Federal Partners Federal Issues:

2. What You Should Know as a Substance Use Disorder Professional Federal PartnersFederal Issues:

3. DC Impact Statement What goes on in Washington, DC as it relates to substance use disorder and the workforce often trickles down to every state and impacts what and how you provide treatment and prevention services. Knowing who the federal partners are and issues they are addressing can provide much needed background to why certain decisions are made in states and local communities

4. Workforce Characteristics • White, female, over age 45 • 29% of direct staff is in recovery • 36% master’s degree; 24% bachelor’s degree • Median annual wage/2012 = $38,520 • DOL expects a 31% growth for substance use disorder counselors between 2012-2022

5. Workforce continued • 2012 – total workforce 89,600 • 2022 – total workforce needed 117,700 • Younger professionals from diverse racial/ethnic backgrounds are needed

6. Top 10 List • Based on the DOL expected growth for SUD counselors, another study captured the 10 best states to work or live in for SUD counselors • Ranked on average income; projected employment growth; cost of living; alcohol use rates; illicit drug use rates; and substance abuse related arrest stats

7. Best States Are: 1. Colorado 2. Nevada 3. Montana 4. Minnesota 5. Iowa 6. Idaho 7. Wisconsin 8. New Hampshire 9. Wyoming 10.Virginia Sorry Oklahoma – you did not make the Top 10 list!!!

8. Federal Partners • Who are they and what do they do?

9. SAMHSA – US Department of Health & Human Services Substance Abuse and Mental Health Services Administration • SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities • In existence since 1992; headquarters in Rockville, MD • SAMHSA four Centers include: Center for Behavioral Health Statistics and Quality; Center for Mental Health Services; Center for Substance Abuse Prevention; Center for Substance Abuse Treatment

10. SAMHSA continued • 10 regional centers in the US • 7 advisory councils: national issues; mental health services; substance abuse prevention; substance abuse treatment; women’s services; drug testing; and tribal technical • Budget supports programs to reduce the impact of substance abuse and mental illness in US communities = $3.6 billion

11. SAMHSA continued • 2015-2018 six Strategic Initiatives include: Prevention of Substance Abuse and Mental Illness; Health Care and Health Systems Integration; Trauma and Justice; Recovery Support; Health Information Technology; and Workforce Development • SAMHSA’s budget fully funds the prevention and treatment Block Grant funneled down to states

12. SAMHSA continued • Prevention budget covers the Strategic Prevention Framework and all other programs of regional and national significance

13. SAMHSA continued • Treatment budget covers criminal justice activities; minority AIDS; SBIRT; primary care and addiction services integration; health information technology; ATTCs; STAR (business operation practices); and all other programs of regional and national significance

14. Strategic Initiative on Workforce Development: Goals • Develop/disseminate workforce training & education tools and core competencies to address behavioral health issues • Develop & support deployment of peer practitioners in all public health & health care delivery settings

15. Goals continued • Develop consistent data collection methods to identify & track behavioral health workforce needs • Influence & support funding for the behavioral health workforce

16. What concerns SAMHSA about workforce? • Shortages in the workforce • Retention/recruitment efforts • Serving diverse populations with a workforce that matches these diverse populations • Advancement of evidence-based practices

17. SAMHSA continued • August 2014 SAMHSA created the Office of Tribal Affairs & Policy • Primary contact for tribal governments, tribal organizations, federal departments and agencies and other governments and agencies on behavioral health issues facing American Indian and Alaskan Native populations

18. SAMHSA Resources • TIPS and TAPS available free of charge • (Treatment Improvement Protocol) • (Technical Assistance Publication) • Webinars & Listening Sessions • Reports & National Surveys • Grants, Data, TA • Toolkits

19. The problem with funding • Funding initiatives are great but are often not refunded • Funding for special projects needs to be sustained by the receiver of the funding which is often not occurring • Funding comes and goes depending on what the climate is/issues are in DC

20. WORKFORCE • SAMHSA-HRSA Center for Integrated Health Solutions • Workforce development is essential to integrated care. Resources are organized in six categories that capture the essential components of this unique labor force. They are: Recruitment/Retention; Education/Training; Supervision; Partnerships; Leadership; Team Members.

21. WORKFORCE • http://www.integration.samhsa.gov/workforce • Who is HRSA? Health Resources & Services Administration under HHS • HRSA is the primary Federal agency for improving access to health care by strengthening the health care workforce, building healthy communities and achieving health equity. HRSA’s programs provide health care to people who are geographically isolated, economically or medically vulnerable.

22. HRSA • HRSA also supports the training of health professionals, the distribution of providers to areas where they are needed most and improvements in health care delivery. • DATA driven – Loans & Scholarships for workforce – Grants for health care programs

23. HRSA • MDS – collecting data on all professionals that touch substance use disorder • www.hrsa.gov

24. ONDCP – Office of National Drug Control Policy • Executive Office of The President within The White House • Director Michael Botticelli (MA) former SSA Director and a person in long-term recovery

25. ONDCP • ONDCP was created by the Anti-Drug Abuse Act of 1988. ONDCP advises the President on drug-control issues, coordinates drug-control activities and related funding across the Federal government, and produces the annual National Drug Control Strategy, which outlines Administration efforts to reduce illicit drug use, manufacturing and trafficking, drug-related crime and violence, and drug-related health consequences.

26. The National Drug Control StrategyA 21st Century Approach to Drug Policy • Addressing the National Opioid Epidemic • Preventing Drug Use Before it Begins • Intervening Early, Before a Medical Condition Becomes Chronic • Making Access to Treatment a Reality for Millions of Americans • Eliminating Barriers to Recovery • Taking a ‘Smart on Crime’ Approach to Drug Enforcement

27. A Look at Each Strategy

28. Addressing the National Opioid Epidemic • Fast-track approval by the FDA of an auto-injector for opioid overdose reversal (Naloxone); • Release of an Opioid Overdose Toolkit by the Substance Abuse and Mental Health Services Administration (SAMHSA); • Public Education and Prevention efforts through 670 Drug-Free Communities (DFC) Support Program coalitions; • The launch of approximately 60 new continuing education or continuing medical education programs on safe prescribing and substance misuse that health care personnel and prescribers may take for credit toward licensure requirements; • Interstate data-sharing by 24 of 49 state PDMPs (prescription drug monitoring programs); and • Issuance of boxed warnings concerning the effect of long-acting extended-release opioids on newborns.

29. Preventing Drug Use Before it Begins • Promote national, state, and community-based programs that are evidence-based and work to prevent substance use in schools and in the workplace; • Provide information on effective prevention strategies, including environmental approaches, for use by youth advocates, parents, local prevention service providers, law enforcement officers, faith-based representatives, health care workers, and community organizers nationwide; and • Spread prevention to the workplace through programs that ensure the safety and wellness of employees and their families.

30. Intervening Early, Before a Medical Condition Becomes Chronic • Support education and legislation aimed at providing health care professionals with continuing education and training on addiction and safe prescribing practices for opioid painkillers; and • Seek to reduce opioid overdose deaths by expanding comprehensive overdose prevention measures, including the use of the lifesaving overdose-reversal medicine Naloxone among first responders.

31. Making Access to Treatment a Reality for Millions of Americans • Detail actions to implement the Affordable Care Act, which ends discrimination against people with substance use disorders by requiring insurance companies to cover treatment for these disorders just as they would cover any other chronic disease; • Promote the use of medication-assisted treatment to help guide people into recovery; • Work to expand treatment and re-entry services for those incarcerated; and • Expand health insurance coverage for all Americans, including college and university students and Native Americans.

32. Eliminating Barriers to Recovery • Work to lift the stigma associated with substance use disorders by partnering with those in the recovery community to speak out about their successes and encourage others to seek treatment; • Review and reform laws and regulations that unfairly target those with substance use disorders and impede recovery, including laws and regulations that restrict access to housing, employment, and obtaining a driver’s license or student loan; and • Support youth and young adults in recovery and promote approaches for assisting youth in recovery via school- and campus-based recovery efforts, including recovery schools and collegiate recovery communities.

33. Taking a ‘Smart on Crime’ Approach to Drug Enforcement • Focus limited law enforcement resources to address the greatest threats to public safety; • Promote the diversion of non-violent drug offenders into treatment in lieu of incarceration through innovative programs like Drug Courts and other community services; and • Highlight innovations that show promise in reducing rates of incarceration while protecting public safety, such as such as Hawaii’s Opportunity Probation with Enforcement (HOPE) and the Drug Market Intervention program.

34. ONDCP Celebrates 25 Years of Recovery Month • Held September 17 at The White House and streamed live; • Panel of recovery advocates sharing their stories of hope; • Raise awareness of substance use disorders and recovery, highlight Administration priorities and accomplishments in this area, educate the public and policymakers, and help dispel stigma by promoting the understanding that addiction is a disease and not the result of a personal or family failing.

35. NIDA – National Institute on Drug Abuse • Established in 1974; under National Institutes of Health; current Director Dr. Nora Volkow • NIDA's mission is to lead the nation in bringing the power of science to bear on drug abuse and addiction • How? • By the strategic support and conduct of research across a broad range of disciplines • By ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention and treatment and to inform policy as it relates to drug abuse and addiction

36. NIDA For professionals: • Research Studies & Reports • DrugFacts • E-newsletters • Journals • Education materials • Podcasts

37. NIAAA – National Institute on Alcohol Abuse & Alcoholism • NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. It is the largest funder of alcohol research in the world. • Current Director Dr. George Koob

38. HOW? • Conducting and supporting research in a wide range of scientific areas including genetics, neuroscience, epidemiology, health risks and benefits of alcohol consumption, prevention, and treatment • Coordinating and collaborating with other research institutes and federal programs on alcohol-related issues • Collaborating with international, national, state, and local institutions, organizations, agencies, and programs engaged in alcohol-related work • Translating and disseminating research findings to health care providers, researchers, policymakers, and the public

39. NIAAA For professionals: • Publications, brochures, fact sheets • Research • Clinical Trials • Grants • Journals & Videocasts • Educational materials

40. Climate in DC • A cultural shift in Congress is emerging on addiction; more willingness to deal with addiction-related issues in a bi-partisan manner • Recent public attention given to overdoses - be they celebrity or the everyday person in our communities - is creating motivation for lawmakers to care about addiction • This short window of opportunity must be seized!

41. Feds watching closely • Opioid epidemic • Marijuana legalization in states and its impact on prevention, treatment, crime, etc. • Integration of SUD into primary health

42. Recent Legislation • Sept. 17 – Bi-partisan legislation introduced by Senators Portman (R-OH) and Whitehouse (D-RI); The Comprehensive Addiction & Recovery Act of 2014 • $80 million to states and local governments • Well-documented stats used as rationale for this legislation included:

43. More Americans die every day from drug overdoses than from car accidents – an average of 110 people per day, according to the Centers for Disease Control & Prevention • 22.7 million Americans needed treatment for a SUD in 2013 but only 2.5 million received it

44. Death rate from heroin overdoses doubled from 2010 to 2012 per the CDC (cheaper, easier to access, more potent than painkillers) • The Northeast saw the largest increase in heroin deaths, followed by the South

45. What would the legislation do? • Expand prevention and education efforts to prevent abuse of opioids and heroin and promote treatment & recovery; • Expand availability of Naloxone; • Expand resources to identify & treat those incarcerated with addiction disorders; • Expand disposal sites for unwanted prescription medications;

46. Launch an evidence-based opioid and heroin treatment and intervention program via training & resources to expand treatment best practices; • Strengthen prescription drug monitoring programs

47. More Legislation • The Expanding Opportunities for Recovery Act introduced in August 2014 by Congressmen Foster (D-IL) and Maloney (D-NY) • To increase low-income and uninsured patients’ access to inpatient rehabilitation services for heroin and other opioid abuse • Up to 60 days of treatment - evidence-based, clinically appropriate and may include MAT • States apply for the funding through SAMHSA

48. What else in DC about addiction? • Language shift needs to occur to stop the stigma • Stop the negative & blaming language such as addicts, abusers, etc. • Instead use “people with substance use disorders”

49. Other Federal Partners

50. DOT (Transportation) • Assessment and referral required for DOT employees for violation of drug and alcohol regulations