President's proposed budget would slash treatment and prevention funding

We had a feeling of déjà vu when the White House sent its proposed budget to Congress last week. Similar to past years, the Office of National Drug Control Policy (ONDCP) would be decimated, moving the $100 million Drug‐Free Communities program to the Center for Substance Abuse Prevention (CSAP) at the Substance Abuse and Mental Health Services Administration (SAMHSA). There's no additional money in the Substance Abuse Prevention and Treatment (SAPT) block grant and cuts to the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, CSAP and SAMHSA's Center for Substance Abuse Treatment.     

NASADAD calls for nominations for annual SSA award

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) is requesting nominations for the annual Ramstad/Kennedy Award, presented to a single state agency (SSA) — the state director who is responsible for the Substance Abuse Prevention and Treatment block grant (and STR and SOR grants, now).     

SAMHSA refers to streamlining in proposed budget cuts

Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released its Congressional Justification (CJ), issued by agencies in conjunction with the White House budget request for the next fiscal year. For FY 2020, the White House budget did not request additional money for SAMHSA's Substance Abuse Prevention and Treatment (SAPT) block grant, and included cuts to substance abuse prevention (see ADAW, March 18).     

Senate Appropriations Committee hears about funding needs for SAPT block grant

The opioid epidemic is persisting, calling for the need for more funding, according to testimony on Capitol Hill last month. Mark Stringer, director of the Missouri Department of Mental Health and single state authority (SSA) for the state's Substance Abuse Prevention and Treatment (SAPT) block grant. In addition, it's important to transition from opioid‐focused funding to general funding for substance use prevention and treatment in general, via increasing the block grant, he said.     

Transitioning SOR to the SAPT BG: Why not?

It's time to think about transitioning the State Opioid Response (SOR) grants to the Substance Abuse Prevention and Treatment (SAPT) block grant, Robert Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), told the House Energy and Commerce Committee at its March 3 hearing on opioid legislation. The STR and SOR grants went directly to single state authorities (SSAs) in charge of the SAPT block grants — NASADAD members — so this makes perfect sense. These are the officials who best know how funding should be spent in their states — on what substances, including alcohol. Instead of having a designated amount set up for opioids — although that was expanded to include stimulants as well (see “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” ADAW, Dec. 23, 2019, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ) — each SSA should just have this funding added permanently to the block grant.     

Senators call for $2 billion in supplemental SAMHSA funding

As the fourth stimulus bill, the HEROES Act, awaits action by the Senate, 19 senators sent a letter last week to Senate and House leadership calling for increased investments in substance use disorder programs during the COVID‐19 pandemic. The letter, from Senators Tammy Baldwin (D‐Wisconsin) and Jeanne Shaheen (D‐New Hampshire), along with 17 other senators (all Democrats), calls for “$2 billion in funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) to administer supplemental grant allocations under the Substance Abuse Prevention and Treatment (SAPT) Block Grant program and the State Opioid Response (SOR) grant program.”     

More than a funder,the SSA needs community providers

The Single State Authority — SSA — is an office, but, in reality, is actually a person. This person is in charge of the ongoing Substance Abuse Prevention and Treatment (SAPT) block grant. There is one in every state. This person is also in charge of the STR and SOR grants for opioid use disorder treatment. For this story, we interviewed four longtime former SSAs about their lessons learned and their advice to new SSAs in a role that is in the spotlight both within state government and in the community, as billions of new dollars flow out to their systems. Each SSA is a member of the National Association of State Alcohol and Drug Abuse Directors (NASADAD).     

STR grants: How one physician in rural Florida is trying to help

If the State Targeted Response (STR) and State Opioid Response (SOR) grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) grants are like an elephant — large, especially relative to funding for addiction treatment in general — they are also almost impossible to generalize about. But seeing one piece in context of the whole is essential in trying to find out where the money is actually going. The money goes to the single state authority (SSA) in charge of the Substance Abuse Prevention and Treatment (SAPT) block grant in each state, the person who knows most about what is needed in that state. The funding comes from the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants added $2 billion‐plus to addiction treatment services for opioid use disorders for four years — and many expect this number to be doubled. For perspective, the entire SAPT block grant is under $2 billion and has been for decades.     

Sign‐on letter for SAPT increase due March 20

Representatives Paul Tonko (D‐New York) and Brian Fitzpatrick (R‐Pennsylvania) need signatures for their letter to the House Appropriations Committee urging a $500 million increase for the Substance Abuse Prevention and Treatment (SAPT) block grant in fiscal year 2020. “This funding stream serves as the cornerstone of States' substance abuse treatment, prevention, and recovery systems,” states the letter. “SAPT Block Grant funds, which are distributed by formula to all States and Territories, provide lifesaving treatment services to approximately 1.5 million individuals per year. In some States, the SAPT investment accounts for 100 percent of substance use prevention dollars. Unfortunately, SAPT Block Grant funding has not kept up with inflation, resulting in a 24 percent—or $444 million—decrease in actual funding since 2009.” The block grant has been just over $2 billion for decades. The letter requests that legislators fund just over $2.358 million for the SAPT block grant, which is equal to what the House of Representatives approved in the FY2019 Labor‐Health and Human Services Appropriations legislation and a $500 million increase over current funding levels. To sign on to the letter, contact Jeff Morgan in Rep. Tonko's office at jeff.morgan@mail.house.gov or Joseph Knowles in Rep. Fitzpatrick's office at joseph.knowles@mail.house.gov .     

NASADAD pushes block‐grant increase for stimulus 4 bill

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) last week wrote to Sen. Patty Murray (D‐ Washington) and Sen. Roy Blunt (R‐Missouri), the Senate co‐chairs of the Labor, Health and Human Services (HHS), Education, and Related Agencies Appropriations Subcommittee, asking specifically for the $1.5 billion in supplemental funding as provided by the House in the HEROES Act for the Substance Abuse Prevention and Treatment (SAPT) block grant (see “Proposed bill for HEROES Act would give $1.5 billion to SAPT block grant,” ADAW, May 18, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32722 ).     

Briefly Noted

Drug‐Free Communities (DFC), a significant prevention grant program totaling more than $101 million and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), will be moving to the Centers for Disease Control and Prevention (CDC), but the change is mainly one that affects interagency machinations in Washington and not the end recipients of the funding — drug‐free coalitions. The Office of National Drug Control Policy (ONDCP) will retain the program and policy oversight. The funding will go to the ONDCP, and then be distributed to the CDC instead of to SAMHSA, as it has been in the past. The DFC grant program funds anti‐drug coalitions ‐‐ there are more than 700 across the country. Most are members of Community Anti‐Drug Coalitions of American (CADCA), which has 5,000 members. The CDC will be the new agency that subcontracts with the ONDCP to do the day‐to‐day administration of the DFC program. The change was announced Feb. 4 at CADCA's National Leadership Forum by ONDCP Director James Carroll. For a 2019 fact sheet on DFC, see https://www.whitehouse.gov/wp‐content/uploads/2019/12/FY‐2019‐DFC‐Fact‐Sheet‐20191220‐converted.pdf .     

SAMHSA to write new application for new SOR with stimulants included

The addition of stimulants as an allowable use for State Opioid Response (SOR) grants will require a new application, which the Substance Abuse and Mental Health Services Administration (SAMHSA) is working on, ADAW has learned. The change was in the FY 2020 appropriations bill passed last month by Congress (see ADAW, Dec. 23, 2019; “FY 2020 Appropriations: Stimulants added to SOR's $1.5 billion,” https://onlinelibrary.wiley.com/doi/10.1002/adaw.32573 ), along with funding for other SAMHSA programs, including the Substance Abuse Prevention and Treatment block grant (SAPT BG). After the bill passed before Christmas, Washington went away for the holidays.     

Toward an effective treatment system for adolescents with substance use disorders: The role of the states

A 2002 national expert panel found that the treatment system for adolescents with substance use disorders was inadequate and underdeveloped. The panel recommended immediate improvement in five areas: youth-serving agency collaboration, treatment system financing, workforce development, the implementation of evidence-based practices, and family involvement in all aspects of treatment. In 2004, the Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration (SAMHSA), designed the State Adolescent Substance Abuse Treatment Coordination Grant program (SAC) and implemented it in 2005 to address the critical need in the field. This paper reviews the adolescent substance use disorders treatment system, discusses selected drivers for change and the design of the SAC grant program, and summarizes some of the program's results. Both quantitative and qualitative data analysis document that substantive systems development occurred within each of the sixteen grantees and that federal–state partnerships are useful in creating systemic change.     

Blending Prevention Models: An Effective Substance Use and HIV Prevention Program for Minority Youth

Illicit drug use and rates of HIV infection among youth have increased over the past decade, indicating the need effective substance use and HIV prevention programs. Particularly at risk are minority youth living in poor urban environments. This study examines effectiveness of an innovative prevention program that blends the “All Star” substance abuse prevention model with the “Popular Opinion Leader” model for HIV prevention. In general, the results indicate non-significant increases in drug and sex risk, behavior and significant positive changes and trends in related areas (i.e., changes in perception, self esteem) thought to be related to drug use and risky sexual behavior.Sally Stevens and Velia Leybas-Amedia are affiliated with the Southwest Institute for Research on Women, University of Arizona. Beth Bourdeau is affiliated with the Pima Prevention Partnership, Tucson, AZ. Lovelle McMichael and Alan Nyitray are affiliated with the Southern Arizona AIDS Foundation, Tucson, AZ. Financial assistance for this project was provided by the Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Prevention Grant# SP08916. The opinions expressed herein are those of the authors and do not reflect official positions of the government. The Southern Arizona AIDS Foundation and the authors would like to acknowledge the staff at the Tucson Urban League Academy Charter School and Luz Social Services Charter School for their assistance and support of the Check Yourself Youth Team prevention project.     

SAMHSA grantees can't use funds for medical cannabis

Some states are adjusting their contracts to the recent edict from the Substance Abuse and Mental Health Services Administration (SAMHSA) banning grantees, including Substance Abuse Prevention and Treatment (SAPT) and State Opioid Response (SOR) grantees, from.     

NASADAD to NIDA: Connect research to practice

When the National Institute on Drug Abuse (NIDA) sought input on its five‐year plan, the people responsible for publicly funded prevention, treatment and recovery — state directors — called for returning to the days of communication between federal agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and between NIDA researchers and the service delivery system. In an Aug. 7 letter to NIDA's strategic planning team, Robert I.L. Morrison, executive director of the National Association of State Alcohol and Drug Abuse Directors (NASADAD), noted that each state alcohol and drug agency has a critical role to play in NIDA initiatives. This role includes.     

Names in the News

Introducing Lisa K. Bernhardt , who now heads her LKB Strategies, which lobbies for public health organizations. For many, she needs no introduction: She has a long history on Capitol Hill and in the Department of Health and Human Services (HHS). Nobody on the Hill knows more about the Substance Abuse Prevention and Treatment block grant (SAPT BG). From 2010 until last fall, she was the top staffer at the Senate Appropriations Committee, Subcommittee on Labor, HHS, Education & Related Agencies. Prior to that, she was a budget analyst at HHS for eight years and interned there for two years previously. She knows how things work. When she left Capitol Hill last October, she did so because she felt she could do more good as an advocate helping public health navigate the appropriations process. We have known her for years as a source. Now she is out there helping people work through the systems she knows inside and out. When she worked for the great Sen. Tom Harkin (D‐Iowa), with whom she was in lockstep on policy, legislative language was clear and to the point. The Substance Abuse and Mental Health Services Administration, which had been hankering to get SAPT BG money into mental health, was put in its place more than once. There was no tinkering with the law. Thank you for your years of service, Lisa, and welcome to the exciting world of the private sector. To reach her, email Lisa.Bernhardt@LKBStrategies.com .     

Nuggets from AATOD: New CSAT director comments

Here are more reports from last month's American Association for the Treatment of Opioid Dependence (AATOD) conference in Orlando — in particular, insights from Louis Trevisan, M.D., the new director of the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).     

Table of Contents

Analysis of Client Deaths in California Recommends Tougher Counselor Standards New Study Claims Parents Can Judge Teen Substance Use Reality of Relapse Requires Changing to a Chronic Care Approach Center for Substance Abuse Prevention (CSAP) Stands to Lose More Than $40 Million if White House Vetos Spending Bill Parental Behavior Influences Teen Drug Use Briefly Noted State Watch Resources Call for Presentations Coming up     

Disseminating science-based prevention: lessons learned from CSAP's CAPTs

A wide variety of prevention approaches that reduce substance use and associated problems have been developed and tested. But successes have been limited in promoting the use of these scientific advances by the policy makers, practitioners, and concerned citizens. The Center for Substance Abuse Prevention's six regional Centers for the Application of Prevention Technologies (CSAP's CAPTs) are a major mechanism by which CSAP brings research to practice. This article synthesizes the issues that the CAPTs have faced, the solutions they have developed, and conclusions concerning the work that still needs to be done to increase the application of science-based approaches to prevention. These discussions highlight the particular importance of addressing issues related to the larger systems in which prevention programs and strategies operate.