# Presentation: 126600

## SAMHSA

**SAMHSA**

**Substance Abuse Treatment**

**Capacity Strategy**

*Supporting** *
**Treatment**   &  **Recovery**

## Overview

- Introduction
- Where We Are Now
- New Initiatives/Programs
- Where We Are Going
- Next Steps

## Let us bring to all Americans who struggle with drug addiction this message of hope:  the miracle of recovery is possible, and could be you.

***	******	******(Excerpt from the State of the Union Address,                   January 28, 2003: George W. Bush)***

## Introduction

**“*****Recovery*****”** is the ultimate outcome.  Appropriate treatment is an important part of achieving that outcome.
-  SAMHSA’s Substance Abuse Treatment Capacity Strategy outlines the national drug policy goals, SAMHSA’s mission, program priorities, and principles.
-  Further, the Strategy highlights SAMHSA’s specific treatment and recovery goals and approaches.
-  The document provides discussion points on “where we are now” and “where we want to go”.

## The Administration’s Direction

- The Bush Administration established drug use reduction goals in the *National Drug Control Strategy.*
- Reduce drug use among young people by 10 percent within two years
- 	(Between 2001-2003 the use of illicit drugs by teenagers dropped by 11%)
- Reducing drug use by 25 percent within five years
- SAMHSA’s Mission Statement *Building Resilience and Facilitating Recovery *further emphasizes a strong commitment to recovery.
- SAMHSA’s program priorities, and cross-cutting principles are illustrated on its matrix.

## The SAMHSA Matrix

## SAMHSA/CSAT Goals

**Enhancing **
_***C***_**apacity**

**Promoting **_***A***_**ccountability**

**Assuring**
_***E***_**ffectiveness**

-  Accountability:  establish systems to measure performance
-    and ensure accountability
-  Capacity:  build, enhance and maintain treatment
-     infrastructure and capacity
-  Effectiveness:  enable all communities and providers to
-    deliver effective treatment services

## Recovery from substance use disorders means ...

**Decreased Involvement with Criminal Justice**

**Increased**
**Social Connectedness**

**No Drug Use or Alcohol Abuse**

**Increased/Retained Employment and School Enrollment**

**Increased Stability in Family and Living Conditions**

**Increased**
**Access to **
**Services**

**Increased Retention in Treatment  Services**** **

***The Seven Domains***

## Where We Are Now

## Current Facts

- The 2002 National Survey of Drug Use and Health (NSDUH) estimated:
- 22.8 million people can be classified with alcohol/drug abuse dependence
- During the prior 12 months, 2.3 million people received alcohol or other drug treatment at a specialty Substance Abuse  facility*
- Alcohol/drug abuse and addiction are preventable and treatable
- Scientific advances have created an array of effective behavioral and pharmacologic interventions
- *	Substance Abuse and Mental Health Services Administration (2003). *Overview of Findings from the 2002 National Survey on Drug Use and Health* (Office of Applied Studies, NHSDA Series H-21, DHHS Publication No. SMA 03-3774). Rockville, MD

## Current Facts

- 1.2 million of those who did not receive treatment knew they needed help
- 446,000 sought treatment but were unable to get the treatment they needed
- 744,000 made no effort to get treatment
- However, 19.3 million people needed treatment for substance use disorders and did not recognize the need

- Ninety-Four Percent of
- those who needed 	treatment
- did not recognize this need
- and did not receive treatment

## Substance Abuse Treatment Admissions: 1992 and 2001, by Substance

- 1992

- 2001

- Alcohol

- Opiates

- Cocaine

- Marijuana/ Hashish

- Stimulants

- Other

- Note: Other includes sedatives, tranquilizers, hallucinogens, PCP, inhalants, and OTCs.
- Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS)

## Persons Aged 12+ Who Received Substance Abuse Treatment (in Thousands), 2000-2002

- Sources:
- SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001.
- SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
- Note: Estimates for 2002 include persons who received treatment specifically for any illicit drug or alcohol, as well as persons who received treatment but not specify for what substance(s).

## Number of Substance Abuse Treatment Facilities

- Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data 1996-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000.

## CSAT Budget for Block Grants and Programs of Regional and National Significance FY 2001-2005 (in Millions of Dollars)

- * Requested in President’s budget
- Source: SAMHSA Justification of Estimates for Senate Appropriations Committee

## Substance Abuse Treatment Admissions, by Type of Health Insurance, 1999

- Source: 1999 SAMHSA Treatment Episode Data Set (TEDS)

## Substance Abuse Prevention and Treatment Funding Trends (1997 – 2001)

**Substance Abuse Prevention and Treatment Funding Trends (1997 – 2001)**

- Source: SAMHSA CSAT Data Infrastructure Branch

## SAMHSA’s Role

**Promoting Evidence-Based Treatment Practices**

**Supporting Clinical and Administrative Education and Training Programs**

**Promoting Community-Based Service Availability and Quality**

**Administering Substance Abuse Prevention and Treatment Block Grant Programs**

**Providing TA and Capacity-Building Tools**

**Supporting a Nationwide **
**Toll Free Referral Hotline**

**Regulating and Training the Field in Pharmacologic Therapies**

## Major Initiatives/Programs

## Access to Recovery

- 3-year competitive grants to States, territories, DC and Tribes
- Approximately $100 million in FY 2004 for up to 15 awards
- Goals:
- Reward performance (_***A***_CE!)
- Expand capacity (A_***C***_E!)
- Empower consumer choice and effectiveness (AC_***E***_!)
- Uses vouchers to purchase addiction treatment and recovery support services

## Partners For Recovery

**Introduced by Administrator, Charles Curie in July 2003**
**Broadens the discussion beyond treatment to recovery**
**Builds on national guidelines:  Invest for Results; Commit to Quality;**
**Change Attitudes; Build Partnerships; and Every Door to Treatment **
**is the Right Door**
**Moves to implementation and action focusing on the**
**SAMHSA priority areas**

***A collaboration of communities and organizations ***
***mobilized to help individuals and families***
***achieve and maintain recovery, and lead fulfilling lives***

## Partners For Recovery

- Goals:
- Build partnerships
- Facilitate dialogue
- Create products to support and improve treatment and recovery services (A_***C***_E!)

**Partners For Recovery**

## Substance Abuse Prevention and Treatment Block Grant (SAPTBG)

- Approximately $1.7 billion in FY 2004 for awards to States
- Goals:
- Demonstrate program efficiency and effectiveness (AC_***E***_!)
- Collect quality of life outcome measures (_***A***_CE!)
- Enhance system capacity (A_***C***_E!)

## Screening, Brief Intervention, Referral and Treatment (SBIRT)

- Five-year competitive state grants
- $21 million awarded in FY 2003 to 6 States and 1 tribe
**Goals**
- Expand continuum of care to include screening, intervention, referral, and limited treatment (A_***C***_E!)
- Support clinically appropriate treatment for nondependent and dependent users
- Improve linkages among community agencies performing SBIRT and specialist substance abuse treatment agencies (AC_***E***_!)
- Identify system and policy changes to increase access

## Targeted Capacity Expansion (TCE)

-    Awarded over 431 competitive, three-year TCE grants, since 1998
-    **Goals**
-  Address treatment gaps for those in need
-  Provide resources and technical assistance to better identify and address
-    emerging substance use disorder needs **(AC**_***E***_**!)**
-  Implement, evaluate, and disseminate treatment information
-  Expand the types of services offered and the types of populations served **(A**_***C***_**E!)**
-  Enhance and expand substance use disorder treatment and related HIV/AIDS
-     services for women, adolescents and minority communities

## Medication Assisted Treatment (MAT)

**Goals**
- Reform Federal regulations applicable to Opioid Treatment Programs **(**_***A***_**CE!)**
- Develop treatment options so that the medical and health needs of well-stabilized
- patients, where possible, can be met by individual physicians in office-based settings
- Establish treatment delivery models that incorporate new addiction treatment
- modalities and pharmacological therapies broadly acceptable to mainstream medicine
- and their patients **(AC**_***E***_**!)**
- Increase substance use disorder stakeholder access to MAT information and training
**(AC**_***E***_**!)**

## Science To Services Initiatives

**Addiction Technology Transfer Centers (ATTCs)**
- National office and 14 regional centers serving 50 states, The District
- of Columbia, Puerto Rico, U.S. Virgin Islands and the Pacific Islands
**Goals**
- Promote“Best Practices” to effect change in the treatment system **(AC**_***E***_**!)**
- Create a multitude of products that are timely and relevant to the
-  many disciplines represented by the addiction treatment workforce
- Disseminate the latest-research based information on best practices and
- treatment techniques to addiction treatment professionals

## Science To Services Initiatives

**Knowledge Application Program (KAP)**
**Goals**
- Provide support for adoption of best practices
- (workshops, technical assistance) **(AC**_***E***_**!)**
- Produce knowledge application products
- (TIPS, Quick Guides, brochures for patients, etc.)
- Disseminate products to target audiences
- Adapt products for clients whose first language is not English

## Science To Services Initiatives

**Strengthening Treatment Access and Retention (STAR)**
- Administered in partnership with the Robert Wood Johnson Foundation’s (RWJF)
- “Paths to Recovery” program
**Goals**
- Improve the core processes that facilitate patient access to and
- retention in treatment
- Successfully use process improvement techniques to improve the
- treatment system **(AC**_***E***_**!)**
- Utilize quality improvement teams to set access and retention performance
- targets, identify access and retention practices and change strategies,
- pilot test implementation strategies and monitor performance **(**_***A***_**C*****E*****!)**

## Slide 30

## Where We Are Going

## SAMHSA/CSAT’s Ongoing Commitments

- Promote Partnerships
- Support and Manage Recovery
- Enhance System Effectiveness
- Develop the Workforce
- Reduce Stigma

## Promote Partnerships

- Create forums in which SAMHSA and private organizations can develop collaborative strategies to improve alcohol and drug treatment and recovery services
- Promote communication and collaboration among:
- States and communities
- Service providers
- Academic institutions
- Researchers
- Other stakeholders
- to provide an efficient, seamless system of services
- Continue to expand partnerships with:
- Prevention
- Mental Health
- Primary healthcare providers
- Public Health System
- Child welfare agencies
- Faith-based organizations
- Law Enforcement and Criminal Justice System
- Schools
- to enhance appropriate, quality service delivery in all health and human services

## -

- Primary Health Care

- Addicted
- Users

- At-Risk/
- Non-addicted
- Users

- Diagnosis

**Specialty Treatment System**

**Comprehensive **
**Assessment**

**Substance**
**Use Disorder **
**Treatment**

**Post-Treatment**
**Monitoring & Support**

**Substance**
**Use Disorder**
**Screening**

**Brief**
**Intervention**

- Diagnosis

- Exit
- Intervention

## Support and Manage Recovery

- Reduce treatment system gaps
- Facilitate and support community efforts to build the capacity to participate in the public dialogue about addiction and recovery
- Promote access to treatment for those abusing or dependent on prescription drugs
- Define and support recovery management services

## Integrated Systems of Care

## The Strategic Prevention Framework

**The Strategic Prevention Framework**

**Organize the Community to Profile Needs, Community Readiness**

**Evaluate for Results **

**Develop the Prevention Plan (Activities, Programs, & Strategies)**

**Mobilize the Community & Build Capacity to **
**Address Needs**

**Implement the Prevention Plan**

**Capacity**

**Implementation**

**Planning**

**Evaluation**

**Assessment**

**Sustainability**
**and**
**Cultural Competency**

## Mental Health System Transformation

- Help Americans to understand that mental health is essential to overall health
- Promote consumers and families as drivers of  mental health care
- Eliminate disparities in mental health services
- Ensure that early mental health screening, assessment, and referral to services are common practice
- Deliver excellent mental health care and accelerate research
- Increase the use of technology to access mental health care and information

** ****Goals**

## Many Pathways to Recovery

- A voice for the recovery community
- Peer-to-peer recovery support services
- CSAT’s Recovery Community Services Programs
- Credentialing
- Faith-based
- 12-Step Programs
- Medication-assisted Treatment

## Enhance System Effectiveness 

- Facilitate consensus on quality of care and treatment outcomes
- Support implementation of evidence-based practices that guide screening, intervention, assessment, engagement, individual and group therapies, relapse prevention, and continuing care
- Develop reimbursement mechanisms that:
- Incorporate performance requirements
- Ensure support for system reinvestment

## Develop the Workforce

- Develop a comprehensive report on the state of the workforce
- Establish national addiction professional minimum competency standards
- Develop ongoing data collection of information about the changing characteristics of the workforce
- Continue dissemination of research findings and evidence-based clinical and organizational practices through the ATTC’s and other mechanisms
- Provide training to professionals on effective intervention and treatment services

## Reduce Stigma

- Promote stigma reduction for persons in alcohol/substance use disorder treatment and recovery
- Support educational initiatives that inform the public about treatment and recovery
- Promote the dignity of persons in treatment and recovery

## www.samhsa.gov

- 1-800-729-6686
- 1-800-487-4889 (TDD)
- Publication Ordering and Funding Information
- 1-800-662-HELP
- SAMHSA National Helpline