Looking to the Future

Federal Funding for Women's Programs

Funding for programs specifically designed to reduce substance abuse among women has varied in the past two decades. In 1984, Congress enacted the Alcohol Abuse, Drug Abuse and Mental Health Amendments, which included a set-aside for women. The set-aside required each state to devote 5 percent of its total block grant funding to the expansion of prevention and treatment services for women. When the crack cocaine epidemic became a dominant public concern a decade ago, women's programs became a greater priority. In 1988, the set-aside was increased to 10 percent, and states were required to emphasize funding programs for pregnant women and women with young children. Yet treatment for women was still scarce.(179)

In 1991, the General Accounting Office (GAO) called for "an urgent national response" to the thousands of drug-exposed infants born each year. According to the GAO, the projected costs for medical and social services for each of these infants was $750,000.

In 1992, Congress authorized funding for women and children's demonstration projects through the Substance Abuse and Mental Health Services Administration(SAMHSA). These included new Residential Women and Children (RWC) programs and interventions for Pregnant and Postpartum Women (PPW), for which 5 percent of SAMHSA block grant funds were reserved. Prior to this, most programs did not make a great effort to engage women in treatment, and gender-based data on treatment outcomes were relatively limited. Once SAMHSA funded a critical number of demonstration programs, studying gender-specific treatment outcomes became a real possibility. Budgets for these programs peaked in1994 at nearly $60 million. Although this was a substantial increase over previous years, these funds represented less than 3 percent of SAMHSA's total budget.(180)

Despite increasing drug abuse among women and rising numbers of women convicted of drug-related crimes, Federal funding to reduce drug problems among women has declined in recent years. Federal funding for treatment programs targeting pregnant and postpartum women and their children is now only 10 percent of the funding provided in 1995.(181)

Overall SAMHSA funding designated for women has dropped by 38 percent since 1994. In 1996, SAMHSA began shifting funds from targeted treatment programs, such as RWC and PPW, to its new Knowledge Development and Application (KDA) initiative which received $329 million in substance abuse funding in the current fiscal year (FY99). The move was a response to a Congressional requirement that SAMHSA emphasize evaluation and research in its demonstration grant programs, rather than services for designated populations. KDA may fund some women's programs if they include rigorous evaluations that can enhance general knowledge on outcomes. However, these programs must now compete for funds with other research initiatives. About 16 percent of KDA funds ($52 million) is allocated to women's programs.(182)

Other Federal agencies, such as NIDA, NIAAA and the Centers for Disease Control and Prevention (CDC) have research programs designated for women. While CDC has programs related to HIV/AIDS, STDs and other communicable diseases, funds are not specifically allocated for women's initiatives. The National Cancer Institute also has no set-aside for programs targeting women smokers. Only a small percentage of the SAMHSA budget is currently directed to women's programs; however, it is important to note that states have the option of allocating as much of their Substance Abuse Prevention and Treatment block grant funds (through SAMHSA) as they wish to women's programs. However, data on state expenditures of Federal funds for women's programs have not been compiled.

Despite the growth in the number of women arrested and imprisoned for drug crimes, the Department of Justice has few initiatives focused specifically on women. In FY 1998, Congress approved $3.3 billion for the Office of Justice Programs (OJP), of which 8 percent was designated for programs to reduce violence against women. OJP funds correctional treatment, drug courts and other programs related to substance abuse, but none of these initiatives have set-asides for women.

Intensive Prevention Efforts Needed

The harmful effects of substance abuse often extend beyond individual life spans to impact the healthy development of future generations. In this context, the need for more effective prevention and treatment efforts is particularly urgent. Timely intervention can save lives, reduce economic costs, curtail crime and strengthen both children and families. Yet, despite the compelling data on increasing alcohol, tobacco and other drug problems among women and girls, demand reduction remains a low priority of Federal drug policy.

In 1998, two-thirds of the national drug control budget supported efforts to reduce the supplies of illicit drugs through law enforcement, interdiction and international source country programs. Only one-third went to prevention, education and treatment. These budget allocations have remained essentially unchanged since 1991, largely because Congress under both Democratic and Republican leadership continues to concentrate on supply control. The Congress in September 1998 authorized an additional $2.6 billion for interdiction over strong Administration objections that the measure was driven by election-year politics; $690 million was appropriated for the current fiscal year (FY99).

Since 1981, the Federal government has spent more than $30 billion trying to curtail foreign drug supplies; however, drugs are cheaper and more plentiful in this country than they were a decade ago. According to the Drug Enforcement Administration, heroin now sells for less than half its 1981 street price,and heroin purity exceeds 70 percent in many cities, compared with only 7 percent in 1981. Cocaine prices have dropped by two-thirds. At the same time, consumption of heroin and cocaine has increased since 1992, while the number of "hard-core" addicts has also risen, according toOffice of National Drug Control Policy figures.(183) Teen marijuana use is climbing. If current trends continue, within three years, teen use will reach the epidemic levels of the late 1970s. As much as half of the marijuana consumed in this country comes from illegal domestic production, not foreign sources, which interdiction and source country programs do not address.

Most Americans do not realize the widespread damage that smoking, drinking and other drug use cause, even for unborn children. These threats are particularly overlooked for women, since their use rates have traditionally been significantly lower than those of men. Yet girls are rapidly catching up with boys in rates of smoking and drinking. Many will develop lifelong dependencies with devastating health and social consequences. Teens view tobacco and alcohol as less harmful than they once did. Girls are particularly vulnerable. They are more likely than boys to become addicted to tobacco and more susceptible to alcohol and tobacco related diseases. Nonetheless, the Administration's major youth prevention initiative-an anti-drug advertising campaign projected to cost about one billion dollars over five years-does not include tobacco and alcohol. Together, both the tobacco and alcohol industries spend an estimated $6.5 billion annually on promotion, much of it directed towards teenagers, even though they cannot legally purchase these products. Current trends in teen smoking and drinking will not decline without intensive prevention and research efforts, as well as increased funding.

Alcohol, tobacco and other drug use during pregnancy harm not only the mother but also her unborn child. Although warning labels on tobacco and alcohol products advise that smoking and drinking during pregnancy can have adverse effects, most women are not aware of recent research findings that any use can be harmful to the fetus. Moreover, several studies suggest that children exposed to alcohol, tobacco and other drugs in utero are more likelyto become drug users in adolescence. Aggressive public education campaigns will be required to inform women of the risks involved in drinking, smoking or using other drugs during pregnancy. Doctors, who are often a primary point of contact with the health care system, can play a key role in educating women about these dangers. However, most medical school curricula still give cursory attention to the implications of alcohol, tobacco and other drug use, particularly in the context of the long-term health of women and children.

Information on Women and Substance Abuse Limited

Alcohol, tobacco and other drug use patterns, health consequences and related crimes among women differ substantially from those of men. However, women are rarely a priority in Federal drug control research and policies. This oversight results in part from the lack of in-depth data on women and substance abuse. Because women still represent a relatively small portion of illicit drug users and prison inmates, trends among women addicts are often eclipsed by those of men. Moreover, much of the information on women gathered by Federal surveys and reporting systems is available only on special request. Since published data influence funding directions as well as public perceptions of the problem, the lack of readily accessible information on women effectively excludes them from critically important policy decisions.

Expanded research in a number of key areas would generate more informed approaches to women's alcohol, tobacco and other drug problems. These areas include gender-specific risk factors for addiction and age of onset; the relationship between prostitution and drug addiction; women drug dealers supporting families; recidivism among female drug offenders; and outcomes for children of incarcerated women. Although research on pregnant addicts increased in response to the crack cocaine epidemic, this focus should be sustained even as the epidemic wanes. The long-term damage of maternal alcohol and other drug use on the fetus is only beginning to be understood.

Treatment for Women

Although significant progress has been made in the past decade in understanding the health and socioeconomic impacts of substance abuse among women, treatment is still scarce. Only a small fraction of the estimated 9 million women with serious alcohol and other drug problems are able to get treatment, unless they can afford to pay. Programs that treat pregnant addicts are even more limited, particularly those that allow women to live with theirchildren during treatment.

Yet treatment can make an enormous difference for individual addicts, their children, and their communities. The savings in social and economic costs are also impressive. For example, the cost of incarcerating women drug offenders in Federal prisons in 1997 was $102 million. Annual expenditures for all alcohol and other drug related foster care cases (many of whom have mothers in state and Federal prisons) reached $1.2 billion in 1997. The lifetime health care costs for drug-related AIDS cases in women now exceeds $6 billion.

Treatment for a mother means prevention for a child. In 1997, more than a third of pregnant drug users had young children living with them. In recentyears, innovative treatment programs targeting pregnant, post-partum and parenting alcohol and other drug abusers have begun to intervene early in the lives of high risk children. These programs provide treatment as well as parent training and job readiness skills. And the results are good. Follow-up studies of women's programs funded by the Center for Substance Abuse Treatment found that two-thirds of the women were not using any drugs, including alcohol, after treatment; more than one-third of the women were employed; 86 percent of the children were living with their mothers; and less than 10 percent of the women were involved with the criminal justice system.

Accessible treatment for women, including child care, is critically important for the success of welfare-to-work programs. Several states are currently experimenting with the concept of making treatment a requirement for continued welfare payments with the goal of improving participation in treatment and long-term employment. Unfortunately, too few programs specifically designed for women are available to meet the need.

Related Data Tables   |   Next Section

Keeping Score 1998
Introduction | Drug Use and Attitudes | Healthand Welfare |
Drugs and Crime | Lookingto the Future | Data Tables | Endnotes

Spotlight | Methadone Maintenance Treatment | Welfare Reform and Drug Abuse
Women and Drug Abuse: Court Innovations

Programs | Prevention Programs | Pregnant and Parenting Women's Programs
Family Treatment Programs| Criminal Justice Programs

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