Existing resources and any new funding to close the treatment gap must be better coordinated to maximize the impact of treatment dollars. Partnerships between the state and federal systems, as well as between state and community agencies should be strengthened by improved coordination that utilizes the unique assets of each system. Stronger collaboration would help identify and fill gaps in services and other resources, as well as boost accountability for publicly funded treatment programs across different funding sources. Indeed, while the degree of the persistent shortfall in substance abuse treatment has been a topic of considerable controversy, there is no doubt that there is a significant gap between the need for drug treatment and the national capacity to deliver it. Any effort to close these gaps will require an inter-agency collaboration that prioritizes expanding treatment capacity to meet the existing demand and clear current waiting lists.

In addition, states need more flexibility in spending federal treatment funds so that they can both provide services to communities and populations that they determine are most in need or most at risk and use the treatment methods most effective for those targeted areas and groups. For example, current statute requires that states spend funds from the Substance Abuse Prevention and Treatment Block Grant program (the main federal treatment funding stream) on certain populations or services that may not match the unique priority needs of a particular state. As a result, the states are engaged in a process with SAMHSA to address the current legislative mandates and to develop performance measures for activities supported through the SAPT Block Grant. This effort, part of the transition into the PPG program, will contribute to the development of the prevention and treatment data necessary to inform efforts to close the treatment gaps.

A second coordination concern involves discretionary grants from various federal agencies that frequently bypass the state AOD agencies, going directly to various treatment programs themselves. There is usually no mechanism in the grant or contract itself that requires notification to the state AOD agency of the award. This hinders or prevents these funds and programs from being considered in state needs assessments, state monitoring data collection, services coordination, and outcomes analysis. In addition, these programs often turn to state agencies for resources when their federal grants expire without giving the state adequate time to plan for the support of such requests. Direct and up-front state agency involvement can prevent the creation of programs that may be redundant, inefficient, disconnected, and often discontinued for lack of funding.

There also is a need for improved coordination among both federal agencies and state agencies that provide supportive services or financial support to individuals in need of substance abuse treatment. Such streamlining and collaboration is critical to ensuring that treatment is delivered effectively and efficiently. A recent example of enhanced coordination federal coordination is the establishment of the Interagency Coordinating Committee on the Prevention of Underage Drinking, which includes representation from several key federal agencies (and relies on the states and other non-federal stakeholders as advisors). To facilitate coordination at the state level, state substance abuse administrators should seek memoranda of understanding (MOUs) or other formal partnerships with their counterparts in state benefits, mental health, physical health, housing, corrections, and other service agencies, in order to promote "no wrong door" access by individuals to needed supports.

Policymakers should focus particular attention on promoting coordination between substance abuse and mental health agencies, given the high rate of co-occurring disorders. ^[1]   Many people suffering mental health problems, such as depression, are unable or unwilling to seek psychological or medical treatment for their illness, and they turn instead to illicit drugs as a way of self-medicating. Addressing the full spectrum of needs of individuals with both substance abuse and mental health disorders is critical to promoting their successful recovery and ability to participate fully in community life.