Mental Health Services Administration Research Articles

Addressing stimulant use disorder through state opioid response grants from the substance abuse and mental health services administration: Missouri’s initial approach

ABSTRACT Background: The alarming growth of stimulant-involved deaths underscores the urgent need for states to expand existing opioid-specific approaches to intentionally reach and serve people who use stimulants. Recent permission from federal agencies has allowed states to spend grant funding that was previously restricted to opioid-related activities on approaches addressing stimulant use. Objectives: This manuscript describes the rationale, methods, and initial results supporting the implementation of Missouri’s recent stimulant-focused efforts – including previously-prohibited activities such as Contingency Management and fentanyl test strip distribution. Methods: Missouri’s State Opioid Response team facilitated the design and implementation of Contingency Management pilot programming abiding by federal spending limits of no more than $75 of incentives per client, mass distribution of fentanyl test strips, and publicly accessible harm reduction trainings and materials specific to stimulant use. Data sources used for initial evaluations included state-level treatment claims, fentanyl test strip distribution counts by type and region of organizations receiving them, and qualitative feedback from stakeholders. Results: Six substance use treatment agencies developed Contingency Management programs, serving 29 individuals in the first nine months. Over 20,000 fentanyl test strips were distributed using a prioritization system designed to reach those most likely to benefit from their use. Conclusions: Recent federally funded efforts to better address stimulant use in Missouri have increased access to evidence-based treatment and harm reduction resources. Lessons learned from early implementation, especially those regarding time allowed for program development and how best to ensure equitable resource distribution, will inform future stimulant-focused program efforts.

SAMHSA's new 988 “lifeline” not just for suicide

This month the Substance Abuse and Mental Health Services Administration (SAMHSA) is beginning the transition from the 10‐digit National Suicide Prevention Lifeline (Lifeline) to the three‐digit 988. This number is not just for suicide, but all kinds of mental health and other crises. The launch follows a three‐year joint effort by the U.S. Department of Health and Human Services (HHS), Federal Communications Commission (FCC), and the U.S. Department of Veterans Affairs (VA) to make crisis care more available and is part of President Biden's strategy to address the mental health crisis in the country. The cost was $432 million. Initially, the investment was only $24 million.

Prescription Stimulants in College and Medical Students: A Narrative Review of Misuse, Cognitive Impact, and Adverse Effects

Stimulants are effective in treating attention-deficit/hyperactivity disorder (ADHD). Psychiatrist Charles Bradley first made this discovery in 1937 when he found that children treated with amphetamines showed improvements in school performance and behavior. Between 1995 and 2008, stimulants to treat ADHD increased six-fold among American adults and adolescents at an annual rate of 6.5%. Stimulants without a prescription, known as nonmedical use or misuse, have also increased. The highest rates of nonmedical prescription drug misuse in the United States are seen most notably in young adults between 18 and 25 years, based on data from the Substance Abuse and Mental Health Services Administration in 2021. Aside from undergraduate students, nonmedical prescription stimulant use is prevalent among medical students worldwide. A recent literature review reported the utilization of stimulants without a prescription in 970 out of 11,029 medical students. The percentages of medical students across the country misusing stimulants varied from 5.2% to 47.4%. Academic enhancement, reported in 50% to 89% of college students with stimulant misuse, is the most common reason for nonmedical stimulant use. With the increasing use of stimulants among adolescents and adults, it is unclear what long-term outcomes will be since little data are available that describe differences in how side effects are experienced for prescribed and non-prescribed users. The present narrative review focuses on these adverse effects in this population and the reasonings behind misuse and nonmedical use.

Crisis jam session celebrates, reviews plans for 988 launch

Shining a light on the life‐saving work of crisis centers and continuing to strengthen the 988 workforce, along with building awareness and understanding of 988, and supporting states, territories and tribes in their 988 implementation efforts, are among the key objectives that the Substance Abuse and Mental Health Services Administration (SAMHSA) has outlined in its 988 crisis hotline transition efforts, according to a SAMHSA official in the days before the July 16 national rollout.

Broadband access and telemedicine adoption for opioid use disorder treatment in the United States.

Buprenorphine utilization remains low in the United States. Telemedicine guidelines and flexibilities introduced during the COVID-19 pandemic provide an opportunity to increase patient access to buprenorphine. However, it is not known whether Americans without access to buprenorphine waivered provider, especially those residing in rural counties, have sufficient broadband internet access to support telemedicine. Administrative data from the Substance Abuse and Mental Health Services Administration's Buprenorphine Treatment Practitioner Locator Tool and the Fixed Broadband Deployment Data from the Federal Communications Commission are utilized to identify counties with low broadband penetration rate and the number of buprenorphine waivered providers with capacity to accept patients within a 30 miles radius. 23.9% of the US population does not have access to any buprenorphine waivered provider with a capacity to accept new patients within a 30 miles radius. In counties with low broadband penetration rate, 78.9% of residents does not have access to any buprenorphine waivered provider with patient capacity. In rural counties with low broadband penetration rate, 82.3% of the residents does not have access to any buprenorphine waivered provider with patient capacity within a 30 miles radius. Federal policy initiatives are expected to continue the COVID-19-related telehealth flexibilities and to increase the number of providers available to prescribe buprenorphine, but for that to translate into more patients utilizing treatment via telemedicine, high-speed internet access will be essential. This is particularly salient for residents in rural counties where access to both buprenorphine providers and high-speed internet access is limited.

Appropriations subcommittee calls for transparency in SAMHSA block grants

The appropriations bill released this month from the federal Labor, Health and Human Services, Education, and Related Agencies congressional subcommittee (Labor–HHS) (see House spending committee adds funding, other requests for SAMHSA, ADAW July 11; https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.33490) includes a call for the Substance Abuse and Mental Health Services Administration (SAMHSA) to gather more information about how the Substance Abuse Prevention and Treatment (SAPT) block grant is being used. SAMHSA administers the SAPT block grant.

National Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic Region.

Back to table of contents Previous article Next article DatapointsFull AccessNational Suicide Prevention Lifeline 2020 In-State Answer Rates, Stratified by Call Volume Rates and Geographic RegionJonathan Purtle, Dr.P.H., M.Sc., Michael A. Lindsey, Ph.D., M.S.W., Ramesh Raghavan, Ph.D., Elizabeth A. Stuart, Ph.D.Jonathan PurtleSearch for more papers by this author, Dr.P.H., M.Sc., Michael A. LindseySearch for more papers by this author, Ph.D., M.S.W., Ramesh RaghavanSearch for more papers by this author, Ph.D., Elizabeth A. StuartSearch for more papers by this author, Ph.D.Published Online:14 Jul 2022https://doi.org/10.1176/appi.ps.202200020AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail On July 16, 2022, the number 988 will become the new toll-free dialing code for the National Suicide Prevention Lifeline (the major crisis telephone hotline in the United States) (1). Lifeline calls are initially routed to crisis centers within the caller’s state. If the call cannot be answered in a reasonable amount of time, it is rerouted to an out-of-state crisis center. Answering calls within the same state as the caller is considered to be a best practice because crisis center staff can effectively connect callers to local resources. The “in-state answer rate”—defined as the percentage of Lifeline calls originating from a state that are answered in that state—is a Lifeline quality metric, with 90% being the benchmark goal. This analysis characterized variation across states’ in-state answer rates and assessed associations with rates of Lifeline call volume and geographic region.State-level 2020 data on in-state answer rates and number of Lifeline calls—excluding calls from veterans (state mean=25.0% of calls) and Spanish speakers (state mean=1.4% of calls), because callers from these populations are routed to separate Lifelines—were obtained from publicly available Lifeline reports (2). Using data from the U.S. Census Bureau (3) and Department of Veterans Affairs (4), we estimated the number of nonveteran residents within each state in 2020. We used these data to calculate a rate of Lifeline calls per 1,000 nonveteran state residents. This served as a population size–adjusted measure of demand for Lifeline services.The mean±SD in-state answer rate was 71.3%±19.5%, and the range was 10.0% (Minnesota) to 98.2% (Rhode Island). Only seven states were at or above 90.0%. Mean in-state answer rates by U.S. Census region were as follows: Northeast, 76.1%; West, 76.7%; South, 70.6%; and Midwest, 62.7% (F=1.32). The mean Lifeline call volume rate per 1,000 nonveteran state residents was 5.54±1.33, and the range was 3.75 (Maine) to 11.00 (Alaska). No correlation was found between a state’s in-state answer rate and its Lifeline call volume rate (Spearman correlation=−0.11, Pearson correlation=0.06) (Figure 1).FIGURE 1. National Suicide Prevention Lifeline 2020 in-state answer rates and call volume rates for each U.S. stateaa The line is the correlation between in-state answer rate and call volume per 1,000 residents for all 50 states.We found a substantial variation in Lifeline in-state answer rates across states. The absence of an inverse correlation between in-state answer rates and call volume rates suggests that low in-state answer rates are not the result of high demand for Lifeline services. Understanding how to improve in-state answer rates is important because Lifeline call volume is projected to potentially triple following the launch of the new 988 dialing code (5).Department of Public Health Policy and Management, Global Center for Implementation Science, School of Global Public Health (Purtle), McSilver Institute for Poverty Policy and Research (Lindsey), and Silver School of Social Work (Raghavan), New York University, New York City; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore (Stuart).Send correspondence to Dr. Purtle ([email protected]). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.The authors report no financial relationships with commercial interests.References1 Hogan MF, Goldman ML: New opportunities to improve mental health crisis systems. Psychiatr Serv 2021; 72:169–173Link, Google Scholar2 National Suicide Prevention Lifeline State Reports. Rockville, MD, Substance Abuse and Mental Health Services Administration. https://suicidepreventionlifeline.org/lifeline-state-reports/. Accessed Jan 8, 2022Google Scholar3 State Population Totals: 2010–2020. Suitland, MD, US Census Bureau, 2021. https://www.census.gov/programs-surveys/popest/technical-documentation/research/evaluation-estimates/2020-evaluation-estimates/2010s-state-total.html. Accessed Jan 8, 2022Google Scholar4 National Center for Veterans Analysis and Statistics. Washington, DC, US Department of Veterans Affairs. https://www.va.gov/vetdata/veteran_population.asp. Accessed Jan 8, 2022Google Scholar5 988 Appropriations Report. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2021. https://www.samhsa.gov/sites/default/files/988-appropriations-report.pdfGoogle Scholar FiguresReferencesCited byDetailsCited byGrowing inequities in mental health crisis services offered to indigent patients in Puerto Rico versus the US states before and after Hurricanes Maria and Irma8 November 2022 | Health Services Research, Vol. 50 Volume 74Issue 2 February 01, 2023Pages 204-205 Metrics KeywordsCrisis interventionSuicide and self-destructive behaviorPublic policy issuesPDF download History Received 9 January 2022 Revised 14 March 2022 Accepted 20 May 2022 Published online 14 July 2022 Published in print 1 February 2023

Improving geographic access to methadone clinics

IntroductionOpioid misuse is a nationwide public health crisis. Methadone treatment is proven to be highly successful in preventing opioid use disorder, reducing the use of illicit drugs, and preventing overdoses. Clients acquire methadone daily from clinics, making geographic access crucial for the initiation of and adherence to treatment. MethodsThis work estimates unsatisfied methadone demand due to lack of geographic access at a census tract level and models the problem of identifying optimal locations to open new methadone clinics. The objective function of the model is a weighted combination of providing access to individuals with unmet methadone demand and improving the travel time of individuals currently attending a clinic. Data on existing methadone clinics and statewide methadone demand is acquired from Substance Abuse and Mental Health Services Administration (SAMHSA) surveys from 2019. Unsatisfied demand is estimated through a linear regression model after aggregating the population, heroin use, and satisfied methadone demand at the state level. ResultsNationwide, we find 18.2 % of the United States population does not have geographic access to a methadone clinic and estimate 77,973 individuals in these areas would attend a clinic if geographic access barriers were removed (95 % CI: 67,413–88,532). In a case study of six Midwestern states, we find that geography significantly contributes to the value of opening additional clinics and we see large differences in expected gains between states sharing similar characteristics such as population and satisfied methadone demand. The number of additional clients served by opening one new clinic ranges from 180 to 804 across these six states, representing between 8.4 % and 16.2 % of state unmet demand. Between 1.2 % and 14.1 % of existing clients were reassigned with a single newly opened clinic, with a one-way average travel distance improvement between 6.3 and 11.9 miles / person / day for these clients. ConclusionsThe results demonstrate the large unserved methadone demand in the United States, the significant improvement in methadone access for new and existing clients that can be achieved by opening new clinics, and the important role state-specific geography plays in these decisions.

House spending committee adds funding, other requests for SAMHSA

While adding more money to the Substance Abuse and Mental Health Services Administration (SAMHSA) for the Substance Abuse Prevention and Treatment (SAPT) block grant, the House Committee on Appropriations approved proposed fiscal year (FY) 2023 funding on June 20 that includes an additional $500 million for the block grant. The bill also proposes changing the name of the block grant to the Substance Use Prevention and Treatment block grant, and refers to it as that, as well as changing the name of SAMHSA to replace ‘abuse’ with ‘use.’

Impact of an osteopathic peer recovery coaching model on treatment outcomes in high-risk men entering residential treatment for substance use disorders.

The United States has witnessed a disproportionate rise in substance use disorders (SUD) and co-occurring mental health disorders, paired with housing instability, especially among racially minoritized communities. Traditional in-patient residential treatment programs for SUD have proven inconsistent in their effectiveness in preventing relapse and maintaining attrition among these patient populations. There is evidence showing that peer recovery programs led by individuals who have lived experience with SUD can increase social support and foster intrinsic motivation within participants to bolster their recovery. These peer recovery programs, when coupled with a standardized training program for peer recovery coaches, may be very efficacious at improving patient health outcomes, boosting performance on Substance Abuse and Mental Health Services Administration (SAMHSA) national outcome measures (NOMs), and helping participants build an overall better quality of life. The goal of this study is to highlight the efficacy of a peer recovery program, the Minority Aids Initiative, in improving health outcomes and associated NOMs in men with SUD and/or co-occurring mental health disorder. Participants received six months of peer recovery coaching from trained staff. Sessions were guided by the Manual for Recovery Coaching and focused on 10 different domains of recovery. Participants and coaches set long-term goals and created weekly action plans to work toward them. Standardized assessments (SAMHSA's Government Performance and Results Act [GPRA] tool, Addiction Severity Index [ASI]) were administered by recovery coaches at intake and at the 6-month time point to evaluate participant progress. Analyses of participant recovery were carried out according to SAMHSA's six NOMs and assessed the outcomes of the intervention and their significance. A total of 115 participants enrolled in the program over a 2-year period. Among them, 53 were eligible for 6-month follow-up interviews. In total, 321 sessions were held, with an average of three sessions per participant. Participants showed marked improvement across five of the six NOMs at the end of the 6-month course and across all ASI outcomes, with the exception of three in which participants reported an absence or few symptoms at intake. Our study shows that participants receive benefits across nearly all NOM categories when paired with recovery coaches who are well trained in medication-assisted treatment (MAT) and medications for opioid use disorder (MOUD) over a 6-month period. We see the following: a higher rate of abstinence; increased housing stability; lower health, behavioral, and social consequences; lower depression and anxiety; longer participant-recovery coach exposure time; and higher follow-up rates. We hope that our results can contribute to advancements and greater acceptance in the implementation of peer recovery coaching as well as an improvement in the lives of the communities affected by substance use.

In Case You Haven't Heard…

The National Alliance for Medication Assisted Recovery (NAMA Recovery) has a new website, and despite some board changes, is moving forward in its mission. There are other players who have recently left the NAMA Recovery board, namely Walter Ginter, Joycelyn Woods, and Bob Lubran, who will still be very much involved with helping promote the rights of patients. Lubran, who was formerly with the Substance Abuse and Mental Health Services Administration and is now involved with other opioid treatment initiatives, including Stop Stigma Now, resigned, as did Ginter and Woods. For NAMA Recovery, which is headed by Zachary C. Talbott, president and CEO of Talbott Legacy Centers and a long‐time patient and advocate, the transition “recognizes and celebrates a plethora of patient advocates that have gone before us and who no longer serve on our board.” The “majority MOUD patient board will continue to focus on the modernization of this critical organization, the only one whose sole mission is to represent the voices of and advocate for MOUD patients,” Talbott added. For the NAMA Recovery website, go to https://namarecovery.org/.

Assessment of adult learning outcomes from a school-based training on adverse childhood experiences science and trauma-informed care

BackgroundImplementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response. ObjectivesTo assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K−12) staff. Participants and settingA TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %). MethodsCurricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC. ResultsBetween 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice. ConclusionsTIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC.

Trauma-Informed Clinical Practice with Clients with Suicidal Thoughts and Behaviors

ABSTRACT In 2020, almost 46,000 individuals in the United States died from suicide, 1.2 million adults made a suicide attempt, and 12.2 million had serious suicidal thoughts. Clinicians in diverse practice settings will work with clients experiencing suicidal thoughts and behaviors. Due to a strong association between trauma and suicidality, suicidology experts have recommended the use of trauma-informed practice when working with clients with suicidal thoughts and behaviors. However, although there are guidelines for trauma-informed care and for working with clients with suicidality, there are no models, explanations, or discussions about how clinicians can provide trauma-informed care in their work with individuals with suicidal thoughts and behaviors. This conceptual paper describes examples of the application of the Substance Abuse and Mental Health Services Administration (SAMHSA)’s trauma-informed care principles to clinical work with individuals with suicidal thoughts and behaviors. Strategies are provided for each of the guiding principles, and case examples used to illustrate strategies, barriers, and potential pitfalls.

NIAAA Definition of Recovery Provides Measurable Endpoints for AUD Researchers

NIAAA Definition of Recovery Provides Measurable Endpoints for AUD Researchers

Much more in store before, and if, H.R. 7666 becomes a reality

Last month, the House of Representatives passed H.R. 7666, which would alter much treatment for opioid use disorder and revamp many Substance Abuse and Mental Health Services Administration (SAMHSA) programs (see House passes H.R. 7666, setting stage for revamping SAMHSA, ADAW June 27, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33477). However, there's a lot to be done before, and if, this package passes the Senate.

988 is Coming, But Most Localities Still Not Prepared

988 is Coming, But Most Localities Still Not Prepared

House passes H.R. 7666, setting stage for revamping SAMHSA

On June 22, the House of Representatives overwhelmingly passed H.R. 7666, the Restoring Hope for Mental Health and Well‐Being Act of 2022. The bill, if passed by the Senate and signed, will revamp many programs in the Substance Abuse and Mental Health Services Administration (SAMHSA). The 462‐page bill includes many provisions fought for by the American Society of Addiction Medicine (ASAM) and others.

Public struggles with naloxone access, acceptance.

It’s easy to go into a pharmacy in Rhode Island and walk out with a supply of the opioid reversal drug naloxone. But not enough people are doing so, says Anita Jacobson, clinical professor at the University of Rhode Island College of Pharmacy. Anita Jacobson “People aren’t taking the initiative to go in and ask for it,” she said. “That’s something they just don’t do. It really has to be almost aggressively marketed to them.” Jacobson does her part to get naloxone where it’s most needed by setting up tables during rural community events and offering the lifesaving reversal agent at no cost to people who stop by. The effort, initially funded through a rural opioid technical assistance grant from the federal Substance Abuse and Mental Health Services Administration, is part of the Community First Responder Program, which Jacobson has led since its launch in late 2019. The program has distributed more than 6,500 naloxone nasal spray kits at “tabling events” and during in-person and virtual education programs. During the program’s events, Jacobson works alongside student pharmacists, nursing students, and others to educate community members about naloxone and teach them how and when to administer it.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption.

SAMHSA's new Office of Recovery includes mental illness

The Substance Abuse and Mental Health Services Administration (SAMHSA) has taken another step toward merging mental illness and substance use disorder (SUD) with its new Office of Recovery that blends both. Peers (differentiated from professionals) with “lived experience” of having either SUDs, mental illness, or both in the SAMHSA‐preferred terminology of “co‐occurring” will be key to this new office, which was announced last fall (see Advocates hold hope that SAMHSA office will deliver for recovery support, ADAW Oct. 11, 2021; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33218).