Date: 03/08/2006

Final
Addiction Treatment Programs

COMMITTEE ON JOINT HEALTH AND HUMAN SERVICES

Votes: View--> Action Taken:
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10:13 AM --
Performance Measurement in Addictions Treatment Programs

Representative Boyd introduced the presentation on Performance Measurement in Addictions Treatment Programs. In addition to the Joint Health and Human Services Committee members, the following legislators were also present for the presentation: Representatives Buescher and Judd. The presentation was brought to the committee by the National Conference of State Legislatures. A. Thomas McLellan, PhD., began the presentation and distributed three documents to committee members (Attachments A, B, and C). He stated 80 percent of funding for addiction specialty care comes from government sources. It is unlike any other medical condition in its reliance on government funding. He described addiction as an illness. He listed a number of addiction therapies that have met an FDA-level of evidence in their success rates. He described medications that are used to treat addictions to alcohol, opiates, cocaine and marijuana. There is currently no medication available to treat addiction to methamphetamines. He stated neither the addiction therapies nor the medications he listed are currently used in addiction treatment.


10:23 AM

Dr. McLellan discussed the role of personal motivation in the success in addiction treatment. He described studies of persons who were not seeking treatment for their addictions. A University of Denver study showed just four counseling sessions significantly reduced substance abuse levels. A Johns Hopkins study of pregnant women using cocaine found one week of inpatient addiction treatment was correlated with reduced usage of cocaine and healthier babies. Dr. McLellan discussed recidivism rates among substance abusers who have been jailed and did not receive treatment. He stated a majority of persons in treatment drop out within one month. He compared individuals' approach to addiction treatment to their management of other "real" illnesses such as diabetes and asthma. Less than 30 percent of persons with hypertension adhere to the recommended diet and exercise. Similar findings applied to persons with asthma and diabetes. Dr. McLellan stated the lack of proper illness management is due to human fallibility and not due to characteristics unique to addicts.


10:38 AM

Dr. McLellan showed slides of brain scans of a methamphetamine user compared to a non-user. Long -term use of methamphetamine can lead to serious mental health problems for the user even if they are able to quit. He stated substance abuse treatment can work and posed a question regarding why it so often seems not to work. He discussed the 25 percent closure rate of substance abuse treatment programs. He stated counselor and program director turnover rate is 50 to 60 percent per year. He answered questions regarding pay rates for drug counselors. He stated the high turnover rate may be due to low pay rates and frustration with the low success rates among substance abusers. Dr. McLellan described the lack of availability of computers and web access for substance abuse counselors. He described the lack of market demand and political pressure to fund addiction treatment programs.


10:52 AM

Dr. McLellan discussed the nationwide presence of drug courts. He stated the first drug court was established in Florida approximately 10 years ago. There are now thousands of such courts around the country. He described efforts to inform drug court judges of offenders' attendance at treatment centers and results of their urine screens. Dr. McLellan described the high level of regulation and paperwork required by drug treatment programs. He described Delaware's use of performance contracting. The state has 11 outpatient providers. Delaware promised providers that each year they would get at least 90 percent of their previous year's state funding even in years when the state's budget was reduced. In years one and two, two programs lost state contracts and two new providers replaced them. After three years, the percent of persons attending treatment grew to 69 percent. Dr. McLellan answered questions about outcomes such as continued employment for persons in treatment.


11:05 AM

Dr. McLellan discussed purchasing power to create treatment value. He stated detoxification without follow-up care is one of the least successful treatment approaches but is widely used despite its high cost. He described one approach for incentivizing treatment beyond detox. He answered questions about the costs for inpatient and outpatient treatment. He stated the best outcomes come from programs that prepare addicts for the next step in their treatment. He concluded his presentation with the statement that system change is necessary. Purchasers with the appropriate incentives can create those changes. Committee members posed questions regarding the cost of addiction treatment and the availability of model legislation. Dr. McLellan described efforts at improving provider reimbursement and provider efforts to reduce new arrests of persons in treatment.