NCADD :fts?new JERSEY

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Marilyn Burke
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1 - :fts?new JERSEY 2013 NEW JERSEY STATE LEGISLATIVE ADDICTION PREVENTION, TREATMENT, and RECOVERY SURVEY I. General Views on Alcohol and Drug Addiction Policies to Address Stigma Addictive illness is recognized as a chronic brain disease. It requires a long-term care approach focused on disease management like asthma, diabetes and other chronic illnesses. Relapse rates are better for addiction than these other chronic illnesses. Alcohol and drug disorders have only recently become recognized as a chronic disease, much like diabetes or hypertension. Yet the stigma associated it continue to persist and often prevent people from seeking the treatment they need, contributing to disease severity and adding huge costs to public programs. Despite the ample and growing scientific research supporting the view that addiction is a disease, the public and medical profession has not yet fully embraced this concept. Policies and attitudes such as this hinder access to treatment and make it difficult to sustain recovery. Indicate which principles (if any) you agree with regarding your general views of alcohol and drug addiction and policies to address the stigma surrounding addictive illnesses by placing a check mark next to the letter(s) which correspond with your views. a) Alcohol and drug addiction are preventable, treatable, chronic diseases and are as consistently diagnosable as other illnesses such as diabetes, asthma and hypertension. b) Alcohol and drug addiction treatment are very effective and work as well as other established medical treatments for illnesses such as diabetes, asthma and hypertension. c) Stopping addiction is a matter of will and choice and those who chose to commit crimes to support its use should be severely punished. > d) Support funding to ensure that treatment and recovery services are available to those who need them. e) Other II. Health Care Reform and Addiction The Patient Protection Affordable Care Act of 2010 (PPACA) recognizes addiction as a health issue and includes treatment in the essential health benefits and alternative health benefits package. It also requires compliance with the Mental Health Parity and the Addiction Equity Act (MHPAEA), and provides provisions to integrate addiction with physical health care. The intent of the PPACA is to provide comprehensive services in the 10 categories. The PPACA requires the essential health benefits to not only cover substance use disorder treatment but to also cover habilitative and preventive services. When you add that to parity it is clear that the essential and alternative health benefits package should cover a full continuum of care and

fr t/new JERSEY include long- and short-term inpatient, halfway house, outpatient, and intensive outpatient, under substance use disorders treatment and, peer recovery support and medication

2 fr t/new JERSEY include long- and short-term inpatient, halfway house, outpatient, and intensive outpatient, under substance use disorders treatment and, peer recovery support and medication management and other services typically covered for chronic illnesses such as diabetes under habilitative services. Indicate which principles (if any) you agree with regarding addiction and the policies to implement the PPACA by placing a check mark next to the letter(s) which correspond with your views a) Support legislation and/or regulations that require all qualified health plans and the alternative health benefits package to cover a full continuum of treatment and services for addictive illness. J b) Addiction should be included as one of the primary chronic conditions addressed in health homes and accountable care organizations. ^ c) Supporting initiatives that integrate addiction services with other health care is the appropriate approach to address drug and alcohol problems. d) Other III. Closing the Alcohol and Drug Addiction Treatment Gap Addictive illness is one of the most serious health problems facing our society today. It affects millions of people, devastates families, individuals, and communities, and overwhelms our legal system and state budget. If treatment is not made accessible to those that need it, New Jersey will continue to spend billions of dollars ($3.8) on the consequences of untreated addiction. According to the National Institute on Drug Abuse, addiction treatment not only saves lives, but for every dollar spent on treatment, the state saves $12 or more in criminal justice and health care costs. No other disease affects so many New Jerseyans and yet receives such little funding support. There is a substantial gap between the number of New Jersey residents who need addiction treatment and the capacity to deliver such treatment. The most recent numbers show 959,282 residents of New Jersey were in need of addiction treatment; yet only 5% to 7% received the treatment they needed. Additionally, as many as 30,521 adults and 9,400 adolescents demanded treatment but were turned away because of lack of funds, lack of or limited insurance, or lack of capacity in the state to treat them. The PPACA, MHPAEA (parity), Medicaid expansion, and the expansion of Drug Court will greatly increase the number of people who are eligible for treatment and significantly impact workforce shortage and capacity to serve those in need. The Medicaid expansion alone will provide coverage for an additional 44,000 individuals in need of substance use disorder treatment. As Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance misuse become more commonplace in primary care, more people will be identified as needing services. 2

<V /NEW JERSEY Indicate which principles (if any) you support to close the addiction treatment gap by placing a check mark next to the letter(s) which correspond with your views.

3 <V /NEW JERSEY Indicate which principles (if any) you support to close the addiction treatment gap by placing a check mark next to the letter(s) which correspond with your views. *S a) Enact treatment on demand initiatives that aim to offer all those seeking addiction treatment immediate entry into a program. b) Use money allocated for prisons to expand addiction treatment capacity. c) Increase the $11 million allocated to the Alcohol Education, Rehabilitation and Enforcement Fund (AEREF) from the alcohol excise tax, which has not been increased since 1992, by dedicating an additional 5% of the alcohol excise tax each year until the allocation reaches/25%. d) Increase and establish reimbursement rates to be paid to addiction treatment providers through the Administrative Service Organization and Medicaid that are reasonable. e) Other IV. Parity Enforcement The parity law will save lives and money by ending the discrimination that exists in health care. Under the PPACA addiction services must be provided at parity with other health care in all of the plans (Medicaid, Basic, Exchange, Employer, SHOP) and cannot be accompanied by financial requirement and treatment limitations that are any more restrictive than those placed on medical and surgical benefits. Preliminary regulations implementing the MHPAEA require that covered health plans provide benefits for mental health conditions or substance use disorders in every classification in which medical/surgical benefits are offered, including non-quantitative treatment limitations i.e. medical necessity. Medical necessity guidelines for behavioral health services have often been more restrictive than they are for other chronic diseases and medical services. Often these guidelines are not based upon generally accepted medical standards, i.e., fail first policy, opiates don't cause life threatening withdrawal, severely dysfunctional living environment. The State Health Benefits Plan (SHBP) and School Employees Health Benefits Program (SEHBP) opted out of the MHPAEA. Recently there was state legislation to require them to cover treatment for alcoholism, other substance-use disorders, and non biologically-based mental illnesses under same terms and conditions and to the same extent that it covers other diseases or illnesses. The legislation also required the use of American Society of Addiction Medicine patient placement criteria, the most widely used criteria to determine the appropriate level of care, required coverage when prescribed by a physician or licensed clinical addiction counselor, and defined SUD treatment as including all levels of care. The legislation was vetoed, because the Health Benefits Design Committee, established to review coverage and costs and develop health insurance plan options, would address this issue. The State Education Health Benefits Plan decided to provide the same coverage for mental health disorders as for physical disorders. However the SHBP Design Committee has not yet 3

^NEW JERSEY reached a similar agreement. It is not clear whether either committee will address all the issues that were provided for in the federal law or state legislation.

4 ^NEW JERSEY reached a similar agreement. It is not clear whether either committee will address all the issues that were provided for in the federal law or state legislation. Indicate which principles (if any) you support to close the addiction treatment gap by placing a check mark next to the letter(s) which correspond with your views. a) Medical Necessity Guidelines should us ASAM-PPC to determine the appropriate level fare, must be no more restrictive than they are for physical illnesses, and policies such as failed first should be eliminated. \/ b) Support legislation or policies that establishes a mechanism to enforce parity and provide for appeals of violations of parity in real time. c) Whether or not recommended treatment meets medical necessity should be left up to the insurance companies. / d) Will work to ensure that the Health Benefits design committees recommend full parity wnich covers benefits for mental health conditions or substance use disorders in every classification, non-quantitative treatment limitations, ASAM-PPC. e) other V. Criminal Justice and Treating the Addicted Offender Untreated alcoholism and drug addiction fuels crime and recidivism. The majority of individuals released from prison have not received treatment and thus often recidivate and return to the correctional system with devastating costs to community safety and the state's budget. In New Jersey, 29% of prisoners are incarcerated due to a base offense involving drugs and 81% have a substance abuse problem. According to the Office of National Drug Control Policy (ONDCP) data from the 2008 Arrestee Drug Abuse Monitoring Program (ADAM II), 87% of the arrestees in 10 major metropolitan areas tested positive for illicit drug use. The Bureau of Justice Statistics found that a third of state inmates reported having committed their current offense while under the influence of drugs, half reported drug use in the month before the offense, and two thirds had used drugs regularly. It is well established that treatment, not prisons, reduce recidivism. Prisons have been ineffective in deterring individuals with a substance use disorder from engaging in criminal behavior to maintain their drug use. Governor Christie understands this, as is evident by his support of Drug Court expansion. Yet, there is still an operational law that denies judges discretion if a prosecutor requests an expanded prison sentence for a defendant who has been convicted of more than one drug offense (except possession), including possession with intent to distribute. The majority of people convicted of possession with intent to distribute and other drug crimes are individuals with a substance use disorder who are attempting to obtain drugs to combat an involuntary and intense compulsion for drugs. Treatment is effective in addressing such compulsions. 4

5 NEW JERSEY Indicate which principles (if any) you support concerning the criminal justice system and the treatment of the addicted offender by placing a check mark next to the letter(s) which correspond with your views. a) As recommended in the State Commission of Investigation report, the state should more heavily emphasize strategies of interdiction and prosecution, which aim to control the problem by reducing the available supply of drugs. b) The state should more heavily emphasize strategies that favor a public health approach to alcohol and drug addiction and target demand reduction activities, such as prevention and treatment. c) Repeal expanded sentences for drug offenses involving possession of a controlled substance with intent to distribute. d) Judges, not prosecutors, should determine if an expanded sentence is appropriate after'hearing all the facts, including whether the individual has a substance use disorder. e) Other VI. Certificate of Recovery Addiction is a treatable disease, and with treatment, supports and services, sustained recovery occurs. More than 23.5 million adults are in recovery from addiction in the United States, many of whom have criminal records that resulted from actions committed while under the influence of or to obtain drugs to which they were addicted. ' Research shows that after four to seven years (depending on the crime) of being crime-free, individuals with a criminal record are no more likely to commit a crime than the general population. A person in recovery from an addiction for five years is stable in recovery and less likely than the general population to commit a subsequent crime. A national survey found that people in recovery have good values, are upstanding citizens, take care of their families, are trustworthy, give back to their community and exemplify qualities that are beneficial to the community at large. In New Jersey there are 162 statutes that prevent individuals with a criminal record from fully participating in their community. These individuals are subject to disabilities unrelated to their current circumstances and community safety. In addition, many employers are reluctant to hire someone who has been convicted of a drug-related crime because of erroneous stereotypes unrelated to his or her ability to perform the job. Allowing individuals to fully participate in their community and have employment opportunities help reduce recidivism and facilitates rehabilitation. In addition, holding the same job for over a year can predictably lower recidivism. New Jersey law states, "it is the intent of the Legislature... to facilitate where feasible the rehabilitation of drug dependent persons." 5

$^NEW JERSEY ^ \ Indicate which principles (if any) you support concerning the criminal justice system and the treatment of the addicted offender by placing a check mark next to the letter(s) which$

6 ^NEW JERSEY ^ \ Indicate which principles (if any) you support concerning the criminal justice system and the treatment of the addicted offender by placing a check mark next to the letter(s) which correspond with your views. a) Repeatedly punishing someone whose crime was related to an addictive illness and who has been in recovery for five-plus years, with long term collateral consequences, does not facilitate community safety and is unjust. b. If all other factors are equal, individuals who have been in recovery and crime-free for five-plus years should have the same opportunities as individuals who do not have a criminal record in: employment licensure voting housing education motor vehicle child custody and guardianships J c) Except for very serious crimes like sex offenses, support legislation that would enable a court to grant a Certificate of Recovery to individuals who are in long-term, stable recovery and crime-free for five years, which would remove the disabilities attached to a criminal record in the following areas: _employment.//licensure v/voting *i housing v, education J /motor vehicle J child custody and guardianships d) Criminal records, no matter how old, are a good indicator of the propensity to commit future crimes and therefore disabilities attached to criminal records should remain intact in the following areas: e) Other. employment licensure voting housing education motor vehicle child custody and guardianships 6

7 j NEW JERSEY VII. Other On an attached page, in seventy-five (75) words or less, please explain any other legislative priorities you will have regarding the prevention and treatment of alcohol and drug addiction if elected. CANDIDATE MUST SIGN SURVEY TO BE INCLUDED IN THE DATABASE Candidate Name: Party: Date:

Module 6: Substance Use

Module 6: Substance Use Part 1: Overview of Substance Abuse I am Martha Romney and I am presenting on substance abuse. This module focuses on the healthy people 2020 objective to reduce substance abuse