Understanding Texas Faith-based Chemical Dependency Programs

By Terence T. Gorski (2-6-01)
( www,tgorski.com; www.relapse.org; www.cenaps.com )

Recent Executive Orders by President George W. Bush are raising important questions about the safety and effectiveness of faith-based programs.  The key questions are:  

1. What should faith-based addiction programs do?  

2. To what standards, if any, should they be held accountable?  

3. Should faith-based programs receive federal funding?  

4. If so, what type of funding and where should it come from?  

5. And, most importantly, are faith-based programs safe and effective?  

To answer these questions, I took a hard look at the Texas experience with Faith-based Programs.

In 1997, the Texas legislature, under the leadership of then Governor George W. Bush, passed House Bill (HB) 2481, which became effective in 1998.  This legislation provides faith-based addiction treatment programs with an exemption from all state program licensure requirements and state oversight.  There are only two restrictions: 

HB 2481 specifically exempts faith-based treatment programs from: 

1. Facility standards for residential programs and outpatient programs; 

2. Program standards specifying the type or content of treatment,

3. Staff training and licensure requirements; and

4. External objective oversight by a licensing body. 

In essence, HB 2481 makes it possible for any faith-based organization to provide any form of addiction treatment or counseling to addicted people and their families without any base-line standards or oversight. 

The four exemptions that HB 2481 provides to faith-based organizations, are the basic foundation of all current national licensure and accreditation standards for addiction programs.  This basic foundation is essential to assure the safety and effectiveness of addiction programs and the people using them. 

These four foundational building blocks are so essential that they are the basis for defining malpractice.  To be charged with malpractice there must be a failure to meet usual and customary standards for treatment.   By exempting faith-based programs from basic foundational standards, it becomes difficult to use malpractice laws to hold faith-based programs accountable should dangerous practices cause harm.

Common sense tells us that the safety and effectiveness of addiction treatment can only be assured if: 

1. Addicts are treated in safe facilities that meet their needs in treatment

2. Addicts are involved in a programs that conforms with usual and customary treatment practices that have been proven to be effective

3. Addicts are treated by properly trained and supervised staff who have specialty knowledge of addiction treatment; and

4. There is objective external oversight to identify and correct problems before they escalate into atrocities. 

Most national addiction licensure and credentialing boards take the following position:

To assure the safety and effectiveness of addiction treatment, treatment programs need to operate under the protective umbrella of mandatory oversight that can identify and act to protect addicts from dangerous facilities and practices. 

Faith-based programs in Texas are specifically exempted from the very standards needed to assure their safety and effectiveness.

 As of February 6, 2001, Texas has granted exemptions to approximately ninety faith-based addiction programs.  The programs qualified for these exemptions by completing the following process: 

 It is important to note that Texas does not provide funding for faith-based programs.  Texas  allows faith-based programs to receive an exemption from facility, program, staff, and monitoring requirements imposed upon all other treatment programs.

Getting A Faith-based Exemption

In order to get an exemption as a Faith-Based Chemical Dependency Treatment Program , an application must be submitted that documents two things:  

1. That the organization is approved by Internal Revenue Service (IRS) as a 501-C3 not-for-profit organization; and 

2. That the primary purpose of the organization is the propagation of religious belief as evidenced by either their articles of incorporation or certification by the Texas comptroller for religious exemption.

The specific language of the application is contained in Section 464.052, Subchapter C of the Health and Safety Code (HB 2481, 75th Legislature) [http://www.tcada.state.tx.us/rules/145/figure1.html] and reads as follows:

I claim exemption to licensure as a chemical dependency treatment facility. I claim this exemption as a Faith-Based Chemical Dependency Treatment Program and I attest the statements below are true and correct:

1.         the chemical dependency treatment program is conducted by a religious organization; [A] religious organization as defined means a church, synagogue, mosque, or other religious institution … the purpose of which is the propagation of religious beliefs; and … that is exempt from federal income tax under the Internal Revenue Code (26 U.S.C.), Section 501 (a) being listed as an exempt organization under Section 501 (c) of that code (26 U.S.C. Section 501 (c)].

2.         the chemical dependency treatment program is exclusively religious, spiritual, or ecclesiastical in nature;

3.         the chemical dependency treatment program does not treat minors;

4.         upon any change affecting the exemption of this program, I will notify the Commission in writing within 10 working days; and

5.         I have read, understand, and will comply with Commission Rules pertaining to this exemption.

Do Texas Faith-based Programs Work?

Right now there is no way to tell if Texas Faith-based Chemical Dependency Programs are safe or effective.  In other words, we don't know if they work or not!  Why?  Because faith-based programs are exempted from objective oversight and systematic monitoring that allows objective evaluation.  I could not find any study documenting the outcome of Texas Faith-based Programs.  This means that recent claims that faith-based programs are safe and effective are probably no more than personal opinion based on wishful thinking rather than evidence. 

For further information on the rules governing Texas faith-based programs you can contact The Texas Commission On Alcohol And Drug Abuse (TCAADA), P.O Box 80529, Austin, Texas 78753-5233,  512/349-6600.