(Full article published in the October 17, 2011 issue of Alcoholism & Drug Abuse Weekly, available electronically to current subscribers on October 14.

Washington State is proposing to eliminate all alcohol and drug abuse treatment for adults — inpatient, outpatient, and detoxification — except for those in drug court, and pregnant and parenting women (PPW). The proposed cut — $72 million from the $152 million budget designated for substance abuse treatment for the 2012-2013 biennium — is 47 percent — much deeper than the 10 percent required from each department by the state’s Office of Financial Management (OFM).

The original proposal from the state’s Division of Behavioral Health and Recovery, headed by David Dickinson, preserved a larger portion of substance abuse treatment funding. But when all of the agency proposals were in to the Department of Social and Health Services (DSHS), there wasn’t enough to meet the department’s 10-percent target. So DSHS sent it back to Dickinson to make more cuts.

“What I said was to include these reductions was unconscionable but necessary to meet the requirements,” he told ADAW last week. “We were aiming to hit 10 percent of the alcohol and substance abuse budget.” Instead, the alcohol and substance abuse budget was cut almost in half.

There were initially three tiers of possible reductions across DSHS, labeled “strategic and aligned with our new economic realities” ($89 million), “difficult but doable” ($146 million), and “necessary to build to the 10 percent target” ($343 million). The third tier cuts are the ones the state is heading to.

The DSHS cuts aren’t the whole story. At the same time that the cuts to treatment services are proposed, the Health Care Authority is proposing to eliminate adult pharmacy — which includes methadone and buprenorphine.

Alcohol and substance abuse represents 3 percent, or $152 million, of DSHS biennial budget of $11.2 billion today. The disproportionate cuts substance abuse services are taking “don’t pass the straight face test,” said Dickinson, who is in a difficult position. “Not being in the room when these decisions were made, it is clear that they are moving to the 10-percent option,” he said. Still, alcohol and substance abuse treatment are getting more than four times that percentage cut.

“This is not a cut yet, it is an option for the Governor to consider as she builds a budget for the legislature to consider,” said Dickinson. “It’s not a done deal yet.”

Dreyfus resigns

Even DSHS Secretary Susan N. Dreyfus is calling the cuts unconscionable. She’s also leaving. On October 12, she announced that effective Jan. 2 she is taking a job as president/CEO of Families International.

Two years ago, the Division of Alcohol and Substance Abuse (DASA), merged with the Mental Health Division (see ADAW, Jan. 26, 2009, April 13, 2009 and September 14, 2009). Since then, the ongoing recession has continued to batter state revenue. “I came here to run DASA, not to do what I’m doing now,” said Dickinson. “I get it on the provider level, I was a clinician for 25 years.”

But massive changes are taking place across the country, he said, pointing to New York, where a merger with mental health was unthinkable but is now likely, and to California, for the entire state Department of Alcohol and Drug Programs may be dismantled.

Threat to infrastructure

Dickinson called on provider organizations to keep doing what they’re doing — mobilizing. Of the 590 providers that are publicly funded, 300 would have to shut down under the cuts, he said. This means that even treatment for adolescents and pregnant and parenting women is jeopardized. “You can’t take away this much of the system and sustain pregnant and parenting women and adolescent treatment,” he said, noting that the effect of the cuts could permanently damage treatment in the state. “If half of the programs go under, even if there’s an economic turnaround, it will take decades to rebuild the infrastructure.”

The federal block grant funds priority services — to pregnant and parenting women and adolescents — and that’s why the state is keeping them. But programs may not be able to provide services even to those populations, under these cuts.

“I run a program for these mothers and children that would not be able to stay open if my detox and outpatients services are all defunded,” said Linda Grant, executive director of Evergreen Manor in Everett, in an email to ADAW last week. “The proposal is catastrophic and would bring a system that was once the envy of the nation to extinction.”

Evergreen Manor currently receives $1.1 million a year for detoxification, and $700,000 a year for adult outpatient treatment (not including PPW and drug court). With this funding, it treats 1,100 patients a year in medically supervised detoxification, with daily waiting lists of 25-30, 750 outpatients a year (130 are PPW or drug court) at the Everett facility, 311 outpatients a year (50 are PPW or drug court) at the Lynwood facility, 98 mothers and 54 of their children a year in residential treatment, and 45 families of addicted women in case management.

Under the cuts, Evergreen would lose all funding for its 15-bed detoxification program, leaving nowhere for those 1,100 patients to go in the entire county, said Grant. Over 200 of these people would be homeless, and hospitals, mental health responders, jails, and law enforcement would have to respond to crises, she said. Finally, the Everett and Lynwood outpatient offices would have to close — the PPW and drug court patients wouldn’t be able to pay for enough to keep them open.

Nearly half of the mothers in treatment have already lost custody, and would not be eligible for funding for treatment until they regain custody. And they would not be able to regain custody until they successfully complete treatment.

In Snohomish County, where Evergreen Manor is located, there are 1,228 patients in outpatient treatment, 256 in methadone or buprenorphine treatment, and 1,100 admitted a year for acute detoxification by county.

Finally, 98 Evergreen Manor employees would be laid off, and 5 properties, including 3 transitional homes, would risk foreclosure, said Grant.

Special legislative session

Ironically, Washington had scrupulous cost offset data that made the state a national model and resulted in a huge treatment expansion in 2005 (see ADAW, November 14, 2005). “In the division, we have not forgotten about the cost offset data,” said Dickinson.

The cost offset data and input from providers can be fodder for the upcoming weeks as the budget continues to be hashed out in a special session of the legislature, announced by Gov. Chris Gregoire, which will convene Nov. 28. The current budget proposal was sent to the OFM last month.

The next revenue forecast is due on November 17, and is anticipated to be negative, meaning that the 10-percent cuts — or more — will still have to be made. Governor Gregoire will present her plan to departments later this month, and in December will release a complete supplemental budget.