State Principles for Financing Substance Use Care Treatment and Support Services

Hadley Fitzgerald and Disha Williams
September 2023
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Principles to help states build more comprehensive, sustainable, and equitable substance use disorder treatment, harm reduction, and recovery systems of care.


More state options for financing substance use disorder (SUD) treatment and recovery services have become available in the last decade. These options include coverage expansion and SUD benefit requirements under the Affordable Care Act, increases in SUD-related federal grant funding, and the opioid-related litigation settlements. However, few people with an SUD receive adequate treatment, overdose mortality rates continue to rise, and certain historically marginalized groups experience SUD-related health disparities. The principles outlined in this report can support states to maximize the use of available public funding to strategically strengthen SUD treatment and recovery systems, as well as address related inequities.


This report describes 10 principles intended to guide states in developing more robust, sustainable, and equitable SUD treatment and recovery support systems. The principles were informed by a group of expert stakeholders, including research and policy experts, providers, state officials, and people with lived experience accessing the SUD treatment system. Each principle is accompanied by a review of barriers, opportunities for adoption, policy actions, and state implementation examples. The principles describe ways that policymakers can maximize public SUD-related funding streams and design policy mechanisms to increase access to care, particularly for populations disproportionately impacted by SUD.

A series of companion checklists offer practical guidance for state investment in evidence-based peer supports, medications for opioid use treatment, and harm reduction strategies.


State policymakers can use this report to improve SUD treatment and recovery support systems, with a focus on increasing treatment and recovery service sustainability and health equity.

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