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The Hidden Tax
The Dollar Impact
The annual cost of substance abuse in Maine is estimated to be $1.2+ billion$916 for every man, woman, and child in Maine.2 This hidden tax on the people of Maine is two-thirds the size of the States annual budget. This does not begin to account for the suffering and burden on those whose well-being is affected directly or indirectly by substance abuse. The State collects $64 million in annual taxes from alcohol, but spends only $7.4 million on the budget for Maines Office of Substance Abuse (OSA). In 1997, OSA spent $14.3 million in state and federal dollars on substance abuse prevention and treatment services.
Studies have shown that preventing problematic substance use can be an important component in helping reduce both the social and economic costs of substance abuse. Research suggests that for every dollar spent in preventing illicit drug use, there is a fifteen dollar savings in dealing with the consequences of drug use and addiction.3 Studies also have shown that the cost savings from providing substance abuse treatment to juvenile offenders are significant compared to the costs of incarceration (up to 16 to 1 in financial savings alone).4 Studies in California, Illinois, and Missouri have shown that criminal activity of adult offenders is reduced after substance abuse treatment, thus resulting in financial savings.5
The Human Impact
Its the vastness of the problem thats overwhelming...We see a huge number of lives destroyed... Paul A. Fritzsche, Superior Court Judge, State of Maine.6
The gifts that this program has given me cannot possibly be measured in dollars and cents... What I thought was the end of my life, actually became a brand new start...
I was given the tools and...the love and understanding I need to lead a happy, productive life free from addiction. Without programs like [this one] many lives would be lost in the maze of senseless addictive pain, and never-ending torture...It saved my life. Letter by resident of halfway house to United Way.
This hidden tax takes its toll on the lives of individual Maine people. According to the Secretary of State and the Maine State Police, operating under the influence has significant human impact. In 1996, 37.5% of all traffic fatalities in Maine involved alcohol. Drivers with a blood alcohol content of 0.15 or more are 200 times more likely to be involved in a fatal crash than the average non-drinking driver.
People in Maines general population have more education and more money than people receiving substance abuse services. Twice as many people in Maines general population (40%) receive at least some college education,7 than do people entering OSA-funded services (19.6%).8 The per capita income of all Maine people ($20,105 in 1995) is at least two and a half times greater than the income ($7,992 or less a year) reported by the people entering OSA-funded services who report household incomes.9
Two-thirds of the people receiving OSA-funded services are involved in the legal system (probation, awaiting trial, incarcerated, driving under the influence). An estimated 47% of adult probationers were under the influence of drugs or alcohol at the time of their offenses.10 Over the past two years, OSA has screened 1,300 juvenile offenders, of whom 72% required further substance abuse intervention. However, only about 20% were referred for screening. An estimated 68% of Maines incarcerated adult offenders require intervention for substance abuse, yet fewer than 8% of those who need treatment receive it.
Maines substance abuse services mitigate the devastating effects of substance abuse; often they are life-saving to those trying to recover from alcoholism and other drug addiction. However, over seven times as many people need substance abuse services than those who actually receive services. For example, OSA estimates that in 1997, 75,600 adults needed substance abuse treatment, but only 10,607 adults were admitted for it.
The Task Force
Concerns about this hidden tax led to the creation of the Task Force on Substance Abuse. This has been a combined effort of the Joint Select Committee on Substance Abuse of the 118th Maine Legislature and the Substance Abuse Services Commission, an advisory committee to the Office of Substance Abuse (OSA) in the Maine Department of Mental Health, Mental Retardation and Substance Abuse Services. The Task Force came together in the spring of 1998 to conduct a comprehensive study of substance abuse problems in Maine. Its charge was to review issues related to substance abuse, to determine how to address these issues in a coordinated fashion, and to recommend changes in policies which affect substance abuse prevention and treatment. The Task Force worked throughout the summer and into the early fall to complete its work.
This Executive Summary highlights the Task Forces 42 recommendations. These are not listed in order of priority. Beginning on page 20 there is more in depth discussion of the recommendations.
The Substance Abuse Services System
1. Expand resources to fund substance abuse initiatives by: reallocating state General Fund revenues; making changes in state tax policies; successfully applying for federal grants; building municipal support; and obtaining private sector grants from businesses, foundations, and other philanthropic organizations.
2. Implement mechanisms to ensure that OSA is appropriately positioned in State Government and that substance abuse issues receive an appropriate level of attention in both the Executive and Legislature Branches. Ensure full compliance with current Maine law that requires state agencies to cooperate with OSA. Ensure that all state agencies which spend funds on substance abuse services notify OSA at least annually about all expenditures of state, federal, and other dollars for these services. Require that OSA report directly to the Legislatures Joint Select Committee on Substance Abuse and/or other Joint Committees on the substance abuse services budget and the use of substance abuse resources, as well as the status of Maines substance abuse system.
3. Continue to bring together representatives of the Legislatures seven key policy committees into the Joint Select Committee on Substance Abuse so they can address substance abuse issues in a coordinated manner and examine:
4. Support the development of an independent consumer initiative in Maine to play an active role in the discussion and resolution of substance abuse issues.
Strategies and Services Embracing All Groups
5. Assess which substance abuse services are needed in each region of Maine. Provide funding, in proportion to population and geography, to support all components of the continuum of care in each region.
6. Increase access to and availability of substance abuse screening tools and assessments for youth. Establish a long term treatment facility for adolescents, as well as alternative services for youth that are geographically accessible (including but not limited to intensive outpatient treatment, family therapy, home-based family therapy, and gender-specific treatment.) Increase the availability of transitional housing for youth.
7. Recruit and retain appropriate and adequate staffing throughout the continuum of care. Coordinate resources to help non-profit substance abuse service agencies retain competent staff and to prevent the migration of their staff to other private sector organizations.
8. Address barriers to treatment and ensure the existence and consistency of support services throughout the continuum of care.
9. Institute action-oriented outreach programs that target isolated populations. Target substance abuse education and training programs to members of special population groups.
10. Develop and carry out a media campaign to encourage respect for diversity. Develop a standard curriculum that focuses on cultural diversity and make licensing of substance abuse providers contingent upon completion of this curriculum.
11. Maximize the use of Medicaid funding to support the costs of substance abuse services for Maines low income people. Design managed care for Medicaid recipients that is based on outcomes research and on the substance abuse treatment system developed by OSA.
12. Provide training for Department of Human Services caseworkers and supervisors, as well as assistant attorneys general to improve their recognition of substance abuse, to make sure they understand confidentiality, and to underscore their responsibility to refer people for substance abuse treatment. Increase referrals to substance abuse treatment by DHS.
Publicly Intoxicated People at Risk
13. Enact legislation to allow the involuntary commitment of individuals in need of substance abuse services who are a danger to themselves and whose lives are at risk.
14. Create opportunities for youth to participate in the development of legislation and policies that affect their lives.
15. Expand substance abuse prevention programs in traditional and alternative schools and communities statewide.
16. Develop and maintain a revolving loan fund at OSA to assist communities with start up funds for substance abuse prevention.
17. Develop a system to ensure that technical assistance in program development, grant writing, and coalition building in relation to substance abuse issues is available to all Maine communities. See recommendation 3.
18. Develop funding partnerships involving OSA and other public and private organizations to support the continuation of coalitions involved in efforts such as the study circles.
19. Conduct a public information campaign to develop awareness about the devastating effects of alcohol and other drug abuse and to encourage individuals and communities to take action.
20. Review the status and outcomes of primary prevention programs across Maine, how these programs are funded, and how they can collaborate to work more effectively and efficiently. See recommendation 3.
21. Study the issues related to certification standards for prevention specialists in Maine. See recommendation 3.
22. Establish a Task Force comprised of representatives from Maines public and private post-secondary schools with the mission to address underage and abusive drinking by students.
Services for Juvenile Offenders
23. Complete OSAs development of and fully implement the comprehensive differentiated program of evaluation and treatment for juvenile offenders who are substance abusers. Ensure that the program is carried out through the regional treatment networks and the southern and northern Maine Youth Centers.
24. Provide stable, long term funding through OSA to the regional networks to increase differentiated treatment capacity to meet the unmet treatment needs of juvenile offenders who are substance abusers and living in the community. Cover the services of providers who are willing to participate in formal network operations and who specialize in the diagnosis and differential clinical treatment of juvenile offenders who abuse substances. Also use funding for:
25. Provide stable, long term funding through OSA to implement a differentiated therapeutic intervention program at the southern and northern Maine Youth Centers. Ensure that the program has differential content, duration, and intensity for addressing substance abuse clinically as a primary condition related to criminal behavior.
26. Implement Juvenile Drug Court projects in each of the four Juvenile Corrections Regions through a collaborative process involving the Judicial Department, Department of Attorney General, District Attorneys, Department of Corrections, and OSA. Use the treatment capabilities of the regional treatment networks.
Services for Adult Offenders
27. Provide stable, long term funding through OSA for a seamless, statewide comprehensive adult offender substance abuse service system, which includes:
28. Assess the need for substance abuse treatment for adult offenders in county jails, with special attention paid to treatment for incarcerated OUI offenders.
29. Continue the Drug Court pilot project for adult offenders in Cumberland County and expand it to three additional sites in Maine through a collaborative process involving the Judicial Department, Department of Attorney General, District Attorneys, Department of Corrections, and OSA. Use the treatment capabilities of the regional treatment networks.
30. Create, by executive order, a Law Enforcement OUI Task Force to develop comprehensive joint action plans for providing the most effective and efficient means possible to reduce the incidence of intoxicated drivers.
31. Report to the Legislature by January 15 of each year results and recommendations regarding the effectiveness of the Young Driver Legislation passed in 1998.
32. Develop legislation to allow more flexibility in the design of OSAs Driver Education and Evaluation Program.
33. Make training in the use of the intoxilyzer machine, Horizontal Gaze Nystagmus, and advanced OUI recognition techniques a mandatory requirement of Basic Police Training.
34. Restore funding to the Maine Drug Enforcement Agency to the 1992 level.
35. Direct the Maine State Police and Maine Drug Enforcement Agency to develop and execute a Joint Plan for Illicit Drug Flow Control, designed to provide Maine law enforcement officers with training to enhance their skills in identifying and prosecuting offenders.
36. Expand training at the Maine Criminal Justice Academy to focus on drug trafficking, drug recognition, and expanding threats to law enforcement officers from the hazards of clandestine drug laboratories. Provide grant funds for local communities, so that they can expand Drug Recognition Training for local law enforcement officers.
37. Enhance the Maine State Police capability to track and identify suspected and convicted drug offenders and provide pertinent data to all local and county law enforcement agencies.
Private Sector Responses to Substance Abuse
38. Amend Maines health insurance laws to require parity benefits for substance abuse treatment under the same terms and conditions as benefits for physical conditions and illnesses. If the Legislature does not require parity benefits for substance abuse treatment, amend the current law mandating coverage for substance abuse treatment to require mandatory coverage in HMO plans and to require coverage in all individual and group insurance policies.
39. Revise insurers utilization review standards, based on the medical necessity guidelines adopted by the American Society for Addiction Medicine. Require training in substance abuse treatment for those who review and approve managed care plans.
40. Improve the quality of Employee Assistance Programs (EAPs) by encouraging the development of programs that use core technologies and by initiating state licensing for qualified and certified EAP professionals.
41. Streamline the statutory and regulatory provisions governing EAPs and drug testing policies. The Legislature should amend 26 MRSA, chapter 7, subchapter III-A (Substance Abuse Testing) to increase its effectiveness so that more employers will develop fair, equitable, and responsible drug testing and EAP programs.
42. Examine the issues related to drug testing by employers, including screening for alcohol. See recommendation 3.