SUMMARY SUMMARY AND ANALYSIS OF VA DRUG DEPENDENCE TREATMENT PROGRAM July 1 December 31, 1972 The VA is presently providing treatment in 43 specialized Drug Dependence Treatment Centers which involves 52 hospitals and 2 independent Satellite Clinics. One additional center was scheduled for operation by December 31, 1972 at the Birmingham, Alabama VA Hospital but funds were withdrawn at the request of the station. No alternate site has yet been chosen. For the reporting period, admissions for drug dependence were approximately 600 greater nationwide than for the comparable period in FY 72. However, based on projections made with the available data, it appears that the total admissions to inpatient care for FY 73 will be less than for FY 72 by approximately 2,000. The major difference in anticipated workload comes in the area of ASMRO where admissions dropped from a high of 600 in May 1972 to a low of 60 in December 1972. At the same time, the average length of stay has increased from 22 to 25 days with a slight increase in the average daily census. The composition of patients admitted also seems to be changing. For FY 72, 90.6% of all patients admitted to DDTC's were for some form of opiate dependence. This figure has declined to 83.7% in FY 73. The most dramatic change in workload appears in the outpatient category. Outpatient visits have already surpassed the total for all facilities for all of FY 72. Admission to outpatient status is well above the comparable period last year and there has also been a tremendous increase in the number of stations availing themselves of the pre-bed care option. The Alcohol and Drug Dependence Service has been carefully monitoring the performance of all DDTC's with respect to caseload and unit costs. It has recently recommended the reallocation of funds among stations in order to more effectively utilize the resources available. In FY 74 this process is being refined so that target allowances for the stations will be based on a fair cost for each average daily census bed and for each visit to the outpatient clinic. The formulae used for the allowances have had the informal approval of SAODAP. In the field of employment, the VA is employing 230 ex-addicts in various capacities. Most are employed in treatment centers as rehabilitation technicians but the policy of hiring ex-addicts, does not seem to have spread nationwide. ANALYS IS 1. Admission for FY 73 should approximate 17,500. It appears as if the program experienced its greatest level of activity in March, April and May of 1972 when admissions exceeded 2,000 per month for the entire VA system. The number has steadily dropped since May and appears to be leveling off. Possible reasons for the decline include: a. b. C. Decreasing number of men returning from Viet Nam. The scope of the drug problem among Viet Nam veterans was not Fluctuating supplies of methadone on the streets have affected d. Increased Federal and local activity in the areas of prevention, 2. The decrease in activity of the ASMRO program is an indication of the troop withdrawls from Viet Nam and also the increased treatment capacity of the Department of Defense, 3. The increase in the average length of stay may be interpreted many ways. This f.gure represents an averaging of both the long and short stays. A more thorough analysis of the meaning of this statistic will be possible when the second phase of the Performance Measurement System, which is an evaluation of treatment success, is implemented. 4. There is an interesting aspect to the average daily census (ADC). For most hospital categories, the ADC exhibits a severe drop in the month of December as people go home for the holidays. This was not our experience; in fact, December had the second highest ADC for the fiscal year thus far. With the concurrent slowing of the admission rate, this indicates that people in the hospital chose to reamin in house during the holidays. 5. We seem to be dra ing a changing composition of patients. It may be that we are not only drawing in the hard core heroin addicts but are now beginning to treat other forms of addiction. 5. The growth in the number of outpatient visits has two causes. In FY 72, a bank of inpatients was established and these patients have now moved to the outpatient mode of treatment. Also, there is an increasing emphasis on ambulatory care and a simultaneous de-emphasis on long hospital stays. By the end of December, over 1,700 outpatients had been admitted via the pre-bed care option. 7. The participation by DVB continues to increase. By the end of the reporting period, 55.8% of the problems serviced by the USVAC teams were resolved, 25.2% were referred to other programs for action, and 19.1% remain unresolved. 8. Inpatient unit costs have dropped during the last 2 months. This office is recommending certain reallocations of funds and FTEE in order to better utilize our resources. Target allowances for stations will be based on experienced workload and this readjustment should lower the unit costs. Outpatient unit costs have inflated slightly since the beginning of the fiscal year due to the effect of the new stations starting to report their costs. This figure turned downward in December and it is anticipated that it will continue to decline for the rest of the year. Of this The remainder are 9. The VA is presently employing 230 known ex-drug addicts. 10. 136 of the Rehabilitation Technicians are Schedule A appointments. To date, over 50 research applications have been submitted for review Thirty-four projects are currently funded ranging from studies on the metabolism of heroin, automated analysis of blood and urine for psychoactive drugs, behavioral effects of narcotic analgesics, to preventing G.I. drug users from entering stateside heroin subcultures. 11. In the area of training, approximately 1,200 staff members have been trained to date. Educational and training opportunities have included national and regional conferences, workshops, symposia, institutes, intraand extra-VA details, consultants and on-site training using ongoing DDTC's |