[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 538 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                 S. 538

To educate health professionals concerning substance use disorders and 
                               addiction.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 7, 2005

   Mr. Biden introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To educate health professionals concerning substance use disorders and 
                               addiction.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Professionals Substance Abuse 
Education Act''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--Congress makes the following findings:
            (1) Illegal drugs and alcohol are responsible for thousands 
        of deaths each year, and they fuel the spread of a number of 
        communicable diseases, including AIDS and Hepatitis C, as well 
        as some of the worst social problems in the United States, 
        including child abuse, domestic violence, and sexual assault.
            (2) There are an estimated 19,500,000 current drug users in 
        America, nearly 4,000,000 of whom are addicts. An estimated 
        14,800,000 Americans abuse alcohol or are alcoholic.
            (3) There are nearly 27,000,000 children of alcoholics in 
        America, almost 11,000,000 of whom are under 18 years of age. 
        Countless other children are affected by substance abusing 
        parents or other caretakers. Health professionals are uniquely 
        positioned to help reduce or prevent alcohol and other drug-
        related impairment by identifying affected families and youth 
        and by providing early intervention.
            (4) Drug addiction is a chronic relapsing disease. As with 
        other chronic relapsing diseases (such as diabetes, 
        hypertension and asthma), there is no cure, although a number 
        of treatments can effectively control the disease. According to 
        an article published in the Journal of the American Medical 
        Association, treatment for addiction works as well as treatment 
        for other chronic relapsing diseases.
            (5) Drug treatment is cost effective, even when compared 
        with residential treatment, the most expensive type of 
        treatment. Residential treatment for cocaine addiction costs 
        between $15,000 and $20,000 a year, a substantial savings 
        compared to incarceration (costing nearly $40,000 a year), or 
        untreated addiction (costing more than $43,000 a year). Also, 
        in 1998, substance abuse and addiction accounted for 
        approximately $10,000,000,000 in Federal, State, and local 
        government spending simply to maintain the child welfare 
        system. The economic costs associated with fetal alcohol 
        syndrome were estimated at $54,000,000,000 in 2003.
            (6) Many doctors and other health professionals are 
        unprepared to recognize substance abuse in their patients or 
        their families and intervene in an appropriate manner. Only 56 
        percent of residency programs have a required curriculum in 
        preventing or treating substance abuse.
            (7) Fewer than 1 in 5 doctors (only 19 percent) feel 
        confident about diagnosing alcoholism, and only 17 percent feel 
        qualified to identify illegal drug use.
            (8) Most doctors who are in a position to make a diagnosis 
        of alcoholism or drug addiction do not believe that treatment 
        works (less than 4 percent for alcoholism and only 2 percent 
        for drugs).
            (9) According to a survey by the National Center on 
        Addiction and Substance Abuse at Columbia University (referred 
        to in this section as ``CASA''), 94 percent of primary care 
        physicians and 40 percent of pediatricians presented with a 
        classic description of an alcoholic or drug addict, 
        respectively, failed to properly recognize the problem.
            (10) Another CASA report revealed that fewer than 1 percent 
        of doctors presented with the classic profile of an alcoholic 
        older woman could diagnose it properly. Eighty-two percent 
        misdiagnosed it as depression, some treatments for which are 
        dangerous when taken with alcohol.
            (11) Training can greatly increase the degree to which 
        medical and other health professionals screen patients for 
        substance abuse. It can also increase the manner by which such 
        professionals screen children and youth who may be impacted by 
        the addiction of a parent or other primary caretaker. Boston 
University Medical School researchers designed and conducted a seminar 
on detection and brief intervention of substance abuse for doctors, 
nurses, physician's assistants, social workers and psychologists. 
Follow-up studies reveal that 91 percent of those who participated in 
the seminar report that they are still using the techniques up to 5 
years later.
            (12) The total economic costs of untreated addiction is 
        estimated to be $274,800,000,000. Arming health care 
        professionals with the information they need in order to 
        intervene and prevent further substance abuse could lead to a 
        significant cost savings.
            (13) A study conducted by doctors at the University of 
        Wisconsin found a $947 net savings per patient in health care, 
        accident, and criminal justice costs for each individual 
        screened and, if appropriate, for whom intervention was made, 
        with respect to alcohol problems.
    (b) Purpose.--It is the purpose of this Act to--
            (1) improve the ability of health care professionals to 
        identify and assist their patients in obtaining appropriate 
        treatment for substance abuse;
            (2) improve the ability of health care professionals to 
        identify and refer children and youth affected by substance 
        abuse in their families for effective treatment; and
            (3) help establish an infrastructure to train health care 
        professionals about substance abuse issues and the impact on 
        families.

SEC. 3. HEALTH PROFESSIONALS SUBSTANCE ABUSE EDUCATION.

    Part D of title V of the Public Health Service Act (42 U.S.C. 290dd 
et seq.) is amended by adding at the end the following:

``SEC. 544. SUBSTANCE ABUSE EDUCATION FOR GENERALIST HEALTH 
              PROFESSIONALS.

    ``(a) Secretary of Health and Human Services.--The Secretary shall 
carry out activities to train health professionals (who are generalists 
and not already specialists in substance abuse) so that they are 
competent to--
            ``(1) recognize substance abuse in their patients or the 
        family members of their patients;
            ``(2) intervene, treat, or refer for treatment those 
        individuals who are affected by substance abuse;
            ``(3) identify and assist children of substance abusing 
        parents;
            ``(4) serve as advocates and resources for community-based 
        substance abuse prevention programs; and
            ``(5) appropriately address the non-therapeutic use of 
        prescription medications.
    ``(b) Use of Funds.--Amounts received under this section shall be 
used--
            ``(1) to continue grant support through cooperative 
        agreements to the Association for Medical Education and 
        Research in Substance Abuse (AMERSA) Interdisciplinary Faculty 
        Development Project;
            ``(2) to continue grants to the Association for Medical 
        Education and Research in Substance Abuse (AMERSA) 
        Interdisciplinary Faculty Development Project; and
            ``(3) to support the Addiction Technology Transfer Centers 
        counselor training programs to train substance abuse counselors 
        and other health professionals such as dental assistants, 
        allied health professionals including dietitians and 
        nutritionists, occupational therapists, physical therapists, 
        respiratory therapists, speech-language pathologists and 
        audiologists, and therapeutic recreation specialists.
    ``(c) Collaboration.--The Secretary shall participate in 
interdisciplinary collaboration and collaborate with other 
nongovernmental organizations with respect to activities carried out 
under this section.
    ``(d) Academic Credits.--The Secretary shall encourage community 
colleges and other academic institutions determined appropriate by the 
Secretary to recognize classes offered by the Addiction Technology 
Transfer Centers for purposes of academic credit.
    ``(e) Evaluations.--The Secretary shall conduct a process and 
outcome evaluation of the programs and activities carried out with 
funds received under this section, and shall provide annual reports to 
the Secretary and the Director of the Office of National Drug Control 
Policy.
    ``(f) Definitions.--In this section--
            ``(1) the term `health professional' means a allopathic or 
        osteopathic physician, advanced practice nurse, physician 
        assistant, social worker, psychologist, pharmacist, dental 
        health professional, psychiatrist, allied health professional, 
        drug and alcohol counselor, or other individual who is 
        licensed, accredited, or certified under State law to provide 
        specified health care services and who is operating within the 
        scope of such licensure, accreditation, or certification; and
            ``(2) the terms `allopathic or osteopathic physician', 
        `nurse', `physician assistant', `advanced practice nurse', 
        `social worker', `psychologist', `pharmacist', `dental health 
        professional', and `allied health professional' shall have the 
        meanings given such terms for purposes of titles VII and VIII 
        of the Public Health Service Act (42 U.S.C. 292 et seq. and 296 
        et seq.).
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $9,000,000 for each of fiscal 
years 2006 through 2010. Amounts made available under this subsection 
shall be used to supplement and not supplant amounts being used on the 
date of enactment of this section for activities of the types described 
in this section.

``SEC. 545. SUBSTANCE ABUSE INTERDISCIPLINARY EXPERT EDUCATOR.

    ``(a) Establishment.--The Secretary shall establish and administer 
a substance abuse faculty fellowship program through grants and 
contacts under which the Secretary shall provide assistance to eligible 
institutions to enable such institutions to employ interdisciplinary 
faculty who will serve as advanced level expert educators (referred to 
in this section as `expert educators').
    ``(b) Eligibility.--
            ``(1) Institutions.--To be eligible to receive assistance 
        under this section, an institution shall--
                    ``(A) be an accredited medical school or 
                undergraduate or graduate nursing school, or be an 
                institution of higher education that offers one or more 
                of the following--
                            ``(i) an accredited physician assistant 
                        program;
                            ``(ii) an accredited dental health 
                        professional program;
                            ``(iii) a graduate program in pharmacy;
                            ``(iv) a graduate program in public health;
                            ``(v) a graduate program in social work;
                            ``(vi) a graduate program in psychology;
                            ``(vii) a graduate program in marriage and 
                        family therapy; or
                            ``(viii) a graduate program in counseling; 
                        and
                    ``(B) prepare and submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require.
            ``(2) Qualifications for expert educators.--To be eligible 
        to receive an advanced level expert educator faculty 
        appointment from an eligible institution under this section, an 
        individual shall prepare and submit to the institution an 
        application at such time, in such manner, and containing such 
        information as the institution may require. Expert educators 
        should have advanced level training in education about 
        substance use disorders and expertise in such areas as 
        culturally competent and gender specific prevention and 
        treatment strategies for vulnerable populations (such as adults 
        and adolescents with dual diagnosis, older individuals, 
        children in families affected by substance abuse, and 
        individuals and families involved in the criminal justice 
        system) and will serve as resources and advisors for health 
        professional training institutions.
    ``(c) Use of Funds.--
            ``(1) In general.--An eligible institution shall utilize 
        assistance received under this section to provide one or more 
        fellowships to eligible individuals. Such assistance shall be 
        used to pay a sum of not to exceed 50 percent of the annual 
        salary of the individual under such a fellowship for a 5-year 
        period.
            ``(2) Fellowships.--Under a fellowship under paragraph (1), 
        an individual shall--
                    ``(A) devote a substantial number of teaching hours 
                to substance abuse issues (as part of both required and 
                elective courses) at the institution involved during 
                the period of the fellowship;
                    ``(B) incorporate substance abuse issues, including 
                the impact on children and families, into the required 
                curriculum of the institution in a manner that is 
                likely to be sustained after the period of the 
                fellowship ends (courses described in this subparagraph 
                should be provided as part of several different health 
                care training programs at the institution involved); 
                and
                    ``(C) educate health professionals about issues 
                related to the nontherapeutic use of prescription 
                medications.
            ``(3) Evaluations.--The Secretary shall conduct a process 
        and outcome evaluation of the programs and activities carried 
        out with amounts appropriated under this section and shall 
        provide annual reports to the Director of the Office of 
        National Drug Control Policy and the appropriate committees of 
        Congress.
    ``(d) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $6,000,000 for each of the 
fiscal years 2006 through 2010. Amounts made available under this 
subsection shall be used to supplement and not supplant amounts being 
used on the date of enactment of this section for activities of the 
types described in this section.

``SEC. 546. CENTER OF EXCELLENCE.

    ``(a) In General.--The Secretary shall establish centers of 
excellence at medical centers or universities throughout the United 
States to--
            ``(1) initiate, promote, and implement training, research, 
        and clinical activities related to targeted issues or special 
        areas of focus such as brief intervention in general health 
        settings, children and families affected by substance abuse, 
        older individuals, maternal and child health issues, 
        individuals with dual diagnosis, prevention in the general 
        health setting, and clinical practice standards for primary 
        care providers; and
            ``(2) provide opportunities for interdisciplinary 
        collaboration in curriculum development, course development, 
        clinical practice, research and translation of research into 
        practice, and policy analysis and formulation.
    ``(b) Use of Funds.--Centers of excellence established under 
subsection (a) shall use funds provided under this section to--
            ``(1) disseminate information on evidence-based approaches 
        concerning the prevention and treatment of substance use 
        disorders; and
            ``(2) assist health professionals and alcohol and drug 
        treatment counselors to incorporate the latest research into 
        their treatment practices.
    ``(c) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $6,000,000 for each of the 
fiscal years 2006 through 2010.''.
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