February 3, 2018
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that it is ending the National Registry of Evidence-Based Programs and Practices (NREPP) and replacing it with an as-yet undefined effort to be administered by SAMHSA’s newly created Policy Lab. We hope that this development will advance our nation’s efforts to prevent and treat substance abuse and mental illness. As behavioral scientists who have been working on these efforts for the past forty years, we highlight below some critical steps that are needed for this change to truly improve Americans’ health.
In her recent statement, Assistant Secretary for Mental Health and Substance Use, Dr. McCance- Katz, focuses on deficiencies in the evidence base of some interventions in the NREPP system and the lack of treatments for those with serious mental illness and addiction. We agree with others who have expressed concerns about the standards of evidence used to select programs for the NREPP registry. As scientists entrenched in this research, we have endorsed higher standards for dissemination of evidence based programs including the Society for Prevention Research’s Standards of Evidence, 2015 [1] and the Blueprints for Healthy Youth Development Standards, also adopted by the 2016 Surgeon General’s Report, Facing Addiction in America: Alcohol, Drugs and Health.[2]
While we understand that the 21st Century Cures Act requires SAMHSA to address treatment of those with serious mental illness, we do hope that this will not mean a de-emphasis of the importance of tested, effective universal, selective, and indicated prevention programs. Health care expenditures are overwhelmingly directed to treating disorders that could have been prevented; far more investments in prevention are needed. Many prevention interventions and policies, when rigorously tested in controlled trials using the above standards, have proven benefit in preventing substance abuse and mental illness. Many of these interventions continue to have benefits years after they are implemented. Most cost less than they save in reduced health care, educational, and criminal justice costs. While treatment will always be needed, prevention significantly reduces the likelihood of developing these serious problems. As the 2009 Institute of Medicine Report on the Prevention of Mental, Emotional, and Behavioral Disorders Among Young People [3] and the Surgeon General’s report cited above show, prevention programs have been demonstrated effective at preventing mental illness and substance abuse. As examples, consider: (i) the efficacy of cognitive therapy in reducing the likelihood of a schizophrenia diagnosis or the need for antipsychotic medication, compared to a minimally treated control group, with benefits maintained for at least three years.[4,5] (ii) A simple, scalable program to increase positive classroom management by teachers among primary grade children that has documented benefit in preventing suicide and opiate misuse7 in adolescence and young adulthood. [6,8,9] (iii) Two additional prevention programs--a parenting program, and a middle school-based program, that have demonstrated independent and important complementary effects on opioid misuse in randomized controlled trials.[10,11] (iv) Finally, approaches to aid communities to choose and implement tested, effective prevention interventions have, in randomized trials, shown community-wide uptake with positive impacts on substance use and delinquent behavior in a cohort of middle school aged youth with preventive effects lasting into young adulthood.[10,12] These examples represent but a few of the prevention strategies proven to alter the progression to serious mental illnesses and addictions.
The integrity of the nation’s efforts to prevent and treat mental, emotional, behavioral, and physical disorders depends on our making use of the enormous amount of behavioral science knowledge generated in the past forty years. As behavioral scientists, practitioners, and community leaders invested in interventions that effectively prevent mental health and substance use disorders, we offer our expertise to SAMHSA as science, practice, and policy advisors. Together, we can shape a healthier America.
Respectfully,
Leslie Leve, Ph.D. President, Society for Prevention Research Professor, College of Education University of Oregon Diana H. Fishbein, Ph.D. President, The National Prevention Science Coalition to Improve Lives Professor, Department of Human Development and Family Studies The Pennsylvania State University
Lisa J. Crockett, Ph.D. President, Society for Research on Adolescence Professor of Psychology University of Lincoln-Nebraska