Last-minute gift idea: Mindfulness

December 22, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

The holidays can be difficult for people in recovery and keeping the season stress-free for everyone can be tricky.  UW Health Psychologist Dr. Shilagh Mirgain  offers some great suggestions for reducing stress in this post from the UW Health E-Newsletter, Give the Gift of Mindfulness this Holiday.

New Resources from the Center of Excellence on Racial and Ethnic Minority YMSM + LGBT Populations

December 17, 2015

Brandy Oeser, MPH
Project Director
YMSM-LGBT Center of Excellence

The project is funded by SAMHSA as a supplement to ATTC Network and represents a collaboration between three ATTC Centers: Pacific Southwest ATTC, the National American Indian and Alaska Native ATTC, and the Northeast and Caribbean ATTC.  The National Hispanic and Latino ATTC and Charles R. Drew University of Medicine and Science are also lending their expertise in working with racial and ethnic minorities. Charles R. Drew University is a Los Angeles-based Historically Black Graduate Institute and charter member of the Hispanic-Serving Health Professional Schools.

A Mobile App for Integrating Addiction Treatment and Primary Care: Seva

December 11, 2015
Andrew Quanbeck, Ph.D.
Associate Scientist
Center for Health Enhancement Systems Studies/NIATx

Technology, evidence-based practices, and health care integration are important issues in addiction treatment today. A research project underway at The Center for Health Enhancement Systems Studies is combining all three.

With funding from the National Institute on Drug Abuse, we’re studying how to implement an evidence-based mobile intervention for addiction treatment into primary care. This research is another example of our increasing focus on the best ways to implement evidence-based practices and technologies in healthcare. The integrated system we have developed is called Seva (say’-va), the a Sanskrit word for “selfless caring." 

We'll study the organizational change resulting from implementing Seva in three federally qualified health centers: Access Community Health Center in Madison, Wisconsin; Partnership Health Center in Missoula, Montana, and the Institute for Family Health in Bronx, New York.  

What's it like to be your customer?

Maureen Fitzgerald
NIATx, Great Lakes ATTC

NIATx coaches share their favorite walk-through stories

Understanding and involving the customer is the first and most important of the NIATx principles, and the walk-through is the most crucial tool for accomplishing this. The walk-through allows you to see your organization from your customers’ point of view. This simple exercise is also part of the pre-work for the NIATx Change Leader Academy to help participants focus on the customer experience.

NIATX coaches have guided many organizations through the walk-through exercise. Here we share some of their favorite walk-through stories:

Doors locked during business hours? 

“In 2005 I did a walk-through in several programs. One of the programs on my list was an outpatient and medication-assisted treatment program. Both of the doors I tried at the building’s entrance were locked. Eventually I rang the bell and someone answered, unlocked the door, and let me in. My thought was “If is this really a legitimate business, why are the doors locked during business hours?” The results of that walk-through saw lots of changes in the organization. The first one was unlocking the doors, which the board of directors had resisted for years. Other changes including having a live person answer the phone, improving the assessment process, starting walk-in assessments, and many other process improvements. The program has continued using the NIATx model for the last 10 years: just recently they conducted a walk-through to look at changing medication dispensing operations to address client engagement.”
Janet Zwick, NIATx Coach
President, Zwick Healthcare Consultants

The walk-through: a paperwork reduction act

In all of my experience doing walk-throughs, paperwork is almost always noted as something to fix—a showstopper for most everyone. Most everyone works on trimming it down, eliminating redundancy, developing checklists, and dispensing sheets when it is necessary to complete for diagnosis, payment etc. This turns out to be a vast improvement over handing patients an overwhelming packet that has to be completed before any service can start.”
Amy McIlvaine, NIATx Coach
Educational Services Director, NIATx

From skeptic to instant convert in just one phone call 

“I was leading a Change Leader Academy and an executive director of an SUD treatment organization had arrived without having completed a “walk-through” of a customer process at her agency, prior to attending the CLA. During a break, I suggested she do a quick walk-through by trying to schedule an appointment over the phone at her agency.

She said, “I will simply end up talking to our receptionist--is that really beneficial?”

I said, “Tell her you are role-playing a customer and would like to set up an appointment.” She finally agreed and went out in the hallway to make the call.

Five minutes later she came back with her eyes wide and a surprised look on her face. She said, "I called the main office line that is used by the public, but the receptionist was on another call so my call was bumped to voicemail, which is what should have happened. The problem is the voicemail I was sent to belongs to a staff person who left our organization three months ago!"

This phone line was one neither she nor her staff utilized very often, so no one knew what the customer was experiencing. This executive director was an instant convert to the value of the walk-through and the need to continually check your processes from the perspective of your customers.”
Scott Gatzke,
NIATx Coach
Elder Tree Dissemination Manager

Found the building. How do I get in?

“The walk-though creates an invaluable new lens through which to see the familiar, thereby opening up new possibilities for improvement. Years ago I did a walk-through at a residential program—a program run by my agency that I had visited dozens of times—and quickly learned that I had no idea how to get into the building.

The simple act of changing my perspective to one of a consumer who needed information that was not available resulted in a clear and quick understanding of the need for improved signage that would direct customers to the right door with clear labels for the bell and intercom system on that door. This was quickly and easily fixed after the walk-through.”
Mat Roosa, NIATx Coach
Director of Planning & Quality Improvement
Onondaga County, Syracuse NY.

From intake to the emergency room

“I think one of the most amazing walk-through stories I’d ever heard was the one done by a drug court. The staff doing the walk-through went to great lengths to walk in the customer’s shoes as an offender/patient. As it thankfully turned out this program, among an extensive list of steps and assessments, measured blood pressure as part of the normal intake procedures. The staff person pretending to be an offender/patient was so overcome by anxiety and discomfort during the walk-through that her blood pressure skyrocketed—it was so high that she was rushed to the hospital. The organization then realized the high-stress environment that the clients were being exposed to throughout their enrollment was not productive and visibly harmful.”
Mark Zehner, NIATx Coach
Associate Researcher
Center for Health Enhancement Systems Studies  

Do you have a favorite walk-through story that opened your eyes to your customers' experience? Share your story in the comment section below!

Medicines for Life: Native American Culture, Spirituality, and Healing Practices

December 1, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office

National Native American Indian Heritage month, November, celebrates Native American communities and the countless ways they've enriched our country and the world. But this month is also a time to think about attitudes and perceptions. The November webinar, "Native American Culture, Spirituality, and Healing Practices," presented by the American Indian and Alaska Native National Focus Area ATTC in honor of National American Indian Heritage month sure gave me a lot tot think about.

The webinar featured presentations from Dr. Clyde McCoy, PhD, Eastern Cherokee, Raymond Slick, MSW, Meskwaki Tribal Nation, and Sean A. Bear 1st, BA Meskwaki Tribal Nation. Sean Bear is also the Senior Behavioral Health and Training Coordinator for the AI/AN ATTC. The webinar was recorded so you can view it anytime if you missed the live session.

Celebrating Native American Indian Heritage Month

November 13, 2015
Lena Thompson, MPH
Research Associate
National American Indian and Alaska Native ATTC

November marks the celebration of Native American Indian Heritage Month, a time to honor the many achievements and contributions made by a group of people who are rising above grief and trauma. Within the American Indian culture are many different practices, legends, and people to celebrate. While flipping through American Indian Myths and Legends, a book of American Indian stories selected and edited by Richard Erdoes and Alfonso Ortiz, I came across a Cherokee tale, reported by James Mooney in the 1890s. The tale is of how Grandmother Spider stole the sun.

UNITE to Face Addiction: Celebrating Recovery and Fighting Status Quo

November 10, 2015
Dr. Gary Fisher
Founder, Center for the Application of Substance Use Technologies (CASAT)
University of Nevada Reno
Former Principal Investigator and Director, Mountain West ATTC 

UNITE to Face Addiction Rally concert-goers.
Photo: UNITE to Face Addiction
For those of us in long-term recovery, the UNITE to Face Addiction Rally was powerful on so many levels. On October 4, 2015, an estimated 30,000 recovering individuals and our allies gathered at The Mall in Washington, D.C. The speakers included well-known public figures such as U.S. Surgeon General Dr. Vivek Murthy, Director of National Drug Control Policy Michael Botticelli, former Congressman Patrick Kennedy, Senator Edward Markey, and Dr. Oz; public figures affected by family members’ addiction, like Allison Janney, whose brother died of an overdose; and “ordinary” recovering folks like those in the audience. Recovering musicians provided incredible entertainment:  Joe Walsh, Steven Tyler, Sheryl Crow, and Paul Williams.

UNITE to Face Addiction: I am Not Alone

October 29, 2015
Brendan Gault
University of Nevada Reno Recovery & Prevention Community

Brendan (second from left) in front of the White House
with fellow students from NRAP: 
Alicia M., Dan S., and Claire C.
I am a person in recovery from a substance use disorder and a member of the University of Nevada, Reno’s Recovery & PreventionCommunity (NRAP). I was blessed with the opportunity to attend the UNITE to Face Addiction Rally in our nation’s capital.
     UNITE to Face Addiction was an attempt to raise awareness about the addiction crisis facing our country. The object of the rally, which was held on the National Mall, was to show that there really are people, like me, who are affected and, more importantly, recovering from the disease of addiction.

"Goomers" and Frequent Flyers: Adjusting Attitudes

October 22, 2015

Louise Haynes, MSW
Medical University of South Carolina

Have you ever heard the term "Goomer?"  It's the acronym for "Get out of my emergency room" and was the 1970s term for a person who would be later called a "frequent flyer"--someone who was seen repeatedly in hospital emergency departments. The person often had a mental illness, substance use disorder, or both. "Goomers" were reviled by medical residents working in emergency rooms because they required lots of time and attention, and visit after visit, they never seemed to get any better. For many physicians, exposure and training in the treatment of addiction has consisted of caring for the down-and-out emergency room patient who barely survived from crisis to crisis. Physicians-in-training rarely, if ever, saw substance abusing patients get better, and their knowledge of what we know as recovery was non-existent.

Is that still true today?


Weapons of Mass Ridiculousness: Stomping out Teen Smoking

October 16, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

This month's ATTC Network iTraining (Thursday, October 22, 2:00-3:30 ET) features an overview of SAMHSA's 2014 National Survey on Drug Use and Health results. Jonaki Bose, Chief of the Populations Survey Branch at SAMHSA's Center for Behavioral Health Statistics and Quality, will give a "big picture" of the results and also discuss the most significant changes since last year's survey.

Register for the webinar here.

One promising result in this year's survey is the decrease in tobacco use among teens. I checked in with Dr. Bruce Christiansen, tobacco researcher at the University of Wisconsin Center for Tobacco Research and Intervention, on what factors might be contributing to that trend.

A variety of things, says Dr. Christiansen.

UNITE to Face Addiction: This is just the beginning

October 12, 2015
Kim Johnson, PhD
Co-Director, ATTC Network Coordinating Office
Deputy Director, NIATx

Two days before the UNITE to Face Addiction rally, forecasters were predicting that Hurricane Joaquin would hit the East Coast by the weekend. Everyone kept saying that the hurricane was only a metaphor; that people in recovery had been to hell and back and Hurricane Joaquin didn't scare them.

Thankfully, Joaquin changed direction at the last minute and headed out to sea. Talk about a sea change. We didn't need to prove anything, as thousands of people gathered under overcast skies on October 5 to celebrate recovery on the National Mall.

UNITE to Face Addiction: "Our AIDS Quilt Moment"

September 29, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

See you at the mall this Sunday?

That's the National Mall in D.C., of course, for UNITE to Face Addiction!  The ATTC Network will be there--will you?

" advocacy movement that's different from anything we've ever done..."
UNITE to Face Addiction

Look for us in tee-shirts with the logo specially designed for this historic event by our talented colleague Mike Wilhelm of the National Rural and Frontier ATTC:
And a big thank you to the Central East ATTC for providing the tee shirts!
UNITE to Face Addiction brings together a diverse group of people to raise awareness about the impact of addiction. Along with celebrities and some of pop music's favorite performers (Joe Walsh, Steven Tyler, Aloe Blacc, Sheryl Crow, Jason Isbell, the Fray and others), elected officials, and inspirational speakers, more than 75 ATTCers (at last count) will be there to send a unified message and stand up for recovery.

This Could Change Everything

September 2015
Kim Johnson, PhD
Co-Director, ATTC Network Coordinating Office
Deputy Director, NIATx

I started to write this blog post with the “Chinese curse”:  “May you live in interesting times.”

And then found myself spending ten minutes Googling the source of the curse.

You know how that goes, right? You look up something that you think will take 10 seconds, and 10 minutes later you stop yourself from going from link to link to link because the fascinating non-answer to your question leads to more sites with more information. You might never get the straightforward answer to your question, but you get more information on the subject than you ever thought you wanted to know. We live in times where information is abundant, but the process of sorting through it all takes more of our time and energy than we could ever have imagined 25 years ago.

Linking Hispanics and Latinos to Health Care: Promotora Programs

September 15, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

September 15-October 15 2015 marks National Hispanic Heritage Month, first established in 1968 to honor and recognize Hispanics and Latinos and their many contributions to U.S. culture and society.

Among the Latinos making a difference today are groups of Promotores: bilingual, bicultural healthcare workers who receive special training to help their neighbors navigate local social and health services and gain access to education, employment, and healthcare.

Promotoras (women) and promotores (men) are trusted advisors who are welcomed into homes and community centers to talk about reproductive health, nutrition, parenting and how to manage chronic health conditions such as diabetes and hypertension.

Promotora programs are widely used in the states and communities with large Hispanic and Latino populations, and are gaining recognition elsewhere in the U.S.

10 Webinars You Won't Want to Miss: National Recovery Month 2015

September 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx
National Recovery Month 2015 celebrates stories of people in recovery, writes Michael Botticelli in this month's feature article in the ATTC Messenger, and September 2015 is packed with activities across the nation sharing the Recovery Month message that treatment and prevention work and people do recover from mental health and substance use disorders.

And as President Obama says in today's  Presidential Proclamation, "This year's theme is "Join the Voices for Recovery: Visible, Vocal, Valuable!"  It encourages us all to do our part to eliminate negative public attitudes associated with substance use disorders and treatment."

The webinar lineup for Recovery Month 20125 offers almost daily opportunities for us to learn about innovations in treatment and recovery as well as ways to change attitudes. Here are just a few (well, 10) that you won't want to miss:

Change, Test, Repeat: Using NIATx to implement SBIRT

Catherine Ulrich Milliken
Director, Addiction Treatment Program
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire


Introducing a new practice like Screening, Brief Intervention, and Referral to Treatment (SBIRT)  can be a challenge in any setting. In the Dartmouth Hitchcock Medical Center (DHMC) Perinatal Addiction Treatment Program (PATP) we faced the added challenge of implementing a new practice across three departments and two institutions. 

That’s where my previous experience with the NIATx model came into play. I was fortunate to be a part of a NIATx STAR-SI grant in Maine while working for Crossroads for Women ( Over three years beginning in late 2006, the ten state-provider partnerships used the NIATx diffusion model to accomplish four goals: build state capacity to improve access and retention; build payer/provider partnerships that drive the improvement process; implement payer improvement strategies; and implement performance monitoring and feedback systems.

Integrating care and improving birth outcomes with SBIRT: An update from the field

August 2, 2015
Catherine Ulrich Milliken
Director, Addiction Treatment Program
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

It’s hard to believe that almost two years since I first wrote in this blog about the Dartmouth Hitchcock Medical Center (DHMC) Perinatal Addiction Treatment Program (PATP).

The PATP is a joint, multidisciplinary, and interprofessional venture that spans two institutions, (Dartmouth Hitchcock Medical Center and The Geisel School of Medicine at Dartmouth College), three departments (Psychiatry, OB/Gyn and Pediatrics) and the inpatient and outpatient environments. 

Turning 2 and Our Top Ten List

August 7, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Senior Editor, NIATx
The DipR is the ultimate cookie spoon.
It was almost exactly two years ago that we launched the ATTC/NIATx Service Improvement Blog with our first post: Better Together. In that post, ATTC co-directors Laurie Krom and Kim Johnson wrote about the true innovation that comes from collaboration. They announced the main goal for our blog: to publish regular posts featuring information, tools, and techniques to help behavioral health professionals manage programs and provide services.

Over the past two years, we've published, on average, three times each month, on a wide range of topics. Our blog writers have included ATTC and NIATx staff along with guest bloggers representing research, clinical care, state and national organizations, and people in recovery.

Factors influencing organizations' use of NIATx: Dr. Tom Hilton responds

July 23, 2015

Tom Hilton is a retired NIH science officer and NIDA program official now in private practice. Tom has over 40 years of experience studying and conducting large-scale organizational change initiatives in publically-traded corporations, DOD and other large federal agencies, as well as general-medical and addiction health service organizations. In this blog post, Dr. Hilton comments on a recent study published in the Journal of Behavioral Health Services Research that discussed the factors influencing use of NIATx. That study found that larger organizations with more administrative resources that treat more patients and participate in national associations and in NIDA’s Clinical Trials Network are more likely to use the NIATx model.
Organizations change in response to one of two things: being oriented towards continuous improvement, or crisis. Both are usually rooted in leadership.

Organizations in crisis suffer from emotional blindness caused by fear, panic, and role overload. As far as leaders of declining organizations can see, exploring changes in policies and practices is an impediment to immediate mission accomplishment. That lack of foresight too often leads to the organizational equivalent of a massive coronary that usually puts the organization out of business.
How does one overcome such thinking? The real challenge in change involves overcoming inertia. Usually that inertia emanates from the widely accepted values, beliefs, and practices that determine what and how work gets done (i.e., organizational culture). Some cultures facilitate productivity and quality outcomes. Other cultures unwittingly undermine it. So how can one determine if their culture is in need of peaks and tweaks or complete overhaul?

How to Integrate Addiction Services with Primary Care: The Integration Institute

July 20, 2015
Kathy Reynolds, MSW, ACSW 

Principal, Reynolds Associates

With all of the state Health Home amendments that include addiction treatment being approved by CMS under Section 2703 of the Affordable Care Act, the time has come for addiction treatment providers! In the new healthcare environment, specialty treatment providers can extend services to millions of people who now have health insurance that covers addiction treatment. Many of those clients will be seeking care in integrated health care settings.

As the ATTC White Paper Integrating Substance Use Disorders and Health Care Services in an Era of Health Reform points out, research shows that integrating addiction treatment and health care services improves patient outcomes. Yet, addiction treatment providers face a number of challenges in integrating services, including:

 “…needs to define and develop appropriate services, cultivate staff support, identify strategies for implementing change, train the SUD, mental health, and medical workforces, bring payers to the table, and transcend the currently bifurcated systems of SUD and mental health care. On the other hand, as integration moves forward, it creates opportunities for the current SUD workforce to work in new settings.”  
(ATTC White Paper, Integrating Substance Use Disorders, p. 6)

Technology Trends in Behavioral Health: Prepare for the Future at the National Frontier and Rural ATTC Summit

July 7, 2015

Nancy Roget, M.S., MFT, LADC
Project Director and Principal Investigator
National Frontier and Rural ATTC

Save the date for the the National Frontier and Rural ATTC's 3rd Annual Summit, September 2-3, 2015, in Austin, Texas!

Although behavioral health is considered an essential healthcare benefit, it is not always easily accessible to everyone who needs it, particularly in frontier and rural areas. This is especially true when talking about substance use disorder treatment and recovery, as access to these services is hindered due to workforce shortages and transportation issues. One way this gap in services is being bridged is by integrating the use of technologies into the behavioral health delivery system.

Break the silence: UNITE to Face Addiction

June 25, 2015

Pat Taylor
Community Outreach Coordinator
UNITE to Face Addiction

On October 4, 2015, tens of thousands of people representing organizations and families from the prevention, treatment, criminal justice, health and recovery communities will convene on the National Mall in Washington, DC. We’re grateful to the National ATTC Network and NIATx for standing up as one of the founding partner organizations for the UNITE to Face Addiction rally and for your help in mobilizing people to join us.

We are coming together to let policymakers, the media and our friends and neighbors know that addiction is preventable and treatable, that far too many of those affected have been incarcerated, and that people can and do get well.  As a member of the ATTC Network, you are needed to ignite and grow a movement that will demand solutions to the addiction crisis.

One of our nation’s best-kept secrets is that long-term recovery from addiction is a reality for over 23 million Americans. Regardless of the paths people choose to achieve recovery, their lives and the lives of their families, friends, neighbors, co-workers and communities are vastly improved. People in recovery and their allies are the living proof that there are real solutions to the devastation of addiction.

Although millions prove that recovery is real, more than 350 lives are lost each day to alcohol and other drugs – some 135,000 people each year – more than who die from either homicides or motor vehicle accidents. Another 22 million Americans are still suffering from addiction and the majority never receive any help.

Where is the national outrage about this needless loss of life, the costs to families and the economy, and more importantly, the demand for solutions? It’s time to speak up about the failed policies and poor care due to long-standing stigma and discriminatory public policies. For too long, a great majority of people connected to addiction have remained silent.

The time is now to break that silence.

Why 2015 and Why Washington, D.C.?
  • The grassroots constituency that has developed over the last 15 years is organized
  • To build on greater acceptance of treating alcohol and other drug problems as health issues
  • Too many Americans lack access to the individualized treatment and other recovery support services they need to get their lives on track
  • Introduction of the bi-partisan Comprehensive Addiction and Recovery Act (CARA) in Congress and other public policy initiatives to address addiction and discrimination
  • Across the political spectrum, there is an understanding that current rates of incarceration, including for alcohol- and other drug-related offenses, can’t be sustained
We’ve developed an array of resources that you can use to let other people know about UNITE to Face Addiction that can be downloaded from our web site. We also have a team of field organizers who are mobilizing people in communities across the country to get to Washington, DC for the rally on October 4 and for our Advocacy Day on Capital Hill on October 5. We’re going to make history when we demand solutions to the addiction crisis. Together, we can end the silence.

What you can do:
1. Go to and sign up to get updates and information about how you can get involved.
2. Contact the field organizer working in your state who is ready to help you mobilize.
3. Share your story about why you’re going to DC on our web page.
4. Follow us on Facebook and Twitter
5. Tell your friends that you’ll be in Washington, DC on 10.4.15 and ask them to join you!

See you in October!

Pat Taylor has over 40 years of experience developing and managing local and national public interest advocacy campaigns on a range of issues including healthcare, the environment, community development and philanthropy.  Most recently she served as Executive Director of Faces & Voices of Recovery from 2003-2014, where she led the development of the organization into the national voice of the organized addiction recovery community.

Marijuana Lit: Even more resources for SUD providers

June 23, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC NCO
Editor, NIATx

Marijuana Lit: Fact Based Information to Assist you in Providing SUD Services launched in January this year with a goal: to supply SUD providers with the straightforward, accurate information about marijuana from trusted sources. The team at the ATTC Network Coordinating Office has  been busy adding new information and resources! 

Here's a quick recap of the most recent additions to the Marijuana Lit site, along with other ATTC activities related to marijuana use:

The changing healthcare landscape: tools for states and treatment providers

June 11, 2015
Todd Molfenter, PhD

Senior Scientist, Center for Health Enhancement Systems Studies

Co-Deputy Director, NIATx

In this time of health system reform, states have had to plan for and implement dramatic changes, particularly in the way they purchase and provide addiction treatment services. The unprecedented amount of change has compromised states’ abilities to provide the full spectrum of technical assistance that addiction treatment programs may need to adapt to the changing environment (see Andrews et al., Health Affairs, 2015).

For the past several years, NIATx has led a range of SAMHSA-funded projects designed to help states make the transition to this new landscape. Lessons from earlier NIATx projects such STAR-SI and Advancing Recovery have helped inform these state-based initiatives. A recurring theme in the earlier projects was the key role that state purchasers of addiction treatment services play. That remains true with our current efforts. What we’re finding in our work is a set of competencies that states can develop to increase the viability of their publicly-funded addiction treatment systems.

Some states and treatment providers are focusing on administrative operations through SAMHSA’s BHBusiness Plus and other programs. The Strategic Provider Partnerships collaborative that we're now working on as part of BHBusiness Plus is helping three states (Texas, Louisiana, and Mississippi) look at ways to strengthen their addiction treatment systems at both policy and service delivery levels. Other states (like Ohio and Missouri, to mention just two)  are focusing on use of evidence-based practices such as medication-assisted therapy to reduce the impact of opioid misuse. Through these efforts, it’s become increasingly clear that states want evidence of improved treatment access and clinical quality, regardless of their ACA status or how they pay for substance use disorder (SUD) services.

At the provider level many efforts are, or should be occurring, that states may or may not be able to support with technical assistance. These efforts start with better access to treatment for SUDs. As a recent news stories reported, people seeking help for an SUD continue to encounter barriers to treatment. With improving access, we’re talking about reducing wait times and adding weekend and evening hours, or open access. Improving access also involves helping people get connected to health insurance that will cover their treatment.

Another driving quality indicator within the context of the ACA is documented use of evidence-based practices that are supported by better retention and completion rates.

Ultimately, ensuring treatment agency viability will likely rely on their ability to engage third-party payers to pay for treatment services. This, in turn, is driving treatment agencies to hire staff who meet requirements for insurance reimbursement. Earning accreditation from organizations such as The Joint Commission or CARF International has also become a quality improvement priority for many treatment organizations. 
There are many instances of states supporting the adoption and proliferation of these competencies that improve access and quality. At the same time, providers are also pursuing these capabilities on their own through the many training and technical assistance tools that NIATx and the ATTC Network offer.

What has your state or treatment organization been doing to adapt to the changing healthcare environment?  Let us know in the comment section below. 

Todd Molfenter, PhD, is Deputy Director of NIATx and a Senior Scientist at the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. He is currently a principal investigator for an NIH study focused on increasing use of buprenorphine in Ohio. Todd has led a variety of statewide projects designed to improve addiction treatment access and quality through system and organizational change efforts.  You can reach Todd at

National Hepatitis Testing Day: Ask the Expert, Corinna Dan

May 19, 2015

National Hepatitis Testing Day in the United States is part of an educational initiative of CDC's Division of  Viral Hepatitis and the U.S. Department of Health & Human Services' Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care & Treatment of Viral Hepatitis, Updated 2014-2016 .

Corinna Dan, R.N., M.P.H., is Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infections Disease Policy, U.S. Department of Health and Human Services. In this role, she is working to implement the the Viral Hepatitis Action Plan, which aims to build awareness of new hepatitis C screening recommendations and treatments, as well as prevention, diagnosis, care and treatment for viral hepatitis now available under the Affordable Care Act. 

Here, Ms. Dan responds to questions about hepatitis C as part of our observation of Hepatitis Awareness Month, the launch of our the new ATTC resource, HCVCurrent, and  National Hepatitis Testing Day.

Mike Boyle: In Memoriam

May 16, 2015

The behavioral health field lost a great leader on May 7, 2015, with the sudden passing of Mike Boyle.

Mike’s nearly 40-year career at Fayette Companies (now known as The Human Service Center) in Peoria, Illinois was focused on improving the quality of care for people suffering from substance use and mental health disorders. From his start as a youth outreach worker, Mike went on to lead Fayette Companies as president and CEO. Upon his retirement, he joined the Center for Health Enhancement Systems Studies at the UW-Madison as a Senior Innovation Officer. 

Under Mike’s leadership, Fayette Companies was among the nation’s first treatment agencies to test the NIATx model of process improvement, as part of the Robert Wood Johnson Foundation’s Paths to Recovery project. One of Fayette Companies’ first NIATx change projects focused on increasing retention in treatment at the agency’s residential program for women. With Mike at the helm, NIATx tools and techniques became part of Fayette Companies organizational culture. Fayette Companies has contributed to the success of numerous NIATx projects as well as to the development of Addiction-CHESS. 

Mike loved to share his lessons with the field in writing, as a lead author or contributor to several scholarly articles published in peer-reviewed journals.  He wrote frequently for the NIATx E-news and the ATTC/NIATx Service Improvement Blog, and also served on the editorial board for The Bridge, the ATTC Network’s quarterly research e-zine.  Mike’s knowledge and experience appears in a range of NIATx publications, including Getting Started with Medication-Assisted Treatment, the NIATx Workbook, and The NIATx Third-Party Billing Guide, and NIATx: Process Improvement in Behavioral Health.

Mike often said that he was fortunate to work with NIATx and the Center for Health Enhancement Systems Studies, but we were really fortunate to have him as one of our biggest champions. Here, some who worked closely with Mike share their thoughts on his commitment to quality care, innovation, and his lasting impact on the addiction treatment field:

"Know More Hepatitis" with HCVCurrent

May 5, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

"Maintaining my recovery while dealing with a diagnosis of Hepatitis C is a lot like juggling while walking a tightrope." Kimberly Walline, ATTC Network's In My Own Words Essay Contest, 2013

Kimberly’s story appears in the “In My Own Words” essay book, the result of the ATTC Network’s  Recovery Month 2013 essay contest. With Faces and Voices of Recovery, the Hepatitis C Association, the Harm Reduction Coalition, and Help4Hep, our  Recovery Month partners that year, we invited essays from people who are coping with Hepatitis C and also in recovery from a substance use disorder or mental illness.

Medication-assisted treatment: an update from Missouri

April 28, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

In the April 2015 NIATx E-news, Mike Boyle shared results of recent studies on use of medication-assisted treatment (MAT). Overall results suggest that a lot of work remains to be done in order for MAT to gain wide acceptance.

But MAT is firmly established in states like Missouri, which was among the first states to make a commitment to providing MAT.

Mark Stringer, Director, Division of Behavioral Health at the Missouri Department of Mental Health (DMH) says his state’s involvement with a NIATx program, Advancing Recovery (AR) helped build the foundation the MAT program that exists toda. Stringer also serves as the state's Single State Authority.

Alcoholism research to the real world: Addiction Science Made Easy

April 21, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx
Held every year in April, the National Council on Alcoholism and Drug Dependence (NCADD) Alcohol Awareness Month has a special focus on underage drinking—a particular problem in April, the beginning of prom and graduation season.

NCADD promotes early education as key to preventing underage drinking and to helping individuals and families seek help for drinking problems. If you’re looking for quick access to research to accompany your alcohol and addiction related education activities during April—or any other time of the year—look no further than the Addiction Science Made Easy (ASME) feature on the ATTC website. There, you’ll find research briefs based on articles from the journal Alcoholism: Clinical and Experimental Research and the the NIDA CTN Dissemination Library.

The dilemma of alcohol use among the elderly: Then what?

April 7, 2015
Dave Gustafson, Director
Center for Health Enhancement Systems Studies and NIATx
University of Wisconsin-Madison

April marks NCADD’s 28th Annual Alcohol Awareness Month with a focus on preventing underage drinking and its harmful consequences. Alcohol use and misuse among young people is extremely dangerous, no doubt about it. But at the other end of the lifespan, alcohol use among the elderly presents another dilemma.

Let me tell you more about my view of this.

Teen brains and marijuana: Marijuana Lit Video Series

March 27, 2015

Maureen Fitzgerald
ATTC Network Coommunications Coordinator
Editor, NIATx

There’s a lot that’s new on the ATTC website!

Have you seen the new HCV Current site? We’ve also released Integrating Substance Use Disorder and Health Care Services in an Era of Health Reform, the first white paper for our project on Advancing Integration.
But another new item that we don’t want you to miss is the latest video in the ATTC Network’s Marijuana Lit series. Just released:  “Effects of Marijuana Use on Developing Adolescents.”

You don't have a gambling problem, do you?

March 16, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Senior Editor, NIATx
Have you filled out your bracket?  March Madness officially began on March 15, 2015, Selection Sunday,  with 64 college basketball teams embarking on a four-week odyssey to the Final Four and the ultimate championship game. Across the country people are rooting for their teams, practicing their bracketology skills, and placing bets.

(By the way, how about those Badgers?)

It’s no coincidence that March is also the National Council on Problem Gambling’s Problem Gambling Awareness Month, and in some states (Iowa, for example) March 15-21 is National Problem Gambling Awareness Week.

For many people betting on sports teams is just plain fun, and gambling is considered a harmless pastime. As Christine Reilly, Senior Research Director of the National Center for Responsible Gaming states in this month’s ATTC Messenger, “an estimated 80 percent of adults in the U.S. gambled in the past year,” in activities ranging from buying lottery tickets to making illegal bets with bookies. Of this group, about 1 percent of the U.S. population meets the diagnostic criteria for a gambling disorder.

That seems like a pretty low number. But is it really an accurate estimate of the number of people who may be experiencing serious difficulties because of their  gambling?
Dr. Lori Rugle, Program Director of the Maryland Center of Excellence on Problem Gambling at the University of Maryland School of Medicine, has more than 30 years of experience in problem gambling prevention and treatment. Her presentation “Screening, Brief Intervention, and Referral to Treatment,” is the second webinar in the ATTC Network’s Problem Gambling Webinar Series.
Dr. Rugle believes that better and wider screening will lead to a more accurate representation of the true extent of gambling disorders, which often accompany substance use and mental health disorders.
View Dr. Rugle’s presentation slides and watch her recorded webinar here.

I caught up with Dr. Rugle last week to ask a few questions about gambling disorder screening tools. As she points out in her recorded webinar, some screening tools that work well in research settings are less effective in real-world clinical practice.  (Sound familiar?)

 “After finding this in state after state, we realized that we need to see how we can help counselors use the screening tools more effectively in actual clinical practice,” says Dr. Rugle.
It may be that addiction treatment counselors are just as uncomfortable asking their patients about their gambling behavior as, say, some primary care physicians are when asking people about their alcohol and other drug use.

 “What happens so often in clinical practice is that a counselor will ask a Yes/No question such as ‘You don't have a gambling problem, do you?’” says Dr. Rugle.  “Counselors and doctors are wary of asking questions about an area they’re unsure about,” she says. “With training on the right techniques and how to ask the right questions, clinicians can overcome their lack of confidence about exploring their patients’ gambling behaviors.”
One solution might be to include a question about problem gambling in existing SBIRT activities.
“Asking the question ‘What role does gambling play in your life, and is it helping or hurting?’ could start a longer conversation that might lead to treatment,” says Dr. Rugle.

That question is part of the conversations in Maryland, which has provided funding to agencies to integrate gambling into screening activities.

“I’m asking people to include gambling in every section of the intake, so patients can start making the connection between gambling and other parts of their lives,” she explains.

It's also important to define what is meant by gambling.

"Often, people don't automatically think about playing the lottery or bingo as gambling, just as some may discount beer when asked whether or not they drink alcohol," comments Dr. Rugle. 
Maryland is also introducing a program for a high-risk group for problem gambling: young adults. The Above All Odds campaign aims to help young adults recognize how to keep gambling fun and affordable, and how to get help if it gets out of hand.

Gambling disorder awareness has increased significantly since Dr. Rugle began her career.

“The DSM-5 reclassification of gambling disorder with substance use has also brought more attention to gambling disorder, and it has also encouraged state systems to look at it differently,” says Dr. Rugle. “In Maryland, it helped us to include problem gambling in the state’s recent integration of substance use and mental health disorders,” she says. “Without that new definition, it would have been much more difficult.”
With the increase of legalized gambling (and no end to that in sight) more treatment for problem gambling is available than in the past.
“Right now, 39 states offer funding of varying amounts to address problem gambling, but in most cases it is just a fraction of what’s available for other disorders,” comments Dr. Rugle. She’d like to see a public source of funding for research in this area and to be included along with funding for other addictive disorders, especially as gambling continues to proliferate.

For more information, see the 2013 National Survey of Problem Gambling Services.

One potential funding source is the tax revenue that the federal government receives from gambling winnings. “This could provide more funding for problem gambling prevention and treatment,” notes Dr. Rugle.

In conclusion, Dr. Rugle encourages treatment professionals to think about ways they can “have the conversation” about gambling behaviors with their clients. “People are really surprised to learn how pervasive it is and the issues it’s creating in families, at work, and as a relapse risk factor," says Dr. Rugle. “Not addressing gambling issues decreases treatment effectiveness and adds to treatment costs,” says Dr. Rugle.

For more information, visit:
Maryland Center of Excellence on Problem Gambling
National Council on Problem Gambling
ATTC Network Problem Gambling Webinar Series

Urgent care for the uninsured: a walk-through with an international visitor

March 9, 2015
Kim Johnson, PhD
Deputy Director, NIATx
Co-Director, ATTC Network Coordinating Office

Last week I was able to experience the American health care system through the eyes of a person without health insurance. This unexpected walk-through was a Kafkaesque experience that made me wish deeply for Madison to have a “Doc in a Box” or a Walmart or CVS walk-in clinic.

I have great appreciation for that business model now.

Tools for Treating Teens: the Center for Adolescent Substance Abuse Research

February 23, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx
This year, the Center for Substance Abuse Research (CASAR) at the University of Minnesota Medical School celebrates 25 years of developing research-based tools and resources for adolescent drug abuse assessment and treatment.  Dr Ken C. Winters, director of CASAR, shares some insights on adolescent treatment in the interview that follows.

A Hidden Epidemic: Older Adults and Substance Abuse

February 10, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx
North Carolina filmmaker Linda Warden left a career in information technology to make movies, focusing on topics that help children and families. Having lost a child to addiction, she is especially interested in increasing awareness of substance use disorders and their impact on families and communities.

 “Addiction affects people of all ages,” she comments. “To my knowledge, nothing has really been done on older adults and addiction in the mass media.”
That explains, in part, her interest in producing a documentary on older adults and substance use disorder, A Hidden Epidemic. “Although addiction is a part of this program, the focus is on prevention and recovery,” says Ms. Warden.

Lost in the weeds about marijuana?

February 4, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

If you've been to the ATTC website in the past few days, we hope you've stopped by the webpage for our new resource,  Marijuana Lit: Fact Based Information to Assist You in Providing SUD Services. 

As you'll notice, we've made it easy to find!

Bringing research to the teen world: National Drug Facts Week

January 22, 2015

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx
The latest Monitoring the Future study released in December 2014 reported that both teen alcohol and cigarette use are at their lowest points since the study began in 1975. Use of a number of other illicit drugs has also declined.

University of Michigan researchers who led the study, Drs. Lloyd Johnson and Richard Miech, comment on the results in this two-minute You Tube video:  E-cigarettes Surpass Regular Cigarettes Among Teens.

Tales of Bath Salts and Zombie Cannibalism

January 14, 2015
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

The ATTC Network’s November iTraining, “Will they Turn You into a Zombie? An Overview of Synthetic Drugs” was packed with information on synthetics, including the major classes of synthetic drugs, the acute and chronic effects of using them, and the extent of use in the United States.

Beth Rutkowski, Associate Director of Training for the Pacific Southwest ATTC  and UCLA Integrated Substance Abuse Programs presented the webinar, which is based on the Synthetic Drug Training Package-2nd Edition that the PSATTC developed in partnership with the South Southwest ATTC.

You can watch “Will they Turn You into a Zombie?” on the ATTC Network’s Vimeo site. The presentation included time for audience questions, but we ran out of time to answer them all.

Here, we provide Beth’s in-depth replies to the remaining questions

Three wishes for 2015

January 5, 2015
Kim Johnson, PhD
Co-director, ATTC Network Coordinating Office
Deputy Director, NIATx

Instead of giving you my resolutions, I am going to tell you what I hope for and what in my own way I intend to work for in 2015. It’s a mishmash of things that I  wish I could wave my magic wand and make happen right now—instead of waiting for the evolution that will someday lead us to fixing these problems.