[Senate Hearing 106-74]
[From the U.S. Government Publishing Office]
S. Hrg. 106-74
RIO ARRIBA COUNTY STRATEGY TO COMBAT HEROIN ADDICTION
=======================================================================
HEARING
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS
UNITED STATES SENATE
ONE HUNDRED SIXTH CONGRESS
FIRST SESSION
__________
SPECIAL HEARING
__________
Printed for the use of the Committee on Appropriations
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
______
U.S. GOVERNMENT PRINTING OFFICE
57-116 cc WASHINGTON : 1999
_______________________________________________________________________
For sale by the U.S. Government Printing Office
Superintendent of Documents, Congressional Sales Office, Washington, DC
20402
ISBN 0-16-058704-2
COMMITTEE ON APPROPRIATIONS
TED STEVENS, Alaska, Chairman
THAD COCHRAN, Mississippi ROBERT C. BYRD, West Virginia
ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii
PETE V. DOMENICI, New Mexico ERNEST F. HOLLINGS, South Carolina
CHRISTOPHER S. BOND, Missouri PATRICK J. LEAHY, Vermont
SLADE GORTON, Washington FRANK R. LAUTENBERG, New Jersey
MITCH McCONNELL, Kentucky TOM HARKIN, Iowa
CONRAD BURNS, Montana BARBARA A. MIKULSKI, Maryland
RICHARD C. SHELBY, Alabama HARRY REID, Nevada
JUDD GREGG, New Hampshire HERB KOHL, Wisconsin
ROBERT F. BENNETT, Utah PATTY MURRAY, Washington
BEN NIGHTHORSE CAMPBELL, Colorado BYRON L. DORGAN, North Dakota
LARRY CRAIG, Idaho DIANNE FEINSTEIN, California
KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois
JON KYL, Arizona
Steven J. Cortese, Staff Director
Lisa Sutherland, Deputy Staff Director
James H. English, Minority Staff Director
------
Subcommittee on Commerce, Justice, and State, the Judiciary, and
Related Agencies
JUDD GREGG, New Hampshire, Chairman
TED STEVENS, Alaska ERNEST F. HOLLINGS, South Carolina
PETE V. DOMENICI, New Mexico DANIEL K. INOUYE, Hawaii
MITCH McCONNELL, Kentucky FRANK R. LAUTENBERG, New Jersey
KAY BAILEY HUTCHISON, Texas BARBARA A. MIKULSKI, Maryland
BEN NIGHTHORSE CAMPBELL, Colorado PATRICK J. LEAHY, Vermont
ROBERT C. BYRD, West Virginia
(ex officio)
Subcommittee Staff
Jim Morhard
Kevin Linskey
Paddy Link
Dana Quam
Clayton Heil
Lila Helms (Minority)
Emelie East
C O N T E N T S
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Page
Statement of Laurie O. Robinson, Assistant Attorney General,
Office of Justice Programs, Department of Justice.............. 1
Statement of Joseph H. Autry, III, M.D., Acting Deputy
Administrator, Substance Abuse and Mental Health Services
Administration, Department of Health and Human Services........ 1
Statement of Timothy P. Condon, Ph.D., Associate Director,
National Institute on Drug Abuse, National Institutes of
Health, Department of Health and Human Services................ 1
Opening statement of Pete V. Domenici............................ 1
Statement of OJP Administrator Laurie O. Robinson................ 5
OJP initiatives.................................................. 6
OJJDP block and formula grant programs........................... 7
Prepared statement of Laurie O. Robinson......................... 8
Technical assistance team........................................ 12
Statement of Dr. Joseph H. Autry................................. 12
Prepared statement........................................... 17
Prepared statement of Timothy P. Condon, Ph.D.................... 24
Trigger for coordinated response................................. 26
NONDEPARTMENTAL WITNESSES
Statement of Alfredo Montoya, Chairman, Rio Arriba County
Commission..................................................... 31
Statement of Lorenzo Valdez, county manager...................... 31
Statement of Lauran Reichelt, director, health and human services
department, Rio Arriba County.................................. 31
Rio Arriba County Maternal Child & Health Council Substance Abuse
Related Detention Costs........................................ 35
Letter from the Rio Arriba Board of County Commissioners,
Espanola Branch Office......................................... 35
A Report on Substance Abuse, Mental Health and Related Medical
Costs for Individuals Incarcerated at the Rio Arriba County
Detention Center, Tierra Amarilla, New Mexico.................. 36
Adoption of Rio Arriba Strategic Plan for Substance and Alcohol
Abuse and Treatment............................................ 47
Rio Arriba Strategic Plan for Substance and Alcohol Abuse
Prevention and Treatment....................................... 49
Rationale for a County-Wide Substance Abuse Prevention and
Treatment Plan in Rio Arriba County, New Mexico................ 49
Current Substance Abuse Reduction Activities in Rio Arriba
County, New Mexico............................................. 53
Youth Development as Primary Prevention.......................... 55
The Participatory Planning Process............................... 59
Statement of Darren White, cabinet secretary, New Mexico
Department of Public Safety.................................... 60
Statement of Dorian Dodson, deputy secretary, New Mexico
Children, Youth and Families Department........................ 60
Statement of Alex Valdez, cabinet secretary, New Mexico
Department of Health and Human Services........................ 60
Prepared statement of Darren White............................... 62
Prepared statement of Alex Valdez................................ 70
Prepared statement of Dorian Dodson.............................. 75
Statement of Dr. Fernando Bayardo, M.D., chief of staff and
medical director of the emergency room, Presbyterian Hospital,
Espanola....................................................... 77
Statement of Bruce Richardson, president, Chimayo Crime
Prevention Organization........................................ 77
Statement of Tess Cassados, executive director, La Clinica del
Pueblo......................................................... 77
Statement of S.S. Mukta Kaur Khalsa, secretary of foreign
affairs, Chief Religious and Administrative Authority for Sikh
Dharma for the Western Hemisphere.............................. 77
Prepared statement of Fernando Bayardo........................... 81
Prepared statement of Bruce Richardson........................... 86
Prepared statement of Tess Cassados.............................. 93
3HO SuperHealth Drugless Addiction Treatment Program........98
(iii) deg.
RIO ARRIBA COUNTY STRATEGY TO COMBAT HEROIN ADDICTION
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TUESDAY, MARCH 30, 1999
U.S. Senate,
Subcommittee on Commerce, Justice, and
State,
the Judiciary, and Related Agencies,
Committee on Appropriations,
Espanola, NM.
The subcommittee met at 9:38 a.m., in the auditorium, Nick
Salazar Center for the Arts, Northern New Mexico Community
College, 921 Paseo De Onate, Espanola, NM, Senator Domenici
presiding.
Present: Senator Domenici.
DEPARTMENT OF JUSTICE
Office of Justice Programs
STATEMENT OF LAURIE O. ROBINSON, ASSISTANT ATTORNEY
GENERAL
DEPARTMENT OF HEALTH AND HUMAN SERVICES
STATEMENTS OF:
JOSEPH H. AUTRY, III, M.D., ACTING DEPUTY ADMINISTRATOR,
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
TIMOTHY P. CONDON, Ph.D., ASSOCIATE DIRECTOR, NATIONAL
INSTITUTE ON DRUG ABUSE, NATIONAL INSTITUTES OF HEALTH
opening statement of pete v. domenici
Senator Domenici. The hearing will please come to order.
Thank you, everyone. This is actually an official meeting of
the Subcommittee on Commerce, Justice, State, and Judiciary.
It's chaired by Senator Judd Gregg of New Hampshire, and he
authorized this subcommittee to meet here in Espanola and Rio
Arriba County to take testimony regarding the serious problem
that we have with reference to heroin and heroin addiction in
and around Rio Arriba County.
Let me thank all those in Rio Arriba County, from the
Chairman of the County Commission, Mr. Alfredo Montoya, who has
been very helpful in permitting us to arrange this and helping
us work with the various people in the community to see that
the Senate gets a very good taste by way of witnesses and
testimony of what's going on.
We brought some witnesses both from the state level and the
Federal level who will tell us what they think can be done, and
I'm very hopeful that at the end of the day, there would be
some hope in the community that we're on the way to putting
together something very meaningful that will make the lives of
average New Mexicans who live here a better life and a better
place to live.
Having said that, let me also thank the Mayor of Espanola
for his cooperation, and I don't know how many of you read the
paper about the Mayor praying for rain, but the last time I
read a little article that he prayed for rain and it rained,
and he did that twice, and the Mayor is here somewhere, so they
asked him, ``Since you are a good friend of Senator Domenici,
who is your better friend, Senator Domenici or God?'' And he
quite appropriately, although for wrong reasons, quite
appropriately said God because, he said, ``Senator Domenici,
I've asked him for rain twice, and it never came.'' And so he
chose God.
I wrote him a letter, and said, ``Mayor, you have made your
choice. Therefore I won't see you for about 4 years, and we'll
find out whether you continue to choose God for the entire 4
years, or whether you find it necessary to call your friend the
Senator during that time.''
Having said that, let me give you a little overview
quickly, for those who are present and for the media, about
what's happened since the last meeting that I had here. It is
very significant. So that everybody will understand, I've had
an opportunity to speak with the following people and received
unequivocal and absolute commitment from them, that they are
going to help us and work with this community to put together
what must be put together to alleviate this crisis. First, I
spoke with Janet Reno, the Attorney General of the United
States, in an open hearing. She listened to me, and I told her
of the facts about the dangerous situation bordering on an
epidemic that existed here; and how it was affecting the lives
of many, many people here, even beyond those who are addicted
and using drugs; how there was an insecurity about the
community because of all of the serious crimes that are
committed when people pursue a habit of this magnitude. She
instantly, on the spot, said, ``We are going to do whatever we
can, and we will send somebody out to New Mexico who will tell
you what can be done, and tell the people there what the
Department of Justice can do.''
Now, you should know that justice is an omnibus sort of
word, and you might think it all has to do with law
enforcement. Well, that isn't the case, although law
enforcement is a part of this problem. The Justice Department
has most of the U.S. Government's prevention programs, most of
the United States Government's programs to help the community
get better action and do things that cause the drug addiction
to recede. They have a myriad of programs which you will hear
about, and you will hear a pledge to do something with those
programs with you, under your leadership locally, and the
Attorney General has lived up to that commitment, and has sent
to us today a woman who will be our first witness. She is the
Assistant Attorney General, Office of the Justice Programs,
Laurie Robinson.
The next thing that's different from the last meeting is
that I spoke to the Federal Bureau of Investigation's Director,
Louis Freeh, in person over breakfast regarding the problem,
and he and the Drug Enforcement Administration's chief officer,
Mr. Constantine, who I spoke with in my office, have all
pledged a cooperative effort with the New Mexico law
enforcement officials to do something about the rampant sellers
and purveyors of this drug who are selling it in this
community, including the fact that there are many illegals from
Mexico who are part of this incredible situation, and obviously
some attention will be directed to that kind of problem also.
So let me say good morning to everyone. It's certainly a
pleasure to be back in Espanola. I wish it were a couple of
years from now and that we could look back and say we are
having some great success. But that's not true, although I
believe in 2 years when we come back, we will have a very
different community, not that I would wait 2 years, but I
believe we will have many things change, and many people here
will be living a much better life, feeling much more secure,
and there will be less and less people addicted to this very
foul 70 percent black heroin from Mexico.
It was a little over a month ago when I first came to the
community with some Federal and local officials and gathered
some information about the situation. Today, as I indicated,
marks a historic opportunity for us to use this community as a
model to achieve a comprehensive solution to the drug problem.
In the long run, what we accomplish here will not only assist
Rio Arriba, but also serve as an example for other rural
communities in distress throughout our Nation. I hope that the
work we begin might ultimately serve as such a model for other
areas around the United States which face the devastating
problems of drugs. Since we are devastated by it and it is at
such a high level of use, clearly some very comprehensive
approach is necessary.
After our last meeting, as I indicated, I spoke to the
Attorney General, and she indicated on the spot that she would
send her best person here, and I think we have Laurie here
right now. However, even though there is a growing cooperation,
I'm very pleased to welcome Laurie Robinson, the U.S. Assistant
Attorney General, to Northern New Mexico today. I look forward
to hearing how this community can pull itself together, and
with Federal programs that fit the problem, with local
participation and broad community support, that we would begin
to see some real changes.
The Department of Justice also awards and administers the
millions of Federal dollars that are spent each year on
important anti-drug education and prevention programs. I am
very hopeful in the not too distant future that we will see an
evaluation of what we are doing already and try to improve it
and make it as good a prevention program as exists anywhere in
the country, that will have to be tailor made to the problems
that are here. And while a lot is going on in that area, it's
obvious to everyone that we need to do better, and the Federal
experts will come with resources to try to evaluate what ought
to be done that will make this a more effective activity.
I also hope that Ms. Robinson will speak a little bit about
other Department of Justice programs, like Weed and Seed, drug
courts and a multitude of prevention initiatives funded by the
Department of Justice.
There are several goals which I believe are essential
ingredients in developing such a comprehensive workable
program. First, all together, we must identify available
resources, and that will be done very soon, and some of it is
being done now. We will foster greater coordination and
increase community involvement. I believe we have to all work
together, and I think this can be done with the multitude of
available resources. We just have to make sure that our goal is
clear and that the commitment is an appropriate commitment and
everyone is on the same wavelength in trying to rid this
community of heroin use so that we get back to some kind of
normalcy of living. But I submit, all the resources in the
world aren't going to be effective unless there is a will in
this community, and there is a coordination to insure these
resources are delivered in the most efficient manner.
The final component that I've mentioned is the community
involvement, and I firmly believe that the heroin problem
currently gripping this area cannot be solved without
involvement. In fact, I believe that is the most crucial piece
of this puzzle.
There is one bit of news that I would share with you. You
have perhaps heard that the Senate approved an amendment for
$750,000 in new funding which will be achieved in a bill within
the next 2 weeks, in an urgent supplemental bill. I submitted
the amendment, and it would permit the expansion of the high
intensity trafficking area that would bring together all law
enforcement, a concerted effort, and use all of their
collective resources on the law enforcement. This will
designate Rio Arriba, Santa Fe, and San Juan Counties as new
counties that will now come under the high intensity drug
trafficking designation.
Building upon what I have just indicated, I would like to
mention two other very excellent Federal witnesses, Dr. Joseph
Autry, the acting Deputy Administrator of Substance Abuse and
Mental Health Services Administration, and Tim Condon, both of
whom are with us this morning. He is the Associate Director of
the National Institute of Drug Abuse. I believe these two
witnesses can address the problem from the prevention and
treatment perspective, which is also very critical. And while
the Department of Justice is involved, some of these very
specialized agencies are involved also. We have an excellent
panel of state witnesses, including the Department of Safety,
Darren White, the Department of Health Secretary, your own Alex
Valdez, and the Department of Children, Youth, and Families,
Dorian Dodson, the deputy, is with us today.
I believe all of these witnesses can help us immeasurably
if we will just get together and accept their services and put
together a comprehensive effort. We have representatives from
Rio Arriba County. I have already mentioned one of those is
Chairman Alfredo Montoya to present the recent countywide plan
to address this problem, and finally, we are lucky to have
representatives from the community which will speak out on the
impact the problem has on the health care system, as well as
the impact on our schools and neighbors.
There are two final points that I would like to make
because I feel they are both extremely important. One, there is
no magic solution or program that will single-handedly solve
this problem facing this county in Northern New Mexico.
Moreover, we must also recognize other problems facing the
area, like lack of activities for our youth and jobs for area
residents.
I believe programs, like the Community Development Block
Grant administered through the U.S. Department of Housing and
Urban Development, are a good source of capital funds for
needed facilities like the treatment centers or youth activity
centers.
Second, today does not mark the end of the commitment.
Rather, today merely marks the next step in a long journey to
address the problem.
In closing, again I would like to thank the chairman of the
full subcommittee, Senator Judd Gregg of New Hampshire, for
letting me host this hearing at his request. All of you in the
audience, I thank you for taking time out of your busy
schedules. I don't believe there is anything more important
going on in New Mexico than this.
As a matter of fact, we are all distracted today by things
going on in some foreign countries, and obviously we worry
about Americans there, and we worry about the outcome, but
right here and now, we have somewhat of a war of our own. I
think we ought to declare war against this heroin addiction,
and if we do that and decide to use all the resources properly,
we may also all have a significant increase in hope, and in
fact, we may achieve some significant results.
Thank you for listening, and now we will proceed with our
three witnesses. Let me introduce Laurie O. Robinson, Assistant
Attorney General for the Office of Justice Programs of the
United States. I don't think I will go into her background
other than to tell you she was asked to come here by the
Attorney General.
From what I understand, she's the kind of person who likes
to help solve these problems, and that's who we told the
Attorney General we wanted, and so she is here. We would start
with her, and then I will introduce the panelists that follow.
We would require and ask you to please be quiet while she
testifies. Your patience will be rewarded, and we will hear
from some of you as we move through this day, up until 3:00
this afternoon. Assistant Attorney General Laurie Robinson,
will you please talk with us this morning?
statement of ojp administrator laurie o. robinson
Ms. Robinson. Mr. Chairman, thank you so much for inviting
me this morning. And for the opportunity to talk about the
resources that are available through the Justice Department's
Office of Justice Programs to help this community in addressing
drugs and drug-related crime. Senator, I would like to
compliment you as well as the residents of this area for your
willingness to join together to tackle what clearly are very,
very difficult issues. I want to assure you that the Justice
Department and OJP will do everything we can to work with you
to assist this community.
OJP has more than three decades of experience in providing
financial and other assistance to States and local communities
to help reduce crime and illegal drug use, to prevent and treat
juvenile delinquency and assist crime victims, and based on
that experience, we've learned two critical facts.
First, although smaller towns and rural communities face
many of the same crime-related problems as large urban areas,
they also confront unique hurdles that stand in their way to
effectively addressing crime and drug hurdles like geographic
isolation, scarce resources, and distance from criminal justice
services and treatment.
Second, we've really learned the critical importance of a
comprehensive response to crime, identifying the problems and
the local, State, and Federal resources available to address
them, developing an action plan that involves everyone in the
community, law enforcement, business, citizens, treatment,
schools, social services; all of the players who need to work
together to combat crime, and then establishing partnerships
among those parties, as well as with Federal and State agencies
to put the plan into action. I'm pleased to learn that this
community has already begun that important process.
ojp initiatives
What I would like to highlight today are a number of OJP
initiatives that county officials may want to consider as they
develop their crime reduction strategy, and then some other OJP
resources they may find helpful in this process.
One program that the Senator mentioned that's had enormous
success in reducing crime and helping revitalize high crime
communities throughout the country is Weed and Seed. That's a
program that was first developed, as you may know, Senator, by
the Bush Administration, and it involves a two-prong strategy
combining law enforcement efforts to weed out crime with
seeding services focusing on prevention, intervention,
treatment and neighborhood revitalization, and then community
police providing the bridge that fills the gap between the
weeding and seeding components. Weed and Seed programs are
created and operated in cooperation with the local United
States Attorney. I would strongly encourage Rio Arriba
officials to contact U.S. Attorney John Kelly here in New
Mexico about how to begin that process toward seeking the
funding and other Weed and Seed assistance.
I went ahead last week and spoke with John about that
possibility. I know he has two members of his staff here today,
and John is enthusiastic about working with us on this
initiative, and he's well-experienced with Weed and Seed
because he is involved already with two Weed and Seed sites
here in New Mexico, one in Albuquerque and another in the
Laguna Pueblo. We look forward to working with you to carry
that forward.
Officials here in Rio Arriba County and the surrounding
counties may also want to take a look at a new Justice
Department initiative on community prosecution. That builds on
the successes we've seen around the country with community
policing and emphasizing partnerships with the communities to
address drugs and public safety, and we've seen successful
results with community prosecution already around the country.
They shift emphasis from solely prosecuting cases to focusing
on identifying local crime problems, working with the
community, and finding solutions.
OJP also provides funding for a broad range of after school
activities, which we know from our research can reduce crime by
young people. We know that most juvenile crimes are committed
in the after school hours between 3 and 8 p.m., and we also
know that after school activities, like Boys and Girls Clubs,
and well-defined mentoring programs, like Big Brothers/Big
Sisters, can actually reduce drug use, improve school
performance, and keep kids from getting involved in crime.
Our Juvenile Justice Office within OJP is currently funding
a number of after school initiatives in New Mexico, including
statewide prevention projects led by the University of New
Mexico and the New Mexico Police Athletic League.
Substance abuse prevention is also clearly a critical part
of any crime prevention effort. OJP supports several prevention
programs, including the Drug-Free Community Support Program,
which funds community coalitions of parents, kids, and
volunteer organizations to work together to spread the word
about the dangers of drug use and get the public involved.
Presbyterian Medical Services in Santa Fe and three other
community coalitions in New Mexico received funding under this
program last year, and we are currently accepting applications
for this year's funding.
In addition to preventing drug use, it's also critical to
provide treatment for current users. I know you will be hearing
in a few minutes from the Associate Director of NIDA, but I
want to underscore how drug treatment is an important piece of
our crime control efforts. Last week I spoke with NIDA's
director, who I know well, Dr. Alan Leschner, to insure that
our efforts here in New Mexico can be fully collaborated and
coordinated and our agency outreaches will actually be
complementary. In particular here, I wanted to mention the role
of drug courts. That's really the intersection of the criminal
justice system and drug treatment, and we have seen tremendous
success around the country with these, for juveniles as well as
adults, in reducing drug use and recidivism by drug involved
offenses. They involve treatment, drug testing, and graduated
sanctions under the authority of the courts, and a number of
them are currently operating already here in New Mexico.
ojjdp block and formula grant programs
In addition to these discretionary grant programs, OJJDP
awards formula and block grants funds to States, and it passes
through to local government. Here in New Mexico it is to the
Department of Public Safety and, of course, you will be hearing
from them in a few minutes. There was more than $4 million
received last year under our Byrne formula grant program. These
funds can be used for a variety of different things at the
discretion of the governor.
As well, the New Mexico Department of Children, Youth, and
Families also received funds from our Juvenile Justice Office
to prevent delinquents and improve the juvenile justice system.
In addition to this funding, OJP also provides a wealth of
technical assistance in trying to help local communities.
prepared statement
To help Rio Arriba officials actively pursue OJP resources,
I am very pleased to announce today, Mr. Chairman, that I'll be
sending a technical assistance team here within the next
several weeks, which I will be personally tracking, to help
assist in the kinds of comprehensive collaborative community
building planning that can be effective in addressing problems
of drugs and crime in this community. Based on that assessment
and plan, we would then move ahead to provide whatever
assistance we can to help this community clean up its problems
and put a strategic program in place that can work toward the
future. I look forward very much to continuing to work with
you, Mr. Chairman, and I would be happy, of course, to respond
to your questions.
[The statement follows:]
Prepared Statement of Laurie O. Robinson
Good morning, Senator Domenici. I want to thank you for inviting me
here to discuss the resources the Office of Justice Programs has
available to assist communities in preventing and controlling crime,
and how those resources can assist the people of Rio Arriba County and
the surrounding areas, including Santa Fe County, tackle the problems
caused by drug trafficking and illegal drug use, particularly the
recent influx of black tar heroin in the community. I commend you,
Senator, for your efforts to help Rio Arriba County deal with this
tragic situation, and I also want to commend the county and state
officials, as well as individual members of the community themselves,
who are working with you to rid their neighborhoods of this terrible
scourge.
As you know, the Office of Justice Programs (OJP) and its
predecessor agencies have more than 30 years of experience in providing
financial and other assistance to states and localities to help reduce
crime and illegal drug use, prevent and treat juvenile delinquency, and
assist victims of crime and their families. With the research and
evaluation results of our National Institute of Justice, the
statistical analyses of our Bureau of Justice Statistics, and the
funding and program development initiatives of our Bureau of Justice
Assistance, Juvenile Justice, Victims of Crime, Violence Against Women,
Corrections, Drug Courts, and other offices, OJP offers an invaluable
treasure trove of information, funding, technical assistance, and
training to states and local communities to address crime-related
problems.
After three decades of assistance to states and local communities
in combating drug-related and other crime, we have learned two
important things--
--First, we have learned that although rural communities face many of
the same crime-related problems as large, urban areas--such as
drugs, gangs, and violent crime--we know that rural areas also
often face unique hurdles, such as geographic isolation, scarce
resources, and limited access to criminal and civil remedies.
--Second, we have learned the critical importance of a comprehensive
response to local criminal justice problems. This involves
identifying the problem and local, state, and federal resources
available to address the problems identified; developing an
action plan encompassing all the critical components of the
criminal justice system, as well as social services, education,
and other parts of the community; and then establishing
partnerships locally and with federal and state agencies to put
that plan into action.
I am pleased to learn that Rio Arriba has already begun this
critical process. And I hope that the information I provide today--and
the assistance OJP will provide in the near future for strategic
planning and other technical assistance--can help further those
efforts.
Operation Weed and Seed
Let me give you an example of one innovative and comprehensive
multi-agency approach to preventing crime and revitalizing communities
that has proven to be very effective. Weed and Seed, as you know, is a
strategy developed during the Bush Administration to prevent, control,
and reduce violent crime, drug abuse, and gang activity in targeted
high-crime neighborhoods of all sizes nationwide. Currently, Weed and
Seed programs are underway in 200 communities all across the country,
up from 23 when the program first began in the early 1990's. In fact,
Albuquerque has a Weed and Seed program that has been in operation for
a little over a year, and the Laguna Pueblo is also implementing Weed
and Seed.
The Weed and Seed strategy involves a two-pronged approach to a
neighborhood's crime problems. Law enforcement agencies and prosecutors
cooperate in ``weeding out'' criminals participating in violent crime
and drug abuse, while attempting to prevent offenders from returning to
the targeted area. Simultaneously, the ``seeding'' aspect brings human
services to the area focusing on prevention, intervention, treatment,
and neighborhood revitalization. A community policing component bridges
the gap between the weeding and seeding components. Residents aid the
weeding efforts, while police officers help in community restoration.
Every site is created through the efforts of concerned community
residents. As a first step, a Steering Committee is created with
members from the United States Attorney's Office, city or county
officials, local law enforcement officers, local business people,
community leaders, and individuals from the targeted sites. They are
the ones responsible for bringing together the various components of
the Weed and Seed strategy and for implementing the local plan. OJP
assists each site through its Executive Office for Weed and Seed
(EOWS), which provides overall coordination and other assistance.
I encourage Rio Arriba officials to work with John Kelly, the
United States Attorney for New Mexico, to consider beginning to develop
a Weed and Seed strategy and consider applying for Official Recognition
as a Weed and Seed site. Once a site receives Official Recognition
status, it becomes eligible to receive funding from participating
federal agencies, including OJP Weed and Seed funds, and is designated
a high priority for federally sponsored training and technical
assistance.
As U.S. Attorney, John Kelly also convenes the Law Enforcement
Coordinating Committee (LECC), which coordinates regional law
enforcement efforts and is comprised of federal, state, and local law
enforcement officials from throughout New Mexico. I would also urge
your county law enforcement officers to become involved in the LECC, if
they are not. Because the LECC involves law enforcement officials from
throughout your state, as well as federal agents, it can be very
effective in combating drug kingpins who traffic across regional,
state, and international borders.
I would also urge Rio Arriba area officials to look into
establishing a community prosecution program. This emerging approach
builds on the success of community policing by emphasizing partnerships
with the community to solve crime-related problems and improve public
safety. Under community prosecution, local prosecutors work closely
with law enforcement, other criminal justice components, and community
groups to prevent, investigate, and respond to local crime. Community
prosecutors are based in the community, not at some high-rise, big city
office building. This year, OJP has $5 million to support efforts to
plan, implement, or enhance community prosecution programs, and we are
requesting $200 million in fiscal year 2000 to greatly increase the
number of local community prosecutors.
After-school Programs
I understand, Senator Domenici, that Rio Arriba officials are
particularly interested in providing after-school and other
opportunities for young people--to keep them from becoming involved in
the drug trade, either as traffickers or users. A required component of
every Weed and Seed program is a Safe Haven--usually a school or
community center that provides a safe place where young people can come
after school and on weekends to do their homework, participate in
recreational and educational activities, and obtain community services.
For example, in Albuquerque the Weed and Seed program is about to
open a new, state-of-the-art community center in its Trumbull
neighborhood that is located next to the police substation. The
community center and the substation are planning to jointly host crime
prevention fairs and other activities for residents. In addition,
neighborhood residents are being asked to serve on ``Safe Haven
Activity Councils'' to help plan and evaluate the educational and
recreational activities at the Safe Haven.
Studies show that these kinds of after-school activities greatly
reduce crime by young people. More than 50 percent of violent juvenile
crime occurs after school--between 3 p.m. and 8 p.m. By keeping young
people involved in fun, wholesome activities at Safe Havens or other
facilities, we can keep them from becoming involved in crime out of
boredom or peer pressure.
Studies also show that Boys and Girls Clubs and well-designed
mentoring programs, such as Big Brothers/Big Sisters, can reduce
juvenile alcohol and drug use, improve school performance, and prevent
youth from getting involved in crime and violent behavior. This year,
our Bureau of Justice Assistance will award Boys and Girls Clubs
national headquarters $40 million to establish and operate local clubs
throughout the country. Boys and Girls Clubs provide at-risk boys and
girls with constructive youth development opportunities and programs in
supervised, supportive environments. Clubs are staffed by caring adult
leaders, who provide guidance, discipline, and values. Clubs also
provide educational support and access to comprehensive, coordinated
services that meet the complex needs of at-risk youth.
Through its Juvenile Mentoring Program (JUMP), our Office of
Juvenile Justice and Delinquency Prevention (OJJDP) supports one-to-one
mentoring programs for youth at risk of educational failure, dropping
out of school, or involvement in delinquent activities, including
gangs. JUMP is administered either by a local education agency or a
public or private nonprofit organization. In either case, both entities
must collaborate to achieve the program's goals of improving academic
performance and reducing the dropout rate. To receive funding, programs
must target at-risk youth in high-crime areas that have 60 percent or
more of their youth eligible to receive Chapter I funds under the
Elementary and Secondary Education Act of 1965 and that have a
considerable number of youth who drop out of school each year. Last
month, Albuquerque, Gallup, and the Santo Domingo Pueblo received funds
for JUMP programs, and we expect that additional funds will be
available next year under this program.
OJJDP is also supporting two youth initiatives administered by the
University of New Mexico and the New Mexico Police Athletic League
(PAL). PAL is implementing a statewide prevention project consisting of
recreational, educational, and cultural activities for at-risk youth
between the ages of 5 and 18 and their families. The Albuquerque PAL is
serving as the initial model for this program, which will be
implemented in at least 12 other New Mexico communities.
The New Mexico PAL is also working with the University of New
Mexico to develop and evaluate an after-school program to reduce
juvenile delinquency and increase educational retention in the Gadsden
Independent School District in Dona Ana County. Through a curriculum of
hands-on science and reading projects and supervised recreation, the
Estrella project provides a constructive alternative to afternoons of
unsupervised free time. Middle school students are trained to mentor
elementary school students under the program, and the New Mexico PAL
provides a sports component to round out the program. I would encourage
Rio Arriba officials to contact New Mexico PAL or the University of New
Mexico to determine how your county could become involved in these
initiatives.
Drug Abuse Prevention and Treatment
OJP also supports two programs that help communities keep young
people from using illegal drugs. With funds transferred from the Office
of National Drug Control Policy (ONDCP), OJJDP makes Drug-Free
Community Support Program grants to community coalitions to reduce
youth substance abuse. The coalitions include parents, youth, business,
the media, youth-serving organizations, schools, law enforcement, and
civic, volunteer, and fraternal organizations. These partners work
together to reduce youth substance abuse, encourage citizen
participation in drug abuse reduction efforts, and disseminate
information about effective programs. Last year under this program,
grants were awarded to Presbyterian Medical Services in Santa Fe and
three other community coalitions in New Mexico. The application kit for
this year's program is currently available, and the deadline for
applying is April 12, 1999.
OJJDP also has $10 million available this year under the Drug
Prevention Demonstration Program for efforts to reduce drug use by
encouraging young people to pursue healthy lifestyles, by fostering
decision-making skills to help them choose alternatives to high-risk
behavior, and by providing them with the motivation and tools to build
constructive lives.
In addition to preventing drug use, it is also critical to provide
treatment--under the supervision of the criminal justice system--for
juveniles and others who are already involved in drug use and crime.
Studies show that substance abuse is closely linked to crime. Data from
our Bureau of Justice Statistics show, for example, that: 1 in 6
offenders landed in prison for a crime committed just to get money for
drugs; almost a third of prisoners were using drugs or alcohol at the
time they committed their crimes; and more than 80 percent of prisoners
have a history of drug and alcohol use.
Studies also show that treatment--particularly when it is combined
with meaningful, graduated sanctions--can reduce recidivism and drug
use. Our Residential Substance Abuse Treatment program is providing the
State of New Mexico with over $416,000 this year to implement prison-
based drug treatment programs.
Drug courts are another example of how combining treatment and
sanctions is proving effective. Drug courts use the coercive authority
of the court to combine treatment and graduated sanctions to change the
behavior of drug-involved offenders. In 1989, a few communities began
experimenting with an approach to address the needs of substance-
abusing offenders that integrated substance abuse treatment, sanctions,
and incentives with case processing to place nonviolent drug-involved
defendants in judicially supervised habilitation programs.
Now, nationally more than 530 courts have implemented or are
planning to implement a drug court to address the problems of substance
abuse and crime. In New Mexico, the Administrative Office of the
Courts, the Pueblo of Taos, the Eleventh Judicial District Court,
McKinley County, the Mescalero Apache Tribe, and the San Juan Pueblo
have all received grants under our Drug Court Grant Program to plan,
implement, or enhance their drug courts. I would encourage Rio Arriba
County to look into the merits of drug courts. Our Drug Court Program
Office would be happy to work with county officials to begin planning
for a drug court and provide information on how to apply for funding.
Formula Grant Funding
Under these discretionary grant programs I have just mentioned, OJP
awards funds directly to local communities and other organizations.
However, as you know, Senator, the majority of OJP funding is awarded
to states through our formula grant programs. In New Mexico, the
Department of Public Safety receives funding under the Edward Byrne
Memorial State and Local Law Enforcement Assistance Formula Grant
Program. Last year, the state received more than $4 million in Byrne
Formula funds, which it can use for any of 26 purpose areas, including
crime prevention, law enforcement, adjudication, corrections, victims
assistance, and other initiatives. Under the Byrne program, the state
decides what state and local programs to support and is required to
pass-through a percentage of funds to local jurisdictions. If Rio
Arriba County has not yet done so, it should contact the Department of
Public Safety to determine what funding might be available for its
crime control, treatment, and prevention initiatives.
In addition, the New Mexico Department of Children, Youth, and
Families last year received $789,000 from OJJDP to support state and
local efforts to prevent delinquency and improve the juvenile justice
system. The state also received OJJDP funding under the State Challenge
Grants, Local Delinquency Prevention, Juvenile Accountability Incentive
Block Grants, and Combating Underage Drinking programs. Again, Rio
Arriba officials should contact the state office regarding the
availability of funding under these programs.
Other Resources
In addition to funding, OJP also provides a wealth of information
resources, technical assistance, and training to help local communities
plan, develop, and implement crime control initiatives. Much
information is available electronically through the Office of Justice
Programs site on the World Wide Web. The OJP Website
(www.ojp.usdoj.gov) provides up-to-date information about OJP grant
programs and application kits, downloadable applications and
publications, and links to state formula agencies and other resources.
For example, the Fiscal Year 1999 OJP Program Plan, which describes all
the discretionary grant programs for which OJP will provide funds this
year--including programs open to competition--is available on our
Website.
Our Website also links to special E-mail addresses for each of our
bureaus and offices to answer inquiries about our funding, programs,
and other resources. In addition, the Department of Justice Response
Center is staffed by specialists who answer questions and provide
information about Justice Department funding programs, including all
OJP and COPS (Community Oriented Policing Services) funding programs.
The Response Center can be reached by calling toll-free at 1-800/421-
6770.
OJP also supports the National Criminal Justice Reference Service
(NCJRS), one of the most extensive sources of information on criminal
and juvenile justice in the world. NCJRS disseminates OJP research
reports, statistical bulletins, application kits, program
announcements, and other materials. Citizens need only call with a
general request and our specialists can send these materials out.
Documents can be obtained by calling a toll-free telephone number (1-
800/851-3420) or online at www.ncjrs.org.
In addition, OJP supports state and local criminal and juvenile
justice initiatives by providing training and technical assistance. I
am pleased to announce, Senator Domenici, that I have asked that an OJP
technical assistance team be assembled to come to Rio Arriba to work
with community leaders to determine how OJP resources can assist the
county with its crime prevention and intervention efforts.
Conclusion
In conclusion, OJP is committed to working with you to provide
assistance to help the Rio Arriba community clean up its drug abuse
problem and put a strategic infrastructure in place to prevent and
respond to future crime. I look forward to working with you, Senator,
and Rio Arriba County and surrounding area officials, to reduce drug
use, trafficking, and other crime and to improve the quality of life
for the residents of the Rio Arriba community. I would be pleased now
to answer any questions you may have.
Senator Domenici. Thank you very much. Did you bring a
number of copies of your speech?
Ms. Robinson. We certainly have copies of the statement
here, yes.
Senator Domenici. For those who might want them, there will
be a few here, if you want to go through and underscore some of
these things as you begin to work together. Thank you very much
for your wonderful remarks. I think Ron Lopez is coordinator of
the Weed and Seed program. Is Ron here?
Mr. Lopez. Yes, I am.
Senator Domenici. I can see the way these lights are
structured, I can't see you. I can--I got you. I can see a tie
and shirt. Is it fair to say that as soon as the community can
begin to work on this, that you will be available to work with
them on this, Mr. Lopez?
Mr. Lopez. Yes, sir. We have already begun some meetings
here with some of the local community action groups, and we'll
be available.
Senator Domenici. Great.
Mr. Lopez. And you-all can get a hold of me. I am here with
plenty of cards and information.
Technical assistance team
Senator Domenici. Laurie, before I move to the next
witness, might I ask, this technical assistance team that you
are going to send, that the members of the community, once they
decide what they want to do, you could expedite and cut through
red tape so we aren't waiting 2 years for some of these
programs.
Ms. Robinson. Right, I understand you are impatient. The
Federal Government does not always have a good reputation for
moving swiftly.
Senator Domenici. I am more than aware of that.
Ms. Robinson. And I will tell you, Mr. Chairman, I am an
impatient person. I will be personally tracking this, and the
answer to your question is yes, we will try to cut through red
tape, we will try to use that plan as the means of identifying
resources that are available, and available now so that we can
move money forward.
Senator Domenici. I may have some additional questions, but
let's move now to Dr. Autry, Acting Deputy Administrator of the
Substance Abuse and Mental Health Services Administration of
the U.S. Department of Health and Human Services. Dr. Autry, I
note, I've seen your prepared remarks, but I wonder if you
would take a moment before you testify and tell us what you do.
Statement of Dr. Joseph H. Autry
Dr. Autry. Well, Substance Abuse and Mental Health Services
Administration is the arm of Department of Health and Human
Services that funds prevention and treatment services for
substance abuse and for mental illness throughout the Nation.
We do this primarily through two types of programs. One is a
block grant program. That's a formal grant to the State and the
States have a great deal of flexibility in deciding how to
allocate those funds within the State and local communities.
Second, is a State incentive grant program which is a
competitive grant program in which we have target areas to
improve prevention and treatment services, and also a program
to get those services and effective strategies out in the
community for their use.
Senator Domenici. Would it be fair then to say that as part
of this comprehensive effort that goes on the discretionary
program side, that you will also be available as the project
and program is put together, you will be willing to get
together to see how you can contribute?
Dr. Autry. Right. Here in Rio Arriba we have already begun
discussions with the State on the need for technical assistance
and training needed. We have encouraged them to submit an
application for additional identification of those needs
preliminarily. Discussions so far show that the State has the
need for funds to transition to the infrastructure for the
delivery of services for substance abuse, the need to develop
common data systems, the need to develop performance measures,
the need to look at women's services and services for current
illnesses, and also prevention in the continuum of care with
training-based and science-based modules. We've also had some
preliminary discussion with people in Rio Arriba County just
within the past week, and they've identified physical needs
such as programs for youth, policies for effective resource
allocation and model programs on self-sufficiency, where I know
you have some concern.
Senator Domenici. Please proceed. Thank you so much.
Dr. Autry. As I begin my formal testimony, I have submitted
my written testimony and request that it be entered into the
record.
Senator Domenici. That will be made a part of the record
and abbreviate it as you see fit.
Dr. Autry. Thank you. I am very pleased to be here on
behalf of Nelba Chavez, who is Administrator of the Substance
Abuse and Mental Health Services Administration, SAMHSA, as the
acronym is known. She would love to have been here herself but
she was already committed to give an address in Atlanta, and
she has asked me to fill in for her, and I am very glad to do
that.
I have talked a little bit about who we are. I also want to
acknowledge the Senator's work on behalf of mental health
services, particularly your efforts to enact legislation
requiring parity for mental health services in insurance
coverage. We look forward to working together with you on that.
Senator Domenici. Thank you very much.
Dr. Autry. In preparing for this hearing, I was fortunate
that one of our staff members was out here 2 weeks ago
attending a meeting, and she took the opportunity to visit with
a number of local people to talk firsthand about some of the
problems here in Rio Arriba County and in New Mexico, and I am
stunned to learn that New Mexico is the number one State in the
nation for drug-induced death and that within New Mexico, Rio
Arriba is number one for drug-induced death.
I was also surprised to find out that New Mexico is number
one in driving under the influence arrests and convictions, so
I think if we need any testament to the number of problems in
this county and an argument needed for assistance, we couldn't
really ask for more than that. I won't go into detail to talk
about what we do or hear, but will talk about some of the
programs that we are funding on the ground here.
Many of you know drug and alcohol abuse ravage the lives of
Americans. It does fuel crime, as you heard, promote domestic
violence, disease, and premature death. When you link substance
abuse to other headline-grabbing problems such as unintended
pregnancies, HIV, AIDS, and hepatitis for this community,
crime, welfare, violence, school dropouts, suicide,
homelessness and injuries, substance abuse is clearly one of
the most costly public health problems.
There was a recent survey in which 56 percent of American
adults listed drugs as the top problem area facing American
children. Crime was second at 24 percent. The relationship
between crime and drugs and the cost of drugs and crime is
clear. More than 1.7 million people are behind bars at an
annual cost to the taxpayer of about $38 billion. Seventy
percent or 1.2 million of them have histories of drug and
alcohol abuse and addiction. We know, as our colleagues at
Justice do, for hundreds of thousands of these individuals,
drug abuse and addiction is the core problem that prompted
their criminal activity. Back here it must be coupled with
public health programs, such as prevention, treatment and
resources to reach adult adolescents and children in the field
of treatment services before they reach the criminal justice
system, not once they have come into contact with the criminal
justice system.
We have recently expanded our national health survey so
that over the next year, we will be able to give you both
regional level and State level estimates of drug and alcohol
abuse in this county. They talk specifically about some of the
programs that we have here.
We recently initiated our State Incentive Grant Program,
which offers technical and financial support to governors in 19
States to help them deliver research-based substance abuse
prevention services. Of this money, 85 percent of this must go
to services, only 15 percent can be used for administrative
costs, and to date, over the past 12 years, we funded programs
in 19 States and 500 communities. This program is designed to
encourage the governors to mobilize and coordinate statewide
efforts in preventing youth substance abuse, to look at all the
funding streams focused on preventing substance abuse in their
State and identify the needs and gaps, to leverage resources to
reach youth, parents and families in the homes, in their
schools, and their workplace with proven substance abuse
strategies. In addition to adapting effective prevention
models, it must be modified to meet local needs, it requires
the State to account for, coordinate and strategically manage
all substance abuse prevention funding streams in the State,
including the 20 percent prevention set aside for the Substance
Abuse Prevention and Treatment Block Grant, Safe and Drug Free
Schools, and Communities Programs and other Federal programs.
I'm pleased to say that we awarded the State Incentive Grant to
New Mexico this past year. The first year of funding was $2.8
million. With these funds, New Mexico will be able to focus on
its prevention efforts on the 12 to 17-year olds and especially
girls and ethnic minorities.
We also established six regional centers for the
Application of Prevention Technology to look at and translate
the finding of the National Institute on Drug Abuse, National
Institute on Alcohol Abuse and Alcoholism, and SAMHSA proven
and promising research-based substance abuse prevention
practices, methods and policies to help augment the State
Incentive Grant funds. These centers will reach out to
practitioners and programs in the funding State to make sure
that we have access to the latest science based prevention
knowledge available to reduce substance abuse at the community
and individual level.
We also recently started programs that are focused on age 0
to 7, called the Starting Early-Starting Smart Program. It's a
comprehensive program that looks at children who are at risk
and provides services to the children and their families or
care givers, in order to avert some of the problems that may
develop later on with reference to mental health problems and
substance abuse. The first year of this grant was awarded in
1997 at the cost of $689,000 per year.
Recently research has shown that with co-occurring mental
and addictive disorders, the mental disorder occurs before the
onset of substance abuse disorders by 5 to 10 years. This gives
us a window of opportunity to target prevention activities
before the individual develops substance abuse problems.
Unfortunately, we know that two-thirds of the young people in
this country that suffer from this disorder are not receiving
the services they need. We are making a vigorous effort to help
families, educators and others who work with children and
adolescents, as well as young people themselves, to recognize
mental health problems and seek appropriate services.
Many of you have also seen the National Youth Anti-Drug
Media Campaign, which has been launched this past year. They
have some of the most stunning commercials on television, I
think, that rival more of the private sector than more costly
programs. While the corporate ``in kind'' contributions of free
public service announcements have exceeded expectations, which
has also exceeded our expectations is the number of people who
are reaching out after seeing those ads and asking for help. We
have expanded the hours of our Clearinghouse, the National
Clearinghouse of Drug and Alcohol Information, it's now in
operation 7 days a week, 24 hours a day and responds to
approximately 2,000 calls a day. About half of these calls are
from parents looking for ways of how to talk to their kids
about drugs. We have distributed over 600,000 copies of the
publication ``Keeping Youth Drug Free,'' and in a number of
these out in the vestibules for those of you who would like to
have them. This is the primer that goes through and suggests
the conversations with parents and other care givers to
increase their confidence and knowledge in talking with their
children about substance abuse.
We continue our collaboration with the NIAAA, National
Institute on Alcohol Abuse and Alcoholism, to look for more
effective prevention and treatment prevention programs, and I'm
sure you will hear about those from Dr. Condon later.
One of the things that we are actually pleased with this
year is the launching of the Strengthening Families Initiative
which is implementing random programs aimed at helping
individuals learn how to be more effective parents, how to be
more effective adults and how to deal with problems as they
emerge in their families and head those off at an early age.
We've also done a number of studies looking at treatment
effectiveness, and again, I am sure you will hear more about
those from Dr. Condon, but studies have shown that there is a
50 percent reduction in drug use following treatment, 1 year
following treatment.
We have also shown that people that go into treatment are
less likely after treatment to be homeless, less likely to be
involved in criminal activities and risky sexual behavior.
Studies by NIDA and others have shown that we have made as much
progress in the drug treatment arena as patients who are
treated for other diseases such as diabetes, hypertension and
asthma.
Let me turn just very briefly to one or two other programs.
I mentioned earlier that we give block grants to the States
funding treatment and prevention services in the State that
allocate those funds that meet the needs within their States.
That program for substance abuse treatment prevention is about
$1.6 billion. This year New Mexico is eligible to receive $8.3
million from that program, an increase of $1.5 million over
last year.
We also talk about the need to perform effective and
efficient practices into prevention and treatment services. One
of the things that we work collaboratively with others on not
only generated knowledge about what works and how well it
works, but also to make sure that that knowledge goes out to
the practitioners so that they're doing the most effective and
efficient programs they can to end their studies.
We have been working with the Department of Justice through
our national substance abuse treatments by piloting three
family drug courts to look at alcohol and other drug treatment
combined with intervention, prevention and support services for
children and their families as well as the legal processing for
those cases. Recently we've initiated a program with the
National Institute of Health and Food and Drug Administration
to increase access to and improve the quality and
accountability of methadone and levo-alpha-acetyl-methodol, or
LAAM, treatment for people with heroin addiction. We look
forward to continuing to improve access to make heroin
treatments more widely available to the States.
Lastly I want to point out that we've involved ourselves
with discussions with mayors, town and county officials, tribal
leaders and have developed a program on targeting capacities as
long as there is a program where treatments services are
provided and communities that are facing a rising and
unexpected increase in drug use or where current treatment
facilities are not adequate to respond to those programs. We
recently awarded a Target Capacity Expansion Grant to a program
in Gallup, and I have here an announcement for additional
targeted grant programs for development programs, as I
mentioned earlier, for which you may apply and for which you
are eligible. As I already mentioned, we are currently working
on a proposal for technical assistance to how to assist the
problems here in Rio Arriba County.
prepared statement
I look forward to continuing our dialogue, and I would be
glad to respond to any questions you have and doing everything
we can to assist the State of New Mexico to deal with the
problems that you are currently facing.
[The statement follows:]
Prepared Statement of Joseph Autry, III, M.D.
Mr. Chairman, on behalf of Nelba Chavez, Ph.D., Administrator of
the Substance Abuse and Mental Health Services Administration (SAMHSA)
I want to thank you for the opportunity for SAMHSA to testify this
morning here in Espanola, New Mexico. Dr. Chavez would have been here
herself except that she was already committed to give an address in
Atlanta when we were notified about the hearing.
Mr. Chairman, your commitment to a comprehensive response to the
Nation's drug abuse problem and in particular to the problem of drug
abuse in New Mexico is much appreciated. We have long noted your
support for policies and legislation to improve access to quality
mental health services including your efforts to enact legislation
requiring parity for mental health services in insurance coverage.
In preparation for this hearing, I read several articles that
appeared in local papers and was briefed by my staff on your concern
for black tar heroin use in northern New Mexico. I wish there were a
simple way to address this problem, unfortunately there isn't. But I
can tell you that Federal, State and local governments as well as
parents and children and businesses across the United States are
committed to addressing it in a comprehensive fashion involving law
enforcement, interdiction, prevention, education and treatment. I am
here today to share with you what SAMHSA is doing to address the issue.
SAMHSA's mission is to improve access to quality substance abuse
and mental health services for those in need of such services. The
importance of our work in substance abuse prevention, addiction
treatment and mental health services cannot be overstated. Drug and
alcohol abuse ravage the lives of millions and fuel crime, domestic
violence, disease and premature death. When the link is made between
substance abuse and other headline grabbing problems--unintended
pregnancy, HIV/AIDS, crime, welfare, violence, school drop-out,
suicide, homelessness, and injuries, substance abuse is clearly one of
our most costly public health problems.
As with any other public health problem, we must achieve public
health solutions. Study after study has shown, drugs are dominating the
public's concern about the future of children in this country. A survey
of American adults found 56 percent listed drugs as the top problem
facing American children. Crime was second, at 24 percent.
The relationship between crime and drugs and the cost of drugs and
crime to our country is clear. More than 1.7 million people are behind
bars in America at an annual cost to the taxpayer of $38 billion.
Seventy percent or 1.2 million of them have histories of drug and
alcohol abuse and addiction. For hundreds of thousands of these
individuals drug abuse and addiction is the core problem that prompted
their criminal activity. Our prison and punishment approach to
substance abuse is not sufficient by itself. Instead we need to
approach drug abuse as a public health issue and invest our resources
in reaching adults, adolescents, and children in need of substance
abuse prevention and treatment services before they reach the criminal
justice system.
In the area of prevention, our investments seem to be paying off.
Each year we release SAMHSA's National Household Survey on Drug Use.
While we are cautiously optimistic that the recent increase in drug use
may be leveling off among youth, we are concerned that our young people
continue to use drugs and drink alcohol at an unacceptable rate. To
ensure our programs are keeping up with current issues and trends, over
the past three years at SAMHSA we have re-engineered our programs,
widened our circle of partners and adopted a long term public health
approach. With this shift in strategy we have redirected our efforts
from narrowly focused drug prevention efforts to a more comprehensive
coordinated community approach that identifies and addresses family,
school, and mental health problems that may lead to substance abuse and
other destructive behaviors.
For example our new State Incentive Grant Program offers technical
and financial support to Governors in 19 states to help them deliver
research-based substance abuse prevention services. A full 85 percent
of these funds are being directed to community prevention programs,
resulting in the funding of approximately 500 community based programs
in the 19 States. The ``incentive'' nature of the State Incentive
Grants, encourages Governors to mobilize and coordinate state-wide
efforts in preventing drug use among youth. In developing this program,
we asked Governors to take a fresh look at all the funding streams
focused on preventing substance abuse in their state and identify the
needs and gaps. Then we asked for innovative plans that leverage
resources to reach youth, parents and families in their homes, schools,
and workplaces with proven substance abuse strategies. In addition to
adapting effective prevention models to local situations and their
needs the State Incentive Grant program requires states to account for,
coordinate, and strategically manage all substance abuse prevention
funding streams in the state, including the 20 percent prevention set-
aside of the Substance Abuse Prevention and Treatment Block Grant, Safe
and Drug Free Schools and Communities Programs and other Federal
programs. I am happy to report that last year we awarded a State
Incentive Grant to New Mexico. Its first year funding was $2,812,042.
With these funds New Mexico will focus its prevention efforts on 12 to
17 year olds, especially girls and ethnic/racial minorities.
We have established 6 Regional Centers for the Application of
Prevention Technology to focus on the application of National Institute
on Drug Abuse (NIDA), National Institute on Alcohol Abuse and
Alcoholism (NIAAA) and SAMHSA proven and promising research-based
substance abuse prevention practices, methods, and policies in the
states that receive incentive grants. These regional centers are
critically important. They will identify and reach out to practitioners
and programs to ensure they are using the latest science based
prevention knowledge available to reduce substance abuse at the
community and individual level.
To continue to improve services that are available to very young
children, SAMHSA has initiated the Starting Early-Starting Smart
collaborative effort. I say collaborative because SAMHSA is
collaborating with The Casey Family Program, the Department of
Education and other HHS operating divisions to develop new knowledge,
demonstrate what works, and create community-based partnerships that
will sustain improved health and health care services for children from
birth to age 7 and their families or care givers. SAMHSA initiated the
Starting Early-Starting Smart program because so many social and
economic factors impact children's mental health and their potential
for substance abuse. This interagency collaboration will bring all the
available resources to bear on providing coordinated, quality services
for children and their care givers. I clearly see this collaboration as
just the beginning of a much needed effort to improve the lives of
children and, ultimately, as our first line of defense in preventing
drug use. In 1997 we gave such a grant to the University of New Mexico.
Their award for this year is $689,438.
Research has shown that with co-occurring mental and addictive
disorders, the mental disorder often occurs first, during adolescence
and 5 to 10 years before the addictive disorder. While this provides a
``window of opportunity'' for targeted substance abuse prevention
interventions and needed mental health services, two-thirds of young
people in this country who suffer from a mental disorder are not
receiving the help they need. Without that help these problems can
lead, in addition to alcohol and illicit drug abuse, to school failure,
family discord, violence and even suicide. SAMHSA is leading a vigorous
effort to help families, educators, and others who work with children
and adolescents, as well as young people themselves--to recognize
mental health problems and seek appropriate services. This is a key
goal of our Children's Mental Health Services Program and our Caring
for Every Child's Mental Health: Communities Together initiative.
We are also very pleased with the initial response to the National
Youth Anti-Drug Media Campaign. While the corporate ``in kind''
contributions of free public service announcements have exceeded
expectations and the goal for reaching target audience members
continues to be surpassed, the first measures of impact are coming from
SAMHSA. The national phone number used to obtain more information is
SAMHSA's National Clearinghouse for Drug and Alcohol Information. In
cooperation with the Office of National Drug Control Policy (ONDCP), we
have expanded our hours of operation to 7 days a week, 24 hours a day.
We are receiving about 2,000 calls a day as a result of the media
campaign. Approximately half are parents looking for ways to start a
conversation about drugs with children in their care. Since the
campaign started to run nationally last July, SAMHSA has distributed
over 600,000 copies of the publication ``Keeping Youth Drug Free''
which includes suggested conversations for parents and other care
givers to increase their confidence and knowledge.
SAMHSA's Center for Substance Abuse Prevention (CSAP) is also
working with other federal agencies on a number of targeted areas,
including underage drinking, family-focused prevention programs, and
children of substance-abusing parents to improve system performance and
service quality. For example, CSAP and NIAAA have a study underway to
examine the effects of alcohol advertising on underage drinking. We are
also working with NIAAA to identify, test and develop effective
interventions to prevent and reduce alcohol-related problems, including
death, among college students.
When it comes to our families, there are many effective strategies
for preventing substance abuse among children in the home. Our efforts
at SAMHSA are focusing on improved implementation of appropriate family
strengthening substance abuse prevention strategies. Also of great
concern are the 8.3 million American children who live with at least
one parent who is alcoholic or using drugs and in need of substance
abuse treatment. These children face a significantly higher-than-
average risk for early substance abuse, addiction and the development
of a variety of physical and mental health problems. To address this
high risk population, CSAP is developing prevention interventions
specifically designed for these children and families as part of an
interagency Strengthening Families Initiative.
In the area of alcohol and drug treatment SAMHSA has repeatedly
demonstrated the effectiveness of Federally supported programs. For
example, an evaluation of treatment programs funded by the Center for
Substance Abuse Treatment (CSAT) found a 50 percent reduction in drug
use among their clients one year after treatment. Additional outcomes
include improved job prospects, increased incomes, and better physical
and mental health. Clients are less likely after treatment to be
homeless and less likely to be involved in criminal activity and risky
sexual behaviors. Our Services Research Outcomes Study, released in
September 1998, produced similar findings. This national sample of
substance abuse treatment programs showed that participating
individuals sustained reductions in substance abuse for at least five
years following treatment. Similar findings have been produced by NIDA
and in the States of California, Oregon and Minnesota and by RAND
corporation. We have achieved successful results that parallel or
exceed the results of patients receiving treatment for other chronic
illnesses like diabetes, hypertension and asthma. Yet, we are living in
an America where substance abuse treatment is stigmatized and private
insurance coverage for treatment is not equal to coverage for treatment
of other medical conditions. According to the National Household Survey
on Drug Abuse (NHSDA) 63 percent of people with a severe drug problem--
about 3.6 million people in need of treatment--did not receive the care
they needed in 1997. With the Congress's leadership we can help others
understand that drug abuse is a serious public health issue that must
be addressed and can be addressed successfully.
To help support and maintain State substance abuse treatment and
prevention services, SAMHSA is providing $1.6 billion in funds through
the Substance Abuse Prevention and Treatment Block Grant in fiscal year
1999. New Mexico is eligible to receive this year $8,261,541, an
increase of about $1.5 million over the State's allotment in fiscal
year 1998. While there are some requirements associated with the use of
these funds, States have tremendous flexibility to use them to address
the needs of the State.
While block grant investments that support and maintain state
systems are vital, they represent only one part of the comprehensive
approach needed to improve access to quality substance abuse prevention
and addiction treatment services in the U.S. To increase access and
reduce waiting times for services, Federal investments in targeted
capacity expansion and development and application of new more
effective and efficient interventions are essential to improve system
performance and service quality, as well as cultivate a system that is
responsive to current and emerging needs. These investments help to
connect the laboratory research funded by the National Institutes for
Health and others to the needs of our citizens through the delivery of
everyday health care services. Without the bridge that SAMHSA provides,
the benefits from Federal investments in bench science and biomedical
research will not reach our citizens or achieve full potential.
Wise investments in improving performance and quality of services
through SAMHSA's Knowledge Development and Application (KD&A) grant
program stimulate the discovery of new and more cost effective ways to
deliver services paid for through block grant funding, Medicaid,
Medicare and private sector insurance. For example, CSAT has launched
an initiative to determine the effectiveness of available
methamphetamine addiction treatments for various populations and the
cost effectiveness of the various treatment approaches. CSAT is also
investing in improving treatment services available for adolescents and
adults dependent on marijuana. Additionally, CSAT has also initiated a
program to identify currently existing and potentially exemplary
adolescent treatment models and to produce short-term evaluation of
outcome measures and cost-effectiveness of such models with a special
emphasis on models that focus on treatment for adolescent heroin
abusers. Because the effectiveness of current treatment models for
adolescents is still being developed, CSAT is working with NIAAA to
identify effective treatment interventions for adolescents who abuse
alcohol and those who have become alcoholics. CSAT is also working with
the Department of Justice to support the Drug Court Program and through
this effort we are piloting three Family Drug Courts projects in which
alcohol and other drug treatment, combined with intervention and
support services for child and family, are integrated with the legal
processing of the family's case. And, SAMHSA is working with the Food
and Drug Administration and the National Institutes of Health to
increase access to and improve the quality and accountability of
methadone and levo-alpha-acetyl-methadol (LAAM) treatment for people
with heroin addiction. Improving access and quality of treatment will
be accomplished by moving from the current regulatory environment to a
system that will combine program accreditation with statutory
requirements.
While the drug problem is national in scope, our data provides us
the ability to gauge the regional nature of emerging trends. In
addition, mayors, town and county officials, the Congressional Black
and Hispanic Caucuses and Indian Tribal Governments experiencing the
effects of drug use in their communities have appreciated Federal
leadership in helping them address emerging drug trends and the related
public health problems, including HIV/AIDS. SAMHSA's Targeted Treatment
Capacity Expansion program is key to these efforts. These grants,
already in 41 communities, are providing rapid and strategic responses
to the demand for services that are more regional or local in nature.
For example, the outbreak of methamphetamine use that has spread across
the Southwest or dramatic heroin use increases reported in localized
areas can be more rapidly addressed as a result of this program. Last
year we awarded a Targeted Capacity Expansion Grant to a program in
Gallup and I have here an announcement for additional grants to be made
this year for which State, county and local governments including
Indian tribes and tribal organizations may apply.
In conclusion, Mr. Chairman, SAMHSA is very interested in sharing
with New Mexico the knowledge that it has gained over the years. In
fact the State is currently working on a proposal for technical
assistance on how to address the problems here in Rio Arriba County.
The State is working hard and I want to acknowledge their efforts.
SAMHSA has had a good working relationship with the States over the
years and we look forward to assisting New Mexico in any way we can.
Senator Domenici. Thank you very much. Now, I gather from
what you have said, Doctor, that a number of the block grant
programs, at least two that you have mentioned, are working
through the State, and I think it would probably be the State's
officials that are going to speak after you, Secretary Alex
Valdez of Human Services and the head of our law enforcement,
they would be the ones that would be putting the plan together
for the governor on that one plan and implementing the other
programs if they are going to get funding for it; is that
correct?
Dr. Autry. The block grant program is coordinated through
the State and the Targeted Capacity Program, city, counties,
States can apply. We ask that they coordinate the reference, so
we only get one coordinated application in, and then our other
program, individual institutions, cities, counties and States
apply for those. The information is available to anybody who
asks for assistance.
Senator Domenici. So what I am gathering here is, the
Secretary will speak to us soon on what they were doing, but as
part of the comprehensive plan, they could further the area,
further apply for the two programs you have spoken about, in
addition to the grant; is that correct?
Dr. Autry. That's correct.
Senator Domenici. And how much money is available in those
programs?
Dr. Autry. Targeted Capacity Program----
Senator Domenici. Let me ask, that program has already been
given reasonable effort here in New Mexico, has it not?
Dr. Autry. Absolutely. That is a program that has been
very, very, very well supported and we appreciate that, and
certainly there is adequate money to respond to applications.
Senator Domenici. Let's move to Dr. Condon. Doctor, first,
would you please take back to Dr. Leschner my extreme gratitude
for participating by sending you here. I know him very, very
well.
Dr. Condon. Yes, I know.
Senator Domenici. You are making incredible science
breakthroughs. You all should know that we are not just relying
upon people finding a way to avoid drugs or getting off drugs,
we know it's very difficult. Our best and greatest scientists
are working on ways to be helpful in terms of finding what it
is that causes that, why people cannot control this desire and
this use, and there is some fantastic research, and I know that
maybe you can share some thoughts with us to give us a little
hope in our future.
Dr. Condon. Certainly, thank you, Senator. I believe our
written testimony for the record is in the back. I will just
summarize my statement.
Senator Domenici. The statement will be attached to the
record. Thank you.
Dr. Condon. Let me also convey our regards to the community
here. We have very high regards as well. Mr. Chairman and
members of the committee, I am pleased to have this opportunity
today to share with you what science is teaching us about drug
addiction, abuse and about heroin addiction in particular. We
so often hear about certain drug use patterns around the
neighborhoods from the national media, but it really doesn't
hit home until you see the impact that drugs have within your
own community.
Recently, this past fall, having made a number of visits to
the Midwest, particularly, to Des Moines and to Omaha, I
witnessed firsthand what methamphetamine is doing to those
communities, and they were, of course, struggling to figure out
what to do about that as well. It's now that I am here in Rio
Arriba County, hearing from you about the impact of black tar
heroin, and what an impairment it's having on you, on your
children and your families and your community that I truly
realize that heroin is a major public health threat that
affects us all. It brings in its wake a myriad of health,
social, economic problems, including HIV, AIDS, and other
infectious diseases and disruptions of families, communities,
and societies in general.
The good news is, however, that we do have a strong
research base that communities can call upon in their efforts
to combat drug abuse and addiction, and I will talk a little
bit more directly about some of those efforts in a few minutes,
and about some of the research-based materials that the
National Institute on Drug Abuse has developed that can be
useful for you in this community.
Let me encourage you to pick up the materials that we
brought out here, 200 copies of just about everything we have
produced in the last couple of years in prevention and
treatment are in the back.
Let me focus first on the science of heroin. Heroin is an
illegal, highly addictive drug that is sold in various forms,
including black tar heroin. Heroin is both the most abused and
the most rapidly acting of all of the opiates. It is processed
from morphine, a naturally occurring substance extracted from
the seed pod of certain poppy varieties. Heroin is actually 3
times more potent than morphine. Because of its chemical
structure, heroin is able to rapidly enter the brain where it
is converted back into morphine. In the brain morphine attaches
to the natural opioid receptors, also known as endogenous
endorphin receptors. In fact, thanks to advances in molecular
biology, we have now cloned at least three of the known opiate
receptor subtypes, the so-called mu, delta, and kappa opiate
receptors, and we are studying the mechanism of their action in
very fine detail. Heroin can initiate its multiple
physiological effects, including pain reduction for morphine,
depression of heart rate and slowing of respiration. Heroin
also acts in those receptors. However, heroin also acts on the
brain's natural reward circuitry to produce a surge of
pleasurable sensations. That is, in fact, why people take a
drug because they like what it does to their brain. It modifies
their mood, their perception and their emotional state. It
either makes them feel good or it makes them feel better.
However, the problem is, that pleasure doesn't last long.
Prolonged heroin use has been found to cause pervasive
changes in brain function. The manifestation of these brain
changes can be seen in the development of tolerance and
physical dependence. While those two features of heroin
addiction actually can be managed pretty easily with
appropriate medications, the most challenging, particularly for
treatment providers, as you all know, are the cravings and the
compulsive aspects of heroin addicts after addiction occurs.
This is why we are continuing to support research that will
help us develop innovative approaches, both behavioral and
pharmacological, to what we now believe to be the essence of
addiction; that is, craving and compulsive drug use.
We are confident that we can develop even more tools to
expand our clinical toolbox available to treatment providers.
We have supported research on two of the most successful
treatment regimens for heroin addiction to date--methadone and
LAAM. LAAM is a long-acting methadone. These medications block
effects of heroin, reduce cravings, eliminate the uncomfortable
withdrawal symptoms that many patients can experience.
As good as these treatments may be, however, there is no
silver bullet for treating heroin addiction. While heroin
addiction can successfully be treated with or without
medications, research has shown that integrating medication,
such as methadone and LAAM, with behavioral-based therapies is
likely to have the most success. Behavioral therapies such as
contingency management and cognitive-behavioral interventions
have been found to increase the effectiveness of these
medications.
In an effort to give treatment providers another effective
tool to combat heroin addiction, NIDA is working in
collaboration with the Food and Drug Administration to bring to
market a new medication called buprenorphine. One of the
advantages of buprenorphine is its ability to be administered,
with hope, in less traditional environments than methadone,
thus expanding treatment to populations who either do not have
access to methadone programs or who, in fact, may not be suited
for them, such as adolescents. Buprenorphine would not be a
replacement for methadone or LAAM but would be another
component or option for treatment providers.
Buprenorphine is just one of a number of new treatment
approaches that NIDA will be testing in our soon to be launched
National Drug Abuse Treatment Clinical Trials Network. The
network will test new behavioral and pharmacological therapies
that have been shown to be effective in small-scale laboratory
studies then evaluate them, in large scale, multi-site clinical
trials conducted in what we called ``real life settings,'' like
the community here. Through this network, we hope to more
rapidly and systematically bring science-based research into
actual treatment. This community-based network will be able to
design treatments to meet the specific needs of special
populations, such as those in your community.
Ultimately we know that our best treatment is, of course,
prevention, and 25 years of prevention research has told us
that communities can, need, and should play an active role in
preventing drug abuse. We are attempting to provide communities
with tools that can be used to accomplish this. We realize that
we cannot just distribute the research, and that's why we have
translated research from over the last few years in a way that
is useful for communities. This is the main reason, actually,
why we developed the first ever science-based prevention guide,
``Preventing Drug Use Among Children and Adolescents,'' and we
have 200 copies of that in the back. We call this the ``red
book.'' It is a very useful manual.
Senator, we have circulated over 200,000 copies of this
publication in the last 2 years. We have gotten positive
reports back. They are incredibly user-friendly documents that
can be used by just about anyone.
We have also collaborated with other Federal agencies, such
as Substance Abuse and Mental Health Services Administration,
Department of Education, and Laurie Robinson of the Department
of Justice, the Office of Juvenile Justice and Delinquency
Prevention, and the Bureau of Justice Assistance to help
communities combat drug abuse. We also have an active education
program that develops and disseminates science-based materials
on a continuous basis. Publications such as our Research Report
Series and our INFOFAX, which is available both in English and
Spanish, and available on the worldwide web, provide
information on drugs of abuse in a concise manner that is
understandable to all.
Again, I brought you a copy of the Heroin Research Report
series that we have developed. There are a number of copies in
the back as well as the INFOFAX, which has Rolodex cards
attached to it in both English and Spanish references, because
it is important that people have accurate, science-based
information so that they can make healthy lifestyle choices.
We have developed education programs. For example, we have
produced the award winning ``Mind Over Matter'' series, and
have launched a program called ``NIDA Goes to School.'' ``NIDA
Goes To School,'' Senator, is a science-based drug abuse
education information kit that can be used in the classroom.
It's designed for middle school, grades five through nine, and
we made a decision to send it to every middle school in the
country, all 18,000, including Espanola Middle School, here in
New Mexico received a copy of this material. Again it's
designed for grades five through nine. It's designed to spark
more than their curiosity about science, but to teach them
about the effects of drugs on the brain and the body.
prepared statement
In conclusion, it is science that is, in fact, leading the
way with developing more effective proponents to prevent and to
treat drug addiction. Research has already brought us a great
distance, yet we still have a very lengthy journey.
Thank you for inviting NIDA to participate in this panel,
Senator, and we would be happy to answer any of your questions.
[The statement follows:]
Prepared Statement of Timothy P. Condon, Ph.D.
Mr. Chairman and Members of the Committee, I am Dr. Timothy P.
Condon, Associate Director of the National Institute on Drug Abuse
(NIDA), one of the research institutes at the National Institutes of
Health. I am pleased to have been invited here today with my colleagues
to testify at this important hearing to tell you what science has
taught us about heroin addiction.
The National Institute on Drug Abuse (NIDA) supports over 85
percent of the world's research on the health aspects of drug abuse and
addiction. It does this through a comprehensive research portfolio that
incorporates many diverse fields of scientific inquiry and addresses
the most fundamental and essential questions about drug abuse, ranging
from its causes and consequences to its prevention and treatment. The
scientific knowledge that is generated through NIDA research is
providing us with new insights into addiction, and importantly, how to
both prevent and treat it.
Today, in the United States, approximately 600,000 people are
addicted to heroin. Data from several sources suggest that the number
of people using heroin for the first time continues to escalate with a
large proportion of these new users being young, with 90 percent being
under the age of 26. Part of what may be fueling the rising numbers
seen here in the Southwest is the ready availability of inexpensive
black tar heroin. Black tar heroin derives its name from its color and
consistency which results from the crude processing methods used to
illicitly manufacture heroin in Mexico. Regardless of its form, black
tar heroin is addictive with street purities ranging from 20 to 80
percent.
Heroin addiction is often associated with increased criminal
activity and human suffering. In addition to the medical consequences
of collapsed veins, increased risk of bacterial infections in the heart
and lungs, in the past 10 years, there has been a dramatic increase in
the prevalence of human immunodeficiency virus (HIV), hepatitis C virus
(HCV), and tuberculosis among intravenous heroin users. From 1991 to
1995 in major metropolitan areas, the annual number of heroin-related
emergency room visits has increased from 36,000 to 76,000, and the
annual number of heroin-related deaths has increased from 2,300 to
4,000. The associated morbidity and mortality further underscore the
enormous human, economic, and societal costs of heroin addiction. This
is a problem that is widespread and growing and impacting every
community in America, both rural and urban.
The good news is that we know more about how opiates such as heroin
and morphine work to produce their myriad of effects than almost any
other drug. From this scientific base, researchers have been able to
develop a number of effective weapons to combat heroin addiction.
Heroin is chemically derived from morphine and is approximately
three times more potent than morphine. Because of its chemical
structure heroin is able to very rapidly enter the brain where it is
actually converted into morphine. In the brain, morphine attaches to
the natural opioid receptors also known as, endogenous endorphin
receptors, where it can initiate its multiple physiological effects,
including pain reduction, depression of heart rate and the slowing of
respiration. It is heroin's effects on respiration, in particular, that
can be lethal in the case of heroin overdose. Heroin also acts on the
brain's natural reward circuitry to produce a surge of pleasurable
sensations.
Advances in molecular biology, are providing scientists with tools
such as new animal models, to better understand how heroin produces its
addictive effects at the cellular and molecular levels. For example, we
have cloned the genes for 3 opiate receptor subtypes, the so-called,
mu, delta and kappa opiate receptors. In the past two years, using
state-of-the-art genetic engineering technology, we have been able to
create new strains of ``knockout'' mice that lack each one of these
receptor subtypes. A number of studies now point toward the mu opiate
receptor as being critical in mediating opiates' addictive effects.
This type of information can be invaluable in designing new, more
effective treatment medications that can specifically target cellular
sites relevant to addiction.
Prolonged opiate use has been found to cause pervasive changes in
brain function. The manifestation of these brain changes can be seen in
the development of tolerance and physical dependence. With physical
dependence, the body adapts to the presence of the drug and withdrawal
symptoms often occur if use is discontinued or abruptly reduced. The
first symptoms may occur within a few hours after the last time the
drug is taken. The major symptoms peak between 24 and 48 hours and
subside after about a week. However, some people have shown persistent
withdrawal signs for many months.
Physical dependence and withdrawal were once believed to be the key
features of heroin addiction. We now know that this is not the case
entirely, since craving and relapse can occur weeks and months after
the withdrawal symptoms are gone.
Understanding the biology of addiction has led us to develop a
number of effective tools to treat heroin addiction and to help manage
the sometimes severe withdrawal syndrome that accompanies sudden
cessation of drug use. Through NIDA-supported research, for example,
LAAM (levo-alpha-acetyl-methadol), a new drug for the treatment of
heroin addiction was developed and is now available as a supplement to
methadone. Both drugs block the effects of heroin and eliminate
withdrawal symptoms. Treatment with methadone requires daily dosing.
LAAM blocks the effects of injected heroin for up to three days.
Research has demonstrated that, when methadone or LAAM are given
appropriately, they have the ability to block the euphoria caused by
heroin, if the individual does in fact try to take heroin. Methadone
has allowed many heroin addicts to lead a productive life.
As good as these treatments may be, there is no silver bullet for
treating heroin addiction. Research has shown, however that integrating
pharmacological approaches with behavioral therapies is the most
successful approach to treating drug addiction. Behavioral therapies,
such as contingency management and cognitive-behavioral interventions
for example, have both been found to compliment anti-addiction
medications, such as methadone, successfully.
In an effort to give treatment providers another effective tool to
combat heroin addiction, NIDA is working with the Food and Drug
Administration and the pharmaceutical industry to bring to market a new
medication called buprenorphine. This medication has the potential for
administration in less traditional environments, thus expanding
treatment to populations who either do not have access to methadone
programs or are unsuited to them, such as adolescents. Buprenorphine
would not be a replacement for methadone or LAAM, but yet another
treatment option for both physicians and patients.
Buprenorphine is just one of a number of new treatment approaches
that NIDA will be testing in our soon to be launched National Drug
Abuse Treatment Clinical Trials Network. This Network will serve as
both the infrastructure for testing science-based treatments in diverse
patient populations and treatment settings, and the mechanism for
promoting the rapid translation of new treatment components into
practice.
In addition to testing new medications, a number of behavioral
therapies such as cognitive behavioral therapies, operant therapies,
family therapies, brief motivational enhancement therapy, and new
manualized approaches to individual and group drug counseling are ready
to be evaluated in real life settings. It is important to note that all
new pharmacological therapies will be tested in conjunction with a
behavioral therapy.
This community based Network will enable us to design treatments to
meet the specific needs of special populations, such as those in rural
communities.
Ultimately, we know that our best treatment is prevention. We also
know that we must provide the public with the necessary tools to play
an active role in preventing drug use in their own local communities.
This is likely one of the reasons that the first ever research based
guide, NIDA's ``Preventing Drug Use Among Children and Adolescents,''
has become one of our most popular publications since we debuted it
almost two years ago. This user-friendly guide of principles summarizes
our knowledge gleaned from over 20 years of prevention research. Over
200,000 copies have been circulated to communities throughout the
country. The prevention booklet is just one example of how we are
bringing research to local communities, both rural and urban, to reduce
drug use.
NIDA is also teaming with other federal agencies, such as two
components of the Department of Justice, the Bureau of Justice
Assistance and the Office of Juvenile Justice and Delinquency
Prevention to help communities combat drug addiction. In conjunction
with the Department of Justice, we are working to implement science-
based prevention programs into schools and evaluate their
effectiveness. All of NIDA's prevention activities reflect our
commitment to target prevention interventions to the specific needs of
youth at risk for drug abuse, including members of different ethnic
groups.
In short, we are interested in providing community's with the tools
necessary to reduce the Nation's overall drug use. Thus, in addition to
our research to prevent and treat drug abuse, NIDA is also concerned
about education on these topics. NIDA has an active information
dissemination program that develops and disseminates science-based
materials on a continuous basis. Publications such as our Research
Report Series and our INFOFAX, which is available on the world wide web
or by calling an 800 number, present the latest information on drugs of
abuse in a concise manner that is understandable to members of the
general public.
We also have a strong science education program to ensure that our
Nation's youth have accurate science-based information to make healthy
lifestyle choices. For example, we have developed award winning
materials such as our ``Mind Over Matter'' series that was sent to
every middle school in the Nation. ``Mind Over Matter'' is a series of
drug education brochures for students in grades five through nine to
spark their curiosity and to inform them with the most up-to-date
scientific research findings on the effects of drug abuse.
In conclusion, I would like to reiterate that 25 years of research
has provided us with effective prevention and treatment strategies that
can be used to combat heroin addiction, as well as other drug problems.
Research has shown that these strategies are effective in reducing not
only drug use but also in reducing the spread of infections like HIV/
AIDS and in decreasing criminal behavior.
It is important that there be a sound platform of scientific
research to build upon as communities around the country develop and
implement their drug abuse prevention and treatment programs. NIDA
supported research continues to lead the way in strengthening and
expanding that platform.
Thank you once again for inviting me to participate on this panel.
I will be happy to answer any questions you may have regarding the
scientific findings I just presented.
Trigger for coordinated response
Senator Domenici. Thank you very much, Doctor. We are going
to take about 10 more minutes with this panel, and then we will
stay on time and take a brief recess and put our State
witnesses up. I have a number of questions, but I think what I
would prefer to do, rather than ask them, is to seek out some
discussion with you. Let me be very honest. When the facts
became public about the degree of addiction and abuse in Rio
Arriba County with reference to black heroin, I was kind of
wondering to myself, how could it get so bad without it
triggering some big red light somewhere that would say, ``State
government, Federal Government, State programs, Federal
programs, law enforcement, Federal law enforcement, this is an
epidemic we ought to be focusing on.'' And I guess I have come
to the conclusion that we really don't have anyone that's
supposed to do that, that I know of. If I'm wrong, I wish
somebody would tell me, but it's only in the last couple of
months that those who have programs, and no criticism of any of
those programs, that they've all come to the conclusion that we
found out about this.
I think the first thing that kind of disturbs me--I am
bewildered--is what should trigger a more coordinated response
when things are so bad, or are we really going to expect the
local government to bring it to everyone's attention? I am
amazed at the principal law enforcement agencies that work in
this area, DEA, which has become very elaborate, and the very
informed Administrator of the DEA, Constantine, has become a
primary organization, but there is no red flag set of facts
that brings them to play in an area such as this. It has to get
called to their attention.
Now, having said that, we all know about it now, right? You
know about it, presumably, and I know the U.S. Attorney knows
about it. SAMHSA knows about it. Our Attorney General of the
United States knows about it. We have all these State people
that know about it. Now, they've known for a while longer, so
they will come up here and say, ``Senator, what you are talking
about? We knew about this,'' but that's wonderful. But the
point is, nothing comprehensive was done by anyone, including
me. You and I are all in the same boat, but now that we know,
what really worries me, I do believe the network can be of
assistance, general assistance, but I don't want to leave today
without understanding that there's some way that some entity is
going to pick up the coordination efforts and make sure that,
be it SAMHSA, NIDA, or clearly it will be, for certain,
Department of Justice, with its myriad of programs, and that
leaves aside the law enforcement, which I assume will be doing
their work. What I would ask, first starting with you, Laurie
Robinson, if you know, and if there's something you can
suggest, I think it will not do very much if we don't leave by
the end of the day with some understanding of how is all this
going to be put together, and frankly, I say to the local
people, ``This is not my job. I do not choose to put this
together over your heads,'' I just don't want to come back in
six months and have the local people say nothing happened.
Right, or I would like them to say we tried and maybe it didn't
work, but I really don't think we ought to keep having hearings
and keep on discussing what's available. Someone has to take
this and go.
Now, maybe I am premature and maybe the State cabinet
members, including Alex Valdez, can tell me later how that
would occur, and maybe the very active chairman of the County
Commission, but could you talk to that a little bit so I feel
more comfortable that you are not going to fall off the log too
and not be around doing this kind of thing? Would you start,
please?
Ms. Robinson. Certainly, Senator. What we have seen in
other communities around the country is, of course, and you and
I talked about this earlier this morning, the importance of
local engagement. This can never be something that the Federal
Government comes in and does to the local community or even
State government comes in, so clearly you have layers--the
Federal, State and local--that have got to work together on
this. And at the same time, it's stating the obvious, that the
pieces of the Federal side have got to be coordinated.
As I indicated earlier, we work very closely with Dr. Alan
Leshner at NIDA, with Dr. Chavez at SAMHSA, and my
recommendation here would be that we would be happy--if that's
your choice--to have the Justice Department be kind of the
center of the team, or however my colleagues would like that.
When we send out our technical assistance team, as I indicated
in my statement, we would plan ahead of time to coordinate, to
make sure that the SAMHSA and the NIDA efforts are tied in
together so that we have a collaborative approach. And then
part of that has got to be working with the local mayors to
have everyone at the table--going across the board from local
law enforcement to social services, education, every piece of
the team at the local level--to put together what we would call
the strategic plan. That may not be about individual funding
programs, per se, but it will identify what the needs are. And
then what we can do coming back from the Federal side and
working with our State colleagues, is to see where we can meet
those needs through existing programs, and to be pretty
creative about it. But I agree with you, it cannot be done in a
segmented way. It can't be done in an isolated way. We have got
to think about it as a whole.
Senator Domenici. Doctors, in your opinion, do you have any
comments?
Dr. Autry. Let me just echo those sentiments. As you heard
from my earlier comments, we are already working and activated,
and the State is already, in point of fact, working with the
County at this point in time to identify what kinds of needs
there are and what sorts of training and technical assistance
will be necessary to help meet those needs. You asked the
question earlier about how much money is in the Targeted
Capacity Program. There is $133 million in that program that's
eligible to be competed for, and the knowledge, development,
and application program is $267 million, and these monies can
augment the already ongoing State effort.
I want to compliment the State on having gotten to us early
on with their concerns and having already started to work in
looking at what the TA needs are and looking to see if there
are applications for target capacity expansion that might be
useful in helping address this problem. I also share Justice's
concern that this must be done in a coordinated way. We all
know that our population of interest has a significant overlap,
and if we don't deal with them vividly and to go, then we are
certainly going to miss a lot of opportunity. Similarly, as you
heard from Dr. Condon, having the best effective treatment
prevention, treatment and working to upgrade those in the
community, is part of what the technical assistance will focus
on.
Dr. Condon. I just echo the same comments, and let me just
mention that NIDA will be happy to participate with the
technical assistance team, if not directly by having staff on
site, we will be able to put the members of the team in contact
with the NIDA researchers doing the cutting edge research on
this topic.
Senator Domenici. I want to thank you very much. I have
additional questions. I am not even sure I will submit them
because I know what we heard and what you said is what we have
got, and I don't think I can make it any better by asking
questions. I think we all understand our goal, and I thank you
very much. It would be helpful and I am hopeful that the
community will avail itself in a coordinated way without
competition. I hope we can eliminate competition among groups
here as to what we are doing. We have got to focus in on what
we are going to do very soon, it seems to me, and I am not
going to be the arbitrator in that regard. We are going to
excuse you now, and unless you have meetings scheduled with any
of the local people, we will not need you anymore as witnesses,
and you are free to enjoy beautiful New Mexico for whatever
time you are going to stay here.
NONDEPARTMENTAL WITNESSES
STATEMENTS OF:
ALFREDO MONTOYA, CHAIRMAN, RIO ARRIBA COUNTY COMMISSION
LORENZO VALDEZ, COUNTY MANAGER
LAURAN REICHELT, DIRECTOR, HEALTH AND HUMAN SERVICES
DEPARTMENT, RIO ARRIBA COUNTY
Senator Domenici. We have the County witnesses, the County-
wide strategic panel, would you please come to the witness
table? Alfredo Montoya, Rio Arriba County Commissioner, Lorenzo
Valdez, County Manager, and Lauran Reichelt, the Director.
Would you please join us here and talk with us a bit?
Shall we proceed in the order that we called you, Mr.
Chairman, going first and then the Manager and then the
Director. Mr. Chairman, please proceed.
Mr. Montoya. Senator, thank you very much for your
involvement in addressing our dilemma here. I don't think you
quite realize how much everyone here appreciates what you are
doing at this time, the attention that you have helped us bring
to the situation we find ourselves in. We are extremely
appreciative as well as all of the local people that are here
today, and many of those that couldn't be here.
I would like to start, Senator, if I may, recognizing some
leaders in the community that are playing a big role in
assisting with the epidemic that we find ourselves in. Without
the leadership of all these individuals and some others that
aren't here, we couldn't quite get to a solution that we want
to get to.
I would like to recognize my colleagues on the commission
who are Moises Morales and Ray Tafoya. I would also like to
recognize the President of this fine institution, the Northern
New Mexico Community College, Sigfredo Maestas, and the Vice
President Priscilla Trujillo. I would like to recognize also
the municipal judge for Espanola, Mr. Charles Maestas, who is
doing a lot in his courtroom to deal with this problem. He
started teen court and other initiatives. Representative Nick
Salazar was here. Debbie Rodella and Senator Arthur Rodarte
were hoping to attend, and I am not sure if they are here, the
mayor from our fine city, and I believe he was here earlier
this morning. I believe he is in the audience, members of the
City Council and members of the Santa Fe County Commission, and
fellow officials, the people who will be on the State panel.
They will be recognized a little later. All the other efforts,
Senator, are dually needed, and we are very happy that they
have all been willing to be participants in our efforts at
addressing some of our problems here.
I would like to start, Senator, by saying that in our role,
in our responsibility as a county government, we are really not
in the business of providing treatment or prevention services
to substance abusers and families, nor are we trained to
provide law enforcement and detention, and so forth, to the
level that this current epidemic we find ourselves in requires.
We have been aware of the extensiveness of the problem and the
serious negative effects it has on our population, so when we
were challenged to step up to the plate to provide leadership,
we responded as local elected officials. We take our
responsibilities very seriously, and when our families are
distressed due to all the negative impacts that drugs generate,
it concerns us a great deal. Locally we feel this is our
responsibility to mobilize whatever forces are needed to deal
with this epidemic, and here is where we are extremely grateful
that you are responding to our call for help. We have no
intention of being service providers, because there are plenty
of professional people in the community that are very capable
and can do this, but we did see a need to draw attention to our
dilemma. We also have found a need, more than at any other time
before, to come together as a community and as a county and as
a region.
We have a genuine interest, Senator, in gaining control of
this problem that is costing us the precious lives of our loved
ones. It's costing us the use of our limited resources that are
desperately needed elsewhere, and it has given us a reputation
that we wish we didn't have.
Senator, we really don't want to be first in the nation in
all of these negative categories. It would be wonderful if we
had gathered here to discuss something more pleasant. Our
community, as the statistics indicate, has a tremendous and
enormous thirst for illicit drugs, and we all know that if we
put all our resources into interdiction, it will not work. At
the previous hearing that you had here, the information
gathering hearing some weeks ago, we heard Secretary White
indicate that law enforcement alone could not address this
problem. So until we deal with that and work on decreasing the
demand, we will not be successful. We have to have a balanced
approach between interdiction, prevention, and treatment. That
is why it's so encouraging, hearing from the previous Federal
panel's information on all of the programs that are available
to deal with the treatment and prevention part, as well as
interdiction for law enforcement.
Senator, again we are very encouraged with your
involvement. Thank you for putting together or assembling all
of the ingredients needed. I believe through the extensive
resources, through SAMHSA, through NIDA, we will have a
balanced attack on drug abuse in our area. Our role in local
government, Senator, is to make efforts to ensure that everyone
involved in this issue is working with one another. There will
never be sufficient resources, and if we don't apply them
wisely, we will not be able to get anywhere. We would like to
see the providers of treatment working with prevention
providers. We would like to see how law enforcement
collaborates with providers to the extent possible. We would
like to see primary and emergency care providers coordinating
data and services with others, and we would like to see the
schools very, very involved, in an effort to ensure that
precious resources are utilized wisely, that duplication is
minimized. We all have a game plan, as varied as it might be.
We have sanctioned the creation of the Rio Arriba Strategic
Plan for Substance and Alcohol Abuse, Revision and Treatment
Plan, and my colleagues will speak a little more on that.
I would like to close, Senator, by saying that the Federal
panelists before us all spoke about the much needed
coordination of civic action, that we will greatly need to
coordinate what we are doing, and I believe that is the intent
of this plan. I hope we can do that, and we can bring everyone
to the table and work together on this, Senator. I will allow
our county manager to speak on our plan.
Senator Domenici. Please, Mr. County Manager. Glad to have
you, and will you share some of your thoughts on what you all
are doing together. It's good to have you with us.
Mr. Valdez. Thank you, Senator. I have only been privileged
to address committees one, two or three times in my life,
actually, and it's always a little overwhelming to be able to
speak to the government in Washington on these occasions, so
bear with me as I gather myself for this.
My task for the Rio Arriba Board of County Commissioners is
to administer and to manage their directives and their view and
their plan for Rio Arriba County and to assure that their
statutory mission is accomplished in this community. That
mission has four words that motivate the work that we do, and
that is to maintain the health, safety, welfare and
conveniences of the residents of Rio Arriba County.
The reason that we are gathered here today is because that
mission is being impaired in some form or fashion. The facts
are that substance abuse that is the focus of today's
activities impact all of the Commission's responsibilities and
abilities to provide for the health, safety, welfare and
convenience of our citizens is being eroded by the reality of
the substance abuse problems in the community. I remember in
1978, I was at my home after I had left a situation. I was
working with youth, at a group home, and a home full of 25 kids
for which I was a responsible parent, tough job, but the home
was having some problems. So I left and--it was about a month
later, a good friend of mine who is now deceased, came to my
home and said, ``Lorenzo, I have worked with you before. Would
you please assist me in a project that I want to undertake,
myself and some other friends,'' that he had already
contracted. Well, I respect this individual, so I said yes. And
the project was the Rio Grande Center at Embudo, which is the
alcoholism treatment facility. At that time, the State had just
passed a law making funds available for regional alcoholism
treatment facilities. I eventually became treatment-program
coordinator for that program. I worked there for 6 years. I
have maintained contact with the treatment community all along,
and I have seen the face of substance abuse change in Rio
Arriba County.
To say that heroin abuse is a new drug problem in the
county is not the case. We know that heroin has been in our
community from the 1940s, the 1950s and has evolved. I remember
a lot of publicity about Las Vegas during the 1960s and 1970s
calling it ``Smack City'' and lots of our students went to
school in that time. We know about the impact that history had
on this community.
To say that the Mexico connection is the source of heroin
is a fact. It was then and is now, because we don't grow
poppies in New Mexico, so it has to be produced and
manufactured somewhere else, and it must grow from that site.
What we have done in Rio Arriba County is to begin the
planning process that is comprehensive and unified. In the
effort to do prevention, the possibility is that we will misuse
or mismanage the meager resources available, so we need
everyone on board for this plan and process. It's open, it's
available to everyone. We want everyone at the table, we want
to ensure we have the maximum impact on the county problem. We
have sent out notices and had numerous meetings in coming up
with this plan. We have the expectations that the planning
efforts will be coordinated not only for use of the resources,
but the status and modalities that are most effective. It is
fine to have a million dollars to spend, but then we have to
come out with ways that are effective and take into
consideration who we are. It's the only way that we will have a
desired outcome, and outcome is why we do things. So we must
really look at outcomes.
We must also spend time working with State and Federal
agencies. We must be realistic and look at those outcomes so
that we know whether we are being successful. We really need to
investigate what it is that we desire from this process. It is
the only way that we can manage the resources effectively.
I remember when I was working with alcohol abusers and
alcohol addicts, because alcohol is a drug, and I was struck by
the statement ``mind over matter,'' and the people I had in
treatment always used to turn it over, ``if you don't mind, it
doesn't matter.'' So we have to mind because if we don't mind,
then nothing else will happen. We have to be certain that we
approach this from the right perspective, and that means each
individual has to internalize the reasons for why we are
undertaking this mission.
I like mission better than war because mission implies
something religious, and today we are turning into a very
important period in Northern New Mexico. I want to emphasize
something that we are taught here, is that at the base of our
motivation should be compassion, hope, charity, and if we base
ourselves in that, we will be successful, because those are the
factors or the virtues that make human endeavors better and
successful in the long run.
We need to focus on where our hearts and minds are at. I
worry a little bit when I was reading an article in an
interview with general--the person involved with the drug war.
Senator Domenici. General McCaffrey.
Mr. Valdez. Right, and how scientific discovery and
instrumentation can help in the drug war. I was reading about
techniques for looking through roofs and walls and listening to
conversations two miles away. I would caution that we be very
careful about that. Northern New Mexico is a community where
you don't want to martialize the law here. We are very
independent. We are very reactionary to those kinds of things,
and you will find lots of residents. We want cooperation. We
want people to join us, so I emphasize again that the other
approach is one that was given to us by the mayor's favorite
friend, and so I want to defer to that.
Senator Domenici. Is that God?
Mr. Valdez. I think so, yeah. Good instructor, but we have
some good direction from there. I think if we all realize His
mission, we can solve a lot of these problems. I think that's
from the perspective in Rio Arriba administration, because I
have talked to the public officials in this New Mexico county.
They are very much influenced by those kind of sentiments, and
like this, it's very much in the mind, and it's very much in
the hearts. A lot of them are actually going out and isolating
themselves so they can think about it. We need to think about
it, and the community needs to think about it, and we need to
deal with the afflicted, and Spanish here we call it (spoke in
Spanish), he who is next to us. (Spoke in Spanish) He who is
identical to us. I think that's where we need to come from in
terms of dealing with the problem. So thank you very much.
[The information follows:]
Rio Arriba County Maternal Child & Health Council Substance Abuse
Related Detention Costs
Letter From the Rio Arriba Board of County Commissioners, Espanola
Branch Office
March 23, 1999.
SUBJECT: COST OF ENFORCEMENT FOR SUBSTANCE AND ALCOHOL ABUSE-RELATED
CRIMES TO THE TAXPAYERS OF RIO ARRIBA COUNTY
Dear Taxpayer: The Rio Arriba Maternal Child Health Council
(RAMCHC) recently became concerned that a significant percentage of the
County's operating budget was being used to finance the apprehension
and detention of individuals for substance abuse-related crimes.
Because these individuals are released into the community without
proper treatment, they inevitably fall into abuse and crime, and are
arrested again. Enforcement is the most expensive and least effective
method of dealing with alcohol and substance abuse.
The RAMCHC commissioned Shaening and Associates to determine the
impact of substance and alcohol abuse on the county's enforcement
budget. We learned that 38.55 percent of all inmate days at the T.A.
detention center are the direct result of substance/alcohol abuse and
other behavioral health problems, resulting in a cost to the County of
$570,814. This does not include administrative costs associated with
holding these inmates, nor does it include the cost of apprehension.
The RAMCHC studied the period from June 1, 1997 through May 31, 1998.
The Rio Arriba County Sheriff's Departmental budget for the current
fiscal year is $1,108,426. Detention center costs for the current
fiscal year are $1,857,549. This means that the County is spending a
total of $2,965,975 out of a total operating budget of $10,186,875 on
enforcement. In other words, Rio Arriba, an impoverished County, is
forced to spend 29.1 percent of its total operating budget catching and
locking up criminals. If we estimate that 38.55 percent of the
enforcement budget is the result of substance/alcohol abuse, we can say
conservatively that local taxpayers are spending $1,143,383 or 10
percent of the County's operational budget holding substance abusers.
This is money that cannot be used for schools, economic development,
health care, roads, etc.
Because this study is preliminary, and we still lack data about
juveniles, women and offenses such as burglary that are indirectly
related to substance abuse, it is safe to assume that our figures are
extremely low. It is likely that the true figure is closer to 20
percent, or approximately $2.2 million.
Cost studies indicate that substance abuse is far more expensive
than treatment. Money can be saved for communities, employers and
families by providing an effective, comprehensive and coordinated
substance abuse treatment delivery system.
A recent report by the California Department of Alcohol and Drug
Programs showed that for each dollar spent on treatment, seven dollars
is saved in crime and health care costs. California has spent $209
million on treatment and has estimated savings of $1.5 billion. Studies
in Oregon have showed that once treatment was initiated, arrest rates
dropped, as did use of the welfare and food-stamp systems.
In fact, the study showed that wages increased by 65 percent as a
result of treatment. Medical costs decreased simultaneously. Thus,
every tax dollar spent on treatment produced $5.60 in avoided costs to
the taxpayer. Similarly, Minnesota found that introduction of substance
abuse treatment resulted in a 65 percent decrease in cost to the state
through decreased utilization of health care facilities and prisons.
A 65 percent decrease in substance abuse expenditures by Rio Arriba
County could free up $1,430,000 (65 percent of $2.2 million) to benefit
our community in other ways.
The RAMCHC and the Rio Arriba Department of Health and Human
Services would like to suggest that some of these savings be invested
in our children.
Sincerely,
Lauren Reichelt,
Director, Health and Human Services.
Joann Salazar,
Chair, Rio Arriba Maternal Child Health Council.
A Report on Substance Abuse, Mental Health and Related Medical Costs
for Individuals Incarcerated at the Rio Arriba County Detention Center,
Tierra Amarilla, New Mexico
submitted by shaening and associates, inc., june 30, 1998
introduction
Shaening and Associates, Inc., was engaged by Rio Arriba County to
examine data at the Rio Arriba County Detention Center and other
facilities that house inmates for the County. The purpose of the study
was to identify the detention and related costs to Rio Arriba County of
substance abuse and/or mental health related detention. Shaening and
Associates was assisted by interns from the Rio Arriba Works project in
gathering portions of the data included in this report.
data collection procedures
Initial interviews were held with the Administrator of Rio Arriba
Detention, Anthony Valdez, to determine appropriate sources of data. A
data collection process was established that included: security of
confidential information; procedures to access records; and, use of Rio
Arriba Works interns. At all times the detention center staff were
cooperative and extremely helpful to this research, especially
Administrator Valdez, Assistant Administrator Bidal Candelaria, and the
detention center's Administrative Assistant Margie Atencio.
Rio Arriba Detention prepares an inmate roster each day that is
used by staff to verify the inmate population. This check of inmates is
conducted early each morning, usually around 2 a.m. This roster
includes name, cell location, charge, date of incarceration, bond and
sometimes sentencing information. These daily rosters were used to
collect most of the data in this report. The daily rosters are each
three to four pages in length. They were examined for the period June
1, 1997, through May 31, 1998, to create a twelve month profile.
Daily inmate rosters were examined manually by the researcher with
assistance at various times from three Rio Arriba Works interns. Manual
counts were made of substance abuse and mental health related charges
from 347 daily rosters. Rosters for eighteen additional days were not
available. Estimates of the charges for these eighteen days were made
by the researcher using the rosters from the day before and the day
after each missing day. For example, if there were ten DWI charges
(inmate days) on April 1, and eight on April 3, an average of nine was
used to fill in the missing day. In this way a profile of a complete
year is presented in the data reported here. In the tables of this
report, these estimates are shown in a separate column to demonstrate
how the total projected costs are established.
There are also inmates whose charge status is reported as one of
several types of warrants. These inmates are held under a warrant for
arrest and incarceration, usually issued by Magistrate Court. The
information that describes the underlying charge is usually forwarded
at a later date to the Detention Center and placed in the inmate file.
The daily inmate rosters that are created at the time of incarceration
are not revised later to reflect the underlying charge, as this
information is not used by the detention center staff in the daily head
counts, though it is noted in other locations and used for other
purposes. Therefore the daily rosters were unable to supply the charge
or offense data for these inmates. There were usually eight to twelve
inmates in this category on each daily roster. In order to obtain
charge data or these inmates, the individual inmate files were examined
to determine the underlying charge. When the charge was included in the
file, it was recorded. Due to the time consuming nature of this task,
only six months of data (December 1997 through May 1998) were examined
in order to complete this report in a timely manner. The totals for
each category of charge found and counted in this six month period were
doubled in order to create a twelve month profile. This is reported in
a separate column to show how total costs were determined. It may be
appropriate, at some time in the future, to examine the data for the
remaining six months, depending upon the future use of these data.
There are no data included in this report for protective custody
status and 24-hour mental health hold status. This information, which
involves holds for observation of intoxication or mental crises but no
criminal charges, is defined by state statute as confidential. Staff
therefore destroy all information related to these holds. In
interviews, staff estimate that, on average, there is no more than one
per month of each of these categories.
The Rio Arriba County Detention Center held an average of 72 adult
male inmates per night during the period under study. This is the
maximum capacity of the physical plant. Rio Arriba County has no
facility to house female or juvenile inmates. When additional inmates
must be held, or when there are female inmates, they are transported to
and held by other detention facilities, including those in Santa Fe
County, San Miguel County, Colfax County, and the City of Espanola. All
juvenile inmates are held at the Santa Fe County Detention Center. The
Rio Arriba County Detention Center is billed for these services.
Billing records from these detention centers were reviewed during
this analysis and those aggregate costs as well as estimates of the
substance abuse and mental health related costs under study in this
report are included in a later section. They are estimated because the
billing records do not include information about criminal charges. Male
inmates are housed in these facilities only due to a lack of space
locally. There is no known reason why the patterns of criminal charges
observed at Rio Arriba County Detention would not apply to these other
adult male inmates. Therefore, for purposes of this report, the same
percentage of substance abuse and mental health related costs found at
the Rio Arriba County Detention Center is used to project similar types
of costs for adult male inmates at these other detention centers.
This report includes no projections for substance abuse and mental
health related costs for female and juvenile inmates because there are
no data on charges supplied with the billing records. Women are
primarily housed in the Santa Fe County Detention Center, but sometimes
also in the detention centers in San Miguel County, and Espanola.
Juveniles from Rio Arriba County are housed in the Santa Fe County
Detention Center.
Male and female inmates are combined on a single listing in the
billings from these detention centers to Rio Arriba County Detention.
In order to make the estimates about the male inmate population housed
at these other facilities, and for purposes of this report only, the
billing rosters were reviewed and, using first names of inmates, gender
was determined as male or female. This will provide a reasonably
accurate basis upon which to include these data for this report.
Cost data for medical care, provided by area clinics to inmates of
Rio Arriba Detention, were examined when available by reviewing
billings to the detention center. Though some of this information is
relatively complete, further research into these costs is warranted in
the future.
Costs are segmented by source in the sections that follow,
including: Rio Arriba County Detention Center inmates; Inmates housed
in other Detention Facilities; and Medical Procedures provided to
inmates in Rio Arriba County Detention Center.
results
Rio Arriba County Detention Center
The Rio Arriba County Detention Center houses male inmates only. It
housed an average of 72 inmates per day during the twelve month period
under review, with a total of 26,302 inmate days of detention for all
offenses or charges.
The table below shows the inmate days for the categories of
offenses or charges under study. The charges are grouped into five
categories (which are detailed in five tables that follow this
aggregate table). Those categories are DWI offenses, narcotics
offenses, domestic and child abuse offenses, liquor/minor offenses, and
disorderly conduct offenses.
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR SUBSTANCE ABUSE AND MENTAL HEALTH RELATED OFFENSES AND FOR
ALL TYPES OF OFFENSES--JUNE 1, 1997 TO MAY 31, 1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
DWI Offenses............................................. 4,417 210 524 5,151
Narcotics Offenses....................................... 1,377 97 444 1,918
Domestic/Child Abuse Offenses............................ 2,104 105 332 2,541
Liquor/Minor Offenses.................................... 488 20 .............. 508
Disorderly Conduct....................................... 21 ........... .............. 21
------------------------------------------------------
TOTAL SUBSTANCE ABUSE & MENTAL HEALTH RELATED 8,407 432 1,300 10,139
INMATE DAYS.......................................
======================================================
TOTAL INMATE DAYS FOR ALL OFFENSES....................... 25,005 1,297 NA 26,302
----------------------------------------------------------------------------------------------------------------
NA: Not available.
A total of 10,139 inmate days was used to house inmates for the
charges under study. This represents 38.55 percent of all inmate days
for the twelve month period under review.
It was observed during this study, especially from arrest reports,
that many inmates who were incarcerated for charges not examined in
this study, were in fact intoxicated or using narcotic drugs at the
time of arrest, or are admitted drug users or gang members. These types
of information are also collected by the detention center in
assessments of inmates. It can confidently be assumed that the
substance abuse and mental health related issues under study are
underestimated. Estimates of the fiscal impact are thus also
understated.
In order to project the fiscal impact, it was necessary to examine
the operating budget for the detention center. The total of
expenditures for the fiscal year that ends June 30, 1998 is $1,688,779
($1,580,129 budgeted) with some billings still outstanding. Additional
expense of $98,400 is included in other County budget lines, also with
outstanding billings (propane, $21,836; electricity, $28,561; $36,119,
building maintenance; telephone, $10,812; and postage, $1,072). This
total expense is $1,787,179. $600,000 of this is a line item for
payment to other detention facilities for housing inmates of Rio Arriba
County. Therefore the cost of the Tierra Amarilla facility alone is
$1,187,179 (acknowledging some outstanding billings). This total is
divided by the total inmate days in the table above, 26,302, for a
calculated cost per inmate day of $45.14. When this is multiplied by
the days noted in the table above for substance abuse and mental health
related charges the resulting projected cost to Rio Arriba County is
$457,674 for substance abuse and mental health related charges.
DWI and Related Charges
DWI and related charges were counted for the twelve month period.
Inmate days were counted for DWI, Aggravated DWI, Reckless or Careless
Driving, Open Container Violations, and Party to a Crime (charge levied
against passenger in DWI vehicle).
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR DWI AND RELATED CHARGES--JUNE 1, 1997 TO MAY 31, 1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
DWI...................................................... 2,991 137 524 3,652
Aggravated DWI........................................... 1,250 64 .............. 1,314
Reckless or Careless Driving............................. 132 6 .............. 138
Open Container........................................... 26 3 .............. 29
Party to a Crime......................................... 18 ........... .............. 18
------------------------------------------------------
SUBTOTAL........................................... NA NA NA 5,151
----------------------------------------------------------------------------------------------------------------
NA: Not available.
Narcotics Charges
Narcotics charges include: trafficking in (sale of) a controlled
substance, usually heroin or cocaine, occasionally marijuana;
possession of a controlled substance, usually heroin or cocaine; and
possession of drug paraphernalia.
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR NARCOTICS CHARGES--JUNE 1, 1997 TO MAY 31, 1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
Trafficking in Narcotics................................. 585 52 208 845
Possession of Narcotics.................................. 635 37 236 908
Possession of Drug Paraphernalia......................... 157 8 .............. 165
------------------------------------------------------
SUBTOTAL........................................... NA NA NA 1,918
----------------------------------------------------------------------------------------------------------------
NA: Not available.
Domestic and Child Abuse Charges
Domestic and Child Abuse Charges, though not specifically substance
abuse or mental health offenses, are presumed to have a strong
correlation with substance abuse and mental health behaviors. The
County has requested that they be included in this study. Domestic and
Child Abuse Charges include: domestic violence, assault/battery against
a household member, and violation of a restraining order; child abuse
and criminal sexual penetration of a minor.
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR DOMESTIC AND CHILD ABUSE CHARGES--JUNE 1, 1997 TO MAY 31,
1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
Domestic Abuse or Violence, etc.......................... 1,619 79 106 1,804
Child Abuse.............................................. 46 ........... .............. 46
Criminal Sexual Penetratn. Minor......................... 439 26 226 691
------------------------------------------------------
SUBTOTAL........................................... NA NA NA 2,541
----------------------------------------------------------------------------------------------------------------
NA: Not available.
Liquor/Minor Charges
Liquor/Minor Charges include: contributing to the delinquency of a
minor; providing liquor to minors; and other liquor violations, usually
unlawful sale or distribution (not necessarily involving a minor).
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR LIQUOR/MINOR CHARGES--JUNE 1, 1997 TO MAY 31, 1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
Contributing to Delinquen. Minor......................... 410 19 .............. 429
Providing Liquor to Minor................................ 31 ........... .............. 31
Other Liquor Violations.................................. 47 1 .............. 48
------------------------------------------------------
SUBTOTAL........................................... NA NA NA 508
----------------------------------------------------------------------------------------------------------------
NA: Not available.
Disorderly Conduct Charges
Disorderly Conduct Charges have been found to frequently, if not
always, be levied against individuals who are intoxicated, mentally ill
and in crisis or acting out, and/or homeless individuals. For this
reason they are included in this cost analysis. Disorderly conduct
charges were not typically detailed on the daily inmate rosters; when
they were specified they included charges such as fighting or
trespassing. Other possible causes for a disorderly conduct charge
include disturbing the peace, creating a public nuisance, loitering,
prowling, threatening, using abusive or obscene language, reporting a
false fire, damaging property, refusing to leave private or public
property when ordered, obstructing an officer, etc.
RIO ARRIBA COUNTY DETENTION CENTER INMATE DAYS FOR DISORDERLY CONDUCT--JUNE 1, 1997 TO MAY 31, 1998
----------------------------------------------------------------------------------------------------------------
Estimated
Inmate Days Inmate Days Projected
Charge from Daily for Days Inmate Days TOTAL
Rosters with No from Warrant INMATE DAYS
Roster Incarcerations
----------------------------------------------------------------------------------------------------------------
Disorderly Conduct....................................... 21 ........... .............. 21
------------------------------------------------------
SUBTOTAL........................................... NA NA NA 21
----------------------------------------------------------------------------------------------------------------
NA: Not available.
Other Detention Facilities
Santa Fe County Detention Center (Cornell Corrections,
Inc.)
Billing records were examined from the Santa Fe County Detention
Center, which is operated by Cornell Corrections, Inc. Before July
1997, it was operated by Corrections Corporation of America (CCA).
Records for February 1998 were not available for review. For this
reason, the review period began with May 1997. In addition, the billing
records for May 1998 had not been received and processed as of the date
of this report. The eleven months that were reviewed were totaled and
annualized to create a twelve month profile.
Since gender is not included on the rosters, adult male inmates
were identified from inmate rosters using the first name as an
indicator. Adult males comprise 58 percent of the population billed,
and thus 58 percent of the total costs.
A factor of 38.55 percent, as determined by analysis of the data
reported above from the Rio Arriba County Detention Center, is then
used to project a cost for substance abuse and mental health related
charges for adult male inmates housed in the Santa Fe County Detention
Center. Charges for inmates are recorded at the Santa Fe County
Detention Center. These were requested of Cornell Corrections but could
not be obtained at this time. It is therefore recommended that Rio
Arriba County request that this information be routinely included as a
part of the billing records so that this information will be available
in the future.
Rio Arriba County Costs for Housing Rio Arriba County Adult Male Inmates
at the Santa Fe County Detention Center with Substance Abuse and Mental
Health Related Charges
Actual Cost to House Adult Inmates for 11 Months Using
Available Billing Data.................................... $158,594
Annualized, 12 Month Projected Cost to House Adult Inmates.... $173,012
Adult Male Inmate Days (from 11 Months' Data, using first
names as indicator of gender)............................. \1\ 1,170
Annualized, 12 Month Cost to House Adult Male Inmates
($173,012 58 percent)........................... $100,347
Annualized Projected 12 Month Cost for Substance Abuse and
Mental Health Related Charges for Adult Males ($100,347
38.55 percent).................................. $38,684
\1\ 58 percent of total.
As is shown in the table above, the annualized, projected 12 month
cost to house Rio Arriba County adult male inmates (who for lack of
space in the Rio Arriba County Detention Center are held elsewhere) in
the Santa Fe County Detention Center is $100,347. Of this amount,
$38,684 is estimated to be for substance abuse and mental health
related charges.
San Miguel County Detention Center
Billing records were examined from the San Miguel County Detention
Center for the period of June 1997 through May 1998. Records for
February 1998 were not available for review. Since the February 1998
billing information was not available, the eleven months that were
reviewed were totaled and annualized to create a twelve month profile.
Since gender is not included on the rosters, adult male inmates
were identified from inmate rosters using the first name as an
indicator. One of the eleven months of billing information did not have
inmate rosters attached, so ten months of rosters were used to
establish these male/female ratios. Adult males comprise 75.5 percent
of the population billed, and thus 75.5 percent of the total costs.
A factor of 38.55 percent, as determined by analysis of the data
reported above from the Rio Arriba County Detention Center, is then
used to project a cost for substance abuse and mental health related
charges for adult male inmates housed in the San Miguel County
Detention Center. As with Santa Fe County, it is also recommended that
Rio Arriba County request of San Miguel County that criminal charge
information be routinely included as a part of the billing records so
that this information will be available in the future.
Rio Arriba County Costs for Housing Rio Arriba County Adult Male Inmates
at the San Miguel County Detention Center with Substance Abuse and
Mental Health Related Charges
Actual Cost to House Adult Inmates for 11 Months Using
Available Billing Data.................................... $86,269
Annualized, 12 Month Projected Cost to House Adult Inmates.... $94,112
Adult Male Inmate Days (from 10 Months' Data, using first
names as indicator of gender)............................. \1\ 695
Annualized, 12 Month Cost to House Adult Male Inmates ($94,112
75.5 percent)................................... $71,055
Annualized Projected 12 Month Cost for Substance Abuse and
Mental Health Related Charges for Adult Males ($71,055
38.55 percent).................................. $27,392
\1\ 75.5 percent of total.
As is shown in the table above, the annualized, projected 12 month
cost to house Rio Arriba County adult male inmates (who for lack of
space in the Rio Arriba County Detention Center are held elsewhere) in
the San Miguel County Detention Center is $71,055. Of this amount,
$27,392 is estimated to be for substance abuse and mental health
related charges.
Colfax County Detention Center
During the period in review, the Colfax County Detention Center
held one inmate for Rio Arriba County from November 21, 1997 to May 6,
1998. This inmate was incarcerated for substance abuse charges. The
total cost was $11,787 as indicated on billing records, which also
included medical costs for the inmate.
City of Espanola Detention Facility
The City of Espanola Detention Center also holds inmates for Rio
Arriba County. Many of the inmates are held for very short periods of
time (less than a day) and transported to the Rio Arriba County
Detention Center for incarceration or to Magistrate Court for
arraignment. Some female inmates are also held here for short periods
of time. Billings are therefore not based on inmate days, but on
various hourly rates. From billing records of four months that could be
examined, the monthly charges for all inmate categories and charges
ranges from a low of $1,584 to a high of $8,694, with monthly Rio
Arriba County inmate totals ranging from 55 to 70.
The four months of data that could be examined have been annualized
below. Because of the hourly billing procedures, inmate days are not
easily determined. However, adult male inmates were identified by first
name and a ratio used to determine costs prorated for adult male
inmates for the year. A factor of 38.55 percent, as determined by
analysis of the data reported above from the Rio Arriba County
Detention Center, is then used to project a cost for substance abuse
and mental health related charges for adult male inmates housed in the
City of Espanola Detention Center. As with Santa Fe County, it is also
recommended that Rio Arriba County request of the City of Espanola
Detention Center that criminal charge information be routinely included
as a part of the billing records so that this information will be
available in the future.
Rio Arriba County Costs for Housing Rio Arriba County Adult Male Inmates
at the City of Espanola Detention Center with Substance Abuse and Mental
Health Related Charges
Actual Cost to House Adult Inmates for 4 Months Using
Available Billing Data.................................... $25,398
Annualized, 12 Month Projected Cost to House Adult Inmates.... $76,194
Adult Male Inmates (from 4 Months' Data, using first names as
indicator of gender)...................................... \1\ 224
Annualized, 12 Month Cost to House Adult Male Inmates ($76,194
86.8 percent)................................... $66,136
Annualized Projected 12 Month Cost for Substance Abuse and
Mental Health Related Charges for Adult Males ($66,136
38.55 percent).................................. $25,495
\1\ 86.8 percent of total.
As is shown in the table above, the annualized, projected 12 month
cost to house Rio Arriba County adult male inmates (who for lack of
space in the Rio Arriba County Detention Center are held elsewhere, and
in the case of Espanola Detention, are housed for short periods of time
awaiting transport to Tierra Amarilla) in the City of Espanola
Detention Center is $66,136. Of this amount, $25,495 is estimated to be
for substance abuse and mental health related charges.
Medical Procedures for Inmates
Rio Arriba County Detention Center pays for medical care provided
to its inmates. Calculation of medical costs for substance abuse and
mental health related incidents has not been done as a part of this
project because of the complications of dealing with confidential
medical information. The billings to the detention center do not
include diagnosis information as this would violate confidentiality
requirements. It is possible that these data could be tracked by inmate
and matched with criminal charge, which would allow at least all
medical care costs to be calculated for inmates incarcerated under one
of the charges in this study. However, to do this manually is a very
large research task that falls beyond the scale of the present study.
It also would not capture substance abuse and mental health care
provided for other inmates. Clearly, this area requires further study.
Medical cost data that could be collected within the present
project are reported below and include overall medical costs to the
detention center as billed by the clinics who serve these patients. In
order to project a cost related to substance abuse and mental health
related inmates, the factor of 38.55 percent (determined above from
detention center charges) is used to prorate each aggregate medical
cost. It should be noted that this rate produces a very conservative
estimate of substance abuse related costs for two reasons. It is known
that substance users or abusers use a disproportionately high level of
medical care, both physical and behavioral. In addition, this ratio
accounts only for projected medical costs of inmates held for substance
abuse related criminal activity, not for substance abuse related costs
of other inmates.
La Clinica del Pueblo de Rio Arriba
Information on medical costs for inmates of Rio Arriba Detention
was received from La Clinica del Pueblo de Rio Arriba. The total of all
charges for June 1, 1997 through May 31, 1998 for medical care of all
types was $8,378.69 for 182 encounters; 38.55 percent of total medical
costs: $3,229.98.
Health Centers of Northern New Mexico (Chama)
Information on medical costs for inmates of Rio Arriba Detention
was received from Health Centers of Northern New Mexico. The total of
all charges for June 1, 1997 through May 31, 1998 for medical care of
all types was $5,779.23 for 94 encounters, 89 male, 5 female. The male
prorated amount is $5,471.77 (94.68 percent); 38.55 percent of total
medical costs: $2,109.36.
Other Providers.--It is unknown what portion of the costs for other
providers is related to substance abuse and mental health related
charges. However, the following amounts were paid or projected for a
twelve month period:
Rio Drugs of Chama: information was obtained from year to date
billings. From calendar year 1997, one half ($5,568.35) of total
charges ($11,136.69) was used. From calendar year 1998, information on
costs through June 6 ($4,206.63) was projected as a six month total of
$4,853.82. The combined total of $5,568.35 and $4,853.82 is $10,422.17.
Dr. Ray Martin (dental): total charges during the period under
review: $937.00.
Dr. Gabriela Munoz: total charges during the period under review:
$167.35.
Combined medical costs to Rio Arriba Detention Center from these
three providers is $11,526.52. As was noted, it is unknown what portion
of this cost is related to substance abuse and mental health charges or
reasons. It may be appropriate to study these issues in further detail
in the future. For substance abuse and mental health related
projections for this study, 38.55 percent of total medical costs is
$4,443.47
summary and recommendations
Summary
The total detention related costs to Rio Arriba County for adult
males--as reported in the body of this document--of substance abuse and
mental health related charges, as well as projected medical costs for
these inmates, are summarized and reported in the table below.
Rio Arriba County Costs to Rio Arriba County Originating from Detention
of Adult Male Inmates Due to Substance Abuse and Mental Health Related
Charges and Costs Related to Medical Care of these Inmates--June 1997
through May 1998
Source of Cost Cost
Rio Arriba County Detention Center............................ $457,674
Santa Fe County Detention Center.............................. 38,684
San Miguel County Detention Center............................ 27,392
Colfax County Detention Center................................ 11,787
City of Espanola Detention Center............................. 25,495
La Clinica del Pueblo de Rio Arriba........................... 3,230
Health Centers of Northern New Mexico......................... 2,109
Other Health Care Providers................................... 4,443
--------------------------------------------------------------
____________________________________________________
GRAND TOTAL............................................. 570,814
As is clear from this table, the financial costs to Rio Arriba
County, through detention, for substance abuse and mental health
related charges are substantial.
Recommendations
Shaening and Associates recommends that a computerized data system
be put in place in the Rio Arriba County Detention Center to track, in
an integrated fashion, all cost and assessment data, including charge,
length of stay to date, bond and sentence information, medical
assessment information as reported by inmate, medical costs for each
inmate, and the many other items of use to Detention Center
administrators and the County. It is recommended that this system be
linked to a similar system in the Magistrate Court that tracks court
proceedings and outcomes. A similar linkage to the County's main office
may serve the interests of all by making the accounts payable function
automated for reporting and record-keeping functions of these large
sums of dollars.
Information on underlying charges and remand to custody status can
be automatically added to client records through an integrated computer
system linked to Magistrate Court. Until this is a reality, Shaening
and Associates recommends that this information be recorded on a
centralized or master list of inmates that does not otherwise add to
the record-keeping burden of detention staff. This will allow the
collection of not only the kinds of information in this report, but
will have other uses as well.
Shaening and Associates recommends that incident data for
protective custody and mental hold cases, without identification of
individuals, be kept by the detention center so that costs associated
with these situations can be determined in the future.
Shaening and Associates recommends that the County request other
detention centers that bill Rio Arriba County for housing inmates to
include information on charges as a routine part of the monthly billing
process. No data on criminal charges for inmates held in other
detention centers, male or female, are currently available to the Rio
Arriba County Detention Center. It is possible that this information is
available manually from Magistrate Court, but even so, an automated
listing from other detention centers requires only a different report
format. It is unknown whether there is a reason to also request further
information from Santa Fe County Detention Center on juvenile
detainees, but this should be considered as to pro's and con's, as well
as the legal and confidentiality issues this would create.
As noted previously, there were many observed substance abuse
related narratives in the arrest reports of individuals not otherwise
counted in these data. The data reported here for detention costs
relate to specific criminal charges only, and are therefore quite
conservative in relation to the true impact of substance abuse and
mental health related costs. To obtain a true picture of the impact of
substance use on the County budget for detention, it would be necessary
to read the arrest and assessment documents for a large sample of
inmates. However, this is a large undertaking and probably is not
necessary for the present project.
Senator Domenici. Thank you very much. I must confess to
you all that having been a Senator for 26 years, it means that
I am showing my age, and so we are going to have you talk, but
first we are going to have a recess, and if any of you needs a
recess, you can avail yourself of it. If not, we will start
back up in about eight or nine minutes. We are in recess.
[A brief recess was taken.]
Senator Domenici. We are going to proceed now with your
talk about the plan. Can you do that in 10 minutes?
Ms. Reichelt. Yes.
Senator Domenici. I would appreciate it very much. We are
going to start. We have 10 minutes remaining with this panel,
and then we will go with your State witnesses. Will you please
proceed.
Ms. Reichelt. Senator, I thank you for the opportunity to
testify and, like our county manager, I have never even talked
to a Senator, let alone testified, so it's a real honor and
very intimidating.
Senator Domenici. You talked to me before. You didn't seem
intimidated.
Ms. Reichelt. Right. I am the Director of County Health and
Human Services Department for the County of Rio Arriba, and
it's my job to try to assist our health and human-service
providers to coordinate their activities. Originally we didn't
start out to address the substance abuse problem. We began with
the project called ArribaCare, which was an attempt to create a
county-wide health care financing system, probably insurance,
to finance primary health care for the medically indigent. What
we very quickly found was we were looking at the indigent funds
as a course of money for this, but we found that we could not
even begin to think about using the indigent funds to finance
primary care until we addressed the substance abuse problem.
The reason for this is that the bulk of--we don't know the
exact number. I am just guessing--it's just almost all of the
hospital's unreimbursed costs are due to substance abuse, and
so if we do that, we would cause a collapse of the hospital,
which certainly wasn't our intent. I would just like to say
that ArribaCare is a project of Robert Johnson--the policies
and the funding. Robert Johnson was down here for this event.
So as a result of that, we felt we had to create a
secondary objective to ArribaCare, which is create an
integrated prevention and treatment system, which is needed for
emergency care, and which is totally relevant. We began by
addressing the issue of planning around substance abuse. The
planning method that we used was unique in that instead of
beginning with activities to address need or demands, we began
with creating outcomes or measures of success, and I would like
to say right off the bat that this was an extremely
participatory process, especially for the short period of time
that we had to do it. We convened two workshops where we had
all of our major providers represented, and just interested
parties as well. We disseminated the plan to about 300 people
with instructions for how to proceed. We went to different
areas of the county and made the plan available for comment to
the Chama Valley Health Coalition and to the DWI Counsel to
include law enforcement and the people from the north. The
final result was approved by the County last week.
When we say we began with the indicators, what we did was
we asked the participants to set criteria for success around
the strategy that we targeted what we wanted to work with. So
one of the problems that we have had with substance abuse and
substance abuse treatment and prevention in Rio Arriba County
is we've been spending a lot of money because we don't have
evaluation in many cases as part of the program, and we don't
exactly know what outcomes we are striving to achieve. The
providers set very clear targeted outcomes, and I believe that
this is really going to improve the quality of services in Rio
Arriba County. I would like to say a little bit about the
content of the plan.
Senator Domenici. What kinds of services will they improve?
Ms. Reichelt. It will improve both prevention and treatment
services, and if I can expand on that a little bit by turning
to the plan, for example, and this is on page 16 under
``Education and Information Dissemination.'' Some of the
outcomes that were created were improvement in academic
performance of participants in substance abuse education
programs. In other words, what we are asking for the State and
the Federal Government to do is to look at that criteria when
they fund the program. If it is not actually improving the
behavior of the participants in the program, as opposed to just
self-reporting that they feel better, then it's not an
effective program. Let's see if I can find another one in here.
There is quite a lot, I think, in terms of outcomes that we
listed under treatments. Primarily under treatment, we really
looked at access and creating a scope of treatment and that
speaks more to coordination and availability of services.
So if I skim just a little bit to the contents of the plan,
what the providers agreed upon is that there are three
strategies that we want to target for new activities and new
funds this year. They want to fund treatment identification and
referral and environmental strategy. What this means, treatment
means treatment for substance or alcohol abuse, and we really
have a poly-substance problem. We don't want to look at it as a
heroin problem or an alcohol problem. We want to look at it as
a substance dependency problem because we are finding that most
of the people who present with poly-substance symptoms and----
Senator Domenici. What if they're just heroin users and not
alcoholics?
Ms. Reichelt. If they are just heroin users, they can be
treated simply for heroin, but in terms of funding it, one of
the problems we have right now is a lot of the funding is
categorical. For example, we have an alcoholism treatment
center, that if they want to treat heroin addicts, they have to
first prove that the patients are alcoholics. We want to get
away from the problem and just be able to treat individuals for
substance abuse problems, whether it's alcohol or heroin,
whether they are youth or whether they are older.
Senator Domenici. Well, that sounds great, but treating
alcoholics is different than treating heroin addicts, and
whenever you have a program to treat heroin, then you are
suggesting that won't work unless it was poly--whatever you
called it?
Ms. Reichelt. No, I am not suggesting that. What we need to
do is to create more of, I think, a continuum of treatment so
that whatever somebody has, they can be treated for it. We want
to eliminate the gaps in services, and to have the treatment
providers coordinate with one another so that individuals do
not have to go to a different place to be treated, say, for
heroin than treated for alcohol. Or at least it's nearby, so
that if someone does present with both problems, that it's
possible to treat them for both problems.
Senator Domenici. Do we have some kind of a problem here
where the people who treat for alcoholism are concerned that
they won't be funded, because we are going to fund heroin
treatment?
Ms. Reichelt. I would actually like to refer that one, if
you don't mind, to Lorenzo as a former treatment provider.
Senator Domenici. Let's don't do that. Let me just do this.
We are going to make your plan a part of the record, as you
say, but your time is very close. I want to ask a couple of
very practical questions of any of the three of you. You know I
have spent a great deal of time, whether I am right or wrong, I
don't know, trying to get the Feds and State to focus on making
available, consistent with the local needs, the maximum
resources to help address this issue. Now frankly, I think we
are in a position where when you finish hearing from the
cabinet people, and you have heard the Federal people, I think
they are going to say we are ready to do that. Now, what I am
now beginning to worry about is are you ready for them to do
that? I think it's very important that you all decide who it is
that is going to be in charge of this program, and if it's more
than one entity, then at least there ought to be somebody that
recognizes that there's more than one. They are all trying to
do the same thing. They are not trying to double up, and you
already have a competition between two countywide planning
organizations. It's not for me to decide, but you have Rio
Arriba Family Care Network and you have La Vision del Valle,
and frankly, sooner or later it seems to me somebody has to
decide if the Feds and the State are going to be saying ``We
want to come down here and work with you to get the resources
in,'' they have to know with whom to deal. I think being a good
manager, you know that, and I don't care if you tell me today,
but I want to make the point that sooner or later, that must
happen.
Mr. Valdez. We are local government. We have our
responsibilities to create plans for all manner of activities
in the County, including land use, health, everything that
impacts the health, safety and welfare of our community. We are
not giving our responsibility to anyone. I have attended
meetings with La Vision del Valle. There are a lot of good
people there. I am aware of RAFCN--same thing there.
The Board of County Commissioners, before this issue arose
2 years ago, signed and passed the resolution designating Rio
Arriba Family Care Network (RAFCN) as the health care council
to the Commission. At that time, La Vision was not organized,
and we were encouraging everyone to come to the table to help
us plan, excluding no one.
Ms. Reichelt. I would also like to say something about the
structure of the relationship between the County and Rio Arriba
Family Care Network. The Rio Arriba Family Care Network has
members which pay a member fee and belong to a particular
category, so we know there is commitment, and 51 percent of
their government board has to be made up, at any time, of local
resident direct service providers, which means that they must
have an office in Rio Arriba, provide services in Rio Arriba
and 69 percent of their government body must be residents in
Rio Arriba. The reason why this arrangement has worked out with
the providers was, first of all, the providers do not want to
come under the County because they are afraid of patronage, and
this was an arrangement the County worked out to ease their
concerns, and secondly, because we need to have an entity that
the Commission feels sure is responsive to the people of Rio
Arriba County.
[The information follows:]
Adoption of Rio Arriba Strategic Plan for Substance and Alcohol Abuse
and Treatment
resolution 1999-61
Whereas, the Rio Arriba Maternal Child Health Council listed
substance and alcohol abuse and their corollary impacts as the greatest
threat to the health of the residents of Rio Arriba County in their
most recent county-wide needs assessment.
Whereas, the Rio Arriba Family Care Network has determined that
ArribaCare cannot be successfully implemented without reducing un-
reimbursed hospital costs, and has determined that substance and
alcohol abuse are the greatest contributors to that cost.
Whereas, the State of New Mexico leads the nation and the County of
Rio Arriba leads the state for per capita deaths attributed to heroin
overdose.
Whereas, the incidence of deaths attributed to homicide for both
men and women leads New Mexico at over three times the statewide rate.
Whereas, cirrhosis in men is a leading cause of death at over three
times the statewide rate.
Whereas, Rio Arriba ranks third among New Mexico counties in deaths
of men from alcohol-related accidents and fourth in suicide.
Whereas, Rio Arriba County ranks ninth for alcoholism, diabetes and
HIV-AIDS related deaths, primarily from injection-drug use.
Whereas, the Rio Arriba Years of Potential Life Lost (YPLL) index
surpasses the state by 116.0 to 81.5. Three of the top four causes of
death in Rio Arriba resulting in the highest YPLL are accidents,
homicide and suicide.
Whereas, these corollary impacts of substance and alcohol abuse
both increase the cost of health care and decrease the quality of life
for all Rio Arribans.
Whereas, the County of Rio Arriba spent a minimum of $570,814
housing inmates for crimes directly related to substance abuse over a
one-year period from June, 1997 to May 1998.
Whereas, the County of Rio Arriba is currently spending $2,965,975
out of a total operating budget of $10,186,875 on enforcement. It is
likely that tax-payers are spending at least $1,143,383, or 10 percent,
of the County's operational budget, and probable that they are spending
$2.2 million, or 20 percent, on substance and alcohol abuse-related
enforcement costs.
Whereas, The United States loses $37 billion per year from alcohol-
related illnesses and injuries, and $8 billion per year to illness and
injury caused by drugs. Approximately $11 billion of total U.S. health
care costs are the result of alcohol abuse. Another $4 billion are
caused by the abuse of other drugs. In addition, we spend $16 billion
on crimes related to property loss caused by alcohol abuse and $46
billion on crimes related to property loss caused by other drugs. The
County of Rio Arriba spends proportionally more per capita on substance
abuse than the national average.
Whereas, a recent report by the California Department of Alcohol
and Drug Programs showed that for each dollar spent on substance and
alcohol abuse treatment, seven dollars is saved in crime and health
care costs. California has spent $209 million on treatment and has
estimated savings of $1.5 billion. Studies in Oregon have showed that
once treatment was initiated, arrest rates dropped, as did use of the
welfare and food-stamp systems. In fact, the study showed that wages
increased by 65 percent as a result of treatment. Medical costs
decreased simultaneously. Thus, every tax dollar spent on treatment
produced $5.60 in avoided costs to the tax-payer. Similarly, Minnesota
found that introduction of substance abuse treatment resulted in a 65
percent decrease in cost to the state through decreased utilization of
health care facilities and prisons.
Whereas, according to the New Mexico Department of Health, local
providers received $780,448 for prevention of substance and alcohol
abuse in fiscal year 1997-98, a per capita expenditure of $20.77. This
represents the third highest per capita expenditure on substance abuse
prevention in the state of New Mexico. Rio Arriba also surpasses the
state-wide average for treatment services.
Whereas, at the same time, according to the New Mexico Department
of Health, in fiscal year 1997-98 Rio Arriba's outcome indicators for
substance abuse (mortality, DWI and Crashes/Fatalities) were the second
worst in the State.
Whereas, all major Rio Arriba providers of substance and alcohol
abuse prevention and treatment, as well as Rio Arriba providers of
primary and emergency care gave generously of their time to participate
in the County's planning effort.
Whereas, representatives of justice and law enforcement were also
included in the planning process through the DWI council, and
representatives of the North County were included through the Chama
Valley Health Coalition.
Whereas, the process was science-based and comprehensive and
participants were able to reach consensus on the need for improved
coordination of prevention and treatment services as well as on the
contents of a plan.
NOW, THEREFORE, BE IT RESOLVED that The Board of Rio Arriba County
Commissioners, representing the tax-payers and citizens of Rio Arriba
County, has determined that addiction has become an epidemic in Rio
Arriba County and must be addressed as an emergency using the
principals of public health and epidemiology. This entails an inclusive
planning process leading to a system of substance and alcohol abuse and
prevention which is integrated into primary and emergency care. The
Board of Rio Arriba County Commissioners adopts the Rio Arriba
Substance and Alcohol Abuse Prevention and Treatment Plan as its
official county plan for purposes of all health and human planning
efforts and for coordination of new and existing services. The Board of
Rio Arriba County Commissioners strongly urges relevant state and
federal agencies and private foundations to require conformance with
this plan as a condition of funding for substance and alcohol abuse
prevention and treatment in the County of Rio Arriba.
Passed, adopted and approved this 25th day of March, 1999.
Board of County Commissioners,
Rio Arriba County, New Mexico.
Alfredo L. Montoya,
Chairman, District II.
Moises A. Morales,
Commissioner, District III.
Ray R. Tafoya,
Commissioner, District I.
ATTEST: Fred Vigil, County Clerk.
Rio Arriba Strategic Plan for Substance and Alcohol Abuse Prevention
and Treatment
executive summary
Providers agreed to target three strategies for new activity. These
include Environmental, Treatment, and Identification & Referral. We are
requesting your assistance locating funding for these strategies.
We agree that consensus and coordination are essential to our
success. We request that future funding be dependent upon our ability
to demonstrate that: (1) the proposed activity addresses an actual
need; (2) that the activity is an effective activity; and (3) that the
activity is in conformance with the County's strategic plan.
We agree that Rio Arriba must establish formal protocols and
procedures for future planning efforts. Protocols must include the
County's efforts at community planning, as well as provider attempts to
initiate activities that impact one or more local governments. The
County is working with the community and its providers to establish
internal protocols. The County will work with local school boards,
neighboring counties, local municipalities, tribes and regional
entities such as the Regional Care Coordinators to establish multi-
entity protocols.
We request that state and federal funding agencies uphold
protocols. We have agreed to hold off on creating new alternative
activities until protocols are in place since these activities
frequently impact more than one local government, and are resource-
intensive. We exempt after-school care from this category as it usually
falls under the auspices of a single entity such as a school district,
and is sorely needed. We do request assistance locating resources for
quality after-school care and child care.
We recognize the need to evaluate educational prevention
activities. We request federal assistance conducting this evaluation.
We also request that either the county or its local health council
conduct the evaluation in order to insure both local control and
neutrality.
We recognize the need to distribute educational prevention
activities fairly throughout the County. We request the assistance of
state and federal funding agencies in this matter.
Rationale for a County-Wide Substance Abuse Prevention and Treatment
Plan in Rio Arriba County, New Mexico
In 1996, the Rio Arriba Maternal Child Health Council (RAMCHC)
identified substance abuse and its corollary impacts as the greatest
threat to the health of County residents. The incidence of deaths
attributed to homicide for both men and women leads New Mexico at over
three times the Statewide rate. Cirrhosis in men is also a leading
cause of death, again at triple the state rate. Rio Arriba ranks third
among New Mexico counties in deaths of men from alcohol-related
accidents and fourth in suicide. Alcoholism, diabetes and HIV-AIDS
related deaths, primarily from injection drug use, all ranked ninth.
Besides homicide and cirrhosis, the greatest incidence of death for
women is diabetes mellitus, which is related to poverty and lack of
access, but which can be exacerbated by substance and alcohol abuse.
Many years of potential life are lost due to conditions related to
substance and alcohol abuse. Rio Arriba years of potential life lost
index (YPLL) surpasses the state by 116.0 to 81.5. The top three causes
of death in Rio Arriba resulting in the highest YPLL are accidents,
homicide, suicide and malignant tumors. Rio Arriba is the second
highest county for DWI deaths. New Mexico leads the nation in per
capita deaths from heroin overdose, and Rio Arriba leads New Mexico.
The Rio Arriba Maternal Child Health Council (RAMCHC) recently
commissioned a study to determine the cost of substance abuse to tax-
payers in Rio Arriba County. Shaening and Associates examined the costs
of adult males incarcerated for charges directly related to substance
abuse and behavioral health such as DWI, narcotics trafficking,
domestic violence, etc. They considered only that data which was housed
at the TA detention center. They did not look at data for females or
juveniles since it was not locally available. They also did not
consider data for charges indirectly involving substances such as
breaking and entering, since that data is housed elsewhere as well. The
most conservative possible estimates were used in all cases. Hence, it
can be assumed that our figures are the lowest possible estimate of the
cost of substance/alcohol abuse to the County of Rio Arriba.
Shaening and Associates determined that 38.55 percent of all inmate
days at the T.A. detention center are the direct result of substance/
alcohol abuse and other behavioral health problems, resulting in a cost
to the County of $570,814. This does not include administrative costs
associated with holding these inmates, nor does it include the cost of
their apprehension. The RAMCHC studied the period from June 1, 1997
through May 31, 1998.
The Rio Arriba County Sheriff's Departmental budget for the current
fiscal year is $1,108,426. Detention center costs for the current
fiscal year are $1,857,549. This means that the County is spending a
total of $2,965,975 out of a total operating budget of $10,186,875 on
enforcement. In other words, Rio Arriba, an impoverished County, is
forced to spend 29.1 percent of its total operating budget catching and
locking up criminals. If we estimate that 38.55 percent of the
enforcement budget is the result of substance/alcohol abuse, we can say
conservatively that local taxpayers are spending $1,143,383 or 10
percent of the County's operational budget holding substance abusers.
This is money that cannot be used for schools, economic development,
health care, roads, etc.
Because this study is preliminary, and we still lack data about
juveniles, women and other offenses, it is safe to assume that our
figures are extremely low. It is likely that the true figure is closer
to 20 percent, or approximately $2.2 million.
According to the New Mexico Department of Health, local providers
received $780,448 for prevention of substance and alcohol abuse in
fiscal year 1997-98, a per capita expenditure of $20.77. This
represents the third highest per capita expenditure on substance abuse
prevention in the state of New Mexico. Likewise, Rio Arriba County is
outspending the rest of the state in substance abuse treatment. At the
same time, in fiscal year 1997-98 our outcome indicators for substance
abuse (mortality, DWI and Crashes/Fatalities) were the second worst in
the state. High expenditures and poor outcomes indicate a lack of
planning and oversight within this area.
The Board of Rio Arriba County Commissioners believes that
addiction has become an epidemic in Rio Arriba County, and that we can
only end the epidemic through a public health approach. This entails an
inclusive planning process leading to a system of substance and alcohol
abuse and prevention which is integrated into primary and emergency
care. A coordinated service delivery system will result in a reduction
in substance abuse rates in Rio Arriba County.
All of Rio Arriba's constituents are adversely impacted by this
epidemic. Substance abuse depresses the local economy, impedes learning
in the schools, decreases safety on the roads and in communities, and
drives up the cost of health care astronomically. The Board of Rio
Arriba County Commissioners believes it must provide leadership and
direction to attack the epidemic.
the planning process
The County of Rio Arriba has conducted its strategic planning
process in collaboration with its designated local health council, the
Rio Arriba Family Care Network (RAFCN). RAFCN contracted all
facilitators, provided meals, equipment and materials, and prepared
packets and mailings for all meetings. Beth Leopold of the Northern New
Mexico Health Care Alliance, and Ron Hale of Hale and Associates, were
contracted by RAFCN to lead Rio Arriba providers through a ``Systems
Thinking'' process. We were also assisted by Christino Griego, the San
Miguel DWI Coordinator.
The object of Rio Arriba's planning process has been to assist
providers to develop a science-based substance abuse prevention and
treatment plan. The plan should aid us to integrate prevention and
treatment into the primary and emergency care system.
Before embarking upon any planning activities, RAFCN and the
District II Public Health Office jointly encouraged potential
participants to attend the New Mexico Department of Health Behavioral
Service Division (BHSD) Espanola workshop on effective prevention
strategies. Participation in the BHSD workshop was heavy and included
many of the planning partners.
Our planning tool made use of eight potential strategies:
Environmental, Community Processes, Identification and Referral,
Alternative Activities, Education and Information Dissemination,
Treatment, Sustained Coordinated Effort, and Youth Development as
Primary Prevention. The first five strategies are CSAP (Center for
Substance Abuse Prevention) strategies, and are listed in order of
proven effectiveness. Three more strategies were added because research
has consistently proven their necessity: Treatment, Sustained
Coordinated Effort, and Youth Development as Primary Prevention. In an
ideal world, the CSAP strategy Community Processes would encompass
Sustained Coordinated Effort. Similarly, the strategy Youth Development
as Primary Prevention could be subsumed under the CSAP strategies
Education and Information Dissemination, and Alternative Activities. We
added these categories because Rio Arriba has not yet approached the
ideal, and we wished to emphasize the purpose of the CSAP strategies.
In other words, we wished to emphasize that Community Processes should
lead to Sustained Coordinated Effort. Alternative Activities and
Education/Information Dissemination should lead to Youth Development as
Primary Prevention.
Initially, we convened a small group of providers to set the
workshop agenda. We then convened larger groups of providers,
representatives of community organizations and interested citizens for
two full-day workshops. In the first workshop we established a common
aim: to reduce substance and alcohol abuse in Rio Arriba County, New
Mexico. We then examined current substance abuse reduction activities
(the resource assessment) and current gaps in services (the needs
assessment). Finally, we began to work with participants to describe
and identify outcome indicators.
The systems thinking approach to strategic planning is unique
because it encourages the group to identify measures of success before
activities. First we all reached consensus regarding our group
definition of success. We agreed upon outcome indicators to measure our
success. Only then did we begin to ask ourselves what sort of
activities would move the outcome indicators, or produce success.
Focussing on the indicators before discussing activities insures
that two things will happen: (1) The group will select activities
designed to improve outcomes rather than competing over pet projects;
and (2) the group will be encouraged to engage in continuous evaluation
and adjustment instead putting off evaluation until project completion
(the usual scenario).
In our second workshop, we established general criteria for a good
plan. We then identified criteria for selecting our target strategies
and selected those strategies. Finally, we re-visited our outcome
indicators for those strategies, and selected activities designed to
move those indicators.
A wide variety of providers attended our workshops. This included
representatives of two school districts (Mesa Vista and Espanola), the
Espanola Hospital, Hoy and Rio Grande Treatment Centers, Delancey
Street, Pinon Hills, all three Rio Arriba Clinic systems, private
practitioners, JPO, Rio Arriba DWI, North Central Community Based
Services, Hands Across Cultures, Chimayo Crime Prevention Organization,
Rio Arriba Works, The RAMCHC, the National Association for the Mentally
Ill, the Welfare Reform Council, the Rio Arriba Detention Center, Las
Cumbres and the Public Health Office. Representatives of the Pueblos
chose not to participate as they preferred a Native American carve-out.
The County of Rio Arriba agrees to support this alternative.
In order to insure that the planning process is inclusive, reaching
rural communities, law enforcement, youth and other populations, we
will conduct mini-workshops allowing for refinement of the plan. Mini-
workshops and presentations will be conducted for the Rio Arriba DWI
Council, the ArribaCare Steering Committee, the Chama Valley Health
Coalition, and for youth. The Board of Rio Arriba County Commissioners
considers this plan to be an evolving document, and will refine and
revise it frequently.
the prevention/treatment continuum
The New Mexico Department of Health (DOH) defines the substance
abuse service delivery continuum in the following manner:
--Prevention--Universal: services are aimed at the entire population;
Selective: services target subgroups of the general population
that are determined to be at risk for substance abuse; and
Indicated: services target individuals who are identified as
at-risk.
--Treatment.
--Maintenance.
The DOH recommends that a full continuum of services be made
available to the community. We summarized this information at the
beginning of our planning workshop and posted it on the wall. An
examination of the needs and resource assessments accompanying the
strategic plan reveals huge gaps in selective and indicated prevention
as well as treatment and maintenance. Examination also reveals an
overabundance of universal strategies being applied in the schools,
especially in and around Espanola. The indicators and activities
selected under two strategies, Identification and Referral, and
Education, are specifically designed to focus attention on selective
and indicated prevention while discouraging the multiplication of
universal services.
other doh criteria
The DOH has identified the following components as essential to
effective prevention strategies:
--They reduce risk factors for substance abuse while increasing
protective factors.
--They target all substances.
--They are based on an assessment of the problem and the population.
--They vary in intensity based on the type of problem.
--They are interactive (for youth).
--They are culturally appropriate.
--They are science-based.
--They have specific, realistic goals.
--They have buy-in from key players and decision makers.
--They are monitored and evaluated.
--They involve families.
--They build skills.
These components were summarized prior to the workshops and posted
on the wall. They are consequently reflected in the Rio Arriba
Strategic Plan.
criteria for a successful plan
The following criteria was selected by participants as essential
for a successful Rio Arriba plan:
--Applicable to diverse communities.
--Possible, realistic, attainable.
--Inclusive (e.g. youth, law enforcement, people in the north).
--Language has to make sense to the community; can't be just jargon.
--Process for local participation, continuous feedback and revision
--Process for cooperation with RCC, Santa Fe, Taos and other
neighboring counties, City of Espanola and Village of Chama.
--Continuous tracking of progress in measurable terms.
--Culturally appropriate.
target strategies
We asked the group first, to select criteria for target strategies.
They chose the following criteria:
--Strategy must be a foundation strategy upon which others are built.
--Should build upon and improve what is in place.
--Must be collaborative with broad impact.
--Must be flexible, able to change and refine activities (without
bailing out too soon).
--Must be comprehensive to include prevention, treatment and
maintenance.
They then used these criteria to select target strategies.
Environmental, Identification and Referral, and Treatment were selected
as high priority ``foundation'' strategies. The group agreed that there
were significant gaps in these areas that must be addressed before
other strategies could be made successful. In addition, the group
selected two strategies for refinement. These were Community Processes
and Education and Information Dissemination. It was agreed that there
is a great deal of current activity in these areas that needs
evaluation, improvement and direction.
The group agreed that Sustained Coordinated Effort should be
included with Community Processes. The group also agreed to include
Youth Development as Primary Prevention under Education.
Two CSAP strategies, Education (which is primarily interactive) and
Information Dissemination (which is not interactive) had been combined
into a single strategy. The group agreed to focus on Education because
it has been shown to be more effective than Information Dissemination,
and to discourage Information Dissemination as the least effective of
all CSAP strategies. It was agreed that resources are not fairly
distributed throughout the County, resulting in too many uncoordinated
activities in the Espanola Schools and a lack of activity in rural
districts. The County is therefore requesting assistance from state and
federal granting agencies to redistribute those activities.
Finally, it was agreed that Alternative Activities, although
exceedingly important, should not be targeted during the current fiscal
year for several reasons:
--Research has repeatedly demonstrated that alternative activities
are only effective in combination with other strategies. It was
therefore agreed that these activities should be addressed
after other strategies.
--Research has demonstrated that alternative activities are often the
most expensive prevention strategies, diverting funding from
more effective measures.
--The most important ingredient of successful alternative activities
as prevention is adult supervision. It was suggested that we
consider piloting small, affordable educational projects
involving adult-child interaction that can possibly be expanded
later.
--No formal protocol currently exists to facilitate collaboration
amongst local governments on large projects resulting in
frequent project failure. This problem is especially acute in
the south, since the Espanola Valley straddles two counties,
one municipality, and several pueblos and school districts. It
was agreed that the community should wait to address large-
scale alternative activities until protocols have been
established for inter-governmental agreement.
time frames
The timeline for the Commission's initial approval of this plan is
extremely short due to Federal and State funding time frames. A
preliminary plan must be presented to Senator Domenici's office no
later than Wednesday, March 24 for inclusion in testimony of the March
30 Senate Subcommittee hearing. Procrastination beyond this date will
prevent the Senator from working to insure that potential federal
resources are targeted for substance abuse in Rio Arriba County in the
coming fiscal year.
A preliminary plan must be submitted to the Secretary of Health at
the end of the same week. The Secretary has stated repeatedly that no
new funds for prevention or treatment will be allotted to Rio Arriba
County until it produces a plan.
The County Commission will officially hear the plan at its regular
March meeting. The official plan will then be put before other local
governments and boards of directors for dialogue, continuing
refinement, and ratification.
Aim: To reduce substance and alcohol abuse in Rio Arriba County and
its adjacent communities.
Current Substance Abuse Reduction Activities in Rio Arriba County, New
Mexico
(assessment of resources)
Environmental \1\
---------------------------------------------------------------------------
\1\ Indicates that this strategy is identified as a CSAP (Center
for Substance Abuse Prevention) strategy. CSAP strategies are listed in
order of proven effectiveness. The three non-CSAP strategies listed in
this section of the plan were included because research has shown them
to be effective if not essential for the reduction of substance abuse.
---------------------------------------------------------------------------
Presumptions: alcohol not a drug; DENIAL.
What's really going on? Inconsistent law enforcement;
intergenerational drug & alcohol use; lack of employment.
What's improving? Collaboration between providers.
Community Processes \1\
Rio Arriba Family Care Network: Coordination and improvement of
health and behavioral health services in Rio Arriba County.
Rio Arriba Maternal Child Health Council: Improved outcomes for
mothers and children in Rio Arriba County.
Rio Arriba DWI Planning Council: Reduction of DWI incidents in Rio
Arriba County.
Northern Neighbors Network: Substance abuse prevention in Dulce,
Northern Rio Arriba County and Los Alamos.
Chama Valley Health Coalition: Provider networking in Chama Valley.
Healthier Communities ENIPC: Building a healthier community for
Eight Northern Indian Pueblos.
UNM CASAA: Case management and advocacy for Eight Northern Indian
Pueblos.
La Vision del Valle: Reduction of substance abuse in Espanola and
Pojoaque Valley.
North Central Providers: Networking for behavioral health providers
in Rio Arriba and Santa Fe Counties.
Espanola Domestic Violence Task Force: Reduction of domestic
violence in Espanola Valley.
Chimayo Crime Prevention Organization: Crime reduction in Chimayo.
UNM Environmental Health Project: Improve environmental health in
rural north central New Mexico.
Minesterial Alliance: Networking for Churches in Rio Arriba and
surrounding areas.
Partnership for Raising Healthy Kids: Improved environment for kids
in El Rito area.
Parent/Teacher Organizations.
Identification and Referral \1\
---------------------------------------------------------------------------
\1\ Indicates that this strategy is identified as a CSAP (Center
for Substance Abuse Prevention) strategy. CSAP strategies are listed in
order of proven effectiveness. The three non-CSAP strategies listed in
this section of the plan were included because research has shown them
to be effective if not essential for the reduction of substance abuse.
---------------------------------------------------------------------------
NOT consistent across county or over time!
Community advisory teams, SAT Team, hospital, police ID children at
risk.
Alternative Activities \1\ (Times of day, county, accessibility, age
groups, program, youth/adult, drop-outs)
School: County-wide.
Day care: Some center-based services available in Espanola, Tierra
Amarilla and Canones.
After-school care: Very few programs available; almost non-existent
in rural areas.
Sports: Activities available through organized leagues such as Pop
Warner and Little League. League activities are sporadic in rural
areas. Limited access due to fees. Activities available through schools
county-wide including organized team sports, swimming, and skiing. All-
day summer sports program through NNMCC in Espanola.
Community Centers: Pueblos, Jicarilla, NNMCC, Lucero Center.
La Clinica del Pueblo: Americorps, Academic tutoring.
Cruise-No-Booze and Alcohol-Free Dances: County-Wide through County
DWI.
Natural Helpers: Building youth leadership skills in Chama Valley.
4-H: Youth experiential learning county-wide through NMSU Rio
Arriba County Extension Network.
Boys and Girls Clubs: Available in Espanola Valley.
Lunch Buddies: Mentorship program in Espanola Schools.
Cultural Awareness Camps: County-wide through Hands Across
Cultures, North Central Community-Based Services.
Sky's the Limit: Youth leadership activities in Espanola and
Pojoaque Valley.
Education and Information Dissemination \1\ (Teaching New Skills and
Behaviors, Information Dissemination, Press and Mass Media
Campaigns)
Synar, ATOD Awareness: Espanola and Pojoaque Valley (HACC), Chama
Valley and Dulce (NCCBS).
ASSIST, Smoking Cessation: Espanola and Pojoaque Valley (HACC),
(Hospital), (NCCBS).
AA, Alanon, NA, Twelve Step Groups: Available through providers
county-wide.
DWI Impact Panels: Available County-wide through Rio Arriba DWI.
Parenting Classes: Las Cumbres Learning Center (County-wide with a
concentration of activity in Espanola Valley), NMSU County Extension
Service (County-wide), Rio Arriba Works (for Works clients only), and
La Clinica del Pueblo (Chama Valley).
School Programs including Healthier Kids 2000 and Character Counts
Hoy Alcoholism, Inc: Educational activities in the community county-
wide with a concentration of activity in Espanola Valley.
La Clinica del Pueblo: Two Licensed Alcohol and Drug Abuse
Counselors on staff serving Chama Valley.
NCCBS, La Clinica del Pueblo: Family Preservation Services in Chama
Valley.
HACC, La Vision del Valle: Media Campaigns in Espanola Valley.
Technical Training: UNM, NNMCC (Concentrated primarily in Espanola
Valley).
Treatment
Hoy Alcoholism, Inc: 12 available beds for community integration
program (inpatient substance and alcohol abuse treatment); intensive
outpatient treatment in Espanola and Chama; anger management and other
groups; facilities in Espanola, branch office in Chama. Serves Region
2.
Rio Grande Alcoholism Treatment Program: 36 available beds for
intermediate alcohol and substance abuse inpatient treatment for Region
2. Facility located in Embudo.
Pinon Hills: Inpatient Behavioral Health Services.
Ayudantes: Methadone treatment.
Una Ala Clinic: Methadone treatment for 125 clients.
Esperanza: Shelter and counseling services for victims of domestic
violence; counseling services for perpetrators.
Crisis Center of Northern New Mexico: Shelter and counseling
services for victims of domestic violence; counseling services for
perpetrators.
DWI Program: Mandatory DWI treatment for offenders.
St Francis Academy: Counseling and case management services.
Las Clinicas del Norte: Suicide prevention counseling.
Sustained, Coordinated Effort
County-approved planning and policy-making bodies: County Health
and Human Services Department, Rio Arriba Family Care Network (county-
wide coordination of health and human services), ArribaCare and
ArribaCare Steering Committee (health care), Rio Arriba DWI Council
(DWI enforcement and prevention), Rio Arriba Maternal Child Health
Council (coordination of health promotion activities), Chama Valley
Health Coalition (networking and coordination in Chama Valley).
Youth Development as Primary Prevention
Need to target high-risk kids, drop-outs, throw-away kids for
services, intervention.
DIAGRAM OF EXISTING GAPS IN DRUG AND ALCOHOL ABUSE RELATED SERVICE
DELIVERY IN RIO ARRIBA COUNTY, NEW MEXICO
(Assessment of Needs)
------------------------------------------------------------------------
Strategy Gap
------------------------------------------------------------------------
Environmental............................. Apathy
Denial
Youth participation in
leadership
Adult support
Lack of adjudication;
offenders are not
sentenced, or are sentenced
leniently; Sentences are
not enforced
Need to re-establish work
ethic
Not enough opportunity for
legal economic activity
Community Processes....................... Inconsistent distribution of
information
Need to consistently define
membership vs.
participation across
coalitions
Joint goals
Common indicators
Common language to describe
treatment and prevention
Need to track stability of
coalitions over time
Identification and Referral............... Teacher training around
behavioral issues linked to
ID and referral
Process for follow-up for
referrals
Lack of intervention
programs to refer kids to:
Families of inmates
Indicated intervention
for at-risk youth
Drug and alcohol
treatment, especially for
youth
Counseling programs in
general
Counseling for families
of known alcohol and
substance abusers
Services for children 0-
5 and their families
Opportunity for regularly
discussing ID and referral
processes
Opportunity for teachers to
regularly discuss drug and
alcohol related problems
Cannot access confidential
data such as results of
employer drug testing for
purposes of referral.
Byzantine and incomplete
state welfare-to-work
structure makes it
impossible to refer Works'
clients for DOH-sponsored
welfare-to-work substance
abuse treatment services
Drug court.
At-risk youth don't know
normal emotions.
Alternative Activities.................... Few drug and alcohol-free
community events and
activities
Lack of safe outdoor
recreational equipment in
schools makes it hard to
start-up after-school and
other programs
Difficult to access
community buildings such as
senior centers, churches
and schools
Lack of access to activities
because of lack of
transportation
No incentives for alcohol-
free family celebrations
such as weddings
Resources unevenly disbursed
throughout county; lack of
activities in rural areas
Lack of access to some
activities because of fees,
equipment costs
Education................................. Resources, programs unevenly
disbursed across County.
Not enough activity in
remote rural areas.
Too much focus on
information dissemination
county-wide.
Too many activities in
schools take away from
students' academic
activities in Espanola
Valley
Not enough focus on families
or on younger children
(ages 0-5, 6-12).
Treatment................................. Lack of financial access to
existing treatment services
due to:
Lack of insurance/
financial access
Inconsistent MCO
requirements for youth
treatment
Lack of transportation
to services
Laws and regulations
prevent youth from
accessing treatment for
narcotics
Women's services
In-patient treatment
facilities for youth
Treatment for youth
offenders in detention
centers, ESPECIALLY for
rural youth
Services for families of
inmates
Services for families of
known alcohol and substance
abusers
Indicated intervention for
at-risk youth
Indicated intervention for
young children, especially
ages 0-5
Drug and alcohol IOP
services
Drug court
Case management or
supervised probation
Follow-up--enforcement and
completion of sentencing,
especially around community
service requirements
Sustained, coordinated effort............. Need to develop community
prevention plan
Develop clear lines of
leadership; who's in charge
of plan development?
Need to regularly evaluate
progress against plan
Need to update plan
regularly independently of
funding sources and
deadlines
Develop clear lines of
communication with state,
county and local providers
Youth Development as primary prevention... Youth participation in
leadership
Alternative activities for
youth
Consistent youth development
in and across schools
Family activities
Consistent standards for PTO
involvement, encouragement
and activity across schools
and districts
------------------------------------------------------------------------
DIAGRAM OF SELECTED STRATEGIES, INDICATORS AND ACTIVITIES FOR 1999 FOR THE REDUCTION OF SUBSTANCE ABUSE IN RIO
ARRIBA COUNTY, NEW MEXICO
(Strategic Plan)
----------------------------------------------------------------------------------------------------------------
Strategies Indicator Activities
----------------------------------------------------------------------------------------------------------------
Environmental...................... Get current baseline measure of County-wide community-based judicial
attitudes regarding what is oversight. Must include community
acceptable with respect to use of education regarding oversight
alcohol, drugs and tobacco. process.
Increased rates of self-referral for Sting operations and education aimed
treatment. at vendors of legal substances
Increased rate of adjudication/ (alcohol and tobacco).
conviction for drug, alcohol-related Educate community about what its
offenses. norms are AFTER researching them.
Increased employment levels of known Employment assistance for recovering
abusers. addicts.
Community Processes................ Numbers and diversity of participants Identify central county-wide
in community based planning coordinating council.
processes. Establish formalized structure and
Existence of plan with regular procedures to insure continuing
updating. planning process.
Services provided are in conformance Establish standards and policy in
with plan strategies and accepted Rio Arriba County for substance
standards. abuse prevention.
Identification and Referral........ Percentage of primary health patients Training for school personnel and
presenting substance abuse problems providers in identification of at-
who receive a referral. risk behavior and referral process.
Increase in number of referrals of Multiple points of entry into a
children from age 0 and youth to single, coordinated intervention
service providers by schools and and treatment system.
other sources. Train primary, emergency and
behavioral health providers, and
other agencies to systematically
assess families of children age 0-5
for behavioral health problems and
to refer.
Identify statutory changes necessary
to improve referral system and
advocate for these changes.
Alternative Activities............. ................................... Suspend new large-scale activities
until protocols for inter-
governmental cooperation have been
established.
Education and Information Increase in numbers of participants Establish glossary of terms.
Dissemination. in interactive education programs Teach emotion management to children
that involve families. and families.
Increase in self-reported changes in Indicated intervention with families
knowledge, attitudes and behavior of children 0-5.
(outcomes) as a result of Educate communities to create a
involvement in substance abuse community environment supportive of
education programs. recovery.
Improvements in academic performance Conduct thorough assessment of
and reduction in anti-social current education and prevention
behavior of participants in services.
substance abuse education programs. Redistribute activities evenly
across county.
Treatment and Intervention......... Full and effective scope of treatment Thorough needs and resource
services available in community for assessment regarding treatment
all age groups. continuum not to exclude children
Access to treatment services......... ages 0-5.
Increase direct intervention and
treatment services to youth and
families for substance abuse based
on needs/resource assessment.
Develop outcome tool to measure
quality of new and existing
services.
Sustained, Coordinated Effort...... ..................................... ....................................
Youth Development as Primary ..................................... ....................................
Prevention.
----------------------------------------------------------------------------------------------------------------
The Participatory Planning Process
In 1997, the Rio Arriba Maternal Child Health Council compiled Rio
Arriba's first comprehensive county-wide needs assessment. They
identified Substance and Alcohol Abuse and its corollary impacts as the
top threat to public health in Rio Arriba. The Board of Rio Arriba
County Commissioners decided as a result to prioritize substance abuse.
The Board of Rio Arriba County Commissioners was asked by the
Secretary of Health to assist local providers to develop a coordinated
substance abuse treatment and intervention plan. Coincidentally, our
county-designated health council, the Rio Arriba Family Care Network,
was funded by the Robert Wood Johnson and Kellogg Foundations to create
ArribaCare, a county-wide health care financing system for the
medically indigent. It was determined that ArribaCare must prioritize
substance abuse in order to bring down high-end health care costs.
RAFCN agreed to supply the County with professional facilitators to
improve our planning efforts. We have prioritized the need for planning
which emphasizes:
--A process that insures broad involvement and consensus-building
--A plan which is based upon sound outcome measures agreed to in
advance by the community
--Activities that have been proven to work
--A plan that calls for ongoing evaluation of all activities
--A process that will improve coordination amongst providers.
We held two all-day workshops (on 1/22 and 2/22) facilitated by
individuals trained in the ``Systems Thinking'' method of planning. We
requested that participants also attend an all-day training workshop
sponsored by the Behavioral Health Services Division of the NMDOH in
order to insure that all participants would have some knowledge of best
prevention practices.
A draft of the plan was widely disseminated to the community, at
the request of participants, prior to the second workshop.
Approximately one hundred copies were mailed to the community along
with instructions for submitted verbal or written comment. Another two
hundred copies were passed out to attendees of Senator Domenici's town
hall along with an announcement of the next meeting and instructions
for comment. The intent and importance of the plan were explained as
part of the County's presentation. A number of interested citizens
attended the February planning workshop as a result.
The planning method itself required participants to establish
outcome measures, or measures of success, prior to identifying
activities. The purpose of this exercise was to insure that
participants focus on outcomes, not on pet projects. Once outcomes were
established, we asked participants to identify specific activities that
would cause those outcomes to improve.
Several complaints were raised in the workshops that there was not
enough participation from the North, from youth, and from law
enforcement. As a result, we placed ourselves on the agendas of the DWI
Council, the Chimayo Crime Prevention Organization and the Chama Valley
Health Coalition. All three entities were extremely supportive of our
efforts. We have not yet presented the plan to youth.
We approached Eight Northern Pueblos and were informed that they
preferred a Native American carve-out and would prefer not to
participate. We chose to honor their request by not soliciting other
input from Pueblo providers.
Currently, there is no established protocol for this type of
planning. At each stage of the process, we asked participants, ``How
can we do this better the next time around?'' We are incorporating
their advice into a protocol for county-directed community health and
human service planning efforts.
Finally, no protocol currently exists for the planning of projects
that involve or impact multiple local governments. The County is
attempting to define an inter-governmental protocol. In the interim, we
will systematically present our approved strategic plan to the
appropriate local governments, such as school boards, municipal
governments and neighboring counties, for ratification.
It is the opinion of The Board of Rio Arriba County Commissioners
that the degree of disruption our planning process has caused is the
result of a lack of defined protocol rather than a lack of effort to
involve the community.
We appreciate the support you have extended to us in our efforts to
remedy this situation.
Senator Domenici. OK. We are going to close this part, and
once again, I really mean this, I thank Rio Arriba County,
under your leadership, Mr. Chairman, and you, Mr. Valdez, your
excellent management for getting involved and taking a position
that we have to work together and get something done. While I
agree with Mr. Valdez, and never said anything to the contrary,
that there has been some kind of a relationship between heroin
and some parts of Northern New Mexico as far back as you have
said, I will stand by the proposition that we, nonetheless, did
not have an epidemic during all those years. And I don't know
what that is, but I tell you what we have got is certainly
defined as something rare and different than when it was mildly
used by people here, and we have to unite to do something about
it. All I am suggesting is that I don't know anyone else to
turn to, when I leave here today and say, ``I believe we have
got commitments from those people with resources,'' and I am
looking for you all----
Mr. Valdez. I think you can rest assured that we are
working with you and the State at every level.
Senator Domenici. And to the extent that you have got to
resolve issues between so-called competitors for services, you
will do it in your way. You wouldn't say it that way, but I
will say it another way.
Mr. Valdez. We will work with all of them.
Senator Domenici. Thank you very much. The next panel is
the State panel. I want to thank all three of you for your
patience. We have to choose some order of priority, and I guess
I chose to have you here later, with the hope that you too
would learn something, like I did, from the testimony. Let me
welcome you. I know all of you are very busy, but I would like
to summarize my views for you right now and that should leave
you with the belief that the Governor, and you all, as his
cabinet of people, are very important to the Federal Government
in terms of solving the problem that we are talking about. I
think you only have to read the way we have handled a lot of
resources to know that we send them to the State, and I think,
Mr. Secretary, you are totally familiar with that. The fact
that you have devoted so much time to this County and this
problem would indicate to me that you are aware that that block
grant money that you received--that you clearly have to find a
way to make it do something positive here. And the same holds
true for you, Deputy Secretary Dodson, in terms of you having
expertise. Clearly it goes without saying, Secretary Darren
White, that you have a big responsibility too, because
everybody knows interdiction is part of the three legs of this
stool, and we thank you for reminding us about getting the
money that we hope will make your job somewhat easier. We are
going to proceed with you, Secretary White, because you have a
number of very important issues in New Mexico, and I want to
make sure you get to leave here as soon as practical. Will you
proceed, and we will make your testimony part of the record, so
you can abbreviate it and just share with us what you would
like everybody here to know.
STATEMENTS OF:
DARREN WHITE, CABINET SECRETARY, NEW MEXICO DEPARTMENT OF
PUBLIC SAFETY
DORIAN DODSON, DEPUTY SECRETARY, NEW MEXICO CHILDREN, YOUTH AND
FAMILIES DEPARTMENT
ALEX VALDEZ, CABINET SECRETARY, NEW MEXICO DEPARTMENT OF HEALTH
AND HUMAN SERVICES
Mr. White. Thank you, Chairman. I might note that visiting
us from Las Cruces is Mr. James Jennings, who is our director
from New Mexico HIDTA [high intensity drug trafficking area]. I
asked him to be with us so he could hear the remarks, and I
know we extend our gratitude for all the work that you have
done to bring a HIDTA to Northern New Mexico where it's much
needed.
Mr. Chairman, even though we have been working hard to
lessen the stranglehold of drugs in this area, there is still a
lot of important work to be done. For too long Northern New
Mexico has been held hostage by the trafficking and use of
drugs in a wide variety of crimes that precipitate from drug
activity. I believe that the combined Federal and State efforts
represented here today marks an important breakthrough in our
attempts to finally regain some level of peace and improved
quality of life for this community.
The Department of Public Safety serves as the State's
administrator for the Federal Edward Byrne Formula Grant
Program. This program was created by Congress in the Anti-Drug
Abuse Act of 1988, and places emphasis on reducing violent and
drug-related crime through the development of multi-
jurisdictional and multi-state efforts that support national
drug-control priorities. The Department's administrative
responsibility is to achieve this goal of interagency
cooperation by funding such efforts with a portion of the
State's annual Federal award.
For a state like New Mexico, this Federal assistance is
essential to our law enforcement efforts. Without this support,
we could not coordinate the multiple jurisdictional task forces
and allow us to pool our resources and intelligence for more
effective crime fighting. And yet with the understanding that
we will never be able to arrest our way out of this crime
problem, we also fund local initiatives that address issues
such as youth and gang violence, treatment for offenders, and
domestic violence.
These initiatives could not necessarily meet the usual
definition of law enforcement, but they represent the important
evolution in our understanding of law enforcement's
responsibilities. I am talking about what is commonly referred
to as community policing. And though it does not take a great
deal of thought and/or planning, it is really very simple. It's
a return to recognizing that police officers must be fully
vested members of the community so that they can use their
firsthand knowledge of the causes and effects of crime to do
their job more effectively.
So even at the risk of using a somewhat over-used phrase, I
will say that we are ``putting our money where our mouth is.''
Or more specifically, when reviewing applications for these
grant monies, the Department gives preference for those
initiatives that foster interagency collaborative efforts to
address prevention and intervention as well as enhanced
enforcement. We are in the final year of a 3-year strategic
plan and will soon begin developing the task of developing
another multi-year strategy to reflect the priorities of the
Department of Justice and law enforcement in New Mexico. We
will complete a comprehensive threat assessment and then use
this information to name the major priority issues for law
enforcement in the coming years.
The Department plans to complement these funded
initiatives, which is to continue the cooperation with local
groups such as the Chimayo Crime Prevention Organization. This
group was formed a few years ago when a group of citizens
decided that they could no longer accept the escalating crimes
in their community and decided to do something about it. They
reached out to the Department of Public Safety, and I am happy
to say that through a joint effort by the community and the
State police, crime in Chimayo dropped an astounding 65
percent. We look at this partnership as a telling example of
what can be accomplished when law enforcement and communities
come together for a common cause, and we thank the Chimayo
group for their tireless efforts to inform and support our
enforcement efforts.
Yet even with this level of success, the reality is that
there is still much more to be done. This is why I am so
pleased to be here today to discuss the unique opportunities
made possible by the involvement of Senator Domenici, the
Senate Appropriations Committee, and the Department of Justice.
With their help, I believe we can achieve even greater success
in Northern New Mexico. I believe we can return communities to
their law-abiding citizens and restore a sense of hope to our
people. And instead of Northern New Mexico serving as the
example of drug problems, we can help make Northern New Mexico
an example of the solutions. Thank you, Mr. Chairman.
[The statement follows:]
Prepared Statement of Darren White
Good morning. I'm glad to be here today with Senator Domenici and
representatives from the Senate Appropriations Subcommittee on
Commerce, Justice, State, and the Judiciary because even though we have
been working hard to lessen the stranglehold of drugs in this area,
there is still a lot of important work to be done. For too long,
northern New Mexico has been held hostage by the trafficking and use of
drugs and the wide variety of crimes that precipitate from drug
activity. I believe that the combined federal and state effort
represented here today marks an important breakthrough in our attempts
to finally regain some level of peace and improved quality of life for
this community.
The Department of Public Safety serves as the state's administrator
for the federal Edward Byrne Formula Grant Program. This program was
created by Congress in the Anti-Drug Abuse Act of 1988 and places
emphasis on reducing violent and drug-related crime through the
development of multi-jurisdictional and multi-state efforts that
support national drug-control priorities. The Department's
administrative responsibility is to achieve this goal of inter-agency
cooperation by funding such efforts with a portion of the state's
annual federal award.
For a state like New Mexico, this federal assistance is essential
to our law enforcement efforts. Without this support, we could not
coordinate the multi-jurisdictional task forces that allow us to pool
resources and intelligence for more effective crime fighting. And yet,
with the understanding that we will never be able to ``arrest'' our way
out of our crime problem, we also fund local initiatives that address
issues such as youth and gang violence, treatment for offenders, and
domestic violence.
These initiatives don't necessarily meet the usual definition of
law enforcement but they represent an important evolution in our
understanding of law enforcement's responsibilities. I'm talking about
what is now commonly referred to as ``community policing.'' And, though
it does take a great deal of thought and planning, it's really very
simple. It's a return to recognizing that police officers must be fully
vested members of the community so that they can use their firsthand
knowledge of the causes and effects of crime to do their job more
effectively.
So, even at the risk of using a somewhat over-used phrase, I'll say
we've ``put our money where our mouth is.'' Or more specifically, when
reviewing applications for these grant monies, the Department gives
preference to those initiatives that foster inter-agency collaborative
efforts to address prevention and intervention as well as enhanced
enforcement. We are in the final year of a three-year strategic plan
and will soon begin the task of developing another multi-year strategy
to reflect the priorities of the Department of Justice and New Mexico
law enforcement. We will complete a comprehensive threat assessment and
then use this information to name the major priority issues for law
enforcement in the coming years.
The past year has been spent educating applicants about our plans
to increase the focus given to prevention efforts. As a result, each
initiative requesting money for the next funding cycle will have to
identify a specific prevention component of their program. Then, to be
considered for continued funding, their efforts will be subject to
specific performance-based evaluations to determine the success of
their drug abuse and crime prevention measures.
The Department plans to complement these funded initiatives by
continued cooperation with local community groups such as the Chimayo
Crime Prevention Association. This group was formed a few years ago
when a group of citizens decided that they could no longer accept the
escalating crimes in their community and decided to do something about
it. They reached out to the Department of Public Safety and I am happy
to say that through a joint effort by the community and the State
Police, crime in Chimayo has dropped by an astounding 65 percent. We
look at this partnership as a telling example of what can be
accomplished when law enforcement and communities come together for a
common cause and we thank the Chimayo group for their tireless efforts
to inform and support our enforcement efforts.
Yet, even with this level of success, the reality is that there is
still much more to be done. This is why I am so pleased to be here
today and discuss the unique opportunities made possible by the
involvement of Senator Domenici, the Senate Appropriations Committee,
and the Department of Justice. With their help, I believe we can
achieve even greater success in northern New Mexico. I believe we can
return communities to their law-abiding citizens and restore a sense of
hope to our people. And, instead of northern New Mexico serving as an
example of drug problems, we can help make northern New Mexico an
example of solutions.
Senator Domenici. Thank you very much. Secretary Valdez,
could I indulge you and just ask Secretary White a couple of
questions and then let him leave? He has informed me he is
supposed to be in the other side of the State. Secretary White,
we have a Byrne Grant Fund, and the grants are awarded annually
by the department. The grants are named after a victim of high
visibility for whom great empathy and sympathy was aroused, and
we named it after that person. What portion of the State's
Byrne Grant funds are used specifically for anti-drug programs,
if you know?
Mr. White. Mr. Chairman, we receive $4 million each year.
Sixty percent of those funds, roughly $2.4 million have been
awarded for several regional programs for funding the 14
different narcotics task forces across the State. They include
operation supervisor, contract accounts, confidential funding,
overtime, and operating costs of those task forces. About 9
percent, roughly $362,000 was awarded to the New Mexico Gang
Task Force, local agencies for youth and gang involvement.
Those are for training school resource officers, so that's more
of the prevention component of that program, sir.
Senator Domenici. Well, we now know that Northern New
Mexico has a very severe and serious problem proportionately
speaking, worse than any other county, and this region will be
affected soon. Is sufficient of the Byrne funds, whatever it
can be used for, coming to this area? Are you putting enough
resources in here, in your opinion?
Mr. White. No, Mr. Chairman, we were not, to this point,
putting in the resources necessary, and I think that goes to
what we have been talking about with the designation of a HIDTA
and how important that will be to us.
Senator Domenici. So that may be corrected in the next
month?
Mr. White. Mr. Chairman, that is our hope.
Senator Domenici. All right. A little bit about community-
based law enforcement. I have not been a very big advocate of
the Federal Government telling us how to do community policing.
Nonetheless, the Federal Government put some money into
community policing. What are the components of a successful
community program, if you were to have one in New Mexico?
Mr. White. Well, Mr. Chairman, I would only reflect on the
crime prevention organizations.
Senator Domenici. That is kind of one with----
Mr. White. That is, absolutely, and one of those components
of that program was, when it was first introduced, Mr.
Chairman, we had to recognize that we had limitations, that the
community has limitations, as well as law enforcement. I think
we talked--we have to talk about first that old adage, Mr.
Chairman, that we all had to recognize that we had a problem.
That's the first step, and I'm not saying that the community
had a problem. It's been acknowledged that law enforcement has
a problem as well, because if there is an epidemic of the
proportion in Rio Arriba County with heroin, that it was not
just a community problem, that it is a law enforcement problem
as well.
Senator Domenici. Well, let me move for a minute to
prevention, and you know well the DARE Program, I assume we
still have it in some places. Strangely enough, while it
appears on the surface, if you attend these DARE classes and
saw the promotional aspects of it, one would conclude that it
is very effective. It seems like the Federal Government's
evaluation of it is that it's not very effective in that we had
two budgets where the President vetoes it out, I assume not
because he didn't like DARE, but because he funded something he
thought might be more effective.
What do you suggest with reference to law enforcement
officials being involved in prevention, or would you rather
just wait for the plan to evolve and see how law enforcement
gets into the plan?
Mr. White. Mr. Chairman I don't think we can take a back
seat. I think we have to be pro-active in that arena as well. I
do know that the DARE program has been a very good public
relations tool for law enforcement across this county, but as a
means of reducing drug use and discouraging drug use in our
country, I don't think it's actually met up to that goal. I do
see some programs throughout New Mexico, such as some of the
PAL programs, the Camp Courage Program that is put on, which
has the direct involvement of law enforcement, these are a few
programs that I think are successful, and again, it goes back
to, Mr. Chairman, of again recognizing the limitations. We
would like to be the be-all, end-all, the panacea to all the
problems, but we cannot be that.
Senator Domenici. I have no further questions. If I have
anything else, I will submit them and you can answer them for
the record. You are excused. Thank you very much for your
patience in being with us today.
Mr. White. Thank you very much for this opportunity.
Senator Domenici. Secretary Valdez, I assume you are in a
position of statewide concern, but you have special concern
since you live here with your beautiful and wonderful wife,
Rosemary, who worked in my office while you went to school. Now
your four daughters, who are grown up, live here, and we are
prepared to say that you are going to work very hard to make
the State money do something positive in this county. Could you
share with us your remarks.
Mr. Valdez. I will, Senator. Senator Domenici,
distinguished guests and members of the public, I thank you for
taking great interest in Northern New Mexico, and in a serious
problem which we have inflicted on our great State and our
great country. This problem is the use, dependency, and
addiction to illegal and legal drugs. Before I discuss
strategies to address this most critical of problems, I want to
discuss what this problem means to me as a New Mexican and a
native of Espanola, NM.
We are gathered here in Espanola, my hometown, where I was
born and raised and where I have chosen to raise my family. I
have always cherished my upbringing in this valley with its
grand vistas, wonderful cultures and rich history. Anyone who
enters this valley need only look to the Sangre de Cristo
Mountains, with their snow caps, to our centuries old churches,
to our Rio Grande River, to understand what this valley means
to its inhabitants. Throughout history many have been
captivated by its beauty, people, and way of life, and have
elected to stay. We welcome all who come and who will bring
good will. New Mexico is known as the Land of Enchantment. When
you look out upon this valley, it is a microcosm of all that
this State has to offer.
As a parent, I know what I want for my four daughters. I
want them to grow up safe. I want them to be kind and
understanding. I want them to be well-educated and successful.
I want them to love our Lord. I want them to be proud of their
community. I am sure that every other parent in this valley and
in this State wants the same for their family.
What a contrast to be gathered here today not to celebrate
our great fortunes but to discuss the tragedy inflicted on our
children, families, and friends as a result of substance abuse.
There is a pale cloud hanging over the Land of Enchantment
which threatens to undermine the very fabric which holds our
community together and makes us a great State. That is the
havoc inflicted on persons, families and communities when
heroin, cocaine and amphetamines and other drugs are imported,
manufactured or grown in this state, and sold for a tremendous
profit without consideration for the resulting trail of
destruction. This occurs while the profiteer of the drug trade
lives among us and enjoys this Land of Enchantment.
As Cabinet Secretary for the Department of Health and Human
Services in New Mexico, I am able to witness firsthand the
effects of substance abuse on our State. Many people who find
themselves in a state of poverty find an outlet through the use
of illegal drugs. The use of illegal drugs lead to further
degradation of the family structure, abuse and neglect of
children, and a continual downward spiral for every person in
the family. The state of poverty for many becomes a way of life
rather than a temporary condition. Substance abuse leads to low
birth weight babies whose lives are continually challenged.
When we look at many children who are developmentally delayed,
we can attribute the developmental delay to substance abuse.
When we consider the abuse and neglect of children, we know
substance abuse is a contributing factor. When we look at
children with behavioral problems, who act out through violence
and crime, drop out of school, and have low self-esteem, we
know they are 2 to 6 times more likely to use alcohol and drugs
than their peers. When we look at people with other mental
health problems, we know that as drug use increases, the level
of depression increases, and self-esteem decreases. Hepatitis B
and C, which are rampant in New Mexico, HIV, AIDS, and other
infectious diseases can find themselves spreading, particularly
through a needle-exchanging, drug-using population. Let us
spend a Friday or Saturday night at the local emergency room in
our community, and we will see firsthand the effects of an
overdosing segment of our population and the stresses it places
on our health care delivery system.
Senator, it is important that we send clear messages about
the public policy we are going to pursue when addressing
substance abuse. As Secretary of Health, I am a strong
proponent and supporter of our interdiction efforts to reduce
the supply of drugs. I want to thank you and others for your
efforts in increasing the Federal presence in New Mexico in
protecting our borders and looking inwardly to reduce the
supply of drugs. Our understaffed law enforcement agencies have
an incredible and often dangerous challenge in confronting the
interdiction of drugs. A Federal response, well-coordinated
with our local law enforcement agents, will only serve to
improve our interdiction efforts. As we step up our
interdiction efforts, we must also support our prosecutor and
court system as well as our corrections systems to assure
speedy and long-term punishment for the drug profiteer.
I believe our response to illicit drug use must be like a
three-legged stool. The first leg is interdiction. The second
leg of this stool must be a well-coordinated and financed
prevention strategy to employ with our youth. The State of New
Mexico recently received a State incentive grant from the
Department of Health and Human Services to improve our
prevention strategies in our community. Prevention specialists
must be well-coordinated in their approach to children in our
communities. Their efforts must be outcome based with the
ultimate outcome being a measurable reduction in the use of
drugs within a reasonable time frame. We, as legislators,
administrators, providers and the taxpaying public should not
settle for anything less.
A request for proposals, Senator, for this grant was issued
last week. It is a $2.4 million grant which is well-coordinated
through the Governor's office prevention activities throughout
the State. The various State agencies that are represented on
the coordinating agreement advisory committee established by
Governor Johnson represents over $10 million that flow into the
State already for purposes of substance abuse prevention. The
SID grant, which will be given to providers or entities in
communities, will be used to address prevention strategies,
assure that they are well-coordinated in our communities, and
assure that there are measurable outcomes that are coming from
the strategies. It's very important that we convey the matter
to the treatment provider and communities that they are
employing tactics which are not effective, and we will cease
funding those tactics. We also need to be scientific-based and
look for the best strategies possible and the SID grant allows
us to do that.
Senator Domenici. Mr. Secretary, the three Federal
witnesses are involved in prevention and treatment. Two of them
spoke about scientific information, with reference to both
prevention and treatment. This is now a critical mass of how to
do things that might work because they've been tried, and there
is experimentation and research, but now I am fully aware that
we cannot have the same prevention program that Concord, NH has
(where the chairman of this subcommittee comes from). Are you
suggesting that it would be the prerogative of you, as a
representative of the Governor, as far as this $2.4 million,
and what portion we may get up here, to determine in some way
an effective program with reference to prevention? Who is going
to make those kinds of decisions?
Mr. Alex Valdez. Senator, the coordinating entities which
have been established will be making these decisions.
Senator Domenici. Is Rio Arriba represented on that?
Mr. Alex Valdez. Senator, I don't believe that Rio Arriba
is represented as a county, although I am a member of that
coordinating committee.
Senator Domenici. Well, I think it's very important, Mr.
Secretary. And I want to tell you I think that drug problems
exist everywhere in New Mexico, but if we are going to have a
comprehensive program here then we end up trying to say,
``Look, it's a pilot, it's going to work, and I have got a
better chance than we thought 6 months ago.'' You know, we have
to have some assurance that every graphic of this situation is
going to be called to the attention of this group, and I assume
you are telling us publicly you will see to that?
Mr. Alex Valdez. Senator, what we will see to is that we
get sound proposals coming out of Rio Arriba so that we can
consider those proposals at the State level, but it will
receive very, very sound scrutiny, and, I am sure, a lot of
importance.
Senator Domenici. All right. Thank you.
Mr. Alex Valdez. Senator, the third leg of this stool is
treatment. Treatment has been underfunded in this country and
in this State for a number of years. We must all agree that if
we do not treat the drug user, he or she will continue to
present a demand for drugs. As long as there is a demand for
drugs, someone, someplace will figure out how to provide the
supply. As long as there is a demand and thus a need for
supply, the drug user will continue to commit crimes and bring
harm to the citizenry of our county, State and Nation. Once
again, we all have a responsibility to convey clear messages
that for the majority of drug users, we expect to see an
improvement in their condition to the point where they are drug
free. We should not settle for anything less. To accept, for
instance, that maintenance through methadone is a goal to be
achieved for the heroin addicted user is to send the message to
our youth that: ``you can become addicted and we will then
figure out how to maintain you for the remainder of your
life.'' I believe we must accept strategies that recognize that
being drug free is the goal. While we are cognizant that people
will relapse, we must also accept that relapsing is a temporary
condition, and we will try again for a drug free lifestyle.
In terms of treatment, Senator, the New Mexico State
Legislature just passed this legislative session authorizing
legislation to allow the Department of Health to organize, on a
regional basis, our regional care coordination. We see the
establishment of a regional solution with a regional care
coordinating entity, one who will address issues within that
region in terms of eligible determination, in terms of making
the process as streamlined as possible to get people into
treatment.
Senator Domenici. Is that bill going to be signed?
Mr. Valdez. Yes, it's going to get signed. This is an
assurance, Senator, that our treatment is appropriate for the
needs in our community. If there is a demand for more bed
space, we measure that and we fund that. If there is a demand
for sounder after-care programs, we develop those with our
provider communities, and see those types of activities locally
driven, regionally driven with our providers, our counties and
other workers to see as sound a system develop as is possible
for the region. Our providers in Rio Arriba are participating
in that effort, and we look forward to seeing them continue
with that participation.
Senator Domenici. Mr. Secretary, might I ask, with
reference to treatment, you also heard those who have spent a
great deal of time and resources, that were on the first panel,
talking about kinds and quality of treatment where successes
are more apparent, and there are ways to do it better than 20
years ago. I understand that in this County, there are far more
alcohol treatment beds than there are treatment beds for
heroin; is that correct?
Mr. Alex Valdez. Yes, Senator, that is correct. Once again,
one of our previous speakers alluded to categorical funding
under the Federal block grant. It's broken down in terms of how
you designate a portion of that dollar, and historically it's
been designated more on the alcohol side of the equation. The
State has funded more treatment beds for alcohol in Rio Arriba
County, in fact, than any other part of the State.
Senator Domenici. What about treatment beds for heroin?
Mr. Alex Valdez. Senator, there are available resources and
treatment beds can be utilized, even here in Rio Arriba County,
for purposes of heroin. We also have treatment beds at
Turquoise Lodge in Albuquerque. It's our intent to see that we
work to fund and establish more treatment beds for heroin and
some of the other harder drugs as we proceed forward.
Senator Domenici. Mr. Secretary, I want to make a point
with you, if I might, and then I surely will let you finish. I
am sorry for interrupting, but let me suggest that if we are
going to put together a comprehensive program here that people
will support, it's quite obvious to me that it has to be taken
very seriously and looked at very seriously. If we are very
serious about all three of the legs of the stool, as you
adequately called it, then whether the treatment center works
and is ultimately 100 percent successful, or 50, may not be the
question. The question may be are we doing the best job to pick
the best treatment, and then are we trying to provide
treatment? I think the people are saying we want that as a
component of this, because while we know this is bad stuff, we
have a great deal of empathy for those who are already victims.
I don't see us succeeding if we aren't making an effort there
that is very visible and can be looked at and observed and say,
``We are really trying.''
So do you gather that from your meetings up here and your
participation?
Mr. Alex Valdez. Yes, Senator, I do. I think to a certain
extent the fact that the Federal dollars flow down in a
categorical fashion. There are ways, there are means, and it
shouldn't be looked at as a prohibitive factor to keep us from
being able to expand our treatment beds for purpose of heroin
addiction. Second, we've commenced the process of working on
the education component and the training component from the
local providers. In fact, we brought a researcher out of the
University of Austin on Friday to this same campus to hold a
day-long seminar with all of our treatment providers about what
is some of the most recent and cutting-edge form of treatment
that we can possibly do. We absolutely need to continue
enhancing the skills and abilities of our treatment providers
to make sure that we are as effective as quickly as possible
with the population that we are serving.
Senator Domenici. You understand, Mr. Secretary, that this
morning both NIDA and SAMHSA pledged their expertise and
assistance to you, and I assume that you would avail yourself
of that, if needed, am I correct?
Mr. Alex Valdez. That is correct. Senator, we've already
taken advantage of one of the technical assistance grants
coming out of SAMHSA. That's a $60,000 grant, and we had a
function here in Rio Arriba at this campus, I believe, about a
week and a half ago, on that technical assistance grant. We are
also preparing proposals for the statewide prevention needs
assessment through SAMHSA, as well as looking for a capacity
expansion grant which will be targeted for purposes of Northern
New Mexico.
Senator Domenici. Thank you very much.
Mr. Alex Valdez. Our prevention and treatment providers
must also be well-educated and trained in terms of the latest
and most effective strategies for prevention and treatment.
Thus scientific-based practices with continual research
activities are necessary to assure we are employing the most
sophisticated practices in our work.
Lastly, we must recognize that government neither has all
of the solutions nor does it have the sole responsibility for
addressing these matters. Personal responsibility for our own
actions and family responsibility for our families is where
this matter is ultimately going to be addressed. We have
responsibilities as adults to not abuse drugs and alcohol
ourselves. We have a responsibility to not look lightly on
those among us who do. We have a responsibility to be
accountable for our own actions. Parents have a responsibility
to educate our children as to the ill effects of drugs. We have
a responsibility to seek treatment for our loved ones who are
engaged in the use of illicit drugs. We have a responsibility
to our communities to make sure that we testify and cooperate
with those who are trying to rid our communities of illicit
drugs.
I want to close by commending the citizens of Rio Arriba
and Northern New Mexico. We recognize we have a problem. We are
gathered today to continue our efforts to address this problem.
We are proud of our State and citizens of the Espanola Valley.
Through the concerted efforts of those you see gathered today,
we will rid our community of this great cloud hanging over us.
With your assistance, we will continue to be the Land of
Enchantment. Thank you, Senator.
[The statement follows:]
Prepared Statement of Alex Valdez
Mr. Chairman, Senators, distinguished guests and members of the
public, I thank you for taking great interest in New Mexico, in
Northern New Mexico, and in a serious problem which we have inflicted
on our great state and our great country. This problem is the use,
dependence and addiction to illegal and legal drugs. Before I discuss
strategies to address this most critical of problems, I want to discuss
what this problem means to me as a New Mexican and a native of
Espanola, New Mexico.
We are gathered here in Espanola, my home town, where I was born
and raised and where I have chosen to raise my family. I have always
cherished my upbringing in this valley with its grand vistas, wonderful
cultures and rich history. Anyone who enters this valley need only look
to the Sangre de Cristo Mountains, with their snow caps, to our
centuries old churches and to our Rio Grande River to understand what
this valley means to its inhabitants. Throughout history many have been
captivated by its beauty, people and way of life and have elected to
stay. We welcome all who come and who will bring good will. New Mexico
is known as the Land of Enchantment. When you look out upon this
valley, it is a microcosm of all that this state has to offer.
As a parent, I know what I want for my four daughters. I want them
to grow up safe. I want them to be kind and understanding. I want them
to be well educated and successful. I want them to love our Lord. I
want them to be proud of their community. I am sure that every other
parent in this valley and in this state wants the same for their
families.
What a contrast; to be gathered here today not to celebrate our
great fortunes, but to discuss the tragedy inflicted on our children,
families and friends as a result of substance abuse. There is a pale
cloud hanging over the Land of Enchantment which threatens to undermine
the very fabric which holds our communities together and make us a
great state. That is the havoc struck on persons, families and
communities when heroin, cocaine, amphetamines and other drugs are
imported, manufactured or grown in this state and sold for a tremendous
profit without consideration for the resulting trail of destruction.
This occurs while the profiteer of the drug trade lives among us and
enjoys this Land of Enchantment.
As Cabinet Secretary for the Department of Health and Human
Services in New Mexico, I am able to witness first hand the effects of
substance abuse on our state. Many people who find themselves in a
state of poverty find an outlet through the use of illegal drugs. The
use of illegal drugs leads to further degradation of the family
structure, abuse and neglect of children and a continual downward
spiral for the person and the family. The state of poverty for many
becomes a way of life rather than a temporary condition. Substance
abuse leads to low birth weight babies whose lives are continually
challenged. When we look at many children who are developmentally
delayed, we can attribute the developmental delay to substance abuse.
When we consider the abuse and neglect of children, we know substance
abuse is a contributing factor. When we look at children with
behavioral problems who act out through violence and crime, drop out of
school and have low self esteem, we know they are two to six times more
likely to use alcohol or drugs than their peers. When we look at people
with other mental health problems, we know that as drug use increases
the level of depression increases and self esteem decreases. Hepatitis
B and C, HIV/AIDS, and other infectious diseases can find themselves
spreading particularly through a needle exchanging drug using
population. Let us spend a Friday or Saturday night at the local
Emergency room in our communities and we will see first hand the
effects of an overdosing segment of our population and the stresses it
places on our health care delivery system.
It is important that we send clear messages about the public policy
we are going to pursue when addressing substance abuse. As Secretary of
Health, I am a strong proponent and supporter of our interdiction
efforts to reduce the supply of drugs. I want to thank Senator Domenici
and others for their efforts in increasing the Federal presence in New
Mexico in protecting our borders and looking inwardly to reduce the
supply of drugs. Our understaffed law enforcement agencies have an
incredible and often dangerous challenge in confronting the
interdiction of drugs. A Federal response, well coordinated with our
local law enforcement agencies, will only serve to improve our
interdiction efforts. As we step up our interdiction efforts we must
also support our prosecutorial and court system as well as our
corrections systems to assure speedy and long term punishment for the
drug profiteer.
I believe our response to illicit drug use must be like a three
legged stool. The first leg is interdiction. The second leg of this
stool must be a well coordinated and financed prevention strategy to
employ with our youth. The State of New Mexico recently received a
State Incentive Grant from the Department of Health and Human Services
to improve our prevention strategies in our communities. Prevention
specialists must be well coordinated in their approach to children in
our communities. Their efforts must be outcome based with the ultimate
outcome being a measurable reduction in the use of drugs within a
reasonable time frame. We as legislators, administrators, providers and
the tax paying public should not settle for anything less.
The third leg of this stool is treatment. Treatment has been under
funded in this country and in this state for a number of years. We must
all agree that if we do not treat the drug user, he or she will
continue to present a demand for drugs. As long as there is a demand
for drugs, someone, someplace, will figure out how to provide the
supply. As long as there is a demand and thus a need for supply, the
drug user will continue to commit crimes and bring harm to the
citizenry of our state and nation. Once again, we all have a
responsibility to convey clear messages that for the majority of drug
users we expect to see an improvement in their condition to the point
where they are drug free. We should not settle for anything less. To
accept, for instance, that maintenance through methadone is a goal to
be achieved for the heroin addicted user is to send the message to our
youth that you can become addicted and we will then figure out how to
maintain you for the remainder of your life. I believe we must accept
strategies that recognize that being drug free is the goal. While we
are cognizant that people will relapse, we must also accept that
relapsing is a temporary condition and we will try again for a drug
free life style.
Our prevention and treatment providers must also be well educated
and trained in terms of the latest and most effective strategies for
prevention and treatment. Thus, scientific based practices with
continual research activities is necessary to assure we are employing
the most sophisticated practices in our work.
It is not enchanting that New Mexico leads the nation in drug
related deaths and alcohol related mortality. This county leads the
state in drug related deaths. In fact, New Mexico's illicit drug death
rate has doubled in the last nine years. Eighteen percent of our eighth
graders report using illegal drugs other than Marijuana as compared to
12 percent nationally.
Last summer, two young men murdered a youth of this community by
throwing him over the Rio Grande Gorge bridge in order to steal his car
so they could sell it for drugs. It impacted the victim's family with
the grief and tragedy of the loss of a son with a bright future, the
judicial and corrections system who must deal with the perpetrators,
and all of us who must pay for the system. We are all the losers, the
addicted who perpetrate the crimes to feed their addictions, the
families who must live the dehumanizing cycle addiction brings to their
family members, those families and individuals victimized by the crime
and trafficking of drugs, and all of us who must pay to cope with this
ever increasing problem in our hospitals, emergency medical systems,
courts and prisons.
Lastly, we must recognize that government neither has all of the
solutions nor does it have the sole responsibility for addressing these
matters. Personal responsibility for our own actions and family
responsibility for our families is where this matter is ultimately
going to be addressed. We have responsibility as adults to not abuse
drugs and alcohol ourselves. We have a responsibility to not look
lightly on those among us who do. We have a responsibility to be
accountable for our own actions. Parents have a responsibility to
educate our children as to the ill effects of drugs. We have a
responsibility to seek treatment for our loved ones who are engaged in
the use of illicit drugs. We have a responsibility to our communities
to make sure that we testify and cooperate with those who are trying to
rid our communities of illicit drugs.
I want to close by commending the citizens of Rio Arriba and
Northern New Mexico. We recognize we have a problem. We are gathered
today to continue our efforts to address this problem. We are proud of
our state and being citizens of the Espanola Valley. Through the
concerted effort of those you see gathered today we will rid our
community of this grey cloud hanging over us. With your assistance, we
will continue to be the Land of Enchantment.
Senator Domenici. Thank you very much. I want to raise one
other issue.
[Clapping in background.]
Go ahead and clap. I would say to you that's normally not
permitted, but it's fine with me if you give a big round of
applause to Alex. He is doing a splendid job, and I will
participate with you in applauding him.
Mr. Secretary, before we move to our next witness, I
suggest to you that one of the dimensions in the prevention
area that we are finding across this land as working, is to
find some things for the young people, that have nothing
whatsoever to do, to do after school hours. In fact, that might
apply to both of you. If it fits you, you can respond to my
observation also.
You know, we all look around for activities and activity-
type institutions that can do this and provide opportunities
for our young people. We, in Congress, have grown so weary of
putting aside money for cities and counties and saying, ``Here,
do a program where the children can participate,'' only to find
they are not really capable of doing that. They are not really
in that business. We tried something very different. We tried
funding--with nobody filing any lawsuits--we funded directly
Boys and Girls Clubs. And frankly, I was part of a couple of
Senators that said, ``Why don't we put even more in than
that?'' And last year, I recall, we put $40 million directly
into Boys and Girls Club facilities. New Mexico is getting its
share of those. I understand we have a Boys and Girls Club
facility at Santa Cruz, but we don't have one here in this
county because it appears that there are more than one
competing for doing this activity, and I surely don't want to
put you in the middle of this. This is local, but I really
believe Congress has found something here, and that is, there
is a method to the Boys and Girls Clubs that is consistent,
reliable, and it works. We are probably going to continue to
fund more and more of them. I wish in your efforts here that
you would join, not by way of indicating which one of the
people or the entities' choosing (trying to get funding here
prevails), but rather that Boys and Girls Club will probably
have more resources over time, and we ought to surely attempt
to do something here in this county to do that. If either of
you wants to comment, I would appreciate hearing from you on
that issue.
Mr. Alex Valdez. Senator, you are exactly right in terms of
the need for us to make sure that our children are engaged as
much as possible while in school as well as after school, and,
indeed getting their homework done in the evenings and things
of that nature. Anything we can do after school to see that
kids are active in a positive sense, whether it be sports or
music or arts, is only going to benefit those children. It's
absolutely necessary that we quickly resolve whatever conflicts
and challenges we have in our community to see that we are
moving quickly and expeditiously to receive the funding and get
the services to provide to kids in the after-school arena, and
we will support efforts, particularly efforts that are going to
reach conclusion quickly.
Senator Domenici. Secretary Dodson, would you care to
provide us with your testimony at this point? Your written
remarks will be made a part of the record. If you want to
abbreviate, that would be helpful.
Ms. Dodson. Thank you, Senator. I am here representing the
secretary, Deborah Hartz, who deeply regrets that she could not
be here today. She cares very much about this issue. The
mission of the Children, Youth, and Families Department is to
enhance the safety, dignity and well-being of children, youth,
and families in New Mexico. We provide a variety of services
designed to protect children and adults from abuse, neglect,
and exploitation, to hold juvenile offenders accountable for
their actions and rehabilitate them; to prevent abuse, reduce
juvenile crime, promote quality child care and support healthy
families.
How does this relate to substance abuse, specifically
heroin abuse, and specifically in Rio Arriba County? We know
that many of the families we serve have multiple problems and
that substance abuse is one of them. Substance abuse is a
contributing factor too, as well as a symptom of the stress and
problems facing these families. To address heroin abuse,
therefore, we must put it in the context of all the factors,
problems, and issues that keep families from being healthy.
Like the Department of Health and Public Safety, the
Children, Youth, and Families Department addresses this and all
the problems in our mandate on two fronts. We have heard
prevention and intervention over and over again today. Both are
essential components of our services. If we don't prevent,
children, youth and their families become addicts and abuse
each other or get in trouble with the law, and they even lack
the basic brain development that we now know must happen in the
early years of a child's life.
If we don't intervene, those already affected by addiction,
abuse, neglect, those in trouble with the law, and those
forever disenfranchised because some critical bonding or
development didn't take place in early years, will develop more
problems and problems of even greater magnitude. And of course,
heroin abuse is one of those problems that we see in families
with these problems where there was no prevention or
intervention. Heroin addiction and other substance abuse and
their underlying causes and effects, obviously, must be
prevented and treated--but we all know that. We've been saying
that.
In Rio Arriba County, my Department provides over $1
million for direct services in areas of counseling for high
risk youth, non-secure alternatives to detention, preschool
programs, domestic violence shelter care, child care, mentoring
and many, many others. And of course, we have field officers
for protective services for children and adults and juvenile
probation as well as child care services. So given the
resources provided to Rio Arriba by CYFD and its sister
agencies, coupled with the other funding streams and program
initiatives, why don't we solve the problem? Why is the
problem, as we've already heard, becoming worse?
Through our own staff and contract providers, we have
learned a lot about the heroin addiction in Rio Arriba County.
We have learned that the traditional treatment model, such as
methadone, while somewhat successful for some adult
populations, is not as successful with the adolescents in Rio
Arriba County. Providers are researching other effective
treatment methods for juveniles. Model programs with success in
other states offer intensive outpatient programs combining
education, psychological, and medical treatment for
adolescents. The key of the success of these models appears to
be that they address both the physical and emotional issues of
the client and work extensively with the family, but I think
anyone in this room who has worked with these clients could
have told us that a long time ago.
It is our responsibility to support treatment providers in
Rio Arriba County with the necessary child and family support
services. We know there's an increase in the number of women
and juveniles with heroin addiction in Rio Arriba County. Some
women who need our domestic violence services appear to be
using heroin as a means of self-medicating to cope with violent
home situations. Therefore, it is our responsibility to assist
service providers for victims of domestic violence in Rio
Arriba County who help them regain their sense of self-worth
and to become emotionally self-sufficient. This is the first
stop in becoming financially self-sufficient and capable of
making major life choices for themselves.
More and more adolescents are being referred to our service
providers after discharge from a residential treatment center
for heroin addiction. One agency reported to us recently a
notable lack of success with this population due to the multi-
generational aspect of addiction, and we heard some of that
discussion earlier. Adolescents go back into families which are
using and into communities where drug dealers pursue them to
resume drug usage. It is therefore our responsibility to
continue to enhance and augment the services to adolescents, to
provide them with choices, skills and support systems to resist
these terrible pressures.
Of course, every agency and group represented here today
cannot, in isolation, solve this problem. Coordination of and
communication amongst the various services and programs related
to substance abuse in Rio Arriba is essential, and I would like
to answer one of your earlier questions. Secretary Valdez has
brought that group together that is coordinating substance
abuse prevention grants and has really insisted upon and made
sure a lot of different players got to the table, and it's very
important that we do so. We have learned from each other in
that process.
Finally, and of course, none of these outside-looking-in
coordination efforts will work without the willingness and
guidance of the County, comprised of its many distinct and
unique communities, leaders and citizens in acknowledging,
recognizing and addressing the underlying problems and custom-
designing the strategies and programs to combat and prevent
drug abuse and addiction. Without a total system commitment to
address the underlying problems, including poverty,
unemployment, school dropout rates, all of the things we have
heard here today already, we are not going to be able to get
rid of heroin abuse. Each of us represented here today,
including the leaders, parents, teachers and youth of Rio
Arriba, has a right to name its problem and, of course, to
share responsibilities of solving it.
CYFD has worked with the Department of Health, the Human
Services Department, State and legislators and other State
agencies, tribal representatives and many others to develop the
Children's Health Insurance Program in New Mexico. In addition
to expanding basic coverage for children up to 235 percent of
poverty, which in and of itself is a very important step, the
group has developed Phase II, which will, if approved, provide
behavioral health and related services to vulnerable
populations of children and youth. These services would
increase the ability of all counties, including Rio Arriba, to
meet the needs of children and youth at risk of using or
abusing heroin.
The focus of the service delivery network would be
community determined and implemented. Rio Arriba would be able
to target the services toward its most critical self-identified
problems.
Finally, we must seize every opportunity to make the best
and highest use of the resources we administer and share to
both solve heroin addiction and the underlying problems,
including coordination with each other. Again, it means giving
up sacred turf and territory we all hold so dear. We must think
of each and every child and family in Rio Arriba as children
and families worth working for, and perhaps most important of
all, listening to. A true commitment to a full and equal
partnership, with shared authority and responsibilities will
allow us to succeed. Thank you.
[The statement follows:]
Prepared Statement of Dorian Dodson
The mission of the Children, Youth and Families Department (CYFD)
is to enhance the safety, dignity and well-being of children, youth and
families in New Mexico. We provide a statewide array of services
designed to protect children and adults from abuse, neglect and
exploitation; to hold juvenile offenders accountable for their actions
and rehabilitate them; to prevent abuse, reduce juvenile crime, promote
quality child care and support healthy families.
How does this relate to substance abuse--specifically heroin
abuse--in Rio Arriba County? We know that many of the families we serve
have multiple problems, and that substance abuse is prevalent among
these families. Substance abuse is a contributing factor to, as well as
a symptom of the stresses and problems facing these families. To
address heroin abuse, therefore, we must put it in the context of all
of the factors, problems and issues that keep these families from being
healthy.
Like the Departments of Health and Public Safety, the Children,
Youth and Families Department addresses this and all problems in our
mandate on two fronts--prevention and intervention. Both are essential
components of our services. If we don't prevent, children, youth and
their families become addicted, or abuse and neglect each other, or get
in trouble with the law and even lack the basic brain development that
we now know must happen in the early years of a child's life.
If we don't intervene, those already affected by addiction, abuse,
neglect, those in trouble with the law and those forever
disenfranchised because some critical bonding or development did not
take place in the early years will develop more problems, and problems
of even greater magnitude. Heroin addiction and other substance abuse,
and their underlying causes and effects must, therefore, be both
prevented and treated. But we all know that.
In Rio Arriba County, Children, Youth and Families provides over
one million dollars for direct services in the areas of counseling for
high-risk youth, non-secure alternatives to detention, adult home care
services, transitional living services, preschool programs with
nutritional and family counseling and home visits, community/victim
restoration services, domestic violence shelter care, child care,
client service management, therapeutic pre-school services, family
preservation and support, mentoring, clinical assessment and mental
health counseling. We also have field offices for protective services
for children and adults, juvenile probation and parole and child care
services. Finally, CYFD has a range of statewide services that also
work for Rio Arriba County, including evaluation and training to assist
in the development of a continuum of quality care.
So, given the resources provided to Rio Arriba by CYFD and its
sister agencies, coupled with other funding streams and program
initiatives, why haven't we solved the problem? Why is the problem, as
we have already heard, becoming worse?
Through our own staff and contract providers we have learned a lot
about the heroin addiction in Rio Arriba County. We know that substance
abuse in general, and heroin use specifically, is a multi-generational
problem. It appears to affect several generations, and is often very
ingrained in the culture of family, as well as in specific communities
in the County.
Based on provider experience, we also believe that traditional
treatment models, such as methadone, while somewhat successful with the
adult population, is not successful with adolescents in Rio Arriba
County. Providers are researching other effective treatment options for
juveniles. Model programs with success in other states offer intensive
outpatient programs combining education, psychological and medical
treatment for adolescents. The key to the success of these models
appears to be that they address both the physical and emotional issues
of the client and to work extensively with the family. It is,
therefore, CYFD's responsibility to support treatment providers in Rio
Arriba County with these necessary child and family services.
We know that there is an increase in the number of women and
juveniles with heroin addiction in Rio Arriba county. Some women who
need our domestic violence services appear to be using heroin as a
means of ``self-medicating'' to cope with violent home situations. It
is, therefore, CYFD's responsibility to assist service providers for
victims of domestic violence in Rio Arriba County who help them regain
their sense of self-worth and to become emotionally self-sufficient.
This is the first step in becoming financially self-sufficient and
capable of making major life choices for themselves.
More and more adolescents are being referred to our service
providers after discharge from a residential treatment center for
heroin addiction. One agency reported a notable lack of success with
this population due to the multi-generational aspect of the addiction:
adolescents go back into families which are using, and into communities
where drug dealers pursue them to resume drug usage. It is, therefore,
CYFD's responsibility to continue, enhance and augment the services to
adolescents, to provide them with choices, skills and support systems
to resist these pressures.
Of course, every agency and group represented here today cannot, in
isolation, solve this problem. Coordination of, and communications
among the various services and programs related to substance abuse in
Rio Arriba is essential. CYFD is involved in many groups, including the
DWI Interagency Task Force; the Cooperative Agreement Advisory
Committee, led by the DOH Substance Abuse Program; the Juvenile Justice
Advisory Committee, and the Juvenile Accountability Block Grant
Coalition. Representatives on these groups come from various other
state agencies, law enforcement, the judiciary, providers and
advocates.
Finally, and of course, none of these ``outside-looking-in''
coordination efforts will work without the will and guidance of the
County--comprised of its many distinct and unique communities, leaders,
and citizens--in acknowledging, recognizing and addressing the
underlying problems and in custom-designing the strategies and programs
to combat and prevent drug usage and addiction. Without a total system
commitment to address the underlying problems, including poverty,
unemployment, school dropout rates, teen pregnancy and family violence,
all of the program-specific funding in the world is not going to get
rid of heroin use in this County. Each agency, group and advocate
represented here today, including the leaders, parents, teachers and
youth of Rio Arriba, has a right to name the problem and the shared
responsibility of solving it.
There are specific intervention strategies that all of us,
regardless of our role, can pursue together. Some are not as directly
related to the mission of the Children, Youth and Families Department,
but require our participation and support. For example, sustained and
targeted traffic enforcement has been shown to decrease drug and
violence related activities, especially when combined with community
policing efforts that involve neighborhoods or subsections of a
community. In working with youth in our juvenile justice system, we can
reinforce these efforts.
Other strategies directly relate to our mission and services. We
should and will be part of all public information campaigns and efforts
to inform the public of enforcement efforts, and we should provide
information on the support services we fund in Rio Arriba for children,
youth and families to prevent and combat drug abuse.
CYFD has worked with the Department of Health, the Human Services
Department, state legislators, other state and local agencies, tribal
representatives, clinicians, providers and advocates to develop the
Children's Health Insurance Program for New Mexico. In addition to
expanding basic coverage for children up to 235 percent of poverty,
which has already been implemented as Phase I, this group has developed
Phase II which will, if approved, provide behavioral health and related
services to vulnerable populations of children and youth. These
services would increase the ability of all counties, including Rio
Arriba, to meet the needs of children and youth at risk of or using
heroin.
The focus of the service delivery network would be community
determined and implemented. Rio Arriba would be able to target the
services toward its most critical self-identified problems.
Finally, we must seize every opportunity to make the best and
highest use of the resources we administer and share to solve both
heroin addiction and the underlying problems. This includes
coordination with each other--even if it means giving up sacred turf
and territory. We must think of each and every child and family in Rio
Arriba as children and families worth working for and, perhaps most
important of all, listening to. Without a true commitment to a full and
equal partnership, with shared authority and responsibilities, these
efforts will never succeed.
Senator Domenici. Thank you. Madam Secretary, I just
generally want to ask you, are you satisfied now that whatever
your Department has to do in this area with reference to this
problem that we are here discussing today, that you will
coordinate that with other agencies and that it will be
maximized as you see it in terms of the assets being made
available for the population here that needs it?
Ms. Dodson. Senator, I think that we are making every
effort to do that, but I think it is axiomatic that every time
you think you are coordinating enough, there is more that you
can do. I think that that is what we need to continue to do,
that is, never assume that there is enough coordination; always
assume that we need to work together, and always put our money
where our mouth is, in terms of a full partnership with the
local counties.
Senator Domenici. Well, I whole-heartedly agree, but I do
believe there comes a time that I think coordination has to
stop and has to follow. I assume that's still consistent with
your last statement; is that correct?
Ms. Dodson. Absolutely, Senator.
Senator Domenici. I just want to make a point for the
record. I'm informed that the chairman of this subcommittee,
Senator Judd Gregg, who I already described for you, intends to
put more than $40 million into Boys and Girls Clubs for the
year 2000. I think that's very exciting. It probably means that
we need to get together here in Rio Arriba, and with a little
push, we might be one of the new starts for Boys and Girls
Clubs. I don't know how that sits with the community, but I
think in most places, it's welcome news, and I hope it is here.
To both of you, and to the Governor whom you represent,
Governor Johnson, I thank you very much for your concerted
efforts to address this problem. I am there to be helpful, if I
can, and if I ask you from time to time what's going on, I hope
you will assume it's because I am concerned, not because I am
trying to meddle in your affairs.
Mr. Alex Valdez. Senator, you have been very helpful. Thank
you.
STATEMENTS OF:
DR. FERNANDO BAYARDO, M.D., CHIEF OF STAFF AND MEDICAL DIRECTOR
OF THE EMERGENCY ROOM, PRESBYTERIAN HOSPITAL, ESPANOLA
BRUCE RICHARDSON, PRESIDENT, CHIMAYO CRIME PREVENTION
ORGANIZATION
TESS CASSADOS, EXECUTIVE DIRECTOR, LA CLINICA DEL PUEBLO
S.S. MUKTA KAUR KHALSA, SECRETARY OF FOREIGN AFFAIRS, CHIEF
RELIGIOUS AND ADMINISTRATIVE AUTHORITY FOR SIKH DHARMA FOR
THE WESTERN HEMISPHERE
Senator Domenici. Our next witnesses then--thank you both--
and this is our last panel, after which I will go visit
Delancey Street Treatment Facility. Dr. Fernando Bayardo, Chief
of Staff and Medical Director of the Emergency Room at
Presbyterian Hospital here in Espanola; Bruce Richardson,
Chimayo Crime Prevention Organization, the president of this
group; Tess Cassados, Executive Director of La Clinica del
Pueblo; and S.S. Mukta Kaur Khalsa, Secretary of Foreign
Affairs, Chief Religious and Administrative Authority for Sikh
Dharma for the Western Hemisphere. We get all four of you, and
we will start with Dr. Bayardo. Doctor, thank you very much for
taking your valuable time to be here. We look forward to
hearing from you. If you want to make your statement part of
the record and want to abbreviate, whatever you choose, would
be fine with me.
Dr. Bayardo. Thank you for the opportunity to go ahead and
address this issue. Both I and everyone here, I, unfortunately,
have had the opportunity to do it several times, and it's
unfortunate, to represent the size of our problem and what is
going on in this county, and I think not just the county but
statewide. I think it also reflects what's going on nationwide.
I will apologize for probably repeating some things that
have probably been said throughout the day, but as you know, we
do have some very terrible things going on that is a serious
problem, which is illicit drug use in Rio Arriba County.
I personally do not have a solution to this problem, but I
do feel strongly that as a health care professional and
representative of our local health care facility that we do
play and can play a vital role in addressing the issues and,
hopefully, resolve it as well.
Briefly, the State Department of Health Statistics from
1993 to 1995 ranked New Mexico as the number one State in
illicit drug overdose deaths in the country. That was a typo I
gave, just so you know that we probably do have more deaths per
100,000 population here in this State. That's 11.16 per
100,000, but Rio Arriba is 18.3 per 100,000, more than any
other county that at least was looked into in the Nation. And I
have included a figure in the packet that you all may or may
not have yet.
One other thing that I would really like to point out
though, in terms of drug-induced deaths, that's not what I am
seeing. Most of those people do not make it to my emergency
department. What I am seeing is morbidity, fatalities related
to substance abuse, including overdose, and I really think when
we speak of overdose as a whole, we are only addressing the tip
of the iceberg. I have mentioned in the past some issues, and
briefly I will mention them here. Talking about Hepatitis B and
C, and it's defined as inflammation of the liver due to virus.
We are talking about cellulitis; how often do I see people with
cellulitis, which is inflammation under the skin or connective
tissues? Things which are due to infection from shooting up,
for example, abscesses, and we are talking about people coming
in covered with abscesses. They are collection pockets, pockets
of pus, on arms and legs. It's something you would expect to
see in a picture in a medical book of some rare tropical
disease. Unfortunately, we are seeing it here due to substance
abuse. That says we are talking about sepsis, which is
widespread tissue destruction caused by bacteria in our
bloodstream, and people are dying from this as well.
Pneumonia we are seeing--we have to understand that
substance abuse or alcoholics, people who are frequently
immunodeficient, they don't have the safety resistance you and
I do, so pneumonia is seen more in these people.
Where are they injecting? Are they injecting heroin, are
they injecting baby powder, we don't know, and these go into
the lungs, et cetera. We are talking about brain damage, we are
talking about these drugs that unfortunately down their
respiration and cause lack of oxygen to the brain. This is
basic CPR lifesaving procedures. Finally a major factor of this
is we are also talking about violent acts, such as stabbings,
shootings. I rarely see a violent act that winds up in my
emergency department which does not involve some type of
substance abuse.
Senator Domenici. Say that again.
Dr. Bayardo. I rarely see a violent crime that occurs and
results in a visit to my emergency department that does not
involve substance abuse of some kind. We are also talking about
motor vehicle accidents. We are talking direct injury. We are
talking about deaths associated with them, and we are also
talking about long-term sequela and disability and direct
injury due to accidents due to substance abuse.
I think that the State Department of Health has done a good
job at breaking motor vehicle accidents, in terms of--they use
standard mortality ratios. Where we stand is the State of New
Mexico is compared with our nationwide statistic, I think it's
1 in 5, and I believe Rio Arriba County is 1 in 3 for motor
vehicle accidents. How many of those are related to substance
abuse? I think that I do believe we are quite probably in the
top three, if not number one for drug-related motor vehicle
accidents.
The other dimension of other things that may or may not be
a primary cause here in this county is we have heard about HIV
and AIDS. Right now in this county HIV and AIDS probably is not
secondary to substance abuse in terms of exchanging needles,
but it may be. This is how other people get HIV, as well as
through intercourse, but it could easily be spread that way as
well and may well hit our local area as well. In the same way,
I also think that it's important to try to manage the dollars
associated with the treatment and impacts of preventable
disease in this county.
I also think it's important to mention other factors that
affect our county. That is, for example, a recent Health and
Human Services Department study mentioned that 38.6 percent of
all inmates, in a recent 12-month study, were attributable to
substance abuse in this county. Over $1 million of our county
budget were felt to be used toward law enforcement alone in
substance abuse related issues in our county. This was felt to
be a very conservative effort.
Substance abuse also affects the attraction of new
businesses to our community, industry, and also influences
strongly on their successes once they are here, and of course,
the desire to stay here. It also impacts our own personal and
home security, learning in schools and low performance in
school. We are talking about petty thefts, shoplifting, home
robbery.
Focusing on education, along with other social problems, I
think that--and I was going to mention before, I apologize--a
recent Rio Arriba Maternal and Child Health Care Council report
from March 1997 pointed out that substance abuse is the number
one health threat to Rio Arriba County. It's also affected many
people for many years. Personally, I have patients tell me they
have used a substance, heroin, for example, for 30 years. We
put a lot of time in on the issue of resolving it, but keep in
mind that people really have been around that substance for a
long time.
I also think it's important to understand that we cannot
fix some of our gradient problems in addressing the most basic
needs in our community. I think that it's not just heroin
abuse, but also an issue of economic development. I also think
it's an issue of quality of local primary and secondary
education. I also think it's an issue of early parenthood,
accessibility, and transportation issues. I also think it's an
issue of adequate law enforcement, and I do not see enough
about helping them have DRE, as we call it, drug recognition
experts, enough patrols, community and judicial support,
enforcement of existing laws, and funding.
I also think that we also need to encourage positive family
role models. There are certain traditions that exist in our
homes, and role models, mentoring, all those things really can
make a difference and probably make the biggest difference. I
mentioned intervention services for young children. I have
Deborah Harris from the school district to thank for this.
Thinking in terms of focusing on our youngest victims, which
has been mentioned earlier, that without a doubt, and I agree
with this 100 percent, is that the brain develops most rapidly
in the first 3 years of life. We are talking about emotional,
physical, and cognitive development as well, and it's really
dependent on what a child experiences within his first 3 years
of life. So I can not mention enough what in-utero exposure, as
well as environmental exposure, either during pregnancy or
shortly after, the first years of life have on a child,
especially when we have to deal with domestic violence,
homicides, child abuse and neglect, poor nutrition, all which
can be secondary to substance abuse.
The other thing to keep in mind is this is one hundred
percent preventable. I cannot say enough for outreach regarding
education, prenatal care, early detection and intervention with
regard to this. I also cannot say enough regarding the cost
effectiveness of dealings with prevention rather than dealing
with problems in substance abuse in adolescent and adult care.
Again, we are talking about education, health care, and
identification of substance abuse early, early on and referrals
of treatments in the meantime. I also think that as has been
mentioned before, that as young children grow older, they may
be prone to criminal activity, repeated patterns of abuse,
self-destruction and problems secondary to nonintervention when
things were preventable.
I would also like to make very, very clear that in my
practice in the emergency department here in Espanola Hospital,
on a daily basis, I deal with people like you, your neighbors,
citizens like you, and it is a pleasure to do so. I am not
seeing necessarily the picture of one drug abuser after another
that some people may or may not imagine. I see generally these
hard-working people and people who care about how this issue
impacts them, whether they use substances or not. I think that
it's also heartbreaking to see how devastating the affects of
such a health problem, a social problem, has on the public. I
also believe that despite this talk today, that all of us do
not know how much of a problem this really is, and we are only
beginning to touch upon it.
I ask the support of those today in addressing this threat
to our community, by helping with law enforcement, its
barriers, its costs and, of course, recognizing their
successes. I am sure this has been said before, we may or may
not be able to arrest ourselves out of this condition, but at
the same time, it's of vital importance and does not stop being
a crime to use or sell drugs.
I also seek help with coordination, development of local
efforts and organizations involved in the prevention of and
treatment of substance abuse, and I also ask you and your
committee to set an example for us and also to work together at
your level so that we can do the same. I also seek help
regarding development of strategies to counsel members of our
community to reduce and stop demands for current drug abuse.
And more than anything else, I would like our community to help
develop strategies to support healthy norms, those behaviors
and beliefs that have made this the Land of Enchantment.
[The statement follows:]
Prepared Statement of Fernando Bayardo
Proceeding talks today have probably been reflective of grim
statistics that seem to reflect a serious prevalence of illicit drug
use in the County of Rio Arriba.
I clearly do not have a solution to this serious problem, but feel
strongly that as a health care professional and representative of the
local health care facility that we can play a vital role in this issue.
New Mexico State Department of Health Statistics for 1993-95 ranked
New Mexico as the number one state in illicit drug overdose deaths in
the country. (More deaths per 100,000 people in this state than any
other state--18.3 per 100,000) See attached Figure #2.
In addition Rio Arriba Statistics for alcohol present in deaths
significantly surpass those for the state average as noted in Figure
#2b.
Though the preceding figures are quite grim, I can only suspect
that the noted mortality rates are only the tip of the iceberg.
Substance abuse related morbidity and mortality figures probably rise
dramatically when one takes into account not only overdoses but also:
--Hepatitis B and C--inflammation of liver due to virus
--Cellutis--inflammation of connection tissue (such as skin and
surrounding organs)
--Abscesses--localized collection of pus
--Sepsis--widespread tissue destruction from disease causing bacteria
in blood stream.
--Pneumonia--lung infection
--Brain damage--from hypoxemia (lack of oxygen), accidents and direct
effects of substance abuse
--Violence--assaults, stabbings, shootings, etc.
--Domestic violence, abuse and neglect
--Motor Vehicle Accidents--Direct Injury, Deaths, Long term sequelae
and disability
Statement on Effects of Substance abuse on preventable disease
My point in mentioning the above list only touches on the impact of
substance abuse on a wide array of preventable disease and injury. The
impact of substance abuse devastates a large percentage of families in
this area as throughout the state with the above effects. I also must
mention HIV/AIDS, as we know an incurable and fatal disease.
In addition to the cost and value of human health, there is also
the dollar cost one must consider in addressing all of the above
effects of substance abuse. It is necessary to include substance abuse
related liver disease and its associated diseases (gastrointestinal
bleeds, cirrhosis, hepatitis, etc.) We can only begin to imagine the
impact of all the substance abuse related disease and the health care
dollar spent.
Statement of Substance abuse and related healthcare issues impacting
economic, social and criminal justice factors
38.6 percent of all inmate days in a 12-month study were
attributable to substance abuse according to a recent Rio Arriba Health
and Human Services Department study. Over 1 million dollars of county
budget were felt to be used towards law enforcement alone in substance
abuse related issues in our county (note that this is felt to be a very
conservative figure.
Substance abuse and related issues also affects the attraction of
new business and industry to our community as well as influencing
strongly on their success and desire to stay in our community. In
addition, these issues also impact on our own personal and home
security, learning and overall performance in out schools.
Statement of Effects of Substance abuse on Family Health
I recently spoke to many of this group regarding the effects of
substance abuse on family health and as of yet it is hard to figure out
where to begin. I would like to point out that the county of Rio Arriba
Maternal and Child Health Care Council in their March 1997 report
listed substance abuse as the number one health threat to Rio Arriba
County residents. We are dealing with a problem that is entrenched in a
significant number of our population and affecting some families for
generations. I personally have had patients who tell me that substance
abuse has been part of their lives for 30 years. At the same time some
of our local physicians are seeing from one to two new young substance
abusers a week in their practice. The issue of health and resolving
some to the major threats against it is not substance abuse alone. This
valley and adjacent areas lack many items, which contribute to our
present social situation and problems. We cannot ``fix'' some of our
greatest problems without addressing some of the most basic needs such
as:
--Economic Development
--Quality of local primary education
--Early parenthood
--Accessibility/Transportation issues
--Adequate law enforcement--Drug recognition experts (DRE), Enough
patrols, Community and judicial support for enforcement of
existing laws, Funding
Statement on substance abuse and early intervention services for young
children in Rio Arriba County
To truly address the pervasive problem of substance abuse in Rio
Arriba County it is imperative to focus on the very youngest victims in
our communities. Research has shown that the brain develops most
rapidly in the first three years of life. Emotional, physical and
cognitive development is largely dependent upon what a child
experiences during the first three years of life. Infants and young
children are affected by parental and familial substance abuse in a
multitude of ways. In-utero exposure, as well as environmental exposure
to the sequlea of substance of substance abuse such as crime, domestic
violence, homicide, child abuse and neglect, and poor nutrition--can
produce life long developmental delays, disabilities and emotional
disturbances. Fortunately, these consequences of substance abuse are
completely preventable. Outreach and education, prenatal care, early
detection, and early intervention efforts with prospective parents,
pregnant mothers and young children are proven and effective means of
intervention.
Newborns and children with or at risk of, developmental or
biological delays or disabilities, as well as those who suffer from
delays and emotional disturbances induced by exposure to substance
abusing adults, can be helped through a continuum of detection and
prevention services. These early childhood prevention programs are
considerably more cost-effective than dealing with the problems of
substance abuse in adolescence or adulthood. Critical prevention and
early intervention services for the unborn child and children up to the
age of five include many components working in tandem. These include:
education; health care; prenatal identification of substance abuse'
referrals to treatment facilities and mental health services;
developmental assessments for infants and children (to detect delays
and disabilities); therapies for identified disabilities and delays,
case management; prevention services for at-risk infants; regular
health care for infants and young children; and behavioral health
services for infants, young children and their families.
When the total range developmental needs are not addressed early on
in life, we see results in an increase in the number of young children
in special education classes, behavioral problems, and psychiatric
disorders. As they grow older, these children are prone to criminal
activities and repeated patterns of abuse and self-destruction. The end
result is a need for continued and prolonged involvement in government-
funded systems. Rio Arriba currently has sparse but high quality,
collaborative programs that work with parents, guardians and infants
and young children from birth to age five. Rio Arriba needs support,
not only to maintain the model projects that exist, but also to
strengthen and expand these services in order to eliminate waiting
lists, so that all children who would benefit from early intervention
and prevention can be reached. Parents must be educated about the long-
term effects on their children of substance abuse.
Children who are in need, yet do not get referred or sewed because
aid is lacking, are unnecessary victims in the state of New Mexico. We
request support in order to most effectively help our youngest
community members, and to intervene in the deadly epidemic of substance
abuse that is killing our children's future.
Closing
I would like to make it clear that my daily practice consists of
dealing on a daily basis with people such as you, your friends and
family. I am not seeing drug abusers one after another, but genuinely
nice and hard working, caring people who may very well be impacted by
this issue as all of us in this room are. It is a pleasure to work with
and serve the vast majority of the members of this valley and
surrounding area. I must say though, it is heartbreaking to see the
devastating effects that a health and social problem such as this one
has on the patient population I serve.
I ask the support of those here today in addressing this threat to
our community with support in:
--Education in understanding what substance abuse is and its impact
on our community;
--Law enforcement and its barriers, costs and successes;
--Help with coordination and development of local efforts and
organizations involved in the prevention and treatment of
substance abuse;
--Development of strategies to encourage the members of our community
to reduce and stop the demand for illicit drug use;
--Help our community develop strategies to support healthy norms,
behaviors and beliefs that have made this the State of
Enchantment.
[GRAPHIC] [TIFF OMITTED] T11MA30S.000
[Figure 2]
[GRAPHIC] [TIFF OMITTED] T11MA30S.001
[Figure 2b]
Senator Domenici. Thank you very much, Doctor. I
particularly appreciate your positive comments with reference
to the practice of medicine as it impacts on you, and I assume
you are speaking for many doctors.
Dr. Bayardo. Yes, I am.
Senator Domenici. It is not all this. There is a lot of
great joy and satisfaction----
Dr. Bayardo. And assurances.
Senator Domenici. And we really appreciate your assessment
of this problem. You are right, we don't know exactly how to
fix it, but with people like you helping us, we are going to do
our best to be aware of this. Thank you for what you do.
Mr. Richardson, we have heard much about your organization,
and we want to hear a little bit from you today about whatever
it is you want to share with us.
Mr. Richardson. Well, first of all, Senator, we would like
to thank you for showing the leadership that's been lacking as
far as we're concerned about this problem. We started on it 2
or 3 years ago as a volunteer community action group, and we
finally have gotten to the point where we have all the
resources in this room to address the problem. It's just a
matter of coordination, and I was going to harp upon that, but
I think we have got that right. It sounds like the coordination
will happen, and not only needs to happen within this
jurisdiction but across other jurisdictions and counties.
The county line up there is kind of killing us. Rio Arriba
and Santa Fe County lines go right through Chimayo, and in our
opinion, it creates a lot of problems. We thank Rio Arriba
County for doing their health plan, but it just further
institutionalizes the county line and makes a distinction. So
we need to make sure that that gets coordinated across the
county line as well, and I hope Santa Fe County is listening,
that they deserve some credit or blame as the case may be.
Senator Domenici. Very good.
Mr. Richardson. I would also like to thank Secretary White
for his kind statements. The Department of Public Safety has
been more than just a partner and adviser, it's been an ally
and our main source of satisfaction. We would like to thank all
the law enforcement people and everyone else that's partnered
with us. The list is too long to mention, but all those guys
wear white hats, and we are very happy to have them.
I would like to thank the Rio Grande Sun and New Mexican
and Albuquerque Journal for continuing to bring attention to
the issue that's been absolutely necessary. And now that we're
here, I would like to thank all of the members of the Chimayo
Crime Prevention Organization. These people are very dedicated,
and we plan on being here for awhile, and whatever kind of
community input we need on any initiative, we would be very
happy to serve. I would like to request that you accept our
written testimony into the record.
[The statement follows:]
Prepared Statement of Bruce Richardson
Mission statement.--Through public involvement, the citizens of
Chimayo strive to improve the quality of life in the community by
reducing the threat of crime.
The Chimayo Crime Prevention Organization (CCPO), composed strictly
of volunteers, was formed to address rampant crime in a small, rural,
traditional community in north-central New Mexico. Property crimes such
as larceny and burglary had reached epidemic proportions. These crimes
were the by-product of other serious criminal activity, particularly
illegal drug-trafficking in hard narcotics, mainly heroin and cocaine.
The drug dealers are well-known in the community, with some families
being involved for generations. In most cases, these families own their
land and are not transient newcomers. This situation presents unique
problems with regard to the potential solutions to the problems. As a
result, concerned community members contacted local representatives
including politicians, judges, law enforcement agencies and clergy to
initiate discussions on how to effectively address criminal activity.
CCPO has become a state and regional model of community policing.
We have developed extremely productive relationships within the New
Mexico Department of Public Safety, the State Legislature and the local
Judicial District including the District Attorney's Office. The
productiveness is apparent when crime statistics are analyzed comparing
pre- vs. post CCPO creation. Our goals have expanded beyond crime
prevention to addressing the adverse social conditions which exist in
the area, such as providing options and opportunities to youth in an
effort to improve the dysfunctional nature of their current situation.
It was therefore necessary to create a strategic organizational
plan in order to identify needs and priorities for both the short and
long terms. The need to maintain a strong and effective organization
which offers alternative solutions to complex problems will require the
creation of partnerships to share responsibilities and resources.
Funding such potential solutions will become a high priority to the
organization. The plan identifies completed and/or anticipated tasks
and will provide guidance to the CCPO, as well as information to
partners on who we are, what we've done and where we hope to lead. This
reiterative planning document is perceived to be central to achieving
our mission as stated previously.
History.--Chimayo is an unincorporated rural area with astounding
natural beauty, a rich cultural and religious heritage, blessed with a
relatively abundant water supply that is the valley's lifeblood. There
is no elected leadership. CCPO has been the primary catalyst in
improving the quality of life for its community members by initiating
discussions with anyone and everyone who would listen. Crime prevention
through community policing has always been, and will continue to be our
focus. Community policing is in our view a cooperative effort between
law enforcement and the community to address our common interests
related to public safety. When honest, hard working, law-abiding
citizens are living in fear with security bars on all their windows and
doors, something is seriously wrong. We began struggling with the
enormous scope of the problem three years ago and were repeatedly
informed that our goals were unachievable. Many questioned our sanity.
We aren't doing this because we wanted to, but because we had to. The
problem is invasive to every quality of life issue imaginable (see
supporting document: memo to Sen. Domenici). The first step in dealing
with the problem has been taking responsibility for a solution, as a
community. We have built upon every success and every failure to get to
where we are today. The organization is working on formalizing and
strengthening our relationships with all our partners in preparation
for future funding and program initiatives. We are here for the long
haul.
Our success has resulted from refining the global issues to local
initiatives which we feel could be achievable. We seldom fail to follow
up on potential opportunities. We have learned to apply subtle yet
relentless pressure in pursuit of our objectives. Initially, we engaged
law enforcement and the criminal justice system in order to educate
ourselves. The picture which emerged was that the entire system was
broken: from inadequate police investigations at the crime scene, to
lackadaisical prosecution by the District Attorney's office, to lenient
sentencing by judges, to the revolving door at the State Penitentiary.
We met with those involved, identified problems, provided initiative
and demanded accountability. Consequently, the system began to work,
but it's a long way from being functional on a self-regulating basis.
Lack of coordination is the culprit here in our opinion.
The coordination of community services is essential if any
significant and lasting gains are to be made in Chimayo. In fact, the
community is split down the middle by the Rio Arriba-Santa Fe county
line. The presence of this political boundary is a nightmare with
regard to any kind of coordinated effort, whether it be rural
addressing and delivery of emergency services such as fire fighting and
ambulance service, or planning and zoning. Local law enforcement is
made basically ineffective in this regard, because they are never
certain whether they are within their proper jurisdictions. This
situation has contributed to the current conditions as much as any
other, if not more, and has made the area conducive to the kinds of
illegal activities we are experiencing today.
Organizational vision.--To promote a vital and effective
organization capable of capitalizing on opportunities by mobilizing and
maximizing both financial and human resources in furtherance of the
organization's mission.
Accomplishments.--CCPO developed a strategic plan during 1997 which
created an organizational structure and set priorities (see supporting
document). Filing for non-profit organization status is presently
underway. Organizational by-laws have been approved by the Board,
chairpeople assigned to guide sub-committee initiatives and a community
phone bank developed to mobilize community support. Standing committees
include community policing, liaison legislative/judicial, youth
services/education, membership and finance, as well as special and Ad
hoc committees. Local actions have included organization of community
meetings to facilitate communication between all interested parties,
Summit Meetings held every six months to facilitate communication
amongst criminal justice entities (see supporting document), and
newsletters to inform and involve the public (see supporting document).
CCPO most recently sponsored a meeting for the business community in
the village to inform them of the issues relating to crime prevention
and discuss a strategy to counter the negative publicity and impacts
from decreased tourism dollars. Potential relationships between CCPO
initiatives and economic development opportunities were also presented.
Former Congressman Redmond submitted a funding request for a Boys and
Girls club at our urging although its current status is unclear. A
grant for $1,000 has been secured from the LANL Foundation to be used
as seed money. Another grant application has been recently submitted to
a private foundation for additional start-up funds which will be used
towards initial staffing and implementation of a youth conservation
corps program (see supporting document).
CCPO was instrumental in influencing legislation during 1998 to
increase the salaries and numbers of State Police officers. The
organization assisted the Department of Public Safety in securing
federal funds to pay officers overtime to conduct saturation patrols
known as ``Wolf Packs''. These patrols were extremely effective in
reducing crime rates in Chimayo. Continued funding for this program has
been lacking recently. CCPO has mapped approximately 35 known drug
trafficking locations in the village which have been provided to State
Police/Narcotics personnel. A legislative funding request was sponsored
by State Senator Carlos Cisneros during the 1999 session to rejuvenate
this program and is pending approval. The interim use of DWI/
Transportation Safety funds to conduct saturation patrols and provide
vital police presence within the area is underway.
A liaison position through the Victim's Assistance Program within
the First Judicial District Attorney's office has provided CCPO with
the ability to track offenders through the judicial system and provides
the community with the opportunity for input with Judges regarding bond
and sentencing hearings. We have also arranged for the dissemination
and posting of warrant lists in an effort to remove criminal elements
from the community. In affiliation with the New Mexico National Guard-
Counter Drug Division and local School Board, CCPO will host a math and
science/team building camp this summer. Implementing other National
Guard programs within the schools is also being considered. Developing
funding and program strategies is also ongoing with the U.S. Attorney's
Office through the Department of Justice.
Initiatives at the county level, both Santa Fe and Rio Arriba, have
met with limited success. Initiatives with the local School Board are
in their initial stages and appear very promising (see supporting
document). Meetings have been conducted with Dr. Fernando Bayardo of
Vision del Valle and the Espanola Hospital Emergency Services, Ms.
Loren Reicheldt, Rio Arriba County Health Care Coordinator and the New
Mexico Departments of Health and Environment (see supporting document)
on public health issues and their relationship to crime prevention. We
have provided advice and consultation to several neighborhood watch
groups and the Village of Questa in northern New Mexico.
In all cases, the lack of fiscal and human resources is cited as
the primary barrier to progress. We believe that in almost every case,
entities are doing what they can with what they have. Additional
resources are sorely needed for undercover narcotics operations. Within
State Police Narcotics Division, there are two agents responsible for
the northern half of the state. This is not going to get the job done.
Assistance from the Immigration and Naturalization Service was
requested. Their response was they were only interested in business
related issues. In addition, an inordinate amount of bureaucratic red
tape makes their assistance too burdensome to be useful.
Needs.--CCPO's most immediate needs involve securing start-up
monies to establish and maintain an office location within the
community. This would provide the organization with a physical and
obvious presence in Chimayo which to date has been lacking. Office
space and functioning computer equipment will be donated by members of
the business community. Additionally, funds for staffing would allow
the volunteer organization to move toward becoming a policy board as
opposed to a working board.
Recommendations.--CCPO realizes the equation for potential
solutions is complex and involves law enforcement, education, public
health and community participation. We intend to engage the educational
and public health systems in the same manner we did the criminal
justice system. We recommend formal coordination councils be created as
prerequisites for funding law enforcement, public health and education
initiatives. Coordination should occur not only within separate
jurisdictions but across the political or jurisdictional boundaries. An
essential element of the councils should be community representation to
provide needed accountability and oversight. CCPO is willing and able
to provide such a service. It is our position that funding law
enforcement and the criminal justice system concurrently should be top
priority. The reasoning being that law enforcement must effectively
curtail the supply of drugs before education and public health
professionals can be successful instituting demand reduction
initiatives. Increased funding for law enforcement should increase case
loads beyond what can presently be handled by D.A.'s, Judges and
Corrections. Therefore, serious consideration should be given to
funding all the links in the chain of criminal justice.
Now that the problem has received the attention it deserves, it has
become politically correct to be on board. This has begun to create
problems in and of itself. It is as if our elected state politicians
have been given open license to request half a million here, half a
million there for well intentioned solutions without the least amount
of foresight as to conducting consultations with the agencies affected
or the constituents they mean to serve. We propose a multi-
jurisdictional Task Force to identify both long and short term program
and funding needs to be prioritized according to immediacy of need and/
or impact, cost effectiveness, and be culturally appropriate. The task
force should include federal, state, local and community
representatives from law enforcement, education and the public health
sectors as well as the community-at-large. This task force should be
responsible for developing a comprehensive program and recommend
priorities for funding to elected officials, thus preventing
duplication of efforts while providing essential coordination
functions.
Finally, there is a strong and pervasive opinion within the
community that we couldn't have degenerated to this stage without
significant corruption and collusion occurring within the system. The
fox is not guarding the hen house, he's inside. We have no proof or
strategy to address such an issue, yet we are unwilling to abandon its
plausibility.
Senator Domenici. It will be done.
Mr. Richardson. I am sure that you folks have probably
heard a lot of information, been fed a lot of facts and figures
on the extent of the problem. My premise is to try to give you
a little bit more of a picture of what it's like to live in
Chimayo at ground zero.
Senator Domenici. All right.
Mr. Richardson. I would like to agree with what Dr. Bayardo
has said. It's not doom and gloom there. Some of the most
wonderful people live in Chimayo. They are very concerned about
this whole problem. We have identified probably 35 to 40 drug
dealing locations in the community of about 4,100, so that's
about one dealer per hundred people. We feel like the county
line has somewhat made local law enforcement ineffective
because of the jurisdictional boundary.
Senator Domenici. How do they make a living?
Mr. Richardson. Excuse me?
Senator Domenici. How does that one in 100 make a living?
That means they are selling to a lot of people.
Mr. Richardson. Yes, sir, I believe that's true. We have
heard things that Chimayo is kind of a local distribution
center, and people come from Taos County, you know, they come
from far and near to get their drugs.
Senator Domenici. Some of them illegal from Mexico?
Mr. Richardson. I think that's the case, and some instances
also, but in many instances, they are--it has been an
intergenerational problem that has been going on for
generations. It's 30 years, and nothing seems to have been
done. It's kind of sending a message to the youth that there
are no negative connotations to these kinds of activities, and
so the county line, I guess in our opinion, kind of makes it
conducive for these kinds of activities to occur. So the state
police has really stepped forward in taking the lead as far as
law enforcement in the area.
I would like to make a couple of points about the history
of Chimayo and Santa Fe. Back in the late 1700s, people were
sent from Santa Fe to Chimayo as punishment. It was an outlying
community and subject to Indian attacks and very lacking of
resources from the capital in Santa Fe. This has kind of
continued to this day, and also there was a Chimayo rebellion,
which has kind of perpetuated our reputation, you know, for
being involved with a lot of illegal kinds of things. Again, I
would like to say that there are some of the most wonderful
people in Chimayo. They are not all that way.
As far as the history of this organization, this is
probably the fourth incorporation of this organization. These
kinds of community policing attempts have been made in the past
with limited success. A lot of it ends up going away as some of
the criminals would threaten these individuals. It's going to
be difficult going back up there and living in the community.
We have never really been out in public like this before, so I
would like to say, kind of reiterate also what Alex Valdez said
about the beauty of the area. That's one of the reasons a lot
of us have lived here and moved here and have continued to
stay, but I would like to point out specifically my reason for
getting involved. I would like to present a water quality
sample to be an aggregate sample, but this is one that I got
from the acequia along the bank. It is covered with hypodermic
needles which is considered hazardous waste. I would like to
submit that for the record.
Senator Domenici. We won't be able to take it back to
Washington. You might be able to use it again. Maybe somebody
can take a picture of it, but thank you very much for your
submittal.
Mr. Richardson. At this point, I decided I am kind of a
new-bee to Chimayo. I have only been living there since 1995. I
decided if I was at risk for doing nothing, it would be just as
good to be at risk for doing something. So I have a 12-year old
that plays along the pasture and river and this is the reason
that I got involved and why I'm here today. This is a public
health issue, but we recognize that the three legs in the stool
are correct: law enforcement, public health, education. But
it's our opinion that law enforcement probably needs to be the
number one priority, at least in the short term, because if we
can't curb the supply, we don't really feel that demand
reduction activities through education and public health are
going to be as effective. Once some effect is made on the
supply, then I think education and public health are well-
positioned to step in and be effective.
Our accomplishments have been enumerated in our written
statement, and I won't go into a great deal of detail, only to
stay that we've involved everybody and anybody that would
listen. Now that we're at this level, again, I feel we have the
resources in this room to do what needs to be done, and we
would be willing to serve and to work with any of those
entities in any way possible.
What we have done has been on a shoestring. We have done it
with no resources, just volunteer work and a coordination,
community policing-type of effort.
Senator Domenici. What do you cite to the committee as a
success, as a recorded success. Just tell us a little bit about
that.
Mr. Richardson. Well, we started conducting meetings just 3
years ago with the community and law enforcement elected
officials in general, and after about 5 years, I think we
realized that we needed not only law enforcement in our
activities, but to make the public education or public health
and education issues also a part of it. We have worked on a
youth conservation plan to provide for alternatives for our
youth. We feel that a Boys and Girls Club or rec center would
be appropriate up there and very much needed, although it
seemed like it would be a long ways off, so we wanted to get
something up and running right now. So that's why we decided to
do the youths conservation project. We submitted for some
grants for that, and we are waiting to see what is going to
happen there. We feel if we could fund the Youth Corps program
fully, it would need a long-term scope of work, and so we have
been working on a voluntary, community-based land use plan,
using the entire Santa Cruz River as river watershed, and
working with the Federal entities and all the local
jurisdictions, all the land ownership sectors, to come up with
some management practices, implementation practices also that
would provide the long-term scope work for the youth program.
The Youth Corps program is envisioned to provide mainly
vocational skills to the youth. There are educational assisted
program components to that as well, with projects involving our
water rights and some land use planning--to take responsibility
up there for who we are and what we're doing. If we could get
the Youth Corps program funded, we believe that we would be
doing youth development, economic development, community
policing or crime prevention and some environmental
restoration, possibly spending $1 and getting numerous dollars
back in return. It would also give ownership to those projects
as they get off the ground. I think we can add some of our
infrastructure needs in terms of paving roads and recyclable
water system and groundwater contamination, those types of
things. That's part of our vision, I suppose at this point. And
we feel like the integration of those programs would be very
cost-effective.
Senator Domenici. Thank you very much. Are you finished?
Mr. Richardson. Coordination has been well addressed. I
would be happy to cooperate with anybody and everyone that's
involved with this thing and, again, we need to stress in our
opinion that law enforcement needs to be the priority in the
short-term. Thank you.
Senator Domenici. Thank you very much. I wonder if the
staff would do something for the record, that it seems to me
that we have a number of youth conservation-type programs that
we fund, and I wonder if it might be possible to take a look
and see if it would be feasible to address another ingredient
to qualifying for that kind of activity by saying if it is part
of a comprehensive drug prevention activity in an area that
they would receive some priority for funding for youth
conservation-type efforts. I think that might be an interesting
thing, because we are doing youth conservation funding. If we
chose to say well, if you submit an application and somebody
will look at what you are doing, and it was a comprehensive
effort to also reduce drug use, you might get some significant
priority for that and that might be a way to open channels for
funds. If the staff would do that, I would appreciate it and
would you inform Mr. Richardson of either our success or
failure, or what it is we find out. They are doing their job.
We ought to try to see if we could do some of ours, and we will
do that.
Mr. Richardson. Senator, probably it will be significant to
point out that as far as Federal land ownership in the
watershed, it's probably 70 percent. We feel that not only
would we work with the local water donor and Santa Fe
Irrigation Districts, but that the benefit to those people
would be if we funded the Youth Corps program, then the
implementation plans that were created through the planning
process would be fully funded so that these entities would not
have costs associated with implementation of some of their
needed projects. So given the Federal presence and that
opportunity of assistance, I believe that we could do that.
Senator Domenici. Thank you very much. Tess Cassados,
Executive Director of La Clinica del Pueblo, would you like to
talk with us for a few minutes, ma'am?
Ms. Cassados. Thank you very much, Senator Domenici and
staff. I very much appreciate the opportunity to testify on
this panel. I need to remind everyone about the outlying, very
rural areas of New Mexico and Rio Arriba County and unique
problems that we face.
La Clinica del Pueblo is housed in the Rio Arriba Community
Health Center in Tierra Amarilla, NM. Tierra Amarilla is the
county seat of Rio Arriba County, renowned nationwide for its
natural beauty. La Clinica is the primary health care provider
to our entire service area known as the Chama Valley. All of
our clients are impacted by substance abuse problems that make
our society and the Chama Valley in northern Rio Arriba County
no exception. Through the years, our rural, isolated community
was forced to address substance abuse issues on our own, with
minimal resources that do not begin to cover all of the needs.
La Clinica's personnel sees the problems firsthand. We
address them as best we can with our mental health component.
We are witness to the problems in the medical issues that are
presented by the patient, like La Vision de Valle has also
described. We also assist with emergencies in which DWIs or
suicide attempts are the result of using substances. If the
individual is lucky enough to survive the crisis, then we see
them again, or we attempt to see them again, accessing our
mental health and medical services.
Overall, the community is impacted by the tremendous losses
in terms of activities and medical costs. Over half of all
families who access our services are affected by issues
regarding substance abuse. The families, who are often the
forgotten ones of those who are chemically affected, are
impacted also, and they too access services. So our community
is affected directly and indirectly as well.
La Clinica del Pueblo is the first agency in the community
to bring mental health services to the area. We have provided
medical services since 1969. We celebrate our 30th anniversary
this summer. In 1991, we recognized the need for mental health
services, and brought the very first mental health service to
our community. Our social workers estimate that 60 percent of
the 100 active patients that they are currently treating have
problems extending from substance abuse. Currently, our
services to address these substance abuse issues are provided
by two licensed clinical social workers at La Clinica. Services
are provided in several settings, such as our clinic, the
schools, and the detention center. Many of the referrals from
the detention center are entangled with the legal system and
present issues related to their drug use. The clinic also makes
our building available for Alcoholics Anonymous meetings and
Al-Anon meetings that are held weekly. These meetings are
conducted by clinic and community members. The alcohol
treatment center also sponsors similar groups in Chama.
In recent years, North Central community-based services
have joined in the community's fight against substance abuse
through their preventive measures geared towards middle school
and high school youth.
Within the past couple of years, the Community Outreach
Department of La Clinica del Pueblo have made a concerted
effort to focus on early intervention. To truly address the
basic problem of substance abuse in Rio Arriba County, it is
imperative to focus on the very youngest victims in our
community. Infants and young children are affected by parental
and familial substance abuse in a multitude of ways. In-utero
exposure, as well as the secondary results of substance abuse,
such as crime, domestic violence, homicides, child abuse and
neglect and poor nutrition can produce lifelong developmental
delays, starting with developmental delays, disabilities and
emotional disturbances. Fortunately, these consequences of
substance abuse are completely preventable. Outreach and
education, prenatal care, early detection and early
intervention efforts are proven and effective means of
intervention. While the clinic does see the problem as one that
merits resources to address the issues, there is never quite
enough that is done.
Our community needs to recognize the problem as one worthy
of additional resources. The problem needs to be recognized as
a priority so that it can be addressed. While it does what it
can, we as a community can do more. Resources for research-
based prevention programs are lacking. Comprehensive problems
can be implemented in the schools where children can learn the
consequences of substance abuse and seek help for themselves if
they are impacted. Additional resources to address mental
health needs can be incorporated into the plan for the future.
Detox and residential services are virtually nonexistent,
except for referral out of the community. Long waiting lists
discourage those who want service and lack of insurance
benefits can hinder the availability of services. The system is
working against those who are seeking treatment. All of those
factors need to be incorporated into planning for the future
where the needs of the rural communities are not left out, and
our needs can be seen as the priority that they truly are. They
are very fortunate to have a well-established coalition of
health service providers, called the Chama Valley Health
Coalition, which has almost a 10-year history of collaboration
and has made great impact throughout our community.
We are also very pleased about the initiation of the
county-wide plan to encompass substance abuse, and we expect
the planning process to include the rural areas.
We're all, of course, very interested in the well-being of
all our families. We need all to work together to provide the
resources that are needed to address them. Again, I very much
appreciate, Senator Domenici, your effort in including the
rural communities in this initiative.
[The statement follows:]
Prepared Statement of Tess Cassados
the substance abuse problem in the chama valley
All communities are impacted by the substance abuse problems that
plague our society. The Chama Valley in northern Rio Arriba County is
no exception. We, as a rural isolated community, are left to address
the issues on our own with minimal resources that do not cover all of
the needs.
The Clinic personnel see the problems first hand. We address them
through our mental health component. We are witness to the problems in
the medical issues that are presented by the patient. We also assist
with emergencies in which DWI's or suicide attempts are the results of
using substances. If the individual is lucky to survive the crisis,
then we see them again accessing our mental health and medical
services.
Overall, the community is impacted by the tremendous losses in
terms of lost productivity, and medical costs. Over half of all
families who access our services are affected by issues regarding
substance abuse. The families (often the forgotten ones) of those who
are chemically affected are impacted also, and they too access
services. So our community is affected directly, and indirectly as
well.
what are we doing?
The Clinic was the first agency in the community to bring services
to the area. It has provided medical services since 1969. In 1991 it
recognized the need for mental health services, and brought the first
mental health services to the community. Currently services to address
this issue are provided by 2 Licensed Clinical Social Workers. Services
are provided in several settings, such as the clinic, the school, and
the detention center. Many of the referrals from the detention center
are entangled with the legal system and present issues related to their
drug use. The Clinic also makes the building available for AA and
Alanon meetings that are held weekly.
Within the last couple of years, the Community Outreach Department
of La Clinica del Pueblo have made a concerted effort to focus on early
intervention. To truly address the pervasive problem of substance abuse
in Rio Arriba County, it is imperative to focus on the very youngest
victims in our communities. Infants and young children are affected by
parental and familial substance abuse in a multitude of ways. In-utero
exposure, as well as environmental exposure to the sequlea of substance
abuse--such a crime, domestic violence, homicide, child abuse and
neglect, and poor nutrition--can produce life long developmental
delays, disabilities and emotional disturbances. Fortunately, these
consequences of substance abuse are completely preventable. Outreach
and education, prenatal care, early detection, and early intervention
efforts are proven and effective means of intervention. While the
Clinic does see the problem as one that merits resources to address the
issues, there is never quite enough that is done.
what needs to be done?
The community needs to recognize the problem as one worthy of
additional resources. The problem needs to be recognized as a priority
so that it can be addressed. While it does what it can, we as a
community can do more. Resources for research-based prevention programs
are lacking. Comprehensive programs can be implemented in the schools
where children can learn the consequences of substance abuse, and seek
help for themselves if they are impacted. Additional resources to
address mental health needs can be incorporated into the plan for the
future. Detox and residential services are virtually non-existent
except for referral out of the community. Long waiting lists discourage
those who want services, and lack of insurance benefits can hinder the
availability of services. All these factors need to be incorporated
into a plan for the future where the needs of the rural communities are
not left out, and our needs can be seen as the priority that they truly
are. We are interested in the well-being of all our families. Lets work
together to provide the resources that are needed to address them!
Senator Domenici. Thank you very much.
Ms. Cassados. Thank you very much.
Senator Domenici. May I ask, just by way of definition, as
you spoke of the need for mental health treatment with social
case workers and the like, are you equating that term with drug
addiction?
Ms. Cassados. In many cases we are, Senator. Again, just
because the study of our active clients who come to us for
mental health counseling revealed 60 percent of those clients'
problems extend from drug abuse in one way or the other,
whether through the family, significant other, through the
children. Sixty percent of our active clients seeking mental
health counseling feel that their problems come or are
initiated through the drug abuse, substance abuse.
Senator Domenici. But you can have mental illness,
schizophrenia, manic depression, bipolar-like problems, and not
have drug addiction. Conversely, you can have those illnesses
and be addicted, too, so I imagine you distinguish that in
terms of treatment and they're all lumped together, though, in
your testimony regarding mental illness.
Ms. Cassados. Absolutely, yes, sir.
Senator Domenici. Thank you very much.
I don't quite know what title to address you by. I am
thinking that maybe it ought to be Madam Secretary. Is that
fair enough?
Ms. Khalsa. Thank you. Honorable Senator Domenici and
esteemed Mayor and distinguished guests, and the public at
large. It is my pleasure to be here with you today as a
representative of a good friend of yours, Dr. Yogi Bhajan, who
is the founder of our program 3HO SuperHealth, and I would like
to just reference him by saying the program that I am going to
speak of, which originates in Tucson, AZ can be reproduced here
in Espanola or anywhere for that matter.
Senator Domenici. Could I ask you, for purposes of our
timing, since we are supposed to be somewhere, how long will it
take you to make your presentation?
Ms. Khalsa. Five minutes.
Senator Domenici. You have seven minutes. I am going to be
generous.
Ms. Khalsa. 3HO Foundation, Healthy, Happy, Holy
Organization which was founded in 1969 as a nonprofit
organization dedicated to the advancement of the individual
through education, science, and religion, and Dr. Yogi Bhajan
serves as the Director of Spiritual Education and has done so
since its inception.
3HO provides various programs designed to help individuals
alleviate and resolve social and personal problems, utilizing a
yogic approach to live a healthy, happy, and productive life.
In 1973, 3HO SuperHealth was founded in Tucson, AZ to help
people suffering from addiction to drugs and alcohol. Since
then the program has worked with thousands of clients in the
residential program. The expanded services incorporated
outpatient prevention, education and training located in
schools, private corporations, and within the criminal justice
system.
The program has a remarkable success rate and is a tribute
to yogic science and holistic integration of body, mind, and
spirit. The Joint Commission of Accreditation of Healthcare
Organizations accredited the program in 1978. It has received
the highest commendation and distinguished itself by being
rated in the top 10 percent of all residential programs
throughout the United States.
3HO is a perfect blend of East and West. It combines the
ancient wisdom of the East with the sophistication and
innovation of a quality care program. The 5,000-year-old
science of yoga and meditations has proven highly successful as
the backbone of the 3HO program.
The science of SuperHealth technology is precisely applied
to people with specific behavioral problems, including drugs,
alcohol, depression, stress, and other dependencies plaguing
our society.
The program's belief is that the human potential of each
individual is unlimited. Philosophy and specialized programs
help each person achieve their highest potential. SuperHealth's
innovative approach to health and healing acknowledge that each
person is a whole being in which body, mind, and spirit are
interconnected. Freedom from addictions occurs when each of
these facets change together, and such change occurs most
easily when one is in an environment and support system that is
structured to guide integrated personal growth. It is this
ongoing ability to exert impulse control over oneself that
prevents recidivism.
The program goal is to get one in touch with their inner
strength so that they can conquer their problems. Practical
techniques are given to eliminate addictions and methods to
achieve self-discipline, inner fulfillment, and peace of mind.
The root cause of why people use external stimuli is to
fulfill shallowness and inner emptiness. Lack of stamina, inner
strength, and the desire to face the nonfunctional personality
of the self motivates one to escape as a productive,
unfulfilled person of life.
Students and dropouts, young and middle-aged alike, are
being plagued by depression, loneliness, and unfulfillment. The
program uses tools to gain the psychological edge necessary to
remain calm and nonreactive under the most challenging
situations. The process results in freedom from pain, fear,
guilt, isolation, and resentment. It is here that true
happiness lies and the mental traumas of everyday life slowly
disappear.
The SuperHealth program eliminates the physical, mental,
and spiritual blocks that keep one from living a deeply
satisfying life. These blocks are often demonstrated as lack of
control over drugs and alcohol. At 3HO we believe that one has
all that it takes to reach his full potential. We must help
unlock the true self that is powerful and fully capable of
resolving all issues.
People may have spent their lives looking outside
themselves for a quick fix in fads, trends, and addiction. The
real answers lie within. At 3HO we give tools to discover one's
inner self by building confidence and self-esteem. The need to
abuse the self with drugs, alcohol, and other destructive
behaviors is therefore eliminated.
The treatment program encompasses a drugless, holistic
technology that treats the whole person. This technology is
designed to induce self-empowerment and includes yoga,
meditation, nutrition, vitamin and herbal therapy, individual
and group counseling and massage.
Clinical yoga is the yoga of awareness. Yoga and meditation
are the foundation of the program. It's therapeutic effect is
designed to balance the demands so that they can secrete in
proportion to each other allowing for optimum health. It also
strengthens the nervous system which may have been weakened
with substance abuse. This is not a permanent damage and the
nerves can be rebuilt again. Yoga and meditation are an
excellent tool to help to do this. A person cannot change and
sustain change until awareness or consciousness is highly
independent. The practice allows for the successful response to
life's challenges and stresses with more flexibility, stamina,
and confidence. Yoga helps reduce chronic tension, improves the
circulatory system, and helps provide sound sleep.
The meditation which deals with the psychological addiction
helps calm the mind and creates clarity, perseverance, and
mental concentration and greater self-control. These facets are
essential to overcome the psychological addiction and
destructive patterns of the mind. As awareness is heightened,
insight is gained into the correlation between actions and
behavioral conditioning. Through this process, one learns to
cultivate the qualities necessary to change for the better.
Specialized yoga and meditation sets are designed to eliminate
blocks by creating greater self-awareness and discipline. Yoga
is practiced throughout the treatment regimen and is
instrumental as part of the discharge and aftercare planning to
ensure drug-free living.
Nutrition is one of the most important components of the
SuperHealth experience. A carefully planned vegetarian diet
balances the entire system during the detoxification and
rehabilitation periods. The purpose is to strengthen the body
and cleanse it of toxins from drugs or alcohol. The healing
process is remarkably accelerated with specific foods and
spices that are easily digestible and can be assimilated and
quickly eliminated from the body. A therapeutic blend of fresh
juices is provided that are rich in vitamins and restore
nutrients that are absorbed and utilized by the body. These
foods provided sustenance and restore vitality and health. The
diet is highly nutritious and very delicious tasting.
The intake of toxins and harmful substances, also stressful
living and poor health and eating habits, cause imbalances and
weaknesses in the body. A personalized program is designed to
subtly heal deficiencies. An herbal and vitamin program
rebuilds all of the body systems and optimum health.
Counseling helps gain insight into addictive patterning and
resolve inner conflicts which cause destructive behavior.
Through individual and group counseling, each person learns to
release stress, anger, insecurity, depression, and loneliness
which inhibits fulfillment, happiness, effective communication,
and personal and spiritual growth.
Sessions provide opportunities to develop and enhance
communication skills in an atmosphere of trust and safety. Each
session builds awareness and self-respect. The integration of
yoga and meditation supports the process to deal with personal
issues so that one can learn from their past experiences free
from guilt or blame.
Counseling goals are to increase self-esteem, learn proper
expressions of feelings and intuitive perceptions, develop
honest and sincere relationships, improve body image and
awareness, improve communication skills and enhance self-worth
to strive for excellence.
Therapeutic massage allows the physical body to relax. It
soothes tired muscles and relieves the physical fatigue while
alleviating tension, improving circulation, and promoting sound
sleep.
Senator Domenici. I wonder if you might summarize, please.
Ms. Khalsa. I will. SuperHealth has received the highest
commendation by the Joint Commission on Accreditation of
Healthcare Organizations. It has been funded by all levels of
government, including the Center for Disease Control, to
operate a Better Health Through Awareness Program in the
schools.
For over 25 years, 3HO has perfected the program, and we
take our high success rate seriously. Today many people are
lost and depressed amidst a world of confusion and unknowns. It
is our most heartfelt intent through the techniques in this
program to give people an experience which could lead them back
to themselves and their families. In that most precious
experience, there is no better place to offer this than the
Land of Enchantment in Espanola, NM.
[The information follows:]
3HO SuperHealth Drugless Addiction Treatment Program
incorporating a natural, holistic approach to addictive behavior based
on the teachings of yogi bhajan, ph.d., founder of 3ho superhealth
3HO's technological system can be incorporated in a program for:
Outpatient or Residential treatment; Prevention in schools; Corrections
Department with incarcerated inmates; Education, training and staff
development; and Aftercare and Follow-up.
organizational structure
3HO Foundation, Healthy, Happy, Holy Organization, was founded in
1969 as a non-profit organization dedicated to the advancement of the
individual through education, science and religion. Yogi Bhajan serves
as the Director of Spiritual Education, and has done so since its
inception.
3HO provides various programs designed to help individuals
alleviate and resolve social and personal problems, utilizing a yogic
approach to live a healthy, happy, and productive life.
In 1973, 3HO SuperHealth was founded in Tucson, Arizona to help
people suffering from addiction to drugs and alcohol. Since then, the
program has worked with thousands of clients in its residential
treatment program. Expanded services include outpatient, prevention,
and education and training located in schools, private corporations and
within the criminal justice system.
The program has a remarkable success rate and is a tribute to yogic
science and holistic integration of body, mind and spirit. The Joint
Commission on Accreditation of Healthcare Organizations accredited the
program in 1978. It has received the highest commendation and
distinguished itself by being rated in the top 10 percent of
residential programs throughout the United States.
In May 1994, 3HO Foundation was approved as an NGO, Non-Government
Organization, in Consultative Status (Roster) with the Economic and
Social Council of the United Nations. 3HO serves as a consultant to the
United Nations Secretariat on matters of mutual concern regarding
topics of economy, women, social issues, human rights, cultural
affairs, educational, health and related matters.
philosophy
3HO is a perfect blend of East and West. It combines the ancient
wisdom of the East with the sophistication and innovation of a quality
care program. The 5,000-year-old science of yoga and meditation has
proven highly successful as the backbone of the 3HO SuperHealth
program.
The science of SuperHealth technology, as taught by Yogi Bhajan, is
precisely applied to people with specific behavioral health problems
including drugs, alcohol, depression, stress and other dependencies
plaguing our societies.
The program's belief is that the human potential of each individual
is unlimited. The philosophy and specialized programs help each person
achieve their highest potential. SuperHealth's innovative approach to
health and healing acknowledges that each person is a whole being in
which body, mind and spirit are interconnected. Freedom from addictions
occurs when each of these facets change together; and such change
occurs most easily when one is in an environment and support system
that is structured to guide integrated personal growth. It is this
ongoing ability to exert impulse control over oneself that prevents
recidivism.
The program goal is to get one in touch with their inner strength
so that they can conquer their problems. Practical techniques are given
to eliminate addictions and methods to achieve self discipline, inner-
fulfillment, and peace of mind.
problem
The root cause of why people use external stimuli is to fulfill
shallowness and inner emptiness. Lack of stamina, inner strength and
the desire to face the non-functional personality of the self,
motivates one to escape as a product of an unfulfilled purpose of life.
Students and drop-outs, young and middle-aged alike are being
plagued by depression, loneliness and unfulfillment. The program gives
tools to gain the psychological edge necessary to remain calm and non-
reactive under the most challenging situations. The process results in
freedom from pain, fear, guilt, isolation and resentment. It is here
that true happiness lies and the mental traumas of everyday life,
slowly disappear.
3HO SuperHealth helps eliminate the physical, mental and spiritual
blocks that keep one from living a deeply satisfying life. These blocks
are often demonstrated as lack of control over drugs, alcohol.
3HO believes that one has all that it takes to reach his full
potential. We help unlock the true self that is powerful and fully
capable of resolving all issues.
People may have spent their lives looking outside themselves for a
quick fix in fads, trends and addiction. The real answers lie within.
At 3HO, we give tools to discover ones inner self by building
confidence and self esteem. The need to abuse the self with drugs,
alcohol, and other destructive behaviors is therefore eliminated.
methodology
The treatment program encompasses a drugless, holistic technology
that treats the whole person. This technology is designed to induce
self-empowerment and includes yoga, meditation, nutrition, vitamin and
herbal therapy, individual and group counseling, massage.
SuperHealth programs include treatment for the following: Alcohol &
Chemical Dependency, Smoking, Stress, Eating disorders, Anxiety/
depression, and Co-dependency.
The comprehensive treatment includes:
Physical examination by a medical doctor as needed.
Personal and psychological histories evaluated.
Yoga:
--Kundalini Yoga is the yoga of awareness as taught by Yogi Bhajan.
Yoga and meditation are the foundation of the program. Its
therapeutic effect is designed to balance the glands so that
they secrete in proportion to each other allowing for optimum
health. It also strengthens the nervous system which may have
been weakened by substance abuse. This is not a permanent
damage and nerves can be rebuilt with this excellent tool.
Kundalini yoga balances the neuron patterning of the
hemispheres of the brain which affects addictive behavior. A
person cannot change and sustain the change until his awareness
or consciousness is heightened. The practice allows for the
successful response to life's challenges and stresses with more
flexibility, stamina and confidence. Yoga helps reduce chronic
tension, improves the circulatory system, and helps provide
sound sleep.
Meditation:
--Meditation calms the mind and creates clarity, perseverance, mental
concentration and greater self control. These facets are
essential to overcome psychological addiction and destructive
patterns of the mind. As awareness is heightened, insight is
gained into the correlation between actions and behavioral
conditioning. Through this process, one learns to cultivate the
qualities necessary to change for the better. Specialized yoga
and meditation sets are designed to help eliminate blocks by
creating greater self awareness and discipline. Yoga is
practiced throughout the treatment regimen, and is instrumental
as part of the discharge and aftercare planning to ensure
sobriety and drug-free living.
Nutrition Restoration:
--Food is one of the most important components of the SuperHealth
experience. A carefully planned vegetarian diet balances the
entire system during the detoxification and rehabilitation
period. The purpose is to strengthen the body and cleanse it of
toxins from drugs or alcohol. The healing process is remarkably
accelerated with specific foods and spices that are easily
digestible and can be assimilated and quickly eliminated from
the body. A therapeutic blend of fresh juices is provided that
are rich in vitamins and restore nutrients that are absorbed
and utilized by the body. These foods provide sustenance and
restore vitality and health. The diet is highly nutritious and
very delicious tasting.
Herbal & Vitamin Therapy:
--The intake of toxins and harmful substances, stressful living, and
poor health and eating habits, all cause imbalances and
weaknesses in the body. A personalized program is designed to
subtly heal deficiencies. An herbal and vitamin program
rebuilds all of the body systems and optimum health.
Counseling: Individual & Group Therapy:
--Counseling helps gain insight into addictive patterning and resolve
inner conflicts which cause destructive behavior. Through
individual and group counseling, each person learns to release
stress, anger, insecurity, depression and loneliness which
inhibits fulfillment, happiness, effective communication, and
personal and spiritual growth.
--Sessions provide opportunities to develop and enhance communication
skills in an atmosphere of trust and safety. Each session
builds awareness and self-respect. The integration of yoga and
meditation supports the process to deal with personal issues so
that one can learn from their past experiences free from guilt
or blame.
--The counseling goals are: Increase self-esteem, learn proper
expressions of feelings and intuitive perceptions, develop
honest and sincere relationships, improve body image and
awareness, improve communication skills and enhance self worth
to strive for excellence.
Massage:
--Therapeutic massage allows the physical body to relax. It soothes
tired muscles and relieves physical fatigue while alleviating
tension, improving circulation and promoting sound sleep.
Massage assists the body in eliminating toxins and repairing
damage from chronic stress, poor nutrition, and self defeating
attitudes.
commendations
SuperHealth has received the highest commendation by the Joint
Commission on Accreditation of Healthcare Organizations and is
distinguished as being in the top 10 percent of all residential
treatment facilities in the United States. This is an American medical
organization that maintains rigorous professional standards to assure
the provision of quality heath care. 3HO SuperHealth has been well
classified as a specialized hospital for drug, alcohol and mental
health disorders.
All levels of federal, state, city and county governments have
funded the program. Private corporations including IBM, have funded the
prevention program to help establish an educational system for students
in elementary and secondary grades. The Center for Disease Control,
supported a youth prevention program in the schools called ``Better
Health Through Awareness.'' Various private companies have supported
specialized programs for high risk populations for teen pregnancy and
school drop-outs. 3HO has contracted for services with The Department
of Corrections for services for inmates from maximum through minimum
security. The Department also offered services as part of their staff
development and training for correctional officers.
expertise and credentials
3HO SuperHealth staff have been invited to make presentations
throughout the United States and extensively worldwide. We have been
invited as a joint venture by the government of Russia to assist with
their very critical problem of alcoholism. We have provided
international training and seminars to both staff and clients
throughout Europe, Asia, Canada and Mexico.
SuperHealth has been a member of the American Hospital Association
and is currently on the International Council of Alcoholism and
Addictions and the World Federation of Therapeutic Communities. This is
a worldwide membership of treatment and prevention professionals that
establish official liaison with international governments as well as
professional and private bodies. This federation assist colleagues and
health ministers to develop mutual understanding and partnership in
health delivery with other specialists, education and government
representatives.
In the summer of 1998, Senator Pete Domenici was instrumental in
designating New Mexico to conduct a pilot project with the United
States Department of State with Drug Demand Reduction by President
Clinton. Yogi Bhajan, Ph.D. conducted the training for the 43 officials
from Honduras, Mexico and El Salvador in the field of health,
corrections, psychology and educators. The training was a successful
component of the Drug Demand Reduction experience in the United States.
conclusion
For over 25 years, 3HO has perfected the program, and we take our
high success rate seriously. Today, many people are lost and depressed
amidst a world of confusion and unknowns. It is our most heartfelt
intent, through the techniques in this program, to give people an
experience which can lead them back to themselves and their families.
In that most precious experience, there is no better place to offer
this than the Land of Enchantment--Espanola, New Mexico.
Senator Domenici. Thank you very much. I assume that as
they proceed with the planning here, from what you are saying,
you will be in touch with the people that are looking for more
treatment facilities and see if you fit, and where you fit. I
appreciate your comments today. Do any of you have any further
comments?
Doctor, I want to thank you. I know you are busy, and you
took a lot of time out today, as you did the last time. I just
hope that from you we have learned something and will justify
all the effort you put forth.
Mr. Richardson, we thank you for your efforts. We are
hopeful we all learned from you, and we will do a better job.
And, Ms. Cassados, we know you have a great clinic, and we
know you serve a lot of people, and you have a hard job, but
most of our clinics around the State are doing a wonderful job,
and we have many of them. They have different foundations and
different origins, but they are kind of moving toward the same
basic format, and all of you know that in the last couple of
years, you have been a provider for the Veterans. Most of the
clinics in the north have become certified providers, so our
Veterans don't have to go all the way to the hospital in
Albuquerque for medicines and things of that sort. There's a
big help if you do that, but many of the clinics do.
Ms. Cassados. I would love to speak with you about that.
Senator Domenici. We have had a lot of trouble with the VA.
They've had lots of trouble, but surely eventually, clearly,
there are a whole lot of them, and they are doing a good job.
Let me see, we are going to wrap up this part of the hearing
right now and visit Delancey Street.
I want to thank everybody that participated and those of
you who have spent a very long time here. Members of the media
have given us a great deal of attention, and lastly but not
least, the chairman of this committee, Senator Judd Gregg. This
record will be transcribed and made a part of the record of the
Appropriations Committee of the United States, which helps in
all of these areas, and perhaps in due course, they will learn
something from it or those of us who participated will learn
from it.
It's a privilege to participate. I think some good is going
to come out of this, if we don't expect miracles, but rather go
along with a community effort and build upon the three legs of
this stool. As they become stronger, I think we are going to
have some success.
conclusion of hearing
I want to close this hearing and indicate that the hearing
will not reconvene but rather will be closed now, and the
record will be perfected and we stand in recess.
[Whereupon, at 1:05 p.m., Tuesday, March 30, the hearing
was concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]
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