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The state of Texas occupies a unique place in American history, geography, and culture. Three of the top 10 most populous cities in the United States are found within its borders; as of 2014, the state itself is home to 26.5 million people, giving it 8.4 percent of the national population.1,2
However, that size comes with a cost, as Texas has continually struggled with healthcare problems, and some of those problems are issues of substance abuse and mental health. The landscape of addiction treatment programs in Texas is as vast and diverse as the state itself, providing an equal range of challenges, opportunities, and lessons in the fight against drug abuse.
Texas has many claims to fame – at rdaddphp.648 trillion, its gross state product is the second highest in the United States, and higher than gross domestic products of Australia and South Korea – but it also has one of the worst healthcare systems in America.3 In 2012, the federal Agency for Healthcare Research and Quality found that Texas ranked below the national average for providing care for breast cancer patients, in-home healthcare, treating cancer and diabetes, and for the disabled and poor.4,5 As far back as 2007, the Dallas Daily News attributed Texas’s healthcare problems to a combination of “politics, poverty and illegal immigration.” The border between Texas and Mexico is almost 2,000 miles, according to the Federation of American Scientists, giving it the second-highest number of illegal immigrants in a single state, after California; and the state’s poverty rate of 17.5 percent is above the national average.6,7,8
However, one area of healthcare where Texas succeeds is in drug addiction treatment. In 2013, Trust for America’s Health published a report entitled Prescription Drug Abuse: Strategies to Stop the Epidemic, which found that the Lone Star State ranked the eighth lowest for drug overdose mortalities in the United States in 2010: 9.6 per 100,000 people died as a result of improper prescription drug abuse. By contrast, West Virginia was the state with the highest rate of prescription drug fatalities, with 28.9 deaths per 100,000 people. North Dakota had the lowest mortality rate: Prescription drug abuse deaths claimed only 3.4 people per 100,000.9
To be fair, Texas is still struggling. The figure of 9.6 per 100,000 is a 78 percent increase from 1999, when the state lost 5.4 people per 100,000 to drug overdoses. Nonetheless, Trust for America’s Health found six out of 10 indicators of “promising strategies to help curb prescription drug abuse.”
The Centers for Disease Control consider the state of prescription drug abuse in the United States to be of “epidemic” proportions, saying that overdoses from improperly taking prescription drugs kills 44 people a day. The Director of the Johns Hopkins Center for Injury Research and Policy tells Trust for America’s Health that more than 6 million people suffer from various physical or psychological disorders related to prescription drug abuse disorders, and the abuse of painkillers costs the United States almost .4 billion in terms of lost productivity, medical costs and legal fees.10
Part of Texas’s success in combating the spread of drug abuse is due to Rick Perry, the longest-serving governor in the history of the state (2000-2015). According to Globe News Wire, Texas had only seven drug courts when Perry took office; in 2014, when Perry was presented with the National Award for Criminal Justice Reform by the National Association of Drug Court Professionals, his state had 136 drug courts and 15 specialized courts for treating army veterans (focusing on the connection between combat-related stress disorders and substance abuse).11,12
What’s changed? How is Texas transitioning from its lowly healthcare rank to becoming a “national and international model for reform,” where an estimated $2 billion are saved in closing prisons and giving Texas its lowest crime rates in years?
One of the solutions comes from one of Texas’s own problems that the Dallas Daily News mentioned: politics. The Daily Beast reports that from 1985-2005, Texas’s prison population jumped from 37,281 to 152,000, giving the state the second-highest incarceration rate across America. Prisons overflowed, forcing state officials to use county jails. Some convicts were forced to sleep on the floor; others were released early, some of them serving only a month for every year of their sentence before they were rotated out of the prison system to make room for a wave of new inmates.13
For as bad as Texas’s situation was, California had it much worse. The controversial “Three Strikes” law had the most populous state in the country see a 570 percent jump in its prison population from 1980-2010; in that same timeframe, the general population of California grew only 57 percent. Inmates killed themselves at a rate of nearly 80 percent that of the national average for a prison population, and the U.S. Supreme Court finally stepped in and decided that California’s state penitentiary system was in violation of the Eighth Amendment’s understanding of what constituted cruel and unusual punishment.14,15,16
As California refocused its efforts away from going after nonviolent crime (as part of the equally contentious Proposition 47), Rick Perry took note. When the National Association of Drug Court Professionals bestowed upon him the National Award for Criminal Justice Reform, they noted his action in “[combining] accountability and extensive treatment.” Perry himself pointed out Texas’s focus on “specialty courts” that provide exclusive and distinct treatment services for patients from all walks of life, giving millions of Texans an alternative to being put into prison without any care or consideration given to social or mental health factors.
As part of that drive, The Texas Tribune noted that lawmakers allocated unheard of levels of funding to services to assist patients with mental health disorders. Spurred in part by a spate of mass shootings and the controversy over people with mental health problems having access to firearms, Texas lawmakers approved budget increases for mental health services that rank among the largest in the United States. The 2013 legislative session allocated around $300 million in that direction more than the previous session did. A mental health policy analyst for the Center for Public Policy Priorities said that the $2.6 billion earmarked by the Department of State Health Services is “unprecedented.”
It’s a drastic change from 2010, when Texas came 49th in the country in per capita expenditures for mental health services. Then, the state spent less than $1 for every $3 spent per patient in other states. Today, Texas is closer to the national average for mental health services expenditures.
A specific part of the drive goes towards reducing waitlists at community mental health services. July 2013 saw more than 5,200 adults and 190 children who were waiting to receive care at such facilities. The Texas State Legislature put aside around $48 million for community health centers to hire more psychiatrists, or do whatever they felt was necessary, so that the people who required mental health services the most could get them.
However, Texas’s Medicaid eligibility standards, which are among the most restrictive in the country, might disqualify a large number of people living below the poverty line, who have co-occurring mental health and substance abuse disorders, to receive the expanded health insurance covered offered by the Affordable Care Act. Low-income individuals, or those who are homeless or have criminal records, usually have the greatest need for mental health and drug addiction services, but often get the least access to them. The associate general counsel for the Texas Hospital Association tells The Texas Tribune that the people her organization sees the most with mental health issues are the ones who have no mental health coverage.17
In 2010, the Houston Chronicle broke a story on the rise of prescription drug abuse in Texas, finding that 1,900 of the state’s residents died every year as a result of overdosing on their medication. In response, addiction expert Jane Maxwell led the calls for state legislators to fund a system to track prescription drugs in real time, and to create a system whereby state authorities could monitor overdose deaths to improve their responses.
Meanwhile, colleges took their own steps. Some schools have posted information about the causes and signs of overdoses on dormitory doors, offering classes and seminars on substance abuse. Some have even provided amnesty to students who are hesitant to ask for help, for fear that divulging drug use or illicit alcohol consumption might lead to punitive academic or legal measures.18
Such steps are especially notable because of the prevalence of dangerous substances on college campuses. Risky, impulsive behavior is widely considered to be “part of the college experience,” to the point where the National Institute on Alcohol Abuse and Alcoholism found that more than 80 percent of college students consume alcohol on campus.19,20
In 2013, the University of Texas published a report on the substance abuse trends in Texas, disclosing that 58 percent of secondary school students (grades 7-12) in the state had used alcohol, making alcohol the “primary drug of abuse.” Twelve percent of secondary school students said that when they did consume alcohol, they would usually drink five or more beers in a row, behavior that fits the definition of binge drinking, which can lead to a heart attack, high blood pressure, poor judgment, and death.21,22
An example of the deep penetration of drinking in Texas comes in an opinion piece written for the Dallas Morning News, where the writer quotes a statistic about Dallas County (population 2.37 million, making it the ninth most populous county in the United States): Almost 2,100 adults were arrested for providing alcohol to underage drinking. Other writers for the Dallas Morning Newspointed the finger at adults who permit underage drinking parties on their property, which was blamed on “the degree to which drinking is so ingrained in [Texas] culture.” With beer being sold at the Six Flags Over Texas theme park, baseball games and ball games, the writer argues that Texas is indoctrinating its youngsters that the only way they can have fun is with a drink in their hand, and another one on the way.23
Marijuana possession, meanwhile, is one of the most common causes of arrest in Texas, with almost 70,000 adults arrested in 2013 for possession. They accounted for 60 percent of all drug possession-related arrests in the state. Despite Texas’s reputation for being deeply conservative (the state has elected Republican governors since 1994 and last voted for a Democrat in a presidential election in 1976), My San Antonio reports that 49 percent of Texans support legalizing small amounts of marijuana for recreational use, and 77 percent favor marijuana being legalized for medical use.24
Perhaps anticipating the shift, then-Governor Perry spoke in favor of reducing penalties for small amounts of marijuana use. He spoke of how his policies of allocating resources away from prison sentences, and towards probation and progressive forms of treatment, have set a model for other states to follow. While still opposing the outright legalization adopted by Washington state and Colorado, Perry touted his “diversionary and rehabilitative programs” (such as drug courts) as examples of how decriminalization keeps minor offenders out of jail, keeps families together, and provides appropriate counseling and therapeutic services.25
The White House’s Office of National Drug Control Policy talks about the Drug-Free Communities (DFC) Support Program in Texas. DFCs work with local organizations to prevent drug use by adolescents.26 In 2011, the White House gave grants to Texas groups like:
The White House explains that Drug-Free Communities are meant to facilitate communication and collaboration between local communities, public and private treatment agencies, and law enforcement, with the goal of addressing the factors in high-risk communities that can compel people to resort to substance abuse, as well as providing services that can minimize the risk of drug consumption.27
Today, an organization like the Texas Mental Health Counselors Association works to provide the practice of mental health therapy services and education thereof, as well as influence policy that benefits the field.28 Other groups, like the Bay Area Council on Drugs and Alcohol, or the Mental Health Association of Greater Houston, provide geo-specific services and resources to residents of some of the most populous cities in the United States.
The measures may be working. The Texas Department of Public Safety released statistics that showed from 2007-2008, the state experienced a 5 percent decline in murders, a 4.3 percent drop in robberies, and a 6.8 decline in rapes. The number of parolees convicted of a new crime dropped 7.6 percent, and the number of incarcerations went down 4.5 percent.
And to Rick Perry’s point that his investing in drug courts saved the state billions of dollars, The Daily Beast mentions that it costs the state of Texas $50.04 a day to hold someone in a maximum-security prison. Putting them in an appropriate probationary system costs Texas $3.63 a day.
Texas’s proactive approach in adopting drug courts is part of the reason there are 2,800 drug courts across the United States (as of 2014). Drug courts refer more individuals to treatment programs than any other criminal justice system in America, says Globe News Wire in writing about Rick Perry’s award from the National Association of Drug Court Professionals. Seventy-five percent of the individuals who go through a drug court system are never arrested again, and such programs save up to $13,000 for every person who goes through the system.
For various reasons, Texas has enjoyed (and endured) a reputation for being unrelentingly tough on crime (PBS explains that the state executes more convicts than any other, at a rate that far outpaces any other state). But with a growing understanding of the myriad causes of drug addiction, as well as the harmful effects of wholesale penalization and incarceration, Texas’s forward-thinking approach to changing its landscape of treatment and therapy might be the tipping point in the fight against drug abuse.
In June 2014, the Community Epidemiology Work Group pulled together a report on drug use within the state of Texas. That report, as published by the National Institute on Drug Abuse, contained some good news. For example, cocaine use was on the decline throughout the state, and MDMA use declined as well, though these declines may be due to an increase in abuse of synthetic stimulants and synthetic cathinones. Many people in Texas have turned to the abuse of heroin, and there were 307 calls to poison control centers due to this drug in 2013 alone.
But where there is a problem, there is always a solution. For people living in Texas, that solution involves innovative treatment programs. And there are plenty to choose from in the state of Texas. Here are some of the options available.