Transcript Slide 1

Aligning Concepts, Practice and Contexts to
Promote Long-term Recovery: An Action Plan
“Recovery Oriented Systems of Care:
SAMHSA/CSAT’s Public Health Approach
to Substance Use Problems & Disorders”
May 2, 2008
Philadelphia, PA
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services
Administration
U.S. Department of Health & Human Services
“…To build a future of
quality health care, we must
trust patients and doctors to
make medical decisions and
empower them with better
information and better
options .”
2008 State of the Union
President George W. Bush
“At SAMHSA, our mission
includes helping prevention
and treatment counselors,
clinics, and health care
providers develop ways to
change their service systems
to increase positive outcomes
for their clients.”
Terry L. Cline, PhD
Administrator
Substance Abuse and Mental Health Services
Administration
September 2007
An Introduction to the
Substance Abuse and Mental Health Services
Administration (SAMHSA)
• One of the eleven grant making agencies of the U.S.
Department of Health and Human Services, with a
budget of approximately 3 billion dollars.
• SAMHSA’s Mission:
– To build resilience and facilitate recovery for
people with or at risk for substance abuse and
mental illness.
• Website: http://www.SAMHSA.gov
SAMHSA’s Role in Fighting Substance
Misuse and Abuse
• SAMHSA works to ensure that science, rather than
ideology or anecdote, forms the foundation for the
Nation’s addiction treatment system.
• SAMHSA serves health professionals and the public
by disseminating scientifically sound, clinically
relevant information on best practices in the treatment
of addictive disorders and by working to enhance
public acceptance of that treatment.
The SAMHSA Matrix
SAMHSA’s Matrix
provides a graphic
representation of the
collaboration needed to
promote holistic,
integrated approaches
that advance the health
and well-being of
individuals, families,
and communities.
SAMHSA Centers
Center for Mental Health Services Mission:
• To ensure access and availability of quality mental
health services to improve the lives of all adults and
children in this Nation.
Center for Substance Abuse Prevention Mission:
• To decrease substance use and abuse by bringing
effective substance abuse prevention to every
community.
Center for Substance Abuse Treatment Mission:
• To improve the health of the nation by bringing
effective alcohol and drug treatment to every
community.
SAMHSA Programs Support a
Comprehensive Approach to Public Health
Law
Enforcement
Substance
Abuse
Treatment
Public
Health
Mental
Health
Substance
Abuse
Prevention
We Face Multiple Challenges
• Reaching those in need of services
• Providing adequate resources
• Developing culturally-appropriate, evidence-based
interventions
• Building and sustaining a qualified workforce
• Integrating substance use disorder services into the
public health paradigm
Greater Burden on Public Sector
Private
Private
23%
50%
50%
Public
1986 All SA = $9.3B
Public = $4.6 B
Private = $4.6 B
Source: Health Affairs, July-August 2007
77%
Public
2003 All SA = $20.7 B
Public = $16.0 B
Private = $4.7 B
A Public Health Imperative
Substance Misuse can:
Lead to:
• Worsened medical conditions (e.g. diabetes,
hypertension) and
• Worsened brain disorders (e.g. depression, psychosis,
anxiety & sleep disorders)
• Unintentional injuries & violence
Result in:
• Dependence, which may require multiple treatment
services
• Low birth weight, premature deliveries, and
developmental disorders, child abuse & neglect
A Public Health Imperative
Substance Misuse can:
Contribute to or be associated with :
• Homelessness
• Criminal justice involvement
• The effect and abuse of prescribed medications
• Unemployment
• Gambling
• Bankruptcy
• Legal Issues (e.g. DUI, DWI, domestic violence)
• Dropping out of school
A Public Health Imperative
Substance Misuse can:
Induce or facilitate:
• Medical diseases (e.g. Stroke, dementia, hypertension,
cancers)
• Acquiring Infectious diseases & infections (e.g. HIV,
Hepatitis C)
• Suicide attempts or tendencies
Past Month Alcohol Use - 2006
• Any Use:
51% (125 million)
• Binge Use:
23% (57 million)
• Heavy Use:
7% (17 million)
(Current, Binge, and Heavy Use estimates are
similar to those in 2002, 2003, 2004, and 2005)
Source: NSDUH 2006
Drug Use Among the General Population –
2006
70
Percent Using
60
50
Lifetime
40
Past Year
30
Past Month
20
10
65+
60-64
55-59
50-54
45-49
40-44
35-39
30-34
26-29
15-25
0
Age Category
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use & Health, 2005 & 2006
Illicit Drug Dependence or Abuse in Past Year among Persons Aged
12 or Older: Percentages,
Percentages of
Persons
3.11-4.25
2.92-3.10
2.82-2.91
2.57-2.81
2.10-2.56
Source: Annual Averages Based on 2005-2006 NSDUHs
Non-Medical use of Pain Relievers in Past Year among Persons aged
12 or Older: Percentages
Percentages of
Persons
5.66-6.72
5.31-5.65
4.83-5.30
4.40-4.82
3.85-4.39
Source: Annual Averages Based on 2005-2006 NSDUHs
Alcohol Dependence or Abuse in Past Year among Persons Aged 12
or Older: Percentages
Percentages of
Persons
8.78-10.81
8.15-8.77
7.52-8.14
6.81-7.51
6.30-6.80
Source: Annual Averages Based on 2005-2006 NSDUHs
The Challenge
Past Year Perceived Need for and Effort Made to Receive
Treatment among Persons Aged 12+ Needing But Not Receiving
Specialty Treatment for Illicit Drug or Alcohol Use: 2006
Did Not Feel
They Needed
Treatment
(20,114,000)
Felt They Needed
Treatment and Did
Not Make an Effort
(625,000)
95.5%
3.0%
1.5%
Felt They Needed
Treatment and Did
Make an Effort
(314,000)
21.1 Million Needing But Not Receiving
Treatment for Illicit Drug or Alcohol Use
Identifying & Treating Substance Abuse
Substance abuse is often observed, but ignored or excused, before
the client is identified as needing treatment.
Drug Courts
Alcohol Treatment
Family
Friends
Employer/
Co-Workers
Public
Health
Treatment
Strategies
SBIRT
HIV/AIDS
Adolescent
Treatment
Women &
Children Services
SAPT Block Grant
Shifting our Paradigm to
Recovery-Oriented Systems of
Care
21
The Recovery Process
Recovery from alcohol and drug problems is a
process of change through which an individual
achieves abstinence and improved health, wellness,
and quality of life.
Source: CSAT National Summit on Recovery, 2005
Recovery-Oriented Systems of Care: A
Paradigm Shift
Recovery-Oriented Systems of Care shift the question
from “How do we get the client into treatment?” to
“How do we support the process of recovery within
the person’s environment?”
A Traditional Course of Treatment for a
Substance Use Disorder
Symptoms
Severe
100
Person’s
Entry into
treatment
Discharge
Remission0
Resource: Tom Kirk, Ph.D
Time
A Traditional Service Response
Symptoms
Severe
100
Remission0
Resource: Tom Kirk, Ph.D
Acute symptoms
Discontinuous treatment
Crisis management
A Recovery-Oriented Response
Symptoms
Severe
100
Continuous
treatment
response
Remission0
Promote Self Care, Rehabilitation
Resource: Tom Kirk, Ph.D
Helping People Move Into A Recovery Zone
Severe
Symptoms
Recovery Zone
Improved client outcomes
Remission
Time
Resource: Tom Kirk, Ph.D
Benefits of Moving into a Recovery Zone
• Most clients undergo 3 to 4 episodes of care before
reaching a stable state of abstinence ¹
• Chronic care approaches, including self-management,
family supports, and integrated services, improve
recovery outcomes 2
• Integrated and collaborative care has been shown to
optimize recovery outcomes and improve costeffectiveness 3
¹ Dennis, Scott & Funk, 2003
2 Lorig
3
et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001
Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)
Defining
Recovery-Oriented Systems of
Care
29
Recovery-Oriented Systems of Care
Approach
• In the recovery-oriented systems of care approach, the
treatment agency is viewed as one of many resources
needed for a client’s successful integration into the
community.
• No one source of support is more dominant than another.
• Various supports need to work in harmony with the
client’s direction, so that all possible supports are working
for and with the person in recovery.
Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest
Frontier ATTC.
ROSC support person-centered and self-directed approaches to care
that build on the personal responsibility, strengths, and resilience of
individuals, families and communities to achieve health, wellness,
and recovery from alcohol and drug problems.
Recovery
Individual
V
Family
Community
Wellness
Health
ROSC offer a comprehensive menu of services and supports that can
be combined and readily adjusted to meet the individual’s needs and
chosen pathways to recovery.
Recovery
Services & Supports
Family/
Child Care
Education
Alcohol/Drug Services
Vocational
Individual
Family
Community
Housing/
Transportation
Spiritual
Physical Health Care
HIV Services
Financial
Wellness
PTSD &Mental Health
Legal
VSO & Peer Support
Case Mgt
Health
ROSC encompass and coordinates the operations of multiple
systems…
Recovery
Systems of Care Addiction
Child Welfare
Services System
and Family
Services & Supports
Social Services
Mental Health
Family/
Alcohol/Drug Treatment
Services
System
Child Care
Vocational
Housing
Individual
Educational
Primary Care
PTSD & Mental Health
Family
System
Housing/
System
Health Care
Transportation
Community
HIV Services
Faith Community Spiritual
Vocational
Indian Health
Services
Financial
Legal
VSO & Peer Support
Services
Case Mgt
Health Insurance
Wellness
Criminal Justice
System
DoD & Veterans Affairs
Health
…providing responsive, outcomes-driven approaches to care.
Recovery
Abstinence
Evidence-Based
Practice
Systems of Care
Child Welfare
and Family
Services
Cost
Effectiveness
Social
Services
Perception
Of Care
Housing/
Transportation
Retention
Indian Health
Services
Alcohol/Drug Treatment
PTSD &Mental Health
Health Care
HIV Services
Spiritual
Financial
Legal
VSO & Peer Support
Criminal Justice
System
DoD & Veterans Affairs
Access/Capacity
Reduced
Crime
Primary Care
System
Vocational Services
Case Mgt
Health Insurance
Wellness
Mental Health
System
Vocational
Individual
Family
Community
Educational
Faith Community
Employment
Menu of Services
Family/
Child Care
Housing
Authority
Addiction
Services System
Social Connectedness
Safe & Drug-free
Housing
Health
ROSC require an ongoing process of systems improvement that
incorporates the experiences of those in recovery and their family
members.
Recovery
Abstinence
Evidence-Based
Practice
Systems of Care
Child Welfare
and Family
Services
Cost
Effectiveness
Perception
Of Care
Social
Services
Housing
Authority
Addiction
Services System
Services & Supports
Family/
Child Care
Alcohol/Drug Treatment
Individual
Family
Community
Educational
Housing/
Transportation
Mental Health
System
Vocational
PTSD & Mental Health
Spiritual
Indian Health
Services
Health Care
Primary Care
System
Reduced
Crime
HIV Services
Financial
Legal
VSO & Peer Support
Vocational Services
Case Mgt
Retention
Health Insurance
Wellness
Employment
Criminal Justice
System
DoD & Veterans Affairs
Access/Capacity
Social Connectedness
Ongoing Systems Improvement
Safe & Drug-free
Housing
Health
Recovery-Oriented Systems of Care
• Support person-centered and self-directed approaches to care
that build on the strengths and resilience of individuals,
families and communities to take responsibility for their
sustained health, wellness, and recovery from alcohol and drug
problems.
• Offer a comprehensive menu of services and supports that can
be combined and readily adjusted to meet the individual’s
needs and chosen pathway to recovery.
Recovery-Oriented Systems of Care
• Encompass and coordinate the operations of multiple systems,
providing responsive, outcomes-driven approaches to care
• Require an ongoing process of systems improvement that
incorporates the experiences of those in recovery and their
family members
Elements of Recovery-Oriented Systems of
Care
Person-Centered:
• Individualized & Comprehensive Services
• Responsive to Culture & Personal Belief Systems
• Community-based
• Commitment to Peer Services
• Involvement of Family and other Allies
• Ongoing Monitoring & Outreach
Elements of Recovery-Oriented Systems of
Care
Cost Effective:
• Outcomes Oriented
• Integrated Services, resulting in NonDuplication of Services
• Competency-based
• Effective use of Collaboration & Partnerships
• Systems-wide Education and Training
• Continuity of Care
• Research-based
• Flexible Funding
How do we “sell” treatment to
those who need it?
40
Alcohol & Drug Related Emergency
Department (ED) Visits
• In 2005 there were an estimated 394,224 ED
visits that involved alcohol in combination with
another drug.
• Alcohol was most frequently combined with one
or more of the following: cocaine, marijuana,
and heroin
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).
Opiate Reports in Emergency Department
Visits Related to Drug Misuse/Abuse
40,000
30,000
36,007 Heroin
20,000
5,694 Methadone
5,085 Hydrocodone*
10,000
5,066 Oxycodone*
225 Buprenorphine*
0
2004
2005
2006
Unweighted reports from
243-445 U.S. hospitals
Source: U.S. SAMHSA; DAWN Live! Oct 2, 2007
* Includes single- and multiingredient products
Traditional Substance Abuse Intervention
• Little attention has been given to the large group of
individuals who use alcohol and other drugs but are
not, or not yet, dependent .
5%
Alcoholics
20% At-Risk
Drinkers
35% Low Risk Drinkers
40% Abstainers
Adapted from Babor,T,F., Higgins-Biddle,J.C., (2001), Brief Intervention for Hazardous and Harmful Drinking: A manual for
use in primary care . p 33. WHO/MSD/MSB/01.6b World Health
Screening, Brief Intervention & Referral to
Treatment (SBIRT)
• Embeds screening, brief intervention & treatment
of substance abuse problems within primary care
settings such as emergency centers, community
health care clinics, and trauma centers.
• Identifies patients who don’t perceive a need for
treatment,
• Provides them with a solid strategy to reduce or
eliminate substance abuse, and
• Moves them into appropriate services.
SBIRT Takes Advantage of the “Teachable
Moment”
“Teachable Moment” is the moment of educational
opportunity – a time at which a person is likely to
be particularly disposed to learn something or
particularly responsive to being taught or made
aware of something.
Source: MSN Encarta Online Dictionary, Retrieved 3/25/08 from http://encarta.msn.com
Top Five Substances Reported by SBIRT
Clients
5%
5%
13%
26%
70%
Source: Services Accountability Improvement System (SAIS)
Alcohol
Marijuana/Hashish
Cocaine/Crack
Methamphetamine
Heroin
CSAT SBIRT Initiative
1. Increases access to clinically appropriate care for
nondependent as well as dependent persons.
2. Links generalist and specialist treatment systems.
3. Combines intervention and treatment toward a
consistent continuum of care.
4. Builds a coalition between health care services
and alcohol and drug treatment services.
SBIRT enhances State substance abuse
treatment service systems by:
Expanding the State’s continuum of care to include
SBIRT in general medical and other community
settings
• community health centers
• nursing homes
• schools and student assistance programs
• occupational health clinics
• hospitals, emergency departments.
SBIRT enhances State substance abuse
treatment service systems by:
• Changing how substance abuse is managed in
primary care settings
• Treating substance abuse issues at the lowest level
of acuity, before clients are diagnosed with
substance use disorders
SBIRT: Core Clinical Components
• Screening: Very brief screening that identifies
substance related problems
• Brief Intervention: Raises awareness of risks and
motivation of client toward acknowledgement of
problem
• Brief Treatment: Cognitive behavioral work with
clients who acknowledge risks and are seeking help
• Referral: Referral of those with more serious
addictions
SBIRT: Screening
• Quick method to identify individuals who may be
at risk for developing alcohol and substance abuse
problems
• Includes screening plus immediate feedback
– serves as an intervention and
– is tailored to the level of either illness or risk
• Screening is performed using a brief questionnaire
about the context, frequency, and amount of alcohol
or other drugs used by an individual
SBIRT: Brief Intervention
• Healthcare provider uses the results of a screening
questionnaire that indicates a moderate alcohol or
drug problem to motivate an individual to begin to
do something about his/her substance use behavior
– Typically 1-3 sessions, not more than 5 sessions
– One or more follow-up care management
contacts with patients either in brief face-to-face
counseling or by telephone
• Low-cost, effective treatment alternative for alcohol
and other drug problems
Components of Brief Interventions
• Give feedback about screening results, impairment
and risks, while clarifying the findings
• Inform the patient about hazardous consumption
limits and offer advice about change
• Assess the patient's readiness to change
• Negotiate goals and strategies for change
• Arrange for follow-up treatment
SBIRT: Brief Treatment
• Based on moderate to high risk screening scores
• Involves motivational discussion and client
empowerment
• Similar to brief intervention, but more comprehensive
• Includes assessment, education, problem solving, and
building a supportive social environment
• Examples include:
– Brief cognitive-behavioral therapy
– Brief psychodynamic therapy
– Brief family therapy
SBIRT: Referral to Treatment
• Healthcare provider -- using the results of a
screening questionnaire that indicates alcohol or
drug dependence -- refers an individual to a
specialized treatment setting
• Proactive process facilitates access to specialty
treatment for individuals requiring more extensive
resources than can be provided in a primary care
setting
• This integral component of SBIRT ensures access
to the appropriate level of care for all who are
screened
Coding for SBI Reimbursement
February 2008
Reimbursement for screening & brief intervention is
available through commercial insurance CPT codes,
Medicare G codes and Medicaid HCPCS codes
• HCPCS Codes (Medicaid)
H0049: Alcohol &/or Drug Screening ($24)
H0050: Brief Intervention:15 mins. ($48)
• CMS G-Codes (Medicare)
G0396: 15-30 mins ($29.42)
G0397: > 30 mins ($57.69)
• CPT Codes (Commercial Health Plans)
99408: 15-30 mins ($33.41)
99409: > 30 mins ($65.51)
SBIRT Current Grantees
& Colleges
Massachusetts
Connecticut
Delaware
College/University Grants
State Grants
SBIRT– Patients Served
625,937 patients have been seen through the
SBIRT process:
• 16.2% received brief intervention
• 3.1% received brief treatment
• 3.6% were referred to treatment
SBIRT Outcomes
• Since FY 2004, there has been a 152.6% increase
in the number of clients reporting abstinence 6
months after intake.
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
41.9%
Intake
6 Month
Follow-up
16.6%
Source: Random sample collected at baseline & 6 months post intake, as of 3/24/08.
Results are from SBIRT early implementation and reflect a more severely involved substance abuse population.
Alcohol to Intoxication & Illegal Drug Use –
SBIRT Outcomes
The data below represent follow-up from the SBIRT
programs as of 3/24/08. Sample selection was random
and collected at intake and 6 months post intake.
Measure
Intake %
Follow-up %
Change Rate
Alcohol to
intoxication (5+
drinks)
51.7%
32.2%
- 37.7%
Use of any illegal
drugs
37.1%
18.6%
- 49.9%
Important to note: Results are from SBIRT early implementation and reflect a more severely involved
substance abuse population.
Access to Recovery:
A Recovery-Oriented Systems of
Care Model
61
Access to Recovery (ATR)
• ATR is a Presidential Initiative designed to promote
client choice through
– the expansion of treatment capacity,
– the implementation of a voucher system, which
allows most grantees to choose their target
populations and geographic area(s) of coverage,
and
– the inclusion of non-traditional substance abuse
treatment providers, such as faith- and community
based organizations
Access to Recovery (ATR)
• The recovery-oriented approach contributes to the
effective application of the ATR program.
– Recovery support services in conjunction with
clinical treatment help to establish a more
continuous treatment response.
• The recovery-oriented model ultimately means
that the program focuses on reducing the acute and
severe relapses that substance abusing clients
often experience.
More Choices for Clients
• ATR has helped mobilize community networks and
build collaborative partnerships that result in more
choices and more services for clients with substance
abuse issues.
• Faith-based organizations have expanded the concept
of choice by offering faith-based options to clients
who may have a more spiritual approach to their
recovery
More Flexibility
• Empowers clients to directly participate in their own
recovery by offering them choices about where and
from whom they receive treatment.
• Levels the playing field so that smaller and newer
providers can improve their ability to compete for
Federal funds and address the issues of their
communities.
Helps Build Networks
• ATR provides a platform to develop linkages with other
federal agencies/programs which can help to leverage
ATR funds or serve as a source of referrals/services:
– Drug courts may be sources of referrals into the
program
– DOJ-DOL program—Prisoner Reentry Program
– HUD—Housing services (direct housing services such
as rent payments are not permissible under ATR)
ATR Electronic Voucher System
• Significantly reduces paperwork and creates
administrative efficiencies;
• Streamlines the referral process for clients;
• Improves data collection on client outcomes to track
the impact of the program on clients;
• Increases accountability by tracking clients through the
system, and tracks ATR dollars to manage program
funds and monitor for fraud, waste, or abuse;
• Links various providers together through an electronic
database.
Examples of Services That Can be Paid for
Using ATR Vouchers
•
•
•
•
•
•
•
Employment coaching
12-step groups
Recovery coaching
Spiritual support
Child Care
Housing Support
Literacy Training
• Traditional Healing
Practices, e.g.:
– Sweat lodge
– Sundance ceremony
– Burning sage
– Beading
– Other
Contributions of Faith- and Communitybased Organizations (FBCOs)
• FBCOs have expanded the concept of choice by offering
faith-based options to clients who may have a more
spiritual approach to their recovery.
• In many cases clients consider them trustworthy sources
that were located within the client’s community and who
were unaffiliated with any formal state or federal
structure.
• FBCOs are particularly effective for engaging and
retaining clients who had been incarcerated or had
criminal records.
Contributions of Faith- and Communitybased Organizations (FBCOs)
• FBCOs infused the treatment networks with recovery
support services such as transportation, child care,
scriptural study groups, faith-based counseling, and
peer-to-peer support.
• The inclusion of recovery support services has
enhanced treatment outcomes and has helped clients to
remain motivated and engaged in their treatment.
• FBCOs can counter the “spiritual malaise” the results
from guilt and shame for how addiction has affected
loved ones and can, consequently, can hinder recovery.
Benefits of Faith- and Community-based
Treatment Programs
• 79% of Americans believe that spiritual faith
can help people recovery from disease.
• 63% think that physicians should talk to
patients about spiritual faith.
Source: Sloan, R. P., Bagiella, E., Powell, T. (1999) Religion, spirituality, and medicine. Lancet,
353(9153), 664-667, cited in CASA study: So Help Me God: Substance Abuse, Religion and
Spirituality, 2001
ATR Evidences of Success
• More than 206,000 individuals with substance abuse
problems have received treatment and/or recovery
support services through the first round of ATR grants
awarded in August 2004.
• 1,233 Faith-based providers account for 23% of all
recovery support providers and 31% of all Clinical
Treatment providers with voucher redemptions.
Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability
Improvement System (SAIS). 12/31/07
ATR Evidences of Success
• 74.3% of clients who reported using substances at intake into
ATR were abstinent from substance abuse at discharge.
– This exceeds the success rate of most national programs.
Behavior
At Discharge
Clients involved with the criminal justice system at intake
reported no involvement at discharge
87.8%
Clients reporting lack of stable housing at intake reported
being stably housed at discharge.
24.1%
clients who were unemployed at intake reported being
employed at discharge
clients who reported not being socially connected at intake
were socially connected at discharge.
Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability
Improvement System (SAIS). 12/31/07
32%
60.6%
SAMHSA Programs –
Paths to Recovery
74
Treatment Drug Courts
•
•
Treatment Drug Courts combine the sanctioning
power of courts with effective treatment programs
Currently, there are 25 Family & Juvenile Drug Court
grantees in the following states:
–
–
–
–
–
–
–
Alabama
California
Florida
Kentucky
Massachusetts
Michigan
Missouri
–
–
–
–
–
–
–
Montana
Ohio
Oregon
Pennsylvania
Rhode Island
Texas
Wyoming
SAMHSA’s Commitment to Treatment Drug
Courts
Family & Juvenile Drug Court grants allocate funds to
be used by treatment providers and the courts for:
• the provision of alcohol & drug treatment,
• Wrap-around services supporting substance
abuse treatment,
• Case management, and
• Program coordination.
Treatment Drug Courts Evidences of Success
A total of 8,363 clients were served from FY 2003 to
FY 2006.
Of the clients served in FY 2007:
• 1,152 clients were discharged from the program
• 57.1% of those discharged graduated/completed the
program
• Nearly three-quarters stayed in the program for
more than 121 days.
Source: SAMHSA Services Accountability Improvement System (SAIS) 2006
Treatment Drug Courts
Evidences of Success
Behavior “within past 30
days”…
% at
Intake
6-Month
Difference
Follow-up (%)
Clients reporting being arrested
14.5%
7.8%
Decreased
46.2%
Clients reporting being arrested
for drug related offences
42.7%
35%
Decreased
18%
Clients reporting spending time
in jail/prison
22.5%
14.1%
Decreased
37.3%
Clients reporting committing a
crime
55.7%
28.2%
Decreased
49.4%
Clients reporting awaiting
charges, trial, or sentencing
17.9%
12.2%
Decreased
31.8%
Clients reporting being on
parole or probation
55.3%
46.4%
Decreased
16.1%
Source: SAMHSA Services Accountability Improvement System (SAIS) March 3, 2008
Injection Drug Use & HIV/AIDS
According to CDC data on U.S. adolescents and adults
– in 2006:
• Approximately 13% of the reported new AIDS cases
were related to injection drug use.
• 19% of males and 32% of females living with AIDS were
exposed through injection drug use.
• Almost one-third (27.8%) of AIDS deaths were
adolescents and adults infected through injection drugs.
Source: CDC. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: US Department of Health and Human
Services, CDC; 2008.
The HIV/AIDS Challenge
Number of HIV Infected in the U.S. at end of 2003:
1,039,000 to 1,185,000
Number unaware of their HIV infection (U.S.) at end
of 2003:
252,000 to 312,000 (24% - 27%)
Source: Glynn M, et al. Estimated HIV prevalence in the United States at the end of 2003.
National HIV Prevention Conference; June 12–15, 2005; Atlanta. Abstract T1-B1101.
CSAT - Minority AIDS Initiative
• Minority AIDS grants are awarded to communitybased organizations with two or more years of
experience in the delivery of substance abuse
treatment and related HIV/AIDS services.
• Programs target African American, Latino/Hispanic
and other racial or ethnic communities highly affected
by substance abuse and HIV/AIDS.
• HIV Outreach grants served 22,760 clients
• TCE/HIV grants served 18,158 clients
• As a whole, the HIV Portfolio served a combined
40,918 clients
2007 CSAT TCE/HIV Grantees
AK
WA
NH
VT
MT
MN
OR
ID
SD
WI
NY
WY
NV
MI
IA
NE
IL
AZ
OH
IN
WV
CO
CA
KS
MO
VA
KY
NC
TN
NM
OK
MA
PA
UT
AR
CT
NJ
DE
MD
RI
DC
SC
MS
TX
AL
GA
LA
HI
ME
ND
FL
Puerto Rico
Virgin Islands
States with 2007 Grantees
HIV/AIDS Outreach – TCE/HIV
Evidences of Success
National Outcome
Measures (NOMs)
% at
Intake
6-Month
Follow-up
(%)
Difference
Clients reporting no
substance use
31.9%
56.1%
Increased
75.9%
Clients reporting being
employed
25.0%
37.6%
Increased
50.7%
Clients reporting being
housed
33.5%
39.8%
Increased
18.8%
Clients reporting no
arrests
84.9%
87.3%
Increased
2.9%
Clients reporting being
socially connected
68.9%
73.0%
Increased
6.0%
TCE/HIV and HIV Outreach
Changes in Risk Behaviors
Risk Behavior
% at Intake
6-Month
Difference
Follow-up (%)
Clients reporting injection drug use
11.6%
4.4%
Decreased
62.3%
Clients reporting having
unprotected sex
68.9%
61.7%
Decreased
10.4%
Clients reporting having
unprotected sex with an HIV+
individual
5.2%
4.6%
Decreased
10.1%
Clients reporting having
unprotected sex with an IDU
8.9%
5.8%
Decreased
34.2%
Clients reporting having
unprotected sex with an individual
high on some substance
33.6%
20.8%
Decreased
38.1%
Source: SAIS data FY 2004 through 3/21/08
Residential Treatment for Pregnant and
Postpartum Women (PPW)
• PPW is a gender and culturally specific residential
treatment program for pregnant and postpartum
women.
• Providing comprehensive services to women during
pregnancy significantly improves the lives of women,
children, and their families.
• These services are also important after birth, since the
effects of alcohol and drug use continue to have
negative consequences for women, their children, and
the entire family.
Residential Treatment for Pregnant and
Postpartum Women (PPW)
• Target is traditionally underserved populations -especially racial and ethnic minority women, as an
important subpopulation
– Low-income women, age 18 and over, who are
pregnant, postpartum (the period after childbirth
up to 12 months), and their minor children, age 17
and under, who have limited access to quality
health services are the target population for the
PPW program.
Pregnant, Postpartum & Parenting Program
Residential Treatment for Pregnant and Postpartum Women
and Residential Treatment for Women and their
Children program served 2,067 women from FY 2004
through the present.
Black or African American
1.3%
12.1%
15.9%
Asian
1.0%
7.9%
0.7%
2.3%
27% of women
also considered
themselves
Hispanic, in
addition to race
reported.
Native Hawaiian or Other
Pacific Islander
Alaska Native
White
American Indian
Other
58.8%
Multi-Racial
Source: SAMHSA data reported by grantees through the Services Accountability Improvement System (SAIS). 2/19/08
Substance Abuse Prevention and Treatment
(SAPT) Block Grant
• The SAPT Block Grant distributes funds to 60 eligible:
– States
– Territories
– The District of Columbia
– The Red Lake Indian Tribe of Minnesota
• 95% of appropriate funds are distributed to States through
a formula prescribed by the authorizing legislation. (For
information, contact the your Single State Authority)
• The Goal: To support and expand substance abuse
prevention and treatment services, while providing
maximum flexibility to the States.
• In FY 2008 over 1.8 million admissions to treatment
programs received public funding.
SAPT Block Grant Evidences of Success
Preliminary data collected for all SAPT Block Grant
programs indicate:
• 73.4% of clients reported alcohol abstinence at the
time of discharge – up 42.5% from time of
admission.
• 67.8% of clients reported drug abstinence at the
time of discharge – up 58.1% from time of
admission.
• 63.4% of clients reported having social support at
the time of discharge – up 44.3% from time of
admission.
Source: FY 2008 Uniform application for Substance Abuse Prevention and Treatment (SAPT) Block
Grant Treatment Measures, 10/01/2007 (revised 12/02/07)
SAPT Block Grant Evidences of Success
SAPT Block Grant preliminary data cont’d::
• 40.8% of clients reported being employed at the
time of discharge – up 10.9% from time of
admission.
• 93.4% of the clients reported having housing at the
time of discharge – up 2.4% from time of
admission.
• 87.9% of clients reported no arrests at the time of
discharge – up 19.2% from time of admission.
Source: FY 2008 Uniform application for Substance Abuse Prevention and Treatment (SAPT) Block
Grant Treatment Measures, 10/01/2007 (revised 12/02/07)
Programs Focusing on Children &
Adolescents
• Approximately 5% to 9% of children (aged 9-17)
have a serious emotional disturbance
– Many have a co-occurring substance abuse
disorder.
• 8.8 % adolescents (aged 12 - 17) have met the criteria
for dependence and/or abuse of illicit drugs or
alcohol.
• Adolescents who had experienced a past year major
depressive episode were more than twice as likely to
have used illicit drugs in the past month than their
peers who had not (21.2% vs. 9.6%).
Programs Focusing on Children &
Adolescents
SAMHSA treatment & prevention programs that focus
on the unique needs of children and adolescents include:
• Safe Schools/Healthy Students
– Designed to prevent violence and substance abuse among
our Nation's youth, schools, and communities.
• Helping America’s Youth
– Led by First Lady Laura Bush to benefit children and
teenagers by encouraging action in three key areas: family,
school, and community.
• StopAlcoholAbuse.gov
– Comprehensive portal of Federal resources for information
on underage drinking and ideas for combating this issue.
Programs Focusing on Children &
Adolescents (cont’d)
• Systems of Care
– An approach to mental health services that
recognizes the importance of family, school and
community.
• Too Smart to Start
– An underage alcohol use prevention initiative for
parents, caregivers, and their 9-to-13 year-old
children.
Recovery Month – September 2008
Goals:
• Support the administration’s goal of reducing demand
and promoting the message that recovery is possible
• Generate momentum for hosting state and local
community-based events
– Enhance knowledge, Improve understanding,
Promote support for addiction treatment
• Publicize messages that:
– Reduce the stigma & discrimination associated with
addiction
– Encourage those in need to get treatment
– Support those who are already in recovery
Get involved in Recovery Month
Help bring hope and healing to others
• Visit the Recovery Month Web site at
www.recoverymonth.gov
• Use the tools to spread the Recovery Month message:
– Toolkits, presentations, giveaways, public service
announcements, and more
• Join thousands of individuals and organizations by hosting a
Recovery Month event in your community
• Educate others about the effectiveness of treatment and the
hope of recovery
• For more information call 1-800-662-Help
SAMHSA/CSAT Information
• SAMHSA web site: www.samhsa.gov
• CSAT web site: http://csat.samhsa.gov/
• ATR web site: http://atr.samhsa.gov/
• SBIRT web site: http://sbirt.samhsa.gov/
• Recovery Month web site: http://www.recoverymonth.gov/
• SHIN 1-800-729-6686 for publication ordering or
information on funding opportunities
– 1-800-487-4889 – TDD line
• 1-800-662-HELP – SAMHSA’s National Helpline
(average # of tx calls per mo.- 24,000)