Treating Drug Problems Volume 2 (1992) / Chapter Skim
Currently Skimming:
Federal Leadership in Building the National Drug Treatment System
Federal Leadership in Building the National Drug Treatment System
Pages 63-88
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 63... ...
This paper outlines the history and development of the federally supported drug treatment system from the 1960s to the present. First, it notes the role of new therapeutic ideas in the 1960s.
|
From page 64... ...
It also emphasizes the importance of experienced leadership to deal with other interests at the federal level. EARLY PROGRAMS From the mid-1930s until the mid-1960s, the entire federal drug treatment system consisted of two prison-hospitals: Fort Worth and Lexington.
|
From page 65... ...
In New York, a distinct independent agency, the Narcotic Addiction Control Commission, was established to administer treatment to persons committed from the civil and criminal courts. Its procedures allowed narcotic addicts to be treated within the corrections department and within mental health facilities.
|
From page 66... ...
Addiction Research Center at Lexington, in writing a summary of the Second National Conference on Methadone Treatment In 1970, noted with disappointment that established clinical research criteria were not being met by proponents of the modality in their evaluation of the treatment (Martin, 1970~. Additionally, during this period in the early 1960s, a variety of small demonstration programs sprang up across the country with the help of very modest federal funding.
|
From page 67... ...
Department of Health, Education and Welfare, 1966~. At about this same time, Attorney General Nicholas Katzenbach testified to the Senate Judiciary Committee that, in order to reform the federal courts and to better serve the many narcotic addicts across the country, he was proposing a civil commitment procedure that could be invoked in lieu of prosecuting drug-related crimes.
|
From page 68... ...
NARA, in its final form, laid the groundwork for a federally funded national drug treatment system, although the decision to proceed with such a system was not made until 1971. As proposed by the Johnson administration, NARA had two basic concepts.
|
From page 69... ...
These developments coincided with a rapid infusion of money and demands for expansion of the national treatment capacity. NARA's implementation was an important step toward a national drug treatment system for three reasons.
|
From page 70... ...
Training programs were designed by experienced professional treatment staff of the Narcotic Addict Rehabilitation Branch of NIMH. Most of these individuals had experience with heroin addicts at Lexington or Fort Worth, and some had experience from early community demonstration projects supported by the Vocational Rehabilitation Administration or the Office of Economic Opportunity (OEO)
|
From page 71... ...
mandating and supporting the provision of drug abuse and alcoholism treatment within community health facilities helped influence the service delivery field to address drug addiction treatment. Furthermore, the initiative by the Office of Economic Opportunity in supporting community-based treatment of alcoholism and drug abuse, along with the requirement that people within the services community be part of the caregiving staff, enabled some nontraditional treatment agencies to win federal support and achieve financial stability.
|
From page 72... ...
The end result was a period of micromanagement by the Special Action Office of NIMH drug abuse grant awards. LEGISI^TIVE EXPANSION Special Action Office for Drug Abuse Prevention The period from 1971 to 1975 was the most fruitful and productive in federal history in establishing and expanding drug treatment services.
|
From page 73... ...
These findings led the President to the decision that federal investment in drug treatment would reduce crime and save money. Consequently, on June 17, 1971, President Nixon issued Executive Order 11599 in which he established the Special Action Office for Drug Abuse Prevention (SAODAP)
|
From page 74... ...
The SAODAP legislation also established stringent restrictions of 8 percent on the administrative costs paid by the states and state programs as overhead. Then, building on the work done in the NARA program to define treatment, SAODAP produced treatment guidelines that standardized the service expectations of the federal system for the programs receiving federal support (Special Action Office for Drug Abuse Prevention, 1974a1974e)
|
From page 75... ...
It also provided the opportunity to involve the state governments in the management of the drug treatment system. As the massive size of the task to establish a national drug treatment system became clear, NIMH, with the endorsement of SAODAP, contracted for technical assistance to grantees.
|
From page 76... ...
A further point of divergence related to staffing: whereas OEO programs encouraged employment of local citizens as a designed asset of the program, NIMH programs encouraged professional leadership and staff. Moreover, NIMH drug abuse programs operated under strict performance guidelines, overhead limits, and accounting practices.
|
From page 77... ...
A series of monographs were produced that offered community agencies specific guidance regarding program design, facility requirements, staffing patterns, treatment planning, and the applicable federal regulations. The monograph series covered central intake functions and the various treatment modalities: outpatient and residential methadone treatment and outpatient and residential drug-free treatment (Special Action Office for Drug Abuse Prevention, 1974a, 1974b, 1974c, 1974d, 1974e)
|
From page 78... ...
Therefore, as the system was built, the priority was rapid implementation of treatment capacity, with little attention given to the relationship of drug abuse treatment to other components of the health care system. Many people saw drug treatment as an adjunct to the criminal justice system; others saw it as part of the social service system.
|
From page 79... ...
Block Grants With the installation of the Reagan administration in 1981, the states received a clear policy message: they were to have prime responsibility for all service systems; despite the actions of previous administrations, the federal government now assumed no special responsibility for drug treatment services. After a period of assessment, the proposal to initiate the block grant funding mechanism for alcohol, drug abuse, and mental health
|
From page 80... ...
With this action, the institute was stripped of the senior professional leadership to whom the states had historically turned for help in the solution of their drug treatment problems. Initially, there was excitement at the state level with the freedom and independence of action given them by the block grant.
|
From page 81... ...
In addition, the 1988 legislation placed greater requirements on the states to adopt federally mandated priorities with the block grant monies. Today, the philosophical struggle between the executive and legislative branches of government is being fought directly within the drug treatment authorities.
|
From page 82... ...
Because of limited personnel resources, the legislative mandate of the 1988 anti-drug bill to establish a national data system offering a national perspective on the size and performance of the drug treatment system is also being implemented slowly. Prior to the block grants, the federal
|
From page 83... ...
Resource commitments to address drug abuse and addiction with solutions other than law enforcement erode during periods of relative public calm about these problems. With another declared emergency situation and a legislative infusion of federal funds, federal executives need to devise and follow a strategy to ensure the sustained ability of the Public Health Service to provide leadership for the drug treatment services community.
|
From page 84... ...
Proceedings: Fifth National Conference in Methadone Maintenance. Rockville, Md.: National Institute of Mental Health.
|
From page 85... ...
Special Action Office for Drug Abuse Prevention (1974e) Residential Methadone Treatment Manual.
|
From page 86... ...
1974 With the Division of Community Assistance, the National Institute on Drug Abuse became operational. SAODAP directed other federally funded community treatment service grants to be transferred to NIDA, which received approximately $40 million worth of projects and a $20 million increase in budget to fund and administer these projects.
|
From page 87... ...
In the end, although programs were eliminated and consolidated, there were other impacts that appeared. 1975 At the insistence of DHEW, NIDA converted all statewide services contracts to statewide services grants.
|
From page 88... ...
88 BESTEMAN 1979 NIDA permitted a reduction -- from 95,000 to 84,000 -- in the number of federally supported treatment slots. These funding policies remained in effect until the block grant era began in 1981.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.