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Home My WebLink AboutMINUTES - 02252003 - D1 DA THE BOARD OF SUPERVISORS CONTRA COSTA COUNTY, CALIFORNIA Date: February 25, 2003 - - -__-- Public Comment The following people addressed the Board on Public Comment: Alice Schofield, Tice Creek Watershed Flood Prevention Constituency, 1573 Webb Lane, Walnut Creek regarding flood problems in the Tice Creek neighborhood; Dick Weyand, Tice Creek Watershed Flood Prevention, 1741 Meadow Lane,Walnut Creek regarding Tice Creek and Rossmoor flooding; Frank Higgins, Tice Creek Watershed Flood Prevention Constituency, 1666 Castle Hill Road, Walnut Creek.; Janet Abbott,Contra Costa Tobacco Prevention Coalition, 77 Karen Lane, Walnut Creek, spoke in appreciation for Supervisor Gerber's role in tobacco prevention; Maria Rigazio, 3911 Raap Avenue,Martinez, regarding funding for Alcohol and Other Drug Treatment program; Harold Parsley,Chairman, Alcohol and Other Drugs Advisory Board, 3967 Bellwood Court, Concord,regarding funding for the Alcohol and Other Drugs Program. Greg Feere, Contra Costa Building Trades Council, 935 Alhambra Ave, Martinez; regarding a new revenue source for the County. THIS IS A MATTER FOR RECORD PURPOSES ONLY NO BOARD ACTION WAS TAKEN ............................................... ................ .......................................................................... ............. ..................... . . .. .. -------------- .g. ............. ............. K*� . ........ IN.: go FX I Am: Kw. -g",'g' m , m m.. MM. M. /ffg W, Fg'.E: IMI ml 'x om m................ -- ---------- . .................. MA 0 XIV. i K 'I WVAr'. x xg :g M X. y .............. ............. MM, 0, ............. X. ....KIKX�X' X-KK X 4 X mill r:. ME ....... ....... w M. :Z**" *:;--K* MEMO= M., XWX M X. I'll:V1. "'I—M%K. .OZ:xv MR wr/P.?..P, j:j�4' RM I"I—wIll M. �x 1. Z �IMKIMIZM *M I 011 e A* ............ �:**"A%. xi.*"� X ......� �K*K*K* m ............... Im.z w"I'll x '*KE M, X-X. N., ...x. KK 00::: x ..V. K*%-**Zl'x�*'*w--::::::I m §�X ��'K-X- �§O`:� 1%... ;§K� OK � . :>,'-- ................ K P�M: K K: K M: �A-: z ...... ..... .: 'I, :� i� - � KK KKK X:X XKK ggg ......... ..... ...... ........... X* rM, -*XZM�§*K 1 .................... X0 ;g-%�-Vxg v..... ...V. ...................�**::*.:v�'.:.......... x-:4.x��-x g'�X K %.%................. ........ V.--V......... IV................... ............ X. �M- :x:x:x:x:x::: j: 1: .............................. ............................. . . ..... .. . ............................... .. .... ..................................... .................................................. ...... ................................................ ......... January 21,2043 Walnut Creek City Council Members 1666 Forth Main Street Walnut Creek,CA 94596 Dear City Council Members. The Tice Creek Watershed flooded on December 16a`, 2002. We,the citizens of Walnut Creek, who live in the'Tice Creek Watershed,request that City funds be designated to pay for a permanent solution to the flood problems of our neighborhoods. Flooding this year caused major health, safety and financial problems. Not only were the neighborhoods flooded with overland flows aril waters from Tice Creek,they were also flooded with.sewer waters. Data from previous studies show that the protection of our homes will require the following= 1. Enlarge the detention basin in Ltossmoor to full capacity to protect the downstream homeowners from further damage. 2. Construct a 72"bypass pipe between Meadow Road and Orchard Lane to protect homeowners from overland flows as well as flows corning from Tice Creek. I Correct the piping system under Castle Hili road to prevent floodwaters from backing up at the intersection cif Castle Hill Road and Meadow Road. Representatives of the neighborhood met with the City Manager and his staff on January Ie, 2003. We feel the time for studies has ended and the time for doing is now.j Multiple studies have been completed and sufficient data has been gathered to allow the City to proceed with the agreement between City and County to build the detention basis to its hill size and add the bypass pipe. One final nate: It is important to the City and County residents within the Tice Creek watershed that the Tice Creek itself remain in its natural state. Sincerely, Alice Schofield Neighborhoods Representative Cc: Mike p`arness, City Manager Supervisor Donna.Gerber Supervisor Gayle Ulikema t;t V Si# y :rb' arty,. Gi i<. fi t++ •S as nt .,� L L s •''d r r r �' t sd i ya#d Y � y} ass Fdc+ _ td #- y ✓' 4.� •'A tt �t alit wWi yy, x,mv .3: i, $tit ItF i � G� } x 34 +¢� • '�,,, y �.---'"' " 1At as� 6 �• • td r 6£ SZ �I � .y� � rrr 9 S _.. Z }: :Sc. rrr+ id � • S yi. ZS � . gt 1. St gt mJ �' S JA 29 3£ i>i CNa i tl i. yti till .\ 'L gyro 'J '6 sdc� L '. t'A 1 Dirt t;s4 RO 01 SS + aH s a~1?` � sxpv -4E •�° °' ,�Y .t�" a ?��` 3 - gg e l -100H:75 --O+i3YtX aV3WX14Vd y? Ot t ; • It ,;a of e ► as 1 , �. s• ..�.�� iy *� .t �� wk •`�,` •j,? g • iKF aN gE E d'/y/ 'G: tE'� ' w ._ r7 ��9p�s ey u r Ei jg83 f to If 404 yt e FI yaar t •+� E 1 $ fsi� gx r ' gE SVY40-1 SV a { N! OS k CONTRA COSTA TIMES Sunday, February 23,2003 f r _ t SUSAN TRIPP PpLkARDMMES MIKE DOUGHERTY has covered most of his living roam in plastic sheeting after a Dec. 16 storm caused water to cone up from under his Castle Hili Road home in Walnut Creek.The water damaged the flooring and left a musty smell throughout his hone: r Crc*k 8 Ater member storm Musolf checked her basement inundates their about 4 a.m.and found it dry.A qx`�, half-hour later,floodwaters had neighbors implore Walnut filled it and were rushing by her Creek and Contra Costa home, carrying garbage cans, lumber,and branches with it. County for des "The entire neighborhood was flawing,"Musolf said."This By Logen Hannah was more like a dam release nMES STAFF w?XM than a flood." WALNUT CREEK — Tie More than two months after Greek had spilled its banks be- the Dec. 16 torrent, residents fore-but never likethis, and government officials con- In the predawn darkness dur- ; tinue to tally the toll from the ing a mid-December 2002 del- Wyear storm.:Floodwater is es- uge the swollen creek.surged. SUSAN TRiPP POLLAROMMES timated to have damaged at Within minutes water up to sev- TERRI MIRA says the water in this drainage flitch on the east side least 60 houses,with many re- eral feet deep rushed down of her Walnut Creek property was above her head on Dec. 16. pain bills in the tens of thou- streets, across yards and into sands and some surpassing houses of a neighborhood just "One minute we were dry Couden,whose Lancaster Road $100,000. south of downtown and west of and the next minute ... it was house was inundated. Interstate 6$0. like a raging river,"said Susan Doom the block, DeAnne See FLOODING, Rage 32 Fl"� Tice Creek 114 mile ooding N Approximate area prone to drainage and flooding problems, �. FROM PAGE 29 , Pushed by irate and frets- Residents near TO Creek want traced homeowners, Walnut Walnut Creek and Contra Costa - Creek and Contra Costa County county to mom improvements to officials are looking yet again at reduce the risk of flooding. what can be done to reduce the risk in an area naturally prone :. . to flooding.A half-century of de- A ate rniiiion-dd in the late 198s, velopment, in low-lying areas created plan and upstream, in the creek's included a basin.... a & E detention basin.... - four-square-anile watershed has # tiuerts,.. ...m modifying . exacerbated the problem. a bridge... "I'm anticipating that we're going to drive this thing home," , 8 said 30-year Castle bill Road resident prank Higgins, whose basin R .}x ,..and house sustained some 20,000 '' � instaNing in damage. "We're going to get �X .. abypass some things done.,, t lit �- Government officials who TIMES heard_emational testimony from Sotrrce:Contra Costa County some 200 residents at a com- munity meeting this month said vices."It seems to the that there "Lots of talk;"said 17-year they are just as determined.The are." ' Webb Lane resident Alice city and county cannot yet af- Many residents remain sleep- Schofield. "Never a solution." ford a comprehensive solution tical.It seems to them that every The city-courity border bi but probably can begin snaking big flood, some longtime rest- sects the neighborhood,and res- a difference,they said. dents recall at least eight in the idents want both governments 'Are there things that we canlast few decades,brings another to follow through with a multi do right now that are cost-ef- public outcry, more official million-dollar plan to reduce the festive and effective?"said lean head-scratching, fresh govern- flood risk. Crafted in the late Richardson,Walnut Creek's as- ment assurances and little, if 1980s,the plan has lingered on sistant director of public ser- any,action. the shelf for lack of funding, government officials said. "That's one o€:the things I think cheaper and yet potentially sig- It includes installing a mile- we can took at." nifcant improvements.Among long, 6-foot-diameter bypass Planners estimated the cost other things,they might be able pipe to increase the creek's of expanding the basin and to modify the detention basin's downstream capacity and im- other drainage improvements at weir so that it holds back more prove drainage in low-lying ar- $3.8 million, with city, county, water during smaller storms,en- eas. It calls for enlarging sev- federal governments and new large culverts and help residents eral culverts or bridges and development paying the bill.But keep drainage ditches clear of expanding an upstream"deten- the county has been unable to debris. tion basin" that temporarily line up the money, partly be- "There's several little things holds runoff into"Tice Creek. cause residents have been re- we can do that might provide The city required the basin, luctant to contribute, Avalon some immediate relief,"'Avalon built in the mid-1980s neer the said. said. entrance to Rossmoor, because "The district has been work.- County and city officials plan the growing retirement com- ing about forever to try and pro- to present their latest findings unity would be funneling ;vide flood protection in the and possible courses of action more and more runoff into the area,"Avalon said. "Funding is to the community within the creek. Residents contend the the biggest issue." next couple of imonths. Like basin should be nearly twice as In the 1960s, residents re- other residents near Tice Creek, large, ser it can prevent runoff jected a levy to pay for im- Terri Mira is eager to hear what from flooding the creels down- provements.The district gained they say. stream. some ground in the late I980s As the rain.poured down that That would help in larger,rel- when a development fee was mid-December evening,the Cas- atively rare storms,government imposed. tleHill Road resident stayed officials said. But because,Tice Then in 1992 the Army Corps awake throughout the night.A Creek spills its banks even dur- of Engineers passed on the pro- few hours before)dawn her fears ing smaller stories that hit every ject, concluding that the bene- came true as floodwater began few years, the basin could use fit did not justify the cost. swirling around her house. other,less-expensive changes to Today,that price is probably "Every winter I don't get improve its ability to limit the well over$10 million because of much sleep," Mira said. "This flow of water at those times, increased construction costs and can't happen every year. This they said. other factors, Richardson said. just can't happen every year." "("The basin) works. The The city has set aside no money question is, could it work bet- for the project,and the district Do en Hannah covers Walnut ter?" said Mitch Avalon, direc- has just$400,000 for it. Creek, Reach him.at 925-945- tor of the county's flood control For now,the city and county 4794 or and water conservation district. are considering smaller, faster, dhannah@cctimes.com. ............................................................................................................................................................................................................. ................................................................................................. . .... . .. .................. ................... 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MK§*K .....................*..:j:............... .................. .............................................. .......... j ........ ... ..... ........ ................... ............ ........................ ........................ ...................... ............. ............ ....... NOW ... .. ..... ....... ......... .... I................................ .................... ........... .... ... ... .................................. ....... ................. ..... .......... ........... .... ..................................................... ............................. ......................................................... ............................. ..... The CASA State Budget Advisory Panel Gregory Bloss John (Jack)Gustafson Public Health Analyst Former Executive Director National Institute on Alcohol Abuse and National Association of State Alcohol and Alcoholism Drug Abuse Directors Bethesda,MD Washington, DC Frederick M. Bohen The Honorable Herschella',Horton Executive Vice President(Retired) Former State Representative The Rockefeller University Phoenix,, AZ New York,NY Nolan E.Jones, Ph.D. The Honorable Gaston Caperton Director,Human Resources Group President National Governors Association The College Board. Washington,DC New York,NY Dorothy P.Rice, Sc.D. Hale Champion, Ph.D. Professor Emeritus Lecturer Emeritus in Public Policy University of California John F.Kennedy School of Government Institute on Health and Aging Harvard University San Francisco, CA Cambridge, MA Ron Snell Timothy P. Condon, Ph.D. Director of Economic, Fiscal and Human Resources Associate Director,National Institute on Drug Abuse National Conference of State Legislatures Director, Office of Science Policy and Communications Denver, CO Rockville, MD Gloria Tinuner Cabell Cropper Former Executive Director Executive Director National Association of State Budget Officers National Criminal Justice Association Washington,DC Washington, DC Julie Wilson,Ph.D. Ester Fuchs, Ph.D. The Kennedy School of Government Director Harvard University Columbia University, Barnard-Columbia Center for Cambridge, MA Urban Policy New York,NY Nancy Young, Ph.D. Director Kristine Gebbie,Ph.D, R.N. Children and Family Futures Professor Irvine, CA Columbia University, Center for Health Policy and Health Services Research New York,NY Consultants Donald J. Boyd Director Fiscal Studies Program Rockefeller Institute of Government Albany,NY Deborah Ellwood Former Senior Researcher Rockefeller Institute Rochester,NY Dall W. Forsythe,Ph.D. Senior Fellow Rockefeller Institute of Government Albany,NY Sherry A. Glied,Ph.D. Division Head, Associate Professor Division of Health Policy and Management Mailman School of Public Health Columbia University New York,NY Russell Gould Senior Vice President for Finance J. Paul Getty Trust Los Angeles, CA Deborah Hasin, Ph.D. Professor of Clinical Public Health Mailman School of Public Health Columbia University New York,NY Brian Roherty Vice President IDL Systems Washington, DC Marvin A. Weidner Weidner Consulting Austin,TX Table of Contents Foreword and Accompanying Statement .....................................................i I. Introduction and Executive Summary..................................................... 1 NextSteps.................................................................................. 3 IL The Elephant in the Living Room........................................... . ........... 7 Uncovering the Hidden Casts of Substance Abuse to State Budgets............... 8 Linking Expenditures to Substance Abuse ............................................ 9 Weighing the Elephant.............:..................................................... 9 State Spending by Drug.................................................... ..........10 State Spending for Children ............................................... ..........11 M. The Elephant. State Spending on the Burden of Substance Abuse toState Programs..........................................................................13 The Distribution of the Substance Abuse Burden ...................................13 Justice......................................................................................15 AdultCorrections.....................................4................. ..........15 Juvenile Justice ..... ..............................................................16 Judiciary ..............................................................................16 Education..................................................................................16 Health......................................................................... ..........17 Child and Family Assistance................................_..........................17 ChildWelfare........................................................................17 Income Support Programs..........................................................18 Mental Health/Developmental Disabilities ...........................................18 MentalHealth........................................................................18 Developmental .Disabilities.........................................................19 PublicSafety.................................................................. ..........19 StateWorkforce..........................................................I........,......19 IV. The Elephant's Tail: State Spending for Substance Abuse Prevention, Treatment and Research .................................................................21 State Spending by Category ............................................................21 Prevention.................................................................................22 Treatment ..................................................................... .........24 Research...................................................................................24 Variations by State.......................................................................25 V. Taxation and Regulation of the Sale of Legal Thugs.................................27 Taxation...................................................................................27 Regulation.................................................................................28 VI. Substance Abuse Spending by State....................................................29 StateTables...............................................................................31 ....................000......... ........................ ................ ......................................... .................... .................111,111,....................................... . .............. ............... VII. Moving from Spending to investments ...............................................81 Treatment for Drug Addiction is Cost Effective ....................................82 Treatment Saves Tax Dollars............................................... ..........83 Focusing on the Future...................................................... .........84 NextSteps ................................................................................85 Notes ................................................................................................89 AppendixA-Survey ................................................................. .........97 Appendix B-Methodology.......................................................... ....... 163 ReferenceList......................................................................... ....... 179 AIL Foreword and Accompanying Statement by Joseph A. Califano, Jr. Chairman and President Substance abuse and addiction is the elephant in the living room of American society. Too many of our citizens deny or ignore its presence. Abuse and addiction involving illegal drugs, alcohol and cigarettes are implicated in virtually every domestic problem our nation faces. crime; cripplers and killers life cancer,heart disease, AIDS and cirrhosis;child abuse and neglect; domestic violence;teen pregnancy;chronic welfare;the rise in learning,disabled and conduct disordered children;and poor schools and disrupted classrooms. Every sector of society spends hefty sums of mo#ey shoveling up the wreckage of substance abuse and addiction. Nowhere is this more evident than in the public spending of the states. The heaviest burden of substance abuse and addiction on public spending falls on the states and programs of localities that states support. Of the two million prisoners in the United States,more than 1.8 million are in state and local institutions. States run the Medicaid programs where smoking and alcohol abuse impose heavy burdens in cancer,heart disease and chronic and debilitating respiratory ailments and where drug use is the largest cause of new AIDS cases. States fund and operate child welfare systems--social services,family courts, foster care and adoption agencies—where at least 70 percent of the cases of abuse and neglect stem from alcohol-and drug-abusing parents. The states are responsible for welfare systems that are overburdened with drug-and alcohol- abusing mothers and their children. State courts handle the lion's share of drunk driving and drug sale and possession cases. States pour billions of dollars into elementary and secondary public school systems that are more expensive to operate because of drug-and alcohol-abusing parents and teenagers. Governors and state legislatures have the largest • The states spend 113 times as much to clean financial, social and political interest in up the devastation substance abuse and preventing and treating all substance abuse and addiction visit on children as they do to addiction,whether it involves alcohol,tobacco prevent and treat it. J or illegal drugs, and especially among children and teens. While the federal government has heavy responsibilities to fund biomedical • Each American paid$277 per year in state research, classify and regulate chemical taxes to deal with the burden of substance substances and interdict illegal drugs,the brunt abuse and addiction in their social programs of failure to prevent and treat substance abuse and only$10 a year for prevention and and the cost of coping with the wreckage of this treatment. problem falls most heavily on the backs of governors and state legislatures across America. • Of the$453.5 billion states spent in the 16 budget categories of public programs we For three years,The National Center on examined, $813 billion--17.9 percent--was Addiction and Substance Abuse at Columbia linked to substance abuse and addiction. University has been scouring the fine print of 1998 budgets of the states in an unprecedented This report is a clarion call for a revolution in effort to measure the impact of substance abuse the way governors and state legislators think and addiction on their health, social service, about and confront substance abuse and criminal justice, education,mental health, addiction. States that want to reduce crime, developmentally disabled and other programs in slow the rise in Medicaid spending, move more 16 budget categories. Forty-five of the states, mothers and children from welfare to work and the District of Columbia and Puerto Rico responsible and nurturing family life must shift responded to our survey--the most extensive and from shoveling up the wreckage to preventing sophisticated ever conducted in this field--and children and teens from abusing drugs,alcohol answered the endless questions of our staff. and nicotine and treating individuals who get Based on an exhaustive analysis of the data hooked, collected,we also estimated the total costs of substance abuse to the budgets of the five states The next great opportunity to reduce crime is to (Indiana, Maine,New Hampshire,North provide treatment and training to drug and Carolina and Texas)that did not respond to our alcohol abusing prisoners who will return to a inquiries. life of criminal activity unless they leave prison substance free and, upon release,enter treatment The results are stunning, especially given that in and continuing aftercare. The remaining welfare every case we made the most conservative rolls are crowded with individuals suffering assumptions about the burden that substance from substance abuse and addiction. The abuse imposes on state budgets. Four findings biggest opportunity to cut Medicaid costs is by are particularly striking. In 1998: preventing and treating substance abuse and addiction. Governors who want to curb child • Of the$620 billion total the states spent, abuse,teen pregnancy and domestic violence in $81.3 billion--a whopping 13.1 percent--was their states must face up to this reality: unless used to deal with substance abuse and they prevent and treat alcohol and drug abuse addiction. and addiction, their other well intentioned efforts are doomed. • Of every such dollar states spent, 96 cents The choice for governors and state legislators is went to shoveling up the wreckage of this: either continue to tax their constituents for substance abuse and addiction and only four funds to shovel up the wreckage of alcohol, drug cents was used to prevent and treat it. and nicotine abuse and addiction or recast their -ii- priorities to focus on preventing and treating to children is illegal, and for good reason. such abuse and addiction. Second,tobacco,alcohol and illegal drugs all affect the dopamine systems in the brain and, State spending on children is time cruelest with repeated use, can change the structure of misallocation of taxpayer funds. We know that the brain itself resulting in cravings and a child who gets through age 21 without addiction. Finally,most individuals who fail smoking, abusing alcohol or using illegal drugs prey to abuse and addiction are involved with is virtually certain never to do so. It is a slap in more than one substance. the face of this knowledge for states to spend 113 times more to shovel up the wreckage of What this report reveals for the first time is that children savaged by substance abuse and the biggest bang for the buck in terms of tarning addiction in social,criminal justice and the costs of social programs will come to those education programs than they spend to states that curb substance abuse and addiction.. encourage children to stay away from these The return is not simply in reduced state substances and treat those who ignore that spending. It also comes in reduced crime`-and advice. most importantly in reduced human suffering not only for the addict and abuser,but for This unprecedented report looks behind the parents and children,classmates,friends and traditional budget labels--education,criminal neighbors. And,it can be counted in positive justice,transportation,health care,child welfare, economic benefits to states from productive, welfare, mental health—to detect just how many law-abiding,taxpaying citizens. of their taxpayer dollars the states spend to deal with the financial burden that unprevented and Addiction is a disease--a chronic, relapsing one-- untreated substance abuse and addiction impose that,untreated,has nasty and costly social on public programs. It is our hope that exposing consequences, illness,disability,death,learning these heretofore hidden costs will encourage disabilities,poor school performance,child governors and stats legislatures to make sensible abuse and neglect,domestic violence,crime--to investments in comprehensive efforts to reduce name a few. Our fear of these consequences the use of tobacco, alcohol and illegal drugs, often leads us to respond with tough sanctions. particularly by children. It is of course important to hold individuals accountable for their conduct. But the first line States spend some$25 billion a year shoveling of defense is prevention and we can do a much up after the savage impact of substance abuse on better job at it. Treatment is no sure bet,but our children. The largest share is spent on the success rates of good programs exceed those of burden of substance abuse to the education marry long shot cancer therapies on which we system--$1 6.5 billion;another$5.3 billion is spend millions of dollars. And if we fail to treat spent for children who are victims of child abuse the disease,there is little hope of stemming these and neglect,nearly$3 billion is spent for consequences. substance-involved youth in the state juvenile justice systems. By comparison,pennies are America is not the Garden of Eden and the spent to prevent these problems. This is perhaps challenge to state executives and legislators is to the worst example of current investment policies balance the importance of holding individuals because of the enormous payoff that could be accountable for their actions with the need to realized by preventing addiction in the first provide treatment for this disease that causes and place. aggravates so many social problems. It is our hope that this report will help these public Children are key to the lasting success of any officials find that balance. effort to curb the casts of substance abuse. Prevention and treatment efforts, especially Governors and state legislators(as well as those directed to children, .must cover all mayors, city councils and county officials)hold substances. First,sale of any of these substances critical keys to the future of our nation. It is the -iii- states, in concert with local governments,which assess the impact of substance abuse and face day-to-day the tasks of moving individuals addiction, and this report contains no costs in from welfare to work, reshaping our prison and these areas. criminal justice systems, dealing with child abuse and neglect,responding to highway As a result,this report significantly accidents, assuring public safety,administering underestimates the impact of substance abuse mental health programs, and helping with the on state budget& process of educating our children. Successfully accomplishing these tasks will require many This report covers only state costs. It does not different programs and strategies. What this cover federal matching funds that states spend report makes clear is that these programs and (e.g.,on Medicaid and welfare); federal strategies will be of limited value if they fail to government costs;the spending of local deal with substance abuse and addiction. governments(which bear most of the law Energetic, effective and comprehensive efforts enforcement burden),the costs to parochial and to prevent substance abuse and addiction and private schools and other private sector costs treat those who fall prey to these problems hold (such as employee health care, lost productivity the promise of freeing up billions of dollars of and facility security) which are the subject of state funds for other pressing needs and reducing ongoing CASA analyses. the burden on taxpayers. Finally,the human suffering of addicts, abusers This undertaking has been CASA's most and their families and friends are incalculable. ambitious public policy analysis. To accomplish it we convened an extraordinary advisory panel This report continues CASA's ongoing Analysis of distinguished public officials, researchers and of the Impact of Substance Abuse and Addiction representatives of the National Governors' on America's Systems and Populations. We Association, the National Conference of State expect that it will form the basis of a Legislatures,the National Association of State forthcoming conference on substance abuse and Budget Officers and the National Association of state budgets as part of our series of State Alcohol and Drug Abuse Directors. We CASACONFERENCES. assembled a team of experts in economics, epidemiology and state government budgeting The report contains a list of the seasoned experts and finance. We reviewed some 400 articles, who served on our advisory board and worked books and other publications on substance abuse as our consultants,who made an invaluable and public spending. We extensively contribution. We are greatly indebted to each of interviewed state budget officers,devised a them. Let me single out particularly Dall W. survey instrument and tested it in California, Forsythe, Ph.D.,at the Rockefeller Institute, Florida and New York in order to refine it before former budget director of New York State and sending it to all the states. The survey captured director of public finance with Lehman Brothers 1998 spending in lb budget categories for the 47 who helped to structure the project and the responding jurisdictions. report; Brian Roherty, former executive director of the National Association of State Budget Some caveats are appropriate. The complexity Officers and former budget director in of this unprecedentedeffort means that this Minnesota who opened the doors of many state report should be regarded as a work in progress budget offices; and Donald Boyd, director, and that will be refined in the future;that complexity Deborah Elwood, former senior researcher, at has led us in every case to use the most the Fiscal Studies Program, Rockefeller Institute conservative assumptions. of Government,who helped to design and administer the state survey and analyze the data In several areas, such as public housing,higher it elicited. With regret we note that one of our education and state employee healthcare, advisors, Gloria Timmer, former executive because of lack of data,we were unable to director of the National Association of State -iv- Budget Officers,whose expert advise and good spirit enriched our work,died last year. Susan E. Foster, M.S.W., CASA`s Vice President and Director of Policy Research and Analysis, is the principal investigator and staff director for this effort. She was ably assisted by CASA Research Associate Darshna P.Modi, M.P.H.and data analyst,Liz Peters, David Man,Ph.D.,CASA's librarian,and library assistants Barbara Kurzweil and Ivy Truong were a big help. Jane Carlson,as usual,tackled the administrative chores with efficiency and good spirit. For the financial support that made this undertaking possible,the Board of Directors of CASA and our staff'of professionals extend our appreciation to The Starr Foundation, The Robert Wood Johnson Foundation,the Carnegie Corporation of New York,Primerica Financial Services,the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism and The Abercrombie Foundation. While many people contributed to this effort,the findings and opinions expressed herein are the responsibility of CASA. Joseph A. Califano, Jr. -v- Chapter Introduction and Executive Summary In 1998, states*spent$620 billion of their own funds to operate state government and provide public services such as education,Medicaid, child welfare,mental health and highway safety. A stunning 13.1 percent of that amount-w-$81.3 billion--went to shoveling up the wreckage of substance abuse and addiction,a problem that too many of us prefer to deny or ignore. Substance abuse and addiction is the elephant in the living room of state government, overwhelming social service systems,impeding education,causing illness,injury,death and crime,savaging our children--and slapping a heavy tax on citizens of every state. This$81.3 billion is only part of the cost tobacco,alcohol, illicit and prescription drug abuse and addiction visits on America. It does not include the financial tollsuch abuse extracts from federal or local spending or the hefty private costs such as lost productivity or premature death. These costs far exceed the burden on state budgets. And,there is no way to measure the cast of human suffering—destroyed lives, broken families,addicted children. This report is the result of an intensive three year analysis of the impact of substance abuse on state budgets. As part of this unprecedented study, CASA convened an advisory panel of distinguished public officials;researchers and representatives of the National Governors' Association,the National Conference of State Legislatures,the National Association of State Budget Officers and the National Association of State Alcohol and Drug;Abuse Directors. To provide additional guidance,CASA formed a team of consultants with vast experience in economics,epidemiology and state government finance and budgeting. CASA conducted an extensive review of some 400 articles and publications linking substance Including the District of Columbia and Puerto loco. abuse to public spending. We examined state impact is hidden in departments and programs designed to prevent and treat activities that do not wear the substance substance abuse or deal with its consequences abuse label. and consulted with state budget and program officials to understand how these programs are • Each American paid$277 per year in state financed. Four other CASA studies taxes to deal with the burden of substance documenting the costs of substance abuse to abuse and addiction in their social programs entitlement programs,aid to families and and only$10 a year for prevention and children, prisons and jails and child welfare treatment. informed our work, and we built on our detailed assessment of the cost of substance abuse to Of every dollar states spend on substance New York City. abuse: To develop and refine our methodology for this ➢ 95.8 cents goes to pay for the burden of study, CASA selected five states that would this problem on public programs. provide a cross section in terms of demographics, budgeting practices and data Untreated substance abuse increases, for availability--California,Florida, Minnesota, example,the cost of every state's New Jersey and Vermont. CASA conducted criminal justice system; elementary and detailed site visits in these states between March secondary schools; Medicaid; child and August of 1998,and consulted with scores welfare,juvenile justice and mental of state officials. health systems;highways;and state payrolls. These costs totaled$77.9 Based on this extensive research, CASA, billion in 1998, working with the Fiscal Studies Program of the q. Only 3.7 cents goes to fund prevention, Rockefeller Institute of Government, developed a survey of substance abuse-related spending for treatment and research programs aimed all 50 states,the District of Columbia and Puerto at reducing the incidence and Rico. We pretested it in California,Florida and consequences of substance abuse. State New York. The survey was administered in spending for prevention,treatment and September of 1998, and captured spending in 16 research amounted to$3 billion in 1998. budget categories for 47 responding jurisdictions. ➢ One-half of one cent covers costs of collecting alcohol and tobacco taxes and This report reveals for the first time the regulating alcohol and tobacco products. pervasive impact of substance abuse on state Regulation and taxation is an untapped budgets: how little each state spends on resource to help control spending on the prevention and treatment and how much each consequences of alcohol and tobacco devotes to shoulder the burden of failure to abuse and addiction. State spending on prevent substance abuse and treat those who are regulation and compliance was$433 substance abusers and addicts. Among the million in 1998. findings of this report are these: • States spent$24.9 billion in 1998 on the i State governments spent$81.3 billion in costs of substance abuse to children—an 1998 to deal with substance abuse. This amount comparable to the entire state budget amounts to more than 13 cents of every state of Pennsylvania. For every$113 states budget dollar. Substance abuse is among the spend on the consequences of substance largest costs in state budgets,although its abuse just for our children,they only spend one dollar on prevention or treatment. Indiana,Maine,New Hampshire,North Carolina and Texas did not participate in the survey. -2- States spent$30.7 billion in 1998 on the remaining spending, $63.6 billion, could not burden of substance abuse on the justice be,differentiated by drug,but most of this system--fir incarceration,probation and amount is linked to both alcohol and illegal parole,juvenile justice and,criminal and drug abuse. family court costs of substance- Figure 1 • States collected involved The Substance Abuse dollar $4,0 billion in alcohol offenders. 'These Prevention, Ttelatsor+t and$7.4 billion in Costs total 4.9 "Treatment, Compliance tobacco taxes in 1998 percent of state Research s�ants for a total of$11.4 cents budgets,more billion. For each dollar P tw than 10 times the aubli�t° in alcohol and tobacco �t�s amount that states Progtame taxes that hit state spent in total for coffers,states spent substance abuse $7.13 on the problem of treatment and alcoholism and drug prevention. addiction-46.83 to cope with the burden, $0.26 for prevention and treatment and +► Other areas of significant state spending for $0.04 to collect taxes and run licensing failing to prevent or treat substance abuse boards. Few states dedicate revenues to the include; burden of untreated substance abuse or use alcohol and tobacco tax increases as a way ➢ $16.5 billion in education(2.7 percent to reduce use by teens. of state spending), + On average,of every$100.00 states spend ➢ $15.2 billion in health(2.4 percent of on substance abuse they spend$95.80 on the state spending), burden of substance abuse to public programs compared to$3.70 for prevention, > $7.7 billion in child and family treatment and research($0.50 is spent on assistance(1.2 percent of state regulation and compliance),but state spending),and spending varies widely. The proportion spent on shoveling up the wreckage ➢ $5.9 billion in mental health and compared to prevention and treatment developmental disabilities(0.9 percent ranges from to$89.71 vs. $10.22 in North of stare spending). Dakota to$99.94 vs. $0.06 in Colorado. (Table 1.1) + States spend more on the problem of substance abuse than they do on Medicaid Next Steps ($60.4 billion or 9.7 percent of state budgets)or on transportation($51.4 billion By providing a map of state substance abuse or 8.3 percent of state budgets). They spend spending,this study establishes a base against as much on substance abuse as on higher which policymakers can judge how to get the education($81.3 billion or 13.1 percent of biggest bang for their buck. Many studies have state budgets). demonstrated that carefully designed treatment and prevention initiatives are cost-effective tools • The drug linked to the largest percentage of in reducing substance abuse and related state state substance abuse costs is alcohol.At costs. For example, Oregon estimated their least$9.2 billion is spent on alcohol alone, return on every dollar spent on treatment $7.4 billion on tobacco alone and$1.1 services to be a$5.62 savings in state costs, billion on illicit drug use only. The -3- Table 1.1 For Every$100.00 States Spend on Substance Abuse:' ranked by spen4Lngprevention,treatment and research t 011001 primarily in the areas of corrections,health Arno tSpsz >ah I n nt tr'tt3tdt.tti 'lx� tmet}i and and welfare. Since investments in prevention and treatment take time to North Dakota $89.71 $10.22 mature,they will not immediately reduce Oregon 91.21 8.61 spending on substance abuse. State Delaware 93.72 6.27 policymakers will be challenged to consider Arizona 93.60 6.02 the value of returns to the state beyond the New York 93.96 5.81 two to four year election window; however, Alaska 95.02 4.98 over the long run the payoff for taxpayers Oklahoma 94.61 4.87 can be enormous. California 95.30 4.32 District of Columbia 95.70 4.30 To reduce the burden imposed on public Washington 91.91 3.79 programs, CASA recommends a revolution Massachusetts 96.41 3.59 in the way governors and state legislators Illinois 96.45 3.42 think about and confront substance abuse Connecticut 96.88 3.12 and addiction: Nebraska 90.92 3.07 Missouri 96.63 3.04 Idaho 96.71 2.93 • Investment in prevention and South Dakota 97.08 2.92 treatment. The most significant Penn,Vlvania 97.03 2.91 opportunity to reduce the burden of Puerto Rico 97.12 2.88 substance abuse on public programs is Minnesota 97.13 2.82 through targeted and effective prevention Montana 96.75 2.82 programs. if we can keep children from Marvland 97.13 2.71 smoking cigarettes,using illicit drugs and Alabama 93.40 2.67 abusing alcohol until they are 21,they are Mississippi 97.45 2.55 virtually certain never to do so. Treatment Florida 96.80 2.46 is also a cost-effective intervention as it New Jersey 97.06 2.45 both reduces the costs to state programs in Wyoming 96.58 2.42 the short term and avoids future costs. New Mexico 97.52 2.35 States should make targeted interventions West Virginia 95.80 2.30 on selected populations that hold promise Vermont 96.67 2.24 for high return: Utah 97.97 2.02 Hawaii 97.99 1.99 Virginia 9?.78 1.57 > Prisoners whose substance abuse Iowa 98.23 1.56 problems make them more likely to return Kansas 98.38 1.43 to the criminal justice systems after parole Ohio 98.40 1.42 or release. Kentucky 98,62 1.38 Louisiana 98.29 1.36 ➢ Clients in the mental health system Nevada 98.68 1.28 whose substance abuse problems increase Tennessee 98.63 0.96 the probability that they will cycle back into Arkansas 98.87 0.88 mental hospitals or emergency rooms. Wisconsin 99.43 0.55 South Carolina 99.69 0.26 ➢ Parents of children in the foster care Rhode Island 99.60 0.24 system whose abuse of alcohol or drugs Michigan 99.71 0.07 interferes with their ability to care for their Colorado 99.94 0.06 children at home. Georgia b NA NA Average' $95.76 $3.70 *Che difference between the sum of the columns is the amount spent on regulation/compliance. b Spending on prevention and treatment was not included in survey response. 'Throughout this report,"notal"or"Average"refers to the 50 states, Puerto Rico and the District of Columbia. ➢ Welfare recipients whose substance juvenile justice, education,mental abuse interferes with their ability to be health,child welfare. Also require self-supportive. treatment for substance-abusing state employees and for those convicted of ➢ Youth in the juvenile justice system who alcohol-and drug-related trade are substance-involved. violations. Coerced treatment is as effective as voluntary treatment and 5> Children of substance-abusing threat of incarceration or loss of benefits individuals in the criminal justice can provide the needed incentive to system who have an increased move toward recovery.2 likelihood of berth abusing substances and committing crimes. 5> Increase taxes on alcohol and tobacco. Increases in price for alcohol and ➢ Children of substance-abusing parents tobacco lead to decreases in the amount who have a higher likelihood of both people,especially youth consume.3 abusing substances and neglecting and California has combined a$:75 tax abusing their own children. increase per pack of cigarettes with a public health campaign to achieve a 14 ➢ Children of substance-abusing welfare percent decrease in lung cancer over the recipients who have a greater likelihood past 10 years,4 and Maine's doubling of of both abusing substances and being on tobacco taxes and anti-smoking welfare. campaign have yielded a 27 percent decline in smoking among high school > Substance-abusing pregnant women and students.' As early las 1981,a study their partners. showed that a 10 percent increase in the real price of cigarettes leads to a 12 ➢ Alcohol-and drug-involved drivers. percent decrease in consumption among 12-to 17-year olds. Other studies have + Expansion of use of state powers of shown that a one percent increase in the legislation,regulation and taxation to price of beer results in a one percent reduce the impact of substance abuse. decrease in traffic fatalities, and that States have available a range of legislative, doubling of the federal beer tax would regulatory and tax powers to reduce the reduce total robberies by 4.7 percent and impact of substance abuse on state budgets. murders and rapes by three percent! For example, states can: ➢ Step up regulation and enforcement of ➢ Eliminate mandatory sentences for drug the prohibition of alcohol and tobacco and alcohol abusers and addicts. When sales to minors. point of sale prisoners are required to serve their inspections,tougher sanctions against entire sentence without the option of offending retailers,and establishing a parole or early release,the state loses licensing system for;tobacco sale,can the carrot of early release that can help reduce regular cigarette use among 12- persuade them to enter treatment and the to 13-year olds by 44 to 69 percent. By stick of parole that can motivate them rigorous enforcement, Louisiana upon release to continue treatment and reduced the number of stores selling aftercare, tobacco products to minors from 75 percent in 1996 to seven percent in ➢ Require treatment for substance-abusing 1999.11, individuals in state-funded programs. prisons,probation, parole,welfare, ➢ Include questions about substance abuse on licensing examinations for teachers, -5- social workers,health care problem can be viewed across budget professionals,corrections and juvenile categories. If investments are to justice staff and court personnel. succeed, budget officers and policymakers will track the returns > Dedicate taxes from tobacco and alcohol across budget categories and examine sales to prevention,treatment and projected versus actual returns on coping with the burden of substance investments in current budget and out abuse and addiction. years. + Management for better results. States > Place responsibility for managing state should set targets for reducing the impact of substance abuse-related investments in a substance abuse on their budgets and install designated state agency. management practices to achieve them. ➢ Invest in research and evaluation of Train teachers,health care workers, cost-effective substance abuse social service,criminal and juvenile prevention and treatment policies and justice staff and court personnel to programs. implement comprehensive screening for substance abuse in programs that bear a 1 will exert presidential leadership to send the significant burden in coping with its clear and consistent message that drug abuse is consequences. For example, CASA's dangerous and wrong. And I will help marshal research shows that even though at least resources at every level starting with parents, 70 percent of child welfare cases are schools and communities closest to the needs of caused or exacerbated by alcohol and young Americans--to turn back the tide of drug abuse." drug abuse, case workers are not properly trained to assess and screen --Governor George W.Bush parents for such abuse. Texas Assure that individuals who screen positive are given full assessments and receive timely,appropriate and effective treatment, including relapse management. ➢ Establish systems to measure the cost- effectiveness of prevention and treatment programs,including regulatory and tax policies aimed at curbing use, in order to concentrate resources on interventions that will provide the highest return on investment for the states and the greatest benefits for individuals. ➢ Require state agencies to report on the short and long term results of substance abuse-related investment strategies in the budget process. The state budget process is the only context in state government where the impact of a -6- Chapter 11 61 The Elephant in the Livin Room Substance abuse spending Historically has registered as a minor blip on the radar screen of state budgeting. As the insidious links between substance abuse and crime,violence,family breakup,child abuse and neglect,traffic accidents,disease and disability have been uncovered;state policymakers have begun to understand that substance abuse and their associated costs impose greater burdens on state budgets than previously imagined. Previous CASA studies have demonstrated the tight connection between substance abuse and crime, child welfare, welfare and health.' This unprecedented report reveals that states are spending$81.3 billion dollars each year on substance abuse and addiction or 13.1 percent of their state budgets. Most disturbing is that 96 percent of this spending goes to shoulder the burden of our failure to prevent and treat substance abuse and addiction--cleaning up the destruction caused by the elephant of substance abuse in the living room of state government. While this report focuses on state dollars spent on substance abuse and addiction,it is important to note that these funds are not the whole picture. According to the Office of National Drug Control Policy,the federal government spent approximately$16 billion in 1998 for prevention,treatment and lave enforcement related to this problem and many more billions to cope with the consequences through programs such as child welfare, corrections, special education, Indian Health, Medicare and Medicaid. Significant portions of these funds are channeled through the states. Local governments spend billions each year as well. The private sector also is burdened with many costs: lost productivity,higher insurance rates and facility security. And,the.human costs of pain and suffering, broken families,neglected and abused children, lives shattered by drunk drivers,domestic violence or teen pregnancy are incalculable. Taken together,these costs make -7- substance abuse the number one domestic To create a map of substance abuse spending in problem facing our nation. each state, CASA--with help from the Fiscal Studies Program,Rockefeller Institute of In our state, and 1 suspect this of other states as Government--administered a survey in well, the total costs associated with substance September of 1998 to all 50 states,the District abuse and addiction far exceed the total budget of of Columbia and Puerto Rico. Forty-five states, our state government.] Puerto Rico and the District of Columbia completed the survey.t The participating --Ben Brown jurisdictions constitute approximately 90 percent Deputy Commissioner, Substance Abuse Services of total state budget spending for the nation and (former State Senator)Oklahoma 87 percent of the population. To determine which state programs to include in This report is designed to: the study, CASA reviewed some 400 articles and publications on the consequences of • Reveal the true impact, often hidden,that substance abuse to government programs, and substance abuse has on the costs of state identified programs designed to prevent or treat government; substance abuse or deal with its consequences. CASA focused on those programs where the • Document the substance abuse bill to states, most significant spending was caused or itemized by expenditures on prevention, exacerbated by substance abuse. treatment and research; regulation and compliance; and the burden to public CASA conducted extensive site visits in five programs of not preventing and treating states9--California,Florida,Minnesota,New substance abuse; and, Jersey and Vermont--between March and August of 1998 to understand how these • Illustrate the value of more cost-effective programs are financed and to determine the most state investments. efficient and effective way to gather the spending data. These five states were chosen to provide a cross section in size,geographic Uncovering.the Hidden Costs of location,demographics,economics, budget Substance Abuse to State Budgets process and practices, substance abuse programming and services,data availability and Most previous attempts to document costs of capacity to document performance. CASA substance abuse have focused on the overall conducted scores of in-depth interviews with economic costs to society of abuse of drugs, state officials and their staffs in order to identify alcohol and tobacco.' These studies have been ways to develop a cost base that was accurate valuable, but none has provided comprehensive, and consistent with the way in which programs detailed estimates of costs to state government.` are organized and administered in different Other efforts have estimated the costs of states. substance abuse to selected government programs such as healthcare,'federal CASA also consulted with numerous state entitlement programs,6 prisons and jails'and budget and program officials to inform the list of child welfare! The narrow focus of these government programs that are affected by studies has not provided policymakers with a substance abuse and to learn what, if anything, sense of the aggregate state--and state-by-state had already been done to track state substance impact--of substance abuse and addiction on abuse costs. A handful of states had already spending across budget categories. focused on the problem. Oklahoma, Maine, For a review of these studies,see Appendix B, t Indiana,Maine,New Hampshire,North Carolina Methodology. and Texas did not participate in the survey. -8- Texas and Washington had estimated casts of Weighing the Elephant this problem to the economy of their states. California had itemized state spending on the The 47 jurisdictions that responded to CASA`s prevention and treatment of substance abuse.1° survey reported spending of$67.6 billion that can be directly linked to substanceabuse and State budget officers were selected as the addiction. CASA estimates that spending appropriate target for data collection because associated with substance abuse in the five they have the broadest view and deepest nonparticipating states and for certain categories expertise. To capture as much of the spending of spending not supplied by the participating associated with a particular program as possible, states equals approximately$13.7 billion.t The CASA designed a survey instrument requesting sum of these two amounts($67:6 billion and data on State Fiscal Year 1998 spending, $13.7 billion)equals$81.3 billion or 13.1 excluding federal and local funds.* CASA pre- percent of the$624 billion total state budget tested the questionnaire in three states: spending in 1998. California, Florida and New York to be certain it would elicit the desired information. Substance abuse has a huge effect on the financial health of government at all levels. Yet, Linking Expenditures to Substance when we look in state budgets for spending Abuse specifically marked"substance abuse,"we find only the funds allocated to treatment and Substance abuse causes and exacerbates costs prevention programs. Most substance abuse states bear. Certain cancers,for example,may costs are hidden in departments and activities be caused by smoking or drinking or both,or that do not wear the substance abuse label,for abuse of these substances may be a contributing example,corrections,aid to education, factor to the illness(e.g.,an estimated 88 percent Medicaid, child welfare and mental Health, of lung cancers in men are attributable to transportation and absenteeism costs of state smoking and 13 percent of stomach ulcers are employees. (Table 2.1) attributable to alcohol abuse)." Likewise, Table 2.1 addiction may actually cause child abuse and neglect,violent crime or mental illness or it may Substance Abuse Spending by Category($000) be one of the contributing factors. The bottom Prevention Treatment and Research $ 3,011,104 line for states is that substance abuse must be Burden to State Pro treated or prevented in order to reduce spending Justice 30 655 320 and avoid future costs. Education gementar)VSccondarytb 48 58 Health 15,167,270 This report establishes the categories of state ChildfFamil Assistance 7Z721,990 spending tightly linked to tobacco, alcohol and Mental HealthiDevelo mentall Disabled 5 887 766 drug(e.g., marijuana, cocaine, heroin, LSD) Public S*t 1.507.447 abuse--the targets:for policy intervention. State Workforce 407,926 ke lationtCom fiance 433,070 Total LL8.1j290,479 Among the troubling findings of this report is State spending includes general funds(predominant that states spend more on substance abuse than funds for financing a state's operations received from on Medicaid($70.3 billion or 11.3 percent of bread-based state taxes)and nongeneral funds state budgetsl)or transportation($51.4 billion or (revenue sources restricted by taw for particular 8.3 percent of state budgets).` Indeed, states governmental functions or activities,such as a gasoline tax dedicated to a highway trust fund or t See Appendix B,Methodology.. expenditures from the sale of bonds dedicated to t Total state spending for Medicaid and transportation capital projects). includes costs linked to substance abuse. -9- spend as much on substance abuse Figure 2.A and addiction as Percent of Substance Abuse Spending by Category on higher Percent education($81.3 billion or 13.1 50 percent of state budgets). 40 37.8 These estimates of 30 state spending on substance abuse 2u"4 20 18.7 and addiction are in fact low. 9.5 7.3 Several areas of 10 3.7 state spending I EM 1•s o.5 o.s have been left out a of the CASAP� �� 5 � � \` S90 e analysis becausefav a�,t� es �10� `a�o�1G� � data are not ��F ttg u available to uer` quantify the Q�e connection to million(.07 percent of the state budget) substance abuse,even though practice and regulating alcohol and tobacco and collecting common sense suggest a link. Costs omitted taxes. Figure 2.A shows the percent distribution from CASA's calculations include the costs of of the$81.3 billion in state substance abuse lost productivity,of attributable health care of state employees,of state police and state spending by category. The largest share is subsidies for local law enforcement linked to linked to the burden of substance abuse on the justice system. illicit drugs,of civil courts for divorce,domestic disputes,small claims and other larger civil litigation cases, and of regulation,enforcement, Stine Spending by Drug health care and lost productivity in higher education. A second reason why these cost The largest portion of state substance-linked estimates are low is that CASA has used costs ($63.6 billion), cannot be disaggregated by conservative estimates of spending where drug. Research suggests that most of these costs limited data exist. For example, Individuals who are associated with both alcohol and illicit smoke or abuse alcohol have more frequent, drugs.12 longer and more severe illnesses. These costa are not included in our analysis because of Addicts and abusers commonly abuse more than constraints of available data. (Appendix B, one substance.13 CASA's own research shows Methodology) that 31 percent of substance-involved juvenile arrestees and 43 percent of substance-involved Of the$81.3 billion states spent in 1998 on adult arrestees use both alcohol and drugs.t4 problems associated with substance abuse, $77.9 Other CASA research suggests that over 80 billion(12.6 percent of the state budget)was percent of substance-involved parents who spent to carry the burden of substance abuse in neglect or abuse their children abuse both state programs. Only$3.4 billion or one-half of alcohol and drugs. one percent(.5 percent)of total state budgets, was spent on programs directly aimed at In another study, 60 percent of men and 30 preventing or reducing it_ States spent$433 percent of women diagnosed as drug dependent -10- also reported abusing alcohol.16 Other studies show that 70 Figure 2.B percent of substance-abusing Estimated Substance Abuse Spending by pregnant women also smoke Substance f$in Billions) cigarettes,and 83 percent of pregnant and postpartum cocaine- � and heroin-addicted women report drinking heavily.17 Some two- thirds of those 13 and older who 50 - ao use illicit drugs also drink � alcohol.'$ Use and abuse of multiple substances is even more 20 -1u 1.1 7.4 9.2 characteristic of severe substance o abusers,who are the individuals Mick Drugs Only Tobacco Only Alcohol Only Alcohol&other most likely to end up in state Drugs prisons, mental health or public assistance systems,or with children in foster at least$24.9 billion on the costs of substance care.19 abuse to children--an amount comparable to the entire state budget of Pennsylvania. Of this CASA's analysis revealed a few cost categories amount, $24.7 billion was spent on all the where only a single category of substances is consequences to them while only$218 million implicated. (Figure 2.13) For instance,CASA went to prevention and treatment for children. identified$1.1 billion in state spending linked to (Figure 2.C) illicit drug use only: $574 million for public safety costs for drug enforcement programs; The largest share of state substance abuse $114 million for drug courts;and$412 million spending for children was on the burden of linked to illegal drugs in state spending;on substance abuse to the education system--$16.5 Medicaid. billion. For those children who are victims of child abuse and neglect, states spent$5.3 billion CASA estimates that$7.4 billion in state on foster care costs, independent living spending is linked exclusively to tobacco programs, in preparing children and families for through state Medicaid spending. adoptions, and other child welfare programs. States spent another$2.9 billion for substance- The single drug linked to the largest percentage involved youth in the state juvenile justice of state costs is alcohol. We were able to system. identify$9.2 billion in state spending linked to only to alcohol in addition to the Figure 2.0 costs associated with abuse of both The Casts of Substance Abuse to Children alcohol and illegal drugs: $915 million on $24.9 Billion highway safety and local law enforcement Prevention, associated with drunk driving, $837 Treatment and million in state costs for the -''� Research developmentally disabled as a result of ::`'' $216 Million fetal alcoholsyndrome;and $7.4 billion ?, in state Medicaid costs. :t; ::.<,s ;{;;::: ',; t+'lllld Welfare f $5.3 Billion State Spending for Children ��,� Juvenile Justice $2.9 Billion One of the most striking findings of the Educa#ion $15.5 Billion • sw { CASA analysis is that in 1998 states spent For every$113 states spend on the consequences of substance abuse just for our children,they only spend one dollar on prevention:and treatment for them. This is perhaps the worst example of current investment policies because of the enormous payoff that could be realized by preventing addiction in the first place. CASA's research has shown that if we can keep a child from smoking cigarettes,using illicit drugs or abusing alcohol until they are 21,they are virtually certain never to do so.z° Solving the addiction problem in America is all about investing in children. -12- Chapter III The Elephant: Mate Spending On the Burden Of Substance Abuse t4 State Programs Of the$81.3 billion states;spent on substance abuse in 1998,$77.9 billion were spent shoveling the wreckage of this enormous health and social problem. These clean-up costs equal 12.6 percent of the total$620 billion in state spending for 1998. (Table 3.1) Almost ninety-six(95.8)cents of every state dollar spent on substance abuse goes to carry its burden in state programs such as criminal justice, school aid, Medicaid,child welfare,developmental disabilities and mental illness because of our failure to prevent substance abuse and treat those who are abusers and addicts. The Distribution of the Substance Abuse Burden Spending to shoulder the burden of substance abuse in public programs is like pouring oil into the leaky crankcase of a car--a costly and at best temporary solution. This report seeks to disclose the size and shape of the leak and how prevention and treatment can plug the holes. State spending leaks occur in seven major budget categories. justice,education,health,child and family assistance, mental health and developmental disabilities,public safety and state workforce. (Table 3.2). To cope with the burden of substance abuse and addiction, states spend an amount equal to$.287 for every person in America. (Table 3.3) The full methodology for how CASA arrived at these estimates is detailed in Appendix B. -13- .... ................................................... . Table 3.1 Table 3.3 Burden of Substance Abuse on Per Capita Burden of State Programs' Substance Abuse on State Programs" Pereertt ou New York 16.9 $ 8,149,194 District of Columbia $777 Massachusetts 16.8 2,604,036 Alaska 505 Minnesota 16.4 1,972,898 Delaware 469 California 15.2 10,428,036 New York 449 District of Columbia 14.9 411,092 Massachusetts 426 Montana 14.9 247,504 Minnesota 421 Pennsylvania 14.0 3,402,244 Hawaii 361 Missouri 12.5 1,325,791 California 324 Colorado 12.4 845,375 Rhode Island 302 Alabama 12.2 1,118,140 Penn lvania 283 Illinois 12.2 2,766,735 Montana 282 Mlchi an 12.2 2,731,964 Michigan 279 Vermont 11.9 130,343 Nevada 279 VirgWa. 11.5 1,758,502 Wisconsin 272 Utah 11.4 489,760 New Mexico 265 Rhode Island 11.3 298,230 Virginia 261 South Dakota 10.6 125,216 Alabama 259 Idaho 10.5 229,239 Connecticut 259 Maryland 10.2 1,251911 Ohio 259 Ohio 10.2 2,903,903 Oregon 254 New Jersey 10.1 1,970,489 Iowa 253 West V# ' 'a 10.1 324,567 Washington 248 Washin on 10.0 1,387,147 Maryland.... 246 Oklahoma 10.0 667,486 Missouri 245 Louisiana 9.9 1,040,768 New Jerse 245 Tennessee 9.9 918,728 Kentucky _ 242 New Mexico 9.7 455,956 Louisiana 239 Georgia. 9.7 1,567,708 Utah 237 Delaware 9.6 344,505 W orcin 232 Wisconsin 9.4 1,413,409 Illinois 230 Florida 9.4 3,051,652 Puerto Rico 228 Alaska 9.4 307,734 Vermont 221 Kansas 9.3 575,085 Kansas 220 Kentucky 9.2 943,766 Colorado 217 Iowa 9.2 720,839 Gear is 209 Mississi i 9.1 474,179 Florida 208 Arizona 9,0 871,595 Arkansas 203 Nevada 9,0 466,801 Oklahoma 201 Hawaii 8.4 429,041 Arizona 191 Oregon 8.2 823,132 Idaho 189 Arkansas 7.7 513,031 West Virginia 179 Wyon,ing 7.5 111,296 Mississippi 174 Nebraska 7.4 264,665 South Dakota 171 Connecticut 7.4 846,136 Tennessee 171 North Dakota 7.3 88,879 Nebraska 160 South Carolina 6.6 597,474 South Carolina 158 Puerto Rico 6.0 872,996 North Dakota 139 Avera a 12.6 $1,497,044 . Average $287 'State programs include justice,education,health,child/family 9 State programs include justice, assistance,mental health/developmental disabilities,public education,health,child/family safety and state workforce. assistance,mental health/developmental disabilities, -14- public safety and state workforce. Table 3.2 State spending for substance Burden of Substance Abuse abuse in the justice system on State Programs by State Budget Sector amounts to over one-third (39.4 percent)of the$77.9 _ p�rrt billion states spend on the inuxden btt burden of substance abuse illr� € to state programs--10 times Vin.. the amount states spend on Justice $30,655 39 4 $113 all substance abuse Adult Corrections 24,141 89 prevention,treatment and Juvenile Justice 2t889, 11 research. Judiciary 3,625 13 Education Tlementag/Secondar 16,498 21.2 61 Health 15 16719.5 56 adult Corrections Child/Fampy Assistance 72721_.. 9.9 28 Child Welfare 5 298 UT 20 Stas spent$29.8 billion in Income Assistance 2,4239 1998 for adult corrections Mental Healthlll+evelo mexrtal Disabilities 5,887 7.6 22 including incarceration Mental Health 5,050 probation and parole. Developmental Disabilities 837 19 Eighty-one percent of this Public Sg!!±E 507 1.9 6 amount($24.1 billion)was State Workforce 408 .5 2 spent on substance-involved Total* $77,846' 200.0 S28r off'enders.t Of the$24.1 *Numbers do not add due to rounding. billion $21.4 billion went to 'State spending on the burden of substance abuse to public programs totals$77.846 billion. run and buildrisons to Spending for prevention,treatment end.research equals$3,011 billion and spending for p regulation and compliance totals$.433 million. The combined total equals$81.290 billion. house substance-involved CASA has rounded total spending to$81.3 billion and spending on the burden to state offenders,$1.1 billion for Urograms to$77.9 billion, parole and$695 million for In this report,CASA hes used population estimates for 1997 from the U.S.Census Bureau probation for substance- to calculate, cls itsspendir` involved offenders. An additional'$899 million was spent on state aid to Justice localities to for substance-involved offenders. In 1998,states spent a total of$39.7 billion for (Figure 3.A) justice-related programs in adult corrections, Punishing someone by keeping them in prison is juvenile justice and the judiciary amounting to 6.3 no longer effective. We meed to break their percent of their budgets. Of this amount,$30.71 billion(77 percent)was linked to substance abuse. habit Representative John Freeman House Corrections Committee that we all have to understand is that there's a Chair, Michigan connection--a rent connection--between substance abuse and violence....lt's a vicious cycle and its got to be broken.' --Governor Tom Vilsack Iowa t The term"substance-involved offender"refers to an innate with one or more of the following characteristics: ever used illegal drugs regularly;convicted of a drag law violation;convicted of a DUI;under the influence of drugs and/or alcohol during the crime that led to `Total state expenditures are estimated based on CASA incarceration;conintitted offense to get money for analysis unless otherwise noted, drugs;had a history of alcohol abuse. -15_ Figure 3.A family court system. For all these functions, Burden of Substance Abuse on except civil courts, states spend approximately Adult Corrections ($ in Millions) $4.5 billion each year. The substance abuse tab Total=$24,140 for state courts is,at a minimum., 80 percent of this total or$3.6 billion each year. Release and Categorical Aid Other Similar to Localities By far,the largest portion of ate substance abuse Programs $ (4%) spending in the judiciaryis associated with (s9�) criminal courts,totaling$2.4 billion. The Probation and remaining funds are expended in the family courts °it's` ($682 million), state aid to local counts($419 Alternatives to n Incarceration million)and drug courts($114 million). (Figure $695(3%) Prisons 3.B) $21,448(88%) Figure 3:S Burden of Substance Abuse can the The largest percentage of the$77.9 billion states Judiciary($in Millions) spent on the burden of substance abuse to state Total=$3,626 programs{31.1 percent)was in the area of adult state Aid to Localities for corrections. Couls $419(12%) Juvenile Justice FarruiyCourts I' States spent a total of$4.4 billion in 1998 for thug juvenile detention and corrections and for t ourtsJSpecial Programs for construction and maintenance of juvenile Violations of crininsl Coutts correctional facilities. Of this amount,an Drug Laws $2,410(66%) estimated 66.3 percent or$2.9 billion was spent on $114(3%) substance-involved youth. Of the total amount states spend on the burden of substance abuse to The substance abuse-related costs borne by the public programs, 3.7 percent is spent in the area of courts equal 4.6 percent of the total $77.9 billion juvenile justice. states spend on the burden of substance abuse to Judiciary public programs. Education The goal of the ffmmily)court is to identify juveniles with drug problems before they In 1998, states spent approximately$165 billion or become habitual criminal offenders, and to 26.E percent of their state budgets on elementary provide them with the intensive treatment they and secondary education. CASA estimates that 10 need percent of this amount or$16.5 billion was spent --Jeremiah S.Jeremiah,Jr. coping with the impact of substance abuse in our Chief Judge,Family Court elementary and secondary schools. This is an Rhode Island especially conservative estimate because of limited data;actual costs are likely much higher. Total costs of substance abuse to public schools The judicial system is carved into several branches--criminal,family,civil and drug courts (which may be further differentiated into family drug courts or juvenile drug courts). In many Civil courts were not included in our analysis because states,juvenile ceases are administered tinder the of the lack available data linking these costs is substance abuse. -16- likely double when taking into account local programs. States pay five times the total amount spending. they spend on prevention,treatment and research just to cope with the health consequences of ...the frightening results of a survey on school substance abuse'and addiction. discipline_listed the topfive problems to be Table 3.4 drug abuse, alcohol abuse,pregnancy,suicide Burden of Substance Abase on and rape. The State[has]an important role to play in ensuring that every child in Colorado Health Care has a drug-free and crime free school.° ,:....;... __Governor Bill Owens Medicaid $14A2 Colorado Other health insulate pEqnLm 321 General assistance in medical care 244 Programs for people with special 219 Of total state spending on the burden of substance health needs abuse to public programs,21.2 percent falls to the 'Total* S15,167 schools--five and one-half times more than states - Numbersdo not add duetorounding. spend on all prevention,treatment and research. Chile and Family .Assistance CASA did not include estimates of the cost of substance abuse to higher education due to the States spent$24.01 billion in 1498 on child welfare lack of available data. and income support programs. Of this amount, $7.7 billion(32.1 percent)is linked directly to Health substance abuse. (Table 3.5) Health cage spending is the second largest Table 3.5 component of state budgets, after elementary and Burden of Substance Abuse on secondary education. In 1998, states spent about Child and Family Assistance $601.4 billion(9.7 percent)of their awn funds to finance health care under the Medicaid program, d"'... .. the federal state program of health insurance for Child Welftre1 $5,298 the poor and medically needy, and to finance Income'Support 2,423 health care costs for people who do not qualify for Total 87J21 Medicaid.*5 The burden of substance abuse Of the$77.9 billion states spend to carry the drained more than$15.1 billion dollars (25.1 burden of substance abuse in public programs, 9.9 percent)from state health care budgets. percent is devoted to child and family assistance Nearly all of these expenditures ($14.4 billion)are programs. States report spending more than twoand one-half times more responding to the state funds for the Medicaid program. Other health insurance programs, health programs for problem of substance abuse in child and family assistance programs than they do for all persons with special needs and general assistance prevention,treatment and research. medical care account for the remaining$70}0,000 in state expenditures. (":fable 3.4) Child Welfare Substance abuse-related spending for health care In 1998, states spent$7.6 billion of their town amounts to 19 percent of the$77.9 billion states revenues on the child welfare system. Of this spend'on the burden of substance abuse to public amount, at least 70 percent or$5.3 billion is caused or exacerbated by substance abuse and Y Other state funded health care programs include those addiction. The largest share of spending was for for child health care,prenatal care and IUV infected adoption assistance, foster care and independent patients eligible for general assistance. living programs($3.4 billion). (Figure 3.C) These -17- SSI. In 1998 states spent$4.5 billion in Figursupplemental payments for individuals receiving Burden of Substance Abuse on Supplemental Security Income(SSI). An Totall $5,29$ Child Welfare{$In Millions) extremely conservative estimate of one percent of = Child Welfare, Other Child this amount or$45 million underwrites costs Farrily Welfare linked to substance abuse. Preservation and Program lydan Child $495(9%) Welfare Mental Health/Developmental Adoption Disabilities Assistance, Child 4wuseand Foster Care, Ne�Irdake kideperdert In the areas of mental health and developmental egih;. and Asp PrVa" disabilities, states spent$19.3 billion in 1998 of W1 t8%3 A372(64%) their own revenues. An estimated$5.9 billion (30.6 percent)of it was spent on treatment of some costs signal the potential for future trouble since co-occurring mental health problem or children who are neglected or abused by a developmental disability caused or exacerbated by substance-involved parent are more likely to abuse substance abuse and addiction. (Table 3.6) their own children and to become substance Table 3.6 abusers. State Spending on the Burden of Substance Abuse Substance abuse spending for child welfare equals Mental Health/Developmental Disabilities 6.8 percent of the total$77.9 billion states spent on the negative consequences of alcohol and drug u. t S br : ... ,:$:x h 1ls�ns addiction to public programs. Mental health mSnMs $4 848 Developmentally disabled pKgVams 824 Income Support Programs Mental health facilities 202 Developmentally disabili facilities 12 Total state spending for income support was$16.4 'Total* LSS 887 billion in 1998 for Temporary Assistance to Needy Numbers do not add due to rounding. Families(TANF),General Assistance and state supplements to the Supplemental Security Income The impact of substance abuse on the mental Program(SSI). Of this amount,a conservative health and developmental disabilities systems estimate of$2.4 billion(15 percent)supports amounts to 7.6 percent of the$77.9 billion states individuals with substance abuse problems. spend on the burden of substance abuse. For every dollar states report spending on substance abuse Of the$77.9 billion states spend on the burden of prevention,treatment and research,they spend two substance abuse, 3.1 percent goes for income dollars to deal with its burden in programs for the support. mentally ill and developmentally disabled. TANF and General Assistance. Total state .Dental Health spending for the TANF program in 1998 was $10.8 billion; for general assistance$1.1 billion. State spending in 1998 on mental health programs States spent at least 20 percent of these amounts or totaled$103.0 billion. An estimated 503.9 percent or $2.4 billion to pay for the effects of substance $5.1 billion was spent to cope with the impact of abuse on our welfare system--$2.2 billion through substance abuse on the mental health system. This the TANF program and$223 million in General amounts to 6.5 percent of total state spending on Assistance. These estimates are obviously low the burden of substance abuse to public programs. because of limited data in the General Assistance program and CASA's use of a conservative estimate for the TANF program. -IB- Developmental Disabilities CASA estimates that 17.6 percent of state costs for highway patrol, local lave enforcement programs, In 1998,states spent$9.3 billion on programs for and highway safety and accident prevention the developmentally disabled. Substance use by a programs are due to alcohol abuse, and 100 woman during pregnancy can result in percent of the costs of special drug enforcement developmental disabilities for the chill. CASA programs are attributed to substance abuse, estimates that at least nine percent or$837 mullion Substance abuse-related spending for public safety of state costs for programs for the developmentally amounts to approximately 1.9 percent of the$77.9 disabled are a result of petal Alcohol Syndrome billion state spend on the burden of substance (FAS). Because of data limitations, CASA was abuse to state programs. unable to estimate the costs to programs for the developmentally disabled linked to tobacco or CASA believes that state costs in this area actually illicit drug use,hence this estimate is extremely are much higher because this estimate does not conservative. include coasts of accidentslinked to illicit drug use; however,data are not available for a more precise Emma Pohl had no idea that her drinking estimate, during pregnancy would cause her son permanent brain damage. Today..her life State Workforce revolves around caring for five boys,four r�,f whom have fetal alcohol syndrome. In 1998,states spent$136 billion in payroll and fringe benefit costs for state workers. Substance Nfin—Star Tribune abuse and addiction compromise the productivity ' 'alis,MN of the state workforce and increase the costs of doing business. Substance abuse is associated The cost of substance abuse to programs for the with lower productivity, increased turnover, developmentally disabled amount to 1.1 percent of workplace accidents and higher health insurance the$77.9 billion states spend on the burden of costs. Because of severe data limitations, substance abuse. however,CASA has focused only on absenteeism for this study;that is,the extra days substance Public Safety abusers are absent compared to non-users. CASA estimates that states spent.03 percent of payroll In 1998 states spent$5.7 billion on public safety and fringe benefit costs or$408 million in including highway safety and accident prevention, absenteeism costs alone due to substance abuse. state highway patrol, local law enforcement (Table 3.8) programs and special drug enforcement programs. Table 3.8 Approximately$1.5 billion(26.3 percent)was Burden of spent on the cost of alcohol-involved traffic Substance Abuse on accidents to state and local law enforcement,drug State Workforce Coasts enforcement and highway safety programs. (Table 3.7) $ tSo;cto+r $iia.ltllaoa >> Table 3.7 Total my-roll $340 Burden of Substance Abuse on Total frin a benefits 68 Public Safety Programs Total $408 # Statespe spending on the impact of substance abuse g p State Mghwa atrol $ 632 on workforce absenteeism equals a half a percent Special Oug enforcement Wgrains 559 (.5 percent)of the$77;9 billion states spend on the Local law enforcement programs 2.54 burden of substance abuse to state programs. Highway safety and accident prevention pTgrams 63 Total* $1 5137 Numbers do not add due to mundin#t, ri nr irrri rirriir�rr.wr -19- .......... -20- ................ ........ .. ......... Chapter 1V The Elephant's Tail: State Spending for Substance Abuse Prevention, Treatment and Research Of the$81.3 billion states spent on substance abuse in 1998,only$3 billion or .5 percent of state budgets event for prevention,treatment and(in very small measure)research. When states are asked how much they spend on substance abuse, this category is usually what they report,yet it is only the tail of the elephant, For every dollar states spend on substance abuse prevention,treatment and research programs to reduce the incidence of substance abuse and its enormous costs to state governments, states spend$26 shoveling up the wreckage in public programs. (Table 4.1) State Spending by Category While it is difficult to differentiate expenditures for prevention vs.treatment because of the way the states reported spending,'CASA estimates that the balk of this$3 billion--about 83 percent--is spent on treatment,while prevention accounts for approximately 17 percent. State spending for substance abuse-related research is practically nonexistent, accounting for only four-fifths of one percent of total spending in this category. (Table 4.2) Several states lumped together spending for prevention and treatment to a total of$i`.3 billion. In these cases, CASA assumed that reported expenditures for the justice system (prisons,parole, probation,juvenile justice and drug Courts),capital spending,mental health/developmentally disabled,state workforce,child welfare and health were largely for treatment and that reported education spending was largely for prevention. Hence,$80 million in education is included in spending on prevention while$1.17 billion is countedas spending on treatment. -21- Table 4.2 Examples of spending for prevention, Substance Abuse Prevention, Treatment and treatment and research are state-wide Research Expenditures ($000) media campaigns;grants for community prevention and treatment Pew programs; local prevention networks; Pr u substance abuse treatment for TANF tnres "1`r Wit +er recipients;HIWAIDS prevention and lsh treatment; school-based prevention programs;treatment facilities such as Prevention S 513,314 1.7.0 1.89 detox clinics, community medical Treatment 2,495,266 82.9 9.19 services;police enforcement of laws Research 2,524 0.1 0.01 regulating sale or distribution of Total $3,011,104 100.0 $11.09 tobacco to rninors;2 evaluation of Of the$3 billion states spend on prevention, treatment programs; and, capital spendingfor treatment facilities. treatment and research,$920 million(30.7 percent)is spent by state health agencies; $843 million Prevention (27.9 percent)by ",..for each year under age 21 that drinking onset is state alcohol and delayed, risk of later life injury diminishes."I Only$513.3 million drug abuse in state funds is spent offices-' $433 --Enoch Gordis,M.D.,Director nationwide on million(14.3 National Institute on Alcohol Abuse and Alcoholism substance abuse percent)by the prevention. This justice system. includes$223 million through the department of health, $210 million through Capital spending for the construction of the department of substance abuse and$80 substance abuse treatment facilities accounts million in prevention in elementary and for$391 million(12.9 percent)of spending secondary education. Most spending for on prevention,treatment and research. An prevention through the schools is federally additional$240 million(eight percent)of funded and that amount is not included here. state spending in this category is for mental health treatment for patients with a co-morbid substance abuse Figure 4.A problem. Prevention, Treatment and Research Spending The remaining$182 million(six by Category($ in Millions) percent)of state spending is 12co 920 843 distributed among employee 1000 (30°7%) (27.9%) assistance programs for the state 8W workforce($97 million or 3.2 600 433 391 percent);prevention programs aoo 240 182 targeting children and (&0%) adolescents through the 200 {e.(}%) department of education($80 0 million or 2.7 percent);and Heath Dept of Justice Capital M-tIDD Other specialized programs provided Substance through the child welfare and Abuse health departments($4.5 million or 0.2 percent)(Figure 4.A). -22- Table 4.1 Table 4.3 Burden of Substance Abuse Substance Abuse Prevention, Treatment on State Programs for Each and Research Spending Dollar Spent on Prevention, by State Treatment.and research f P f She........ . 2f tt North Dakota $8.79 3nte.r..::.. . . :....:s . .,r. .:. `... ....n:: Ore an 10.59 New York 1.044 $503 815 Delaware 14.95 North Dakota 0.$31 10,121 Arizona 15.54 Ore on 0.776 77,711 New York 16.17 California 0.690 4.72,442 Alaska 19.07 District of Columbia t3.671 18,468 Oklahoma 19:41 Delaware 0.639 231039 California 22.07 Massachusetts 0.62:5 97,006 District of Columbia 22.26 Arizona 0.579 56,069 Washington 24,25 Oklahoma 0.512 34,382 Massachusetts 26.84 Alaska. 0.490 16,140 Illinois 28.20 Minnesota 0.446 57,346 Nebraska 29.59 Montana 0.433 7,214 Connecticut 31.06 Illinois 0.432 98,095 Missouri 31.82 1'e vas 0.422 102192 Idaho 3.2.99 Washin on 0.412 57,199 South Dakota 33.23 Missouri 0.393 41,671 PopLiUlvania 33.29 Alabama 0.348 31,964 Puerto Rico 33.68 South Dakota 0.319 3,769 Montana 34.31 Idaho 0.318 6,949 Minnesota 34.40 _Marland 0.285 34,963 Alabama 34.98 Vermont 0.275 31024 Maxyland 35.81 New terse 0.254 49,704 Mississippi 38.19 Nebraska 0.251 8,946 Florida 39.33 West Vir ' 'a 0.242 7,798 New Jersey 39.64 Nlississi i 0.239 12,415 W -min 39.89 Connecticut 0.238 27,244 New Mexico 41.43 Florida 0.238 77,595 West V' inia 41.62 Utah 0,235 10,103 Vermont _ 43.10 New Mexico 0.235 11,005 Utah 48:48 W orcin 0.188 2,790 Hawaii 49.32 Vi ` ''a 0.184 28 248 Virginia 62.25_ Puerto Rico 0.117 25,920 Iowa _ 63.07 Hawaii 0.171 8,699 Kansas 63.66 Ohio 0.147 41,943 Ohio - - - . 69.23 Iowa 0.146 11 429 Kentgqla, 71.62 Louisiana 0.137 14,450 Louisiana 72:03_ Kansas 0.135 8,376 Nevada 77.2_1_ Kentuc 0.129 13,177 Tennessee 102.89 Nevada 0.116 6,046 Arkansas 112.53 Tennessee 0.096 8,929 Wisconsin 180.42 Arkansas, 0.068 4,559 South Carolina 382.51 Wisconsin 0.052 7,834 Rhode Island 409.66 Rhode Island 0.028 728 Michigan 1464.08 South Carolina 0.017 1,562 Colorado 1,542.65 Michi art 0.008 1,866 Geo is N/A Colorado 0.008 548 Average $25.85 Geon 'a NA NA Avera a 0.485 $57906 -23- Treatment Research States report spending$2.5 billion a year on States spent$2.5 million on substance abuse treatment. States did not distinguish research in 1998. Only five jurisdictions whether the treatment was for alcohol, illicit reported any spending in this area--Puerto drug abuse or nicotine addiction. Of the Rico($1.6 million), accounting for more $2.5 billion total, $695 million is spent than half of those expenditures; Oklahoma through the departments of health and$633 ($492,000); Vermont($263,000);Tennessee million through the state substance abuse ($143,000);and Arkansas($14,000). agencies. We believe that virtually all of Research activities as defined by the states these funds are spent on alcohol and illegal included special data collection,needs drug treatment. assessment,outcome studies of various modes of substance abuse treatment and More than 10 million individuals addicted to program evaluation. drugs andlor alcohol are not receiving treatment.3 The lion's share of the biomedical research and research on prevention and treatment of --Center for Substance Abuse Treatment alcoholism,tobacco and other drug The Substance Abuse and Mental Health addiction is funded by the federal Services Administration government. There is, however, a role for states in social science and practice-based The justice system spends $433 million on research. States can compare the cost- treatment. $149 million for state prison effectiveness of providing intensive inmates; $103 million for those on probation substance abuse training for all child welfare and parole; $133 million for juvenile workers against providing certified offenders;$46 million to help localities treat substance abuse counselors as resources to offenders;$1 million on drug courts. help the child welfare staff. They can Treatment provided by mental health measure the return on an investment of drug institutions for co-morbid patients totals courts compared to incarceration or strictly $241 million. The remaining$492 million enforced probation with drug testing. States is for the substance abuse portion of state can examine the cost effectiveness of employee assistance programs($97 million), increased taxation of alcohol beverages with treatment programs for adults involved in or without education campaigns. States are child welfare services($4.5 million)and uniquely positioned to conduct this type of capital spending for the construction of research that can help guide future treatment facilities ($391 million). (Figure investments and the federal government 4.13) would benefit from supporting it. Figure 4.B The Substance Abuse Treatment Dollar Dept of Health Substance 28 cents Abuse 25 cents Chid Welfare <.01 cent Mental Healthl Developmental capital Disabilities 16 cents 10 cents State Workforce Justice 4 cents 17 cents -24- Table 4.4 Per Capita Spending for Variations by State Substance Abuse Prevention, Treatment and Research Average state spending masks wide by State individual variations.("fable 4.3) Two states--Colorado and Michigan-spend less than a 0.01 percent of their budgets on District of Columbia $34.93 prevention,treatment and research linked to Delaware 31.34 substance abuse. New York,North Dakota New York 27.77 and Oregon report spending the most-more Alaska 26.51 than three-quarters of a percent. Although Ore on 23.96 New York spends the largest portion of any Massachusetts 15.86 state budget on prevention and treatment North Dakota 15.79 (1.0 percent), it also spends the largest California 14.66 portion of its budget on the wreckage of Arizona 12.32 substance abuse(16.9 percent). North Minnesota 12.23 Dakota and Oregon, in contrast, spend 7.3 Oklahoma 10.37 percent and 8.2 percent of their budgets on Washn can 10.21 Penn the consequences of substance abuse, ticut 8.54 Connecticut 8.34 respectively--considerably less than.the Montana 8.2.0 national average of 12.6 percent. Illinois 8.17 Missouri 7.71 Another way to look at state investments in Alabama 7.40 prevention,treatment and research is to Hawaii 7.31 examine how much each state spends per land 6.87 person. The average annual, state per capita Puerto Rico 6.77 spending on prevention,treatment and New Mexico 6.39 research is $11.09. Per capita spending in New JerLe6.17 this area ranges from a low of$0.14 in Wyoming 5.81 Colorado to a high of$34.93 in Washington Idaho 5.74 DC. (Table 4.4) Nebraska 5.40 Florida 5.28 South Dakota 5.16 Vermont 5.14 Utah 4.89 Missigs i 4.54 West Virginia 4.30 Vi rota 4.20 Iowa 4.00 Ohio 3.74 Nevada 3.61 NsEt-Uck 3.37 Louisiana 3.32 Kansas 3.20 Arkansas 1.81 Tennessee 1.66 Wisconsin 1.51 Rhode Island 0.74 South Carolina 0.42 Michigan 0.19 Colorado 0.14 Geor 'a NA Average 511.09 -25. .......... ............. -26- .................................. ......................................... ...................... ... .......... . ........... ........... Chapter V Taxation and Regulation of the Sale ofLegal Drugs The final component of state substance abuse spending is the$433 millionstatesspent in 1998 to regulate the sale of alcohol and tobacco and to collect alcohol and tobacco axes- (Table 5.1) Tax rates vary significantly from state to state and revenues generally are not dedicated to prevent,treat or cope with the burden substance abuse and addiction places on many state programs. In 1998, states collected$4.0 billion in alcohol and$7.4 billion in tobacco taxes for a total of $11.4 billion.' For every dollar of such tax revenues,states spent$7.13 on substance abuse and addiction--$6.83 to shoulder the burden on public programs,$0.26 for prevention and treatment,and$0.04 to collect alcohol and tobacco taxes and run licensing boards. Table 5.1 State Substance Abuse Spending on Regulation and Compliance Alcohol and tobacco licensing and control board $346 Collection of alcohol and tobaccos taxes 87 "Postal 5433 Taxation All 50 states,the District of Columbia and Puerto Rico have excise taxes on alcohol and tobacco. State revenues for alcohol and tobacco taxes equal 1.8 percent of total state revenues. Most states have different tax rates for beer, liquor, wine, cigarettes and other tobacco products. Taxes vary by state from a 5.025 cents tax on a pack of cigarettes in Virginia to $1.11 in New York.. Likewise,taxes vary for alcoholic beverages from$3.30 tax on a barrel of beer in Massachusetts to$6.20 in California. The excise tax on a six-pack of beer sold in -27- Missouri is $.03 compared to$.52 per six-pack Regulation tax in Hawaii.' The cost to states for programs and personnel to About 2.3 million smoking-related deaths per collect alcohol and tobacco taxes(including year could be prevented during the next 40 years if$].00 were added to the federal excise tax on fringe benefits)was $87 million in 1998. Of the each pack ofcigarettes.g $11..4 billion collected from alcohol and tobacco taxes,$8.5 billion are not dedicated to a --Pacific Institute for Research and Evaluation particular area of spending"and usually revert to the general fund.6 The remaining$2.9 billion are dedicated to particular areas of state CASA estimates that states spend$346 million spending but not necessarily to substance abuse. for boards or governing bodies which issue They may be targeted to local governments for alcohol and tobacco licenses and regulate the general use or to transportation purposes like sale of alcohol and tobacco. This cost is a construction and maintenance of roads,bridges miniscule proportion(0.4 percent)of the state and airports. In fact,of all state dedicated tax substance abuse dollar,yet regulatory policies revenues($90 billion) including alcohol and can offer significant opportunities to control tobacco taxes, only$3.9 billion are dedicated to state substance abuse spending. For example, health purposes which include many uses other location of liquor stores, price increases for than substance abuse.' alcohol and tobacco products and enforcement of laws limiting sale to minors all have The windfall to states created by the settlement significant effects on substance use and the of the states'suit against the tobacco industry consequences that flow from it.}0 One national creates an opportunity for states to dedicate study has shown that a 10 percent increase in the these revenues to prevent,treat or cope with the price of cigarettes leads to a 12 percent decrease consequences of substance abuse and addiction. in consumption among 12-to 17-year olds." Forty-six states will receive$206 billion over the next 25 years by the tobacco companies; eight billion of this settlement will be spent by states in fiscal year 2001. The other four states, Mississippi, Texas,Florida and Minnesota, settled their tobacco lawsuits separately for a total of$40 billion over the next 25 years. While approximately 43 percent of the 46 state $8 billion settlement amount for fiscal year 2001 is slated to be spent on health care for low- income people($3.5 billion) and$270 million will be targeted for long term care, less than 10 percent will be targeted to smoking prevention ($754 million). Nonhealth-related programs will receive$1.3 million,tobacco growers$537 million and$496 million will be placed in reserves,g $8.5 billion is derived from subtracting the amount of alcohol and tobacco taxes that were dedicated(not including Washington,DC or Puerto fico)from the total collected by states from alcohol and tobacco taxes(Fiscal Plaruiing Services, Inc.,Fiscal Year 1997 and US Census Bureau,Fiscal Year 1997). -28- 011iChapter VI eI Substance Abuse SiDendina bv State This report provides for the first time a comprehensive picture of the substance abuse- related spending patterns of 45 states,the District of Columbia and Puerto Rico. CASA's analysis shows that while states spend on average 13.1 percent of their budgets on substance abuse and addiction, levels of spending vary considerably by state--from 6.1 percent of the state budget in Puerto Rico to 18 percent in New York(Table.6.1). Spending per capita ranges from a low of 155 3n North Dakota to a high of$812 in Washington DC (Table 6.2). These data reflect estimates of the amount state governments spend of their own funds on substance abuse and addiction--information that has never before been assembled. These data are presented as a tool for states to understand the size and shape of the substance abuse draw on their resources and as a basis for considering more cost-effective investment patterns, These data do not reflect all spending in a state on the problem since this report does not deal with local government,federal and private sector spending. For example,New York State requires local governments to pay for approximately 50 percent of the state's share of welfare casts.' In other jurisdictions,state government fully fund all the nonfederal share of those costs. Accounting for local spending in New York and ming it comparable with reported spending instates that fully fund the nonfederal snare of welfare would double the burden of substance abuse to the New York welfare program. Similarly,we know that states impose different cost burdens on localities for support of other programs analyzed here, including mental health, child welfare,portions of the criminal justice system, education and substance abuse treatment and prevention. _29- Table 6.1 Table 62 Total Substance Abuse Spending by State Per Capita Substance Abuse Spending by State Percent ol:.: Arhour�t tat ... ... .. ., .... ..... .... ;a:. Vit. ...: ..... : District of Columbia $812 New York 18.0 $ 8,673,254 Alaska 532 Massachusetts 17.4 2,701,042 Delaware 500 California 16.0 10,942,032 New York 478 Minnesota 15.8 2,031180 Massachusetts 442 District of Columbia 15.6 429,560 Minnesota 433 Montana 15.4 255,818 Hawaii 368 Pennsylvania 14.5 3,506,309 California 340 Alabama 13.0 1,197,105 Rhode Island 303 Missouri 12.9 1,371,999 Pennsylvania 292 Illinois 12.6 2,868 512 Montana 291 Colorado 12.4 845,923 Nevada 282 Vermont 12.3 134 835 Michigan 282 Mich an 12.3 2,754,910 Oregon 278 Virginia 11.7 1,798,374 Alabama 277 Utah 11.6 499,923 Wisconsin 273 Rhode Island 11.3 299,421 New Mexico 271 Sough Dakota 10.9 128,985 Washington 269 Wasj in on 10.9 1,509 295 Connecticut 267 Idaho 10.8 237,025 ViEginia _ 267 Oklahoma 10.5 705,489 Ohio 263 - -Mmyland 30.5 1288,941 Iowa 257 West Virginia 10.5 338,804 Missouri 254 New Jersey 10.4 2,030,261 Maryland 253 Ohio 10.3 2,951,008 New Jerse 252 Delaware 10.2 30,591 Kentucky 245 Louisiana 10.1 1,058,834 Louisiana 243 Tennessee 10.0 931,532 Utah 242 New Mexico 10.0 467,531 Wyoqdng 240 Alaska 9.8 323,874 Illinois 239 Georgia 9.7 1,570,005 Puerto Rico 235 Florida 9.7 3,152,481 Vermont 229 Arizona 9.6 931,164 Kansas 223 Wisconsin 9.5 1,421,566 Colorado 217 Kansas 9.4 584,534 Florida 215 Iowa 9.4 733,857 Oklahoma 213 Kentucky 9.4 956,943 Georgia 210 Mississippi 9.4 486,594 Arkansas 206 Nevada 9.1 473,045 Arizona 205 Oregon 9.0 902,435 Idaho 196 Hawaii 8.6 437,826 West Virgima 187 Nebraska 8.2 291,103 Mississippi 178 North Dakota 8.1 99,078 South Dakota 176 Arkansas 7.8 518,892 Nebraska 176 Wyoming 7.8 115,234 Tennessee 173 Connecticut 7.6 873,380 South Carolina 158 South Carolina 6.6 599,339 North Dakota 155 Puerto Rico 6.i 898,916 AveraLe $299 AveraLe 13.1 $1,563,278 -30- Mate Tables The tables that fallow set forth state spending for all 47 jurisdictions that participated in this study. Data for each state is presented in three major categories. spending on the burden of substance abuse to public programs;spending for regulation and compliance; and spending on prevention,treatment and research. The tables include each state's total budget as reported by the states to the National Association of State Budget Officers and its population as reported by U.S. Census Bureau in 1997. Those data allow computations of the fraction of the state budget spent on substance abuse and per capita spending. The state tables include state spending on justice (adult corrections,juvenile justice,and judiciary),education(elementary/secondary), health, child and family assistance(child welfare and income support), mental health and the developmentally disabled,public safety and the state workforce. State revenues collected from alcohol and tobacco taxes,and total state spending for Medicaid,transportation and higher education are listed as a point of comparison to various expenditures. -31- Alabama Summary of State Spending an Substance Abuse (1998) a A . c t :...... :.: .. .. . . :.Ki ii: ..... 4ffected Pro rams: $6,986,92&0 $1,118,140.4 . .:.:;:...::;;: 12.2 $258.81 Justice 357,U5,0 270,018.8 2.9 62.50 Adult Corrections 196 327.0 153,273.7 78.1 Juvenile Justice 65,627.0 40,795.6 62 2 Judiciary 95,891.0 75,949.5 79.2 Education (Elementary/Seconds 2,494 831.0 211832.5 8.5 2.3 49.03 Health 2,439,370.0 506 036.9 20.7 5.5 117.13 Child/Family Assistance 78141.0 51639.3 0.6 11.95 Child Welfare 78,141.0 51,639.3 66 1 Income Assistance NA NA NA Mw Mental Health/Developmentally Health/DevelopmentallyDisabled 187 939.0 69,47&0 . .. 0.8 16.06 Mental Health 140 628.0 65,392.4 46.5 Developmentally Disabled 47,311.0 3,985.6 8.4H. Public Safety 28 459.0 5,725.1 20.1 0.1 1.33 State Workforce 1,400 343.0 3,509.9 0.3 <0.01 0.81 Re ulationlCom Bance: 47,001.0 47,001.0 104.0 0.5 10.88 Licensing and Control 47,001.0 47,001.00 ` Collection of Taxes NA NA Prevention, Treatment and Research: 31,964 0 31,964.0 100.01 0.4 7.40 Prevention 27,651.0 27,651.0 Treatment 4,313.0 4,313.0 ... . .. ...:: .. x.. :.`. Research 0 0 Total $1,197,105.4 13.4 1 $277.09 The Substance Abuse Dollar Treatment Regulation/ <1 cent Compliance Prevention 4cents Shouldering the Burden of 2cents Substance Abuse Mental Health/ Public Safety Developmentally 1°10 Disabled State Workforce $urden to Sty, Public Justice Programs ChildtFamily 24% 94 cents Assistance 5% Health Education 45% 19% Total State Budget $9,178 M ♦ Substance Abuse $1,197 M ♦ Medicaid $ 758 M Transportation $ 526 M Higher Education $2,683 M Population 4.3 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$190,389,000; $44.28 per capita. -32- Alaska Summary of State Spending on Substance Abuse (1998) F IF* ......::. ..:.:... :..; ..:.:.. .....:.. _ :ate A ff eted Iry rams: $1 250 424.0 $3077343 > .. . ;... :...... 9.4 $504.44 Justice 156 363.0 131,470.0 4.0 215.93 Adult Corrections 155,000.0 130,501.1 84.2 Juvenile Justice 11363.0 968.9 11.1 Judici NA NA NA Education lementa /Seconda 773 000.0 _94t235.2 12.2 2.9 154.78 Heal#h 150 000.0 38 307.3 25.5 1.2 62.92 Child/FamilyChild/Family Assistance 98 53.0 13480.2 0.4 22.30 Child Welfare NA NA 1A Income Assistance 9$,353.0 13,580.2 1.3.8 :.: Mental Health/Developmentally Health/DevelopmentallyDisabled 72 708.0 30141 fi 0.9 49.51 f.. .. Mental Health 49,796.0 28,150.3 56.5 level xnentallsabled 22,912.4 1,99. 1.4 8.7 Public Safe NA NA NA NA NA State Workforce NA NA NA NA NA R`e uladowcv Nance: .NA NANA NA NA Licens!ng and Control NA NA Collection of Taxes NA NA ... Prevention Treatment and.Research: 16,140.0 1_6 140.0 10#.0 0.5 26.51 Prevention 4,847.0 4,847.0 :..:... Treatment 11,293.4 11293.0 ... 77777777 Research 4 Total $3232874.3 9.8 $531.95 The Substance Abuse dollar Prevention Treatment 1 cent 3 cents Shouldering the Burden of Substance Abuse ChildlFamity hlerdalHealttV Burden to Assistance Developmentally Public 4% Disabled Programs IIIA 96 cents Health 92% Justice 43% Total State Budget $3,291 M ♦ Substance Abuse $ 324 M education 31% ♦ Medicaid $ 154 M + Transportation $ 411 M ♦ Higher Education $ 392 M Population .649 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$45,026,400; $73.95 per capita. -33- Arizona Summary of State Spending on Substance .Abuse (1998)* .. � W � AffiTted Pro rams: $5,736,814.7 $871,595. 9.0 ' $191.47 Justice 617 404.1 454 552.4 4.7 98.97 Adult Corrections 517,994.1 388,556.9 75.0 Juvenile Justice 66,971.0 38,894.6 58.1 . Judiciary 32,039.0 23,101.0 72.1 k Education lementa ISeconda 2,119,390.0 153 786.2 7.3 1.6 33.78 Health 510 930.6 122 849.1 24.0 1.3 26.98 Child/Family Assistance 165 342.0 78 862.7 0.8 17.32 Child Welfare 114,657.0 71,275.8 62.2 <. Income Assistance 50 6$S.fl 7,586.9 15.0 Mental Health/Developmentally Health/DevelopmentallyDisabled 206 600.0 45 664.(1 :::.: 0.5 10.03 Mental Health 90,025.0 38,074.2 42.3 .:::;..... Deveio trlentally Disabled 116,575.0 7,589.8 6.5 Public Safety 52 083.0 15 54.4 29.9 0.2 3.42 State Workforce 2,065,465.0 4 367.1 4.2 4.1 0.96 Re ulation/Co fiance: 3,499.0 3,499.11 100.0 <0.01 0.77 Licensing and Control 3,032.0 3,032.0 Collection of Taxes 467.0 467.0 _ Prevention, Treatment and Research: 56 069.2 56,069.2 100.0 0.6 12.32 Prevention 6,676.0 6,676.0 Treatment 49,393.0 49,393.2 Research 0 0 ;> Total :..... $931,163.7 6 $204.55 The Substance Abuse Dollar Treatment Regulation/ 5 cents Compliance Prevention <1 Gent Shouldering the Burden O I cent -- Substance Abuse Menial Health[ Public Setety State Workforce Developmertally 2% 1% Disabled Burden to 5% Public Child/Family Programs Assistance 94 cents 9% Justice Health 51% 14% Education Total State Budget $9,683 M 18% a Substance Abuse $ 931 M a Medicaid $ 662 M ♦ Transportation $ 982 M Higher Education $1,588M Population 4.6 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$219,343,000;$47.68 per capita. -34- Arkansas Summary of State Spending on Substance Abuse (1998)* f` ` � PPcf f Y Affected!_!?grams. 325 586.0 $513,031.3 x: $203.26 Justice 239106.0 187,413.7 :: ..... .� 2.8 74.25 Adult Corrections 203 489.0 164,007.0 80.6 h .....:.::r Juvenile Justice 35,617.0 23,406.7 65.7 ,,.'._::... ..:..f>.. Judicin NA NA NA Education ` iewenta !Seconds 1550 39,0 151451.0 9.8 2.3 60.00 Health 398,472.0__ 97 754.1 24.5 1.5 38.73 Child/Fa9fly Assistance 72 106.0 33,;15.1 .;. .. . ..,:_ 0.5 13.16 Child Welfare 38,288.0 26,541.9 69.5 Income Assistance 33,818.0 6,623.2 19.5 Mental Health/DevelopmentallyHealth/Developmentally Disabled 94 168.0 32 42.8 ::.< .. .... :: ..; 0.5 1:3.05 Mental Health 57,609.0 29 007 0 Develo mcntall T is6bled 36,.559.0 3,93K8 10.g ...._: Public Safety 26 607.0 3 975,8 14.9 0.1 1.58 State Workforce 205147,788.0 6,278.8 ' 0.3 0.1 2.49 lie ulativr 'Q Iiance 1,302.0 1)302.0--- 100:0 <0.01 11.52 Licensmg and Control 1,302.0 1,302,0 i Collection of Truces NA NA Prevention, Treatment and Research. 4 559.0 4559.0 .100.0 01 .X.8.1 Prevention 829.0 929.0 .: ... ... Treatment 3,716.0 3,716 0 Research 14.0 14.0 Total $515 892.3 :. 7.8 $205.35 The Substance ,Abuse dollar Treatment Regulation/ loom Compliance r cent Pravention Shouldering the Burden of <I want Substance Abuse M ental Heattty Putt Safety Burden to DevelopmentallyState Workforce Public Disabled �- IIA Ilya Programs 6% 99 cents CNWFamriy ,., Justice Assistance 37% 6% Health Total State Budget $6,658 M 49% + Substance Abuse $ 519 M + Medicaid $ 398 M Education 301M ♦ Transportation $ 701 M + Higher Education $1,279 M Population 2.5 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$123,345,000;$49.34 per capita- -35- California Summary of State Spending on Substance Abuse (1998)* . . :. ........:... Affaled Pro rams: $51,567,629.9 $10,428,035.2 1S.2 $323.67 Justice 4,955,8%.0 4 053 556.7 5.9 125.82 Adult Corrections 4,560,686.0 3,780,101.8 82.9 Juvenile Justice 393,852.0 272 096.8 69.1 Judiciary 1,358.0 1,358.0 100.Of Education lementa /Secunda 22 982 082.0 2,474,734.9 11.2 3.6 76,81 Health 8 10 362.0 2,040,249.0 24.6 3.0 63.33 Child/Family Assistance 6039,691.0 1404 025.2 2.1 43.58 Child Welfare 976,837.0 709,247.7 72.6 Income Assistance 5,062,854.0 694,777.5 13.7 ;:. ... . .......:.. .. Mental Health/Developmentally Disabled 1455 865.0 368168.5 0.5 11.43 Mental Health 515,348.0 279,198.6 54.2 !... ,. Developmentally Disabled 930,517.0 88,969.9 9.6 Public'Safe 220 115.0 58 300.1 26.5 0.1 1.81 State Workforce 8,513,618.9 29 000.9 0.3 <0.01 0.90 Re uladonlCom licence: 41,555.0 41,555.0 100.0 0.1 1.29 Licensing and Control 35,238.0 35,238.0 Collection of Taxes 6,317.0 6,317.6- Prevention, 317.0Prevention, Treatment and Research: 472 442.0 472,442.0 100.0 0.7 14.66 Prevention 54,295.0 54,295.0 Treatment 418,147.0 418 147.0 Research 0 0 Total $10,942,032.2 16.0 $339.63 The Substance Abuse dollar Treatment Regulation! 4 cents Compliance Prevention P <1 cont e i cervi Shouldering the Burden of Substance Abuse M ental Health! Public Safety Burden to Developmentally 1% State Workforce Public Disabled Programs 4% 96 cents Child/Family Justice Assistance - 36% 13% Health Total State Budget $68,483 M 20% ♦ Substance Abuse $10,942 M Education ♦ Medicaid $ 6,767 M 24% ♦ Transportation $ 4,062 M a Higher Education $ 8,152 M Population 32.2 M Numbers may not add due to rounding. Tobacco and alcohol tax revenues total$954,096,000;$29.63 per capita. t California only reported judiciary spending for drug courts. -36- Colorado Summer of State Spending on Substance Abuse (1998)* k s � r A �cted l'ry rags: $51708,737.0 $845 374 5 .I2.4 $217.25 Justice 462 97 93.0 379 9 ' 5.6 97.47 Adult Corrections 370,000.0 303,932.3 82.1 Juvenile Justice NA NA NA ..'..... F . :.:.:. ......:..: judicLar92,593.0 75365.7 81.4 - .. . Education lernenta ISeconda 1,884,000.0 201704.5 10.7 3.0 51.83 Health 827 000.0 201797.4 24.4 3.0 51.86 Child/FamilyAssistance 91670.0 8,434.2 ........ 0.1 2.17 Child Weare 135.0 96.6 71.6 Income Assistance 91 535.0 8,337.6 9 1 Mental gealth/I>evelo mere#all Disabled 124t652.0 46 042.6 0.7 11.83 Mental Health 78,663.0 41,612.5 52.9 ....:,.... Develop tal!y disabled 45,989.0 4 430.1 9 6 Public Safety 651.0 595.1 91.4 <0.01 0.15 State Workforce 2 18171.0 7,502.7 0.3 0.1 1.93 AegglationlCo lr'anee, NA NA NA NA NA USSnsig ,and Control NA NA .. ....., ._... :::... ..... ;: Collection of Taxes NA NA .... _.. Prevention, Treatment and Research: 54th 0 548.>0 100.0 <#.01 014 Prevention 340.0 340.0 -.. Treatment 208.0 208.0 Research 0 0 Total $845,922 5 ::..' 1 Z 4 $217.39 The Substance Abuse Dollar Prevention Tteatment <1 cent <,cent Shouldering the Burden of Substance Abuse M ental Health/ Punto$arety Develo pmentalty <1% Burden to Disabled Public 5% StateWorkiorce Programs Child/Family 1% S 1.U0 Assistance 10� Justice Health 5° 24% Total State Budget $6,821 M Education • Substance Abase $ 846 M 24% • Medicaid $ 827 M • Transportation $ 564 M • Higher Education $1,491 M Population 3.9 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$97,08 3,0008 $24.89 per capita. Colorado did not report any spending for highway safety or local law enforcement. -37- Connecticut Summary of State Spending on Substance Abuse (1998)* � nd>n tented tai n�n��Atii�se pew Axt retzt1x Caa A ectad Pro racros: 5 593 393.0 $846,136.2 . 7.4 $258.87 .Justice 410 071.0 326,463.2 2.9 99.$8 Adult Corrections 392,000.0 314,671.5 80.3 1=0 Juvenile Justice 18,071.0 11,791.7 65.3 JudiciTy NA NA NA Education lernenta /Seconds 1575 000.0 151 024.1 9.6 1.3 46.21 Health 1,133,000.0 286 830.2 25.3 1 2.5 87.76 Child/Family Assistance 98,19&0 67 770.0 0.6 20.73 Child Welfare 98,198.0 67,770.0 69.0 Income Assistance NA NA NA Mental Health/DevelopmentallyDisabled 14 613.0 7,282.6 0.1 1 2.23 Mental Health 14,613.0 7,282.6 49.8 <, Devem lo entall Disabled NA NA NA Public Safety NA NA NA NA NA State Workforce 2,362,511.0 6 766.1 0.3 0.1 2.07 ftuladonlCoTphance. NA NANA NA NA Licensingand Control NA NA Collection of Taxes NA NA Prevention, Treatment and.Research: 27,444.0 27,244.0 100 0 0.2 8.34 Prevention 1,070.0 1,070.0 Treatment 26,174.0 26,174.0 44 Research 0 0 Total ::_ $873,380.2 7.6 $257.21 The Substance Abuse Dollar Prevention Treatment <i cent 3 cents Shouldering the Burden of Substance Abuse Mental Wealthl State Workforce Develo pmentalky 1% Burden to Disabled Public % Programs Justice 97 cents Child/Family 38°{n Assistance 8% Education f' Total State Budget $11,428 M 34 h „ 18% n r Substance Abuse $ 873 M ♦ Medicaid $ 1,133 M a Transportation $ 828 M ♦ Higher Education $ 998 M Population 3.3 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$184,142,000;$55.80 per capita. -38- . Delaware Summary of State Spending an Substance Abuse (1998)* 4 . ypwyyjj :: A ected Pro amts. V,549,315.2 ,$'344,305 5 9.6 $468:70 Justice 162 406.0 131,093.3 :.:... ` 3.7 179.1.7 Adult Corrections 159,262.5_ 129,511.5 813 Juvenile Justice 22893.5 11931.9 66.8 Judie 250.0 250.0 100.0 Education Tlementar /Seconds 611 288.3 6228&0 10.2 1.7 84.74 Health 404 07.0 97 688.7 24.2 2.7 132.91 Child/Family Assistance 26 58.3 6A31.8 f;,. 0.2 9.29 Child Welfare 3,209.0 2,260.3 10.4 Income Assistance 23 349.3 4,571.5 19.6 ....... 1llenta!Health/Developmentally Disabled 110 51.6 32 754.3 .= . 0.9 44.56 Mental Health 55,717.7 28,706.9 515 Developmentally Disabled 54,54L9 4,047.4 7A Pgblie Safe 32,4%.0 9,567.2 29.4 0.3 13.02 State Workforce 1,202,100.0 3 582.2 0.3 0.1 5.01 Re ulation/C'om Bance: 46.7 46.7 100.0 < OI 0.06 Licensin end Control 9.60 9.60 Collection of Taxes 37.10 37.10 Prevention Treatment and Research: 23 039.3 23,039.3 100.0 0.6 3.1.34 Prevention NA NA Treatment 23,039.3 23,039 3 Research 0 0 _.. :.: ... . ::.. Total $367,51 Z t Z $50fI.11 The Substance Abuse Dollar Treatment Regulation! B cents CO mptiance s 3 darn Shouldering the burden of Substance Abuse M ental tteaftty Public Safety �wdento Deveicpmeitatiy 30A State VNbrktcroe Public Disabled 't% Pivgrams to°h Justice 94 Cents oNkVFamily 38% Assistance 2% Total State Budget $3,604 M Health 2 '� Education ♦ Substance Abuse $ 368 M - 18% i Medicaid $ 202 M f Transportation $ 243 M Higher Education $ 209 M Population .735 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$33,448,1700; $45.51 per capita. t Delaware only reported judiciary spending for drug courts. -39= District of Columbia Summary of Stag Spending on Substance Abuse (1998)* Affected Frn rams: $2,679'd1ll.0 $4.11,091.8 14.9 ' $977.48 44 Justice 333,400.0 266 294.0 9.7 503.63 Adult Corrections 254,531.0 211,539.0 83.1 Juvenile Justice 78,869.0 54,755.0 69.4 Judiciary NA NA NA Education Elewenta /Seconda 463 519.0 52 685.8 11.4 1.9 99.64 Health 261,200.0 59,387.8 22.7 2.2 112.32 Child/Family Assistance 87 673.0 27 415.7 1.0 51.85 Child Welfare 17,500.0 12,761.4 72.9 Income Assistance 70 173.0 14,654.4 20 9 Mental Health/Developmentally Health/DevelopmentallyDisabled NA NA NA NA Mental Health NA NA NA .. .. ... Develo mentally Disabled NA NA NA Public Safety NA NA NA NA NA State Workforce 1,533,818.0 . 5,308.4 0.3 0.2 10.04 ftulationlCompliance. NA NA NA NA NA Licensing and Control NA NA Collection of Taxes NA NA Preuendo,y, Treatment and Research. 18,468.0 18,468.0 100.0 tit►.7 34.93 Prevention 2,079.0 2,079.0 . Treatment 16,389.0 16,389.0 Research 0 0 :............. :.'. Total $429,559.8 15.6 $812.40 The Substance Abuse Dollar Prevention Treatment c 1 cent A cents Shouldering the Burden of Substance Abuse Child/Family State Workforce Assistance 1°� Burdento 7 " Public Health Programs 14% 96 cents Education Justice 13% 65% Total State Budget $2,752 M ♦ Substance Abuse $430 M Medicaid $ NA ♦ Transportation $ NA r Higher Education $ NA Population .529 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$25,924,000, $49.01 per capita. -40- Florida Summary of Sete Spending on Substance Abuse (1998)* vvYk +, A ecteti Pi t3gramv . $17,951,216.0 $3,051651.5 �....:. 9.4 Justice 2,051,553.0 1 96 696.7 4.9 108.74 Adult Corrections 1,446,479.0 1,173 855.1 81,2 ; ....:. Juvenile Justice 478,000.0 317 974,4 66.5 .,.. Judi!# 127,074.0 144 867.1 82,5 .......7.... ' ......... Education letnel to /Secondary 6A73,000.0 693 476.4 10.1 2.1 47.23 Health 1471039.0 379 797`2 25.8 1.2 25.87 Child/FamilyChild/Family Assistance 653 701.0 219 {33.1 0.7 14.95 Child Wefte 182,904.0 1:28 414.4 10.2 Income Asmstance 474 797.4 91099.1 19 3 s Mental Health/ vela mental! Disabled 286,679 121,167.4 : : .:,...'....,._: 0;4 8.25 Mental Health 225,31:8.0 115,472.1 512 Developmental Disabled 61,361.0 51695.3 9 3 Public Safety 115 244.0 21316.4 10,5 0.1 1.45 State Workforce 615"1000.0 19 694.3 0.3 0.1 1.34 Re ulativnlCv Hance: 231234.0 23,234.0 1000 0.1 1.58 Licensing and Control 14,859.4 14 859.0 Collection of Taxes 8,375,4 $,375,4 Preventian, Treatment and Research: 77 595.0 77,595.0 100.0 0.2 5.28 Prevention 58,276.0 58,276,0 Treatment 19 319.4 19 319.0 Research 0 4 Total $3,152,480.5 9. $214.70 The Substance Abuse Dollar Prevention Treatment Regulation/ 2 cents 1 cent Compliance 1 cent Shouldering the Burden of Substance Abuse Mental Heattty Pubft 5afoty state Workforce DevetopmenteW 1% 1% Bto £Ns8tbled PUIUIC 4% r,_ Programs 96 cents CniidfFamity Assistance Y 796 Justice ....... Health 52% Total State Budget $32,568 M 12% i Substance Abuse $ 3,152 M Education ♦ Medicaid $ 2,888 Ma% ♦ Transportation $ 3,745 M Higher Education $ 3,255 M Population 14.7 M M Numbers may not acid due to rounding. Tobago and alcohol tax revenues total$1,062,155,000;$72.26 per capita. -41- Georgia Summary of State Spending on Substance Abuse (1998)* s . At1t1 :.: � > Affected Pro rums: $11,166,402.6 $1,567 708.4 9.7 $209.42 Justice 698 000.0 529 870.5 3.3 70.78 Adult Corrections 648,000.0 529,870.5 '75.9 Juvenile Justice NA NA NA : :...... Judiciary NA NA NA Education lement 1Seconda 4,860,987.0 368 71.8 7.6 2.3 49.29 Health 1,325,835.0 329 623.2 24.9 2.0 44.03 Child/Family Assistance 330 746.0 173 652.3 1.1 23.20 Child Welfare 255,875.0 161,973.5 63.3 Income Assistance 74,871.0 11 678.8 15.6 Mental HealthtDevelo mentall Disabled 496 555.0 145,9 81.6 0.9 19.50 Mental Health 310 287,0 134,927.1 43.5 <. _.!,....... Developmentally Disabled 186,268.0 11,054.6 5.9 Public Safe 79,692.0 12 119.1 15.2 0.1 1.62 State Workforce 3,374,587.6 7 489.9 0.2 0.1 1.00 Re ulutio»/Com fiance. 2,296.9 2,296.9 100.0 <0.01 0.31 Licensing and Control 1,624.8 1,624.8 Collection of Taxes 672.1 672.1 Prevention Treatment unci Research; NA NA NA NA NA Prevention NA NA Treatment NA NA Research NA NA Total ::: $1,570,005.3 9.7 $209.72 The Substance Abuse Dollar Regulation/ Compliance 1 cent Shouldering the Burden of Substance Abuse M ental Health! Public Safety State Workforce Surdento Developmentally 1% <1% Public Disabled Programs Justice 34% ChOd/Famiy Assistance 11% Total State Budget $16,205 M ♦ Substance Abuse $ 1,570 M Health Education +1 Medicaid $ 1,442 M 21% 24% a Transportation $ 603 M ♦ Higher Education $ 3,630 M Population 7.5 M *Numbers may not skid due to rounding. Tobacco and alcohol tax revenue total$220,254,000;$29.37 per capita. -42- Hawaii Summary of State Spending on Substance Abuse (1998)* S 'tom ,,�t'��j}{.�.��. t ,iffectad Pro rain .• 3L_ 059.5 $429 040� .: .. ....:� 8 d $360.74 Justice 179 688.0 147645.9 s 2.9 124.14 Adult Corrections 122,988.0 102,815.2 93.6 Juvenile Justice 4.629.0 3,248.1 701 7udici 52,071.;0 41,582.6 79 9 Education lernenta ISeconda 710162.5 83 273.6 11,.7 1.6 70.02 Health 3€8 297.0 78&10.5 25.3 1.5 65.59 ChildfFamily Assistance 373 736.0 49,148.5 1.0 41.32 Child Welfare 301832.0 22,696.0 73.6 Income Assistance 142,904,0 26 452.5 19.5 _.... :. .,., :. . . .:.:.. Mental Health/Develo meStally Disabled 133L758.0 62 12.2 .> , 1.2 52.56 Mental Health 101026.0 59,338.6 $5.4 DevelopmenLapy Disabled 26,732.0 3,173.6 I19 Public Safety 3,619.0 1,231.5 34.0 <0.01 1.04 State Workforce 2 013 800.0 7.218.4 0.4 0.1 6.07 Re ulat on Com liance. 86.0 86.0 100.0 <0 01 0.07 Licensing and Control. NA NA r,... ...... Collection of Taxes 85.0 86.0 .Prevention Treatment and,Research: 8,699.0 8,699.0 10.0.0 03.2 7.31 Prevention 35.0 35.0 Treatment 8,664.0 8,664.0 Research 0 0 Total $43 7,825 S ;> 8.6 $36813 The Substance Abuse Dollar Treatment Regulation/ Prevention 2cents Compliance a i cent <1 cent Shouldering the Burden of Substance Abuse Mentalldeatthl Publlossfety State Workforce c1% 2% B urden to Developmentally Public Disabled Justice Programs 150A 35% 98cents ChildtfiaMily {f Assistance 1156 Total State Budget $5,100M ♦ Substance Abuse $ 438 M Health Education Medicaid S 313 M ♦ Transportation $ 629 M ♦ Nigher Education $ 552 M Population 1.2 M "Numbers may not add due to rounding„ Tobacco and alcohol tax revenue total$74,992,000; $62.49 per capita. -43- Idaho Summary of State Spending on Substance Abuse (1998)* ::..... - nd�r lam t,r► ........ Ati�e Por f ► ` 4� ..:.:.. .. .:::.. :.. ... ....:.:.. ...... .. ...:.:F. A ected Pro rams. $1888,673.$ $229,238.6 10.5 $189.35 Justice 121976.4 92 32.3 4.2 76.27 Adult Corrections 74,537.3 59, 173.3 79.4 . ,::... ......... :. . Juvenile Justice 32 201.5 20,607.2 64.0 Judiciary 15,237.6 12,551.7 82.4 Education(Elementary/Secondary) 751390.0 68 544.3 9.1 3.1 56.62 Health 152 145.0 34A30.4 22.9 1.6 28.77 ChldfPamil Assistance 36 408.0 11 114.3 : :;:.... 0.5 9.18 Child Welfare 12,608.0 8,551.4 67.9 Income Assistance 23,800.0 2,562.9 10.8 ...: .. ....... . Mental Health/Developmentally Health/DevelopmentallyDisabled 50 686.0 17 569.8 0.8 14.51 Mental Health 33,401.0 16,186.6 48.5 ..;;- ........:....... Develo mental# Disabled 17,285.0 1,383.2 8.0 .: Public Safety 16 8689 2,789.4 16.5 0.1 2.30 State Workforce 759 199.5 2,058.2 0.3 0.1 1.70 Re ulutivnl[;v #`lance. 837.3 8373 100.0 <0.01 0.59 Licensing and Control 817.3 817.3 Collection of Taxes 20.0 20.0 . .. .Prevention Treatment and.Research: 6,949.2 6,949.2 . 100.0 0.3 5.74 Prevention 4,131.0 4,931.0 Treatment 2,018.0 2,018.0 Research. 0 0 Total $237,0251 10.8 $195.79 The Substance Abuse Dollar Prevention Treatment Regulation/ 2cents #cent Compliance 1 cent Shouldering the Burden of Substance Abuse M ental Health/ public Safety State Wo rkfo roe 8urdento Developmentally t% ?% Public Disabled Programs 8% 97 cents Chlid/Family Assistance Justice 4 40% a i 5 Health Total State Budget $2,188 M 15° Substance Abuse $ 237 M + Medicaid $ 125 M Education 30% Transportation $ 270 M a Higher Education $ 302 M Population 1.2 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$35,608,000;$29.67 per capita. -44- Illinois Summary of State Spending can Substance Abuse (1998)* ggN q �{ 00 . .. ...::. ..'. :.:.'., ..n.....: . ..✓....... is_ .. ......: d ... - ' f elcted pr© rarats: $16,185973:1 $2,766,734.812.E $230.54 Justice 887172.7 710144.8 3.1 59.12 Adult Corrections 805,063.4 655,239.9 814 ,..::..: Juvenile Justice 82,109.3 54 904,9 66.9 Judi2Lar NA NA NA :. Education lementa /Seconda 5176 589.5 529L676.8 10.2 2.3 44.10 Health 2, 30,N0.7 582 717.9 24.0 2.6 48.51 Child/Family Assistance 1,116,309.2 651 044.8 2.9 54.20 Child Welfare 856,165.6 6031883.1 70.5 Income Assistance 260 143.6 47,162.7 181 ........ .... Mental Realt" gel)pmentally Disabled 710 651.6 233153.1 `.....; 1.0 13.41 Mental Health 377,908.6 195 144.0 51.6 DevelopmentallyDevelopmentaUy Disabled 412,743.0 38,019.1 9.2 Public Safety 125,711.5_ 42t573.9 33.1 0.2 3.54 State Workforce 5 658,597.9 17.413.5 0.3 0.1 1.45 ke ulatiox jqq liance: 3L681.9 3t681.9 100.0 <A 01 0.31 Licensig and Control 3,122.4 3 222:4 ........ z,: ' Collection of Taxes 560.5 560.5 Prevention , Treatment and Research: 9$ 095.2 98 095.2 100.0 0.4 8417 Prevention 12,505.8 12,505.8 Treatment 85,589,4 Research 0 0 Total $2,868,511.9 1 Z 6 $238.81 The Substance Abuse Dollar Treatment RegulatiorJ Prevention 3cord Campttance <1 cent _ a 1 cent Shouldering the Burden of Substance Abuse Mer4alHeatth! PWoo Safety State Workforce Developmentally 2% 1% Surde+to DIS Justice Public B96 25% Programs 97 cents ChiidtF amlly Assistance 24% Total State Budget $22,72.7 M Education Health 1996 ♦ Substance Abuse $ 2,869 M 21% -- ♦ Medicaid $ 3,583 M s Transportation $ 2,492 M ♦ Higher Education $ 2,247 M Population 12.0M Numbers may not adze due to rounding. Tobacco and alcohol tax revenue total$525,455,000;$43.79 per capita. -45- Iowa Summary of State Spending on Substance Abuse (1998)* Abtxs tt >suit >< tti >rt WOO -- E - W 4fLected Pro rams: $3,678,682.4 $720,839.4 9.2 $252.54 Justice 360 526:0 289 077.2 3.7 101.27 Adult Corrections 222,200.0 179,754.3 90.9 Juvenile Justice 36,845.0 24,373.5 66.2 ... Judiciary 101,481.0 84 949.3 93.7 ;: ..:: ::.. Education lementa !Second 1 714 014.0 170,379.3 9.9 2.2 59.69 Health 404148.0 91781.4 22.7 1.2 32.15 Child/Family Assistance 190 824.0 106105 :< 1.4 37.17 Child Welfare 143,892.0 100,523.4 69.9 Income Assistance 46 932.0 5,581.7 11.9 Mental HealthlDevelymentall Disabled 165 066.0 50816.8 0.7 17.73 Mental Health 85,586.0 43,506.8 50.8 .:;'. ......:. Developmental!Devel2pmental!y Disabled 79,480.0 7,110.1 8.9 Public Safet 41271.0 10,487.1 25.4 0.1 3.67 State Workforce 802 833.4 2,392.6 0.3 <0.01 0.84 Re ulationlCom lzance: 1,589.0 1,589.0 100.0 <0.01 0.56 Licensing and Control 1,589.0 1,589.0 Collection of Taxes NA NA PM ention, Treatment and Research: 11,4.28.8 11,428.8 100.0 0.2 4.00 Prevention 1,654.0 1,654.0 Treatment 9,774.8 9,774.8 Research 0 0 Total $733,8572 9.4 $25 .10 The Substance Abuse Dollar Prevention Treatment Regulation/ <1 cent 1 t Co mphance <Icent Shouldering the Burden of Substance Abuse M ental Healtht Public Safety statteftrkforce o Develpmentally 1% <1% Disabled B urden t o 7% Public Justice Programs Child/Family 40% 99 cent Assistance cent 1e 15°h Health Total State Budget $7,810 M 13% t ducation ♦ Substance Abuse $ 734 M 24% t Medicaid $ 553 M ♦ Transportation $ 605 M ♦ Higher Education $2,213 M Population 2.9 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$119,988,000;$41.38 per capita. -46- Kansas Summary of State Spending on Substance Abuse (1998)* Oe AX ty }} "Ric Pe F Affected Programs: $4 982, 58U 8 $5750853 ..... .w 9.3 $219.81 Justice 248 616.2 185,153.2 3.0 70.77 Adult Corrections 1903 233.0 148,758.3 78.2 ..... Juvenile Justice 58 383.2 36,394.9 62.3 ludici NA NA NA Education lementa ISada 1885 227,8 161 167.0) 8.5 2.6 6i,60 Health 372 0145.0 88,4W7_ 23.8 1A 33.82 ChdtFamll Assistance 153,999.0 67,672.9 1.1 25.87 Child Welfare 84 1003.0 55,717.6 65.3 '. >.... Income Assistance 69,899.0 11,955.3 17.1 Mental Health/Deveiggmentaft Disabled 2521.13.0 61 07.5 1.0 23.39 Methal Health 107,703.01 50 281.9 46.7 ...`;.: ..... ... : bevelo rnentall '1?isabled 144,410.0 10 925.6 16 Public Safety 40A00.0 6 69,9 15.4 0.1 2.40 State Workforce 2,029,979.8 5 126.1 0.3 0.1 1.96 Re utationlCo ,Liance. 1,0710 1,073.0 100.0 <0.01 0.41 Licep� tS and Control 968.0 968.0 ::.1 ......... .... .... Collection of Taxes 105.0 105.0 : Prevent on, Treatment and Research: 8,376.2 8,376.2 100.0 0.1 3.20 Prevention 1,512..5 1,512.5 ..,...... .. . Treatment 6,8616 6,863.6 Research 0 0 Total $S84 534 4 .f.:r 9.4 $223.42 The Substance Abase Collar Treatment Regulation/ 1 cent Compliance Prevention: <1 cent <1 cent Shouldering the Burden of Substance Abuse M ental Health/ PubiicsafetY Statevwtkforce surdento Developmentally 1% 1% Public Disabled Programa 11` Justice 99 cents 3296 ChudtFamdy Assistance 1296 Total State Budget $6,208 M Health a Substance Abuse $ 585 M 15% Edwast#on ♦ Medicaid $ 422 M 28% ♦ 'Transportation $ 656 M t higher Education $1,183 M Population 2.6 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$123,665,000;$47:56 per capita -47- Kentucky Summary of State Spending on Substance Abuse (1998)* sA A s sets A � :.. .. , A acted Pro rams: $5158q,754.9 $943,765.4 9.2 $241.51 Justice 316 094.0 257,490.4 2.52 65.89 Adult Corrections 263,266.0 220,279.7 83:7... Juvenile Justice 51,748.0 36,368.8 70.3 Judiciary 1,080.0 841.9 78.0 Education lementa /Secunda 2,513,665.0_ 296,165.3 11.8 2.9 75.79 Health 764 000.0 186455.5 24.4 1 1.8 47.71 Child/Family Assistance 202 004.0 101 155.8 1.0 25.89 Child Welfare 107,704.0 79,396.0 73.7 Income Assistance 94,300.0 21,789.8 23A Mental Health/DevelopmentallyHealth/Developmentally Disabled 244 195.0 94 404.1 .... 0.9 24.16 Mental Health 146,762.0 81,565.9 55 6 Develo mentally Disabled 97,433.0 12,838.2 13 2 Public Safety 10 455.0 2 549.1 24.4 <0.01 0.65 State Workforce 1,530,341.9 5,515.2 0.4 0.1 1.41 Re ulationlCom dance: NA NA NA NA NA Licensing and Control NA NA Collection of Taxes NA NA Prevention, Treatment and Research. 13,1770 13,177.0 100.0 0.1 3.37 Prevention 1,517.0 1,517.0 . .. Treatment 11,660.0 11,660.0 Research 0 0 Total $956,942.5 9.4 $244.88 The Substance Abuse Dollar Prevention Treatment <1 cent 1 cent Shouldering the Burden of Substance*Abuse OWN I No- Mental Health/ PublicSafety State Workforce Burdento Developmentally X19', 190 Public Disabled "`` P rograms 10% Justice 99 cents C hiidrF amity 27'0 A ssistance 119" Total State Budget $10,216 M Health Education + Substance Abuse $ 957 M 2WO 31% + Medicaid $ 764 M + Transportation $ 845 M + Higher Education $ 1,718 M Population 3.9 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$83,758,000-, $21.48 per capita. -48- Louisiana Summary of State Spending on Substance Abuse (1998)* vA 20,, s A ectcd�o an;a:_ 58'9. $1,ad(t 768. 9.9 $239.18 Justice 521 304.0 419 446.8 4.0 96.39 Adult Corrections 424,966.0 351.,372.2 92.7 Juvenile Justice 84,962.4 58 438.9 68.8 .. :<:;.... . Jtidici 11.,376.0 9 635.7 $4 7 Education (Elementary/Secondary) 2,324,472.0 257 241:.6 11.1 2.4 59.12 Health 874 817.0 210161.0 24.0 1 2.0 48.30 Child/Family Assistance 127 026.0 66,14&1 0.6 15.24 Child Welfare '76,041.4 54,995.6 72.3 Income Assistarice 50,985.0 11,152.5 21.9 ...::..:... .... Mental Healtb/Developmentally Health/DevelopmentallyDisabled 175 462.0 59 434.5 0.6 : 13.66 Mental Health 91,281-0 49,131.6 53,8 Develo mentali Disabled 84,181.0 10,342.9 122 public Safety 85 508.0 18 374.6 21.5 0.2 4.22 State Workforce 2P66 000.0 9,961.6 0.3 0.1 2.29 ReulatioL% fiance: 3,616.0 3,616.0 100.0 <11.#1 0.83 Licensing and Control 3,616.0 3,616.0 .::..... ... Collection of Taxes NA NA .. Prevention, Treatment and Research: 14,450.0 14,450.0 11111.0 0.1 3.32 Prevention 13,866.0 13 866.4 ......... Treatment 584.0 584.4 Research 0 0 Total ;243-33 x D X $243.33 The Substance Abuse dollar Treatment Regulation/ zl cent Compliance Prevention c1 Cent I cent Shouldering the Burden of Substance,Abuse Surdento MentaiHeatth/ PublicSatety StateWorktorce public tievelopmentaliy o 'la Program Disabled 99 cents 69a Chftfamily Justice Assistance 4079 Total State Budget $10,533 M 6%Health ♦ Substance Abuse $ 1,459 M a ♦ Medicaid $ 946 M Education Transportation $ 948 M 25% + Higher Education $ 1,611 M Population 4.4 M 1. Numbers inay not add due to rounding. Tobacco and alcohol tax revenue total$141,813,004;$32.23 per capita. -49- .. ..... ......... .....__. ......................................................... ......... ..............._.. Maryland Summary of State Spending on Substance Abuse (1998)* sPei ::.:. Rt> t s>z :. s�st> Amt . Q .:..... Affected Pro rums: $8,86$1235.4 $1,251,910.6 10.2 $245.81 Justice 686 483.3 487 009.0 4.4 95.62 Adult Corrections 573,952.1 423,440.6 718 :. > Juvenile Justice 112,531.2 63,568.4 56.5 3udici NA NA NA Education lementa /Secondar 2,451,759.9 167 492.6 6.8 1.4 32.89 Health 1,179,177.0 292t924.9 24.8 2.4 57.52 Child/Family Assistance 311279.7 101754.7 0.8 19.98 Child Welfare 129,899.0 78,753.9 60.6 Income Assistance 181,380.7 23 000.8 12.7 ; Mental Health/Deve!opmentally Health/DevelopmentallyDisabled 638 770.7 166 488.0 .:;.. .:.: 1.4 32.69 Mental Health 375,201.0 152,774.7 40.7 :. ..... .. .:. Developmentally Disabled 263,569.7 13,713.3 5.2 Public Safety 149 371.0 29 411.4 19.7 0.2 5.77 State Workforce 3 446 93.7 6 830.0 0.2 0.1 1.34 Re ulatiion/ om liance: 2,066.9 2,066.9 100.0 <0.01 0.41 Licensing and Control 1,788.6 1,788.6 :::. ... . ::.... . ::.:.:..... .:.:.... .. ..:....: Collection of Taxes 278.3 278.3 .Prevention, Treatment andResearch: 14,963.0 34,963.0 100.0 1 0.3 6.87 Prevention 606.0 606.0 ----------------- . Treatment 34,357.0 34,357.0 Research 0 0 .... ...... . :........ 77777 Total L :...::, $1,288,940.6 10.5 $253.09 The Substance Abuse Dollar Treatment Regulation/ Scents Compliance Prevention {1 cent Shouldering the Burden of c 1 cent Substance Abuse Mental HeaW PubbcSafety Stat&Workforce DevelopmantaUy Z90 % 8urcanto Disabled Justice P ublic 130 40aj 0 Programs C hild)F amity 97 cents A ssistance $�o Health kEcation Total State Budget $12,260 M 2Wo l W, a Substance Abuse $ 1,289 M ♦ Medicaid $ 1,080 M ♦ Transportation $ 1,778 M ♦ Higher Education $ 2,028 M Population 5.1 M Numbers my not add due to rounding. Tobacco and alcohol tax revenue total$152,677,000;$21.94 per capita. ..50_ Massachusetts usetts Summary of State Spending on Substance Abuse (1998)* IMUXONOWMNOW � � ..:.i.,. ... ... ,. ...:.:. .:.. ... ,, F A acted Pro rtxrns: $8,464,3360 $2 {,f34 035 8 16.8 $425.81 Justice 961212.7 816 18 1 .... ... ;...:: 5.3 133.57 Adult Corrections 654 085.7 556,888.7 85.1 Juvenile Justice 14 582.0 14 580.4 72.6 ......- ... ;:< Judiciajy 292 545.0 249 349.0 85.2 Education lementa 1Seconda 2,854,000.0 374 81#.1 13.0 2.4 611.b3 Health 1 63 319,11 477142.2 25.6 3.1 78.02 Child/Family Assistance 11171759.0 379,99Q.4_` ,..... ::,.... 2.4 61.99 7-77M Child Welfare: 301 982.0 228 967:11 15.8 Income Assistance '769,777.0 150 123.4 19.5 Mental Health/Develo mentall ,Disabled 1 35 763.0 517 23.7 ::_... 3,3 84.69 Mental Health 740,795.0 431,977.1 58.3 Developmentally Disabled 794,968.0 85 946.6 10.8 _:. . . . .... . :;s Public Safe 178 282.3 42251.3 23.7 0.3 6.91 State Workfome NA NA NA NA NA Re ulognlCvnt liance. ,NA .NA NA NA NA Licensingand Control NA NA Collection of Tuxes NA NA Prevention, Treatment and Research: 97,006.0 006�J 11�f�0 (I.6 15.86 Prevention 2133.0 2133.0 Treatment 94,873.4 94,873:0 Research 0 0 Total $2 7111,1141.6 17.4 $441.67 The Substance Abuse [dollar Prevention Treatment <1 cent 4 cants Shouldering the Burden of Substance Abuse M ental H*alth✓ P ublic Safety Developrnentaly o 8urdento Disabled Justice P ublic 2C%O. 31 0 Programs 96 cants C hildrf ar, y A ssistance Total State Budget $15,517 M Education ♦ Substance Abuse $ 2,'701 M Health 14g� + Medicaid $ 2,319 M a Transportation $ 1,2931!4 + Higher Education $ 910 M Population 6.1 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total S362,824,000-,$59A8 per capita. -51- .......... ...._.... ......._. .... ......... _ ......__. _ ......................__... . _ Michigan Summary of State Sending an Substance Abuse (1998)* en Re1a#ed t S'u �i Alit �� >� Aected Pro rants: $15,459,656.3 $2,731,964.4 1 .2 $27919 Justice 1 362 272.3 1,126,943.5 5.0 115.17 Adult Corrections 1,256,145.0 1,044,449.6 83.1 Juvenile Justice 23,827.3 16,555.8 69.5 Judici4g 92,300.0 65,938.1 801 Education lementa 1Seconda 9,496,957.0 1082 059.0 11.4 4.8 110.58 Health 380 757.0 94 631.8 24.9 0.4 9.67 Child/Family Assistance 750 450.0 305 291.7 ... ...:' 1.4 31.20 Child Welfare 296,301.0 216,227.4 73.0 :,; .,..... Income Assistance 454,149.0 89,064.3 19.6 .:..: ......... Mental HMth/Developmentally Health/DevelopmentallyDisabled 109,751.0 59,M7.4 0.3 6.12 Mental Health 109,527.0 59,844.4 54.6 Developmentally Disabled 224.0 23.0 10.3 Public Safeg 149 606.0 52,032.0 34.8 0.2 5.32 State Workforce 3,209A63.0 11139.0 0.3 0.1 1.14 Re utationlCo 1`ance. 21,480.0 21,084.4 11111.4 0.1 2.1 S Licensing and Control 19,380.0 19,380.0 Collection of Taxes 1,700.0 1,700.0 Prevention, Treatment and Research. 1,866.0 1,866.0 100.0 <0.01 4.19 Prevention NA NA Treatment 1,866.0 1,M6.0 Research 0 0 .... Total $2,754,910.3 12.3 $281.53 The Substance Abuse Dollar R egulatio n/ Treatment Compliance r l cent I cent.. Shouldering the Burden of Substance Abuse MentalHealth/ PublicSatsty Developmentaliy 21jc State Workforce Burden to Disabled Public 2, Prograrns chikwamgy o 99 cents Assistance Justice l itfo 427, Health 3% Total State Budget $22,460 M education + Substance Abuse $ 2,755 M 4oq� + Medicaid $ 2,786 M + Transportation $ 1,921 M + Higher Education $ 1,864 M Population 9.8 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$711,718,000;$72.62 per capita. -52- Minnesota Summary of State Spending on Substance ,Abuse (1995)* : :. Aeted Prc� ms $111811,121.9 $1,92 898.4 15.4 $420.86 Justice 232 27.0 1852370.1 ... 1.4 39.54 Adult Corrections 210,776.0 171,094.0 91.2 Juvenile 451:0 14,276.1 66.6 Justice 21, r.....'.. .......:..: . ....:. . .::.:. ::: Judicia U NA NA NA Education(Elements 1Seconda 3,230,613.0 326 363.2 10.1 2.5 69.62 Health 5,793,00&4 1 Y34801.8 23.3 10.5 287.69 Child/Family Assistance 220 623.0 6Z,168.7 0.5 13.30 Child Welfare 45,412.0 31,896:0 701 Income Assistance 175,211.4 30,472.8 17A .,.. Mental Health/Developmentally Health/Developmentallydisabled 253 434.0 32 491.1 <..... ..,,::' 0.3; 6.93 Mental Health 20,584.0 10,556.0 51.3 , ........... Develo mentall bisabled 232 850.0 21,934.1 9,4 ' ..;;. . .. .: :: Public Safety 61 216.0 13 793.6 22..5 Ori 2.94 State Workforce 1 9 000.4 3,910.8 0.3 <0.01 0.83 ftrxlutranlC m (lance. 9.36.0 936.0 100.0 <0 01. tJ 20 Licensing and Control 362.0 362.0 Collection of Taxes 574.0 574:0 .<... .. Prevention, Treatment and Research. 57,346.0 57346.0 100.0 0.5 12.23 Prevention 5,430.0 5,434.0 Treatment 51,916,0 51,916.0 Research 0 0 Total $2,031,181.4 1 S.8 $433.30 The Substance Abuse Dollar Treatmerd Prevention Stents RegWationf c1 cObi e Shouldering the Burden of Substance Abuse MentalHeatth/ PubticSatety Stateworkforce Deveto pmentxtiy e i go to Disabled Justice s CttitdsFarrritEducation s A ssistance Health Total State Budget $12,848 M �`� t Substance Abuse $ 2,031 M ♦ Mediicaid, $ 1,.521 M ♦ Transportation $ 1,384 M ♦ Higher Education $ 1,660 M Population 4.7 M *Numbers my not add due to rounding. Tobacco and alcohol tax revenue total$247,224,000;$52.60 per capita. -53- MII1f1esota (updated 0 8/3 1/01 to include revised health spending data from Minnesota) Summary of State Spending on Substance Abuse (1998)* .. t . : p Arnoutlteeext 31nt P pi trsry zl ::.... ` b 10111.. .. .:: ... A acted Pro rams: $6,844,043 $987,035.6 7.7 $210.56 Justice 232 227.0 185 370.1 1.439.54 Adult Corrections 210,776.0 171,094.0 81.2 Juvenile Justice 21,451.0 14,276.1 66.6 Judicia NA NA NA :.'.. . . Education lementa /Secunda 3,230,613.0 326 363.2 10.1 2.5 69.62 Health 1,556,M.0 362,739.1 23.3 2.8 77.38 Child/FamilyAssistance 220 623.0 62 358.7 ::: .. 0.5 13.30 Child Welfare 45,412.0 31,896.0 70.2 .: Income Assistance 175,211.0 30,472.8 17.4 ..: Mental Health/Developmentally Health/DevelopmentallyDisabled 253434.0 32 490.1 :....., 0.3 6.93 Mental Health 20,584.0 10,556.0 51.3 .;;.. . DevelopmentallyDeyclopmentally Disabled 232,850.0 21,934.1 9.4 Public Safety 61 216.0 D,793.6 22.5 0.1 2.94 State Workforce 1,289000.0 3,910.8 0.3 00.01 0.83 Re u la do nlCo Lnp fiance: 936.0 936.0 100. <0 til 01.20 Licensing and Control 362.0 362.0 Collection of Taxes 574.0 574.0 Prevention, Treatment and.Research. 57,346.0 57,346:0 100.01 0.4 12.23 Prevention 5,430.0 5,430.0 Treatment 51,916.0 51,916.0 Research 0 0 ..: ....: ::.. . Total $1,045,31 7.6 ...:,•!......... 8.1 $222.99 The Substance Abuse Dollar Treatment Regulation/ 5% CompNance Prevention <I�a Shouldering the Burden of Substance Abuse Burdento MentalHealth/ Public Safety 5tateWoMorce Public Developmentally �1% Programs Disabled t Justice 94% 3cfo Child f army A ssistance 6%0 Total State Budget $12,84$M Health . Education Substance Abuse $ 1,045 M % 33% ♦ Medicaid $ 1,521 M a Transportation $ 1,384 M ♦ Higher Education $ 1,660 M Population 4.7 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$247,224,000; $52.60 per capita. -54- ::.:. Mississippi Summary of Mate Spending on Substance Abuse (1998)* A coed Prrg rams: $3,065,239.5 $474179.2 .,. 9..1 $173.38 Justice 208 978.0 168,407.0 3.2 61.65 Adult Corrections 135,474.0 158;007.9 $0,8 Juvenile Justice NA NA NA Judiciary 13 504.0 10,399.1 77,0 Education lementa ,y/Secondary) 1 40 000.0 132 702.8 9.9 2.6 48.58 Health 380 757.0 92 393.4 24.3 1.8 1 33.82 Child/Family Assistance 34,474.0 12,480.2 0.2 4.57 Child Welfare 11302.0 7,885.7 69.9 .. ..:4 . Income Assistance 23,172.0 4,594.5 19.9 Mental Health/Developmentally Disabled 208 927.0 65 346.1 1.3 23.92 Mental Health 108,857.0 55,223.2 50.7 .:. ::...... :.: Developmentally Disabled 100,070.0 10122,9 191 .... Public Safety 1205.0 205.6 17,1 <0.01 0,08 State Workforce 890 98.5 2,644.1 0.3 1.1 0,97 A, lulatzvn1Com fiance: NA NA NA NA NA Licensing and Control NA NA Collection of Taxes NA NA Preivndon Treatment and.Research: 12,415.0 12415 O 2 4.34 Prevention NA NA Treatment 12,415.0 12,415:0 :< Research 0 0 Total _ $486 594.2 Y 9.4 7 Y2 The Substance Abuse Dollar TreatmerR Shouldering the Burden of Substance Abuse MentalHealtht podicSafety State Workforce wMWOMMONNO IN Developmentally <1% tea A,r&nto Disabled ` p ublic 14% Justice P engrams Child f arrily gr,yo 97 cents A ssistanca Scents 10- 3`}'c Health Total State Budget $5,196 M xggo Eziucation + Substance Abuse $ 487 M 28% + Medicaid $ 383 M s Transportation $ 611 M + Higher Education $1,316 M Population 2.7 M Numbers may not add due to rounding. 'Tobacco and alcohol tax revenue total$100,095,000;$37.97 per capita. -55- .... .................. ....._.._..... ......_.. _. Missouri Summary of State Spending on Substance Abuse (1998)* a Relaters trip Apt .. .:. .. .. ; ::.: ... ..:: .::.. .. ,.; c Affected Pro rams: $6,928,833.9 $1,32.5,79!1.9 .......: 12.5 $24.5.19 Justice 864 448.3 699 253.3 6.6 129.32 Adult Corrections 750,662.2 612,361.1 81.6 Juvenile Justice 52,649.9 35,349.7 67 1 Judiciary 61,136.2 51,542.5 84.3 ;. Education(Elementary/Secondary) 3-062 755.2 316,876.2 10.3 3.0 58.60 Health 28 603.2 81903.0 31.1 0.1 1.65 Child/Family Assistance 219 745.6 67 164.7 0.6 12.42 Child Welfare 59,620.9 42,205.3 70.8 Income Assistance 160,124.7 24,959.4 15.6 Meatal Health/DevelopmentallyHealth/Developmentally Disabled 515 624.8 201,864.51.9 37.33 Mental Health 358,411.5 186,180.9 51.9 Developmentally Disabled 157,213.3 15,683.6 10.0 .. ..::.. Public Safety 144,887.0 25 209.3 17.4 0.2 4.66 State'Workforce 2,092,769.8 6 519.9 0.3 0.1 1.21 Regulation/Com liance: 4,536.8 4,536.8 104.0 <01 4.84 LLicensing and Control 4,150.0 4,150.0 .. ... .:: ...:.:......:: Collection of Taxes 386.7 386.7 Prevention, Treatment and Research: 41,670.9 41,674.9 100.01 4.4 7.71 Prevention NA NA Treatment 41,670.9 41,670.9 Research 0 0 Total ::.. $1371,998.5 1.2.9 $253.74 The Substance Abuse Dollar Tmatment Regulation/ scents Compliance <Icent Shouldering the Burden of Substance Abuse MentalHealth/ PubhcSafety StateWorktorce Developmentally a <I% 8 urden to Disabled P ublic 1�% P rograms C hildrf amity 97 cents A ssistance 5%Health t #tee Ilk 5/do Total State Budget $10,599 M Education ♦ Substance Abuse $ 1,372 M 21 r Medicaid $ 839 M ♦ Transportation $ 1,071 M ♦ Higher Education $ 928 M Population 5.4 M "Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$141,276,000;$26.16 per capita. -56- Montan Summary of State Spending on Substance Abuse (1998)* f .9 ffA cted E!j ratm $1,31 8 054.5 $247503.7 ;. 14.9 $281.67 Justice 90,789.0 70,208.3 . ..... . 4.2 79.90 Adult Corrections 68,93.0 55,342.9 . Juvenile Justice 18 437.0 12,030.6 65.3 Judici 3,409.0 2,831.9 83,2 : :: ..... Education lernenta 1Seconda 467 456.0 44,#23.6 9.6 2.7 51.01 Health 83 339.0 2003.6 24.8 1.2 1 23.52 Child/Family Assistance 47 354,{3 22 186 b1.3 25.25 Child Welfare 26,295.(3 18,147.1 69.0 Income Assistance 21,059.0 4,038.9 19.2 ....... Mental Heafth/Developmentally Disabled 202 0340.0 68 657.2 .: 4.1 78.13 Mental Health 125,549.0 62,569.3 4948 Develo mentall Disabled 76,491.0 6,088.0 8:0 Public Safety 31947.0 19,P3.4 62.1 1.2 22.57 State Workforce 395 129.5 1,131.6 0.3 0.1 1.29 Re c;fla i trli 'tt lirxnce: 1100.0 1,1010 100 0 0.1 1.25 Licensing and Control 366.0 366.0 .. . . .. ` Collection of Taxes 734.0 734.0 Prevention, Treatment and Research: 7,214.0 72140 100..0 0.4 8.21 Prevention 2.0 2.0 Treatment 7,212.0 7,212 0 -- Research 0 0 Teat $255 817 7 15.4 $291.13 The Substance Abuse Dollar Treatment Regulation/ Scents Compliance Prevention <larsnt <1 cent Shouldering the Burden of Substance Abuse PublicSafety state44oMorce B urden to P ublic kfieafth ustice Programs M ental Health! 97 cents Dev elnpmenta"y Disabled �8SYs Total State Budget $1,665 M Education s Substance Abuse $ 256 M cl,ildam�ly taxa ♦ Medicaid $ 115 M assistance ♦ Transportation $ 175 M + Higher Education $ 227 M Papulation .879 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$33,287,000;$37.#17 per capita. -57- Nebraska Summary of State Spending on Substance Abuse (1998)* Atnf� nexts lrat 3� :.. . .... 4.: .. ..,,: ::dud . ..:.....:.. A ected Pro rams: $1 967,751.16 $264,665.4 7.4 $159.82 Justice 87 314.0 66M0.8 1.9 40.12 Adult Corrections 73,451.0 57,624.6 79.5 .. Juvenile Justice 14,063.0 8,816.1 62.7 Judici NA NA NA Education lementa /Secunda 594 625.0 51 37.4 8.7 L5 31.12 Health 308145.0 72,813.4 23.6 2.1 43.97 Child/FamilyAssistance 64 297.0 35,612.1 1.0 21.50 Child Welfare 51,489.0 34,284.9 66.6 Income Assistance 12,808.0 1,327.2 10.4 Mental Health/Developmentally Health/DevelopmentallyDisabled 112 833.0 29,925.80.8.. ..... ........ 18.07 Mental Health 53,286.0 25,076.4 47.1 Develo mentall Disabled 59,547.0 4,849.4 8.1 Public Safety___ 23 053.0 6,343.6 27.5 0.2 3.83 State Workforce 777 4.6 1,992.5 0.3 0.1 1.20 Re i'xtatianlCam fiance: 17,492.0 17,492.0 100..0 0.5 10.56 Licensj!j&and Control 720.0 720.0 ... Collection of Taxes 16,772.0 16,772.0 Prevention, Treatment and Research: 8,945.7 8,945.7 100.0 0.3 540 Prevention NA NA Treatment 8,945.7 8,945.7 Research 0 0 ::....: fic+fal $291,103.1 8.2 $175.78 The Substance Abuse Dollar Treatment Regulation/ Scents Compliance cents Shouldering the Burden of Substance Abuse MentafHealth/ Public Safety StateWorttforce Bur3ento Developmentally P ublic Dis abled Programs 13eJa Justice 25%e 91 cents Childamif� Assistance 13y„ Total State Budget $3,560 M Health Education a Substance Abuse $ .291 M 29% ice° Medicaid $ 273 M t Transportation $ 435 M ♦ Higher Education $1,038 M Population 1.7 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$63,981,000;$37.64 per capita. -58- __ _.__. Nevada Summary of State Spending can Substance Abuse (1998)* * 1& >� AbijL 4010 : . ....... ... .. ected fro ants. $146287 3.6 $466 8013 9. $28. 9 Justice 235 817.2 1974958 3.8 117.87 Adult Corrections 218 2457 184 866.0 $4.7 Juvenile Justice 17571..5 12,629.8 71.9 JudiciaryNA NA IIIA Education jglemertta iSeconda 579 91.0 73 070.2 12.6 1.4 43.61 Health 4264983 117 87?ft 27 6 2.3 70.35 Child/FamilyAssistance 600037 26 010-1 0.5 15.88 Child Welfare 25,734.1 19,350.4 75.2 Income Assistance 34,269.6 7,259.6 21.2 Mental Health/Developmentally Health/DevelopmentallyDisabled 96 682.2 4051816 0.8 ....;...... Mental Health 64,442.8 37,045.1 57.5 Developmentally Disabled 32,239.4 3,473.5 10.8 Prublic Safet 426332 11 144.1 26.1 0.2 6.65 State Workforce 21 948.1 85.46 0.4 X0.01 0.05 Reulatic,nlCom liais e. 198.f! 198.0 144:,4 <0.of Il 12 Licensing and Control NA NA Collection of Taxes 198.0 198 0 Frt�ventinn, Treatment and Research; 6,046.2 60442 14th.t1 4.1 3.61 Prevention 158.4 158.0 77? 7777777= Treatment 5,8881 5 888.2 Research 0 0 .:.. Total 32 The Substance Abuse Dollar Prevention Treatment Regulation/ E <1 cent ca»i 'Compliance <1 cent Shouldering the Burden of Surdento Substance Abuse Pubfic MentalHealfh/ Pr.Wc Safety Stateworkforce Programs Developmentally 29'c <iq� 99eents Disabled 9% Cht7drfarnily Justice Assistance 42% 67, Total State Budget $5,195 M Substance Abuse f� afth $ 473 M 25% s Medicaid $ NAM Education Transportation $ NA M 169:0 Higher Education $ NAM Population 1.7 M Numbers may not add due to rounding. Tobacco and alcoliol tax revenue total$81,564,000;$47.98 per capita. -59- ....... ......... ......... ......._. _.. ... ......... ......... ......... _ New Jersey Summary of State Spending on Substance Abuse (1998) Wbdia, 'd ' . . . .. :. A ected Pro rams: $9,137,291.0 $1,970,079.73 10.1 $24465 Justice 995 18.0 764160.2 3.9 94.88 Adult Corrections 783,072.0 613,878.6 E744.1 ..:''. .. <i... Juvenile Justice 61,546.0 38,532.7 ., Judiciary150,900.0 111,749.0 Education lementa ISeconda 1340 000.0 115 768.1 0.6 14.37 Health 1 785 409.0 447 468.1 25.1 2.3 55.56 Child/Family Assistance 725 820.0 322 701.5 1.7 40.07 Child Welfare 418,903.0 278,606.5 66.5 Income Assistance 306,917.0 U,095.0 14.4 .. . . ........... . . Mental Health/Developmentally Health/DevelopmentallyDisabled 957 520.0 272 320.2 . 1.4 33.81 Mental Health 504,941.0 273,183.2 47.0 . . ,. Developmentally Disabled 452,579.0 35,137.0 7.9 Public Safet 133 024.0 39,897.1 30.0 0.2 4.95 State Workforce 3 200 000.0 8,174.0 0.3 <0.01 1.01 Re ulatonlCotrt liance: 10068.0 10,068.0 100.0 0.:1 1.25 Licensjn&and Control 10,068.0 10,068.0 Collection of Takes NA NA Prevention Treatment and Research: 49,704.0 49,704.0 100.01 0.3 6.17 Prevention 18,136.0 18,136.0 '. Treatment 31,568.0 31,568.0 Research 0 0 ?"otal $2 030,261.1 10:4 $252.08 The Substance Abuse Dollar Prevention Treatment Regulation/ 1 cent 2cents Compliance <I cent Shouldering the Burden of Substance Abuse MentalHealth/ Public Safety State Workforce Burdento Developmentallyo P ubtic Disabled P rograms 14% S ustice 57 cents C hildf arnsly % Assistance 16%'0 Total State Budget $19,577 M ♦ Substance Abuse $ 2,030 M Health education t Medicaid $ 2,792 M 23% 6% Transportation $ 1,266 M ♦ Higher Education $ 1,951 M Population 8 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$419,388,000;$52.42 per capita. -60- _.... ..........._.... ...... ........ _.. . .._._... _. .................. _.. ............ New Mexico SUMMary of State Spending on Substance Abuse (1998)* � � :. . A&Sleds rams. $2l44 849 4 $455 955 8 9.7 $264.64 Justice 206 135.0 160,382.6 3.4 93.09 Adult Corrections 159 672.4 129 505.31 1 Juvenile Justice 46,463.0 30,877.3 66.5 Judici NA NA NA Education lemen# 1Secondar 1 405 000.0 141 .1 10.1 3.0 82.06 Huth 26W921.0 12,982.9 27.0 1.6 42.36 Child/FamilyCiAssistance 81996.0 43,223.3 0.9 25.09 Child Welfare -. 53,428.0 37,477.7- 70.1 Income Assistance 28,568.0 5,745 5 -20.1 Mental Health/Devele_pmentally Disabled 108 72.0 30 130 3 Mental Health 0.6 17.52 51,548.0 26,379.3 51.2 _ Develoomentally Disabled 57,024.0 3,811.0 6.7 Public$afet � :. 33 225.0 7 792.7 2;3.5 0.2 4.52 StateWorkfnrce NA NA NA NA NA Re ulaticrn/Cotn Bunce.: 574,4 574.4 100 0 &0,,01 0 33 Licens' and Control 574.0 570.0 Collection of Taxes NA NA Prevention, Treatment and Research: Il,445.11 11 !145.4, 144.0 0.2 6:39 Prevention OTO- 77777=150 0 Treatment 10,855.4 1(1,855.0 Research 0 .:..: Total $467,534 s Its $271.36 The Substance Abuse Dollar Treatment Regulatianf Prevention 2cents Compliance <lcent ``,L cicent Shouldering the Burden of Substance Abuse BNlentalHealth/ Public Safety P oPubli td Developmentallg grra' Disabled 2° grns 7�6 .IUStICe 98 cents C hill f amity 35% A ssistance Total State Budget $4,683 M He al , 26% a Substance Abuse $ .468 M - Education Medicaid $ 297 M 31% Transportation $ 374 M Fbgher Education $1,050 M Population 1.7 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$64,319,000;$37.83 per capita. -61- ....... ......... ......... ......... ......... ......... ......_.. New York Summary of State Spending on Substance Abuse (1998)* s di a tts , Ttattttt #+; # trtt Ca3i SW 5t:: X. {� t1 . Affected Pro rums: $36 833,718 2 $8,149,194.3 16.9 $449.16 Justice 3 84 661.2 3 084 682.0 6.4 174.02 Adult Corrections 3,162,080.0 2,484.870.3 79.6 Juvenile Justice 272,639.2 171,414.4 62.9 Judiciag 549,942.0 428 401.4 77.9 _. . . :_ . . Education(ElementarylSecondIry21434108.0 1,870,884.6 8.7 39 143.12 Health 0,430,555.0 1 646 425.4 25.6 3.4 90.72 Child/Family Assistance 2690 759.0 728 467.6 . ..:.::.....:: .. 1.5 40.15 Child Welfare 717,759.0 479,165.1 66.8 Income Assistance 1,973,000.0 249,302.4 12.6 Mental HealthlDevelo �nentall 'Disabled 1,595,428.0 564 031,7 11 34.87 Mental Health 1,119,354.4 528,922.9 473 ;:.:..... Developmentally Disabled 476,474:4 31 108.8 6.5 PublicSafety 698 207.0 259 143.0 37.1 0.5 14.28 State'Workforce NA NA NA NA NA Re ulationJCo lice: 20,245.0 20,245.0 100.0 <0.01 1.12 Licensing and Control 13,535.4 13,535.0 Collection of Taxes 6,710.0 6,710.0 Prevention, Treatment and Research: 503 815.0 503,815.0 100.0 1.0 2777 Prevention 23,896.0 23 896.0 Treatment 479,919.0 479,919.0 Research 0 fl Total $8,673254.3 18.0? $478.04 The Substance Abuse Dollar Treatment Regulation! 6cents -Compliance P rev ention <I cent <1 cent Shouldering the Burden of Substance Abuse Mental Health/ Pmblic Safety Developmentallye urcienta Disabled Public 7 0 Programs t' Justice tCefitS l"N{dl1•"a..^�s 38% A ssistance 9% Total State Budget $48,243 M Health t Substance Abuse $ 8,673 M 20% Elation a ♦ Medicaid $10,479 M ♦ Transportation $ 2,355 M ♦ Higher Education $ 4,300 M Population 18.1 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$885,593,004; $48.93 per capita. -62- Forth Dakota Summary of Mate Spending on Substance Abuse (1998)* Aat � tu1a Affected Pre rams $1,058,2260 $88879 ...:: 7. $138.67 Justice 21 26.0 16,555.2 :.. .... 1.4 25.83 Adult Corrections 15,931.0 12;953.8 81.3 Juvenile Justice 5,395.fl 3,601.4 66.8 :: Judiciary NA NA -N4 Education(Elementag/Second!g) 291.275.0 29 666.8 10.2 2.4 46.29 Health 65 285.0 15 26.4 23.3 1.3 23.76 Child/Family Assistance 15 311.0 8,097.8 0..7 12.63 Child Welfare 9,951.0 7,009.2 70.4 .,.:..... :... ::: Income Assistance 5,3%0 1,689.6 20.3 .....::::.... . Mental Health/Develn mentall Disabled 56 03.0 16 684.2 < ., ..::...... 1.4 26.03 Mental Health 27 169.0 13 994.7 51.5 . .:::.::.. ......,... DevelopmentalDevelopmontalt Disabled 29 334.0 2;689.:5 9.2 Pubfic Safe 1,286.0 789..9 61.4 0.1 1.23 State Workforce 607 240.0 1,859.2 0.3 0.2 2.90 Re ulationlCon> Bance: 78.0 78:0 100.0: <0.01 0.12 Licensing and Control39.0 391? :.: .....::...::.:... Collection of Taxes 39.0 39.0 Prevention, Treatment and Research. 10,1. 1.0 10121..0 100.0 0.8 1S'.79 Prevention 493.0 4910 Treatment 9,628.0 9,628.0 Research 0 0 Total $99,078.4 8.1 $154.58 The Substance Abuse dollar Treatrnent regulation! 10 cents .-con*iance Prevention 'I cent Shouldering the Burden of 1 cent "- Substance Abuse Public Safety' StateWorklnrce M ental Health/ 2% , Burden to Devetopmentahy Justice P ublic bisabfed � Programs 19 fa 90cents 0 hilciF amily A ssistance Education Total State Budget $1,219M r>,ah a + Substance Abuse $ .99 M + Medicaid $ 97M + Transportation $ 124 M + Higher Education $ 235 M Population .641 M Numbers may not add clue to rounding. Tobacco and alcohol tax revenue total$29,822,100;$46.52 per capita. -63- _ ... Ohio ......... ......... ......... ... ......... ......... ......... ...... Ohio Summary of State Spending on Substance Abuse (1998)* :. endi:: ,u :. .. ....::... OWN ....:..: .:: .::.. ..: ...... ::: :....:. . Affected Programs: $11,607,1260 $2 903,902.7 10.2 $258.99 Justice 11700,233.0 1293184.4 4.5 115.33 ....... .....: Adult Corrections 1,470,079.0 1,149,682.9 782 Juvenile Justice 230,154.0 143,497.5 62 3 Judiciary NA NA NA Education lernent /Secantla 495?865.0 424 017.6 8.6 1.5 37.82 Health 2,M,181.0 593 891.7 24.9 2.1 52,97 Child/Family Assistance 783 167.0 134 027.9 0.5 11.45 Child Welfare NA NA NA ,:.:...`'. Income Assistance 783,167.0 134 027.9 17 1 ....:. Mental Health/Develo Ilnentall' Disabled 1 55? 33.0 423 268.6 1.5 37.75 Mental Health 792,999.0 370,305.0 46.7 DevelopMentally Disabled 764,934.0 52,963.5 6.9 Public Safety 158 647.0 35 44.6 22.3 0.1 3.15 State'Workfnme 68 040.0 171.9 0.3 <0.01 0.02 Rg-d ZatiarrlCv Bance: 5162.0 5,162.0 100.0 <0.01 0.46 Licensing and Control 3,762.0 3,762.0 .... . .:...... .. Collection of Taxes 1,400.0 1,400.0 Nevent`ion, Treatment and Research: 41,943.0 41,943.0 100.0 0.2 3.74 Prevention 7,594.0 7,594.0 :..... Treatment 34,349.0 34,349.0 Research 0 0 ..:::>.. ...:.. ... .......: Total $2,951,0117.7 I0.4 $263.19 The Substance Abuse Dollar Prevention Treatment Regulation/ <1 cent 1 cent Compliance <1 cent Shouldering the Burden of Substance Abuse MentalHaattfV PUWieSatety StateWorkforce Developmental Disabled B urden to 1 W, P ublic C hildf armyJustice Programs Assistance 44% 99 cents lation- Total 2WE State Budget $28,518 M ls% ♦ Substance Abuse $ 2,951 M Medicaid $ 5,720 M a Transportation $ 2,022 M r Higher Education $ 2,211 M Population 11.2 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$401,742,000;$35.87 per capita. -64- Oklahoma Summary of State Spending on Substance Abuse (1998)* ! ectedll rams: $4 7380.1 $667,485.8 1110 $.241.40 Justice 441231.0 326 384.2 ..... .. ....... 4.9 98.45 Adult Corrections 341,186.0 261,892.6 76.8 Juvenile Justice 71,295.0 43,050.3 60.4 Judiciaq 28,750.0 21,437.4 74.6 Education lementa /Seconds 1613 792.0 12? 07.8 7.91 1.9 38.59 Health 372 08.0 86 658.9 23.2 1.3 216.15 Child/Faily Assistance 163 498.4 49 405.7 0.7 14.91 Child Welfare 59,8 38,559.1 64.4 Income Assistance 103,609.0 10,84b.5 10 5 . Mental Realth/Developmentally Health/DevelopmentallyDisabled 237039.0 68 873.9 1.0 24.78 Mental Health 137,791.0 61,510.€1 44.6 : Developmentally Disabled 99 248.0 7,364.0 7.4 Public Safety 39 59.0 5,352.9 13.6 0.1 1.62 State Workforce 1 249 652.7 2,946.4 0.2 <0.01 0.88 Re ulationJI o� fiance: 3 6.22.0 3,622.0 10110 0.1 1.09 Licensing and Control 3,622.0 3,622.0 Collection of Takes NA NA :Prevention Treatment and Research: 34 381.7 34,381.7- 000 01 115 10.37 Prevention 5,882.45,852.4 Treatment 28,007.3 28,007.3 Research 492.0 492.0 .. ....::: . Total $705 48x1.51115 $212.86 The Substance Abuse Dollar Treatment Regulation/ 4cents Compliance Prevention I cent 1 cent Shouldering the Burden of Substance Abuse Mental Health/ PublicSatety Statewomorce Burdento Developmentally 19ro Iq P ublic Disabled � P rograms ° 94 cents Childlrarnity A ssistance Justice 7% 50gn Health Total State Budget $6,709 M 139„ a Substance Abuse $ .705 M Education Medicaid $ 488 M ♦ Transportation $ 609 M ♦ Higher Education $1,274 M Population 3.3 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$139,992,000;$42.42 per capita: -65- ......... ......... ......... ......... ._....... _ Oregon Summary of State Spending on Substance Abuse (1998)* s ndti � � tailsc stud , 1 A Pix sp- Cal >4a... . Affected I'ro rams: $5,034,874.0 U23,131.9 . ;, 8.2 $2�, Justice 524 927.0 419 085 6 :. 4.2 1 Adult Corrections 465,300.4 379,134.0 81.5 ? Juvenile Justice 59,627.0 39,951.6 67.0 Judiciary NA NA NA Educationlementa /Seconds 2 112,110.0 21?295.1 10.3 2.2 Health 347 495.0 78098.2 22.5 0.8 Child/Family Assistance 142,508.0 62 615 3 0.6 Child Welfare 66 574.0 47,040.8 70.7 ... Income Assistance 75,934.0 15,574.4 20.5 ....,.::. .....:..... . .::..:. Mental Health/Developmentally Health/DevelopmentallyDisabled 342 43.0 29,947.9 0.3 Mental Health 906.0 469.2 51.8 bevelo _pmentaUy Disabled 341,637.0 29,478.7 &.6 Public Sgfeq 43,177.0 11 377.3 26.4 0.1 State Workforce 19522)114.0 4 712.5 0.3 0.1 Re urat on1Com Bunce: -1,592.0 1,592.0 100.0 <0,01 Liqqijst:ng and Control 1,592.0 1,592.0 Collection of Taxes NA NA Prevention, Treatment and Research: 77,71X.0 77,711.0 100.0 0.8 Prevention 77,485.0 77,486.0 Treatment. 225.0 225.0 Research 0 0 Total $902,434.9 9.0 $2: The Substance Abuse dollar Treatment Regulation/ Prevention <1cent Compliance 9 cents �" <I cent Shouldering the Burden of Substance Abuse No M ental Health/ Public Safety State W o rkfo rce 6urdento Developmentally 1% Iqo Public disabled Programs 49a 91 cents Chid/Family A ssistance SAO Justice i Health 511Yn Total State Budget $10,010 M 9T. r + Substance Abuse $ 902 M Education + Medicaid $ 656 M 2691. + Transportation $ 538 M + Higher Education $ 1,234 M Population 3.2 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$217,554,000;$67.99 per capita. -66- Pennsylvania Summary of State Spending on Substance Abuse (1998)* 90 ' ultaul t8te Ar#itkttf6ant €a ff Affected Pro ,rams: $16 160519.8 $3,402,243.5 14.0 $283.15 .Justice 1,430,114.0 1140,059.8 4.7 94.88 Adult Corrections ,1 143,035.0 93$485.5 82 1 Juvenile Justice 86,308.0 58,621.2 67.9 IuAdary 200,771.0 142 953.1 71.2 , Education lementa /Seconds 5,885.49&0 628 613.5 10.7 2.6 52.32 Health 2,85 888.0 721,788.2 25.3 3.0 60.07 Child/Family Assistance 1,183,457-0 428 058.9 .... ..:......... 1.8 35.67 Child Welfare 400,801.0 286,650.4 71.5 Income Assistance 782,651.0 142,008.3 18.1 < . :. ... Mental Health/Developmentally Disabled 1,341,381.0 379 77.6 1,6 31.57 Mental Health 570,460.0 301,3917 52.8 ..:<;..... Develgmentally Disabled 770,921.0 77,984.9 10.1 Public Safety 321,259;0 932591.0 29.1 0.4 7.79 State Workforrme 3,145,927.9 10,154.7 0.3 <€1.01 0.85 Rg ulution1Cnm I*ee: 1,873.5 1,873.5 100.0 e0 01 0.16 Licensing and Control 2203 220.5 Collection of Taxes 1,653.0 1,653.0 :. Prevention, Treatment and Research: 102,19Z 3 102,192.3 100.0 0.4 8.50 Prevention 16,564.0 16,564.0 Treatment 85,628.3 85,628.3 ; . ... .::.. _.:.::.. Research 0 0 Total $3,506,309.3 14.5 X291.81 The Substance Abuse Dollar Treatment Regulation/ Prevention 2cents Compliance <I cent <1 cent Shouldering the Burden of Substance Abase Public Safety state Workforce 8uniento MentalHealt#t/ 390 >'' •c qa P ublic Developmentally PMRrms [Disabled Justice 9$cants i1% `fo Childk amily A ssistance. . Total State Budget $24,237 M 13% Substance Abuse $ 3,506 M Health Education * Medicaid $ 4,2891x1 21% 18y, Transportation $ 2,6961x1 ♦ higher Education S 1,686 M Population 12.0 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$508,445,000,$42.37 per capita.. -67- Puerto Rico Summary of State Spending on Substance Abuse (1998)* Ptec � � � Aff ected Pro rams: $7,980 9 4.0 $872,996.3 0 $2 Justice 600 030.0 499 896 5 3.4 1 Adult Corrections 4.17,406.0 360,105.3 86.3 Juvenile Justice 148,497.0 11.0,422.4 74.4 Judiciary 34,127.0 29,36$.8 Education lementa /Seconds 1,379,981.0 194 219.6 14,1 1.3 Health 167 000.0 40 700.87 24.4 0.3 Child/Family Assistance 41 197.0 14,461.9 0.1 C ld Welfare 6,663.0 5,162.2 77.5 Income Assistance 34,534.0 9,299.7 26.9 1 LL Mental Health/Developmentally Disabled 72 888.0 27.598.7 0.2 Mental Health 35,649.0 21,582.4 60.5 Uevelo_gmentally Disabled 37,239.0 6,016.2 16.2 :::. 77 .:.. Public Safety 279 426.0 72 093.0 25.8 0.5 State Workforce 5,440,452.0 24 025.8 0.4 0.2 Re ulation/Ca Dance: NA NSI NA NA Licensing and Control NA NA Collection of Takes NA NA Prevention, Treatnwnt and Research: 25,920.0 25,920.0 100.0 0.2 Prevention 13,268.0 13,268.0 Treatment 11,040.0 11,040.0 Research 1,612.0 1612.0 Total $898,916-3 The Substance Abuse dollar Prevention Treatment I cent I cent Shouldering the Burden of Substance Abuse MentalHealth/ Public Safety StateWorktorce Burdento Developmentally $fin 391, Public Disabled Programs 3% 98 cents C hOdfamiy A ssistance O Health ,i',II � Justice Total State Budget $14,624 M 57% Substance Abuse'' $ 899 M Education ♦ Medicaid $ 167 M 22% t Transportation $ 1,275 M ♦ Higber Education $ 771 M Population 3.8 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$NA;$NA per capita. -68- ... ......... ..._.._. . _.... . ._. . Rhode Island Summer of State Spending on Substance Abuse (1998)* iu V low K Affected Pro rans: $218134X.tI $294 23(!.4 :.,.. X1.302.16 Justice 158 036.0 12$653.9 4.9 130.35 Adult Corrections 128 000.0 106,807:0 83.41 Juvenile Justice 24,386.0 17,053.5 69.9 Judiciary 5,650.0 4,793.4 84.8_, Education lementa /secunda 521044.0 60 441.0 11.6 2,3 61.24 Health 249A4.0 67 02.0 26.9 2.61 68.19 Child/Family Assistance 78 14.0 13 907.9 0.5 14.09 Child Welfare 276.0 202.6 73.4: Income Assistance 78 638.0 13,705.4 17 4 ...:...........:.:. .:.: Mental Heatth/Devetopmentally Disabled 104 188.0 21443.3 0.8 : 21.73 Mental Health 24,692.0 13,621.4 .Developmentally Disabled 79,496.0 7,822,4 PublieSafety 10 669.0 2 730.1 25,6 0.1 2.77 State Workforce 1,058,586.0 3 752.2 0.4 0.1 3.80 Re ulationlCnnn licence: 463.0 463.0 100.0 <0,01 047 Licensing and Control 97.0 97.0 Collection of Taxes 366:0 366.0 Prevent on, Treatment and Research: 728.0 728.0 10010 <AOI 074 Prevention NA NA Treatment 728.0728.0 : - . :. Research 0 0 Total $299.421.4 ..;: 11.3 $303.37 The Substance Abuse Dollar Treatment Regulation/ <i cent Compliance <I cent Shouldering the Burden of Substance Abuse MentalKeatth/ PublicSafely t3urdento Developmordany IcJb P ublic Dis anted State W a rkto rce P rograms I $1.(7tt C hikW amity A ssistance Sc�a Justice `Wc Health Total State Budget $2,643 M 23�a ♦ Substance Abuse $ 299 M Medicaid $ 535 M Education * Transportation $ 85M ° s Higher Education $ 390M Population .987 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$71,850,000; $72.80 per capita. -69- ......... ......... ......... ......... ..._................... ...................................... ....... South Carolina Summary of State Spending on Substance Abuse (1998)* .�te� s�Epetlr Atr � � v .:..: . : WOO Affected ft rams: $5,556,243.5 $597,474 4 6.6 1S Justice 199 901.0 154.711.5 .; . .... : .:...> 1.7 Adult Corrections 82,252.0 69,360.0 84.3 Juvenile Justice 94,973.0 67,703.8 71.3 Judiciary21776.0 17,647.7 $1.0 , :. ... .. Education lementa /Smonda 1977 807.0 243 225.7 12.3 2.7 Health 387 797.0 96 875.2 25.0 1.1 Child/Family Assistance 134 519.0 55,598.8 0.6 Child Welfare 52,512.0 39,199.8 74.6 Income Assistance 82 007.0 16,399.0 20.0 Mental Heatth/Deveio mentall Disabled 42 356.4 23,053.0 0.3 Mental Health 40,178.0 22,811.3 56.8 Developmentally Disabled 2,178.0 241.7 11.1 Public Sxfety 67,571-0 13 617.7 20.2 0.2 State Workfome 2747192.5 10 392.7 0.4 0.1 Re ulutivn/Co Bance: 343.0 303.0 100..0 <0.01 Licensing and Control NA NA `:..... . .... ..... _ ............. Collection of Taxes 303.0 303 0 Preuentinn, Treatment and Research: 1,562.0 1,562:#1 100.0 <0.01 Prevention 455.0 455.0 Treatment 1,107.0 1,107.0 Research 0 0 Total $599t339.46.6 The Substance Abuse Dollar P reventio n Regulation/ cY cent Treatment compliance <I cent <I cent Shouldering the Burden of Substance Abuse MentalHeaith/ PubNeSafety StateWorkforce Developmentally 2% 2s/g B urden to Disabled PublicJustice 26 Programs 4�C hiid/F amity �O $1.00 A ssistanc6 9% Health 16% Education Total State Budget $9,046 M 415r0 Substance Abuse $ 599M ♦ Medicaid $ 677 M Transportation $ 474 M ♦ Higher Education $2,118 M Population 3.7 M y Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$158,586,000;$42.86 per capita. -70- South Dakota Summary of State Spending on Substance Abuse (1998)* 1 Ae Affected R' o rams. $t�80 795.6` $123 216 :.;_ 10,6 $171,33 Justice 57516.0 46,021,63.9 62.97 Adult Corrections 32,992.0 27,149.2 82.3 ,... :., Juvenile Justice 11,693.0 7,974.3 69.2 .: ... ....-, Judiciary 12,831.0 113,898.1 84 9 Education lementa f5econda 265 045.7 28,631.2 10,8 2,4 39.17 Health 109 080.0 26 131.8 24.0 2.2 35.76 ChildlFarnil,y Assistance 11 395.0 4,790.5 0,4 6.55 Child Welfare 5,403.0 3,878.1 71 8 ...,::. .. ..: : . . Income Assistance 5,992.0 912.4 Mental Health/Developmentally Disabled 50 931.6 17 18.2 -; 1.5 23.70 Mental Health 27,549.2 14,642.2 53.1 :.: ....... DevelopmenWly Disabled 23,382.4 2,676.0 114 Public Safety 11 164.7 1,748.8 15.7 0,2 2,39 State Workforce 175 662,6 574.2 0.3 0.1 0.79 Re `idation/Carn trance: NA NA NA NA NA' Licenseand Cf�ntrol NA NA Collection of Taxes NA NA . Prevention, Treatment and Research: 3,768.6 3,768.6 I00.0 lJ 3 5,16 Prevention 256.7 256.7 :. ::......... s Treatment 3,511.9 3,511.9 :...::........:. ... ..: ::: Research 0 p Total $128Y985.0 :: 1 d 9 $176,49 The Substance Abuse Dollar P rev ention Treatment <3 cent 3 cents Shouldering the Barden of 5 Substance Abuse Mental t°teatthl Public Saf* State Workforce Burdento Devetopmentapy i% <1% P ublic disa6ted Programs 14% Justice 97 cents 3750 ChitdlFarnIN Assistance 4% Health Total State Budget $1,183 M 21% Hucation r Substance Abase $ 129 M s Medicaid $ 1121x1 a Transportation $ 138 M Higher Education $ 229 M Population .731 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$31,106,000;$42.55 per capita.. 71 Tennessee Summary of State Spending on Substance Abuse (1998) ..: .:: s � nx �� A ected 'ro stns: $4,643,339.9 $918,728 9 $17 Justice 452 406.0 343195.2 2 3.7 F Adult Corrections 364 604.0 282,911,9 77.6 EE Juvenile Justice 55,231.0 33,973.4 61.5 Judiciary32,571.0 26,309.9 80.8 _ Education (Elementary/Second 2,432,879.0 . 201 413.1 8.3 2.2 ; Health 1,147,977.0 240,390.4 20.9 2.6 c Child/Family Assistance 227 90.0 106 270.5 1.1 I Child Welfare 139,559.0 91,359.9 65.5 Income Assistance 88,331.0 14,910.6 16.9 . . Mental Health/Developmental! Disabled 71 632.0 16.787.1 0.2 Mental Health 29,721.0 13,616.4 45.8 , Developmentally Disabled 41,911.0 3,170.7 7:6 :... Public Safety 59 997.9 10061.3 16.8 0.1 State Workforce 250 58.0 611.0 0.2 <0.01 Re ulativn/Co Bance: 3,875.0 3,875.0 100.0 <4 01 Licensing and Control 2,959.0 2,9590 .:,. .. Collection of Takes 916.0 9160 Prwendon Treatment and Research: 8,929.0 8,929.0100.0 41 Prevention 2,786.0 2,786.0 Treatment 6,000.0 6,000.0 ..:: :`, ............ ...::...° Research 143.0 43.0 .'...< . ..... Total $931, 141! 1 i The Substance Abuse Dollar Treatment Regutation/ Prevention I cent Compliance <I cent c I cent Shouldering the Burden of Substance Abuse Mental t-04h/ Public Safatymate Workforce Burdentc [3evekrpmentaity 1% c 19+0 P L"ie Disabled f Programs 2% 99 cents Chiki/Famity Justice Assistance 37% 12% Total State Budget $9,310 M Health Substance Abuse $ 932 M 213% Education + Medicaid $1,204 M 22% Transportation $ 633 M Higher Education $1,610 M Population 5.4 M Numbers may not add clue to rounding. Tobacco and alcohol tax revenue total$158,329,000,$29.32 per capita. -72- Utah Summary of State Spending on Substance Abuse (1998) -------------- Ott~ AtlllE31 1a 6. A acted l'ro rtttrts $2,986,596.0 $489,759.9 1.1.4 $23713 Justice 262 25.0 202108.1: 4,7 97.85 Adult Corrections 212,947.0 170,129..9 79.9 Juvenile Justice 48,905.0 31,646.3 64*7 , Judiciary 473.0 331.9 70.2 Education lementa /Seconda 1,332,294.0 125 024.3 9.4 2.9 64.53 Health 682152.0 129 528.8 19.01 3.0 62.71 Child/Family Assistance 23970.0 4,502.8 0.1 2.18 ChildWelfare NA NA NA ::. ... .:......... Income Assistance 23,970.0 4,502.8 18.8 Menten Health/Develypmentally Health/DevelopmentallyDisabled 831 26 11.6 ;., 0.6 13.03 Mental Health 48,436.0 23,850.29 49.2 DevelopmentallyDevelgpmentally Disabled 35,137.0 3,061.4 87 :...:> Pulblie Safety NA NA NA NA NA State Workforce 602,U0.0 1,684.4 0.3 <0.01 0.82 Re ulationlCo fiance. 60.0 60.0 100.0 <0.01 0.03 Licensing and Control NA NA ........... . .. Collection of Taxes 60.0 60.0 Prevention, Treatment and Research: 10,103.0 101 03:0 100.0 0.2 4.89 Prevention 2,134.0 2,134.0 :... Treatment 7,969.0 7,969.11 Research 0 0 Total $499 922.9 Z I.7 $242-05 The Substance Abuse Dollar Treatment Regulation/ Prevention 2cents _--Compliance <1 cent <1 cent Shouldering the Burden of Substance Abuse M ental Heafth/ Developryxmtahy State Workto rce Burdento Disabled - - - -� c9c Public -- P mmgrarns C hildf amity 98 cents J ustice Assistance Sistanca 42 1q a a Health Total State gadget $4,293 M 2691, ♦ Substance Abuse $ 500 M Education 4 Medicaid $ 189 M ze�go a Transportation $ 443 M ♦ Higher Education S 643 M Population 2.1 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$65,732,000,$31.30 per capita. -73- _...._.. ......... ............ .... _...... ......... _ Vermont Summary of State Spending on Substance Abuse (1998)* s pktk ::: a ....... A ected Pro rams: $860,366.1 $130 342 7 11.9 $2.2 Justice 54 158.0 434t8:-3 4.0 Adult Corrections 42,957.0 34,971.4 81.4 Juvenile Justice 1,851.0 1,238.3 66.9 1- Judiciary 9,350.0 7,168.7 76.7 Educationlementa /Secunda 231 734.0 23 739.5 10.2 12 Health 110 836.4 _27,131.9 24.5 2.5 Child/Family Assistance 5898 .3 18,3136.4 1.7 Child Welfare 16,607.3 11,718.3 70.6 imome Assistance 42,382.0 6,668.0 15:7 : . .. Mental Health/Developmentally Disabled 42 994.5 12,041.0 .: Mental Health 18,832.0 9,730.7 51.7 Dev6ppmentally Disabled 24,162.5 2,310.3 9.6 PublicSafet 25 756.9 4,6 0.5 18.0 0.4 State Workforce 335 901.0 1,035.1 0.3 0.1 R uIafton�Co fiance: 1468.4 1,468.0 100.0 0.1 Licensing and Control 1,277.0 1,277.0 . Collection of Taxes 191.0 191.0 Prevention, Treatment and Research: 3,024..0 3,024.0 100.0 0.3 Prevention 603.0 603.0 Treatment 2,158.0 Research 263.0 263.0 Total $134,834.7 :..... 12.3 $2. The Substance Abuse Dollar Treatment Regulation/ Prevention 2cents <I cant -Compliance I cent Shouldering the Burden of Substance Abuse Burdertto MentaYHealifi/ PuNicSafsty State Workforce P uplic Developmentally P rograms Dis awed Justice 97 cents 9% 337, Child/Family A ssistance Total State Budget $1,098 M 14T, + Substance Abuse $ 135 M + Medicaid $ 151 M Health Education 21�d + Transportation $ 105 M + Higher Education $ 56M Population .589 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$27,974,000,$47.49 per capita. -74- ....... .... ............. . ...... _.._ _.... .._.... ..............................................................................................................................................................................................................................................................................................................._.____.. Virginia Summary of State Spending on Substance Abuse (1998)* t � ...... f ,Affected Pra rams: $11,x63,129.9 $1,758,501.10 :.I 11.5' $261.18 Justice 1,170,121.1 879 864.5 :......._.. 5.8 130.68 Adult Corrections 703 376.8 547,418.2 -77.8 : Juvenile Justice 212 362.1 131,301,8 !79.1 1 8 Judici 254 382.2 201 144.6 9k9 Education lementa lSecondat 2 89 766.1 242 707.2 8.4 1.6 36.05 Health 1,163,264.0 264 988.8 22.8 1.7 39.36 ChildNamily Assistance 153 660.6 37462.8 _._: 0.2 5.56 Child Welfare 29 140.0 19,164.4 65,8 Income Assistance 124,520.6 18,298.5 147 : Mental Health/Developmentally Health/DevelopmentallyDisabled 754 397.7 243 69.2 1.6 36,18 Mental Health 475,262.8 219,324.7 46.1 Devel© entall pisabled 279,134.9 24 245.4 8 7 Pub&SaAdy 434311.5 78 808.8 18.1 0.5 11.71 State Workforce 4,491,608.9 11 100.2 0.2 0.1 1.65 Re utado!! CC !lance; 11,624.1 4624.1 100.0 a 1, 1.73' Liqq!*uig and Control 11 424.1 11,424:1 *:. Collection of Taxes 200.0 2000. ... ` Prevention Treatment and Research. 2q,248.1 28,248.1 100.0 0:.2 4.20,' Prevention 4,339.6 4,339.6 :...... Treatment 23,948.5 23,908.5 Research 0 0 Total $1,798,374.1 11.7 $26710 The Substance Abuse Dollar Treatment Regulation/ Prevention 1 cent Compliance <I cent I cent Shouldering the Burden of Substance Abuse Mer:talHealth/ Public Safety 5tatoworktorce 8urdento Developmentally 4% I o P ublic Disabled P rograrns 147, 98 cents C hIkW army Assistance .lustice. Health o Total State Budget $15,315 M Is`t`o + Substance Abuse $ 1,798 M Education + Medicaid $ 1,140 M 14q ♦ Transportation $ 2,117 M ♦ Higher Education $ 2,295 M Papulation 6.7 M Numbers may not acid due to rounding. Tobacco and alcohol tact revenue total$133,755,000;$19.96,per capita. -75- .............................................. .......................1.11,11,11.111.1...... ............. Washington Summary of State Spending on Substance Abuse (1998)* ................. .............. ........... ............... .. .. .. . .......... .......... . ........... . .... ...... Consequences: $6,782,43&8 $1387,146.7 10.0 $24. Justice 4852023.0 378,772.7 2.7 Adult Corrections 39I,000.0 316,506.5 80.9 Juvenile Justice 94,023.0 62,266.2 66.2 Judiciary NA NA NA Education(Elementand/Smondary) 425022000.0 448,832.7 10.0 3.2 Health .1,125,458.0 2732679.8 24.3 2.0 Child/Family Assistance 149,711.0 139 655.9 1.0 Child Welfare 199,711.0 139,655.9 69.9 Income Assistance NA NA NA Mental Health/Dev"o mentally Disabled 464,960.0 145,061.3 1.1 Mental Health 24,6,389-0 125,450.3 50.9 Developmentally Disabled 218,571.0 19,611.0 9. Public Safety ---5,286.8 1,144.3 21.6 <0.01 State Workforce NA NA NA NA ftylationlCo!nphance: 64,950.0 64,9 0.0 100.0 0.5 1, Licensing and Control 64950.0 64,950.0 Collection of Taxes NA NA Prevention, Treatment and Research: 57,198.0 57 198.0 100.0 0.4 1 Prevention 3,940.0 3,9400 t Treatment 53,258.0 53,258.0 Research 0 0 "7 $1509 294.7 10.91 $2t Total The Substance Abuse Dollar Treatment Regulation/ P rev antio,n 4cents Compliance <I cent 4cents Shouldering the Burden of Substance Abuse MentalHealth/ Public Safety Developmentally 1% INN-- Disabled 8 urden to P ublic 109r, Justice 277o W arrify Programs C h 92 cents A ssistance Health Total State Budget $13,874 M 2CKY* Education * Substance Abuse $ 1,509 M + Medicaid $ 1,464 M * Transportation $ 1,094 M * Higher Education $ 2,646 M Population 5.6 M Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$432,241,000;$77.19 per capita. -76- West Virginia Summary of Mate Spending on Substance Abuse (1998)* r n ` metednle tr Affected Pry ratm• $2,805,39Z 9 $324,566.6 .10.fl $1 X8.77 Justice 64186.0 51992.5 :.:........ 1.6 28.64 Adult Corrections 53 086.0 42947.4 80.7 .. Juvenile Justice 5,730.0 3,775.2 65,9 Judiciary5,37{1.0 5,370.0 100 0 Education (Elementary/Seconds 1,348 553;0 132 522.1, 9,8 4.1 73.05 Health 360 000.0 86 792.4 24.1 2.7 47.80 Child/Family Assistance 86 066.0 38 150.7 :: 1.2 21.01 Child Welfare 42,464.0 29,558.9 69.6 : .. .. :.:: Income Assistance 43,602.0 8,591.8 19 7 ... ....:..::......:: Mental HeWth/Develo mentall Disabled 12 941.5 3 350.? :-..,..,...r 0.1 1.85 Mental Health - 4,915.1 2,483.9 50.5 DevelopmentallyDevelopTgntally Disabled 9,026.4 866.8 10.8 ,:: EEE. )Public Safety 66 739.0 9 105.0 13.6 0.3 5.01 State Workforce $66 912.4 2,553.1 0.3 0.1 1.41 Re ulatinnlCcr like.: 6,439.0 6,439.0 100.0 02 3.55 Licensing and Control 6,439.0 6,439.0 Collection of Taxes NA NA Prevention Treatment and Research: 7,798.1 7,798.1 100.0< 0.2 4.311 Prevention NA NA .. Treatment 7L798.1 7,798.1 :.. : . . . Research 0 0 Total $33 803.7 10.5 $186 61' The Substance Abuse Dollar Treatment Regulation/ 2cents Compliance Shoulderingthe Burden of 2 cants Substance Abuse MentalHealthl PublicSaf elY I Now- Developmentally StataWorkiorce Disabled' ��D 1"x'0 B uiden to 1% Justice Public Childkarnity Programs A ssistance i 96cents 129r�, Health Total State Budget $3,229 M 27%, Education Substance Abuse $ 339 M `W° ♦ Medicaid $ 344 M + Transportation $ 501 M + Higher Education $ 792 M Population 1.8 M *Numbers may not add due to rounding. Tobacco and alcohol tax revenue total$50,942,000;$28.30 per capita. t West Virginia only reported judiciary spending for drug courts. -77- Wisconsin Summary of State Spending on SubstanceAbuse (1998)* 731)St L#.IMA....-w,.... Nixj N. Affected Pro rams. $9 313,252.0 $1,413,409.0 9:4 $27. Justice 684,453.0 557,996.0 .. ....::..... 3,7 1{ Adult Corrections 509,757.0 427,708.0 83.9 Juvenile Justice 109,625.0 77,435.5 70.6 Judiciary 65,071.0 52,852.5 81-2 Education lementa /Seconda 3,805,000.0 455 123.1 12.0 3.0 S Health 904 817.0 224 759.5 24.8 1.5 6 Child/Farnijly Assistance 421 705.0 102 b78 0 :: 0.7 Child Welfare 64,552.0 47,798.8 74.0 :.::..;. ........ Income Assistance 357 153.0 54 879.2 15.4 Mental Health/Develo mentall Disabled 215 244.0 46 005 5 0.3 Mental Health 50,395.0 28,220.7 56.4 Developmentally Disabled 164t 849.0 17,784.9 10.$ .;y . Public Safety 53 420.0 15 011.3 28.1 0.1 State Workforce 3228 613.0 11,835.6 0.4 0.1 Re ulation/Com Bance. 3.23.0 323.0 100.0 <0,01 Licensingand Control NA NA Collection of Taxes 323.0 323-0 Prevendon Treatment and Research. 7,834.0 7,834.0 100.0 0.1 Prevention 1,512.0 1,5110 Treatment 6,322.0 6,322.0 Research 0 0 :: .... ..:.: .......:...... Total $1,421,5660 The Substance Abuse Dollar Treatmerd Regulation/ Prevention entron <i cent Compliance - <I cent <I cent Shouldering the Burden of Substance Abuse Mental Health/ Public Safety State Workforce Developmentally 1 1 Burdento Disabled �a % Public 31YO P rograms C hiid/F amity $1•£30 A ssistance Justice 7%, 4070 Health 1610 Total State Budget $15,028 M Substance Abuse $ 1,422 M Education ♦ Medicaid $ 905 M 32% ♦ Transportation $ 1,200 M 14igher Education $ 2,268 M Population 5.2 M Numbers may not add clue to rounding. Tobacco and alcohol tax revenue total$299,480,00; $57.59 per capita. -78- Wyoming Summary of Mate Spending on Substance Abuse (1998)* st lt� & e pc d t� A i nt .M A ...::. ' � Alkqed Pry rams: $830,172.4 $111,296.0 7.5 $231.85' Justice 56154.0 43,531-3 2.9 90.68` Adult Corrections 32,127.0 26,121.9 81.3 Juvenile Justice 16,109.0 10,752.6 66,7 Judiciary 7,918.0 6,656.8 841 Education(Elementa 1Seconda 326 265.0 33 23.3 10.2 2.2 69.21 Health 79,228.0 181447.3 23.3 1.2 38,43 Child/Family Assistance 19697.0 8 959.5 0.6 18.66 Child Welfare 10,025.0 7,459.8 70.4 :, .._:;.. Income Assistance 9,672.0 1,899.8 19,6 ........ Mental 11ealth/Develo mentall Disabled 16 227.0 31411.5 . < : 0.2 7.11 Mental Health 4,629.0 2,384.1 51 5 Developmentally mentall Disabled 11,598.0 1,027.4 8.9 ....:.: Public Safety 12 83.0 2,743.5 21.8 0.2 5.72 State Workforce 3201118.4 979.6 0.3 : 0.1 2.04 1Ze ulczdonlr 'n tzarnce: 1,148-0 1,148.0 100.0 0.12.39' Licensin and Control NA NA ::;. .....,. ....:.. Collection of Taxes 1,148.4 1,1484 Prevention Treatment and.Research: 2,790.0 2,790.0 100.0 02 5.81' Prevention 379.0 379.4 : : :...::. Treatment 2,411.0 21411.0 Research 4 4 Total $115,234.0 : 7:8 $24006' The Substance Abuse Dollar Treatment Regutation/ Prevention 2cents Compliance r1 cent scent Shouldering the Burden of Substance Abuse memo 10-- tvtental Health/ Public safety Developmentalty 2% State'NorRforce Burden to Disabled P ublic 3% 1% Programs Child/Fan-0y 97cents Assistance Justice Health 177x, Total State Budget $1,486 M Education Substance Abuse $ 115 M o "" 4 Medicaid $ 56M Transportation $ 249 M ♦ Higher Education $ 172 M Population .480 M Numbers may not add due to rounding. Tobacco and alcohol tax revenues total$7,324,040; $15.26 per capita. -79- ......... ........ ... ......... r -80- ................................ 80- .......................................................................................................................................................... .............................. ....... ...... .... ... ............ ..... ...--- - .... _................................................................................................................................................................................................................. .................................................. Chapter V11 Moving from Spending to Investment AV , this report shows,substance abuse has an enormous and previously unacknowledged impact on the costs of state government. Many state policies in response to the problem of substance abuse,such as incarceration and foster care, impose staggering costs and fail to attend to the root problems. often state policies unintentionally increase the problem for filture generations. States can reduce their costs linked to abuse of alcohol,drugs and tobacco only by adopting strategies to prevent and eliminate,not just manage,the consequences of such abuse. Instead of accepting government spending to shovel up the wreckage of substance abuse as inevitable,states can make investments in cost- effective prevention a treatment to reduce the impact of such abuse. In the private,for-profit sector, no priority tops the search for profitable investment opportunities. Corporate CEOs look systematically stematically at various investment options and calculate their expected returns over a multi-year framework. Their goal is to secure investments with positive financial returns and,as the success of American business demonstrates, they often find such opportunities. While better investments in the area of substance abuse are essential,the concept of investment is a difficult one for state governments. Budget offices are willing to consider proposals offered up by state agencies as investments,but they are understandably skeptical when the return on investment comes in generalized social benefits instead of budgetary savings. If,for example, public higher education is considered to be a good investment for states but the recipient of this investment the student--moves to another state, it is difficult for budget officials to count those benefits as accruing to the states. Businesses and individuals have the same ............. problem taking account of what economists call onerous social consequences. It brings people the "externalities"of their actions. Many budget into contact with the criminal justice,child analysts reject the idea of counting any benefits welfare and welfare systems,for example,like except those that directly affect their budgets, no other chronic, relapsing condition. For these mimicking the model set by the private sector. consequences, individuals must be held accountable. Applying the private sector model of analysis to state expenditures in substance abuse means that But a state policymaker cannot lose sight of the government investments would be considered fact that the condition must be treated or it will sound if the discounted value of future savings recur and visit more misery and costs to the exceeds the costs of the programs. Looking at people of the state. Research has demonstrated substance abuse spending across the state budget that substance abuse causes significant changes highlights specific opportunities to target in the function of the brain which can last long investments in the form of substance abuse after a person stops USmg.4 The chemical prevention and treatment programs and use state changes in the brain cause many behavioral powers of regulation and taxation to achieve responses in individuals, including the better results. '"compulsion to use drugs despite adverse consequences--the defining characteristic of Treatment for Drug Addiction is addiction."s Only if we treat this condition do Cost Effective we have any hope of stemming the burdensome social consequences. The concepts of A sticking point for many policyrnakers is the accountability and treatment are not antithetic; they are companions. The substance abuser or perception that treatment does not work. addict must choose—exercise his free will--to Decades of research have established,however, shake the habit,but treatment is usually an that a variety of alcohol and drug abuse essential tool to help that individual help treatment methods are successful. These himself, treatments include both behavioral therapy and medication. For treatment to be most effective, ifyou want to save taxpayer dollars, and you it must be readily available,tailored to the want to reduce violence in your communities, if individual needs of patients,and part of a you want to accomplish all of these larger social comprehensive program that addresses goals,you have to draw them into effective drug associated medical,psychological, education, treatment.' training and other needs.2 Individuals must --General Barry R.McCaffrey remain in treatment for an adequate length of time to accept that they are addicts and learn how to manage their addiction, including how to When treatment is provided in accordance with manage relapse.' known principles of effectiveness, it is a Many policyniakers hold to the notion that profitable investment in tenns of both social substance abusers lack conviction and moral benefits and cost effectiveness or cost savings. gJust examining the largest area of state spending rounding;that their problem is fundamentally a on the consequences of substance abuse-- lack of will rather than a need for treatment and criminal justice--research demonstrates the that punishment is the appropriate response. return on investments in treatment. According 'Mese policymakers frequently take the position to the Bureau of Justice Statistics, the cost of that policy should be tough and that treatment effective treatment ranges from$1,800 to$6,800 equates with being soft--on crime, on child per year while the national average cost of abuse,on drunk drivers,on juvenile delinquents. .6 incarceration is$20,805 a year While substance abuse is a health condition--a chronic, relapsing one—it has some particularly ------------- ............. CASA's own research on substance abuse and a$7.00 return for every one dollar invested in crime,Behind Bars:Substance Abuse and treatment." America's Prison Population,showed that it would cost approximately$6,500 per person on The most recently performed national surveys top of incarceration costs to provide one year of also have confirmed the effectiveness of a comprehensive treatment and training program substance,abuse treatment and that their returns in prison plus aftercare.' The successful accrue to other areas of state spending beyond treatment of one prisoner would realize benefits the justice system, The largest national survey of approximately$68,800 of treatment outcomes to during the first year after Everybody has moral responsibility and moral date is the National release,greater than 10 accountability for everything they do. However, Treatment Improvement times the initial cost of we need to understand that tfwe want to deal Evaluation Study treatment.' with the addict,punishment doesn't cure the (NTIES). The study, disease. Our problem as a society is we need to sponsored by the Center If we successfully treat and get these people to be productive members of for Substance Abuse train only 10 percent of the society. We can worry about their moral failure Treatment(CSAT), estimated 1.2 million and favus on punishing that But iffhat doesn't followed the progress of get them to stop using drugs, it's not very 4,411 individuals who substance-involved productive. Science teaches us tofocus on what inmates—120,000—the works and what we can change. "at we can participated in federally economic benefit.in the change is the brain state. We can provide funded treatment first year of work after treatment that will help pelople survive their programs over a five year release would be$816 addiction and return to full,productive life in period. NTIES found billion. That's$456 society.' that clients'use of their million more than the$7.8 —Alan 1.Leshrier.Ph.D. primary drug or the drug billion cost of providing Director,National Institute on Drug Abuse they were entered into treatment and training(ata treatment for, declined cost of$6,500 each)for all from 73 to 38 percent one of the 1.2 million inmates with drug and alcohol year after treatment. Treatment recipients problems. Thereafter,the nation would receive demonstrated a 64 percent reduction in arrests an economic benefit of more than$8 billion for for any crime, increased their rate of each year these 120,000 former inmates remain employment from 51 to 60 percent,and reduced sober and employed."' their level of homelessness from 19 to I I percent. NTIES research also determined that Since an average addict commits at least 100 treatment is cost effective as opposed to other crime a year, for each 10,000 substance-abusing policy alternatives, such as incarceration.'2 ex-inmates that are successfully treated,we can expect a.reduction of 1,000,000 property and A second national survey on treatment is Tire violent crimes each year. Services Research Outcome Study(SROS), conducted by the federal Substance Abuse and Treatment Saves Tax Dollars Mental Health Services Administration {SAMHSA). This survey compares the status of California's evaluation of its treatment outcomes 1,799 clients in the five years before they enter for prisoners,entitled the CALDATA study, treatment to the five years after they complete finds that former inmates who received treatment. The results indicate a 21 percent treatment were less likely to return to prison. overall drop in illicit drug use and a sharp The cost to taxpaying citizens of treating decrease in crime—between 23 and 38 percent—a approximately 150,000 participants in the study full five years after initial treatment.13 In fact, sample was$209 million,while benefits from the SROS study asserts,that"the reduction in treatment were worth about$1.5 billion in crime alone produces benefits to society that taxpayer savings. This equates to approximately outweigh the investment in treatment." -83- A RAND Corporation study of the relative cost- Focusing on the.Future effectiveness of treatment, domestic enforcement, interdiction, and source country For states to move to more cost effective control found that for heavy users of cocaine, investments in substance abuse,policymakers each dollar spent on treatment interventions must confront three major obstacles: the would result in a savings of$7.46 while the tendency to budget by program rather than supply-control programs resulted in a savings of considering the cost impact of a problem across only between$0.15 to'$0.52.'4 These savings programs;the annual orbiennial budgeting were only measured in lost productivity and process; and the short-term vision imposed by costs of crime which underestimate the true elected terms of office. impact of treatment since costs would be avoided in many other areas,such as health or Most state budgets are organized by function or welfare. silos--transportation, corrections,human services, etc. Costs are broken down within Oregon estimates its return on every dollar spent these categories and usually comport with the on treatment services to be$5.62 savings in state organizational structure of state government. costs,primarily in the areas of corrections, Very rarely do states examine costs across health and welfare spending. A smaller study of budget categories and when this is done it is publicly supporters outpatient addiction usually a separate activity than the annual or treatment in the city of Philadelphiafound that biennial budget process. For example, several the benefits of treatment clearly outweighed the states have compiled children's budgets. This costs. The average cost per treatment episode silo budgeting process is not designed to reveal for outpatient programs from 1992 to 1997 was the costs of a particular social problem to the $1,275,while the benefits from avoiding costs state; it only shows annual outlays of specific such as increased crime,unemployment,etc., programs bearing the functional label. This were estimated at$8,408.'s Numerous other method of budgeting makes it difficult to count research reports and studies are available and returns on an investment in treatment for a could be replicated easily by willing state parent who neglects or abuses his or her child, governments. Substance abuse treatment is both for example,that might accrue to the Medicaid cost effective and socially beneficial to society. budget or state aid for education or to the mental Beyond the import of savings to taxpayers is the health budget. fact that with treatment addicts can become A second obstacle to more cost-effective productive,self-reliant,taxpaying citizens, investments is that state government is responsible parents and contributing members of dominated by battles over spending in the annual communities. or biennial budget. As state decision makers focus their attention on the next year or two, The days ofhigh substance abuse rates to they find it difficult to develop initiatives that Florida are numbered. The increased funding have up-front costs but longer term savings.. The for treatment and lase enforcement efforts in this difficulty arises because the standard budget will go along sway toward meetin�our methodology used in budget analysis does not goal ofcutting drug use in haY'by 2004.' allow the explicit use of savings beyond the budget period as a financial offset for the up- --Governor Jeb Bush front costs of those programs. 1n this sense, Florida then, standard budgeting methodology is very different from the model of investment analysis used in the private sector. -84- HUMAN/SOCIAL SERVICES State Spending on Income Support Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds(000s of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTSAELIGIBM 1. Temporary Assistance to Needy Families (TANF): Please briefly describe the eligible population for TANF and any special programs within TANF such as Emergency Assistance. Specific Program Names: a. b. C. d. e. 2. General Assistance: Ifeligibility is determined state-wide,please briefly describe the eligible population and specify if substance abusers are explicitly excluded from the program. If you can not provide General Assistance eligibility because it is a local decision,please indicate this in the comments. Specific Program Names: a. b. C. d. e. 3. State Supplements to Supplemental Security Income Program (SSI) Specific Program Names: a. b. C. d. e, HUMAN/SOCIAL SERVICES Descriptions for Income Support Programs Temporary Assistance to Needy Families (TANF) Description: This program was established to take the place of Aid to Families with Dependent Children (AFDC), Emergency Assistance to Needy Families and Job Opportunities and Basic Skills Training(JOBS). TANF provides block grants to states for economic assistance to people transitioning to work. Include spending on TANF-related employment programs. Special Instructions: Please briefly describe the eligible population for TANFand any special programs within TANF such as Emergency Assistance. General Assistance Description: Any program that provides income assistance to families or individuals who do not qualify for benefits from ether income support programs. Special Instructions: If eligibility is determined state-wide, please briefly describe the eligible population and specify if substance abusers are explicitly excluded from the program. If you can not provide General Assistance eligibility because it is a local decision, please indicate this,in the comments. State Supplements to Supplemental Security Income Program(SSI) Description: Any program that provides basic income maintenance for the aged,blind, and disabled. This also includes programs that are designed to provide income maintenance for those individuals who have AIDS or are HIV positive. 107- HUMAN/SOCIAL SERVICES Instructions for Income Support Programs Instructions: provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include all program costs including grants to individuals or families, the cost of caseworkers or service providers, as well as the cost of program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit casts is all that is necessary. 3. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. However, if you have specific substance abuse programs within these larger program areas, please list that spending separately. 4. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 5. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at (518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email ' her at ess@rockinst.org. -106- ................. ............................... ................................................................ ............... INCOME SUPPORT PROGRAMS within HUMAN/SOCIAL SERVICES -105- ............. ................... .............. HUMAN/SOCIAL SERVICES State Spending on Substance Abuse Prevention and Treatment Programs Agency Name• AMOUNT BUDGETEDFY 1998 Total State Funds 000s of$ PROGRAM NAME (General Fund and Non-General Fund) COMWENTS 1. Substance Abuse Prevention Toni All Programs Substances: Total Alcohol: Total Illicit Drug: Total Tobacco: Specific Program blames: a b. C. d- e. 2. Substance Abuse"Treatment Total All Programs Substances: Total Alcohol• Total Illicit Druz Total Tobacco: Specific Program Names: a b. C. d. e. -104- HUMAN/SOCIAL SERVICES Substance Abuse Prevention and Treatment Program Descriptions Substance.Abuse Prevention Programs Description: Any program with the goal of reducing alcohol, drug and tobacco abuse. This includes state-wide media campaigns, local prevention networks, interagency coordination of prevention programs and any prevention education activity. Substance Abuse Treatment Programs Description. Any program that provides treatment for alcohol, drug and tobacco abuse. This includes treatment facilities and out-patient care programs. This would include direct state spending as well as funds provided to local governments for treatment. Multi-agency task forces are also included. -103- 11 . ......... ......... ......... ......... ......... ..... ..... .._..._. .... ........ ........ ....... ........ ........ .......... ......... ..__................. HtUMAN/SOCI L SERVICES Instructions for Substance Abuse Prevention and 'Treatment Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following program on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include current year capital spending (actuals or estimated actuals, not appropriations)unless' budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes ("Pay As You Go"), capital spending from bond proceeds(Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of GO bonds,;revenue bonds, certificates of partiepation or other state-backed bonds, 3. Include all program costs including the cost of caseworkers or service providers, the cost of program administrators and/or policy analysts who spend the majority of their time on this program and the cost of contracted out services. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 5. To avoid double counting, list only the spending for the programs that fall within the human/social services budget (see attached survey overview). Other department spending will be requested from other departments (e.g. health). 6. Do not include publicly funded health insurance programs. (In particular, do not include Medicaid spending). 7. Include categorical funding to localities in these areas. 8. Break out your spending into the following categories, if possible: drugs, alcohol and tobacco. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:04 p.m. Eastern Time. You may also email her at cssrockinst.org. -102- .......................................................................................................................................................................................................................................................... SUBSTANCE ABUSE PREVENTION & TREATMENT PROGRAMS within HUMAN/SOCIAL SERVICES ......................... ................ .......... _... ......... .._...... ..._..... ......... ......... .._..... . .................. .. .... ___ .. .... ........ .. .. ... .. ........ ....... ...... ...... ......_ VI. PUBLIC SAFETY 1. Special Drug Enforcement Programs 2. highway Safety and Accident Prevention Programs 3. State Highway Patrol 4. Local Law Enforcement Programs VII.. JUDICIARY * 1. Drug Courts and Other Special Programs for Violations of Drug Laws 2. Criminal Courts 3. Family Courts 4. State Aid to Localities for Criminal Courts and Family Courts VIII. REGULATORY/COMPLIANCE * 1. Alcohol and Tobacco Licensing and Control Boards 2. Collection of Alcohol and Tobacco Taxes TX. CAPITAL SPENDING X. STATE WORKFORCE * -�oa- ...........I..................................................................................................................................-.... .......... H. DEVELOPMENTALLY DISABLED AND MENTAL HEALTH 1. Developmentally Disabled Programs(within the Developmental Disabilities and Mental Health agencies) 2. Mental Health Programs (within the Developmental Disabilities and Mental Health agencies) III. HEALTH A. SUBSTANCE ABUSE PREVENTION, TREATMENT, & RESEARCH PROGRAMS (within the health agency) 1. Substance Abuse Prevention Programs 2. Substance Abuse Treatment Programs 3. Substance Abuse Research B. HEALTH SERVICES FOR SPECIAL POPULATIONS 1. Developmentally Disabled Programs (within the health agency) 2. Mental Health Programs(within the health agency) 3. Other Programs for People with Special Health Needs C. HEALTH INSURANCE PROGRAMS 1. Medicaid 2. General Assistance Medical Care 3. Other Health Insurance Programs IV. EDUCATION 1. Substance Abuse Prevention Programs(within the education agency) 2. Substance Abuse Treatment Programs (within the education agency) 3. Categorical Spending for Programs for At-Risk Children 4. Total K-12 Spending V. CORRECTIONS A. JUVENILE PROGRAMS 1. Juvenile Detention/Correction Centers Programs B. ADULT PROGRAMS 1. Total Prison Costs 2. Parole/Early Release and Other Similar Programs 3. Probation and Other Alternatives to Incarceration 4. Categorical Aid to Localities -99- ............... ................... ....................... SURVEY OVER PTE THE NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE AT COLUMBIA UNIVERSITY SUBSTANCE ABUSE AND STATE BUDGETS PROJECT The National Center on Addiction and Substance Abuse at Columbia University is conducting a survey to determine the cost of substance abuse to state governments. We greatly'appreciate your cooperation in filling out this survey. To ease completionof the survey, we have broken it into ten broad budget areas: human/social services, mental health and developmental disabilities, health, education, corrections, public safety,judiciary, regulatory/compliance, capital'spending and state workforce. Within these main areas are several program groupings which are listed below. The asterisks(*)'next to the headings correspond to the 16 program packets that were provided to your survey coordinator. please note that several of the program groupings appear in more than one place. This is because the relevant programs reside in different agencies in different states. If you have any questions and/or problems with completing the survey, please contact Kathy Snyder, Center for the Study of the States, at(518)443-5787 between 9:00'a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. Thank you. I. HUMAN/SOCIAL SERVICES A. SUBSTANCE ABUSE PREVENTION & TREATMENT PROGRAMS (within the Human/Social Services agency) * 1. Substance Abuse Prevention Programs 2. Substance Abuse Treatment Programs B. INCOME SUPPORT PROGRAMS 1. Temporary Assistance to Needy Families (TANF) 2. General Assistance 3. State Supplements to Supplemental Security Income Program (SSI) C. CHILI?WELFARE PROGRAMS * 1. Adoption Assistance, Foster Care, and Independent Living Programs 2. Child Welfare, Family Preservation and Support, and Indian Child Welfare 3. Other Child Welfare Programs 4. Child Abuse and Neglect Intake and Assessment D. OTHER SOCIAL SERVICE PROGRAMS * 1. Developmentally Disabled Programs(within the Human/Social Services agency) 2. Mental Health Programs (within the Human/Social Services agency) -98- Appendix A State Survey SURVEY CHECKLIST 1. SUBSTANCE ABUSE PREVENTION & TREATMENT PROGRAMS. 13 (Human/Social Services Agency) 2. INCOME SUPPORT PROGRAMS 0 3, CHILD WELFARE PROGRAMS O 4. OTHER SOCIAL SERVICE PROGRAMS C] 5. DEVELOPMENTALLY DISABLED AND MENTAL HEALTH 6. SUBSTANCE ABUSE;PREVENTION,TREATMENT& RESEARCH O PROGRAMS(Health;Agency) T HEALTH SERVICES FOR SPECIAL POPULATIONS � 8. HEALTH INSURANCE PROGRAMS D 9. EDUCATION D 10. JUVENILE CORRECTIONS PROGRAMS CI 11. ADULT CORRECTIONS PROGRAMS D 12. PUBLIC SAFETY 13. JUDICIARY 14. REGULATORY/COMPLIANCE Q 15. CAPITAL SPENDING 16. STATE WORKFORCE 0 17. STATE STUDIES ON SUBSTANCE ABUSE C? State Name: Survey Coordinator: Telephone Number: _97_ -9b- Chapter VII Notes ' Wren,C. S. (January 8,200 1) 2 National Institute on Drug Abuse. (1999) 3 National Institute on Drug Abuse. (1999) 4 Liu,X.,Matochik,J. A.,Cadet,J.L.,&London,E. D. (1998) 5 National Institute on Drug Abuse. (1999) 6 Bureau of Justice Statistics(as cited in The National Center on Addiction and Substance Abuse(CASA)at Columbia University, 1998) Firshein, J. (1998) The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998),p. 163 $The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998),p. 164 '0 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998),p. 165 " Gerstein,D.R.et al. (1994) 12 Center for Substance Abuse Treatment. (2400) F3 Substance Abuse and Mental Health Services Administration. (1999) t4 Rydell,C.P.&Everingham,S.S. (1994),p.xvi 'S LSAT by Fax. (1999) 16 Florida Office of Drug Control. (January 11, 2044) "The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998),p.211 '$National Institute on Drug Abuse. (1999) '9 Abel,E. L. (1998),Grossman,M.,Chaloupka,F.J.,&Sirtalan,I. (1998) 2°Associated Press. (December 1,2444) 2' Nacelewica,T. (Septermber 30,2400) 22 Lewit,E. M.,Coate,D.,&Grossman,M. (198 1) 23 Ruhm,C. J. (1996) 24 Grossman,M.,et al. (1993). "Abel, E. L. (1998);Grossman,M.,Chaloupka,F.J.,&Sirtalan,I. (1998) 26 Ritea,S. (November 10, 1999) _95_ Chapter VI Notes ' New York City Independent Budget Office. (1998),pp. 5, 11 -94- Chapter V Notes ' US Census Bureau. (2000) 2 Garrett T.A.&Leatherman,J.C. (1999) 3 Federation of Tax Administrators. (2000) 4 The Beer Institute. (1998) 5 Drug Strategies. (1999x) Dall W.Forsythe,Ph.D.,Rockefeller institute of Government(personal communication November 13, 2000) Fiscal Planning Services,Inc. (2000),pp. 23,31-32 8 Campaign for Tobacco-Free Kids,American Cancer Society,American Heart Association,and the American Lung Association. (200 1) s Levy,D.T.,Cummings,K.M.,Hyland,A. (2000) io Ritea, S. (November 10, 1999);Grossman,M.,Chaloupka,F.J.,&Sirtalan,1. (1998) Lewit,E. M.,Coate,D.,&Grossman,M. (1981) -93- Chapter IV Notes National Institutes of Health. (2WO) 2 Alcohol,Drug Abuse and Mental Health Administration Reorganization Act(The Synar Amendment). (1992) Requires the state to:have in effect a lav prohibiting any manufacturer, retailer or distributor of tobacco products firom selling or distributing such products to any individual under the age of 18; enforce such laws in a manner that can reasonably be expected to reduce the extent to which tobacco products are available to individuals under the age of 18;and conduct annual random, unannounced inspections to ensure compliance with the law which are to be conducted in such a way as to provide a valid sample of outlets accessible to youth. J Center for Substance Abuse Treatment. (1997) -92- ............................................................. Chapter HI Notes Associated Press. (August 31,2000) Mullen, A. (NWch 4, 1999) Abbott E. (October 19,2000) 4 State of Colorado. (2000) National Associationof State Budget Officers. (1999),p.67,Includes all general fund and other state fund spending other than local funds and intergovernmental transfers. Miller,K. (April 16,2000) -91- ......... . ......... ....... ..................... ...... ... —........... Chapter TI Notes ' The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1993, 1994x, 1994b, 1998& 1999) 2 Office of National Drug Control Policy_ (2000),p.90 3 Ben Brown,Deputy Commissioner for Substance Abuse Services,Oklahoma Department of Mental Health and Substance Abuse Services(personal communication,January 11,2001). 4 Harwood,H.,Fountain,D.,&Livermore,G. (1998);Rice,D.P. (1993) 5 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1993& 1994a) b The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1995) 'T'he National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998) s Geen,R.,Boots, S.W.,&Tundin,K.C. (1999);The National Center on Addiction and Substance Abuse(CASA) at Columbia University. (1999) 9 The National Center on Addiction and Substance Abuse(CASA)at Columbia University contracted with Dal]W. Forsythe,Ph. D.,former state budget director of New York and former director of public finance with Lehman Brothers,and Brian Roherty,former state budget director of Wisconsin and Minnesota and former Director of the National Association of State Budget Officers(NASBO), to help choose states and set up interviews. 10 Gerstein,D.,Johnson,R A.,Harwood,H. J.,Fountain,D., Suter,N.,&Malloy, K. (1994) " The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1993) '2 Feldman,J. G.,Minkoff,H.L., McCalla,S.,&Salwen,M. (1)92);Harwood,H.,Fountain,D.,&Livermore,G. (1998);Kandel,D.B. (as cited in O'Brien, C.R&Jaffe,J. H.,2000); Smith,1.E.,Dent,D.Z.,Coles,C.D.,& Falek,A. (1992) 13 Harwood,H_,Fountain,D.,&Livermore, G. (1998),p.2-3 14 The National Center on Addiction and Substance Abuse(CASA)at Columbia University analysis of Arrestee Drug Abuse Monitoring(ADAM)Data, 1997. (Unpublished data,2000) 15 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1999) '6 Kandel,D.B.(as cited in O'Brien,C.P.&Jaffe, J.H.,2000) "Feldman,J. G.,et al. (1992);Smith,1.E.,et al. (1992) " Harwood,H.,Fountain,D.,&Livermore,G. (1998).p.2-3 '9 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998& 1999) 20 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1995);The National Center on Addiction and Substance Abuse(CASA)at Columbia University analysis of the 1997 National Household Survey on Drug Abuse. (Unpublished data, 1999);Boleyn,J. (August 10,2000),p.8 _90- Chapter I Notes ' The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1996) 2 National Institute on Drug Abuse. (1999) Abel,E. L. (1998);Grossman,M.,Chaloupka,F.J.,&Sirtalan,I. (1998) 4 Associated Press. (December 1,2000) s Nacelewicz,T. (September 30,2000) 6 Lewit,E. M,Coate,D.,&Grossman,M. (1981) 'Ruhm,C.J. (1996) e Grossman,M.,S ndelar,J.L.,Mullahy,J,,&Anderson,R. (1993). 9 Abel,E.L. (1998),Grossman,M.,Chaloupka,F.J.,&Sirtalan 1. (1998) io Ritea,S. (November 10, 1999) " Bush-Cheney 2000. (2000) -89- �88- consequences. For example, CASA's abuse on their budgets. CASA welcomes research shows that even though 70 refinement and updating of these data by states percent of child welfare cases are caused and the development of state systems to assure or exacerbated by alcohol and drug and monitor progress in preventing and treating abuse,case workers are not properly America's most pressing health and social trained to assess and screen parents for problem. abuse. ➢ Assure that individuals who screen positive are given full assessments and receive timely and appropriate treatment, including relapse management. ➢ Establish systems to measure the cost- effectiveness of prevention and treatment programs, including regulatory and treatment policies aimed at curbing use, in order to concentrate resources on interventions that will provide the highest return on investment for the state and the greatest benefits for individuals. > Require agencies to report on the short and long term results of substance abuse-related investment strategies in the budget process. The state budget process is the only context in state government where the impact of a problem can be viewed across budget categories. If investments are to succeed,budget officers and policyrnakers will track the returns across budget categories and examine projected versus actual returns on investments in current budget and out years. ➢ place responsibility for managing state substance abuse-related investments in a designated state agency. ➢ Invest in research and evaluation of cost-effective substance abuse prevention and treatment policies and programs. This report provides the basis for states to plan and execute more cost-effective investments designed to reduce the impact of substance -8'7- the result of the stimulating effect of their students.2! As early as 1981,a study contribution to the economy. showed that a 10 percent increase in the real price of cigarettes leads to a 12 Expand use of state powers of legislation, percent decrease in consumption among regulation and taxation to reduce the 12-to 17-year olds. ? Other studies impact of substance abuse. The purchase have shown that a one percent increase states have on substance abuse and addiction in the price of beer results in a one 23 is not limited to investments in prevention percent decrease in traffic fatalities, and treatment. States have a broad range of and that doubling of the federal beer tax legislative, regulatory and taxation powers would reduce total robberies by 4.7 that can be considered. For example,they percent and murders and rapes by three could: percent.24 Eliminate mandatory sentences for drug ➢ Step up regulation and enforcement of and alcohol abusers and addicts. When the prohibition of alcohol and tobacco prisoners are required to serve their sales to minors. Point of sale entire sentence without the option of inspections,tougher sanctions against parole or early release,the state loses offending retailers, and establishing a the carrot of early release that can help licensing system for tobacco sale, can persuade them to enter treatment and the reduce regular cigarette use among 12- stick of parole that can motivate them to 13-year olds by 44 to 69 percent.25 upon release to continue treatment and By rigorous enforcement, Louisiana aftercare.17 reduced the number of stores selling tobacco products to minors from 75 ➢ Require treatment for substance-abusing percent in 1996 to seven percent in individuals in state-funded programs: 1999.' prisons,probation,parole,welfare, juvenile justice, education, mental > Include questions about substance abuse health,child welfare. Also require on licensing examinations for teachers, treatment for substance-abusing state social workers, health care employees and for those convicted of professionals,corrections and juvenile alcohol-and drug-related traffic justice staff and court personnel. violations. Coerced treatment is as effective as voluntary treatment and > Dedicate revenues from tobacco and threat of incarceration or loss of benefits alcohol to prevention, treatment and can provide the needed incentive to coping with the burden of substance move toward recovery.'a abuse and addiction. ➢ Increase taxes on alcohol and tobacco. i Manage investments for better results. Increases in price for alcohol and States should set targets for reducing the tobacco lead to decreases in the amount impact of substance abuse on their budgets people,especially youth consume-'9 and install management practices to achieve California has combined a$.75 tax them: increase per pack of cigarettes with a public health campaign to achieve a 14 ➢ Train teachers, health care workers, percent decrease in lung cancer over the social service, criminal and juvenile past 10 years,20 and Maine's doubling of justice staff and court personnel to tobacco taxes and anti-smoking implement comprehensive screening for campaign have yielded a 27 percent _ substance abuse in programs that bear a decline in smoking among high school significant burden in coping with its -86- This problem is exacerbated by the tendency of ➢ Clients in the mental health system elected officials to want short term results and to whose substance abuse problems be substantially less concerned with benefits that increase the probability that they will may accrue to the state beyond their tenure in cycle back into mental hospitals or office. emergency rooms. State officials often acknowledge the superiority ➢ Parents of children in the foster care of private sector business techniques and system whose abuse of alcohol or drugs promise to put them into effect in government. interferes with their ability to care for Private corporations'top priority is to fund their_ children at home. investment opportunities that can demonstrate a positive net present value. Sound public ➢ Individuals in the welfare system whose stewardship requires that state governments substance abuse interferes with their follow this lead and aggressively seek out ability to be self-supportive. opportunities to invest in initiatives that will produce greater economic and social value to the ➢ Youth in the juvenile justice system who state and provide a high return on investment. are substance-involved. There is perhaps no greater opportunity for such investment than in the area of substance abuse ➢ Children of substance-abusing prevention and treatment. individuals in the criminal justice system who have an increased Next Steps likelihood of both abusing substances and committing crimes. To design and implement successful strategies to prevent and treat this enormous public problem > Children of substance-abusing parents and reduce the costs of substance abuse to states, who have a higher likelihood of both CASA recommends a revolution in the way abusing substances and neglecting and governors and state legislators think about and abusing their own children. confront substance abuse and addiction: > Children of substance-abusing welfare • Make targeted investments in prevention recipients who have a greater likelihood g p of both abusing substances and being on and treatment. The most significant welfare, opportunity to reduce the burden of substance abuse on public programs is > Substance-abusing pregnant women and through targeted and effective prevention their partners. programs. If we can keep children from smoking cigarettes,using illicit drugs and > Alcohol-and drug-involved drivers. abusing alcohol until they are 21, they are virtually certain never to do so. Treatment Carefully targeted and designed prevention is also a cost effective intervention as it both and treatment interventions are likely to be reduces the costs to state programs in the sound investments, because they yield short term and prevents future costs. States returns directly to a state budget in the form, should target interventions on selected for example,of avoided costs in the prison, populations that hold promise for high mental health, child welfare and public return: assistance systems. To the extent that Y Prisoners whose substance abuse substance abusing individuals recover problems make them more likely to through treatment or individuals at high risk avoid the problem altogether,a net return to the criminal justice systems economic benefit also will accrue to states in after parole or release, the form of taxes paid on earnings and on 85 GILD WELFARE PROGRAMS Within HUMAN/SOCIAL SERVICES -109- HUMAN/SOCIAL SERVICES Instructions for Child Welfare Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. j 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include all program costs including grants to individuals or families, the cost of caseworkers or service providers, as well as the cost of program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 3. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. However, if you have specific substance abuse programs within these larger program areas, please list that spending separately. 4. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 5. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at (518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. .......................................................................... ....................................................................................................................................................................................................................................................................................................................... HUMAN/SOCIAL, SERVICES Descriptions for Child Welfare Programs Adoption Assistance, Foster Care, and Independent Living programs Description: Any program in the areas of adoption assistance, faster care, and independent living. This includes programs that receive funds under Title IV-E of the Social Security Act, but also those that are state-only programs. Adoption and foster care placement services and any training and skills-building programs related to these areas are included. Child Welfare, Family preservation and Support, and Indian Child Welfare Description: Any program that is intended to prevent out-of-home placements, promote reunification of families, or providea safe environment for children. This includes programs that receive funds under Title N-E of the Social Security Act, but also those that are state-only programs. All programs that fall under the area of child welfare, family preservation and Indian child welfare are included. Other Child Welfare programs Description: Any non-IV-I3 and non-IV-E program that focuses on the areas of child abuse and neglect prevention, family/parent support, runaway/homeless intervention, medical neglect of children, crisis nurseries or any similar program. Prevention and treatment programs dealing with the issue of domestic violence and home visiting programs are included. This also includes programs that provide education, training and resources to local and non-profit prevention and intervention organizations in these areas. Programs that assist individuals and families with finding emergency services are also included. Child Abuse and Neglect Intake and Assessment Description: Any program that focuses on investigating and assessing child abuse and neglect complaints or reports. -tt�- HUMAN/SOCIAL SERVICES Stale Spending on Child Welfare Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds(000s of$} PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Adoption Assistance, Foster Care, and Independent Living Programs Specific Program Names: a. b. C. d. e. 2. Child Welfare, Family Preservation, and Indian Child Welfare Specific Program Names: a. b. C. d. e. 3. Other Child Welfare Programs Specific Program Names: a. b. C. d. e. 4. Child Abase and Neglect Intake and Assessment Specific Program Names: a. b. C. d. e. ...................................................................................................................................................................................................................................................................................................................... OTHER SOCIAL SERVICE PROGRAMS within HUMAN/SOCIAL SERVICES HUMAN/SOCIAL SERVICES Instructions for Other Social Services Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include current year capital spending(actuals or estimated actuals, not appropriations) unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes("Pay As You Go"), capital spending from bond proceeds (Bond Proceeeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes captial projects funded by proceeds of GO bonds, revenue bonds, certificates of participation or other state-backed bonds. 3. Include all program costs including grants, the cost of caseworkers or service providers, as well as the cost of program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. To avoid double counting, list only the spending for the programs that fall within the human/social services budget (see attached survey overview). Other department spending will be requested from other departments (e.g. health). 5. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 6. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 7. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at (5 18)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. -114- ..................__...._................................._. ............................................... .......... ....................................................................................................................................................................................................................................................................................................................... _. __ HUMAN/SOCIAL SERVICES Descriptions for Other Social Services Programs Developmentally Disabled Programs Description; Any program that provides services to individuals with developmental disabilities and their families. This includes institutional facilities, out-patient care and programs that provide education,training and resources to local and non-profit organizations. 'ental Health Programs Description; Any program that provides prevention and/or intervention services to the mentally ill and their families. This includes treatment facilities, out-patient care and programs that provide education, training and resources to local and non-profit organizations. Any substance abuse prevention and treatment programs and facilities in the area of mental health are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs. �I15- HUMAN/SOCIAL SERVICES State Spending on Other Social Services Programs Agency Name: AMOUNT BUDGETED FY 1995 Total State Funds (OOOs of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Developmentally Disabled Programs Specific Program Names: a. b. C. d. C. 2. Mental Health Programs: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs, Specific Program Names: a. b. C. d. e. -116- DEVELOPMENTALLY DISABLED Al''wiD► MENTAL HEALTH PROGRAMS DEVELOPMENTALLY DISABLED AND MENTAL HEALTH Instructions for Developmentally Disabled and Mental Health Services Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include current year capital spending (actuals or estimated actuals, not appropriations) unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes ("Pay As You Go"), capital spending from.bond proceeds (Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of GO bonds, revenue bonds, certificates of particpation or other state-backed bonds. 3. Include all program costs including grants, the cost of caseworkers or service providers, as well as the cost of program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4, To avoid double counting, list only the spending for the programs that fall within the developmental disabilities and/or mental health budget (see attached survey overview). Other department spending will be requested from other departments (e.g. health). 5. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 6. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 7. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. ............. .......... ............. DEVELOPMENTALLY DISABLED AND MENTAL HEALTH Descriptions for Developmentally Disabled and Mental Health Services D4n,elopment,ally Disabled Programs Description: Any program that provides services to individuals with developmental disabilities and their families. This includes institutional facilities, out-patient care and programs that provide education,training and resources to local and non-profit organizations. Mental Health Programs Description: Any program that provides prevention and/or intervention services to the mentally ill and their families. This includes treatment facilities, out-patient care and programs that provide education;training and resources to local and non-profit organizations. Any substance abuse prevention and treatment programs and facilities in the area of mental health are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs. -Il9- DEVELOPMENTALLY DISABLED AND MENTAL HEALTH State Spending an Developmentally Disabled and Mental Health Services Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds (000s of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Developmentally Disabled Programs Specific Program Names: a. b. C. d. e. 2. Mental Health Programs: Please idents any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs. Specific Program Names: a b. C. d. C. -120- SUBSTANCE ABUSE PREVENTION,TREATMENT AND RESEARCH PROGRAMS within HEALTH HEALTH Instructions for Substance Abuse Prevention, Treatment and Research Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include current year capital spending(actuals or estimated actuals, not appropriations)unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes("Pay As You Go"), capital spending from bond proceeds (Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of GO bonds, revenue bonds, certificates of participation or other state-backed bonds. 3. Include all program costs including grants, the cost of caseworkers or service providers, the cost of program administrators and/or policy analysts who spend the majority of their time on this program and the cost of contracted out services. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 5. To avoid double counting, list only the spending for the programs that fall within the health budget (see attached survey overview). Other department spending will be requested from other departments(e.g. social services). 6. Do not include publicly funded health insurance programs. (In particular, do not include Medicaid spending). 7. Include categorical funding to localities in these areas. 8. Break out your spending into the following categories, if possible: drugs, alcohol and tobacco. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at (518) 443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. -122- .................................................................................... ............................................................. ..................................... _ __. ...... ......... HEALTH Descriptions for Substance Abuse Prevention, Treatment and Research Programs Substance Abuse Prevention Programs Description: Any program that provides drug, alcohol and tobacco prevention services. This includes programs involved in information dissemination(including media campaigns), education, and community-based planning. Programs that provide education, training and resources to local and non-profit organizations are also included. Multi-agency task forces are also included. ,Substance Abuse Treatment Programs Description: Any program that provides intervention services to individuals with chemical, tobacco and/or alcohol dependency and their families. This includes any program for pregnant women, fetal alcohol syndrome babies or similar programs. This includes treatment facilities, out-patient care, and programs that provide education, training and resources to local and non- profit organizations. Multi-agency task forces are also included. Substance Abuse Research Description: Any program to conduct or support medical, behavioral, policy, or other research related to substance abuse. -123- HEALTH State Spending on Substance Abuse Prevention, Treatment and Research Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds (OOOs of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Substance Abuse Prevention Total All Programs Substances: Total Alcohol: Total Illicit Drug: Total Tobacco: Specific Program Names: a. b. C. d. e. 2. Substance AbuseTreatment Total All Programs Substances: Total Alcohol: Total elicit Drug: Total Tobacco: Specific Program Names: a. b. C. d. e. 3. Substance Abuse Research Total All Substances: Total Alcohol: Total Illicit Drug: Total Tobacco- Specific Program Names: a. b. C_ d. e. -124- HEALTH SERVICES FOR SPECIAL POPULATIONS within HEALTH -125- HEALTH Instructions for Health Services for Special Populations Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include current year capital spending (actuals or estimated actuals, not appropriations) unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes ("Pay As You Go"), capital spending from bond proceeds(Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of GD bonds, revenue bonds, certificates of participation or other state-backed bonds. 3. Include all program costs including grants, the cost of caseworkers or service providers, as well as the cost of program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. To avoid double counting, list only the spending for the programs that fall within the health budget (see attached survey overview). Cather department spending will be requested from other departments(e.g. social services). 5. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 6. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 7. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at (518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. -126- HEALTH Descriptions for Health Services for Special populations Developmentally Disabled Programs Description: Any program that provides services to individuals with developmental disabilities and their families. This includes institutional facilities, out-patient care and programs that provide education,training and resources to local and non-profit organizations. Mental Health Programs Description: Any program that provides prevention and/or intervention services to the mentally ill and their families. This includes treatment facilities, out-patient care and programs that provide education, training and resources to local and non-profit organizations.. Any substance abuse prevention and treatment programs and facilities in the area of mental health are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs. Other Programs for People with Special Health Needs Description: Any program that provides health services for people with substance abuse related conditions that are not covered by private insurance or Medicaid. For example, this would include services for children with special health needs as well as prevention and treatment programs for HIV or ADDS, sexually transmitted diseases and tuberculosis. -127- HEALTH State Spending on Health Services for Special Populations Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds (000s of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Developmentally Disabled Programs Specific Program Names: a. b. C. d. e. 2. Mental Health Programs: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for mental health programs. Specific Program Names: a. b. C. d. e. 3. Other Programs for People with Special Health Needs Specific Program Names: a. b. C. d. e. -128- HEALTH INSURANCE PROGRAMS within .HEALTH -129- HEALTH Instructions for Health Insurance Programs Instructions: Provide the amount of state dollars budgeted in the fiscal years ending in 1996 (FY 1996) and in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. CASA will use the 1995-96 data you provide in conjunction with detailed data from HCFA for 1996(the latest available) to develop estimates of substance abuse attributable fractions for Medicaid expenditures. CASA then will apply the 1996 fractions to your 1997-98 data. We will not need data for 1996-97. If you are interested, CASA would be pleased to provide information on this methodology to you once it is finalized and fully documented. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Please provide the state share of Medicaid spending(exclude federal share and local, if any) by the following categories: ❑ Hospital ❑ Physician ❑ Institutional Long Term Care ❑ Home Care ❑ Managed Care ❑ All Other If you can allocate managed care to the first four categories, please do so instead of providing it as a separate category. 3. To avoid double counting, list only the spending for the programs that fall within the health budget (see attached survey overview). Other department spending will be requested from other departments(e.g. social services). 4. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 5. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518) 443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at ess@rockinst.org. -]30- HEALTH Descriptions for Health Insurance Programs Medicaid(Social Security Act, I xtle II'E) Description: Any program that receives funds under Title)IX of the Social Security Act and provides medical services to low-income persons who are aged, blind, disabled, members of families with dependent children, or certain other pregnant women and children. General Assistance Medical Care Description: Any health care program for people qualified under the state's general assistance program. Special Instructions: Please briefly describe the eligible population. Other Health Insurance,Programs Description: Any program that provides health insurance to individuals and/or their families not covered by public or private insurance. Special Instructions: Please briefly describe the eligible population(e.g, children under 18). -131- HEALTH State Spending on Health Insurance Programs Agency Name: AMOUNT BUDGETED Total State Funds (OOOs of$) (General Fund and Non-General Fund) PROGRAM NAME Provider Type FY 1995-1996 FY 1997-1998 COMMENTS/ELIGIrBILITY 1. Medicaid Hospital Physician Institutional Long Term Care Home Care Managed Care All Other Total Specific Program Names: a. b. c. d. e. 2. General Assistance Medical Hospital Care: Please briefly describe the eligible papulation. Physician Institutional Long Term Care Home Care Managed Care All Other Total Specific Program Names: a. b. C. d. e- -132- ................... ..........................: .__............................................................................................................................ HEALTH State Spending on Health Insurance Programs Agency Name• AMOUNT BUDGETED Total Stere Funds(000s of$) (General Fund and Non-General Fund) PROGRAM NAME Provider Type FY 1995-1996 FY 1997-1998 COMMENTS/ELIGIBILITY 3, Other Health Insurance Hospital Programs: Please briefly describe the eligible population(e.g. Physician children under 18). Institutional Long Tern► Care Nome Cure Managed Care All Cather Total Specific Program Names. a. b. C. d. e. -133- EDUCATION PROGRAMS -134- ....................... ............................ ............... ............................ .......... EDUCATION Instructions for Education Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars,for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include all state program costs including the cost of teachers and staff at the schools,the cast of program administrators and/or policy analysts, as well as the cost of supplies. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 3. To avoid double counting, list only the spending for the programs that fall within the education budget(see attached survey overview). Other department spending will be requested from other departments (e.g. social services). 4. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. -135- EDUCATION Descriptions for Education Programs Total State Aid far K-12 Education Description: Total state spending on K-12 education including all categorical spending. This includes all aid to localities for education. Any categorical spending for programs for at-risk children and ether substance abuse-related spending are also included. Special instructions: Please identify any categorical spending for programs for at-risk children and any Other substance abuse-related spending separately. Note that this number should also be included within the total state aid for K-12 education. Please also provide us your state's definition of"at-risk children" if possible. -136- EDUCATION State Spending on Education Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds (000s of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Total State Aid for K-12 Education: Please identify separately below: a) any categorical spending for programsfor at-risk children; and b) any substance abuse-related spending separately. These amounts should also be included within the total state aid or K-12 education. Please also provide us your state's definition o "at-risk children"ifpossible. Specific Program Names. a b. C. d. e. -137- JUVENILE PROGRAMS within CORRECTIONS —138— .................. ................................. ...............................��—XXXXX�a ............ ....... ..............I........... CORRECTIONS Instructions for Juvenile Corrections Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include currant year capital spending (actuals or estimated actuals, not appropriations)unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated tapes ("Pay As You Go"), capital spending from bond proceeds(Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of Gtr bonds, revenue bonds, cerficates of participation or other state-backed bonds. 3. Include all program costs, such as the cost of all state personnel involved in directly running a program or facility,the cost of state program administrators and/or policy analysts who spend the majority of their time on this program, the cost of supplies and the cost of other associated programs such as health care. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. Include spending on privately operated facilities. 5. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 5. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. 7. Include categorical funding to localities in these areas. If you have any questions and/or problems with completing this survey, please,contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at cssrockinst.org. -139- CORRECTIONS Descriptions for Juvenile Corrections Programs Juvenile DetentionlCorrection Centers Programs Description: Any program that provides resources that are used at the state and local level to reduce juvenile delinquency. This includes both juvenile detention and correction centers and early-intervention services for families and children. This includes psychiatric, education,job- training and juvenile camp programs. Programs that provide education, training and resources to local and non-profit organizations are also included. Any substance abuse prevention and treatment programs and facilities for juvenile prisoners are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for juvenile detention/correction centers programs. -140- CORRECTIONS State Spending an Juvenile Corrections Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds(000s of$) PROGRAM NAME (General Fund and Tion-General Fund) COMMENTS 1. Juvenile Detention/CCorrection Centers Programs: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending or juvenile detentoi/correction centers ro ams. Specific Program Names: a b. C. d. e. -141- ADULT PROGRAMS within CORRECTIONS -142- . ............... .......... ............... ................ ..........................- .......................... CORRECTIONS Instructions for Adult Corrections Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state G=eneral Fund and state non-{General Fund spending. Do not include federal or local spending. 2. Include current year capital spending (actuals or estimated actuals, not appropriations)unless budgeted elsewhere. Capital spending includes any spending that is paid for out of current general taxes or dedicated taxes("Pay As You Go"), capital spending from bond.proceeds (Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects fended by proceeds of GO bands, revenue bonds, certificates of participation or other state-backed bonds. 3. Include all program costs, such as the cost of all state personnel involved in directly running a program or facility, the cost of state program administrators and/or policy analysts who spend the majority of their time on this program, the cost of supplies and the cost of other associated programs such as health care. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 4. Include spending on privately operated facilities. 5. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 6. If several small programs fall under one bread program heading, aggregate spending if it is easier to do so. 7. If it is impossible to distinguish between parole/early release and probation, submit spending as one combined number that gives the costs for all alternatives to incarceration (and label accordingly on the worksheet). If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9.00 a.m. and 5.00 p.m. Eastern Time. You may also email her at cssrockinst.org. -143- CORRECTIONS Descriptions for Adult Corrections Programs Total Prison Casts Description: Any facility that is set up for the purpose of incarcerating individuals who have committed crimes. Included within these costs are all psychiatric, education and job-training programs and central processing facilities that provide initial examination and evaluation of prisoners. Any substance abuse prevention and treatment programs and facilities for prisoners are also included. Special Instructions. Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total prison costs. ParolelEarly Release and Other Similar Programs Description: Any program that manages the early release of prisoners. This includes programs that fund activities involved in the parole of prisoners and monitoring the parolees once they,are released. Any substance abuse prevention and treatment programs and facilities for parolees are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for parole/early release and other similar programs. Probation and Other Alternatives to Incarceration Description: Any program that supervises and manages persons convicted of a crime but not incarcerated. Facilities that act as an alternative to the incarceration of individuals in prison are also included. This also includes programs that provide job training or educational and confidence building activities for these individuals. Any substance abuse prevention and treatment programs and facilities for individuals on probation are also included. Special Instructions: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for probation and other alternatives to incarceration. Categorical Aid to Localities Description: Any funding to localities for corrections activities. -144- CORRECTIONS State ,Spending on Adult Corrections Programs Agency Name: AMOUNT BUDGETED FY 1998 Total Mate Funds(0000,of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Total Prison Costs: Please idents any special spending on substance abuse prevention and treatment programs and facilities separately,but this number should also be included within the total prison costs. Specific Program Names. a. b. c. d. e. 2. Parole/Early Release and Other Similar Programs: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for parolelearly release and other similar programs. Specific Program Names: a. b. C. d. e. 3. Probation and Other Alternatives to Incarceration: Please identify any special spending on substance abuse prevention and treatment programs and facilities separately, but this number should also be included within the total spending for probation and other alternatives to incarceration. Specific Programs Names: a. b. c. d. e. 4. Categorical Aid to Localities Specific Programa Names: a. b. C. d. e. -145- PUBLIC SAFETY PROGRAMS -146- ............ ..."I..... ..........- ....... ..... ........ .....%%..."...,.,%........... ......................... PUBLIC SAFETY Instructions for Public Safety Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include all program costs including the cost of law enforcement personnel, the cost of state program administrators and/or policy analysts who spend the majority oftheir'time on this program and the cost for contacts for services. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 3. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. 4. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at cssrockinst.org. -147- PUBLIC SAFETY Descriptions for Public Safety Programs Special Drug Enforcement Programs Description: Any program that is intended to eliminate the interstate, intrastate, and international movement of illegal drugs. This may include drug interdiction activities or special task forces. Highway Safety and Accident Prevention Programs Description: Any program that is intended to promote highway safety and reduce the number of highway accidents. This would include broad public education and media campaigns, sobriety checkpoints, and DWI initiatives. Special Instructions: If this spending is included in the State Highway Patrol spending, please indicate this in the comments. State Highway Patrol Description: Any personnel and other costs involved in the state patrol of highways. Local Law Enforcement Programs Description: Any program that provides resources to local districts for law enforcement. -148_ PUBLIC SAFETY State Spending on Public Safety Programs Agency Name: AMOUNT BUDGETED FY 1998 Total State Funds 000s of PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Special Drug Enforcement Programs, Specific Program Names: a. b. C. d, e. 2. Highway Safety and Accident Prevention Programs: If this spending is included in State Highway.Patrol spending,please indicate this in the comments. Specific Program Names: a. b. C. d. e. 3. State Highway Patrol Specific Program Names: a. b. C. d. C. 4. Local Law Enforcement Programs Specific Program Names: a. b. C. d. e. -149- JUDICIARY PROGRAMS ............................ ........................................................ ........................... ............ ............. ........... ... ...............- .................................... JUDICIARY Instructions for Judiciary Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the following programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Ido not include federal or local spending. 2. Include all state program costs including court personnel, contracted services, supplies and the cast of state program administrators and/or policy analysts who spend the majority of their time on this program. Please include the cost of fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. 1 If it is not possible to give state spending on the court system in the following program groupings, please estimate the casts. For example, to derive a family court spending number, it may be possible to determine the share of total caseload represented by family courts and apply that percentage to total state court spending. When the spending is estimated Tease identify it as an estimate and indicate how the number was derived. 4. Give total program spending, not just substance abuse-related costs. The National Center on Addiction and Substance Abuse at Columbia University is developing a methodology to determine what share of these program costs are substance abuse-related. However, if you have specific substance abuse programs within these larger program areas, please list that spending separately. 5. If several small programs fall under one broad program heading, aggregate spending if it is easier to do so. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at cssrockinst.org. -151- JUDICIARY Descriptions for Judiciary Programs Drug Courts and Other Special Programs for Violations of Drug.Laws Description: Any state costs associated with the drug court system. Criminal Courts Description: Any state costs associated with the criminal court system. Family Courts Description: Any state costs associated with the family court system. State Aid to Localities for Criminal Courts, Family Courts and Drug Courts Description: Any funds given to localities for their criminal courts, family courts and drug courts. -152- JUDICIARY State Spending on Judiciary Programs State Agency: AMOUNT BUDGETED FY 1998 Total ,State Funds (000s of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Drug,Courts and Other Special Pro rams for Violations of Dru&Laws Specific Program Names: a. b. C. d. e. 2. Criminal Courts Specific Program Names: a. b. C. d. e. 3. Family Courts Specific Program Names: a. b. C. d. e. 4. State Aid to Localities for Criminal Courts, Family Courts and Drug Courts Specific Program Names: a. b. C. d. e. -I53- ................. _.. REGULATORY/COMPLIANCE PROGRAMS -tsa- REGULATORY/COMPLIANCE Instructions for Regulatory/Compliance Programs Instructions: Provide the amount of state dollars budgeted in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for the fallowing programs on the attached worksheet. 1. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 2. Include all program costs including fringe benefits for all state personnel. A rough estimate of fringe benefit costs is all that is necessary. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518)443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org.rockinst.org. �155- ................................. ... REGULATORY/COMPLIANCE Descriptions for Regulatory/Compliance Programs Alcohol and Tobacco Licensing and Control Boards Description: Any board or governing body that enforces alcohol and tobacco regulations and/or issues alcohol and tobacco licenses. Collection of Alcohol and Tobacco Taxes Description: Total spending on state personnel who are responsible for collecting alcohol and tobacco taxes. -15b- REGULATORY/COMPLIANCE State Spending on Regulatory/Compliance Programs Agency Name• AMOUNT BUDGETED FY 1998 Total State Funds (OOOs of$) PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Alcohol and Tobacco Licensing and Control Boards Specific Program Names: a. b. C. d. e. 2. Collection of Alcohol and Tobacco Taxes Specific Program Names: a. b. C. d. e. -157- .......... CAPITAL SPENDING -158- .......... .............. . ........... ............. .......... .............. CAPITAL SPENDING Instructions for Capital Spending Instructions: Provide the amount of state dollars expended in the fiscal year ending in 1998 (FY 1998), in thousands of dollars, for prisons (bath juvenile and adult facilities), substance abuse facilities, mental health facilities, and facilities for the developmentally disabled. Nate that in all other parts of the survey we have asked for budgeted amounts. 1. Please complete this section only if capital spending is not accounted for in other program worksheets. 2. Include 1997-1998 budget costs only. 3. Include any spending(actuals or estimated actuals, not appropriations)that is paid for out of current general taxes or dedicated taxes("Pay As You Go"), capital spending from bond proceeds (Bond Proceeds), and interest paid out for bonds already issued (Debt Service). Capital spending from bond proceeds includes capital projects funded by proceeds of G0 bonds, revenue bonds, certificates of participation or other state-backed bonds. 4. Include state General Fund and state non-General Fund spending. Do not include federal or local spending. 5. Include the spending on new construction, capital improvements, and equipment. 6. If you do not have accurate information for each category, please provide a,'rough approximation (and identify it as an estimate). 7. It is not necessary to separate capital costs for each separate facility. For example, if it is possible to express prison capital costs in the aggregate rather than for each prison individually please do so. If you have any questions and/or problems with completing this survey, please contact Kathy Snyder at(518) 443-5787 between 9:00 a.m. and 5:00 p.m. Eastern Time. You may also email her at css@rockinst.org. rockinst.org. -159- CAPITAL SPENDING Agency Name: AMOUNT EXPENDED FY 1995 Total State Funds 000s of$ PROGRAM NAME (General Fund and Non-General Fund) COMMENTS 1. Adult Prisons "Pay As You Go" Bond Proceeds Debt Service 2. Juvenile Correctional "Pay As You Go" Facilities Bond Proceeds Debt Service 3. Substance Abuse Facilities "Pay As You Go" Bond Proceeds Debt Service 4. Mental Health Facilities "Pay As You Go" Bond Proceeds Debt Service 5. Developmental Disabilities "Pay As You Go" Facilities Bond Proceeds Debt Service .. -160- ......... . ..................................................... ............................................................................................................................................................................................................................................................. STATE WORKFORCE STATE WORKFORCE State Spending on State Government Workforce We are requesting information on your state's government workforce to do a calculation of state employee productivity losses due to substance abuse. Please answer the following questions for the state workforce in FY 1998. Please estimate if unavailable. Number of Employees: Total Payroll: Gender Breakdown: Percent Male: Percent Female: Age Composition: Percent Age 18-29: Percent Age 30-50: Percent Age 51-64: Other: Total Fringe Benefits: Substance Abuse Share of Employee Assistance Programs:* *Note: If you cannot estimate the substance abuse share,please provide total spending on these programs and describe the extent to which these programs are targeted to substance abuse. -162- Appendix B Methodology The First Steps In 1997, CASA assembled a project team including consultants with expertise and recent experience in financing,budgeting and management at a high level of state government. The consultants helped CASA develop, evaluate and refine the methodology for estimating costs, define the needed data elements and provide us with access to the states. CASA selected an Advisory Panel of distinguished public officials, researchers and representatives of the National Governors' Association,the National Conference of State Legislatures,the National Association of State Budget Officers and the National Association of State Alcohol and Drug Abuse Directors. Panel members held considerable expertise in substantive areas relevant to the research, including technical and specialized knowledge about state policymaking and budgeting, substance abuse and addiction and cost-of- illness studies. The Panel was convened on December 15, 1997. CASA staff consulted with researchers from other institutions including the Urban Institute, the Center for.Budget and Policy Priorities, and The Malcolm Weiner Center for the Study of Social policy at Harvard to better inform the design of the study and the structure of the survey instrument. In order to develop a methodology that would take advantage of previous research, CASA conducted an extensive review of substance abuse costs studies. This included a review of all existing studies related to the cost calculation of substance abuse and addiction, papers that laid out the theoretical foundation of the cost analysis and literature that guided the development of the cost estimation model. We also kept track of specific state initiatives in substance abuse prevention and treatment and evaluations of such programs. -163- Previous Research Efforts $14.3 million was spent on prevention and treatment services by the Maine Office of Previous attempts to document costs of Substance Abuse in 1997(includes state and substance abuse primarily have taken the form federal dollars).g of cost-of-illness studies estimating the overall economic costs to society of abuse of drugs, ➢ Texas published a study in 1998 that alcohol and tobacco.' These studies have been updated a 1989 tally of economic costs of rich and compelling,but they have not provided alcohol and drug abuse. The Texas comprehensive estimates of costs to Commission on Alcohol and Drug Abuse government. Other approaches have estimated estimated that these substances cost the costs of substance abuse to selected taxpayers $19.3 billion in 1997. More than government programs such as healthcare,2 60 percent of this total results from lost federal entitlement programs,prisons and jails productivity($8.1 billion)and premature and child welfare. These estimates have been death($3.9 billion)." Treatment costs of value to states,but their narrow focus has not comprised $1.5 billion or 7.7 percent of the provided policymakers with aggregate spending total cost--$1,001 per man,woman and child across budget categories. in the state. Costs included healthcare, crime, motor vehicle crashes, social welfare Several states have conducted studies to estimate administration and costs to the victims of the costs of alcohol,tobacco,and/or illicit drug crime. These are the costs to society in use(or some combination of these). The Texas,not just the cost to the state budget. methodologies and cost areas vary from study to study, making comparisons between states Several reports documenting the economic costs impossible. These studies do not look only at of substance abuse to states and cities (i.e., state budgets; rather they calculate costs to Arizona, California, Detroit, South Carolina) society which include some federal, state and have been done by Drug Strategies. In their local spending and the costs of lost productivity latest report,they found that alcohol and drugs and premature death. While not specifically cost Washington, DC about$1.2 billion in 1995; targeted to costs to state budgets,these efforts when tobacco-related illnesses are added,the indicate a dawning awareness of how big a total jumps to$1.7 billion." Spending in the financial problem substance abuse really is. criminal justice system drives many of these costs;nearly 70 percent of all arrestees tested > Washington State estimated their costs of positive for drugs, fewer than 10 percent drug and alcohol abuse for 1996. This study received drug treatment.12 Alcohol and tobacco uses a prevalence-based, cost-of-illness excise taxes, which surpassed$24 million in assessment that calculates both direct costs 1997,are not earmarked for prevention, (costs for which payments are made)and treatment or law enforcement efforts to reduce indirect costs(costs for which resources are alcohol-related problems or efforts to curb sales last). Washington determined that its of alcohol/tobacco to minors." economic costs of drug and alcohol abuse totaled$2.54 billion,which equals $531 per The most comprehensive recent national cost non-institutionalized person in the state.7 study, done by the Lewin Group in 1998 and The largest cost is premature death ($929 funded by the National Institute on Drug Abuse million), followed by crime($541 million) (NIDA)and the National Institute on Alcohol and morbidity($369 million).' Abuse and Alcoholism (NIAAA),estimated the cost of alcohol and drug abuse to society to be Y Maine estimated annual costs of substance $246 billion in 1992.34 This represents$963 for abuse to the state's economy at$1.2 billion every man,woman and child living in the United (about$916 per person)an amount equal to States in 1992.'$ Approximately 60 percent two-thirds of the state's annual budget. Only ($148 billion) was attributed to alcohol abuse while the remaining 40 percent was the result of -164- drug abuse($98 billion).16 Areas of costs enables estimates of spending linked to include crime,lost productivity, morbidity and substance abuse where comprehensive data sets mortality, motor-vehicle crashes, and social do not exist. Consequently,it should be a useful welfare programs. Projected costs for 1995, starting point for local governments or for other adjusted for population growth and inflation, are countries without extensive,!data systems. $276 billion.' The Survey The costs for the health effects of tobacco have been thoroughly investigated. Extensive work CASA conducted an extensive review to choose was done to find out how much states were five model states where we would gather paying for illnesses caused by tobacco use when information to develop a budget survey. states sued tobacco manufacturers for health Selection criteria for these five states included care costs. Smoking attributable fractions were size, location, demographic characteristics and determined based on scientific literature that economic conditions. Starting from a links smoking to illness,disability and death. preliminary list of 15 states;identified through For example, in a report for the state of extensive discussions between project team Minnesota researchers calculated that the state members and researchers at other institutions and Blue Cross spent$21.8 billion for health with knowledge of state data collection, CASA care services between 1978 and 1996; of this staff and the Advisory Panel decided on the final amount, $1.42 billion was attributed to five model states. smoking." Other countries have used similar approaches to To determine state programs to include in thestudy, CASA: estimate the costs of alcohol,tobacco and drugs. New Zealand estimated that alcohol abuse and ➢ Reviewed a wide range jof literature on the tobacco use cost them$39 billion a year. consequences of substance abuse to Healthcare costs, loss of productivity, premature government programs; death and social costs comprise this figure. Canada estimated the national economic costs of ➢ Identified state programs designed to alcohol,tobacco and illicit drugs to be$18.4 prevent or treat substance abuse or that deal billion in 1992. Tobacco accounted for the with the consequences of substance abuse. largest portion-49.56 billion. Alcohol costs In the latter category,we included only totaled$7.52 billion and included lost those programs that were large enough to be productivity, law enforcement and health care 71 of any consequence in the overall sum of costs. Illicit drugs cost Canadians $1.4 billion. substance abuse spending. An Australian study estimated that their cost of alcohol,tobacco and illicit drug use is at least y Consulted with state budget and program $14 billion dollars with tobacco being the most officials to understand how these programs costly drug and illicit drugs representing a are financed and to determine the most relatively small proportion of total costs. All efficient and effective way to gather the government outlays for dealing with substance 22 spending data. abuse in Australia totaled$730 million dollars. Detailed data systems are necessary for cost-of ➢ Conducted site visits in the five selected states.y Between March 1998 and August illness studies. The countries cited above and the federal government have detailed databases that allow for this type of work. Even in these « CASA contracted with Dall W. Forsythe, Ph.D., wealthy countries,however, data on substance former state budget director of New York and former abuse is lacking in certain budget sectors and at director of public finance with Lehman Brothers,and the sub-national levet. The methodology Brian ltoherty, former state budget director of Wisconsin and Minnesota and former Director of the employed in this report for state governments National Association of State Budget Officers -165- 1998,site visits were conducted in ➢ State Fiscal Year 1998, state own source California, Florida, Minnesota,New Jersey general revenues including General Fund and Vermont to inform our list of and nonGeneral Fund spending,but not government programs that are affected by federal or local funds;t substance abuse and to learn what, if anything, had already been done to track ➢ Reported expenditures (not appropriations) state substance abuse costs. from the executive budget presented in the winter or spring of 1998,since some states CASA selected state budget officers as the do not publish adopted budget data. appropriate target for data collection because Differences between the proposed and they have the broadest view of and deepest adopted budgets were not expected to be expertise in the budget and because CASA was large enough to skew the findings; particularly interested in informing budget officers about the extent to which substance ➢ All costs (program administration, fringe abuse affects the budget. We designed a benefits, service providers and capital). questionnaire consistent with the way most budget offices are organized,dividing it into To refine the program categories,clarify our broad functional sections. To facilitate instructions, and get a sense of the kinds of completion,we grouped the programs for which questions state budget officers would have, we needed data into nine clusters: human/social CASA pre-tested the questionnaire in three services, developmental disabilities/mental states: California, Florida and New York. health, health, education,corrections,public safety, state workforce, regulation/compliance CASA administered the survey in September of and capital spending. The instrument was 1998 to all 50 states,Puerto Rico and the designed in this fashion to make it easier for the District of Columbia(Appendix A). Forty-five budget office to parcel out the survey questions states,Puerto Rico and the District of Columbia among a variety of specialists in the budget completed the survey.t The participating office, requesting a manageable amount of data jurisdictions constitute approximately 90 percent from each individual. of total state budget spending for the nation, including DC and Puerto Rico. To capture as much of the spending associated with a particular program as possible, CASA Linking Expenditures to Substance designed a survey instrument*requesting data Abuse on: The data, by design, contain a mix of costs attributable to substance abuse and costs associated with substance abuse. Costs (NASBO), to help choose states and set up attributed directly to substance abuse and interviews. The study team consisting of staff and consultants conducted over 40 interviews with state officials and their staff. The interviews were designers t General funds: predominant funds for financing a to identify ways to develop a cost base that was both state's operations. Revenues are received from complete and consistent with the way in which broad-based state taxes. There are differences in how programs are organized and administered in different specific functions are financed from state to state, states. however. Non-general funds: other state funds, The survey instrument was developed for and with expenditures from revenue sources which are CASA by the Fiscal Studies Program(FSP),a restricted by law for particular governmental research unit within the Rockefeller Institute of functions or activities. For example,a tax dedicated Government(Albany, NY)under the direction of to a particular trust fund;and bonds,expenditures Donald Boyd. FSP was responsible for collecting the from the sale of bonds,generally for capital projects. budget data,verifying the information and $ Indiana,Maine,New Hampshire,North Carolina conducting specific analyses. and Texas did not participate in the survey. -166- _............................ - ........................................................................... addiction fall into four main categories: Estimating Substance Abuse Shares spending on prevention,treatment and research; of State Spending spending on the burden of substance abuse and addiction to health care spending based on the CASA developed estimates of the share of probable causal link between substance abuse spending for each program Haat reasonably could and addiction and a particular disease state; be attributed to or associated with substance spending on state worker absenteeism linked to abuse by relying on an extensive review of the substance abuse;and expenditures for alcohol literature, including our own research. Where and tobacco regulation. For these categories it is possible,these shares are firmly grounded in either sell-evident that costs are attributable peer-reviewed research as discussed below. (prevention,treatment,research,regulation and sere published research is lacking,CASA has compliance) or a causal link can be established developed estimates and clearly documented the (health care and state workforce). techniques. This range of techniques lacks For other areas of spending we were less methodological purity,but moves us toward concerned with whether substance abuse caused estimates where none are currently available. the spending than with whether treatment or We first identified and tallied spending on intervention will reduce the cost of the burden programs that were 140 percent attributable to associated with the problem. This is a very substance abuse. For those programs where important policy distinction, The cost-of-illness costs are partially linked to substance abuse,we model has focused on increasing the precision of scaled the shares to adjust for differences in linking costs to causality. The operational prevalence of substance abuse by state."(Table question for a policymaker, however,is not how B.I) many welfare recipients are receiving assistance only because of their substance abuse,but rather To derive a national estimate of state spending haw many welfare recipients will be impeded in on substance abuse,CASA calculated average their efforts to leave the welfare rolls and return per capita substance abuse spending in each to work because they abuse alcohol or drugs. program area for the total of the 47 responding Similarly, it is less important for our purposes to jurisdictions. 'Vire multiplied these averages by establish the percentage of state inmates who the population of the nonresponding states to committed crimes as a direct result only of estimate their substance abuse spending. substance abuse than to determine the group of Estimated spending for both responding and prisoners for whom substance abuse treatment is nonresponding jurisdictions were summed to a necessary condition to keep them from estimate spending levels for the nation as a returning to prison. whole. Although 47 jurisdictions participated in In fact, in all areas where substance abuse places the project,in some instances they did not a burden on state programs,even health care and complete certain sections of the survey. In these state employee costs,substance abuse and cases, CASA also estimated aggregate spending addiction can both cause and exacerbate the for nonresponding states in all categories except conditions that lead to the draw on public funds. Our estimates establish the pool of substance- `The prevalence of alcohol binge drinking and of involved individuals--the target for policy illicit drug use were weighted in a 50-50 proportion intervention. Subsequent work should focus on in each state due to the lack of data identifying the targeting different interventions to address the proportion of users in each category or the proportion different needs of individuals within this pool. ofpolysubstance users in each budget sector. This Because substance abuse more often than not methodology is repeated in each budget sector other appears as one of a cluster of behaviors leading than highway safety and developmentally disabled to increased costs to states, solving the addiction where only alcohol binge drinking prevalence rates roblem will be a necessary ste to eliminating were used to adjust the alcohol linked costs;data on p p g the prevalence of illicit drug use in these areas is not these costs. available. -1b7- Table B.I Prevalence of Alcohol Binge Drinking research because of the low response rate in this and Illicit Drug Use by State section of the survey(only five states reported state spending on substance abuse research). 1 }rtg T1ltc�t Mate..:.......... Substance Abuse Prevention, Treatment Alabama 5.4 5.1 Alaska 5.5 10.7 and Research Arizona 2.2 7.1 5.0 CASA asked states to report all spending for Arkansas 7.1 California 6.1 8.3 programs with the explicit goal of reducing Colorado 4.7 9.3 alcohol, drug and tobacco use and abuse and Connecticut 4.6 7.7 programs that provide treatment for tobacco use Delaware 4.7 8.5 and alcohol and illicit drug abuse. Examples of District of Columbia 7.0 7.6 programs included in this category are state- Florida 6.0 6.8 wide media campaigns, local prevention Gear is 3.7 5.8 networks, interagency coordination of Hawaii 7.9 7.1 prevention programs, prevention education, Idaho 5.1 6.4 treatment facilities,out-patient care programs, Illinois 6.1 6.9 research and capital spending for treatment Indiana 6.4 7.5 facilities. All of these programs are 100 percent Iowa 6.9 5.5 attributable to substance abuse. Kansas 4.8 5.9 Kentucky 8.9 6.0 Louisiana 8.2 5.7 Criminal Justice Maine 3.8 7.1 Maryland 3.2 5.3 In its report, Behind Bars: Substance Abuse and Massachusetts 7.1 10.1 America's Prison Papulation,CASA Michi an 6.7 8.0 documented the enormous impact substance Minnesota 6.1 6.7 abuse has on state spending for corrections.23 Mississippi 6.6 5.8 To estimate the percent of the inmate population Missouri 6.5 6.6 that is "substance involved," CASA used the Montana 4.6 7.7 following categories: ever used illegal drugs Nebraska 5.2 5.6 regularly; convicted of a drug law violation; Nevada 7.0 9.6 convicted of a DUI;under the influence of drugs New Ham shire 4.2 7.0 and/or alcohol during the crime that led to New Jersey 3.4 7.7 incarceration;committed offense to get money New Mexico 4.2 8.9 for drugs;or had a history of alcohol abuse New York 4.1 7.0 (defined as ever in alcohol abuse treatment). North Carolina 4.7 6.3 Using this definition, 81 percent of state inmates North Dakota 7.3 5.4 are substance involved. Oleo 4.3 6.5 Oklahoma 4.7 5.1 7.7 To arrive at total state costs for adult corrections Oregon 5.5 pew Ivania 6.5 7.0 associated with substance abuse, CASA totaled Puerto Rico 11.3 6.9 state expenditures for corrections in the Rhode Island 6.4 8.7 following areas: South Carolina 10.1 5.4 South Dakota 7.6 6.0 > Costs of running and maintaining adult Tennessee 4.8 5.5 correctional facilities,associated Texas 7.4 5.4 administrative and staffing costs, Utah 5.6 6.2 Vermont 6.2 6.8 Virginia 5.6 4.7 --Washington 4.5 8.4 West Virginia 7.1 5.1 Wisconsin 9.3 7.0 Wyoming 5.7 7.3 -I68- 52 State Average 5.8 6.9 S> Costs of special programs such as mental those in CASA's adult corrections report,Behind health, education or religious services Bars. The categories of involvement were: provided to adult inmates, tested positive for drugs; reported using alcohol in the past 72 hours; were under the influence of > Parole and early release programs, or in need of alcohol/drugs; received treatment in the past; currently receiving treatment for,or )0- Adult probation, thinks they could use treatment for alcohol or various illicit drugs.1 Using this definition, 66.3 > State categorical aid to localities for adult percent of youth in the juvenile justice system corrections,and are substance involved. > Capital spending on prisons. To arrive at total state costs for juvenile justice associated with substance abuse, CASA totaled CASA applied the 81 percent share, adjusted by state expenditures in the following areas: state specific alcohol and illicit drug use prevalence data,to these state corrections costs > Juvenile corrections facilities including and added 100 percent of the costs of alcohol residential centers,boot camps and and drug programs provided by state work/study camps, departments of corrections. We assumed that a similar 81 percent of adult probationers and > Diversion programs,and parolees were similarly substance involved and that local spending of state aid for corrections > Capital costs of juvenile corrections would mirror the same pattern. As better data facilities. become available on the extent of substance involvement in corrections, states can adjust the CASA applied the 66.3 percent share,adjusted shares. by state specific alcohol and illicit drug use prevalence data, to these juvenile justice costs Juvenile Justice and added 100 percent of the costs of alcohol and drug programs provided by state The prevalence of drug and alcohol involvement departments of juvenile justice. in the juvenile justice system is less well documented.* An older study found that 70 Judiciary percent of juvenile offenders had a serious alcohol or illicit drug problem.'4 A more.recent The judiciary system is carved into several study in New Jersey found that 67 percent of the branches—criminal,family, civil or drug courts male juvenile offenders reported using (which may be further differentiated into family marijuana in the last 30 days while 57 percent 3 drug court or juvenile drug court). CASA did reported using alcohol in that same timeframe.2not identify any studies that documented the full A study in Maricopa, Arizona, found that 56 impact of substance abuse on our courts, percent of male juvenile offenders tested although several studies have identified the positive for drugs.26 prevalence and characteristics of drug law offenders(drug possession and trafficking)in 27 In the absence of recent national estimates of both juvenile and adult courts. Todevelop a substance involvement in the juvenile justice more comprehensive picture of the impact of system, CASA conducted an analysis of Arrestee Drug Abuse Monitoring Program t Juveniles in the sample were a males. Tbe sample (ADAM)data from the National Institute of size of females was too small to be of any Justice, 1997. Variables were chosen to mirror significance,Ilius,females were excluded from the database but the associated percent of substance- CASA is conducting a study of substance abuse and involved juveniles was assumed to apply to females the juvenile justice system,forthcoming. as well as males. -169- substance abuse on the courts, CASA employed reasonable proxies to estimate state budget the following methodology: spending until more definitive research is conducted. Criminal Courts: CASA analyzed the substance involvement of arrestees, using the Education Arrestee Drug Abuse Monitoring Program (ADAM) 1997,to estimate the proportion of In this area of the budget it is difficult to substance abusers entering the judiciary system. establish substance abuse shares for state We used the following definitions of substance spending for three major reasons. First,state involved: tested positive for drugs; reported governments allocate most education funds in using alcohol in the past 72 hours; were under broad lump sums to local school districts. the influence of or in need of alcohol/drugs; Second,there is a bias against labeling children; received treatment in the past,are currently therefore, it is very difficult for researchers to receiving treatment, or think they could use determine which children were exposed to treatment for alcohol or various illicit drugs. substances in utero or in the home and which Using this approach, 83.8 percent of criminal children are abusing substances. Lastly,there is court costs are substance-linked, very little literature or research that has been done linking costs in the education system to Family Courts: Previous CASA research has substance abuse. shown that 70 percent of child welfare cases are substance involved;28 that is, the case is either Using the"International Guidelines for caused or exacerbated by substance abuse and Estimating the Costs of Substance Abuse" as a addiction. In some states,juvenile justice cases benchmark,there is neither a matrix of costs nor may be represented in this category as well, has there been any delineation of the theoretical Seventy percent of these costs were assumed to issues that help lead to agreement on how to be linked to substance abuse. measure those costs in the case of public education.29 Nonetheless,there is a broad Civil Courts: No substance abuse share was consensus that the costs are potentially developed for civil courts due to the lack of significant.* ability to link costs of tort, property rights,estate or small claims cases to substance abuse and Substance abuse affects schools in several ways. addiction. Parental use can affect the capacity and readiness of children to learn. Faculty and staff Drug Courts: Any state spending specifically use can affect the learning environment. Student on drug courts, including family dependency use can affect their interest and capacity to learn drug courts,was given a 100 percent substance and school security. abuse share. All of these factors might affect the costs of To estimate substance abuse costs linked to our education. For example, maternal alcohol use courts, states were asked to identify all state during pregnancy could result in increased program costs for criminal, family and drug special education costs for students with fetal courts including court personnel, contracted alcohol syndrome. Parental substance abuse services,supplies and the cost of state program might result in programs for at-risk youth, staff- administrators and/or policy analysts who spend intensive compensatory education programs, the majority of time on the program. The after-school programs,summer school and other substance abuse shares, adjusted by state programs. Student use might necessitate specific alcohol and illicit drug use prevalence data,then were applied to the total spending by court type. Substance-linked spending by court 4 Conclusion of a focus group conducted by CASA type was summed to produce a total for courts. July 19, 1999,in Washington DC of experts in the p field of education,school finance and substance While imperfect, these approaches represent abuse cost estimation. -170- ... ....... _ _ increased support and health care staff or may Capital outlays for special facilities needed result in class disruption. Violence associated for substance abusing students. with student use might require increased school costs for security personnel and equipment, CASA estimates that the aggregate of these costs insurance and workers compensation,and could total between ten and 22 percent of annual repairs and replacement of vandalized or stolen state expenditures for elementary and secondary materials. Faculty use might involve increased education. workforce costs and last productivity. To review this approach and associated Few of these costs are reported to states in ways estimates of costs, CASA convened a group of that can be linked to budgets but in the aggregate experts in the area of school finance and represent considerable expenditures. To take the substance abuse. This group also was troubled first steps toward developing an estimate of the by an inability to find data to make more precise costs of substance abuse to the education estimates, but after reviewing and refining this system, CASA identified cost areas that can be list of effects informally posited a range of 10 to linked to substance abuse. These include: 20 percent for the estimated impact of substance abuse on the public education system. For the Lost productivity of staff'and added costs purposes of this study, we have chosen the lower for additional staffing, end of the range, 10 percent,'as a conservative estimate of a substance abuse share for ➢ Special programs for children at risk, education spending. This figure was adjusted by state specific alcohol and illicit drug use and > Special education programs for those with applied to state expenditures'. substance related retardation or learning disabilities, CASA has included this estimate as a placeholder for budget purposes for three Student assistance programs, reasons. First, state budgets are heavily dominated by education spending and failing to ➢ Alcohol-and drug-related truancy, recognize costs in this area would be a major oversight. Second,according to experts in the ➢ Administration costs linked to coping with field and qualitative literature, substance abuse alcohol and drug problems, has a significant impact on schools and on the achievement of their goals. Finally, schools ➢ Property damage and liability insurance represent an important opportunity to intervene costs driven by alcohol and drugs, since problems of substance abuse that start in elementary and secondary school will show up > Higher health insurance costs for substance- later in other state systems like corrections, child involved staff, welfare, mental health or welfare. By including this budget estimate, CASA hopes to promote > Legal expenses linked to alcohol and drugs, research into the question of the impact of substance abuse on schools and education Y Drug testing costs, spending. ➢ Employee assistance programs for substance Health Cure abusers, Substance abuse increases state health care Y Employee training, policy and staff spending in at least three ways: development to increase awareness of and cope with substance abuse, and 1. Some people become ill or injured as a result of their own substance abuse and receive health care services related to the -171- illness. For example, lung cancer resulting in order to estimate the substance abuse share of from smoking leads to a variety of health state health expenditures,taking advantage of as care expenditures, such as hospital, much state-specific data as possible: physician, and drug costs. ➢ Estimate national-level attributable fractions 2. Substance abuse can injure innocent parties. by substance and provider type. An Mothers who smoke during pregnancy may attributable fraction is an estimate of the have low birth-weight babies, increasing share of spending in a given program that is state-financed costs upon the child's birth caused by smoking, alcohol or drug abuse. (and possibly increasing state-financed For example, if we say that the"smoking health expenditures throughout the child's attributable fraction" for Medicaid-financed life). physicians' services is 12 percent,we mean that on average about 12 percent of 3. People who smoke or abuse alcohol or drugs Medicaid payments to physicians are caused often have a generally lower level of health by smoking. and have more frequent, longer,and more severe illnesses. For example, bouts with ➢ Multiply those attributable fractions by influenza tend to last longer for smokers state-specific health spending to arrive at than for nonsmokers. Because of constraints state estimates of spending attributable to of available data,our analysis does not substance abuse. include these costs. Step One: National Attributable Fractions. CASA calculated the healthcare portion of the We developed national-level attributable analysis independent of cost data from the state fractions for each major form of substance abuse survey for two reasons. The underlying basis for (smoking, alcohol and drugs), for each major estimates of health-related spending is type of medical provider(e.g.,hospitals, epidemiological research showing a link physicians, home providers,etc.). We between substance abuse and illness. Some developed 24 different attributable fractions in states might have explored this literature in total--three substance types by eight provider greater depth than others, and some might types." interpret the research differently than others. It makes sense to interpret and apply the To estimate attributable fractions,we used epidemiological research uniformly across population-attributable risk(PAR) values,either states. Further, many states do not have ready estimated directly or as reported in access to data describing the illnesses or health epidemiological research. A PAR value is an care received by their Medicaid populations that estimate of the probability that a given episode is specifically related to substance abuse or that of disease is attributable to(or caused by) a identifies substance abusers so that their factor such as substance abuse. It reflects both Medicaid utilization patterns can be analyzed. the relative risk of getting the disease and the While such data sometimes do exist at the state prevalence of substance abuse. For example, if level,they are in massive databases containing we say that the alcohol-related PAR value for confidential patient information. It is a liver cancer is 19 percent, we mean that 19 significant undertaking for states to use these percent of new liver cancer cases result from databases for research purposes. alcohol abuse. Although we could not obtain a dataset with state-level spending by type of illness--the ideal-- we did obtain state-level data on spending by type of provider. CASA devised a two step The provider types are. hospital inpatient, emergency rooin,outpatient,medical provider visit, methodology to link the effects of substance home provider visit,medical supply purchase, abuse on particular diseases with state.spending prescription drugs and dental. -172- For alcohol,we used PAR values developed by Step Two: Applying Attributable Fractions NIAAA for specific disease states. For illicit to State Health Spending. To develop state- drugs,we developed our own PAR values based by-state estimates of Medicaid and other health on a thorough review of the epidemiological spending attributable to substance abuse, CASA research. In the case of smoking,we applied multiplied the attributable fractions by provider state specific attributable fractions that had been type(derived in step one)by the 1998. spending developed by other researchers by provider type obtained from the Health Care Financing Administration(HCFA). Several We applied these PAR varies to the latest states did not provide a sufficiently detailed available public-use medical care databases to breakdown of spending by provider type. For determine what portion of spending is linked to these states we used a two-step process. First, substance abuse, relying on the ICD-9 we calculated average attributable fractions by (International Classification of Disease, 9th substance type using state-specific HCFA data Revision)coding system. We used the National for 1997,effectively weighting the national Medical Care Expenditure Survey(NMES)from provider-type attributable fractions by the states 1987 for hospital inpatient,hospital outpatient, spending by provider type. We then multiplied physician services,and prescription drugs, and these state-specific weighted-average miscellaneous services. We assumed that attributable fractions by 1998 total state nursing home expenditures would have the same spending on health programs to arrive at attributable fractions as elderly hospital patients. substance abuse attributable spending. The example below illustrates this process for alcohol-attributable hospital spending: Child Wey�zre Prograna > Multiply Medicaid-financed hospital The link between substance abuse and child spending for each patient with a given neglect and abuse has been well documented. disease by that disease's PAR value. CASA's research found that substance abuse and Aggregate spending across all patients with addiction cause or exacerbate 74 percent of child that disease to develop an estimate of welfare cases nationally. Other studies have Medicaid hospital spending for that disease placed the rate of substanceabuse among attributable to alcohol abuse. Repeat for parents of children in child protective services each illness represented on the data file. between Oft and 90 percent. i For this study,we, used 70 percent as the substance abuse share of > Aggregate alcohol-attributable Medicaid child welfare spending. hospital spending across all illnesses to estimate total alcohol-attributable Medicaid To determine child welfare spending, states were hospital spending. asked to identify all program costs including grants to individuals and families, the cost of ➢ Divide alcohol-attributable Medicaid caseworkers or service providers and other hospital spending by total Medicaid hospital program costs. There were asked to include spending to arrive at the"alcohol-- costs for adoption assistance;foster care, attributable fraction"--the share of Medicaid independent living;family preservation and hospital spending attributable to alcohol other programs to prevent out of home abuse. placements,promote reunification of families,or provide a safe environment for children; child ➢ Repeat for other provider types and other abuse and neglect intake and assessment;and substance types. The result is an attributable administrative/staffing costs to run these fraction for each provider type and programs. substance type. The 70 percent substance abuse share,adjusted by state specific alcohol and illicit drug use prevalence data,was applied to total state child -173- welfare spending, after any child welfare percent)of these people retained or re- programs specifically aimed at substance abuse established eligibility as of December, 1997 on were removed. Both categories of costs were the basis of a condition other than substance summed for the total costs of substance abuse to abuse.35 Therefore, only one percent of people the child welfare system. receiving SSI was originally certified by virtue of drug or alcohol addiction. CASA could find Income Support.Programs no studies documenting the extent to which individuals qualifying for SSI under another Substance abuse may be the primary reason condition also have drug and alcohol problems, people need income assistance or it may impede and if so,what percent might be capable of self- a person's ability to become self-supporting. support if their addiction problems were The income support programs included in this addressed. Therefore,we are using one percent study are Temporary Assistance to Needy as the associated share for SSI. Families (TANF), General Assistance and state supplements to the Supplemental Security To estimate substance-linked costs for these Income Program (SSI). programs, states were asked to identify costs for cash assistance,emergency assistance, TANF and General Assistance: The majority employment and training services for the TANF of national and state prevalence studies have or GA populations,income maintenance to the estimated that between seven and 37 percent of aged, blind,and disabled and administrative welfare recipients have a substance abuse costs to run these programs. Substance-linked problem.32 Two previous studies by CASA have shares, adjusted for differences in alcohol and estimated the prevalence of women on AFDC illicit drug use prevalence by state,were applied with substance abuse problems to be between 20 to total costs in each area to develop aggregate and 27 percent.33 For purposes of this study,we spending for income support programs. are using a more conservative 20 percent as the substance abuse share for Temporary Assistance Mental health to Needy Families (TANF)recipients. Preliminary data analysis from a forthcoming Data from a nationally representative sample of CASA welfare policy analysis study confirms the civilian,noninsttutionalized U.S. population our findings.* indicate that half(50.9 percent) of those with a lifetime mental disorder also have a lifetime Very little data are available on the percentage addictive disorder—drug and alcohol abuse and of the general assistance(GA)population that is dependence.36 This may be a conservative substance involved. One study of a county in estimate of the occurrence of comorbid California estimated that at least 43.3 percent of addictive disorder in the population that receives the GA population had a substance abuse mental health treatment through the state since problem that was linked to their receipt of the institutionalized population was not surveyed assistance.3$ In the absence of national data, and people with more severe mental health CASA has used the 20 percent substance-linked problems often receive residential care. share used for the TANF program, recognizing that it is probably a very conservative estimate. Mental health costs included in this study are those for administration,community contracts, SSI: Federal legislation passed in 1996 ended housing programs, institutionalization and payments to individuals who were receiving SSI capital costs for building and maintaining because of drug addiction and alcoholism. facilities. The substance-linked share of 50.9 When benefits were terminated as of January 1, percent was applied to the total of these costs, 1997,2.6 percent of all beneficiaries were after adjusting for differences in state prevalence removed from the roles- About a third (34 of alcohol and illicit drug use. CASA,forthcoming. -174- Developmental Disabilities the proportion of reported accidents that are alcohol involved:t To estimate the share of state costs for the developmentally disabled caused or exacerbated > Calculate the number of alcohol-positive by tobacco, alcohol or drugs, CASA used as a crashes for each type of accident(property base work done by Harwood and colleagues in damage, injury,fatality). Alcohol-involved The Economic Costs ofAlcohol and Drug Abuse crashes account for 16.7 percent of property in the United States, 1992. Their estimate of the damage only accidents,20.4 percent of FAS population receiving care in 1992* (38,884) accidents that involve injuries and 40.8 was approximately nine percent of the total percent of accidents involving fatalities. developmentally disabled population of 434,657 served in 1992 in institutional and residential > Calculate the percent of total alcohol- care across the United States. 37 While CASA involved accidents for each accident type. believes that the nine percent share is Alcohol-involved property damage conservative since it is based solely on fetal represents 78 percent of all alcohol-involved alcohol syndrome,we have used it to calculate traffic accidents; injuries represent 21 the substance abuse share of state spending for percent and fatalities represent .003 percent. the developmentally disabled. This share, adjusted for state differences in prevalence of > Calculate an average for the total of alcohol- alcohol use,was applied to total state costs for positive accidents. developmental disabilities--administration, community contracts,housing programs, Using this approach, CASA estimates that 17.6 institutionalization and capital cost to build and percent of highway traffic accidents are alcohol maintain facilities--to develop state totals of involved. We also applied this percentage to associated costs. accident prevention programs,state highway patrol and local law enforcement programs that Public Safety are not specifically targeted to alcohol or drugs. Costs were adjusted by differences in prevalence Very limited data are available for estimating of alcohol use by state. The total cost of costs to the state for public safety other than for programs targeted to alcohol or drug abuse was criminal and juvenile justice and courts. CASA included. asked states to report costs for special drug enforcement program,highway safety and State Workforce accident prevention programs,state highway patrol and local law enforcement programs. Several studies have focused on documenting and quantifying the adverse effects of alcohol, The main area where some data are available is tobacco and illicit drug use on the workforce.31 for highway safety;that is,the proportion of car Some have been studies of just one organization, accidents that are alcohol involved. There is no others of large firms, and others of particular database, currently,that collects the number of regions;therefore, comparison of the results has drug related accidents. Using data collected by been difficult. A further complicating factor is the National Highway Traffic Safety the variation in definitions of the quantity and Administration, CASA calculated an estimate of frequency of substance use. Drug and alcohol use have been associated with employee absenteeism, lower productivity, increased turnover, workplace accidents and Includes mild/moderately retarded FAS populations higher health insurance CoStS.39 Because of from ages 22 to 65 in the developmentally disabled systems,and severely retarded people with FAS in t This calculation was made with the guidance of the those systems from ages 5 to 65 author,Lawrence Blincoe. -175- severe data limitations, CASA has focused only (workforce x 230)to get a substance abuse on absenteeism for this study; that is,the extra share. days substance abusers are absent compared to nonusers by sex and substance type. In the state workforce section of the survey, CASA requested payroll figures for state CASA adopted the methodology employed in its government employees,total spending on fringe forthcoming study of Substance.Abuse and benefits and the substance abuse share of American Business to calculate absenteeism employee assistance programs. The substance costs linked to substance abuse. While this abuse share(.03 percent),adjusted by state methodology focuses on individuals who have a specific binge drinking and illicit drug use job and work for pay in the private sector prevalence data,was applied to the payroll and (excluding farming,fishing and forestry), it fringe benefits. That total was added to 100 provided a more detailed analysis that would percent of the substance abuse share of otherwise be available. employee assistance programs to get total substance abuse related spending in the state CASA conducted a logistical regression using workforce sector. National Household Survey of Drug Abuse (NHSDA) 1994 data and two panels of the Capital Costs National Longitudinal Survey of Youth(NLSY), (1984-88 and 1992-94). The NLSY allowed us As mentioned in other categories, CASA to control for a large number of relevant included in its analysis funds expended(not demographic and socioeconomic variables and budgeted amounts)by the state for new to capture absenteeism. CASA employed this construction,capital improvements and methodology to pinpoint a probable causal equipment for adult and juvenile corrections relationship between employee substance abuse facilities, substance abuse treatment, mental and absenteeism. From this analysis, CASA health and developmentally disabled facilities. identified prevalence rates and extra days absent We included funds paid for out of current due to substance abuse for men and women by general taxes or dedicated taxes,capital substance type." spending from bond proceeds and interest paid out for bonds already issued. We used the Next,we multiplied the prevalence of substance adjusted substance abuse share from the abuse(by gender and substance abuse type)to respective category to estimate the portion of the state workforce(broken down by gender)to capital spending linked to substance abuse(i.e., get the estimated number of substance abusers in 81 percent for adult corrections capital spending, the workforce by gender and type of substance. 50.9 percent for mental health capital spending, These subtotals were multiplied by gender and etc.). This substance abuse associated capital substance specific extra days of absences per spending was added to other costs in each person, per year to get the total number of days respective category. lost per year. Once these subtotals were aggregated,that number was divided by the Regulation and Compliance expected number of days of work per year CASA included in its analysis total spending on Smoker:An employee who smokes 16+cigarettes state personnel who are responsible for per day in the past month. Heavy Drinker: A male collecting alcohol and tobacco taxes (including employee drinking 5+drinks five or more times in fringe benefits)and state funds budgeted for the past month. A female employee drinking 3+ boards or governing bodies that enforce alcohol drinks five or more times in the past month. Current and tobacco regulation and/or issue alcohol and Drug User: An employee who uses marijuana and/or cocaine at all in the past month. Absent: An indicator tobacco licenses. These costs are l00 percent for worker absence at any time during the survey attributable to substance use. CASA also month(NHSDA)or week(NLSY). estimated the total tax revenues states receive from alcohol and tobacco sales. -176- Appendix B Notes Harwood,et al. (1998);Rice,D.P. (1993) 2The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1993& 1994a) 3 The National Center on Addiction and Substance Abuse(CASA)at Columbia University, (1995) 4 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998) 5 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1999) 6Wickizer,T.M.(1999),p.vi-vii Wickizer,T.M.(1999),p. vii Wickizer,T.M.(1999),p.vii 9 Joint Task Force on Substance Abuse. 1998,p. 1 '0 Liu,L. (1998),p. I 11 Drug Strategies. (1999a),p.4 !2 Drug Strategies[news release]. (1999b),p, 2 13 Drug Strutegies.(1999a),p.7 14Harwood,H.,et al. (1998),p. 1_1 '5 CASA analysis based on 1992 population from the Bureau of the Census. '6Harwood,H.,et al. (1998),p, 1-1 "Harwood,H.,et al. (1998),p. 1-1 'a Zeger,S.L.,Wyant,T.,&Miller,L. S. (1997),p. 3 '9 Easton,B. (1997),p.29 20 Single,E.,Robson,L.,Xie,X.,&Rehm J. (1998),p. 991 21 Single,E.,Robson,L.,Xie,X,&Rehm,J. (1998),p. 991 22 Collins,D.I&Lapsley,H.M. (199 1) 23 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1998) 24 Santo,et al.,&Inciardi,as cited in Brenna,D. (1992) 25 Kline,A.,&Rodriguez,G. (1996) 26Arizona Department of Juvenile Corrections, (1997) 27 Brown,I M.,&Langan,P. A. (1998); Stahl,A. L., Sickmund,M.,Finnegan,T. A., Snyder,H. N,,Poole,R- &Tierney,N. (1999) 28 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1999) 29 Single,E.,Collins,D.,Easton,B.,Harwood,H.,Lapsley,H.,&Maynard,A. (1996) 30 Miller,L. S.,Zhang,X.,Rice,D.P.,&Max,W. (1998) 3' Bane,M. J., &Semideij (1992);Connecticut Department of Children and Families. (1997)-,U. S.General Accounting Office, (1994);Washoe County Department of Social Services. (1995) 32 Olson,K,&Pavetti,L. (1996) 33 The National Center on Addiction and Substance Abuse(CASA)at Columbia University. (1994b& 1995) 34 Schmidt,L., Weisner,C.,&Wiley,J. (1999) 35 Stapleton,D.C.,Wittenburg,D.,Tucker,A.,Moran G.E.,Ficke,R.,&Han-non,M. (1998) 36 Kessler,R. C.,Nelson, C.B.,McGonagle,K. A.,Edlund,M.J.,Frank,R. G.,&Leaf,P. J. (1996) 37 American Association of Mental Retardation(as cited in Harwood,et al., 1998) 38 Blum,T.C.,Roman,P.M,&Martin,I K. (1993);Hoffman et al. (1997);French,M.T.,Zarkin,G. A.,& Dunlap,L. I (1998) 39 Hoffman,et al. (1997)\ -177- -178- Reference List Alcohol, Drug Abuse and Mental Health Administration.Reorganization Act, P. L. 102-321, (199.0. Abbott,E. (2000, October 19). Special court for juvenile drug offenders set to begin in county. The.Providence,Journal, p. 1 C. Abel, E. 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