Legislature(2007 - 2008)SENATE FINANCE 532

04/17/2007 09:00 AM Senate FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 100 SUBSTANCE ABUSE/MENTAL HEALTH PROGRAMS TELECONFERENCED
Heard & Held
+ SB 76 TUITION FOR CERTAIN CHILDREN TELECONFERENCED
Scheduled But Not Heard
+ SB 137 LAND TRANSFERS ALASKA RR & DOTPF TELECONFERENCED
Scheduled But Not Heard
+ HB 168 LAND TRANSFERS ALASKA RR & DOTPF TELECONFERENCED
Moved HB 168 Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
= SB 89 ELECTRONIC MONITORING OF GANG PROBATIONER
Moved CSSB 89(FIN) Out of Committee
                                                                                                                                
     CS FOR SENATE BILL NO. 100(STA)                                                                                            
     "An  Act  relating  to substance  abuse  and  mental  health                                                               
     disorder prevention and treatment  programs; and relating to                                                               
     long-term  secure   treatment  programs  for   persons  with                                                               
     substance abuse  or co-occurring substance abuse  and mental                                                               
     health disorders."                                                                                                         
                                                                                                                                
                                                                                                                                
This was  the first hearing for  this bill in the  Senate Finance                                                               
Committee.                                                                                                                      
                                                                                                                                
Co-Chair  Stedman  expressed  that  substance  abuse  and  mental                                                               
health issues  are a statewide  concern. Since this is  the first                                                               
hearing  for this  bill  in  Committee, the  intent  would be  to                                                               
discuss it and then hold it for further consideration.                                                                          
                                                                                                                                
9:31:00 AM                                                                                                                    
                                                                                                                                
SENATOR  JOHNNY  ELLIS, the  bill's  sponsor,  noted that,  while                                                               
Members'   packets  contain   a  plethora   of  information   and                                                               
statistics attesting to the "enormous  human tragedy and negative                                                               
budget impacts of  untreated … substance abuse  and addiction" on                                                               
the  State,  his  remarks  would   concentrate  on  the  remedies                                                               
proposed in this  legislation as "there must be a  better way" to                                                               
address these issues than what is currently being done.                                                                         
                                                                                                                                
Senator Ellis  noted that the  efforts proposed in this  bill are                                                               
supported by the Department of Health and Social Services.                                                                      
                                                                                                                                
Senator  Ellis cited  there  being two  major  components to  the                                                               
bill. The first  component consists of three parts.  The first of                                                               
those  would modernize  State  Statutes  pertaining to  substance                                                               
abuse  programs. The  effort  would  mirror nationwide  endeavors                                                               
spurred  by the  fact that  many policy  and budget  writers "are                                                               
tired of funding treatment programs  that may not work". The goal                                                               
is to  achieve results  by developing  "evidence-based, research-                                                               
based treatment programs".                                                                                                      
                                                                                                                                
Senator Ellis  assured the  Committee that  even though  he would                                                               
like  to see  these treatment  programs expanded  in the  future,                                                               
this bill did  not include such action. It  simply specifies that                                                               
the programs be evidence and research based.                                                                                    
                                                                                                                                
Senator Ellis stated that the  second part of the first component                                                               
would require programs to give  priority to pregnant women. Since                                                               
the majority  of these programs  have long waiting  lists, giving                                                               
pregnant women  priority would assist  in negating the  impact of                                                               
fetal alcohol  syndrome (FAS) on  the State. Efforts  to mitigate                                                               
FAS disorders  have long  been touted by  Senator Dyson.  FAS "is                                                               
totally   preventable,    wildedly   expensive,    tragic   human                                                               
consequences".                                                                                                                  
                                                                                                                                
9:34:28 AM                                                                                                                    
                                                                                                                                
Senator Ellis  identified the third  part of the  first component                                                               
as being the inclusion of  a non-discriminatory clause that would                                                               
allow "faith-based  approaches to  treatment". There  is evidence                                                               
that  faith-based  approaches  have   been  "very  effective"  in                                                               
treating some  people. They  should be allowed  "as long  as they                                                               
can  compete on  the same  basis of  being evidence  and research                                                               
based". This would be akin  to "secular programs for treatment in                                                               
our public facilities". The  inclusion of this non-discrimination                                                               
clause is  supported by the  Office of Faith-based  and Community                                                               
Initiatives.                                                                                                                    
                                                                                                                                
Senator Ellis  noted that a copy  of a memorandum [copy  on file]                                                               
he received  from Jean Mischel, Legislative  Council, Division of                                                               
Legal and  Research Services,  Legislative Affairs  Agency, dated                                                               
April   2,  2007,   speaks  to   the  inclusion   of  this   non-                                                               
discriminatory clause.  The Attorney  General has  also indicated                                                               
this  would  be  "a  positive  thing,  it's  constitutional,  and                                                               
actually  improves our  Statutes" by  protecting the  State "from                                                               
any challenges in the future".                                                                                                  
                                                                                                                                
Senator  Ellis  characterized  these  three parts  of  the  first                                                               
component as "easy, non-controversial,"  and necessary updates to                                                               
State Statutes.                                                                                                                 
                                                                                                                                
Senator  Ellis advised  that  the second  component  of the  bill                                                               
would be the  implementation of a pilot project  that would allow                                                               
between ten  and twelve secure  beds in a  detoxification (detox)                                                               
center  for  individuals  who  were  involuntarily  committed  by                                                               
judges for substance abuse treatment.  The State currently has an                                                               
involuntary commitment statute through  which judges could commit                                                               
people  who  have  co-occurring mental  disorders  and  substance                                                               
abuse problems".  This component should be  thoroughly considered                                                               
as  it  would  require  an  annual  commitment  of  approximately                                                               
$2,000,000 for six years.                                                                                                       
                                                                                                                                
Senator Ellis advised that following  the discussion on the bill,                                                               
he   would  present   a  proposal   on  this   issue  for   their                                                               
consideration.  He noted  having already  discussed the  proposal                                                               
with Co-Chairs Stedman and Hoffman.                                                                                             
                                                                                                                                
Senator Ellis  stressed that  "it is  absolutely true"  that some                                                               
people  are  "very  very  expensive" to  the  State:  they  cycle                                                               
through the  system repeatedly "at  great public  expense". These                                                               
are  the people  who "wind  up dead  in snow  banks or  [are] the                                                               
suspect at  the scene of  a murder". Other states  have developed                                                               
"more cost effective and humane way to deal with this".                                                                         
                                                                                                                                
9:36:51 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman  understood that  the  pilot  project would  be                                                               
operated  in one  location. Thus,  he asked  whether the  program                                                               
would  be  available  to  individuals  throughout  the  State  or                                                               
limited to the area in which it was administered.                                                                               
                                                                                                                                
Senator Ellis  stated that the intent  would be to allow  a judge                                                               
to place a person in the  program regardless of where they reside                                                               
in the  State. Even  though the  proposal would  be to  have this                                                               
program "co-exist" in an area  with an existing detox" center, he                                                               
would support providing one in both an urban and rural setting.                                                                 
                                                                                                                                
Senator Ellis  expected that there  would be  considerable demand                                                               
for this  program. It would  also produce significant  savings to                                                               
the State.                                                                                                                      
                                                                                                                                
9:38:12 AM                                                                                                                    
                                                                                                                                
JEFF JESSEE, Chief Executive Officer,  Alaska Mental Health Trust                                                               
Authority, Department of  Revenue, spoke in support  of the bill.                                                               
The actions being proposed would  be "a significant step forward,                                                               
both in  overall policy for  substance abuse treatment,  but also                                                               
taking an innovative  approach to really trying to  get some push                                                               
on  some  of the  people  that  are  having the  most  difficulty                                                               
overcoming their alcohol addiction".                                                                                            
                                                                                                                                
Mr. Jessee  communicated that the  Trust is "very  supportive" of                                                               
implementing   evidence-based  practices   "across  the   board";                                                               
specifically as  this approach analyses "the  science behind what                                                               
we do and rigorously" evaluates a program's results.                                                                            
                                                                                                                                
Mr. Jessee  concluded that mental health  treatment programs have                                                               
not "traditionally"  done "a very  adequate job" in  this regard.                                                               
Therefore,  "emphasizing,  through legislation,  the  expectation                                                               
that we  are going to  use evidence-based practices; that  we are                                                               
going to  rigorously evaluate our  outcomes is really  crucial in                                                               
the long-run, not  only to the effectiveness of  our program, but                                                               
in cost-containment".                                                                                                           
                                                                                                                                
Mr.  Jessee  stated that  any  money  supporting a  non-effective                                                               
treatment program should be moved  to support those demonstrating                                                               
proven effectiveness.                                                                                                           
                                                                                                                                
Mr.  Jessee  characterized  the  directive  to  provide  priority                                                               
treatment for pregnant  women with substance abuse  problems as a                                                               
"huge"  step forward.  FAS/Fetal  Alcohol Effects  (FAE) "is  the                                                               
most preventable  mental health  condition that  we deal  with at                                                               
the Mental Health  Trust. It's hugely expensive for  every one of                                                               
those cases.  Anything that we  can do to  get a handle  on those                                                               
problems I think is to the good".                                                                                               
                                                                                                                                
9:40:35 AM                                                                                                                    
                                                                                                                                
Mr.  Jessee  next  addressed  the  pilot  involuntary  commitment                                                               
component of  the bill. For the  majority of the 28  years he has                                                               
represented the  civil rights  of people,  his position  was that                                                               
involuntary commitment did  not work and "was  an infringement on                                                               
people's  liberties".  However,  after reviewing  literature  and                                                               
witnessing  the   positive  results  of   involuntary  commitment                                                               
efforts,  he has  now  changed his  mind.  Evidence does  support                                                               
"that involuntary  treatment and  treatment while  in Corrections                                                               
is, in fact effective, and it  does reduce the incidence of abuse                                                               
when somebody is no longer confined."                                                                                           
                                                                                                                                
Mr.  Jessee also  realized that  many individuals  with substance                                                               
abuse issues "consume  so much of our other  resources in cycling                                                               
through  emergency   rooms,  and  the  jails,   and  API  (Alaska                                                               
Psychiatric  Institute),  and  all  of our  other  systems,  that                                                               
frankly, it's  just not fair.  We need  to be more  efficient and                                                               
effective in  our use  of resources and  that means  these people                                                               
that are high utilizers of  these other services, frankly need to                                                               
get a  handle put on them.  They need to get  put into treatment.                                                               
We need to follow up on  that with after-care, which is something                                                               
that  we'll be  looking at  working  with Senator  Ellis and  the                                                               
Department on  as we  move along. But,  we're very  supportive of                                                               
looking  at  this for  Alaska.  There  is  good data  from  other                                                               
jurisdictions  that   it's  effective,  and  we   will  certainly                                                               
participate and  collaborate with  you in evaluating  the results                                                               
to ensure that you are making  the kind of investment that you're                                                               
hoping to make."                                                                                                                
                                                                                                                                
9:42:42 AM                                                                                                                    
                                                                                                                                
Senator  Olson,  after  hearing Mr.  Jessee's  testimony  on  the                                                               
merits  of  the program,  asked  why  this  effort had  not  been                                                               
undertaken earlier.                                                                                                             
                                                                                                                                
9:43:01 AM                                                                                                                    
                                                                                                                                
Mr. Jessee  responded that the  effort had been curtailed  by the                                                               
fact that "two different commitment  statutes and structures have                                                               
evolved".  Individuals who  are  subject to  mental health  civil                                                               
commitments are  in "the  care and custody  of the  Department of                                                               
Health and Social  Services", and the State is  required to treat                                                               
these  individuals. The  alcohol commitment  process however,  is                                                               
"very different".  A petition in  this regard could  be initiated                                                               
by anyone,  and the individual  would be committed to  a facility                                                               
that is not operated by the State.                                                                                              
                                                                                                                                
Mr. Jessee  disclosed that these  facilities are  often incapable                                                               
of  providing   the  "security   aspects  of   that  kind   of  a                                                               
commitment". In addition,  "many judges have been  reluctant … to                                                               
use the  State's police power  to commit someone to  a non-profit                                                               
entity". The  differences in these  two processes,  combined with                                                               
"the thinking  and understanding of  addictions and what  kind of                                                               
treatments are effective have evolved  … the pendulum is swinging                                                               
on this  issue of civil  liberties". People such as  himself have                                                               
concluded "that there  has to be a different  balance struck, and                                                               
that we have  to hold people more accountable  for their behavior                                                               
even  if we  believe  it's  an addiction  that  they  need to  be                                                               
treated for".                                                                                                                   
                                                                                                                                
9:45:01 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman,  observing that  the  pilot  program would  be                                                               
limited to  ten beds, asked  how many  people could be  served by                                                               
the program  each year. He  also asked to  the length of  time an                                                               
individual could be involuntary committed.                                                                                      
                                                                                                                                
9:45:26 AM                                                                                                                    
                                                                                                                                
KATE HERRING,  Staff to Senator  Ellis, communicated  that people                                                               
are  initially committed  for a  30  day period.  At that  point,                                                               
their  progress  is  evaluated,   and  if  necessary  they  would                                                               
continue  in  the  program another  30  days.  This  case-by-case                                                               
evaluation would be  conducted every 30 days thereafter,  up to a                                                               
maximum commitment of 180 days.                                                                                                 
                                                                                                                                
9:46:17 AM                                                                                                                    
                                                                                                                                
Senator Thomas voiced being "generally  supportive of this bill".                                                               
One concern however was the  recognition of there being two types                                                               
of  people  with  alcohol  substance  abuse.  In  Fairbanks,  for                                                               
example, the  experience is that  there "are drunks",  who, while                                                               
bothersome  to  downtown  businesses,  might  be  doing  harm  to                                                               
themselves  but not  to  society. In  contrast,  there are  other                                                               
inebriates "who are  a danger to society as  well as themselves".                                                               
Requiring that these  individuals be the first  addressed by this                                                               
legislation,  would  further  the  success of  this  program,  in                                                               
addition, to garnering more public support.                                                                                     
                                                                                                                                
Senator Thomas acknowledged that  some of these individuals might                                                               
also  suffer from  a mental  disorder  in addition  to having  an                                                               
alcohol or substance abuse problem.                                                                                             
                                                                                                                                
9:47:35 AM                                                                                                                    
                                                                                                                                
Senator Ellis clarified that the  focus of this legislation is to                                                               
those  individuals  "who were,  under  a  judge's discretion  and                                                               
judgment",  considered a  danger  to themselves  and to  society.                                                               
Data  would  indicate  that  these   people  are  typically  both                                                               
"substance abusers and mentally  ill". The involuntary commitment                                                               
statute  proposed  in this  legislation  would  target the  "most                                                               
severe cases that  are the most expensive and  the most dangerous                                                               
folks".                                                                                                                         
                                                                                                                                
Mr. Jessee  stressed that the  results of this endeavor  would be                                                               
thoroughly   reviewed.   This   would   include   comparing   the                                                               
individual's behavior  after being  released from the  program to                                                               
their prior  history, their prior  utilization of  resources, and                                                               
the social consequences of their  behavior. "Only by that kind of                                                               
rigorous  evaluation   can  you  really  tell   whether  you  are                                                               
achieving the results that you set out to accomplish".                                                                          
                                                                                                                                
9:48:48 AM                                                                                                                    
                                                                                                                                
Co-Chair  Hoffman asked  whether  the  priority treatment  status                                                               
given  to pregnant  women  would also  apply  to the  involuntary                                                               
commitment program.                                                                                                             
                                                                                                                                
Senator  Ellis  affirmed  that  pregnant  women  would  be  given                                                               
priority in each component.                                                                                                     
                                                                                                                                
Senator  Elton   recommended  that  the   involuntary  commitment                                                               
program  evaluation include  a  comparison of  its  costs to  the                                                               
costs  that otherwise  might  be incurred  by  the Department  of                                                               
Public Safety,  the Alaska  Court System,  and the  Department of                                                               
Corrections.                                                                                                                    
                                                                                                                                
Mr.  Jessee  considered  the  cost comparison  to  be  of  utmost                                                               
importance.  There  is  not  much doubt  that  a  sober  person's                                                               
quality of life  is happier and safer than that  of a person "who                                                               
is drinking themselves to death under a bridge".                                                                                
                                                                                                                                
Mr. Jessee anticipated  that the cost of the program  would be of                                                               
interest  to  the Finance  Committee,  and  he did  not  consider                                                               
viewing  the legislation  in  that light  to  be "cold  hearted".                                                               
Money that  is spent "inappropriately or  unnecessarily on people                                                               
in these other  systems is money that is not  available for other                                                               
services that we  really need. We need to look  at those numbers.                                                               
The  public inebriate  under the  bridge is  not free.  There are                                                               
huge costs  centered around those individuals."  For example, the                                                               
experience in  Fairbanks is  that the  cost associated  with some                                                               
public inebriates is between $45,000  and $50,000 a year. A study                                                               
in  New York  found that  services  provided to  one such  person                                                               
there cost  that state in  excess of  one million dollars  over a                                                               
ten-year period.  "That is  intolerable, and we  have to  look at                                                               
the numbers and we have to get  a handle on these people that are                                                               
creating this huge, huge cost centers."                                                                                         
                                                                                                                                
Co-Chair Hoffman  asked what benchmarks  would be  established to                                                               
gauge the success  of the program; specifically  whether a dollar                                                               
amount of savings per individual might be a determining factor.                                                                 
                                                                                                                                
Mr.  Jessee  expressed that  information  regarding  the cost  of                                                               
treating  these  individuals  before entering  the  program,  the                                                               
actual costs  of treating them in  the program, and the  costs of                                                               
aftercare would  be provided to the  Legislature. The Legislature                                                               
would make  the final determination  as to whether  this approach                                                               
is a good investment. "Other  jurisdictions have information that                                                               
leads them to believe it has  been a good investment"; however he                                                               
advised that the  costs must be available  before a determination                                                               
to the success of the program could be made.                                                                                    
                                                                                                                                
9:53:33 AM                                                                                                                    
                                                                                                                                
Co-Chair    Hoffman   communicated    that   the    Legislature's                                                               
determination  would   also  depend  on   whether  professionals'                                                               
"expectations"  on  the  program   were  met.  "The  delivery  of                                                               
services" as well as program costs should be a consideration.                                                                   
                                                                                                                                
Mr. Jessee agreed. Developing "performance  benchmarks" is one of                                                               
the  components   that  would  be  undertaken   in  "the  program                                                               
development phase". There must be "a target" to aim for.                                                                        
                                                                                                                                
9:54:38 AM                                                                                                                    
                                                                                                                                
Senator Huggins expressed that,  while the answer to homelessness                                                               
and  other "things  that  cost our  society  money", is  evasive,                                                               
"intuitively, this makes  me very very nervous".  Even through he                                                               
has  participated  in such  things  as  Operation Stand-down  and                                                               
programs  for homeless  veterans, he  continues to  be unable  to                                                               
understand the homeless syndrome.                                                                                               
                                                                                                                                
Senator  Huggins cited  the expense  of dealing  with the  people                                                               
identified  in  this  legislation  as   being  one  part  of  the                                                               
discussion.  The second  part was  the treatment  aspect. He  had                                                               
previously participated  on a board  that "dispose[d]  of people"                                                               
by placing them in such things as in-home treatment facilities.                                                                 
                                                                                                                                
Senator Huggins  recalled professionals stating that  the success                                                               
rate of such programs was based on  the fact that there had to be                                                               
"consequences". He did  not believe it possible  that any program                                                               
could   protect   people   from  themselves.   Thus,   while   he                                                               
acknowledged "the  passion" in the  supporting testimony,  he was                                                               
not convinced it would work.                                                                                                    
                                                                                                                                
9:56:20 AM                                                                                                                    
                                                                                                                                
LONNIE  WALTERS, Chair,  Governor's Advisory  Board on  Alcohol &                                                               
Drug Abuse and  co-executive director of a  small substance abuse                                                               
and  mental health  facility  in Craig  Alaska,  shared with  the                                                               
Committee  that he  was a  26-year recovering  alcoholic who  had                                                               
been involuntarily committed to  an alcohol treatment center when                                                               
he was in the military. "That saved my life."                                                                                   
                                                                                                                                
Mr. Walters  also stated that prior  to moving to Alaska,  he had                                                               
served as  an involuntary commitment  specialist in the  State of                                                               
Washington. He  had personally committed people  to programs such                                                               
as that being proposed in this legislation.                                                                                     
                                                                                                                                
Mr.  Walters was  disturbed  to  find that  while  Alaska had  an                                                               
involuntary commitment law,  there was no place  to commit people                                                               
to. The  two people he had  committed in this State,  both simply                                                               
walked out  of the facility  they were  placed in because  it was                                                               
not a secured facility.                                                                                                         
                                                                                                                                
Mr. Walters committed approximately  30 individuals when he lived                                                               
in Washington. The program in  Washington had approximately an 80                                                               
percent success rate. The people  committed to the program had an                                                               
extensive  history  of  intoxication.  Some  had  upwards  of  50                                                               
arrests and numerous emergency services visits.                                                                                 
                                                                                                                                
Mr. Walters  declared that  all of  the people  he knew  who were                                                               
admitted to the involuntary commitment  program thanked those who                                                               
were responsible for  placing them there. "We  saved their life."                                                               
He  firmly   believed  that  "every   alcoholic  wants   to  quit                                                               
drinking".                                                                                                                      
                                                                                                                                
9:58:50 AM                                                                                                                    
                                                                                                                                
Senator  Olson  asked Mr.  Walters  to  respond  to some  of  the                                                               
concerns voiced  by Senator Huggins;  particularly in  regards to                                                               
how "the effectiveness of the  program eventually curtails, or is                                                               
to  the  degree"  where  its benefits  to  society  would  become                                                               
apparent.                                                                                                                       
                                                                                                                                
Mr.  Walters  responded  that  the  benefits  of  an  involuntary                                                               
commitment  program would  take time.  "The more  promiscuity" is                                                               
present the  more time is  required to recover. A  "normal 30-day                                                               
program would  not work  for these people  … their  brain doesn't                                                               
even clear up in 30 days. They need time, they need length."                                                                    
                                                                                                                                
Mr. Walters disclosed  that of every drug and  alcohol program he                                                               
has been  affiliated with, "involuntary commitment  gives you the                                                               
biggest bang for your dollar".                                                                                                  
                                                                                                                                
10:00:37 AM                                                                                                                   
                                                                                                                                
Dr.  MARC PELLICCIARO,  Medical  Director, Psychiatric  Emergency                                                               
Room, Providence  Hospital, testified via teleconference  from an                                                               
offnet  location  in  support  of  the  bill.  It  would  provide                                                               
"increased  energy   and  resources   and  attention   to  people                                                               
suffering from chemical dependency";  particularly those who also                                                               
suffer from  a mental  illness. Approximately  30 percent  of the                                                               
4,000  patients  served by  the  Psychiatric  Emergency Room  are                                                               
referred  by  police.  Approximately  70  percent  of  the  4,000                                                               
patients  have some  "chemical dependency  issue associated  with                                                               
their current  situation". Each patient is  evaluated, diagnosed,                                                               
treated, and  then referred "to  the next best place  to continue                                                               
the road to recovery so they  don't end up back involved with the                                                               
police or back in the emergency room".                                                                                          
                                                                                                                                
Dr. Pellicciaro informed the Committee  that, of the multitude of                                                               
services he  has access to,  the resource most lacking  is "detox                                                               
or treatment options  for the duel-diagnoses patient".  This is a                                                               
person  with  "a legitimate  mental  illness  plus a  significant                                                               
substance  abuse chemical  dependency  problem".  There are  only                                                               
eight  beds  in  Anchorage  to  which  his  and  other  emergency                                                               
services in Anchorage can refer such patients to.                                                                               
                                                                                                                                
Dr. Pellicciaro declared  that "the first step"  in getting these                                                               
patients  better  "is  get  them  to  a  detox  program  and  the                                                               
surroundings  of   sobriety  that  both  identify   the  chemical                                                               
dependency issues and the mental heath issues".                                                                                 
                                                                                                                                
10:03:21 AM                                                                                                                   
                                                                                                                                
MARGARET  LOWE, Trustee,  Alaska Mental  Health Trust  Authority,                                                               
testified  via   teleconference  from  an  offnet   location  and                                                               
informed  the  Committee  that alcohol  addiction  and  substance                                                               
abuse problems  in the State  are increasing and  are devastating                                                               
the lives of many Alaskans.                                                                                                     
                                                                                                                                
Ms.  Lowe shared  that "virtually  all  of the  child abuse"  and                                                               
child neglect  cases reviewed in  a 15-year research  project she                                                               
conducted, included "substance abuse as  a part of" or "the basis                                                               
of the problem".  Improving the lives of  children whose "parents                                                               
or  caregivers who  are unable  to  manage well  and be  reliable                                                               
parents for their  children" … "is cost effective and  is a moral                                                               
responsibility."                                                                                                                
                                                                                                                                
Ms. Lowe recounted  that at the time she was  commissioner of the                                                               
Department  of Health  and Social  Services,  the Department  was                                                               
just becoming  aware "of  the commonality  of mental  illness and                                                               
substance   abuse".  Since   that   time,   the  Department   has                                                               
established the  Division of Behavioral Health  to provide "state                                                               
of  the art  treatment". However,  the availability  of treatment                                                               
programs must  be increased;  specifically programs  for pregnant                                                               
women and mothers of young children.                                                                                            
                                                                                                                                
Ms. Lowe also recalled that in  her role as commissioner, she had                                                               
been asked why the problem was  increasing even as more money was                                                               
being appropriated  to the Department. Her  response continues to                                                               
be that  far more  money than  is being  spent is  required. More                                                               
"treatment facilities  and personnel  and personnel  training" is                                                               
necessary to provide "the basic approach to prevention".                                                                        
                                                                                                                                
Ms. Lowe asserted that educating  children about the negatives of                                                               
substance abuse  must begin earlier  than middle school.  "One of                                                               
the best ways to do that  kind of prevention is that children are                                                               
in homes  where parents have  received appropriate  treatment and                                                               
are  able  to   model  the  kind  of   wellness  and  appropriate                                                               
behavior…"                                                                                                                      
                                                                                                                                
10:06:50 AM                                                                                                                   
                                                                                                                                
Senator  Olson  agreed  there  was merit  to  the  program  being                                                               
proposed. To  that point, he  asked Ms.  Lowe why such  a program                                                               
had not been implemented earlier.                                                                                               
                                                                                                                                
Ms. Lowe communicated that treatment  programs have been in place                                                               
for  several   years.  While  evidence-based   methodologies  and                                                               
effective  treatments  are key  elements,  an  adequate level  of                                                               
funding must be provided "to  deal with an overwhelming problem".                                                               
Even thought Alaska has done  a good job providing "state-of-the-                                                               
art  professionals"  and  advancements  in  how  to  address  the                                                               
problem  are  occurring, the  State  has  "unique problems".  For                                                               
example, no  follow-up support is  available to people  when they                                                               
return  to their  village  after receiving  treatment  is a  "hub                                                               
village" or  larger city. Providing  that level of support  is an                                                               
expensive proposition.                                                                                                          
                                                                                                                                
10:08:44 AM                                                                                                                   
                                                                                                                                
Senator Elton  surmised that increasing  funding to a  level that                                                               
would  adequately  support  programs would  generate  savings  in                                                               
other service areas.                                                                                                            
                                                                                                                                
Ms. Lowe agreed.  Savings would result from such  things as fewer                                                               
children being placed in foster  homes, fewer visits to emergency                                                               
rooms, and even fewer house fires.                                                                                              
                                                                                                                                
10:10:56 AM                                                                                                                   
                                                                                                                                
SUEY  LINZMEIER, mother  of  an alcohol  and  drug addicted  son,                                                               
testified in Juneau  in support of the bill. "It's  a really good                                                               
starting  place for  this State."  Alcohol is  everywhere, across                                                               
all  boundaries  of society.  Her  son  began experimenting  with                                                               
drugs  when  he  was  13,  and now,  seven  years  later,  he  is                                                               
struggling  against both  drugs and  alcohol. He  is one  of many                                                               
young  people  experiencing  this  struggle, as  evidenced  by  a                                                               
recent  incident in  Anchorage where  an intoxicated  17-year old                                                               
youth allegedly committed a serious crime.                                                                                      
                                                                                                                                
Ms. Linzmeier  informed the  Committee that  her son  sought help                                                               
two  months  ago  and  luckily,  the  family's  health  insurance                                                               
circumstances  allowed  him  to  enroll in  a  21-day  non-profit                                                               
treatment program  in the State  of Washington that  cost $4,200.                                                               
There  is no  similar in-state  program. A  person who  commits a                                                               
crime while  under the influence  of alcohol  or drugs or  who is                                                               
charged with  Driving Under the  Influence (DUI) could  choose to                                                               
either  go to  jail or  enter a  treatment program.  Many of  the                                                               
people attending  the Washington program were  there because they                                                               
realized they had a problem.                                                                                                    
                                                                                                                                
Ms. Linzmeier communicated  that prior to her  son's entering the                                                               
program  she blamed  him,  the school  district,  and others  for                                                               
contributing to  the problem. She  now believes  that "alcoholism                                                               
and addiction are  a disease", and the program  teaches people to                                                               
address these issues as such.                                                                                                   
                                                                                                                                
Ms. Linzmeier  stated that in  addition to providing her  son the                                                               
tools he  required to  return to Alaska  and to  continue getting                                                               
the help he required, it also  taught the family how to deal with                                                               
his addiction. The program convinced  her son "he had a condition                                                               
that  he  cannot  help".  He now  attends  counseling  and  daily                                                               
Alcoholics Anonymous (AA) meetings.                                                                                             
                                                                                                                                
Ms. Linzmeier  stressed that  her son  and other  AA participants                                                               
are very  "committed"; they do not  want to be a  burden on their                                                               
family, their  friends, or  their employer.  They are  the people                                                               
that this  legislation would help,  as "some sort of  a treatment                                                               
plan" is required.                                                                                                              
                                                                                                                                
Ms. Linzmeier also  noted that most of the  programs available to                                                               
her son  have a "sliding  scale" fee structure. This  enables him                                                               
to get  those services. Her  son chose to enter  treatment rather                                                               
than going to jail.                                                                                                             
                                                                                                                                
Ms. Linzmeier  contended that  had her son  instead gone  to jail                                                               
for 90 days,  upon release, he would have continued  to drink and                                                               
use  drugs. The  treatment program  enlightened him  to the  fact                                                               
that  he, like  many people,  had mental  and emotional  problems                                                               
that he needed to address.  "Mental illness is huge;" many people                                                               
have social  anxiety disorder, depression,  post-traumatic stress                                                               
syndrome. For  many, "drinking and doing  drugs is a way  to kind                                                               
of take the edge off that".                                                                                                     
                                                                                                                                
Ms. Linzmeier  urged the Committee  to acknowledge the  fact that                                                               
this  problem is  far-reaching. This  legislation "would  be good                                                               
for all Alaskans and all families".                                                                                             
                                                                                                                                
Co-Chair Stedman assured Ms. Linzmeier  that her paraphrasing her                                                               
written  remarks  and  then  providing  the  written  remarks  to                                                               
Members was a very effective way to communicate her message.                                                                    
                                                                                                                                
10:15:54 AM                                                                                                                   
                                                                                                                                
VERNER  STILLNER, Psychiatrist,  Bartlett  Regional Hospital  and                                                               
Member,  Governor's  Advisory  Board  on Alcohol  &  Drug  Abuse,                                                               
shared that he had personally lost two relatives to alcoholism.                                                                 
                                                                                                                                
Dr.  Stillner, speaking  from  a  professional viewpoint,  deemed                                                               
"the weakness  in the current system"  to be that "if  we want to                                                               
involuntarily  commit   someone  through"  the   State's  current                                                               
alcohol  statutes,   "virtually  all  facilities  will   say  no,                                                               
especially for something that is  a 30 day or longer commitment".                                                               
In addition, a person, who  has "a co-occurring disorder" such as                                                               
an alcoholic with a diagnosed  bi-polar disorder, is not eligible                                                               
for  an alcohol  treatment  program under  existing statutes.  In                                                               
contrast,  medical   hospitals  do  not   similarly  discriminate                                                               
against  someone  who  might  have,  for  example,  diabetes  and                                                               
hypertension.                                                                                                                   
                                                                                                                                
Dr. Stillner also informed the  Committee that the current system                                                               
does not  function well 24 hours  a day, seven days  a week. This                                                               
concern is addressed in this legislation.                                                                                       
                                                                                                                                
Dr.  Stillner  described  a  detox center  as  a  facility  which                                                               
prepares  someone for  treatment.  "Drying someone  out does  not                                                               
really contribute  much". It could  however, prepare  someone for                                                               
the next course of treatment.                                                                                                   
                                                                                                                                
Dr.  Stillner  contended that  the  status  quo system  does  not                                                               
appropriately  address   people  who  are  "rapid   recyclers  or                                                               
repeaters" who "simply take up a  good deal of time" from police,                                                               
emergency rooms, ambulance service, and hospital beds.                                                                          
                                                                                                                                
Dr. Stillner  voiced support for  the bill with  one modification                                                               
which he would address later in his testimony.                                                                                  
                                                                                                                                
Dr.   Stillner  next   addressed  "the   notion  of   involuntary                                                               
treatment". Alaska's mental health statutes  allow a person to be                                                               
committed  because  they  are  "gravely  disabled.  I  think  the                                                               
alcoholic  or  the  chemically  dependent  is,  at  the  time  of                                                               
addiction or  intoxication, gravely disabled and  as eligible for                                                               
commitment as the mentally ill".                                                                                                
                                                                                                                                
Dr. Stillner disagreed with the  "false notion" that treatment is                                                               
only effective  if the person  wanted to be there.  "Treatment is                                                               
as  effective for  voluntary patients  as it  is for  involuntary                                                               
patients".  This  determination  is  based on  his  35  years  of                                                               
experience as a  psychologist. It is also  supported by research.                                                               
Few people enter treatment programs  voluntarily; most are forced                                                               
to enter a program for some reason.                                                                                             
                                                                                                                                
Dr.  Stillner specified  that this  legislation  would result  in                                                               
there being  secured detox centers, intense  case management, and                                                               
treatment for  those with co-occurring disorders  and the chronic                                                               
repeater.                                                                                                                       
                                                                                                                                
Dr. Stillner concluded that the  legislation would "divert people                                                               
from  emergency  services,  hospital  beds,  [and]  the  criminal                                                               
justice  system". It  would have  an immediate  affect. While  it                                                               
might be  impossible to quantify  the amount of money  that would                                                               
be  saved, a  person undergoing  treatment for  30 days  would be                                                               
consuming fewer services from a variety of agencies.                                                                            
                                                                                                                                
Dr.  Stillner next  addressed the  lone concern  he has  with the                                                               
bill. That being that it would  operate a single pilot project as                                                               
opposed to multiple  pilot projects. A lot of time  would be lost                                                               
were the  State to  wait for  the results of  this program  to be                                                               
evaluated  before establishing  the program  in other  places and                                                               
adequately  addressing  the  State's "number  one  public  health                                                               
problem".                                                                                                                       
                                                                                                                                
Dr. Stillner suggested  that the bill be expanded  to allow three                                                               
regional pilot programs. "They could  compete against each other,                                                               
learn from each other, and improve our entire systems".                                                                         
                                                                                                                                
Dr.   Stillner  thanked   Senator   Ellis   for  presenting   the                                                               
legislation.                                                                                                                    
                                                                                                                                
10:20:52 AM                                                                                                                   
                                                                                                                                
Senator Olson  asked Dr.  Stillner to comment  on a  situation in                                                               
Bethel  where  a  pregnant woman  was  involuntary  committed  to                                                               
treatment. He  understood that  the judge  who committed  her was                                                               
criticized for his action.                                                                                                      
                                                                                                                                
While Dr.  Stillner could  not comment on  the specifics  of that                                                               
case, he  observed that  there could  be "times  when involuntary                                                               
treatment  is  the  best treatment  available".  The  traditional                                                               
argument  against involuntary  treating pregnant  women has  been                                                               
the concern that making this  a criminal offense might discourage                                                               
other  people from  seeking  treatment.  He contended  otherwise:                                                               
consideration should  be given to  the fact that the  behavior is                                                               
affecting the life of the baby as well as the mother.                                                                           
                                                                                                                                
Senator Olson  asked whether a person  involuntarily committed to                                                               
treatment ever  "challenged" Dr.  Stillner after  their treatment                                                               
ended.                                                                                                                          
                                                                                                                                
Dr.  Stillner responded  "never". Many  individuals have  thanked                                                               
him for committing them to treatment.                                                                                           
                                                                                                                                
Senator  Ellis  thanked  the Committee  for  the  opportunity  to                                                               
present  this  legislation.  He  noted  that  during  the  bill's                                                               
progress  through  committees,  many people  have  come  forward,                                                               
unsolicited, to testify  on its merits. "This is  really a public                                                               
health  emergency in  our State."  While  civil liberty  concerns                                                               
deterred  him  from  proposing  this   action  in  the  past,  he                                                               
contended  that  it is  now  time  to  move  forward with  a  new                                                               
approach.                                                                                                                       
                                                                                                                                
Senator Ellis  stated that, after discussions  with the Co-chairs                                                               
of  this  Committee and  other  Legislators,  he has  decided  to                                                               
separate the  two components of  the bill. This would  allow "the                                                               
popular,  free,  non-controversial  portions"   of  the  bill  to                                                               
advance. To that  point, he asked that the Committee  adopt a new                                                               
committee substitute  which would  not include the  pilot program                                                               
language. This would allow that  component to be further analyzed                                                               
by the Administration, the Legislature,  the Department of Health                                                               
and Social  Services, the Alaska  Mental Health  Trust Authority,                                                               
and other  affected parties. The  program could  be re-introduced                                                               
at a later time.                                                                                                                
                                                                                                                                
AT EASE 10:25:44 AM \ 10:29:08 AM                                                                                             
                                                                                                                                
10:26:13 AM                                                                                                                   
                                                                                                                                
Co-Chair  Hoffman moved  to adopt  committee substitute,  Version                                                               
25-LS015\R as the working document.                                                                                             
                                                                                                                                
Senator Elton objected to comment.                                                                                              
                                                                                                                                
Senator  Elton  appreciated  the  intent of  separating  the  two                                                               
components,  but raised  concern  to  the fact  that  "this is  a                                                               
public  health crisis".  While furthering  the  bill without  the                                                               
pilot  program would  be taking  a first  step in  addressing the                                                               
crisis, he  thought a bigger step  should be taken. He  was "more                                                               
compelled" to expand the pilot project than to eliminate it.                                                                    
                                                                                                                                
Nonetheless, Senator Elton acceded to  the wishes of the sponsor.                                                               
Work on the pilot project  should continue during the Legislative                                                               
Interim.  Furthermore,  the  discussion  should  be  expanded  to                                                               
address other parts  of the system. For example,  it is "criminal                                                               
that  we have  people  …  in our  prison  system  that are  there                                                               
because  of crimes"  they committed  when they  were addicted  or                                                               
under the  influence, in  light of the  fact that  "we've reduced                                                               
the substance abuse programs within the prison system."                                                                         
                                                                                                                                
Senator Elton considered the problem  to be "systemic and I think                                                               
that  the demonstration  projects,  such as  the Therapeutic  and                                                               
Wellness Courts  have demonstrated success and  have demonstrated                                                               
that the money being spent on them does result in savings".                                                                     
                                                                                                                                
Senator Elton  had felt  compelled to object  to the  adoption of                                                               
Version "R"  because the need to  address this issue is  real. No                                                               
one on the Committee could disagree with that.                                                                                  
                                                                                                                                
Senator  Elton  removed  his objection  and  noted  that  further                                                               
discussions  on  the pilot  program  might  assist in  persuading                                                               
others to its merits.                                                                                                           
                                                                                                                                
There  being  no further  objection,  the  Version "R"  committee                                                               
substitute was ADOPTED.                                                                                                         
                                                                                                                                
Co-Chair  Stedman agreed  with Senator  Elton that  a cooperative                                                               
effort during  the Interim would  assist in determining  the most                                                               
appropriate way to implement, and  even expand, the pilot program                                                               
component.                                                                                                                      
                                                                                                                                
Co-Chair  Stedman advised  that a  new fiscal  note, relevant  to                                                               
Version "R", was being developed.                                                                                               
                                                                                                                                
The bill was HELD in Committee.                                                                                                 
                                                                                                                                

Document Name Date/Time Subjects