Substance Abuse Prevention And New Jersey - NJ

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Substance Abuse Prevention andSynar System Review ReportNew JerseyFederal Fiscal Year 2012May 1–3, 2012

Substance Abuse Prevention and SynarSystem Review ReportNew JerseyMay 1–3, 2012Federal Fiscal Year 2012Substance Abuse and Mental Health ServicesAdministrationCenter for Substance Abuse Prevention

ContentsSystem Review Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Prevention System Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Prevention System Organization and Implementation. . . . . . . . . . . . . . . . . . . . . . . 1Substance Abuse Needs Assessment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Workforce Development and Capacity Building. . . . . . . . . . . . . . . . . . . . . . . . . 16State Strategic Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Implementation—Compliance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Implementation—Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25State Policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Synar Program Development, Organization, Compliance, and Support. . . . . . . . . 29Synar Program Development and Organization. . . . . . . . . . . . . . . . . . . . . . . . . . 29Description of Trends in New Jersey’s Retailer Violation Rate and OtherTobacco Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Summary of Synar Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Appendix A: System Review Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Appendix B: Participant List From the System Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Appendix C: Sources of Information Reviewed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Appendix D: Summary of New Jersey’s Estimated FFY 2011 and PlannedFFY 2012 Prevention and Synar Budgets . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Appendix E: SSA Organizational Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Appendix F: Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

System Review SummarySystem Review SummaryThe Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act (P.L. 102-321) enactedby Congress in July 1992 authorized the SubstanceAbuse Prevention and Treatment Block Grant(SABG) administered by the Substance Abuse andMental Health Services Administration (SAMHSA).SAMHSA’s Center for Substance Abuse Prevention (CSAP) is charged with providing policy andprogram guidance to help States1 use and report onthe 20-percent primary prevention set-aside of theSABG. CSAP is committed to providing support andguidance for advancing Single State Authority (SSA)substance abuse prevention systems through technical assistance (TA), expert panel meetings, nationaland regional conferences, training, videos, guidancedocuments, and other products.The review included an analysis of the system reviewfindings (appendix A). The findings identify potentialareas of capacity and infrastructure developmentthat could further enhance the New Jersey preventionsystem and Synar program, either through Statesupported efforts or through TA requested from CSAP.In addition to appendix A, which details New Jersey’ssuccesses and challenges and maps out next steps,the System Review Report contains: A list of participants from the system review(appendix B) A list of New Jersey’s prevention and Synardocuments that were consulted in preparationfor the system review (appendix C) A summary of the State’s estimated Federalfiscal year (FFY) 2011 and planned FFY 2012prevention and Synar budgets (appendix D)CSAP also supports States by conducting thoroughsubstance abuse prevention system reviews to examinehow a State’s substance abuse prevention system isaddressing State needs. This report is a summary ofthe most recent CSAP system review for New Jersey. The SSA organizational charts (appendix E)The system review conducted on May 1–3, 2012,examined the progress of the New Jersey substanceabuse prevention system and Synar program inimproving the substance abuse indicators andoutcomes measured by SAMHSA’s NationalOutcome Measures (NOMs), as well as other Statespecific goals and objectives. The system review alsoinvolved detailed discussions with State participantsconcerning the State’s current capacity for usingperformance management processes to achieveand sustain outcomes measured by the NOMs andother State-specific outcomes. The System ReviewReport will help guide New Jersey in enhancing itsinfrastructure and State prevention system capacityto implement the five steps of the Strategic Prevention Framework (SPF) or other equivalent planningprocess and to achieve population-level reductionsin the incidence and prevalence of substance abuseand related problems and consequences.Prevention System Organization The abbreviations used in the System ReviewReport (appendix F).Prevention System ElementsOrganization of State Prevention SystemSSA Prevention SystemThe Division of Mental Health and Addiction Services(DMHAS) in the Department of Human Services(DHS) serves as the SSA for substance abuse aswell as the State Mental Health Authority for mentalhealth services in New Jersey. DHS also serves as theumbrella organization to the Commission for the Blindand Visually Impaired and the Divisions of the Deafand Hard of Hearing, Developmental Disabilities,Disability Services, Family Development, Medical Assistance and Health Services, and the newly transferredDivision of Aging Services. The Commissioner of DHSreports directly to the Governor. The newly appointedAssistant Commissioner of DMHAS, who is the designated SSA, reports to the Commissioner of DHS. ADeputy Director, who oversees offices responsible forIn this document, the word State refers to the 50 States and the District of Columbia and to the Territories, Pacific jurisdictions, andNative American tribe that receive SABG funds.1Federal Fiscal Year 20121

Substance Abuse Prevention and Synar System Review ReportSTRENGTHS The restructured DMHAS provides a venue forcoordinated planning and implementation ofsubstance abuse and mental health servicesacross the lifespan at both the State and thecounty levels. DMHAS is funding services that cover the State. Prevention staff within DMHAS are providingcommitted leadership for State substance abuseprevention efforts.substance abuse prevention and treatment, reports tothe Assistant Commissioner.DMHAS was created July 1, 2010, through a mergerof the former Divisions of Mental Health Services(DMHS) and Addiction Services (DAS). The restructured DMHAS provides a venue for coordinatedplanning and implementation of substance abuseand mental health services across the lifespan atboth the State and the county levels. The formerSSA Director for substance abuse now serves as theDeputy Director of DMHAS.As part of the restructure, addiction services foradolescents up to age 18 and persons ages 18 to21, as well as mental health services for persons ages18 to 21, will be transferred to the oversight of theDepartment of Children and Families (DCF) duringState fiscal year (SFY) 2013. Other changes to theoperation of the SSA include increases in communityoptions for the mentally ill to comply with the 2009Olmstead Act and a recent transfer of responsibilityfor children with developmental disabilities, substanceabuse, and mental illness—and all associatedfunds—to DCF. During the system review, DMHASstaff reported they were attending the first-ever jointmeeting between a Local Advisory Committee onAlcoholism and Drug Abuse (LACADA) and a countymental health board to show their support for serviceintegration at the county level.DMHAS has a budget of nearly 1 billion and morethan 1,400 employees. It is charged with coordina-2tion and management responsibilities for Statepsychiatric institutions and community mental healthservices. DMHAS also is charged with planning forand supporting a statewide network of communityaddictions services to prevent, treat, and supportthe recovery of people with addiction disorders. Inaddition, DMHAS is responsible for coordinating withother mental health programs and providing counseling programs for compulsive gamblers. DMHASOffice of State Hospital Management manages theState psychiatric hospitals.DMHAS is organized into multiple units. Reportingdirectly to the Assistant Commissioner are the Officesof State Hospital Management, Legal Liaison, QualityManagement, Information Technology, MedicalDirector, Human Resources, Fiscal Management andOperations, and the Deputy Director. The Office ofthe Deputy Director oversees the Offices of Prevention, Early Intervention, and Community Services(OPEICS), Treatment and Recovery Supports (OTRS),Care Management, and Research, Planning, andEvaluation (ORPE). The Deputy Director’s purview isto oversee the State’s publicly funded, communitybased system of mental health and addiction services.Its policy and supervisory functions include: Overseeing the transition of the system of careto a managed behavioral health care approachand integrating addiction and mental healthservices in primary health care settings Supervising DMHAS supportive housing opportunities, which includes expanding communityhousing opportunities, enabling many peoplewith mental illness and substance abuse to live insettings that are less restrictive than State psychiatric hospitals, and administering Federal BlockGrants for substance abuse and mental health Directing all programmatic aspects of DMHAS,including research, planning, and evaluation;workforce development; care management; mentalhealth and addiction prevention, early intervention,treatment, and recovery support services; criminaljustice; and adolescent and women’s services.New Jersey System Review

System Review SummaryDMHAS carries out its responsibilities with the adviceand counsel of a number of advisory bodies. AProfessional Advisory Committee, whose membersserve at the pleasure of the Commissioner of DHS,makes recommendations relative to substanceuse disorders and addictions to the Commissionerthrough DMHAS. Membership on the ProfessionalAdvisory Committee ranges from 15 to 30 memberswho have exhibited leadership and expertise onservices and/or advocacy issues related to substanceuse disorders and addictions. A separate AdvisoryCommittee on the Alcohol and Drug Abuse Programfor the Deaf, Hard of Hearing, and Disabled advisesDMHAS on the operation of an alcohol and drugabuse program for persons who are deaf, hard ofhearing, and disabled with a specific funding sourcethat is legislated.A Citizens Advisory Council focused on addictionissues serves as a resource to DMHAS as it consistsof consumers of addiction services and individualsin recovery from substance abuse in fulfillment ofDMHAS goal to develop and sustain a system ofclient-centered care. DMHAS also has a stakeholdersteering committee that was created to guide healthcare reform and the transition to a managed behavioral health system, which includes an emphasis onprevention. DMHAS also hosts the Mental HealthPlanning Council (MHPC), which is federally andState legislated. Prior to the merger of the divisions, the SSA had a seat on the council to adviseon substance abuse-related topics. As part of themerger, in February 2012 the MHPC issued a call formembers to add more members with addiction experience. As a result, addiction representation fromsubstance abuse providers and persons in recoveryhas increased. The MHPC committee also partnerswith the New Jersey Mental Health Stigma Council,which was created by Executive Order in 2004, totake a leadership and advisory role on mental healthpromotion and mental illness prevention. Theirefforts include cosponsoring a public awarenesscampaign called “A Community Effort.”Federal Fiscal Year 2012DMHAS also supports the planning efforts of otheradvisory bodies. Most recently, it responded to aFebruary 2012 call for members by New Jersey’sMental Health Planning Council, which was interested in adding more members with experience andexpertise in addiction. As a result, DMHAS now hasa seat on the Planning Council and will representsubstance abuse addiction and prevention in thecouncil’s efforts.OPEICS comprises one statewide and three regionaloffices that are primarily responsible for oversightof the community behavioral health system ofcare. OPEICS negotiates contracts with communityproviders for the provision of prevention and earlyintervention services, as well as ambulatory outpatient and inpatient behavioral health care. OPEICSalso participates in agency reviews and assistsconsumers in navigating the service system.The State’s representative to the National Prevention Network (NPN) reports to the Assistant DivisionDirector of OPEICS, who reports to the DeputyDirector of DMHAS. The NPN representative currentlysupervises six staff: an administrative assistant; threeprogram officers; and two consumer advocate positions, one for mental health and one for addictionservices. The NPN representative is responsible foroversight of the primary prevention set-aside from theSABG, early intervention services, a Strategic Prevention Framework State Incentive Grant (SPF SIG), anda State Prevention Enhancement (SPE) grant fromSAMHSA; both grants will end in September 2012.New Jersey was awarded a SPF SIG in October 2006and received a 1-year no-cost extension from CSAPto extend funding an additional year.The prevention unit monitors more than 14 millionin funding to 52 contracted provider agencies and 17coalitions that offer prevention programming and facilitate environmental change in all 21 counties of theState. The State representative to the NPN also servesas the County Liaison for DMHAS, and in this rolecollaborates with 21 County Alcohol and Drug AbuseDirectors and other county and local government3

Substance Abuse Prevention and Synar System Review Reportentities in the administration of prevention and earlyintervention services. A strength noted by the CSAPsystem review team was the stable leadership displayedfor substance abuse prevention and treatment effortsduring a time of agency restructuring. Positioning theprevious SSA Director to maintain an active role andkeeping the NPN representative within DMHAS prevention unit and the Synar Coordinator in the DeputyDirector’s office allowed for stable and consistentleadership with regard to SABG administration.ORPE is responsible for updating New Jersey’sEpidemiological Profiles in conjunction with the StateEpidemiological Outcomes Work Group (SEOW).ORPE’s responsibilities include overseeing theadministration of New Jersey’s Middle and HighSchool Risk and Protective Factors Surveys, NewJersey’s Household Survey on Drug Use and Health,and individual and family program-level evaluations. ORPE contracts out certain data collectionand survey functions to Rutgers University, the StateUniversity of New Jersey.DMHAS partners with the Department of Law andPublic Safety (DLPS) on efforts to reduce underagedrinking and promote responsible drinking amongadults. Among these efforts are public serviceannouncements, training, driving under the influence (DUI) programs, and college and high schoolprograms. DLPS is the administering agency for NewJersey’s Enforcing Underage Drinking Laws (EUDL)Block Grant funds from the Federal Office of JuvenileJustice and Delinquency Prevention (OJJDP). Thispartnership is new since the 2009 CSAP system review.DMHAS also works with the Office of the AttorneyGeneral to support a gang awareness initiative.DMHAS partners with the Department of Health andSenior Services (DHSS) and Medicaid. The partnership with DHSS supports programming for AIDS andtuberculosis prevention, family health services, andfetal alcohol spectrum disorders (FASD). DMHASpartners with Medicaid on waiver programs andstrategies to assist health maintenance organizationsand others in establishing health homes (long-term4care facilities). In addition, DMHAS has assistedprograms funded by SAMHSA grants and public–private partnerships to establish health homes andfederally qualified health centers. DMHAS furtherparticipates on a task force developed by the NewJersey Association of Mental Health and AddictionAgencies and the New Jersey Primary Care Association to work on integration across discipline issues.DMHAS formed the Primary Care and BehavioralHealth Care Task Force to examine the specificcausative factors for early mortality, most of whichare related to potentially preventable risk factorsthat shorten life expectancy (e.g., smoking, lack ofexercise, poor nutrition, substance use, exposureto communicable diseases). The main goal of thistask force is to increase access to primary care andimprove collaboration between mental health agencies and health care providers.SSA Approach to PreventionAt the time of the 2009 system review, New Jersey’sSABG funds were primarily supporting individuallyfocused strategies targeted at indicated populations(i.e., groups of individuals identified as exhibitingearly warning signs of problems, such as experimentation with substance abuse or instances of intenseuse). The CSAP review team encouraged DMHASto adopt a more comprehensive approach andbroaden its focus to include not only other populations but also environmental strategies in order toachieve desired outcomes at the population level.The 2012 system review team found that DMHAShas since demonstrated its commitment to a morecomprehensive prevention approach by significantlyreallocating SABG funds to support environmental aswell as individual strategies.In addition, the 2009 system review team noted thatalthough DMHAS was using data for preventionplanning, the division had not fully operationalizedSAMHSA’s SPF to infuse performance managementprinciples throughout its prevention system operations. During the 2012 system review, team membersnoted that New Jersey has since fully adopted theNew Jersey System Review

System Review SummarySPF and is using it to guide prevention efforts at boththe State and the county levels. DMHAS used theSPF as an organizing framework for the most recentrequest for proposals (RFP) it issued to allocate themajority of SABG funds. During the system review,the Deputy Director remarked that DMHAS alsointends to adopt the SPF to guide mental health andtreatment planning as well.According to the mission and vision statementsthat DMHAS staff discussed during the systemreview, DMHAS “seeks to institutionalize a systematic approach to prevention that synthesizes andstrengthens knowledge from multiple disciplines andaddresses substance abuse and its related societalconcerns based upon the following tenants:STRENGTHS DMHAS has demonstrated its commitment to amore comprehensive prevention approach bysignificantly reallocating SABG funds to supportenvironmental as well as individual strategies. New Jersey has fully adopted the SPF and is usingit to guide prevention efforts at both the State andthe county levels.CHALLENGES The CSAP system review team was unable to finda written definition of primary prevention that hasbeen adopted by DMHAS to guide the SABGprevention system. Health is more than healthcare or the absenceof injury or disease.recovery, a sense of personal responsibility and ameaningful role in the community.” The environment in which we live profoundlyshapes our health and wellbeing.DMHAS staff also noted that the agency’s work is“driven by the following values shared by Division staffand partner agencies: person-centered and persondirected services; the strength of consumers, theirfamilies and friends as a foundation for recovery; thecommitment of its partner agencies to professionalism,diversity, hope and positive outcomes; evidence-basedpractices that are consumer-informed and peer-led;and effective and efficient services.” Prevention requires commitment and dedication. Prevention offers hope by saving lives andmoney.”In accordance with its mission, DMHAS worksin partnership with consumers, family members,providers, and other stakeholders to promote wellness and recovery for individuals with mental illness,substance use disorders, or co-occurring disordersthrough a continuum of prevention, early intervention, treatment, and recovery services delivered by aculturally competent and well-trained workforce.DMHAS vision, as presented by SSA staff, is “anintegrated mental health and substance abuseservice system that provides a continuum of prevention, treatment, and recovery supports to residentsof New Jersey who have, or are at risk of, mentalhealth, addictions or co-occurring disorders. At anypoint of entry the service system will provide promptand easy access to appropriate and effective personcentered, culturally competent services delivered by awelcoming and well trained work force. Consumerswill be given the tools to achieve wellness andFederal Fiscal Year 2012DMHAS prevention framework, which is outlined in a2011 strategic plan, specifies that DMHAS “seeks tofund programs and strategies that: Apply a comprehensive strategy across diversedisciplines, populations, and issues Respond to and address national priorities anddirectives as identified by Federal funders Advance changes in social norms and systems Advocate for solutions that concurrently have animpact on multiple problems Research, synthesize, and disseminate information that builds on successes Inspire a broad vision and fresh approach thatincorporates a variety of strategies5

Substance Abuse Prevention and Synar System Review Report Are responsive to, and reflective of, communityneeds, including culturally diverse communitiesand individuals with special needs Acknowledge the importance of a comprehensive approach to prevention that includes bothindividual and family-focused, evidence-basedcurricula as well as environmental approaches Integrate a community and policy orientationinto prevention practice that utilizes a multidimensional approach to risk and protectivefactors to have an impact on multiple problemsand communities Expand the field by encouraging new participants, dialogue, and explorations.”The CSAP system review team was unable to find awritten definition of primary prevention that has beenadopted by DMHAS to guide the SABG preventionsystem. Although references to the risk and protective factor framework and the Institute of Medicine(IOM) model appear in State documents, the lackof a formal State definition of prevention appears tocontribute to a lack of clarity for some subrecipients asto what constitutes primary substance abuse prevention. DMHAS recent restructure and emphasis on theintegration of substance abuse and mental healthservices might add to a lack of clarity at both the Stateand the subrecipient levels as to where the boundariesfor primary prevention services are drawn.DMHAS might benefit from developing a conceptualframework for prevention that can consistentlyguide SABG-funded primary prevention serviceswithin an integrated behavioral health system. Theframework should include a written definition forprimary prevention that can clearly distinguish activities intended to prevent or delay onset of substanceabuse from those that are intended for early intervention, treatment, or relapse prevention purposes.Multiagency/State Prevention SystemDuring the 2006 and 2009 system reviews, CSAPdocumented New Jersey’s struggle to establishunified direction and leadership for the State’smany substance abuse prevention programs and6authorities. The 2012 CSAP review team noted,however, that DMHAS has made significant progressin strengthening and expanding its partnerships atthe State level to better unify prevention efforts. Inaddition to the new partnership with DLPS, otheraccomplishments in this area are 1) coordinatingwith the Governor’s Council on Alcoholism and DrugAbuse (GCADA), 2) forming a multiagency PreventionUnification committee to streamline and coordinateneeds assessment processes at the local level andreduce duplication and facilitate coordination, and 3)expanding the membership of the SEOW.GCADA was established by the New JerseyLegislature as an independent body charged withconducting research and generating public awareness of substance abuse. Also, GCADA is chargedwith reviewing, coordinating, and evaluating theState’s efforts to prevent and treat alcoholism anddrug abuse. The council is further responsiblefor preparing a State plan on substance abuse,advising the Governor on substance abuse funding,supporting employee assistance and other programs,collecting data as necessary to carry out its responsibilities, and reviewing and coordinating all Statedepartments’ efforts in regard to substance abuse.Accordingly, GCADA has broad powers to administer and set policy for substance abuse programs.GCADA has 26 members, 14 of whom are publicmembers appointed by the Governor or legislative leadership. The remaining members representState departments, including DMHAS. The councilmaintains the following standing subcommittees:Planning, Interdepartmental Advisory Panel, Veteransand Military Families, Municipal Alliance Prevention,Criminal Juvenile Justice, Legislative, and Treatment.GCADA has undergone some changes in leadershiprecently. The Governor appointed a new executivedirector and several new public members in January2010, and a new staffing pattern resulted in thehiring of two more staff. In addition, an AdvisoryPanel of national experts, including a representative from the Community Anti-Drug Coalitions ofNew Jersey System Review

System Review SummaryAmerica (CADCA), is being convened to assist thecouncil carry out its duties.GCADA also administers the State funds earmarkedfor the Municipal Alliance Network, a volunteer-drivennetwork of 402 grassroots coalitions encompassingmore than 560 municipalities in New Jersey. Municipal Alliance Network members—many of whom havebeen trained in the SPF—design and implement local,public prevention public activities and mobilize forenvironmental prevention approaches.The Municipal Alliance Network also helps advanceGCADA advocacy objective by educating legislatorsabout the benefits of using evidence-based strategiesto prevent alcohol, tobacco, and other drug (ATOD)problems among the residents of New Jersey. Theauthority of GCADA, combined with the coverageand active advocacy of the Municipal AllianceNetwork, positions New Jersey well to leverage fundsacross sectors and advance positive public policiesat the State and municipal levels.The Partnership for a Drug-Free New Jersey (PDFNJ)is funded by DMHAS and was founded in 1992 as“a state anti-drug alliance to localize, strengthen,and deepen drug-prevention media efforts.”PDFNJ has gained 10,000 in donated media andcoordinates its campaign efforts with the municipalalliances, regional coalitions, and County Alcoholand Drug Coordinators. DMHAS contracts with thePDFNJ for its work in environmental strategies.At the time of the 2009 system review, the CSAPreview team noted the roles of GCADA, theMunicipal Alliance Network, the Prevention Coordinating Council (a subcommittee of the Governor’sOversight Committee for Safe Streets and Neighborhoods), the SPF-SIG Advisory Council, and the SSAwere not clear, and coordination was sporadic.Complicating matters, DMHAS’s relationship withGCADA was strained. Since this time, the PreventionCoordinating Council and SPF-SIG Advisory Councilare no longer active and DMHAS and GCADA bothreported working together to unify prevention efforts.Federal Fiscal Year 2012STRENGTHS DMHAS has made significant progress instrengthening and expanding its partnerships atthe State level to better unify prevention efforts. New Jersey’s GCADA and Municipal Allianceprovide a means of leveraging funds andadvancing policies at the State and municipallevels. New Jersey’s GCADA funds a Municipal AllianceNetwork to implement prevention efforts usingthe SPF. The State uses a process it calls PreventionUnification to improve coordination of substanceabuse prevention across agencies at all levels. DMHAS has been able to broaden the missionof the SEOW and integrate it into existing Stateinfrastructure. The widespread adoption of the SPF, along withPrevention Unification, in New Jersey has createdan avenue for DMHAS and its diverse partners touse a common language when working towardshared goals.During the 2012 system review, a representativefrom GCADA noted the council’s intent to modelcoordinated planning at the State level beforeexpecting this at the county and municipal levels.Both DMHAS and GCADA require coordinationbetween the regional coalitions and the municipalalliances in their service areas to maximize prevention ef

how a State's substance abuse prevention system is addressing State needs . This report is a summary of the most recent CSAP system review for New Jersey . The system review conducted on May 1-3, 2012, examined the progress of the New Jersey substance abuse prevention system and Synar program in improving the substance abuse indicators and

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