Tag: Substance Abuse Treatment and Prevention Task Force

Task Force resumes look at Missouri’s response to substance abuse

      A Task Force that hopes to advance Missouri’s response to substance abuse has resumed work. 

Representative John Black (Photo: Tim Bommel, Missouri House Communications)

      The Substance Abuse Treatment and Prevention Task Force met in the 2023 interim and developed recommendations for the legislature, some of which were enacted.  One of those was that it be continued this year, and its chairman, Representative John Black (R-Marshfield), is glad that was passed.

      “I think we’ll do more or less the same thing we did last year.  We’ll look at some of the issues that we’ve identified for review this year and then hopefully the Task Force will continue to refine those and come up with more issues.  The budget, of course, is a big deal,” Black said after the Task Force met Monday.

      Representative Del Taylor (D-St. Louis) is glad to be a part of the group.

Representative Del Taylor (Photo: Tim Bommel, Missouri House Communications)

      “Missouri, as our counterpart 49 other states, as well as most countries in the world, are really struggling with getting our arms around substance abuse disorder.”  He said the group heard from experts Monday that, “[Substance abuse] is kind of how we respond to our own different mental illnesses.”

      The Department of Mental Health’s Chief Medical Director, Dr. Angeline Stanislaus, opened the session with a discussion of the neurobiology of addiction.  She said much has been learned in the last three decades that can guide the state’s programs. 

      It was believed in the medical field some 20 or 30 years ago that when a substance was out of a person’s system and they resumed using it, it was by choice and they had an issue with discipline or willpower.

      “That was the mindset in which we were trained as physicians in the 1990s,” Stanislaus said.  “There’s been more research now to show that just because a substance is out of the system … but all the neurotransmitter changes the substance did before it got out, they’re still lingering and the body’s still working on them.  This is the new understanding over the last couple of decades, it took us this long to understand that.”

Dr. Angeline Stanislaus and Director Valerie Huhn with the Department of Mental Health (Photo: Tim Bommel, Missouri House Communications)

      Stanislaus said many people who abuse substances like alcohol, cocaine, and heroin do so because they were victims of childhood abuse or neglect that altered their brain chemistry.

      “The brain wasn’t connected the way to produce a natural level of dopamine and neurotransmitters that a brain needs for us to lead healthy lives … same thing with violence.  Witnessing a lot of violence changes the brain chemistry.  There’s a lot of fear.  The neurotransmitters that are impacted by fear will go up, so when you have so many fear neurotransmitters going on in your brain you may seek a substance to decrease that fear.”

      A brain disrupted by substance abuse will never return to what it was before, but it can heal.

      “The brain is such a wonderful organ.  It’s very neuroplastic, that can produce itself more neurotransmitters given enough time, given treatment, this is how treatment works.  Give them enough time for the brain to recreate all this dopamine and all those other neurotransmitters, either through medications, combination of therapy, combination of whatever needs to be put together … that’s the true potential of what the brain can possibly do and that’s what we try to do as treatment providers.”

      Former Missouri House Speaker Todd Richardson has been the Director of MO HealthNet since 2018.  Much of what the Task Force discussed with him was its recommendation from last year that a new state executive be created – what members have tentatively referred to as a “czar” – to oversee substance abuse issues across the various state departments that deal with those. 

      He said while the idea has merit and could work, giving one figure authority over three, four, and even five departments and asking that person to understand and take on all that is involved in substance abuse issues, could prove too much to ask.

      He thinks the effort the Task Force has set in motion should be given time to work.

      “I think it is incredibly important that the departments continue to collaborate in this space and make sure that our policies are complimentary of each other … I think that collaboration is better than it has ever been before.  While I think the idea behind having somebody to oversee this is the right thinking, I really think the best way to accomplish what you’re trying to accomplish is by trying to continue to encourage that collaboration between those departments.”

      To the Task Force’s credit, Richardson said, “I do think the focus that this task force has put on it has already led to more collaboration and coordination and discussion about this subject than I’ve seen in the 15 years I’ve been coming to Jefferson City.”

Representative Todd Richardson (Photo: Tim Bommel, Missouri House Communications)

      Taylor appreciates the different backgrounds brought to the group.  A budget-minded legislator himself, Taylor hopes to get more data about Missouri’s substance abuse response.  

      “Consistently I want to know:  what are the programs and how do we measure effectiveness?  Is the program actually working?  How much have we appropriated for that program and are we spending the money that we appropriate?  Let’s at least be honest and up front about how much of that is actually going to get used, how many people are you going to actually hire, and how much of that is going to lapse?”

      Some members weren’t present at Monday’s hearing due to technological or medical issues.  Black hopes more members will be able to attend in subsequent hearings.

      “The more people we have, the more involvement, the more good questions.  That would be beneficial, but I’m very happy that the Senate, the House, and the governor’s office are supportive of the continuing work of the task force.”

      The Task Force will meet again in July.

House plan to create mental health courts advancing

     A House committee has advanced a plan to create treatment courts in Missouri that would focus on mental health issues, and offer offenders treatment options as an alternative to incarceration.  Its bipartisan supporters say it would be a meaningful expansion of the state’s successful treatment courts. 

Representative John Black (Photo: Tim Bommel, Missouri House Communications)

      The mental health courts that would be created by House Bill 2064 would be similar to the already existing veteran courts, DWI courts, drug courts, and family treatment courts.  In each of those, a defendant must go through a regimen of relevant treatment programs.  Those who succeed, or graduate, can avoid prison time or having a crime appear on their record.  

      “The goal is that they receive treatment to help them overcome, have the tools that they are now aware of, that they’ve experienced, which they have available to them to maintain a lifestyle without the problems that haunted them,” said Representative John Black (R-Marshfield), the bill’s sponsor. 

      He said this would be a continuation of the existing treatment courts, which are widely viewed as an achievement by Missouri’s legal system and a cost-effective way to avoid incarceration.  They allow offenders a chance to remain connected to and active in their communities while working and remaining with families.  They are also associated with reductions in crime and the need for foster care, and with ensuring timely payment of child support. 

      Black noted that perhaps most importantly, “The percentages of those folks who are able to avoid recidivism … with those folks who have actually completed the treatment courts, are very impressive.”

      The proposal is one recommendation to come from the Substance Abuse Treatment and Prevention Task Force, created under legislation passed in 2019 and chaired by Black.  That task force sought to get a handle on what is happening throughout the state of Missouri and across all agencies, to deal with substance abuse issues. 

      One of its recommendations was to see that existing treatment courts receive more funding, as well as the creation of mental health treatment courts. 

      Black said among the existing treatment courts there is already a lot of overlap with mental health.  

      “In fact, it’s called, ‘co-occurring disorder,’ and if put the mental health courts in the statute, specifically, then they’re also available for funding.  There are some people who are in jail and have a mental health problem and they’re there for that problem, when in fact it is a co-occurring disorder involving substance abuse.  This just allows a more comprehensive treatment.”

      Black said such courts would likely rely heavily on counseling that is specific to a given defendant’s circumstances, “and it is a tough program.  It’s not something that’s easy.  They have to invest a lot of effort in completing the program, so if there was a co-occurring problem – substance abuse would be the most likely – then the persons in that program would be referred not only to mental health professionals but also those folks that could help them with their substance abuse problem.”

      The bill has been unanimously endorsed by the House Judiciary Committee, where it was praised by members of both parties.  Ranking Democrat Representative Robert Sauls (Independence) said this is a subject that needs more attention.

      “I can unequivocally say that we do not do enough to address mental health in this country or this state.  I’ve seen it time and time again.  I’ve seen it as a prosecutor, as a public defender, I’ve seen situations where people, quite frankly, possibly, wouldn’t have committed crimes if situations were addressed prior to,” Sauls said.

      For any who question the effectiveness of the treatment courts Missouri already has, or the desire to expand on them, Black said one need only be present at a graduation.   He called them, “inspiring, humbling, you see people who are there fully acknowledging that the program has turned their life around for themselves and their families.  They show great gratitude to the elements of the treatment courts, including the prosecutor’s office, they usually organize the effort … it’s one of the things Missouri is doing well.”