Substance Abuse Treatment Services Research Articles

Tailoring services in opioid treatment programs for patients involved in America\u2019s criminal justice system: national associations and variation by state and Medicaid expansion status

BackgroundOpioid treatment programs (OTPs) are the primary source of medication-assisted treatment (MAT) for many individuals with opioid use disorder, including poor and uninsured patients and those involved in the criminal justice (CJ) system. Substance use treatment services that are tailored to the unique needs of patients often produce better outcomes, but little national research has addressed characteristics associated with whether OTPs offer services specifically tailored to community members involved in the CJ system. Medicaid expansion under the Affordable Care Act has broadly strengthened MAT services, but the role of expansion in supporting MAT services that are specifically tailored towards CJ-involved populations remains unknown. Moreover, it is unknown whether the availability of tailored services varies between Medicaid expansion states.MethodsWe used the 2019 National Survey of Substance Abuse Treatment Services to identify OTPs in the US (n = 1679) and whether they offered services specifically tailored for CJ-involved patients. We used logistic regression to model the association between OTPs offering tailored services and state Medicaid expansion status, adjusted for state-level opioid overdose and community supervision rates.ResultsNationally, only a quarter of OTPs offered services tailored to CJ populations, and the majority of OTPs (73%) were located in Medicaid expansion states. Compared to OTPs in non-expansion states, OTPs in expansion states demonstrated nearly double the odds of offering tailored services (adjusted odds ratio = 1.90, 95% confidence interval = 1.41–2.57, p < 0.0001). The predicted probability of offering tailored services varied by state; probability estimates for all expansion states were above the national mean, and estimates for all non-expansion states were below the national mean.ConclusionOur findings reiterate the role of Medicaid in promoting the adoption of comprehensive OTP services for CJ-involved populations. However, the proportion of OTPs that offered tailored services was relatively low, pointing to the need to continually strengthen Medicaid services and coverage.

HIV Testing and Counseling at U.S. Substance Use Treatment Facilities: A Missed Opportunity for Early Identification.

The objective of this study was to determine the availability and national distribution of HIV testing and counseling at substance use treatment facilities in the United States. Analyses of data from the 2018 National Survey of Substance Abuse Treatment Services assessed HIV testing and counseling availability in U.S. substance use treatment facilities (excluding those in U.S. territories). Facilities were subcategorized by availability of mental health services and medication for opioid use disorders and compared by using logistic models. Descriptive statistics were calculated to characterize the availability of HIV testing and counseling by state, state HIV incidence, and facility characteristics. Among U.S. substance use treatment facilities (N=14,691), 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither. Across states, the proportions of facilities offering HIV testing ranged from 9.0% to 62.8%, and the proportion offering counseling ranged from 19.2% to 83.3%. In only three states was HIV testing offered by at least 50% of facilities. HIV testing was significantly more likely to be offered in facilities that offered medication for opioid use disorder (48.0% versus 16.0% in those not offering such medication) or mental health services (31.2% versus 24.1% in those not offering such services). Higher state-level HIV incidence was related to an increased proportion of facilities offering HIV testing. Only three in 10 substance use treatment facilities offered HIV testing in 2018. This finding represents a missed opportunity for early identification of HIV among people receiving treatment for substance use disorders.

Patient Perspectives on Detox: Practical and Personal Considerations through a Lens of Patient-Centered Care

Inpatient detoxification is often required before a client can move on to additional substance abuse treatment services. Although often short-term, time spent in inpatient detoxification tends to have long-lasting effects on the recovery process. This qualitative study focuses on one treatment facility in Tampa, Florida that offers a range of recovery services, including inpatient detox and outpatient treatment. Focus groups (N = 70 participants) captured client perceptions of direct clinical care operations, access to resources, and relationships with direct care staff within the inpatient detox program. Perceptions were then assessed using a thematic analysis approach with attention to the literature on person-centered care best practices, behavior change, and patient engagement theories to better understand how facility practices affect treatment engagement and retention. Findings elucidated several practical facilitators and barriers to recovery such as facility resources, services offered, transition to aftercare, and sustainability of treatment. Findings also illuminated several personal facilitators and barriers including patient-staff interactions, personal motivation, and family and community support. The resulting recommendations for practice and research are discussed.

The Readiness, Resilience and Recovery Tool: An Emerging Approach to Enhance Readiness Amidst Disruption.

Disruptions of varying severity often occur in the course of an organization’s work to implement new programs or projects. These disruptions may slow their progress or even derail the work altogether. Resilient organizations must be prepared to respond in a thoughtful and timely way to disruptions. Readiness, Resilience and Recovery is an adaptable readiness assessment tool that organizations can use to proceed with their work with insight about their readiness status and how their readiness has been impacted by a disruption. The resulting information can then be used to guide the development of solutions for recovery and build the organization’s overall capacity for resilience. Based on our early experience, the Readiness, Resilience and Recovery approach is emerging as a tool that can be useful when organizations face significant disruptions. We have found it to be adaptable to different types of projects, at various points in the implementation cycle, and with multiple types of disruptions. To demonstrate its use, this illustrative paper provides five examples from different projects and settings: Substance Abuse Treatment Services, Multi-Site Sexual Assault Prevention Initiative, Serve and Connect (a Police-Community Relationships Initiative), Carolina Family Engagement Center (family engagement in schools), and Action for Equity (an equity intervention). Practical uses of the tool and conceptualizing it within important implementation science concepts are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43477-021-00011-6.

Association between availability of medications for opioid use disorder in specialty treatment and use of medications among patients: A state-level trends analysis

IntroductionAccess to medication for opioid use disorder (MOUD) is a recognized public health challenge to improving the health of people with opioid use disorder (OUD) in many communities. Prior studies have shown that although MOUD availability has increased over time, particularly in some states, many substance use treatment facilities still do not offer medications. The relationship between greater availability of MOUD and use of MOUD among patients in treatment programs is not well understood. MethodsWe used the National Survey of Substance Abuse Treatment Services to calculate the percent of specialty facilities per state providing MOUD from 2007 to 2018 and the Treatment Episode Data Set-Admissions (TEDS-A) to estimate the likelihood that a patient would have MOUD as part of their treatment plan during the same time period. We estimated models with patient-level TEDS-A data as the outcome and state-aggregated one-year lagged availability of MOUD in facilities as the main predictor, stratifying by treatment facility type (intensive outpatient, non-intensive outpatient, and residential). ResultsWe found that increasing MOUD availability at the facility level was associated with increased MOUD use in non-intensive and residential facilities at the patient level. Specifically, a 10 percentage point increase in MOUD availability was associated with a 4.5 percentage point increase in MOUD use among patients of non-intensive outpatient facilities (p-value = 0.03), and a 2.5 percentage points increase in residential facilities (p-value = 0.02). Non-Whites and patients in the Northeast had greater likelihoods of increased MOUD use in response to increased availability by facilities. ConclusionIncreasing MOUD availability among specialty treatment facilities is likely to promote better access to MOUD for patients seeking treatment for OUD.

Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care.

Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.

Suicide Prevention Programs Across U.S. Outpatient Mental Health Care Settings: Differences by Facility Ownership

This study aimed to examine whether facility ownership (public, private nonprofit, private for-profit ownership) was associated with provision of suicide prevention programs.A retrospective cross-sectional study identified self-reported suicide prevention program status across 7,597 mental health facilities with outpatient settings by using data from the 2019 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator. Multivariable logistic regression models examined whether facility ownership was associated with availability of these programs.In 2019, only 61.2% of facilities provided outpatient suicide prevention programs. Higher odds of program provision were associated with public ownership (adjusted odds ratio [AOR]=1.64, 95% confidence interval [CI]=1.37-1.97, p<0.001), facilities serving young adults (AOR=2.16, 95% CI=1.66-2.82, p<0.001) or serving seniors (AOR=1.44, 95% CI=1.27-1.63, p<0.001), and facilities accepting Medicare (AOR=1.34, 95% CI=1.16-1.53, p<0.001), compared with their counterparts, with significant differences across facility ownership types by rurality of locations. Facilities accepting uninsured patients (AOR=0.81, 95% CI=0.68-0.98, p=0.027) or Medicaid patients (AOR=0.76, 95% CI=0.62-0.92, p=0.006) had lower odds of providing these programs.Facility ownership contributed to significantly different decisions on provision of outpatient suicide prevention programs. Maldistribution of these services should raise concerns, given nationwide efforts to prevent suicide and weak ownership regulations for mental health facilities. Understanding barriers and facilitators for deployment of these programs may improve access to suicide prevention services for all, especially for eligible patients in rural areas.

Institutions For Mental Diseases Medicaid Waivers: Impact On Payments For Substance Use Treatment Facilities.

The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34percent at residential treatment facilities and 9percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees.

In Case You Haven't Heard…

Mark Weber, whom we have known for our entire career as a master public affairs official in the federal government, is now acting assistant secretary for public affairs (ASPA), the top communications job interfacing with the media and others, at the Department of Health and Human Services (HHS). Weber is a lifelong HHS employee; we first met him when he was launching the Substance Abuse and Mental Health Services Administration (SAMHSA), formerly the Alcohol, Drug Abuse, and Mental Health Administration, which we had also covered for the former Substance Abuse Report. “I was part of the team that rolled out SAMHSA, but little did I know I would soon be communications director there,” he told ADAW last week. Weber has no doubt the Biden team will bring in their own ASPA, but his reflections on how treatment for substance use disorders (SUDs) has changed over his “short lifetime” (we're with him there) are key. “When I first started working at SAMHSA, our challenge was to educate the public and funding officials (Congress) that substance abuse prevention, treatment and mental health services worked,” he told ADAW last week. At the time — the late 1980s and 1990s — there was a “belief that you can't prevent substance abuse and that people who have substance use disorder can't recover, have no hope.” Initially, SAMHSA conducted the studies, took programs to scale and showed they were effective and there was a return on investment. “A major turning point was the National Treatment Evaluation Study, the first major study across publicly funded treatment programs, which showed real impact,” he said. “We have gone from trying to help the public and funding officials understand that these programs are not only effective but there's a return on investment, to achieving equity in the health system.” There is now “equality,” thanks to parity, but actual “equity,” which means treating substance use disorders the same way as any other health condition, is not yet a reality. There would still be specialties, of course, but all integrated within the health care system. “That's what we're moving towards,” said Weber. In addition, he learned early on, from working for 16 years at SAMHSA, that SUDs and mental illness touch on everything else. He values lived experience. “I credit that experience with helping me move into the Office of the Assistant Secretary for Public Affairs,” where he has been in the number‐2 position. “I started at SAMHSA as a bureaucrat and left as an advocate,” he said. Incidentally, Weber went to the border during the Trump administration to talk to the press about the HHS (not Homeland Security or Immigration and Customs Enforcement) arrangements for migrant children. “I've lived in shelters for at least 6 weeks,” he said. “I'm looking forward to continuing to speak from lived experience and going deep on topics.”

Medications for opioid use disorder among American Indians and Alaska natives: Availability and use across a national sample

BackgroundAmerican Indians and Alaska Natives (AI/ANs) are disproportionately affected by the opioid overdose crisis. Treatment with medications for opioid use disorder (MOUD) can significantly reduce overdose risk, but no national studies to date have reported on the extent to which AI/ANs access these treatments overall and in relation to other groups. MethodsThe current study used two national databases - the 2018 National Survey on Substance Abuse Treatment Services and the 2017 Treatment Episode Dataset - to estimate the extent to which MOUD is available and used among AI/ANs across the U.S. ResultsWe found that facilities serving AI/ANs (N = 1,532) offered some MOUD at similar rates as other facilities (N = 13,277) (39.6 vs. 40.6 %, p = 0.435) but were less likely to offer the standard of care with buprenorphine or methadone maintenance (22.4 % vs. 27.6 %, p < 0.001). AI/AN clients in specialty treatment (N = 8,136) exhibited slightly higher MOUD use (40.0 % vs. 38.6 %, p = 0.009) relative to other race groups (N = 673,938). AI/AN clients were also more likely to exhibit greater prescription opioid use and methamphetamine co-use relative to other groups. AI/AN clients in the South (aOR:0.23[95 %CI: 0.19−0.28] or referred by criminal justice sources (aOR:0.13[95 %CI: 0.11−0.16] were least likely to receive MOUD. ConclusionsWe conclude that most AI/ANs in specialty treatment do not receive medications for opioid use disorder, and that rates of MOUD use are similar to those of other race groups. Efforts to expand MOUD among AI/ANs that are localized and cater to unique characteristics of this population are gravely needed.

Electronic health record adoption among US substance use disorder and other mental health treatment facilities

ObjectiveThis study examined Electronic Health Record (EHR) utilization among US substance use disorder (SUD) versus mental health (MH) treatment facilities. MethodsData from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey were used to examine differences in clinical and administrative utilization of EHR. ResultsEHR use was significantly less common among SUD facilities compared to MH facilities for both non-exclusive (mixed computer and paper) and exclusive (paper-free) use. Fewer than 25 % of facilities of either type reported exclusive EHR use for core clinical activities (progress notes, laboratory monitoring, and prescriptions) with wide variability among states. Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or a public facility were significantly positively associated with exclusive EHR use for core clinical activities; these associations were stronger among SUD facilities than MH facilities. Accepting Medicare was associated with exclusive EHR use for core clinical activities in both facility types, while accepting private insurance was associated with such use only among SUD treatment facilities. ConclusionsEHR adoption among SUD facilities lags behind MH facilities. However, exclusive EHR use for clinical purposes remains elusive for both types of facilities with no more than a quarter of facilities in any state reporting such use. Some of the factors associated with exclusive EHR use for clinical purposes among SUD treatment facilities—such as Joint Commission accreditation—may be policy leverage points to expedite EHR adoption in these facilities.

Elderly male with late-onset heroin dependence

Substance use disorders usually have their onset during the adolescent period. However, in rare cases environmental and psychosocial factors can contribute toward a later onset. We describe a case of an elderly male who initiated his heroin use for the first time at 65 years of age and eventually developed dependence. This late-onset of heroin use was mediated by contextual factors such as loneliness, boredom, and easy access to heroin while craving and withdrawal symptoms served as maintaining factors. He responded well to a combination of opioid antagonist and nonpharmacological approaches focusing on activity scheduling and social support. As the demographic transition and societal changes take place, the elderly population with substance use problems will increase. There is an urgent need to upgrade substance abuse treatment services to meet the specific needs of the elderly using supportive and nonconfrontational approaches with special focus on improving social support access.

Characteristics of Mental Health and Substance Use Service Facilities for Older Adults: Findings from U.S. National Surveys

ABSTRACT Objectives To describe the characteristics of U.S. mental health and substance use service programs dedicated/tailored for older adults (age 65+). Methods Data came from the 2012 and 2019 National Mental Health Services Survey (N-MHSS) and the National Survey of Substance Abuse Treatment Services (N-SSATS). Using Pearson χ2 and Fisher’s exact tests, we compared the numbers/proportions of older-adult programs in 2012 and 2019 and examined differences between facilities with or without an older-adult program in 2019. Results From 2012 to 2019, the percent of all mental health and substance use service facilities for adults that had a dedicated/tailored program for older adults increased significantly, from 20.7% to 28.9% for mental health facilities and from 7.1% to 24.8% for substance use facilities, with 101 mental health facilities and 53 substance use facilities serving older adults exclusively in 2019. Compared to facilities without an older-adult program, higher percentages of facilities with such a program offered treatment for co-occurring mental and substance use disorders and supplemental health and social care services. Conclusions Given the rapidly aging society, more accessible and affordable programs dedicated/tailored for older adults are needed. To achieve this goal and better meet older adults’ needs, more detailed data on facility characteristics are needed to build the knowledge base on improving the treatment environment. Clinical Implications Programs for older adults should be designed to meet the complex needs of those with mental health and/or substance use problems and incorporate innovative service delivery models that can improve older adults’ access.

Medicaid Expansion and Availability of Opioid Medications in the Specialty Substance Use Disorder Treatment System.

Research has examined the effect of Medicaid expansion on access to physicians with buprenorphine waivers, but less attention has been paid to Medicaid's impact on opioid use disorder medication availability within the specialty substance use disorder treatment system. To address this gap in the literature, this study examined the impact of Medicaid expansion on availability of opioid medications in specialty programs. This study used data from the National Survey of the Substance Abuse Treatment Services (2002-2017), containing all known substance use disorder treatment programs in the United States, to examine the effect of Medicaid expansion on the availability of opioid use disorder medications by treatment program ownership type (publicly owned, private for profit, and private nonprofit) among opioid treatment programs (OTPs) and non-OTPs. The effects of Medicaid expansion were limited to nonprofit and for-profit OTPs. Medicaid expansion was associated with 135.1% and 57.5% increases in the number of nonprofit and for-profit OTPs offering injectable naltrexone, respectively, and with a 64.4% increase in the number of nonprofit OTPs offering buprenorphine. Nonprofit and for-profit OTPs compose <10% of the treatment system, indicating that improvements in opioid use disorder treatment associated with Medicaid expansion were limited to a small share of the specialty system. The limited impact of Medicaid expansion on the specialty treatment system may perpetuate disparities in the accessibility and quality of opioid use disorder treatment for Medicaid enrollees and fail to alleviate high rates of opioid use disorder and opioid overdose deaths in this vulnerable population.

The Role of State Medicaid Expansions in Integrating Comprehensive Mental Health Services into Opioid Treatment Programs: Differences Across the Rural/Urban Continuum.

Co-occurring mental health (MH) problems are common among those with opioid use disorders (OUDs). However, most opioid treatment programs (OTPs) do not provide MH services. We measured the association between state level characteristics (Medicaid expansion status and rurality) and MH/OUD services integration. We used a generalized linear model to estimate how the association between integration and Medicaid expansions varied across levels of rurality (National Survey on Substance Abuse Treatment Services; 2018; n = 1507 OTPs). The predicted probability of OTPs offering MH services decreased as rurality increased, and the strength of the negative association was greater in non-expansion states ([Formula: see text]=-0.038, SE = 0.005, p < 0.0001) than in expansion states ([Formula: see text]=-0.020, SE = 0.003, p < 0.0001). Access to integrated MH services was lowest in rural non-Medicaid expansion states, despite the high risk of opioid misuse and a high need for MAT and MH services in this population.

The availability of LGBT-specific mental health and substance abuse treatment in the United States.

To examine the availability and facility-level predictors of LGBT-specific mental health and substance abuse treatment in the United States. 2016 National Survey of Substance Abuse Treatment Services, 2016 National Mental Health Service Survey, and 2015-2016 Gallup Daily tracking survey. Logistic regression models and average marginal effects were used to identify characteristics of facilities that offer LGBT-specific programs. Linear regression models were used to estimate the association between the state-level proportion of LGBT people and the proportion of facilities that offer LGBT-specific programs. Secondary data analysis. Cases with missing values for any predictor were excluded. 12.6 percent of mental health and 17.6 percent of substance abuse facilities reported LGBT-specific programs. Several facility characteristics were statistically associated with the likelihood of mental health and substance abuse facilities providing LGBT-specific programs, including offering outpatient or residential treatment, private ownership, religious affiliation, and payment type. The proportion of LGBT adults living within each state was statistically associated with state-level density of LGBT-specific mental health programs, but not substance abuse programs. Findings suggest limited availability of culturally competent mental health and substance abuse treatment, despite well-documented need.

The role of perceived treatment need in explaining racial/ethnic disparities in the use of substance abuse treatment services

ObjectiveThe current study examined the role of perceived treatment need in explaining racial/ethnic disparities in treatment utilization for a substance use disorder (SUD). MethodsWe pooled data from the National Survey on Drug Use and Health survey for years 2014–2017. The analytic sample included adult white, Black, and Latino participants with a past-year SUD (n = 16,393). Multivariable logistic regressions examined racial/ethnic disparities in perceived treatment need—the perception of needing mental health and/or SUD treatment services within the past 12 months—and utilization of past-year substance use, mental health, and any treatment. ResultsLatinos with SUD were less likely to perceive a need for treatment than whites. Black and Latino participants, relative to white participants, had lower odds of past-year treatment utilization, regardless of treatment type. In models stratified by perceived treatment need, racial/ethnic differences in the use of past-year SUD treatment and any treatment service were only significant among persons without a perceived need for treatment. We found no disparities in use of mental health treatment. ConclusionsAdults with SUD have low perceived treatment need overall but especially among Latinos. Furthermore, Black and Latino disparities in SUD treatment use may be driven in part by lower perceived need for treatment. Interventions that promote better perceived need and delivery models that strengthen the integration of SUD treatment in mental health services may help to reduce these disparities.

COVID-19 Could Change the Way We Respond to the Opioid Crisis-for the Better.

COVID-19 Could Change the Way We Respond to the Opioid Crisis-for the Better.

The Therapeutic Community: A Unique Social Psychological Approach to the Treatment of Addictions and Related Disorders.

The evolution of the contemporary Therapeutic Community (TC) for addictions over the past 50 years may be characterized as a movement from the marginal to the mainstream of substance abuse treatment and human services. TCs currently serve a wide array of clients and their diverse problems; through advances in research in treatment outcomes, the composition of staff has been reshaped, the duration of residential treatment has been reduced, the treatment goals have been reset and, to a considerable extent, the approach of therapy itself has been modified. An overview of the TC as a distinct social-psychological method for treating addiction and related disorders is provided by this paper. Included in this is a focus on the multifaceted psychological wounds that consistently show a strong association with addiction and thereby require initiating a recovery process characterized by life-style and identity changes.

The Effects of State Regulations and Medicaid Plans on the Peer Support Specialist Workforce

Peer support specialists have proven to be a cost‐effective and clinically effective workforce in improving patient quality of life and symptom management, while decreasing avoidable emergency room visits and care overutilization. This study used publicly available datasets to map and type locations where peer services are provided, and determine how state policies are associated with peer support provision.We transcoded the 2018 National Survey on Substance Abuse Treatment Services (N‐SSATS) and 2018 National Mental Health Services Survey (N‐MHSS) directories, yielding a list of street addresses and characteristics for substance use disorder treatment (SUDTx) and mental health treatment (MHTx) facilities nationwide. We then pulled all state regulations for peer provider licensing/certification, service authorization, and Medicaid reimbursement from public, online repositories. Stepwise regressions associated these regulations with the proportion of SUDTx and MHTx facilities in the state offering peer services to determine what effect, if any, state policies may have on the peer workforce.Behavioral health treatment facilities offering services in 2018, specifically such facilities offering peer support services.The transcoding uncovered 9,294 MHTx facilities and 12 074 SUDTx facilities, nationwide. Approximately 25% of MHTx facilities (2311/9294) and 56% of SUDTx facilities (6806/12 074) self‐reported offering peer support services in 2018. Most counties had at least one facility offering peer services, with more densely populated counties having more of such facilities. Facilities offering peer services were more concentrated in urban hubs, like Detroit, Chicago, Los Angeles, etc., as opposed to rural or frontier areas.In MHTx facilities, peer services were included in the greatest proportion in community mental health centers (35%, 782/2194), multisetting health facilities (31%, 102/332), and residential treatment centers for adults (26%, 138/528). In SUDTx facilities, peer services were included in the greatest proportion in residential treatment (79%, 2203/2776), residential detoxification (76%, 618/817), and outpatient day treatment facilities (71%, 1145/1614).Stepwise regression found Medicaid reimbursement rates positively associated with peer service provision (P &lt; .05). To be reimbursed by Medicaid, many state Medicaid plans require peers to have a state‐recognized certification. Other positively associated policies were requiring education and supervision hours for a credential (P &lt; .05, each) and allowing applicants to apply college degrees toward requirements for a peer credential (P &lt; .05). These policies were more common in state‐regulated credentials than more informal registrations.Transcoding the N‐MHSS and N‐SSATS datasets allowed us to map where peer services were being offered nationwide, determine the types of facilities offering peer services, and see how their provision rates varied by state. Testing regulatory data for peer credentials and state Medicaid plans against these provision rates found Medicaid reimbursement rates and certain peer credential requirements were positively associated with peer service provision.The Centers for Medicare and Medicaid Services has approved peer services for Medicare reimbursement, and states are increasingly adding peers to their lists of approved Medicaid providers. Our statistical analysis suggests that increasing the Medicaid reimbursement rate for peers and creating a state‐regulated peer credential (license or certification) could improve the rate at which MHTx and SUDTx facilities offer peer services within states.Health Resources and Services Administration.