Task Force resumes look at Missouri's response to substance abuse

Mo.gov | Mike Lear

A Task Force that hopes to advance Missouri’s response to substance abuse has resumed work. 

 The Substance Abuse Treatment and Prevention Task Force met in the 2023 interim and developed recommendations for the legislature, some of which were enacted.  One of those was that it be continued this year, and its chairman, Representative John Black (R-Marshfield), is glad that was passed.

      “I think we’ll do more or less the same thing we did last year.  We’ll look at some of the issues that we’ve identified for review this year and then hopefully the Task Force will continue to refine those and come up with more issues.  The budget, of course, is a big deal,” Black said after the Task Force met recently

  “Missouri, as our counterpart 49 other states, as well as most countries in the world, are really struggling with getting our arms around substance abuse disorder.”  He said the group heard from experts that, “[Substance abuse] is kind of how we respond to our own different mental illnesses.”

      The Department of Mental Health’s Chief Medical Director, Dr. Angeline Stanislaus, opened the session with a discussion of the neurobiology of addiction.  She said much has been learned in the last three decades that can guide the state’s programs. 

      It was believed in the medical field some 20 or 30 years ago that when a substance was out of a person’s system and they resumed using it, it was by choice and they had an issue with discipline or willpower.

      “That was the mindset in which we were trained as physicians in the 1990s,” Stanislaus said.  “There’s been more research now to show that just because a substance is out of the system … but all the neurotransmitter changes the substance did before it got out, they’re still lingering and the body’s still working on them. This is the new understanding over the last couple of decades, it took us this long to understand that.”

Stanislaus said many people who abuse substances like alcohol, cocaine, and heroin do so because they were victims of childhood abuse or neglect that altered their brain chemistry.

      “The brain wasn’t connected the way to produce a natural level of dopamine and neurotransmitters that a brain needs for us to lead healthy lives … same thing with violence.  Witnessing a lot of violence changes the brain chemistry.  There’s a lot of fear.  The neurotransmitters that are impacted by fear will go up, so when you have so many fear neurotransmitters going on in your brain you may seek a substance to decrease that fear.”

      A brain disrupted by substance abuse will never return to what it was before, but it can heal.

      “The brain is such a wonderful organ.  It’s very neuroplastic, that can produce itself more neurotransmitters given enough time, given treatment, this is how treatment works.  Give them enough time for the brain to recreate all this dopamine and all those other neurotransmitters, either through medications, combination of therapy, combination of whatever needs to be put together … that’s the true potential of what the brain can possibly do and that’s what we try to do as treatment providers.”

      Former Missouri House Speaker Todd Richardson has been the Director of MO HealthNet since 2018.  Much of what the Task Force discussed with him was its recommendation from last year that a new state executive be created – what members have tentatively referred to as a “czar” – to oversee substance abuse issues across the various state departments that deal with those. 

      He said while the idea has merit and could work, giving one figure authority over three, four and even five departments and asking that person to understand and take on all that is involved in substance abuse issues, could prove too much to ask.

      He thinks the effort the Task Force has set in motion should be given time to work.

      “I think it is incredibly important that the departments continue to collaborate in this space and make sure that our policies are complimentary of each other … I think that collaboration is better than it has ever been before.  While I think the idea behind having somebody to oversee this is the right thinking, I really think the best way to accomplish what you’re trying to accomplish is by trying to continue to encourage that collaboration between those departments.”

      To the Task Force’s credit, Richardson said, “I do think the focus that this task force has put on it has already led to more collaboration and coordination and discussion about this subject than I’ve seen in the 15 years I’ve been coming to Jefferson City.”

Taylor appreciates the different backgrounds brought to the group.  A budget-minded legislator himself, Taylor hopes to get more data about Missouri’s substance abuse response.  

      “Consistently I want to know: What are the programs and how do we measure effectiveness?  Is the program actually working?  How much have we appropriated for that program and are we spending the money that we appropriate?  Let’s at least be honest and up front about how much of that is actually going to get used, how many people are you going to actually hire, and how much of that is going to lapse?”

      Some members weren’t present at the recent hearing due to technological or medical issues.  Black hopes more members will be able to attend in subsequent hearings.

      “The more people we have, the more involvement, the more good questions.  That would be beneficial, but I’m very happy that the Senate, the House, and the governor’s office are supportive of the continuing work of the task force.”

      The Task Force will meet again in July.