The Substance Abuse and Mental Health Services Administration (SAMHSA) has provided us with two documents that describe the "Access to Recovery" substance abuse treatment initiative that the President announced in his State of the Union address.

These documents answer many of the questions that have been raised regarding this new initiative. "Access to Recovery" will provide our field with: (1) an opportunity to implement innovative changes in the way services are delivered; (2) an additional mechanism to expand the array of available services; and (3) an expansion of existing service capacity.

The "Access to Recovery" initiative has come a long way in the past few months. The attached documents explain the core components of the initiative. We hope that you will not only take the time to read the attached documents, but that you will share them with others in the field who need to know the details about this important initiative.

Access to Recovery

Background: President Bush announced in his State of the Union Address a new substance abuse treatment initiative, Access to Recovery. This new initiative will provide people seeking drug and alcohol treatment vouchers to pay for a range of appropriate community-based services. The President proposed $600 million in new funds over the next three years for Access to Recovery. The first $200 million installment is included in the 2004 budget for the Substance Abuse and Mental Health Services Administration (SAMHSA).

Too Many Americans Do Not Receive Help. The economic costs associated with drug abuse are estimated at around $110 billion. The human costs are measured in lost jobs, lost families, and lost lives. In 2001, 5 million of the 6.1 million people needing treatment for an illicit drug problem, never got help. Of the 5 million, only 377,000 reported that they felt they needed treatment for their drug problem, including 101,000 people who knew they needed treatment, sought help, but were unable to find care.

Addiction Treatment Works; Recovery is Real. With treatment, even hard-to-reach populations reduce their illegal drug use by nearly half. Further, addiction treatment reduces criminal activity by 80%. It markedly increases employment and decreases homelessness, results in substantially improved physical and mental health, and reduces risky sexual behaviors. When tailored to the needs of the individual, addiction treatment is as effective as treatments for other illnesses, such as diabetes, hypertension, and asthma.

Access to Recovery: The President's proposal will establish a State-run voucher program for substance abuse treatment built on three principles:

. Consumer Choice. The process of recovery is a personal one. Achieving recovery can take many pathways: physical, mental, emotional, or spiritual. With a voucher, people in need of addiction treatment and recovery support will have the choice to select the programs and providers that will help them most. Increased choice protects individuals and encourages quality.

. Results Oriented. Payment to providers will be linked to demonstration of treatment effectiveness and recovery, measured by outcomes such as: abstinence from drugs and alcohol, no involvement with the criminal justice system, attainment of employment or enrollment in school, and stable housing.

. Increased Capacity. The initial phase of Access to Recovery will support treatment for approximately 100,000 people per year and expand the array of services available including medical detoxification, inpatient and outpatient treatment modalities, residential services, peer support, relapse prevention, case management, and other recovery-promoting services.

How It Will Work: Because Governors are key to assuring a coordinated approach among various State departments such as state drug and alcohol authorities; mental health authorities; departments of education, child welfare, Medicaid, and criminal justice agencies that come into contact with people with addictive disorders, Governors' offices will be eligible to apply for Access to Recovery funds. Funds will be awarded through a competitive grant process. States will have considerable flexibility in designing their approach and may target efforts to areas of greatest need, to areas with a high degree of readiness or to specific populations including adolescents. Specific requirements, including eligibility criteria will be spelled out in a request for applications that will be developed in partnership with States and treatment providers. Critically, States must use the new funds to supplement, not supplant current funding and build on existing programs, including SAMHSA's Substance Abuse Prevention and Treatment Block Grant, for which the President has requested $1.785 billion, an increase of $63 million over the FY03 amount. The Block Grant, with its required State maintenance of effort, provides the basic national addiction treatment infrastructure.

For more information contact SAMHSA's Office of Communications - Phone: (301) 443-8956

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Access to Recovery
How it Will Work

Background: The Nation's substance abuse treatment system is shaped, supported, and maintained by the States. These services are funded primarily through state revenues and Federal programs, including SAMHSA's Substance Abuse Prevention and Treatment Block Grant and Targeted Capacity Expansion grants, and Medicaid dollars. While these resources continue to help millions of Americans obtain and sustain recovery from addiction, too many people who seek help are unable to find care. By providing those individuals with vouchers to pay for the care they need, Access to Recovery will foster consumer choice, improve service quality, and increase treatment capacity. Vouchers, along with other State-operated programs, provide an unparalleled opportunity to create profound change in substance abuse treatment financing and service delivery in America, change that both will reduce human suffering and save countless dollars in lost productivity.

Competitive Grant Program: An Access to Recovery workgroup is developing a Request for Applications with input from a broad array of stakeholders in the field, among them, service providers, States, and technical experts. The workgroup is examining potential standards for participating states, performance measures, service cost ranges, and assessment and placement instruments. An Executive Steering Committee with White House and Department of Health and Human Services (HHS) leadership is providing overall policy guidance. The RFA will be issued after funds are appropriated by Congress. Governors' offices will be eligible to apply because Governors are key to assuring a coordinated approach among various State departments such as state drug and alcohol authorities; mental health authorities; departments of education, child welfare, Medicaid, and criminal justice agencies that come into contact with people with addictive disorders.

States Will Have Flexibility. Governors applying for Access to Recovery funds will have considerable discretion in the design and focus of the model they select. They may choose to implement the program through a State or sub-State agency, or may implement some or all of the program in partnership with a private entity. States may target the program to areas of greatest need, to areas with a high degree of readiness to implement such an effort, or to specific populations, including adolescents. Applications must delineate a process for screening, assessment, referral, and placement for treatment appropriate for the individual client. Clients will be assessed wherever they present, will be given a voucher for identified services, and will be referred to appropriate service providers. Applications will be expected to detail how the provider base will be expanded and how a broad array of provider organizations will become eligible for voucher reimbursement. Critically, Access to Recovery funds will be required to supplement, not supplant current funding, thus expanding both capacity and available services.

Applications Must Be Results Oriented. In both program design and implementation, State grant applications must delineate a process to monitor outcomes, among them: drug or alcohol use, involvement with the criminal justice system, employment, social support, living situation, access to care, and program retention. These performance data not only will be used to measure treatment success, but also to measure the ultimate success of the voucher program itself. Successful State applicants will establish:

• Need based on data on rates of abuse and dependence
• Documentation of the most feasible approaches consistent with the voucher program's guiding principles
• Eligibility criteria for providers
• Eligibility criteria for clients
• Criteria for matching clients with appropriate treatment and support services
• Standard costs/reimbursement for treatment modalitie
• Effective approaches to address those with special needs (e.g., homeless populations, co-occurring populations, persons living in rural areas)

For more information contact SAMHSA's Office of Communications - Phone: (301) 443-8956