The integration of substance abuse and mental health services into the general health care system is the primary goal of the SAMHSA AIDS office, which was created in 1992 by the ADAMHA Reorganization Act. Currently, SAMHSA has an associate administrator for AIDS who is located in the office of the SAMHSA administrator. The associate administrator works with the three center offices on AIDS. These, too, were established by the ADAMHA reorganization bill, and are responsible for ensuring that HIV/AIDS issues are addressed and integrated into the overall programs of the center.

SAMHSA's total budget (comparable to the ADAMHA services programs' budget before FY 1993) increased from $794.7 million in FY 1988 to a $2.1 billion appropriation in FY 1993. During the same time period, specifically identified AIDS funding decreased from $42.5 million to $28 million (falling from 5 percent of the total budget to 1 percent). To some degree, the small proportion of the SAMHSA budget devoted to AIDS is a legacy of the ADAMHA years, during which the vast majority of AIDS funding at the agency was allocated to research activities (Figure S.5). These research activities are now located at NIH.

As of FY 1994, only four programs are recognized in SAMHSA's formal budget as AIDS-related. Two of these programs—which constitute the bulk of the agency's specific HIV/AIDS funds—are located in CSAT (formerly OTI). These are the Demonstrations and Training Program and the Treatment Improvement Demonstration Program, also known as the Comprehensive Community Treatment Program (CCTP). The CMHS AIDS program includes Training and AIDS Training, which began at NIMH in FY 1990, and a new AIDS Mental Health Services Demonstration Program, which was initiated in FY 1994. CSAP (formerly OSAP) had no AIDS program until FY 1994, when it proposed providing supplements to the Prevention Demonstrations for HighRisk Youth Program to fund outreach and risk reduction activities related to HIV/AIDS, including skills building, pre-post HIV test counseling, outreach to resistant populations, and services to those who have lost people to AIDS.


A major concern about the ADAMHA Reorganization Act of 1992 (see Chapter 5) was how it would effect the relationship

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