You asked a series of questions about drug rehabilitation in Connecticut. Specifically you asked about:

1. the number of public and private in- and outpatient adult drug rehabilitation facilities and beds in Connecticut and how that number compares to other states;

2. the average length of stay in Connecticut facilities;

3. normal insurance coverage for drug rehabilitation;

4. the effect closing Norwich and Fairfield Hills hospitals had on the state's ability to treat substance abusers;

5. the number of judicial referrals for drug rehab over the past 10 years;

6. the number of substance abuse-related incarcerations (i.e., incarcerations for substance-related crimes and of substance abusers); and

7. Connecticut's annual spending on drug rehabilitation, including capital spending, and how this compares to other states.

SUMMARY

The Department of Public Health (DPH) licenses 181 private substance abuse treatment facilities; three mental health hospitals that provide some substance abuse treatment services; and 17 general hospitals that provide in- or outpatient substance abuse treatment. The Department of Mental Health and Addiction Services (DMHAS) directly operates inpatient and outpatient rehab services at four locations, and the Correction Department provides residential and outpatient substance abuse treatment at all prisons and follow-up care after release.

DMHAS reports that these facilities provide 1,245 inpatient beds (4.6 beds/10,000 adults), 7,027 residential treatment slots (26.1/10,000), and 9,746 medication-assisted therapy (e.g., methadone maintenance) slots (35/10,000). Connecticut has more hospital and residential rehabilitation beds per 10,000 people than any other state in an eight-state sample of Northeastern states and others with similar-sized populations.

The length of stay in substance abuse facilities varies by the service provided and type of facility. In 2006, the median stay in residential detoxification was four days and 30 days in ambulatory detox. It was 20 days in hospital and short-term residential rehabilitation and 88 days in long-term rehab. The intensive outpatient treatment median stay was 36 days and 67 in regular outpatient care.

Connecticut law requires most individual and group health insurance policies to cover diagnosis and treatment of substance abuse. Benefits are payable on the same basis as any other medical condition. All but one of Connecticut's managed care organizations cover inpatient and outpatient substance abuse treatment services, including detoxification, at hospitals and treatment facilities, according to a 2007 Insurance Department document.

After DMHAS closed Norwich Hospital, it relocated the detoxification beds to smaller, short-term hospitals and started a telephone access line to screen and refer people to a regional network of providers for evaluation and treatment. After it closed Fairfield Hills, DMHAS increased detox bed capacity at one of its Bridgeport facilities. A 2003 assessment of the closings determined that they did not adversely affect access to medical detoxification services or the likelihood of people entering follow-up rehabilitation in either region.

A court can send someone to substance abuse treatment through four pretrial diversion programs: pretrial drug education, community service labor, treatment of drug and alcohol offenders in lieu of prosecution, and pretrial alcohol diversion. Between 12,000 and 13,000 people have been diverted in each of the past five years.

Narcotics sale and narcotics possession have been among the top four causes of incarceration for the past five years. Incarcerations for these offenses dropped steadily between July 2002 and July 2007 (2,914 to 2,547), according to Correction Department statistics. They fluctuated between 15.6% and 12.6% of all incarcerations during that period.

Six state agencies spent over $200 million in FY 05 on substance abuse treatment; DMHAS accounted for $128,862,295 of that amount. It also awarded $1,575,169 in bond funds to substance abuse treatment agencies for capital improvements. In FY 05, DMHAS spent $24.05 per capita on substance abuse treatment, the fifth highest in the nation.

SUBSTANCE ABUSE TREATMENT FACILITIES

Connecticut

Substance abuse treatment occurs in a variety of locations—specialized substance abuse treatment facilities, general and mental health hospitals, prisons, and clinics and professional offices. DPH licenses 181 private “facilities for the care or treatment of substance abusive or dependent persons.” Fifty-three (53) of these are licensed to provide various categories of residential treatment: intermediate and long-term treatment and rehabilitation, intensive treatment, and residential detoxification and evaluation. The remaining 128 facilities provide only outpatient services, including ambulatory detoxification.

DPH also licenses three mental health hospitals and 30 general hospitals. The mental health hospitals provide inpatient and outpatient treatment for people with substance abuse and co-occurring disorders (i.e., mental illness and substance abuse). They contain 275 licensed treatment beds, but the data do not specify how many beds are solely for substance abuse treatment. The Connecticut Hospital Association (CHA) reports that six general hospitals have inpatient substance abuse treatment units and 16 provide outpatient treatment, but CHA could not determine the specific number of beds or slots they provide.

DMHAS provides inpatient substance abuse treatment at its Connecticut Valley and Blue Hills hospitals and outpatient treatment at its Connecticut and Capital Region Mental Health Centers.

All of these facilities, plus the Correction Department's (DOC) prison-based treatment services, report to DMHAS' Substance Abuse Treatment Information System. Table 1, prepared by DMHAS, shows the number of public and private treatment beds and outpatient slots these facilities reported as of November 5, 2007. (It does not include beds or treatment in general hospitals or Veterans' Administration hospitals (unless DMHAS provides the funds) or private practitioners' offices).

Table 1: Substance Abuse Treatment System Capacity,

Total and Per Capita

Many of these facilities offer multiple services. For example, the Rushford Center provides the following services at its 1250 Silver Street, Middletown facility: residential community-based and ambulatory detoxification; community-based intensive, community-based intermediate, and halfway house residential rehabilitation; and standard, partial hospitalization, and intensive outpatient. Attachment 1, prepared by DMHAS, lists substance abuse treatment providers and their programs. (It separately lists programs jointly funded by DMHAS, DOC, and the Judicial Branch, which make for some duplication in the list.)

Interstate Comparisons

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) annually surveys substance abuse treatment facilities. It surveys program-level, clinic-level, and multi-site respondents (which helps explain why the number of facilities it reports exceed the number of facilities DPH licenses, as described above). Table 2 compares the number of facilities in Connecticut with those in (1) three Northeastern states and (2) four states with populations similar to Connecticut.

The table shows that Connecticut and Massachusetts maintain a higher proportion of residential facilities and hospitals than other states relative to outpatient treatment facilities. Consequently, they have more hospital and residential treatment beds per 10,000 people.

Table 2: Comparison of State Substance Abuse Facilities

AVERAGE LENGTH OF STAY

Connecticut law requires most individual and group health insurance policies to provide benefits for the diagnosis and treatment of mental disorders, as defined in the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) (CGS §§ 38a-488a and 38a-514). DSM-IV, the most recent edition of the DSM, classifies substance abuse and substance dependence as substance-related mental disorders.  Therefore, insurance policies must cover their diagnosis and treatment.  All Connecticut managed care organizations (except for Celtic Insurance) cover inpatient and outpatient substance abuse treatment services, including detoxification, at hospitals and treatment facilities, according to the Insurance Department's 2007 Comparison of Managed Care Organizations in Connecticut.

By law, benefits are payable on the same basis as any other medical condition. Benefits payable for a physician's services are payable for the same services provided by a psychologist, social worker, marital and family therapist, alcohol and drug counselor, or professional counselor (CGS § 38a-514(d)).

Group health insurance policies must cover the treatment of medical complications from alcoholism (e.g., cirrhosis of the liver, gastrointestinal bleeding, pneumonia, and delirium tremens; CGS § 38a-533).

To compensate for the closures, DMHAS implemented different service models in the two affected regions. In the Eastern region (which Norwich served), it (1) relocated Norwich's detoxification beds to smaller, short-term hospital programs and (2) started a telephone service to screen and refer people to a regional network of providers for further evaluation and treatment. In contrast, DMHAS replaced few of the beds Fairfield Hills provided for Northwest region residents. Instead, it increased the bed capacity at a single facility in Bridgeport to accommodate those residents as well as meet the growing demand for detoxification services in the Southwest region.

State law establishes four pretrial diversion programs through which a court can send someone to substance abuse treatment: separate pretrial drug and alcohol education programs, community service labor, and treatment in lieu of prosecution. The Judicial Branch also operates a special drug intervention session in three courts—Bridgeport, New Haven, and Danielson—where judges, attorneys, and other court officers can refer nonviolent, drug-dependent defendants to treatment.

The pretrial drug education and community service labor programs are for people charged with possession of drugs or drug paraphernalia. The latter program can be a pretrial diversion, part of a sentence of conditional discharge, or a condition of probation. The pretrial alcohol education system is for people charged with driving while under the influence. Courts can also commit drug-or-alcohol-dependent offenders into treatment in lieu of prosecution or incarceration. The pretrial diversion aspect of the program covers all drug sale and possession crimes. A Judicial Branch publication, A Guide to Special Sessions and Diversionary Programs in Connecticut (available at http://www.jud.ct.gov/Publications/CR137P.pdf), provides more information on each alternative.

The Judicial Branch's Biennial Report provides data on participation in some of these programs. The available data show that the pre-trial alcohol education program is consistently the most heavily used and its use has grown over the past decade. Participation in the pre-trial drug education program has increased nearly five-fold over in the past five years while participation in the community service labor program has dropped by over 50% over the same period. Table 4 displays the available data.

Table 4: Pretrial Drug and Alcohol Diversion Program Participation, FY 1997-06

Source: Judicial Branch, Biennial Reports, 1996-97 to 2005-06; Judicial Branch communication

The number of substance abuse-related incarcerations dropped steadily between July 2002 and July 2007 (2,914 to 2,547), according to DOC statistics. Substance abuse-related incarcerations as a percentage of all incarcerations fluctuated during that period, ranging from a high of 15.6% of the total population in January 2003 to a low of 12.6% in July 2006. Table 5 shows the number of people incarcerated for sale and possession and the percentage of total incarcerations attributable to those offenses.

Table 5: Substance Abuse-Related Incarcerations, 2002 to 2007

Connecticut

A 2007 DMHAS report states that six state agencies spent over $200 million in FY 05 on substance abuse treatment. Table 6 displays each agency's expenditures.

Table 6: Substance Abuse Treatment Expenditures by Agency,

FY 05

Source: DMHAS, Collection and Evaluation of Data Related to Substance Use, Abuse and Addiction Programs, June 2007

¹ Treatment expenditures include services provided to offenders in Parole & Community Services.

In addition, in FY 05 DMHAS awarded $1,575,169 in bond funds to nonprofit substance abuse treatment agencies for capital improvements to their facilities.

In FY 05, Connecticut ranked fifth nationally in per capita spending by state substance abuse service agencies, even without including Medicaid and State Administered General Assistance (SAGA) behavioral health expenditures. Table 7 compares states' FY 05 substance abuse treatment and prevention spending.

The table is derived from the federal Substance Abuse Prevention and Treatment Block Grant (SAPTBG) application for FY 07. States whose drug and alcohol agency has purview over Medicaid funds include that money in their spending report, but since DSS, not DMHAS, is responsible for Connecticut's Medicaid spending, the table does not show this $37,175,576 expenditure. Nor does it show the $39,954,902 DMHAS spent on its SAGA behavioral health program.

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