JTO Interview: NASADAD Executive Director Lewis Gallant

Lewis Gallant recently was appointed executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), which represents the interests of state alcohol and other drug agencies on matters of national policy. Join Together interviewed Dr. Gallant about his new position, dealing with the Bush administration, and major issues currently confronting the addiction field.

Having been a state agency director, how has your perspective changed upon becoming executive director of NASADAD, and having to deal with the interests of 50 state directors?

I don't think it has changed appreciably, because I was NASADAD president for a year and a half before that, and had been with the association for over eight years. So I understood some of the issues that were occurring at the national level that impact the state level.

But there's probably a lot more going on than state directors realize. We work with other associations as partners to resolve cross-cutting issues, and we're fortunate to have a good relationship with our federal partners. We try to work with both so that the field can move forward with a single voice — we've been stressing that for the past few years.

For example, on the issue of providing services to people with co-occurring disorders, we've worked with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Association of State Mental Health Program Directors (NASMHPD) to develop a position that we're now attempting to move forward as national policy. For a number of years this has been a real concern for patients and providers, and to have two national associations collaborate with the federal government enabled us to put forward a position that's a win-win — one that ensures that patients encounter no wrong door, and recognizes the strength of the two systems (addiction and mental health) to treat this population.

We developed a framework that was published a year and a half ago jointly by NASADAD, NASMHPD and SAMHSA. That is now being infused in all of our discussions around this issue, and hopefully will be a model that treatment providers nationally will use.

Regarding the funding formula for the block grant, NASADAD and NAMHSPD worked out a methodology so no state would be hurt … We also are continuing our work with the Center for Substance Abuse Treatment to implement the National Treatment Plan. Our members were involved in this initiative from the beginning, because we felt it was important to have a consensus document for developing the nation's treatment programs. We've been very successful in getting state input into the plan. Now that it has been rolled out, we can put all of our weight behind it, so that when it is presented to state directors they will be ready to understand and implement it.”

Do you see vast differences between the states in the nature of their addiction problems and their policies to deal with them — particularly where treatment is concerned?

There are regional differences in the kinds of drugs being used; we have the core drugs like alcohol, tobacco, heroin, and cocaine, but the states differ in the use of methamphetamine and club drugs, although ecstasy is becoming more of a national problem.

Most states really been very successful in developing a treatment delivery system that can respond. But we don't have enough capacity, and we know that. The gap between capacity and need is about 6.6 million persons nationally, and we estimate we would need $5-6 billion in additional dollars to close that gap.

The block grant would be one mechanism to deliver those services, but we also could have separate funding streams for special population, such a those in the criminal-justice system, welfare, and for children. The Child Protection, Alcohol and Drug Partnership legislation (S-484) now in Congress would be an ideal way for us to address the needs of the 11 percent of the nation's children who are impacted by at least one parent's use of alcohol or other drugs.

What is the nature of interaction between state directors and the administrators of corporate insurance plans, as opposed to the public-sector programs?

It depends on the state, and what kind of regulation or legislation they have in place (such as parity laws) to open up plans to treating alcohol or other drug abuse. Some state agencies are working to help insurance plans be responsive, Some are getting involved in consultation, collaboration, and providing guidance to insurers on what should be in the plan, and what the continuum should look like. State agencies also are educating them about the long-term and short-term costs of treating addiction, urging insurers to treat these problems early to avoid the long-term costs.

Regarding parity laws, state directors have primarily a monitoring role; state insurance agencies would have the regulatory role. The fact that many states have taken the initiative to put parity on the front burner is important. What we need now is a piece of national legislation to tie it all together.

This was the first year the National Household Survey data was available on a state-level basis. Was it helpful to state directors? How was it used?

I think that the survey is good indicator on national trends, but we're not very comfortable with the state-level data. The CSAP and CSAT needs-assessment data is a far between mechanism for getting state-level data. Because of the size of the household survey and the way it's conducted, it would be difficult to get at the kind of needs data states would find useful. If some of the resources used for expanding the Household Survey were redirected to the needs-assessment efforts, we probably would be better served.

What differences are you seeing working with a Republican administration versus eight years of the Clinton administration?

Thus far, since President Bush has not made a lot of appointments that impact our field, I don't have a great sense of what the transition might mean. The president clearly articulating a need for more treatment money right out of the gate was very good. We could use more, and we would ask that he hold to the commitment he made during the campaign, when he said he would like to see another $1 billion going into the treatment part of system.

We believe, based on data from the National Treatment Plan, the Office of National Drug Control Policy, and the Institute of Medicine, that we're going to have to have at least $5-6 billion to meet current treatment needs. So, the $115 million in the president's budget request is a good down-payment, but we believe a lot more resources will be needed.

As he looks at the interdiction policy, the president may want to think about redirecting some resources to treatment. I think he recognizes that the nation's drug policy really needs reassessment — I've heard him say it — and I'm hoping he'll see that interdiction efforts, although successful in some ways, can be reduced if we can give people high-quality treatment on demand.

The administration's budget gives $100 million for treatment, but takes away $300 million from the Public Housing Drug Elimination Program. The budget also increases spending on prisons by $1 billion, and maintains the long-standing imbalance between demand and supply spending. What are you impressions of the first Bush budget, and do you see a truly balanced drug budget as an attainable goal?

I do believe there needs to be a greater degree of parity on what is spend on interdiction and demand. I think there's a disparity there. If you look at the literature and the work done during the early Nixon administration, when we gave treatment on demand, the demand for drugs went down. When the policy shifted, the numbers went up.

If the president is true to his word about looking at drug policy, I think it would be wise to look at the disparity of what is channeled to treatment versus interdiction. I think it's on the table now. As he puts appointees at ONDCP, SAMHSA, and elsewhere in place, it may be a real opportunity to work together to try to figure out how to craft a response to the issues faced by the nation's substance-abuse system.

NASADAD has been an effective advocate for the Substance Abuse Prevention and Treatment Block Grant. Yet on other issues of importance to the field, NASADAD's voice has often been missing. In trying to balance the needs of 50 state directors and governors, is NASADAD essentially hamstrung on many advocacy issues? Do you see any way to make NASADAD's advocacy voice more prominent?

We do have to be concerned about our 50 state members, but we have other association partners, so where we might not be able to speak on certain state issues, we draw on the strengths of others. Our members represent 50 states, governors, legislators, and citizens, so we have to be very careful about what we sign on to and support. We try to be in congruence with the National Governor's Association, so we walk that fine line.

We have to be very careful that we don't say or do something that might impact any member. We try to carefully select the things that are important to our system. I think we have a mechanism whereby the interests of our 50 members can impact policy development. We collaborate with those we can and reach consensus when can, but go the other way when have to.

What do you think the biggest misperception of NASADAD's role is?

It's not all about the block grant. Localities and state systems provide the majority of treatment funding, so our goal is to make sure have best system of care that can. We are working to improve the nation's system for people with substance abuse, and establish standards of care for people so they can get high-quality, accessible treatment.

What is your vision for NASADAD's future?

My vision is to continue to work to ensure that the issues we have been struggling with over the last 30 years don't exist anymore — the stigma we have to deal with, the availability of treatment in the workplace, closing the treatment gap, and working with our federal partners to increase the level of resources to reduce addiction.

We also need to develop a high-quality recovery community that can advocate for themselves, so they are not overlooked by state or federal lawmakers. That's one of our weakest points. Our advocacy community is fairly small but is growing, and one of my goals is to see that continue to evolve so they can really have an impact on policy development and implementation. State directors can provide support and guidance to these initiatives, and help them to identify other resources to keep going and expand to all 50 states once federal funding like the Recovery Community Support Program runs out.

JTO Interview: NASADAD Executive Director Lewis Gallant. Original feature article, Join Together Online (www.jointogether.org), April 26, 2001.

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