1. Bureau of Drug and Alcohol Services (BDAS) /DHHS Presentation to the Gaming Study Commission March 16 th, 2010 Joe Harding – Director 271 6104 – jharding@dhhs.state.nh.usjharding@dhhs.state.nh.us

2. BDAS Mission Mission: To significantly reduce alcohol and other drug abuse and its social, health, and behavioral consequences for the citizens of New Hampshire through public policy and resource development, education, and supporting initiatives that ensure the delivery of effective and coordinated prevention and treatment services.

3. BDAS Organizational Chart

4. Organization Bureau of Drug and Alcohol Services Prevention Services Unit (PSU) Alcohol & Other Drug Prevention Programs Strategic Prevention Framework Initiative Clinical Services Unit (CSU) Alcohol & Other Drug Treatment Programs Methadone Treatment Programs Tirrell Half Way House Resources and Develop Unit: Facilitates all State Agency Trainings/Oversees Provider Training Services; Integration at State Level/Coordination across Communities Impaired Driver Services Unit Impaired Driver Intervention (IDIP) Programs Multiple Offender Programs (MOP) Business and Financial Services Unit

5. BDAS Cost Drivers Treatment: 100,000 People in NH meet the criteria for substance abuse (National Survey on Drug Use and Health) 60,000 of these individuals meet the criteria for substance dependence (addiction) (National Survey on Drug Use and Health) 44% of clients are criminal justice involved (Client Event Data) 40% to 60% of clients in the system funded by BDAS have a co- occurring mental health disorder (McGovern, Drake, et al) Prevention: 28.4% of high school students are involved in binge drinking; 5 or more drinks in a row within a couple hours)* 22.9% of the students used marijuana one or more times during the past 30 days* (* NH YRBS, 2007)

6. BDAS Service Delivery System 23 Treatment providers offering varying length and intensity of services - Tirrell Halfway House for Men Administrative oversight of 9 methadone maintenance programs (not funded by DHHS) Contracts with four Multiple Offender Programs (MOP) and administrative oversight of 6 Impaired Driver Programs  Support 10 Regional Community Prevention Coalitions, 43 Direct Service Prevention Contracts, Media campaign and Clearinghouse

7. ADMISSIONS TO TREATMENT SERVED BY GENDER – SFY2008

8. Primary Substances Used by Clients in Treatment – SFY2008

9. Governor’s Commission Commission Established; There is hereby established a Commission which shall serve in an advisory capacity to the governor regarding the delivery of effective and coordinated alcohol and drug abuse prevention, intervention, and treatment services throughout the state.

10. AOD Prevention and Treatment Services Budget Summary – SFY2009

11. Prevalence - Premise: There are approximately 983,000 adults 21 years of age or older in New Hampshire 2% or 19,665 will be engaged in problem gambling 60% or 11,800 of problems gamblers will be engaged in pathological gambling 50% or 5,900 of the Pathological Gamblers may avail themselves to counseling services if available 550,000 (56%) of NH Adults engage in some form of gambling (Target for Awareness and Education efforts) Intervention Services for Problem Gambling: 19,666 Clinical Services for Pathological Gambling = 5,900

12. Prevention Services – Education & Awareness Target Population: Individuals at some risk: 56% (550,000 - Adults ) of NH population participate in some form of Gambling Media Campaign Media Development TV, Radio, Newspaper Ad, Brochures Television and Radio Ads Print Ads (newspapers) Materials Dissemination

13. Intervention Services - Social Marketing Targeted Social Marketing Campaign Target Audience: Individuals Engaged in Problem Gambling (n = 19,665) Media Television, Radio and Print (newspaper) Ads Materials Dissemination: Regional (prevention) Networks Health & Social Services Agencies Gaming Establishments Information and Referral: Hotline Health & Social Services Agencies

14. Co-occurring Substance Abuse & Pathological Gambling The rate of co-occurrence of pathological gambling among people with substance use disorders has been reported as ranging from 9 to 30 percent, and the rate of substance abuse among individuals with pathological gambling has been estimated at 25 to 63 percent. At a minimum, the rate of problem gambling among people with substance use disorders is four to five times that found in the general population. Among pathological gamblers, alcohol has been found to be the most common substance of abuse. Even though pathological gambling is often viewed as an addictive disorder, clinicians cannot assume that their knowledge or experience in substance abuse treatment qualifies them automatically to treat people with a pathological gambling problem. Ref; SAMHSA CSAT Tip 42: Substance Abuse Treatment for Persons with Co-occurring Disorders

15. Prevalence of Suicide and Pathological Gambling A 1999 study conducted by Maccallum et al. found that 38% of suicidal ideation is related to gambling, of which 8% of the subjects were actively suicidal.

16. Clinical Services Screening / Brief Intervention / Referral Hot Line Health and Social Service Agencies Crisis Evaluations (n = 236) Out Patient Services (n = 5310) Intensive Outpatient Services (n = 590)

17. Clinical Services - Continued Crisis Evaluations at Hospital Emergency Rooms (Master’s Prepared > Clinicians) Counseling Services: Community Mental Health Centers Alcohol and Other Drug Treatment Programs Master Prepared > Independent Practitioners Board of Mental Health Practice Board of Alcohol and Drug Abuse Professionals

18. Program Development / Provision of Services Community Level Prevention Services Media / Social Marketing Clinical Services Program Development Training / Certification Administration Program Evaluation

19. BDAS Org Chart with Gaming

21. Budget