CRS Issue Brief CRS. Alcohol, Drug Abuse, and Mental Health Block Grant;;^^:;itelated Programs. Updated June 1, 1990

Transcription

1 Order Code IB88009 CRS Issue Brief Alcohol, Drug Abuse, and Mental Health Block Grant;;^^:;itelated Programs Updated June 1, 1990 by Edward Klebe Education and Public Welfare Division Congressional Research Service The Library of Congress CRS

2 CONTENTS SUMMARY ISSUE DEFINITION BACKGROUND AND ANALYSIS Program History and Description Appropriations The Anti-Drug Abuse Act of 1988 Alcohol and Drug Abuse Provisions Mental Health Provisions Supplemental Appropriations Legislation in the 101st Congress Major Issues Revision of the Block Grant Allocation Formula Set-Asides Program Effectiveness LEGISLATION CONGRESSIONAL HEARINGS, REPORTS, AND DOCUMENTS CHRONOLOGY FOR ADDITIONAL READING

3 IB Alcohol, Drug Abuse, and Mental Health Block Grant and Related Programs SUMMARY The Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant authorizes (1) grants to States for prevention, treatment, and rehabilitation programs and activities to deal with alcohol and drug abuse; and (2) grants to community mental health centers for the provision of mental health services, including services for the chronically mentally ill, severely mentally disturbed children and adolescents, mentally ill elderly individuals, and other underserved populations. The ADMS block grant was created in 1981 by P.L , and amended and extended in 1984 and 1985 by P.L and P.L The Anti-Drug Abuse Act of 1986, P.L , authorized new substance abuse prevention and treatment programs to supplement the ADMS block grant authority. The 100th Congress as part of omnibus drug abuse legislation, P.L , the Anti-drug Abuse Act of 1988, amended and extended the authority for the block grant and related programs. P.L also provides supplemental appropriations of $283 million in FY1989 for alcohol and drug abuse prevention and treatment activities. Total FY1989 funding for alcohol, drug abuse, and mental health services grants to the States is $805.6 million. The FY1990 appropriation for the block grant is $1.193 billion. The Administration budget proposed for FY1991 includes $1.293 billion for the block grant. The major issues in the operation of the ADMS block grant and in legislation to amend it are the allocation formula for the block grant, the question of set-asides in the block grant authority requiring States to reserve specific portions of their block grant allotments for certain program activities, and the effectiveness of such programs.

4 IB ,90 ISSUE DEFINITION The Alcohol, Drug Abuse, and Mental Health Services Block Grant, authorized under Title XIX of the Public Health Service Act, provides grants to States for alcohol and drug abuse treatment and prevention activities and community mental health services. Created by the Omnibus Budget Reconciliation Act of 1981 and amended and extended in 1984 and 1985, the block grant was reauthorized by the 100th Congress. Issues surrounding the reauthorization process included a change in the formula to allocate funds among the States, the addition of set-asides, and the level of Federal support for the program. Total FY1990 funding for block grants to the States for alcohol, drug abuse, and mental health services is $1.193 billion; the Administration's FY1991 budget requests $1.293 billion for the block grant. BACKGROUND AND ANALYSIS Program History and Description The Omnibus Budget Reconciliation Act of 1981, P.L , among other things, established four health block grants, one of which was an Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant. This block grant, authorized under Title XIX of the Public Health Service (PHS) Act, consolidated categorical programs from separate authorities: the Community Mental Health Centers Act of 1963 as amended; the Mental Health Systems Act of 1980; the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 as amended; and the Drug Abuse Prevention, Treatment, and Rehabilitation Act of 1970 as amended. P.L authorized appropriations for FY1982 through FY1984 for grants to States to be used for - (1) prevention, treatment, and rehabilitation programs and activities to deal with alcohol and drug abuse; and (2) grants to community mental health centers for the provision of mental health services, including services for the chronically mentally ill, severely mentally disturbed children and adolescents, mentally ill elderly individuals, and other underserved populations. The ADMS block grant authority was amended and extended through FY1987 in 1984 by P.L , and further amended in 1985 by P.L The Anti-Drug Abuse Act of 1986, P.L , authorized additional appropriations for the block for FY1987, and, in addition, established new authorities for FY1987 for alcohol and drug abuse treatment and prevention activities. As originally authorized, block grant funds were allocated to the States by means of a formula based on their allocations for certain years under the previous categorical programs. Under this allocation formula, each State's proportion of block grant funds would equal, for alcohol and drug abuse services and mental health CRS-2

5 IB ,90 services, the proportion of funds received by the State in FY1980 of total funds allocated for the alcohol and drug abuse programs and in FY1981 (prior to an FY1981 rescission) for the mental health programs that were consolidated into the block. The conference report for the 1981 legislation stated that the conferees anticipated that this two-part formula would result in national allocations for mental health and substance abuse programs which were approximately equal to each other. The 1984 amendments to the block grant, P.L , revised the allocation formula to reflect the relative populations and per capita incomes of each State. Conferees on this bill expressed the belief that population and per capita income were "a more reliable and equitable means" of allocating block grant funds than the original formula. The law establishes a method for States to distribute block grant allotments between mental health and substance abuse services. Under the original 1981 enactment, all of a State's allotment from the block grant in FY1982 had to be spent to support mental health services and substance abuse services in the same proportion that Federal funds were awarded to support such services in the State in the relevant base years - the years the allocation formula was based on. In FY1983, 95% of the State's allotment, and in FY1984, 85% of the State's allotment, had to be obligated in this manner. The 1984 amendments made permanent a percentage of 75% that States have to allocate in this manner; States may exercise discretion over the remaining 25%. States are required to distribute their allotments for drug abuse and alcoholism services in a certain way: of funds received by a State for substance abuse services, at least 35% must be used for alcoholism and alcohol abuse services and at least 35% for drug abuse services. In addition, of funds allotted to a State for substance abuse services, at least 20% must be used for prevention and early intervention programs. The 1984 amendments established, and the 1985 amendments modified, two new set-aside provisions requiring States to allocate specific portions of their block grant allotments for certain program activities. These provisions require that States set aside funds for new or expanded alcohol and drug abuse services for women, and new (and expanded in FY1986 and FY1987) comprehensive community mental health services for under-served areas or populations, with special emphasis on services for severely disturbed children and adolescents. The ADMS block grant is administered by the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) of the Department of Health and Human Services. ADAMHA performs certain policy oversight and coordination activities related to the block. In addition, it is responsible for assessing State compliance with legislative provisions for the block by reviewing State applications, annual reports and audits, conducting compliance reviews and investigations, and processing complaints. The Anti-Drug Abuse Act of 1986, P.L , authorized, and the continuing appropriations act for FY1987, P.L , appropriated funds for, several new program activities in ADAMHA related to substance abuse treatment and prevention. The 1986 act authorized a new program of grants to States to enhance ongoing treatment and rehabilitation programs. Appropriations for this authority are allocated CRS-3

6 IB to States on the basis of population (45%) and on the basis of need, as determined by the Secretary (55%). The Act also authorized the creation of an Office of Substance Abuse Prevention (OSAP) within ADAMHA to carry out substance abuse prevention activities, including a program of demonstration project grants for substance abuse prevention, treatment, and rehabilitation among high-risk youth. The appropriation authorizations in P.L were for 1 year only, FY1987, and are included in discussions of the reauthorization of the ADMS block grant authority by the 100th Congress. Appropriations The FY1989 DHHS appropriations Act, P.L included funding levels of $ million for the ADMS block grant, $ million for the substance abuse treatment grants to the States, and $ million for OSAP. In addition, Title X of P.L , the Anti-drug Act of 1988, as passed by the Congress and described below included a supplemental appropriation of $283 million for FY1989 for prevention and treatment programs and activities, of which $125 million was earmarked for ADMS block grants to the States. The total FY1989 appropriation for grants to the States for the block grant was $ million. Appropriations for FY1990 for alcohol, drug abuse, and mental health programs were included both in P.L , the appropriation for the Departments of Labor/HHS/Education, and in emergency drug abuse supplemental appropriations passed as part of P.L , the appropriation for the Department of Transportation. The total FY1990 appropriation for the block grant after sequestration is $1.193 billion, of which $1.133 billion is available for allocation to the States. Nationwide, 21% of the amount of the block grant available for distribution to the States in FY1990, or $237.6 million, will be used for mental health services, while 79%, or $895.6 million, will be used for substance abuse services. These percentages may vary from State to State. The FY1990 appropriation for OSAP after sequestration is $193.4 million. The President's FY1991 budget proposal includes $1.293 billion for the block grant, $1.219 billion for allocation to the States, and $261.9 million for OSAP. CRS-4

7 IB ^90 TABLE 1. Alcohol, Drug Abuse, and Mental Health Services Block Grant - Authorizations and Appropriations, FY1982-FY1990 (dollars in thousands) Fiscal Year Authorization Appropriation 1982 $491,000 $428, , ,972 a , , , , ,930 b ,365 t*\ - 671, d. ^V*-- 643,217 -> ,500,000 \Vf^A^ 805, ,500,000 «*** 1,192,851 e 1991 budget request 1,500,000 7ffc - 1,292,775 Includes regular appropriation of $ million plus a supplemental appropriation of $30 million added by P.L to be used for alcohol 1 and drug abuse problems related to unemployment. f V<-f'f*' Represents post- sequestration under Gramm-Rudman-Hollings from an appropriation of $490 million. ^* c Includes appropriation of $495 million plus $13.8 million authorized f by P.L and appropriated by the FY1987 continuing resolution, P.L for the ADMS block grant and $163 million for treatment grants to States. d Legislation to reauthorize the program in FY1988 was not enacted, but the appropriation of funds for FY1988 through the continuing resolution P.L , served as de facto authorization for the year. The total appropriation includes $487.3 million for the ADMS block and $155.9 million for treatment grants to States. e After sequestration. /)/l ^~? Cft L/*M Legislation in the 100th Congress ' The Anti-Drug Abuse Act of 1988 The 100th Congress, as part of the 1988 Anti-Drug Abuse Act, P.L , amended and extended the ADMS block grant authority. On Aug. 11, 1988, Representatives Foley and Michel introduced H.R. 5210, the Omnibus Drug Initiative Act of This was the bill that was eventually enacted into law as P.L This legislation was modeled on the 1986 Anti-Drug Abuse Act and provided major funding increases in most drug abuse program areas along with changes in authorizing legislation and additional authorities. Through September and October of 1988 the House and Senate worked on separate proposals for a comprehensive drug abuse bill. After extensive negotiations between the two houses, the Congress CRS-5

8 IB on Oct. 22, 19S8, just before final adjournment, passed and sent to the President a compromise bill, H.R. 5210, the Anti-Drug Abuse Act of The President signed the bill into law on Nov. 18 as P.L Title H of the bill, entitled Treatment and Prevention Programs, amends and extends existing program authorities, such as the Alcohol, Drug Abuse, and Mental Health Services Block Grant, the Alcohol and Drug Treatment and Rehabilitation Block Grant, and the programs of the Office for Substance Abuse Prevention. Title n also authorizes new program authorities for support of substance abuse and mental illness prevention and treatment activities. Title X of the bill as passed by the Congress includes supplemental appropriations for various programs in the other nine titles of the bill, including drug and alcohol abuse prevention and treatment activities. The following provides a brief summary of the highlights of Titles n and X of H.R as passed by the Congress. Alcohol and Drug Abuse Provisions Revises and extends authority under Title XIX of the Public Health Service Act for the Alcohol, Drug Abuse, and Mental Health Services (ADMS) Block Grant, at an authorization level of $1.5 billion for FY1989 and such sums as may be necessary for FY1990 and FY1991. Revises method for allotment of ADMS block grant funds to the States to a formula based on each State's population of age groups at greatest risk for substance abuse and mental illness and on total taxable resources of each State. Requires States, starting in FY1990, to agree to use at least 50% of their drug abuse treatment allotments under this block grant for (1) intravenous drug abuse treatment programs with priority to programs which treat individuals infected with the etiologic agent for AIDS; (2) training of drug abuse counselors and other health care providers in providing such treatment; and (3) outreach activities to encourage individuals in need of drug abuse treatment to undergo such treatment. States may not use such funds for any program which distributes sterile needles or bleach to cleanse needles or to carry out testing for AIDS unless testing is accompanied by appropriate counseling. A State may receive a waiver of these requirements if the Secretary determines that the incidence of intravenous drug abuse in the State warrants it. Requires an intravenous drug abuse treatment program receiving funds under the block grant to notify the State when it reaches 90% of its capacity to admit individuals to the program, and requires each State, when so notified, to ensure that, to the maximum extent practicable, each individual who requests and is in need of such treatment is admitted to a program within 7 days of such request. Amends block grant authority to permit the use of block grant funds for the construction of substance abuse treatment facilities. Requires a State to use at least 10% of its allotment under the block grant for programs and services designed for women (especially pregnant women and women with dependent children) and demonstration projects to provide residential treatment services to pregnant women. Requires each State, in order to receive block grant funds, to establish a revolving loan fund to make loans for establishing group homes for recovering substance abusers. CRS-6

9 IB Authorizes the appropriation of $100,000,000 to be available until expended, for grants to reduce the waiting lists of public and nonprofit private programs providing drug abuse treatment services. Extends authority for Office for Substance Abuse Prevention (OSAP) and related programs in Title V of the PHS Act. Authorizes appropriation of $95 million for FY1989 and such sums as may be necessary for FY1990 and FY1991 for OSAP, the Clearinghouse on Alcohol and Drug Abuse Information, the Model Projects for High Risk Youth, and for Model Projects for Pregnant and Postpartum Women and Their Infants. Requires that $5 million of each year's appropriation be made available for programs to train drug abuse counselors and other health personnel in drug abuse education, prevention, intervention, diagnosis, and treatment. Authorizes appropriation of $34 million for FY1989 and such sums as may be necessary for FY1990 and FY1991 for grants for drug abuse demonstration projects of national significance. Of the amount appropriated, $10 million shall be made available for projects to (1) determine the feasibility and efficacy of programs providing drug abuse treatment and vocational training in exchange for public service; (2) conduct outreach activities to intravenous drug abusers to prevent exposure to, and transmission of, the etiologic agent for AIDS and to encourage intravenous drug abusers to seek treatment; and (3) provide drug abuse treatment services for pregnant and postpartum women, and their infants. Authorizes service research, through the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), to evaluate the quality, appropriateness, and costs of various forms of alcohol and drug abuse treatment programs. Extends existing authority under Title V of the PHS Act for research on alcohol abuse and alcoholism (such sums as may be necessary for each of FY1989 through FY1991) and drug abuse ($135 million for FY1989 and such sums as may be necessary for each of FY1990 and FY1991). Requires the Secretary to collect and publish data each year on incidence and prevalence of various forms of mental illness and substance abuse nationally and in selected major metropolitan areas. Authorizes the Secretary to conduct a study to determine the relationship between mental illness and substance abuse and develop recommendations on treatment of individuals with both mental illness and substance abuse problems. Authorizes the National Institute on Drug Abuse to coordinate with the Commission on Alternative Utilization of Military Facilities and with State agencies responsible for drug abuse programs on the utilization of military facilities to house nonviolent persons for drug treatment. Mental Health Provisions Requires that, of the amounts allotted to a State under the block grant for mental health activities for FY91, the State must agree to use not less than 55% to develop and provide community mental health services not available on Oct. 1, Funds for such new services shall be provided only for a limited period of time (as determined by the State). Under this requirement, new services developed between CRS-7

10 IB ^90 Oct. 1, 1984, and Oct. 1, 1988, may be treated as a new service. A State may seek a waiver to reduce the new service requirement to 35% under certain circumstances, including - (1) the State is judged to be in a financial crisis; (2) more than 15% of the State's community mental health budget is derived from Federal grants and it would not be feasible for the State to meet the 55% standard without reductions in existing services; and (3) the Secretary determines that the State has demonstrated substantial ongoing development of new mental health services for priority populations and any shift in funding percentages would disrupt this process and services in place. Amends a mental health set-aside requirement in the block grant authority to require that a State use not less than 10% of its block grant allotment intended for mental health services to provide services and programs for seriously emotionally disturbed children and adolescents, and to use, by the end of FY1990, not less than 50% of that set-aside to provide new or expanded services and programs that were not available before Oct. 1, Authorizes a new program of service research on community-based mental health treatment programs and services, through the National Institute of Mental Health (NIMH), including evaluation of methods of providing community-based services for the mentally ill; and of the quality, appropriateness, and costs of different methods of treatment. Service research and evaluations may be carried out through grants, contracts, cooperative agreements, and through the establishment of research centers. Amends existing authority for mental health research at NIMH - (1) to authorize grants, contracts, or cooperative agreements for research and related activities on the cause, diagnosis, treatment, control, and prevention of mental illness; (2) to authorize the development and publication of information on prevention of youth suicide; (3) to establish a National Mental Health Education Program to create a national focus on mental health problems, care, and research. Authorizes $60 million each in FY1989 and FY1990 to establish a program of grants for demonstration projects related to community mental health services, prevention of youth suicide, improvement of care for depressive disorders, and treatment and prevention of sex offenses, and provision of prevention services for persons at risk of developing mental illness. Fifteen percent of the appropriation for demonstration projects will be available for projects in rural areas. Authorizes $1 million for FY1989 for the Secretary of HHS to contract with an independent body for a study of the current use of involuntary commitment for inpatient or outpatient treatment of mental illness and make recommendations for changes if warranted. Supplemental Appropriations P.L (H.R. 5210), the Anti-drug Abuse Act of 1988, includes in its Title X supplemental appropriations totaling $283 million for alcohol and drug abuse prevention and treatment program authorities in Title II. CRS-8

11 IB Legislation in the 101st Congress The President, on Sept. 5, 19S9, issued his National Drug Control Strategy. The strategy included priorities for funding increases in drug treatment education and prevention programs, as well as changes in the authorities for such programs to increase effectiveness and make other improvements. Congress, in acting to implement the President's strategy and make other changes in Federal drug control activities, amended H.R. 3015, the FY1990 appropriation for the Department of Transportation, to add supplemental appropriations for FY1990 and amend various drug program authorities. Signed into law as P.L , H.R includes $727 million for ADAMHA prevention and treatment activities. The 100th Congress, during its 1989 sessions, also considered several pieces of authorizing legislation related to treatment and prevention. As passed by the Senate on Oct. 5, 1989, S includes provisions, among other things, to authorize the establishment of a National Resource and Information Center for Perinatal Addiction, grants for substance abuse treatment of pregnant and postpartum women, grants for training of drug treatment professionals, and an amendment to the ADMS block grant authority requiring States to develop Statewide drug treatment plans in order to receive their block grant drug abuse allocations. On Oct. 5, 1989, the Senate also passed another omnibus drug abuse proposal, S Some of the treatment and prevention provisions in S are identical to those in S. 1735, including authority for the National Resource and Information Center for Perinatal Addiction, the grants for training of drug treatment professionals, grants for treatment for pregnant and postpartum women, and the requirement for Statewide drug treatment plans under the ADMS block grant. The House, instead of acting on S and S as passed by the Senate, passed H.R. 3630, which contained provisions to amend the block grant and related authorities by, among other things, splitting it into two block grants - for substance abuse and for mental health.. The Senate disagreed with this House proposal and the first session of the 101st Congress adjourned before conference agreement could be reached. ' On Jan. 25,1990, the President issued a second National Drug Control Strategy, reiterating some of the themes from the September Strategy, and calling for improved drug treatment services, with particular emphasis on services for pregnant, drugabusing women and their children. The legislation pending at the end of the first session addresses these issues. In May 1990, the Senate Committee on Labor and Human Resources considered two bills dealing with substance abuse treatment and prevention. S reauthorizes the Drug Treatment Waiting Period Reduction Grant Program. S amends and extends the ADMS Block Grant, as well as categorical grant programs targeting pregnant and postpartum addicts, rural substance abuse, treatment in the criminal justice system, training of treatment and prevention professionals, and community-based prevention programs. It also authorizes a pharmacotherapy development initiative. CRS-9

12 EB ,90 Major Issues The debate over the ADMS block grant and related programs features the consideration of several issues. These included the revision of the allocation formula for the block, the issue of set-asides under the block grant, and the effectiveness of prevention and treatment approaches. Revision of the Block Grant Allocation Formula Since the creation of the ADMS block grant in 1981, the formula under which funds from the block are allocated among the States has been an issue of discussion and concern. When the block grant was established, the allocation formula was based on historical funding proportions from the categorical grant programs which the block grant replaced. Those categorical programs included project grant programs for alcohol and drug abuse treatment, as well as the Community Mental Health Centers (CMHC) program, also a project grant program. The laws authorizing these project grants did not establish priorities for awarding grants. Under the CMHC program, for example, grants were awarded directly to CMHC applicants by the Department of Health, Education, and Welfare, now the Department of Health and Human Services. States were not involved in the grant process and State-by-State proportional funding was not considered. The CMHC program was based on an 8-year funding cycle, under which a grantee would receive grants for an 8-year period, after which Federal support would end. By 1981, when the ADMS block grant was created, those States in which CMHCs had applied for and received grant funds early in the program's history would have, because of the funding cycle, been receiving less under the program in comparison to those States which had begun participating in the CMHC program in the early or mid-1970s. A formula, therefore, using FY1981 as a benchmark for allocating State allotments might appear to penalize those States which had been aggressive early in pursuing funds to support community mental health services. The 1984 amendments required the Department of HHS to enter into an agreement with a nongovernmental entity to study the allocation formula. The Department contracted with the University of California, San Francisco, to study the current block grant formula. The study, conducted in 1986, concluded that the current formula is inequitable, and that the inequity is primarily the result of the "hold harmless" provision. The report recommended that the "hold harmless" provision be phased out (limiting change in any year to 10% of the States' current share of ADMS funds), and that the current formula be refined to include need indicators based on age and gender of the population at risk, and on program factors, and that a State fiscal capacity measure be maintained and refined within the formula. The 1988 legislation reauthorizing the ADMS Block Grant established a new formula to allocate grant funds to the States. The new formula is based on population at risk (population of the State living in urban areas, percentages of population of the State between ages of 18 and 25, between 25 and 44, and between 25 and 64) and on total taxable resources of the State. Each State will receive a CRS-10

13 IB minimum allotment of the lesser of $7 million or 105% of the total of allotments received in FY1988 for the ADMS block grant and the substance abuse treatment grants to the States. Set-Asides Another area of concern and discussion regarding the ADMS block grant is the issue of set-asides - percentage restrictions or requirements that govern expenditure of funds under the block grant. The 1981 legislation creating the block required, for instance, that each State use at least 35% of the substance abuse portion of its block grant allocation for alcohol abuse activities and 35% for drug abuse activities, and that each State use at least 20% of its substance abuse allocation for prevention and early intervention activities designed to discourage the abuse of alcohol and drugs. Later amendments to the authority in the 98th and 99th Congresses included additional set-aside requirements pertaining to alcohol and drug abuse services for women and mental health services for underserved areas and for underserved populations, with special emphasis on new mental health services for severely disturbed children and adolescents. Those who oppose the requirement of set-asides in block grants argue that such provisions act against the purpose of block grants by limiting flexibility of States to administer these programs in response to their own specific needs and problems. Those in favor of set-asides argue that such provisions act to stimulate new and expanded services in areas, such as substance abuse services for women, that would not be addressed without the specific authority that the set-aside provides. The 1988 amendments to the block grant authority contain new earmarks and set-asides for the block grant program. For instance, a State must use block grant funds appropriated in the 1988 Anti-Drug Abuse Amendments for substance abuse treatment only, and must spend at least 50% of those funds for programs of prevention and treatment of intravenous drug abuse, with priority to programs for individuals infected with the AIDS virus, and related activities. States are required to use not less than 10% of block grant funds for programs and services designed for women, especially pregnant women and women with dependent children. The block grant reauthorization also includes set-aside requirements for the mental health part of the block grant emphasizing the support of new mental health services programs as well as services for children and adolescents. States must use at least 55% of block grant funds allocated for mental health activities to develop and provide community mental health services and programs that were not available on Oct. 1, 1988, and can provide funds for these new services only for a limited period of time. At least 10% of the mental health allocation of a State's block grant allotment must be used to provide services and programs for seriously emotionally disturbed children and adolescents. Program Effectiveness As the Congress authorizes and funds programs to support substance abuse treatment services, there is continued discussion about the effectiveness of such services. There has always been such concern about program effectiveness. Twenty years ago, drug abuse treatment programs were aimed primarily at the older heroin CRS-11

14 IB addict and alcohol abuse programs were aimed at the adult alcoholic. In recent years, the emphasis has shifted to a younger population of substance abusers, who use a variety of non-opiate substances, such as marijuana, cocaine, alcohol, or a combination of these and other substances, but the debate about the effectiveness of various treatment approaches has continued. A variety of treatment approaches are available, residential and nonresidential. Some specialized residential treatment programs, such as therapeutic communities, have been effective with certain types of drug and alcohol abusers. Many of these programs are extremely expensive and require an extensive commitment of time, and therefore are often not a viable option for lower or middle income persons, who cannot afford the time or money. The development of a variety of outpatient treatment programs has provided alternatives. Outpatient programs utilize less intensive counseling and employ different approaches, such as psychotherapy, behavior modification, family therapy, and the use of pharmacological products, such as antidepressants. Evaluations of treatment modes indicate that a variety of existing approaches to treatment have been effective in achieving reductions in drug and alcohol use and associated problem behaviors. There is little evidence that any one type of treatment is superior to others. Characteristics of the patients, such as desire to enter treatment, stable family or other relationship, and existence of employment after treatment, are also important factors in the effective outcome of treatment. The 1988 Anti-Drug Abuse Amendments legislation authorizes services research, through both NIAAA and NIDA, to evaluate the quality, appropriateness, and costs of various forms of alcohol and drug abuse treatment programs. LEGISLATION S. 26 (Moynihan) / H.R, 705 (Rangel) Anti-Drug Abuse Act of 1988 Appropriations. Provides a supplemental appropriation to fully fund the 1988 Anti-Drug Abuse Act. S. 26 introduced Jan 25, 1989; refereed to Committee on Appropriations. H.R. 705 introduced Jan. 27, 1989; referred to Committee on Appropriations. H.R (Dingel) Drug Abuse Treatment Technical Corrections Act of Makes technical corrections in the Anti-Drug Abuse Act of Introduced Mar. 15, 1989; referred to Committee on Energy and Commerce. Called up under suspension of rules and passed by House Mar. 21, Passed Senate with amendments Apr. 19, House disagreed with some Senate amendments June 13. Senate receded from its amendments July 12th and returned the bill to the House. Signed into law on Aug. 16 as P.L H.R (Natcher) Departments of Labor, HHS, Education and Related Agencies Appropriations bill, Included $790 million for the ADMS block grant and $83.3 million for OSAP. Introduced July 25, 1989 (H.Rept ). Passed by House Aug. 2; passed CRS-12

15 DB that provide aftercare. Introduced Apr. 19, 1990; referred to Committee on Labor and Human Resources. Ordered reported May 16, S (Kennedy) Drug Abuse Treatment and Prevention Improvement Act. Extends and expands categorical grant program for pregnant and postpartum addicts and their infants. Authorizes new grants for training, for treatment in the criminal justice system, for rural substance abuse, for treatment in the national capital region, and for comprehensive community-based drug prevention. Extends and revises the ADMS block grant authority, including the allocation formula. Requires that States prepare statewide treatment plans as a condition of block grant funding. Authorizes a new Pharmacotherapy Development program for research and development of medicines to treat substance abuse. Introduced May 17, 1990; referred to Committee on Labor and Human Resources. CONGRESSIONAL HEARINGS. REPORTS. AND DOCUMENTS U.S. Congress. House. Committee on Energy and Commerce. Subcommittee on Health and the Environment. ADAMHA programs reauthorization. Hearings, 100th Congress, 1st session. Apr. 3, U.S. Congress. House. Select Committee on Narcotics Abuse and Control. Implementation of State and local grants programs. Hearings, 100th Congress, 2d session. May 26, U.S. Congress. Senate. Committee on Labor and Human Resources. Drug abuse-prevention, education and treatment. Hearings, 100th Congress, 2d session. June 16, CHRONOLOGY 01/29/90 Administration's FY1991 budget proposal was released. 01/25/90 President's second National Drug Control Strategy was issued. 09/05/89 The President issued his first National Drug Control Strategy as required by the Anti-drug Abuse Act of /18/88 H.R. 5210, the Anti-drug Abuse Act of 1988, signed into law, P.L CRS-14

16 IB by Senate Sept. 26 (S.Rept ). Conference report agreed to by House Oct. 11 and by Senate Oct. 19 (H.Rept ). Vetoed by President Oct. 21, veto upheld in House vote Oct. 25. H.R (W. Lehman) Department of Transportation and Related Agencies Appropriations Act, As passed by the Senate, contains certain Administration proposals for increasing authorization ceilings for some treatment and prevention programs. Introduced July 26, 1989; reported to House (H. Kept ). Passed House, amended, Aug. 3. Reported to Senate (S. Kept ) Sept. 7. Passed Senate, amended, Sept. 27. Conference agreement reported Oct. 26. H.R (Natcher) Departments of Labor, HHS, Education and Related Agencies Appropriations bill, Included funds for the ADMS block grant and OSAP. Reported Nov. 14, 1990 (H.Rept ). Passed by House Nov. 15, and by Senate with amendment Nov. 16. House agreed to Senate amendment Nov. 20. Signed into law Nov. 21 as P.L H.R (Waxman) Emergency Drug Abuse Treatment Expansion Act of Provides for separate block grants for substance abuse and for mental health. Authorizes categorical grant funding for rural drug abuse, treatment for addicted mothers and infants, and drug abuse treatment in primary care providers. Amends block grant allocation formula. Authorizes an Office for Treatment Improvement in ADAMHA. Introduced Nov. 9 and passed by House under suspension of rules Nov. 13. Passed by Senate Nov. 15 after substituting language from S House disagreed to Senate amendments Nov. 17 and agreed to a conference. S (Dole) Introduced to implement part of the President's national drug control strategy. The Senate approved 61 floor amendments, including those: (1) to provide for grants for training professionals to assist in the rehabilitation of drug abusers, for substance abuse treatment for pregnant and postpartum women and their infants, for rural substance abuse treatment and education, and for other related purposes; (2) to provide for community substance abuse prevention programs; and (3) to require the establishment of Federal guidelines for States in allocating ADMS block grant funds for treatment of drug abuse. Introduced Oct. 2, 1989; ordered placed on Senate calendar. Passed Senate, amended, Oct. 5. S (Byrd) Provides for increases in authorizations of appropriations for various drug abuse treatment and prevention programs (increases requested by the Administration and accommodated in H.R. 3015, the Transportation appropriations bill described above). Introduced, considered, and passed Senate Oct. 5, S (Kennedy) Drug Treatment Waiting Period Reduction Grant Program Reauthorization and Improvement Act. Reauthorizes Waiting List Reduction grant authority and includes priorities for programs serving pregnant and postpartum addicts and for programs CRS-13

17 IB r90 FOR ADDITIONAL READING U.S. General Accounting Office. Federal set-asides for substance abuse and mental health services. Report to the Chairman, House Committee on Energy and Commerce Subcommittee on Health and the Environment. Washington, October GAO/HRD Proposed formulas for substance abuse, mental health provide more equity. Briefing report to the Chairman, House Committee on Energy and Commerce Subcommittee on Health and the Environment. Washington, July GAO/HRD BR U.S. Library of Congress. Congressional Research Service. Drug control, by Harry Hogan. [Washington] (Updated regularly). CRS Issue Brief Anti-drug abuse act of 1988 (P.L ): summary of major provisions, by Charles Doyle, Harry Hogan, Edward Klebe, and Raphael Perl. [Washington] p. CRS Report GOV National drug control strategy, 1989: background and policy questions, coordinated by Harry Hogan. [Washington] p. CRS Report GOV CRS-15