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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Consensus Study Report

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-69753-8
International Standard Book Number-10: 0-309-69753-0
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Review of four CARA programs and preparing for future evaluations. Washington, DC: The National Academies Press. https://doi.org/10.17226/26831.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
×

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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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

MARCELA HORVITZ-LENNON, Senior Physician Scientist, RAND Corporation

SANDEEP KAPOOR, Assistant Professor, Medicine, Emergency Medicine, and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

RAYMOND C. LOVE, Professor and Director, Mental Health Program, School of Pharmacy, University of Maryland

ROSALIE PACULA, Professor and Elizabeth Garrett Chair in Health Policy, Economics, and Law in the Sol Price School of Public Policy, University of Southern California

JOSÉ A. PAGÁN, Chair and Professor, Department of Public Health Policy and Management, New York University School of Global Public Health

SHARON REIF, Professor, Heller School for Social Policy and Management, Brandeis University

GERY RYAN, Professor, Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine

Study Staff

KATHLEEN STRATTON, Study Director

M. KELLY McHUGH, Associate Program Officer

CRYSTI PARK, Administrative Assistant

MISRAK DABI, Senior Financial Business Partner

ROSE MARIE MARTINEZ, Senior Board Director

CHRISTOPHER LAO-SCOTT, Senior Research Librarian

NAM Fellow

RUCHI FITZGERALD, Service Chief, Inpatient Addiction Medicine at PCC Community Wellness

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Reviewers

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 re-

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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lease. The review of this report was overseen by JACK C. EBELER, member of NASEM Health and Medicine Division committee, and JOSIAH (JODY) D. RICH, Brown University. 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.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Acknowledgments

The committee of this study 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 report series.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Acronyms and Abbreviations

BCOR Building Communities of Recovery
BRSS TACS Bringing Recovery Supports to Scale Technical Assistance Center Strategy
CAPTA Child Abuse Prevention Treatment Act
CARA Comprehensive Addiction and Recovery Act
CBA cost-benefit analysis
CDC Centers for Disease Control and Prevention
CEA cost-effective analysis
CSAP Center for Substance Abuse Prevention
CSAT Center for Substance Abuse Treatment
DSP-MRT Division of State Programs Management Reporting Tool
EMS Emergency Medical Services
EPIS Exploration, Preparation, Implementation, Sustainment
FDA U.S. Food and Drug Administration
FOA Funding Opportunity Announcement
FQHC federally qualified health center
FR first responder
FR-CARA First Responder Training
FY fiscal year
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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GAO U.S. Government Accountability Office
GPRA Government Performance and Results Act
HHS U.S. Department of Health and Human Services
MOUD medications for opioid use disorder
OD Treatment Access Improving Access to Overdose Treatment
OIG Office of Inspector General
OMB Office of Management and Budget
OUD opioid use disorder
PAF Public Access File
PPW pregnant and postpartum women
PPW-PLT State Pilot Grant Program for Treatment for Pregnant and Postpartum Women
QRT Quick Response Team
RCO recovery community organization
RSS recovery support services
SAMHSA Substance Abuse and Mental Health Services Administration
SBIRT Screening, Brief Intervention, and Referral to Treatment
SSA State Agency for Substance Abuse
SUD substance use disorder
TA technical assistance
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2023. Review of Four CARA Programs and Preparing for Future Evaluations. Washington, DC: The National Academies Press. doi: 10.17226/26831.
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The Comprehensive Addiction and Recovery Act (CARA; P.L. 114-198) was signed into law in 2016 to help address the challenges of overdose deaths and opioid use disorder, and to expand access to evidence-based treatment. Among these efforts was the authorization of four grant programs to be overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA).

In 2018, SAMHSA requested that the National Academies establish a committee to conduct a review of the four programs, which focus primarily on opioids, but occasionally include treatment and recovery services for co-occurring substance use disorders. The review resulted in three consensus study reports over five years. This third and final report aims to (1) understand the processes of the four grant programs; actions taken by grantees and their partners; impacts to clients, patients, the community, and public; and structural or environmental changes that might have resulted from grant funding, and (2) analyze how future congressionally mandated evaluations can be structured and carried out to better support policy makers.

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