"We're not going to go backwards," said Jurith during a keynote speech at the annual meeting of the National Association of State Alcohol and Drug Abuse Directors, held June 3-6 in New Orleans. Jurith, a longtime ONDCP staffer, took over leadership of the agency after the resignation of Clinton administration drug czar Gen. Barry McCaffrey, and will hold the job until Bush drug-czar nominee John Walters is confirmed.

Despite Walters' reputation as a drug-war hawk and treatment skeptic, Joe Autry, deputy administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), said, "I suspect that substance-abuse demand reduction will take on an increasingly important role, just as supply reduction has in the past."

Still, he noted: "We really don't have all the facts in regarding where this administration is going." Autry pointed out that much of the political leadership around addiction issues is not yet in place, with Senate confirmation of Walters and former Rep. Asa Hutchinson (R-Ark.) as head of the Drug Enforcement Administration still pending.

Cherilyn Scism, a healthcare lobbyist for the National Governor's Association (NGA), said the slow pace provides an opportunity for the addiction field to press its issues with the new administration before policies are set. Unfortunately, she said, the recent power shift in the U.S. Senate may mean "an increased reliance on politics and rhetoric to get things done, which is not necessarily good for our issues."

One change that could have a big impact on the addiction community is the establishment of a new drugs and crime subcommittee to the Senate Judiciary Committee. Chaired by Sen. Joseph Biden, this newly created panel "will put a big spotlight on these issues," predicted Harri Kramer, director of the office of congressional and public affairs at the Office of Justice Programs within the U.S. Department of Justice.

Paul Samuels, director of the Legal Action Center, which lobbies on behalf of state treatment-provider organizations, said that while President Bush has paid "quite a bit of attention" to addiction issues -- such as pledging during the Walters nomination ceremony to spend $1.6 billion on treatment over the next five years -- prospects in Congress are not clear.

Tax cuts will impact the budgets of federal agencies, he noted, and treatment programs will have to compete with Bush's pledge to double research funding at the National Institutes on Health. "Research is important, but if we do great research and we don't have the money to put it into practice, what are we doing?" asked Samuels.

Jurith Says Administration Supports Treatment, Prevention

Jurith said the new administration is committed to supporting treatment, prevention, drug courts, and workplace programs. New initiatives like the $5 million Drug-Free Futures Program, which will train parents' groups to do prevention, and $50 million in new drug-court funding "rebut the idea that we are stagnant," he said.

"We've had a lot of success and come a long way in the last 20 years," said Jurith, dismissing the popular notion of the drug war being a lost cause. "I challenge you to look at any other policy area where we have done as well as in this field."

Looking forward, Jurith told state treatment and prevention leaders that the administration's faith-based funding initiative will help, not hinder, their efforts. "Many faith-based organizations are in communities where hard-to-reach populations are," he said. "They can break down barriers to acceptability of services."

"I look upon it as an opportunity, but we still need to work for the idea of science-based treatment," Jurith said. Autry echoed that sentiment, saying, "SAMHSA's position is that regardless of who the provider is, they must meet the same standards as any other provider in the state in terms of licensing, credentialing, etc."

Samuels said that the treatment and prevention community needs to provide input as the administration develops its faith-based initiative. "There is a danger that the administration may direct money to ineffective programs, but we also could use the momentum of the faith-based initiative to increase funding not only to faith-based programs, but to other effective programs, as well," he noted.

Jurith also hinted that the Bush administration may have more to say about parity for addiction services in the coming months, noting that both federal employees and the military now enjoy parity coverage. "We're excited about the future of parity," he said.

State Public Policy Priorities Unveiled

During the meeting, NASADAD announced its top public-policy priorities for the coming year; topping the list was working to close the gap between addiction treatment capacity and need. Significantly, the White House has asked SAMHSA to conduct a state-by-state estimate of the treatment gap.

Not only could this data be used to support requests for addition treatment funding, it also may provide valuable insight into the current treatment system. "If we do have huge increases to close the treatment gap, do we have the capacity?" asked Autry, echoing the concerns of many state officials.

SAMHSA's role may also be expanded in the coming months, said Autry, as the Department of Housing and Urban Development seeks to transfer responsibility for addiction treatment and prevention services to the Department of Health and Human Services. SAMHSA also is due to submit a report on the proposal to transform the current addiction block grant to a performance-partnership program, which would give states increased flexibility in spending federal addiction funds in exchange for more accountability.

Revising the Synar regulations on tobacco control is another top legislative priority for both NASADAD and the NGA, who argue that the law unfairly ties compliance with underage-sales laws -- controlled by local law enforcement -- to the addiction block grant, which is administered by state agencies.

Scism said that the Bush administration's Health and Human Services secretary, former Wisconsin Gov. Tommy Thompson, is sympathetic on Synar, but that the states have "very few natural supporters" in Congress. "It's very grim from a lobbying standpoint," she said. "We need to communicate to the governors that they need to be active on the federal level on this issue."

Other top public-policy priorities for NASADAD include:

• lifting the Medicaid IMD exclusion, which prevents freestanding addiction-treatment programs from accessing Medicaid funds to pay for services
• restoring the 20 percent governor's set-aside in the Safe and Drug-Free Schools program
• supporting the National Treatment Plan
• reauthorizing the Temporary Aid to Needy Families program, which provides welfare benefits to many families with addiction problems
• collaborating with the National Association of Drug Court Professionals to address addiction in criminal-justice populations
• providing enhanced services to Native-American populations
• improving services for those in the child-welfare system

Bush's Addiction Policy Remains Unclear, But Field Retains Hope for Change. Feature article by Bob Curley for Join Together Online (www.jointogether.org), June 18, 2001.

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