[Congressional Record Volume 151, Number 25 (Monday, March 7, 2005)]
[Senate]
[Pages S2161-S2164]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BIDEN:
  S. 538. A bill to educate health professionals concerning substance 
use disorders and addiction; to the Committee on Health, Education, 
Labor, and Pensions.

[[Page S2162]]

  Mr. BIDEN. Mr. President, I rise today to introduce legislation to 
address the problem of substance abuse in our country.
  The Robert Wood Johnson Foundation has called substance abuse 
America's No. 1 health problem. I don't think that overstates it.
  Most of us knows someone--a family member, maybe a neighbor, a 
colleague, or a friend--who is addicted to drugs or alcohol. In fact, 
nearly 15 million people in this country abuse alcohol or are 
alcoholics. More than 19 million use drugs, and an estimated 4 million 
are in need of treatment but not receiving it.
  Drug and alcohol abuse has far-reaching consequences. It exacerbates 
social ills. It is a public safety problem. It is a public health 
problem. It is a public expenditure problem. There is an undeniable 
correlation between substance abuse and crime. Eighty percent of the 2 
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 $275 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 is the right 
thing to do.
  Yet there remains a reluctance to recognize substance abuse as a 
health issue. There is a reluctance to accept addiction as a disease. 
It is 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.
  But it is 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 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. 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 policymakers, we need to get the 
message out 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 help 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 1 to 5 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.
  My legislation does the following three things: authorizes $9 million 
in grants to train medical generalists to recognize substance abuse in 
their patients and their families and know how to properly refer them 
for treatment; authorizes $6 million to fund substance abuse faculty 
fellows at educational institutions to teach courses on substance 
abuse, incorporate substance abuse issues into to required courses at 
the institution, and educate health professionals about issues related 
to non-therapeutic uses of prescription medications; and establishes 
centers of excellence at medical centers or universities across the 
United States to (1) initiate, promote and implement training, research 
and clinical activities related to special areas of substance abuse and 
(2) provide opportunities for interdisciplinary collaboration in 
curriculum development, clinical practice, research and policy 
analysis. The bill authorizes $6 million for this purpose.
  These are additional steps--and, in my view, crucial ones to help 
bridge the divide between research and practice. They will help chip 
away at the incredible substance abuse-related costs we face each year 
in human as well as monetary terms.
  I hope 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. 538

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. FINDINGS AND PURPOSE.

       (a) Findings.--Congress makes the following findings:
       (1) Illegal drugs and alcohol are responsible for thousands 
     of deaths each year, and they fuel the spread of a number of 
     communicable diseases, including AIDS and Hepatitis C, as 
     well as some of the worst social problems in the United 
     States, including child abuse, domestic violence, and sexual 
     assault.
       (2) There are an estimated 19,500,000 current drug users in 
     America, nearly 4,000,000 of whom are addicts. An estimated 
     14,800,000 Americans abuse alcohol or are alcoholic.
       (3) There are nearly 27,000,000 children of alcoholics in 
     America, almost 11,000,000 of whom are under 18 years of age. 
     Countless other children are affected by substance abusing 
     parents or other caretakers. Health professionals are 
     uniquely positioned to help reduce or prevent alcohol and 
     other drug-related impairment by identifying affected 
     families and youth and by providing early intervention.
       (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 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 $54,000,000,000 in 2003.
       (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.

[[Page S2163]]

       (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) The total economic costs of untreated addiction is 
     estimated to be $274,800,000,000. Arming health care 
     professionals with the information they need in order to 
     intervene and prevent further substance abuse could lead to a 
     significant cost savings.
       (14) A study conducted by doctors at the University of 
     Wisconsin found a $947 net savings per patient in health 
     care, accident, and criminal justice costs for each 
     individual screened and, if appropriate, for whom 
     intervention was made, with respect to alcohol problems.
       (b) Purpose.--It is the purpose of this Act to--
       (1) improve the ability of health care professionals to 
     identify and assist their patients in obtaining appropriate 
     treatment for substance abuse;
       (2) improve the ability of health care professionals to 
     identify and refer children and youth affected by substance 
     abuse in their families for effective treatment; and
       (3) help establish an infrastructure to train health care 
     professionals about substance abuse issues and the impact on 
     families.

     SEC. 3. HEALTH PROFESSIONALS SUBSTANCE ABUSE EDUCATION.

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

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

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

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

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

     ``SEC. 546. CENTER OF EXCELLENCE.

       ``(a) In General.--The Secretary shall establish centers of 
     excellence at medical centers or universities throughout the 
     United States to--
       ``(1) initiate, promote, and implement training, research, 
     and clinical activities related to targeted issues or special 
     areas of focus such as brief intervention in general health 
     settings, children and families affected by substance abuse, 
     older individuals, maternal and child health issues, 
     individuals with dual diagnosis, prevention in the general 
     health setting, and clinical practice standards for primary 
     care providers; and
       ``(2) provide opportunities for interdisciplinary 
     collaboration in curriculum development, course development, 
     clinical practice,

[[Page S2164]]

     research and translation of research into practice, and 
     policy analysis and formulation.
       ``(b) Use of Funds.--Centers of excellence established 
     under subsection (a) shall use funds provided under this 
     section to--
       ``(1) disseminate information on evidence-based approaches 
     concerning the prevention and treatment of substance use 
     disorders; and
       ``(2) assist health professionals and alcohol and drug 
     treatment counselors to incorporate the latest research into 
     their treatment practices.
       ``(c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $6,000,000 for 
     each of the fiscal years 2006 through 2010.''.
                                 ______