Task Force on Substance Abuse Services

Substance abuse carries huge direct and indirect costs to society. In 2005-2006 in North Carolina, more than 700,000 people age 12 or older (8.5%) reported being addicted to alcohol, drugs, or both. The prevention, diagnosis, and treatment of substance abuse is difficult for several reasons. The NCIOM Task Force on Substance Abuse looked at how to improve the statewide substance abuse delivery system. This report presents their findings and recommendations.
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Rep. Verla Insko
NC House of Representatives
Sen. Martin L. Nesbitt, Jr., JD
NC Senate
Dewayne Book, MD
Medical Director
Fellowship Hall
Project Director  Pam Silberman, JD, DrPH
President and CEO
North Carolina Institute of Medicine
Substance abuse is a complex and costly disease. The prevention, diagnosis, and treatment of substance abuse is difficult for several reasons. Many individuals with substance abuse problems either do not recognize they have a problem or do not seek treatment due to access barriers. Nearly 90% of people that abuse or depend on alcohol or illicit drugs never seek treatment. The few who do seek treatment may encounter problems accessing it due to service availability or cost. Approximately 2.6% of North Carolinians needed but did not receive treatment for alcohol disorders in 2004. The percentage of the population with unmet drug treatment needs is even higher (5.1%).

Alcohol and drug abuse cost the North Carolina economy over $12.4 billion in direct and indirect costs in 2004. Only 6% ($66.8 million) of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services' (MHDDSAS) expenditures in 2005 were for substance abuse services for 42,000 people. Overall, North Carolina spent less then $140 million to fund substance abuse services in the state, a sum that left North Carolina substance abuse services under-funded in relation to other states. A report presented to the NC General Assembly in 2007 estimated it would take an additional $35 million in appropriations to achieve parity with national per capita funding for substance abuse services. In addition to the direct costs of prevention, treatment, and rehabilitation, substance abuse accrues additional indirect costs associated with motor vehicles accidents, premature death, comorbid conditions, loss of productivity, and unemployment.

The North Carolina General Assembly asked the NCIOM to convene a task force to study substance abuse services in the state. The legislature asked the task force to:
1) Identify the continuum of services needed for treatment of substance abuse services, including but not limited to prevention, outpatient services, residential treatment and recovery support.
2) Identify evidence-based models of care or promising practices in coordination with the NC Practice Improvement Collaborative for the prevention and treatment of substance abuse services, and develop recommendations to incorporate these models into the current substance abuse service system of care.
3) Examine different financing options to pay for substance abuse services at the local, regional and state levels.
4) Examine the adequacy of the current and future substance abuse workforce.
5) Develop strategies to identify people in need of substance abuse services, including people who are dually diagnosed as having mental health and substance abuse problems.
6) Examine barriers that people with substance abuse problems have in accessing publicly funded substance abuse services and explore possible strategies for improving access.
7) Examine current outcome measures and identify other appropriate outcome measures to assess the effectiveness of substance abuse services.
8) Examine the economic impact of substance abuse in North Carolina.
9) Make recommendations on the implementation of a cost-effective plan for prevention, early screening, diagnosis and treatment of North Carolinians with substance abuse problems.