# Presentation: 774009

## Three of SAMHSA’s Priority Areas Co-Occurring DisordersHIV/AIDSSubstance AbuseUlonda Shamwell, M.S.W.Director, Division of Policy CoordinationOffice of Policy, Planning and BudgetFriday, December 12, 2003

## SAMHSA’s Matrix

## Co-Occurring Disorders

- Seven to ten million individuals in the US have at least one mental disorder as well as an alcohol or drug use disorder.
- Individuals with co-occurring disorders have particular difficulty seeking and receiving diagnostic and treatment services, even though, separately, these disorders are as treatable as other chronic illnesses.

## Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders
Released November 2002.  
Available at http://www.samhsa.gov/reports/congress2002/index.html
Included in this report is a Five-Year Blueprint for Action.

- Released November 2002.
- Available at http://www.samhsa.gov/reports/congress2002/index.html
- Included in this report is a Five-Year Blueprint for Action.

- Co-Occurring Disorders- continuation

## National Summit – Policy Academy
One of the major items of the Blueprint.
Facilitate the development and implementation of State action plans to address co-occurring disorders.
The national summit evolved into the co-occurring Policy Academy, to be held April 14-16, 2004.  Participants will be encouraged to share ideas, practices, and lessons learned in areas of prevention, evidence-based practices, funding and service system change.  
Planning partners include the State Associations of Addiction Services, National Council for Community Behavioral Healthcare, NASADAD, NASMHPH. 

- One of the major items of the Blueprint.
- Facilitate the development and implementation of State action plans to address co-occurring disorders.
- The national summit evolved into the co-occurring Policy Academy, to be held April 14-16, 2004.  Participants will be encouraged to share ideas, practices, and lessons learned in areas of prevention, evidence-based practices, funding and service system change.
- Planning partners include the State Associations of Addiction Services, National Council for Community Behavioral Healthcare, NASADAD, NASMHPH.

- Co-Occurring Disorders- continuation

## Achieving the Promise: Transforming Mental Health Care in America
Released July 2003 by the President’s New Freedom Commission on Mental Health. 
Available at http://www.mentalhealthcommission.gov/reports/reports.htm       
Goal 4 of the report ensures that early mental health screening, assessment, and referral to services are common practices.  A recommendation to achieve this goal is to screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies.  

- Released July 2003 by the President’s New Freedom Commission on Mental Health.
- Available at http://www.mentalhealthcommission.gov/reports/reports.htm
- Goal 4 of the report ensures that early mental health screening, assessment, and referral to services are common practices.  A recommendation to achieve this goal is to screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies.

- Co-Occurring Disorders- continuation

## The first Co-Occurring State Incentive Grants (COSIG) grantee meeting will occur December 15-17, 2003.  Seven states will participate.     
The contract for the National Co-Occurring Disorders Cross-Training Center for Excellence was awarded this September.   

- The contract for the National Co-Occurring Disorders Cross-Training Center for Excellence was awarded this September.

- Co-Occurring Disorders- continuation

## HIV/AIDS

- Since the AIDS epidemic began, injection drug use (IDU) has directly and indirectly accounted for more than one-third of AIDS cases in the United States. Of the estimated 381,012 persons living with AIDS at the end of 2002, 98,794 (26%) were IDU-associated.
- African Americans and Hispanic/Latinos account for 12 and 9 percent of the US population respectively, yet they currently represent almost 50 and 20 percent of new case of HIV/AIDS respectively.

## Participation with HHS and Office of HIV/AIDS Policy
HIV/AIDS Program Management Coordination Team- promotes interagency coordinated efforts on organizational and operational issues related to HIV/AIDS prevention, care and treatment, and grants management.
Capacity Building Roundtables- training and technical assistance activities for HIV/AIDS.
OHAP/The Leadership Campaign on AIDS- Forum on Substance Abuse and HIV/AIDS in Communities of Color- convened community-based minority leaders to discuss HIV/AIDS and substance abuse.

- HIV/AIDS Program Management Coordination Team- promotes interagency coordinated efforts on organizational and operational issues related to HIV/AIDS prevention, care and treatment, and grants management.
- Capacity Building Roundtables- training and technical assistance activities for HIV/AIDS.
- OHAP/The Leadership Campaign on AIDS- Forum on Substance Abuse and HIV/AIDS in Communities of Color- convened community-based minority leaders to discuss HIV/AIDS and substance abuse.

- HIV/AIDS- continuation

## Significant Collaboration with other HHS Agencies
Cross-Training for Collaboration Systems of Prevention, Treatment and Care- CDC, HRSA, SAMHSA, and the Association of State and Territorial Health Officials (ASTHO). 
Advancing HIV Prevention Initiative- SAMHSA and CDC.

- Cross-Training for Collaboration Systems of Prevention, Treatment and Care- CDC, HRSA, SAMHSA, and the Association of State and Territorial Health Officials (ASTHO).
- Advancing HIV Prevention Initiative- SAMHSA and CDC.

- HIV/AIDS- continuation

## Policy Studies on Coordination of HIV, Substance Abuse and Mental Health Services
HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study.
Jointly funded by HRSA, NIH and SAMHSA.
Focuses on the effects of integrated treatment interventions on person living with HIV and co-occurring mental health and substance abuse disorders. 
Coordination to Address the Co-Occurrence of HIV, Chemical Dependency, and Mental Illness- examines state interagency coordination activities on HIV, substance abuse and mental health services.

- HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study.
- Jointly funded by HRSA, NIH and SAMHSA.
- Focuses on the effects of integrated treatment interventions on person living with HIV and co-occurring mental health and substance abuse disorders.
- Coordination to Address the Co-Occurrence of HIV, Chemical Dependency, and Mental Illness- examines state interagency coordination activities on HIV, substance abuse and mental health services.

- HIV/AIDS- continuation

## Minority AIDS Initiative (MAI)- funding to enhance and expand integrated substance abuse prevention, treatment, and mental health services in conjunction with HIV/AIDS to African American, Latino/Hispanic, and/or other racial or ethnic communities.
Block Grant Early Intervention Services (EIS or “HIV set-aside”).
SAMHSA- wide Workgroup on HIV/AIDS and Hepatitis.
Coordination with NASTAD, NASADAD, NASMHPH, and ASTHO- external stakeholders provide input to SAMHSA policy discussion. 

- Block Grant Early Intervention Services (EIS or “HIV set-aside”).
- SAMHSA- wide Workgroup on HIV/AIDS and Hepatitis.
- Coordination with NASTAD, NASADAD, NASMHPH, and ASTHO- external stakeholders provide input to SAMHSA policy discussion.

- HIV/AIDS- continuation

## Substance Abuse

- SAMHSA's 2002 National Survey on Drug Use & Health estimates that among the general population age 12 and older, 120 million Americans were current alcohol users, 75.1 million Americans were current tobacco users, and 19.5 million Americans were current illicit drug users. An estimated 22 million Americans were classified with abuse or dependence on either alcohol, illicit drugs or both.

## President’s Access to Recovery Initiative
Ensure that voucher recipients have a genuine, free, and independent choice of clinical treatment and recovery support service options.
Increase capacity over the period of the voucher program.
Enable providers previously not able to compete for Federal funds to participate in the Access to Recovery program (such as some faith- and community- based providers). 

- Ensure that voucher recipients have a genuine, free, and independent choice of clinical treatment and recovery support service options.
- Increase capacity over the period of the voucher program.
- Enable providers previously not able to compete for Federal funds to participate in the Access to Recovery program (such as some faith- and community- based providers).

- Substance Abuse- continuation

## The President proposed $200 million a year for three years for this program.  Based on the recent conference report, we expect that this program will be funded at the $100 million level. 
The conference report directed that will providers participating in the Access to Recovery program should be held accountable to the same standards of care, performance, licensure and certification as other licensed or certified drug and alcohol programs in their respective States. 

- The conference report directed that will providers participating in the Access to Recovery program should be held accountable to the same standards of care, performance, licensure and certification as other licensed or certified drug and alcohol programs in their respective States.** **

- Substance Abuse- continuation

## Strategic Prevention Framework
Grounded in SAMHSA’s mission to promote resilience and facilitate recovery by reducing risk factors that lead to substance abuse, and by promoting protective factors.
Emphasizes the use of evidence-based practices, and the idea that systems of prevention work better than silos. 
Operationally, it means that all levels of government, and communities, should: (1) profile their needs, including readiness for change,  (2) mobilize and build capacity, (3) select and implement programs that are know to be effective, and (4) evaluate programs for effectiveness.  

- Grounded in SAMHSA’s mission to promote resilience and facilitate recovery by reducing risk factors that lead to substance abuse, and by promoting protective factors.
- Emphasizes the use of evidence-based practices, and the idea that systems of prevention work better than silos.
- Operationally, it means that all levels of government, and communities, should: (1) profile their needs, including readiness for change,  (2) mobilize and build capacity, (3) select and implement programs that are know to be effective, and (4) evaluate programs for effectiveness.

- Substance Abuse- continuation

## Screening, Brief Intervention and Referral Program (SBIRT)
Instituted in recognition of the strong evidence base for the effectiveness of brief interventions- particularly for those who abuse alcohol- and the fact that this cost effective strategy is underutilized in most States.
Designed to expand the continuum of care to include screening, brief intervention, referrals and brief treatment. 
In FY 2003, SBIRT awards totaling $20 million were made to seven States. 

- Instituted in recognition of the strong evidence base for the effectiveness of brief interventions- particularly for those who abuse alcohol- and the fact that this cost effective strategy is underutilized in most States.
- Designed to expand the continuum of care to include screening, brief intervention, referrals and brief treatment.
- In FY 2003, SBIRT awards totaling $20 million were made to seven States.

- Substance Abuse- continuation

## Addiction Technology Transfer Center (ATTC) Network
Improves addiction treatment by strengthening the knowledge, skills, and attitudes of substance abuse treatment practitioners by creating and expanding continuing education and university coursework, developing academic programs, increasing clinical placements, and setting educational standards.
Advocates for and carries out initiatives that are designed to enhance the addiction treatment profession and make it attractive to today’s best and brightest professionals. 
Operates as 14 individual Regional Centers and a National Office.
Additional information can be found at: http://www.nattc.org/ 

- Improves addiction treatment by strengthening the knowledge, skills, and attitudes of substance abuse treatment practitioners by creating and expanding continuing education and university coursework, developing academic programs, increasing clinical placements, and setting educational standards.
- Advocates for and carries out initiatives that are designed to enhance the addiction treatment profession and make it attractive to today’s best and brightest professionals.
- Operates as 14 individual Regional Centers and a National Office.
- Additional information can be found at: http://www.nattc.org/

- Substance Abuse- continuation

## Questions?