Studies indicate that alcohol and drug abuse problems cost almost $300 billion a year nationally, and Columbia University's Center on Addiction and Substance abuse estimates that in 1998, Louisiana spent almost 10 percent of its state budget dealing with abuse and addiction problems, including criminal justice, prevention and treatment. The state recently received a three-year, $22.8 million grant from the Substance Abuse and Mental Health Services Administration to help bolster the state's efforts to deal with addictions. Michael Duffy, assistant secretary of the state Department of Health and Hospital's Office for Addictive Disorders, discusses the state's problems and plans.

Q: What impact will this grant have on the state's programs to deal with alcohol and drug addiction?

A: The grant we received will create an electronic voucher that will pay for clinical services and support services. The other feature of the grant is that there will be a major outreach over the next few months to faith-based, community-based, private and public sectors and the recovering community to partner with our office to expand the capacity to treat others who suffer from addiction.

Q: What areas of the state budget are affected when dealing with addictions in the community?

A: My take is that addiction ultimately impacts just about every area of our state budget ... social services, education, criminal justice, and healthcare in general, then you have lost work productivity. It's all there, yet we don't have the resources to change that. I guess it's a philosophical discussion of do we pay now or do we pay later?

Q: Is there evidence to determine how much money is saved by investing in prevention and treatment?

A: Dr. Loren Scott's study ("Potential Cost Savings to the State of Louisiana from the Expansion of Substance Abuse Treatment Programs") looked at the fiscal impact of getting back money for every dollar we invest in prevention. (He found that) for every dollar of taxpayers' money invested, you save up to $5.19, and that's just future healthcare costs associated with crime. Louisiana has the highest per capita incarceration rate in the nation. We did a study in conjunction with the Department of Corrections that identified 77 percent of our current prison population as being in need of treatment or serious intervention.

Q: So what does that tell you?

A: It brings you to that question of do we address the issue of addiction up front or do we address the problems they create after they are addicted? I think the infusion of the funds we have in this grant will enable us to touch more people's lives ... in a positive way. We all know that treatment is effective; it saves lives and it restores people to productive members of society.

Q: Just how bad is the addiction problem? I've seem estimates from your office that the existing budget only reaches about 8 percent of those who need treatment, and that there generally are as many as 1,000 people on a waiting list to receive 24-hour care.

A: Historically, we have for years indicated that about 10 percent of the general population as a whole is affected by addiction. ... Last month we had 955 people every day access either detox services, in-patient treatment services or a halfway house. Last year, for the entire year, we admitted 32,700 individuals.

Q: What types of addiction are the most prevalent in Louisiana?

A: The No. 1 problem we face is still alcoholism. Following that is cocaine, marijuana, opiates.

Q: What should be done in addition to treating the actual addiction?

A: What we're now discovering is that it's not just that one stops drinking or drugging, we're finding that if one doesn't have a safe place to live and is in a drug-infested neighborhood, it's hard to stay clean and sober. We need to help them with safe housing, employment, and (a way to) improve familial relationships. The grant we just received will help us not only to address clinical treatment services ... but it also will help us with support services, better employment, transitional housing, providing transportation or childcare. ... These are pieces that public and private sectors have not traditionally been able to provide.

Q: How do addictions further affect Louisiana residents?

A: When you look at the education system and the struggles that we have relative to dropouts, it's real hard for a child to learn if they're either living in an environment where active drug use is going on or they are involved in alcohol or drug use themselves. If you're talking about social services, we know a lot of domestic violence occurs as a result of alcohol or drug use, and results sometimes in the kids being removed from the home. I don't want to frame it all in terms of money, because it is a quality-of-life issue also. With treatment, individuals don't have to live like that. If we provide treatment and prevention services in our communities, they will become better places to live.

Q: How do you start in the schools?

A: One of the things I've already discussed with some of the school-based health clinics is of our providing screening assessments, intervention and treatment, if that's possible. Another thing we've begun to pilot in the state is to provide screening assessments, brief intervention and treatment to pregnant WIC recipients in two public health facilities in Monroe and Baton Rouge. My goal would be to phase that in over time all over the state. We do know that the genetic predisposition to the illness is a reality we have to face. The youths of those mothers or fathers who have demonstrated addiction are at high risk of developing the addiction themselves. Anytime we can interrupt that cycle, we improve the opportunities for those youths to live clean and sober.

Q: What should an individual do if they suspect abuse in someone they know?

A: It's important for family members, relatives, significant others to talk about it and confront the person. It needs to be done in love and, from your standpoint, that you see something that is out of control. They can contact any of our facilities throughout the state and request assistance in conducting an intervention. ... Our constant struggle is to make sure that help is available when that person finally surrenders to the fact that they need help.


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