Guide to Mental Health and Addiction Treatment in Florida

Addiction is a common disease. In 2013, approximately 23 million Americans aged 12 and older needed some kind of treatment for issues related to drug or alcohol use or abuse.¹ In addition, about one in four adults in the United States will suffer from some form of mental illness in a given year.²

Substance abuse, addiction, and mental illness are all considered mental and behavioral health issues, and they often occur simultaneously. Between 2009 and 2013, approximately 880,000 Floridians received treatment for any mental illness (AMI), which was only 36.3 percent of those who needed treatment, leaving a further 63.7 percent without treatment that may have helped them during that time.³

There may be several perceived barriers to treatment, from cost to health insurance to just not knowing where and how to get help. Within the state of Florida, there are many different forms of substance abuse, addiction, and mental health treatment options that can be tailored to the specific requirements of each individual. Help is within reach.

Types of Behavioral Health Services Offered within Florida

Florida, the Substance Abuse and Mental Health (SAMH) program operates within the Florida Department of Children and Families(DCF). It is federally designated as the state authority on substance abuse and mental health, and any issues relating to either or both.⁴ The SAMH program helps to treat individuals battling mental illness, addiction, or substance abuse, and it oversees the state system. The Substance Abuse and Mental Health Services Administration (SAMHSA) lists 226 substance abuse and mental health facilities around the state.⁵ In addition to state-funded and public substance abuse programs, there are several private addiction treatment centers to choose from as well.

The Florida Mental Health Act, or the Baker Act, may be enacted in the case of individuals who present symptoms of mental illness, are potentially a danger to themselves or others, and may not perceive or understand that treatment can help.⁶ The Baker Act provides legal recourse to mental health and medical professionals, as well as law enforcement and officers of the court, in order to submit someone for an involuntary psychiatric exam and further treatment if necessary.

Each of the facilities in Florida offering behavioral health services is likely to offer their own selection of services that may be different from location to location. Substance abuse treatment programs may offer an array of services, including but not limited to:

• Medical detox
• Mental health assessment
• Group and individual therapy
• Counseling
• Education
• Life skills training
• Parenting education and skills training
• Transitional housing
• Peer-support groups
• Family support and counseling
• Recovery support

In 2011, approximately 150,000 people in Florida received an involuntary exam.⁷Medical and mental health professionals initiated involuntary exams in 49 percent of the cases, while law enforcement initiated another 49 percent and circuit courts initiated 2 percent of the exams.⁸ In many cases, how someone enters into treatment may not be as important as getting them there. Motivation can come in many forms and involuntary admission into a program may work just as well as voluntarily entering into treatment.

In Florida, when treatment admissions were measured in 2010, marijuana was the most common primary drug found in people admitted for substance abuse services, followed by opiates and then cocaine.⁹ Treatment services may be offered in a residential or outpatient basis, depending on the situation of the individual seeking treatment. Residential treatment may also be called inpatient care, and individuals may stay on site in a specialized facility receiving around-the-clock treatment, care, and medical supervision for a certain amount of time.

No two people are exactly alike; therefore, treatment for addiction or mental illness should be customized to the individual in need. Many services can be provided on an outpatient basis wherein the individual returns home to sleep at night.

There are differing levels of care even within inpatient and outpatient treatment. An assessment is typically done first in order determine what level and type of treatment is best in each individual case, so the correct form of comprehensive care can be provided. Individuals may move between levels of care as needs and situations change as well.

High Drug Overdose Fatality Rates in Florida

Nationally, about 8 percent of Americans admit to using an illicit drug in the past month, and in Florida, rates are about the same.¹⁰ What may be particularly concerning is that the mortality rate for drug overdoses is higher in the state of Florida than the national average.¹¹ In 2013, Florida was found to have the 11th highest mortality rate for drug overdoses in the United States.¹² There were 16.4 deaths per 100,000 people in 2013 in the state.¹³ Over 4,000 people died with drugs in their system in Florida in the first six months of 2014.¹⁴

Specific drugs found present in fatal overdoses in the first six months of 2014 (January through June) and their rate of occurrence from highest to lowest:

• Alcohol: 1,983
• Cocaine: 725
• Xanax: 577
• Morphine: 525
• Cannabinoids: 492
• Oxycodone: 470
• Hydrocodone: 339
• Nordiazepam: 302
• Tramadol: 301
• Valium: 270
• Methadone: 245
• Temazepam: 231
• Hydromorphone: 206
• Fentanyl: 199
• Oxazepam: 183
• Klonopin: 170
• Heroin: 156
• Amphetamine: 132
• Codeine: 125
• Oxymorphone: 121
• Zolpidem: 114
• Methamphetamine: 109
• Carisoprodol/Meprobamate: 91
• Ativan: 90
• Midazolam: 81
• Bath salts: 72
• Chlordiazepoxide: 46
• Inhalants: 31
• Buprenorphine: 17
• Ketamine: 13
• Sympathomimetic amines: 12
• Others with less than 10 ¹⁵

Across the nation, drug overdose has become an epidemic and surpassed even traffic accidents as the number one cause of injury death in the country.¹⁶ Prescription drugs are largely to blame, as 44 people die in America every day from an overdose on prescription pain relievers.¹⁷ In Florida, prescription drugs account for almost 79 percent of all the listed drug occurrences in the first six months of 2014; however, heroin is considered the cause of death almost 90 percent of the time it was present in the system.¹⁸

Florida a Hot Spot for Drug Trafficking

The central, northern, and southern regions of Florida are designated High Intensity Drug Trafficking Areas (HIDTAs) by the U.S. Department of Justice (DOJ). There are 28 in the nation and three within the state of Florida.¹⁹

• South Florida HIDTA:
  This area contains Broward, Monroe, and Miami-Dade counties and was designated in 1990. The Miami International Airport (MIA) is the busiest airport for international cargo and the second busiest for international passengers. The Florida Keys and Florida coast seaports provide close access to the Caribbean, South America, and Central America. Much of the nation’s trade with these neighboring countries comes through Florida: 40 percent of trade with Central America, 35 percent of trade with the Caribbean, and 17 percent of trade with South America pass through South Florida. Marine smuggling operations and cruise ships porting in Miami and Ft. Lauderdale have been uncovered, and drugs have been seized all along the southern shores of Florida. Marijuana may also be regularly grown in this region. Drug-related violence and money laundering operations may also be common in South Florida.²⁰
• Central Florida HIDTA:
  This area contains Seminole, Orange, Polk, Pinellas, Volusia, Osceola, and Hillsborough counties and was designated in 1998. Four international airports, two seaports, 75 miles of coastline on the Gulf of Mexico and an additional almost 50 miles of Atlantic Ocean coastline, and the cities of Daytona Beach, Orlando, and Tampa make this a popular tourist location as well as high drug use area. Drugs may be smuggled along the US Interstate 4 or I-4 corridor, and drug labs may also be prevalent in this region.²¹
• Northern Florida HIDTA: 
  This area contains Baker, Clay, Columbia, Alachua, Flagler, Duval, Nassau, Putnam, Marian, and St. Johns counties and was established in 2001. Proximity to Atlanta, Georgia, as well as the eastern seaboard of the United States make this region attractive to drug smugglers. Significant nightlife in Jacksonville, Gainesville, and St. Augustine may increase drug-using populations, and large homeless populations may also contribute to rampant drug abuse. Big and growing cities such as Ocala may also see large drug-using populations.²²

New and ‘Old’ Drugs Fill the Void

Unfortunately, as prescription drug abuse drops, use of other drugs may rise. One such drug that was commonly abused decades ago, declined in popularity, and now seems to be rising again is heroin. Between the first half of 2013 and the first half of 2014, drug-related incidents involving heroin jumped 119.7 percent.²³ Heroin may be being substituted for opioid pain relievers and may prove more dangerous, as users may turn to injecting the drug for a more rapid and intense high. Injection drugs carry a plethora of risks in addition to accidental overdose, including the potential contraction of infectious diseases, engaging in criminal activity, and enhancing possible underlying or co-occurring mental illness symptoms.

New designer type drugs are also showing up on Florida streets, especially in the club scene. New drugs like Budder, which is made by soaking marijuana stems and leaves in a solvent such as butane and producing high levels of THC, and flakka, a new version of bath salts, or synthetic cathinones, similar in structure to crystal meth are being added to e-cigarettes and smoked, or vaped.²⁴ Miami-Dade, Broward, and Palm Beach counties all report instances of Budder abuse, and in Boca Raton, a large explosion of a grow lab may have been linked to the dangerous new drug.²⁵ These drugs are unpredictable and can have dangerous and potentially fatal consequences when taken even once.

Legislation Impacts Drug Diversion and Abuse

Florida has taken several steps to combat the prescription drug abuse explosion within the state, and fortunately, abuse and diversion rates seem to be declining. There was a 3.4 percent drop in drug overdose fatalities in 2014 from 2013 when considering the timeframe from January to June.²⁶

In 2011, it was estimated that doctors in Florida dispensed more than 10 times the amount of oxycodone to patients than those in any other state.²⁷ Around the state “pill mills” were common, and pain pills especially were diverted and abused like candy. The Florida Prescription Drug Monitoring Program (PDMP) and the Electronic-Florida Online Reporting of Controlled Substances Evaluation program (E-FORCE) have been working to change that by requiring healthcare practitioners to log their prescriptions of controlled substances, such as opioid pain pills and benzodiazepine medications, into a database making them more accountable.²⁸

Interstate 75, or I-75, is a known route for drug trafficking along which in cities like Miami, Fort Lauderdale, Jacksonville, and Palm Beach lie in the infamously drug-heavy South Florida. In 2011, the Drug Enforcement Administration, or DEA, made more than 20 arrests in a joint law enforcement operation cracking down on some of Broward County’s pill mills.²⁹

Declining prescriptions of these controlled substances, stricter criminal legislation, and more regulation may have directly impacted the number of overdose deaths caused by these drugs. The number of drug overdose deaths decreased 16.7 percent between 2010 and 2012 after stricter laws and legislation regarding prescription drug regulation was enacted in Florida.³⁰

Drug abuse prevention methods have also been ramped up and Florida scored a 7 out of 10 on strategies being used to prevent prescription drug abuse within the state.³¹ Drug courts in the state of Florida also exist to help divert people from the criminal justice system into substance abuse programs.

Requirements to Treat Substance Abuse in Florida

In the state of Florida, providers offering substance abuse and/or mental health services to families or individuals must be licensed through the state in accordance with what level of care they are providing.³² For example, a facility providing detox services needs to be specifically licensed to handle this level of care. There are several levels of substance abuse counseling certifications a person can receive in Florida as well:

• Certified Addiction Specialist (CAS):
  lowest certification level that requires 150 hours of training, passage of a background check, three professional letters of referral, 2,000 hours of supervised experience, passage of the Florida A&D exam, and agreement to FCB’s code of ethics
• Certified Addiction Counselor (CAC):
  middle-tier certification that requires 250 hours of training, three professional letters of recommendation, 6,000 hours of supervised experience (unless an associate’s degree in a behavioral science is held; then only 4,000 hours are required), passing the Florida A&D examination, agreeing to and signing the FCB code of ethics
• Certified Addiction Professional (CAP):
  higher certification level that requires 350 hours of professional training, three professional reference letters, a bachelor’s degree in a behavioral science from an accredited school, 6,000 hours of supervised experience (unless a master’s degree or PhD in counseling is held; then only 4,000 hours are necessary), passing the Florida A&D exam, and signing the FCB code of ethics³³
• Certified Master’s Level Addiction Professional (MCAP):
  new certification offered to those with a CAP and a master’s degree in a related field; individuals may be able to apply to upgrade their CAP to an MCAP³⁴

Other Florida certifications include:

• Certified Criminal Justice Addiction Professional, Counselor, and Specialist (CCJAP, CCJAC, CCJAS)
• Certified Recovery Support Specialist (CRSS)
• Certified E-therapist (CET)
• Certified Gambling Addiction Counselor (CGAC)
• Certified Tobacco Treatment Specialist (CTTS)
• Certified Mental Health Professional (CMHP)
• Certified Behavioral Health Technician (CBHT)
• Certified Peer Recovery Specialist (CPRS)
• Certified Prevention Professional and Specialist (CPP and CPS)³⁵

Medical doctors, nurses and other medical professionals may also work with individuals suffering from addiction or mental illness in an integrated care format to ensure the highest levels of comprehensive treatment are being provided.

Paying for Services

A lcohol and drug abuse is expensive, producing a drain on the economy and costing the state of Florida $43.7 billion each year.³⁶ Much of cost is reflected in healthcare, criminal justice, and lost workplace production costs. Treatment can save both the community and individuals money. For example, in Florida the average cost of an emergency room visit is close to $3,000, each day spent in the hospital may cost an average of $2,000 a day, and drug offenders in prison cost the state $55,000 a year.³⁷ In contrast, crisis stabilization beds cost around $300 a day, detox services are usually just over $200 a day, and drug or alcohol abuse treatment costs may be about $2,400 a year, while mental health treatment may cost about $1,500 annually.³⁸

Florida has several state-funded substance abuse and mental health treatment options that may be low-cost or no cost to individuals needing services. The goal is to ensure that all Floridians have access to mental health and substance abuse services regardless of financial standing. Florida even has a specialty fund for families experiencing temporary financial difficulties or employment issues due to mental health or substance abuse problems that can provide help with screening, outreach, and treatment services to those in need under the Temporary Assistance for Needy Families Substance Abuse and Mental Health (TANF SAMH) program.³⁹ Those seeking private or additional treatment may have the option of using their individual or employee insurance policy to cover some of the costs of care. Most substance abuse and mental health facilities will have a designated hotline or group of professionals trained in helping individuals figure out what insurance may cover and how to fund treatment.

The Affordable Care Act of 2010 (ACA) changed the face of mental health and addiction treatment as well, opening up care to more people. For instance, Medicaid benefits are being extended to 1.2 million uninsured Florida residents by 2016 under the ACA, providing more people with access to healthcare.⁴⁰ Additionally, adding on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), substance abuse and mental health services are required to be covered under most insurance plans now and not excluded for coverage even if the conditions are considered pre-existing.⁴¹ This is the largest expansion of mental health and substance abuse coverage in over 50 years and may provide about 62 million Americans access to substance abuse and mental health services that may not have had coverage before.⁴² Preventive medicine is also included in the ACA. Check with the insurance provider to see if these benefits apply and how to use them to pay for addiction or mental health treatment.

Treatment and Substance Abuse Prevention Resources in Florida

There are many agencies within the state of Florida that offer support and guidance for individuals and families who need help understanding how to find and receive the proper treatment for addiction, substance abuse, or mental illness. Some of these resources are operated by the state or other government agencies while others are nonprofit organizations or community groups. Some of these resources and links to their website for more detailed information are included here:

• SAHMSA has an online locator tool to help individuals find treatment facilities offering substance abuse services, mental health services, or those that offer both.⁴³
• The Florida DCF provides a list of state-run mental health treatment facilities; currently there are seven.⁴⁴
• Florida has 31 Florida Assertive Community Treatment (FACT) teams that provide public mental health services, including clinical services, housing, medications, and funding subsidies for individuals.⁴⁵
• The State Mental Health Planning Council of Florida provides a listof resources for Florida residents with mental health concerns.⁴⁶
• Florida’s DCF provides a tool on their com website that allows individuals to choose their Florida county from a drop-down menu and find local providers that way.⁴⁷
• The Florida DCF also keeps an updated list of officially licensed substance abuse treatment facilities and providers that are organized by city.⁴⁸
• The Mental Health America of Northeast Florida seeks to improve and advocate for mental health services within the region by providing education, individual, and family resources and connecting people to community programs.⁴⁹
• Community-based mental health and substance abuse services are represented by the nonprofit the Florida Alcohol and Drug Abuse Association (FADAA), which strives to positively impact substance abuse policy across the state.⁵⁰
• The Drug Abuse Resistance Education, or D.A.R.E. program, is active within the state of Florida and provides education to children to help prevent them from turning to drugs. The new keepin’ it REAL program was taught in 261 elementary schools and 18 middle schools in 2014 with positive results. The D.A.R.E. program is a drug abuse prevention resource used around the country.⁵¹

For every $1 invested in treating mental health issues, almost $4 are saved in hospitalizations and criminal activities while $1 spent on drug or alcohol treatment can save the local taxpayers over $7.⁵² Mental illness and addiction are treatable disorders, and there are many locations and resources within Florida that can help.

Citations

1. Sept. 2014). “Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed September 14, 2015.
2. (Mar. 2013). “Mental Illness FACTS AND NUMBERS.” National Alliance on Mental Illness (NAMI).Accessed September 14, 2015.
3. (2015). “Behavioral Health Barometer, Florida 2014.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed September 14, 2015.
4. (n.d.) “Substance Abuse.” Florida Department of Health. Accessed September 14, 2015.
5. (n.d.). “Behavioral Health Services Treatment Locator.” Substance Abuse and Mental Health Services (SAMHSA). Accessed September 14, 2015.
6. (2013). “Florida’s Baker Act: 2013 Fact Sheet.” Department of Children and Families. Accessed September 15, 2015.
7. Ibid.
8. Ibid.
9. (n.d.) “Florida Drug Control Update.” Executive Office of the President of the United States. Accessed September 15, 2015.
10. Ibid.
11. Ibid.
12. (Oct. 2013). “Drug Abuse 2013 Data for Florida.” Trust for America’s Health (TFAH). Accessed September 14, 2015.
13. Ibid.
14. (April 2015). “Drugs Identified in Deceased Persons by Florida Medical Examiners Interim Report 2014.” Florida Department of Law Enforcement. Accessed September 14, 2015.
15. Ibid.
16. (April 2015). “Prescription Drug Overdose Data.” Centers for Disease Control and Prevention (CDC). Accessed September 14, 2015.
17. Ibid.
18. (April 2015). “Drugs Identified in Deceased Persons by Florida Medical Examiners Interim Report 2014.” Florida Department of Law Enforcement. Accessed September 15, 2015.
19. (2015). “High Intensity Drug Trafficking Areas (HIDTA) Program.” Office of National Drug Control Policy (ONDCP). Accessed September 15, 2015.
20. (n.d.) “South Florida HIDTA.” Office of National Drug Control Policy (ONDCP). Accessed September 15, 2015.
21. (n.d.) “Central Florida HIDTA.” Office of National Drug Control Policy (ONDCP). Accessed September 15, 2015.
22. (June 2007). “North Florida High Intensity Drug Trafficking Area Drug Market Analysis.” U.S. Department of Justice (DOJ). Accessed September 15, 2015.
23. (April 2015). “Drugs Identified in Deceased Persons by Florida Medical Examiners Interim Report 2014.” Florida Department of Law Enforcement. Accessed September 15, 2015.
24. Brochu, N. (Oct. 2014). “‘Budder and ‘Flakka’: New Designer Drugs Hit South Florida Streets.” Sun-Sentinel. Accessed September 15, 2015.
25. Ibid.
26. (April 2015). “Drugs Identified in Deceased Persons by Florida Medical Examiners Interim Report 2014.” Florida Department of Law Enforcement. Accessed September 15, 2015.
27. Allen, G. (Mar. 2011). “The ‘Oxy Express’: Florida’s Drug Abuse Epidemic.” NPR. Accessed September 15, 2015.
28. September 15, 2015.
29. Allen, G. (Mar. 2011). “The ‘Oxy Express’: Florida’s Drug Abuse Epidemic.” NPR. Accessed September 15, 2015.
30. (June 2014). “Decline in Drug Overdose Deaths After State Policy Changes.” Centers for Disease Control and Prevention (CDC). Accessed September 15, 2015.
31. (Oct. 2013). “Drug Abuse 2013 Data for Florida.” Trust for America’s Health (TFAH). Accessed September 15, 2015.
32. (2014). “Licensure and Regulation.” Florida Department of Children and Family Services (DCF).Accessed September 14, 2015.
33. (2015). “Substance Abuse Counseling Certification in Florida.” HumanServicesEdu.org.Accessed September 14, 2015.
34. (2015). “Certified Master’s Level Addiction Professional.” Florida Certification Board. Accessed September 14, 2015.
35. (2014-2015). “Addiction Counselor Requirements in Florida.” Addiction-Counselors.com.Accessed September 14, 2015.
36. (n.d.). “Best Return on Investment (ROI): Mental Health and Substance Abuse Treatment.” Florida Council for Community Mental Health. Accessed May 10, 2016.
37. Ibid.
38. Ibid.
39. (2014). “Temporary Assistance for Needy Families (TANF)/ Substance Abuse and Mental Health (SANF).” Florida Department of Children and Families. Accessed September 20, 2015.
40. (n.d.) “Benefits of the Affordable Care Act.” Health Care for Florida Now. Accessed September 15, 2015.
41. (Sep. 2015). “Health Insurance and Mental Health Services.” U.S. Department of Health and Human Services (HHS). Accessed September 15, 2015.
42. Ibid.
43. (n.d.). “Behavioral Health Services Treatment Locator.” Substance Abuse and Mental Health Services (SAMHSA). Accessed September 14, 2015
44. (2014). “State Mental Health Treatment Facilities.” Florida Department of Children and Families (DCF). Accessed September 14, 2015.
45. (2014). “Treatment.” Florida Department of Children and Families (DCF). Accessed September 20, 2015.
46. (n.d.) “State Mental Health Planning Council of Florida.” Florida Department of Children and Families (DCF). Accessed September 14, 2015.
47. (2014). “Get Help.” Florida Department of Children and Families (DCF). Accessed September 14, 2015.
48. (Aug. 2015). “Licensed Substance Abuse Providers By City .” Florida Department of Children and Families (DCF). Accessed September 14, 2015.
49. (n.d.). “About Us.” Mental Health America of Northeast Florida. Accessed September 14, 2015.
50. (2015). “Florida Alcohol and Drug Abuse Association.” FADAA.org. Accessed September 15, 2015.
51. (2014). “2014 Annual Report.” Drug Abuse Resistance Education (D.A.R.E.). Accessed September 14, 2015.
52. (n.d.). “Best Return on Investment (ROI): Mental Health and Substance Abuse Treatment.” National Alliance on Mental Illness (NAMI). Accessed September 15, 2015.