on treatment of the chronically addicted, including the public inebriate, and on DUI services, have led to a shift in the substance abuse clients being treated. Although the number of clients admitted have remained essentially the same, a large majority of client admissions are public inebriates, and those identified through evaluations in the DUI program. WISCONSIN: o As a result of increased public demand for the enforcement of driving under the influence laws the Wisconsin AODA treatment oyster, especially outpatient treatment, has seen a dramatic increase in the number of clients assessed and the number entering treatment. The amount of publicity generated by the intoxicated °driver program has spilled over into other areas and has sparked an increased concern in areas as teenage alcohol and drug abuse, teenage drunk driving, curtailing "happy hours", stiffer drunk driving 'laws, penalties, and alcohol and drug abuse and the elderly. In addition, premiums for liquor liability insurance are either so high the expense is prohibitive or the insurance is not available. D-20 138 o In 1985 one recommendation of the Minority Needs Assessment Study was acted on. The Wisconsin legislature appropriated $125000 to fund a program which will train and certify minority AODA counselors. o An increased awareness was brought to the pervasive problem of cocaine abuse and the State is now in the process of determining the extent of the problem and the most appropriate way to treat cocaine abusers. o State ZAP, SAP and prevention consultants saw a dramatic increase in demand for technical assistance from local communities. This, again, is seen as a result of increased public awareness and willingness to do something about AODA abuse. WYOMING: o The method of funding services changed: there was a move from a grant type mechanism that provided for the general availability of services whereby reimbursement is provided for units of service actually provided. o A need for expanded Hervices for children/adolescents/ youth clearly merged. o A number of different parent, citizen, education oriented and impaired driving groups are beginning to emerge in the State. o With regard to impaired driving, the proposed federal mandate for a legal drinking age of 21 emerged as a major issue, but one primarily of States' rights, and not of alcohol and drug abuse prevention; also, questions are being raised about the effectiveness (or lack of it) of impaired driver schools. U.S. 130VINNMINT PRINTINO OFFICk 9 6 - 4 9 /,' 3 5 0 5 3 5 3 6 D-21 139