The cost of substance abuse to society has reached unsustainable levels. With the annual cost of alcohol use in California at $38.4 billion and illicit drug abuse at $23.8 billion, the combined toll on the state ($62.2 billion) cannot be sustained from a fiscal standpoint.
This, in conjunction with the very real human toll the disease of addiction takes on individuals, families and communities, makes it critical for policy makers to take a proactive role in addressing the complex substance abuse issues facing the state.
Recognizing the costly nature of addiction on many public service systems, California’s publicly funded Alcohol and Other Drug (AOD) services system has been on a path over the last several years to increase effectiveness and cost efficiency of services to those Californians in need. The AOD Field has made much progress in instituting evidence based practices, process improvements and performance measures to increase effectiveness of services as part of its Continuum of Services System Re-engineering efforts.
The state Department of Alcohol and Drug Programs (ADP) has taken the next step in reengineering efforts by instituting system improvements through development of a data informed planning and decision making process. The Statewide Needs Assessment and Planning (SNAP) process has been established within ADP business operations to fill that role. This first report represents the beginning of the assessment phase of the process which will culminate in establishing state-level priorities. This is followed by a planning, implementation and evaluation phase.
Based on the data analysis in this report the following recommendations were developed to be considered in establishing state-level priorities.
Recommendations for the Continuum of Services
Employ more science-based population level prevention strategies.
Identify new funding or resource strategies to expand Prevention activities in California.
Build the AOD system capacity for early intervention strategies such as SBIRT.
Continue to focus on increasing treatment effectiveness through strategies such as evidence-based practices, process improvements, performance measures, etc.
Build the AOD system capacity for Recovery Support Services including identifying funding or other resource strategies.
Recommendations for Health Care Reform
Develop a plan based on the “knowns” of health care reform and add to it as further information and details come to light.
Consider how to partner with and educate the primary care system on AOD issues.
A thorough examination of the Medicaid and California's Medi-Cal system must be undertaken in relation to impacts on the AOD system and services.
Understanding and planning for the uninsured population will be just as important as building capacity to serve additional insured individuals.
Appropriately preparing and developing the AOD workforce will be a critical step.
Recommendations for Specific Substances
Institute specific programs aimed at preventing and reducing the high rate of underage and excessive alcohol use and abuse.
Institute strategies to arrest the growth of prescription drug and opiate abuse.
Recommendations for Specific Populations
To address overall need:
o Target youth aged 12 through 20 for evidence-based universal prevention strategies.
o Target youth aged 16 and 17 years old for evidence-based selective prevention strategies.
o Target young adults aged 21 through 25 for evidence-based early intervention strategies.
o Target youth aged 18 through 25 for evidence-based prevention, early intervention, and treatment services.
Complete an in-depth analysis of race/ethnicity data to understand its relationship to the AOD service needs in California to inform program decisions.
Consider instituting programs to increase the treatment capacity for the following subpopulations in the listed order:
o Individuals with SMI and a concurrent AOD problem
o Pregnant women
o Homeless individuals
These are all strategies that the data in this report indicate would be of most value in impacting the state’s substance use issues. Decisions related to the setting of state-level priorities will be made by senior leaders within the AOD Field at the state and county levels. While the data suggest certain courses of action, decisions must also factor in resource and other environmental issues.
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