Reducing Substance Abuse in America: Building the Nation's Demand Reduction Infrastructure A Framework for Discussion

Healing America’s Drug Users

Access to Recovery

Chief among SAMHSA's substance abuse treatment priorities is a focus on facilitating recovery. A key addition to the demand reduction infrastructure is the Access to Recovery (ATR) Program. Thousands of people seek treatment each year and sadly, many are unable to find care. With the leadership of the President, access to recovery is now a reality for thousands of Americans. ATR expands consumer choice through a unique voucher program aimed at increasing recovery options by focusing on both clinical treatment and other recovery support services. States (including eligible tribes and territories) take the lead on implementation of the Access to Recovery Program because Governors are key to ensuring a coordinated approach among various State departments.

ATR is built on three principles:

Free and Open Consumer Choice. Achieving success in recovery takes many pathways. With a voucher, people in need of addiction treatment and recovery support are able to choose the programs and providers that will help them most. Increased choice protects individuals, encourages quality, and allows individuals to select the program that best fits their needs, including faith-based treatment programs as approved by the State.

Outcomes. ATR measures success by outcomes such as abstinence from drugs and alcohol, attainment of employment or enrollment in school, no involvement with the criminal justice system, stable housing, social support, access to care, and retention in services.

Increased Capacity. Access to Recovery supports treatment for approximately 50,000 people per year and expands the array of services available including medical detoxification, inpatient and outpatient treatment modalities, residential services, peer support, relapse prevention, case management, pre-employment counseling, employment coaching, recovery coaching (including stage-appropriate recovery education, assistance in recovery management and telephone monitoring), family support services including marriage education, parenting and child development services, and other recovery support services.

Success Story

Wisconsin issued the first Access to Recovery voucher to a 41-year old mother from Milwaukee in December 2004. Her addiction and related felony conviction had become roadblocks to getting a job and raising her children. This single mother chose an agency which provides residential clinical treatment and recovery support services that will allow her one-year old baby to live with her in treatment once she is ready for re-unification. She worked with her Access to Recovery Coordinator to develop her own unique Recovery Support Team which includes her service providers, probation officer, church members, family members and others to help her achieve and then sustain recovery. When asked to describe the impact of the Access to Recovery program she describes the program as "an angel on her shoulder."

Treating People with Co-occurring Mental and Substance Use Disorders

According to SAMHSA’s 2004 National Survey on Drug Use and Health, an estimated 4.6 million people experienced co-occurring mental and substance use disorders during the year. Nearly half of the adults with co-occurring disorders received no treatment for either problem, and only 6 percent received treatment for both. The resulting human and societal costs are high. People with co-occurring disorders are at greater risk for HIV/AIDS, homelessness, contact with the criminal justice system, violence, and suicide. To better serve individuals in need, states and communities must strengthen their systems to address both substance abuse and mental health disorders.

In a landmark 2002 Report to Congress, SAMHSA recognized that people in need with co-occurring disorders are the expectation, not the exception, in substance abuse and mental health treatment systems. In this report, SAMHSA outlined its commitment to ensure that States and communities have the incentives, technical assistance, and training they need to effectively serve people with co-occurring disorders. To this end, SAMHSA has awarded Co-occurring State Incentive Grants to help States develop or enhance their infrastructure to provide accessible, comprehensive, and evidence-based treatment services to people with co-occurring substance use and mental disorders. SAMHSA has also established the National Co-occurring Center for Excellence, published a new Co-occurring Treatment Improvement Protocol (TIP 42), and held policy academies to encourage the development of State action plans.

Co-occurring Center for Excellence

SAMHSA created the Co-occurring Center for Excellence (COCE) as a vital link between the agency and States, communities, and providers. COCE provides the technical, informational, and training resources needed for the dissemination of knowledge and the adoption of evidence-based practices in systems and programs that serve persons with co-occurring disorders.

COCE's Mission is to:

Receive, generate, and transmit advances in substance abuse and mental health treatment that address mental health and substance use disorders at all levels of severity that can be adapted to the unique needs of each client Guide enhancements in the infrastructure and clinical capacities of the mental health and substance abuse service systems Foster the infusion and adoption of evidence- and consensus-based treatment and program innovation into clinical and organizational practice.