**Director's Report to the**

**Center for Substance Abuse Treatment's**

**National Advisory Council**

**\[January through April 2005\]**

**H. Westley Clark, M.D., J.D., M.P.H.**

**Director**

**TABLE OF CONTENTS**

# 

[Significant Legislation 3](#significant-legislation)

[Director's Highlights 3](#directors-highlights)

[Highlights of CSAT Activities by SAMHSA Matrix Area
3](#highlights-of-csat-activities-by-samhsa-matrix-area)

[Substance Abuse Treatment Capacity
3](#substance-abuse-treatment-capacity)

[Co-Occurring Disorders 3](#co-occurring-disorders)

[Homelessness 3](#homelessness)

[Criminal Justice 3](#criminal-justice)

[Children and Families 3](#children-and-families)

[HIV/AIDS and Hepatitis 3](#hivaids-and-hepatitis)

[Disaster Readiness and Response 3](#disaster-readiness-and-response)

[Older Adults 3](#older-adults)

[Appendix A 3](#appendix-a)

[CSAT FY 2005 Funding Announcements
3](#csat-fy-2005-funding-announcements)

[Appendix B 3](#appendix-b)

[CSAT Funding Opportunities Proposed in the President's FY 2006 Budget
3](#csat-funding-opportunities-proposed-in-the-presidents-fy-2006-budget)

#  

# Significant Legislation

***Status of FY 2006 Budget.*** SAMHSA's FY 2006 Justification of
Estimates for Appropriations Committees, in support of the FY 2006
President's Budget, was submitted to the Department on February 3, 2005.
The following table compares the FY 2006 Request to the FY 2005 Enacted
and FY 2004 Actual budgets.

**FY 2006 Budget**

(dollars in millions)

+--------------------+--------+---------+--------+---------+---------+
| **Budget Line**    | **FY   | **FY    | **FY   | **Inc / | **Inc / |
|                    | 2004** | 2005**  | 2006** | Dec**   | Dec**   |
|                    |        |         |        |         |         |
|                    | **Ac   | **      | **Req  | **FY    | **FY    |
|                    | tual** | Enacted | uest** | 2006    | 2006    |
|                    |        | \***    |        | vs**    | vs**    |
|                    |        |         |        |         |         |
|                    |        |         |        | **FY    | **FY    |
|                    |        |         |        | 2005**  | 2004**  |
+--------------------+--------+---------+--------+---------+---------+
| **Programs of      | \      | \$422.4 | \      | \+ \$   | \+ \$   |
| Regional and       | $419.2 |         | $447.1 | 24.7    | 27.9    |
| National           |        |         |        |         |         |
| Significance**     |        |         |        |         |         |
+--------------------+--------+---------+--------+---------+---------+
| *Best Practices    | *(     | *       | *(     | *(-     | *(-     |
| (non-add)*         | 46.4)* | (48.0)* | 28.1)* | 19.9)*  | 18.3)*  |
+--------------------+--------+---------+--------+---------+---------+
| *Targeted Capacity | *(3    | *(      | *(4    | *(+     | *(+     |
| (non-add)*         | 72.8)* | 374.3)* | 19.0)* | 44.7)*  | 46.2)*  |
+--------------------+--------+---------+--------+---------+---------+
| ##                 | \$1    | \$      | \$1    | \$ 0.0  | \- \$   |
| # SAPT Block Grant | ,779.1 | 1,775.6 | ,775.6 |         | 3.5     |
+--------------------+--------+---------+--------+---------+---------+
| **Total CSAT**     | *      | **\$2,  | *      | **+ \$  | **+ \$  |
|                    | *\$2,1 | 198.0** | *\$2,2 | 24.7**  | 24.4**  |
|                    | 98.3** |         | 22.7** |         |         |
+--------------------+--------+---------+--------+---------+---------+

\* Reflects funding after application of an "across-the-board" 0.8
percent appropriation rescission and an HHS administrative reduction
(total for CSAT was minus \$3.6 million).

[Key Elements of the FY 2006 Budget]{.underline}

-   CSAT has focused its proposed FY 2006 resources around the
    President's Drug Treatment Initiative (PDTI). President Bush
    launched a major component of the PDTI in his 2003 State of the
    Union Address when he proposed Access to Recovery (ATR), a voucher
    program for treatment services. Interest in ATR was overwhelming: 66
    states, territories, and tribal organizations applied for \$99.4
    million in grants in FY 2004. In August, 2004, CSAT awarded grants
    to 14 states and one tribal organization. We estimated that 125,000
    persons would be served by ATR funds over the three-year life of
    these grants. In FY 2006, the President has proposed \$150 million
    for ATR. This proposed increase will continue 15 grants and fund 7
    new grants. With the additional \$50 million in funds, an estimated
    62,500 additional persons can be served.

-   The President's budget also proposes to increase the Screening,
    Brief Intervention, Referral, and Treatment program (SBIRT) by
    almost \$6 million for a total of \$31 million, which includes \$2
    million for program evaluation. We expect to award 2 additional
    SBIRT grants with this funding increase, for a program total of 9
    grantees.

-   General Targeted Capacity Expansion grants are proposed to be funded
    in FY 2006 at a little over \$33 million.

-   Almost \$30 million is proposed to address the problem of
    homelessness among those with substance abuse disorders.

-   About \$61 million is proposed for capacity expansion programs that
    provide outreach and substance abuse treatment for African American,
    Latino/Hispanic, and other racial and ethnic minority populations
    which have been disproportionately affected by substance abuse and
    HIV/AIDS.

-   A little over \$33 million is being proposed to support programs for
    children and adolescents, including programs that focus on
    adolescent use of alcohol, marijuana, and other illicit drugs.

-   \$25 million is being proposed to support programs that address the
    substance abuse treatment needs of adults and adolescents who become
    involved in the criminal justice system.

-   Best Practices programs, which promote effective treatment through
    the adoption of evidence-based practices, will be supported at
    approximately \$28 million, which is a reduction of approximately
    41.6%, or \$20 million, from FY 2005. This decrease will impact
    several current best practices initiatives, notably:

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-   Program Coordination and Evaluation Activities: - \$5.1 million

-   Pharmacologic Activities: - \$1.3 million

-   Addiction Technology Transfer Centers (ATTCs): - \$1.6 million

-   Women, Children, and Family Activities: - \$0.8 million

-   Minority Fellowship Program, CSAT share: Discontinued

-   Conference Grant Program, CSAT share: Discontinued

-   Knowledge Application Program (KAP): - \$1.6 million

-   Partners for Recovery: - \$1.0 million

-   SAMHSA Health Information Network (SHIN), CSAT share: - \$1.2
    million

-   Consumer Affairs Activities: - \$0.8 million

-   National Alcohol Screening Day, CSAT share: Discontinued

-   Technical Assistance (printing of TIPS and TAPS): -\$0.7 million

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-   The FY 2006 budget proposes to maintain the substance abuse
    prevention and treatment block grant at the same level as the FY
    2005 appropriation, which is just under \$1.8 billion.

Mr. Charles Curie, SAMHSA Administrator, appeared before the House
Appropriations Subcommittee for Labor, HHS, and Education on April 26,
2005, to provide testimony and respond to questions regarding the FY
2006 budget submission. In addition to SAMHSA, other witnesses included
the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the
National Institute on Drug Abuse (NIDA), and the National Institute on
Mental Health (NIMH).

#  

# Director's Highlights

***FY 2005 Funding Opportunities Update.*** CSAT's final FY 2005 funding
opportunity (Family and Juvenile Treatment Drug Courts) was announced on
February 16. An updated listing of FY 2005 Funding Opportunities that
includes program names, anticipated funding levels, and receipt dates is
included in Appendix A. The Council will review summaries of the
applications received at its May and September (conference call)
meetings. Awards will be made subsequent to Council reviews.

***Proposed FY 2006 Funding Opportunities.*** The President's Budget
includes sufficient funding for 11 substance abuse treatment initiatives
in FY 2006. CSAT has begun developing these initiatives, and may
announce some funding opportunities prior to the receipt of the FY 2006
appropriation. Some initiatives, e.g., Access to Recovery (ATR) and
Screening, Brief Intervention and Referral to Treatment (SBIRT) will not
be announced until SAMHSA receives its FY 2006 appropriation. CSAT's
proposed FY 2006 funding opportunities and the amount of funding
requested in the President's Budget are included in Appendix B.

***Prescription Drugs Meeting.*** SAMHSA convened an open dialogue
meeting with pharmaceutical companies on February 9, 2005, to provide a
forum to discuss problems associated with prescribing and dispensing of
controlled pharmacological drugs, including opioid analgesics.  This
interaction enabled SAMHSA and the pharmaceutical companies to share
information and perceptions, to facilitate better understanding of the
issues, and to brainstorm possible actions, strategies, and types of
stakeholders that could be involved in a mutual effort. 

Representatives from the following pharmaceutical companies were
present:  Abbott Laboratories; Endo Pharmaceuticals; Forest
Laboratories, Inc.; Johnson and Johnson Pharmaceutical Services; Ligand
Pharmaceutical Incorporated; Mallinckrodt, Inc.; Mylan Laboratories,
Inc.; New River Pharmaceuticals; Pfizer, Inc.; Pinney Associates, Inc.;
Purdue Pharma, L.P.; Reckitt Benckiser Pharmaceutical, Inc.; and Wyeth.

The pharmaceutical representatives expressed their willingness to
cooperate and contribute to a public health effort in this area. Issues
raised during the meeting included: monitoring of prescription drugs in
ways that can enhance treatment capability and not interfere with pain
management; data collection; evaluation; risk management; drug safety;
and pediatric exposure to the higher drug dosage levels currently
available. 

The consensus was that current issues around opioid pain medication
should be dealt with as a public health concern. Representatives agreed
to participate in a second meeting to be held within 6 to 12 months.

***Commission on Narcotic Drugs (CND).*** On March 7 - 14, 2005, Dr.
Clark joined representatives from the State Department, the National
Institutes of Health, the Department of Justice, the Drug Enforcement
Administration, the U.S. Customs Service and the Office of National Drug
Control Policy on the U.S. Delegation for the 48^th^ Session of the
United Nations Commission on Narcotic Drugs (CND), held in Vienna,
Austria. The CND is comprised of 60 nations, and meets annually to
address the implementation of the international drug control treaties.

Recent CND meetings have focused on the control of precursors used to
clandestinely produce Amphetamine Type Stimulants (ATS) such as
methamphetamine and MDMA. In addition, this CND meeting included special
thematic debates on drug abuse prevention, treatment, and
rehabilitation, focusing on community capacity building and preventing
HIV/AIDS and other blood-borne diseases in the context of drug abuse
prevention.

ONDCP Director John Walters addressed the Commission on the U.S. stand
on needle exchange programs and other harm reduction strategies,
and drug legalization issues. 

Dr. Clark presented the U.S. position on drug demand reduction. Dr.
Clark worked with Delegates from other nations in reviewing proposed
resolutions to assure that the resolutions were consistent with U.S.
drug abuse control goals and policies.

***Congressional Methamphetamine Briefings.*** On April 6, Dr. Clark
briefed the U.S. House of Representatives Addiction, Treatment and
Recovery Caucus, co-chaired by Rep. Jim Ramstad (R-MN) and Rep. Patrick
Kennedy (D-RI), on methamphetamine use and treatment. Other panelists
presenting on the Caucus topic, "With Treatment, People Recover from
Meth Addiction," included: Ms. Ellen Breyer, CEO, Hazelden; Ms. Carol
Falkowski, Director, Research Communications, Hazelden; and Mr. Jim
Atkins, Manager of Admissions and Case Management, Hazelden.

Dr. Clark's presentation addressed both the impact of methamphetamine
use in the United States and the effectiveness of treatment. He noted
that amphetamines/methamphetamine were the primary substance of abuse
reported in more than 124,000 specialty substance abuse treatment
admissions, equaling 6.6 percent of admissions in 2002, and that primary
amphetamine/methamphetamine admissions were more likely to have been
referred to treatment by the criminal justice system (50 percent) than
admissions for other substances (36 percent). He also reported that 16
western States in 2002 saw higher rates of amphetamine/methamphetamine
admissions than cocaine or heroin related admissions (Arkansas, Arizona,
California, Hawaii, Iowa, Idaho, Montana, North Dakota, Nebraska,
Nevada, Oklahoma, Oregon, South Dakota, Utah, Washington and Wyoming).
Finally, Dr. Clark outlined SAMHSA's work on methamphetamine and
identified the Federal funding streams that assist in providing both
prevention and treatment resources to assist States, tribes and
communities with the problem of methamphetamine.

On April 11, Dr. Clark, accompanied by Cheryl Gallagher, CSAT's staff
lead for methamphetamine, provided a pre-hearing briefing to two
representatives from the Senate Appropriations Committee, Subcommittee
on Labor, Health and Human Services, Education and Related Agencies, on
methamphetamine. The briefing included information on the prevalence of
methamphetamine use, the biology and symptoms of methamphetamine abuse,
treatment protocols, proven prevention techniques, available materials,
available technical assistance, and funding sources. Dr. Clark again
reported that in more than three-quarters of western States,
methamphetamine/amphetamine-related treatment admissions rates are
higher than cocaine- or heroin-related admissions rates. He also noted
that about five percent of clients in CSAT-funded discretionary grant
programs are methamphetamine users and that data reported on treatment
outcomes show methamphetamine use decreased 69%, employment increased
60%, housing status increased about 24%, arrests decreased about 38%,
and the number of clients reporting good or excellent health increased
about 30%. SAMHSA Administrator Charles Currie testified on April 21
before the Subcommittee, where he presented SAMHSA's substance abuse
prevention and treatment response to the growing methamphetamine crisis.

***Faith- and Community-Based Initiative.*** CSAT's Consumer Affairs
Office is undertaking a pilot project to assist the faith community in
directing families and individuals in distress to treatment and recovery
services.  The Non-Denominational Individual and Family Recovery
Resources Training project will 1) support the development and packaging
of consumer-oriented written products for use and distribution by
clergy, and 2) create and conduct a training program for faith
congregation representatives in one designated city.  SAMHSA/CSAT will
partner with the National Association for Children of Alcoholics (NACoA)
in this project. 

Since the March publication of *Successful Strategies for Recruiting,
Training and Utilizing Volunteers, A Guide for Faith- and
Community-Based Service Providers*, over 10,000 copies have been ordered
by faith and community organizations, behavioral health organizations,
community coalitions and State and other government agencies. Copies of
the publication are available from the National Clearinghouse for
Alcohol and Drug Information (NCADI); P.O. Box 2345; Rockville, MD
20847-2345; phone 301-468-2600 or 1-800-729-6686.

Another publication, *Maximizing Program Services Through Private Sector
Partnerships,* is scheduled to be released late this summer. The
publication provides faith and community organizations with practical
guidance on the fundamental aspects of partnering successfully with
private corporations, charities and foundations.

The Faith-and Community-Based Initiative will be hosting six forums on
Building Recovery and Treatment Capacities Through Federal and State
partnerships during May and June. The forums are designed to provide
information to faith- and community-based provider organizations on the
President's Access to Recovery (ATR) initiative and how they can partner
with ATR grantees. The forums will be held in Hartford, Connecticut;
Atlantic City, New Jersey; Los Angeles, California; Seattle, Washington;
Chicago, Illinois; and Baton Rouge, Louisiana.

***E-Therapy Initiative.*** The *SAMHSA News* devoted the
January/February 2005 newsletter to the e-Therapy, Telehealth,
Telepsychiatry and Beyond Conference that CSAT held in December 2004. To
download a copy of the newsletter go to
[http://www.samhsa.gov](http://www.samhsa.gov/). Look to your right for,
"Communication Center" box, scroll down and click on "SAMHSA
Newsletter".

At the February 3 Joint Workgroup on Tele-Health (JWTH) at the
Appalachian Regional Commission in Washington, DC, the Special Assistant
to the Director, Sheila Harmison, D.S.W., L.C.S.W., presented on the
SAMHSA/CSAT e-Therapy conference. The JWGT is a Federal interagency
group that coordinates members\' telehealth activities and provides a
forum to discuss information and develop specific actions that reduce
barriers to the effective use of telehealth technologies.

***Consumer Affairs Activities.*** In February, Consumer Affairs
Director, Ivette Torres, became President-Elect of HHS's Hispanic
Employee Organization (HHS-HEO).  Her term begins in November 2005.  Ms.
Torres has been involved in a new CSAT Hispanic Workgroup that aims to
broaden services to the Nation's Latino communities and to enhance the
ranks of Latino staffers at CSAT.  Additional activities include: 
continued facilitation of all Recovery Month planning meetings;
development of a corporate/consumer stigma education effort; and
facilitation of sessions in training and grantee conferences, such as
the recent White Bison Conference in Denver, CO.  

A new project with Faces and Voices of Recovery has been funded to
support regional train the trainer meetings in the midwest and west as
well as conduct a national symposium in Washington.  The project will
assist in the education of consumers of substance abuse treatment and
recovery services to join forces and become active in transforming the
treatment and recovery services available to all Americans.

On March 17, SAMHSA/CSAT partnered with the National Inhalant Prevention
Coalition to kick off National Inhalants Week at the National Press
Club.  Dr. Clark; John P. Walters, Director, ONDCP; Beverly Watts Davis,
Director, CSAP; David Shurtleff, Ph.D., Director, Division of Basic
Neuroscience and Behavior Research, National Institute on Drug Abuse,
NIH; Stephen J. Pasierb, President and CEO of Partnership for a
Drug-Free America; Harvey Weiss, MBA, founder and Executive Director of
NIPC and President of Synergies participated.  Media included CNN, CBN
television, AP, Reuters, NBC, ABC Radio, Cox online, Televisa News
Network, American Press Associates, and others.

***New Staff.*** Subsequent to the retirement of several staff, we were
pleased to recruit the following exceptionally well-qualified new staff.

**Kenneth J. Hoffman**, **M.D., M.P.H.,** began duty on February 22, as
the second medical officer in the Division of Pharmacologic Therapies.
Dr. Hoffman recently retired from the Department of Defense Office of
Health Affairs/TRICARE where he worked as the Surgeon General's Drug and
Alcohol Consultant to improve addiction prevention and treatment
services for all beneficiaries. He is board certified in Psychiatry,
Addiction Psychiatry, and Preventive Medicine/Public Health.

**Laura House**, **Ph.D.**, joined the Division of Service Improvement
as a project officer with the Evaluation Team. Dr. House earned her
doctorate from Howard University focusing on adolescent mental health,
resiliency, and cultural issues. She did a post-doctoral fellowship with
NIDA from 2002 to 2004 at Washington University and has done significant
research in substance abuse, mental health, adolescents, community-based
interventions, resiliency, religiosity and spirituality, and cultural
and racial identity.

# 

# Highlights of CSAT Activities by SAMHSA Matrix Area

# 

## Substance Abuse Treatment Capacity

***SAMHSA's Action Plan Long Term Goals: Increase the number of
treatment programs using effective treatment practices. Increase the
percentage of people with substance abuse problems who receive
treatment. Improve treatment outcomes for people receiving services.***

***Partners for Recovery (PFR) Initiative.*** The PFR is a collaboration
of communities and organizations mobilized to help individuals and
families achieve and maintain recovery, and lead fulfilling lives. In a
concerted effort to promote and support the mission, goals, and
objectives of SAMHSA, the PFR are continuing activities in the following
areas:

-   ***Stigma.*** The PFR conducted three *Know Your Rights* pilot
    trainings and has additional trainings scheduled for 2005. Interest
    regarding the rights of individuals in treatment and recovery has
    been overwhelming.

> These highly interactive sessions provide an overview of Federal and
> State laws and serve as a forum for answering questions related to
> rights and obligations of individuals in treatment and recovery. The
> sessions are targeted not only to those in treatment and recovery, but
> to their allies, family members, providers, employers and any other
> interested participant. More than 400 persons have attended the
> sessions to-date.
>
> Because of the success of the pilots, a series of regional *Know Your
> Rights* training sessions is being planned. These will adopt a
> training-of-trainers (TOT) approach in an effort to develop a cadre of
> attorneys who will provide sessions that cover applicable Federal and
> State statutes, rules and relevant legal precedent. Between 5 and 10
> additional trainings will be held across the country.
>
> A Spanish translation of the Federal *Know Your Rights* brochure,
> prepared by the Legal Action Center, is currently under review.
> Seventy-five thousand copies of the standard brochure are available
> through the National Clearinghouse for Alcohol and Drug Information
> (NCADI) and will also be posted to the PFR website. Once the Spanish
> version has been cleared, it will be printed and distributed as well.
> On April 8, 2005, SAMHSA issued a press release informing the public
> of the brochure.

-   ***Performance Measurement in Substance Abuse Treatment Programs.***
    This PFR-funded collaborative project involves the State
    Associations of Addiction Services (SAAS), the National Conference
    of State Legislatures (NCSL), and the Treatment Research Institute
    (TRI). The project seeks to foster collaborative dialogue among
    researchers, practitioners and State legislators to inform
    decision-making around funding and accountability in addiction
    treatment. A series of briefings for State legislators and their
    staffs are being held as part of this initiative. The first in the
    series, "Educating State Legislators on Performance Measurement in
    Substance Abuse Programs," was presented at the NCSL 2005 Spring
    Forum in Washington, D.C. It featured A. Thomas McLellan, Ph.D.,
    Professor of Psychiatry from the University of Pennsylvania; Jack
    Kemp, Director of Alcohol and Drug Services for the Delaware
    Division of Alcoholism, Drug Abuse and Mental Health; and Kevin
    Doyle from Vanguard Services, a large treatment agency based in
    Arlington, Virginia. Legislators and legislative staff attended the
    session. The session was well received, sparking dialogue among
    legislators and resulting in an inquiry as to the possibility of
    providing training to legislators in the State of Utah.

> The next scheduled session will take place at the NCSL annual
> conference in Seattle, Washington, August 16-20, 2005. In addition to
> the two presentations at the NCSL meetings, the project plan includes
> up to two presentations for members of specific State legislatures.

-   ***Leadership Institutes.*** The PFR/ATTC Leadership Institutes are
    being offered in all 14 ATTC regions across the country to address
    the dramatic need for future leaders in the addiction treatment
    field. Through April 2005, nine Institutes have been held, with
    approximately 10-15 individuals enrolled in each intensive 6-month
    leadership program.

> The following ATTC regions have initiated the Institute process since
> December: Central East, Prairielands, New England, and Mountain West.
> The Leadership Institutes consist of a formal leadership skills
> assessment; a 5-day immersion classroom training; e-learning (called
> blackboard); an experiential period where participants plan and
> execute a project; and work with a mentor. The Leadership Institutes
> conclude with the presentation of participants' projects and a
> graduation celebration. Resource materials continue to be developed
> and disseminated to enhance the professional development opportunities
> available through the Institute.
>
> Government Performance and Results Act (GPRA) evaluations are
> completed on the immersion training. A formal evaluation of the entire
> Institute is under review. The USDA Graduate School, which conducts
> the immersion training, is also collecting feedback. All involved
> continue to be delighted with the quality and success of the program.
> The PFR-supported Leadership Institutes are highlighted in the
> March/April 2005 SAMHSA News.

-   ***Public Education Campaign.*** A historic consensus was reached at
    the Providence, Rhode Island, Summit on Addiction in May 2004,
    regarding the urgent need for a multi-year public education campaign
    increasing America's understanding of addiction and recovery. A
    group of leading organizations in the field joined forces with the
    National Council on Alcoholism and Drug Dependence (NCADD) agreeing
    to coordinate the effort. CSAT offered seed money for foundational
    work for the campaign, with primary resources coming from in-kind
    contributions and fundraising activities of various parties.
    Burson-Marstellar has been retained to handle public relations. The
    following progress has been made:

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-   An action plan has been developed with input from the Providence
    Summit;

-   A Steering Committee was formed and has met twice;

-   A campaign brochure has been developed and is in production;

-   Viewpoints from diverse groups of stakeholders have been gathered;

-   A body of secondary research has been compiled;

-   Fundraising efforts continue; and

-   A draft public education blueprint has been developed. The blueprint
    was sent to the Steering Committee members prior to the May 2005
    Providence Summit to allow for discussion at the Summit. To further
    the campaign's efforts, the PFR offered to host the next Steering
    Committee meeting to assist members in incorporating the Campaign's
    messages in their organizational mission.

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-   ***National Treatment Network (NTN).*** The PFR continues to support
    the establishment of the NTN, for which conceptual development began
    several years ago. The actual birth of the Network should occur this
    June, when the National Association of State Alcohol and Drug Abuse
    Directors, Inc. (NASADAD), officially amends its bylaws. The PFR has
    sponsored several meetings to facilitate the creation of draft
    operating procedures and a work plan, which will also be adopted at
    the annual meeting in June. The mission of the NTN is to promote
    effective, socially responsive programs, and evidence- and
    research-based practices to expand and improve the publicly funded
    substance abuse treatment system in each State.

-   ***PFR Co-sponsored Activities.*** PFR has co-sponsored a range of
    State and Federal activities supporting PFR's five focus
    areas---Workforce Development, Leadership Development, Stigma
    Reduction, Collaboration, and Recovery. These activities include:

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-   Alcoholism and Substance Abuse Providers of New York State
    Conference in Rochester, New York, April 2005

-   Iowa Substance Abuse Program Directors Annual Conference in Des
    Moines, April 2005

-   Providing assistance to CSAT's Division of Systems Improvement in
    support of the CSAT Recovery Conference Planning Meeting in June
    2005

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-   ***Communications.*** The PFR website is expected to be operational
    by July 2005. The design and initial content for the website have
    been developed and are under review by SAMHSA. The website will
    provide opportunities for dialogue and exchange of information about
    PFR's five focus areas. A number of products will be featured on the
    website, including the Federal *Know Your Rights* brochure and
    SAMHSA/CSAT's workforce development strategy. The website will also
    provide information about the Partners for Recovery/ATTC Leadership
    Institutes and the specific projects that participants (called
    protégés) are conducting based on their leadership goals.
    Additionally, the website will invite States and partner
    organizations to share their products and information about
    activities related to the PFR focus areas. Currently, Partners for
    Recovery is developing a plan for promoting the website to treatment
    providers, professional associations, States, advocacy
    organizations, persons in recovery, and family members. Promotion
    will include a press release, distribution of promotional items such
    as a Rolodex card at PFR-sponsored events and other national
    meetings, a "PFR button" that other websites can use to link
    individuals to the PFR website from their sites and branding of all
    PFR print materials with the website URL.

-   ***PFR Steering Committee.*** Activities are underway to host a PFR
    Steering Committee meeting in July 2005. Several new members have
    recently been invited to join the Committee, broadening the
    membership primarily in the mental health area. The committee is
    well represented from the three disciplines in SAMSHA, allowing for
    collaborative approaches within the five PFR focus areas.

***2005 Dr. Lonnie E. Mitchell National HBCU Substance Abuse
Conference.*** SAMHSA, with CSAT as the lead, held the 7^th^ Annual Dr.
Lonnie E. Mitchell National HBCU Substance Abuse Conference at the
Wyndham Inner Harbor in Baltimore, Maryland, April 19-23, 2005. The
conference provided a forum for 700 HBCU students and faculty, members
of the faith community, SAMHSA, NIDA and other Federal Government staff
to exchange cutting-edge knowledge of substance abuse treatment, mental
health, prevention, HIV/AIDS, research and education as it related to
African Americans. The conference provided a dialogue for HBCU students
to network with their peers, experts in the in the field, and with
representatives of faith-based communities. The participants heard
presentations from all three SAMHSA Center Directors in addition to many
other speakers. The conference attendees participated enthusiastically
in the workshops, Town Hall meeting and the Plenary Session. The
conference was a major success.

***State Treatment Needs Assessment Program (STNAP).*** A final closeout
meeting was held in Gaithersburg, MD, on March 29-30, 2005, for the last
cycle of the 3-year STNAP grants. All eight State grantees invested
STNAP grant funds in the development of sustainable treatment
performance indicators, including SAMHSA's National Outcome Measures
(NOMs). Two States (IA and IL) developed and deployed new State-hosted,
clinical management information systems. Both states can now report NOMs
at virtually no cost beyond normal treatment service costs. Seven States
(CT, IL, IN, OK, NJ, NM, WA) developed new treatment performance
indicators from administrative data, based on counting treatment
episodes and unique clients (as well as TEDS admissions). Six States
(IL, IN, IA, NJ, NM, OK) linked administrative treatment data with other
State data in order to quantify treatment needs, outcomes, and gaps. All
of these investments reduce future NOMs reporting costs.

***State Data Infrastructure (SDI) Grants.*** Thirty-two States plus DC
and Puerto Rico are in their third and final year of this
(\$100,000/year) grant. AK, CA, CO, CT, DC, DE, HI, IL, IN, IA, KY, LA,
ME, MA, MD, MO, MS, NV, NJ, NY, NC, OK, OR, RI, SD, TX, UT, VA, WA, WI,
and WY have used SDI funds to be prepared to report NOMs immediately, or
no later than 2006. NE, PR, and VT, may not be prepared before 2007.
Eleven States (AK, DE, IA, IL, MA, MD, MO, NJ, NV, TX, UT, and WY)
currently host or will host (real time) clinical management information
systems for all publicly-funded treatment providers. Once in place, the
latter systems minimize NOMs reporting costs, and at the same time
associate NOMs treatment outcomes with case mix, type of service, and
cost.

***Culturally Sensitive and Sustainable Information Services for Native
American Substance Abuse Treatment (Orion).*** Orion continues to help
eight American Indian/Alaska Native treatment providers make treatment
services evidence-based and culturally sensitive, partly by automating
decision-support and clinical management information. This project also
helps providers bill Medicaid for American Indian/Alaska Native clients
that recently became eligible for 100% Federal reimbursement under
Public Law 106-417 (the Alaska Native and American Indian Direct
Reimbursement Act). New Medicaid resources are key to expanding and
sustaining services to indigent clients and to improving service
quality.

***State Systems Technical Assistance Project (SSTAP).*** The SSTAP
project has begun providing assistance to Michigan's SSA with five
training series focused on Client-Oriented, Outcome-Informed Clinical
Work; three 1-day trainings on Motivational Interviewing, and three
1-day trainings on Co-Occurring Substance Abuse and Personality
Disordered Clients. SSTAP worked with the South Dakota SSA and
consultants on defining the scope of work to help the State prepare
guidelines for addressing methamphetamine issues and different levels of
care, and also provided technical assistance to Delaware's SSA and
consultants to deliver intensive follow-up training on their Cannabis
Youth Treatment Protocols. Technical services are also being provided to
Missouri's SSA in preparation for training on trauma issues in treatment
during their spring 2005 Conference.

***Performance Management Technical Assistance Coordinating Center
(PMTACC).*** The CSAT-funded PMTACC continues to facilitate and deliver
ongoing technical assistance (TA) to the Access to Recovery (ATR) grant
projects.  Currently five grantees are actively receiving TA on five
separate implementation issues. To date, eight TA events have been
completed to five separate grantees on six different implementation
issues.

***National Outcomes Measures (NOMs).*** On March 3**-**4, the National
Association of State Alcohol and Drug Abuse Directors (NASADAD) convened
its Performance Measurement workgroup as an activity funded through its
grant from CSAT.  The purpose of the meeting was to review the
agreements established during the December 2-3, 2004, NOMs meeting,
discuss State efforts to collect and report NOMs data, and provide
feedback and input on the data reporting forms in the Substance Abuse
Prevention and Treatment Block Grant.  Additionally, the group provided
input on the proposed timeline for implementation and provided
recommendations on outstanding issues.

In March 2005, SAMHSA published, *Performance Management: Improving
State Systems through Information Based Decision-making,* which provides
valuable information on performance management initiatives and puts this
information into context for the substance abuse field.  The publication
describes a framework that allows States and providers to self assess
their current capabilities in their efforts to facilitate improvements
to the performance management capabilities.   Eleven examples of
specific performance management activities at the State systems level
are provided in the form of State case studies in an appendix to the
publication. The States of CA, CO, DE, IA, LA, NY, OK, SC, TN, VA, and
WA volunteered these case examples.

On May 5-6, in Minnesota, CSAT and State representatives from the
Central Region convened the first of five regional meetings to discuss
the implementation of the 10 domains of recovery, the NOMs. The domains,
identified December 2004 by the States and CSAT, include: abstinence
from drug use and alcohol abuse; getting and keeping a job or enrolling
and staying in school; decreased involvement with the criminal justice
system; securing a safe, decent and stable place to live; and social
connectedness.  Two domains look directly at the treatment process
itself in terms of available services and services provided.  One
measure is increased access to service and another is increased
retention in services.  The final three domains examine the quality of
services provided.  These include client perception of care,
cost-effectiveness and use of evidence-based practices in treatment.

The discussion included data from the State data systems, admission and
discharge data, unique client identifiers, and timely reporting of data
resulting in full NOMs reporting within three years (by the beginning of
FFY 2008). 

Preliminary data from the 2005 Substance Abuse Prevention and Treatment
Block Grant applications, which report 2002 data, indicate that:

-   11 States are reporting admission and discharge data in the
    Abstinence Domain and all identify improvements in abstinence. 

-   16 States report data in the Employment Domain and all identify
    improvements in client employment.

-   8 States report data in the Criminal Justice Domain and all identify
    a reduction in arrests.

-   For the 13 States that report data in the Housing Domain, 12 of 13
    identify improvements in stable housing.

A meeting for the Southeast Region is scheduled for May 25-26, 2005, to
provide those States with the same opportunity for discussion and
technical assistance, and to ensure full reporting capabilities will be
reached within the 3 year target period. The remainder of the regions
will be addressed throughout the summer.  

***Confidentiality Project**.* This project has provided call-center
e-mail and telephonic consultations from January 1 through April 30,
2005, to the following States: AL, AK, DE, GA, ID, IN, MI, MS, OH, OR,
PA, TX and WI. Most questions pertained directly to the interface
between the confidentiality and HIPAA regulations relating to
organizational requirements, electronic security issues, and Qualified
Service Organization Agreement (QSOA) guidelines.

***State Healthcare Reform Technical Assistance (HCR) Project.*** During
the past four months, this project has provided ongoing technical
assistance to Arizona, North Carolina, and Puerto Rico. The technical
assistance provided involved implementation of peer support and
peer-provided family-support services, development of data training
curriculum, provider network development and strategic planning and
quality of care standards. The project staff also provided a secondary
analysis of the FY 2004 Substance Abuse Prevention and Treatment (SAPT)
Block Grant applications submitted by all 60 SAPT BG recipients, and
assisted in the preparation of an Office of Management and Budget (OMB)
package for the re-design of the SAPT Block Grant Application. Project
staff also initiated a technical assistance activity in April at the
request of the Tennessee SSA to assess the impact of the TennCare
Partners program on the State's substance abuse treatment delivery
system.

***Substance Abuse Prevention and Treatment Block Grant (SAPTBG)
Program.*** Consistent with findings from the Office of Management and
Budget review of the SAPTBG using the Performance Assessment Rating Tool
(PART), CSAT and CSAP have completed preparations for initiation of a
two-year evaluation of the SAPTBG.

***Opioid Treatment Program Certification**.* From January 1 through
April 30, 2005, SAMHSA provisionally certified 21 Opioid Treatment
Programs (OTPs). There are 1,140 OTPs with an active SAMHSA
certification. Of these, 1,013 OTPs have achieved accreditation. Five
OTPs closed during this period.

For the first time, a new OTP was approved in the State of Mississippi,
located in Jackson. Two other programs in Mississippi are pending SAMHSA
approval.

***Accreditation Grant Awards.*** On April 1, five grants were awarded
to SAMHSA-approved accreditation bodies totaling \$1,984,000, to
partially subsidize the accreditation survey and accreditation training
costs. The grantees are the Commission on Accreditation of
Rehabilitation Facilities (CARF), the Council on Accreditation (COA),
the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), the National Commission on Correction Health Care (NCCHC) and
the Washington State Division of Alcohol and Substance Abuse. The awards
will be continued for two additional years. Four of the grantees
received grant awards for the same purposes in 2001-2004. NCCHC is a new
grantee. NCCHC is the national organization that conducts accreditation
services of OTPs in jails and correctional facilities.

***Medication Assisted Treatment Consumer Education.*** Two new consumer
education publications are being developed for distribution as part of
the Patient Support and Community Education Project (PSCEP) --
*Methadone 101* and *Pregnant Women and Methadone.*  A contract to
support a pilot project to assist the faith community in directing
families and individuals in distress to treatment and recovery services
has been awarded.

***Impact of Opioid Treatment Program Accreditation Evaluation***. Data
collection for the Impact of Opioid Treatment Program Accreditation
Evaluation is nearing completion, and the analysis phase has commenced.

***Opioid Treatment Data Systems for Disaster Planning***. In March,
site visits were completed to a sample of OTPs as part of a 'bridge'
project to test a protocol and instrument to be used in the development
of functional requirements for the overall system. Phase II, a regional
pilot for the "Opioid Treatment Data Systems for Disaster Planning"
project, will be initiated this fiscal year. The final report from Phase
I (a related feasibility/planning study) is expected later this year.

***Opioid Treatment Regional Technical Assistance.*** The first in a
series of technical assistance workshops for opioid treatment programs
will be held on June 13-14 at the Hilton Hotel in Silver Spring,
Maryland.  The main topics of the workshop will be Risk Management and
Co-Occurring Disorders. Workshops are also planned for other locations
to be held later this year.

***Drug Addiction Treatment Act of 2000 (DATA) Physician Waivers.***  As
of April 27, 2005, SAMHSA had received approximately 5,568 waiver
notifications, and 4,842 physicians have been granted a waiver.  There
are 2,948 physicians with a DATA 2000 waiver listed on the Buprenorphine
Physician Locator System. 

Data from the Drug Enforcement Administration's (DEA) Automation of
Reports and Consolidated Orders System (ARCOS) shows a steady increase
in Subutex and Suboxone distribution. The quantity of Subutex and
Suboxone distributed in 2004 was four times that distributed in 2003. 
The DEA data are consistent with other data sources that indicate the
number of prescriptions issued increases every month.

***Buprenorphine Waiver Study***. Preliminary findings from the
evaluation of the Buprenorphine Waiver Study, reported in April at the
CSAT/NIDA Buprenorphine Summit as well as at the American Society of
Addiction Medicine's national conference held in Dallas, reflect
positively on the impact of the Waiver program. For instance,
availability of treatment sites has more than doubled nationally under
the program, and patients appear to include a large number who are new
to treatment. A significant percentage of patients were non-heroin users
who appear to differ in many characteristics from the traditional
methadone patient seen in publicly funded OTPs. At this point, access to
buprenorphine still seems limited to persons who can pay-out-of-pocket
for treatment. This finding is in fact not surprising, as buprenorphine
is new in the United States, more expensive than methadone, and
insurance companies and Medicaid systems have been slow to adopt it into
their formularies, at least at this point in time. 

***Buprenorphine Patient Study*.** Follow-up data collection for the
longitudinal patient study being conducted as part of the Buprenorphine
Study continues. A survey of some 1,836 waivered physicians, conducted
last month, concluded with an 85.5% response rate. Very preliminary
results indicate that 71% of these physicians were prescribing,
[versus]{.underline} the 52% of addiction specialists who reported
prescribing in a survey conducted for this study in the fall of 2003.

***Buprenorphine Information Dissemination and Outreach Project Task.***
Ninety physicians and addiction treatment providers in the surrounding
areas of Jackson, MS, were acquainted with the medication buprenorphine
and its availability to treat opiate addiction at the SAMHSA/CSAT Paths
to Recovery Forum on April 18. CSAT is partnering with the SSAs in West
Virginia, Mississippi, Kentucky and Missouri for the new FY 2005 series
of New Paths to Recovery forums.  The New Paths to Recovery forum in
Huntington, WV, was held March 14, the Lexington, KY, forum was May 12
and the St. Louis, MO, forum is scheduled for August. 

***2005 Recovery Month Activities.*** Printing was awarded in April for
10,000 posters and 75,000 toolkits for the 2005 Recovery Month. The
products are due May 20.  The kit can be viewed at
[www.recoverymonth.gov](http://www.recoverymonth.gov/). Public service
announcements have been finalized and currently are being prepared for
release.  The national Recovery Month kick-off press conference will be
held September 8 at the National Press Club, Washington, DC.

The Road to Recovery 2005 Web Casts Series, Treatment Approaches for
Women, was aired May 4; The Dangerous Frontiers of Substance Abuse:  A
Look at Alcohol and Drug Use Trends, will air June 1; Medication
Assisted Therapies, on July 6; and Addiction in the Home:  Healing
Lives, Families, and Communities, will air on August 3.  Earlier in the
year, The Road to Recovery, aired in January; Today's Recovery
Movement:  Remembering the Past and Planning for the Future, aired in
February; Treatment 101:  The Science and Methodologies of Treating
Alcohol and Drug Use Disorders aired in March; and Binge Drinking and
Youth:  What Everyone Needs to Know, aired in April.   

***Screening, Brief Interventions and Referral to Treatment (SBIRT).***
The SBIRT grantees have served over 165,000 patients thus far and are
ahead of target. We are learning a great deal about the integration of
SBIRT into primary care. Although it is very early in our work, initial
information suggests the approach is very successful in modifying the
consumption/use patterns of those who consume five or more alcoholic
beverages in one sitting and those who use of illegal substances. The
initial grantees included six states (California, Illinois, New Mexico,
Pennsylvania, Texas and Washington) and the Cook Inlet Tribal Council. A
subsequent Targeted Capacity Expansion (TCE) grant that focused on early
identification of and interventions for persons with substance use
disorders that have not progressed to dependence was awarded to the
State of Connecticut. The grantees have implemented the concept in
trauma centers/ER, community clinics, federally qualified health
centers, and school clinics.

In the TCE grant announcement for this year, a new category for
applications targets underage drinking and screening and brief
intervention for substance use problems on college and university
campuses. As an indication of interest, we had 42 applications,
including large single institutions, small colleges, coalitions of
institutions, faith-based institutions, and HBCUs**.**

The White House Office of National Drug Control Policy (ONDCP) has
visited four of the SBIRT sites during this past quarter and will soon
visit the other three. ONDCP has been very impressed with the varying
models of brief intervention and early treatment being implemented by
grantees. ONDCP is promoting SBIRT as an effective addition to the
armamentarium of medical practitioners in dealing with substance use
issues.

***Access to Recovery (ATR)*.** In his 2003 State-of-the-Union Address,
President Bush resolved to help people seeking treatment for a substance
abuse problem. He proposed a new consumer driven approach for obtaining
treatment and sustaining recovery called Access to Recovery. On August
3, 2004, President Bush announced the award by SAMHSA of approximately
\$100 million in grants to 15 recipients. The 15 recipients were chosen
through a competitive process from 66 applications submitted by 44
States, Washington D.C., Puerto Rico, and 20 tribal organizations.
Three-year grants were awarded to 14 States and 1 tribal organization:
California, Connecticut, Florida, Idaho, Illinois, Louisiana, Missouri,
New Jersey, New Mexico, Tennessee, Texas, Washington, Wisconsin,
Wyoming, and the California Rural Indian Health Board. ATR is designed
to accomplish three main objectives:

1.  Expand capacity by increasing the number and types of providers,
    including faith-based providers, who deliver clinical treatment
    and/or recovery support services;

2.  Support client choice and allow recovery to be pursued through many
    different and personal pathways; and

3.  Require grantees to manage performance, based on outcomes that
    demonstrate patient successes.

The ATR grantees are providing a broad range of innovative services and
approaches to a variety of target populations. To date, more than 1,500
clients have been screened and assessed with a high proportion receiving
vouchers for clinical treatment or recovery support services. To recruit
clients, significant outreach is being conducted in a number of ways.
Grantees are using a broad range of professional and community sources
including self referral, family, friends, self-help organizations,
recovered and recovering persons, social support systems, faith-based
organizations, human service organizations and professionals, health
care professionals and centers, community-based organizations,
employers, educational institutions, substance abuse treatment
facilities, and recovery management services. Many ATR grantees have
implemented an 800 information number or a 24-hour access hotline to
enable access to this program.

Grantees are conducting outreach to organizations, including faith-based
and community organizations. For most ATR grantees, identifying and
working directly with non-traditional providers is a new experience. An
Outreach Coordinator position has been created by a number of grantees
to conduct outreach and marketing to providers previously unable to
compete for Federal funds, including faith-based and community
organizations. Lead faith-based agencies are being utilized by some
grantees for reaching out to faith-based provider organizations.
Training is an important part of outreach to interested recovery support
service providers previously unable to compete for Federal funds. Mass
mailings have also been successfully used by ATR grantees to reach-out
to providers previously unable to compete for Federal funds. Extensive
technical assistance and support is being provided to assist with this
outreach process.

All 15 grantees have processes in place to prevent, detect, and
investigate incidents of fraud and/or potential abuse. Since all ATR
grantees will ultimately be using electronic tracking systems, ATR
clients will be cross-referenced against other public data systems to
identify the receipt of duplicative services and potential payments for
the same service by more than one payer. Most ATR grantees plan to
conduct random audits of provider billings and service data.

SAMHSA is carefully managing ATR grantee implementation progress to
ensure ATR programs are being established in accordance with the
established program goals. Grantees are being provided considerable
targeted technical assistance. Technical assistance provided to grantees
has included: helping establish rates for recovery support services,
assisting with crafting appropriate incentives to encourage high quality
provider performance, provider recruitment and outreach assistance,
voucher management help, and many other topics. According to grantees,
this assistance is critical to ATR program success.

More information about the Access to Recovery Initiative can be viewed
at [http://www.atr.samhsa.gov](http://www.atr.samhsa.gov/)

***Activities Related to Methamphetamine.*** Through its Knowledge
Application Program (KAP), CSAT is continuing its efforts to address the
growing methamphetamine problem in the Nation.  Recently there have been
requests from the Office of the Administrator and from Congress
regarding funding and other resources available to the treatment field
and to local communities regarding this issue. In addition to the
congressional briefings described in the Director's Highlights section
of this report, a briefing book has been created that contains products
produced by CSAT. These products include Treatment Improvement Protocol
(TIP) 33 and the companion Quick Guide for Clinicians and KAP Keys, and
digital training modules produced by the Pacific Southwest ATTC,
Methamphetamine 101 and 102. The briefing book also contains the Matrix
Model materials and other information from the CSAT Methamphetamine
Treatment Project including publications by the principal investigators
at the participating sites.

CSAT leadership and staff attended and presented on methamphetamine at
the West Virginia Governor's Summit on Methamphetamine, "West Virginia
Together: Building Meth-Free Communities." This summit was a
collaborative effort of the Office of the Governor, the US Attorney's
Office, Southern District of West Virginia, SAMHSA/CSAT and the Drug
Enforcement Agency.  Ms. Cheryl Gallagher is also making a presentation
on methamphetamine treatment at the Indian Health Service Health Summit
in Mesa, Arizona, in June 2005.

***Addiction Technology Transfer Center Network (ATTC).*** The following
are recent highlights of notable events, collaborations, and future
plans involving CSAT's ATTC Network:

-   The ATTC Network is continuing to collaborate with SAMHSA's Partners
    for Recovery (PFR) program to produce Leadership Institute Training
    that focuses on identifying, nurturing and training tomorrow's
    leaders in the addiction treatment field. The Institute, which is
    now offered nationwide, has been presented at the New England,
    Mountain West, Great Lakes, Southeast and Central East ATTC Regions
    since January. Leadership Institutes will have been presented in all
    14 ATTC Regions by September 2005. The National ATTC Office and PFR
    are collaborating on web-based resources for assisting with this
    initiative and planning jointly for sustaining this effort.

-   The NIDA/SAMHSA ATTC Blending Initiative currently has five
    operational Blending Teams designed to assist with the introduction
    and adoption of new evidenced-based practices for the addiction
    field. The products and training produced by these teams will be
    featured in workshops and panel presentations at both the NASADAD
    conference and the NIDA Blending Conference in Miami, Florida, June
    3-7, 2005, as well as the CSAT Satellite Session at the College on
    Problems of Drug Dependence in Orlando, Florida, June 18-23.

-   The ATTC National Office authored and piloted a new course to
    prepare trainers for the ATTC Network April-May 2005. The seven week
    course consists of three weeks of on-line instruction and
    assignments concentrating on principles of adult education and
    learning, followed by a three-day face to face session on
    presentation skills, training material preparations and working with
    resistant audiences, and a final three weeks of on-line instructions
    on the application of the previous work. Sixteen participants will
    complete the first pilot course. After incorporating the feedback
    from this pilot, the course will be available to trainers in all 14
    ATTC Regions.

-   The Central East ATTC and Mid-Atlantic ATTC Regions are co-sponsors
    for the 2005 INCASE conference for addiction educators which will be
    held in Silver Spring, Maryland, in October 2005. More information
    can be obtained from either ATTC Region. NIDA and the SAMHSA/CSAT
    ATTC's are sponsors for the 2005 conference.

-   The Southern Coast, Mid-Atlantic, Central East, Gulf Coast and
    Southeast ATTC Regions are co-sponsoring and making presentations at
    the Southeast School, August 13-19, in Athens, Georgia. The ATTC
    involvement in this summer school is to present advanced training
    and materials for experienced counselors and clinical supervisors
    and not duplicate the training available at single State drug and
    alcohol summer schools throughout the states covered by the ATTC
    Regions involved.

***Project Mainstream.*** As part of CSAT's workforce development
activities, an evaluation contract was awarded to Health Systems
Research, Inc., (HSR) to design an evaluation plan of the
HRSA/AMERSA/SAMHSA/CSAT Interdisciplinary Faculty Development Program,
called Project Mainstream, and conduct an evaluation of Goals I, II, and
III of the project. The contract will also implement the approved
evaluation plan and provide a final report that focuses on process,
intermediate outcomes, and outcomes of the AMERSA training program. The
evaluation will identify program successes as well as areas in which the
program could be improved and administered more effectively. The
evaluation will describe the fellowship program, analyze its impact and
its ability to be continued and disseminated. The CSAT representative
has been engaged with HRSA and AMERSA staff working on the effort to
assess this project through the evaluation project.

***Strengthening Treatment Access and Retention (STAR).*** STAR grants
seek to improve access to and retention in substance abuse treatment.
The 13 grantees awarded in 2003, along with their counterparts from the
Robert Wood Johnson Foundation (RWJF) "Paths to Recovery" Program, met
in Phoenix, Arizona, in February 2005 for their third Learning
Collaborative meeting. The meeting provided the grantees with the
opportunity to learn a variety of strategies for implementing innovative
practices including improvements in workforce development, business case
development and the four main aims of the grant, to reduce waiting,
reduce no shows, increase admissions and improve continuation in
treatment.

CSAT and RWJF are providing technical assistance to five States to
disseminate the access and retention practices that have been
demonstrated by CSAT grantees. Under the Network for the Improvement of
Addiction Treatment (NIATx) State Pilot program, State SSAs will work
with treatment providers to remove State level barriers to access and
retention and support the operation of treatment provider learning
networks. The five States that are participating in this diffusion pilot
include: Delaware, Iowa, North Carolina, Oklahoma and Texas. NIATx
members in New York and LA County/California are also actively promoting
diffusion initiatives, e.g., hosting workshops for treatment providers
and developing peer networks.

***The Knowledge Application Program (KAP).*** KAP is CSAT's initiative
to coordinate the Center's knowledge application activities. KAP's
award-winning Website
([http://www.kap.samhsa.gov](http://www.kap.samhsa.gov/)) continues to
be improved and updated with new materials. Under the Multi-Language
Initiative (MLI), several existing publications have been adapted into
languages other than English and have been added to the KAP web-site.

***Upcoming Treatment Improvement Protocols (TIPs).*** Several TIPs are
in various stages of development. Getting close to final content
approval are: *Medication-Assisted Treatment for Opioid Treatment in
Opioid Treatment Programs*, and a two-volume TIP on *Intensive
Outpatient Treatment for Alcohol and Drug Abuse* -- *Clinical Issues and
Administrative Issues*.

## Co-Occurring Disorders

***SAMHSA's Action Plan Long Term Goals: Increase the percent of persons
with or at risk for co-occurring disorders who receive prevention and
appropriate treatment services that address both disorders. Increase the
percentage of persons who experience reduced impairment from their
co-occurring disorders following appropriate treatment.***

***Co-occurring Disorders TIP.*** Treatment Improvement Protocol (TIP)
42, *Substance Abuse Treatment for Persons With Co-Occurring Disorders,*
was released on January 31, 2005. Developed through the Knowledge
Application Program (KAP) within CSAT, this TIP revises TIP 9,
*Assessment and Treatment of Patients With Coexisting Mental Illness and
Alcohol and Other Drug Abuse.* By April 11, just 9 weeks after the
release of 27,000 copies of the TIP, the supply was depleted. The TIP
has since been reprinted and is again available.

The revised TIP provides state-of-the-art treatment guidelines for
counselors and others working in the field of co-occurring substance use
and mental disorders. It includes selected literature reviews, synopses
of many co-occurring disorders treatment approaches, and empirical
information. The TIP contains chapters on terminology, assessment,
treatment strategies and models, and an overview of specific mental
disorders and cross-cutting issues, such as suicide and nicotine
dependency. In addition to substance abuse treatment professionals, this
document will be useful for administrators, mental health providers,
primary care providers, criminal justice staff, and other healthcare and
social service personnel who work with people with co-occurring
disorders. A comprehensive marketing and dissemination plan that was
developed through KAP has proven to be very effective.

TIP 42 is available from the National Clearinghouse for Alcohol and Drug
Information ((NCADI) at (800) 728-6686, or on the web at
[[www.ncadi.samhsa.gov]{.underline}](../www.ncadi.samhsa.gov). CSAT's
KAP is developing a Quick Guide to TIP 42 specifically for clinicians
and administrators and KAP Keys for clinicians, providing succinct
summaries of critical information in TIP 42.

***Co-Occurring Policy Academy.*** Planning has begun with SAMHSA's
Office of Policy Planning and Budget, Office of the Administrator, and
the three Centers to conduct the third Co-Occurring Policy Academy,
September 13-15, 2005, in Philadelphia, PA. Final decisions are imminent
for the selection of the next 10 States that submitted applications.
Further details on the Academy will follow over the next several months.
The Co-occurring Center for Excellence (COCE) is the primary technical
assistance resource for the Academies.

***Co-Occurring Center for Excellence (COCE) Web site.*** SAMHSA is
pleased to announce the launch of the Co-occurring Center for Excellence
Web site, which is designed to provide information and resources on
co-occurring disorders and support the COCE's technical assistance
efforts primarily targeted to SAMHSA's Co-occurring State Infrastructure
Grant (COSIG) States, Policy Academy and other States, sub-State
organizations, tribes and tribal agencies, community based providers,
and other social and behavioral health entities. The new Web site was
operational on February 14 and is located at
[[http://coce.samhsa.gov]{.underline}](http://coce.samhsa.gov/). The
COCE Web site received over 200,000 total hits in the first six weeks of
its operation. COCE continues to provide technical assistance and
overall support on a range of co-occurring issues.

***Co-occurring Conference Presentations.*** CSAT co-sponsored a
conference in February, hosted by the National Association of State
Mental Health Program Directors Research Institute. Dr. Clark presented
on The Epidemiology of Co-Occurring Disorders at a plenary session. The
conference also featured several sessions presented by CSAT's
Co-occurring State Infrastructure Grant participants.

Two panels developed by CSAT's Co-Occurring and Homeless Activities
Branch were accepted for presentation at the August 2005 American
Psychological Association meeting. Dr. Clark will participate on both
panels, one on legal issues in substance abuse treatment and one on
co-occurring disorders.

***Rural and Frontier Initiative.*** This fiscal year, CSAT has agreed
to contribute \$10,000 (in kind and services) to the Western Interstate
Commission on Higher Education (WICHE) web-cast organized by CMHS. The
main goal of this initiative is to increase treatment capacity by
training a new workforce in the rural and frontier areas. These
continuing education courses are designed for the health care providers
in sparsely populated and inaccessible frontier areas. Major issues on
co-occurring substance abuse and mental health disorders were covered
last year, and new topics will be added this year.

## Homelessness

***SAMHSA's Action Plan Long Term Goal:*** ***Increase percentage of
homeless individuals with substance abuse and/or mental illness who
become enrolled in services and report having permanent housing.***

## 

***Chronic Homelessness Initiative (CHI).*** This collaborative
initiative funded by SAMHSA, HRSA, HUD, and VA is designed to help
eliminate chronic homelessness among persons with substance abuse,
mental, or co-occurring disorders. CHI, now in its second year (of 3),
consists of 11 grantees in 9 States. Through March 2005, 623 persons
have been admitted to services, all meeting the criteria for chronic
homelessness (homeless for more than a year, or 4+ lifetime homeless
episodes) and averaging 7.9 years of homelessness. Seventy-two percent
have substance abuse problems; 79 percent have mental disorders; and 53
percent have co-occurring substance use and mental disorders. For
persons served through the initiative, there was a 327% increase in
"having your own place to live," a 95% reduction in days homeless in the
last 90, a 30% reduction in use of illicit drugs, and a 33% reduction in
observed psychotic behavior. CSAT is contributing approximately \$4
million to the CHI in FY 2005.

CSAT and CMHS collaborated to develop two training workshops for CHI
grantees, one on cost benefit analysis and another on planning for
sustainable systems change. The workshops will be conducted in
June/July, 2005.

***Treatment for Homeless Program*.** The purpose of this CSAT/CMHS
program is to enable communities to expand and strengthen their
treatment services for homeless individuals with substance abuse
disorders, mental illness, or with co-occurring substance abuse
disorders and mental illness.

The Treatment for Homeless Technical Assistance Workshop will be held in
Bethesda, MD, May 24-26, 2005. About 250 persons, primarily grantees,
will be in attendance to gain knowledge from experts in the field and
share their experiences in serving persons who are homeless. Workshop
topics include substance abuse and homelessness, evidence-based
practices, criminal justice diversion, impact of adverse childhood
experiences, motivational interviewing, lessons learned from third-year
grantees, permanent supportive housing, funding and sustainability, and
healthcare issues affecting homelessness.

Since the inception of the Treatment for Homeless program, over 10,000
persons have received grant-supported services. Out of this population
served, 57% are male, 43% are female, 46.6% are Black/African American,
31.5% are White, 16.7% are Hispanic, 3.5% are American Indian and 2.7%
are other including Asian and Pacific Islander. The majority of the
people are between ages 25 and 54 years. Twenty-seven percent of clients
are served in residential treatment settings, 56% receive outpatient
services, and 86% receive case management services.

As of April 2005, there were 77 active grants. To date, the intake rate
for this program was 99.9%, i.e., the number of clients enrolled was
virtually 100% of the number that had been projected for the program as
a whole. The six-month follow-up goal is 80%, and an actual follow-up
rate of 75.7% was achieved. At the six month follow-up, almost twice the
numbers of clients were now employed/engaged in productive activities
than were at intake, and the number of clients having a permanent place
to live had more than doubled.

***SAMHSA Homelessness In-service Training.*** CSAT staff collaborated
with SAMHSA's Homelessness Matrix Workgroup to conduct a SAMHSA-wide in
service training on April 21 that included presenters Philip F. Mangano,
Executive Director, U.S. Interagency Council on Homelessness; Darren C.
Skinner, Ph.D., Division Director, Co-Occurring Disorders Programs,
Guadenzia, Inc.; Ruth McTiernan, Community Connections; and Fred C.
Osher, M.D., Director, Center for Behavioral Health, Justice and Public
Policy and Associate Professor of Psychiatry, University of Maryland
School of Medicine. The faculty included people who have experienced
homelessness firsthand and other experts who discussed what methods work
best in addressing and preventing homelessness. Donations of food were
collected and then donated to a local shelter.

***Homeless Policy Academies.*** CSAT and the two other SAMHSA Centers,
in conjunction with other DHHS entities, including the Administration
for Children and Families and the Health Resources and Services
Administration, and in collaboration with the Departments of Housing and
Urban Development, Labor, Education, Justice, Agriculture, Veterans
Affairs, and the Interagency Council on Homelessness, conducted the
Homeless Families and Children Policy Academy, April 20-22, in Houston,
Texas. This Academy was the eighth such effort conducted with the above
partners to enhance the capabilities of States to develop State Action
Plans to address homelessness among this sub-population as well as
chronic populations. States participating in this Academy included:
Alabama, Arkansas, Alaska, Hawaii, Minnesota, Pennsylvania, Georgia, and
Kansas. Forty-nine States, the District of Columbia, Puerto Rico, the
Virgin Islands, and the Pacific Territories have attended at least one
of the Academies. A final Academy (on Homeless Families) is planned for
late in 2005.

## 

## Criminal Justice

***SAMHSA's Action Plan Long Term Goals:*** ***To increase access to
quality, evidence-based substance abuse and mental health prevention,
early intervention, clinical treatment, and recovery support services
for adults and juveniles in contact with or involved with the justice
system*.**

***Criminal Justice Matrix Workgroup.*** Randy Muck, CSAT's Adolescent
Team Leader, has joined the group to assist in addressing needs of youth
and their families involved in the juvenile justice system that have a
need for screening, assessment, and treatment for substance use
disorders. On April 28-29, a focus group was conducted to get input from
the field on the strategic framework for the matrix group.

**New Criminal Justice TIP.** CSAT anticipates the release of the new
TIP, Substance Abuse Treatment for Adults in the Criminal Justice
System, either late summer or early autumn. This TIP revises several
older TIPs - TIP 7: Screening and Assessment for Alcohol and Other Drug
Abuse Among Adults in the Criminal Justice System; TIP 12: Combining
Substance Abuse Treatment With Intermediate Sanctions for Adults in the
Criminal Justice System; and, TIP 17: Planning for Alcohol and Other
Drug Abuse Treatment for Adults in the Criminal Justice System. The
revised TIP will provide the current clinical evidence-based guidelines,
tools, and resources necessary to help substance abuse counselors treat
clients involved with the criminal justice system.

***Health Care Reform Technical Assistance.*** CSAT's Division of State
and Community Assistance (DSCA) supported several technical assistance
events at the request of States on issues related to identifying and
treating substance abusing clients who are involved in the criminal
justice system. Technical assistance was provided to the California SSA
on the implementation of the Substance Abuse and Crime Prevention Act
(SACPA), especially with regard to evaluating its impact, developing
county plans, and developing a report entitled "Substance Abuse and
Crime Prevention Act of 2000: Analysis of Plans from the 58 Counties."
In addition, an analysis was conducted of SACPA programs to identify
best practices and recommendations for effective implementation.

## Children and Families

***SAMHSA's Action Plan Long Term Goals:*** ***Increase capacity of
States and communities to provide an integrated continuum of services
and supports for children and their families. Increase number of
children who receive quality mental health and substance abuse services
and support from community-based providers who achieve positive
outcomes.***

***Adolescent Team.*** CSAT's Adolescent Team is collaborating with the
other SAMHSA Centers, the Office of the Administrator (OA), HRSA, and
the American Academy of Pediatrics in the development of the revision of
the *Bright Futures* Document and *Toolkit.* This document and toolkit
provide guidance and screening instruments for frontline health care
providers to identify health care problems across the age-span for
children and youth. This revision will for the first time include
screening for substance use problems.

CSAT has been asked to assist CMHS with planning for a meeting in
Boston, June 20-21, for the CMHS National Center for Child Traumatic
Stress initiative. CSAT is providing guidance on the meeting session
that will address developing strategies for intervention for youth who
have experienced trauma and are experiencing problems with substance
use.

## HIV/AIDS and Hepatitis

***SAMHSA's Action Plan Long Term Goal: Increased access to prevention
and treatment services for individuals with or at risk for HIV/AIDS and
Hepatitis due to substance abuse and mental health disorders, with a
particular emphasis on reaching minority populations disproportionately
affected by the HIV/AIDS epidemic.***

***Hepatitis A and B Pilot Vaccination Program.*** A pilot project that
will seek the prevention of Hepatitis B virus (HBV) and Hepatitis A
virus (HAV) infections by one-time vaccinations in HIV/Hepatitis C
co-infected substance abuse populations has been proposed. Approximately
\$2.5 million may be available to fund this pilot. Eligible entities
will include Opioid Treatment Programs, physicians with SAMHSA Drug
Treatment Act (DATA) waivers, and SAMHSA's current grantees under the
Minority AIDS Initiative.

***Rapid HIV Testing Initiative.*** CSAT has the lead on implementing a
new track for the Rapid HIV Testing Initiative (RHTI). The
implementation includes dissemination of 100,000 OraQuick Advanced ®
Rapid HIV 1/2 test kits to State departments of health (DOHs) by the end
of May. The goal of this project is to have SAMHSA disseminate OraQuick
Advanced HIV 1/2 rapid test kits at no cost to all providers that
currently perform rapid testing in states. These providers include
SAMHSA Minority AIDS Initiative programs and opioid treatment programs.

As of May 6, 2005, Indiana, Delaware, Pennsylvania, and New York have
ordered OraQuick Advanced rapid test kits. To date, the District of
Columbia, which was designated a "pilot site," has received 1,300 test
kits. Delaware has submitted an initial request for 250 kits. Florida,
Delaware, Maryland, and Indiana DOHs have submitted requests for 5,000
to 15,000 rapid HIV testing kits.

CSAT is continuing to assist states in the development of their systems
of care to deliver rapid HIV testing. This effort includes State
orientations, trainings and technical assistance for States that are not
at a high level of readiness. Initial calls to determine readiness were
completed in 47 States. Because a major focus of this initiative is
intended to allow for capacity building to implement rapid HIV testing
in non-traditional testing sites, a second call termed the "State
Orientation Call" was conducted in 15 States. This call included both
SSA and DOH Office of HIV/AIDS representatives. An overview of the
entire process for receiving test kits was presented on the call. The
majority of SAMHSA grantees do not currently have the infrastructure to
implement rapid HIV testing; therefore, this call identified strategies
to build that capacity. Both the SSA and the DOH collaborate on capacity
development. A State Rapid Test Coordinator is also identified on the
call, giving direct access to a single contact within the State to
coordinate with SAMHSA on the distribution process. New York, Texas,
Tennessee, Florida, Pennsylvania, Maryland, Connecticut, New Jersey,
Delaware, and the District of Columbia have identified their
Coordinator. An additional call is made to establish the data collection
process for this initiative.

In an effort to expand the eligible service providers who may access the
available HIV test kits provided through the SAMHSA Rapid HIV Testing
Initiative (RHTI), the State DOHs may make application and request kits
for those DOH HIV testing sites in their respective States who offer HIV
testing to the target populations as identified in the initial
eligibility criteria (MSM, MSM/IDU, injection drug users, at-risk
college students, reentry populations, and transgender populations). The
providers in the State should have the capacity to accept a shipment of
a six-month supply of rapid HIV testing kits. A SAMHSA contractor will
confirm with the State the funding source for these providers (EIS, MAI,
SAPTBG, other SAMHSA funding, CDC, or State). Kits are to supplement the
State's current programming. Kits can be shipped directly to the
provider or to the DOH depending on State preference.

## Disaster Readiness and Response

***SAMHSA's Action Plan Long Term Goal:*** ***Reduce the behavioral
health consequences of terrorism and other disasters.***

***State Targeted Capacity Expansion Grants for Emergency Mental Health
and Substance Abuse.*** These grants are officially ending their
two-year funding cycle on May 31, 2005. However, the majority of the
grantees, including all of the nine managed by CSAT (CA, OK, OR, PA, NY,
SD, TN and WV) are applying for no-cost extensions ranging from three
months to one year. The extension will enable the grantees to enhance or
finish their All-Hazards Plans, particularly their substance abuse
disaster response components. To assist the States in this endeavor,
CSAT is working with the SAMHSA Disaster Technical Assistance Center
(DTAC) on a technical assistance document entitled, *Guide to Substance
Abuse Services All Hazards Planning*.

***TOPOFF.*** CSAT participated in the TOPOFF (Table Top Exercise for
Top Officials) held the week of April 5. This exercise was conducted by
the Federal government to test the Federal, State, and local response
capacity to acts of terrorism. A SAMHSA staff person was deployed to the
Secretary\'s Command Center in Washington, D.C., to serve as the SAMHSA
liaison for mental health needs. Three other SAMHSA staff were deployed
as part of the Secretary\'s Emergency Response Team in SAMHSA Emergency
Response Centers in Connecticut and New Jersey and at the Centers for
Disease Control and Prevention (CDC) offices in Atlanta, Georgia. SAMHSA
staff also shared information with State and community mental health
agencies participating in the exercise and coordinated efforts with the
American Red Cross, CDC, and other organizations that committed mental
health resources to the TOPOFF exercise.

***DTAC.*** SAMHSA/CSAT will be participating in the DTAC Cadre of
Consultants Orientation, May 11--13. The Cadre of Consultants is a group
of experts in the fields of mental health, substance abuse prevention
and substance abuse treatment which will provide technical assistance to
the field on disaster related efforts. This group of consultants will
provide subject matter expertise, training and consultation. In addition
to the technical assistance guide noted above, DTAC is also revising the
CSAT disaster CD.

***Baltimore Emergency Response Grant.*** This grant was awarded to the
Baltimore City Department of Health after the Dawson Family died in
Baltimore City in October 2002, when their home was firebombed by a drug
dealer, in retaliation for Mrs. Dawson's repeated complaints to police
about drug sales in her community.

The Felony Diversion Initiative (FDI) began services in the Circuit
Court for Baltimore City in January 2004. Offenders participating in
this program were felons with serious records who faced five years or
more of incarceration. For the first time, addictions assessors were
placed in the Circuit Court for Baltimore City to increase the
efficiency of the legal process and improve offender compliance with
treatment. The program's accomplishments, which argue for its
continuation and expansion, follow:

-   Eighty-eight (88) felony offenders were admitted to the FDI \-- 82%
    were male, 95% were African American, and most were between the ages
    of 30-44.

-   Almost all of the offenders (93% or 82 of 88) used heroin either
    exclusively (17%) or in combination with other drugs (76%).

-   Substance abuse assessments were performed within 24 hours of court
    appearance; placement into drug treatment occurred within 48 hours.

-   The Court intensively monitored defendants on a monthly basis.

-   Two specially trained probation officers supervised FDI offenders.

-   Eighty percent (80% or 70 of 88) of participants successfully
    completed their initial episode of treatment, with 6% discharged due
    to medical discharge and 4% still in treatment.

-   Ninety-nine percent (99% or 87 of 88) of participants entered a
    second level of care even when their first episode was not
    successfully completed.

-   Five percent (5% or 4 of 88 treated individuals) subsequently
    violated their probation.

-   This cost for treatment for participants in this project averaged
    \$5,000 as compared with \$25,000 per person average incarceration
    costs.

## Older Adults

***SAMHSA's Action Plan Long Term Goals: Promote awareness of mental
health and substance abuse needs of older adults, and promote adoption
of evidence-based mental health and substance abuse programs for older
adults.***

***FDA/SAMHSA Older Adults Initiative*.** *As You Age...A Guide to
Aging, Medicines, and Alcohol* brochures were printed and are
restocked.  New radio, television and print public service announcements
are in production for the age group of 50-60, pending approval. 
Products are planned for dissemination in May 2005 through a radio tour
involving SAMHSA, the Food and Drug Administration and the
Administration on Aging in conjunction with Older American's Month.

# Appendix A

## CSAT FY 2005 Funding Announcements

+---------------------------+---------+----------+---------+----------+
| **Program Name and        | **Est.  | **Est.   | **A     | **El     |
| Announcement Number**     | Funding | No. of   | ppli.** | igible** |
|                           | Avai    | Awards** |         |          |
|                           | lable** |          | **Re    | **Appl   |
|                           |         | **Est.   | ceipt** | icants** |
|                           |         | Award    |         |          |
|                           |         | Am't**   | *       |          |
|                           |         |          | *Date** |          |
+---------------------------+---------+----------+---------+----------+
| Accreditation of Opioid   | \$2.0M  | Up to 6  | 9/30/04 | SAMHSA-  |
| Treatment Programs (OTPs) |         |          |         |          |
|                           |         | \$       |         | approved |
| TI 05-001                 |         | 15,000 - |         | Accred.  |
|                           |         | \$1.0M   |         | Bodies   |
+---------------------------+---------+----------+---------+----------+
| Historically Black        | \       | 1        | 1/18/05 | 104 Nat. |
| Colleges and Universities | $1.075M |          |         | Re       |
| Nat. Resource Ctr.        |         | \$1.075  |         | cognized |
| (HBCU-NRC)                |         |          |         | HBCUs or |
|                           |         |          |         | Co       |
| TI 05-002                 |         |          |         | nsortium |
|                           |         |          |         | of HBCUs |
| (cross-Ctr. with CMHS and |         |          |         |          |
| CSAP)                     |         |          |         |          |
+---------------------------+---------+----------+---------+----------+
| Targeted Capacity         | \$16.0M | 33 (11   | 1/26/05 | States,  |
| Expansion (TCE)           |         | in ea.   |         | Units of |
|                           | (\$5.3M | c        |         | Local    |
| Categories: (1) AI/AN or  | in each | ategory) |         | Gov.,    |
| AA/PI; (2) Meth/Other     | ca      |          |         | Tribe    |
| Emerging Drugs in Rural,  | tegory) | \        |         | s/Tribal |
| Adult Pops; (3)           |         | $500,000 |         | Orgs.    |
| Campus-SBI                |         |          |         | for      |
|                           |         |          |         | Catg.    |
| TI 05-003                 |         |          |         | (1) and  |
|                           |         |          |         | (2);     |
|                           |         |          |         | Colleges |
|                           |         |          |         | and      |
|                           |         |          |         | Univs.   |
|                           |         |          |         | for      |
|                           |         |          |         | Catg.    |
|                           |         |          |         | (3)      |
+---------------------------+---------+----------+---------+----------+
| Family and Adolescent     | \$6.3M  | 16 (8 in | 4/15/05 | Public   |
| Treatment Drug Courts     |         | ea.      |         | and      |
|                           | (       | c        |         | Private  |
| TI 05-005                 | \$3.15M | ategory) |         | No       |
|                           | in each |          |         | n-profit |
|                           | ca      | \        |         | Entities |
|                           | tegory) | $400,000 |         | (i       |
|                           |         |          |         | ncluding |
|                           |         |          |         | Tribal   |
|                           |         |          |         | Go       |
|                           |         |          |         | vs/Orgs) |
+---------------------------+---------+----------+---------+----------+
| State Adolescent SA       | \$7.1M  | Up to 22 | 2/02/05 | States,  |
| Treatment Coordination    |         |          |         | DC,      |
|                           |         | \        |         | Terr     |
| TI 05-006                 |         | $400,000 |         | itories, |
|                           |         |          |         | Fed.     |
|                           |         |          |         | Recog.   |
|                           |         |          |         | Tribal   |
|                           |         |          |         | Gov's    |
+---------------------------+---------+----------+---------+----------+

# Appendix B

## CSAT Funding Opportunities Proposed in the President's FY 2006 Budget

+------------------------------------------+---------------------------+
| **Title of Funding Opportunity**         | **Funding Requested &**   |
|                                          |                           |
|                                          | **Est. No. of Awards**    |
+------------------------------------------+---------------------------+
| Access to Recovery (ATR)                 | \$50.8 M                  |
|                                          |                           |
|                                          | 7 awards                  |
+------------------------------------------+---------------------------+
| Screening, Brief Intervention, Referral  | \$5.6M                    |
| and Treatment (SBIRT)                    |                           |
|                                          | 2 awards                  |
+------------------------------------------+---------------------------+
| Pregnant and Postpartum Women            | \$2.9M                    |
|                                          |                           |
|                                          | 6 awards                  |
+------------------------------------------+---------------------------+
| State Infrastructure Grants for the      | \$2.7M                    |
| Treatment of Persons with Co-Occurring   |                           |
| Substance and Mental Disorders (COSIG)   | 4 awards                  |
+------------------------------------------+---------------------------+
| Targeted Capacity Expansion (TCE)        | \$3.8M                    |
|                                          |                           |
|                                          | 9-10 awards               |
+------------------------------------------+---------------------------+
| Strengthening Access and Retention       | \$2.6M                    |
| (STAR)                                   |                           |
|                                          | 14 awards                 |
+------------------------------------------+---------------------------+
| Recovery Community Services Program      | \$2.5M                    |
| (RCSP)                                   |                           |
|                                          | 7-8 awards                |
+------------------------------------------+---------------------------+
| Family Therapy Models                    | \$9.7M                    |
|                                          |                           |
|                                          | 35 awards                 |
+------------------------------------------+---------------------------+
| Treatment for Homeless/Grants to Benefit | \$4.1M                    |
| Homeless Individuals (GBHI)              |                           |
|                                          | 10 awards                 |
+------------------------------------------+---------------------------+
| Targeted Capacity Expansion Program for  | \$4.4M                    |
| Substance Abuse Treatment and HIV/AIDS   |                           |
| Services (TCE/HIV)                       | 9 awards                  |
+------------------------------------------+---------------------------+
| Family and Juvenile Drug Courts          | \$5.3M                    |
|                                          |                           |
|                                          | 14 awards                 |
+------------------------------------------+---------------------------+