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

2. President George W. Bush
“…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 2

3. “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

4. 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:

5. 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.

6. 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.

7. 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.

8. SAMHSA Programs Support a Comprehensive Approach to Public Health
Substance
Abuse
Treatment
Prevention
Law
Enforcement
Mental

9. 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

10. Greater Burden on Public Sector
Private
Private
Public
Public
1986 All SA = $9.3B
Public = $4.6 B
Private = $4.6 B
2003 All SA = $20.7 B
Public = $16.0 B
Private = $4.7 B
Source: Health Affairs, July-August 2007

11. 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

12. 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

13. 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

14. 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

15. Drug Use Among the General Population – 2006
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use & Health, 2005 & 2006

16. Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older: Percentages,
Percentages of Persons
Source: Annual Averages Based on NSDUHs

17. Non-Medical use of Pain Relievers in Past Year among Persons aged 12 or Older: Percentages
Percentages of Persons
Source: Annual Averages Based on NSDUHs

18. Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older: Percentages
Percentages of Persons
Source: Annual Averages Based on NSDUHs

19. 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
Felt They Needed Treatment and Did Make an Effort
(314,000)
Did Not Feel They Needed Treatment (20,114,000)
Felt They Needed Treatment and Did Not Make an Effort
(625,000)
1.5%
95.5%
21.1 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use

20. 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
Public
Health
Treatment
Strategies
SBIRT
Employer/
Co-Workers
HIV/AIDS
Family
Friends
Adolescent Treatment
Women &
Children Services
SAPT Block Grant

21. Shifting our Paradigm to Recovery-Oriented Systems of Care21 21

22. 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

23. 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?”

24. A Traditional Course of Treatment for a Substance Use Disorder
Person’s Entry into treatment
Discharge
Severe
Symptoms
Remission
Resource: Tom Kirk, Ph.D

25. A Traditional Service Response
Severe
Remission
Acute symptoms
Discontinuous treatment
Crisis management
Resource: Tom Kirk, Ph.D

26. A Recovery-Oriented Response
Continuous treatment response
Severe
Remission
Promote Self Care, Rehabilitation
Resource: Tom Kirk, Ph.D

27. Helping People Move Into A Recovery Zone
Severe
Recovery Zone
Symptoms
Improved client outcomes
Remission
Time
Resource: Tom Kirk, Ph.D

28. 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 cost-effectiveness 3
¹ Dennis, Scott & Funk, 2003
2 Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001
3 Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)

29. Defining Recovery-Oriented Systems of Care
Thinking about the future in our field, I see one new trend that holds particular promise, and that I s the recent shift in thinking away from the clinical treatment model and toward recovery and recovery-oriented systems of care. This shift is leading us to see recovery less as an event and more as a process. The recovery paradigm also invites us to move from a narrow focus on the deficits that accompany addiction to the strengths that come with recovery. We focus less on pathology, more on wellness. We focus not only on recovery from addiction and its negative effects, but also on recovery of a meaningful life in the community. 29 29

30. 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.

31. 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. V
Recovery
Individual
Family
Community
Wellness
Health

32. 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
Alcohol/Drug Services
Vocational
Education
Housing/
Transportation
Individual
Family
Community
PTSD &Mental Health
Physical Health Care
Spiritual
HIV Services
Financial
VSO & Peer Support
Wellness
Health
Legal
Case Mgt

33. ROSC encompass and coordinates the operations of multiple systems…
Recovery
Systems of Care
Addiction
Services System
Child Welfare
and Family
Services
Social
Services
Services & Supports
Mental Health
System
Family/ Child Care
Alcohol/Drug Treatment
Housing
System
Vocational
Individual
Family
Community
Primary Care
System
Educational
PTSD & Mental Health
Housing/
Transportation
Health Care
Faith Community
HIV Services
Vocational
Services
Spiritual
Indian Health
Services
Financial
VSO & Peer Support
Legal
Case Mgt
Health Insurance
Criminal Justice
System
Wellness
Health
DoD & Veterans Affairs

34. …providing responsive, outcomes-driven approaches to care.
Recovery
Abstinence
Evidence-Based Practice
Systems of Care
Addiction
Services System
Child Welfare
and Family
Services
Employment
Menu of Services
Cost Effectiveness
Social
Services
Family/ Child Care
Alcohol/Drug Treatment
Mental Health
System
Vocational
Individual
Family
Community
Housing
Authority
Educational
PTSD &Mental Health
Reduced
Crime
Housing/
Transportation
Health Care
Primary Care
System
Perception
Of Care
HIV Services
Faith Community
Spiritual
Vocational Services
Indian Health
Services
Financial
VSO & Peer Support
Safe & Drug-free
Housing
Legal
Case Mgt
Retention
Health Insurance
Criminal Justice
System
Health
Wellness
DoD & Veterans Affairs
Access/Capacity
Social Connectedness

35. Ongoing Systems Improvement
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
Addiction
Services System
Child Welfare
and Family
Services
Employment
Services & Supports
Family/ Child Care
Alcohol/Drug Treatment
Social
Services
Mental Health
System
Cost Effectiveness
Vocational
Individual
Family
Community
Educational
PTSD & Mental Health
Reduced
Crime
Housing/
Transportation
Primary Care
System
Housing
Authority
Health Care
Perception
Of Care
Spiritual
HIV Services
Vocational Services
Indian Health
Services
Financial
VSO & Peer Support
Legal
Case Mgt
Safe & Drug-free
Housing
Retention
Health Insurance
Criminal Justice
System
Wellness
Health
DoD & Veterans Affairs
Access/Capacity
Social Connectedness
Ongoing Systems Improvement

36. 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.

37. 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

38. 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

39. Elements of Recovery-Oriented Systems of Care
Cost Effective:
Outcomes Oriented
Integrated Services, resulting in Non-Duplication of Services
Competency-based
Effective use of Collaboration & Partnerships
Systems-wide Education and Training
Continuity of Care
Research-based
Flexible Funding

40. How do we “sell” treatment to those who need it?
Thinking about the future in our field, I see one new trend that holds particular promise, and that I s the recent shift in thinking away from the clinical treatment model and toward recovery and recovery-oriented systems of care. This shift is leading us to see recovery less as an event and more as a process. The recovery paradigm also invites us to move from a narrow focus on the deficits that accompany addiction to the strengths that come with recovery. We focus less on pathology, more on wellness. We focus not only on recovery from addiction and its negative effects, but also on recovery of a meaningful life in the community. 40 40

41. 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).

42. Opiate Reports in Emergency Department Visits Related to Drug Misuse/Abuse
225
5,085
Hydrocodone*
36,007
Heroin
5,694
Methadone
5,066
Oxycodone*
Buprenorphine*
* Includes single- and multi-ingredient products
Unweighted reports from U.S. hospitals
Source: U.S. SAMHSA; DAWN Live! Oct 2, 2007

43. 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 .
40% Abstainers
35% Low Risk Drinkers
20% At-Risk Drinkers
5% Alcoholics
At risk population could potentially successfully reduce drug use through “early intervention.”
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 43

44. 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.

45. 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

46. Top Five Substances Reported by SBIRT Clients
Source: Services Accountability Improvement System (SAIS)

47. CSAT SBIRT Initiative
Increases access to clinically appropriate care for nondependent as well as dependent persons.
Links generalist and specialist treatment systems.
Combines intervention and treatment toward a consistent continuum of care.
4. Builds a coalition between health care services and alcohol and drug treatment services.

48. 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.

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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

55. 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

56. 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: mins ($29.42)
- G0397: > 30 mins ($57.69)
CPT Codes (Commercial Health Plans)
: mins ($33.41)
: > 30 mins ($65.51)

57. SBIRT Current Grantees & Colleges
Massachusetts
Connecticut
Delaware
College/University Grants
State Grants

58. 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

59. SBIRT Outcomes
Since FY 2004, there has been a 152.6% increase in the number of clients reporting abstinence 6 months after intake.
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.

60. 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.

61. Access to Recovery: A Recovery-Oriented Systems of Care Model61 61

62. 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

63. 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.

64. 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

65. 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.

66. 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)

67. 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.

68. 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

69. Contributions of Faith- and Community-based 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.

70. Contributions of Faith- and Community-based 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.

71. 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), , cited in CASA study: So Help Me God: Substance Abuse, Religion and Spirituality, 2001

72. 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 72

73. 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
32%
clients who reported not being socially connected at intake were socially connected at discharge.
60.6%
Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability Improvement System (SAIS). 12/31/07

74. SAMHSA Programs – Paths to Recovery74 74

75. 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

76. 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.

77. 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

78. Treatment Drug Courts Evidences of Success
Behavior “within past 30 days”…
% at Intake
6-Month Follow-up (%)
Difference
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

79. 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, Vol. 18. Atlanta: US Department of Health and Human Services, CDC; 2008.

80. 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 National HIV Prevention Conference; June 12–15, 2005; Atlanta. Abstract T1-B1101.

81. CSAT - Minority AIDS Initiative
Minority AIDS grants are awarded to community-based 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

82. 2007 CSAT TCE/HIV Grantees States with 2007 Grantees AK HI WA OR ID MT
Virgin Islands
Puerto Rico HI WA OR ID MT ND MN WY SD NV UT CO AZ NM TX NE IA WI IL IN MI OK MO TN KY OH AR MS AL LA FL GA SC NC VA WV PA NY DC MD CT RI MA ME VT NH KS DE NJ CA
States with 2007 Grantees

83. 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%

84. TCE/HIV and HIV Outreach Changes in Risk Behaviors
% at Intake
6-Month Follow-up (%)
Difference
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

85. 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.

86. 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.

87. 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.
1.3%
12.1%
15.9%
1.0%
7.9%
0.7%
2.3%
27% of women also considered themselves Hispanic, in addition to race reported.
58.8%
Source: SAMHSA data reported by grantees through the Services Accountability Improvement System (SAIS). 2/19/08

88. 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.

89. 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)

90. 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) 90

91. 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 ) 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%).

92. 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.

93. 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.

94. 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

95. Get involved in Recovery Month
Help bring hope and healing to others
Visit the Recovery Month Web site at
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 Help

96. SAMHSA/CSAT Information
SAMHSA web site:
CSAT web site:
ATR web site:
SBIRT web site:
Recovery Month web site:
SHIN for publication ordering or information on funding opportunities
– TDD line
HELP – SAMHSA’s National Helpline (average # of tx calls per mo.- 24,000)