Current SAMHSA priorities include expanding access to MAT and reducing stigma, integrating opioid use disorder treatment with primary care, addressing racial disparities in treatment services, and more.
Tom Coderre is the first person in active recovery to hold the position of Acting Assistant Secretary for Mental Health and Substance Abuse at the Substance Abuse and Mental Health Services Agency (SAMHSA). Prior to this appointment, Tom was Senior Advisor to Rhode Island Governor Gina Raimondo from 2016-2019, where he helped to coordinate the state’s response to the opioid crisis. During the Obama administration, Tom led the team which produced “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” the first report from a U.S. Surgeon General dedicated to this public health crisis. And as the former National Field Director of Faces & Voices of Recovery, he was a key voice in “The Anonymous People” documentary and helped increase peer support services nationwide. The Fix is honored to have the opportunity to speak with him.
The Fix: You are the first person in recovery from substance use disorder to lead SAMHSA. How is this significant? Do you think being in recovery will help you accomplish more?
Tom Coderre: That’s a great question, John, but it’s important to point out that I am the acting assistant secretary for mental health and substance use. I am serving in an interim capacity until the Senate confirms Dr. Miriam Delphin-Rittmon. She was nominated by President Biden last week. I’ll serve until the U.S. Senate confirms her. I am currently leading SAMHSA, but I’m not going to be leading it too much more into the future. At the same time, I’ll continue to be a part of our leadership team here at the agency.
Still, my acting appointment is significant because I count SAMHSA as partially responsible for me getting into recovery. SAMHSA block grant dollars funded the treatment that I received. Moreover, the recovery support services that I received post-treatment were funded by a SAMHSA discretionary grant program, the Recovery Community Services Program (RCSP). My experience speaks volumes about how the agency helps people.
As the acting assistant secretary, being in recovery is the lens from which I view the world. I don’t know if it has helped me accomplish more or will help me moving forward, but it certainly has given me that lens of lived experience to bring to any policy conversation when we are talking about ways we can help more people find sustainable recovery.
Has it been difficult to prioritize prevention, treatment, and recovery services for substance use disorder during the COVID-19 pandemic?
To begin with, the Biden-Harris Administration obviously is remaining focused on the COVID-19 pandemic. At the same time, it also has prioritized the expansion of evidence-based treatment to get people with substance use disorders the help they need. Already, SAMHSA has received significant increases in funding from Congress and from the President to help address our country’s mental health and addiction crisis.
As you know, John, it has only gotten worse during the pandemic. The latest CDC data points to ninety thousand overdose deaths in the twelve-month period that ended last September. It’s the largest increase on record, and that is why SAMHSA has been getting resources to the states and the people who need it the most. In addition to the state block grants, we have awarded a total of almost 700 million dollars to certified community health clinics (CCHPs) across the nation. We just gave a series of COVID Emergency Grants to address mental health disorders that arose during the pandemic. We have even made supplements to those grants with the new American Rescue Plan money.
In terms of innovations, early on in the pandemic, we began the mission of expanding the regulatory definition of telehealth to help ensure that people who need medication-based treatment would access that critical support during the pandemic. We also provided free technical assistance and training for physicians who were unfamiliar with the use of telehealth. Out of necessity, telehealth has blown up during the pandemic, and we wanted to ensure that it was both accessible and well-executed. The free virtual trainings we provided were well-attended, and the response was positive. We knew that we could not focus only on COVID-19 because the parallel track of spikes in mental illness and substance use disorders could not be ignored. We had to ensure that people in crisis could access real help.
Post-pandemic, what do you think will be the biggest challenges facing SAMHSA?
That’s another really good question that we have been discussing at the agency. We know that multiple stressors during the pandemic like isolation, sickness, grief, job loss, food instability, loss of routines, and so many more have been devastating for many Americans. It has led to a series of unprecedented challenges for health providers across the nation.
For example, the CDC also reported that American adults in June of 2020 reported elevated levels of adverse mental health conditions, including symptoms of anxiety and depression that were three to four times the levels of those reported in 2019. Going forward, this is a big challenge for us. Traditionally, SAMHSA’s Disaster Distress Help Line has been a low-volume hotline compared to our others that we operate like the National Suicide Prevention Lifeline. However, the call volume on the disaster distress hotline has increased significantly as people have become more aware of its services. We saw a 440% increase in the twelve months from March 2020 to February 2021. It tells us that people are reaching out and seeking help.
One of the obstacles during the pandemic has been barriers to accessing services and the treatment that these people need. The challenge is that even people with mild or moderate symptoms who are looking for help cannot access it. They are unable to connect with a community mental health center or a treatment center. In response, SAMHSA is promoting the Disaster Distress Help Line and other similar resources because we want to know who needs help and where they are located. We want to be able to support them in the process of knowing where to go to get help.
Another challenge to note is workforce readiness. Are people ready to make the full transition back to work? Mental health professionals have seen a significant increase in people seeking appointments to work past negative public attitudes. We need more trained professionals to help those folks successfully make that transition.
President Biden recently dedicated $2.5 billion to prevention and treatment efforts. How do you see the pie chart of those funds being divided up?
In the bill that Congress passed and the President signed, those resources are pretty prescriptive. SAMHSA does not really get to decide how to split them up. We have been directed to send that money to states and to territories and tribes. They have the flexibility to address those funds to address those various needs. The $2.5 billion in additional money that went to the different block grants for substance use disorder and mental health and those block grants allows states, territories, and tribes to tailor those grants to address the specific needs that they have identified.
As part of the COVID Relief Package, we got $4.25 billion in December and an additional $3.56 billion in March as part of President Biden’s American Rescue Plan. Beyond the block grants targeted at front-line people on the ground, these new grants also help us expand the building out of the Certified Community Behavioral Health Clinics, which provide all sorts of wraparound services for people in the various communities. Each of the bills also dedicated funds to improve suicide prevention efforts and school-based mental health efforts. Also, the money for the National Child Traumatic Stress Initiative is an important step. We are really concerned with what has happened with youth during this pandemic, and we want to make sure they have access to needed resources.
We are extremely grateful to President Biden and Congress for making these resources available. This capital is the largest investment in behavioral health in the history of our country. It’s a big step going from an overall budget of $6 billion to $13.8 billion. Thus, we’ve been tasked with a big, big job to get these funds awarded to states and, most importantly, working in local communities, thus reaching the people in need of this kind of help and support. Thank God for the SAMHSA staff because they have been working tirelessly to make this happen.
In 2018, commenting on the rise in opioid use disorder (OUD) deaths, you told Fox News, “It took too long to get to where we are today. I think there was thought they could do this without declaring a national emergency, but people are dying.” Post-Covid, will we need to declare another national emergency to combat opioid use disorder and resulting overdose deaths?
First of all, did I really say that? It sounds brilliant. Okay, I’m just joking, but I think I was referring to the public health emergency that was being declared at that time. Both SAMHSA and this Administration get the urgency of the current situation. We understand the concept of parity and the importance of delivering care to underserved communities. We understand that all of these statistics related to mental health disorders and substance use are tied to real people with loved ones and families. Suppose you look at the work done under the leadership of the Biden-Harris Administration. In that case, you see that SAMHSA’s funding and efforts are a crucial part of the White House’s tailored response to these challenges, including America’s mental health needs.
An emergency is declared to increase access to funds and speed up the delivery of those funds to people in crisis. It’s precisely what is being done right now by this administration to address the opioid crisis, and the hard work at SAMHSA is making those directives happen. We are taking steps to expand access to evidence-based treatment like MAT [Medication-Assisted Treatment] and reduce the stigma that still exists. For example, we are working to reduce the medical stigma around integrating opioid use disorder treatment with primary care in office settings of doctors across the country. We also know that powerful synthetic opioids like fentanyl in the nation’s drug supply compound the overdose risk for Americans significantly. People with little or no opioid-related tolerance are being given this incredibly potent drug, and they are at a much greater risk of dying as a result from an overdose. This danger is one more reason we are grateful to work with the White House to connect more Americans to the treatment and care they truly need. Indeed, these communities need that support more than ever, and this is why it’s an all-hands-on-deck moment at SAMHSA.
Under the last administration, there was a shift away from community-led, demographically-targeted interventions. Under the new administration, do you think there will be a renewed focus on evidence-based practices that address substance use disorder (SUD) and mental health from a holistic lens, including strategies to address current health disparities among various racial/ethnic groups?
Of course, I do. Both President Biden and Vice President Harris have made diversity, equity, and inclusion a key part of their strategic plan for the nation. At SAMHSA, we have been doing behavioral health equity work for more than a decade. We recognize that there are disparities in treatment services that exist, particularly in Black, Indigenous, and people of color communities. We need to do more to identify those disparities in particular and root them out, do they can be eliminated.
It is not okay to turn a blind eye anymore and expect somebody else to take care of these issues. We are making these efforts a strategic priority, and we are considering steps like disparity impact statements as an ongoing part of our grant programs. Also, although we think globally, we act locally. Although the White House or Xavier Becerra, the first Latino to serve as Secretary of Health and Human Services, can issue the policy, we are responsible for helping to make the change locally through our grant programs.
We need to emphasize this issue regularly through our long-term relationships with states and local communities. Such essential progress in cultural competence and applying it effectively is now a priority on all levels of the federal government. For example, we need to do a lot more recruitment in the workforce at all levels, so the people providing the services look like the people they are serving. From our experience, the best people for helping local communities are people who came out of those communities and know firsthand the nature of the challenges. As you know, I came from the peer movement, and I believe the peer work that is being done around the country is an excellent example of this proposition working in practice.
A perfect exemplification of this work is the success of recovery coaches that walk into emergency rooms. When they sit at the bedside of somebody who has just overdosed, and they can tell that person, “Not that long ago, I was exactly where you are now. I was lying in a bed in this hospital after a drug overdose. I was able to find out, and I am here today as a person in recovery to show you how I did it and how you can do it as well.” It’s so much more likely that such an encounter will lead to a person’s life being saved. We need to recruit a workforce that can walk that journey with people from their communities in need of such help. People who can give them the confidence to take that step, tell them about the pitfalls they’ll encounter along the way, and inspire them to start that journey of recovery.