Department of Health and Human Services
	Research, Demonstration, and Evaluation Activities FY 2003 Plan and Budget February 2002

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RESEARCH AND DEMONSTRATIONS

(by HHS Strategic Plan Objective)

REDUCE THE ABUSE AND ILLICIT USE OF DRUGS (OBJECTIVE 1.5)

FY 2003 Priorities

HEALTH SERVICES RESEARCH (NIH)

Research: In FY 2003, NIH funds will be used to support programs that expand existing knowledge of drug abuse treatment and prevention and translate this knowledge into practice through the provision of proven, effective, and cost-effective services for drug abusers. FY 2003 priorities include:

The National Institute on Drug Abuse (NIDA) will support research on:

• improving the effectiveness and efficacy of drug abuse treatment and prevention interventions.
• examining different models of managed care and their effects on access to services, quality of care, and treatment outcomes.
• decision and management processes in adopting new business and therapeutic processes (i.e., new technology and treatments) and practices.
• looking at contextual and environmental factors that affect the quality, availability, or utilization of drug abuse treatment and prevention services.

NIDA research also will examine what services are needed for a given problem set or specific population, and how these needs can best be met. The priorities in this area are:

• studies on integrating drug abuse treatment with mental health and primary care systems.
• studies of treatment for criminal justice-involved drug users, which integrate drug abuse treatment with legal oversight and sanctions.
• studies about the different patterns of use of services by various populations (adolescents, minorities, women, homeless, mentally ill, HIV-infected drug abusers), and research to improve drug abuse treatment and prevention services for these special populations.
• studies that measure the prevalence of drug use and the extent of co-existing drug abuse and mental disorders, and determine variations in rates among various subpopulations.
• research on health disparities resulting from challenges of access, utilization, or effectiveness of prevention or treatment interventions.

Since cost is a fundamental issue in the field of health services, NIDA will support research on:

• the cost-effectiveness and cost benefits of drug abuse treatment and prevention services.
• alternative payment systems, public and private financing systems, and the design of insurance.
• the development of an economic methodology for estimating the costs of drug abuse and drug treatment and for valuing the benefits of various intervention strategies.

NIDA will continue to support research on effective drug abuse prevention and interventions, including:

• developing strategies that communities can use to better determine their own local needs and readiness for intervention.
• examining the organization, management, financing, and delivery of prevention services.
• assessing the impact of provider characteristics on service delivery and outcomes.
• examining approaches for matching patients to providers and to institutional settings and assessing the impact of matching on outcomes.
• examining how to determine the type and intensity of services necessary for substance abuse treatment.

SUBSTANCE ABUSE PREVENTION (SAMHSA)

Research: The Center for Substance Abuse Prevention (CSAP) program will continue to support the development and dissemination of knowledge toward curbing alcohol and drug abuse and bring about effective prevention programs to every community. Priorities include:

• supporting the development of new practice knowledge for the prevention of substance abuse in diverse populations in real life environments. Special focus areas will be on “ecstacy” use among students, steroid use among young males, and underage alcohol use to determine what prevention efforts work, for whom, and under what circumstances.
• identify effective, science-based models, and disseminate science-based intervention information in areas such as fetal alcohol syndrom, early childhood substance abuse prevention interventions, and programs focused on prevention in high risk youths.
• identify best practices in 20 new model substance abuse prevention programs.
• developing and applying new knowledge to support “Targeted Capacity Expansion” projects, which also address alcohol abuse.

Evaluation:

• SAMHSA will conduct a cross-site evaluation of the State Incentive Grant program to determine whether it has had an impact on youth substance abuse, and how SIG States differ in their impact on youth substance abuse. (This evaluation also contributes to objectives 1.1 and 1.4.) This evaluation will also examine the impact on reducing drugs and other substance abuse, whether States attained the SIG Program’s two main goals of coordinated funding streams and revitalized comprehensive prevention stratSAMHSA will conduct a cross-site evaluatio
• The Methamphetamine Treatment Program (MTP) is an ongoing assessment and multi- site investigation addressing the treatment needs of methamphetamine abusers, and strategies to integrate research into the real world of drug abuse treatment. An evaluation will assess the long-term outcome and functioning of individuals who previously participated in treatment for methamphetamine dependence. Economic Analysis will evaluate the cost effectiveness of both the Matrix and Treatment-as-Usual treatment conditions.The Methamphetamine Treatment Program (MTP) is an ongoing assessment and multi- site investigation addressing the treatment needs of methamphetamine abusers, and strategies to integrate research into the real world of drug abuse treatment. An evaluation will assess the long-term outcome and functioning of individuals who previously participated in treatment for methamphetamine dependence. Economic Analysis will eval
• Conduct evaluation of SAMHSA’s crosscut programs such as the Addiction Technology Transfer Centers and the Centers for the Application of Prevention Technologies.
• Monitor Performance in refining Government Performance and Results Act performance measures and formats for reporting progress. For example, we will conduct an evaluation to identify which measures are most appropriate for use in Performance Based Budgeting for application in the next budget cycle, and will assess the effectiveness of SAMHSA’s performance measures for Congressional Black Caucus programs and other HIV-related activities.
• Evaluate major administrative and management processes to ensure optimal effectiveness and efficiency in accomplishing the Agency mission of reducing drug abuse. For example, (1) continue to conduct evaluation on grants review to develop information for implementing improvements, and (2) conduct an overall assessment of the results of SAMHSA's Knowledge Development and Knowledge Application programs initiated from FY 1993 through FY 1998, and identify the implications of these findings for future research activity.

SUBSTANCE ABUSE TREATMENT (SAMHSA)

Research: The Center for Substance Abuse Treatment (CSAT) is prioritizing the design and testing of innovative treatment approaches for those diagnosed with the most severe drug addition. Priorities include:

• understanding ways to close the substance abuse “treatment gap” through services targeted for diverse communities, to help implement the President’s Initiative to Close the Treatment Gap.
• developing knowledge of addiction that is sensitive and responsive to the cultural and treatment needs of population groups across the United States.
• developing knowledge of substance abuse treatment services for children and adolescents.
• developing and disseminating best practices, such as those found in “integrative” Adolescent Treatment Models and Comprehensive Community Treatment programs, tailored to the developmental and social needs of adolescents.
• examining questions of appropriateness of treatment, feasability, cost-effectiveness, and quality in the delivery of drug treatment service programs for a variety of populations.

Evaluation: More than 38 Treatment Improvement Protocols (TIPs) have been distributed to the public since 1993. The purpose of TIPs is to transfer protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, evaluation, and administrative experts to the nation's AOD treatment field. The overall objective of proposed evaluation work is to learn the impact of TIPs on the substance abuse treatment field. Evaluation priorities include:

• assessing the extent to which target audiences realize, read, and implement TIPs.
• learning ways to strengthen the development, formatting, marketing, dissemination, use, and evaluation of TIPs to ensure effective use of future Federal resources devoted to TIPs.
• The National Treatment Improvement Evaluation Study (NTIES) will explore how drug and alcohol abuse treatment outcomes are affected by different amounts and components of treatment. Evaluating current treatment practices is fundamentally important to improving treatment in the future. We will examine the relationships among treatment components, client-level factors, and treatment outcomes and how these relationships vary by treatment modality. (This evaluation work also contributes to objectives 1.1 and 1.5.)
• The Center for Substance Abuse Treatment (CSAT) and other federal agencies are developing a regulatory framework for opioid substitution therapy that will change the current regulatory system for monitoring opioid treatment programs (OTPs) to an accreditation/regulatory approach. Over a five year period, CSAT will conduct and evaluate a phase-in program to obtain information that will aid in the full implementation of the new system. The evaluation will provide information to guide the national implementaThe Center for Substance Abuse Treatment (CSAT) and other federal agencies are developing a regulatory framework for opioid substitution therapy that will change the current regulatory system for monitoring
• Persistent Effects of Treatment Studies (PETS) The purpose of PETS is to evaluate the long-term effectiveness (up to thirty-six months) of substance abuse treatment services provided through a series of CSAT grants and cooperative agreements, and to conduct a number of special studies and policy analyses that address specific drugs subject to abuse, methods of treatment, populations, or policy issues. The primary follow-up studies will involve obtaining information at selected follow-up periods for personsPersistent Effects of Treatment Studies (PETS) The purpose of PETS is to evaluate the long-term effectiveness (up to thirty
• State Substance Abuse Managed Care Evaluation Program The State Substance Abuse Managed Care Evaluation Project will evaluate the effects of managed care on substance abuse services in five States. Each of these five State studies will inform future behavioral health care policy.