Creating a Safer Iowa by Funding Drug Treatment: A Proposal by Iowa Attorney General Tom Miller

DES MOINES.   Attorney General Tom Miller has rededicated himself during this term in office to finding and promoting policies that will really work to make Iowa a safer state. He strongly believes that one of those policies is to better fund certain key strategies to deal with the problem of drug-related crime in Iowa. This proposal contains requests for strategic state funding increases in drug-related enforcement, prevention and treatment.

Attorney General Miller is especially committed to strengthening Iowa’s efforts in regard to drug treatment. Each legislative session since 2003 he has issued an appeal to the legislature to significantly increase the levels of funding in Iowa for drug treatment. As the state’s top law enforcement official, the Attorney General remains convinced that “The number one thing we can do to fight crime is fight drugs and the number one thing we can do to fight drugs is to do a better job with drug treatment.”

1 The Status of Drug Abuse in Iowa: Much Done, More to Do.

The passage of the Iowa Pseudoephedrine Control Law in 2005 resulted in a dramatic decline in meth labs in the state. The law has been an enormous help in protecting children and others from exposure to toxic meth lab sites and freeing law enforcement from the time-consuming and dangerous job of cleaning up meth labs. The success of this important state legislation has caused Iowa to be seen as a national leader in meth control.

The number of labs has declined from 1,500 in 2004, the year preceding enactment of the law, to 255 for 2006 (through September). One of the important benefits of that success is that fewer children are being exposed to these dangerous labs. In 2003, 353 children were found in homes where meth was being manufactured. By 2005, that number was reduced to 128 -- but it still is too many.

Despite these significant benefits, the drug addiction problem in Iowa is not solved. The landmark 2005 law did not reduce the demand for meth in Iowa. It was never promised to do so. Even before the pseudoephedrine control law was adopted, only about 20% of the meth used in Iowa was “homemade”. Indications from informal law enforcement and treatment providers tell us that, while the number of meth labs is down, the supply of meth in Iowa has not decreased. Imported meth is taking the place of the meth previously made in Iowa. Indeed, in a report by the U.S. Department of Health and Human Services, Iowa is rated as having the eighth-highest meth use rate in the nation.

Other drugs also remain a concern. Alcohol remains the most frequently abused drug in our state. Indeed, there are more arrests for OWI in Iowa than for any other offense. Marijuana continues to be the most frequently abused illegal drug in Iowa. Seizures of cocaine in Iowa were at an all-time high in 2005. Increases in the potency of both marijuana and cocaine are a particular concern to law enforcement and treatment officials. In addition, there is a growing concern about the abuse of pharmaceutical drugs.

Iowa still remains one of the safest places in America in regard to crime, but the use of meth and other drugs remain a persistent threat to that security.

2 A Three-prong Approach Is Needed To Deal With Drugs: Enforcement, Prevention and Treatment.

Enforcement: Law enforcement agencies and prosecutors in Iowa are to be commended for the vigorous job they do in arresting and prosecuting drug dealers and users. Drug shipments crossing the state on our Interstate highways are being intercepted. The remaining meth labs in Iowa are being discovered. Drug dealers and users are being arrested and prosecuted.

According to a report of the Governor’s Office of Drug Control Policy, funding for drug-related enforcement and adjudication will total about $35.9 million in FY2007, a small increase from FY2006. Unfortunately, cuts in federal funding for drug task force personnel are anticipated in state FY2008. These federal funding cuts threaten as many as 42 law enforcement positions in Iowa multi-jurisdictional drug enforcement task forces, primarily law enforcement officers specializing in drug cases. The state needs to find ways to replace these lost federal funds in order to keep up the high-quality drug enforcement work being done by law enforcement officers across the state.

Prevention: Efforts to control demand through education exist throughout the state but more funding is needed to supplement these efforts. There is a new generation of evidence-based prevention strategies, some of which use innovative meth-specific approaches. These strategies have proven to be effective. Overall, the state will spend about $17.8 million on prevention in FY2007 -- a decline due in large part to changes in the federal Safe and Drug Free Schools program that now directs funds to uses other than substance abuse prevention.

Treatment: The state will spend $49.3 million on all treatment-related programs in FY2007. This figure represents a decline from the $55.5 million spent in FY2001 and the $50.2 million spent in FY2006. Those declines are largely due to declining federal assistance for drug treatment. Appropriations of state dollars for drug treatment increased in FY2006 and FY2007, but not enough to make up for the federal cuts nor to deal with the increased need. Overall, the trend has been to under-fund the increasing need for vital treatment services.

Despite this flat to declining support for drug treatment, demand for drug treatment in Iowa has increased. The number of screenings/admissions for drug treatment in Iowa for a primary substance other than alcohol rose 36% from FY2000 to FY2006.

We recommend a significant increase in the funding available for substance abuse treatment in the state. Current funding is not adequate to meet the increasing need. Overall, we are doing a good job with the funding that is available, but it is not adequate for the numbers needing treatment and for the proper length of stay to get the job done.

3 Drug Treatment Reduces Crime and is Cost-Effective. Increasing the money available for substance abuse treatment will reduce crime and make Iowans safer.

Substance Abuse is Directly Correlated with Criminal Behavior. About 80% of those in prison have been identified as having a substance abuse problem. Nearly one-third of state prison inmates reported being under the influence of drugs at the time of their offense. Among state and federal prison inmates, 27% of those serving sentences for burglary said they committed their offense to buy drugs.

Substance Abuse Treatment Works. Research involving numerous large-scale studies consistently demonstrates that treatment has beneficial outcomes. According to the National Clearinghouse for Alcohol and Drug Information, U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Administration (SAMHSA), clients served by federally-funded substance abuse treatment programs were able to reduce their drug use by about 50% for as long as one year after treatment.

These results are verified in Iowa by research conducted by the Iowa Consortium for Substance Abuse Research and Evaluation. The 2006 Outcomes Monitoring Report on treatment in Iowa shows that approximately 40% of treatment clients had successfully abstained six months after treatment. Very importantly, the abstinence percentage for clients who were in treatment longer than 60 days was 61.1%, demonstrating that funding for an adequate length of stay is important.

While these numbers do not suggest that treatment is easy -- nor necessarily successful on the first attempt -- they do suggest that treatment works, especially when funding is adequate to provide an adequate length of stay. Substance abuse treatment is seen as particularly successful when it is compared to other chronic health conditions such as diabetes, asthma and heart disease.

Substance Abuse Treatment Reduces Crime. The National Treatment Improvement Evaluation Study (NTIES) is a congressionally-mandated five-year study of the impact of drug and alcohol treatment on thousands of clients in hundreds of treatment centers that received support from the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Administration (SAMHSA). The results showed that criminal behavior was greatly reduced after treatment:

• Drug use dropped 41%.
  
  
  
• Selling drugs declined 78%.
  
  
  
• Arrests for any crime declined 64%.
  

Research by the Iowa Consortium for Substance Abuse Research and Evaluation confirms these results. In 2005 it reported that 87% of Iowa drug treatment clients reported no arrests in the six months after treatment concluded.

Substance Abuse Treatment is Cost Effective. Multiple studies have shown that the benefits of substance abuse treatment outweigh the costs. According to the National Institute on Drug Abuse, “Treatment for adults and adolescents is cost-effective because it reduces costs related to drug-abuse, associated with health care, and crime-related costs including incarceration.”

• A landmark RAND Corporation study estimated that money spent on treatment for people prosecuted on federal cocaine charges should reduce serious crimes about 15 times more effectively than incarceration.
  
  
  
• The CALDATA study in California found that for every tax dollar invested in substance abuse treatment, taxpayers saved seven dollars in future crime and health-related costs.
  
  
• Studies in two Washington state clinics demonstrated that each dollar invested in inpatient treatment had an economic return of over $9 while outpatient treatment yielded a return of $23.

4 Proposal:

(A) Expand Treatment ($7 Million)

Funding for drug treatment has not kept pace with demand. According to the Governor’s Office of Drug Control Policy, 44,863 clients were screened or admitted to drug treatment in FY2006. That number represents a 100% increase since 1992. But during that same period of time, funding for drug treatment increased by only 56%. The state has under-funded treatment needs.

We propose an increase of $7 million to the Iowa Department of Public Health appropriation that provides funding for community substance abuse treatment services. These services include evaluation, referral, counseling and aftercare. The state currently spends $23.1 million for these services. (FY2007: $11.8 in state tobacco funds, $792,000 in state general funds, and $9.8 million in federal funds.)

Some of the increased funding should be allocated to licensed treatment facilities that allow substance abusing parents to receive services alongside their children while obtaining substance abuse treatment. Increased support for this particular group will make kids safer and also reduce costs for the Iowa human services system.

Children are not safe in homes where drugs are used, particularly meth. In 2005, DHS reported 1,354 cases of child abuse involving the presence of illegal drugs in the child’s body. A 2006 DHS study showed that 46% of the children on caseloads in the 16-county DHS Council Bluffs Service Area come from homes where the parents have been involved in meth. 80% of all Child in Need of Assistance (CINA) cases by the Polk County Attorney’s Office from June 2004 to January 2005 involved parent or care-giver use of meth.

Iowa currently has 3 such facilities funded by the Iowa Department of Public Health: House of Mercy in Des Moines, Heart of Iowa in Cedar Rapids and Jackson Recovery in Sioux City. Funds need to be used to ensure the continued success of these programs and the expansion of this concept to high-need areas of the state where such services do not currently exist.

Given the great risk of harm that comes to children as a direct result of a parent’s addiction, comprehensive services are needed to address a caretaker’s addiction as well as to provide education and support with respect to their role and responsibilities as parents in a family setting. Some portion of any additional funding for drug treatment should be allocated to the particular needs of these children and families.

(B) Expand Drug Courts ($3 Million)

Drug court programs specially tailored to the specific needs of families, juveniles and adults in local communities have shown success in Iowa. Because these programs are proving their effectiveness, the state should ensure their continuation and expansion.

Drug courts are effective because they combine the authority of the court with the effectiveness of drug treatment. The court ensures that there is a strong incentive for clients to complete treatment and stay clean. Defendants hear the message that failure to comply will result in sanctions.

Drug Courts currently exist in Des Moines (family and juvenile and adult models), Davenport, Sioux City, Mason City, Marshalltown, Ida-Cherokee-Crawford Counties and in the Fourth Judicial District. Ensuring the continued existence of these effective programs is a crucial part of Iowa’s fight against drug abuse. Communities that do not yet have drug court programs should be allowed to choose the model most appropriate for their unique community needs.

Substance abuse treatment centers for caretakers of children work best when combined with family drug courts such as the model created by Judge Karla Fultz in Des Moines. The program maintains a 75% success rate in family reunification and sobriety. Family drug courts give caretakers of children the opportunity to succeed in treatment while remaining connected with their children. As early as 2003 a Des Moines Register editorial said that the Polk County Juvenile Drug Court is “.... one program that benefits the entire state. It’s a bargain for taxpayers. It works.”

The Iowa Department of Public Health estimates that placing drug courts to serve 40 adults and 40 juveniles in each of the state’s eight judicial districts would cost approximately $3 million.

(C) Fund After-School Programs ($4 million)

Another key component in fighting drug abuse is prevention. One key prevention strategy is the use of effective after-school programs to provide activities and adult supervision for youth during high-risk hours. These programs provide alternative activities to increase learning opportunities while importantly reducing the likelihood of substance abuse and other risky behaviors.

According to a 2003 study by the Children’s Defense Fund, Iowa has the nation’s second-highest percentage of families where both parents (or the only parent) works. According to one study, 29% of Iowa’s K-12 youth are responsible for taking care of themselves after school. Hundreds of thousands of Iowa youth could benefit both academically and in terms of safety from having structured and supervised activities while their parents are still at work.

Studies show that children are most at risk during unsupervised after-school hours. It is during this time that they are most likely to be involved in risky behaviors such as drug use or sexual activity. Violent juvenile crime is most likely to occur between 3pm and 6pm. Juvenile crime triples during this time.

After-school programs promote the safety of youth by providing safe and supervised places for youth to go until their parents get off work. This time can be used to educate youth about the dangers of substance abuse.

In a study of American teens, the YMCA found that youth who are unsupervised after school are three times more likely to use drugs than their peers who are supervised.
In Iowa, a few federally funded programs, such as the 21st Century Learning Centers, have provided some grant support to some communities, but these grants have largely expired and new criteria makes the grants much more difficult to access. In 2006, the legislature appropriated $150,000 to the Iowa Department of Education for competitive grants for after-school programs. Applications for these funds totaled over $2 million. Another $586,000 was unsuccessfully sought by after-school programs from the Iowa Department of Public Health specifically for substance abuse prevention. Many more programs did not apply at all.

The Iowa Afterschool Alliance is seeking an appropriation of $4 million to fund the demonstrated need for effective after-school programs in Iowa. The alliance is made up of after-school programs, YMCAs, Boys and Girls Clubs, 4-H/Iowa State Extension, Iowa PTA, and others. The Attorney General’s Office supports that request because of our belief that these programs can reduce juvenile crime and prevent future substance abuse.

(D) Replace Lost Federal Funding for Drug Task Forces ($1.8 million)

The Attorney General supports the request of the Governor’s Office of Drug Control Policy for a state appropriation of $1.8 million for Iowa’s multi-jurisdictional Drug Task Forces. This appropriation would offset a previously unforeseen loss of federal grant funds anticipated in Federal Fiscal Year 2007 (State Fiscal Year 2008) for Iowa’s Drug Task Forces. As many as 42 Iowa drug enforcement positions are at risk as a result of this federal cut. While the extent of the federal cut is not known because it is still pending in Congress, it is hoped that Congress will restore at least some part of this funding. The state funding request would leverage local matching funds and support approximately 32 Iowa Drug Task Force positions for which federal financial support might otherwise be lost. We are hopeful that Congress will restore enough funding to support the remaining 10 positions but if it does not then additional state money should be found to replace that lost federal money as well.

5 Conclusion:

These recommendations total $15.8 million in increases in drug enforcement, prevention and treatment funding. Maintaining strong efforts in enforcement, prevention and treatment is crucial to our fight against the devastating effect of drugs on our society.

This proposal pays special attention to drug treatment because inadequate funding for drug treatment continues to be a particular problem. Adequately funding drug treatment is the single most effective thing the state of Iowa can do to fight crime. With these proposals Attorney General Miller continues his advocacy to significantly increase the levels of funding in Iowa for drug treatment. Along with enforcement and prevention, drug treatment is an important component in our fight against drugs. But, unfortunately, it has been consistently under-funded. We know that drug treatment reduces the demand for drugs and that, in turn, reduces crime. Or, stated another way, Drugs drive crime and addiction drives drugs.

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