REPORT TITLE:
Approp.; Substance Abuse


DESCRIPTION:
Appropriates funds for substance abuse prevention and treatment
programs. (SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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THE SENATE                              S.B. NO.           S.D. 1
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 four 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 use survey will reflect that the number of students
 
23 needing treatment is now 16,000.  Currently, the department of
 

 
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 1 health has funds to treat 1,483 of the 8,400 youths in need of
 
 2 treatment.
 
 3      There are approximately 22,000 adults in the criminal
 
 4 justice system, either on supervised release, probation, parole,
 
 5 or incarcerated.  According to the department of public safety's
 
 6 substance abuse screening, eighty-five per cent of male sentenced
 
 7 felons and ninety-five per cent of female sentenced felons are
 
 8 admitted with substance abuse histories and require treatment.
 
 9 For fiscal year 1998, based on substance abuse screening
 
10 instrument, approximately 514 newly admitted inmates required
 
11 substance abuse treatment.  The average inmate population per
 
12 month is approximately 3,944.  In fiscal year 1998, the
 
13 department of public safety was able to provide substance abuse
 
14 treatment to 963 inmates.  Substance abuse treatment provided by
 
15 the department of public safety targets only sentenced felons.
 
16 These statistics are for only the incarcerated populations.
 
17 There is also a need for substance abuse treatment for the
 
18 detention population (those on supervised releases, probation, or
 
19 parole).
 
20      In summary, there is a need for expansion of publicly-funded
 
21 treatment for adults, adolescents, and for specialized
 
22 populations like injection drug users, criminal justice
 
23 populations, and the uninsured and underinsured.  Research has
 

 
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 1 shown that for every $1 invested in substance abuse treatment, $7
 
 2 are saved in future costs, $11.54 are saved in combined remedial
 
 3 and social costs, and $5.60 is returned in reduced welfare, food
 
 4 stamps, Medicaid, crime, courts, and imprisonment.
 
 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 activities shall:
 
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.
 
23      Prevention efforts to address the agent (alcohol, tobacco,
 

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

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

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

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

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

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

 
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 1           strategies, promoting the establishment and review of
 
 2           comprehensive alcohol, tobacco, and drug use policies
 
 3           in individual community organizations, and providing
 
 4           technical assistance to communities to maximize local
 
 5           law enforcement procedures governing the availability
 
 6           and distribution of alcohol, tobacco, and other drugs.
 
 7      The purpose of this section of the Act is to ensure the
 
 8 availability of substance abuse prevention services similar to
 
 9 those mentioned in this section.  Implementation of this section
 
10 during each fiscal year in the 1999-2001 fiscal biennium, to be
 
11 funded from the appropriation authorized in section 7, shall
 
12 provide $480,000, for substance abuse prevention services
 
13 statewide.
 
14                             PART III.
 
15                   ADOLESCENT TREATMENT SERVICES
 
16      SECTION 3.  Results of the "1996 Hawaii Student Alcohol and
 
17 Drug Use Survey," which included self-reports from a sample of
 
18 3,039 public and private school students in grades six, eight,
 
19 ten, and twelve, were extrapolated to provide a projection of the
 
20 number of youths ages twelve to seventeen in need of substance
 
21 abuse treatment.  The findings include the following:
 
22      (1)  Over 3,000 youths statewide need treatment for alcohol
 
23           abuse while an additional 2,227 need treatment for drug
 

 
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 1           abuse.  Additionally, 3,160 require treatment for both
 
 2           alcohol and drug abuse, leading to a combined total of
 
 3           8,426 students who have either an alcohol abuse
 
 4           problem, drug abuse problem, or both;
 
 5      (2)  Adolescent treatment needs for alcohol and/or drug
 
 6           abuse are highest in Hawaii county (13.9 per cent),
 
 7           Maui county (12.8 per cent), and in Kauai county (11.4
 
 8           per cent);
 
 9      (3)  Hawaii and Maui counties have double the percentage of
 
10           sixth and twelfth grade students needing substance
 
11           abuse treatment compared to Kauai county or the city
 
12           and county of Honolulu.
 
13      (4)  Alcohol abuse is highest in Hawaii county for grades
 
14           ten and twelve and Maui county for grade eight; and
 
15      (5)  Less than one-third of the students with treatment
 
16           needs have utilized treatment facilities.
 
17      SECTION 4.  The support of comprehensive adolescent
 
18 substance abuse treatment services is needed.  Descriptions of
 
19 the services provided to adolescents are as follows:
 
20      (1)  Adolescent residential substance abuse treatment
 
21           services provide a planned regimen of professionally
 
22           directed evaluation, treatment, case management, and
 
23           other ancillary and special services.  Observation,
 

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

 
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 1 statewide.  Implementation of this section during each fiscal
 
 2 year in the 1999-2001 fiscal biennium, to be funded from the
 
 3 appropriation authorized in section 7, shall provide funding for
 
 4 adolescent school-based substance abuse treatment services in
 
 5 public high schools statewide in the amount of $600,000.
 
 6                             PART IV.
 
 7                     ADULT TREATMENT SERVICES
 
 8      SECTION 5.  Findings of the 1995 Adult Telephone Household
 
 9 Survey reveal that of the State's total 885,002 adult population
 
10 over the age of eighteen, a total of 79,119 (8.94 per cent) are
 
11 in need of treatment for alcohol, 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 and/or other drug abuse problems.
 
16           A total of 1,988 people (or 3.47 per cent of those
 
17           needing treatment) were provided treatment in publicly-
 
18           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 and/or
 
21           other drug abuse problems.  A total of 242 people (or
 
22           2.65 per cent of those needing treatment) were provided
 
23           treatment in publicly-funded slots;
 

 
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 1      (3)  For Kauai county, 3,886 (9.54 per cent) of the total
 
 2           40,740 adults are in need of treatment for alcohol
 
 3           and/or other drug abuse problems.  A total of 138
 
 4           people (or 3.55 per cent of those needing treatment)
 
 5           were provided treatment in publicly-funded slots; and
 
 6      (4)  For Hawaii county, 9,098 (9.28 per cent) of the total
 
 7           98,036 adults are in need of treatment for alcohol
 
 8           and/or other drug abuse problems.  A total of 659
 
 9           people (or 7.20 per cent of those needing treatment)
 
10           were provided treatment in publicly-funded slots.
 
11      SECTION 6.  Support for the comprehensive continuum of adult
 
12 treatment services is needed.  Descriptions of the services
 
13 provided to adults are as follows:
 
14      (1)  Residential programs provide a planned regimen of
 
15           professionally directed evaluation, treatment, case
 
16           management, and other ancillary and special services.
 
17           Observation, monitoring, and treatment are available
 
18           twenty-four hours a day, seven days a week.  There is a
 
19           minimum of twenty five hours per week of face-to-face
 
20           treatment, including a minimum of one hour per week of
 
21           individual counseling.  The other twenty-four hours
 
22           include group counseling, education, skill building,
 
23           recreational therapy, and family services.
 

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

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

 
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 1           treatment program.  Therapeutic living activities
 
 2           include needs assessment, service planning, individual
 
 3           and group skill building, referral and linkage, case
 
 4           management, client support and advocacy, monitoring,
 
 5           and follow-up.
 
 6      The purpose of this section of the Act is to ensure the
 
 7 availability of substance abuse treatment for adults statewide.
 
 8 Implementation of this section during each fiscal year in the
 
 9 1999-2001 fiscal biennium, to be funded from the appropriation
 
10 authorized in section 7, shall provide the following adult
 
11 treatment services:
 
12      (1)  Crisis intervention/detoxification 
 
13           residential beds statewide                  $  98,000
 
14      (2)  Residential (non-hospital) treatment
 
15           services statewide                          $ 688,000
 
16      (3)  Intensive outpatient services statewide     $ 120,000
 
17      (4)  Therapeutic living homes/programs at 
 
18           two sites statewide                         $ 432,000
 
19      SECTION 7.  There is appropriated out of the general
 
20 revenues of the State of Hawaii the sum of $2,418,550, or so much
 
21 thereof as may be necessary for fiscal year 1999-2000, and the
 
22 same sum, or so much as may be necessary for fiscal year 2000-
 
23 2001, to provide substance abuse prevention and treatment
 

 
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 1 services as specified in sections 2, 4, and 6.
 
 2      SECTION 8.  The sum appropriated shall be expended by the
 
 3 department of health for the purposes of this Act.
 
 4      SECTION 9.  This Act shall take effect on July 1, 1999.