Pew Survey: Half of States Require Recovery Measurement in Addiction Treatment Settings

Eighteen states now require substance use disorder treatment facilities to systematically measure client recovery outcomes—but nearly half cite insufficient staffing and competing federal data requirements as barriers preventing wider adoption, according to a national survey released this week by The Pew Charitable Trusts.

The March 2 survey, which drew responses from behavioral health officials in 39 states and territories, reveals a patchwork landscape where recovery measurement efforts vary dramatically by jurisdiction and setting type. While some states mandate validated assessment tools in recovery community organizations and treatment facilities, others lack the infrastructure or capacity to implement such programs at all.

Recovery measurement tracks whether services help people move toward personal goals that often extend well beyond abstinence—stable housing, employment, family reunification, improved mental health. Yet the survey found that only 12 jurisdictions attempt to measure recovery at the population level, leaving most states unable to assess the broader public health impact of their treatment investments.

Recovery Homes and Community Organizations Lead Adoption

Among the 18 states requiring recovery assessments, recovery community organizations were most frequently mandated to use measurement tools (13 jurisdictions), followed by general substance use treatment facilities (10), recovery homes (8), and opioid treatment programs (8).

Quality improvement initiatives drove these requirements in 21 instances, more than any other factor. External federal grants (19 responses), Medicaid payment requirements (17), and state grant conditions (16) also compelled settings to adopt assessments. For recovery community organizations specifically, external federal funding requirements and jurisdiction grants were the primary triggers.

The most widely used tool was the Addiction Severity Index, a 165-question semi-structured interview covering seven life domains including employment, family relations, and illegal activity. It appeared 18 times across settings. The Brief Assessment of Recovery Capital—a 10-item self-report questionnaire derived from a longer 50-item scale—was the second most common tool, reported nine times.

Recovery Capital Scale and the Substance Use Recovery Evaluator rounded out the top four instruments. Each tool takes a different approach: some are clinician-administered interviews lasting an hour, while others are brief self-assessments that clients complete independently.

Treatment settings tended to favor the Addiction Severity Index, while recovery service settings more often deployed BARC-10. At the population level, three jurisdictions each used the Addiction Severity Index, BARC-10, and Recovery Capital Scale.

Federal Reporting Requirements Emerge as Top Barrier

When asked about obstacles to implementing recovery measurement, 13 of the 18 states with setting-level initiatives cited insufficient staffing within service settings as the leading challenge. Eleven officials pointed to competing data collection requirements, and nine reported insufficient staffing within their own state agencies.

At the population level, the pattern held: six officials each reported insufficient staffing and limited funding within state agencies as primary barriers, with five citing the burden of meeting federal data requirements such as the Government Performance and Results Act, Treatment Episode Data Set, and block grant reporting.

Among the 13 jurisdictions without setting-level recovery measurement and 23 without population-wide initiatives, officials repeatedly mentioned those same competing federal requirements and inadequate staffing capacity as reasons for non-participation.

SAMHSA has begun revising its GPRA data collection tool in response to this feedback, including a public comment period in fall 2024. But the tension between federal accountability demands and state capacity to implement additional quality measures remains unresolved.

Disaggregating Data Reveals Recovery Disparities

Among officials who answered questions about demographic analysis, 10 jurisdictions disaggregated recovery data by demographic variables at the service setting level, while six did so at the population level. Four states analyzed recovery data by demographics at both levels simultaneously.

This level of granular analysis matters because substance use prevalence and recovery outcomes vary significantly by race, ethnicity, age, gender, and other factors. In 2024, illicit drug use among people age 12 and older was highest among American Indian or Alaska Native populations at 29.6% and multiracial populations at 36.2%, compared with 27.5% among White populations, 27.1% among Black or African American populations, and 12% among Asian populations, according to SAMHSA's National Survey on Drug Use and Health.

Among adults who reported ever having a substance use problem, Black respondents were significantly less likely than White respondents to report being in recovery. Researchers have also found that Black clients and American Indians had lower rates of treatment initiation and engagement compared with White clients.

Disaggregating recovery data can surface these disparities and inform targeted interventions. Yet fewer than half of responding jurisdictions currently perform this analysis.

People With Lived Experience Shape Measurement Efforts—Sometimes

Twelve of 17 jurisdictions included people in recovery in their efforts to require settings to conduct assessments. At this level, people with lived expertise helped develop measures and recommend recovery assessment tools.

For jurisdiction-wide measurement efforts, six states involved people in recovery through advisory councils and planning processes to identify recovery metrics.

Having people with lived expertise participate in developing and refining measures helps create systems responsive to community needs and captures outcomes that matter to people in recovery themselves. Their involvement improves data relevance and accuracy while building trust in the process.

But the survey results suggest this practice is far from universal. Many jurisdictions implementing recovery measurement do so without meaningful input from the communities most affected.

Why Measuring Recovery Matters Beyond Treatment Outcomes

Recovery measurement serves multiple purposes beyond individual care planning. It allows jurisdictions to demonstrate the value of recovery supports—such as peer recovery workers—and secure continued funding. It guides quality improvement efforts and ensures services align with client goals rather than institutional assumptions.

The survey also highlighted an emerging opportunity: integrating recovery measurement into value-based payment models that reward providers for delivering coordinated, person-centered care supporting sustained recovery rather than simply billing for services rendered.

Unlike traditional fee-for-service models, value-based approaches could incentivize outcomes like reducing emergency department visits or retaining employment—real-life impacts that recovery measurement tools are designed to capture. But widespread adoption faces challenges including limited infrastructure, insufficient quality measures, and lack of provider readiness.

One Florida recovery housing program generated a net benefit of $143 million over 20 years, with a return of $22.19 for every dollar invested, according to research cited in the Pew report. Studies of collegiate recovery programs and recovery high schools have similarly documented substantial returns on investment when services help people build recovery capital—the internal and external resources they can draw upon to sustain recovery.

Federal Support and State Capacity Will Determine Expansion

Pew's survey demonstrates that recovery measurement is feasible—18 states are already doing it at the settings level, and specific tools like BARC-10 and the Addiction Severity Index have proven practical across diverse service environments.

But broader adoption will require addressing the core barriers: insufficient staffing, limited funding, and competing federal data requirements that consume agency resources without necessarily improving care.

SAMHSA's willingness to revise its GPRA reporting requirements signals federal recognition of the problem. Whether those revisions create meaningful relief or simply rearrange the reporting burden remains to be seen.

For states still on the sidelines, the case for recovery measurement grows stronger as evidence accumulates about cost-effectiveness and as value-based payment models create financial incentives to track patient-centered outcomes. The jurisdictions already implementing these initiatives offer proof of concept.

What's missing is the capacity—human and financial—to turn that concept into standard practice nationwide.