Re: Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014
Strategic Initiative #4: Military Families

Therapeutic Communities of America (TCA) is pleased to have the opportunity to submit comments to SAMHSA on the “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014” document. It is our hope that our comments will inform the discussion at SAMHSA and across agencies at the Department of Health and Human Services, as well as at other federal departments and agencies, and result in positive outcomes for people in and/or seeking recovery.

Therapeutic Communities of America (TCA) was founded in 1975 as a non-profit membership association for therapeutic communities across the United States and Canada. Since then TCA has grown to a consortium of over 650 substance abuse and mental health treatment programs run by 51 non- profit agencies located in 32 states, Washington DC, Puerto Rico, Guam, Virgin Islands, and Canada. The therapeutic methodology of treatment was established in the 1950’s addressing the entire social, psychological, cognitive, and behavioral factors in combating drug and alcohol abuse. TCA member agencies provide services to clients with a diversity of special needs as well as a continuum of care including such services as assessment, detoxification, ER triage, community residential care, in-prison programs, case management, outpatient, family therapy, transitional housing, education, vocational, primary medical services and continuing care. Therapeutic Communities have been leaders, creating innovations in addiction treatment including but not limited to services to addicted women and their children, individuals with co-occurring disorders and clients of the criminal justice system.

TCA commends SAMHSA for conducting this strategic planning process which will guide it as it seeks to fulfill its mission of reducing the impact that substance abuse and mental illness have on America’s communities. As you proceed with this endeavor, TCA respectfully requests that you consider our specific comments and recommendations on Strategic Initiative #3, Military Families.

TCA believes that SAMHSA has accurately identified key challenges that face policymakers who wish to address the significant unfulfilled needs of military servicemen and servicewomen as well as veterans who should be receiving substance abuse and mental health treatment services. As discussed on p.43 of “Leading Change,” TCA agrees that there are many barriers, including stigma, which deter servicemen and servicewomen and veterans for seeking the services for which they are eligible. Instead, these populations often seek care in communities across this country, particularly from local and/or private behavioral health care systems when they are able to access such services at all.

Therapeutic communities traditionally have provided mental health and addiction treatment to disadvantaged Americans with multiple barriers to recovery, including veterans. Our returning veterans from Iraq and Afghanistan who have or are at-risk for substance use and co-occurring mental disease disorders constitute a special population that will need treatment that has been modified from traditional modalities of care. Traditional methods of confrontation for addiction do not always work, especially with women who may have other trauma issues including sexual abuse. Our returning discharged military will need a continuum of care, including co-occurring treatment for Post Traumatic Stress Disorder and will need to be welcomed to a nurturing and safe environment. The buddy camaraderie of a military unit needs to be translated into services located in their home community.

As per SAMHSA, among the fundamental expectations that underlie the work plan for the Military Families Strategic Initiative is that, when appropriate, military families should have access to well-prepared civilian service systems. In light of this, TCA believes that SAMHSA must lead efforts coordinate with the Secretary of the Veterans Administration, the Secretary of HHS, and the Secretary of Defense to develop model programs that coordinate military, Veteran Affairs, and public health systems of care for substance abuse and/or co-occurring mental health disorders for returning veterans and their families. Ideally, this could be implemented through demonstration grants that would support the following:

1. Regional and State case management systems that broker and coordinate private, public, and non-profit resources for substance abuse prevention and treatment for returning veterans and their families.
2. Coordinated programs for women veterans and/or for children of returning veterans specific to substance abuse and co-occurring illness.
3. Coordinated programs for the purposes of developing early intervention, outreach and treatment to veterans at risk in their communities for substance abuse for veterans that do not use or not eligible VA services.
4. Research and evaluation of demonstration grants for both coordination of resources and clinical outcomes.

Please call Dr. Sushma Taylor, President of TCA at the TCA National Office at 202-296-3503, if you need additional information or comments. Thank you again for the opportunity to provide feedback. TCA looks forward to working with SAMHSA to fulfill all the needs of our servicemen, servicewomen, and veterans who have served our country with such distinction.

Sincerely,

Dr. Sushma Taylor
President
Therapeutic Communities of America