REPORT TITLE:
Approp.; Substance Abuse


DESCRIPTION:
Appropriates funds for substance abuse prevention and treatment
programs.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           180
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

MAKING AN APPROPRIATION FOR SUBSTANCE ABUSE PREVENTION AND
   TREATMENT SERVICES. 


BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1                              PART I.
 
 2                 PURPOSE AND LEGISLATIVE FINDINGS
 
 3      SECTION 1.  The purpose of this Act is to ensure that a
 
 4 continuum of services for the prevention and treatment of
 
 5 substance abuse is available.  
 
 6      The legislature finds that a comprehensive approach is
 
 7 necessary to address adequately the impact of alcohol and other
 
 8 drug abuse on individuals, families, and communities.  The
 
 9 advancement of prevention practices must evolve from community-
 
10 based efforts.  These efforts deal with the host (individual),
 
11 the agent (alcohol, tobacco and other drugs), and the environment
 
12 (society).
 
13      Addressing host factors in substance abuse prevention
 
14 involves assisting individuals in examining their motivation for
 
15 using alcohol, tobacco, and other drugs, understanding family and
 
16 community risk factors which may contribute to their use, and
 
17 developing living skills which promote healthy lifestyles.  These
 
18 activities shall:
 
19      (1)  Strengthen identification with viable role models;
 

 
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 1      (2)  Strengthen family involvement and bonding;
 
 2      (3)  Develop problem-solving abilities;
 
 3      (4)  Develop intrapersonal skills;
 
 4      (5)  Develop interpersonal skills; and
 
 5      (6)  Develop skills for assessing individual risk and
 
 6           adapting lifestyle decisions based on the risk
 
 7           assessment for the use of alcohol.
 
 8      Prevention efforts to address the agent (alcohol, tobacco,
 
 9 and other drugs) encourage physicians, legislators, churches,
 
10 schools, and businesses to confront the availability of these
 
11 substances.  These prevention strategies assist the public in
 
12 understanding the dangers of the use and abuse of alcohol and
 
13 other drugs, and the impairment which occurs from the use of
 
14 certain types of alcohol and other drugs.  Prevention efforts can
 
15 target policies and practices influencing alcohol, tobacco, and
 
16 drug availability, price, distribution, and consumption practice.
 
17 Nationally, prevention efforts have focused on promotional
 
18 practices that target certain high-risk populations and advance
 
19 messages discouraging the use of alcohol, tobacco, and other
 
20 drugs.  
 
21      Environmental prevention efforts are aimed at altering
 
22 community norms and policies that contribute to the abuse of
 
23 alcohol, tobacco, and other drugs.  Changing norms frequently
 

 
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 1 involves advocating policies and procedures which make low-risk
 
 2 alcohol use by adults the norm, ensuring that laws related to
 
 3 sales of tobacco to minors are enforced, and promoting abstinence
 
 4 from illegal drug use as the acceptable standard within the
 
 5 community.
 
 6      The legislature also finds that in the treatment of
 
 7 substance abusers, the personal history of each abuser and their
 
 8 related problems must be evaluated to determine the best course
 
 9 of treatment.  The overall goal of treatment is to reduce or
 
10 eliminate the use of alcohol and/or drugs as a contributing
 
11 factor to physical, psychological, and social dysfunction and to
 
12 arrest, retard, or reverse the progress of any associated
 
13 problems.  Treatment refers to a broad range of services,
 
14 including therapeutic activities, counseling services, and
 
15 recreational activities.
 
16      Therapeutic activities and services often address all parts
 
17 of a person's life that have have been disrupted by alcohol and
 
18 other drugs.  For example, clients diagnosed with substance abuse
 
19 related health and nutritional problems receive, or are referred
 
20 to, medical care, voluntary HIV testing and education, and
 
21 Tuberculosis and Hepatitis B testing.
 
22      Counseling services help clients look at the patterns of
 
23 their substance abuse.  In individual therapy, they look at the
 

 
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 1 underlying causes of their addiction.  In group therapy, among
 
 2 other recovering people, clients are encouraged to confront their
 
 3 destructive behaviors and to explore new ways of dealing with
 
 4 people, emotions, and their craving for substances.  Family
 
 5 counseling helps family members understand and participate in the
 
 6 recovery process.
 
 7      Essential to recovery is learning how to spend leisure time.
 
 8 Through recreational activities, clients are introduced to
 
 9 alcohol- and drug-free ways of enjoying themselves and
 
10 contributing to the community.
 
11      Programs may also provide services to meet specific clients'
 
12 needs.  These programs would include classroom instruction for
 
13 students, literacy, remedial reading, and math for clients who
 
14 lack basic skills, job training for unemployed adults, and
 
15 assistance in finding housing for clients without a home.
 
16      In order to ensure high-quality substance abuse treatment,
 
17 all those performing clinical supervision, clinical evaluation,
 
18 treatment planning, and individual, group, and family counseling
 
19 are Hawaii state certified substance abuse counselors pursuant to
 
20 section 321-193(10), Hawaii Revised Statutes, or hold an advanced
 
21 degree in behavioral health sciences.  Agencies must conduct a
 
22 criminal history record check for any person who is employed or
 
23 seeks employment in an adolescent substance abuse treatment
 

 
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 1 program in a position which necessitates close proximity to
 
 2 adolescents, including all administrative and clinical staff.
 
 3                             PART II.
 
 4                        PREVENTION PROGRAMS
 
 5      SECTION 2.  The federal Center for Substance Abuse
 
 6 Prevention (CSAP) developed several primary prevention strategies
 
 7 which address the host, the agent, and the environment.  A
 
 8 description of these strategies are as follows:
 
 9      (1)  Information dissemination provides awareness and
 
10           knowledge of the nature and extent of substance abuse
 
11           and addiction, and its effects on individuals,
 
12           families, and communities.  The strategy is also
 
13           intended to increase knowledge and awareness of
 
14           available prevention programs and services.
 
15           Information dissemination is characterized by one-way
 
16           communication from the source to the audience, with
 
17           limited contact between the two.
 
18                Types of services conducted and methods used for
 
19           implementing this strategy include
 
20           clearinghouse/information resource centers, health
 
21           fairs, health promotion, materials development,
 
22           materials dissemination, media campaigns, radio/TV
 
23           public service announcements, brochures, resource
 

 
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 1           directories, speaking engagements, and telephone
 
 2           information lines.
 
 3      (2)  Education in substance abuse prevention involves
 
 4           two-way communication, and as such is distinguished
 
 5           from the information dissemination strategy.  Services
 
 6           under this strategy aim to affect critical life and
 
 7           social skills, including decision-making, refusal
 
 8           skills, critical analysis, and systematic judgment
 
 9           abilities.
 
10                Types of services conducted and methods used for
 
11           implementing this strategy include children of
 
12           substance abusers support groups, classroom and/or
 
13           small group discussions (all ages), education services
 
14           for youth groups, parenting and family management
 
15           classes, and peer leader/helper services.
 
16      (3)  Constructive and healthy activities are thought to
 
17           offset the attraction to, or otherwise meet, the need
 
18           usually filled by alcohol, tobacco, and other drugs.
 
19           These alternatives allow target populations to
 
20           participate in activities that exclude substance abuse.  
 
21                Types of services conducted and methods used for
 
22           implementing this strategy include alcohol- and
 
23           drug-free dances and parties, community drop-in
 

 
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 1           centers, community services, and youth/adult leadership
 
 2           functions.
 
 3      (4)  Problem identification and referral programs are geared
 
 4           toward those who have indulged in illegal or
 
 5           age-inappropriate use of tobacco or alcohol, and those
 
 6           who have indulged in the first use of illicit drugs, in
 
 7           order to assess whether their behavior can be reversed
 
 8           through education.  It should be noted, however, that
 
 9           this strategy does not include any function designed to
 
10           determine whether a person is in need of treatment.
 
11                Types of services conducted and methods used for
 
12           implementing this strategy include employee assistance
 
13           programs, student assistance programs, and driving
 
14           under the influence (DUI) notices.
 
15      (5)  Community-based process strategies aim to enhance the
 
16           ability of the community to better provide prevention
 
17           and treatment services for substance abuse.
 
18                Types of services conducted and methods used for
 
19           implementing this strategy include accessing services
 
20           and funding, assessing community needs, community and
 
21           volunteer training, community team building,
 
22           multi-agency coordination and collaboration, risk and
 
23           protective factor-based services, staff/officials
 

 
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 1           training, systematic planning, and training of key
 
 2           people in the system.
 
 3      (6)  Environmental strategies deal with both activities that
 
 4           center on legal regulatory initiatives, and those that
 
 5           relate to the service and action-oriented initiatives.
 
 6                Types of services conducted and methods used for
 
 7           implementing this strategy include modifying alcohol
 
 8           and tobacco advertising programs, product pricing
 
 9           strategies, promoting the establishment and review of
 
10           comprehensive alcohol, tobacco, and drug use policies
 
11           in individual community organizations, and providing
 
12           technical assistance to communities to maximize local
 
13           law enforcement procedures governing the availability
 
14           and distribution of alcohol, tobacco, and other drugs.
 
15      The purpose of this section of the Act is to ensure the
 
16 availability of substance abuse prevention services similar to
 
17 those mentioned in this section.  Implementation of this section
 
18 during each fiscal year in the 1999-2001 fiscal biennium, to be
 
19 funded from the appropriation authorized in section 9, shall
 
20 provide $          for substance abuse prevention services
 
21 statewide.
 
22                             PART III.
 
23                   ADOLESCENT TREATMENT SERVICES
 

 
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 1      SECTION 3.  Results of the "1996 Hawaii Student Alcohol and
 
 2 Drug Use Survey," which included self-reports from a sample of
 
 3 3,039 public and private school students in grades six, eight,
 
 4 ten, and twelve, were extrapolated to provide a projection of the
 
 5 number of youths ages twelve to seventeen in need of substance
 
 6 abuse treatment.  The findings include the following:
 
 7      (1)  Over 3,000 youths statewide need treatment for alcohol
 
 8           abuse while an additional 2,227 need treatment for drug
 
 9           abuse.  Additionally, 3,160 require treatment for both
 
10           alcohol and drug abuse, leading to a combined total of
 
11           8,426 students who have either an alcohol abuse
 
12           problem, drug abuse problem, or both;
 
13      (2)  Adolescent treatment needs for alcohol and/or drug
 
14           abuse are highest in Hawaii county (13.9 per cent),
 
15           Maui county (12.8 per cent), and in Kauai county (11.4
 
16           per cent);
 
17      (3)  Hawaii and Maui counties have double the percentage of
 
18           sixth and twelfth grade students needing substance
 
19           abuse treatment compared to Kauai county or the city
 
20           and county of Honolulu.
 
21      (4)  Alcohol abuse is highest in Hawaii county for grades
 
22           ten and twelve and Maui county for grade eight; and
 
23      (5)  Less than one-third of the students with treatment
 

 
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 1           needs have utilized treatment facilities.
 
 2      SECTION 4.  The support of comprehensive adolescent
 
 3 substance abuse treatment services is needed.  Descriptions of
 
 4 the services provided to adolescents are as follows:
 
 5      (1)  Adolescent residential substance abuse treatment
 
 6           services provide a planned regimen of professionally
 
 7           directed evaluation, treatment, case management, and
 
 8           other ancillary and special services.  Observation,
 
 9           monitoring, and treatment are available twenty-four
 
10           hours a day, seven days a week.  There is a minimum of
 
11           twenty-five hours per week of face-to-face treatment
 
12           including a minimum of one hour per week of individual
 
13           counseling.  The remaining time includes group
 
14           counseling, education, skill building, recreational
 
15           therapy, and family services.
 
16      (2)  Substance abuse school-based services provide services
 
17           on a scheduled basis for adolescent students with
 
18           substance abuse problems.  Professionally directed
 
19           evaluation, treatment, case management, and recovery
 
20           services are provided to clients with less problematic
 
21           substance abuse related behavior than those who would
 
22           be found in a residential or day treatment program.
 
23           This program allows between one and eight hours per
 

 
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 1           client per week of face-to-face treatment with a
 
 2           minimum of one hour of individual counseling per client
 
 3           per month.  Addition activities include screening,
 
 4           assessment, treatment planning and counseling, group
 
 5           sessions focusing on process, task, education, skill
 
 6           building, and recreation, and family counseling.
 
 7      The purpose of this section of the Act is to ensure the
 
 8 availability of substance abuse treatment for adolescents
 
 9 statewide.  Implementation of this section during each fiscal
 
10 year in the 1999-2001 fiscal biennium, to be funded from the
 
11 appropriation authorized in section 9, shall provide the
 
12 following adolescent treatment services:
 
13      (1)  Adolescent residential substance 
 
14           abuse treatment statewide.                  $          
 
15      (2)  Adolescent school-based substance 
 
16           treatment services in eleven public 
 
17           high schools statewide.                     $          
 
18                             PART IV.
 
19                     ADULT TREATMENT SERVICES
 
20      SECTION 5.  Findings of the 1995 Adult Telephone Household
 
21 Survey reveal that of the State's total 885,002 adult population
 
22 over the age of eighteen, a total of 79,119 (8.94 per cent) are
 
23 in need of treatment for alcohol, drugs, or both.  Comparable
 

 
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 1 figures by county are as follows:
 
 2      (1)  For the city and county of Honolulu, 57,192 (8.62 per
 
 3           cent) of the total 663,473 adults are in need of
 
 4           treatment for alcohol and/or other drug abuse problems.
 
 5           A total of 1,988 people (or 3.47 per cent of those
 
 6           needing treatment) were provided treatment in publicly-
 
 7           funded slots;
 
 8      (2)  For Maui county, 9,120 (11.02 per cent) of the 82,754
 
 9           adults are in need of treatment for alcohol and/or
 
10           other drug abuse problems.  A total of 242 people (or
 
11           2.65 per cent of those needing treatment) were provided
 
12           treatment in publicly-funded slots;
 
13      (3)  For Kauai county, 3,886 (9.54 per cent) of the total
 
14           40,740 adults are in need of treatment for alcohol
 
15           and/or other drug abuse problems.  A total of 138
 
16           people (or 3.55 per cent of those needing treatment)
 
17           were provided treatment in publicly-funded slots; and
 
18      (4)  For Hawaii county, 9,098 (9.28 per cent) of the total
 
19           98,036 adults are in need of treatment for alcohol
 
20           and/or other drug abuse problems.  A total of 659
 
21           people (or 7.20 per cent of those needing treatment)
 
22           were provided treatment in publicly-funded slots.
 
23      SECTION 6.  Support for the comprehensive continuum of adult
 

 
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 1 treatment services is needed.  Descriptions of the services
 
 2 provided to adults are as follows:
 
 3      (1)  Residential programs provide a planned regimen of
 
 4           professionally directed evaluation, treatment, case
 
 5           management, and other ancillary and special services.
 
 6           Observation, monitoring, and treatment are available
 
 7           twenty-four hours a day, seven days a week.  There is a
 
 8           minimum of twenty five hours per week of face-to-face
 
 9           treatment, including a minimum of one hour per week of
 
10           individual counseling.  The other twenty-four hours
 
11           include group counseling, education, skill building,
 
12           recreational therapy, and family services.
 
13      (2)  Day treatment programs provide a planned regimen of
 
14           comprehensive outpatient treatment, including
 
15           professionally directed evaluation, treatment, case
 
16           management, and other ancillary and special services.
 
17           This level of care provides the client with the
 
18           opportunity to participate in a structured therapeutic
 
19           program while still being able to remain in the
 
20           community.  Day treatment consists of a minimum of
 
21           twenty hours per week of face-to-face treatment,
 
22           including a minimum of one hour per week of individual
 
23           counseling.  The remaining nineteen hours include group
 

 
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 1           counseling, education, skill building, recreational
 
 2           therapy, and family services.
 
 3      (3)  Intensive outpatient programs provide non-residential
 
 4           intensive specialized services on a scheduled basis.
 
 5           Professionally directed evaluation, treatment, case
 
 6           management, and recovery services are provided.  There
 
 7           is a minimum of nine hours, and a maximum of nineteen
 
 8           hours, per client per week of face-to-face treatment.
 
 9           At least one hour per week must include individual
 
10           counseling.
 
11      (4)  Outpatient programs provides non-residential
 
12           comprehensive specialized services on a scheduled
 
13           basis, including professionally directed evaluation,
 
14           treatment, case management, and recovery services for
 
15           clients with less problematic substance abuse related
 
16           behavior than would be found in a residential or day
 
17           treatment program.  Outpatient clients receive between
 
18           one and eight hours per client per week of face-to-face
 
19           treatment with a minimum of one hour of individual
 
20           counseling per month.
 
21      (5)  Therapeutic living programs are intended for
 
22           individuals who are without appropriate living
 
23           alternatives and who:
 

 
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 1           (A)  Are receiving substance abuse treatment in a day,
 
 2                intensive outpatient, or outpatient program; or
 
 3           (B)  Have been clinically discharged within six months
 
 4                from a substance abuse treatment program.  
 
 5           The focus is to provide the necessary support and
 
 6           encouragement for clients in their movement toward
 
 7           independent housing and life management.  There is a
 
 8           minimum of fifteen hours of face-to-face therapeutic
 
 9           activities per week to clients who are actively
 
10           involved in day, intensive outpatient, or outpatient
 
11           treatment services, or those who have been clinically
 
12           discharged within six months from a substance abuse
 
13           treatment program.  Therapeutic living activities
 
14           include needs assessment, service planning, individual
 
15           and group skill building, referral and linkage, case
 
16           management, client support and advocacy, monitoring,
 
17           and follow-up.
 
18      The purpose of this section of the Act is to ensure the
 
19 availability of substance abuse treatment for adults statewide.
 
20 Implementation of this section during each fiscal year in the
 
21 1999-2001 fiscal biennium, to be funded from the appropriation
 
22 authorized in section 9, shall provide the following adult
 
23 treatment services:
 

 
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 1      (1)  Crisis intervention/detoxification 
 
 2           residential beds statewide                  $          
 
 3      (2)  Residential (non-hospital) treatment
 
 4           services statewide                          $          
 
 5      (3)  Day treatment services statewide            $          
 
 6      (4)  Intensive outpatient services statewide     $          
 
 7      (5)  Therapeutic living homes/programs at 
 
 8           eight sites statewide                       $          
 
 9                              PART V.
 
10                         BABY SAFE PROGRAM
 
11      SECTION 7.  It has been estimated that from twelve to
 
12 fifteen per cent of all births have mothers who are substance
 
13 abusers.  Early intervention before and during the pregnancy
 
14 assures healthy birth outcomes as well as a healthier mother.
 
15 Based on figures for 1995, there are potentially 643 to 804
 
16 births to substance abusing mothers in the areas of Waimanalo,
 
17 Kailua, Kaneohe, Ewa-Waipahu, and Wahiawa on Oahu, and 101 to 126
 
18 cases of those births in Kauai.
 
19      SECTION 8.  The support of the baby substance abuse free
 
20 environment (baby S.A.F.E.) program is needed.  The program is
 
21 intended to reduce infant mortality and morbidity among high risk
 
22 substance abusing women through a comprehensive approach to
 
23 decrease the use of substances during pregnancy, to increase
 

 
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 1 access to early prenatal care, to prevent or minimize the impact
 
 2 of substance abuse on pregnancy, and to prepare and refer these
 
 3 women for substance abuse treatment services during the
 
 4 pregnancy.
 
 5      Although the program has been in existence for about ten
 
 6 years, services are available only in Hawaii county, Maui, and
 
 7 Waianae on Oahu.  There was a program on Kauai, but it was
 
 8 terminated due to lack of funding.  The purpose of this section
 
 9 of the Act is to extend the program to needed areas on the island
 
10 of Oahu, and restore the program on the island of Kauai.
 
11 Implementation of this section during each fiscal year in the
 
12 1999-2001 fiscal biennium, to be funded from the appropriation
 
13 authorized in section 9, shall provide the following program
 
14 services:
 
15      (1)  Expansion of the baby S.A.F.E. program to:
 
16                Waimanalo                                 $101,500
 
17                Kailua                                    $203,000
 
18                Kaneohe                                   $399,000
 
19                Ewa-Waipahu                             $1,530,500
 
20                Wahiawa                                   $280,000
 
21      (2)  Restoration of the baby S.A.F.E. program to 
 
22                Kauai                                     $441,000
 
23      SECTION 9.  There is appropriated out of the general
 

 
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 1 revenues of the State of Hawaii the sum of $          , or so
 
 2 much thereof as may be necessary for fiscal year 1999-2000, and
 
 3 the same sum, or so much as may be necessary for fiscal year
 
 4 2000-2001, to provide substance abuse prevention and treatment
 
 5 services as specified in sections 2, 4, 6, and 8.
 
 6      SECTION 10.  The sum appropriated shall be expended by the
 
 7 department of health for the purposes of this Act.
 
 8      SECTION 11.  This Act shall take effect on July 1, 1999.
 
 9 
 
10                           INTRODUCED BY:  _______________________