# Patch Notes for Society #005: Addiction / Mental Health - Evidence Matrix

Version: v0.3
Date: 2026-07-02
Status: Public pre-memo evidence matrix for critique; not a final policy memo

## Working Standard

Every major claim should separate addiction, serious mental illness, co-occurring disorders, homelessness, crisis response, and public safety. A single public story may connect them, but the evidence base should not collapse them.

| Claim | Evidence strength | Initial source anchor | Where used | Reviewer ask |
| --- | --- | --- | --- | --- |
| In 2024, SAMHSA estimated 52.6 million people aged 12+ needed substance-use treatment, defined as having a past-year SUD or receiving substance-use treatment. About 19.3 percent of that group received substance-use treatment. | Strong for national NSDUH estimate; definition-specific | SAMHSA 2024 NSDUH annual report and detailed tables | Baseline data | Ask public health reviewers how to explain "needed treatment" without implying everyone perceived need or sought care. |
| In 2024, SAMHSA estimated 48.4 million people aged 12+ had a past-year SUD, 61.5 million adults had any mental illness, and 14.6 million adults had serious mental illness. | Strong for national NSDUH estimate; survey limitations apply | SAMHSA 2024 NSDUH annual report | Baseline segmentation | Ask reviewers which baseline numbers should lead without conflating SUD, AMI, and SMI. |
| Overdose deaths remain a major public-health crisis even with recent provisional declines. | Strong for death counts; interpretation needs recency caution | CDC/NCHS provisional drug overdose death counts | Public urgency and trend section | Ask addiction researchers how to explain decline without implying the crisis is solved. |
| Medications for opioid use disorder are evidence-based and underused. A serious plan should discuss methadone, buprenorphine, and naltrexone access, retention, prescribing capacity, stigma, payment, and continuity after jail/hospital discharge. | Strong for medication efficacy; implementation barriers vary | FDA, NIDA, National Academies, SAMHSA | Intervention section | Ask addiction-medicine reviewers where access barriers are most binding. |
| Behavioral-health crisis systems need a continuum: someone to contact, someone to respond, and a safe place for help. Hotlines and mobile teams are not enough without receiving/stabilization capacity and post-crisis handoffs. | Strong as SAMHSA model; outcome evidence depends on implementation | SAMHSA crisis care guidance, 988/lifeline materials, model crisis service definitions, CCBHC evidence, local evaluations | Crisis response section | Ask operators what makes mobile crisis and receiving centers work or fail. |
| Serious mental illness, substance-use disorder, and homelessness overlap but are not the same population. | Strong as segmentation principle; prevalence requires careful sourcing | SAMHSA, HUD AHAR, supportive housing literature | Population segmentation | Ask housing and behavioral-health reviewers where overlap is overstated or understated. |
| Permanent supportive housing can improve housing stability for high-need populations, but it does not replace clinical treatment capacity. | Moderate/strong for housing stability; mixed by outcome | HUD/USICH Housing First resources, supportive housing evaluations | Housing interface section | Ask PSH operators which outcomes are strongest and weakest. |
| Civil commitment and involuntary treatment may sometimes be necessary, but should be treated as narrow last-resort authority, not the operating center of the system. Any use needs due process, least-restrictive placement, time limits, review/appeal, quality treatment capacity, discharge continuity, and bias/harm monitoring. | Contested; strong as rights/capacity guardrail; outcomes vary by jurisdiction and model | SAMHSA civil commitment continuum report, HHS/OCR Olmstead/community integration guidance, state AOT statutes and evaluations, psychiatric ethics literature, disability-rights analysis, Cochrane/AHRQ-style evidence reviews | Autonomy/coercion section | Ask psychiatrists, civil-liberties lawyers, family advocates, and crisis operators where the line should be drawn and what safeguards fail in practice. |
| Community integration is a civil-rights constraint as well as a care-design principle: public systems should avoid unnecessary institutionalization and provide services in the most integrated setting appropriate to the person's needs. | Strong legal/civil-rights principle; implementation varies | HHS Office for Civil Rights Olmstead/community living guidance, DOJ/HHS enforcement materials | Rights guardrail and housing/community-care section | Ask disability-rights reviewers how to avoid building a "better" system that recreates unnecessary segregation. |
| AOT/court-ordered outpatient treatment evidence should not be oversold. Some U.S. program evaluations report better engagement or reduced arrests/hospital use when court orders are paired with enhanced services, while randomized and international CTO evidence is more mixed. | Mixed; model- and resource-dependent | NY AOT/Kendra's Law evaluations, Cochrane compulsory community treatment review, AHRQ psychiatric-readmission review, state implementation studies | Autonomy/coercion and public-order section | Ask reviewers whether any apparent benefit comes from compulsion, added service priority, or both. |
| Parity laws and insurance rules matter because nominal coverage does not guarantee timely access. | Moderate/strong | CMS/SAMHSA parity resources, insurer/network adequacy research | Financing section | Ask clinicians and policy experts which access failures are most measurable. |
| Workforce shortages constrain almost every proposed behavioral-health solution. | Strong directionally; needs occupation-specific data | HRSA workforce reports, SAMHSA workforce materials | Capacity section | Ask operators what roles are hardest to staff and what scope-of-practice changes help. |
| A credible strategy needs earlier care, crisis capacity, housing pathways, accountable public-order rules, and rights protections together. | Synthesis hypothesis | Cross-source synthesis | Recommendation section | Ask reviewers where this package becomes overbroad or internally inconsistent. |
| Recent provisional overdose declines are encouraging but should not be used to imply addiction treatment capacity is solved. CDC reported a continued provisional decline in drug overdose deaths in 2025 compared with 2024, but deaths remained far above pre-crisis historical levels. | Strong for provisional mortality trend; interpretation needs caution | CDC/NCHS provisional overdose death counts, CDC press materials | Public urgency / trend caveat | Ask addiction researchers how to frame improvement without complacency. |
| CCBHCs are a promising integrated-care model, but expansion depends on state participation, Medicaid/payment design, workforce, and service requirements. | Moderate/strong for model design; outcomes need source pass | SAMHSA CCBHC, CMS demonstration, ASPE/HHS evaluations | Integrated care / financing | Ask Medicaid and clinic operators what breaks in implementation. |
| Jail diversion can reduce criminal-justice cycling only when there is a real service destination and follow-up care. | Moderate; program-dependent | BJA/GAINS/Stepping Up, behavioral-health diversion literature | Justice interface | Ask diversion operators where court/police handoffs fail. |
| MOUD continuity after incarceration, hospitalization, detox, or residential treatment is a high-risk implementation point. | Strong directionally; needs model-specific source pass | NIDA, FDA, National Academies, correctional MOUD literature | Reentry and crisis handoff | Ask prison/jail and hospital reviewers what continuity barriers are most common. |

## Source Links

- SAMHSA, 2024 NSDUH Annual National Report PDF: https://www.samhsa.gov/data/sites/default/files/reports/rpt56287/2024-nsduh-annual-national-report.pdf
- SAMHSA, NSDUH annual reports and detailed tables: https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
- CDC/NCHS, Provisional Drug Overdose Death Counts: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- NIDA, Medications for Opioid Use Disorder: https://nida.nih.gov/research-topics/medications-opioid-use-disorder
- FDA, Information about Medication-Assisted Treatment: https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat
- National Academies, Medications for Opioid Use Disorder Save Lives: https://nap.nationalacademies.org/catalog/25310/medications-for-opioid-use-disorder-save-lives
- SAMHSA, Medications for Substance Use Disorders: https://www.samhsa.gov/substance-use/treatment/options/medications
- SAMHSA, 988 and Behavioral Health Crisis Coordinating Office: https://www.samhsa.gov/mental-health/988
- SAMHSA, Certified Community Behavioral Health Clinics: https://www.samhsa.gov/certified-community-behavioral-health-clinics
- CMS, Certified Community Behavioral Health Clinic Demonstration: https://www.medicaid.gov/medicaid/financial-management/section-223-demonstration-program-improve-community-mental-health-services/index.html
- 988 Suicide & Crisis Lifeline: https://988lifeline.org/
- HRSA, Behavioral Health Workforce: https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand/behavioral-health
- HUD Exchange, AHAR Reports: https://www.hudexchange.info/homelessness-assistance/ahar/
- USICH, Housing First: https://www.usich.gov/guidance-reports-data/federal-guidance-resources/housing-first
- Crisis-service model definitions: needs a stable current source before use in a formal memo.
- HHS ASPE, Certified Community Behavioral Health Clinic Evaluation: https://aspe.hhs.gov/reports/certified-community-behavioral-health-clinic-evaluation
- SAMHSA, Civil Commitment and the Mental Health Care Continuum: https://www.samhsa.gov/sites/default/files/civil-commitment-continuum-of-care.pdf
- HHS Office for Civil Rights, Community Living and Olmstead: https://www.hhs.gov/civil-rights/for-individuals/special-topics/community-living-and-olmstead/index.html
- Cochrane, Compulsory community and involuntary outpatient treatment for people with severe mental disorders: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004408.pub5/full
- Bureau of Justice Assistance, Justice and Mental Health Collaboration Program: https://bja.ojp.gov/program/justice-and-mental-health-collaboration-program-jmhcp/overview
- The Council of State Governments Justice Center, Stepping Up: https://stepuptogether.org/

## Research Gaps Before Memo v0.1

1. Treatment gap by condition: OUD, AUD, stimulant use, serious mental illness, depression/anxiety, co-occurring disorders.
2. Treatment bottlenecks: insurance, network adequacy, workforce, beds, outpatient slots, medication access, housing, transportation, stigma.
3. Evidence by intervention: MOUD, contingency management, CBT, ACT, crisis stabilization, CCBHCs, supportive housing, peer support.
4. Civil commitment/AOT: legal standards, outcomes, least-restrictive alternatives, due process, bias monitoring, bed/service capacity, and post-discharge continuity.
5. Homelessness overlap: what percentage is primarily housing affordability, SMI, SUD, domestic violence, system exit, or combined.
6. Public-order and safety questions: when noncriminal crisis response works, when court leverage helps, and when enforcement causes harm.
7. Workforce and funding: psychiatry, addiction medicine, therapists, social workers, peers, case managers, nurses, residential and outpatient capacity.
8. More precise treatment gap by condition beyond aggregate SAMHSA "needed substance use treatment" definition.
9. Crisis-care continuum implementation examples: call center, mobile response, crisis receiving/stabilization, and post-crisis follow-up.
10. Jail diversion evidence by model and service capacity.
11. MOUD implementation barriers by setting: outpatient, emergency department, jail/prison, reentry, residential treatment, and rural access.
12. Payment and workforce barriers for CCBHCs, mobile crisis, crisis receiving facilities, and MOUD.