Congressional Stimulus Package: Wake-Up Call? Yes. Apocalypse? No.

In March of 2008, I had the privilege of sitting a few feet away from the President of the United States as he signed offender reentry legislation — also known as the Second Chance Act — into law. This bill, years in the making, included strong provisions for addiction services and recognized the essential role of state substance-abuse authorities in implementing and overseeing a comprehensive system of care. Many advocates can earnestly engage in legislative affairs work for their entire career and never experience the excitement and satisfaction of a White House bill signing ceremony. The event was truly extraordinary.

In December 2008, I also shared the privilege of celebrating the passage of substance-abuse and mental-health parity legislation with many of our colleagues, including leaders such as then-Senator Pete Domenici (R-NM), former First Lady Rosalynn Carter, Rep. Patrick Kennedy (D-RI), then-Rep. Jim Ramstad (R-MN), and others. Again, it was an incredible experience — years in the making — and served as a tribute to the work of Carol McDaid of Capitol Decisions, the Legal Action Center, Faces and Voices of Recovery, Community Anti-Drug Coalitions of America (CADCA), American Society of Addiction Medicine (ASAM), NAADAC, and many others. 

And over the last 4 years or more, the addiction advocacy community has banded together, using a unified voice, to educate Congress on the benefits of reversing proposed budgets that would have enacted deep cuts in vital funding for prevention, treatment and recovery services within the Substance Abuse and Mental Health Services Administration (SAMHSA), including programs supported by the Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP). We should not regularly accept level funding as a cause for celebration. But the reality is that many federal programs would no longer exist without the teamwork and perseverance of the addiction community working in Washington, D.C.

Fast forward to today. The House and Senate recently reached an agreement on the stimulus package that has been the topic of debate for weeks. Other than a small amount of alcohol-abuse funding within Indian country, there is no mention of SAMHSA or of substance abuse as a critical component of any plan to maintain the health-care safety net. Further, it appears as though Congress views prevention and wellness only through the lens of diabetes, obesity, and heart disease — missing a wonderful opportunity to promote the benefits of substance-abuse prevention as a basic tool to ensure healthy families, neighborhoods and communities. 

It is enough to make any advocate want to throw in the towel. Or is it?

No one benefits from spending hours admiring newly framed pictures of legislative victories. It is equally dangerous, however, for the addiction policy community to erase from our memory the hard work that has generated some incredible progress. 

The question remains: what went wrong during the stimulus debate? Through conversations with staffers, members of Congress, officials in the administration and others, we will piece together the story.

We know that the letters and education efforts to add $100 million for the Substance Abuse Prevention and Treatment (SAPT) Block Grant — backed by NASADAD and about 160 other groups — did not grab enough attention.

We also know that the stimulus did not move forward with the regular rules of the game. Specifically, few could anticipate the type of initiatives that Capitol Hill would accept as “shovel ready” and directly tied to jobs and the economy. But the fact remains that addiction was not a part of the deal.

Moving forward, at least a few things seem clear.

First, more work must be done to generate a nimble, forceful and loud grassroots program. While it is easy to theorize regarding the magic message that will captivate staffers and members of Congress alike, my sense is that the volume on substance-abuse issues simply is not loud enough. This is why the work of CADCA, Legal Action Center, the National Council and others is so critical as we gear up for the next round of funding battles.

Second, we need more champions on Capitol Hill, especially now that leaders like Pete Domenici and Jim Ramstad have retired. Efforts must be made to cultivate a new set of Congressional leaders who will take on addiction as a core priority. One specific task will be to rejuvenate the Addiction, Treatment and Recovery Caucus in order to generate a spotlight on these issues.

Third, while the stimulus package charted its own unique pathway towards passage, we know now that legislation to reform the way we manage and promote health in our country will be addressed in some form or fashion. As a result, the addiction community must work to ensure that addiction prevention, treatment and recovery is a prominent part of any final package considered by Congress. This work should also include a strong partnership with the mental-health community to ensure an even stronger voice.

Finally, the addiction and mental-health communities should not assume that the new Congress — or the new administration — fully appreciate the important role SAMHSA plays as the lead federal agency for addiction and mental health. Additional education is needed in order to promote the good work of CSAT, CSAP and the Center for Mental Health Services (CMHS) — and the important partnerships we all have with SAMHSA. 

The stimulus package includes important gains for the country that should not be ignored. For example, the agreement currently includes a moratorium on harmful Medicaid regulations that would have weakened an already fragile set of services for those with substance-use disorders. In addition, the package does include basic resources that are important to states suffering from unimaginable fiscal problems. 

In part, the lesson of the stimulus seems to mirror the rollercoaster nature of policy work in general. We experience highs and lows, quiet lulls and thrilling twists and turns. Yet at the same time, it is hard to ignore the omission of addiction in the current dialogue as new initiatives are discussed and unveiled. 

I do not believe we should somehow declare “lights out” for our policy work as a coalition in Washington, D.C. I do believe that we received an important wake-up call that should serve as an important reminder of the need to redouble our efforts as advocates — and as a field.

Rob Morrison is the interim executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD).