SAMHSA’s evidence-based practices are the treatments, clinical models, and prevention frameworks that the Substance Abuse and Mental Health Services Administration identifies as supported by research and worth federal investment. The agency disseminates them through its Evidence-Based Practices Resource Center, embeds them in grant conditions, and publishes clinical guidance that states, clinics, and providers use to build programs. The list of what SAMHSA backs is specific: FDA-approved medications for opioid and alcohol use disorders, Screening, Brief Intervention, and Referral to Treatment (SBIRT), contingency management for stimulant use disorders, and Coordinated Specialty Care for first-episode psychosis, among others.
What the Evidence-Based Practices Resource Center Is
The Resource Center is SAMHSA’s central hub for tools and information on prevention, treatment, and recovery support for mental and substance use disorders. It publishes treatment improvement protocols, toolkits, resource guides, and clinical practice guidelines aimed at public health professionals, providers, policymakers, and community organizations.1Office of Disease Prevention and Health Promotion. Evidence-Based Practices Resource Center
It was launched in 2018, replacing the National Registry of Evidence-Based Programs and Practices, which SAMHSA suspended in late 2017. As of April 2018 the new center held 138 resources, with nearly half classified as expert consensus or guidelines rather than empirical findings from controlled studies.2National Library of Medicine. NREPP Systematic Review
One boundary is worth flagging before you rely on the site. Section 7002 of the 21st Century Cures Act, enacted in 2016, directs SAMHSA to post reviewed programs, let programs apply for inclusion, and run a review and rating system. In a September 2023 Request for Information, SAMHSA acknowledged that the Resource Center “does not currently seek applications for inclusion in its website” and “has not established a review and rating system” as the statute contemplates, and that it has “primarily posted federally developed materials on practices” instead.3Federal Register. Request for Information: Potential Changes to Its Evidence-Based Practices Resource Center The Center is a curated federal library, not an independent registry that rates outside programs.
The Treatments SAMHSA Identifies as Evidence-Based
Medications for Opioid and Alcohol Use Disorders
SAMHSA identifies several FDA-approved medications as core evidence-based treatments: buprenorphine and methadone for opioid use disorder, naltrexone for both opioid and alcohol use disorder, and acamprosate and disulfiram for alcohol use disorder.4SAMHSA. Evidence-Based Practices Resource Center The agency also publishes resources on the removal of the federal buprenorphine prescribing waiver under the MAT Act and on practitioner training under the MATE Act, both of which broadened access to medication-based treatment.
Screening, Brief Intervention, and Referral to Treatment
SBIRT is a public health approach for identifying people at risk for substance misuse and connecting them to services. It has three steps: screening for risky use, a brief motivational intervention, and referral to more intensive treatment when warranted.5National Library of Medicine. Substance Use Disorders SAMHSA has pushed SBIRT into primary care, emergency departments, and community settings. Evaluations of the agency’s discretionary SBIRT grants from 2021 to 2023 reported a 128 percent increase in individuals reporting no alcohol or drug use six months after the intervention.6National Association of State Mental Health Program Directors. Refocus and Renew Umbrella Paper
Contingency Management for Stimulant Use Disorder
Contingency management uses tangible rewards, such as vouchers, gift cards, or prize drawings, to reinforce abstinence and treatment attendance. There are no FDA-approved medications for stimulant use disorders (cocaine and methamphetamine), and research has found contingency management roughly twice as effective as other psychosocial interventions like cognitive behavioral therapy for this population.7HHS Office of the Assistant Secretary for Planning and Evaluation. Contingency Management in Substance Use Treatment SAMHSA estimates more than four million Americans meet the diagnostic criteria for a stimulant use disorder.
In January 2025, SAMHSA issued updated guidance raising the cap on motivational incentives from $75 to $750 per patient per year for its grant programs, including the $1.4 billion State Opioid Response program. The guidance requires grantees to follow evidence-based protocols lasting at least 12 weeks, use FDA-approved rapid drug testing to verify abstinence, and prohibit cash incentives.8APA Services. SAMHSA Guidelines on Substance Use The Department of Veterans Affairs has run a nationwide contingency management program since 2011, spending about $200 per veteran over a 12-week course.7HHS Office of the Assistant Secretary for Planning and Evaluation. Contingency Management in Substance Use Treatment
Coordinated Specialty Care for First-Episode Psychosis
Coordinated Specialty Care (CSC) is a team-based outpatient model for people experiencing a first episode of psychosis. It combines cognitive and behavioral psychotherapy, personalized medication management, family education and support, supported employment and education, and assertive case management.9Medicaid.gov. Coverage of Early Episode Psychosis Services The model emerged from the NIMH-funded RAISE trial, which followed 404 young people across 34 community clinics and documented gains in symptoms, social functioning, and quality of life over usual care.
SAMHSA’s 2026 guidance on schizophrenia spectrum disorders, part of its “Refocus and Renew” series, describes CSC as the “gold standard” of early psychosis care and recommends that long-acting injectable medications be presented as a routine option rather than a last resort, that clozapine be considered after two failed antipsychotic trials, and that psychotherapy be offered to every person experiencing psychosis.10SAMHSA. Back to Basics: The Latest on Schizophrenia Spectrum Disorders
The Practice Guidance Providers Actually Use
Two document sets carry most of the practice-level guidance. The older Evidence-Based Practices Implementation Resource Kits (EBP KITs), developed in the 2000s, cover five topics: Assertive Community Treatment, Integrated Treatment for Co-Occurring Disorders, Supported Employment, Family Psychoeducation, and Illness Management and Recovery. Each kit provides guides for program building, staff training, evaluation, and the underlying evidence.11University of Maryland Evidence-Based Practice Center. Assertive Community Treatment Resources
The newer Evidence-Based Resource Guide Series now includes more than two dozen topical guides and advisories covering opioid overdose prevention, telehealth for serious mental illness, buprenorphine prescribing in primary care, preventing marijuana use among youth, trauma-informed approaches, workforce burnout, and long COVID-related mental health symptoms.12Abt Global. SAMHSA Evidence-Based Resource Guide Series
SAMHSA’s most current guidance sits in the “Refocus and Renew: Moving Towards Health” series, published in April 2026. The 10 technical assistance papers are directed at state leaders and cover schizophrenia spectrum disorders, maternal mental health for women with serious mental illness, eating disorders, childhood emotional disturbances, cross-system collaboration for youth, grief and loss, legal tools in behavioral health, state hospital systems, and forensic mental health services. An umbrella paper frames the overall goal as closing the 25-year life expectancy gap for people with serious mental illness through integrated physical and behavioral health care.13SAMHSA. Refocus and Renew: Moving Towards Health Technical Assistance Papers
How SAMHSA Pushes States Toward These Practices
The evidence-based designation matters because SAMHSA uses its two big block grant programs to steer state spending. The Community Mental Health Services Block Grant (MHBG) and the Substance Use Prevention, Treatment, and Recovery Services Block Grant both require states to use data to identify, implement, and evaluate evidence-based programs as a condition of funding.14SAMHSA. FY 2026-2027 Block Grant Application
The most concrete lever is the MHBG’s 10 percent set-aside for evidence-based early interventions for serious mental illness. Congress created a 5 percent set-aside in fiscal year 2014 and doubled it to 10 percent in 2016 through the 21st Century Cures Act.15National Library of Medicine. First Episode Psychosis CSC Implementation The effect on CSC availability has been substantial. In 2008, two states reported supporting CSC programs. By 2018, MHBG dollars funded 244 CSC programs, and recent counts put the total at 344 programs operating in every state and four U.S. territories.
A study of 36 CSC programs found that more than half relied on the MHBG set-aside for over 50 percent of their funding, and five programs depended on it entirely. Administrators said the block grant money covered the parts of CSC that insurance does not reimburse: outreach, team leadership, engagement of reluctant patients, and supported employment and education. One administrator told researchers: “Without the block grant funding, these projects would disappear.”16National Research Institute. Financing for CSC Programs
Even so, capacity trails need by a wide margin. With roughly 100,000 new cases of first-episode psychosis each year and only about 24,000 clients admitted to CSC programs in 2021, an estimated 76,000 people annually do not receive this care.17SAMHSA. Financing Coordinated Specialty Care
Recent Policy Shifts Affecting What Grants Can Fund
Two 2026 developments changed the practical scope of federally funded behavioral health services.
On January 13, 2026, SAMHSA terminated approximately 2,800 grants totaling an estimated $1.9 to $2 billion, roughly a quarter of the agency’s budget. The affected grants supported overdose prevention, peer recovery, mental health training for school staff, treatment for pregnant women, HIV prevention, and homelessness services. Termination letters stated the programs did not align with administration priorities.18NPR. Trump Administration Letter Terminating Addiction, Mental Health Grants The funding was restored less than 24 hours later.19The Jed Foundation. Restoring Mental Health Funding Was the Right Move Block grants, State Opioid Response grants, Certified Community Behavioral Health Clinic funding, and 988 crisis line funding were not part of the cancellations.20Behavioral Health Business. Without Warning, SAMHSA Cuts $2B in Grants
On April 24, 2026, SAMHSA issued a “Dear Colleague” letter restricting the use of federal grant funds for several harm reduction tools, including fentanyl and xylazine test strips, sterile syringes, and overdose companion hotlines. The restrictions followed a July 2025 guidance implementing the “Ending Crime and Disorder on America’s Streets” executive order, which directed HHS to ensure discretionary grants exclude efforts seen as facilitating illegal drug use.21National Association of Counties. SAMHSA Implements New Harm Reduction Restrictions
The restrictions have drawn public opposition. The American Society of Health-System Pharmacists said “multiple studies show fentanyl test strips reduce overdose deaths” and formally opposes the guidance.22ASHP. ASHP Opposes New Restrictions on Fentanyl Test Strips Senator Edward Markey and 20 other Democratic members of Congress sent a letter urging reversal, pointing out that the SUPPORT for Patients and Communities Reauthorization Act, signed by President Trump in December 2025, explicitly authorizes grant funding for drug-checking supplies. Critics have also noted that the White House Office of National Drug Control Policy’s 2026 National Drug Control Strategy describes drug checking as an “important tool” that “should not be treated as drug paraphernalia,” which conflicts with the SAMHSA guidance.23North Carolina Health News. Mixed Federal Messages on Drug Checking Leave North Carolina Harm Reduction Programs in Limbo Some state health departments have paused test strip distribution while awaiting clarification.
Why Some Effective Programs Never Get the Label
A persistent critique of the SAMHSA framework is that it screens out programs serving the communities most in need. Many community-based and culturally specific interventions cannot easily be evaluated with randomized controlled trials because they are small in scale, geographically bounded, and serve populations that make control-group recruitment difficult. Effective community programs may therefore never qualify as “evidence-based” under conventional standards.3Federal Register. Request for Information: Potential Changes to Its Evidence-Based Practices Resource Center
Researchers have identified “significant gaps in knowledge about existing or emerging prevention programs, practices, and policies that show evidence of effectiveness for Black people and communities” and observed that behavioral health services are frequently “designed for and accessible to populations that experience the least social inequities and the least trauma.”24Psychiatry Online. Behavioral Health Equity Data from the 2022 National Survey on Drug Use and Health found that 85 percent of youth and adults meeting substance use disorder criteria did not receive treatment in the past year, with many failing to perceive a need for services at all.
SAMHSA’s own definition of evidence-based practices encompasses research evidence, practice-based expertise, cultural competence, and consumer values, which is broader than a research-only standard. The 2023 Request for Information specifically asked how the agency could better evaluate community-driven and culturally informed programs. Whether that broader definition will translate into a working intake and review system, as the Cures Act requires, is still open.