REPORT TITLE:
Approp.; Substance Abuse


DESCRIPTION:
Appropriates funds for substance abuse prevention and treatment
programs.  (SD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        180
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

MAKING AN APPROPRIATION FOR SUBSTANCE ABUSE PREVENTION AND
   TREATMENT SERVICES.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1                              PART I.
 
 2                 PURPOSE AND LEGISLATIVE FINDINGS
 
 3      SECTION 1.  The purpose of this Act is to ensure that a
 
 4 continuum of services for the prevention and treatment of
 
 5 substance abuse is available.
 
 6      The legislature finds that a comprehensive approach is
 
 7 necessary to address adequately the impact of alcohol and other
 
 8 drug abuse on individuals, families, and communities.  This
 
 9 approach must address the continuum of prevention, treatment, and
 
10 continuing support after treatment.  The dire consequences of
 
11 alcohol and other drug abuse in Hawaii are well documented and
 
12 well publicized.  Alcohol and other drug misuse and abuse leave
 
13 physical, psychological, and emotional scars not only on the
 
14 addict or alcoholic, but also on their family members, the
 
15 business community, and numerous segments of our population.
 
16 Alcohol and other drug abuse increases family violence and child
 
17 abuse, increases health care costs, increases crime, results in
 
18 overcrowded prisons, and reduces business productivity.
 
19      Statistics in 1995 for Hawaii show that seventy-five per
 

 
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 1 cent of all child abuse is alcohol or drug related, ten per cent
 
 2 of AIDS cases result from injection drug use, and about eighty
 
 3 per cent of criminal justice clients are in need of substance
 
 4 abuse treatment.
 
 5      There has been and continues to be an increased demand for
 
 6 adult and adolescent substance abuse treatment services,
 
 7 resulting in a daily wait list for residential treatment of
 
 8 between two hundred fifty and three hundred fifty clients.
 
 9      The need for treatment services is documented by the Hawaii
 
10 1995 adult household survey which indicates that over 79,000
 
11 adults in Hawaii are in need of treatment.  The department of
 
12 health's current funding is only sufficient to treat 2,369 adult
 
13 clients, or fewer than three per cent of those in need.  The need
 
14 is also documented by child protective services which estimates
 
15 that ninety per cent of their clients need substance abuse
 
16 treatment.
 
17      There is an increased need for treatment services for youth
 
18 ages twelve to eighteen, as documented by the 1996 Hawaii student
 
19 alcohol and drug abuse survey which indicates that 8,400 students
 
20 in grade six through twelve meet the criteria for needing
 
21 substance abuse treatment.  The soon-to-be released 1998 Hawaii
 
22 student alcohol and drug abuse survey will reflect that the
 
23 number of students needing treatment is now 16,000.  Currently,
 

 
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 1 the department of health has funds to treat 1,483 of the 8,400
 
 2 youths in need of treatment.
 
 3      There are approximately 22,000 adults in the criminal
 
 4 justice system, either on supervised release, probation, or
 
 5 parole, or incarcerated.  According to the department of public
 
 6 safety's substance abuse screening, eighty-five per cent of
 
 7 sentenced male felons and ninety-five per cent of sentenced
 
 8 female felons are admitted with substance abuse histories and
 
 9 require treatment.  For fiscal year 1998, based on a substance
 
10 abuse screening instrument, approximately five hundred fourteen
 
11 newly admitted inmates required substance abuse treatment.  The
 
12 average inmate population per month is approximately 3,944.  In
 
13 fiscal year 1998, the department of public safety was able to
 
14 provide substance abuse treatment to nine hundred sixty-three
 
15 inmates.  Substance abuse treatment provided by the department of
 
16 public safety targets only sentenced felons.  These statistics
 
17 are for only the incarcerated populations.  There is also a need
 
18 for substance abuse treatment for the detention population (i.e.,
 
19 those on supervised releases, probation, or parole).
 
20      In summary, there is a need for publicly-funded treatment
 
21 for adults and adolescents, and for specialized populations like
 
22 injection drug users, criminal justice populations, and the
 
23 uninsured and underinsured.  Research has shown that for every $1
 

 
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 1 invested in substance abuse treatment, $7 are saved in future
 
 2 costs, $11.54 are saved in combined remedial and social costs,
 
 3 and $5.60 is returned in reduced welfare, food stamp, medicaid,
 
 4 crime, court, and imprisonment costs.
 
 5      The advancement of prevention practices must evolve from
 
 6 community-based efforts.  These efforts deal with the host
 
 7 (individual), the agent (alcohol, tobacco and other drugs), and
 
 8 the environment (society).
 
 9      Addressing host factors in substance abuse prevention
 
10 involves assisting individuals in examining their motivation for
 
11 using alcohol, tobacco, and other drugs, understanding family and
 
12 community risk factors which may contribute to their use, and
 
13 developing living skills which promote healthy lifestyles.  These
 
14 prevention activities:
 
15      (1)  Strengthen identification with viable role models;
 
16      (2)  Strengthen family involvement and bonding;
 
17      (3)  Develop problem-solving abilities;
 
18      (4)  Develop intrapersonal skills;
 
19      (5)  Develop interpersonal skills; and
 
20      (6)  Develop skills for assessing individual risk and
 
21           adapting lifestyle decisions based on the risk
 
22           assessment for the use of alcohol, tobacco, or other
 
23           drugs.
 

 
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 1      Prevention efforts to address the agent (alcohol, tobacco,
 
 2 and other drugs) encourage physicians, legislators, churches,
 
 3 schools, and businesses to confront the availability of these
 
 4 substances.  These prevention strategies assist the public in
 
 5 understanding the dangers of the use and abuse of alcohol and
 
 6 other drugs, and the impairment which occurs from the use of
 
 7 certain types of alcohol and other drugs.  Prevention efforts can
 
 8 target policies and practices influencing alcohol, tobacco, and
 
 9 other drug availability, price, distribution, and consumption
 
10 practice.  Nationally, prevention efforts have focused on
 
11 promotional practices that target certain high-risk populations
 
12 and advance messages discouraging the use of alcohol, tobacco,
 
13 and other drugs.  
 
14      Environmental prevention efforts are aimed at altering
 
15 community norms and policies that contribute to the use and abuse
 
16 of alcohol, tobacco, and other drugs.  Changing norms frequently
 
17 involves advocating policies and procedures which make low-risk
 
18 alcohol use by adults the norm, ensuring that laws related to
 
19 sales of tobacco to minors are enforced, and promoting abstinence
 
20 from illegal drug use as the acceptable standard within the
 
21 community.
 
22      The legislature also finds that in the treatment of
 
23 substance abusers, the personal history of each abuser and their
 

 
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 1 related problems must be evaluated to determine the best course
 
 2 of treatment.  The overall goal of treatment is to reduce or
 
 3 eliminate the use of alcohol or drugs, or both, as a contributing
 
 4 factor to physical, psychological, and social dysfunction and to
 
 5 arrest, retard, or reverse the progress of any associated
 
 6 problems.  Treatment refers to a broad range of services,
 
 7 including therapeutic activities, counseling services, and
 
 8 recreational activities.
 
 9      Therapeutic activities and services often address all parts
 
10 of a person's life that have have been disrupted by alcohol and
 
11 other drugs.  For example, clients diagnosed with substance abuse
 
12 related health and nutritional problems receive, or are referred
 
13 to, medical care, voluntary HIV testing and education, and
 
14 tuberculosis and hepatitis B testing.
 
15      Counseling services help clients look at the patterns of
 
16 their substance abuse.  In individual therapy, they look at the
 
17 underlying causes of their addiction.  In group therapy, among
 
18 other recovering people, clients are encouraged to confront their
 
19 destructive behaviors and to explore new ways of dealing with
 
20 people, emotions, and their craving for substances.  Family
 
21 counseling helps family members understand and participate in the
 
22 recovery process.
 
23      Essential to recovery is learning how to spend leisure time.
 

 
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 1 Through recreational activities, clients are introduced to
 
 2 alcohol-free and drug-free ways of enjoying themselves and
 
 3 contributing to the community.
 
 4      Programs may also provide services to meet specific clients'
 
 5 needs.  These programs would include classroom instruction for
 
 6 students; literacy, remedial reading, and math for clients who
 
 7 lack basic skills; job training for unemployed adults; and
 
 8 assistance in finding housing for clients without a home.
 
 9      In order to ensure high-quality substance abuse treatment,
 
10 all those performing clinical supervision, clinical evaluation,
 
11 treatment planning, and individual, group, and family counseling
 
12 are Hawaii state certified substance abuse counselors pursuant to
 
13 section 321-193(10), Hawaii Revised Statutes, or hold an advanced
 
14 degree in behavioral health sciences.  Agencies must conduct a
 
15 criminal history record check for any person who is employed or
 
16 seeks employment in an adolescent substance abuse treatment
 
17 program in a position which necessitates close proximity to
 
18 adolescents, including all administrative and clinical staff.
 
19                             PART II.
 
20                        PREVENTION PROGRAMS
 
21      SECTION 2.  The federal Center for Substance Abuse
 
22 Prevention (CSAP) developed several primary prevention strategies
 
23 which address the host, the agent, and the environment.  A
 

 
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 1 description of these strategies are as follows:
 
 2      (1)  Information dissemination provides awareness and
 
 3           knowledge of the nature and extent of substance abuse
 
 4           and addiction, and its effects on individuals,
 
 5           families, and communities.  The strategy is also
 
 6           intended to increase knowledge and awareness of
 
 7           available prevention programs and services.
 
 8           Information dissemination is characterized by one-way
 
 9           communication from the source to the audience, with
 
10           limited contact between the two.
 
11                Types of services conducted and methods used for
 
12           implementing this strategy include
 
13           clearinghouse/information resource centers, health
 
14           fairs, health promotion, materials development,
 
15           materials dissemination, media campaigns, radio/TV
 
16           public service announcements, brochures, resource
 
17           directories, speaking engagements, and telephone
 
18           information lines;
 
19      (2)  Education in substance abuse prevention involves
 
20           two-way communication, and as such is distinguished
 
21           from the information dissemination strategy.  Services
 
22           under this strategy aim to affect critical life and
 
23           social skills, including decision-making, refusal
 

 
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 1           skills, critical analysis, and systematic judgment
 
 2           abilities;
 
 3                Types of services conducted and methods used for
 
 4           implementing this strategy include support groups for
 
 5           children of substance abusers, classroom and small
 
 6           group discussions (all ages), education services for
 
 7           youth groups, parenting and family management classes,
 
 8           and peer leader/helper services;
 
 9      (3)  Constructive and healthy activities are thought to
 
10           offset the attraction to, or otherwise meet, the need
 
11           usually filled by alcohol, tobacco, and other drugs.
 
12           These alternatives allow target populations to
 
13           participate in activities that exclude substance abuse.  
 
14                Types of services conducted and methods used for
 
15           implementing this strategy include alcohol-free and
 
16           drug-free dances and parties, community drop-in
 
17           centers, community services, and youth/adult leadership
 
18           functions;
 
19      (4)  Problem identification and referral programs are geared
 
20           toward those who have indulged in illegal or
 
21           age-inappropriate use of tobacco or alcohol, and those
 
22           who have indulged in the first use of illicit drugs, in
 
23           order to assess whether their behavior can be reversed
 

 
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 1           through education.  It should be noted, however, that
 
 2           this strategy does not include any function designed to
 
 3           determine whether a person is in need of treatment.
 
 4                Types of services conducted and methods used for
 
 5           implementing this strategy include employee assistance
 
 6           programs, student assistance programs, and driving
 
 7           under the influence (DUI) notices;
 
 8      (5)  Community-based process strategies aim to enhance the
 
 9           ability of the community to better provide prevention
 
10           and treatment services for substance abuse.
 
11                Types of services conducted and methods used for
 
12           implementing this strategy include accessing services
 
13           and funding, assessing community needs, community and
 
14           volunteer training, community team building,
 
15           multi-agency coordination and collaboration, risk and
 
16           protective factor-based services, staff/officials
 
17           training, systematic planning, and training of key
 
18           people in the system; and
 
19      (6)  Environmental strategies deal with both activities that
 
20           center on legal regulatory initiatives, and activities
 
21           that relate to the service and action-oriented
 
22           initiatives.
 
23                Types of services conducted and methods used for
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           implementing this strategy include modifying alcohol
 
 2           and tobacco advertising programs, product pricing
 
 3           strategies, promoting the establishment and review of
 
 4           comprehensive alcohol, tobacco, and drug use policies
 
 5           in individual community organizations, and providing
 
 6           technical assistance to communities to maximize local
 
 7           law enforcement procedures governing the availability
 
 8           and distribution of alcohol, tobacco, and other drugs.
 
 9      The purpose of this section is to ensure the availability of
 
10 substance abuse prevention services similar to those mentioned in
 
11 this section.  Implementation of this section during each fiscal
 
12 year in the 1999-2001 fiscal biennium shall be funded from the
 
13 appropriation authorized in section 7 for substance abuse
 
14 prevention services statewide.
 
15                             PART III.
 
16                   ADOLESCENT TREATMENT SERVICES
 
17      SECTION 3.  Results of the "1996 Hawaii Student Alcohol and
 
18 Drug Use Survey," which included self-reports from a sample of
 
19 3,039 public and private school students in grades six, eight,
 
20 ten, and twelve, were extrapolated to provide a projection of the
 
21 number of youths ages twelve to seventeen years old in need of
 
22 substance abuse treatment.  The findings include the following:
 
23      (1)  Over 3,000 youths statewide need treatment for alcohol
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           abuse while an additional 2,227 need treatment for drug
 
 2           abuse.  Additionally, 3,160 require treatment for both
 
 3           alcohol and drug abuse, leading to a combined total of
 
 4           8,387 students who have either an alcohol abuse problem
 
 5           or drug abuse problem, or both;
 
 6      (2)  Adolescent treatment needs for alcohol abuse or drug
 
 7           abuse, or both, are highest in Hawaii county (13.9 per
 
 8           cent), Maui county (12.8 per cent), and in Kauai county
 
 9           (11.4 per cent);
 
10      (3)  Hawaii and Maui counties have double the percentage of
 
11           sixth and twelfth grade students needing substance
 
12           abuse treatment as compared to Kauai county or the city
 
13           and county of Honolulu;
 
14      (4)  Alcohol abuse is highest in Hawaii county for grades
 
15           ten and twelve and Maui county for grade eight; and
 
16      (5)  Less than one-third of the students with treatment
 
17           needs have utilized treatment facilities.
 
18      SECTION 4.  The support of comprehensive adolescent
 
19 substance abuse treatment services is needed.  Descriptions of
 
20 the services provided to adolescents are as follows:
 
21      (1)  Adolescent residential substance abuse treatment
 
22           services provide a planned regimen of professionally-
 
23           directed evaluation, treatment, case management, and
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           other ancillary and special services.  Observation,
 
 2           monitoring, and treatment are available twenty-four
 
 3           hours a day, seven days a week.  There is a minimum of
 
 4           twenty-five hours per week of face-to-face treatment
 
 5           including a minimum of one hour per week of individual
 
 6           counseling.  The remaining time includes group
 
 7           counseling, education, skill building, recreational
 
 8           therapy, and family services;
 
 9      (2)  Substance abuse school-based services provide services
 
10           on a scheduled basis for adolescent students with
 
11           substance abuse problems.  Professionally-directed
 
12           evaluation, treatment, case management, and recovery
 
13           services are provided to clients with less problematic
 
14           substance abuse related behavior than those who would
 
15           be found in a residential or day treatment program.
 
16           This program allows between one and eight hours per
 
17           client per week of face-to-face treatment with a
 
18           minimum of one hour of individual counseling per client
 
19           per month.  Additional activities include screening,
 
20           assessment, treatment planning and counseling, and
 
21           group sessions focusing on process, task, education,
 
22           skill building, recreation, and family counseling.
 
23      The purpose of this section is to ensure the availability of
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1 substance abuse treatment for adolescents statewide.
 
 2 Implementation of this section during each fiscal year in the
 
 3 1999-2001 fiscal biennium shall be funded from the appropriation
 
 4 authorized in section 7 for adolescent school-based substance
 
 5 abuse treatment services in public high schools statewide.
 
 6                             PART IV.
 
 7                     ADULT TREATMENT SERVICES
 
 8      SECTION 5.  Findings from the 1995 Adult Telephone Household
 
 9 Survey reveal that of the State's total adult population over the
 
10 age of eighteen, 885,002, a total of 79,119 (8.94 per cent) are
 
11 in need of treatment for alcohol or drugs, or both.  Comparable
 
12 figures by county are as follows:
 
13      (1)  For the city and county of Honolulu, 57,192 (8.62 per
 
14           cent) of the total 663,473 adults are in need of
 
15           treatment for alcohol or other drug abuse problems, or
 
16           both.  A total of 1,988 people (or 3.47 per cent of
 
17           those needing treatment) were provided treatment in
 
18           publicly-funded slots;
 
19      (2)  For Maui county, 9,120 (11.02 per cent) of the 82,754
 
20           adults are in need of treatment for alcohol or other
 
21           drug abuse problems, or both.  A total of two hundred
 
22           forty-two people (or 2.65 per cent of those needing
 
23           treatment) were provided treatment in publicly-funded
 

 
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 1           slots;
 
 2      (3)  For Kauai county, 3,886 (9.54 per cent) of the total
 
 3           40,740 adults are in need of treatment for alcohol or
 
 4           other drug abuse problems, or both.  A total of one
 
 5           hundred thirty-eight people (or 3.55 per cent of those
 
 6           needing treatment) were provided treatment in publicly-
 
 7           funded slots; and
 
 8      (4)  For Hawaii county, 9,098 (9.28 per cent) of the total
 
 9           98,036 adults are in need of treatment for alcohol or
 
10           other drug abuse problems, or both.  A total of six
 
11           hundred fifty-nine people (or 7.24 per cent of those
 
12           needing treatment) were provided treatment in publicly-
 
13           funded slots.
 
14      SECTION 6.  Support for the comprehensive continuum of adult
 
15 treatment services is needed.  Descriptions of the services
 
16 provided to adults are as follows:
 
17      (1)  Residential programs provide a planned regimen of
 
18           professionally-directed evaluation, treatment, case
 
19           management, and other ancillary and special services.
 
20           Observation, monitoring, and treatment are available
 
21           twenty-four hours a day, seven days a week.  There is a
 
22           minimum of twenty-five hours per week of face-to-face
 
23           treatment, including a minimum of one hour per week of
 

 
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 1           individual counseling.  The other twenty-four hours
 
 2           include group counseling, education, skill building,
 
 3           recreational therapy, and family services;
 
 4      (2)  Day treatment programs provide a planned regimen of
 
 5           comprehensive outpatient treatment, including
 
 6           professionally-directed evaluation, treatment, case
 
 7           management, and other ancillary and special services.
 
 8           This level of care provides the client with the
 
 9           opportunity to participate in a structured therapeutic
 
10           program while still being able to remain in the
 
11           community.  Day treatment consists of a minimum of
 
12           twenty hours per week of face-to-face treatment,
 
13           including a minimum of one hour per week of individual
 
14           counseling.  The remaining nineteen hours include group
 
15           counseling, education, skill building, recreational
 
16           therapy, and family services;
 
17      (3)  Intensive outpatient programs provide non-residential
 
18           intensive specialized services on a scheduled basis.
 
19           Professionally-directed evaluation, treatment, case
 
20           management, and recovery services are provided.  There
 
21           is a minimum of nine hours, and a maximum of nineteen
 
22           hours, per client per week of face-to-face treatment.
 
23           At least one hour per week must include individual
 

 
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 1           counseling;
 
 2      (4)  Outpatient programs provides non-residential
 
 3           comprehensive specialized services on a scheduled
 
 4           basis, including professionally-directed evaluation,
 
 5           treatment, case management, and recovery services for
 
 6           clients with less problematic substance abuse related
 
 7           behavior than would be found in a residential or day
 
 8           treatment program.  Outpatient clients receive between
 
 9           one and eight hours per client per week of face-to-face
 
10           treatment with a minimum of one hour of individual
 
11           counseling per month;
 
12      (5)  Therapeutic living programs are intended for
 
13           individuals who are without appropriate living
 
14           alternatives and who:
 
15           (A)  Are receiving substance abuse treatment in a day,
 
16                intensive outpatient, or outpatient program; or
 
17           (B)  Have been clinically discharged within six months
 
18                from a substance abuse treatment program.  
 
19           The focus is to provide the necessary support and
 
20           encouragement for clients in their movement toward
 
21           independent housing and life management.  There is a
 
22           minimum of fifteen hours of face-to-face therapeutic
 
23           activities per week to clients who are actively
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1           involved in day, intensive outpatient, or outpatient
 
 2           treatment services, or those who have been clinically
 
 3           discharged within six months from a substance abuse
 
 4           treatment program.  Therapeutic living activities
 
 5           include needs assessment, service planning, individual
 
 6           and group skill building, referral and linkage, case
 
 7           management, client support and advocacy, monitoring,
 
 8           and follow-up.
 
 9      The purpose of this section is to ensure the availability of
 
10 substance abuse treatment for adults statewide.  Implementation
 
11 of this section during each fiscal year in the 1999-2001 fiscal
 
12 biennium shall be funded from the appropriation authorized in
 
13 section 7, provide the following adult treatment services:
 
14      (1)  Crisis intervention/detoxification 
 
15           residential beds statewide                  $
 
16      (2)  Residential (non-hospital) treatment
 
17           services statewide                          $
 
18      (3)  Intensive outpatient services statewide     $
 
19      (4)  Therapeutic living homes/programs at 
 
20           two sites statewide                         $
 
21      SECTION 7.  There is appropriated out of the general
 
22 revenues of the State of Hawaii the sum of $          , or so
 
23 much thereof as may be necessary for fiscal year 1999-2000, and
 

 
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                                     S.B. NO.           S.D. 2
                                                        
                                                        

 
 1 the same sum, or so much as may be necessary for fiscal year
 
 2 2000-2001, to provide substance abuse prevention and treatment.
 
 3      SECTION 8.  The sum appropriated shall be expended by the
 
 4 department of health for the purposes of this Act.
 
 5      SECTION 9.  This Act shall take effect on July 1, 1999.