Mr. Chairman, Ranking Member, members of the committee. Thank you for the opportunity to appear before you today. NAADAC represents 13,000 licensed or certified addiction counselors from across the United States. Our membership reflects a multi-disciplinary range of professional, clinical and academic preparation. Our common denominator is that we are all chemical dependency counselors, clinical specialists in addiction, serving on the frontlines of chemical dependency treatment. We have for the past thirty years advocated for the development and deployment of the highest standards of care for patients seeking treatment for addiction to alcohol and other drugs.
NAADAC welcomes and supports any organization, faith-based or secular, committed to providing quality treatment and care to persons afflicted with drug addiction.. The need is great. The treatment gap is wide. The number of treatment providers across the nation is declining. More providers and funding should result in increased access and availability of treatment. This is a good thing given the public health crisis addiction poses to our nation.
NAADAC’s concern is not with who provides care, but rather by what clinical standards that care is provided. We are committed to the application of science based, best practices, perhaps as most succinctly stated in the National Institute on Drug Abuse (NIDA) publication Principles of Drug Addiction Treatment, a Research-based Guide (NIH # 004180, October, 1999). Addiction is a chronic, complex illness requiring individualized assessment and treatment. Such care should be comprehensive and should extend over a sustained period of time. Treatment may include episodes of medical and/or psychiatric care. As drug addiction impairs social functioning, social service interventions may be indicated as well. The essential element is that treatment plans continually evolve based on the individual needs and progress of the patient. The treater needs to be competent to provide such care.
The NAADAC position statement on what is often called "charitable choice" identifies six principles that we believe should inform your deliberations. This statement was sent to all members of the 107th Congress and key persons in the administration. A copy is attached for your reference.
The six principles are:
1. There is no wrong door to treatment. Specific populations have distinct addiction treatment needs. We support faith-based providers who comply with current state regulations governing substance abuse treatment.
2. Addiction treatment delivered in the public sector is and should continue to be a public health service. Regulations and guidelines to insure consumer protection and safety must be maintained.
3. Charitable choice provisions must support state requirements. Nineteen states now license individual addiction treatment providers. The other thirty-one states have some other form of certification or credentialing process. These public health and safety criteria provide consumer protection and accountability in addiction treatment.
4. Charitable choice provisions must not undermine the Civil Rights Act prohibition on discriminatory hiring practices. We believe that federally funded, public health clinical service providers should not discriminate in employment practices.
5. Requirements to provide secular treatment alternatives "within a reasonable time period"are often unattainable. Addiction treatment is provided in the context of a window of opportunity when the patient is sufficiently ill or desperate to seek help. The patient’s acute medical need for detoxification, often life threatening, does not allow for delay. The lack of availability of treatment services in many communities renders this provision impractical.
6. Taxpayers expect all federally funded programs to comply with stringent accountability and outcome measurement standards. All providers should be held to the same federal standards that safeguard the public treasury.
Chemical dependency is a highly stigmatized illness. There is a profound disconnect between what science and research indicates regarding this disease and public opinion. The most glaring evidence of this misunderstanding is the treatment gap. In any given year there are between 13 and 16 million chemically dependent Americans in need of treatment, but only 3 million receive care. (SAMHSA,1999; Institute of Medicine,1997.)
Recently released CSAT research indicates that in 1997 the social cost of illicit drug addiction alone is $116.9 billion When combined with alcoholism the social cost rises to $294 billion. In contrast expenditures for treatment are $5.5 billion for drug addiction alone and $11.9 million when combined with alcoholism treatment. Substance abuse costs America 25 times what the nation spends on treatment. (Coffey et al. National Estimates of Expenditures for Substance Abuse Treatment, 1997. SAMHSA Publication No. SMA-01-3511, February 2001.)
NIDA director Alan Leshner summarizes what scientific research has taught us about drug abuse: "...addiction is a brain disease that develops over time as a result of the initial voluntary behavior of using drugs. The consequence is virtually uncontrollable compulsive drug craving, seeking, and use that interferes with, if not destroys, and individual’s functioning in the family and in society. This medical condition demands formal treatment." (Leshner, A.I.., Ph.D., Addiction is a Brain Disease, Issues in Science and Technology. Vol.XVII, Num.3, The University of Texas at Dallas, Spring 2001)
Treatment delayed is effectively treatment denied. Access to care in real time is critical by the very nature of the illness. As a brain disorder it requires qualified professional care. The salient issue is the clinical competency of the treatment provider.
We often confuse the manifestation of the illness, the individual behaviors of the addict with the disease itself. That is what we see and experience. These behaviors are often illegal, sometimes criminal, and frequently obnoxious. Yet we would not deny competent medical treatment to a person with coronary disease or any other life threatening ailment on the basis of how we judge their behavior. Medical care would be provided and their behaviors dealt with in other settings. Addiction is a brain disease and must not be stigmatized as sin, willful misconduct, or immoralism.
It is not clear to us what problem Title VII seeks to address. Section 701.(a) page 132 lines 20-21 states "the program is implemented in a manner consistent with the Establishment Clause of the first amendment of the Constitution." Section 701. (K) page 138 lines 3-5 states "...shall be based on a program shown to be efficacious and should incorporate research based principles of effective substance abuse treatment." So why the need for new law? The mechanisms for new treatment providers to enter the field already exist.
Current understanding of the Establishment Clause of the Constitution requires that faith-based organizations provide treatment in a secular atmosphere. There is a long tradition of faith-based organizations of many denominations providing chemical dependency services in accordance with current federal, state, and local law. Catholic Charities, the Salvation Army, and Volunteers of America to name but a few. We believe that a sectarian, doctrinal or overtly religious atmosphere that suggests, even if not stated, that treatment or recovery is somehow contingent on adherence to certain religious practices and beliefs, is not compatible with quality care. The patient presenting for addiction treatment is very vulnerable to subtle and implied coercion. As other treatment options may not exist in real time, the presenting patient may comply in order to continue to receive services. Such coercion would be a violation of the patient’s civil rights. It is also a violation of the ethical code of all human service professional associations.
We welcome faith-based organizations seeking to provide addiction treatment under current law. There is a crying need for more providers if the treatment gap is to be narrowed and eventually closed. We should not, however, confuse professionally competent clinical addiction treatment with the vital adjunctive role community based resources play in reintegrating the newly recovering individual into society.
There is a strong role for spirituality and freely chosen congregational or denominational affiliation in the lives of individuals and families. Indeed in the recovering community there is a long tradition of participation in Twelve Step groups. It is noteworthy that the Twelve Step tradition leaves all questions of doctrine, practice, and affiliation to individual determination and conscience.
NAADAC believes that it is the individualized treatment plan, based on the assessment by skilled trained professionals, that is the cornerstone of effective treatment. We strongly believe that expanded treatment opportunities will have a vital impact on the nation’s demand reduction strategy.