[Congressional Record Volume 148, Number 17 (Tuesday, February 26, 2002)]
[Senate]
[Pages S1210-S1212]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE.
  S. 1965. A bill to meet the mental health and substance abuse 
treatment needs of incarcerated children and youth; to the Committee on 
the Judiciary.
  Mr. WELLSTONE. Mr. President, I rise today to reintroduce the Mental 
Health Juvenile Justice Act of 2002. As many of my colleagues know, 
increasing numbers of children with mental disorders are entering the 
juvenile justice system. Each year, more than one million children come 
into contact with the justice system, and twenty percent of those who 
are incarcerated have a serious mental illness. Many of these children 
are, in effect, dumped on the justice system because of cuts in mental 
health services in the community. These children are overwhelmingly 
poor, a disproportionate number are children of color, and most come 
from troubled homes.
  Contrary to what many believe, most children who are locked up are 
not violent. Justice Department studies show that only one in twenty 
children in the juvenile system has committed a violent offense. Most 
children with mental disorders have committed minor, nonviolent 
offenses or status offenses, such as petty theft or skipping school. 
Still others have simply run away from home to escape physical or 
sexual abuse from parents or other adults. Whenever possible, these 
children should be diverted from the juvenile justice system and toward 
community-based services, including mental health and substance abuse 
treatment as needed. Because some children with mental disorders commit 
serious and violent offenses, it is not always possible to divert them 
from incarceration. Nevertheless, these children need treatment for 
their disorders to aid in their inevitable return to the community.
  Children with mental illness are largely untreated in the current 
system, although this may contribute to the child's delinquency. The 
difficult and sometimes deplorable conditions that prevail in detention 
centers and youth prisons exacerbate the problems of these children. 
Mental health services both prevent them from committing delinquent 
offenses and from re-offending. If appropriate mental health care is 
not provided, our country will pay a higher price in repeated 
incarcerations, substance abuse, and even suicides.
  The Mental Health Juvenile Justice Act of 2002, if enacted into law, 
will go a long way to help address the needs of these children. This 
measure outlines a comprehensive federal strategy for providing 
critical assistance to children with mental illness in our juvenile 
justice system. It would:
  Train state judges, probation officers, and others on the 
identification and need for appropriate treatment of mental disorders 
and substance abuse, and on the use of community-based alternatives to 
placement in juvenile correctional facilities;
  Provide block grant funds and competitive grants to the states and 
localities to develop mental health diversion programs for children who 
come into contact with the justice system, by strengthening the 
collaboration of community agencies serving troubled children, and to 
provide mental health treatment for incarcerated children with 
emotional disorders;
  Establish a Federal Council on the Criminalization of Youth with 
Mental Disorders to report to Congress on proposed legislation to 
improve the treatment of mentally ill children who come into contact 
with the justice system; and
  Remove the most damaging provisions of the Prison Litigation Reform 
Act of 1996, by giving back to the federal courts important tools to 
remedy abusive conditions in state facilities under which juvenile 
offenders and mentally ill prisoners are being held.
  We can no longer ignore this tragedy. The neglect of youth with 
emotional disturbances in our prisons must end. We as a society have 
the moral obligation to see that they get the help they need.
                                 ______
                                 
      By Mr. BIDEN.
  S. 1966. A bill to educate health professionals concerning substance 
abuse and addiction; to the Committee on Health, Education, Labor, and 
Pensions.
  Mr. BIDEN. Mr. President, I rise today to introduce legislation to 
address the problem of substance abuse in our country.
  Last year the Robert Wood Johnson Foundation called substance abuse 
America's number one health problem. I don't think that overstates it.
  Most of us know someone, a family member, maybe a neighbor, a 
colleague, or a friend, who is addicted to drugs or alcohol. In fact, 
14 million people in this country abuse alcohol or are alcoholics. 
Nearly 15 million use drugs. And nearly four million are in need of 
treatment but not receiving it.
  Drug and alcohol abuse has far reaching consequences. It exacerbates 
social ills. It's a public safety problem. It's a public health 
problem. It's a public expenditure problem. There is an undeniable 
correlation between substance abuse and crime. Eighty percent of the 
two million men and women behind bars today have a history of drug and 
alcohol abuse or addiction or were arrested for a drug-related crime. 
Illegal drugs are responsible for thousands of deaths each year. They 
fuel the spread of AIDS and Hepatitis C. They contribute to child 
abuse, domestic violence, and sexual assault. And we all pay the price.
  It costs this Nation almost $276 billion in law enforcement, criminal 
justice expenses, medical bills, and lost earnings each year. That 
means that preventing and treating substance abuse makes sense. It 
makes good criminal justice sense. It makes public health sense. It 
makes budgetary sense. Not to mention the fact that it's the right 
thing to do.
  Yet there remains a reluctance to recognize substance abuse as a 
health issue. There's a reluctance to accept addiction as a disease. 
It's a reluctance that has kept public policy from asserting that 
addicts should be in treatment. Whether addicts are in prison or out, 
it seems to me, treatment is the only legitimate choice.
  Not only must we authorize it, we must take full advantage of the 
treatments that have been developed.
  For too long, access to effective therapies, such as methadone and 
LAAM for heroin addiction, has been strangled by layers of bureaucracy 
and regulation. The result is that only 22 percent of opiate addicts 
are now receiving pharmaco-therapy treatment.
  Yet, when I introduced a bill during the last Congress with Senators 
Hatch, Levin and Moynihan to help improve access by allowing qualified 
doctors to prescribe certain anti-addiction drugs such as buprenorphine 
right from their offices, just like other medicines, the bill initially 
met with resistance.
  But, because the facts about addiction are finally beginning to sink 
in, 69 percent of Americans now support treatment instead of jail as 
the primary focus for drug abusers, and because we were frustrated 
enough to be

[[Page S1211]]

persistent, the bill eventually passed and President Clinton signed it 
into law.
  But it's not only about increasing access to treatment. It is also 
about moving treatment into the medical mainstream. Unless family 
doctors, nurses, physician assistants and social workers can identify 
addiction when they see it, unless they know how to intervene, we will 
never make any real progress.
  That aspect of the challenge came into sharp focus for me when I read 
a report a few years ago by The National Center on Addiction and 
Substance Abuse at Columbia University, CASA.
  That report said that fewer than one percent of doctors presented 
with the classic profile of an alcoholic older woman could diagnose it 
properly. Eighty-two percent mis-diagnosed it as depression, some 
treatments for which are dangerous when taken with alcohol. A follow-up 
study showed that 94 percent of primary care physicians fail to 
diagnose substance abuse when presented with the classic symptoms. And 
41 percent of pediatricians fail to diagnose illegal drug use in 
teenage patients.
  No one recognizes this problem better than the doctors themselves. 
Fewer than one in five, only 19 percent, feel confident about 
diagnosing alcoholism. And only 17 percent feel qualified to identify 
illegal drug use. Having said that, even if they diagnose it, most 
doctors don't believe that treatment works.
  Among practitioners, as well as policy makers, we need to get the 
message out. It needs to be loud and clear. Addiction is a chronic 
relapsing disease, and as with other such diseases, while there may not 
be a cure, medical treatment can help control it.
  The medical professionals have to be educated to recognize the signs 
of substance abuse and to pursue the effective therapies that are 
available. That is why I am introducing legislation to create a grant 
program to train medical professionals to prevent and recognize 
addiction and refer patients to treatment if they need it. 
Representative Patrick Kennedy will introduce companion legislation in 
the House of Representatives.
  Like treatment, training works.
  According to a study published in the Brown University Digest of 
Addiction Theory and Application, 91 percent of health professionals 
who took part in training on addiction at Boston University were using 
the techniques they learned one to five years later.
  Every family doctor does not need to be an addiction specialist, but 
they do need to be able to recognize the signs. And they need to know 
what help is available.
  It's another step, and, in my view, a crucial one, to help bridge the 
divide between research and practice. It will help chip away at the 
incredible substance abuse-related costs we face each year in human as 
well as monetary terms.
  I hope that my colleagues will join me to support this important 
legislation. I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1966

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) Illegal drugs and alcohol are responsible for thousands 
     of deaths each year, and they fuel the spread of a number of 
     communicable diseases, including AIDS and Hepatitis C, as 
     well as some of the worst social problems in the United 
     States, including child abuse, domestic violence, and sexual 
     assault.
       (2) There are an estimated 14,800,000 current drug users in 
     America, more than 4,000,000 of whom are addicts. An 
     estimated 14,000,000 Americans abuse alcohol or are 
     alcoholic.
       (3) There is a significant treatment gap in the United 
     States. Nearly 4,000,000 drug users who are in need of 
     immediate treatment are not receiving it. This includes more 
     than 1,200,000 children ages 12 to 25. These numbers do not 
     take into account the number of alcoholics in need of 
     treatment.
       (4) There are more than 28,000,000 children of alcoholics 
     in America, almost 11,000,000 of whom are under 18 years of 
     age. Countless other children are affected by substance 
     abusing parents or other caretakers. Health professionals are 
     uniquely positioned to help reduce or prevent alcohol and 
     other drug-related impairment by identifying affected 
     families and youth and by providing early intervention.
       (5) Drug addiction is a chronic relapsing disease. As with 
     other chronic relapsing diseases (such as diabetes, 
     hypertension and asthma), there is no cure, although a number 
     of treatments can effectively control the disease. According 
     to an article published in the Journal of the American 
     Medical Association, treatment for addiction works just as 
     well as treatment for other chronic relapsing diseases.
       (6) Drug treatment is cost effective, even when compared 
     with residential treatment, the most expensive type of 
     treatment. Residential treatment for cocaine addiction costs 
     between $15,000 and $20,000 a year, a substantial savings 
     compared to incarceration (costing nearly $40,000 a year), or 
     untreated addiction (costing more than $43,000 a year). Also, 
     in 1998, substance abuse and addiction accounted for 
     approximately $10,000,000,000 in Federal, State, and local 
     government spending simply to maintain the child welfare 
     system. The economic costs associated with fetal alcohol 
     syndrome were estimated at $1,900,000,000 for 1992.
       (7) Many doctors and other health professionals are 
     unprepared to recognize substance abuse in their patients or 
     their families and intervene in an appropriate manner. Only 
     56 percent of residency programs have a required curriculum 
     in preventing or treating substance abuse.
       (8) Fewer than 1 in 5 doctors (only 19 percent) feel 
     confident about diagnosing alcoholism, and only 17 percent 
     feel qualified to identify illegal drug use.
       (9) Most doctors who are in a position to make a diagnosis 
     of alcoholism or drug addiction do not believe that treatment 
     works (less than 4 percent for alcoholism and only 2 percent 
     for drugs).
       (10) According to a survey by the National Center on 
     Addiction and Substance Abuse at Columbia University 
     (referred to in this section as ``CASA''), 94 percent of 
     primary care physicians and 40 percent of pediatricians 
     presented with a classic description of an alcoholic or drug 
     addict, respectively, failed to properly recognize the 
     problem.
       (11) Another CASA report revealed that fewer than 1 percent 
     of doctors presented with the classic profile of an alcoholic 
     older woman could diagnose it properly. Eighty-two percent 
     misdiagnosed it as depression, some treatments for which are 
     dangerous when taken with alcohol.
       (12) Training can greatly increase the degree to which 
     medical and other health professionals screen patients for 
     substance abuse. It can also increase the manner by which 
     such professionals screen children and youth who may be 
     impacted by the addiction of a parent or other primary 
     caretaker. Boston University Medical School researchers 
     designed and conducted a seminar on detection and brief 
     intervention of substance abuse for doctors, nurses, 
     physician's assistants, social workers and psychologists. 
     Follow-up studies reveal that 91 percent of those who 
     participated in the seminar report that they are still using 
     the techniques up to 5 years later.
       (13) According to the National Clearinghouse for Alcohol 
     and Drug Information, drug and alcohol abuse account for more 
     than $400,000,000,000 in health care costs each year. Arming 
     health care professionals with the information they need in 
     order to intervene and prevent further substance abuse could 
     lead to a significant cost savings.
       (14) A study conducted by doctors at the University of 
     Wisconsin found a $947 net savings patient in health care, 
     accident, and criminal justice costs for each individual 
     screened and, if appropriate, for whom intervention was made, 
     with respect to alcohol problems.
       (b) Purpose.--It is the purpose of this Act to--
       (1) improve the ability of health care professionals to 
     identify and assist their patients with substance abuse;
       (2) improve the ability of health care professionals to 
     identify and assist children and youth affected by substance 
     abuse in their families; and
       (3) help establish an infrastructure to train health care 
     professionals about substance abuse issues.

     SEC. 3. HEALTH PROFESSION EDUCATION.

       (a) Secretary of Health and Human Services.--The Secretary 
     of Health and Human Services may enter into interagency 
     agreements with the Health Resources Services Administration 
     or the Substance Abuse and Mental Health Services 
     Administration to enable each such Administration to carry 
     out activities to train health professionals (who are 
     generalists and not already specialists in substance abuse) 
     so that they are competent to--
       (1) recognize substance abuse in their patients or the 
     family members of their patients;
       (2) intervene, treat, or refer for treatment those 
     individuals who are affected by substance abuse;
       (3) identify and assist children of substance abusing 
     parents; and
       (4) serve as advocates and resources for community-based 
     substance abuse prevention programs.
       (b) Use of Funds.--Amounts received under an interagency 
     agreement under this section shall be used--
       (1) with respect to the Health Resources and Services 
     Administration, to support the

[[Page S1212]]

     Association for Medical Education and Research in Substance 
     Abuse (AMERSA) Interdisciplinary Project; and
       (2) with respect to the Substance Abuse and Mental Health 
     Services Administration, to support the Addiction Technology 
     Transfer Centers counselor training programs to train other 
     health professionals.
       (c) Collaboration.--To be eligible to enter into an 
     interagency agreement under this section the Health Resources 
     and Services Administration or the Substance Abuse and Mental 
     Health Services Administration shall demonstrate that such 
     Administration will participate in interdisciplinary 
     collaboration and collaborate with other nongovernmental 
     organizations with respect to activities carried out under 
     this section.
       (d) Evaluations.--The Health Resources and Services 
     Administration and the Substance Abuse and Mental Health 
     Services Administration shall conduct a process and outcome 
     evaluation of the programs and activities carried out with 
     funds received under this section, and shall provide semi-
     annual reports to the Secretary of Health Human Services and 
     the Director of the Office of National Drug Control Policy.
       (e) Definitions.--In this section--
       (1) the term ``health professional'' means a doctor, nurse, 
     physician assistant, nurse practitioner, social worker, 
     psychologist, pharmacist, osteopath, or other individual who 
     is licensed, accredited, or certified under State law to 
     provide specified health care services and who is operating 
     within the scope of such licensure, accreditation, or 
     certification; and
       (2) the terms ``doctor'', ``nurse'', ``physician 
     assistant'', ``nurse practitioner'', ``social worker'', 
     ``psychologist'', ``pharmacist'', and ``osteopath'' shall 
     have the meanings given such terms for purposes of titles VII 
     and VIII of the Public Health Service Act (42 U.S.C. 292 et 
     seq and 296 et seq.).
       (f) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $5,500,000 for 
     each of fiscal years 2002 through 2006, of which $1,000,000 
     in each such fiscal year shall be made available to the 
     Substance Abuse and Mental Health Services Administration and 
     $4,500,000 in each such fiscal year shall be made available 
     to the Health Resources and Services Administration, to carry 
     out this section. Amounts made available under this 
     subsection shall be used to supplement and not supplant 
     amounts being used on the date of enactment of this Act for 
     activities of the types described in this section.

     SEC. 4. SUBSTANCE ABUSE FACULTY FELLOWSHIP.

       (a) Establishment.--The Secretary of Health and Human 
     Services (referred to in this section as the ``Secretary'') 
     shall establish and administer a substance abuse faculty 
     fellowship program under which the Secretary shall provide 
     assistance to eligible institutions to enable such 
     institutions to employ individuals to serve as faculty and 
     provide substance abuse training in a multi-discipline 
     manner.
       (b) Eligibility.--
       (1) Institutions.--To be eligible to receive assistance 
     under this section, an institution shall--
       (A) be an accredited medical school or nursing school, or 
     be an institution of higher education that offers one or more 
     of the following--
       (i) an accredited physician assistant program;
       (ii) an accredited nurse practitioner program;
       (iii) a graduate program in pharmacy;
       (iv) a graduate program in public health;
       (v) a graduate program in social work; or
       (vi) a graduate program in psychology; and
       (B) prepare and submit to the Secretary an application at 
     such time, in such manner, and containing such information as 
     the Secretary may require.
       (2) Individuals.--To be eligible to receive a fellowship 
     from an eligible institution under this section, an 
     individual shall prepare and submit to the institution an 
     application at such time, in such manner, and containing such 
     information as the institution may require.
       (c) Use of Funds.--
       (1) In general.--An eligible institution shall utilize 
     assistance received under this section to provide one or more 
     fellowships to eligible individuals. Such assistance shall be 
     used to pay not to exceed 50 percent of the annual salary of 
     the individual under such a fellowship for a 5-year period.
       (2) Fellowships.--Under a fellowship under paragraph (1), 
     an individual shall--
       (A) devote a substantial number of teaching hours to 
     substance abuse issues (as part of both required and elective 
     courses) at the institution involved during the period of the 
     fellowship; and
       (B) attempt to incorporate substance abuse issues into the 
     required curriculum of the institution in a manner that is 
     likely to be sustained after the period of the fellowship 
     ends.

     Courses described in this paragraph should by taught as part 
     of several different health care training programs at the 
     institution involved.
       (3) Evaluations.--The Secretary shall conduct a process and 
     outcome evaluation of the programs and activities carried out 
     with amounts appropriated under this section and shall 
     provide semi-annual reports to the Director of the Office of 
     National Drug Control Policy and the Secretary of Health and 
     Human Services.
       (d) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $3,500,000 for 
     each of the fiscal years 2002 through 2006. Amounts made 
     available under this subsection shall be used to supplement 
     and not supplant amounts being used on the date of enactment 
     of this Act for activities of the types described in this 
     section.

     SEC. 5. OVERSIGHT COMMITTEE.

       (a) In General.--The Director of the Office of National 
     Drug Control Policy shall convene an interagency oversight 
     committee, composed of representatives of the Health 
     Resources and Services Administration, as well as the 
     National Institute on Drug Abuse, the National Institute on 
     Alcohol Abuse and Alcoholism, the Substance Abuse and Mental 
     Health Services Administration, and the National Institute on 
     Mental Health, and non-governmental organizations determined 
     to be experts in the field of substance abuse, to receive 
     updates concerning and coordinate the Federal activities 
     funded under this Act and the activities of various Federal 
     agencies, toward the goal of educating health professionals 
     about substance abuse.
       (b) Meetings.--The interagency oversight committee 
     established under subsection (a) shall meet at least twice 
     each year at the call of the Director of the Office of 
     National Drug Control Policy.
                                 ______