in Substance Use
OUTCOMES AND METRICS
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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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: 978-0-309-67528-4
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Measuring success in substance use grant programs: Outcomes and metrics for improvement. Washington, DC: The National Academies Press. https://doi.org/10.17226/25745.
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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 for Neuroscience & Human Behavior, University of California, Los Angeles
HORTENSIA AMARO (Vice Chair), Distinguished University Professor and Senior Scholar on Community Health, Florida International University
GINA BRYAN, Director, Post Graduate Psych-Mental Health Program, Clinical Professor, University of Wisconsin–Madison
KAREN CROPSEY, Conaster Turner Endowed Professor of Psychiatry, The University of Alabama at Birmingham
JOAN DUWVE, Associate Professor and Associate Dean of Public Health Practice, Richard M. Fairbanks School of Public Health, Indiana University
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
MARCELA HORVITZ-LENNON, Senior Physician Policy Researcher, RAND Corporation
RAYMOND C. LOVE, Professor and Vice Chair, State of Maryland Mental Health Pharmacy Program, University of Maryland School of Pharmacy
YNGVILD OLSEN, Medical Director, REACH Health Services, Institutes for Behavior Resources, Inc.
SHARON REIF, Senior Scientist and Lecturer, The Heller School for Social Policy and Management, Brandeis University
KATHLEEN STRATTON, Scholar
ANDREW MERLUZZI, Program Officer
AIMEE MEAD, Associate Program Officer
ALEXIS WOJTOWICZ, Research Associate
MISRAK DABI, Financial Business Partner
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 JACK C. EBELER, Health Policy Alternatives, Inc., and 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.
The committee of this study thanks Dr. Tara Benjamin and Dr. Jorge Delva for their service in the early phases of this report. The committee also thanks the Comprehensive Addiction and Recovery Act grantees for their work and for providing information to the National Academies of Sciences, Engineering, and Medicine for this study.
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Substance use disorder (SUD), and opioid use disorder (OUD) in particular, is a significant public health concern in the United States. Drug overdose events and overdose deaths are a national crisis. Health systems and community infrastructures have struggled to adequately respond across a range of prevention, treatment, retention/recovery, and dissemination strategies. Deaths due to opioids number in the tens of thousands every year. Overdose is all too common, particularly given the recent influx of highly potent opioids, such as fentanyl, and the increase of opioid use with benzodiazepines. In addition, treatment for OUD can be challenging to implement, given issues such as lack of client engagement and retention in treatment, lack of access to treatment, social stigma, lack of integration with other services, and financing challenges. In 2016, the U.S. Congress authorized and appropriated funding to fight the opioid epidemic through the Department of Health and Human Services. Among other initiatives, the Comprehensive Addiction and Recovery Act (CARA) gave the Substance Abuse1 and Mental Health Services Administration (SAMHSA) authority and support to implement new grant programs focused on preventing overdose and treating individuals with OUD, including for high-risk populations, such as pregnant women.
1 Where possible, the committee has used non-stigmatizing language throughout this report, such as “use” rather than “abuse,” “medications for opioid use disorder” rather than “medication-assisted treatment,” and “overdose survivors” rather than “overdose victims” as has been the custom in recent scholarship on this topic (NASEM, 2020).
This Consensus Study Report is the first in a series of reports to evaluate the success of several CARA grant programs. This report focuses on reviewing and recommending changes or additions to outcome measures to enhance evaluation of the programs. The committee authoring this report gathered evidence from existing grantees and the broader literature to consider SAMHSA’s existing outcome measures and priorities. Then, given the goals of the CARA grant programs, the committee developed recommendations about metrics and outcomes that would improve the nation’s ability to measure the impact of these important programs. Recognizing that individual service delivery programs may not have the staff or resources to implement large-scale data collection and evaluation and that the funds available to use on data-collection processes through the grants are limited, the metrics and outcomes in this report represent the committee’s view on practical, implementable, and useful ideas for reducing overdose events and enhancing recovery for people who use opioids. We also note that SAMHSA has a substantial history of funding programs and evaluations in this area with publicly available outcome and impact measures. While acknowledging those strengths, we seek to ensure that a range of important outcomes can be identified within and across these programs.
As chair and vice chair, we thank our fellow committee members for their work on this report, their input and expertise, and their commitment to improving the public’s health. The committee would also like to express its appreciation to SAMHSA for sponsoring this program as well as other programs to address substance use generally and the opioid crisis in particular.
Sincere gratitude is given to the individual grantees that have provided their goals and evaluation strategies for implementing activities under the SAMHSA grant programs—these are the individuals and organizations seeking to improve the public’s health every day. In addition, the committee could not have completed this report without the guidance and dedication of the National Academies staff who shepherded it through to its conclusion. We thank Kathleen Stratton, Andrew Merluzzi, Aimee Mead, Alexis Wojtowicz, Misrak Dabi, and Rose Marie Martinez. We hope that our recommendations can help both the grantees and SAMHSA advance their work to address the SUD crisis affecting our nation’s health and ensure that the impacts of the programs can be identified, interpreted, and built on.
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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