NIATx principle #4: Getting ideas...from outside the country

June 26, 2014

Kim Johnson
NIATx Deputy Director
ATTC Co-Director (WI)

Those of you on the NIATx Facebook page know that I recently went to St. Petersburg, Russia, as part of a team put together by Stanley StreetTreatment and Resources (SSTAR), a treatment program in Massachusetts and Rhode Island. We were there working on a white paper about disseminating mobile health applications in Russia and the United States. While we were there, we presented at a conference with our Russian colleagues on the possible uses of mobile applications with people with behavioral disorders.

We toured a psychiatric hospital, three addiction treatment sites, and a couple of mobile outreach vans. What was most interesting to me was how much the treatment systems are alike. What seem like differences sometimes are really issues of translation. For example, the people that do the work of counselors and social workers in the U.S. are called psychologists in Russia, and the people they call social workers are people we would call recovery support specialists or something like that. Sometimes the language barriers were the biggest obstacle to seeing how much alike the two systems are.

One of the mobile vans used
for harm reduction and to
engage high-risk drug users.

But, I’m guessing you are more interested in what is different. So, given that language may have clouded my understanding, here are things that I thought were interesting differences.

First, the substance abuse providers envy our medical model! They do not have access to buprenorphine or methadone and have only begun to use Vivitrol. So while we lament the low utilization of medication and study mechanisms for increasing access to medication, they think we look good in comparison.

What I admired about their system was the strong focus on rehabilitation. Both their mental health system and substance abuse treatment system work with patients to help them develop skills and interests so that they can lead fuller lives through work and recreation.

Waiting area in a St. Petersburg
treatment facility. Look familiar?

The day we visited two addiction treatment facilities, most of the patients were participating in a citywide sports tournament, where the patients from the 18 treatment districts competed against each other in sports like soccer. What a great idea! Wouldn’t it be fun if you could organize a competition with other treatment programs in your area? Even if it was a bowling league or something where you didn’t have to worry so much about liability and injuries.

The Russian system does not have our version of confidentiality. If you want privacy or confidential treatment, you can pay for treatment yourself, and one of the sites we visited had both private pay and public patients. The driver’s license issue is interesting. In Russia, if you enter the public addiction treatment system, you lose your driver’s license for three years and may have repercussions at work. I think most see the potential loss of a driving license as a huge barrier to treatment entry. And it may be, because I didn’t discuss it with any patients. But our hosts did not see it that way. In Russia, in order to initially obtain a driving license, you have to have a sign off from a Narcologist (Addictionologist), a psychiatrist, a neurologist, and an eye doctor. One of the sites we visited primarily served people trying to get their licenses, so they did brief assessments and that was it. Since proving you do not a have a substance use or psychiatric disorder that would inhibit your ability to drive is part of getting your license, in the Russian mind losing it for having a substance use problem seems natural, not restrictive. When we talked about Russia treating driving as a privilege the response was “Nyet!” They didn’t see it that way. They were astounded by how easy it is to get a driver’s license here and how difficult it is to lose it (especially here in Wisconsin, the only state in the nation where a first time DUI is not a criminal offense!)
We had some time for sightseeing. One
of our stops was at the summer
palace of Peter the Great, Peterhof.

I wish we had more opportunity for international exchanges. In Europe, geographic proximity allows for easier exchange between countries, but how many of us have even been to a program in another state, let alone another country? Anyone else been to Russia and want to comment on their impressions? How about other countries? Think of the NIATx principle “Get ideas from outside the organization or field” and extend that to treatment systems in other countries. What do they do that would be fun to implement here? 

Kimberly Johnson, NIATx Deputy Director and ATTC Network Coordinating Office Co-Director served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health. 

States expanding access to technology for addiction treatment

June 11, 2014

Mike Boyle, Associate Researcher
University of  Wisconsin-Madison

For the past 18 months, NIATx, in collaboration with JBS International, has been involved in a SAMHSA-funded project to help a group of five states (Iowa, Maryland, Massachusetts, Oklahoma, and South Carolina) and one county (San Mateo County, California) identify and implement new communication technologies for addressing substance use. The technologies focus on interventions for screening and brief intervention, treatment, and ongoing recovery support. It has been a great learning experience for the project team.

An important step in this process was identifying what technology platforms exist for addressing substance use. Also, the states wanted to know if research supports the use of the interventions. We found tremendous progress over the last decade in the development of new technology for behavioral health interventions. Several of the technologies have been subjected to extensive clinical trials with a variety of populations. And research  results indicate that interventions delivered via technology have equal or better results than services provided solely by a clinician.

Many of these technologies serve as “clinician extenders,” allowing for more efficient delivery of services. Interventions delivered through computers, smartphones, and tablets allow anytime access to treatment modules and/or recovery supports. These programs can provide reports to the clinician, allowing for monitoring of progress, adaptive treatment planning, and intervention as needed. They have the potential for increasing access by removing barriers to services and may lower the cost per episode of care.

The project also identified challenges and barriers to implementing the technologies. The biggest issue is how to reimburse providers for the services. The existing fee-for-service payment system could be used for telephone, telemedicine, or computer services such as “virtual worlds,” where a clinician delivers services directly to a patient in real time.

Payment mechanisms such as case rates or episode of care payments could work for services that patients can access on their own via the Internet. A case rate or episode of care payment can capture the organizational costs of using the technology, such as licensing or purchasing fees, training and support time, and monitoring time by clinicians.

Other challenges include competing priorities for the state and providers, incorporating the technology into the existing workflow, and potential resistance to the changes required.

Please join us for the free webinar on Tuesday, June 17 to find out more about these innovative technologies and what states are doing to implement them.

Adopting Innovative Technology to Support Recovery

Tuesday, June 17

1:00 ET/12:00 noon CT/11:00am MT/10am PT

Michael Boyle is an Associate Researcher at the Center for Health Enhancement Systems Studies at the University of Wisconsin–Madison and provides consulting services. He was formerly President and CEO of Fayette Companies, a behavioral health organization located in Peoria, Illinois, and is the Director of the Behavioral Health Recovery Management project. Boyle recently served on a National Quality Forum committee charged with defining an episode of continuing care for a substance abuse treatment encounter. He has authored several articles and book chapters. His current activities include integrating mental health, addiction and primary care services, implementing evidence-based clinical practices within recovery oriented systems of care, and exploring technologies to support behavioral health treatment and recovery.

Announcing the new!

May 2014

Maureen Fitzgerald, Editor
ATTC Network

Just before we launched the new, improved, we invited people to take a sneak peak and give us some feedback. We wanted to make sure that the new site is doing what it’s been designed to do:

Make it easier for people to find what they’re looking for.

Because, we’ll admit—and you told us—it was getting hard to find things on the previous site.

And what better time to revamp our site than our 20th anniversary as a national resource for the addiction treatment and recovery services community? (Check out the History of the Network on the new site—it has a cool timeline feature that highlights key accomplishments of our first 20 years.)  

And what did our beta-testers have to say about the new site?

“User-friendly” and “Easy to navigate” were the two terms our beta testers used most frequently, often with exclamation points.

In particular, they like new site’s clean lines and the way the home page points users to some of the most popular ATTC resources: 

One beta tester was happy to discover the ATTC/NIATx Service Improvement Blog, (thank you!) now easily accessible from the Communications tab on the home page, along with the Addiction Science Made Easy research briefs and our e-publications, the ATTC Messenger and The Bridge.

Another beta tester appreciated that the role of the Network and “technology transfer” are both defined in a prominent spots on the new site.

“Gorgeous,” said one beta-tester. “A home run!” said another.
To make the new site as lean and clean as possible, some content had to go. You know how some professional organizers advise discarding or donating anything in your closet that you haven’t worn in a year? The web redesign applied a similar principle in taking inventory of the previous website’s pages. Many of them had not been accessed in several years, or had information that was out of date. 

One of the many things that we’re really excited about for the new site is that it’s optimized for mobile devices. That means that the pages change size for easy viewing on a tablet or a smartphone. While most of our beta-testers viewed this site on a desktop or a laptop, we anticipate that many more people will be using mobile devices to access in the near future.

Creating the new site with mobile-device users in mind helped the designers stay focused on the best way to present key pieces of information that you'll be looking for – in a restricted amount of screen space. They applied the same principle in using more white spaceto make it easier to click content, and to reduce the number of clicks required to get to desired content.

Meanwhile, back at the home page

You’ll see three “slider” images, one each for, Recovery Month, and the NIDA/SAMHSA Blending Initiative. We selected these for the website’s “marquee” to highlight their importance to the ATTC Network mission. (By the way, Recovery Month is celebrating 25 years this year--be sure to show your support by posting your Recovery Month events on the site.) We’ll be changing the slider images regularly so you won’t get bored: stay tuned for a new series coming up later this year.

Now that we’ve given you a bit of info on the new site, we hope you’ll take some time to explore it, if you haven’t already. And let us know if you find any glitches. But we mostly want to know that it’s working for you…and that you can find what you’re looking for.


Send your comments on the new website to Dave Gustafson, Jr., at 

P.S. Visit the ATTC Network Facebook and Twitter sites to find out how you could win a $25.00 Amazon Gift Card by posting about!