What question did this study set out to answer?

To understand the licensure requirements imposed by Single State Agencies for substance use disorder treatment programs across the United States.

April 3, 2026Open Access

Single state agency licensure requirements for substance use disorder treatment programs in the United States: results of a national survey

BYBrooks YeltonUniversity of South Carolina MWMelissa A. WestlakeUniversity of South Carolina AAAmanda J. AbrahamUniversity of Georgia

Key Points

To understand the licensure requirements imposed by Single State Agencies for substance use disorder treatment programs across the United States.
Conducted a national survey of Single State Agencies (SSAs) across 50 states and D.C.
Achieved a 94% response rate from the SSAs surveyed between 2020 and 2021.
Analyzed requirements for licensing, staffing, and clinical practices of SUD treatment programs.
58.3% of SSAs were responsible for licensing SUD treatment programs.
Most SSAs required reporting primarily from publicly funded programs.
Varied regulations for staffing and clinical practices across treatment settings, with outpatient programs being less regulated.

Abstract

Substance use disorder (SUD) remains a critical public health crisis in the United States, with high prevalence and overdose mortality rates. Despite the availability of effective treatments, including medications that significantly reduce overdose risk, fewer than 20% of Americans with active SUD receive treatment annually. Single State Agencies (SSAs), which oversee federal funding and regulate SUD treatment programs, hold significant authority to impose licensure and reporting requirements intended to promote treatment quality. This study presents findings from a national survey of SSAs across 50 states and the District of Columbia (94% response rate) conducted between 2020 and 2021, examining their roles in licensing SUD programs and setting requirements to promote evidence-based clinical practice. Results reveal that 58.3% of SSAs were responsible for licensing SUD treatment programs, with most requiring reporting primarily from publicly funded programs rather than all licensed providers. Staffing and clinical practice requirements varied substantially across treatment settings: opioid treatment programs and inpatient withdrawal management services were most frequently subject to medical staffing and supervision mandates, while outpatient programs were less regulated in these respects. Few SSAs required minimum staffing ratios or mandated medical professionals on staff in outpatient settings, limiting access to medication-based treatments. While patient placement criteria and clinical assessments were commonly required, clinical supervision requirements were inconsistent, and data reporting was often limited. Across treatment settings, treatment and aftercare/discharge planning were commonly required. The study findings indicate that agency requirements in many states allow for SUD treatment practices and staffing arrangements that are inconsistent with evidence-based care. Balancing quality improvements with maintaining access to care may necessitate additional resources and technical support for treatment programs to meet higher standards. Enhancing licensure requirements may be a critical step toward closing persistent gaps in SUD treatment quality and expanding access to lifesaving interventions.

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