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62 Alameda Countywide Homeless and Special Needs Housing Plan Substance Use According to federal Substance Abuse and Mental Health Services Administration (SAMHSA) estimates, 21.6 million people in the United States, or 9 percent of the population aged 12 or older, were classified with substance dependence or abuse in 2003. Approximately 3.3 million people in the United States (1 percent of the population) received treatment for a problem related to substance use during 2003.67 However, many people--even a majority of people who need treatment for substance use issues---do not receive it,68 due to a lack of perceived need for services, insurance barriers, lack of publicly funded treatment openings, and/or stigma related to services.69 In FY 2003-2004, community-based providers of substance use-related service with contracts with BHCS provided services to 9,357 clients over the course of the year. Nearly half of service contacts (44 percent) were provided in Oakland, while Newark (17 percent) and Hayward (16 percent) had the next largest numbers of contacts.70 Of the total, 591 contacts (6 percent) were provided in Berkeley. Substance Use in Combination with Homelessness, HIV/AIDS, and Mental Illness Both national and local data confirm that substance use issues affect many people who are homeless and/or living with HIV/AIDS. Ensuring housing stability for Alameda County's homelessness population and for people living with HIV/AIDS can only be accomplished by addressing substance use as well. Population estimates are: · Homelessness. The ACSSS survey found that 30 percent (1,736 adults at a point in time) of community-defined homeless adults had alcohol dependence or drug abuse, as did 50 percent (799 adults at a point in time) of the HUD-defined chronically homeless. · HIV/AIDS. Estimates of the extent of substance use issues among people living with HIV / AIDS are limited by current data collection and by the documented tendency people have to underreport substance use. BHCS substance use treatment and recovery programs do not track information related to HIV/AIDS. However, some information is available from Ryan White services. Based on local and national data, a conservative estimate is 500 to 900 people living with HIV/AIDS with substance use issues in Alameda County. · Co-Occurring Disorders. It is estimated that 35 percent of people with a serious mental illness also have alcohol or other drug dependence.71 Among people who are homeless with a serious mental illness, co-occurring substance use disorders are even more prevalent, perhaps in as 67 Substance Abuse and Mental Health Services Administration, "Overview of Findings from the 2003 National Survey on Drug Use and Health," 2004. Available online: www.drugabusestatistics.samhsa.gov/nhsda/2k3nsduh/2k30verview.htm#toc (Accessed: February 16, 2005). 68 Child Welfare League of America, "The Child Protection/Alcohol and Drug Partnership Act (S. 4841H.R.1909) Will Help Keep Children Safe and in Permanent Families," June 2001. Available online: www.cwla.org/advocacy/aodfactsheet.htm (Accessed: February 16,2005). 69 Substance Abuse and Mental Health Services Administration, "SAMHSA's Latest Survey Provides the Prevalence of Substance Use, Serious Mental Illness, Related Problems, and Treatment in the U.S." Available online: www.oas.samhsa.gov/NHSDA/2k3NSDUH/2k3results.htm#ch7 (Accessed: February 15,2005). 70 Alameda County Behavioral Health Care Services, Office of Management Services, December 31,2004. Includes adults over age 18 who received one or more claimed outpatient services during the 12 months ending June 30, 2004. Excludes office-based services of MediCal Level 3 Provider Network. 71 Alameda County Behavioral Health Care Services, personal communication with AIDS Housing of Washington staff, March 28, 2005.