Arizona Profile 1997

Drug Strategies

Looking to the Future

To reduce substance abuse, Arizona must develop customized solutions for specific subpopulations through community mobilization. However, these locally driven solutions must be integrated into a larger framework of comprehensive prevention. The balance will be found in building public agency partnerships and public-private collaborations, and in strengthening trust between communities, especially where barriers to cooperation now exist. The state will have to remain vigilant in a number of key areas, and invest funds where they will be most effective.

Accountability and Cost-Effective Ideas

Through a commitment to quality and cost-effectiveness, Arizona has realized substantial savings in social programs. For example, the state has been a pioneer in government-run managed health care systems, reducing per capita costs and saving up to $52 million a year by promoting competition and cost containment. The cornerstone is a monitoring system that uses sound scientific data to drive policy. The state must consistently measure the prevalence of problems and the cost-effectiveness of responses. Tracking such data over time is essential to making pragmatic rather than ideological policy and funding decisions.

To that end, the state's annual Program Inventory provides excellent opportunities to correct weaknesses in program services or funding streams. Likewise, the Arizona Needs Assessment Study will offer critical data on substance abuse problems in specific populations and regions of the state.

Given the alarming trends in teen drug use in Arizona, youth prevention should be a prominent theme in coming years. But gathering consistent data to guide new programs and policies poses a challenge, placing extra burdens on schools to meet the needs of multiple agencies. In 1988, the Arizona Criminal Justice Commission recommended that collaborative survey projects be undertaken with the Department of Education. Despite the cost-effectiveness and scientific merits of a cooperatively funded and administered student substance use survey, attempts to develop such a multi-purpose tool have failed. This effort should be redoubled.

Tobacco Initiatives

Arizona's new tobacco program has made an impressive start. Careful planning will sustain its initial success. Three areas merit particular attention.

First, the concentration of smoking among young adults underscores the need for educational efforts targeting adults as well as vigorous youth prevention programs.

Of the $109 million in tobacco tax revenues in 1995, three-quarters was earmarked for tobacco health research, prevention and state supported health care. But the state legislature has frozen about half of the earmarked funds while various state agencies compete for access to the tobacco tax dollars. These dollars should be used for anti-tobacco efforts as soon as possible.

The AzTEPP biennial surveys of youth and adults indicate where prevention is most needed. Such data may strengthen political support for tobacco control initiatives, and free necessary funds.

Cigarette sales on Native American reservations are not subject to state excise taxes. And although 12 of Arizona's 21 tribes have implemented their own tobacco taxes, billboards across the state encourage smokers to buy cigarettes on reservations to save taxes. The state should increase awareness campaigns and outreach efforts near reservations, and create incentives for reservations to tax tobacco products.

Parent Education and Involvement

Arizona parents grossly underestimate their own children's alcohol, tobacco and drug use. Therefore, educating parents should be the centerpiece of the state's new focus on reinvesting in communities. In addition, many adults in Arizona are binge drinkers or smokers, whose habits at home compete with publicly funded prevention messages aimed at youth. Prevention campaigns should challenge parents to be role models as well as communityvolunteers.

Emergency Rooms

In 1997, the Arizona Department of Health Services will implement a new state law requiring all non-Federal hospitals to report emergency room data to the state. The expansion in reporting will create a comprehensive picture of emerging drug problems, which the state can use to target new initiatives.

Treatment

To reduce the state's treatment costs, Arizona officials must create incentives for private insurance plans to cover substance abuse treatment as fully as they cover treatment for other chronic illnesses. Nationally, private insurance plans do not currently provide such parity.

Employee assistance plans (EAPs) that encourage early assessment and referral are also cost-effective. The average annual cost of the most popular EAPs is just $15 per employee. Employers should be urged to adopt these plans.

Finally, publicly funded treatment must be made more accessible in outlying areas of the state, where many indigent residents live. The Department of Health Services should work with the Regional Behavioral Health Authorities to develop standards and common outcomes measures for prevention, outreach and treatment services. A treatment clearinghouse and technical assistance agency, working in partnership with state sponsored prevention resources, would facilitate progress.

Treating Criminals. Treatment has been shown to reduce criminal justice costs over the long term, but in the absence of carefully planned continuing care for parolees, the state's investment in prison-based treatment will fail. Substance abuse is a strong predictor of recidivism, and rates of reincarceration in Arizona indicate that more extensive treatment services are needed for criminals. The Department of Corrections should sponsor further studies documenting the costs and benefits of prison-based treatment. Such efforts will build political support for expanding prison-based intervention. The state should expand and fortify existing partnerships with community treatment providers, and continue to seek input from those providers in developing effective programs. Jail inmates are also in urgent need of drug and alcohol treatment. Without such services, jail inmates are more likely to reoffend upon release.

HIV and AIDS. The U.S. Conference of Mayors, the National Institute on Drug Abuse and the Federal Center for Substance Abuse Treatment contribute research funds for HIV outreach for Arizona's injection drug users. However, few state funds have gone into broad application of these prevention efforts, and the state has not articulated a policy on HIV education and prevention among drug users. These deficiencies must be remedied.

Child Welfare

Arizona voters have repeatedly indicated in surveys that they favor more spending for children's programs and anti-drug initiatives. One place to begin is reliably estimating newborn exposure to alcohol, tobacco and drugs through screening of newborns at birth. Once the state begins tracking this information, it will be able to anticipate related health care, foster care and social services needs, and effectively target prevention efforts. Based on such figures, Ohio has built early intervention programs, realizing savings of $40,000 per child in neonatal intensive care costs alone.

Two successive legislative panels have overseen perinatal substance abuse issues and initiatives in Arizona. Recommendations from the 1995 oversight committee included early identification, prevention, case management and program evaluation goals, as well as treatment priorities for pregnant offenders, teenagers and the entire population of substance-abusing pregnant women.

Further, the Arizona Department of Economic Security (DES) recommended that the Legislature's Committee on Child Welfare fund drug treatment for families with substance-exposed infants and for cases in which parental substance abuse contributes to the need for child protective services. Reforms in the national welfare system will require Arizona to re-examine the goals, administration and effectiveness of its social welfare programs-an excellent opportunity to act on this recommendation.

As for older children, high rates of school dropout, youth violence and teenage pregnancy in Arizona, as well as rising rates of substance abuse, point to the difficulties of preventing high-risk behaviors. Arizona's new Student Achievement Program, which establishes new graduation standards for public schools, exemplifies how innovation can expedite reform. Such innovation will be critical to moving people off welfare, reducing child and elder abuse and creating a more productive workforce.

The Children's Action Alliance, a statewide policy and advocacy organization, informs Arizona's child welfare debate by describing trends in critical outcomes. The scientifically sound, user-friendly reports include data on youth violence, teen births, child abuse and neglect, poverty and other risk factors that impact not only substance abuse, but also children's ability to thrive. Hard facts are sorely needed to inform Arizona's social policy. The tools the Children's Action Alliance provides should be put to use.

Setting an Example

We conclude this discussion of Arizona's future with some comments about methamphetamine. As one of the primary entry points of methamphetamine into the national drug scene, Arizona has had to develop new law enforcement and prevention strategies. The success of these strategies-and of Arizona's ongoing efforts to develop new responses to the fast-growing methamphetamine problem-will prove a key litmus test of the state's overall performance in its battle against substance abuse.

But methamphetamine abuse is not isolated to the Southwest; Arizona's experience serves as a warning to the rest of the nation. Arizona's responses to methamphetamine and other substance abuse challenges can stand as positive examples to other states facing similar threats in the future.

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