Division of Behavioral Health Services

Annual Report on Substance Abuse
Treatment Programs
Fiscal Year 2014
Submitted Pursuant to A.R.S. §36-2023

Report Contents
 Program Names and Locations
 Client Demographics
 Program Funding
 Summary of Available Services
 Service Utilization
 Treatment Needs Addressed
 Programmatic Initiatives
 Treatment Outcomes
 Goals for the Current Fiscal
Year

Report Highlights
 92.5% of treatment recipients
were adults
 42.0% of treatment recipients
were located within Maricopa
County
 10.5% of treatment recipients
were referred to treatment by
the criminal justice system
 31.2% of all treatment recipients
cited alcohol as their primary
substance type; however, Marijuana was the primary substance abused by 78.5% of children/adolescents in treatment
 31.2% of treatment recipients
had a co-occurring Serious
Mental Illness

December 31, 2014

Introduc on
The Arizona Department of Health Services, Division of Behavioral
Health Services (ADHS/DBHS) has conducted an assessment of its
substance abuse treatment programs in accordance with the requisites
outlined in Arizona Revised Statutes (A.R.S) §36-2023(C)(6). This report includes information related to service types and geographic locations, funding sources and expenditures, numbers of clients served
with their corresponding demographic information, substance use patterns and encounters for utilized services. A review of treatment outcomes, including changes in employment, educational participation,
criminal activity, homelessness, and substance use is also included,
along with programmatic goals for the current fiscal year.

Name and Loca on of Each Program
ADHS/DBHS serves as the Single State Authority on substance
abuse, providing oversight, coordination, planning, administration, regulation and monitoring of all facets of the public behavioral health system in Arizona.
Four Regional Behavioral Health Authorities (RBHAs), and three Tribal
Regional Behavioral Health Authorities (TRBHAs), are contracted to
operate as managed care organizations in six distinct geographic service
areas
(GSAs)
throughout the State (see
map).
The T/RBHAs are required to maintain a comprehensive network of
behavioral health providers to deliver prevention,
intervention,
treatment
and rehabilitative services to individuals enrolled in the public behavioral health system.
This structure allows
communities to provide
services in a manner appropriate to meet the
unique needs of individuals and families residing
within their local areas.

Arizona Department of Health Services
Division of Behavioral Health Services
150 N 18th Avenue, Suite 200
Phoenix, AZ 85007

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Enrollment and Demographics
Table 1: FY 2014 Enrollment Distribution
Tribal / Regional Behavioral Health Authority
(Geographic Service Area)

Counties

No. of Enrolled
Substance Abuse
Clients

Percentage of Statewide
Substance Abuse
Population

Apache
Coconino
Mohave
Navajo
Yavapai

Northern Arizona Regional Behavioral Health Authority
(NARBHA - GSA 1)

11,715

18.5%

La Paz
Yuma

Cenpatico Behavioral Health of Arizona (GSA 2)

2,712

4.3%

Cochise
Graham
Greenlee
Santa Cruz

Cenpatico Behavioral Health of Arizona (GSA 3)

1,767

2.8%

Gila
Pinal

Cenpatico Behavioral Health of Arizona (GSA 4)

3,806

6.0%

Pima

Community Partnership of Southern Arizona
(CPSA - GSA 5)

15,246

24.0%

26,659

42.0%

TRBHA: Gila River Indian Community

606

1.0%

TRBHA: Pascua Yaqui Tribe

413

0.7%

TRBHA: White Mountain Apache Tribe of Arizona

101

0.2%

IGA: Navajo Nation

427

0.7%

Maricopa

Magellan of Arizona (GSA 6, July 1, 2013 - May 31, 2014)
Mercy Maricopa Integrated Care (GSA 6, April 1 - June 30, 2014)

Enrollment

Gender

Division policy requires that all behavioral health
clients undergo a clinical assessment, administered by a clinician at the provider level. Among the
information gathered during this process are several identifiable factors, such as date of birth, race
and ethnicity, gender, financial status and reasons
for seeking treatment. The following paragraphs
present this information for those clients with a
Substance Use Disorder (SUD) enrolled in Arizona’s behavioral health system during Fiscal Year
2014 (FY 2014).

The overall behavioral health population is divided
nearly evenly between males and females; however, the substance abuse population is comprised of
more men than women—53.3 percent versus 46.7
percent, respectively.
Financial Status

ADHS/DBHS is responsible for providing treatment
and rehabilitation services to those individuals who
qualify for Title XIX or Title XXI benefits—these
consumers are often referred to as being
“AHCCCS eligible” because their services are
In FY 2014, there were 63,452 consumers enrolled funded through the Arizona Health Care Cost Conin Arizona’s public behavioral health system for tainment System (AHCCCS); the State’s Medicaid
substance abuse treatment. Of enrollees, 42 per- Authority. In FY 2014, 77.8 percent of enrolled subcent were enrolled in GSA 6 (Maricopa County).
stance abuse treatment members were eligible for
AHCCCS.
Table 1 shows enrollment counts throughout the
State’s various geographic service areas. Please Age
note, on April 1st, 2014, there was a transition in
Regional Behavioral Health Authority (RBHA) for Aggregate review of client age data indicates the
GSA 6 from Magellan to Mercy Maricopa Integrat- vast majority of individuals who enrolled for substance abuse treatment in FY 2014 were adults,
ed Care (MMIC).
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with those between the ages of 26
and 45 accounting for 46.7 percent
of all members, and the median age
for this group was 36.3 years. Approximately 6.6 percent of substance
abuse clients were under the age of
18.
Race and Ethnicity

Substance Abuse
SERVED Member
Demographics
(n=49,239)

the system, while 12.1 percent of
individuals enrolled after involvement
with the criminal justice system .

Gender

Behavioral Health Category

Male:

51.9%

Co-occurring mental health issues
such as depression, anxiety and psychotic disorders are commonly noted
with substance abuse. In FY 2014,
22.1 percent of substance abuse
clients had a co-occurring General
Mental Health Disorder (GMH), while
31.2 percent also had a Serious
Mental Illness (SMI), in addition to a
substance use disorder.
_____________________________

Female:

48.1%

The majority (83.8 percent) of persons who were enrolled for substance abuse treatment services in
FY 2014 were White, 6.7 percent
were African American, and 7.3 percent were American Indian., followed
by 1.3 percent whom were of multirace backgrounds, and 0.8 percent
whom were Asian or Pacific Islander. Served Demographics
Statewide, 25.8 percent of participants identified themselves as His- Demographics of enrolled and depanic/Latino.
mographics of those served were
very similar; in most cases, there
was a less than one percent differReferral Source
ence. For example, approximately 93
Substance abuse members enter the percent of those enrolled for subbehavioral health system through a stance abuse were adults, aged 18
variety of means and ADHS/DBHS and over, and 92.5 percent of those
works with the T/RBHAs to reduce who were served were adults, aged
barriers and promote efficient access 18 and over.
to care. In FY 2014, 52.6 percent of
all substance abuse members were Please see sidebar (to the right) for
self-referrals, meaning they decided demographic details of members
to enroll on their own, or upon the who received substance abuse treatrecommendation of friends or family. ment services in the Arizona behavExternal behavioral health providers ioral health system for FY 2014.
referred 13.1 percent of members to
Figure 1— FY 2014 Substance Abuse Treatment Age Distribution

Financial Eligibility
Title XIX/XXI
Non-Title XIX/XXI

84.5%
15.5%

Age Distribution
Birth - 5:
6-12
13-17
18-21
22-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
65+
Median Age

0.0%
0.1%
7.4%
6.7%
8.7%
13.3%
12.9%
10.0%
10.1%
9.6%
10.1%
6.7%
2.8%
1.6%
36.4

Race and Ethnicity
American Indian:
Asian or Pacific
Islander:
African American:
White:
Multiracial:

5.0%

6.9%
83.1%
1.3%

Hispanic:

26.5%

0.8%

Referral Source
Self Referred:
Other Providers:
Other:
Criminal Justice:
Dept. of Econ. Sec.:
AHCCCS/PCP:

53.3%
13.6%
12.0%
10.5%
3.2%
2.8%

Community Agency:

1.9%

Federal Agency:
Child Prot. Serv.:
RBHA:
Dept. of Education:

0.7%
0.7%
0.7%
0.4%

Behavioral Health
Category
Adult—Sub. Abuse
Adult—SMI
Adult—GMH
Child/Adolescent
3

39.1%
31.2%
22.1%
7.5%

Program Funding
Table 2—Substance Abuse Treatment Funding Summary—FY 2014
Fund Source

Dollar Amount

Medicaid Funding (Title XIX & Proposition 204)

Percentage

$97,731,218

76.20%

$19,258,066

15.02%

State Appropriated

$9,499,288

7.41%

Intergovernmental Agreements: Maricopa County; City of Phoenix Local
Alcohol Reception Center (LARC)

$1,689,871

1.32%

$71,775

0.06%

$128,250,218

100.00%

Federal: Substance Abuse Prevention and Treatment Block Grant (SAPT)

Liquor Fees

Total Funding:

During fiscal year 2014, ADHS/DBHS expended $128,250,218 in service funding for individuals and
families with substance abuse disorders. The single largest source of substance abuse treatment funding (76.20%) was Medicaid (TXIX & Proposition 204) as reflected in Table 2, followed by the Federal
Substance Abuse Block Grant (SABG) (15.02%) (non-prevention monies). Additional funding included
State appropriated monies, funds from Maricopa County for local detoxification services, the City of
Phoenix IGA, and Liquor Services Fees.

Available Services
ADHS/DBHS maintains a comprehensive service delivery network providing primary prevention, treatment and rehabilitation programs to Children and Adolescents, as well as Adults with General Mental
Health Disorders (GMH), Serious Mental Illnesses (SMI) and/or Substance Use Disorders (SA/SUD).
With respect to substance abuse treatment, ADHS/DBHS works diligently with its contractors to ensure
the service delivery network presents individuals with a choice of multiple, highly-qualified providers,
each offering varying levels of care spanning multiple treatment modalities.
Generally speaking, services can be grouped into seven categories: Crisis, Support, Inpatient, Outpatient, Medical/Pharmacy, Residential and Rehabilitation. Table 4 (below) details the complete array of
substance abuse services offered.
Table 3: Service Array
Service Category

Description

Treatment Services

Individual and group counseling, therapy, assessment, evaluation, screening, and other professional
services.

Rehabilitation Services

Living skills training, cognitive rehabilitation, health promotion, and ongoing support to maintain employment.

Medical and Pharmacy

Medications which relieve symptoms of addiction and/or promote or enhance recovery from addiction

Support Services

Case management, self-help/peer support services and transportation.

Crisis Intervention

Stabilization services provided in the community, hospitals and residential treatment facilities.

Inpatient Services

Inpatient detoxification and treatment services delivered in hospitals and sub-acute facilities, including
Level I residential treatment centers that provide 24-hour supervision, an intensive treatment program,
and on-site medical services.

Residential Services

Residential treatment with 24-hour supervision in Level II and III Facilities.

Behavioral Health Day
Programs

Skills training and ongoing support to improve the individual’s ability to function within the community.
Specialized outpatient substance abuse programs provided to a person, group of persons and/or families in a variety of settings.
4

Treatment Needs Addressed by the Programs
Alcohol remained the most common substance used by those in treatment in FY 2014; 31.2 percent of
all members cited it as their primary substance, almost a 4 percent decrease from FY 2013. As in past
years, patterns in substance preference differed greatly between children/adolescents and adults.

Table 4 - Primary Substance Type by Group
Substance Type

Child

Adults

All Clients

Alcohol

13.8%

32.6%

31.2%

Marijuana

78.5%

20.8%

25.2%

Narcotics

2.0%

20.1%

18.7%

Stimulants

3.2%

21.9%

20.5%

Other Substances

2.3%

2.9%

2.8%

This disparity between child/adolescents and adults is apparent when comparing substance preference by age group (see Figure 2). Marijuana was more commonly reported by children, adolescents
and adults under age 25; alcohol continues to be more prevalent amongst adults over age 25.
Figure 2—Primary Substance Type by Age Band—FY 2014

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Programmatic Initiatives for Specific Populations
In the following paragraphs, are highlights of programmatic initiatives in FY 2014 that focused on
specific substance abuse populations:

Youth
The behavioral health system has been working to
promote youth substance abuse prevention
through stakeholder meetings, school and community-based trainings, public service announcements, media campaigns, and youth leadership
programs. Provider treatment trainings have included components on how to screen for substance
abuse in the adolescent population and the application of effective substance abuse treatment such
as ACRA and other evidence-based practices targeting the adolescent population.

Pregnant and Parenting Women
Collaborations include the following: creating a protocol for pregnant females using drugs intravenously in order to ensure medically assisted treatment medications are appropriately prescribed for
this population and collaboration with Arizona’s
Family First Program to provide substance use
treatment services to parents who have involvement with the Department of Child Safety (DCS)
due to abuse of substances. In addition, the Women’s Services Network who are currently developing tools for outreach to women in the community,
and a Women’s Services Directory was developed
this last year that lists all treatment providers with
treatment services and programs that are gender
specific to women in Maricopa County.

Military, Veterans and Their Families
Our RBHAs are engaging members of the military,
veterans and their families in a number of ways;
including collaboration with Arizona Coalition for
Military and their Families in Resource Navigator
training. Additionally, Rally Point Tucson, staffed by
experienced veterans, continues to help veterans
and their families in Pima County navigate and access various resources. Providers throughout the
state have been engaged in multiple trainings that
are specific to the needs of service members, such
as Mental Health First Aid for Military, Veterans
and Their Families, Trauma Informed Care, PTSD,
Traumatic Brain injury and employment assistance.

Older Adults
RBHAs continue to work with councils, providers,
and community agencies to make appropriate referrals and monitor substance use diagnoses
among the older adult population. Additionally,
DBHS is continuing to expand the use of SBIRT in
order to reach older adults with substance use disorders who are receiving medical care.
Additionally, DBHS manages a number of grants
that directly support the utilization of substance
abuse treatment services (see Table 6 below).
Table 5: Grants Supporting Substance Abuse Efforts
Grant

Primary Goal

Substance Abuse

Prevention and Treatment Block Grant
(SABG)


To reduce access barriers to substance abuse prevention and treatment services, as
well as community-based mental health services for adults with serious mental illnesses
and for children with serious emotional disturbances
To plan, implement, monitor and evaluate the provision of these services

Projects for Assistance in Transition
from Homelessness



Reduce and eliminate homelessness for individuals with SMI or co-occurring substance
abuse disorders

Screening, Brief,

Intervention, and
Referral to Treatment 
(SBIRT)

Reduce rate of alcohol-induced deaths and drug related deaths per 100,000 individuals
for five northern Arizona counties
Decrease the mean combined cost per member for physical healthcare and behavioral
healthcare services

State Youth Treatment Grant




Prevention Framework Partnership for
Success (PFS)




Successfully transition adolescents and transitional-aged youth with SUDs and those
with co-occurring mental health conditions to the adult behavioral health system
Improve the use of evidence-based practices in services for adolescents with substance
use and co-occurring mental disorders and their families
Reduce 30-day alcohol use for youth and college-aged young adults ages 12 to 20
Reduce the percentage of youth ages 12 to 25 who have misused or abused prescription drugs in the last 30 days
6

Treatment Outcomes and System Performance
Table 6— Outcomes Dashboard
How has participating in the behavioral health
system impacted the lives of our clients?

Outcomes
Our Substance Abuse Clients:

Percent
42.5%

Change
+22.9%

Participate in Self-Help Programs During Treatment

1.1%

+134.8%

Are Not Homeless

93.5%

+1.1%

Are Competitively Employed Full or Part-Time

34.7%

+7.6%

Have No Recent Involvement with the Criminal Justice System

80.8%

+5.1%

Show Reduced or No Substance Use

The Division employs a variety of mechanisms to
measure the effectiveness of treatment; including
assessing the change in numerous functional outcome indicators for persons receiving behavioral
health services. The Substance Abuse and Mental
Health Services Administration (SAMHSA) has established a set of National Outcome Measures
(NOMs) to capture an individual’s improvement in
the areas of employment, educational participation,
abstinence from alcohol or other drugs, criminal
activity and homelessness.
Table 6, above, shows the most recent status and
corresponding change in each of the outcome domains for those receiving treatment for a substance
use disorder. For example, employment for this
population increased by 7.6 percent while the number of clients reducing or abstaining from alcohol

and drug use increased by 22.9 percent. Participation in self-help programs during treatment increased by 134.8 percent; representing a large
change. However, there was a small number of
members participating in self-help programs at intake; this represents a small increase in actual
number of individuals engaged in self-help programs.
When performance falls below acceptable benchmarks, corrective action is taken to drive system
improvement. The Outcomes Dashboard is updated quarterly and reflects statewide and RBHA performance in access to care, coordination of care,
service delivery and consumer outcomes, similar to
Table 6. For updates on the dashboard, please see
the ADHS/DBHS website: http://www.azdhs.gov/
bhs.

Goals for the Current Fiscal Year
ADHS/DBHS will continue to enhance the quality of
substance abuse service delivery, increase the use
of evidence-based practices in prevention and
treatment, and improve clinical outcomes and the
overall efficiency of substance abuse service utilization. The Adult and Children Systems of Care
Plans each have specific initiatives designed to
promote and enhance the effectiveness of treatment, while increasing outreach activities and encouraging more individuals to both seek out, and
complete, treatment. These initiatives will be in
place through 2015 and include the following:

tices (EBPs) in substance abuse prevention and
treatment.
 Increase network of substance abuse prevention
services providers.
 Ensure accurate placement and appropriateness
of continued stay in Substance Abuse Treatment
Services by use of ASAM PPC-2R.
 Continue to expand the availability and utilization
of Medically-Assisted Treatment (MAT) options
through the increased use of Federal Grant
funds.
 Increase outreach, engagement and enrollment
of members of the military and their families.
 Promote the Arizona Prescription Drug Misuse
and Abuse Initiative.
 Continue to integrate Peer and Family Support
Services and self-help participation (AA, NA and
CA) into treatment planning.
 Provide substance abuse and wraparound services for at risk populations through discretionary
grants (such as the grants listed on page 6).

 Continue utilization of the Screening, Brief Intervention and Referral to Treatment (SBIRT) approach in emergency rooms and with primary
care physicians in Northern Arizona in order to
integrate services and more accurately identify
those at risk of developing a substance use disorder.
 Increase the utilization of Evidenced-Based Prac-

Data Source: Arizona Department of Health Services, Division of Behavioral Health Services, Bureau of Business Information
Systems. ARS §36-2023 (FY 2014); December 2014.
7