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State of the State 2013

State of the State 2013. MARK P. FONTAINE, MSW, CAP Executive Director Florida Alcohol and Drug Abuse Association. Impact of Alcohol & Drug Abuse on Floridians & Florida’s Economy is Significant & Understated . Each year, alcohol abuse costs FL $21 billion $3.4 billion in crime

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State of the State 2013

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  1. State of the State2013 MARK P. FONTAINE, MSW, CAP Executive Director Florida Alcohol and Drug Abuse Association

  2. Impact of Alcohol & Drug Abuse on Floridians & Florida’s Economy is Significant & Understated. • Each year, alcohol abuse costs FL $21 billion • $3.4 billion in crime • $1.4 billion to treat health problems • Alcohol abuse causes crimes that victimize more than 63,000 people • Each year, drug abuse costs FL $22.7 billion • $20 billion in losses from drug-related deaths • $2.4 billion in crime • Each hour in Florida: • $392,000 is spent due to alcohol attributable crimes • $393,000 is spent due to crimes committed because of drugs • The negative consequence of alcohol & drug abuse costs $43.7 billion in Florida annually.1 State of the State:Substance Use Disorders Annual Economic Impact of Alcohol and Drug Use in FL (Spectrum, FADAA, et al)

  3. Mental illness describes a broad range of disease types that range in severity based on individual diagnoses • Nationally, 25% of all adults have a mental illness • 20% of children and adolescents have a mental health problem • 6.7% of Americans have depression with 30% being severe • 18.1% of Americans have anxiety disorders • 2.6% of Americans are bi-polar • 1.1% of Americans are affected by schizophrenia State of the State:mental Health Disorders

  4. Costs to Health Care • 7 deaths a day due to prescription drugs • Drugs causing most deaths: oxycodone, benzodiazepines, methadone, and alcohol 2011-2012 PDMP Annual Report • 53+ million dispensing records uploaded • 2.3+ million physician/pharmacist queries 2012 Drugs Identified in Deceased Persons by Florida Medical Examiners (Interim Report January-June 2012) • Overall drug deaths down by more than 100 people • Oxycodone accounted for 8.4% overall (-29.1% drop from July-December 2011) Drugs & Alcohol Have Significant Social Impacts

  5. Serious mental illness cost to American society • $255.4 billion annually in lost earnings ($25.1 billion in Florida) • Half of adolescents who fail to complete high school have a mental illness (46%) • 18.5% of veterans show signs of PTSD or depression • 18% of Florida inmates are in need of and receive mental health services (18,480 individuals) • There is a strong connection between homelessness and mental illness • Providing housing for homeless reduces criminal justice involvement by 38% and prison stays by 84% Mental Health HasSignificant Social Impacts

  6. Science Provides Solutions for Drug Abuse and Addiction Addiction is a disorder of altered cognition. It overlaps the brain regions that are involved in essential cognitive functions such as learning, memory, attention, reasoning and impulse control. Decision-making deficits are linked to a dysfunctional ventromedial prefrontal cortex in alcohol and stimulant users. Neuroscientists have made important advances in identifying the key pathway to reverse changes in DNA production of proteins, laying groundwork for new studies in drug relapse. Genetic factors account for 40-60% of alcohol addiction. Recent studies show similar genetic factor rates for other drug addiction.

  7. Addiction: A Treatable Chronic Brain Disease Like diabetes, asthma or hypertension, addiction is an illness requiring a continuum of care. However, compliance rates for treatment of alcohol, opioids and cocaine are less than those for hypertension or asthma. The value of treatment is demonstrated in over 600 published scientific papers. People who enter and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. Drug treatment reduces drug use by 40-60% and significantly decreases criminal activity during and after treatment

  8. Treatment Reduces Recidivism 65% of Florida inmates have an identified treatment need 57% of Florida probationers have an identified treatment need 81% of Florida offenders in FY2008-2009 who completed addictions treatment had not returned to prison or supervision for a new offense. A five-year study of a Brooklyn, NY drug diversion showed a 26% lower re-arrest rate 2-years post completion. In Baltimore City, MD, arrests for theft, burglary, and robbery were 55% lower for those who received treatment compared to those who did not. In Delaware, 70% of the inmates receiving comprehensive treatment in a work release program remained arrest-free after 3-years post release.

  9. SAMHSA Estimates 1.2 million Floridians need treatment; DCF reports 15% have access to treatment • 180,000 total Department of Children & Families • 25,000 total Medicaid • 10,000 Department of Corrections • 2,000+ Department of Juvenile Justice • 1st party insurance Need for Substance Use Disorder Treatment

  10. Estimates are that 4.75 million Floridians need mental health treatment Number of adults and children served in community mental health system (FY2010-2011) Need for Mental Health Treatment Examining the Efficacy of Florida's Publicly Funded Mental Health Services, 2012

  11. Average cost of Emergency Room visit: $3,819 ($2,400 treatment) • 4 million drug-related emergency room visits (47% drug misuse or abuse) • Treatment reduces emergency room costs by 39% • People with untreated substance use were 46% more likely to have emergency room visit • Most DCF patients are not eligible for Medicaid; of 15% Medicaid eligible 56% need a service that Medicaid does not cover • 2008: 16 times more emergency room visits for unintentional prescription opioid overdoses than heroin • Every $1 spent on treatment offsets $2 - $3.50 in health care costs The Consequences: Healthcare

  12. For 44.2% of those having parental rights terminated: 3,277 children had parental rights terminated due to parental drug abuse (the next closest is 17.6% for neglect) • $10,000 per child in foster care annually • 50-80% of substantiated abuse and neglect cases have some degree of parental substance abuse • Substance abuse by parents are the highest risk factors in child fatality • 46% in treatment have dependent children • 18% increase in the last 2 years of parental substance abuse in child abuse/neglect investigations The Consequences: Child Welfare

  13. 100,000 inmates – 65,000 drugs/alcohol; just over 5,000 treated • 155,000 probationers – 58% of drug/alcohol problem • 84% released needing treatment but did not receive it • 32% recidivate after 3 years post-release • 44% recidivate after 5 years post-release If all offenders needing treatment received it, 769 fewer would return to prison saving $36 million • $10,290 – cost of Community Drug Treatment (7 months) vs. $56,000 – cost of average drug sentence (3.4 years) The Consequences:Criminal Justice

  14. The Legislature’s only Constitutional requirement is to pass a budget each year. • The fiscal year runs from July 1 – June 30. • As passed, Florida’s Budget was $74.5 billion • The Governor vetoed $368 million; bringing the final Budget down to $74.5 billion Florida’s BudgetFY 2013-2014

  15. State employee pay increase with merit-based bonus • Community based mental health and substance abuse funding ($23.2 million GR; 9.2 million TF) • Children’s Community Mental Health/Substance Abuse Action Team Pilot Programs— $6.75 million • Statewide “Moms and Babies” program - $8.967 million • Domestic Violence Centers Funding— ($2 million GR; $1 million TF) • Pilot program linking child welfare & substance abuse treatment - $5 million • Veterans’ benefit counseling Florida’s Budget Highlights:New or Increased Funding

  16. 3% of young Floridians have challenges so severe they cannot function at home, in school or community • Florida’s behavioral health care for youth was never updated for serious cases (schizophrenia, bipolar disorder etc) • Florida ranks 49th in mental health per capita spending • Only 27% of youth behavioral needs funded • State tends to institutionalize seriously disturbed youth rather than seeking alternatives Community Action Teams (CATs)

  17. CATs are modeled after Florida Assertive Community Treatment Team (FACT) for adults • CATs offer parents and caregivers of seriously, emotionally disturbed youth a safe option for raising their son or daughter at home • Provides lower cost alternative to state-funded foster home, residential treatment or juvenile justice • Includes an integrated approach with medical, behavioral, trauma, and substance abuse to treat multiple problems Community Action Teams (CATs)

  18. 3-year evaluation of CAT pilot in Manatee (2010-2012) served 244 youth and 955 family members - 76% ages 11-18 - 69% two major diagnosis, 37% three diagnosis • Outcome measurements diverted: - 87.5% from residential (160 youth) - 93.7% from foster care (95 youth) - 74.2% from juvenile justice (62 youth) • Cost benefit analysis: - $675,000 to serve 75 cases plus 300 family members - State breaks even if only 9 residential admissions are diverted Community Action Teams (CATs)

  19. Legislature funded a total of $6.750 million for CATs in 2013 Communities to be served: • Manatee, Sarasota, Desoto counties • Brevard County • Bay County • Collier County • Duval County • Lee County • Miami-Dade County • Pinellas County • Polk, Highlands, Hardee counties Community Action Teams (CATs)

  20. Until recently, Florida was known as “Oxycontin Express” The CDC released a report on July 3 showing a 415% increase in OPR overdose deaths among women from 1999-2010 Withdrawal Diagnosis • 2005: 254 infants • 2010: 1,355 infants (433% increase) Newborn Infant Discharges: All FL Hospitals (2010) • 1,834 Discharges • 26,815 Patient Days • 14.6 Day Average Stay • $39,362 per case = $72 million • 89.6% Medicaid Fetal Alcohol Syndrome Lifetime Expenses = $1.4 million Substance Exposed Infants:The Problem

  21. B r e v a r d Santa Rosa Holmes ngton J a c k s o n Walton Okaloosa i h Escambia n N a s s a u G a d s d e n s o a s W r H a m i l t o n C a l h o u n e L e o n f f M a d i s o n a e B a y i J b D u v a l B a k e r m u L i b e r t y W a k u l l a l S u w a n n e e o d C T a y l o r r o Lafayette U n i o n S t . f d C l a y Rate of NWS per 100,000 Live Births: F r a n k l i n a G u l f r J o h n s B G i l c h r i s t A l a c h u a P u t n a m D i x i e F l a g l e r L e v y Very High (1000+) M a r i o n Volusia C i t r u s L a k e High (443-999) S e m i n o l e S u m t e r H e r n a n d o O r a n g e P a s c o Moderately High (<443) O s c e o l a Hillsborough P o l k I n d i a n R i v e r P i n e l l a s O k ee H a r d e e M a n a t e e ee c h o S t . L u c i e H i g h l a n d s b e D e S o t o e S a r a s o t a M a r t i n Charlotte G l a d e s Drug Treatment Beds for Pregnant Women and Women with Children in Counties with High Rates of Newborn Withdrawal Syndrome Palm Beach H e n d r y L e e Broward C o l l i e r Dade Monroe

  22. Statewide Task Force on Prescription Drugs and Newborns created in 2012 to study the problem and make recommendations • Legislature funded a total of $8,967,700 in FY 2013-2014 for expanded treatment for pregnant women and women with children • Services offered include: expansion of residential treatment, outpatient treatment with housing support, and post-partum case management supporting both the mother and child • Priority for services given to counties with greatest need and available treatment capacity Substance Exposed Infants

  23. Criminal Justice: $4.27 billion

  24. Department of Corrections - $2.1 billion • Funds to hire 245+ FTEs for high-risk population - $13.7 million • Electronic monitoring for inmates at community work release centers - $3.8 million • Opening Gadsden Re-entry center with drug treatment focus - $2.9 million • Community-based substance abuse treatment expansion - $2.6 million (total) Department of Juvenile Justice - $518.6 million • Addresses children’s psychiatric services - $145,000 • Expands PACE slots - $2 million • Boys and Girls Clubs for Reentry programs statewide - $5 million • Big Brothers Big Sisters program for mentoring/counseling youth of incarcerated parents - $1.5 million Trial Courts - $366 million • Continue Post-adjudicatory drug courts - $5.5 million • Continue Veterans’ courts programs - $750,000 Criminal JusticeFunding Highlights

  25. Science of Addiction: Addiction changes brain structure & function; a treatable chronic brain disease • Evidence-based practice • Recovery-oriented systems of care • Process improvement • Growing awareness of addictive disorder as public health problem…more public dialogue • Managing entities • Floridians for Recovery • Medicated Assisted Treatment • Prescription Drug Epidemic • Dual diagnosis Recent Developments

  26. Paul Wellstone & Pete Domenici Mental Health Parity and Substance Abuse Equity Act (2008) • Patient Protection & Affordable Care Act (PPACA) - Essential health benefit: Substance use disorder • Medical managed assistance (AHCA)/Managed Care/Medicaid • Universal coverage • Integrated care • Health homes/ACO • Commercial coverage Changes in Healthcare

  27. Integration of services • Smart Justice • Diversion, alternatives • Sentencing • Pre-entry • In prison • Re-entry • Juvenile justice • Thresholds • Civil Citation • Drug Court Expansion • Reinvestment grants Trends: Criminal Justice

  28. Financing & service delivery strategies • Managed care for substance use disorder • Substance use and mental health disorders as chronic disease • Changing business environment • Uncertainty of health care reform • Linkage with primary care • Electronic health records • Alternatives: Adult Civil Citation, diversion • Workforce • Performance metrics for Criminal Justice Opportunities

  29. Thank You… Florida Alcohol & Drug Abuse Association www.fadaa.org

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