II 

109TH CONGRESS 

1ST SESSION S. 538 

To educate health professionals concerning substance use disorders and 

addiction. 

IN THE SENATE OF THE UNITED STATES 

MARCH 7, 2005 

Mr. BIDEN introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To educate health professionals concerning substance use 

disorders and addiction. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Professionals 

5 Substance Abuse Education Act’’. 

6 SEC. 2. FINDINGS AND PURPOSE. 

7 (a) FINDINGS.—Congress makes the following find8 ings: 

9 (1) Illegal drugs and alcohol are responsible for 

10 thousands of deaths each year, and they fuel the 
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1 spread of a number of communicable diseases, in2 cluding AIDS and Hepatitis C, as well as some of 

3 the worst social problems in the United States, in4 cluding child abuse, domestic violence, and sexual 

5 assault. 

6 (2) There are an estimated 19,500,000 current 

7 drug users in America, nearly 4,000,000 of whom 

8 are addicts. An estimated 14,800,000 Americans 

9 abuse alcohol or are alcoholic. 

10 (3) There are nearly 27,000,000 children of al11 coholics in America, almost 11,000,000 of whom are 

12 under 18 years of age. Countless other children are 

13 affected by substance abusing parents or other care14 takers. Health professionals are uniquely positioned 

15 to help reduce or prevent alcohol and other drug-re16 lated impairment by identifying affected families and 

17 youth and by providing early intervention. 

18 (4) Drug addiction is a chronic relapsing dis19 ease. As with other chronic relapsing diseases (such 

20 as diabetes, hypertension and asthma), there is no 

21 cure, although a number of treatments can effec22 tively control the disease. According to an article 

23 published in the Journal of the American Medical 

24 Association, treatment for addiction works as well as 

25 treatment for other chronic relapsing diseases. 
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1 (5) Drug treatment is cost effective, even when 

2 compared with residential treatment, the most ex3 pensive type of treatment. Residential treatment for 

4 cocaine addiction costs between $15,000 and 

5 $20,000 a year, a substantial savings compared to 

6 incarceration (costing nearly $40,000 a year), or un7 treated addiction (costing more than $43,000 a 

8 year). Also, in 1998, substance abuse and addiction 

9 accounted for approximately $10,000,000,000 in 

10 Federal, State, and local government spending sim11 ply to maintain the child welfare system. The eco12 nomic costs associated with fetal alcohol syndrome 

13 were estimated at $54,000,000,000 in 2003. 

14 (6) Many doctors and other health professionals 

15 are unprepared to recognize substance abuse in their 

16 patients or their families and intervene in an appro17 priate manner. Only 56 percent of residency pro18 grams have a required curriculum in preventing or 

19 treating substance abuse. 

20 (7) Fewer than 1 in 5 doctors (only 19 percent) 

21 feel confident about diagnosing alcoholism, and only 

22 17 percent feel qualified to identify illegal drug use. 

23 (8) Most doctors who are in a position to make 

24 a diagnosis of alcoholism or drug addiction do not 
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1 believe that treatment works (less than 4 percent for 

2 alcoholism and only 2 percent for drugs). 

3 (9) According to a survey by the National Cen4 ter on Addiction and Substance Abuse at Columbia 

5 University (referred to in this section as ‘‘CASA’’), 

6 94 percent of primary care physicians and 40 per7 cent of pediatricians presented with a classic de8 scription of an alcoholic or drug addict, respectively, 

9 failed to properly recognize the problem. 

10 (10) Another CASA report revealed that fewer 

11 than 1 percent of doctors presented with the classic 

12 profile of an alcoholic older woman could diagnose it 

13 properly. Eighty-two percent misdiagnosed it as de14 pression, some treatments for which are dangerous 

15 when taken with alcohol. 

16 (11) Training can greatly increase the degree to 

17 which medical and other health professionals screen 

18 patients for substance abuse. It can also increase the 

19 manner by which such professionals screen children 

20 and youth who may be impacted by the addiction of 

21 a parent or other primary caretaker. Boston Univer22 sity Medical School researchers designed and con23 ducted a seminar on detection and brief intervention 

24 of substance abuse for doctors, nurses, physician’s as25 sistants, social workers and psychologists. Follow-up 
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1 studies reveal that 91 percent of those who partici2 pated in the seminar report that they are still using 

3 the techniques up to 5 years later. 

4 (12) The total economic costs of untreated ad5 diction is estimated to be $274,800,000,000. Arming 

6 health care professionals with the information they 

7 need in order to intervene and prevent further sub8 stance abuse could lead to a significant cost savings. 

9 (13) A study conducted by doctors at the Uni10 versity of Wisconsin found a $947 net savings per 

11 patient in health care, accident, and criminal justice 

12 costs for each individual screened and, if appro13 priate, for whom intervention was made, with re14 spect to alcohol problems. 

15 (b) PURPOSE.—It is the purpose of this Act to— 

16 (1) improve the ability of health care profes17 sionals to identify and assist their patients in obtain18 ing appropriate treatment for substance abuse; 

19 (2) improve the ability of health care profes20 sionals to identify and refer children and youth af21 fected by substance abuse in their families for effec22 tive treatment; and 

23 (3) help establish an infrastructure to train 

24 health care professionals about substance abuse 

25 issues and the impact on families. 
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1 SEC. 3. HEALTH PROFESSIONALS SUBSTANCE ABUSE EDU2 CATION. 

3 Part D of title V of the Public Health Service Act 

4 (42 U.S.C. 290dd et seq.) is amended by adding at the 

5 end the following: 

6 ‘‘SEC. 544. SUBSTANCE ABUSE EDUCATION FOR GENER7 ALIST HEALTH PROFESSIONALS. 

8 ‘‘(a) SECRETARY OF HEALTH AND HUMAN SERV9 ICES.—The Secretary shall carry out activities to train 

10 health professionals (who are generalists and not already 

11 specialists in substance abuse) so that they are competent 

12 to— 

13 ‘‘(1) recognize substance abuse in their patients 

14 or the family members of their patients; 

15 ‘‘(2) intervene, treat, or refer for treatment 

16 those individuals who are affected by substance 

17 abuse; 

18 ‘‘(3) identify and assist children of substance 

19 abusing parents; 

20 ‘‘(4) serve as advocates and resources for com21 munity-based substance abuse prevention programs; 

22 and 

23 ‘‘(5) appropriately address the non-therapeutic 

24 use of prescription medications. 

25 ‘‘(b) USE OF FUNDS.—Amounts received under this 

26 section shall be used— 
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1 ‘‘(1) to continue grant support through cooper2 ative agreements to the Association for Medical 

3 Education and Research in Substance Abuse 

4 (AMERSA) Interdisciplinary Faculty Development 

5 Project; 

6 ‘‘(2) to continue grants to the Association for 

7 Medical Education and Research in Substance 

8 Abuse (AMERSA) Interdisciplinary Faculty Devel9 opment Project; and 

10 ‘‘(3) to support the Addiction Technology 

11 Transfer Centers counselor training programs to 

12 train substance abuse counselors and other health 

13 professionals such as dental assistants, allied health 

14 professionals including dietitians and nutritionists, 

15 occupational therapists, physical therapists, res16 piratory therapists, speech-language pathologists and 

17 audiologists, and therapeutic recreation specialists. 

18 ‘‘(c) COLLABORATION.—The Secretary shall partici19 pate in interdisciplinary collaboration and collaborate with 

20 other nongovernmental organizations with respect to ac21 tivities carried out under this section. 

22 ‘‘(d) ACADEMIC CREDITS.—The Secretary shall en23 courage community colleges and other academic institu24 tions determined appropriate by the Secretary to recognize 
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1 classes offered by the Addiction Technology Transfer Cen2 ters for purposes of academic credit. 

3 ‘‘(e) EVALUATIONS.—The Secretary shall conduct a 

4 process and outcome evaluation of the programs and ac5 tivities carried out with funds received under this section, 

6 and shall provide annual reports to the Secretary and the 

7 Director of the Office of National Drug Control Policy. 

8 ‘‘(f) DEFINITIONS.—In this section— 

9 ‘‘(1) the term ‘health professional’ means a 

10 allopathic or osteopathic physician, advanced prac11 tice nurse, physician assistant, social worker, psy12 chologist, pharmacist, dental health professional, 

13 psychiatrist, allied health professional, drug and al14 cohol counselor, or other individual who is licensed, 

15 accredited, or certified under State law to provide 

16 specified health care services and who is operating 

17 within the scope of such licensure, accreditation, or 

18 certification; and 

19 ‘‘(2) the terms ‘allopathic or osteopathic physi20 cian’, ‘nurse’, ‘physician assistant’, ‘advanced prac21 tice nurse’, ‘social worker’, ‘psychologist’, ‘phar22 macist’, ‘dental health professional’, and ‘allied 

23 health professional’ shall have the meanings given 

24 such terms for purposes of titles VII and VIII of the 
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1 Public Health Service Act (42 U.S.C. 292 et seq. 

2 and 296 et seq.). 

3 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

5 $9,000,000 for each of fiscal years 2006 through 2010. 

6 Amounts made available under this subsection shall be 

7 used to supplement and not supplant amounts being used 

8 on the date of enactment of this section for activities of 

9 the types described in this section. 

10 ‘‘SEC. 545. SUBSTANCE ABUSE INTERDISCIPLINARY EXPERT 

11 EDUCATOR. 

12 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab13 lish and administer a substance abuse faculty fellowship 

14 program through grants and contacts under which the 

15 Secretary shall provide assistance to eligible institutions 

16 to enable such institutions to employ interdisciplinary fac17 ulty who will serve as advanced level expert educators (re18 ferred to in this section as ‘expert educators’). 

19 ‘‘(b) ELIGIBILITY.— 

20 ‘‘(1) INSTITUTIONS.—To be eligible to receive 

21 assistance under this section, an institution shall— 

22 ‘‘(A) be an accredited medical school or 

23 undergraduate or graduate nursing school, or 

24 be an institution of higher education that offers 

25 one or more of the following— 
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1 ‘‘(i) an accredited physician assistant 

2 program; 

3 ‘‘(ii) an accredited dental health pro4 fessional program; 

5 ‘‘(iii) a graduate program in phar6 macy; 

7 ‘‘(iv) a graduate program in public 

8 health; 

9 ‘‘(v) a graduate program in social 

10 work; 

11 ‘‘(vi) a graduate program in psy12 chology; 

13 ‘‘(vii) a graduate program in marriage 

14 and family therapy; or 

15 ‘‘(viii) a graduate program in coun16 seling; and 

17 ‘‘(B) prepare and submit to the Secretary 

18 an application at such time, in such manner, 

19 and containing such information as the Sec20 retary may require. 

21 ‘‘(2) QUALIFICATIONS FOR EXPERT EDU22 CATORS.—To be eligible to receive an advanced level 

23 expert educator faculty appointment from an eligible 

24 institution under this section, an individual shall 

25 prepare and submit to the institution an application 
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1 at such time, in such manner, and containing such 

2 information as the institution may require. Expert 

3 educators should have advanced level training in 

4 education about substance use disorders and exper5 tise in such areas as culturally competent and gen6 der specific prevention and treatment strategies for 

7 vulnerable populations (such as adults and adoles8 cents with dual diagnosis, older individuals, children 

9 in families affected by substance abuse, and individ10 uals and families involved in the criminal justice sys11 tem) and will serve as resources and advisors for 

12 health professional training institutions. 

13 ‘‘(c) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An eligible institution shall 

15 utilize assistance received under this section to pro16 vide one or more fellowships to eligible individuals. 

17 Such assistance shall be used to pay a sum of not 

18 to exceed 50 percent of the annual salary of the in19 dividual under such a fellowship for a 5-year period. 

20 ‘‘(2) FELLOWSHIPS.—Under a fellowship under 

21 paragraph (1), an individual shall— 

22 ‘‘(A) devote a substantial number of teach23 ing hours to substance abuse issues (as part of 

24 both required and elective courses) at the insti-
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1 tution involved during the period of the fellow2 ship; 

3 ‘‘(B) incorporate substance abuse issues, 

4 including the impact on children and families, 

5 into the required curriculum of the institution 

6 in a manner that is likely to be sustained after 

7 the period of the fellowship ends (courses de8 scribed in this subparagraph should be provided 

9 as part of several different health care training 

10 programs at the institution involved); and 

11 ‘‘(C) educate health professionals about 

12 issues related to the nontherapeutic use of pre13 scription medications. 

14 ‘‘(3) EVALUATIONS.—The Secretary shall con15 duct a process and outcome evaluation of the pro16 grams and activities carried out with amounts ap17 propriated under this section and shall provide an18 nual reports to the Director of the Office of National 

19 Drug Control Policy and the appropriate committees 

20 of Congress. 

21 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this section, 

23 $6,000,000 for each of the fiscal years 2006 through 

24 2010. Amounts made available under this subsection shall 

25 be used to supplement and not supplant amounts being 
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1 used on the date of enactment of this section for activities 

2 of the types described in this section. 

3 ‘‘SEC. 546. CENTER OF EXCELLENCE. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish 

5 centers of excellence at medical centers or universities 

6 throughout the United States to— 

7 ‘‘(1) initiate, promote, and implement training, 

8 research, and clinical activities related to targeted 

9 issues or special areas of focus such as brief inter10 vention in general health settings, children and fami11 lies affected by substance abuse, older individuals, 

12 maternal and child health issues, individuals with 

13 dual diagnosis, prevention in the general health set14 ting, and clinical practice standards for primary care 

15 providers; and 

16 ‘‘(2) provide opportunities for interdisciplinary 

17 collaboration in curriculum development, course de18 velopment, clinical practice, research and translation 

19 of research into practice, and policy analysis and 

20 formulation. 

21 ‘‘(b) USE OF FUNDS.—Centers of excellence estab22 lished under subsection (a) shall use funds provided under 

23 this section to— 
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1 ‘‘(1) disseminate information on evidence-based 

2 approaches concerning the prevention and treatment 

3 of substance use disorders; and 

4 ‘‘(2) assist health professionals and alcohol and 

5 drug treatment counselors to incorporate the latest 

6 research into their treatment practices. 

7 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

8 is authorized to be appropriated to carry out this section, 

9 $6,000,000 for each of the fiscal years 2006 through 

10 2010.’’. 

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