Weekly Memo
California Association of Alcohol and Drug Program Executives
March 28, 2008
Little Hoover Commission urges Governor and Legislature
to fund treatment at effective levels
Releasing its long awaited report, Addressing Addiction:
Improving & Integrating California’s Substance Abuse
Treatment System, the Little Hoover Commission (LHC)
concluded in a transmittal letter
to the Governor and the
Legislature that “California can
reduce substance abuse, but it
must adopt a new model to
transform the way counties
deliver treatment.” Also, the
letter informs decision makers
that “Proposition 36 has shown
promise despite its flaws, and
rather than throw it out, California can and should fix it.”
Commissioners urged the Governor and the Legislature
to shift money to substance abuse treatment to avoid
the larger costs of treating the consequences of addiction
because “of its strong belief that a successful strategy
for fighting addiction has tremendous leverage in
reducing the social ills fueled by substance abuse.” The
report cites the costs of failing to curb substance abuse
and addiction as a cause of significant outlays for
child welfare, foster care, juvenile justice, prisons and
mental health, and predicts that problems will continue
to grow unless addressed.
The report reminds lawmakers that implementation of
reforms that include flash incarcerations have been delayed
due to the lawsuit filed by the Drug Policy Alliance
and others who claim that such reforms violate the mandate
of Prop. 36’s sentencing law. However, Commissioners
argue that “The state, however, should not use
the court case, or the lack of flash incarceration, as an
excuse to delay implementing reforms, allowed by existing
law, that could reduce addiction and increase accountability
for drug offenders through a combination of
treatment and escalating sanctions that stop short of
jail.”
Noting that wide array of evidence-based strategies are
available, the Commissioners told the Governor and the
Legislature that the state must adopt a model for treatment
that emphasizes prevention and screening and
early intervention, and recognizes the need for continuing
recovery services. California must then build its system
of funding and standards to drive treatment providers
toward this model.
The Commission held public hearings in June and August
of 2007 at which it gathered testimony from a
broad cross-section of AOD professionals, law enforcement
officials, and the judiciary. The Commission compiled
that testimony along with the 2006 research report
from UCLA’s Integrated Substance Abuse Programs
which indicated that Prop. 36 saves the state $2.50 to
$4.00 for every $1.00 it spends. The LHC report includes
the UCLA recommendations for changes which
shaped the legislative reforms that sparked the DPA
lawsuit.
The report also cites a January report from the Legislative
Analysts’ Office (LAO) responding to the Governor’s
plan to cut funding for Prop. 36 and drug courts in the
2008-09 budget in which the LAO notes that both programs
save money by reducing costs in the state’s criminal
justice and child welfare systems and it would not be
cost-effective to make the cuts. Instead of cutting the
programs, the LAO recommends sustaining funding at
2007-08 level.
Finally, the LHC report issues a detailed list of recommendations
which are presented in brief herein. A full
report and the details that accompany the following recommendations
are available at www.lhc.ca.gov/ .
Recommendation 1: The state should transform substance
abuse treatment into a performance-driven system
based on a comprehensive model of care through
the use of incentives and mandates to improve quality,
transparency and outcomes.
Adopt a comprehensive model of care.
Tie funding to outcomes. Counties that demonstrate
quality and improved outcomes should be rewarded.
Require performance management.
Prioritize quality, not quantity.
Require Continuous Quality Improvement as a condition
of program licensure.
Standardize counselor certification and create tiered
levels of certification.
Eliminate regulatory and statutory barriers that hinder
counties from adopting a comprehensive model of
care and a system that provides proven, cost-effective
treatment.
Amend regulations for Medi-Cal and other funding
streams to allow for best practices.
Prioritize co-occurring disorders.
Activate reimbursement codes that allow billing for
Screening and Brief Intervention programs.
Repeal the Uniform Accident and Sickness Policy Provision.
Recommendation 2: The state should institutionalize
understanding, leadership and oversight of substance
abuse issues to provide a more cohesive, cost-effective
statewide substance abuse policy. Specifically, the state
should:
Continued on page 2, see “LHC Report”
