Year of Publication



Martin School of Public Policy and Administration

Date Available


Degree Name

Master of Public Financial Management

Committee Chair

Dr. Iulia Shybalkina

Executive Summary

The United States has seen an increasing rate of substance use disorder among individuals. Those convicted and incarcerated are more likely to have substance use disorder. With correctional institutions becoming overcrowded, policymakers struggle to find an answer to the number of individuals incarcerated with substance use disorder. The Cabinet of Health and Family Services and the Department of Corrections created Supportive Assistance with Medication for Addiction Treatment (SAMAT) in Kentucky. SAMAT is an addictive services program focused on preventing overdose and relapse and aiding recidivism for individuals with opioid and alcohol use disorder. The SAMAT has been deemed successful through four years of program evaluations. In 2015, the General Assembly appropriated $3 million to the Department of Corrections for Substance Use Disorder treatment. There is no cost to the SAMAT participant during incarceration, and most insurance providers will cover the cost once released. Kentucky offers SAMAT in all 14 state prisons but only 20 county jails out of the 74 operational. A portion of the paper will evaluate the benefits of scaling up this program to all operating county jails. I reviewed the Kentucky outcome study and a supplemental study to estimate the likely effect of SAMAT. Then, I gather the population of the county jails that do not offer SAMAT and multiply that by the average range of inmates who experience substance use disorder. The third step is to measure the number of inmates who could experience substance use disorder and then multiply it by the average re-offense rate established in Step 1. Finally, based

on the calculation, I take the range of potential inmates that are most likely to re-offend and multiply that by the effect the program can have. Supportive Assistance with Medication for Addiction Treatment (SAMAT) faces social pressure due to existing stigmas surrounding convicted persons and substance use disorder. These stigmas generate barriers to what officials can implement regarding funding. County officials typically raise property tax revenues to support programs within the community. The SAMAT annual report has indicated a positive impact on participants and can potentially lower recidivism. The Commonwealth is seeking additional funding to expand SAMAT to the 54 county jails not participating in the program. SAMAT receives funding through funds appropriated by the General Assembly of Kentucky and Medicaid federal funding. Federal funding from the Substance Abuse and Mental Health Services Administration could provide grant funding for a program but would not fully fund the program. Two methods that could fund the expansion of SAMAT are public-private partnerships and social impact bonds. Social impact bonds demonstrate accountability and affordability for county jails which is essential to implementing the expansion of SAMAT. Accountability by using outcome-based performance measures to monitor the program's ongoing success. Affordability with having a third party provides the upfront operating money for the program, allowing county jails to save and later appropriate funds. Lastly, it would allow the counties to remain in control of the day-to-day operations of the county jails while receiving third-party funding.

Digital Object Identifier (DOI)



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