Agency Budget Summary

Department of Veterans Affairs

I. Resource Summary

II. Methodology

• "Treatment Costs" represent the cost for all inpatient and outpatient care of veterans with a primary or associated diagnosis of drug abuse. These figures include the cost of care for these patients in the following: specialized drug abuse treatment programs; specialized substance abuse programs treating veterans with alcohol and/or drug abuse problems and all other medical programs (e.g., medicine, surgery, psychiatry, etc.).

• For specialized drug abuse treatment programs, 100 percent of the costs are included. The majority of patients receiving specialized treatment for drug abuse problems receive their care in substance abuse treatment programs. Substance abuse treatment programs provide services to drug abusers, alcohol abusers and poly-substance abusers. The costs allocated for the treatment of veterans with drug abuse problems in these programs are based upon an analysis of the proportion of drug abuse diagnoses within the total substance abuse population treated in the specialized programs. In determining the treatment costs for drug use disorders in specialized substance abuse treatment programs, 62.9 percent of the total costs of these programs is allocated.

• The other related medical costs for drug abuse patients (i.e., costs for care other thanspecialized drug treatment in dedicated drug or substance abuse programs) is comprised of five general components: 100 percent of the other related medical costs for patients with a drugdiagnosis and treated in a specialized drug program; 100 percent of the other related medical costs for patients with a primary drug diagnosis and treated in a specialized substance abuse treatment program; 100 percent of the other related medical costs for patients with a primary drug diagnosis and treated in programs other than specialized drug or substance programs; 50 percent of the other related medical costs for patients with a second diagnosis (not primary) involving drug abuse and treated in programs other than specialized drug or substance abuse programs; and 25 percent of other related medical costs for patients with an associated (not first or second) drug diagnosis and treated in programs other than specialized drug or substance abuse program.

III. Program Summary

• The Department of Veterans Affairs, through its Veterans Health Administration, operates a network of substance abuse treatment programs located in the Department's medical centers, domiciliaries and outpatient clinics. VA plays a major role in the provision of services to veterans who are "service connected" or indigent. (The term "service connected" refers to injuries sustained while in military service). All of the drug-related resources support Goal 3 of the Strategy.

• The investment in health care and specialized treatment of veterans with drug abuse problems identified as funded by the resources in Medical Care helps avoid future health, welfare and crime costs associated with illegal drug use.

• In coordination with the National Institute of Drug Abuse (NIDA) on how to best employ outreach models, VA has been a participant in the Treatment Improvement Protocol (TIP) initiative developed by the Center for Substance Abuse Treatment of SAMHSA in HHS. A component of this project is the specific development of a TIP relating to case management and the associated facilitation of access to treatment.

• The dollars expended in research help to acquire new knowledge to improve the prevention, diagnosis and treatment of disease, and to improve the effectiveness, efficiency, accessibility and quality of veterans health care.

• The Department of Veterans Affairs, in keeping with modern medical practice, continues to improve service delivery by expanding primary care and shifting treatment services to lower cost settings when clinically appropriate. Included in this shift to more efficient and cost effective care delivery has been VA's substance abuse treatment system. Initial data suggest these shifts in care delivery may impact budgets in future years. The exact nature of the impact, if any, cannot be determined until additional trend data becomes available.

IV. Budget Summary

1999 Program

• The FY 1999 program includes $1,125.7 million which supports Goal 3 of the Strategy. This program consists of $1,120.3 million for medical care, $0.4 million for prevention activitiesand $5.0 million for research and development to be applied towards drug abuse related research.

2000 Request

• The FY 2000 request is $1,125.7 million, the same level as FY 1999. This request is composed of $1,120.7 million for medical care, $0.4 million for prevention activities and $5.0 million for drug abuse related research.

• In conjunction with the Department of Health and Human Services (HHS) and the Department of Justice (DOJ), the Department of Veterans Affairs (VA) will make available to communities its expertise in drug treatment theory and program development. The emphasis will be on the establishment of a treatment continuum, the implementation of patient/treatment matching and methods of evaluating treatment outcome. The VA will be able to accomplish this within existing resources, primarily through its Center of Excellence in Substance Abuse Treatment and Education (CESATE) and its Program Evaluation and Resource Center (PERC). These two entities already provide these services within VA and will be made available for integration into similar activities within HHS and DOJ.

V. Program Accomplishments

• Specialized substance abuse treatment services are available at 149 VA Medical facilities.

• VA continues to provide inpatient treatment services to veterans with significant substance abuse and psychosocial problems: 36 percent are 50 and older, 75 percent are not married, 38 percent are members of an ethnic minority, and 33 percent have service-connected disabilities. Among patients with drug diagnoses treated in specialized inpatient substance abuse units, 62 percent abuse cocaine, 22 percent abuse opiods, and 38 percent have co-existing psychiatric diagnoses.

• The PERC, Palo Alto VAMC, is conducting a major process-outcome evaluation of substance abuse treatment programs. PERC is focusing on substance abuse treatment programs at 13 VAMCs that follow a traditional 12-step and/or a cognitive behavioral treatment approach. These are the two most prevalent treatment orientations in VA programs. Intake and discharge data have been collected on over 3,000 patients; one- and two-year follow-ups are being conducted. Treatment outcome will be assessed in terms of drug and alcohol use, problems related to use, depression, employment and readmission for treatment. The project will also examine the processes underlying the two treatment approaches and whether certain types of patients fare better in each type of treatment.

  PERC recently completed a prospective 1-year evaluation of a nationwide sample of more than 2,300 VA substance abuse patients seen in the Contract Residential Facilities (CRF) program. The findings are that:

  • Patients in the CRF Program improve substantially between treatment intake and 1-year follow-up.

  • Patients who have longer episodes of care and participate more intensively in the CRF Program have better casemix-adjusted 1-year outcomes.

  • The CRF Program benefits diverse subgroups: substance abuse patients with psychiatric disorders, residentially unstable and homeless patients, patients mandated to treatment, and patients admitted directly from outpatient care.

  • Patients in CRF care have better casemix-adjusted 1-year outcomes than comparable patients discharged from inpatient care to independent living in the community.

  • Patients who are clinically eligible to be admitted directly to CRFs from outpatient care have similar casemix-adjusted 1-year outcomes but lower costs than do comparable patients who first have an episode of inpatient care.

  • Patients who obtain more consistent outpatient mental health care during and after the CRF episode have better 1-year substance use and psychosocial outcomes then do patients who obtain less consistent outpatient care.

• The PERC is working with Mental Health and Behavioral Sciences Service to develop a system of indicators to monitor the provision of services to veterans with substance use disorders. The first phase of development will test monitors designed to assess the effectiveness of early intervention as well as monitors measuring access to treatment and continuity of services. Later phases will evaluate treatment outcome using indicators such as changes in substance use, medical and psychiatric status, economic status and social conditions after receipt of services.

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1999 National Drug Control Strategy Budget Summary	Office of National Drug Control Policy