Progress of Four Programs
from the Comprehensive
Addiction and Recovery Act
Committee on the Review of Specific Programs
in the Comprehensive Addiction and Recovery Act
Board on Population Health and Public Health Practice
Health and Medicine Division
A Consensus Study Report of
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International Standard Book Number-13: 978-0-309-26569-0
International Standard Book Number-10: 0-309-26569-X
Digital Object Identifier: https://doi.org/10.17226/26060
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Progress of four programs from the Comprehensive Addiction and Recovery Act. Washington, DC: The National Academies Press. https://doi.org/10.17226/26060.
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COMMITTEE ON THE REVIEW OF SPECIFIC PROGRAMS IN THE COMPREHENSIVE ADDICTION AND RECOVERY ACT
KENNETH B. WELLS (Chair), Director, Center for Health Services and Society, Semel Institute, University of California, Los Angeles
HORTENSIA AMARO (Vice Chair), Distinguished University Professor and Senior Scholar on Community Health, Florida International University
GINA BRYAN, Director and Clinical Professor, Post Graduate Psych-Mental Health Program, University of Wisconsin–Madison
KAREN CROPSEY, Conaster Turner Endowed Professor of Psychiatry, The University of Alabama at Birmingham
JOAN DUWVE, Public Health Specialist, Kansas Department of Health and Environment
RAHUL GUPTA, Senior Vice President and Chief Medical and Health Officer, March of Dimes
DAVID H. GUSTAFSON, Director, Center for Health Enhancement Systems Studies, University of Wisconsin–Madison (resigned August 2020)
MARCELA HORVITZ-LENNON, Senior Physician Scientist, RAND Corporation
RAYMOND C. LOVE, Professor and Director, Mental Health Program, School of Pharmacy, University of Maryland
YNGVILD OLSEN, Medical Director, REACH Health Services, Institutes for Behavior Resources, Inc.
SHARON REIF, Professor, Heller School for Social Policy and Management, Brandeis University
KATHLEEN STRATTON, Study Director
ANDREW MERLUZZI, Program Officer (until August 2020)
KELLY McHUGH, Research Associate (from October 2020)
MISRAK DABI, Financial Business Partner
CRYSTI PARK, Administrative Assistant
ROSE MARIE MARTINEZ, Senior Board Director
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This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by JOSIAH “JODY” RICH, Brown University and the Miriam Hospital, and JACK C. EBELER, Health Policy Alternatives, Inc. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
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The committee of this study thanks Dr. David Gustafson for his service in the early phases of this report. The committee also thanks both the Substance Abuse and Mental Health Services Administration and the Comprehensive Addiction and Recovery Act grantees for their work, and for providing information to the National Academies for this study.
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At a time in our nation’s history when we are dealing with a major public health crisis from a viral pandemic, while also working to address a longer standing public health crisis from overdose and death from opioid use disorder (OUD), we are pleased as a committee to provide some guidance in this, our second of three reports, on specific initiatives funded by Congress through the Substance Abuse and Mental Health Services Administration (SAMHSA) to address the opioid crisis. The programs included in this report address a number of crucial facets of a public health response to the crisis, spanning prevention of overdose and death, treatment of OUD and co-occurring substance use disorder, and a pilot in the underdeveloped area of supporting pregnant and postpartum women. With some evidence that the incidence of OUD and overdose deaths involving synthetic opioids has increased with the coronavirus disease 2019 (COVID-19) pandemic, it is now perhaps of even greater importance to determine what we can learn from the implementation of these programs. Data to inform policy would be helpful across these areas. As chairs of this effort, we are grateful for the support of the National Academies and our outstanding colleagues on the committee to “take the journey” to understand the programs, consider what data are available, and comment on “progress.” Progress of the programs is the main theme of this report, and we have two main considerations of progress. The first is whether and how the programs started up and implemented the activities specified by SAMHSA. The second consideration is about the progress made in the collection of data that would be necessary to understand the impact of the programs. The committee considered the meaning and interpretability of the data provided by SAMHSA and the grantees for this report, and how these may or may not set the stage for impact evaluation—the focus of Report 3. What follows is our committee’s effort to describe that progress and the journey of the programs. May it help us get to clear lessons learned for Report 3, and for our efforts to improve the health of the public in a key area of need—OUD and its consequences.
Kenneth B. Wells (Chair)
Hortensia Amaro (Vice Chair)
Committee on the Review of Specific Programs in the Comprehensive Addiction and Recovery Act
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Boxes and Tables
|AIDS||acquired immunodeficiency syndrome|
|ASAM||American Society of Addiction Medicine|
|AUD||alcohol use disorder|
|BCOR||Building Communities of Recovery (CARA Program)|
|CARA||Comprehensive Addiction and Recovery Act|
|CDC||Centers for Disease Control and Prevention|
|CHESS||Center for Health Enhancement Systems Studies|
|CSAP||Center for Substance Abuse Prevention (SAMHSA Center)|
|CSAT||Center for Substance Abuse Treatment (SAMHSA Center)|
|DEA||Drug Enforcement Administration|
|DSP-MRT||Division of State Programs Management Reporting Tool (CSAP tool)|
|EHR||electronic health record|
|EMR||electronic medical record|
|EMS||emergency medical services|
|FDA||Food and Drug Administration|
|FOA||funding opportunity announcement|
|FQHC||federally qualified health center|
|FR-CARA||First Responders (CARA Program)|
|GAO||Government Accountability Office|
|GPRA||Government Performance and Results Act (CSAT reporting tool)|
|HHS||Department of Health and Human Services|
|HIV||human immunodeficiency virus|
|IRB||Institutional Review Board|
|MIS||management information system|
|MOU||memorandum of understanding|
|MOUD||medications for opioid use disorder|
|NIDA||National Institute on Drug Abuse|
|OD Treatment Access||Improving Access to Overdose Treatment (CARA program)|
|OD Tx ARF||summary report from the OD Treatment Access reporting form|
|OUD||opioid use disorder|
|PAF||public access file|
|PPW||pregnant and postpartum women|
|PPW-PLT||State Pilot Grant Program for Treatment for PPW (CARA Program)|
|RCO||recovery community organization|
|REACH||Recovery Enhanced by Access to Comprehensive Healthcare|
|ROSC||recovery-oriented systems of care|
|RSS||recovery support services|
|SAMHSA||Substance Abuse and Mental Health Services Administration|
|SBIRT||SAMHSA Screening, Brief Intervention, and Referral to Treatment|
|SSA||State Agency for Substance Abuse|
|SUD||substance abuse disorder|