The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/CS/CS/SB 1180
INTRODUCER: Appropriations Committee; Appropriations Committee on Health and Human Services;
Children, Families, and Elder Affairs Committee; and Senator Harrell
SUBJECT: Substance Abuse Treatment
DATE: February 26, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Hall Tuszynski CF Fav/CS
2. Sneed McKnight AHS Fav/CS
3. Sneed Sadberry AP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/CS/SB 1180 amends the definition of certified recovery residences to distinguish
residences based on the level of care provided at the facility, to include:
Level I: homes that house individuals in recovery who are post-treatment, with a minimum
of nine months of sobriety. These homes are run by the members who reside in them.
Level II: homes that provide oversight from a house manager (typically a senior resident).
Residents are expected to follow rules outlined in a resident handbook, pay dues, and work
toward achieving milestones.
Level III: homes that offer 24-hour supervision by formally trained staff and peer-support
services for residents.
Level IV: homes that are offered, referred to, or provided to patients by licensed services
providers. The patients receive intensive outpatient and higher levels of outpatient care.
These homes are staffed 24 hours a day.
The bill prohibits any recovery residence from denying an individual access to the residence
solely on the basis the individual had been prescribed federally approved medication for the
treatment of substance use disorders.
The bill prohibits a local law, ordinance, or regulation from regulating the duration or frequency
of a resident stay and exempts certified recovery residences from any transient rental taxes.
BILL: CS/CS/CS/SB 1180 Page 2
The bill allows the Department of Children and Families (DCF) to issue one license for all
eligible service components operated by a service provider that offers a continuum of accessible
and quality substance abuse prevention, intervention, and clinical treatment services, rather than
an individual license for each service component.
The bill has no fiscal impact on state and local government revenues and expenditures.
The bill takes effect July 1, 2024.
II. Present Situation:
Substance Abuse
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including
alcohol and illicit drugs.1 According to the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5), a diagnosis of substance use disorder (SUD) is based on
evidence of impaired control, social impairment, risky use, and pharmacological criteria.2 SUD
occurs when an individual chronically uses alcohol or drugs, resulting in significant impairment,
such as health problems, disability, and failure to meet major responsibilities at work, school, or
home.3 Repeated drug use leads to changes in the brain’s structure and function that can make a
person more susceptible to developing a substance use disorder.4
Among people aged 12 or older in 2021, 61.2 million people (or 21.9 percent of the population)
used illicit drugs in the past year.5 The most commonly used illicit drug was marijuana, which
52.5 million people used.6 In the past year:7
Nearly 2 in 5 young adults aged 18 to 25 used illicit drugs;
1 in 3 young adults aged 18 to 25 used marijuana;
9.2 million people aged 12 and older misused opioids;
46.3 million people aged 12 and older (16.5 percent of the population) met the applicable
DSM-5 criteria for having a substance use disorder, including 29.5 million who were
1
The World Health Organization, Mental Health and Substance Abuse, available at https://www.afro.who.int/health-
topics/substance-abuse (last visited February 7, 2024); See also The National Institute on Drug Abuse (NIDA), The Science
of Drug Use and Addiction: The Basics, available at https://archives.nida.nih.gov/publications/media-guide/science-drug-use-
addiction-basics (last visited January 30, 2024).
2
The National Association of Addiction Treatment Providers, Substance Use Disorder, available at
https://www.naatp.org/resources/clinical/substance-use-disorder (last visited January 30, 2024).
3
The Substance Abuse and Mental Health Services Administrator (The SAMHSA), Substance Use Disorders, available at
https://www.samhsa.gov/find-help/disorders (last visited January 30, 2024).
4
Harvard Medical School, Harvard Health Publishing, Brain Plasticity in Drug Addiction: Burden and Benefit, available at
https://www.health.harvard.edu/blog/brain-plasticity-in-drug-addiction-burden-and-benefit-
2020062620479#:~:text=Experience-
dependent%20learning%2C%20including%20repeated%20drug%20use%2C%20might%20increase,drug%20use%2C%20w
here%20people%20ignore%20the%20negative%20consequences (last visited February 7, 2024).
5
U.S. Department of Health and Human Services, SAMHSA Announces National Survey on Drug Use and Health (NSDUH)
Results Detailing Mental Illness and Substance Use Levels in 2021, available at
https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-
illness-substance-use-levels-2021.html (last visited January 30, 2024).
6
Id.
7
Id.
BILL: CS/CS/CS/SB 1180 Page 3
classified as having an alcohol use disorder and 24 million who were classified as having a
drug use disorder. The percentage was highest among young adults aged 18 to 25.
Substance Abuse Treatment in Florida
In the early 1970s, the federal government enacted laws creating formula grants for states to
develop continuums of care for individuals and families affected by substance abuse.8 The laws
resulted in separate funding streams and requirements for alcoholism and drug abuse. In response
to the laws, the Florida Legislature enacted chs. 396 and 397, F.S., relating to alcohol and drug
abuse, respectively.9 Each of these laws governed different aspects of addiction, and thus, had
different rules promulgated by the state to fully implement the respective pieces of legislation.10
However, because persons with substance abuse issues often do not restrict their misuse to one
substance or another, having two separate laws dealing with the prevention and treatment of
addiction was cumbersome and did not adequately address Florida’s substance abuse problem.11
In 1993, legislation was adopted to combine chs. 396 and 397, F.S., into a single law, the Hal S.
Marchman Alcohol and Other Drug Services Act (Marchman Act).12
The Marchman Act encourages individuals to voluntarily seek services within the existing
financial and space capacities of a service provider.13 However, denial of addiction is a prevalent
symptom of SUD, creating a barrier to timely intervention and effective treatment.14 As a result,
treatment typically must stem from a third party providing the intervention needed for SUD
treatment.15
The Department of Children and Families (DCF) administers a statewide system of safety-net
services for substance abuse and mental health prevention, treatment, and recovery for children
and adults who are otherwise unable to obtain these services. Services are provided based on
state and federally-established priority populations.16 The DCF provides treatment for SUD
through a community-based provider system offering detoxification, treatment, and recovery
support for individuals affected by substance misuse, abuse, or dependence.17
8
The DCF, Baker Act and Marchman Act Project Team Report for Fiscal Year 2016-2017, p. 4-5. (on file with the Senate
Children, Families, and Elder Affairs Committee).
9
Id.
10
Id.
11
Id.
12
Chapter 93-39, s. 2, L.O.F., codified as ch. 397, F.S.
13
See ss. 397.601(1) and (2), F.S., An individual who wishes to enter treatment may apply to a service provider for voluntary
admission. Within the financial and space capabilities of the service provider, the individual must be admitted to treatment
when sufficient evidence exists that he or she is impaired by substance abuse and his or her medical and behavioral
conditions are not beyond the safe management capabilities of the service provider.
14
Darran Duchene and Patrick Lane, Fundamentals of the Marchman Act, Risk RX, Vol. 6 No. 2 (Apr. – Jun. 2006) State
University System of Florida Self-Insurance Programs, available at https://flbog.sip.ufl.edu/risk-rx-article/fundamentals-of-
the-marchman-act/ (last visited January 18, 2024)(hereinafter cited as “fundamentals of the Marchman Act”).
15
Id.
16
See ch. 394 and 397, F.S.
17
The DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/services/samh/treatment (last visited
January 18, 2024).
BILL: CS/CS/CS/SB 1180 Page 4
Detoxification Services: Detoxification services use medical and clinical procedures to assist
individuals as they withdraw from the physiological and psychological effects of substance
abuse.18
Treatment Services: Treatment services19 include a wide array of assessment, counseling,
case management, and support that are designed to help individuals who have lost their
abilities to control their substance use on their own and require formal, structured
intervention and support.20
Recovery Support: Recovery support services, including transitional housing, life skills
training, parenting skills, and peer-based individual and group counseling, are offered during
and following treatment to further assist individuals in their development of the knowledge
and skills necessary to maintain their recovery.21
Licensure of Substance Abuse Service Providers
The DCF regulates substance use disorder treatment by licensing individual treatment
components under ch. 397, F.S., and Rule 65D-30, F.A.C. Licensed service components include
a continuum of substance abuse prevention22, intervention23, and clinical treatment services.24
Clinical treatment is a professionally directed, deliberate, and planned regimen of services and
interventions that are designed to reduce or eliminate the misuse of drugs and alcohol and
promote a healthy, drug-free lifestyle.25 “Clinical treatment services” include, but are not limited
to, the following licensable service components:
Addictions receiving facility.
Day or night treatment.
Day or night treatment with community housing.
Detoxification.
Intensive inpatient treatment.
Intensive outpatient treatment.
Medication-assisted treatment for opiate addiction.
Outpatient treatment.
Residential treatment.26
18
The DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/services/samh/treatment (last visited
January 18, 2024).
19
Id. Research indicates that persons who successfully complete substance abuse treatment have better post-treatment
outcomes related to future abstinence, reduced use, less involvement in the criminal justice system, reduced involvement in
the child-protective system, employment, increased earnings, and better health.
20
Id.
21
Id.
22
Section 397.311(26)(c), F.S. “Prevention” is defined as “a process involving strategies that are aimed at the individual,
family, community, or substance and that preclude, forestall, or impede the development of substance use problems and
promote responsible lifestyles.” See also The DCF, Substance Abuse Prevention, available at
https://www.myflfamilies.com/services/samh/substance-abuse-prevention (last visited January 19, 2024).
23
Section 397.311(26)(b), F.S. “Intervention” is defined as “structured services directed toward individuals or groups at risk
of substance abuse and focused on reducing or impeding those factors associated with the onset or the early stages of
substance abuse and related problems.”
24
Section 397.311(26), F.S.
25
Section 397.311(26)(a), F.S.
26
Section 397.311(26)(a), F.S.
BILL: CS/CS/CS/SB 1180 Page 5
Recovery Residences
Recovery residences (also known as “sober homes, “sober living homes,” “Oxford Houses,” or
“Halfway Houses”) are non-medical settings designed to support recovery from substance use
disorders, providing a substance-free living environment commonly used to help individuals
transition from highly structured residential treatment programs back into their day-to-day lives
(e.g., obtaining employment and establishing more permanent residence).27 Virtually all
encourage or require attendance at 12-step mutual-help organizations like Alcoholics
Anonymous (AA) or Narcotics Anonymous (NA), but recovery homes have varying degrees of
structure and built-in programmatic elements, including:28
Length of Stay: some may have a limited or otherwise predetermined, length of stay, while
others may allow individuals to live there for as long as necessary provided they follow the
house rules.
Monitoring: some, but not all, provide monitoring to maintain substance-free, recovery-
supportive living environments and help facilitate house members’ progress by implementing
a number of rules and requirements (i.e., mutual-help organization attendance, attendance at
house meetings, curfews, restrictions on outside employment, and limits on the use of
technology). Typically as individuals successfully follow these rules over time, restrictions
become more lenient and individuals have greater latitude in their choices both in and outside
of the recovery residence.
Size: while recovery residences range in the number of individuals living there at any given
time, there are typically at least 6-8 residents of the same gender.
A recovery residence is defined as “a residential unit, the community housing component of a
licensed day or night treatment facility with community housing, or other form of group housing,
which is offered or advertised through any means, including oral, written, electronic, or printed
means, by any person or entity as a residence that provides a peer-supported, alcohol-free, and
drug-free living environment.”29
Recovery residences can be located in single-family and two-family homes, duplexes, and
apartment complexes. Most recovery residences are located in single-family homes, zoned in
residential neighborhoods.30 To live in a recovery residence, occupants may be required to pay a
monthly fee or rent, which supports the cost of maintaining the home. Generally, recovery
residences provide short-term residency, typically a minimum of at least 90 days. However, the
27
Recovery Research Institute, Recovery Residences, available at https://www.recoveryanswers.org/resource/recovery-
residences/ (last visited January 31, 2024). Substance abuse prevention is achieved through the use of ongoing strategies such
as increasing public awareness and education, community-based processes and evidence-based practices. These prevention
programs are focused primarily on youth, and, in recent years, have shifted to the local level, giving individual communities
the opportunity to identify their own unique prevention needs and develop action plans in response. This community focus
allows prevention strategies to have a greater impact on behavioral change by shifting social, cultural, and community
environments.
28
Id.
29
Section 397.311(38), F.S.
30
Hearing before the Subcommittee on the Constitution and Civil Justice of the Committee on the Judiciary, House of
Representatives, One Hundred Fifteenth Congress, Sept. 28, 2018, available at https://www.govinfo.gov/content/pkg/CHRG-
115hhrg33123/html/CHRG-115hhrg33123.htm. See also The National Council for Behavioral Health, Building Recovery:
State Policy Guide for Supporting Recovery Housing, available at https://www.thenationalcouncil.org/wp-
content/uploads/2018/05/18_Recovery-Housing-Toolkit_5.3.2018.pdf?daf=375ateTbd56 (last visited January 31, 2024).
BILL: CS/CS/CS/SB 1180 Page 6
length of time a person stays at a recovery residence varies based on the individuals’ treatment
needs.31 Because recovery residences essentially provide short-term rental or leasing of living
quarters, recovery residences may