How Budget Cuts Continue to Make Us Sicker, Poorer and Less Secure


Years of Funding Erosion Leave Communities Open to Addiction Epidemic

Featuring: Sara M. Howe, Chief Executive Officer, Illinois Association for Behavioral Health, Springfield, Illinois

Photo Featuring Natalie Maggiore

ROLE OF GOVERNMENT: Protecting the Public’s Health

Maintaining a strong military is one of government’s fundamental responsibilities. But it takes more than just military might to keep Americans safe and secure. Public health—which by definition affects the public, writ large—is an essential pillar of national security, and one that the government is best positioned to support.

One way that the federal government promotes public health is through grants made to the states that allow them to implement strategies to prevent disease in local communities. One such grant, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) is the Substance Abuse Prevention and Treatment (SAPT) Block Grant. It is the cornerstone of States’ substance abuse prevention, treatment, and recovery systems. In fact, SAMHSA estimates that on average, 65 percent of a state’s substance abuse prevention funding is from the SAPT Block Grant.1

Despite the states’ dependence on the SAPT Block Grant for prevention and the 1.5 million Americans affected by substance abuse who depend on it for treatment, funding for the grant has remained relatively flat in recent years. As a result, the purchasing power of the block grant is approximately 29 percent less than it was in 2006, due to health care inflation.2 With the growing opioid epidemic, states will need additional support for both treatment and prevention in order to maintain the public’s health.

“The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off,” President Donald Trump told a crowd in New Jersey in an August 9th speech.6

Substance Abuse Prevention and Treatment Block Grant Funding
(in Billions of FY18 Dollars)

Source: Labor, Health and Human Services, and Education Appropriations FY2009-FY2017

The Opioid Epidemic: A Modern Plague

According to data from the Centers for Disease Control and Prevention (CDC), from 1999 to 2015, more than 183,000 people died in the United States from overdoses related to prescription opioids. In fact, CDC estimates that as many as 91 Americans die each day as the result of an opioid overdose.3 Unfortunately, this is not a trend that appears to be changing direction any time soon. Rather, some reports estimate that as many as 65,000 Americans will die from drug overdoses in 2016 alone.4 If 2015 trends continue, as many as 60 percent of those deaths will be related to opioids.

Preventing Addiction: A Local Approach

States receiving the Substance Abuse Prevention and Treatment (SAPT) Block Grant are required to use 20 percent of the funding to support prevention strategies that are targeted to youth between the ages of 12-17 who are not identified as “in need” of treatment. Strategies may include information dissemination, education, and community-based prevention programs. In 2015, more than 18.6 million Americans received SAPT Block Grant-funded prevention services in individual-based programs, and more than 500 million were served in population-based programs.5

The Illinois Association for Behavioral Health (IABH) uses SAPT funding to support the Cebrin Goodman Teen Institute (CGTI) as part of its prevention strategy. Since 1974, this award-winning, five-day youth leadership conference offers opportunities for teens around the state to learn about leadership, healthy choices, and working with others to create better communities. Upon completing the Institute, teens return home armed with a substance abuse prevention plan that they have created and will implement in their local community.



The program is so successful that many of the attendees return to the Institute year after year, and many become staff volunteers. Natalie Maggiore from Elmwood Park, attended her first conference in 2007 and since has completed each of the Institute’s leadership programs and serves on the Leadership Team. Natalie reflects on her participation:

“CGTI is incredible because it has the capability to serve anyone! From people who are new to the program and just looking for ideas and people to collaborate with, to groups that are well-established, like the one I first came with, who are looking to expand and create positive change in their school and/or community. CGTI’s action planning framework is helpful to all who attend with the bonus of it all happening in an environment that is enthusiastic, open and fun!”

Doing More with Less… and then, Less with Less

According to IABH’s Chief Executive Officer Sara Howe, approximately 95 percent of the support for the Teen Institute comes directly from Illinois’ SAPT grant. In the past, the state invested $7 million annually into the substance abuse prevention system. However, that funding was reduced over several years and was ultimately eliminated in the 2015 budget, which was carried through 2016 and 2017 due to political impasse. The most recent state budget returned $1 million in prevention funding. However, it remains unclear if the governor will expend those funds.

“Our prevention efforts, including the Teen Institute, rely almost entirely on funds provided by the federal government,” explained Sara. With the elimination of state funding, federal funding remaining flat for almost two decades, and with newly emerging threats, we are always looking for ways to stretch our funding but we can only stretch it so thin.”

For years, CGTI utilized foundation support to provide scholarships for the $359 tuition and transportation that allowed students in underserved communities to participate in the training. This year, Sara was not able to fund these efforts as their foundation grant expired and was not renewed. As a result, there were no busses and fewer teens learned how to lead prevention efforts in their local communities.

As Illinois struggles with its own budgetary challenges, Sara and her colleagues look to the federal government for consistency.

“When the state is in crisis, federal dollars provide stability. So, prevention and treatment providers remain concerned with the federal budget.”

Prevention Now, Or Treatment Later

A lot of the focus in the media on the response to the opioid crisis has focused on the immediate treatment of opioid addiction and rehabilitation. However, Sara explains that the best option is to prevent addiction before it starts. Prevention programs like CGTI, which emphasize local prevention strategies, are key in slowing the spread of the epidemic and can also result in significant savings in the long term. According to Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, every $1 spent on effective, school-based prevention programs can save an estimated $18 in costs related to problems later in life.7

Through her work at IABH, Sara knows too well the costs of not investing upfront in prevention programs.

“Not including a line item for prevention in your budget does not mean you saved money. You are still paying it down the line in treatment.”


1. SAMHSA. Report from WebBGAS using 2016 SAPT Block Grant Reports. Accessed December 2016.
3. https://www.cdc.gov/drugoverdose/data/overdose.html
4. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html?_r=1
5. https://www.samhsa.gov/grants/block-grants/sabg
6. http://www.cnn.com/2017/08/08/politics/donald-trump-opioid-briefing-abuse/index.html
7. https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf