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HomeMy WebLinkAboutAGENDApacket__02-21-23_1042_442       NOTICE OF MEETING REGULAR MEETING FOUNTAIN HILLS TOWN COUNCIL      Mayor Ginny Dickey Vice Mayor Peggy McMahon Councilmember Sharron Grzybowski Councilmember Hannah Toth Councilmember Gerry Friedel Councilmember Brenda J. Kalivianakis Councilmember Allen Skillicorn    TIME:5:30 P.M. – REGULAR MEETING WHEN:TUESDAY, FEBRUARY 21, 2023 WHERE:   FOUNTAIN HILLS COUNCIL CHAMBERS 16705 E. AVENUE OF THE FOUNTAINS, FOUNTAIN HILLS, AZ Councilmembers of the Town of Fountain Hills will attend either in person or by telephone conference call; a quorum of the Town’s various Commission, Committee or Board members may be in attendance at the Council meeting.   Notice is hereby given that pursuant to A.R.S. §1-602.A.9, subject to certain specified statutory exceptions, parents have a right to consent before the State or any of its political subdivisions make a video or audio recording of a minor child. Meetings of the Town Council are audio and/or video recorded and, as a result, proceedings in which children are present may be subject to such recording. Parents, in order to exercise their rights may either file written consent with the Town Clerk to such recording, or take personal action to ensure that their child or children are not present when a recording may be made. If a child is present at the time a recording is made, the Town will assume that the rights afforded parents pursuant to A.R.S. §1-602.A.9 have been waived.    REQUEST TO COMMENT The public is welcome to participate in Council meetings. TO SPEAK TO AN AGENDA ITEM, please complete a Request to Comment card, located in the back of the Council Chambers, and hand it to the Town Clerk prior to discussion of that item, if possible. Include the agenda item on which you wish to comment. Speakers will be allowed three contiguous minutes to address the Council. Verbal comments should be directed through the Presiding Officer and not to individual Councilmembers. TO COMMENT ON AN AGENDA ITEM IN WRITING ONLY, please complete a Request to Comment card, indicating it is a written comment, and check the box on whether you are FOR or AGAINST and agenda item, and hand it to the Town Clerk prior to discussion, if possible. TO COMMENT IN WRITING ONLINE: Please feel free to provide your comments by visiting  https://www.fountainhillsaz.gov/publiccomment and SUBMIT a Public Comment Card by 3:00 PM on the day of the meeting . These comments will be shared with the Town Council.        Town Council Regular Meeting of February 21, 2023 2     NOTICE OF OPTION TO RECESS INTO EXECUTIVE SESSION Pursuant to A.R.S. §38-431.02, notice is hereby given to the members of the Town Council, and to the general public, that at this meeting, the Town Council may vote to go into executive session, which will not be open to the public, for legal advice and discussion with the Town's attorneys for legal advice on any item listed on the following agenda, pursuant to A.R.S. §38-431.03(A)(3).        1.CALL TO ORDER AND PLEDGE OF ALLEGIANCE – Mayor Dickey     2.INVOCATION - Rabbi Mendy, Chabad of Fountain Hills     3.ROLL CALL – Mayor Dickey     4.REPORTS BY MAYOR, COUNCILMEMBERS AND TOWN MANAGER     A.RECOGNITION: Stellar Students of the Month for February     B.PROCLAMATION: March as American Red Cross Month     C.PROCLAMATION: February as Black History Month.    5.SCHEDULED PUBLIC APPEARANCES/PRESENTATIONS     A.PRESENTATION: Michael Roldan, Municipal Manager of Republic Services     B.PRESENTATION: Economic Development - Second Quarter Report     6.CALL TO THE PUBLIC Pursuant to A.R.S. §38-431.01(H), public comment is permitted (not required) on matters NOT listed on the agenda. Any such comment (i) must be within the jurisdiction of the Council, and (ii) is subject to reasonable time, place, and manner restrictions. The Council will not discuss or take legal action on matters raised during Call to the Public unless the matters are properly noticed for discussion and legal action. At the conclusion of the Call to the Public, individual councilmembers may (i) respond to criticism, (ii) ask staff to review a matter, or (iii) ask that the matter be placed on a future Council agenda.     7.CONSENT AGENDA ITEMS All items listed on the Consent Agenda are considered to be routine, noncontroversial matters and will be enacted by one motion of the Council. All motions and subsequent approvals of consent items will include all recommended staff stipulations unless otherwise stated. There will be no separate discussion of these items unless a councilmember or member of the public so requests. If a councilmember or member of the public   Town Council Regular Meeting of February 21, 2023 3   wishes to discuss an item on the Consent Agenda, he/she may request so prior to the motion to accept the Consent Agenda or with notification to the Town Manager or Mayor prior to the date of the meeting for which the item was scheduled. The items will be removed from the Consent Agenda and considered in its normal sequence on the agenda.   8.REGULAR AGENDA     A.CONSIDERATION AND POSSIBLE ACTION:  Ordinance 23-01, amending Zoning Ordinance Chapter 1, Introduction, Section 1.12, Definitions, by adding definitions related to detoxification and drug treatment facilities; amending Chapter 12, Commercial Zoning Districts, Sections 12.02, 12.05, and 12.06 to add uses for detoxification and drug treatment facilities; Section 12.03 to amend group home to community residence; and, amending Chapter 19, Town Center Commercial Zoning District, Section 19.05B to amend group home to community residence.     B.CONSIDERATION AND POSSIBLE ACTION: Termination of the proposed roundabout and Fountain Park plaza projects located at Avenue of the Fountains and Saguaro.       C.CONSIDERATION AND POSSIBLE ACTION: Adopting Resolution 2023-05 - A Resolution of the Mayor and Town Council of Fountain Hills, Maricopa County, Arizona, approving the Town of Fountain Hills, Arizona Town Council Rules of Procedure, Amended and Restated February 21, 2023. Amending the Council Rules of Procedure, Section 4.2, Agenda Preparation Article B 2.     D.CONSIDERATION AND POSSIBLE ACTION: Adoption of the Fountain Hills Environmental Plan 2022     E.CONSIDERATION AND POSSIBLE ACTION: Relating to any item included in the League of Arizona Cities and Towns' weekly Legislative Bulletin(s) or relating to any action proposed or pending before the State Legislature.     9.COUNCIL DISCUSSION/DIRECTION to the TOWN MANAGER Item(s) listed below are related only to the propriety of (i) placing such item(s) on a future agenda for action, or (ii) directing staff to conduct further research and report back to the Council.     10.ADJOURNMENT         CERTIFICATE OF POSTING OF NOTICE Town Council Regular Meeting of February 21, 2023 4   CERTIFICATE OF POSTING OF NOTICE The undersigned hereby certifies that a copy of the foregoing notice was duly posted in accordance with the statement filed by the Town Council with the Town Clerk. Dated this ______ day of ____________________, 2023. _____________________________________________  Linda G. Mendenhall, MMC, Town Clerk   The Town of Fountain Hills endeavors to make all public meetings accessible to persons with disabilities. Please call 480-816-5199 (voice) or 1-800-367-8939 (TDD) 48 hours prior to the meeting to request a reasonable accommodation to participate in the meeting or to obtain agenda information in large print format. Supporting documentation and staff reports furnished the Council with this agenda are available for review in the Clerk's Office. Town Council Regular Meeting of February 21, 2023 5   ITEM 4. B. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Reports                  Submitting Department: Administration Prepared by: Angela Padgett-Espiritu, Executive Assistant to Manager, Mayor/Council Staff Contact Information: Angela Padgett-Espiritu, Executive Assistant to Manager, Mayor/Council Request to Town Council Regular Meeting (Agenda Language):  PROCLAMATION: March as American Red Cross Month Staff Summary (Background) Mayor Dickey will be proclaiming March as American Red Cross Month.      Attachments Proclamation - March as Red Cross Month  Form Review Inbox Reviewed By Date Finance Director David Pock 02/02/2023 05:56 AM Town Attorney Aaron D. Arnson 02/02/2023 03:19 PM Town Manager Grady E. Miller 02/06/2023 04:02 PM Form Started By: Angela Padgett-Espiritu Started On: 02/01/2023 04:53 PM Final Approval Date: 02/06/2023  ITEM 4. C. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Reports                  Submitting Department: Administration Prepared by: Angela Padgett-Espiritu, Executive Assistant to Manager, Mayor/Council Staff Contact Information: Request to Town Council Regular Meeting (Agenda Language):  PROCLAMATION: February as Black History Month. Staff Summary (Background) Mayor Dickey will be proclaiming February as Black History Month. Attachments Proclamation - February as Black History Month  Form Review Inbox Reviewed By Date Finance Director David Pock 02/14/2023 03:18 PM Town Attorney Aaron D. Arnson 02/14/2023 03:37 PM Town Manager Grady E. Miller 02/15/2023 06:04 AM Form Started By: Angela Padgett-Espiritu Started On: 02/14/2023 03:13 PM Final Approval Date: 02/15/2023  ITEM 5. B. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Public Appearances/Presentations                   Submitting Department: Administration Prepared by: Amanda Jacobs, Economic Development Director Staff Contact Information: Amanda Jacobs, Economic Development Director Request to Town Council Regular Meeting (Agenda Language):  PRESENTATION: Economic Development - Second Quarter Report Staff Summary (Background) Economic Development Director Amanda Jacobs will be presenting a second quarter (October 1, 2022 - December 31, 2022) economic development update to the Town Council at its meeting on February 21, 2023.  The presentation will include updates on business attraction, business retention and expansion, marketing, advertising, tourism, strategic partnerships and grant funding.   Attachments EcDev 2nd Quarter Report  Form Review Inbox Reviewed By Date Finance Director David Pock 02/09/2023 12:29 PM Town Attorney Aaron D. Arnson 02/09/2023 02:41 PM Town Manager Grady E. Miller 02/10/2023 04:34 AM Form Started By: Amanda Jacobs Started On: 02/02/2023 03:51 PM Final Approval Date: 02/10/2023  TOWN OF FOUNTAIN HILLS WWW.FOUNTAINHILLSAZ.GOV Economic Development Second Quarter Update Presented by: Amanda Jacobs, Economic Development Director WWW.FOUNTAINHILLSAZ.GOV Business Attraction •New Openings •CBD Store P39 •Manny’s Park Place •Coming Soon •Dutch Bros. (Coming Soon) •Motor Vault (Coming Soon) •Coffee Roasters (Coming Soon) WWW.FOUNTAINHILLSAZ.GOV Business Retention and Expansion •Business Retention and Expansion Program •Downtown WWW.FOUNTAINHILLSAZ.GOV Apartment Occupancy Rate Apartment Occupancy Rate Gunsight 75% Casa Del Lago 87% Four Peaks Vista Condos 75% Havenly at Fountain Hills 90% occupied/92.5% leased Luna at Fountain Hills 94% Park Place at Fountain Hills 91% WWW.FOUNTAINHILLSAZ.GOV Vacancy Rate –Existing Buildings Category Vacancy Rate Vacancy Rate Office 13.8%47.2% Industrial 1.0%10.3% Retail 5.3%16.2% Source: CoStar Source: CoStar/Staff WWW.FOUNTAINHILLSAZ.GOV Economic Summit •Creation of Community Economic Development Strategy •Community Engagement WWW.FOUNTAINHILLSAZ.GOV AOT Prop 302 Grants •New Visitor’s Guide •Dark Sky •Live Music •Meetings/Conventions •Top 10 Things to Do •Tourism Video •Website •Blogging WWW.FOUNTAINHILLSAZ.GOV AOT VAI Grants -Marketing •Billboards •Broadcast and Digital Marketing •PBS •NPR •Experience Fountain Hills website •Itinerary Pages •Phoenix Magazine •Public Relations WWW.FOUNTAINHILLSAZ.GOV AOT VAI Grants –MarketingFountain Hills Fall Festival •Investment: $15,000 •Photography WWW.FOUNTAINHILLSAZ.GOV Partnerships •Arizona Business Advisors •Fountain Hills Chamber of Commerce •Greater Phoenix Economic Council •Salt River Pima –Maricopa Indian Community •Discover Salt River WWW.FOUNTAINHILLSAZ.GOV Tourism •Hotel Occupancy: 62% •Social Media: 25% •Experience Fountain Hills Website •20,914 unique visits (75% increase) •Top 5 Cities •Phoenix •Scottsdale •Los Angeles •Mesa •Omaha TOWN OF FOUNTAIN HILLS WWW.FOUNTAINHILLSAZ.GOV Questions? ITEM 8. A. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Regular Agenda Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Town Council Regular Meeting (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION:  Ordinance 23-01, amending Zoning Ordinance Chapter 1, Introduction, Section 1.12, Definitions, by adding definitions related to detoxification and drug treatment facilities; amending Chapter 12, Commercial Zoning Districts, Sections 12.02, 12.05, and 12.06 to add uses for detoxification and drug treatment facilities; Section 12.03 to amend group home to community residence; and, amending Chapter 19, Town Center Commercial Zoning District, Section 19.05B to amend group home to community residence. Staff Summary (Background) The Zoning Ordinance provides for a variety of different zoning districts and lists uses in different zoning districts consistent with the nature of the use and the intent of the various districts.  Chapter 12 of the Zoning Ordinance establishes the commercial zoning districts and the uses allowed in each district.  In addition to uses permitted by right in each district, the ordinance also establishes uses which can be approved through a Special Use Permit process.     Toward the end of 2020, staff received inquires regarding the possibility of establishing a detoxification facility in Fountain Hills.  Detoxification facilities are places people can go for assistance to withdraw from drugs and/or alcohol.  These facilities can range from sub-acute, outpatient facilities to more intense, inpatient facilities.  These facilities can operate in a variety of ways.  In some cases the patients are self-motivated to end their addiction and have the time and means to seek treatment. In other cases the patient may be ordered to go through treatment, starting with the detoxification, or they may not be as personally motivated to seek assistance.  Sometimes their addiction is not severe and the withdrawal process is not significant.  In other cases the addiction and resulting withdrawal process can be significant and require constant medical supervision. The Zoning Ordinance does not currently designate which district or under what conditions this type of use would be allowed.  Staff brought this issue up with the Town Council at the February 2021 annual retreat.  By not having specific regulation in the ordinance, it would be up to staff to determine which zoning district(s) would be appropriate for the use when compared to other similar uses.  The Council asked staff to explore and make a recommendation on how this use could be incorporated into the Zoning Ordinance so the Town would be able to control the placement and any additional requirements that should be included with this use. When staff followed up with a draft ordinance, the Planning and Zoning Commission was addressing the issue of hospitals and possible amendments to allow that use.  Given the public concern about detoxification facilities and possible confusion with what was being considered for hospitals, the Commission voted on April 12, 2021, against the draft ordinance and work on that issue was halted. Following the adoption of a new ordinance addressing hospitals, and with ongoing concern in Town regarding the possibility of detoxification facilities and statements from the Town Attorney that we could not prohibit the use, the Planning and Zoning Commission determined we should move ahead and consider how to address this land use.  A companion issue of group homes and sober living homes was also identified for ordinance update. Through the discussion of detox facilities and group homes, another related issue of treatment centers was identified.  Treatment centers address the early process of recovery from an addiction and provides the patient with the beginning skills to overcome their addiction.  Treatment centers may or may not assist with withdrawal (similar to a detoxification facility) and may have a residential component similar to a sober living home.  Therefore, this use can overlap the other two which creates some challenges with regulation.  The Planning and Zoning Commission determined addressing group homes was the priority issue and focused on that topic first.  Once that issue was resolved staff and the Commission resumed work on drafting an ordinance addressing detoxification facilities and drug and alcohol treatment centers. The Planning and Zoning Commission began review of possible regulations for detoxification facilities and substance abuse treatment centers at their regular meeting in March 2022.  Additional review, input, and discussion occurred at meetings in May and September.  At draft ordinance was presented for public input and Commission direction at the Commission's October meeting.  Based on the input received and the direction provided by the Commission, staff refined the draft ordinance and presented it to the Commission at a public hearing at the Commission's December meeting.  The Commission requested a few final changes to the ordinance.  At their January 2023 meeting they agreed on all final changes and voted to recommend the ordinance to the Council.  The ordinance as recommended by the P & Z Commission is attached.  To provide additional background, also attached are staff reports submitted to the Planning and Zoning Commission during their review along with a couple of other documents. Ordinance Overview The ordinance includes the following definitions; three are new and one is a modification to an existing definition:  DETOXIFICATION FACILITY, OUTPATIENT: FACILITIES PROVIDING OUTPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES WITH OR WITHOUT TRAINING, EDUCATION, OR TREATMENT SERVICES AT THE SAME LOCATION.   DETOXIFICATION FACILITY, INPATIENT: FACILITIES PROVIDING INPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES. SUBSTANCE ABUSE OR ADDICTION Treatment Center: Facilities providing lodging and meals and, primarily, treatment, training or education as a part of an alcoholism or drug addiction program WITHOUT ON-SITE DETOXIFICATION, LODGING, OR MEALS.   SUBSTANCE ABUSE OR ADDICTION TREATMENT CENTER, LODGING: FACILITIES PROVIDING TREATMENT, TRAINING, OR EDUCATION AS PART OF AN ALCOHOLISM OR DRUG ADDICTION PROGRAM. MAY INCLUDE PROVIDING DETOXIFICATION SERVICES IN CONJUNCTION WITH THE TREATMENT AND MAY INCLUDE PROVISIONS WHERE CLIENTS CAN LODGE AT THE FACILITY AND RECEIVE MEALS.    The ordinance recommendation allows substance abuse or addition treatment centers by right in the C-2 and C-3 zoning districts, but requires a minimum 2,000' separation between such uses and from a detoxification center and a transitional community residence.  There are three areas where this use could take place with current zoning designations: Town Center/Commerce Center, Saguaro Blvd, and portions of the Shea Corridor. Detoxification centers, outpatient are recommended to be allowed in the C-2 and C-3 zoning districts with approval of a Special Use Permit and a set of criteria to be met as part of the application.  Detoxification centers, inpatient and substance abuse or addiction treatment centers, lodging, are recommended to be allowed only in the C-3 zoning district with approval of a Special Use Permit and the same set of criteria as detoxification centers.  The same criteria is recommended for all three of these uses as follows:  1. PROVIDE A COPY OF LICENSE OR CERTIFICATION BY THE STATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES. 2. PROVIDE SUFFICIENT INDOOR ACTIVITY AND WAITING SPACE. 3. PROVIDE CONTACT INFORMATION AND PROCESS FOR RESOLUTION OF COMPLAINTS. 4. PROVIDE A COPY OF A CERTIFICATE OF COMMERCIAL LIABILITY INSURANCE POLICY FOR THE BUSINESS AND GIVEN LOCATION. THE POLICY SHALL BE A MINIMUM OF $2,000,000 PER OCCURRENCE AND $4,000,000 IN AGGREGATE. THE POLICY SHALL NAME THE TOWN AS AN ADDITIONAL INSURED AND INCLUDE A WAIVER OF SUBROGATION. 5. COMPLY WITH ARS 36-601.01, THE SMOKE-FREE ARIZONA ACT, AND DESIGNATE SMOKING AREA(S), INCLUDING AREAS FOR VAPING AND E-CIGARETTES, AS FAR FROM ADJACENT USES AS POSSIBLE. 6. DOCUMENT THROUGH A MARKET ANALYSIS BY A CREDENTIALED PROFESSIONAL USING THE MOST RECENT, APPLICABLE FOUNTAIN HILLS CENSUS DATA AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION DATA, THE NEED FOR THE SERVICE ON AN ONGOING BASIS FOR RESIDENTS OF FOUNTAIN HILLS. THE ANALYSIS SHALL TAKE INTO ACCOUNT ANY EXISTING SERVICES ALREADY PROVIDED IN THE TOWN. 7. A DISCHARGE POLICY THAT IS GEARED TOWARD REPATRIATING THE CLIENT BACK TO THEIR PLACE OF ORIGIN. 8. BE LOCATED AT LEAST THE FOLLOWING DISTANCES FROM THE LISTED USES, MEASURED FROM NEAREST PROPERTY LINE TO NEAREST PROPERTY LINE: A. 2,000 FEET FROM ANY OTHER DETOXIFICATION CENTER, SUBSTANCE ABUSE TREATMENT CENTER, OR TRANSITIONAL COMMUNITY RESIDENCE. B. 1,000 FEET FROM ANY CHURCH, PUBLIC LIBRARY, PARK, PRESERVE AND TRAIL, OR SCHOOL, PRE-SCHOOL, OR DAY CARE. C. 500 FEET FROM ANY RESIDENTIAL ZONING DISTRICT OR USE INCLUDING PLANNED AREA DEVELOPMENTS WITH A RESIDENTIAL PRIMARY USE. With the recommended separation requirements, the area available for any of these uses is just 5 lots which are located along Colony east of Enterprise.  Given the separation requirements between uses, only one of them could be used for one of these uses. Related Item When staff prepared the notice for consideration of the text amendment for groups home, to change to community residences and the associated requirements, making changes to the language in Chapter 12 was omitted.  When this was discovered, it was determined the changes to these designations could be included with the ordinance changes addressing detoxification facilities.  Therefore, this ordinance also include language that changes the term from group homes to community residences in both Chapter 12 and Chapter 18 of the zoning ordinance. Related Ordinance, Policy or Guiding Principle Zoning Ordinance Section 1.12. Definitions Zoning Ordinance Chapter 12, Commercial Zoning Districts Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) Staff has worked with the Planning and Zoning Commission to recommend the attached ordinance for Council approval. SUGGESTED MOTION Move to adopt Ordinance 23-01. Attachments Ordinance 23-01  March 2022 P&Z staff report  May 2022 P&Z staff report  September 2022 P&Z staff report  October 2022 P&Z staff report  December 2022 P&Z staff report  January 2023 P&Z staff report  National Institute on Drug Addiction Report  Sample Review of Area Facilities  Form Review Inbox Reviewed By Date Development Services Director (Originator)John Wesley 02/13/2023 09:15 AM Finance Director David Pock 02/13/2023 10:33 AM Town Attorney Aaron D. Arnson 02/13/2023 10:49 AM Town Manager Grady E. Miller 02/14/2023 08:21 AM Form Started By: John Wesley Started On: 02/06/2023 01:21 PM Final Approval Date: 02/14/2023  ORDINANCE NO. 23-01 AN ORDINANCE OF THE MAYOR AND COUNCIL OF THE TOWN OF FOUNTAIN HILLS, ARIZONA, AMENDING THE TOWN OF FOUNTAIN HILLS ZONING ORDINANCE, CHAPTER 1, INTRODUCTION, SECTION 1.12, DEFINITIONS, AMENDING THE DEFINITIONS OF TREATMENT CENTER; AMENDING CHAPTER 12, COMMERCIAL ZONING DISTRICTS, SECTION 12.02 SECTION 12.03 C. TO ADD SUBSTANCE AND ALCOHOL ABUSE TREATMENT CENTER; SECTION 12.03 TO UPDATE THE LANGUAGE FROM GROUP HOME TO COMMUNITY RESIDENCE; SECTION 12.05, USES SUBJECT TO SPECIAL USE PERMITS IN C-2 ZONING DISTRICTS BY ADDING NEW SECTIONS O AND P REGARDING DETOXIFICATION FACILITIES AND TREATMENT CENTERS; SECTION 12.06, USES SUBJECT TO SPECIAL USE PERMITS IN C-3 ZONING DISTRICTS ONLY BY ADDING NEW SECTIONS F, G, H, AND I REGARDING DETOXIFICATION FACILITIES AND TREATMENT CENTERS; AND, AMENDING CHAPTER 18, TOWN CENTER COMMERCIAL ZONING DISTRICT, SECTION 18.05 B. TO UPDATE THE LANGUAGE FROM GROUP HOME TO COMMUNITY RESIDENCE RECITALS: WHEREAS, the Mayor and Council of the Town of Fountain Hills (the “Town Council”) adopted Ordinance No. 93-22 on November 18, 1993, which adopted the Zoning Ordinance for the Town of Fountain Hills (the “Zoning Ordinance”); and WHEREAS, the Town Council desires to amend Chapter 1, Introduction, Section 1.12, Definitions, and Chapter 12, Commercial Zoning Districts, Sections 12.05 and 12.06 to provide for detoxification facilities and drug and alcohol treatment centers; and WHEREAS, the C-2 and C-3 zoning districts have the primary purposes of providing for the sale of commodities, provision of services, and wholesale and distribution; and WHEREAS, the Town wants to ensure uses in commercial areas are focused on businesses that provide for the sale of goods and services to the community, especially those that provide jobs and generate revenues for the Town; and WHEREAS, the uses included in this ordinance are appropriate in commercial areas but should be limited to maintain the primary purpose of these districts; and WHEREAS, in accordance with the Zoning Ordinance and pursuant to ARIZ. REV. STAT. § 9-462.04, public hearings regarding this ordinance were advertised in the November 23 and 30, 2022, and the ??? editions of the Fountain Hills Times; and WHEREAS, public hearings were held by the Fountain Hills Planning & Zoning Commission on December 12, 2022, and by the Town Council on ????, 2023. WHEREAS, in accordance with Article II, Sections 1 and 2, Constitution of Arizona, and the laws of the State of Arizona, the Town Council has considered the individual property rights and personal liberties of the residents of the Town and the probable impact of the proposed ordinance on the cost to construct housing for sale or rent before adopting this ordinance. ENACTMENTS: NOW, THEREFORE, BE IT ORDAINED BY THE MAYOR AND COUNCIL OF THE TOWN OF FOUNTAIN HILLS as follows: SECTION 1. The recitals above are hereby incorporated as if fully set forth herein. SECTION 2. The Zoning Ordinance, Chapter 1, Introduction, Section 1.12, Definitions, is hereby amended as follows: … DETOXIFICATION FACILITY, OUTPATIENT: FACILITIES PROVIDING OUTPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES WITH OR WITHOUT TRAINING, EDUCATION, OR TREATMENT SERVICES AT THE SAME LOCATION. DETOXIFICATION FACILITY, INPATIENT: FACILITIES PROVIDING INPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES. … SUBSTANCE ABUSE OR ADDICTION Treatment Center: Facilities providing lodging and meals and, primarily, treatment, training or education as a part of an alcoholism or drug addiction program WITHOUT ON-SITE DETOXIFICATION, LODGING, OR MEALS. SUBSTANCE ABUSE OR ADDICTION TREATMENT CENTER, LODGING: FACILITIES PROVIDING TREATMENT, TRAINING, OR EDUCATION AS PART OF AN ALCOHOLISM OR DRUG ADDICTION PROGRAM. MAY INCLUDE PROVIDING DETOXIFICATION SERVICES IN CONJUNCTION WITH THE TREATMENT AND MAY INCLUDE PROVISIONS WHERE CLIENTS CAN LODGE AT THE FACILITY AND RECEIVE MEALS. … SECTION 3. The Zoning Ordinance, Chapter 12, Commercial Zoning Districts, Section 12.02 C. Additional Uses Permitted in C-2 and C-3 Zoning Districts, is hereby amended as follows: 26. SUBSTANCE ABUSE OR ADDICTION TREATMENT CENTER. MUST BE LOCATED AT LEAST 2,000 FEET FROM ANY OTHER DETOXIFICATION CENTER, SUBSTANCE ABUSE OR ADDICTION TREATMENT CENTER, OR TRANSITIONAL COMMUNITY RESIDENCE. SECTION 4. The Zoning Ordinance, Chapter 12, Commercial Zoning Districts, Section 12.03, Uses Subject to Special Use Permits in C-1, C-C, C-2, and C-3 Zoning Districts, is hereby amended as follows: C. Group Homes for the Handicapped and Elderly PeopleCOMMUNITY RESIDENCES SUBJECT TO THE REQUIREMENTS IN SECTION 5.13, Nursing Home, Homes for the Aged, Convalescent Home. SECTION 5. The Zoning Ordinance, Chapter 12, Commercial Zoning Districts, Section 12.05, Uses Subject to Special Use Permits in C-2 Zoning Districts, is hereby amended as follows: … O. DETOXIFICATION CENTER, OUTPATIENT. IN ADDITION TO THE REQUIREMENTS IN SECTION 2.02 FOR CONSIDERATION OF A SPECIAL USE PERMIT, APPLICANTS SHALL: 1. PROVIDE A COPY OF LICENSE OR CERTIFICATION BY THE STATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES. 2. PROVIDE SUFFICIENT INDOOR ACTIVITY AND WAITING SPACE. 3. PROVIDE CONTACT INFORMATION AND PROCESS FOR RESOLUTION OF COMPLAINTS. 4. PROVIDE A COPY OF A CERTIFICATE OF COMMERCIAL LIABILITY INSURANCE POLICY FOR THE BUSINESS AND GIVEN LOCATION. THE POLICY SHALL BE A MINIMUM OF $2,000,000 PER OCCURANCE AND $4,000,000 IN AGGREGATE. THE POLICY SHALL NAME THE TOWN AS AN ADDITIONAL INSURED AND INCLUDE A WAIVER OF SUBROGATION. 5. COMPLY WITH ARS 36-601.01, THE SMOKE-FREE ARIZONA ACT, AND DESIGNATE SMOKING AREA(S), INCLUDING AREAS FOR VAPING AND E-CIGARETTES, AS FAR FROM ADJACENT USES AS POSSIBLE. 6. DOCUMENT THROUGH A MARKET ANALYSIS BY A CREDENTIALED PROFESSIONAL USING THE MOST RECENT, APPLICABLE FOUNTAIN HILLS CENSUS DATA AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION DATA, THE NEED FOR THE SERVICE ON AN ONGOING BASIS FOR RESIDENTS OF FOUNTAIN HILLS. THE ANALYSIS SHALL TAKE INTO ACCOUNT ANY EXISTING SERVICES ALREADY PROVIDED IN THE TOWN. 7. A DISCHARGE POLICY THAT IS GEARED TOWARD REPATRIATING THE CLIENT BACK TO THEIR PLACE OF ORIGIN. 8. BE LOCATED AT LEAST THE FOLLOWING DISTANCES FROM THE LISTED USES, MEASURED FROM NEAREST PROPERTY LINE TO NEAREST PROPERTY LINE: A. 2,000 FEET FROM ANY OTHER DETOXIFICATION CENTER, SUBSTANCE ABUSE TREATMENT CENTER, OR TRANSITIONAL COMMUNITY RESIDENCE. B. 1,000 FEET FROM ANY CHURCH, PUBLIC LIBRARY, PARK, PERSERVE AND TRAIL, OR SCHOOL, PRE-SCHOOL, OR DAY CARE. C. 500 FEET FROM ANY RESIDENTIAL ZONING DISTRICT OR USE INCLUDING PLANNED AREA DEVELOPMENTS WITH A RESIDENTIAL PRIMARY USE. SECTION 5. The Zoning Ordinance, Chapter 12, Commercial Zoning Districts, Section 12.06, Uses Subject to Special Use Permits in C-3 Zoning Districts Only, is hereby amended as follows: F. DETOXIFICATION CENTER, OUTPATIENT AND INPATIENT. IN ADDITION TO THE REQUIREMENTS IN SECTION 2.02 FOR CONSIDERATION OF A SPECIAL USE PERMIT, APPLICANTS SHALL: 1. PROVIDE A COPY OF LICENSE OR CERTIFICATION BY THE STATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES. 2. PROVIDE SUFFICIENT INDOOR ACTIVITY AND WAITING SPACE. 3. PROVIDE CONTACT INFORMATION AND PROCESS FOR RESOLUTION OF COMPLAINTS. 4. PROVIDE A COPY OF A CERTIFICATE OF COMMERCIAL LIABILITY INSURANCE POLICY FOR THE BUSINESS AND GIVEN LOCATION. THE POLICY SHALL BE A MINIMUM OF $2,000,000 PER OCCURANCE AND $4,000,000 IN AGGREGATE. THE POLICY SHALL NAME THE TOWN AS AN ADDITIONAL INSURED AND INCLUDE A WAIVER OF SUBROGATION. 5. COMPLY WITH ARS 36-601.01, THE SMOKE-FREE ARIZONA ACT, AND DESIGNATE SMOKING AREA(S), INCLUDING AREAS FOR VAPING AND E-CIGARETTES, AS FAR FROM ADJACENT USES AS POSSIBLE. 6. DOCUMENT THROUGH A MARKET ANALYSIS BY A CREDENTIALED PROFESSIONAL USING THE MOST RECENT, APPLICABLE FOUNTAIN HILLS CENSUS DATA AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION DATA, THE NEED FOR THE SERVICE ON AN ONGOING BASIS FOR RESIDENTS OF FOUNTAIN HILLS. THE ANALYSIS SHALL TAKE INTO ACCOUNT ANY EXISTING SERVICES ALREADY PROVIDED IN THE TOWN. 7. A DISCHARGE POLICY THAT IS GEARED TOWARD REPATRIATING THE CLIENT BACK TO THEIR PLACE OF ORIGIN. 8. BE LOCATED AT LEAST THE FOLLOWING DISTANCES FROM THE LISTED USES, MEASURED FROM NEAREST PROPERTY LINE TO NEAREST PROPERTY LINE: A. 2,000 FEET FROM ANY OTHER DETOXIFICATION CENTER, SUBSTANCE ABUSE TREATMENT CENTER, OR TRANSITIONAL COMMUNITY RESIDENCE. B. 1,000 FEET FROM ANY CHURCH, PUBLIC LIBRARY, PARK, PERSERVE AND TRAIL, OR SCHOOL, PRE-SCHOOL, OR DAY CARE. C. 500 FEET FROM ANY RESIDENTIAL ZONING DISTRICT OR USE INCLUDING PLANNED AREA DEVELOPMENTS WITH A RESIDENTIAL PRIMARY USE. I. SUBSTANCE ABUSE OR ADDICTION TREATMENT CENTER, LODGING. IN ADDITION TO THE REQUIREMENTS IN SECTION 2.02 FOR CONSIDERATION OF A SPECIAL USE PERMIT, APPLICANT SHALL: 1. PROVIDE A COPY OF LICENSE OR CERTIFICATION BY THE STATE OF ARIZONA DEPARTMENT OF HEALTH SERVICES. 2. PROVIDE SUFFICIENT INDOOR ACTIVITY AND WAITING SPACE. 3. PROVIDE CONTACT INFORMATION AND PROCESS FOR RESOLUTION OF COMPLAINTS. 4. PROVIDE A COPY OF A CERTIFICATE OF COMMERCIAL LIABILITY INSURANCE POLICY FOR THE BUSINESS AND GIVEN LOCATION. THE POLICY SHALL BE A MINIMUM OF $2,000,000 PER OCCURANCE AND $4,000,000 IN AGGREGATE. THE POLICY SHALL NAME THE TOWN AS AN ADDITIONAL INSURED AND INCLUDE A WAIVER OF SUBROGATION. 5. COMPLY WITH ARS 36-601.01, THE SMOKE-FREE ARIZONA ACT, AND DESIGNATE SMOKING AREA(S), INCLUDING AREAS FOR VAPING AND E-CIGARETTES, AS FAR FROM ADJACENT USES AS POSSIBLE. 6. DOCUMENT THROUGH A MARKET ANALYSIS BY A CREDENTIALED PROFESSIONAL USING THE MOST RECENT, APPLICABLE FOUNTAIN HILLS CENSUS DATA AND SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION DATA, THE NEED FOR THE SERVICE ON AN ONGOING BASIS FOR RESIDENTS OF FOUNTAIN HILLS. THE ANALYSIS SHALL TAKE INTO ACCOUNT ANY EXISTING SERVICES ALREADY PROVIDED IN THE TOWN. 7. A DISCHARGE POLICY THAT IS GEARED TOWARD REPATRIATING THE CLIENT BACK TO THEIR PLACE OF ORIGIN. 8. BE LOCATED AT LEAST THE FOLLOWING DISTANCES FROM THE LISTED USES, MEASURED FROM NEAREST PROPERTY LINE TO NEAREST PROPERTY LINE: A. 2,000 FEET FROM ANY OTHER DETOXIFICATION CENTER, SUBSTANCE ABUSE TREATMENT CENTER, OR TRANSITIONAL COMMUNITY RESIDENCE. B. 1,000 FEET FROM ANY CHURCH, PUBLIC LIBRARY, PARK, PERSERVE AND TRAIL, OR SCHOOL, PRE-SCHOOL, OR DAY CARE. C. 500 FEET FROM ANY RESIDENTIAL ZONING DISTRICT OR USE INCLUDING PLANNED AREA DEVELOPMENTS WITH A RESIDENTIAL PRIMARY USE. SECTION 6. The Zoning Ordinance, Chapter 18, Town Center Commercial Zoning Districts, Section 18.05, Uses Subject to Special Use Permits, is hereby amended as follows: B. Group Homes for the Handicapped and Elderly PeopleCOMMUNITY RESIDENCES SUBJECT TO THE REQUIREMENTS IN SECTION 5.13, Nursing Home, Homes for the Aged, Convalescent Home. SECTION 7. If any section, subsection, sentence, clause, phrase, or portion of this Ordinance is for any reason held to be unconstitutional by the decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining portions of this Ordinance. PASSED AND ADOPTED by the Mayor and Council of the Town of Fountain Hills, Arizona, this 21st day of February 2023. FOR THE TOWN OF FOUNTAIN HILLS: ATTESTED TO: Ginny Dickey, Mayor Linda Mendenhall, Town Clerk REVIEWED BY: APPROVED AS TO FORM: Grady E. Miller, Town Manager Aaron D. Arnson, Town Attorney ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 03/14/2022 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  REVIEW AND DISCUSS: possible Zoning Ordinance text amendments to address drug and alcohol treatment centers and detoxification facilities. Staff Summary (Background) The Zoning Ordinance provides for a variety of different land uses and places those uses in different zoning districts consistent with the nature of the use and the intent of the various districts.  Chapter 12 of the Zoning Ordinance establishes the commercial zoning districts and the uses allowed in each district.  In addition to uses permitted by right in each district, the ordinance also establishes uses which can be approved through a Special Use Permit process.     Toward the end of 2020, staff received inquires regarding the possibility of establishing a detoxification facility in Town.  Detoxification facilities are places people can go for assistance to withdraw from drugs and/or alcohol.  These facilities can range from sub-acute, outpatient facilities to more intense, inpatient facilities.  These facilities can operate in a variety of ways.  In some cases the patients are self-motivated to end their addiction and have the time and means to seek treatment. In other cases the patient may be ordered to go through treatment, starting with the detoxification, or they may not be as personally motivated to seek assistance.  Sometimes their addiction is not as severe and the withdrawal process is not significant.  In other cases the addiction and resulting withdrawal process can be significant and require constant medical supervision. Staff brought this issue up with the Town Council at their annual retreat in February, 2021.  The Council asked staff to explore and make a recommendation on how this use could be incorporated into the Zoning Ordinance.  When staff followed up with a draft ordinance, the Planning and Zoning Commission was addressing the issue of hospitals and possible amendments to allow that use.  Given the public concern about detoxification facilities and possible confusion with what was being considered for hospitals, the Commission voted on April 12, 2021, against the draft ordinance and work on that issue was halted. Following the adoption of a new ordinance addressing hospitals, and with ongoing concern in Town regarding the possibility of detoxification facilities and statements from the Town Attorney that we could not prohibit the use, the Planning and Zoning Commission determined we should move ahead and could not prohibit the use, the Planning and Zoning Commission determined we should move ahead and consider how to address this land use.  A companion issue of group homes and sober living homes was also identified and is being addressed. Through the discussion of detox facilities and group homes, another related issue of treatment centers was identified.  Treatment centers address the early process of recovery from an addiction and provides the patient with the beginning skills to overcome their addiction.  Treatment centers may or may not assist with withdrawal (similar to a detoxification facility) and may have a residential component similar to a sober living home.  Therefore, this use can overlap the other two which creates some challenges with regulation.  This report also covers this land use and how it might be incorporated into the zoning ordinance. In this report, staff is responding to the comments and issues raised by the Commission and public and putting forth some options for how to address these topics.  Based on the feedback received, staff will draft an ordinance for consideration at a future P&Z Commission meeting, potentially in April. When considering the placement of new uses into the zoning ordinance, it is helpful to know the intended use of each district and to review how some existing uses are placed.  Following are the descriptions for the three primary zoning districts where these uses could be considered:    C-1. Neighborhood Commercial and Professional Zoning District: The Neighborhood Commercial and Professional District is established to provide a location for modest, well-designed commercial enterprises to serve a surrounding residential neighborhood, as well as to provide for services to the community, which is not detrimental to the integrity of the surrounding residential neighborhood, and to provide for the appropriate location of professional offices throughout the community. The intent of this district is to integrate limited commercial activity and professional offices with residential land uses in a climate favorable to both. Particular attention is to be paid to the interface between commercial or professional uses and the residential uses within the same neighborhood. C-2. Intermediate Commercial Zoning District: The principal purpose of this Zoning District is to provide for the sale of commodities and the performance of services and other activities in locations for which the market area extends beyond the immediate residential neighborhoods. Principal uses permitted in this Zoning District include furniture stores, hotels, motels, restaurants, and some commercial recreation and cultural facilities such as movies and instruction in art and music. This Zoning District is designed for application at major street intersections. C-3. General Commercial Zoning District: The principal purpose of this Zoning District is to provide for commercial uses concerned with wholesale or distribution activities in locations where there is adequate access to major streets or highways. Principal uses permitted in this Zoning District include retail and wholesale commerce and commercial entertainment. Examples of existing uses allowed in commercial zoning districts include:  All Commercial Districts: Dentist, Physicians, and other medical offices Counselors Medical and clinical laboratories Pharmacies Retail, restaurant, entertainment Additional Uses allowed in C-2 and C-3: Bars Health spas and public gyms Pool halls or billiard centers Uses requiring a Special Use Permit in all Commercial Districts: Group Homes Single and multifamily dwellings Uses requiring a Special Use Permit in C-2 or C-3  Convenience stores Cabinet shops Automobile fuel dispensing Vehicle storage Construction equipment sales, rentals Temporary storage facilities Detoxification Staff was able to identify two levels of detoxification facilities.  One is sub-acute/outpatient facilities.  In these facilities, the level of addiction is low enough that the resulting process of detoxification and withdrawal does not pose significant medical issues or need constant supervision.  With these facilities the patients either live at home or in a group home and come to the facility on a regular basis for a period of time to complete the withdrawal process.  In many ways, these facilities will not be much different from other medical office facilities.  In review of these types of facilities, however, staff has found examples where the clients spend time outside the facility waiting for treatment or for a ride.  This can have a negative impact on surrounding uses and neighborhoods.  Given the purpose statements for the various zoning district found in Section 12.01, and the existing medical uses allowed in the various zoning districts, staff is suggesting this use be comparable to other uses in the C-2 and C-3 Districts.  It may be possible for the ordinance to include some basic requirements along with the allowance for the use such as requiring provision for indoor waiting, a "Good Neighbor" policy, and/or a contact person in case of complaints. The other level of detoxification facilities are termed acute/inpatient facilities.  These facilities are used by individuals with a more significant level of addiction that require medical supervision during the detoxification process.  By the nature of the facility and the service they provide, they need to be open and operate 24/7.  They may also experience emergency situations that could be disruptive to a neighborhood or other surrounding uses. This use also is different from the traditional commercial, office, and entertainment uses typically found in commercial zoning districts.  Therefore, staff is suggesting this use be allowed only through approval of a Special Use Permit in the C-2 and C-3 Zoning District. The SUP application could also require the submittal of information to address any negative impacts of the use. Treatment Centers When doing an Internet search on the government website FindTreatment.gov, one treatment facility is listed in Fountain Hills, Fountain Hills Recovery, and another 8 are listed within 10 miles, all in Scottsdale.  Attached is a document from the National Institute on Drug Abuse that provides information on drug treatment programs.  In summary, there are a lot of different types of treatment programs.  Some include a residential component where treatment and housing is at the same place.  Some treatment programs do not provide any housing option, just medication, counseling, and education at their offices.  Others have a hybrid approach that provides housing for a person going through treatment with the treatment taking place away from the home.  Some programs include using medications (e.g. buprenorphine, methadone, naltrexone) to help in the detoxification/recovery process.  Many include individual and/or group counseling and education.  The rate of "success" depends a lot on the program and the motivation of the individual.  Treatment centers can be either inpatient and outpatient.  With inpatient treatment centers the person resides at the treatment center where the treatment takes place.  Generally, they are confined to the facility with little to no outside contact during the early stages of treatment.  These treatment programs are most often 28-day programs, but can be longer.  This is considered a medical, treatment program and is not a residential land use.  While these programs can be relatively quiet and controlled, they are subject to all hours of activity.  The semi-residential nature of these treatment facilities, they are somewhat more similar with other uses that require approval of a Special Use Permit in the C-2 and C-3 zoning districts. Outpatient treatment programs usually involve clients coming to the facility on a regular basis.  Depending on the client and the program, it can be every day, all day, or it can be a few days a week for a few hours at a time.  Outpatient programs can resemble medical office land use impacts in many ways.  However, the history also shows they can be very similar to detoxification facilities where clients are left to wait for treatments or rides and can be disruptive to surrounding businesses.  Therefore, it may be appropriate to address these uses in a similar manner and allow them only in C-2 and C-3 with some development standards as listed above. Related Ordinance, Policy or Guiding Principle Zoning Ordinance Section 1.12. Definitions Zoning Ordinance Chapter 12, Commercial Zoning Districts Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) Staff is looking for direction from the P&Z Commission regarding the areas that could be modified in the zoning ordinance to address detoxification and treatment center land uses. SUGGESTED MOTION This will be a discussion item.  While staff is looking for direction, no formal motions will be made. Attachments National Institute on Drug Addiction Report  ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 05/09/2022 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  REVIEW, DISCUSS, AND PROVIDE DIRECTION ON possible Zoning Ordinance text amendments to address drug and alcohol treatment centers and detoxification facilities.  Staff Summary (Background) The Commission began study of a possible text amendment at their meeting in March. At that meeting staff presented some basic background information on these types of uses, the primary zoning districts to be considered for these uses, and some existing similar uses in town. The discussion from staff also included some possible options that could be considered to help address compatibility or impact issues, such as limiting outdoor seating, requiring a good neighbor policy, and contact information. Discussion by the Commission focused mostly on consideration of separation requirements from other uses that might be negatively impacted. Alcohol and drug abuse is an issue that affects virtually all cities and towns. A 2019 National Survey on Drug Use and Health shows that 5.3% of the U. S. population aged 12 and over suffers from Alcohol Use Disorder. If Fountain Hills follows the national trend, that means over 1,000 of our citizens struggle with this condition. Another study shows 11.7% of Americans 12 and older use illegal drugs. This translates into around 2,500 people in Fountain Hills. There has been some expression that the services provided by detoxification facilities and treatment centers are for people from outside of Fountain Hills. While it is likely that a number of people that participate in these programs are from out of the Town, particularly those who reside in a community residence while in treatment, there are local residents who need and use these services. This need is also shown in the fact there are 9 Alcoholics Anonymous groups that meet in Fountain Hills. The Town's zoning ordinance currently allows for a variety of medical services, many of which are currently provided in the community. Substance abuse treatment centers and detoxification facilities are types of medical services. To the degree they are the same as other medical uses they, should be treated in the same manner. If there are differences in land use impacts, then consideration can be given to addressing those impacts. consideration can be given to addressing those impacts. Treatment Centers The zoning ordinance defines treatment centers as: "Facilities providing lodging and meals and, primarily, treatment, training or education as a part of an alcoholism or drug addiction program." While the use is not specifically listed in any zoning district, Fountain Hills Recovery, a licensed business in Town providing these services, is located in a C-2 zoning district. That indicates that this use, when it does not contain an on-site living component, has been recognized as a use permitted in this zoning district. The primary characteristics of this land use are similar to other listed uses for this district (e.g. dentist, physicians, medical offices, counselors, etc.). Therefore, it seems appropriate to continue allowing this use, by right, in the C-2 and C-3 zoning districts. Through the discussion regarding community residences, particularly with regard to sober living homes, it was recognized there is a need to better address treatment centers that include lodging at the treatment center within our definitions and listed uses. Modifying the current definitions will provide clarity that such uses are different from a treatment center that does not provide housing and different than a transitional community residence. Because the focus in these facilities is on treatment, they do not have to be allowed in residential zoning districts. To address this, staff is considering the following changes in definitions:  SUBSTANCE ABUSE Treatment Center: Facilities providing OUTPATIENT lodging and meals and, primarily, treatment, training or education as a part of an alcoholism or drug addiction program WITHOUT ON-SITE LODGING. SUBSTANCE ABUSE TREATMENT CENTER, LODGING: FACILITIES PROVIDING TREATMENT, TRAINING, OR EDUCATION AS PART OF AN ALCOHOLISM OR DRUG ADDICTION PROGRAM WHERE CLIENTS LODGE AT THE FACILITY AND RECEIVE MEALS, TYPICALLY FOR A PERIOD OF 30 DAYS TO 90 DAYS. With this definition for a center that includes lodging, the question then becomes what are the land use characteristics and impacts that help place it in the best zoning district(s) and establish any associated development standards. In many respects this use is very similar to any other medical office, except the patients stay at the facility and the medical staff come and go. It is also in operation 24/7, although any activity at night is typically limited. Given that the person desiring to go into treatment could possibly arrive at odd times and from a variety of means and, more importantly, could choose to leave at odd hours, it is appropriate to consider some policy or procedure requirements for how the facility will manage these transitions to ensure individuals coming or going will not be left to wonder through the surrounding neighborhood. Some regulations which may go along with this use could include: providing a written procedure for how they will assist arriving and departing patients to ensure they are not left to impact the surrounding neighborhood, a separation requirement of some distance from residential developments and parks, a not allowing outdoor seating areas in front of the building and/or requiring an indoor waiting area be provided. Detoxification Facilities Detoxification facilities are not currently defined in our zoning ordinance or listed as an Detoxification facilities are not currently defined in our zoning ordinance or listed as an allowed use. The use is, however, similar to other medical uses that are allowed in the zoning ordinance. In fact, any doctor could be assisting a patient through a detoxification process at any medical office. The focus of this regulation is for those facilities with the primary focus of providing detoxification services. As with the treatments centers, there are two basic levels of detoxification facilities - outpatient and inpatient. Possible definitions for these two types of facilities are: DETOXIFICATION FACILITY, OUTPATIENT: FACILITIES PROVIDING OUTPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES WITH OR WITHOUT ASSOCIATED TRAINING, EDUCATION, OR TREATMENT SERVICES AT THE SAME LOCATION. DETOXIFICATION FACILITY, INPATIENT: FACILITIES PROVIDING INPATIENT DRUG OR ALCOHOL DETOXIFICATION SERVICES. When a person decides to stop using a drug or alcohol their body will go through withdrawal. Symptoms of withdrawal can be mild to severe and include things such as anxiety, depression, changes in blood pressure, sweating, hallucinations, and delirium tremens (a life-threatening condition). Medical staff in a detoxification facility work with the individual and tailor a detoxification program based on the individual needs. Services often include medications to help treat the symptoms. From what staff has learned some, maybe many, outpatient detoxification facilities also include treatment programs at the same location. Beginning treatment early can help give the individual the tools to continue with the detoxification and withdrawal process. In many respects the characteristics of an outpatient detoxification facility are not much different from other medical office uses. Patients will come and go as they receive services. Staff has inspected several sites in surrounding communities which provide outpatient detoxification services. Most of these facilities are located in commercial shopping and office areas along with tenants of the other buildings. In most cases there was no observed difference or impact of the detoxification facility operation; in one case there was clear evidence as clients congregated outside the facility and on a nearby street corner. The detoxification uses could also have a requirement that the facility provide a good neighbor policy, a separation requirement from specific uses, and indoor waiting areas. The zoning ordinance currently includes separation requirements for adult uses and medical marijuana facilities. Those separation requirements are summarized in the following table.  Use Separation Distance from Given Use 2000'1000'500'300' Adult Use Churches, Schools, Similar Uses None Bars, Parks Residential Medical Marijuana Schools, Child care, Similar Uses Library, Parks Churches None Staff has prepared maps that show the impact of these separation distances on existing C-2 and C-3 zoned property, they are attached. While it could be appropriate to establish some separation requirements, the effect cannot be to totally eliminate the opportunity to provide the use in the Town. It is likely that the combination of these separation requirements will be too restrictive, but they provide a place to start a discussion. At the March meeting the Commission requested a walk map showing 1/4 mile (5 minute) and 1/2 mile (10 minute) walk distances from existing commercial areas. That map is attached. Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) N/A SUGGESTED MOTION Staff will be looking for consensus direction on options for an ordinance but no motions will be made. Attachments Walk Map  Residential Separation  Bars Separation  Parks Separation  Schools Separation  MINUTES       Mr. Wesley explained that the Zoning Ordinance provides a list of permitted uses by the zoning district.  In the current ordinance, detoxification facilities are not specifically listed.  Treatment Centers are defined but not listed in the zoning districts. Uses are generally placed on the intent of zoning districts and land use characteristics and the impact of other similar uses.  He said he looked at other cities around the state and did not find those uses listed.  A few cities lump detox into medical uses.  The city of Mesa was the exception. A required permit is reviewed and approved by the city council.  He said at the March meeting a discussion took place about this topic. One of the main things the Commission focused on, in addition to what staff talked about, was the separation distances that would go along with the uses in the zoning ordinances.   These uses are commercial activities and, given the basic nature, C-2 and C-3 districts are the most appropriate for consideration of the uses.  Currently there is a treatment center in Town that is C-2 zoning district use by right. Treatment centers without lodging already exist in the C-2 zoning.   Mr. Wesley suggested that the Commission begin by reviewing the definitions and then review the criteria for placement and regulation. Mr. Wesley said that the Treatment Center definition already exists.  He suggested two definitions for substance abuse; Substance Abuse Treatment Centers that are outpatient and one that includes lodging and meals, typically for a period of 30 to 90 days. Chairman Gray asked that the Town’s definition reflects the state statute regarding treatment centers. Mr. Wesley said there are four definition categories: two types of treatment centers - with lodging and without lodging and two types of detox facilities – inpatient and outpatient. Some of the ways to regulate these facilities are to include separation requirements. Currently, the zoning ordinance includes separation requirements for Adult Use and Medical Marijuana.  Mr. Wesley provided an exhibit map that showed areas of the C-2 and C-3 zoning and the 300 feet separation requirement from residential zoning.  Also, the map displayed the separation requirements for bars (500 ft. buffer), library and parks (1,000 ft. buffer), school (2,000 ft. buffer). Chairman Gray said that he strongly disagreed with the 300’ separation requirement.  He asked Mr. Wesley how many parcels in a municipality are required  to accommodate a business.  Mr. Wesley said that there is not one, but it has to be clear they are not excluded.  Applying the separation requirements would make finding a location challenging.   Commissioner Watts said that he would like to see the requirement for the residential buffer from 300’ to 2,640’. In response to Chairman Gray, Mr. Wesley said that the outpatient treatment facility would be excluded from a buffer requirement. Mr. Wesley said that the 300’ from residential requirement may be too short, but is a good starting point.  He said some things to consider regarding detox facilities are: suggest C-2 and/or C-3 especially for acute inpatient care; patient discharge policy, contact person for issues or complaints, indoor waiting area, and a “good neighbor’ policy to address potential impacts of people loitering.  He said that outpatient treatment centers are typically daytime business hours but could extend into the evening. Clients come for medication, counseling and group meetings. It is possible that outpatient detox is part of the program. The inpatient centers are run 24 hours a day, 7 days a week. The person resides at the center while getting treatment during a 30 – 90 day process.  He suggested amendments to Section 1.12 to amend and add definitions and amend section 12.02 to allow uses in C-2 and C-3 with separation requirements, indoor waiting area, and good neighbor policy and, providing a facility contact person. In response to Chairman Gray, Mr. Wesley confirmed there is no active application with the Town regarding any drug and alcohol treatment centers and detoxification facilities.  Chairman Gray said he is asking because he would like the opportunity for public input. Commissioner Watts commented that the same concern surrounds the detox facilities as did the sober living homes. The primary affected people are the residences.  He said he did not agree with the 300’ separation buffer, it should be much more.  Businesses have the same concern.  They do not want the unintended consequences of people hanging around. He said he wants to be as aggressive as possible but still offer the ability to allow a well-managed and well-controlled facility. Commissioner Dempster suggested that the amendment include discharge details to prevent issues that may occur if someone is kicked out or doesn’t complete the program. Mr. Wesley replied that the city of Mesa asked facilities to provide a statement of leave and how that person was going to get to their destination from the treatment center. They included a requirement related to distance to make sure they were not wandering the neighborhood. Chairman Gray opened the public hearing. John Kavanagh, State Representative and a Fountain Hills resident, said that he had his staff research the restrictions on the zoning of detox centers.  He said they found out that the only type of facilities that can provide detox services are acute hospitals and behavioral health.  Inpatient facilities both fall under the statutory definition of health care institution A.R.S. 36403 in the statute that governs healthcare institutions, and it states nothing in this chapter shall prevent counties or municipalities from adopting and enforcing building and zoning regulations for health care institutions.  The Arizona Department of Health Services medical licensing would be the appropriate entity to address any zoning questions. He suggested that the Town reach out to the AZ Department of Health Services to ensure compliance with the minimum standards set by the AZ DH Rule for health care. He also questioned why the Town is even writing an ordinance to accommodate such facilities.  He said if ‘they zone it, they will come.” He said it could invite a problem that may have never come to Fountain Hills. He said that most existing detox facilities are hidden in municipalities such as an industrial area, very low profile areas. Does Fountain Hills even have an appropriate location for a facility?  He asked that the Commission allow time for the public's input and not rush through the process.   Jane Bell, Fountain Hills resident, thanked the Commission for their work on the sober living ordinance.  She said that if someone needed a detox center there was one located at the corner of Scottsdale Blvd and Shea Blvd. She suggested that a list of requirements should be mandatory for detox centers.  She said that the Commission should provide the public with an opportunity to attend information meetings and give their insight before deciding on a final ordinance. Larry Meyers, a Fountain Hills resident, said that sober facilities are in commercial areas in places like Phoenix.   They are put in areas where they cannot readily be seen, buried on purpose.  In Fountain Hills, you can't bury anything. The facility would be located near a school, near a park, near a residence or near a church.  Businesses don't want to be near them.  He said that he agrees with State Representative Kavanaugh. Lori Troller, a Fountain Hills resident, said that she agreed with everything the last few speakers stated.  She said that she googled ten facilities within nine miles of each other. They are located in Scottsdale. It would be just as easy as going over the hill to Costco as it would  to a treatment facility.  Fountain Hills doesn’t need any here. Darla Jacobs, a Fountain Hills resident, said that she has lived in Fountain Hills since 2005.  She said that “I've just seen absolutely disastrous business development efforts in this town that have given me a huge headache.”  She said she never knew much about sober living homes but now knows a lot because she got involved.  She plans to do the same for detox facilities. She agreed with everyone that had spoken before and asked Chairman Gray and Mr. Wesley to establish some safety for the residents of the sober living homes and the Fountain Hills residents. Ed Stizza, Fountain Hills resident, thanked the Commission and said it has been a very, very difficult ride over the past year dealing with the whole subject and it's caused a lot of problems. He said that it was interesting to hear an applicant tonight say they would put in writing their project would never be a detox facility.    Chairman Gray closed the public hearing.   Chairman Gray asked how staff would interpret an application today. Mr. Wesley replied that the zoning ordinance does not specifically list these uses in the code.  Discussions took place with the Town attorney and he indicated legally, the Town cannot prohibit the use.  If an application is submitted, it will be up to the Zoning Administrator to see where and how to place the use. Since this is a major concern for the Town Council, it prompted the Commission to set the rules so if and when an applicant does submit, there are as many safeguards in place as possible.  A Special Use Permit would not currently be required. It would be up to the Zoning Administrator if the application is approved. Commissioner Watts commented that he doesn’t seem to think there would be an influx of detox applicants, but he would like to see the Commission be as stringent as possible regarding the facilities. Commissioner Kovacevic expressed concern that with the current zoning ordinance, the Commission would never see an application to review. Chairman Gray said that he sides with Commissioner Kovacevic and Watts, that there needs to be constraints and would like to see public outreach as part of the process.   He said he is okay with a few more meetings in order to get that input and continue dialog. In reply to Commissioner Watts, Mr. Wesley said that if an application came in for a use not already listed, the Zoning Administrator could provide information that would allow such a facility. The Zoning Administrator looks at the proposed use compared to other similar uses in the zoning ordinance and determines which it is most similar to and where it can fit. Chairman Gray suggested a public forum take place in the fall in order to allow better attendance numbers and allow time to finalize language. Mr. Wesley agreed and said it would be best to follow up with the Commission at the August 8, 2022 Planning and Zoning Commission meeting.      ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 09/12/2022 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  REVIEW AND DISCUSS draft language for a Zoning Ordinance text amendment to provide for drug and alcohol treatment centers and detoxification facilities. Staff Summary (Background) The Commission began discussion of this text amendment at their March 2022 meeting and followed up with further discussion at their May 2022 meeting. The discussions by the Commission and citizens have provided input and direction to staff in the drafting of an ordinance for further review and discussion. One of the points of discussion at the May meeting was the impact of doing nothing. These uses are not currently specifically listed in the zoning ordinance but must be allowed if someone wanted to establish one of these uses. If a person wanted to start one of these uses, they would need to ask the Zoning Administrator to make a determination as to which zoning district the use would appropriately fall into. In making that determination, the Zoning Administrator would not be able to also put conditions or requirements on the use. By acting proactively and taking the time to specifically consider these uses and their potential impacts, the Town can place them in the appropriate zoning district(s) and also place any necessary processes and requirements on them to help ensure their compatibility. At the May meeting the Commission asked that staff go ahead and take the comments which had been received and put it into an ordinance for the Commission and citizens.  This will give everyone a starting place to consider for finalizing an ordinance to send to the Council. The thought at the May meeting was that staff would make this first draft of possible ordinance language available then the Commission would follow up with a public input session to gather further input on the draft language. After receiving that input, an amended ordinance would be prepared and a public hearing scheduled for Commission consideration. Attached is the first draft ordinance staff has prepared based on the input received thus far. The point of this agenda item is to make this draft ordinance available to the Commission and public. Beyond a basic introduction and overview of the draft ordinance, no action is anticipated at this time.  Based on the direction provided by the Commission, substantive discussion will take place following the public the direction provided by the Commission, substantive discussion will take place following the public input session. The attached draft ordinance to start public discussion includes:  Definitions for detoxification facility, outpatient; detoxification facility, inpatient; substance abuse treatment center; and, substance abuse treatment center, lodging. Lists substance abuse treatment center as a use by right in C-2 and C-3 Lists detoxification center, outpatient as a use in the C-2 district with approval of a SUP and subject to several conditions Lists detoxification center, outpatient and detoxification center, inpatient as uses in the C-3 district with approval of a SUP and subject to several conditions Lists substance abuse treatment center, lodging as a use in the C-3 district with approval of a SUP and subject to several conditions. The ordinance also makes the change in language changing group homes to community residences that was overlooked in the advertisement for the previous change.   Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) N/A SUGGESTED MOTION The purpose of this agenda item is to make the draft ordinance language available for Commission and public review and future comment. No action will be taken. Attachments Draft ordinance  500 foot boundary map  ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 10/10/2022 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  REVIEW AND DISCUSS draft language for a Zoning Ordinance text amendment to provide for drug and alcohol treatment centers and detoxification facilities. Staff Summary (Background) October Meeting Update The Commission and public received a copy of the draft ordinance at the Commission's September 2022 meeting. The next step in the process of drafting this ordinance is to receive public comment at the October Commission meeting.  The Commissioners provided some input at their last meeting.  Staff made note of those comments, but is waiting for further input and direction from the Commission based on the October meeting to make any changes. Two of the comments received at the October meeting had to do with separation distances.  The Commission wanted to see the impact of having separation requirements from schools, day cares, and parks.  Staff added churches and libraries to the list and created a map with a 1,000' separation for Commission review and comment.  These separations did not significantly alter what was already provided with the 500' separation from residential zoned areas.  The Commission also asked to have the 500' separation from residential zoning also applied to residential uses.  A map showing that impact is also attached.  This change did significantly reduce the area available for these uses at the intersection of Keith McMahan and Avenue of the Fountains. Other comments and suggestions from the Commission at the September meeting included:  Alter the wording regarding indoor vs. outdoor waiting to further limit outdoor waiting  Add the word Addiction to the title of treatment centers Consider the 30-90 use period for treatment centers with lodging Require a sign to be posted on the properties with a contact person name and phone number Obtain contact information for the property owner if different from the business owner Consider ways to address outdoor smoking impacts Following is the report outlining the draft ordinance that was provided to the Commission for their September meeting. September Report The Commission began discussion of this text amendment at their March 2022 meeting and followed up with further discussion at their May 2022 meeting. The discussions by the Commission and citizens have provided input and direction to staff in the drafting of an ordinance for further review and discussion. One of the points of discussion at the May meeting was the impact of doing nothing. These uses are not currently specifically listed in the zoning ordinance but must be allowed if someone wanted to establish one of these uses. If a person wanted to start one of these uses, they would need to ask the Zoning Administrator to make a determination as to which zoning district the use would appropriately fall into. In making that determination, the Zoning Administrator would not be able to also put conditions or requirements on the use. By acting proactively and taking the time to specifically consider these uses and their potential impacts, the Town can place them in the appropriate zoning district(s) and also place any necessary processes and requirements on them to help ensure their compatibility. At the May meeting the Commission asked that staff go ahead and take the comments which had been received and put it into an ordinance for the Commission and citizens.  This will give everyone a starting place to consider for finalizing an ordinance to send to the Council. The thought at the May meeting was that staff would make this first draft of possible ordinance language available then the Commission would follow up with a public input session to gather further input on the draft language. After receiving that input, an amended ordinance would be prepared and a public hearing scheduled for Commission consideration. Attached is the first draft ordinance staff has prepared based on the input received thus far. The point of this agenda item is to make this draft ordinance available to the Commission and public. Beyond a basic introduction and overview of the draft ordinance, no action is anticipated at this time.  Based on the direction provided by the Commission, substantive discussion will take place following the public input session. The attached draft ordinance to start public discussion includes:  Definitions for detoxification facility, outpatient; detoxification facility, inpatient; substance abuse treatment center; and, substance abuse treatment center, lodging. Lists substance abuse treatment center as a use by right in C-2 and C-3 Lists detoxification center, outpatient as a use in the C-2 district with approval of a SUP and subject to several conditions Lists detoxification center, outpatient and detoxification center, inpatient as uses in the C-3 district with approval of a SUP and subject to several conditions Lists substance abuse treatment center, lodging as a use in the C-3 district with approval of a SUP and subject to several conditions. The ordinance also makes the change in language changing group homes to community residences that was overlooked in the advertisement for the previous change.   Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) N/A SUGGESTED MOTION The purpose of this agenda item is to provide the public with the opportunity to comment on the draft ordinance. No action will be taken. Attachments Draft ordinance  500 foot boundary map  1000' Separation Map  MINUTES       John Wesley, Development Services Director, presented draft language for a Zoning Ordinance text amendment to provide for drug and alcohol treatment centers and detoxification facilities. Commissioner Kovacevic opened the public comment: the following spoke in opposition to detox centers in Fountain Hills; State Representative John Kavanagh, Liz Gildersleeve, Larry Meyers, Jane Bell, Crystal Cavanaugh, Joann Lyles, and Cyndi Starr.       John Wesley, Development Services Director, presented draft language for a Zoning Ordinance text amendment to provide for drug and alcohol treatment centers and detoxification facilities. Commissioner Kovacevic opened the public comment: the following spoke in opposition to detox centers in Fountain Hills; State Representative John Kavanagh, Liz Gildersleeve, Larry Meyers, Jane Bell, Crystal Cavanaugh, Joann Lyles, and Cyndi Starr.      ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 12/12/2022 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  HOLD A PUBLIC HEARING, CONSIDERATION, AND POSSIBLE ACTION: Ordinance 23-01, amending Chapter 1, Introduction, Section 1.12, Definitions, by adding definitions related to detoxification and drug treatment facilities; amending Chapter 12, Commercial Zoning Districts, Sections 12.02, 12.05, and 12.06 to add uses for detoxification and drug treatment facilities; Section 12.03 to amend group home to community residence; and, amending Chapter 18, Town Center Commercial Zoning District, Section 18.05 B to amend group home to community residence. Staff Summary (Background) The Commission and staff have been studying the options for adding classifications for detoxification facilities and drug and alcohol treatment facilities into the zoning ordinance for a year.  A public hearing has been scheduled for the Commission to receive input, consider, and make a recommendation to the Town Council regarding the draft ordinance for these uses. Staff presented the draft ordinance for the first time at the Commission meeting in September.  The Commission provided some comments at that time.  A follow-up meeting was held in October to receive public comment on the draft ordinance. Comments received at September meeting:  Include a1000' separation from schools, day cares, and parks.  This change was made to the draft ordinance. 1. Have the 500' separation from residential include both zoning and land use.  This change was made to the draft ordinance. 2. Adjust the wording regarding outdoor waiting to further limit the likelihood of this activity.  This change was made to the draft ordinance. 3. Add the word "addiction" to the title of the types of treatment centers.  This change was made to the draft ordinance. 4. Consider removing or amending the definition of treatment centers, lodging regarding the 30-90 day typical stay.  This has been removed in the draft ordinance. 5. Require a sign to be posted on the property with contact person name and phone number.  Staff is proposing that this be addressed on an individual basis as a requirement of the Good Neighbor 6. Statement or a condition of approval of a SUP. Obtain contact information for the property owner if different from the business owner.  This is a standard practice.  All applications have to provide the property owner name and contact information if different from the applicant. 7. Consider ways to address outdoor smoking impacts.  This change has been made to the draft ordinance. 8. Comments received at the October meeting:  Set reasonable distances from residential, consider using the same as for sober living homes.  Sober living homes are set at 1,320 feet apart.  This ordinance requires similar uses to be at least 2,000' apart.  The ordinance has established separation requirements from residential uses and zoning that significantly limit the areas available for most of the uses. 1. Follow the Paradise Valley ordinance.  Staff called and talked to the staff in Paradise Valley.  They regulate group homes/sober living homes but do not have an allowance for detoxification centers or drug and alcohol treatment centers in their ordinance.  Paradise Valley does not have any commercial zoning.  They allow some non-residential uses in their residential zoning districts through Special Use Permits.  These allowances include some medical offices.  Most drug and alcohol treatment facilities are considered medical uses.  The staff in Paradise Valley was not sure if these specific uses would be allowed or if they would need to do a text amendment to allow them if they received such an application. 2. Need to protect the customers, require insurance, providers need to be able to get them to a hospital if needed, text for fentanyl, provide adjustable beds, require reports to the state, etc.  There were several suggestions about regulations for the businesses themselves.  All of these uses are currently regulated by the State.  The types of regulations being suggested do not belong in a zoning ordinance.  If the Commission believes it is necessary to provide this level of review and control in these businesses then the Commission could recommend to the Town Council that they amend the Town's Business Regulations to add these types of provisions. 3. The facilities should demonstrate a local need.  Except for the out patient treatment only facilities (such as Fountain Hills Recovery currently operates) these uses will require approval of a Special Use Permit.  The draft ordinance has been amended to require market data showing a need by Fountain Hills residents be submitted with the application. 4. The attached version of the proposed ordinance uses black lettering with ALL CAPS BOLD letters and  strike through to show the changes from the current ordinance and ALL CAPS BOLD RED letters and  strike through to show changes from the previous draft reviewed by the Commission. As part of the staff review, we used the website www.findtreatment.gov to see what facilities are currently available in the area.  When searching a 25-mile radius for any type of treatment facility, the website showed 135 facilities.  When limiting the search to detoxification facilities, there were 37 facilities listed.  Attached to this report is a summary of a few of the detoxification facilities which were on the list. Related Ordinance, Policy or Guiding Principle Zoning Ordinance Chapters 1, 12, and 18 Zoning Ordinance Chapters 1, 12, and 18 General Plan 2020  Maintain the Commitment to "Sustain the quality of life, vitality, and distinct charm of our Town"; "Maintain the delicate balance of land uses that make the Town a desirable place to live, word, enjoy and visit"; and, "Support existing businesses and continue to attract businesses to that stimulate the Town's economy." Thriving Neighborhoods Goal 1, Policy 2. Protect existing neighborhoods from incompatible development that does into support the character of that area. Thriving Neighborhoods Goal 3, Policy 1.  Protect established single-family residential neighborhoods from the transition, intensification, and encroachment of uses that detract and/or change the character of the residential neighborhood. Public Facilities and Services Goal 7, Policy 9.  Continue to support medical facilities. Economic Development Element Goal 4, Policy 2.  Increase the Town's revenue stream by supporting commercial development and redevelopment in the Town Center, Commerce Center, Shea Corridor and Saguaro Boulevard character areas. Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) Staff recommends approval of the ordinance as presented. SUGGESTED MOTION MOVE to recommend approval of Ordinance 23-01. Attachments Draft Ordinance  Area Detox Facilities  ITEM 6. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 01/09/2023 Meeting Type: Planning and Zoning Commission Agenda Type: Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Staff Contact Information: John Wesley, Development Services Director Request to Planning and Zoning Commission (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION: Ordinance 23-01, amending Chapter 1, Introduction, Section 1.12, Definitions, by adding definitions related to detoxification and drug treatment facilities; amending Chapter 12, Commercial Zoning Districts, Sections 12.02, 12.05, and 12.06 to add uses for detoxification and drug treatment facilities; Section 12.03 to amend group home to community residence; and, amending Chapter 18, Town Center Commercial Zoning District, Section 18.05 B to amend group home to community residence. Staff Summary (Background) The Commission and staff have been studying the options for adding classifications for detoxification facilities and drug and alcohol treatment facilities into the zoning ordinance for a year.  The Commission held a public hearing at their December 2022 meeting and received input on the draft ordinance.  After discussion and consideration.  The Commission voted to continue their consideration to the January meeting to allow staff to make a few adjustments to the draft ordinance. Ordinance Revisions The Commission discussion focused three changes and a clarification to the standards proposed for Section 12.05 O, Detoxification Center, Outpatient, and 12.06 F and I, addressing Detoxification Center, Outpatient and Inpatient, and Substance Abuse or Addiction Treatment Centers, Lodging.  In each of these sections the following changes are proposed:  Add a provision requiring insurance.  The proposed wording is: Provide a copy of a certificate of commercial liability insurance policy for the business and given location.  The policy shall be a minimum of $2,000,000 per occurrence and $4,000,000 in aggregate, The policy shall name the Town as an additional insured and include a waiver of subrogation. Amend the section dealing with smoking areas to read: Comply with ARS 36-691.01, the Smoke Free Arizona Act and designate smoking area(s), including areas for vaping and e-cigarettes, as far from adjacent uses as possible. Clarify that the distance measurement is from property line to property line.  Revised wording is: Be located at least the following distances from the listed uses, measured from nearest property line to nearest property line. Revise the requirement for the market analysis to include a use of a market professional and showing local need.  The revised wording is: Document through a market analysis by a credentialed professional the need for the service on an ongoing basis for residents of Fountain Hills.  The Analysis shall take into account any existing services already provided in the Town. December Staff Report Staff presented the draft ordinance for the first time at the Commission meeting in September.  The Commission provided some comments at that time.  A follow-up meeting was held in October to receive public comment on the draft ordinance. Comments received at September meeting:  Include a1000' separation from schools, day cares, and parks.  This change was made to the draft ordinance. 1. Have the 500' separation from residential include both zoning and land use.  This change was made to the draft ordinance. 2. Adjust the wording regarding outdoor waiting to further limit the likelihood of this activity.  This change was made to the draft ordinance. 3. Add the word "addiction" to the title of the types of treatment centers.  This change was made to the draft ordinance. 4. Consider removing or amending the definition of treatment centers, lodging regarding the 30-90 day typical stay.  This has been removed in the draft ordinance. 5. Require a sign to be posted on the property with contact person name and phone number.  Staff is proposing that this be addressed on an individual basis as a requirement of the Good Neighbor Statement or a condition of approval of a SUP. 6. Obtain contact information for the property owner if different from the business owner.  This is a standard practice.  All applications have to provide the property owner name and contact information if different from the applicant. 7. Consider ways to address outdoor smoking impacts.  This change has been made to the draft ordinance. 8. Comments received at the October meeting:  Set reasonable distances from residential, consider using the same as for sober living homes.  Sober living homes are set at 1,320 feet apart.  This ordinance requires similar uses to be at least 2,000' apart.  The ordinance has established separation requirements from residential uses and zoning that significantly limit the areas available for most of the uses. 1. Follow the Paradise Valley ordinance.  Staff called and talked to the staff in Paradise Valley.  They regulate group homes/sober living homes but do not have an allowance for detoxification centers or drug and alcohol treatment centers in their ordinance.  Paradise Valley does not have any commercial zoning.  They allow some non-residential uses in their residential zoning districts through Special Use Permits.  These allowances include some medical offices.  Most drug and alcohol treatment facilities are considered medical uses.  The staff in Paradise Valley was not sure if these specific uses would be allowed or if they would need to do a text amendment to allow them if they received such an application. 2. Need to protect the customers, require insurance, providers need to be able to get them to a hospital if needed, text for fentanyl, provide adjustable beds, require reports to the state, etc.  There were several suggestions about regulations for the businesses themselves.  All of these uses are currently regulated by the State.  The types of regulations being suggested do not belong in a zoning ordinance.  If the Commission believes it is necessary to provide this level of review and 3. control in these businesses then the Commission could recommend to the Town Council that they amend the Town's Business Regulations to add these types of provisions. The facilities should demonstrate a local need.  Except for the out patient treatment only facilities (such as Fountain Hills Recovery currently operates) these uses will require approval of a Special Use Permit.  The draft ordinance has been amended to require market data showing a need by Fountain Hills residents be submitted with the application. 4. The attached version of the proposed ordinance uses black lettering with ALL CAPS BOLD letters and  strike through to show the changes from the current ordinance and ALL CAPS BOLD RED letters and  strike through to show changes from the previous draft reviewed by the Commission. As part of the staff review, we used the website www.findtreatment.gov to see what facilities are currently available in the area.  When searching a 25-mile radius for any type of treatment facility, the website showed 135 facilities.  When limiting the search to detoxification facilities, there were 37 facilities listed.  Attached to this report is a summary of a few of the detoxification facilities which were on the list. Related Ordinance, Policy or Guiding Principle Zoning Ordinance Chapters 1, 12, and 18 General Plan 2020  Maintain the Commitment to "Sustain the quality of life, vitality, and distinct charm of our Town"; "Maintain the delicate balance of land uses that make the Town a desirable place to live, word, enjoy and visit"; and, "Support existing businesses and continue to attract businesses to that stimulate the Town's economy." Thriving Neighborhoods Goal 1, Policy 2. Protect existing neighborhoods from incompatible development that does into support the character of that area. Thriving Neighborhoods Goal 3, Policy 1.  Protect established single-family residential neighborhoods from the transition, intensification, and encroachment of uses that detract and/or change the character of the residential neighborhood. Public Facilities and Services Goal 7, Policy 9.  Continue to support medical facilities. Economic Development Element Goal 4, Policy 2.  Increase the Town's revenue stream by supporting commercial development and redevelopment in the Town Center, Commerce Center, Shea Corridor and Saguaro Boulevard character areas. Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) Staff recommends approval of the ordinance as presented. SUGGESTED MOTION MOVE to recommend approval of Ordinance 23-01. Attachments Revised Draft Ordinance  Publications Revised January 2018 Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Table of Contents Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Preface Principles of Effective Treatment Frequently Asked Questions Drug Addiction Treatment in the United States Evidence-Based Approaches to Drug Addiction Treatment Acknowledgments Resources Page 1 Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies described. Preface Drug addiction is a complex illness. It is characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. This update of the National Institute on Drug Abuse’s Principles of Drug Addiction Treatment is intended to address addiction to a wide variety of drugs, including nicotine, alcohol, and illicit and prescription drugs. It is designed to serve as a resource for healthcare providers, family members, and other stakeholders trying to address the myriad problems faced by patients in need of treatment for drug abuse or addiction. Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior. That is why addiction is a brain disease. Some individuals are more vulnerable than others to becoming addicted, depending on the interplay between genetic makeup, age of exposure to drugs, and other environmental influences. While a person initially chooses to take drugs, over time the effects of prolonged exposure on brain functioning compromise that ability to choose, and seeking and consuming the drug become compulsive, often eluding a person’s self-control or willpower. But addiction is more than just compulsive drug taking—it can also produce far-reaching health and Page 2 social consequences. For example, drug abuse and addiction increase a person’s risk for a variety of other mental and physical illnesses related to a drug-abusing lifestyle or the toxic effects of the drugs themselves. Additionally, the dysfunctional behaviors that result from drug abuse can interfere with a person’s normal functioning in the family, the workplace, and the broader community. Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is a disease, most people cannot simply stop using drugs for a few days and be cured. Patients typically require long- term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives. Indeed, scientific research and clinical practice demonstrate the value of continuing care in treating addiction, with a variety of approaches having been tested and integrated in residential and community settings. As we look toward the future, we will harness new research results on the influence of genetics and environment on gene function and expression (i.e., epigenetics), which are heralding the development of personalized treatment interventions. These findings will be integrated with current evidence supporting the most effective drug abuse and addiction treatments and their implementation, which are reflected in this guide. Nora D. Volkow, M.D. Director National Institute on Drug Abuse Principles of Effective Treatment 1.Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences. Page 3 2.No single treatment is appropriate for everyone. Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. 3.Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes. 4.Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture. 5.Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment. 6.Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence. 7.Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) Page 4 can be an effective component of treatment when part of a comprehensive behavioral treatment program. 8.An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs. 9.Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co- occur, treatment should address both (or all), including the use of medications as appropriate. 10.Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement. 11.Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions. 12.Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs. 13.Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can Page 5 facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive. Frequently Asked Questions Treatment varies depending on the type of drug and the characteristics of the patient. The best programs provide a combination of therapies and other services. Why do drug-addicted persons keep using drugs? Nearly all addicted individuals believe at the outset that they can stop using drugs on their own, and most try to stop without treatment. Although some people are successful, many attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug abuse results in changes in the brain that persist long after a person stops using drugs. These drug-induced changes in brain function can have many behavioral consequences, including an inability to exert control over the impulse to use drugs despite adverse consequences—the defining characteristic of addiction. Long-term drug use results in significant changes in brain function that can persist long after the individual stops using drugs. Understanding that addiction has such a fundamental biological component may help explain the difficulty of achieving and maintaining abstinence without treatment. Psychological stress from work, family problems, psychiatric illness, pain associated with medical problems, social cues (such as Page 6 meeting individuals from one’s drug-using past), or environmental cues (such as encountering streets, objects, or even smells associated with drug abuse) can trigger intense cravings without the individual even being consciously aware of the triggering event. Any one of these factors can hinder attainment of sustained abstinence and make relapse more likely. Nevertheless, research indicates that active participation in treatment is an essential component for good outcomes and can benefit even the most severely addicted individuals. What is drug addiction treatment? Drug treatment is intended to help addicted individuals stop compulsive drug seeking and use. Treatment can occur in a variety of settings, take many different forms, and last for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring. There are a variety of evidence-based approaches to treating addiction. Drug treatment can include behavioral therapy (such as cognitive-behavioral therapy or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient’s individual needs and, often, on the types of drugs they use. Treatment medications, such as methadone, buprenorphine, and naltrexone (including a new long- acting formulation), are available for individuals addicted to opioids, while nicotine preparations (patches, gum, lozenges, and nasal spray) and the medications varenicline and bupropion are available for individuals addicted to tobacco. Disulfiram, acamprosate, and naltrexone are medications available for treating alcohol dependence,1 which commonly co-occurs with other Page 7 drug addictions, including addiction to prescription medications. Drug addiction treatment can include medications, behavioral therapies, or their combination. Treatments for prescription drug abuse tend to be similar to those for illicit drugs that affect the same brain systems. For example, buprenorphine, used to treat heroin addiction, can also be used to treat addiction to opioid pain medications. Addiction to prescription stimulants, which affect the same brain systems as illicit stimulants like cocaine, can be treated with behavioral therapies, as there are not yet medications for treating addiction to these types of drugs. Behavioral therapies can help motivate people to participate in drug treatment, offer strategies for coping with drug cravings, teach ways to avoid drugs and prevent relapse, and help individuals deal with relapse if it occurs. Behavioral therapies can also help people improve communication, relationship, and parenting skills, as well as family dynamics. Many treatment programs employ both individual and group therapies. Group therapy can provide social reinforcement and help enforce behavioral contingencies that promote abstinence and a non- drug-using lifestyle. Some of the more established behavioral treatments, such as contingency management and cognitive-behavioral therapy, are also being adapted for group settings to improve efficiency and cost-effectiveness. However, particularly in adolescents, there can also be a danger of unintended harmful (or iatrogenic) effects of group treatment—sometimes group members (especially groups of highly delinquent youth) can reinforce drug use and thereby derail the purpose of the therapy. Thus, trained counselors should be aware of and monitor for such effects. Because they work on different aspects of addiction, combinations of behavioral therapies and medications (when available) generally appear to be more effective than either approach used alone. Finally, people who are addicted to drugs often suffer from other health (e.g., depression, HIV), occupational, legal, familial, and social problems that should be addressed concurrently. The best programs provide a combination of therapies and other services to meet an individual patient’s needs. Psychoactive medications, such as antidepressants, anti-anxiety agents, mood stabilizers, and Page 8 antipsychotic medications, may be critical for treatment success when patients have co-occurring mental disorders such as depression, anxiety disorders (including post-traumatic stress disorder), bipolar disorder, or schizophrenia. In addition, most people with severe addiction abuse multiple drugs and require treatment for all substances abused. Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. Another drug, topiramate, has also shown promise in studies and is sometimes prescribed (off-label) for this purpose although it has not received FDA approval as a treatment for alcohol dependence. 1 How effective is drug addiction treatment? In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the patient’s problems, the appropriateness of treatment and related services used to address those problems, and the quality of interaction between the patient and his or her treatment providers. Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma. Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on the brain and behavior and to regain control of Page 9 their lives. The chronic nature of the disease means that relapsing to drug abuse is not only possible but also likely, with symptom recurrence rates similar to those for other well-characterized chronic medical illnesses—such as diabetes, hypertension, and asthma (see figure, "Comparison of Relapse Rates Between Drug Addiction and Other Chronic Illnesses”)—that also have both physiological and behavioral components. Unfortunately, when relapse occurs many deem treatment a failure. This is not the case: Successful treatment for addiction typically requires continual evaluation and modification as appropriate, similar to the approach taken for other chronic diseases. For example, when a patient is receiving active treatment for hypertension and symptoms decrease, treatment is deemed successful, even though symptoms may recur when treatment is discontinued. For the addicted individual, lapses to drug abuse do not indicate failure—rather, they signify that treatment needs to be reinstated or adjusted, or that alternate treatment is needed (see figure, "Why is Addiction Treatment Evaluated Differently?"). Page 10 Is drug addiction treatment worth its cost? Substance abuse costs our Nation over $600 billion annually and treatment can help reduce these costs. Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself. Treatment is also much less expensive than its alternatives, such as incarcerating addicted persons. For example, the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per patient, whereas 1 full year of imprisonment costs approximately $24,000 per person. Drug addiction treatment reduces drug use and its associated health and social costs. According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1. Major savings to the individual and to society also stem from fewer interpersonal conflicts; greater workplace productivity; and fewer drug-related accidents, including overdoses and deaths. Page 11 How long does drug addiction treatment usually last? Individuals progress through drug addiction treatment at various rates, so there is no predetermined length of treatment. However, research has shown unequivocally that good outcomes are contingent on adequate treatment length. Generally, for residential or outpatient treatment, participation for less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes. For methadone maintenance, 12 months is considered the minimum, and some opioid-addicted individuals continue to benefit from methadone maintenance for many years. Good outcomes are contingent on adequate treatment length. Treatment dropout is one of the major problems encountered by treatment programs; therefore, motivational techniques that can keep patients engaged will also improve outcomes. By viewing addiction as a chronic disease and offering continuing care and monitoring, programs can succeed, but this will often require multiple episodes of treatment and readily readmitting patients that have relapsed. What helps people stay in treatment? Because successful outcomes often depend on a person’s staying in treatment long enough to reap its full benefits, strategies for keeping people in treatment are critical. Whether a patient stays in treatment depends on factors associated with both the individual and the program. Individual factors related to engagement and retention typically include motivation to change drug-using behavior; degree of support from family and friends; and, frequently, pressure from the criminal justice system, child protection services, employers, or family. Within a treatment program, successful clinicians can establish a positive, therapeutic relationship with their patients. The clinician should ensure that a treatment plan is developed cooperatively with the person seeking treatment, that the plan is followed, and that treatment expectations are clearly understood. Medical, psychiatric, and social services Page 12 should also be available. Whether a patient stays in treatment depends on factors associated with both the individual and the program. Because some problems (such as serious medical or mental illness or criminal involvement) increase the likelihood of patients dropping out of treatment, intensive interventions may be required to retain them. After a course of intensive treatment, the provider should ensure a transition to less intensive continuing care to support and monitor individuals in their ongoing recovery. How do we get more substance-abusing people into treatment? It has been known for many years that the "treatment gap” is massive—that is, among those who need treatment for a substance use disorder, few receive it. In 2011, 21.6 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem, but only 2.3 million received treatment at a specialty substance abuse facility. Reducing this gap requires a multipronged approach. Strategies include increasing access to effective treatment, achieving insurance parity (now in its earliest phase of implementation), reducing stigma, and raising awareness among both patients and healthcare professionals of the value of addiction treatment. To assist physicians in identifying treatment need in their patients and making appropriate referrals, NIDA is encouraging widespread use of screening, brief intervention, and referral to treatment (SBIRT) tools for use in primary care settings through its NIDAMED initiative. SBIRT, which evidence shows to be effective against tobacco and alcohol use—and, increasingly, against abuse of illicit and prescription drugs—has the potential not only to catch people before serious drug problems develop, but also to identify people in need of treatment and connect them with appropriate treatment providers. Page 13 How can family and friends make a difference in the life of someone needing treatment? Family and friends can play critical roles in motivating individuals with drug problems to enter and stay in treatment. Family therapy can also be important, especially for adolescents. Involvement of a family member or significant other in an individual's treatment program can strengthen and extend treatment benefits. Where can family members go for information on treatment options? Trying to locate appropriate treatment for a loved one, especially finding a program tailored to an individual's particular needs, can be a difficult process. However, there are some resources to help with this process. For example, NIDA’s handbook Seeking Drug Abuse Treatment: Know What to Ask offers guidance in finding the right treatment program. Numerous online resources can help locate a local program or provide other information, including: The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a Web site (findtreatment.gov) that shows the location of residential, outpatient, and hospital inpatient treatment programs for drug addiction and alcoholism throughout the country. This information is also accessible by calling 1-800-662-HELP. The National Suicide Prevention Lifeline (1-800-273-TALK) offers more than just suicide prevention—it can also help with a host of issues, including drug and alcohol abuse, and can connect individuals with a nearby professional. The National Alliance on Mental Illness (www.nami.org) and Mental Health America ( www.mentalhealthamerica.net) are alliances of nonprofit, self-help support organizations for patients and families dealing with a variety of mental disorders. Both have State and local affiliates throughout the country and may be especially helpful for patients with comorbid conditions. The American Academy of Addiction Psychiatry and the American Academy of Child and Adolescent Psychiatry each have physician locator tools posted on their Web sites at aaap.org and aacap.org, respectively. Page 14 Faces & Voices of Recovery (facesandvoicesofrecovery.org), founded in 2001, is an advocacy organization for individuals in long-term recovery that strategizes on ways to reach out to the medical, public health, criminal justice, and other communities to promote and celebrate recovery from addiction to alcohol and other drugs. The Partnership at Drugfree.org (drugfree.org) is an organization that provides information and resources on teen drug use and addiction for parents, to help them prevent and intervene in their children’s drug use or find treatment for a child who needs it. They offer a toll-free helpline for parents (1-855-378-4373). The American Society of Addiction Medicine (asam.org) is a society of physicians aimed at increasing access to addiction treatment. Their Web site has a nationwide directory of addiction medicine professionals. NIDA’s National Drug Abuse Treatment Clinical Trials Network (drugabuse.gov/about- nida/organization/cctn/ctn) provides information for those interested in participating in a clinical trial testing a promising substance abuse intervention; or visit clinicaltrials.gov. NIDA’s DrugPubs Research Dissemination Center (drugpubs.drugabuse.gov) provides booklets, pamphlets, fact sheets, and other informational resources on drugs, drug abuse, and treatment. The National Institute on Alcohol Abuse and Alcoholism (niaaa.nih.gov) provides information on alcohol, alcohol use, and treatment of alcohol-related problems ( niaaa.nih.gov/search/node/treatment). How can the workplace play a role in substance abuse treatment? Many workplaces sponsor Employee Assistance Programs (EAPs) that offer short-term counseling and/or assistance in linking employees with drug or alcohol problems to local treatment resources, including peer support/recovery groups. In addition, therapeutic work environments that provide employment for drug-abusing individuals who can demonstrate abstinence have been shown not only to promote a continued drug-free lifestyle but also to improve job skills, punctuality, and other behaviors necessary for active employment throughout life. Urine testing facilities, trained personnel, and workplace monitors are needed to implement this type of treatment. Page 15 What role can the criminal justice system play in addressing drug addiction? It is estimated that about one-half of State and Federal prisoners abuse or are addicted to drugs, but relatively few receive treatment while incarcerated. Initiating drug abuse treatment in prison and continuing it upon release is vital to both individual recovery and to public health and safety. Various studies have shown that combining prison- and community-based treatment for addicted offenders reduces the risk of both recidivism to drug-related criminal behavior and relapse to drug use—which, in turn, nets huge savings in societal costs. A 2009 study in Baltimore, Maryland, for example, found that opioid-addicted prisoners who started methadone treatment (along with counseling) in prison and then continued it after release had better outcomes (reduced drug use and criminal activity) than those who only received counseling while in prison or those who only started methadone treatment after their release. Individuals who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily. The majority of offenders involved with the criminal justice system are not in prison but are under community supervision. For those with known drug problems, drug addiction treatment may be recommended or mandated as a condition of probation. Research has demonstrated that individuals who enter treatment under legal pressure have outcomes as favorable as those who enter treatment voluntarily. The criminal justice system refers drug offenders into treatment through a variety of mechanisms, such as diverting nonviolent offenders to treatment; stipulating treatment as a condition of incarceration, probation, or pretrial release; and convening specialized courts, or drug courts, that handle drug offense cases. These courts mandate and arrange for treatment as an alternative to incarceration, actively monitor progress in treatment, and arrange for other services for drug-involved offenders. The most effective models integrate criminal justice and drug treatment systems and services. Treatment and criminal justice personnel work together on treatment planning—including implementation of screening, placement, testing, monitoring, and supervision—as well as on the Page 16 systematic use of sanctions and rewards. Treatment for incarcerated drug abusers should include continuing care, monitoring, and supervision after incarceration and during parole. Methods to achieve better coordination between parole/probation officers and health providers are being studied to improve offender outcomes. (For more information, please see NIDA’s Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide [revised 2012].) What are the unique needs of women with substance use disorders? Gender-related drug abuse treatment should attend not only to biological differences but also to social and environmental factors, all of which can influence the motivations for drug use, the reasons for seeking treatment, the types of environments where treatment is obtained, the treatments that are most effective, and the consequences of not receiving treatment. Many life circumstances predominate in women as a group, which may require a specialized treatment approach. For example, research has shown that physical and sexual trauma followed by post-traumatic stress disorder (PTSD) is more common in drug-abusing women than in men seeking treatment. Other factors unique to women that can influence the treatment process include issues around how they come into treatment (as women are more likely than men to seek the assistance of a general or mental health practitioner), financial independence, and pregnancy and child care. What are the unique needs of pregnant women with substance use disorders? Using drugs, alcohol, or tobacco during pregnancy exposes not just the woman but also her developing fetus to the substance and can have potentially deleterious and even long-term effects on exposed children. Smoking during pregnancy can increase risk of stillbirth, infant mortality, sudden infant death syndrome, preterm birth, respiratory problems, slowed fetal growth, and low birth weight. Drinking during pregnancy can lead to the child developing fetal alcohol spectrum disorders, Page 17 characterized by low birth weight and enduring cognitive and behavioral problems. Prenatal use of some drugs, including opioids, may cause a withdrawal syndrome in newborns called neonatal abstinence syndrome (NAS). Babies with NAS are at greater risk of seizures, respiratory problems, feeding difficulties, low birth weight, and even death. Research has established the value of evidence-based treatments for pregnant women (and their babies), including medications. For example, although no medications have been FDA-approved to treat opioid dependence in pregnant women, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental outcomes associated with untreated heroin abuse. However, newborns exposed to methadone during pregnancy still require treatment for withdrawal symptoms. Recently, another medication option for opioid dependence, buprenorphine, has been shown to produce fewer NAS symptoms in babies than methadone, resulting in shorter infant hospital stays. In general, it is important to closely monitor women who are trying to quit drug use during pregnancy and to provide treatment as needed. What are the unique needs of adolescents with substance use disorders? Adolescent drug abusers have unique needs stemming from their immature neurocognitive and psychosocial stage of development. Research has demonstrated that the brain undergoes a prolonged process of development and refinement from birth through early adulthood. Over the course of this developmental period, a young person’s actions go from being more impulsive to being more reasoned and reflective. In fact, the brain areas most closely associated with aspects of behavior such as decision-making, judgment, planning, and self-control undergo a period of rapid development during adolescence and young adulthood. Adolescent drug abuse is also often associated with other co-occurring mental health problems. These include attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct problems, as well as depressive and anxiety disorders. Adolescents are also especially sensitive to social cues, with peer groups and families being highly Page 18 influential during this time. Therefore, treatments that facilitate positive parental involvement, integrate other systems in which the adolescent participates (such as school and athletics), and recognize the importance of prosocial peer relationships are among the most effective. Access to comprehensive assessment, treatment, case management, and family-support services that are developmentally, culturally, and gender-appropriate is also integral when addressing adolescent addiction. Medications for substance abuse among adolescents may in certain cases be helpful. Currently, the only addiction medications approved by FDA for people under 18 are over-the-counter transdermal nicotine skin patches, chewing gum, and lozenges (physician advice should be sought first). Buprenorphine, a medication for treating opioid addiction that must be prescribed by specially trained physicians, has not been approved for adolescents, but recent research suggests it could be effective for those as young as 16. Studies are under way to determine the safety and efficacy of this and other medications for opioid-, nicotine-, and alcohol-dependent adolescents and for adolescents with co- occurring disorders. Are there specific drug addiction treatments for older adults? With the aging of the baby boomer generation, the composition of the general population is changing dramatically with respect to the number of older adults. Such a change, coupled with a greater history of lifetime drug use (than previous older generations), different cultural norms and general attitudes about drug use, and increases in the availability of psychotherapeutic medications, is already leading to greater drug use by older adults and may increase substance use problems in this population. While substance abuse in older adults often goes unrecognized and therefore untreated, research indicates that currently available addiction treatment programs can be as effective for them as for younger adults. Can a person become addicted to medications prescribed by a doctor? Yes. People who abuse prescription drugs—that is, taking them in a manner or a dose other than prescribed, or taking medications prescribed for another person—risk addiction and other serious Page 19 health consequences. Such drugs include opioid pain relievers, stimulants used to treat ADHD, and benzodiazepines to treat anxiety or sleep disorders. Indeed, in 2010, an estimated 2.4 million people 12 or older met criteria for abuse of or dependence on prescription drugs, the second most common illicit drug use after marijuana. To minimize these risks, a physician (or other prescribing health provider) should screen patients for prior or current substance abuse problems and assess their family history of substance abuse or addiction before prescribing a psychoactive medication and monitor patients who are prescribed such drugs. Physicians also need to educate patients about the potential risks so that they will follow their physician’s instructions faithfully, safeguard their medications, and dispose of them appropriately. Is there a difference between physical dependence and addiction? Yes. Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction. How do other mental disorders coexisting with drug addiction affect drug addiction treatment? Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs—i.e., tobacco and alcohol. For these individuals, one Page 20 condition becomes more difficult to treat successfully as an additional condition is intertwined. Thus, people entering treatment either for a substance use disorder or for another mental disorder should be assessed for the co-occurrence of the other condition. Research indicates that treating both (or multiple) illnesses simultaneously in an integrated fashion is generally the best treatment approach for these patients. Is the use of medications like methadone and buprenorphine simply replacing one addiction with another? No. Buprenorphine and methadone are prescribed or administered under monitored, controlled conditions and are safe and effective for treating opioid addiction when used as directed. They are administered orally or sublingually (i.e., under the tongue) in specified doses, and their effects differ from those of heroin and other abused opioids. Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate "rush," or brief period of intense euphoria, that wears off quickly and ends in a "crash." The individual then experiences an intense craving to use the drug again to stop the crash and reinstate the euphoria. The cycle of euphoria, crash, and craving—sometimes repeated several times a day—is a hallmark of addiction and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain. As used in maintenance treatment, methadone and buprenorphine are not heroin/opioid substitutes. In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain. As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids. If an individual treated with these medications tries to take an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Patients undergoing maintenance treatment do not Page 21 experience the physiological or behavioral abnormalities from rapid fluctuations in drug levels associated with heroin use. Maintenance treatments save lives—they help to stabilize individuals, allowing treatment of their medical, psychological, and other problems so they can contribute effectively as members of families and of society. Where do 12-step or self-help programs fit into drug addiction treatment? Self-help groups can complement and extend the effects of professional treatment. The most prominent self-help groups are those affiliated with Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine Anonymous (CA), all of which are based on the 12-step model. Most drug addiction treatment programs encourage patients to participate in self-help group therapy during and after formal treatment. These groups can be particularly helpful during recovery, offering an added layer of community-level social support to help people achieve and maintain abstinence and other healthy lifestyle behaviors over the course of a lifetime. Can exercise play a role in the treatment process? Yes. Exercise is increasingly becoming a component of many treatment programs and has proven effective, when combined with cognitive-behavioral therapy, at helping people quit smoking. Exercise may exert beneficial effects by addressing psychosocial and physiological needs that nicotine replacement alone does not, by reducing negative feelings and stress, and by helping prevent weight gain following cessation. Research to determine if and how exercise programs can play a similar role in the treatment of other forms of drug abuse is under way. Page 22 How does drug addiction treatment help reduce the spread of HIV/AIDS, Hepatitis C (HCV), and other infectious diseases? Drug-abusing individuals, including injecting and non-injecting drug users, are at increased risk of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and other infectious diseases. These diseases are transmitted by sharing contaminated drug injection equipment and by engaging in risky sexual behavior sometimes associated with drug use. Effective drug abuse treatment is HIV/HCV prevention because it reduces activities that can spread disease, such as sharing injection equipment and engaging in unprotected sexual activity. Counseling that targets a range of HIV/HCV risk behaviors provides an added level of disease prevention. Drug abuse treatment is HIV and HCV prevention. Injection drug users who do not enter treatment are up to six times more likely to become infected with HIV than those who enter and remain in treatment. Participation in treatment also presents opportunities for HIV screening and referral to early HIV treatment. In fact, recent research from NIDA’s National Drug Abuse Treatment Clinical Trials Network showed that providing rapid onsite HIV testing in substance abuse treatment facilities increased patients’ likelihood of being tested and of receiving their test results. HIV counseling and testing are key aspects of superior drug abuse treatment programs and should be offered to all individuals entering treatment. Greater availability of inexpensive and unobtrusive rapid HIV tests should increase access to these important aspects of HIV prevention and treatment. Drug Addiction Treatment in the United States Page 23 Treatment for drug abuse and addiction is delivered in many different settings, using a variety of behavioral and pharmacological approaches. Drug addiction is a complex disorder that can involve virtually every aspect of an individual's functioning—in the family, at work and school, and in the community. Because of addiction's complexity and pervasive consequences, drug addiction treatment typically must involve many components. Some of those components focus directly on the individual's drug use; others, like employment training, focus on restoring the addicted individual to productive membership in the family and society (See diagram "Components of Comprehensive Drug Abuse Treatment"), enabling him or her to experience the rewards associated with abstinence. Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. In the United States, more than 14,500 specialized drug treatment facilities provide counseling, behavioral therapy, medication, case management, and other types of services to persons with substance use disorders. Along with specialized drug treatment facilities, drug abuse and addiction are treated in physicians' offices and mental health clinics by a variety of providers, including counselors, physicians, psychiatrists, psychologists, nurses, and social workers. Treatment is delivered in outpatient, inpatient, and residential settings. Although specific treatment approaches often are associated with particular treatment settings, a variety of therapeutic interventions or services can be included in any given setting. Because drug abuse and addiction are major public health problems, a large portion of drug treatment is funded by local, State, and Federal governments. Private and employer-subsidized health plans also may provide coverage for treatment of addiction and its medical consequences. Unfortunately, managed care has resulted in shorter average stays, while a historical lack of or insufficient coverage for substance abuse treatment has curtailed the number of operational programs. The recent passage of parity for insurance coverage of mental health and substance abuse problems will hopefully improve this state of affairs. Health Care Reform (i.e., the Patient Protection and Affordable Care Act of 2010, "ACA") also stands to increase the demand for drug abuse treatment services and presents an opportunity to study how innovations in service delivery, organization, and financing can improve Page 24 access to and use of them. Types of Treatment Programs Research studies on addiction treatment typically have classified programs into several general types or modalities. Treatment approaches and individual programs continue to evolve and diversify, and many programs today do not fit neatly into traditional drug adiction treatment classifications. Most, however, start with detoxification and medically managed withdrawal, often considered the first stage of treatment. Detoxification, the process by which the body clears itself of drugs, is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. As stated previously, detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification should thus be followed by a formal assessment and referral to drug addiction treatment. Because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician in an inpatient or outpatient setting; therefore, it is referred to as "medically managed withdrawal.” Medications are available to assist in the withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives. Further Reading: Kleber, H.D. Outpatient detoxification from opiates. Primary Psychiatry 1:42-52, 1996. Long-Term Residential Treatment Long-term residential treatment provides care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months. TCs focus on the "resocialization" of the individual and use the program’s entire community—including other residents, staff, and the social context—as active Page 25 components of treatment. Addiction is viewed in the context of an individual’s social and psychological deficits, and treatment focuses on developing personal accountability and responsibility as well as socially productive lives. Treatment is highly structured and can be confrontational at times, with activities designed to help residents examine damaging beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious and constructive ways to interact with others. Many TCs offer comprehensive services, which can include employment training and other support services, onsite. Research shows that TCs can be modified to treat individuals with special needs, including adolescents, women, homeless individuals, people with severe mental disorders, and individuals in the criminal justice system (see "Treating Criminal Justice-Involved Drug Abusers and Addicted Individuals"). Further Reading: Lewis, B.F.; McCusker, J.; Hindin, R.; Frost, R.; and Garfield, F. Four residential drug treatment programs: Project IMPACT. In: J.A. Inciardi, F.M. Tims, and B.W. Fletcher (eds.), Innovative Approaches in the Treatment of Drug Abuse, Westport, CT: Greenwood Press, pp. 45-60, 1993. Sacks, S.; Banks, S.; McKendrick, K.; and Sacks, J.Y. Modified therapeutic community for co- occurring disorders: A summary of four studies. Journal of Substance Abuse Treatment 34(1):112- 122, 2008. Sacks, S.; Sacks, J.; DeLeon, G.; Bernhardt, A.; and Staines, G. Modified therapeutic community for mentally ill chemical "abusers": Background; influences; program description; preliminary findings. Substance Use and Misuse 32(9):1217-1259, 1997. Stevens, S.J., and Glider, P.J. Therapeutic communities: Substance abuse treatment for women. In: F.M. Tims, G. DeLeon, and N. Jainchill (eds.), Therapeutic Community: Advances in Research and Application, National Institute on Drug Abuse Research Monograph 144, NIH Pub. No. 94-3633, U.S. Government Printing Office, pp. 162-180, 1994. Sullivan, C.J.; McKendrick, K.; Sacks, S.; and Banks, S.M. Modified therapeutic community for offenders with MICA disorders: Substance use outcomes. American Journal of Drug and Alcohol Abuse 33(6):823-832, 2007. Page 26 Short-Term Residential Treatment Short-term residential programs provide intensive but relatively brief treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat other types of substance use disorders. The original residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as AA. Following stays in residential treatment programs, it is important for individuals to remain engaged in outpatient treatment programs and/or aftercare programs. These programs help to reduce the risk of relapse once a patient leaves the residential setting. Further Reading: Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):291-298, 1998. Miller, M.M. Traditional approaches to the treatment of addiction. In: A.W. Graham and T.K. Schultz (eds.), Principles of Addiction Medicine (2nd ed.). Washington, D.C.: American Society of Addiction Medicine, 1998. Outpatient Treatment Programs Outpatient treatment varies in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs or extensive social supports. It should be noted, however, that low-intensity programs may offer little more than drug education. Other outpatient models, such as intensive day treatment, can be comparable to residential programs in services and effectiveness, depending on the individual patient’s characteristics and needs. In many outpatient programs, group counseling can be a major component. Some outpatient programs are also designed to treat patients with medical or other mental health problems in addition to their drug disorders. Further Reading: Page 27 Hubbard, R.L.; Craddock, S.G.; Flynn, P.M.; Anderson, J.; and Etheridge, R.M. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):291-298, 1998. Institute of Medicine. Treating Drug Problems. Washington, D.C.: National Academy Press, 1990. McLellan, A.T.; Grisson, G.; Durell, J.; Alterman, A.I.; Brill, P.; and O'Brien, C.P. Substance abuse treatment in the private setting: Are some programs more effective than others? Journal of Substance Abuse Treatment 10:243-254, 1993. Simpson, D.D., and Brown, B.S. Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors 11(4):294-307, 1998. Individualized Drug Counseling Individualized drug counseling not only focuses on reducing or stopping illicit drug or alcohol use; it also addresses related areas of impaired functioning—such as employment status, illegal activity, and family/social relations—as well as the content and structure of the patient’s recovery program. Through its emphasis on short-term behavioral goals, individualized counseling helps the patient develop coping strategies and tools to abstain from drug use and maintain abstinence. The addiction counselor encourages 12-step participation (at least one or two times per week) and makes referrals for needed supplemental medical, psychiatric, employment, and other services. Group Counseling Many therapeutic settings use group therapy to capitalize on the social reinforcement offered by peer discussion and to help promote drug-free lifestyles. Research has shown that when group therapy either is offered in conjunction with individualized drug counseling or is formatted to reflect the principles of cognitive-behavioral therapy or contingency management, positive outcomes are achieved. Currently, researchers are testing conditions in which group therapy can be standardized and made more community-friendly. Page 28 Treating Criminal Justice-Involved Drug Abusers and Addicted Individuals Often, drug abusers come into contact with the criminal justice system earlier than other health or social systems, presenting opportunities for intervention and treatment prior to, during, after, or in lieu of incarceration. Research has shown that combining criminal justice sanctions with drug treatment can be effective in decreasing drug abuse and related crime. Individuals under legal coercion tend to stay in treatment longer and do as well as or better than those not under legal pressure. Studies show that for incarcerated individuals with drug problems, starting drug abuse treatment in prison and continuing the same treatment upon release—in other words, a seamless continuum of services—results in better outcomes: less drug use and less criminal behavior. More information on how the criminal justice system can address the problem of drug addiction can be found in Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide (National Institute on Drug Abuse, revised 2012). Treating Criminal Justice-Involved Drug Abusers and Addicted Individuals Often, drug abusers come into contact with the criminal justice system earlier than other health or social systems, presenting opportunities for intervention and treatment prior to, during, after, or in lieu of incarceration. Research has shown that combining criminal justice sanctions with drug treatment can be effective in decreasing drug abuse and related crime. Individuals under legal coercion tend to stay in treatment longer and do as well as or better than those not under legal pressure. Studies show that for incarcerated individuals with drug problems, starting drug abuse treatment in prison and continuing the same treatment upon release—in other words, a seamless continuum of services—results in better outcomes: less drug use and less criminal behavior. More information on how the criminal justice system can address the problem of drug addiction can be found in Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide (National Institute on Drug Abuse, revised 2012). Page 29 Evidence-Based Approaches to Drug Addiction Treatment Each approach to drug treatment is designed to address certain aspects of drug addiction and its consequences for the individual, family, and society. This section presents examples of treatment approaches and components that have an evidence base supporting their use. Each approach is designed to address certain aspects of drug addiction and its consequences for the individual, family, and society. Some of the approaches are intended to supplement or enhance existing treatment programs, and others are fairly comprehensive in and of themselves. The following section is broken down into Pharmacotherapies, Behavioral Therapies, and Behavioral Therapies Primarily for Adolescents. They are further subdivided according to particular substance use disorders. This list is not exhaustive, and new treatments are continually under development. Pharmacotherapies Opioid Addiction Methadone Methadone is a long-acting synthetic opioid agonist medication that can prevent withdrawal symptoms and reduce craving in opioid-addicted individuals. It can also block the effects of illicit opioids. It has a long history of use in treatment of opioid dependence in adults and is taken orally. Methadone maintenance treatment is available in all but three States through specially licensed opioid treatment programs or methadone maintenance programs. Combined with behavioral treatment: Research has shown that methadone maintenance is more Page 30 effective when it includes individual and/or group counseling, with even better outcomes when patients are provided with, or referred to, other needed medical/psychiatric, psychological, and social services (e.g., employment or family services). Further Reading: Dole, V.P.; Nyswander, M.; and Kreek, M.J. Narcotic blockade. Archives of Internal Medicine 118:304–309, 1966. McLellan, A.T.; Arndt, I.O.; Metzger, D.; Woody, G.E.; and O’Brien, C.P. The effects of psychosocial services in substance abuse treatment. The Journal of the American Medical Association 269(15):1953–1959, 1993. The Rockerfeller University. The first pharmacological treatment for narcotic addiction: Methadone maintenance. The Rockefeller University Hospital Centennial, 2010. Available at centennial.rucares.org/index.php?page=Methadone_Maintenance. Woody, G.E.; Luborsky, L.; McClellan, A.T.; O’Brien, C.P.; Beck, A.T.; Blaine, J.; Herman, I.; and Hole, A. Psychotherapy for opiate addicts: Does it help? Archives of General Psychiatry 40:639–645, 1983. Buprenorphine Buprenorphine is a synthetic opioid medication that acts as a partial agonist at opioid receptors—it does not produce the euphoria and sedation caused by heroin or other opioids but is able to reduce or eliminate withdrawal symptoms associated with opioid dependence and carries a low risk of overdose. Buprenorphine is currently available in two formulations that are taken sublingually: (1) a pure form of the drug and (2) a more commonly prescribed formulation called Suboxone, which combines buprenorphine with the drug naloxone, an antagonist (or blocker) at opioid receptors. Naloxone has no effect when Suboxone is taken as prescribed, but if an addicted individual attempts to inject Suboxone, the naloxone will produce severe withdrawal symptoms. Thus, this formulation lessens the likelihood that the drug will be abused or diverted to others. Page 31 Buprenorphine treatment for detoxification and/or maintenance can be provided in office-based settings by qualified physicians who have received a waiver from the Drug Enforcement Administration (DEA), allowing them to prescribe it. The availability of office-based treatment for opioid addiction is a cost-effective approach that increases the reach of treatment and the options available to patients. Buprenorphine is also available as in an implant and injection. The U.S. Food and Drug Administration (FDA) approved a 6-month subdermal buprenorphine implant in May 2016 and a once-monthly buprenorphine injection in November 2017. Further Reading: Fiellin, D.A.; Pantalon, M.V.; Chawarski, M.C.; Moore, B.A.; Sullivan, L.E.; O’Connor, P.G.; and Schottenfeld, R.S. Counseling plus buprenorphine/naloxone maintenance therapy for opioid dependence. The New England Journal of Medicine 355(4):365–374, 2006. Fudala P.J.; Bridge, T.P.; Herbert, S.; Williford, W.O.; Chiang, C.N.; Jones, K.; Collins, J.; Raisch, D.; Casadonte, P.; Goldsmith, R.J.; Ling, W.; Malkerneker, U.; McNicholas, L.; Renner, J.; Stine, S.; and Tusel, D. for the Buprenorphine/Naloxone Collaborative Study Group. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. The New England Journal of Medicine 349(10):949–958, 2003. Kosten, T.R.; and Fiellin, D.A. U.S. National Buprenorphine Implementation Program: Buprenorphine for office-based practice. Consensus conference overview. The American Journal on Addictions 13(Suppl. 1):S1–S7, 2004. McCance-Katz, E.F. Office-based buprenorphine treatment for opioid-dependent patients. Harvard Review of Psychiatry 12(6):321–338, 2004. Treatment, not Substitution Because methadone and buprenorphine are themselves opioids, some people view these Page 32 treatments for opioid dependence as just substitutions of one addictive drug for another (see Question 19). But taking these medications as prescribed allows patients to hold jobs, avoid street crime and violence, and reduce their exposure to HIV by stopping or decreasing injection drug use and drug-related high-risk sexual behavior. Patients stabilized on these medications can also engage more readily in counseling and other behavioral interventions essential to recovery. Naltrexone Naltrexone is a synthetic opioid antagonist—it blocks opioids from binding to their receptors and thereby prevents their euphoric and other effects. It has been used for many years to reverse opioid overdose and is also approved for treating opioid addiction. The theory behind this treatment is that the repeated absence of the desired effects and the perceived futility of abusing opioids will gradually diminish craving and addiction. Naltrexone itself has no subjective effects following detoxification (that is, a person does not perceive any particular drug effect), it has no potential for abuse, and it is not addictive. Naltrexone as a treatment for opioid addiction is usually prescribed in outpatient medical settings, although the treatment should begin after medical detoxification in a residential setting in order to prevent withdrawal symptoms. Naltrexone must be taken orally—either daily or three times a week—but noncompliance with treatment is a common problem. Many experienced clinicians have found naltrexone best suited for highly motivated, recently detoxified patients who desire total abstinence because of external circumstances—for instance, professionals or parolees. Recently, a long-acting injectable version of naltrexone, called Vivitrol, was approved to treat opioid addiction. Because it only needs to be delivered once a month, this version of the drug can facilitate compliance and offers an alternative for those who do not wish to be placed on agonist/partial agonist medications. Further Reading: Cornish, J.W.; Metzger, D.; Woody, G.E.; Wilson, D.; McClellan, A.T.; and Vandergrift, B. Naltrexone Page 33 pharmacotherapy for opioid dependent federal probationers. Journal of Substance Abuse Treatment 14(6):529–534, 1997. Gastfriend, D.R. Intramuscular extended-release naltrexone: current evidence. Annals of the New York Academy of Sciences 1216:144–166, 2011. Krupitsky, E.; Illerperuma, A.; Gastfriend, D.R.; and Silverman, B.L. Efficacy and safety of extended- release injectable naltrexone (XR-NTX) for the treatment of opioid dependence. Paper presented at the 2010 annual meeting of the American Psychiatric Association, New Orleans, LA. Comparing Buprenorphine and Naltrexone A NIDA study comparing the effectiveness of a buprenorphine/naloxone combination and an extended release naltrexone formulation on treating opioid use disorder has found that both medications are similarly effective in treating opioid use disorder once treatment is initiated. Because naltrexone requires full detoxification, initiating treatment among active opioid users was more difficult with this medication. However, once detoxification was complete, the naltrexone formulation had a similar effectiveness as the buprenorphine/naloxone combination. Tobacco Addiction Nicotine Replacement Therapy (NRT) A variety of formulations of nicotine replacement therapies (NRTs) now exist, including the transdermal nicotine patch, nicotine spray, nicotine gum, and nicotine lozenges. Because nicotine is the main addictive ingredient in tobacco, the rationale for NRT is that stable low levels of nicotine will prevent withdrawal symptoms—which often drive continued tobacco use—and help keep people motivated to quit. Research shows that combining the patch with another replacement therapy is more effective than a single therapy alone. Bupropion (Zyban )® Page 34 Bupropion was originally marketed as an antidepressant (Wellbutrin). It produces mild stimulant effects by blocking the reuptake of certain neurotransmitters, especially norepinephrine and dopamine. A serendipitous observation among depressed patients was that the medication was also effective in suppressing tobacco craving, helping them quit smoking without also gaining weight. Although bupropion’s exact mechanisms of action in facilitating smoking cessation are unclear, it has FDA approval as a smoking cessation treatment. Varenicline (Chantix )® Varenicline is the most recently FDA-approved medication for smoking cessation. It acts on a subset of nicotinic receptors in the brain thought to be involved in the rewarding effects of nicotine. Varenicline acts as a partial agonist/antagonist at these receptors—this means that it midly stimulates the nicotine receptor but not sufficiently to trigger the release of dopamine, which is important for the rewarding effects of nicotine. As an antagonist, varenicline also blocks the ability of nicotine to activate dopamine, interfering with the reinforcing effects of smoking, thereby reducing cravings and supporting abstinence from smoking. Combined With Behavioral Treatment Each of the above pharmacotherapies is recommended for use in combination with behavioral interventions, including group and individual therapies, as well as telephone quitlines. Behavioral approaches complement most tobacco addiction treatment programs. They can amplify the effects of medications by teaching people how to manage stress, recognize and avoid high-risk situations for smoking relapse, and develop alternative coping strategies (e.g., cigarette refusal skills, assertiveness, and time management skills) that they can practice in treatment, social, and work settings. Combined treatment is urged because behavioral and pharmacological treatments are thought to operate by different yet complementary mechanisms that can have additive effects. Further Reading: Alterman, A.I.; Gariti, P.; and Mulvaney, F. Short- and long-term smoking cessation for three levels of intensity of behavioral treatment. Psychology of Addictive Behaviors 15:261-264, 2001. Hall, S.M.; Humfleet, G.L.; Muñoz, R.F.; V.I; Prochaska, J.J.; and Robbins, J.A. Using extended Page 35 cognitive behavioral treatment and medication to treat dependent smokers. American Journal of Public Health 101:2349– 2356, 2011. Jorenby, D.E.; Hays, J.T.; Rigotti, N.A.; Azoulay, S.; Watsky, E.J.; Williams, K.E.; Billing, C.B.; Gong, J.; and Reeves, K.R. Varenicline Phase 3 Study Group. Efficacy of varenicline, an ?4?2 nicotinic acetylcholine receptor partial agonist vs. placebo or sustained-release bupropion for smoking cessation: A randomized controlled trial. The Journal of the American Medical Association 296(1):56–63, 2006. King, D.P.; Paciqa, S.; Pickering, E.; Benowitz, N.L.; Bierut, L.J.; Conti, D.V.; Kaprio, J.; Lerman, C.; and Park, P.W. Smoking cessation pharmacogenetics: Analysis of varenicline and bupropion in placebo-controlled clinical trials. Neuropsychopharmacology 37:641–650, 2012. Raupach, T.; and van Schayck, C.P. Pharmacotherapy for smoking cessation: Current advances and research topics. CNS Drugs 25:371–382, 2011. Shah, S.D.; Wilken, L.A.; Winkler, S.R.; and Lin, S.J. Systematic review and meta-analysis of combination therapy for smoking cessation. Journal of the American Pharmaceutical Association 48(5):659–665, 2008. Smith, S.S; McCarthy, D.E.; Japuntich S.J.; Christiansen, B.; Piper, M.E.; Jorenby, D.E.; Fraser, D.L.; Fiore, M.C.; Baker, T.B.; and Jackson, T.C. Comparative effectiveness of 5 smoking cessation pharmacotherapies in primary care clinics. Archives of Internal Medicine 169:2148–2155, 2009. Stitzer, M. Combined behavioral and pharmacological treatments for smoking cessation. Nicotine & Tobacco Research 1:S181–S187, 1999. Alcohol Addiction Naltrexone Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and the Page 36 craving for alcohol. It has been shown to reduce relapse to problem drinking in some patients. An extended release version, Vivitrol—administered once a month by injection—is also FDA-approved for treating alcoholism, and may offer benefits regarding compliance. Acamprosate Acamprosate (Campral ) acts on the gamma-aminobutyric acid (GABA) and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria. Acamprosate has been shown to help dependent drinkers maintain abstinence for several weeks to months, and it may be more effective in patients with severe dependence. ® Disulfiram Disulfiram (Antabuse ) interferes with degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and plapitations if a person drinks alcohol. The utility and effectiveness of disulfiram are considered limited because compliance is generally poor. However, among patients who are highly motivated, disulfiram can be effective, and some patients use it episodically for high-risk situations, such as social occasions where alcohol is present. It can also be administered in a monitored fashion, such as in a clinic or by a spouse, improving its efficacy. ® Topiramate Topiramate is thought to work by increasing inhibitory (GABA) neurotransmission and reducing stimulatory (glutamate) neurotransmission, although its precise mechanism of action is not known. Although topiramate has not yet received FDA approval for treating alcohol addiction, it is sometimes used off-label for this purpose. Topiramate has been shown in studies to significantly improve multiple drinking outcomes, compared with a placebo. Combined With Behavioral Treatment While a number of behavioral treatments have been shown to be effective in the treatment of alcohol Page 37 addiction, it does not appear that an additive effect exists between behavioral treatments and pharmacotherapy. Studies have shown that just getting help is one of the most important factors in treating alcohol addiction; the precise type of treatment received is not as important. Further Reading: Anton, R.F.; O’Malley, S.S.; Ciraulo, D.A.; Cisler, R.A.; Couper, D.; Donovan, D.M.; Gastfriend, D.R.; Hosking, J.D.; Johnson, B.A.; LoCastro, J.S.; Longabaugh, R.; Mason, B.J.; Mattson, M.E.; Miller, W.R.; Pettinati, H.M.; Randall, C.L.; Swift, R.; Weiss, R.D.; Williams, L.D.; and Zweben, A., for the COMBINE Study Research Group. Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. The Journal of the American Medical Association 295(17):2003–2017, 2006. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much: A Clinician’s Guide, Updated 2005 Edition. Bethesda, MD: NIAAA, updated 2005. Available at pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm Behavioral Therapies Behavioral approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse. Below are a number of behavioral therapies shown to be effective in addressing substance abuse (effectiveness with particular drugs of abuse is denoted in parentheses). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine) Cognitive-Behavioral Therapy (CBT) was developed as a method to prevent relapse when treating Page 38 problem drinking, and later it was adapted for cocaine-addicted individuals. Cognitive-behavioral strategies are based on the theory that in the development of maladaptive behavioral patterns like substance abuse, learning processes play a critical role. Individuals in CBT learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it. A central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations. Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment. Current research focuses on how to produce even more powerful effects by combining CBT with medications for drug abuse and with other types of behavioral therapies. A computer-based CBT system has also been developed and has been shown to be effective in helping reduce drug use following standard drug abuse treatment. Further Reading: Carroll, K.M., Easton, C.J.; Nich, C.; Hunkele, K.A.; Neavins, T.M.; Sinha, R.; Ford, H.L.; Vitolo, S.A; Doebrick, C.A.; and Rounsaville, B.J. The use of contingency management and motivational/skills- building therapy to treat young adults with marijuana dependence. Journal of Consulting and Clinical Psychology 74(5):955–966, 2006. Carroll, K.M.; and Onken, L.S. Behavioral therapies for drug abuse. The American Journal of Psychiatry 168(8):1452–1460, 2005. Carroll, K.M.; Sholomskas, D.; Syracuse, G.; Ball, S.A.; Nuro, K.; and Fenton, L.R. We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology 73(1):106–115, 2005. Carroll, K.; Fenton, L.R.; Ball, S.A.; Nich, C.; Frankforter, T.L.; Shi,J.; and Rounsaville, B.J. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: A randomized placebo- Page 39 controlled trial. Archives of General Psychiatry 61(3):264–272, 2004. Carroll, K.M.; Ball, S.A.; Martino, S.; Nich, C.; Babuscio, T.A.; Nuro, K.F.; Gordon, M.A.; Portnoy, G.A.; and Rounsaville, B.J. Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT. The American Journal of Psychiatry 165(7):881–888, 2008. Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine) Research has demonstrated the effectiveness of treatment approaches using contingency management (CM) principles, which involve giving patients tangible rewards to reinforce positive behaviors such as abstinence. Studies conducted in both methadone programs and psychosocial counseling treatment programs demonstrate that incentive-based interventions are highly effective in increasing treatment retention and promoting abstinence from drugs. Voucher-Based Reinforcement (VBR) augments other community-based treatments for adults who primarily abuse opioids (especially heroin) or stimulants (especially cocaine) or both. In VBR, the patient receives a voucher for every drug-free urine sample provided. The voucher has monetary value that can be exchanged for food items, movie passes, or other goods or services that are consistent with a drug-free lifestyle. The voucher values are low at first, but increase as the number of consecutive drug-free urine samples increases; positive urine samples reset the value of the vouchers to the initial low value. VBR has been shown to be effective in promoting abstinence from opioids and cocaine in patients undergoing methadone detoxification. Prize Incentives CM applies similar principles as VBR but uses chances to win cash prizes instead of vouchers. Over the course of the program (at least 3 months, one or more times weekly), participants supplying drug-negative urine or breath tests draw from a bowl for the chance to win a prize worth between $1 and $100. Participants may also receive draws for attending counseling sessions and completing weekly goal-related activities. The number of draws starts at one and increases with consecutive negative drug tests and/or counseling sessions attended but resets to one with any drug- Page 40 positive sample or unexcused absence. The practitioner community has raised concerns that this intervention could promote gambling—as it contains an element of chance—and that pathological gambling and substance use disorders can be comorbid. However, studies examining this concern found that Prize Incentives CM did not promote gambling behavior. Further Reading: Budney, A.J.; Moore, B.A.; Rocha, H.L.; and Higgins, S.T. Clinical trial of abstinence-based vouchers and cognitivebehavioral therapy for cannabis dependence. Journal of Consulting and Clinical Psychology 74(2):307–316, 2006. Budney, A.J.; Roffman, R.; Stephens, R.S.; and Walker, D. Marijuana dependence and its treatment. Addiction Science & Clinical Practice 4(1):4–16, 2007. Elkashef, A.; Vocci, F.; Huestis, M.; Haney, M.; Budney, A.; Gruber, A.; and el-Guebaly, N. Marijuana neurobiology and treatment. Substance Abuse 29(3):17–29, 2008. Peirce, J.M.; Petry, N.M.; Stitzer, M.L.; Blaine, J.; Kellogg, S.; Satterfield, F.; Schwartz, M.; Krasnansky, J.; Pencer, E.; Silva-Vazquez, L.; Kirby, K.C.; Royer-Malvestuto, C.; Cohen, A.; Copersino, M.L.; Kolodner, K.; and Li, R. Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry 63(2):201–208, 2006. Petry, N.M.; Peirce, J.M.; Stitzer, M.L.; Blaine, J.; Roll, J.M.; Cohen, A.; Obert, J.; Killeen, T.; Saladin, M.E.; Cowell, M.; Kirby, K.C.; Sterling, R.; Royer-Malvestuto, C.; Hamilton, J.; Booth, R.E.; Macdonald, M.; Liebert, M.; Rader, L.; Burns, R; DiMaria, J.; Copersino, M.; Stabile, P.Q.; Kolodner, K.; and Li, R. Effect of prizebased incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: A National Drug Abuse Treatment Clinical Trials Network study. Archives of General Psychiatry 62(10):1148–1156, 2005. Petry, N.M.; Kolodner, K.B.; Li, R.; Peirce, J.M.; Roll, J.M.; Stitzer, M.L.; and Hamilton, J.A. Prize- based contingency management does not increase gambling. Drug and Alcohol Dependence 83(3):269–273, 2006. Page 41 Prendergast, M.; Podus, D.; Finney, J.; Greenwell, L.; and Roll, J. Contingency management for treatment of substance use disorders: A meta-analysis. Addiction 101(11):1546–1560, 2006. Roll, J.M.; Petry, N.M.; Stitzer, M.L.; Brecht, M.L.; Peirce, J.M.; McCann, M.J.; Blaine, J.; MacDonald, M.; DiMaria, J.; Lucero, L.; and Kellogg, S. Contingency management for the treatment of methamphetamine use disorders. The American Journal of Psychiatry 163(11):1993–1999, 2006. Community Reinforcement Approach Plus Vouchers (Alcohol, Cocaine, Opioids) Community Reinforcement Approach (CRA) Plus Vouchers is an intensive 24-week outpatient therapy for treating people addicted to cocaine and alcohol. It uses a range of recreational, familial, social, and vocational reinforcers, along with material incentives, to make a non-drug-using lifestyle more rewarding than substance use. The treatment goals are twofold: To maintain abstinence long enough for patients to learn new life skills to help sustain it; and To reduce alcohol consumption for patients whose drinking is associated with cocaine use Patients attend one or two individual counseling sessions each week, where they focus on improving family relations, learn a variety of skills to minimize drug use, receive vocational counseling, and develop new recreational activities and social networks. Those who also abuse alcohol receive clinic- monitored disulfiram (Antabuse) therapy. Patients submit urine samples two or three times each week and receive vouchers for cocaine-negative samples. As in VBR, the value of the vouchers increases with consecutive clean samples, and the vouchers may be exchanged for retail goods that are consistent with a drug-free lifestyle. Studies in both urban and rural areas have found that this approach facilitates patients’ engagement in treatment and successfully aids them in gaining substantial periods of cocaine abstinence. A computer-based version of CRA Plus Vouchers called the Therapeutic Education System (TES) was found to be nearly as effective as treatment administered by a therapist in promoting abstinence from opioids and cocaine among opioid-dependent individuals in outpatient treatment. A version of Page 42 CRA for adolescents addresses problem-solving, coping, and communication skills and encourages active participation in positive social and recreational activities. Further Reading: Brooks, A.C.; Ryder, D.; Carise, D.; and Kirby, K.C. Feasibility and effectiveness of computer-based therapy in community treatment. Journal of Substance Abuse Treatment 39(3):227–235, 2010. Higgins, S.T.; Sigmon, S.C.; Wong, C.J.; Heil, S.H.; Badger, G.J.; Donham, R.; Dantona, R.L.; and Anthony, S. Community reinforcement therapy for cocaine-dependent outpatients. Archives of General Psychiatry 60(10):1043–1052, 2003. Roozen, H.G.; Boulogne, J.J.; van Tulder, M.W.; van den Brink, W.; De Jong, C.A.J.; and Kerhof, J.F.M. A systemic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug and Alcohol Dependence 74(1):1–13, 2004. Silverman, K.; Higgins, S.T.; Brooner, R.K.; Montoya, I.D.; Cone, E.J.; Schuster, C.R.; and Preston, K.L. Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry 53(5):409–415, 1996. Smith, J.E.; Meyers, R.J.; and Delaney, H.D. The community reinforcement approach with homeless alcohol-dependent individuals. Journal of Consulting and Clinical Psychology 66(3):541–548, 1998. Stahler, G.J.; Shipley, T.E.; Kirby, K.C.; Godboldte, C.; Kerwin, M.E; Shandler, I.; and Simons, L. Development and initial demonstration of a community-based intervention for homeless, cocaine- using, African-American women. Journal of Substance Abuse Treatment 28(2):171–179, 2005. Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine) Motivational Enhancement Therapy (MET) is a counseling approach that helps individuals resolve their ambivalence about engaging in treatment and stopping their drug use. This approach aims to Page 43 evoke rapid and internally motivated change, rather than guide the patient stepwise through the recovery process. This therapy consists of an initial assessment battery session, followed by two to four individual treatment sessions with a therapist. In the first treatment session, the therapist provides feedback to the initial assessment, stimulating discussion about personal substance use and eliciting self-motivational statements. Motivational interviewing principles are used to strengthen motivation and build a plan for change. Coping strategies for high-risk situations are suggested and discussed with the patient. In subsequent sessions, the therapist monitors change, reviews cessation strategies being used, and continues to encourage commitment to change or sustained abstinence. Patients sometimes are encouraged to bring a significant other to sessions. Research on MET suggests that its effects depend on the type of drug used by participants and on the goal of the intervention. This approach has been used successfully with people addicted to alcohol to both improve their engagement in treatment and reduce their problem drinking. MET has also been used successfully with marijuana-dependent adults when combined with cognitive- behavioral therapy, constituting a more comprehensive treatment approach. The results of MET are mixed for people abusing other drugs (e.g., heroin, cocaine, nicotine) and for adolescents who tend to use multiple drugs. In general, MET seems to be more effective for engaging drug abusers in treatment than for producing changes in drug use. Further Reading: Baker, A.; Lewin, T.; Reichler, H.; Clancy, R.; Carr, V.; Garrett, R.; Sly, K.; Devir, H.; and Terry, M. Evaluation of a motivational interview for substance use with psychiatric in-patient services. Addiction 97(10):1329-1337, 2002. Haug, N.A.; Svikis, D.S.; and Diclemente, C. Motivational enhancement therapy for nicotine dependence in methadone-maintained pregnant women. Psychology of Addictive Behaviors 18(3):289-292, 2004. Marijuana Treatment Project Research Group. Brief treatments for cannabis dependence: Findings from a randomized multisite trial. Journal of Consulting and Clinical Psychology 72(3):455-466, 2004. Miller, W.R.; Yahne, C.E.; and Tonigan, J.S. Motivational interviewing in drug abuse services: A Page 44 randomized trial. Journal of Consulting and Clinical Psychology 71(4):754-763, 2003. Stotts, A.L.; Diclemente, C.C.; and Dolan-Mullen, P. One-to-one: A motivational intervention for resistant pregnant smokers. Addictive Behaviors 27(2):275-292, 2002. The Matrix Model (Stimulants) The Matrix Model provides a framework for engaging stimulant (e.g., methamphetamine and cocaine) abusers in treatment and helping them achieve abstinence. Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, and become familiar with self-help programs. Patients are monitored for drug use through urine testing. The therapist functions simultaneously as teacher and coach, fostering a positive, encouraging relationship with the patient and using that relationship to reinforce positive behavior change. The interaction between the therapist and the patient is authentic and direct but not confrontational or parental. Therapists are trained to conduct treatment sessions in a way that promotes the patient’s self-esteem, dignity, and self-worth. A positive relationship between patient and therapist is critical to patient retention. Treatment materials draw heavily on other tested treatment approaches and, thus, include elements of relapse prevention, family and group therapies, drug education, and self-help participation. Detailed treatment manuals contain worksheets for individual sessions; other components include family education groups, early recovery skills groups, relapse prevention groups, combined sessions, urine tests, 12-step programs, relapse analysis, and social support groups. A number of studies have demonstrated that participants treated using the Matrix Model show statistically significant reductions in drug and alcohol use, improvements in psychological indicators, and reduced risky sexual behaviors associated with HIV transmission. Further Reading: Huber, A.; Ling, W.; Shoptaw, S.; Gulati, V.; Brethen, P.; and Rawson, R. Integrating treatments for Page 45 methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases 16(4):41-50, 1997. Rawson, R.; Shoptaw, S.J.; Obert, J.L.; McCann, M.J.; Hasson, A.L.; Marinelli-Casey, P.J.; Brethen, P.R.; and Ling, W. An intensive outpatient approach for cocaine abuse: The Matrix model. Journal of Substance Abuse Treatment 12(2):117-127, 1995. Rawson, R.A.; Huber, A.; McCann, M.; Shoptaw, S.; Farabee, D.; Reiber, C.; and Ling, W. A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Archives of General Psychiatry 59(9):817-824, 2002. 12-Step Facilitation Therapy (Alcohol, Stimulants, Opiates) Twelve-step facilitation therapy is an active engagement strategy designed to increase the likelihood of a substance abuser becoming affiliated with and actively involved in 12-step self-help groups, thereby promoting abstinence. Three key ideas predominate: (1) acceptance, which includes the realization that drug addiction is a chronic, progressive disease over which one has no control, that life has become unmanageable because of drugs, that willpower alone is insufficient to overcome the problem, and that abstinence is the only alternative; (2) surrender, which involves giving oneself over to a higher power, accepting the fellowship and support structure of other recovering addicted individuals, and following the recovery activities laid out by the 12-step program; and (3) active involvement in 12-step meetings and related activities. While the efficacy of 12-step programs (and 12- step facilitation) in treating alcohol dependence has been established, the research on its usefulness for other forms of substance abuse is more preliminary, but the treatment appears promising for helping drug abusers sustain recovery. Further Reading: Carroll, K.M.; Nich, C.; Ball, S.A.; McCance, E.; Frankforter, T.L.; and Rounsaville, B.J. One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: Sustained effects of treatment. Addiction 95(9):1335-1349, 2000. Page 46 Donovan D.M., and Wells E.A. "Tweaking 12-step": The potential role of 12-Step self-help group involvement in methamphetamine recovery. Addiction 102(Suppl. 1):121-129, 2007. Project MATCH Research Group. Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol 58(1)7-29, 1997. Family Behavior Therapy Family Behavior Therapy (FBT), which has demonstrated positive results in both adults and adolescents, is aimed at addressing not only substance use problems but other co-occurring problems as well, such as conduct disorders, child mistreatment, depression, family conflict, and unemployment. FBT combines behavioral contracting with contingency management. FBT involves the patient along with at least one significant other such as a cohabiting partner or a parent (in the case of adolescents). Therapists seek to engage families in applying the behavioral strategies taught in sessions and in acquiring new skills to improve the home environment. Patients are encouraged to develop behavioral goals for preventing substance use and HIV infection, which are anchored to a contingency management system. Substance-abusing parents are prompted to set goals related to effective parenting behaviors. During each session, the behavioral goals are reviewed, with rewards provided by significant others when goals are accomplished. Patients participate in treatment planning, choosing specific interventions from a menu of evidence-based treatment options. In a series of comparisons involving adolescents with and without conduct disorder, FBT was found to be more effective than supportive counseling. Further Reading: Azrin, N.H.; Donohue, B.; Besalel, V.A.; Kogan, E.S.; and Acierno, R. Youth drug abuse treatment: a controlled outcome study. Journal of Child and Adolescent Substance Abuse 3:1–16, 1994. Carroll, K.M.; and Onken, L.S. Behavioral therapies for drug abuse. American Journal of Psychiatry 168(8):1452–1460, 2005. Page 47 Donohue, B.; Azrin, N.; Allen, D.N.; Romero, V.; Hill, H.H.; Tracy, K.; Lapota, H.; Gorney, S.; Abdel-al, R.; Caldas, D.; Herdzik, K.; Bradshaw, K.; Valdez, R.; and Van Hasselt, V.B. Family Behavior Therapy for substance abuse: A review of its intervention components and applicability. Behavior Modification 33:495–519, 2009. LaPota, H.B.; Donohue, B.; Warren, C. S.; and Allen, D.N. Integration of a Healthy Living curriculum within Family Behavior Therapy: A clinical case example in a woman with a history of domestic violence, child neglect, drug abuse, and obesity. Journal of Family Violence 26:227–234, 2011. Behavioral Therapies Primarily for Adolescents Drug-abusing and addicted adolescents have unique treatment needs. Research has shown that treatments designed for and tested in adult populations often need to be modified to be effective in adolescents. Family involvement is a particularly important component for interventions targeting youth. Below are examples of behavioral interventions that employ these principles and have shown efficacy for treating addiction in youth. Multisystemic Therapy Multisystemic Therapy (MST) addresses the factors associated with serious antisocial behavior in children and adolescents who abuse alcohol and other drugs. These factors include characteristics of the child or adolescent (e.g., favorable attitudes toward drug use), the family (poor discipline, family conflict, parental drug abuse), peers (positive attitudes toward drug use), school (dropout, poor performance), and neighborhood (criminal subculture). By participating in intensive treatment in natural environments (homes, schools, and neighborhood settings), most youths and families complete a full course of treatment. MST significantly reduces adolescent drug use during treatment and for at least 6 months after treatment. Fewer incarcerations and out-of-home juvenile placements offset the cost of providing this intensive service and maintaining the clinicians’ low caseloads. Further Reading: Henggeler, S.W.; Clingempeel, W.G.; Brondino, M.J.; and Pickrel, S.G. Four-year follow-up of Page 48 multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry 41(7):868-874, 2002. Henggeler, S.W.; Rowland, M.D.; Randall, J.; Ward, D.M.; Pickrel, S.G.; Cunningham, P.B.; Miller, S.L.; Edwards, J.; Zealberg, J.J.; Hand, L.D.; and Santos, A.B. Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child and Adolescent Psychiatry 38(11):1331-1339, 1999. Henggeler, S.W.; Halliday-Boykins, C.A.; Cunningham, P.B.; Randall, J.; Shapiro, S.B.; and Chapman, J.E. Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology 74(1):42–54, 2006. Henggeler, S.W.; Pickrel, S.G.; Brondino, M.J.; and Crouch, J.L. Eliminating (almost) treatment dropout of substance-abusing or dependent delinquents through home-based multisystemic therapy. The American Journal of Psychiatry 153(3):427–428, 1996. Huey, S.J.; Henggeler, S.W.; Brondino, M.J.; and Pickrel, S.G. Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family functioning. Journal of Consulting and Clinical Psychology 68(3):451–467, 2000. Multidimensional Family Therapy Multidimensional Family Therapy (MDFT) for adolescents is an outpatient, family-based treatment for teenagers who abuse alcohol or other drugs. MDFT views adolescent drug use in terms of a network of influences (individual, family, peer, community) and suggests that reducing unwanted behavior and increasing desirable behavior occur in multiple ways in different settings. Treatment includes individual and family sessions held in the clinic, in the home, or with family members at the family court, school, or other community locations. During individual sessions, the therapist and adolescent work on important developmental tasks, such as developing decision-making, negotiation, and problem-solving skills. Teenagers acquire vocational skills and skills in communicating their thoughts and feelings to deal better with life stressors. Parallel sessions are held with family members. Parents examine their particular parenting styles, learning to distinguish influence from control and to have a positive and developmentally appropriate influence on Page 49 their children. Further Reading: Dennis, M.; Godley, S.H.; Diamond, G.; Tims, F.M.; Babor, T.; Donaldson, J.; Liddle, H.; Titus, J.C.; Kaminer, Y.; Webb, C.; Hamilton, N.; and Funk, R. The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized clinical trials. Journal of Substance Abuse Treatment 27(3):197-213, 2004. Liddle, H.A.; Dakof, G.A.; Parker, K.; Diamond, G.S.; Barrett, K;, and Tejeda, M. Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. The American Journal of Drug and Alcohol Abuse 27(4):651-688, 2001. Liddle, H.A., and Hogue, A. Multidimensional family therapy for adolescent substance abuse. In E.F. Wagner and H.B. Waldron (eds.), Innovations in Adolescent Substance Abuse Interventions. London: Pergamon/Elsevier Science, pp. 227-261, 2001. Liddle, H.A.; Rowe, C.L.; Dakof, G.A.; Ungaro, R.A.; and Henderson, C.E. Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment. Journal of Psychoactive Drugs 36(1):49-63, 2004. Schmidt, S.E.; Liddle, H.A.; and Dakof, G.A. Effects of multidimensional family therapy: Relationship of changes in parenting practices to symptom reduction in adolescent substance abuse. Journal of Family Psychology 10(1):1-16, 1996. Brief Strategic Family Therapy Brief Strategic Family Therapy (BSFT) targets family interactions that are thought to maintain or exacerbate adolescent drug abuse and other co-occurring problem behaviors. Such problem behaviors include conduct problems at home and at school, oppositional behavior, delinquency, associating with antisocial peers, aggressive and violent behavior, and risky sexual behavior. BSFT is based on a family systems approach to treatment, in which family members’ behaviors are assumed to be interdependent such that the symptoms of one member (the drug-abusing adolescent, for Page 50 example) are indicative, at least in part, of what else is occurring in the family system. The role of the BSFT counselor is to identify the patterns of family interaction that are associated with the adolescent’s behavior problems and to assist in changing those problem-maintaining family patterns. BSFT is meant to be a flexible approach that can be adapted to a broad range of family situations in various settings (mental health clinics, drug abuse treatment programs, other social service settings, and families’ homes) and in various treatment modalities (as a primary outpatient intervention, in combination with residential or day treatment, and as an aftercare/continuing-care service following residential treatment). Further Reading: Coatsworth, J.D.; Santisteban, D.A.; McBride, C.K.; and Szapocznik, J. Brief Strategic Family Therapy versus community control: Engagement, retention, and an exploration of the moderating role of adolescent severity. Family Process 40(3):313-332, 2001. Kurtines, W.M.; Murray, E.J.; and Laperriere, A. Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. Journal of Family Psychology 10(1):35–44, 1996. Santisteban, D.A.; Coatsworth, J.D.; Perez-Vidal, A.; Mitrani, V.; Jean-Gilles, M.; and Szapocznik, J. Brief Structural/Strategic Family Therapy with African- American and Hispanic high-risk youth. Journal of Community Psychology 25(5):453-471, 1997. Santisteban, D.A.; Suarez-Morales, L.; Robbins, M.S.; and Szapocznik, J. Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process 45(2):259-271, 2006. Santisteban, D.A.; Szapocznik, J.; Perez-Vidal, A.; Mitrani, V.; Jean-Gilles, M.; and Szapocznik, J. Brief Structural/Strategic Family Therapy with African-American and Hispanic high-risk youth. Journal of Community Psychology 25(5):453–471, 1997. Szapocznik, J., et al. Engaging adolescent drug abusers and their families in treatment: A strategic structural systems approach. Journal of Consulting and Clinical Psychology 56(4):552-557, 1988. Page 51 Functional Family Therapy Functional Family Therapy (FFT) is another treatment based on a family systems approach, in which an adolescent’s behavior problems are seen as being created or maintained by a family’s dysfunctional interaction patterns. FFT aims to reduce problem behaviors by improving communication, problem-solving, conflict resolution, and parenting skills. The intervention always includes the adolescent and at least one family member in each session. Principal treatment tactics include (1) engaging families in the treatment process and enhancing their motivation for change and (2) bringing about changes in family members’ behavior using contingency management techniques, communication and problem-solving, behavioral contracts, and other behavioral interventions. Further Reading: Waldron, H.B.; Slesnick, N.; Brody, J.L.; Turner, C.W.; and Peterson, T.R. Treatment outcomes for adolescent substance abuse at 4- and 7-month assessments. Journal of Consulting and Clinical Psychology 69:802–813, 2001. Waldron, H.B.; Turner, C. W.; and Ozechowski, T. J. Profiles of drug use behavior change for adolescents in treatment. Addictive Behaviors 30:1775–1796, 2005. Adolescent Community Reinforcement Approach and Assertive Continuing Care The Adolescent Community Reinforcement Approach (A-CRA) is another comprehensive substance abuse treatment intervention that involves the adolescent and his or her family. It seeks to support the individual’s recovery by increasing family, social, and educational/vocational reinforcers. After assessing the adolescent’s needs and levels of functioning, the therapist chooses from among 17 A- CRA procedures to address problem-solving, coping, and communication skills and to encourage active participation in positive social and recreational activities. A-CRA skills training involves role- playing and behavioral rehearsal. Assertive Continuing Care (ACC) is a home-based continuing-care approach to preventing relapse. Weekly home visits take place over a 12- to 14-week period after an adolescent is discharged from Page 52 residential, intensive outpatient, or regular outpatient treatment. Using positive and negative reinforcement to shape behaviors, along with training in problem-solving and communication skills, ACC combines A-CRA and assertive case management services (e.g., use of a multidisciplinary team of professionals, round-the-clock coverage, assertive outreach) to help adolescents and their caregivers acquire the skills to engage in positive social activities. Further Reading: Dennis, M.; Godley, S.H.; Diamond, G.; Tims, F.M.; Babor, T.; Donaldson, J.; Liddle, H.; Titus, J.C.; Kamier, Y.; Webb, C.; Hamilton, N.; and Funk R. The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. Journal of Substance Abuse Treatment 27:197–213, 2004. Godley, S.H.; Garner, B.R.; Passetti, L.L.; Funk, R.R.; Dennis, M.L.; and Godley, M.D. Adolescent outpatient treatment and continuing care: Main findings from a randomized clinical trial. Drug and Alcohol Dependence Jul 1;110 (1-2):44–54, 2010. Godley, M.D.; Godley, S.H.; Dennis, M.L.; Funk, R.; and Passetti, L.L. Preliminary outcomes from the assertive continuing care experiment for adolescents discharged from residential treatment. Journal of Substance Abuse Treatment 23:21–32, 2002. Acknowledgments The National Institute on Drug Abuse wishes to thank the following individuals for reviewing this publication. Martin W. Adler, Ph.D. Temple University School of Medicine Kathleen Brady, M.D., Ph.D. Medical University of South Carolina Greg Brigham, Ph.D. Page 53 Maryhaven, Inc. Kathleen M. Carroll, Ph.D. Yale University School of Medicine Richard R. Clayton, Ph.D. University of Kentucky Linda B. Cottler, Ph.D. Washington University School of Medicine David P. Friedman, Ph.D. Wake Forest University Bowman Gray School of Medicine Reese T. Jones, M.D. University of California at San Francisco Nancy K. Mello, Ph.D. Harvard Medical School William R. Miller, Ph.D. University of New Mexico Charles P. O’Brien, M.D., Ph.D. University of Pennsylvania Jeffrey Selzer, M.D. Zucker Hillside Hospital Eric J. Simon, Ph.D. New York University Langone Medical Center Jose Szapocznik, Ph.D. Page 54 University of Miami Miller School of Medicine George Woody, M.D. University of Pennsylvania Resources National Agencies The National Institute on Drug Abuse (NIDA) leads the Nation in scientific research on the health aspects of drug abuse and addiction. It supports and conducts research across a broad range of disciplines, including genetics, functional neuroimaging, social neuroscience, prevention, medication and behavioral therapies, and health services. It then disseminates the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction. Additional information is available at drugabuse.gov or by calling 301-443-1124. National Institute on Alcohol Abuse and Alcoholism (NIAAA) The National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides leadership in the national effort to reduce alcohol-related problems by conducting and supporting research in a wide range of scientific areas, including genetics, neuroscience, epidemiology, health risks and benefits of alcohol consumption, prevention, and treatment; coordinating and collaborating with other research institutes and Federal programs on alcohol-related issues; collaborating with international, national, State, and local institutions, organizations, agencies, and programs engaged in alcohol-related work; and translating and disseminating research findings to healthcare providers, researchers, policymakers, and the public. Additional information is available at www.niaaa.nih.gov or by calling 301-443-3860. National Institute of Mental Health (NIMH) The mission of National Institute of Mental Health (NIMH) is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, Page 55 recovery, and cure. In support of this mission, NIMH generates research and promotes research training to fulfill the following four objectives: (1) promote discovery in the brain and behavioral sciences to fuel research on the causes of mental disorders; (2) chart mental illness trajectories to determine when, where, and how to intervene; (3) develop new and better interventions that incorporate the diverse needs and circumstances of people with mental illnesses; and (4) strengthen the public health impact of NIMH-supported research. Additional information is available at nimh.nih.gov or by calling 301-443-4513. Center for Substance Abuse Treatment (CSAT) The Center for Substance Abuse Treatment (CSAT), a part of the Substance Abuse and Mental Health Services Administration (SAMHSA), is responsible for supporting treatment services through a block grant program, as well as disseminating findings to the field and promoting their adoption. CSAT also operates the 24-hour National Treatment Referral Hotline (1-800-662-HELP), which offers information and referral services to people seeking treatment programs and other assistance. CSAT publications are available through SAMHSA's Store (store.samhsa.gov). Additional information about CSAT can be found on SAMHSA's Web site at www.samhsa.gov/about-us/who-we-are/offices- centers/csat. Selected NIDA Educational Resources on Drug Addiction Treatment The following are available from the NIDA DrugPubs Research Dissemination Center, the National Technical Information Service (NTIS), or the Government Printing Office (GPO). To order, refer to the DrugPubs (877-NIDANIH [643-2644]), NTIS (1-800-553-6847), or GPO (202-512-1800) number provided with the resource description. Blending products. NIDA's Blending Initiative—a joint venture with SAMHSA and its nationwide network of Addiction Technology Transfer Centers (ATTCs)—uses "Blending Teams" of community practitioners, SAMHSA trainers, and NIDA researchers to create products and devise strategic dissemination plans for them. Completed products include those that address the value of buprenorphine therapy and onsite rapid HIV testing in community treatment programs; strategies for treating prescription opioid dependence; and the need to enhance healthcare workers' proficiency in Page 56 using tools such as the Addiction Severity Index (ASI), motivational interviewing, and motivational incentives. For more information on Blending products, please visit NIDA's Web site at archives.drugabuse.gov/nidasamhsa-blending-initiative. Addiction Severity Index. Provides a structured clinical interview designed to collect information about substance use and functioning in life areas from adult clients seeking drug abuse treatment. For more information on using the ASI and to obtain copies of the most recent edition, please visit https://eprovide.mapi-trust.org/instruments/addiction-severity-index. Drugs, Brains, and Behavior: The Science of Addiction (Reprinted 2010). This publication provides an overview of the science behind the disease of addiction. Publication #NIH 10-5605. Available online at drugabuse.gov/publications/science-addiction. Principles of Drug Abuse Treatment for Criminal Justice Populations: A Research-Based Guide (Revised 2012). Provides 13 essential treatment principles and includes resource information and answers to frequently asked questions. NIH Publication No.: 11-5316. Available online at drugabuse.gov/publications/principles-drug-abuse-treatment-criminal-justice-populations-research- based-guide. NIDA DrugFacts: Treatment Approaches for Drug Addiction (Revised 2009). This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. Available online at drugabuse.gov/publications/drugfacts/treatment-approaches-drugaddiction. Helping Patients Who Drink Too Much: A Clinicians's guide (published by NIAAA). This booklet is written for primary care and mental health clinicians and provides guidance in screening and managing alcohol-dependent patients. Available online at pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm. Research Report Series: Therapeutic Community (2002). This report provides information on the role of residential drug-free settings and their role in the treatment process. NIH Publication #02-4877. Available online at drugabuse.gov/publications/research-reports/therapeutic-community. Initiatives Designed to Move Treatment Research into Practice Page 57 Clinical Trials Network Assessing the real-world effectiveness of evidence-based treatments is a crucial step in bringing research to practice. Established in 1999, NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN) uses community settings with diverse patient populations and conditions to adjust and test protocols to meet the practical needs of addiction treatment. Since its inception, the CTN has tested pharmacological and behavioral interventions for drug abuse and addiction, along with common co-occurring conditions (e.g., HIV and PTSD) among various target populations, including adolescent drug abusers, pregnant drug-abusing women, and Spanish-speaking patients. The CTN has also tested prevention strategies in drug-abusing groups at high risk for HCV and HIV and has become a key element of NIDA’s multipronged approach to move promising science-based drug addiction treatments rapidly into community settings. For more information on the CTN, please visit drugabuse.gov/CTN. Criminal Justice-Drug Abuse Treatment Studies NIDA is taking an approach similar to the CTN to enhance treatment for drug-addicted individuals involved with the criminal justice system through Criminal Justice–Drug Abuse Treatment Studies (CJ- DATS). Whereas NIDA’s CTN has as its overriding mission the improvement of the quality of drug abuse treatment by moving innovative approaches into the larger community, research supported through CJ-DATS is designed to effect change by bringing new treatment models into the criminal justice system and thereby improve outcomes for offenders with substance use disorders. It seeks to achieve better integration of drug abuse treatment with other public health and public safety forums and represents a collaboration among NIDA; SAMHSA; the Centers for Disease Control and Prevention (CDC); Department of Justice agencies; and a host of drug treatment, criminal justice, and health and social service professionals. Blending Teams Another way in which NIDA is seeking to actively move science into practice is through a joint venture with SAMHSA and its nationwide network of Addiction Technology Transfer Centers (ATTCs). This process involves the collaborative efforts of community treatment practitioners, SAMHSA trainers, and NIDA researchers, some of whom form "Blending Teams" to create products and devise strategic dissemination plans for them. Through the creation of products designed to foster adoption of new Page 58 treatment strategies, Blending Teams are instrumental in getting the latest evidence-based tools and practices into the hands of treatment professionals. To date, a number of products have been completed. Topics have included increasing awareness of the value of buprenorphine therapy and enhancing healthcare workers' proficiency in using tools such as the ASI, motivational interviewing, and motivational incentives. For more information on Blending products, please visit NIDA’s Web site at archives.drugabuse.gov/nidasamhsa-blending-initiative. Other Federal Resources NIDA DrugPubs Research Dissemination Center. NIDA publications and treatment materials are available from this information source. Staff provide assistance in English and Spanish, and have TTY/TDD capability. Phone: 877-NIDA-NIH (877-643-2644); TTY/TDD: 240-645-0228; fax: 240-645- 0227; e-mail: drugpubs@nida.nih.gov; Web site: drugpubs.drugabuse.gov. The National Registry of Evidence-Based Programs and Practices. This database of interventions for the prevention and treatment of mental and substance use disorders is maintained by SAMHSA and can be accessed at www.samhsa.gov/nrepp. SAMHSA's Store has a wide range of products, including manuals, brochures, videos, and other publications. Phone: 800-487-4889; Web site: store.samhsa.gov. The National Institute of Justice. As the research agency of the Department of Justice, the National Institute of Justice (NIJ) supports research, evaluation, and demonstration programs relating to drug abuse in the context of crime and the criminal justice system. For information, including a wealth of publications, contact the National Criminal Justice Reference Service at 800-851-3420 or 301-519-5500; or visit nij.gov. Clinical Trials. For more information on federally and privately supported clinical trials, please visit clinicaltrials.gov. Page 59 This publication is available for your use and may be reproduced in its entirety without permission from NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. Page 60 Findtreatment.gov is an official website of the United States government available to help find treatment facilities in a given area. I put in zip code 85268 with a 25-mile radius, detox facilities, all payment options, all ages, all facilities. This came back with 37 facilities within this radius (changing to all types of facilities resulted in 135 facilities). Following is a listing of a few of these facilities to give the Commission an understanding of where these are and what time of services are provided in these facilities. Name Location Types of Services Types of Payment Medical X 11390 E. Via Linda, Suite 103, Scottsdale • Outpatient • Outpatient detox • Outpatient methadone/buprenorphine or naltrexone treatment • Substance use treatment • Alcohol Detox • Benzodiazepines Detox • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Integrated primary care services • Private, for profit • Cash or self- payment Soul Surgery 14362 N. Frank Lloyd Wright, Suite B111, Scottsdale • Outpatient • Outpatient detox • Outpatient day treatment or partial hospitalization • Intensive outpatient treatment • Outpatient methadone/buprenorphine or naltrexone treatment • Regular outpatient treatment • Substance use treatment • Alcohol Detox • Benzodiazepines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Acupuncture • Case management service • Mental health services • Social skills development • Transportation assistance • Integrated primary care services • Suicide prevention services • Private, for profit • Tribal funds • Medicaid • Federal military • Private health insurance • Cash or self- payment Scottsdale Providence 8889 E. Via Linda, Scottsdale • Outpatient • Outpatient detox • Outpatient day treatment or partial hospitalization • Intensive outpatient treatment • Outpatient methadone/buprenorphine or naltrexone treatment • Regular outpatient treatment • Substance use treatment • Transitional housing, halfway house, or sober home • Treatment for co-occurring substance use plus either serious mental health illness in adults/serious emotional disturbance in children • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Case management service • Mental health services • Social skills development • Transportation assistance • Private, for profit • Tribal Funds • Private health insurance • Cash or self- payment Cornerstone Healing Center 7655 E. Redfield Road, Suite 4, Scottsdale • Outpatient • Outpatient detox • Outpatient day treatment or partial hospitalization • Intensive outpatient treatment • Outpatient methadone/buprenorphine or naltrexone treatment • Regular outpatient treatment • Substance use treatment • Detoxification/Detox • Transitional housing, halfway house, or sober home • Treatment for co-occurring substance use plus either serious mental health illness in adults/serious emotional disturbance in children • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Private, for profit • Tribal Funds • Private Health Insurance • Cash or self- payment • Outcome follow-up after discharge • Case management service • Mental health services • Social skills development • Transportation assistance Gallus Detox Scottsdale 4326 N. 75th St. Scottsdale • Hospital inpatient/24-hour hospital inpatient • Hospital inpatient detoxification • Alcohol Detox • Benzodiazepines Detox • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Case management service • Transportation assistance • Suicide prevention services • Private, for profit • Tribal Funds • Federal military insurance • Private health insurance • Cash or self- payment Banner Behavioral Health Hospital 7575 E. Earll Dr., Scottsdale • Hospital inpatient/24-hour hospital inpatient • Hospital inpatient detoxification • Hospital inpatient treatment • Substance use treatment • Detoxification/Detox • Treatment for co-occurring substance use plus either serious mental health illness in adults/serious emotional disturbance in children • Alcohol Detox • Benzodiazepines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Case management service • Mental health services • Social skills development • Suicide prevention services • Private, non- profit • Tribal Funds • Medicare • Medicaid • Federal military insurance • Private health insurance • Cash or self- payment • State-financed health insurance plan other than Medicaid Scottsdale Detox Center 7283 E. Earll Dr., Scottsdale • Hospital inpatient/24-hour hospital inpatient • Hospital inpatient detoxification • Alcohol Detox • Benzodiazepines Detox • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Private, for profit • Tribal fund • Private health insurance • Medication routinely used during detoxification • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Case management service • Cash or self- payment 2nd Chance Treatment Center 16620 N. 40th St., Suite H-4, Phoenix • Outpatient • Outpatient detox • Outpatient methadone/buprenorphine or naltrexone treatment • Regular outpatient treatment • Substance use treatment • Treatment for co-occurring substance use plus either serious mental health illness in adults/serious emotional disturbance in children • Alcohol Detox • Benzodiazepines Detox • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Naloxone and overdose education • Outcome follow-up after discharge • Mental health services • Transportation assistance • Private, for profit • Medicare • Medicaid • Federal military insurance • Private health insurance • Cash or self- payment • State-financed health plan other than Medicaid New Hope Behavioral Health Center 215 S. Power Road, Suite, 114, Mesa • Outpatient • Outpatient detox • Outpatient methadone/buprenorphine or naltrexone treatment • Buprenorphine detoxification • Buprenorphine maintenance • Federally-certified Opioid Treatment Program • Methadone detoxification • Methadone maintenance • Prescribes buprenorphine • Private, for profit • Federal or any government funding for substance abuse • Tribal funds • Medicare • Medicaid • Maintenance service with medically supervised withdrawal after stabilization • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Case management service • Transportation assistance • Suicide prevention services • Federal military insurance • Private health insurance • Cash or self- payment • SAMHSA funding/block grants Buena Vista Health & Recovery LLC 29858 N. Tatum Blvd., Cave Creek • Hospital inpatient/24-hour hospital inpatient • Outpatient • Hospital inpatient detoxification • Hospital inpatient treatment • Outpatient day treatment or partial hospitalization • Intensive outpatient treatment • Outpatient methadone/buprenorphine or naltrexone treatment • Regular outpatient treatment • Substance use treatment • Alcohol Detox • Benzodiazepines Detox • Cocaine Detox • Methamphetamines Detox • Opioids detoxification • Medication routinely used during detoxification • Aftercare/continuing care • Discharge Planning • Naloxone and overdose education • Outcome follow-up after discharge • Case management service • Domestic violence services, including family or partner • Early intervention for HIV • Mental health services • Social skills development • Transportation assistance • Integrated primary care services • Suicide prevention services • Private, for profit • Tribal fund • Medicaid • Federal military insurance • Private health insurance • Cash or self- payment • State-financed health insurance plan other than Medicaid ITEM 8. B. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Regular Agenda                  Submitting Department: Administration Prepared by: Grady E. Miller, Town Manager Request to Town Council Regular Meeting (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION: Termination of the proposed roundabout and Fountain Park plaza projects located at Avenue of the Fountains and Saguaro.   Staff Summary (Background) Councilmembers Hannah Toth, Allen Skillicorn, and Gerry Friedel have requested an agenda item requesting to formally terminate the proposed roundabout and Fountain Park plaza projects at Avenue of the Fountains and Saguaro.  Both of these projects are in the current Council-approved Capital Improvement Program. Termination of these two projects would mean that these projects would be removed from the Capital Improvement Program and no further expenditure on planning or design costs would occur.   Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) Staff Recommendation(s) N/A SUGGESTED MOTION MOVE to terminate the proposed roundabout project and related Fountain Park plaza project from the Capital Improvement Program and discontinue any current or future expenditures relating to these projects. Form Review Inbox Reviewed By Date Finance Director Linda Mendenhall 01/09/2023 05:06 PM Town Attorney Aaron D. Arnson 01/09/2023 07:02 PM Town Manager (Originator)Grady E. Miller 01/09/2023 07:16 PM Town Manager (Originator)Grady E. Miller 01/09/2023 07:16 PM Form Started By: Grady E. Miller Started On: 01/07/2023 08:35 AM Final Approval Date: 01/09/2023  ITEM 8. C. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Regular Agenda Submitting Department: Administration Prepared by: Linda Mendenhall, Town Clerk Staff Contact Information: Grady E. Miller, Town Manager Request to Town Council Regular Meeting (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION: Adopting Resolution 2023-05 - A Resolution of the Mayor and Town Council of Fountain Hills, Maricopa County, Arizona, approving the Town of Fountain Hills, Arizona Town Council Rules of Procedure, Amended and Restated February 21, 2023. Amending the Council Rules of Procedure, Section 4.2, Agenda Preparation Article B 2. Staff Summary (background) Councilmembers Hannah Toth, Allen Skillicorn, and Gerry Friedel have requested an agenda item to amend Section 4.2, Article B.2 regarding agenda preparation. Councilmember Toth is requesting additional language be added to this section to provide a timeframe for the requested agenda item. Adding the additional language will afford the councilmembers submitting the agenda item a timeline for this action. Current Language: Mayor and Councilmembers: The Mayor or three Councilmembers may direct the Town Manager through a written request to place an item on an agenda for action. Proposed Language: Mayor and Councilmembers: The Mayor or three Councilmembers may direct the Town Manager through a written request to place an item on the next available agenda for action. Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) N/A SUGGESTED MOTION MOVE to adopt Resolution 2023-05 approving the proposed language as presented. Attachments Resolution 2023-05  Council Rules of Procedure - Proposed  Form Review Inbox Reviewed By Date Finance Director David Pock 02/13/2023 08:17 AM Town Attorney Aaron D. Arnson 02/13/2023 08:31 AM Town Manager Grady E. Miller 02/13/2023 11:23 AM Form Started By: Linda Mendenhall Started On: 02/13/2023 06:59 AM Final Approval Date: 02/13/2023  RESOLUTION 2023-05 A RESOLUTION OF THE MAYOR AND TOWN COUNCIL OF FOUNTAIN HILLS, MARICOPA COUNTY, ARIZONA, APPROVING THE TOWN OF FOUNTAIN HILLS, ARIZONA TOWN COUNCIL RULES OF PROCEDURE, AMENDED AND RESTATED FEBRUARY 21, 2023 ENACTMENTS: NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND TOWN COUNCIL OF FOUNTAIN HILLS as follows: SECTION 1. That the Town of Fountain Hills, Arizona Town Council Rules of Procedure, Amended and Restated February 21, 2023, are hereby approved in substantially the form attached hereto as Exhibit A and incorporated herein by reference. SECTION 2. That the Mayor, the Town Manager, the Town Clerk, and the Town Attorney are hereby authorized and directed to execute all documents and take all steps necessary to carry the purpose and intent of this Resolution. PASSED AND ADOPTED by the Mayor and Council of the Fountain Hills, Maricopa County, Arizona, this 21st day of February, 2023. FOR THE TOWN OF FOUNTAIN HILLS: ATTESTED TO: _______________________________ _______________________________ Ginny Dickey, Mayor Linda G. Mendenhall, Town Clerk REVIEWED BY: APPROVED AS TO FORM: ________________________________ ________________________________ Grady E. Miller, Town Manager Aaron D. Arnson, Town Attorney EXHIBIT A TOWN OF FOUNTAIN HILLS, ARIZONA TOWN COUNCIL RULES OF PROCEDURE AMENDED AND RESTATED FEBRUARY 21 APP. E - Page 1 Rules of Procedure - 10/05/21 2/21/2023 SECTION 1. RULES OF PROCEDURE/AUTHORITY 1.1 PROCEDURES The following are the basis for and are used in conjunction with these basic Rules of Procedure for meetings of the Council, Boards, Commissions and Committees: A. State Law B. Town Code, including these Council Rules C. Parliamentary Procedure at a Glance, New Edition, by O. Garfield Jones D. Roberts Rules of Order, 10th edition, as amended In case of inconsistency, conflict, or ambiguity among the documents listed above, such documents shall govern in the order in which they are listed. 1.2 PRESIDING OFFICER As provided by the Town Code, the Mayor, or in the Mayor's absence, the Vice-Mayor, is the Presiding Officer of all meetings of the Council. In the absence or disability of both the Mayor and the Vice-Mayor, the meeting shall be called to order by the Town Clerk, whereupon, the Town Clerk shall immediately call for the selection of a temporary Presiding Officer. If a majority of the Councilmembers present are unable to agree on a Presiding Officer for the meeting, the meeting shall automatically be adjourned and all agenda items shall be carried over to the next regular Council meeting. 1.3 PARLIAMENTARIAN The Town Attorney shall serve as Parliamentarian for all meetings. The Town Clerk shall act as Parliamentarian in the absence of the Town Attorney and the Town Manager shall act as Parliamentarian in the absence of both the Town Attorney and Town Clerk. 1.4 SUSPENSION OF THE RULES The Council, by a three-quarter vote of all members present, may suspend strict observance of these Council Rules or other policies and procedures for the timely and orderly progression of the meeting; provided, however, that a simple majority of the Council may cause a change in the order of items on the agenda. APP. E - Page 2 Rules of Procedure - 10/05/21 2/21/2023 SECTION 2. DEFINITIONS 2.1 AGENDA As set forth in the Order of Business, an agenda is a formal listing of items to be considered by (i) the Council at a noticed meeting of the Council or (ii) the applicable Board, Commission or Committee at a noticed meeting of that body. The content of the agenda may not be changed less than 72 hours prior to the public meeting, except in exceptional circumstances, but in no event shall the agenda be altered less than 24 hours prior to the public meeting, unless otherwise authorized by State law. 2.2 AGENDA PACKET A compilation of documents supporting the items listed on the agenda and requiring Council consideration or action, which may be used by Council, staff and the public for more in-depth information than may be presented in an oral report. The agenda Packet is organized as set forth in the Order of Business in Section 5 below and is made available electronically to the Council or to any citizen on the Town's website: www.fh.az.gov by 6:00 p.m. the Thursday prior to the date of the meeting. 2.3 CONSENT AGENDA Items listed on the Consent Agenda are considered to be routine, non-controversial matters and will be enacted by one motion and vote of the Council. All motions and subsequent approvals of Consent Agenda items will include all recommended staff stipulations unless otherwise stated. There will be no separate discussion of these items unless a Councilmember or member of the public so requests. If a Councilmember or member of the public wishes to discuss an item on the consent agenda, he/she may request so prior to the motion to accept the Consent Agenda or by notifying the Town Manager prior to the date of the meeting. The item will be removed from the Consent Agenda and considered in its normal sequence on the agenda. 2.4 COUNCIL Collectively, the Mayor and Common Council of the Town of Fountain Hills. 2.5 COUNCIL RULES These Town of Fountain Hills, Arizona Town Council Rules of Procedure. 2.6 MEETING The gathering, in person or by technological devices, of a quorum of the Council, Boards, Commissions or Committees, at which the Councilmembers, Board members, Commissioners, or Committee members discuss, propose or take legal action, including any deliberations by a quorum with respect to such APP. E - Page 3 Rules of Procedure - 10/05/21 2/21/2023 action. If a quorum is not present, those in attendance will be named for the record by the Town Clerk or the staff liaison for a Board, Commission or Committee. 2.7 NEWSPAPER A daily or weekly paid publication of general circulation within the Town of Fountain Hills, Arizona. 2.8 NOTICE A formal announcement to the public that sets the date, time and the place at which a meeting will be held. Such notice of meetings shall be in accordance with the State law, the Town Code and these Council Rules. 2.9 QUORUM The minimum number of Members of the Council, Board, Commission, or Committee that must be present in order for business to be legally transacted. With a seven-member body, a quorum is four members, unless otherwise specifically authorized by State law. 2.10 TOWN The Town of Fountain Hills, an Arizona municipal corporation. SECTION 3. MEETINGS 3.1 REGULAR MEETINGS A. Regular Meeting Date; Time. The Council shall hold regular meetings on the first and third Tuesday of each month at 5:30 P.M. When deemed appropriate, any regular meeting date of the Council may be changed or cancelled by a majority of the Council. Notice of the rescheduled or cancelled meeting shall be given to the public as is reasonable and practicable under the circumstances. All regular meetings shall be held at the Town Hall Council Chambers or at such place as may be prescribed by the Mayor or the Town Manager. The Council may provide for a "Call to the Public" at such regular meetings. B. Holidays. When the day for a regular meeting of the Council falls on a legal holiday, no meeting shall be held on such holiday, but such meeting shall be held at the same time and the same location on the day designated by the Council that is not a holiday, unless the meeting is otherwise cancelled by the Council. APP. E - Page 4 Rules of Procedure - 10/05/21 2/21/2023 3.2 ADJOURNED MEETINGS Any meeting may be adjourned to a time, place and date certain, but not beyond the next regular Council meeting. Once adjourned, the meeting may not be reconvened except at the time, date and place provided for in the motion to adjourn. 3.3 SPECIAL MEETINGS The Mayor, the Town Manager, or the Town Clerk (upon the written request of three Councilmembers), may convene the Council at any time after giving at least 24 hours' notice of such meeting to members of the Council and the general public. The notice shall include the date, place, hour and purpose of such special meeting. In the case of an actual emergency, a meeting may be held upon such notice as is appropriate to the circumstances. 3.4 WORK SESSIONS A. How Convened; When Convened; Notice. The Mayor or the Town Manager (at his own discretion or upon the written request of three Councilmembers) may convene the Council in a work session at any time after giving notice at least 24 hours in advance of such work session to members of the Council and the general public. The notice shall include the date, place, hour and purpose of such work session. B. Purpose. Work sessions are held for the purpose of presentations and discussions on such issues that require more in-depth consideration of the Council than may be possible at a regular meeting. No formal action of the Council may be taken at such work session, other than general consensus or conveying direction to staff for further action. These work sessions shall not provide for a “Call to the Public.” 3.5 EXECUTIVE SESSIONS Subject to applicable State law, the Council may hold such closed executive sessions as necessary to conduct the business of the Town. 3.6 EMERGENCY MEETINGS As provided for by State law, the Mayor and Council or the Town Manager may call a special emergency meeting to discuss or take action on an unforeseen issue where time is of the essence and sufficient time does not provide for the posting of a meeting notice 24 hours or more before the meeting. Notice of an emergency meeting of the Council will be posted within 24 hours following the holding of an emergency meeting. The notice will include the emergency meeting’s agenda and a brief but complete description of the nature of the emergency. Emergency meetings shall not provide for a "Call to the Public." APP. E - Page 5 Rules of Procedure - 10/05/21 2/21/2023 3.7 MEETINGS TO BE PUBLIC A. Open to Public. With exception of executive sessions, all regular, special and work session meetings of the Council, Boards, Commissions, and Committees shall be open to the public. B. Public Comment. Public comment is not taken at work sessions, emergency meetings or at special meetings, unless the special meeting is held in place of a regular meeting, or unless the special meeting includes a public hearing on the agenda. 3.8 MINUTES OF MEETINGS A. Staffing. The Town Clerk shall ensure staff attendance at all regular, special, work session, emergency and executive session meetings of the Council for the purpose of taking notes and/or audio recordation of the meeting. The Town staff liaison to each Board, Commission or Committee shall ensure staff attendance at all meetings for the purpose of taking notes and/or audio recordings of the meetings. B. Recordings; written minutes. To the extent possible, all open, public meetings shall be recorded by means of audio or video technology. In addition, written minutes reflecting legislative intent shall be taken so that an accounting of the issues discussed and actions taken is compiled and entered into the permanent Minute Book of the Town and kept on file and of record in the Office of the Town Clerk. Audio or video recordings of meetings will be retained for a period of time in accordance with the current Town of Fountain Hills and/or State of Arizona approved records retention and disposition schedules. Minutes shall identify speakers by name and shall indicate whether they are Fountain Hills residents, and whether they support or oppose the proposed action (i.e. "for" or "against") along with a summary of the speakers' verbal comments provided at the meeting. C. Availability. All meeting minutes of the Council, Boards, Commissions, and Committees are deemed to be public records, with the exception of executive session minutes, which, while they fall under the definition of and are considered public records by State law, are deemed confidential and are only available under limited conditions or by Court Order. Transcribed minutes, or the audio or video recordings of all open meetings of the Council, Boards, Commissions, and Committees must be available for public review by 5:00 p.m. on the third working day following each meeting, or as provided by State law. The Town Clerk or designee shall ensure that the minutes of all regular, and special meetings and work sessions of the Council, Boards, Commissions, and Committees are made available through the Town's Web Site, www.fh.az.gov within two working days following their approval, or as provided by State law. D. Executive Sessions. Minutes of executive sessions (1) shall be confidential; (2) are maintained and secured by the Town Clerk; and (3) may be accessed only as provided by State law. APP. E - Page 6 Rules of Procedure - 10/05/21 2/21/2023 E. Approval. Minutes of all meetings of the Council (other than executive sessions) may be approved under the consent agenda, unless removed for discussion and separate action. SECTION 4. NOTICE AND AGENDA 4.1 POSTING NOTICES A. Time. The Town Clerk, or authorized designee, shall prepare all public meeting notices of the Council, and shall ensure posting of the meeting notices no less than 24 hours before the date and time set for said meetings in accordance with State law. The staff liaison to each Board, Commission or Committee shall ensure that agendas are posted in the same manner as for the Council. B. Locations. Meeting notices shall be posted at a minimum of three locations within the Town, including the Community Center, Town Hall and the Town's website [www.fh.az.gov]. 4.2 AGENDA PREPARATION A. Availability. The Town Manager, or authorized designee, shall prepare the agendas for all meetings of the Council as set forth below. Agendas of all meetings of the Council shall generally be available to the public no less than 72 hours prior to said meetings, except in exceptional circumstances. In no event shall the agenda be made available less than 24 hours prior to said meeting. Agendas and agenda packet materials are made available through the Town's web site. The staff liaison to each Board, Commission or Committee shall ensure that the agenda is available in the same manner as required for the Council. B. Submittal Process. Items may be placed on the Council agenda for discussion and possible action by the following process (the agenda process for Boards, Commissions or Committees shall be as determined by the applicable Department Head which shall be substantially the same as the Council agenda submittal process): 1. All Departments: Preparation of the Staff Report with signatures of the department director and staff (including all attachments) provided to the Town Clerk for submittal to the Town Manager not later than two business days prior to agenda packet preparation day (the Tuesday prior to meeting date). Town Manager approves/amends items and signs off, finalizing the item for inclusion in the agenda packet. 2. Mayor and Councilmembers: The Mayor or three Councilmembers may direct the Town Manager through a written request to place an item on the next available an agenda for action. 3. Town Manager and Town Attorney: The Town Manager or Town Attorney may place an item on the agenda by including appropriate documentation. APP. E - Page 7 Rules of Procedure - 10/05/21 2/21/2023 4. Citizen or Group: A citizen or group may apply to have an item placed on the agenda as follows: a. Obtain a "Scheduled Public Appearance/Presentation" form from the Town Clerk and, when completed, return it to the Town Clerk for submission to the Town Manager. b. The Town Manager or authorized designee shall research the issue to determine if it may be handled administratively or will require Council discussion. If it is determined that the matter should be placed before the Council, the Town Manager shall ensure that documentation, if any, is compiled and the material included in the agenda packet. If the Town Manager determines that the subject should not be placed on the agenda, an individual wishing to have an item on the agenda as a "Scheduled Public Appearance" may (i) ask that the request be forwarded to the Mayor for consideration or (ii) obtain the written request of three members of the Council to place the item on the agenda, and submit that request to the Town Manager. c. The Town Manager may postpone the requested appearance/ presentation date, if additional staff time is needed to research a proposed agenda item. C. Time Lines for Submission of Items. 1. Agenda items shall be submitted to the Town Manager by 2:00 p.m., not less than nine calendar days prior to regular and special meetings to ensure timely delivery to Councilmembers. 2. Agenda items for work sessions shall be submitted to the Town Manager by 2:00 p.m., not less than seven calendar days prior to the meeting to ensure timely delivery to Councilmembers. 3. The Town Manager may approve exceptions to the schedule above in order to ensure that the distribution of all agenda packets to the Council is in conformance with these Council Rules. 4. Any requests requiring audio/visual support must be submitted to the Town Clerk for coordination with the information and technology division a minimum of 48 hours prior to the meeting to ensure proper coordination and preparation. Department directors are responsible for obtaining presentation materials from applicants or presenters involved in their respective agenda items. APP. E - Page 8 Rules of Procedure - 10/05/21 2/21/2023 D. Agenda Item Submittals for Council Executive Sessions. Items may be placed on the agenda for Council executive session discussion (if in compliance with the Town Code and applicable State Statutes) by the following process: 1. Submission by a Councilmember, the Town Manager or the Town Attorney (with notice to all Councilmembers). 2. Submission by the Mayor (with notice to all Councilmembers). 3. The Town Manager and the Town Attorney shall review the submittal for executive session discussions prior to placement on the agenda, to ensure that the item is the proper subject of an executive session pursuant to state law. 4. The Town Attorney shall advice the Town Clerk regarding the appropriate agenda language of executive session items. E. Agenda Packets. Full agenda packets for all noticed meetings (except executive session documentation) of the Council shall be made available to Council members electronically, five days before regular meetings and work sessions; provided, however, that agenda packets may be supplemented later under special circumstances so long as no agenda packet material is made available less than 72 hours prior to the meeting, except in the case of exceptional circumstances or an emergency meeting. F. Removal Requests. Requests to remove items from the Consent Agenda occurring after the 72 hour posting deadline will be announced by the Mayor at the beginning of the meeting at which the item was scheduled. The posted agenda will remain unchanged. 4.3 DISTRIBUTION OF NOTICES AND AGENDAS A. Copies. The Town Clerk shall ensure that the Mayor and Council receive copies of all meeting notices and agendas and any documentation provided for said meeting electronically, not less than 72 hours prior to the meeting, unless exceptional circumstances require a later delivery. B. Distribution. The Town Clerk shall ensure that the meeting notices, agendas and packet documentation, as deemed necessary, are posted to the Town's website: www.fh.az.gov and made available to the Mayor and Council, the public, Town Manager, Town Attorney, and staff electronically by 6:00 p.m. on the Thursday prior to the date of the meeting. C. Amendments. A posted agenda may be amended up to 72 hours prior to such meeting. In exceptional circumstances, such agenda may be amended up to, but not less than, 24 hours prior to the designated meeting, unless otherwise authorized by State Law. Amended agendas shall indicate the date amended. APP. E - Page 9 Rules of Procedure - 10/05/21 2/21/2023 SECTION 5. ORDER OF BUSINESS 5.1 ORDER OF BUSINESS The Order of Business of each meeting shall be as contained in the agenda. The agenda shall be a sequentially numbered listing by topic and a brief description of business items that shall be taken up for consideration. 5.2 REGULAR MEETINGS The agenda shall be prepared substantially in the following order, but may be amended for brevity: AGENDA Call to Order & Pledge of Allegiance Invocation/Moment of Reflection Roll Call Reports by Mayor, Councilmembers and Town Manager (including proclamations) (No discussion) Scheduled Public Appearances/Presentations (if any) Call to the Public (Non-agenda items) (preceded by the following paragraph) Pursuant to ARIZ. REV. STAT. § 38-431.01 (H), public comment is permitted (not required) on matters not listed on the agenda. Any such comment (i) must be within the jurisdiction of the Council and (ii) is subject to reasonable time, place and manner restrictions. The Council will not discuss or take legal action on matters raised during "Call to the Public" unless the matters are properly noticed for discussion and legal action. At the conclusion of the call to the public, individual Councilmembers may (i) respond to criticism, (ii) ask staff to review the matter or (iii) ask that the matter be placed on a future Council agenda. Consent Agenda (preceded by the following explanatory paragraph) All items listed are considered to be routine, non-controversial matters and will be enacted by one motion and vote of the Council. All motions and subsequent approvals of consent items will include all recommended staff stipulations unless otherwise stated. There will be no separate discussion of these items unless a Councilmember or member of the public so requests. If a Councilmember or member of the public wishes to discuss an item on the consent agenda, he/she may request so prior to the motion to accept the Consent Agenda or with notification to the Town Manager or Mayor APP. E - Page 10 Rules of Procedure - 10/05/21 2/21/2023 prior to the date of the meeting for which the item was scheduled. The item will be removed from the Consent Agenda and considered in its normal sequence on the agenda. Action Items (grouped by subject to the extent possible) Council Request for Information From Town Manager Adjournment All agendas shall have the following statement placed at the bottom: The Town of Fountain Hills endeavors to make all public meetings accessible to persons with disabilities. Please call 837-2003 (voice) or 1-800-367-8939 (TDD) 48 hours prior to the meeting to request a reasonable accommodation to participate in this meeting or to obtain agenda information in large print format. A. Roll Call. Following the Call to Order and the Pledge of Allegiance, the Moment of Reflection or Invocation and before proceeding with the business of the Council, the Presiding Officer shall direct the Town Clerk or authorized designee to call the Roll, and the names of Councilmembers both present and absent shall be entered into the minutes. The order of roll call shall be: Mayor, Vice Mayor and then Councilmembers from the Mayor's far right to the Mayor's far left. B. Reports by Mayor, Councilmembers and Town Manager The Mayor may use Reports to read proclamations or conduct other ceremonial matters as listed on the posted agenda and reports may be given by the Mayor, Councilmembers and Town Manager on current events and/or activities. (The Arizona Open Meeting Law does not allow discussion or action on any matter mentioned during the reports.) C. Scheduled Public Appearances/Presentations. The process set forth in Subsection 4.2(B) (4) above applies to members of the public or groups wishing to place an item on the agenda under "Scheduled Public Appearances/Presentations". If the request is approved by the Town Manager, the item will appear on the agenda. The Town Manager shall endeavor to limit the total time for such presentations to ten minutes individually and 30 minutes collectively per Council meeting. Councilmembers may use "Scheduled Public Appearances/Presentations" section to provide an update of official activities, as listed on the posted agenda. D. Call to the Public. 1. All citizens and interested parties will be limited to a maximum of three minutes to address the Council on a non-agenda item. APP. E - Page 11 Rules of Procedure - 10/05/21 2/21/2023 2. All citizens and interested parties wishing to speak before the Council shall fully complete a Request to Comment form (Request Form). Request forms submitted by those who indicate they will not speak will be grouped together in the order in which the cards were received and by the categories of "for" and "against" relating to the item indicated on the request forms. The Town Clerk will announce the number of cards received, if any, and number received per category. 3. At the conclusion of each citizen's comments, the Presiding Officer may take any or all of the following actions: a. Thank speaker for addressing issue. b. Ask staff to review matter. c. Ask that a matter be put on a future agenda. d. Permit individual Councilmembers to respond to criticism raised during the Call to the Public 4. At the discretion of the Presiding Officer a light and/or sound signals may be used to indicate the commencement of the time for speaking and a warning light may flash to show that the appropriate time has passed. A red light will signal that there is no longer any remaining time. E. Consent Agenda 1. The Consent Agenda includes items that are of such a nature that discussion is not required, or issues that have been previously studied by the Council. These items may be adopted by one motion and vote. 2. There is no detailed discussion on items listed under the Consent Agenda, unless a member of the Council or any member of the public in attendance at the meeting requests that an item or items be removed for discussion. Councilmembers or the public may not ask a question without removal of the item from the Consent Agenda. 3. Items removed from the Consent Agenda are considered in their normal sequence as listed on the agenda, unless called out of sequence as provided under Section 1.4 (Suspension of the Rules) above. F. Action Items. 1. At the time each business item is presented to the Council, the Town staff shall present a report on the subject and the applicant, if any, may also speak. The Mayor or the Town Clerk, or authorized designee, will then call the request forms of those citizens desiring input and comments. All citizens and interested parties wishing to speak before the Council shall fully complete request forms and submit the forms to APP. E - Page 12 Rules of Procedure - 10/05/21 2/21/2023 the Town Clerk, or authorized designee, prior to Council discussion of that agenda item. Sufficient request forms shall be located in the Council Chamber's Lobby (the public entry area into the Chamber) and at the Town Clerk's position on the dais. Completed request forms will be retained by the Town Clerk until the draft minutes are approved by the Council at a subsequent meeting. Speakers' names and comments will be summarized and included in the meeting minutes. Speakers will be called in the order in which the request forms were received. If a speaker chooses not to speak when called, such speaker will be deemed to have waived his/her opportunity to speak on that matter. 2. Those speaking before Council will be allowed three contiguous minutes to address Council, but time limits may be waived by (a) discretion of the Town Manager upon request by the speaker not less than 24 hours prior to a meeting, (b) consensus of the Council at a meeting or (c) the Mayor either prior to or during a meeting. Speakers may not (a) reserve a portion of their time for a later time, or (b) transfer any portion of their time to another speaker. 3. The purpose of all public comments is to provide information and the speaker's views for Council consideration. It is not appropriate for the speakers to question directly, or debate the matter under consideration with staff, other speakers, the audience or Councilmembers; all remarks will be addressed to the Presiding Officer and not to individual Councilmembers. All comments shall be addressed through the Presiding Officer who shall decide if any response is warranted and who, if anyone, shall address the concern. Councilmembers may request, upon recognition by the Presiding Officer, clarification of comments or materials presented by the speakers, any applicant's representatives or Town staff; provided, however, that no Councilmember shall engage in debate directly with such speakers, representatives or Town staff. 4. Proper decorum, in accordance with Section 6.4 below, must be observed by Councilmembers, by speakers in providing testimony and remarks and by the audience. In order to conduct an orderly business meeting, the Presiding Officer shall keep control of the meeting and shall require the speakers and audience to refrain from abusive or profane remarks, disruptive outbursts, applause, protests or other conduct that disrupts or interferes with the orderly conduct of the business of the meeting. Personal attacks on Councilmembers, Town staff or members of the public are not allowed. 5. Generally, agenda items requiring public hearings, other than those of a quasi-judicial nature, shall be conducted in the following order: APP. E - Page 13 Rules of Procedure - 10/05/21 2/21/2023 a. The Presiding Officer will announce the matter that is set forth for a public hearing, will then open the public hearing, and, if appropriate, ask the staff to provide a report of the matter. b. The Presiding Officer will then ask the applicant to speak regarding the matter. c. After all public comments are heard, the Presiding Officer will close the public hearing, and may ask staff or the applicant to respond to the comments. d. The Presiding Officer may then call for a motion and second, if applicable, and ask if Council wishes to discuss the issue. Council may then proceed to discuss the matter. e. Upon the conclusion of Council comment, the Presiding Officer will call for action on the motion. f. Exhibits, letters, petitions, and other documentary items presented or shown to the Council on a public hearing item become part of the record of the public hearing and shall be maintained by the Town Clerk. g. Ten collated sets of written or graphic materials should be provided by the speaker to the Town Clerk prior to the commencement of the hearing to allow for distribution to the Council, key Town staff and the Town Clerk for inclusion in the public record. Reduced copies (8”x 11") of large graphic exhibits should be provided as part of the sets of materials for distribution as provided above. The appropriate staff member shall be responsible to notify applicants of this requirement. 6. Questions or comments from the public shall be limited to the subject under consideration. Depending upon the extent of the agenda and the number of persons desiring to speak on an issue, the Presiding Officer may, at the beginning of the agenda item, limit repetitive testimony, and limit the amount of time per speaker. Upon approval of (a) the Presiding Officer or (b) a majority of the Council, persons may be allowed to speak longer than three minutes. Councilmembers may ask the individual speaker questions through the Presiding Officer. 7. Quasi-judicial hearings shall be conducted in accordance with the principles of due process, and the Town Attorney shall advise the Council in this regard. G. Council Request for Information from Town Manager. The Council may (1) request the Town Manager to follow-up on matters presented at that meeting; and/or (2) a consensus of the Council may request the Town Manager to research a matter and report back to the Council. APP. E - Page 14 Rules of Procedure - 10/05/21 2/21/2023 H. Adjournment. The open, public meeting of the Council may be adjourned by consensus of the Council. 5.3 SPECIAL MEETINGS A. As Substitute for Regular Meeting. If a special meeting is being held as an extension of or in place of a regular meeting, the agenda shall be as set forth for a regular meeting. B. Generally. For all other special meetings, the agenda shall be prepared in the following order: AGENDA Call to Order Roll Call Consent Agenda (if needed - explanatory paragraph same as regular meeting) Action Items (grouped by subject to the extent possible) Adjournment 5.4 WORK SESSION MEETINGS The primary purpose of work sessions is to provide the Council with the opportunity for in-depth discussion and study of specific subjects. Public comment is not provided for on the agenda and may be made only as approved by consensus of the Council. In appropriate circumstances, a brief presentation may be permitted by a member of the public or another interested party on an agenda item if invited by the Mayor and Council to do so. The Presiding Officer may limit or end the time for such presentations. The work session agenda shall be prepared in the following order: Call to Order Roll Call Work Session Statement (explanatory statement) All Items Listed Are for Discussion Only. No Action Can or Will Be Taken. The primary purpose of work sessions is to provide the Council with the opportunity for in-depth discussion and study of specific subjects. Public comment is not provided for on the agenda and may be made only as approved by consensus of the Council. In appropriate circumstances, a brief presentation may be permitted by a member of the public or another interested party on an agenda item if invited by the Mayor or the Town Manager to do so. The Presiding Officer may limit or end the time for such presentations. APP. E - Page 15 Rules of Procedure - 10/05/21 2/21/2023 Agenda Items for Discussion (Items Numbered for Order) Adjournment SECTION 6. PROCEDURES FOR CONDUCTING THE MEETING 6.1 CALL TO ORDER A meeting of the Council shall be called to order by the Presiding Officer, (the Mayor or in his/her absence, by the Vice-Mayor). In the absence of both the Mayor and Vice-Mayor, the meeting shall be called to order by the Town Clerk, who shall immediately call for the selection of a temporary Presiding Officer. 6.2 PARTICIPATION OF PRESIDING OFFICER The Presiding Officer may debate from the Chair, subject only to such limitations of debate as are imposed on all Councilmembers, and he/she shall not be deprived of any of the rights and privileges of a Councilmember by reason of his/her acting as Presiding Officer. However, the Presiding Officer is primarily responsible for the conduct of the meeting. 6.3 QUESTION TO BE STATED The Presiding Officer shall verbally restate, or shall ask the Town Clerk to verbally restate, each question immediately prior to calling for discussion and the vote. Following the vote, the Presiding Officer shall ask the Town Clerk or authorized designee to verbally announce the results of voting, including the ayes, nays and abstentions. The Presiding Officer shall publicly state the effect of the vote for the benefit of the audience before proceeding to the next item of business. Formal votes shall not be taken at work sessions or executive sessions. 6.4 RULES/DECORUM/ORDER A. Points of Order. The Presiding Officer shall determine all points of order after consultation with the Parliamentarian, subject to the right of any member to appeal such determination to the whole Council. If any appeal is taken, the question (motion) shall be substantially similar to the following: "Shall the decision of the Presiding Officer be sustained?" In which event, following a second, a majority vote shall govern, and conclusively determine such question of order. B. Order and Decorum 1. Councilmembers: Any Councilmember desiring to speak shall address the Presiding Officer and, upon recognition by the Presiding Officer, may speak. APP. E - Page 16 Rules of Procedure - 10/05/21 2/21/2023 2. Employees: Members of the administrative staff and employees of the Town shall observe the same rules of procedure and decorum applied to Councilmembers. The Town Manager shall ensure that all Town employees observe such decorum and will direct the participation of any staff member in the discussion of the Council. The Town Manager shall first be recognized by the Presiding Officer prior to addressing the Council. Any staff member desiring to speak shall first be recognized by the Town Manager. 3. Public: Members of the public attending the meetings shall observe the same rules of order and decorum applicable to the Council. Unauthorized remarks or demonstrations from the audience, such as applause, stamping of feet, whistles, boos or yells shall not be permitted by the Presiding Officer, who may direct a law enforcement officer to remove such offender/s from the room. C. Enforcement of Decorum. Proper decorum is to be maintained during all meetings by the Council, staff and guests. It is the responsibility of the Presiding Officer of the meeting to ensure compliance with this Policy. The Presiding Officer shall request that a speaker refrain from improper conduct; if the speaker refuses, the Presiding Officer may end the speaker's time at the podium. If the speaker refuses to yield the podium after being asked to do so by the Presiding Officer, the Presiding Officer may (1) recess the meeting for a brief time (2) end the speaker's time at the podium or (3) direct a law enforcement officer present at the meeting to remove from the meeting the person whose conduct is disorderly or disruptive. 6.5 TELECONFERENCE PROCEDURE Meetings may be conducted by teleconference as follows: A. Prior Notice. When a Councilmember is unable to attend a meeting and desires to participate in the meeting by telephone, the Councilmember shall be permitted to do so provided he/she gives the Town Clerk, or authorized designee, notice of his/her inability to be present at the meeting at least 48 hours prior to the meeting. B. Notation on Agenda. The notice of the meeting and the agenda shall include the following: "Councilmembers of the Town of Fountain Hills will attend either in person or by telephone conference call." C. Public Access. Facilities will be used at the meeting to permit the public to observe and hear all telephone communications. D. Notation in Minutes. The minutes of the meeting shall clearly set forth which members are present in person and which are present by telephone. 6.6 ADDRESSING THE COUNCIL A. Manner of Addressing the Council. APP. E - Page 17 Rules of Procedure - 10/05/21 2/21/2023 1. Any member of the public desiring to address the Council shall proceed to the podium after having been recognized by the Presiding Officer. There shall be no loud vocalization (shouting or calling out) from the seating area of the Council Chamber. At the podium, the speaker shall clearly state his/her name for the record and shall indicate if he/she is a Town resident. 2. Special assistance for sight and/or hearing-impaired persons can be provided. Anyone requiring such assistance should contact the Town Clerk 48 hours before a meeting to request an accommodation to participate in the meeting. B. Limitation Regarding Public Comment and Reports. The making of oral communications to the Council by any member of the public during the "Call to the Public: (Non- agenda Items)" or under an action item, shall be subject to the following limitations: 1. All citizens wishing to address the Council shall complete and submit a request form as set forth in Subsection 5.2(F) above. 2. The Presiding Officer may limit the number of speakers heard on non- agenda topics at any single meeting to allow the meeting to proceed and end in a timely manner. 3. If it appears that several speakers desire to provide repetitive comments regarding a single topic, the Presiding Officer may limit the number of speakers. C. Motions. 1. Processing of Motions: When a motion is made and seconded, it shall be stated by the Presiding Officer before debate. 2. Precedence of Motions: When a motion is before the Council, no motion shall be entertained except the following, which shall have precedence in the following order: a. Fix the time to adjourn b. Adjourn c. Recess d. Raise a question of Privilege e. Table f. Limit or extend limits of debate g. Postpone to a certain time and date h. Amend i. Postpone Indefinitely j. Main Motion APP. E - Page 18 Rules of Procedure - 10/05/21 2/21/2023 3. Motion to Postpone Indefinitely: A motion to postpone indefinitely is used to dismiss an item on the agenda. This motion is debatable, and because it can be applied only to the main question, it can, therefore, only be made while the main question is immediately pending (a motion and second is on the floor). This motion is commonly used to postpone an item until a more appropriate time. 4. Motion to Table: A motion to table enables the assembly to lay the pending question aside temporarily when something else of immediate urgency has arisen, in such a way that there is no set time for taking the matter up again. A motion to table shall be used to temporarily by-pass the subject. A motion to table shall not be debatable and shall preclude all amendments or debate of the subject under consideration. If the motion shall prevail, the matter may be "taken from the table" at any time prior to the end of the next regular meeting. 5. Motion to Limit or Terminate Discussion: Such a motion shall be used to limit or close debate on, or further amendment to, the main motion. This is referred to as "Call for the Question" and is the motion used to cut off debate and to bring the group to an immediate vote on the pending motion; it requires a two-thirds vote. The vote shall be taken by voice. If the motion fails, debate shall be reopened; if the motion passes, a vote shall be taken on the main motion. 6. Motion to Amend: a. A motion to amend shall be debatable only as to the amendment. A motion to amend an amendment on the floor shall not be in order. b. An amendment modifying the intention of a motion shall be in order, but an amendment relating to a different matter shall not be in order. c. Amendments shall be voted on first, prior to consideration of subsequent amendments. After all amendments have been voted on, the Council shall vote on the main motion (as amended, if applicable). 7. Motion to Continue: Motions to continue shall be debatable only as to the propriety of postponement. Motions to continue to a definite time shall be amendable and debatable as to propriety of postponement and time set only. D. Addressing the Council after Motion is made. After the motion has been made, or after a public hearing has been closed, no member of the public shall address the Council without first securing permission from the Presiding Officer. APP. E - Page 19 Rules of Procedure - 10/05/21 2/21/2023 E. Voting Procedure. After discussion has been concluded and the Mayor, the Councilmember who made the motion or the Town Clerk has restated the motion under consideration, the following procedure shall apply: 1. Casting a Vote: a. In acting upon every motion, the vote shall be taken by casting a mechanical yes/no vote, voice, roll call or any other method as determined by the Presiding Officer, by which the vote of each member of the Public Body can be clearly ascertained and recorded in the meeting minutes. Upon the request of the Mayor or a Councilmember, the vote shall be taken by roll call. b. The vote on each motion shall be entered into the record by names of the Councilmembers voting for or against. The Record also shall include the names of any member not casting a vote by reason of being absent from the room at the time of the vote. c. If a Councilmember has declared a Conflict of Interest, the Town Clerk shall include a statement such as "Abstained due to declared Conflict of Interest" in the official minutes as part of the results of the vote. d. If the roll call method of voting is used, the Town Clerk or designee shall call the names of all members in random order with each new vote. Members shall respond "Aye" or "Nay." 2. Failure to Vote: a. All Councilmembers in attendance at a duly called meeting that requires formal Council action are required to vote. A member may abstain from voting only if he/she has a conflict of interest under State law, in which case such member shall take no part in the deliberations on the matter in question. b. Should a Councilmember fail to vote or offer a voluntary abstention, his/her vote shall be counted with the majority of votes cast, unless the Councilmember's vote is excused by the State law; however, in the event of a tie vote, his/her vote shall be counted as "Aye." 3. Reconsideration: Any Councilmember who voted with the majority may move a reconsideration of any action at the same or next regular meeting. To ensure that the open meeting law requirements are met, a written request from such Councilmember must be submitted to the Town Clerk’s Office at least nine days prior to the next regular meeting. After a motion for reconsideration has once been acted upon, no other motion for reconsideration thereof shall be made without the unanimous consent of the Council. APP. E - Page 20 Rules of Procedure - 10/05/21 2/21/2023 4. The affirmative vote of a majority of a quorum shall be required for passage of any matter before the Council. SECTION 7. CONFLICT OF INTEREST 7.1 INTRODUCTION Occasionally, a Councilmember may find himself/herself in a situation that requires a Councilmember remove himself/herself from participation in discussion and voting on a matter before the Council. This situation exists when the Councilmember has a "conflict of interest" as defined by the Arizona Conflict of Interest Law. This law establishes minimum standards for the conduct of public officers and employees who, in their official capacity, are, or may become involved with, a decision, which might unduly affect their personal interests or those of their close relatives. 7.2 PURPOSE OF CONFLICT OF INTEREST LAWS The purpose of Arizona's Conflict of Interest Law is to prevent self-dealing by public officials and to remove or limit any improper influence, direct or indirect, which might bear on an official's decision, as well as to discourage deliberate dishonesty. 7.3 APPLICABILITY OF THE ARIZONA CONFLICT OF INTEREST LAW The Arizona Conflict of Interest Law as now set forth or as amended in the future, applies to all actions taken by Councilmembers, Board members, Commissioners, and Committee members. 7.4 DISCLOSURE OF INTEREST Any Councilmember, Board member, Commissioner, or Committee member who may have a conflict of interest should seek the opinion of the Town Attorney as to whether a conflict exists under the State law. Any member who has a conflict of interest in any decision must disclose that interest at the meeting and in writing on a form provided by the Town Clerk. The disclosure of the conflict shall include a statement that the member withdraws from further participation regarding the matter. The Town Clerk or designee shall maintain for public inspection all documents necessary to memorialize all disclosures of a conflict of interest by a member. 7.5 WITHDRAWAL FROM PARTICIPATION Having disclosed the conflict of interest and withdrawn in the matter, the Councilmember, Board member, Commissioner, or Committee member must not communicate about the matter with anyone involved in the decision making process in any manner. Further, the member should not otherwise attempt to influence the decision and should remove himself/herself from the Council Chamber, or APP. E - Page 21 Rules of Procedure - 10/05/21 2/21/2023 other location where a meeting is being held, while the matter is considered. Failure to disclose any conflict of interest is addressed in Section 7.8 below. 7.6 RULE OF IMPOSSIBILITY In the unlikely situation that the majority of Councilmembers, Board members, Commissioners, or Committee members have a conflict of interest and the Council, Board, Commission or Committee is unable to act in its official capacity, members may participate in the discussion and decision after making known their conflicts of interest in the official records. 7.7 IMPROPER USE OF OFFICE FOR PERSONAL GAIN Public officers and employees are prohibited from using or attempting to use their official positions to secure valuable things or benefits for themselves, unless such benefits are (A) part of the compensation they would normally be entitled to for performing their duties or (B) otherwise permitted according to State Law. 7.8 SANCTIONS FOR VIOLATIONS Violations of the conflict of interest provisions set forth herein shall be punished as provided for in State law. 7.9 NON-STATUTORY CONFLICTS OF INTEREST Occasionally, a Councilmember, Board member, Commissioner, or Committee member may feel that he/she should ethically refrain from participation in a decision even though the circumstances may not amount to a conflict of interest under the State law described above. It is the policy of the Council to encourage members to adhere to strongly held ethical values, which are exercised in good faith. However, subsection 6.6(E) (2) above encourages participation in the decision making process unless the matter involves a statutory conflict of interest set forth by State law. SECTION 8. CODE OF ETHICS The purpose of this policy for the Town is to ensure the quality of the Town Government through ethical principles that shall govern the conduct of the Council and members of the Town's boards, commissions, and committees. In furtherance of this purpose, we shall: 8.1 OBEY THE CONSTITUTION AND LAWS OF THE UNITED STATES OF AMERICA, THE CONSTITUTION, AND LAWS OF THE STATE OF ARIZONA AND THE LAWS OF THE TOWN OF FOUNTAIN HILLS. APP. E - Page 22 Rules of Procedure - 10/05/21 2/21/2023 8.2 BE DEDICATED TO THE CONCEPTS OF EFFECTIVE AND DEMOCRATIC LOCAL GOVERNMENT THROUGH DEMOCRATIC LEADERSHIP. We shall honor and respect the principles and spirit of representative democracy and shall set a positive example of good citizenship by scrupulously observing the letter and spirit of laws, rules, and regulations. 8.3 AFFIRM THE DIGNITY AND WORTH OF THE SERVICES RENDERED BY THE TOWN GOVERNMENT AND MAINTAIN A DEEP SENSE OF SOCIAL RESPONSIBILITY AS A TRUSTED PUBLIC SERVANT. 8.4 BE DEDICATED TO THE HIGHEST IDEALS OF HONOR, ETHICS, AND INTEGRITY IN ALL PUBLIC AND PERSONAL RELATIONSHIPS. A. Public Confidence. We shall conduct ourselves so as to maintain public confidence in Town government and in the performance of the public trust. B. Impression of Influence. We shall conduct our official and personal affairs in such a manner as to give a clear impression that we cannot be improperly influenced in the performance of our official duties. 8.5 RECOGNIZE THAT THE CHIEF FUNCTION OF LOCAL GOVERNMENT IS AT ALL TIMES TO SERVE THE BEST INTERESTS OF ALL THE PEOPLE. We shall treat our office as a public trust, only using the power and resources of public office to advance public interests and not to attain personal benefit or pursue any other private interest incompatible with the public good. 8.6 KEEP THE COMMUNITY INFORMED ON MUNICIPAL AFFAIRS; ENCOURAGE COMMUNICATION BETWEEN THE CITIZENS AND ALL MUNICIPAL OFFICERS; EMPHASIZE FRIENDLY AND COURTEOUS SERVICE TO THE PUBLIC; AND SEEK TO IMPROVE THE QUALITY AND IMAGE OF PUBLIC SERVICE. A. Accountability. We shall ensure that government is conducted openly, efficiently, equitably, honorably, and in a manner that permits the citizens to become fully informed to allow them to hold Town officials accountable. B. Respectability. We shall safeguard public confidence in the integrity of Town government by being honest, fair, caring, and respectful, and by avoiding conduct creating the unexplainable appearance of impropriety, or impropriety of which is otherwise unbefitting a public official. 8.7 SEEK NO FAVOR; BELIEVE THAT PERSONAL BENEFIT OR PROFIT SECURED BY CONFIDENTIAL OR PRIVILEGED INFORMATION OR BY MISUSE OF PUBLIC TIME IS DISHONEST. APP. E - Page 23 Rules of Procedure - 10/05/21 2/21/2023 A. Private Employment. We shall take any steps necessary to ensure that we comply with the State law regarding conflicts of interest when we engage in, solicit, negotiate for, or promise to accept private employment or render services for private interests or conduct a private business. B. Confidential Information. We shall not disclose to others, or use to further our personal interest, confidential information acquired in the course of our official duties. C. Gifts. We shall not directly or indirectly, in connection with service to the Town, solicit any gift or accept or receive any gift - of any value - whether it be money, services, loan, travel, entertainment, hospitality, promise, or any other form of gratuity. This policy shall not apply to hospitality, transportation or other assistance provided to Town officials when such hospitality, transportation of other assistance is (i) directly related to their participation in community events as a representative of the Town or (ii) of inconsequential value and accepted as a courtesy. D. Investment in conflict with official duties. We shall not invest or hold any investment, directly or indirectly, in any financial business, commercial or other private transaction that creates a conflict with our official duties. E. Personal relationships. Personal relationships shall be disclosed in any instance where there could be the appearance of conflict of interest or a conflict of interest 8.8 CONDUCT BUSINESS OF THE TOWN IN A MANNER, WHICH IS NOT ONLY FAIR IN FACT, BUT ALSO FAIR IN APPEARANCE. 8.9 PROMOTE UNDERSTANDING, MUTUAL RESPECT AND TRUST AMONG MEMBERS OF COUNCIL, BOARDS, COMMISSIONS AND COMMITTEES CONCERNING THEIR ROLES AND RESPONSIBILITIES WITH RESPECT TO TOWN STAFF'S RESPONSIBILITY FOR IMPLEMENTING THE COUNCIL'S POLICIES. All members of the Council, boards, commissions, or committees shall acknowledge in writing, on a form provided by the Town Clerk, receipt of these provisions relating to ethics. SECTION 9. BOARDS, COMMISSIONS, AND COMMITTEES The Fountain Hills' Council may create such boards, commissions, and committees as deemed necessary to assist in the conduct of the operation of Town government. The Council may authorize and direct the Town Manager to establish ad hoc committees as needed in order to provide additional flexibility with regard to conducting Town business. APP. E - Page 24 Rules of Procedure - 10/05/21 2/21/2023 9.1 REGULARLY SCHEDULED OR UNSCHEDULED BOARDS, COMMISSIONS AND COMMITTEES A. Classification. All boards, commissions, and committees of the Town shall be classified as regularly scheduled or unscheduled boards, commissions, and committees. Regularly scheduled boards, commissions, and committees are those that meet on a regularly- scheduled basis or may be quasi-judicial in nature. Unscheduled boards, commissions, and committees meet on an as-called basis. B. Regularly Scheduled. Regularly scheduled boards, commissions, and committees include: 1. Planning and Zoning Commission 2. Community Services Advisory Commission 3. McDowell Mountain Preservation Commission 5. Strategic Planning Advisory Commission 6. Sister Cities Advisory Commission 6. Municipal Property Corporation C. Unscheduled. Unscheduled boards, commissions, and committees: 1. Ad Hoc Committees 2. Board of Adjustment D. Sunset. Except for the Planning and Zoning Commission and Board of Adjustment, any board, commission, or committee created shall cease to exist (1) upon the accomplishment of the special purpose for which it was created or (2) when abolished by a majority vote of the Council. 9.2 SELECTION OF BOARD, COMMISSION, OR COMMITTEE MEMBERS A. Call for Applications. The call for applications to fill vacant seats for boards, commissions and committees may include a request for: 1. A cover letter of interest. 2. A resume. 3. The application that describes the applicant’s skills, experience, and education background needed to ensure the successful filling of the vacancy. APP. E - Page 25 Rules of Procedure - 10/05/21 2/21/2023 4. Responses to the supplemental questionnaire specific to a board, commission, or committee application, if such questionnaire is included. 5. The consent to executive session form. 6. If a member whose term will be expiring wishes to reapply for an additional term on the same board, commission or committee, such member is exempt from filing those items listed in Subsections 9.2 (A)(1-4). However, such member shall submit in writing, on a form provided by the Town Clerk that includes a request for the Council's consideration of reappointment in addition to the consent to executive session as listed in Subsection 9.2(A)(5). The member may include any new or additional information that is relevant to the original application already on file. B. Advertising/Timing and Location. The Town Clerk shall be responsible for advertising to fill vacant seats to boards, commissions, and committees for at least two weeks and no later than two months, prior to the expiration of the current board, commission, or committee member(s) term, via: 1. The Town's government access channel. 2. Newspaper advertising. 3. The Town website. 4. The Town's official posting sites as listed in Section 2-4-3 of the Fountain Hills Town Code. The downloadable application packet will be placed on the Town's website for public access with hard copies made available to the public through the Customer Service Representative. C. Advertisement Contents. Advertisement of vacancies shall include the following: 1. The name of the board, commission, or committee. 2. The number of vacancies to be filled. 3. A brief description of the board, commission, or committee. 4. A brief description of the qualifications, skills and experience background applicants should possess, if any. 5. An overview of when the board, commission, or committee meets. 6. The deadline for submitting applications. APP. E - Page 26 Rules of Procedure - 10/05/21 2/21/2023 7. Listing of applicant information required and location where application packets may be obtained. 8. Staff liaison contact information. 9. The dates of publication in the local paper. D. Staff Review. Individuals applying for boards, commissions, or committees must submit to the Town Clerk those items as listed in Subsection 9.2(A) above by the published deadline. The Town Clerk and Staff Liaison will review the application(s) to ensure that the applicant(s) meet the qualifications as listed in Subsection 9.4(A) below. E. Council Materials. The staff liaison to the board, commission, or committee will assemble and copy all application packets and provide all supporting materials to all Councilmembers. F. Subcommittee Review/Interview. The Council subcommittee shall interview all applicants, unless there are more than five applicants for each vacancy, in which case the subcommittee may choose, at its discretion, to limit the number of interviewed applicants to five per vacancy after meeting to review all of the applications. The staff liaison will schedule an appropriate time to interview qualified applicants in person or via telephone, and shall prepare and post the agenda for an executive session in accordance with the Arizona open meeting law for said interviews. Interviews shall be conducted in Executive Session unless the applicant requests the interview be held at a public meeting. G. Subcommittee Recommendation. After the interviews have concluded, the staff liaison, Town Clerk or the Council Subcommittee chair shall advise the Mayor of the subcommittee's discussion and appointment recommendation(s). H. Council Consideration. The Town Clerk shall prepare the Staff Report according to the submission deadline for the next appropriate Council meeting agenda, including the following information: (1) a review of the steps taken to recruit applicants, (2) the number of vacancies to be filled along with the names of those members whose terms expire, (3) the number of applications received and (4) the specific term to be filled. I. Notification of Council Meeting. The staff liaison shall notify the appointee(s) that he/she is a possible candidate for appointment to a board, commission, or committee and suggest that he/she may want to be present at the scheduled meeting when the recommendation is presented to the Council. J. Notification of Council Action. Following the Council's approval of the Mayor's appointment(s) to a board, commission, or committee, the Town Clerk shall notify appointees as to their appointment and provide them with an Oath of Office, Ethics Policy and Open Meeting Law APP. E - Page 27 Rules of Procedure - 10/05/21 2/21/2023 Affirmation for their signature and return. Those applicants not chosen to fill a vacancy on a board, commission, or committee, will be provided written notification by the Town Clerk outlining the Council's appointments and they will be provided with an application of interest for consideration of applying for any other board, commission and committee vacancies. K. Appointee Orientation. The staff liaison will provide specific details to the new appointees relative to: (1) their attendance at the "official" board, commission, or committee orientation, and (2) all official literature, agendas, minutes, or other materials specific to their appointment. 9.3 RECOMMENDATIONS FOR APPOINTMENTS TO BOARDS, COMMISSIONS AND COMMITTEES A. Appointments Subcommittee. The Mayor may annually appoint Council Subcommittees for board, commission and committee appointments. Each subcommittee shall be made up of three Councilmembers. The Mayor may appoint himself/herself to this subcommittee. If no such subcommittee is appointed, at a minimum, a quorum of the Fountain Hills Council shall review applications and conduct interviews for the various boards, commissions, and committees to fill vacancies based upon the applicants' skills, experience, and background as required under Section 9.4 below. B. Subcommittee Purpose. The purpose of this Council Subcommittee is to review applications, interview applicants (typically in Executive Session) and provide a recommendation to the Mayor for possible appointment to fill vacancies based upon the applicants' skills, experience, and background as required under Section 9.4 below. C. Appointment Timing. The process of application review and interviews will be conducted in such a manner as to allow for the appointments to coincide with the term expiration of the current board, commission or committee member(s) term or as soon thereafter as reasonably possible. 9.4 QUALIFICATIONS FOR APPOINTMENTS; EMPLOYEES OR APPOINTED OFFICERS AS MEMBERS A. Minimum Qualifications. All members of boards, commissions, and committees shall meet the following minimum qualifications upon their appointment to any board, commission, or committee. Each member must be: 1. Eighteen years of age or older, for any board, commission, or committee seats, designated by Council; except for members appointed to Youth Commissioner position for youth representation. 2. A Fountain Hills resident for at least one year, unless the Council specifically waives this time or residency requirement for a specific board, commission or committee. 3. A qualified elector, except youth appointees. APP. E - Page 28 Rules of Procedure - 10/05/21 2/21/2023 B. Prohibited Appointees. Town employees or appointed officers shall not be eligible for appointment to any board, commission, or committee but may be requested to provide staff support thereto. Councilmembers are prohibited from serving on regularly scheduled commissions as listed in Subsection 9.1(B) above and the Board of Adjustment. C. Ex-Officio Members. The Mayor, with the consent of the Council, may from time to time appoint ex-officio members to those boards, commissions or committees as set forth in the bylaws of such body. Such members shall serve at the pleasure of the Mayor and Council. Ex-officio members shall not be entitled to vote on any matter brought before the commission. 9.5 TERMS, VACANCIES, REMOVAL A. Terms. All members of unscheduled boards, commissions, and committees shall serve a term of up to three years, or until the board, commission, or committee is dissolved, unless Council action, Town Code, or Arizona Revised Statutes specifically designates terms. B. Staggered Terms for Smaller Boards. For those regularly scheduled boards, commissions, and committees having five members or fewer, the terms of office shall be staggered so that no more than two terms shall expire in any single year when possible; provided, however, that no staggering of terms shall be required for any boards, commission, or committee that will be in existence for a single term. C... Staggered Terms for Larger Boards. For those boards, commissions, and committees having more than five members but less than eight members, the terms of office shall be staggered so that no more than three terms shall expire in any single year when possible; provided, however, that no staggering of terms shall be required for any board, commission, or committee that will be in existence for a single term. D. Simultaneous Service Limitation. No individual may serve as a voting member on more than one regularly scheduled or unscheduled board, commission, and committee at one time. E. Vacancies. A vacancy on a board, commission, or committee shall be deemed to have occurred upon the following: 1. Death or resignation of a member of a board, commission, or committee. 2. A member ceasing to be a resident of the Town of Fountain Hills, unless the Council has provided that such member may be a non-resident. 3. Three successive unexcused or unexplained absences by a member from any regular or special board, commission, or committee meetings. However, the term of all members shall extend until their successors are appointed and qualified. APP. E - Page 29 Rules of Procedure - 10/05/21 2/21/2023 F. Removal. Any board, commission, or committee member may be removed as a member to that board, commission, or in accordance with Article 2A-1 of the Fountain Hills Town Code. G. Filling Vacancy. Whenever a vacancy has occurred on one board, commission, or committee procedures described in Sections 9.2, 9.3, and 9.4 above will be used to generate applicants, interview applicants, and make a recommendation for a potential appointee. One exception to this rule is that if a vacancy should occur within twelve months of a subcommittee’s interviewing process for said board/commission/committee, and the subcommittee had submitted a ranking of those previously interviewed, a recommendation may be forwarded to the mayor for appointment of the unexpired term based on said ranking. H. Re-appointment. An incumbent member of a board, commission, or committee seeking reappointment shall submit, in writing on a form provided by the Town Clerk that includes a request for the Council's consideration of reappointment in addition to the consent to executive session form by the published deadline in order to be considered for appointment by the Council. The member may include anyone or additional information that is relevant to the original application already on file. 9.6 APPLICABILITY OF THE ARIZONA OPEN MEETING LAW All boards, commissions, and committees are subject to the Arizona Open Meeting Law and therefore shall attend the Town's Annual Open Meeting Law training. 9.7 RESIDENCY REQUIREMENT Members of all boards, commissions or committees shall be residents of the Town. ITEM 8. D. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Regular Agenda                  Submitting Department: Development Services Prepared by: John Wesley, Development Services Director Request to Town Council Regular Meeting (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION: Adoption of the Fountain Hills Environmental Plan 2022 Staff Summary (Background) Over the last couple of years the Town's Strategic Planning Advisory Commission (SPAC) prepared and recommended to the Council an updated Strategic Plan.  On March 1, 2022, the Commission presented their final plan recommendation to the Town Council.  At that meeting the Council voted to adopt the recommended plan with a few minor modifications. One of the Strategic Priorities in the adopted plan is "Continue to improve the public health, well-being, and safety of our Town." A Signature Strategy under that priority is to "Promote the natural and built environment of Fountain Hills to improve the public health, well-being, and safety of the community." Supporting Task D for this Strategy is "Create and publicize an Environmental Plan for Fountain Hills." Following Council approval of the new Strategic Plan, staff began reviewing options for implementing the strategy to create and publicize an environmental plan and reviewed those options with the SPAC.  Through this review, it was recognized that the voter approved General Plan included just about all the items desired in the environmental plan, but not organized in a manner which was easily read and used.  The one item which was missing was discussion regarding becoming a biophilic community.  Biophilia focuses on connecting people with nature and the environment through our built designs and communities.  It was determined that the desired environmental plan could be created by pulling the elements contained in the General Plan together into one document, adding some clarifying content, and adding a section regarding efforts to become a biophilic community. Attached is a copy of the Fountain Hills Environmental Plan 2022 as recommended by the SPAC.  Once adopted by the Council, staff will work to publicize the Plan and continue our efforts to implement the tasks contained in the Plan.  The recommended plan pulls together the goals, policies, and action items which were previously approved by Council and adopted by the voters in 2020 into one focused document to facilitate review, understanding, and implementation.  Related Ordinance, Policy or Guiding Principle Fountain Hills General Plan 2020 Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) The Strategic Plan Advisory Commission reviewed and discussed the draft plan with staff at several meetings.  At their meeting on November 16, 2022, the Commission voted to approve an endorsement of the Plan to the Town Council. Staff Recommendation(s) Staff recommends the Council adopt the Fountain Hills Environmental Plan. SUGGESTED MOTION MOVE to adopt the Fountain Hills Environmental Plan. Attachments Environmental Plan 2022  Form Review Inbox Reviewed By Date Development Services Director (Originator)John Wesley 02/07/2023 09:00 AM Finance Director David Pock 02/07/2023 09:08 AM Town Attorney Aaron D. Arnson 02/07/2023 03:24 PM Town Manager Grady E. Miller 02/08/2023 11:34 AM Form Started By: John Wesley Started On: 02/01/2023 10:17 AM Final Approval Date: 02/08/2023  TOWN OF FOUNTAIN HILLS ENVIRONMENTAL PLAN 2022 Introduction Environmental Plan 1. Require all newly platted or re-platted hillside properties to provide a Hillside Protection Easement for each parcel as required by ordinance; 2. Identify where appropriate trails should be located per the direction provided in the Parks, Recreation, Trails, and Open Space Map and the Social Environment goals and policies and develop public educational materials to discourage off-trail use and protect wildlife habitat and vegetation; 3. Discourage un-permitted grading or dumping and require re-vegetation for violators; 4. Encourage redevelopment, revitalization, and rehabilitation to reduce land consumption; 5. Continually update the approved low-water use plant list to ensure that all plants on the list are suitable for the community; 6. Continually protect dark skies; and 7. Update the Land Disturbance Regulations when appropriate. Continue to preserve and conserve the natural desert, support open space, identify and protect historical and archaeological resources, and develop and implement programs and policies that encourage water and energy conservation and reduce water and air pollution. Guiding Principles GOAL 1: Continue to promote the vigilance and guardianship of the natural desert. POLICIES Continue to support the following Town policies: ACTION ITEMS 1. Continue to enforce and update all applicable ordinances, including Land Disturbance Regulations, to conserve the natural desert, protect open space, hillsides, unpaved trails, wild habitats, and dark skies, and encourage low-water-use, drought-tolerant landscapes 2. Require observance of all applicable requirements through the Development Review Process. GOAL 2: Provide and maintain an open space network throughout the community. POLICIES 1. Continue to protect the existing natural washes within the platted portions of the community as permanent natural desert open spaces. 2. Continue to identify and evaluate all wash/wildlife corridors in unsubdivided areas and encourage landowners to ensure those corridors are rezoned to one of the Open Space (OS) Zoning Districts. 3. Continue the development of land trusts and taxing mechanisms that have community support to accomplish open space acquisition and management programs. 4. Continue to require new development to meet recreational/open space needs as part of site design through the development plan review process. 5. Encourage the private development of a neighborhood park as a part of subdivision design, which may or may not be conveyed to the Town or other public entities even though its status as a permanent open space is secured. 6. Continually support unpaved trails within the Town limits that provide connectivity and opportunities for recreation, enjoyment, and use of the Sonoran Desert subject to the appropriate findings and studies in places where they have little impact on residential developments and natural wildlife. ACTION ITEMS 1. Continue to protect natural washes, wildlife corridors, open space, and the unpaved trail network through established mechanisms, including subdivision regulations, Open Space (OS) Zoning Districts, available space acquisition, and DRP. 2. Support the creation of neighborhood parks and continued development of unpaved trails through the DRP and subdivision regulations approval processes GOAL 3: Provide open space linkages within the Town and to the regional systems beyond its boundaries where feasible and appropriate. POLICIES 1. Continue to encourage the development of trail systems that link Fountain Hills with McDowell Mountain Regional Park, the City of Scottsdale’s trail system, and Maricopa County’s trail system and potential systems on both the Salt River Pima-Maricopa Indian Community and the Ft. McDowell Yavapai Nation to support eco-tourism efforts, provided that such trails do not infringe on the privacy of residential areas. 2. Continue to update and produce mapping and facility information for the public on the Town’s website and through printed media regarding recreation, trail, and open space facilities. ACTION ITEMS 1. Continue to encourage the development of local trails that connect to the regional trail system to increase opportunities for eco-tourism 2. Update the trail system map and facility information on the Town’s website and social and print media to inform the public of the availability of these assets, as needed. GOAL 4: Identify and preserve historical and archaeological resources. POLICIES 1. Collaborate with studies that aim to uncover and preserve the historical and archaeological resources within the incorporated area. 2. Promote the preservation of archaeological artifacts by applying the latest applicable cultural resource conservation reporting methods working collaboratively with the State Historic Preservation Office and the Arizona State Museum. 3. Continue to support public education programs emphasizing local and regional historical and cultural resources like those provided at the River of Time Museum. ACTION ITEM Work collaboratively with the State Historic Preservation Office and the Arizona State Museum to protect historical and archaeological resources and support educational programs on historic and cultural resources. 1. Continue to support the expansion and development of regional and local transit service and alternative transportation modes to reduce hydrocarbon, carbon monoxide, ozone, and particulate matter pollution. 2. Continue to require the utilization of native, drought-tolerant landscapes that eliminate the use of gasoline-powered landscape equipment. 3. Promote environmentally friendly initiatives supported by the 2022 Fountain Hills Strategic Plan. 4. Support a walkable Town Center. 5. Encourage bicycle and pedestrian connectivity throughout the Town to reduce automobile dependence, improve air quality and support active and healthy lifestyles. GOAL 5: Continue to promote programs that encourage environmentally- friendly alternatives and improve air quality. POLICIES ACTION ITEMS 1. Prepare and adopt a Comprehensive Environment Plan (CEP) that implements the 2022 Strategic Plan and the policy direction included in Goals 5 and 6 of this Element 2. Update all applicable regulations and ordinances to meet the directives of the CEP once adopted GOAL 6: Continue to promote environmental stewardship. POLICIES 1. Continue to pursue improved communication and collaboration with Federal, State, and local partners on environmental concerns and legislation. 2. Promote environmental stewardship and embrace ecological initiatives in partnership with Maricopa County, the Maricopa Association of Governments, the City of Scottsdale, the Fountain Hills Sanitary District, the Fort Mc Dowell Yavapai Nation, and the Salt River Pima-Maricopa Indian Community. 3. Design, construct, and maintain public buildings, infrastructure, and grounds in a manner that is both environmentally sustainable and protects public health and safety. 4. Advance understanding of the environment through the Town’s Communications Office, education programs, and media and environmental agencies partnerships. 5. Consider environmental costs, risks, and impacts as integral components of the planning and decision-making processes when feasible and appropriate. 6. Implement and maintain a process/system to evaluate environmental initiatives that seek input from Town Staff, the business community, citizens, and community services providers. 7. Encourage the use of architectural design using active and passive solar heating, shade elements, and energy-efficient insulating materials to reduce energy consumption. 8. Encourage water conservation through: a. Supporting water use reduction education programs; b. Continuing use of recycled water for turf irrigation Town parks and golf courses; c. Encouraging drought-tolerant landscapes that incorporate water harvesting, drip or low-flow irrigation as water use reduction measures; and d. Encouraging the utilization of low water use features in new development and redevelopment. 9.Encourage salt-free water treatment systems to improve irrigation water used at Town Parks. 10. Where feasible and appropriate, encourage Low Impact Development (LID) designed to support sustainable stormwater management planning and design practices in their watersheds that either enhance or do not significantly diminish environmental quality by encouraging: a. Practices that preserve or restore predevelopment hydrological and ecological functions; b. Site design strategies that minimize runoff and protect natural drainage patterns; c. Structural methods that filter, detain, retain, infiltrate, and harvest stormwater; and d. Reduce the volume and intensity of stormwater flows. GOAL 6: continued . . . ACTION ITEM Amend the Zoning Ordinance to include Low Impact Development (LID) GOAL 7: Support waste reduction programs and proper management of hazardous waste. POLICIES 1. Continue to develop and distribute educational materials regarding the proper handling, collection, and disposal of hazardous materials. 2. Encourage citizens and businesses to participate in the Town’s recycling programs to reduce solid waste. ACTION ITEM Continue to develop/distribute materials to educated and encourage solid waste reduction, proper hazardous waste handling, collection and disposal, and recycling. GOAL 8: Incorporate biophilic design goals and design principles into Town practices and development within the community. POLICIES 1. Consider and, where feasible, incorporate biophilic design into the development of Town facilities. 2. Review and update land development plans, policies, and ordinances to incorporate biophilic design principles. ACTION ITEM Join the Biophilic Cities network. ITEM 8. E. TOWN OF FOUNTAIN HILLS STAFF REPORT    Meeting Date: 02/21/2023 Meeting Type: Town Council Regular Meeting Agenda Type: Regular Agenda                  Submitting Department: Administration Prepared by: Linda Mendenhall, Town Clerk Request to Town Council Regular Meeting (Agenda Language):  CONSIDERATION AND POSSIBLE ACTION: Relating to any item included in the League of Arizona Cities and Towns' weekly Legislative Bulletin(s) or relating to any action proposed or pending before the State Legislature. Staff Summary (Background) This is a regularly recurring agenda item on the Town Council agenda during the legislative session. This agenda item aims to obtain consensus from the Mayor and Council on legislative bills and provide direction, if any, to staff to communicate the town's position on the bills. For every Council meeting, the Legislative Bulletin will be attached to the Town Council agenda, including legislative analysis of the bills and their impacts on municipalities. The Mayor and Council will have an opportunity to review the bills that are under consideration in the Arizona State Legislature and provide direction on supporting or opposing the bills. The Mayor and Council may also bring up other bills of interest to the Town of Fountain Hills for discussion that are not listed in the Legislative Bulletin. Related Ordinance, Policy or Guiding Principle N/A Risk Analysis N/A Recommendation(s) by Board(s) or Commission(s) N/A Staff Recommendation(s) N/A SUGGESTED MOTION MOVE to provide staff direction on one or more bills being considered by the State Legislature.   Attachments Bulletin_4  Bulletin_5  Form Review Inbox Reviewed By Date Finance Director David Pock 01/30/2023 08:24 AM Town Attorney Linda Mendenhall 01/30/2023 12:48 PM Town Manager Grady E. Miller 01/30/2023 01:10 PM Form Started By: Linda Mendenhall Started On: 01/30/2023 06:36 AM Final Approval Date: 02/09/2023  Legislative Bulletin: Today is the 29th day of the 2023 legislative session and over 1,400 bills have been introduced. Last week marked the end for Senate bill introductions and Monday, February 6th will mark the end of House bill introductions. Strike-everything amendments, which can entirely rewrite a bill, will begin emerging as committee bill consideration deadlines approach. Roughly 35 bills will be heard in House and Senate committees this week that the League is monitoring. See a comprehensive list of bills of interest to municipalities here. League Executive Director Tom Belshe presented information about the League to the House Government Committee last week. Yuma Mayor and League President Doug Nicholls joined him and briefed committee members regarding his role as the League’s president. Yuma Mayor and League President Doug Nicholls testified before the Senate Government Committee on Wednesday in support of SB1103 (administrative review; approvals; developments) emphasizing the critical role the League will have in working with municipalities on implementing the bill if it is signed into law, including processes for discussions, best practices and a model ordinance. Residential Rental HB2067 (residential leases; municipal tax exemption), sponsored by Representative Neal Carter (R-San Tan Valley), would prohibit municipalities from levying residential rental taxes beginning Jan. 1, 2024. The bill was approved by the House Ways & Means Committee on Wednesday (6-4-0-0). The League testified in opposition to the bill as it would lower municipal tax revenues by approximately $230.2 million in the first full fiscal year with a full-year impact, according to JLBC. SB1184 (municipal tax exemption; residential leases), sponsored by Senator Steve Kaiser (R-Phoenix), would preempt municipalities from levying a residential rental tax if the dwelling unit has four or fewer units. The bill would apply to all dwelling units in 2028. Additionally, the bill requires cities and towns to use state shared revenue collected from remote sellers for public safety before any other purpose. The League opposes the bill over fiscal implications and preemption of local decision-making. The bill was approved by the Senate Commerce Committee along party lines on Wednesday (4-3-0-0). AZ LEAGUE LEGISLATIVE _ ISSUE - FEBRUARY 3. 2023 Food Tax SB1063 (food; municipal tax; exemption…), sponsored by Senator Sonny Borrelli (R- Lake Havasu City), would prohibit municipalities from levying a TPT on the sale of food for home consumption. The League testified in opposition to the bill as it would lower municipal revenues by up to $182.9 million in the first year, increasing to approximately $195.6 million by FY 2026, according to JLBC. Roundabouts HB2288 (roundabouts; right-of-way; large vehicles), sponsored by Representative David Cook (R-Globe), would allow a vehicle or combination of vehicles at least 40-feet long or at least 10-feet wide to deviate from their lane when proceeding throughout a roundabout. The bill also mandates municipalities to post signs at all roundabouts with text stating that trucks have the right of way. The League testified in opposition to the bill as it preempts the authority of municipalities and imposes an unfunded fiscal mandate affecting numerous municipalities throughout the state. Additional concerns include a municipality’s ability to comply with the federal Manual on Uniform Traffic Control Devices, which could result in a loss of highway aid and complicate federal reimbursements from the state. EORP HB2430 (EORP; appropriations; repayment), sponsored by Representative David Livingston (R-Peoria), appropriates $609M in FY23 to pay off the unfunded liabilities for all employers in Elected Officials’ Retirement Plan (EORP). Municipal and county employers would then pay the amount back to the state over the next ten years. The League supports the bill as it offers a zero-interest mechanism for impacted municipalities to pay down retirement debt. The bill passed the House Ways & Means Committee on Wednesday (9-0-1-0) and will be considered by the House Appropriations Committee this Wednesday. Housing & Homelessness SB1103 (administrative review; approvals; developments), sponsored by Senate President Warren Petersen (R-Gilbert), would authorize municipalities to delegate, by ordinance, city staff to review and approve site plans, development plans, preliminary plats or final plats and design review plans based on objective standards without a public hearing. The bill was unanimously approved (8-0-0-0). An amendment was also approved that grants this same authority to counties. A companion bill (HB2536) in the House, sponsored by House Speaker Ben Toma (R-Peoria), will be considered by the House Government Committee on Wednesday morning. HB2284 (homelessness; housing; facilities) , sponsored by Representative David Livingston (R-Peoria), is on the House Health & Human Services agenda today. The bill would require the Arizona Department of Housing (ADOH) to accept and allocate monies appropriated by the Legislature for services for individuals experiencing homelessness. Vehicle License Tax SB1245 (VLT; cities and towns; counties), sponsored by Senator David Farnsworth (R- Mesa), will be heard in the Senate Transportation & Technology Committee today. The bill would force municipalities to utilize vehicle license tax (VLT) revenues exclusively for transportation-related purposes. Concerns over the bill stem from VLT being a general fund resource for municipalities. In FY 2023, municipalities received nearly $326.5 million in VLT. By restricting VLT, municipalities would potentially be forced to cut services or raise other taxes. HB2418 (law enforcement; response times; requirements), sponsored by Representative Matt Gress (R-Phoenix), would require municipalities to respond to emergency calls in no more than five minutes. The Arizona Criminal Justice Commission is directed to establish policies and procedures to define “law enforcement emergency response time.” The bill will be heard in the House Military Affairs & Public Safety Committee today. HB2446 (smart and safe fund; distribution), sponsored by Representative Teresa Martinez (R-Casa Grande), would modify the Smart and Safe Fund (Fund) to include Indian reservation police agencies, Indian reservation firefighting agencies, university police departments, the Department of Public Safety and joint powers authorities. Provisions also specify such entities will receive 31.4% of the Fund's money based on the number of enrolled members in PSPRS. The change would be retroactive to Jan. 1, 2021. The bill will be heard in the House Commerce Committee on Tuesday. FY 2024 Budget Developments: The Senate approved an FY 2024 budget on Wednesday. The budget was approved by the full Senate along party lines (16-14-0-0). The Senate’s budget totals approximately $15.8 billion, which is more than a billion dollars off from the FY 2024 executive budget. It does not include certain priorities announced by the Hobbs Administration’s FY 2024 executive budget, including housing and homelessness, TPT exemptions and infrastructure spending. The House Appropriations Committee passed an FY 2024 budget on Wednesday along party lines. The budget is nearly identical to the version passed by the full Senate last week. These bills have yet to pass the full House. However, the House scheduled the FY 2024 budget bills for a House Rules Committee vote followed by a Committee of the Whole, or floor debate, today. Legislative Bulletin: Today is the 36th day of the 2023 legislative session. The bill introduction deadline in the House lapsed last Monday, with an influx of strike-everything amendments already being entertained as committee deadlines are approaching. It is worth keeping in mind this is the final week to hear bills in committee from their originating chamber of origin. A total of 1,528 bills and 97 memorials and resolutions have been introduced in the House and Senate. Zero bills have yet to reach the governor’s desk. League Executive Director Tom Belshe testified before the House Government Committee in support of HB2536 (administrative review; approvals; developments.), sponsored by House Speaker Ben Toma (R-Peoria), on Wednesday. The bill will improve the design review process and expedite the administrative approval of developments that do not deviate from municipal rules and guidelines, including community input, if local legislative bodies adopt an ordinance empowering personnel to do so. An amendment was also adopted extending similar authority to a county board of supervisors. The bill passed the committee (8-0-1). A companion bill, SB1103 (administrative review; approvals; developments) sponsored by Senate President Warren Petersen (R-Gilbert), is also underway in the Senate. League Resolutions Senate Majority and Minority Caucuses on Tuesday discussed SB1006 (municipal notices and ordinances; posting), sponsored by Senator John Kavanagh (R-Fountain Hills). The bill is now eligible for Committee of the Whole or a vote by the full Senate (if the bill is placed on a Consent Calendar and not objected to by a member of the chamber). SB1189 (S/E: municipal tax code commission; continuation), sponsored by Senator J.D. Mesnard (R-Chandler), continues the Municipal Tax Code Commission by four years until July 1, 2027. It also authorizes cities and towns to adopt an amendment to the Model City Tax Code if it is a result of a change incorporated by the Arizona Department of Revenue. The strike-everything amendment will be heard in the Senate Finance Committee this afternoon. SB1506 (rental housing; income source discrimination.), sponsored by Senator Anna Hernandez (D-Phoenix), would prohibit landlords from using a prospective or current tenant’s source of income to exclude such person from renting an available dwelling unit. It also subtracts any rent voucher or subsidy from the monthly rent calculation AZ LEAGUE LEGISLATIVE BULLETIN _ ISSUE 5 - FEBRUARY 10, 2023 before determining if a tenant or applicant meets certain income thresholds. The bill will be heard in the Senate Commerce Committee Wednesday morning. Zoning Preemption Bill SB1117 (S/E: housing; infrastructure), sponsored by Senator Steve Kaiser (R-Phoenix), was approved by the Senate Commerce Committee on Wednesday (5-2-0). Tempe Mayor Corey Woods, who served as the local elected official member of the legislatively established 2022 Housing Supply Study Committee (HSSC), testified in opposition to the strike-everything amendment to SB1117 (S/E: housing; infrastructure) and underscored that SB1117 lacks the local recommendations that he conveyed on behalf of cities during the HSSC. A copy of Mayor Corey Woods findings and recommendations to HSSC is here. The League opposes the measure since it upends minimum lot sizes larger than 4,000 square feet, allowing ten residences per acre “by right” and preempts municipalities and charter cities in all housing matters. Additionally, it abolishes the citizen review process, violates voter-approved general plans, the general plan statute and the Voter Protection Act, severely restricts design review authority in cities and towns with a population of 25,000 or more, mandates zoning for single-room occupancy boarding homes and prohibits planning commissions from reviewing housing projects. If the bill is enacted, this could result in a loss of character in neighborhoods and disrupt economic development plans. HB2284 (homelessness; housing facilities) was held by the House Health and Human Services Committee last week but will be heard by the same committee this morning. Municipal Annexation SB1268 (annexation; notice; approval), sponsored by Senator Janae Shamp (R- Peoria), raises the percentage of property owners from 50% to 60% that must petition a county recorder’s office to increase the corporate limits of a city or town by annexation. The bill was approved by the Senate Government Committee (5-3-0) on Wednesday. Moreover, an amendment was adopted requiring a city or town to incur the cost of certified mailings for notices of a public hearing. The League signed in opposed to the bill. Residential Rental Tax SB1184 (municipal tax exemption; residential leases), sponsored by Senator Steve Kaiser (R-Phoenix), preempts cities and towns from levying a tax or fee on the business of renting or leasing real property for residential purposes. The bill was approved by the full Senate (16-14-0). An amendment was adopted to the final bill approved by the Senate that accelerates the effective date by applying the exemption to all units (as opposed to under four units in 2024 and all units by 2028). The amendment allocates $14.9 million each month beginning Jan. 1, 2024 until June 30, 2025 from the General Fund to cities and towns that levied a residential rental TPT based on a city or town’s average monthly rental TPT collections. The bill will move over to the House, which also has its own version via HB2067 sponsored by Representative Neal Carter (R-San Tan Valley). The League opposes the measure as it lowers revenues for cities and towns by $230 million annually and fails to provide any benefit to 5.7 million Arizona residents. Vehicle License Tax SB1245 (VLT; cities and towns; counties), sponsored by Senator David Farnsworth (R- Mesa), would mandate that cities and towns use vehicle license tax (VLT) revenues exclusively for transportation-related purposes. The bill was held by the Senate Transportation and Technology Committee last week but will be reconsidered this morning. Truck Routes SB1097 (truck routes; designation), sponsored by Senator Frank Carroll (R-Peoria), would prohibit cities and towns from regulating motor carriers on major arterials connecting at least two jurisdictions unless a test drive or posted signage indicates it is otherwise unsafe. The League opposes the bill as several of its provisions appear to be inconsistent with the federal Manual on Uniform Traffic Control Devices regarding signage posting. It also imposes an unfunded mandate by requiring cities and towns to conduct safety tests to determine the suitability of certain vehicles operating on major arterials. Finally, the bill unilaterally voids local ordinances if municipalities do not repeal or amend ordinances within 90 days. The bill is in the Senate Transportation and Technology Committee this morning. Partisan Elections SB1011 (municipalities; partisan elections), sponsored by Senator John Kavanagh (R- Fountain Hills), would grant cities and towns the option of holding partisan elections for local office. The bill was approved by the full Senate (18-12-0). It will now be transmitted to the House for consideration. The League is neutral on the measure. Public Safety SB1148 (law enforcement; video recordings; fee), sponsored by Senator John Kavanagh (R-Fountain Hills), would authorize cities and towns to establish a fee to recover costs associated with reviewing, storing, making a copy and, if necessary, redacting a copy of a law enforcement video recording from a person who submits a public records request. The bill will be heard in the Senate Government Committee on Wednesday morning. The League supports the bill as it authorizes a mechanism for municipalities to recover costs associated with a law enforcement public records request, which is something already permitted for the Arizona Department of Public Safety via Laws 2021, Chapter 403. SB1234 (prohibition; photo radar), sponsored by Senator Wendy Rogers (R-Flagstaff), would prohibit municipalities from using photo radar to identify violators of laws or ordinances governing excessive speed or failure to obey a traffic control device. The bill was approved (5-3-0). Paradise Valley Police Chief Freeman Carney, along with a number of traffic safety advocates, testified in support of photo enforcement, emphasizing its efficacy in not only deterring speeders but also citing crash data that showed a 50% reduction since the cameras went live in 1987. The League signed in opposed to the bill as it preempts municipalities from using automated enforcement systems to promote public safety in communities.