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Obama Proposes Increased Funding for Treatment and Prevention, but 'Balance' Proves Elusive Goal

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The Obama administration's first stab at crafting its own national drug-control budget priorities (PDF) adds new funding for addiction treatment and prevention, but does little to close the huge gap between spending on drug supply- and demand-reduction efforts despite promises of a “balanced” strategy.

The FY2011 National Drug Control Budget released by the Office of National Drug Control Policy (ONDCP) on Feb. 1 includes a 13.4 percent increase in spending on alcohol and other drug prevention programs and a 3.7 percent increase for addiction treatment.

“The new budget proposal demonstrates the Obama administration's commitment to a balanced and comprehensive drug strategy,” said ONDCP Director Gil Kerlikowske. “In a time of tight budgets and fiscal restraint, these new investments are targeted at reducing Americans' drug use and the substantial costs associated with the health and social consequences of drug abuse.”

 “We usually have to go to Capitol Hill to dig ourselves out of the cellar, but this year's that's not the case,” said Rob Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD). “Some will look at the [increases] and say they're marginal, but looking at the history it's a darn good start.”

However, the budget plan also calls for modest increases in spending on domestic law enforcement, interdiction, and international programs. So, the bottom line is that the Obama administration is proposing to spend 64 percent of its anti-drug budget on supply reduction efforts and just 36 percent on demand-reduction programs like drug treatment and prevention — numbers that are virtually indistinguishable from the ratio in the final drug budget produced under the Bush administration.

“I was hoping for large cuts on the supply side, especially after the previous administration allocated at least $1 billion more each to interdiction and source-country programs that accomplished absolutely nothing,” said drug budget and policy expert John Carnevale. “This nation must stop blaming source countries for our problems and face the fact that we can do more to reduce drug use by focusing on treatment, prevention, and diversion programs.”

Incremental 'Change You Can Believe In'

Carnevale and others thought that Kerlikowske might define 'balance' by moving to equalize spending on the demand and supply sides of the budget, perhaps by shifting funds from overseas programs to domestic treatment and prevention services. The 2011 plan contains no such revolutionary proposals, however.

“This budget reflects the same Bush-era priorities that led to the total failure of American drug policy during the last decade,” said Aaron Houston, director of government relations for the Marijuana Policy Project (MPP).

Kerlikowske said effective drug policy “does not call for an all-or-nothing, false choice between demand reduction and supply reduction.”

“Instead, it must be a balanced, evidence-based approach that blends the benefits of effective demand reduction with effective supply reduction,” he said.

Arthur Dean, chairman and CEO of Community Anti-Drug Coalitions of America (CADCA), said that expectations of radical change should be tempered by the fact that this was Kerlikowske's first crack at crafting a drug strategy. “I hope that they are committed to making some significant changes,” said Dean while acknowledging, “Change has been slow so far.”

Evidence-Based Prevention System Among Priorities

The centerpiece of ONDCP's demand-reduction plan is $150 million in “new funding for creating a national, community-based prevention system to protect adolescents; training and engaging primary health care to intervene in emerging cases of drug abuse; expanding and improving specialty addiction care; developing safe and efficient ways to manage drug-related offenders; and creating a permanent drug monitoring system.”

After years of declining budgets, the new prevention funding was welcomed by field advocates, although some found the allocation of resources somewhat puzzling. Notably, the budget plan calls for spending $9.5 million less on the Drug Free Communities (DFC) grant program, which had seen steady increases in recent years and is the most popular funding vehicle for community-based anti-drug coalitions nationally.

Dean expressed disappointment with the DFC cuts. “While the renewed focus on prevention is a welcome development, which we wholeheartedly support, we will continue to ensure that the solid foundation of the Drug Free Communities program, which reduces drug use and its consequences in hundreds of communities, is enhanced as well,” said Dean.

“These proposed cuts are not a judgment about the need for, or the effectiveness of, the vital work these programs perform,” said Kerlikowske, who said the decision to trim the DFC budget was rooted in the “lean economic times the country is facing … forcing all of us into having to do more with less.”

Goodbye, 'Safe and Drug Free Schools'; Hello, 'Successful, Safe and Healthy Students'

The Obama administration is proposing a new “Successful, Safe and Healthy Students” grant program to replace the Department of Education's Safe and Drug-Free Schools (SFDS) program, which has suffered significant funding cuts in recent years amid doubts about its effectiveness.

The new program — intended to create “an improved school climate that reduces drug use, violence, and harassment and improves school safety and students' physical and mental well-being” –  would receive $283 million under the Obama plan, $107 million more than SFDS received in FY2010. Unlike the formula-based SDFS national grants, the Healthy Students grants will be awarded on a competitive basis to local education agencies.

CADCA's Dean welcomed the funding but worried about how it will be used. “Although the new program does speak to some drug prevention, it's more implicit than explicit,” he said. “If it's not explicit, school officials might not give drug prevention the attention it deserves.”

The budget would establish a $15-million Prevention Prepared Communities program, a pilot project intended to create a system of evidence-based youth prevention interventions lasting throughout adolescence. Another $5.6 million would be spent on supporting community prevention specialists who would assist in developing these projects in collaboration with the states, and $2 million would be used to evaluate the project.

The National Youth Anti-Drug Media Campaign — a frequent target of critics who claim the program is expensive and ineffective — also would receive a major funding boost under the Obama drug budget, up $21.5 million to a total of $66.5 million in FY2011. “The president is throwing good money after bad when what we really need is a new direction,” said MPP's Houston.

$100 Million More for Treatment, But No New Funds for Block Grant

About $100 million in new funding for treatment programs within the Substance Abuse and Mental Health Services Administration (SAMHSA) would be spread over a variety of programs, notably the Second Chance Act, which would receive $20 million more to provide community-based treatment services to ex-offenders.

Also receiving new funds are programs to add new addiction counselors to federal health systems, increase the use of Screening, Brief Intervention and Referral to Treatment, the Access to Recovery program ($9.9-million budget increase), and $10 million more for drug courts.

None of the new money would go to the keystone, $1.779-billion Substance Abuse Prevention and Treatment Block Grant, however. Also level-funded for FY2010 would be the $30-million Residential Substance Abuse Treatment (RSAT) program, which provides services inside correctional facilities. “It would be nice to see increases, but we're always glad when we don't see cuts,” said Morrison, who nonetheless said NASADAD would urge lawmakers in Congress to increase block grant funding. 

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