Addiction treatment can save state money in long run

From the Salem Statesman Journal, March 15 2009

They took different roads to recovery.

But the stories told by Robert Howe and Deborah “Janie” Marsh at the Capitol last week made one common point to lawmakers looking for cuts — that spending for alcohol and drug abuse treatment is not a losing cause.

At the same time that lawmakers face a big gap between projected tax collections and proposed spending in the next two years — $3 billion and counting — they also have to deal with a ballot measure voters approved four months ago to expand addiction treatment for some offenders and lengthen prison sentences for others.

Howe and Marsh began drinking early — Howe at age 9, Marsh at 12 — and then used methamphetamine.

“My addiction was more than a drug,” Marsh said. “It was a life.”

Marsh managed to avoid arrest until she was 31, by which time she had no job and her children were with her parents.

While at the Coffee Creek Correctional Facility in Wilsonville, Marsh was in the Turning Point program — she said a change in her attitude led to her break with addiction — and she was released in September 2006. She remains under supervision, but she holds a job.

Howe, in contrast, was in and out of jail — but never free of alcoholism, even when he had a son and then a daughter. A member of the Confederated Tribes of Warm Springs Reservation, he credits the
Native American Rehabilitation Association of the Northwest with helping break his addiction.

“I hope my children don’t ever see what I have been through,” said Howe, his 9-month-old daughter in a carrier at his feet during part of his testimony.

State Rep. Chip Shields, D-Portland, said there was a reason he organized the hearings.

“We cannot look at Oregon’s public safety budget and our human services budget as separate and unrelated,” said Shields, who is co-chairman of the public safety subcommittee. “The fact is that they are deeply intertwined, especially when it comes to dealing with substance abuse.”

Budget problem

Gov. Ted Kulongoski’s proposed 2009-11 budget for addiction treatment and mental health within the Department of Human Services is $844 million, almost $69 million less than legislative budget analysts estimate is needed to maintain programs.

The proposed budget adds money for Oregon State Hospital staffing — prodded by a federal investigation — but also cuts deeply into state support for community alcohol and drug treatment programs and mental health services. DHS oversees them, but the money goes to counties, health plans, nonprofit agencies, tribes — and the Department of Corrections and the Oregon Criminal Justice Commission, which oversees drug courts.

Kulongoski hopes to offset those cuts with an expanded Oregon Health Plan, which would cover 75,000 more adults. His plan hinges on lawmakers agreeing to increase provider taxes on hospitals and insurers and to use that money to recoup more federal Medicaid dollars.

But a Legislative Fiscal Office analysis said some people still would go without services if they do not qualify for the plan.

A proposed increase in Oregon’s beer tax, proceeds from which are split between addiction treatment/mental health and general aid to state and local governments, would supply more money for all. But the increase in the tax, now the nation’s lowest, faces stiff opposition.

Link to savings

David Rogers, executive director of the Partnership for Safety and Justice based in Portland, said there is another reason for concern.

“These hearings confirm there is a direct link between addiction treatment and mental health services and crime prevention,” said Rogers, whose organization supports alternatives to prison. “If we make decisions on funding without understanding those connections, we’re making ineffective decisions about policy that are likely to be costly.”

For every dollar spent on treatment, the Department of Human Services estimates savings of $4 to $7 in other costs.

Voters last fall approved Measure 57, which lawmakers proposed as an alternative to an initiative imposing mandatory minimum prison sentences on some property and drug offenders. Measure 57 lengthens prison stays for some repeat offenders but requires drug treatment for others.

“It was a demonstration of public support for Oregon beginning to invest in treatment and proactive approaches to crime prevention,” Rogers said.

Kulongoski’s budget proposes about half the estimated $140 million required to carry out the measure. While the bulk of the $73 million is for housing 1,300 more inmates in prison, about $20 million is proposed for expanded treatment.

Seeking results

Sen. Jackie Winters, R-Salem, said appropriate treatment for a parent with a drug problem can save thousands of dollars for foster care for a child in state custody — and for a prison stay for the parent. According to the Pew Center on the States, a survey of 34 states — including Oregon — found that spending for an inmate averaged $29,000 annually.

“But it’s not enough to say we have wonderful programs,” said Winters of the human-services subcommittee. “What are we getting for the dollars we are spending?”

Rep. Dennis Richardson, R-Central Point, said it’s not enough that people complete treatment.

“When a government agency spending millions in taxpayer money does not know what the outcomes are of drug and alcohol patients 30 days after they leave treatment, that lack of follow-up indicates a lack of concern for recovery — and too much concern on qualifying for treatment dollars,” he said.

State statistics show that 64 percent of enrollees complete treatment, higher than the national average of 51 percent. But it’s harder to know how many stay drug-free.

Winters said success appears to tie in with the possibility of criminal sanctions, such as in drug courts in most counties and diversion programs for first-time drunken-driving offenders. Diversion programs have the highest rate of success at 74.1 percent.

OUR COMMENT – Oregon addiction chief Jeff Kushner presented data showing the ROI for addiction treatment to the Oregon legislature in 1994. He was ignored.