Access to Recovery

Access to Recovery (ATR) was announced by President George W. Bush in the 2003 State of the Union address as a 3-year, $600-million program intended to expand the array of addiction and recovery services available to individuals with alcohol and other drug problems. The initiative, as originally described by President Bush, was intended to provide 100,000 people annually with access to a comprehensive continuum of treatment and recovery support services. ATR marked the first large-scale federal effort to implement a treatment and recovery support services voucher program. It is notable for the role it has played in supporting the development of recovery support services and in expanding the role of faith-based organizations in treatment and recovery systems. ATR is also notable for including peer-led recovery support services as a key component of service continua.

Through the use of vouchers, ATR has provided an indirect funding mechanism that eliminates many obstacles to reimbursing services provided by faith-based and other small, community-based organizations, many of which might not otherwise have access to government funding. A key goal of ATR has been to expand the array of services made available to individuals seeking help for alcohol and drug problems and thereby to increase choice. Under ATR, recovery support services, that is, nonclinical services that assist individuals in initiating and sustaining recovery, have been emphasized as critical service system components.

ATR required grantees to adopt a standard assessment for services provided under the grant, a system for issuing vouchers that can be redeemed for services at eligible providers, and a mechanism for ensuring that individuals served can choose from among different types of services and provider organizations to meet their needs. Vouchers are intended [Page 8]to support client choice under ATR by making available a broader array of service options than would have been available without the program and by providing a mechanism to ensure that funding follows the individual over time rather than flowing directly to programs through grants or contracts. Vouchers also provide a mechanism for quickly expanding and diversifying a service continuum and, potentially, for allowing service capacity to be more responsive to demand than may be the case under grant or contract-funded addictions treatment systems. A wide variety of recovery support services have been available under ATR programs, ranging from transportation, housing assistance, vocational, employment, educational, and child care services to recovery coaching, peer mentoring, and spiritual support. Faith-based and peer-operated services have played a significant role in ATR. Direct funding of providers by contract, grant, or other mechanism has not been permitted under the program.

In 2004, Congress funded ATR at approximately $100 million per year for 3 years, or half of what President Bush had requested in the 2003 State of the Union Address. ATR was implemented through competitive grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services to states and tribal organizations. SAMHSA awarded grants of up to $7.6 million annually for 3 years to 14 states and one tribal organization: California, California Rural Indian Health Board, Connecticut, Florida, Idaho, Illinois, Louisiana, Mississippi, New Jersey, New Mexico, Tennessee, Texas, Washington, Wisconsin, and Wyoming.

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