Substance Abuse Prevention and Control
County of Los Angeles Public Health Substance Abuse Prevention and Control

Reaching the 95% (R95) Initiative

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Background

We are facing the worst overdose crisis in national and local history, and research has shown that two-thirds of people in the United States have been impacted by addiction in some way.

While substance use disorder (SUD) treatment has been proven to save lives, only approximately 5% of people with SUDs are accessing treatment services. One of the major reasons why for this small number is because 95% of people with SUDs who don’t access services either don’t want or believe that they need help.

Data demonstrates that unless we prioritize engaging this 95% of individuals with SUDs, it is unlikely that we will increase our treatment access rates. For this reason, substance use systems need to take a fundamentally different approach to better address SUDs by ensuring that programs are designed not just for the 5% of people with SUDs accessing care, but that services are also designed to engage the 95% who are not.

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R95 Guidance and Resources
Key Indicators in Los Angeles County
0.0%
Individuals 12+ with Substance Use Disorder (2023)
$0.0B
Alcohol or Other Drug Hospital Spending (2022)
0%
Full-Time Employees Use Illicit Drugs (2023)
3,000
Alcohol or Other Drug Deaths (2023)
*Reference - https://lacountydphsapc.inzatastories.com/
*Additional resource - http://publichealth.lacounty.gov/sapc/providers/data-reports-and-briefs.htm
"The opposite of addiction is NOT sobriety;
the opposite of addiction is connection."
Johann Hari, British-Swiss Writer & Journalist
Addiction is often chronic and recurrent, and not all people are at the same stage of readiness to change. Only focusing on individuals in some stages of change as opposed to ALL stages of change limits service reach and impact.

The Reaching the 95% (R95) Initiative was launched by the Los Angeles County Department of Public Health’s Bureau of Substance Abuse Prevention and Control (SAPC) in 2023 to focus on increasing the reach of its SUD treatment system and reshaping the way society perceives these conditions.
Purpose and Goals
To ensure that we are designing a specialty SUD system that is focused not just on the ~5% of people with SUDs who are already receiving and open to treatment, but also the ~95% of people with SUDs who do not receive treatment for any reason.

To communicate – through words, policies, and actions – that people with SUD are worthy of our time and attention, no matter where they are in their recovery journey or their stage of readiness for change.

To disconnect the concept of readiness for treatment from readiness for abstinence. Requiring abstinence is too high of a bar, and people who are not yet ready for complete abstinence should still be considered for SUD treatment.
R95 in Practice

SAPC works hand in hand with SUD treatment provider agencies to operationalize the R95 Initiative, lowering barriers and centering system and service design around people with SUD. The profiles below provide real insights to what these changes mean for SUD treatment agencies, their staff, and their clients.

Featured Agencies
CRI-Help Building Staff Alignment to Support Lower-Barrier, Client-Centered Care
Families for Children Strengthening Access and Engagement with R95 and Stages of Change Group Design
Pax House Recovery Implementing R95 in a Small Provider Setting: A Behavior-Based Approach
Safe Refuge Building Staff Engagement in Discharge Practices Through Transparent Communication
Focus Areas
The Reaching the 95% (R95) Initiative allows agencies to grow their clients and services by leveraging payment reform and identifying high impact strategies to ensure that LA County’s SUD system is designed to engage more people with SUDs. There are two Focus Areas under the R95 Initiative that will guide the work of SAPC and its provider network.
Enhancing Outreach & Engagement Across the SUD System

Expanding field- and street-based services to provide services for people who are not interested or able to receive services in other settings.

Increasing efforts to interface with other areas of health and social systems to better engage individuals who would benefit from SUD care in those systems.

Expanding low barrier and low judgement services such as harm reduction to better engage people who may not be interested in SUD treatment, but may still be interested in evidence-based services that can improve their health.

Expanding offerings of Medications for Addiction Treatment (MAT) to reduce painful withdrawal symptoms and/or cravings with medications that will improve engagement for individuals interested in this evidence-based treatment option.

Optimizing utilization of a new State policy that allows for outreach services to be reimbursable under Medi-Cal for people with potential substance use conditions.

Performing customer experience assessments at the SUD provider level to focus on implementing strategies to make the care environment more inviting, streamline the intake and service delivery process to make it more enjoyable and impactful for participants, and overall improve client engagement.

Establishing Lower Barrier Care Across the SUD System

Lowering the bar of admissions policies to expand the spectrum of readiness levels of people admitted into SUD treatment. For example, requiring complete abstinence from drugs to be admitted into SUD treatment is too high of a bar, and lowering that bar will allow for more people to engage with needed services, similar to how people with diabetes are not required to have a specific blood sugar level before they are considered for diabetes care.

Raising the bar of discharge policies so that there are more nuanced considerations before someone is discharged from treatment as a result of relapse, which is a symptom of addiction.

Strengthening bidirectional referrals between harm reduction and SUD treatment agencies so that individuals with SUDs have access to services that match their readiness and need.

Why the R95 Approach Works
The principles behind R95 are evidence-based and supported by rigorous studies of real world patients and treatment and harm reduction agencies. R95 is designed to empower agencies to support their patients through every step of recovery.

R95


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More additional articles
Guest Editorial – Reconceptualizing Recovery
Reconceptualizing Recovery: Findings from the National Survey on Drug Use and Health
Emily Pasman, PhD, LMSW, for American Society of Addiction Medication (ASAM)
"Treatment and recovery services can benefit people with both abstinent and nonabstinent goals, and close work with a health care professional is sometimes medically necessary. Unfortunately, most people who could benefit from treatment do not receive it, oftentimes because they do not want to stop using or because they prefer to recover without the use of professional services. Aligning service offerings with the realities, goals, and preferences of the intended end user may increase service engagement."
Guest Editorial: One of These Things Is Not Like the Others
One of These Things Is Not Like the Others
Stephen A. Martin, MD, EdM, FAAFP, FASAM, for American Society of Addiction Medication (ASAM)
On toxicology testing in the SUD treatment setting

“While addiction medicine is evolving rapidly in some ways, our specialty still carries remnants of the abstinent-based model. Drug testing without deliberate clinical decision-making does not coincide with a more humane, low-threshold model.

“While these practices are wound down, each of us can act today to reduce patient harm. Here are some practical ways to do less harm with drug testing:
  • Test as infrequently as possible
  • Do not test randomly
  • Use only confirmatory (LC-MS) testing (which is covered by Medicaid)
  • Use oral fluid (saliva) direct to LC-MS testing as the default […]
  • If using urine-based testing, do not observe the patient’s test
  • Test only for the substance of interest: methadone or buprenorphine
  • Make clear you are only looking for the treatment medication
  • If patients want testing—or are required to have it—use the above principles as possible”
[I have a hunch this one is way too long. I’ve cut the list down already but let me know if I need to cut further.]
R95 Guidance and Resources
Program Design and Implementation
R95 Principles
Resource Articles
  • Reconceptualizing Recovery: Findings from the National Survey on Drug Use and Health - American Society of Addiction Medicine (ASAM), August 5, 2025
    Redefining recovery and prioritizing people-centered design to serve people with both abstinent and nonabstinent goals can increase service engagement for people with SUD not receiving life-saving treatment.
  • One of These Things Is Not Like the Others - American Society of Addiction Medicine (ASAM), August 12, 2025
    SUD treatment providers should approach toxicology testing as a therapeutic tool to inform clinical decisions, rather than as a trigger for punitive actions, and prioritize reducing patient harm throughout the process.
Learn More
SAPC is a state leader in launching innovative SUD tools and programs to enhance access to services by individuals who may need treatment, community stakeholders and the SUD workforce.

Click the RecoverLA link to learn more about our award-winning mobile-friendly platform that provides SUD service and overdose prevention resources, as well as a filterable service locater.

Click the link to the Service and Bed Availability Tool (SBAT) to locate a treatment provider near you with filters that make searching for specialty SUD services easy: SUDHelpLA.org.

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