Monday, October 20, 2014

Making MAT a Routine Part of Addictions Care

Aaron Williams, Director of Training and Technical Assistance for Substance Abuse, National Council


Although medications for substance use disorders have been around for many years, numerous studies have shown that people still have limited access to these medications, and they are underused as a treatment option. One thing is clear: safety-net providers can and should do more to expand access to these medications.

There is plenty of evidence that medication-assisted treatment (MAT) for substance use disorders is an effective treatment protocol.

So how do communities move forward in implementing MAT as a routine part of care?

We explored this question through a year-long project with safety-net providers by the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS).

There can be a number of barriers to implementation both inside and outside of the safety-net provider setting, and so our goal was to bring together all parts of the community that are involved to create synergy to then be able to move forward with implementing MAT.

We joined single state authorities with community safety-net providers in three states (California, Maryland, and Ohio) to discuss their MAT implementation needs through meetings, site visits, regular webinars and conference calls, and peer networking opportunities.

Each of the state partnerships experienced challenges to implementing MAT in some or all of three key areas: financing and reimbursement, regulatory issues, and workforce challenges. 

One common workforce challenge was the lack of behavioral health supports for medical staff considering implementing MAT. We observed that some organizations lack the infrastructure that supports physicians in prescribing MAT, such as available counselors who are knowledgeable about MAT or appropriate referral and care coordination resources. If agencies want to make a full commitment to MAT, they must ensure that appropriate continuing care and counseling services are  available to accompany delivery of the medications.

Once the project ended, we asked the participants to share the challenges they faced, what they did to overcome barriers, and what should happen next with MAT. For those wanting to assess where their agency, state, or community is in terms of readiness and willingness to implement or expand MAT, we combined these lessons learned with some of the latest research into a handy checklist about what to consider when trying to move forward in implementing MAT. 

The project participants identified the following key opportunities to expand implementation of MAT:
  • Increasing use of local pilot/demonstration projects
  • Disseminating results to spread promising practices
  • Fostering greater cross-collaboration between federal agencies invested in MAT
  • Encouraging multiple organizations to “share” MAT providers
  • Creating incentives for clinicians to adopt MAT
Read more about the project, and learn about these opportunities in Expanding the Use of Medications to Treat Individuals with Substance Use Disorders in Safety-Net Settings.

CIHS promotes the integration of primary and behavioral health care throughout the country through the sharing of information, development of resources, and through training and technical assistance to grantees in SAMHSA’s Primary and Behavioral Health Care Integration (PBHCI) Program. Learn more about CIHS at www.integration.SAMHSA.gov.



Aaron Williams leads strategic initiatives and directs training and technical assistance on substance use screening and treatment for the SAMHSA-HRSA Center for Integrated Health Solutions at the National Council for Behavioral Health. Mr. Williams' experience in the field of behavioral health services includes developing research plans, training protocols, and evaluating program effectiveness with an emphasis on substance use treatment, workforce development, and the use of evidence-based practices. Mr. Williams has written and contributed to numerous articles and reports on drugs of abuse, workforce development of substance use professionals, and implementation of evicence-based practices.


Wednesday, October 15, 2014

Are better outcomes worth a loss of privacy?


Kim Johnson
NIATx Deputy Director
ATTC Co-Director

As some people know, about half of my work for the UW-Madison is devoted to developing and testing mobile applications to help people manage various behavioral health conditions. I am fascinated by the idea of developing mobile responses tailored to specific needs that arise in the course of daily lives and by mobile phone apps’ potential to help people change their behavior. (I think there’s an application for organizational change too, but haven’t started working on that yet!) The way to tailor mobile responses to specific, immediate needs is to take all of the data that mobile devices collect and then use machine learning algorithms to uncover behavior patterns that might not be apparent otherwise.
Anyone that has heard me speak in the past two years has heard me wax poetic on the possibilities that Big Data offers for healthcare. But for the past six months or so, I’ve been wondering about the negative side effects of this potential revolution in care. Particularly, I am worried about whether giving up privacy is a reasonable trade-off for the results we might be able to achieve. 
People have clearly displayed their willingness to abandon privacy with smart phone apps. I know I have. Every time you download a new app, you get a list of all the information it collects, both from the app and from your phone. When you click the button to “accept these conditions” you can then happily use the app to find a new restaurant, check how many steps you took that day, track calories you consumed, or play the latest version of Angry Birds. 
But have you actually read the list of all the personal information you release when you download a new app? Have you wondered why it’s being collected, and how it’s being used?
In a Big Data world, the more data available, the better the decision the computer can make. And we want to collect everything, because we don’t yet know what is important. In treating addiction, for example, we don’t yet know what combination of experiences may be a precursor for a lapse, or if we can identify a set of predictors for relapse. So we want to collect as much information as we can to help figure out the patterns. The positive outcome will be better treatments. The negative side effect is that we will have a lot of data about a person’s whereabouts, activities, and relationships. 
Maybe, like many people, you say so what? Or maybe, like me, you get a little paranoid.
I graduated from college in 1984. We all had read George Orwell’s dystopian novel and discussed how life was and was not like his prediction. Today, 30 years later, we’re much closer to the level of individual and data tracking predicted in the novel than we were in 1984. And while the recent Edward Snowden episode lets us know that government can and does capture information from our communications, commercial entities now have more data about us than any writer of dystopian fiction could have possibly imagined in the early part of the twentieth century. 


If mobile applications get us to eat better, exercise more, increase our memories and logical thinking, manage our medications and our disease symptoms, help us live healthier lifestyles overall—all while adding convenience to our lives, is the loss of privacy about our thoughts and actions a reasonable trade off? 
Or am I a just being a fearful Cold War baby in an era of openness? 

What are your thoughts on the cost benefits of the current trends in mobile health?



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. 

Wednesday, October 1, 2014

Young People in Recovery: Speaking Up and Reaching Out Because...

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



While SAMHSA’s National Recovery Month 2014 wraps up at the end of September, the ATTC Network’s “In My Own Words” Video Essay contest continues through October, inviting people in recovery to speak up, reach out, and join the voices of recovery. 

The ATTC Network has sponsored the “In My Own Words” essay contest during recovery month for the past few years.  This year, in partnership with Faces & Voices of Recovery and Young People in Recovery, (YPR) entries will be in an entirely different format: 60-second videos of people responding to one of the following statements:
“I’m speaking up because…”
“I’m reaching out because…”

Speaking up and reaching out was the theme of our recent Third Thursday iTraining, when Mariel Harrison from YPR New Jersey, and Andrew Kiezulas from YPR Maine, joined us for a live interview.

(You can view the entire interview  “Young People in Recovery: Advocacy and Action” on the ATTC Vimeo channel.)

I caught up with Mariel and Andrew to ask a couple of questions we didn’t have time for during the iTraining. 

One of them was on anonymity: Do people who speak up and reach out "break tradition" if they’re also part of a 12-step community?

Mariel responded to that question with a firm “No.”

In addition to her affiliation with YPR New Jersey, Mariel also also works for NCADD New Jersey.  


“For the founders of AA, anonymity was intended to keep the meeting halls a safe place for people attending their first meetings, when they’re filled with guilt and shame,” she explains. “AA members were never meant to stand in the shadows,” Mariel adds.  She cites Marty Mann, one of the first women in AA and also the founder of what is NCADD today. “Marty Mann spent her life speaking up about recovery and about alcoholism as a public health issue. She was one of the first advocates to demonstrate that people can recover and lead productive lives.”

I also asked Mariel about the courage it takes for people of any age to speak up about being in recovery. 

“Young People in Recovery works in tandem with Faces & Voices of Recovery, which offers a very comprehensive training on what to say and how to counteract reactions that perpetuate stigma,” says Mariel. “Unfortunately, stigma is alive, which is why we do the work we do, but the mentoring from Faces and Voices makes the possible backlash less heartbreaking.”

Mariel has been in long-term recovery since May 7, 2007 and has worked in the advocacy field since 2012.  While she says there’s still a long way to go, Mariel is optimistic about the climate for recovery.  “The reception that we’re receiving at both the state and national level is unprecedented,” she concludes.

Mariel’s colleague Andrew Kiezulas founded YPR chapter in Maine. Andrew is a full-time student at the University of Southern Maine, a double a major in chemistry and math. In addition to founding YPR Maine, he also started the first campus-based peer support group in Maine, Students in Recovery, for students struggling with addiction, mental illness or any kind of compulsive behavior.

“Losing my roommate is what inspired me to really advocate for people in or seeking recovery, not just participate in my own,” says Andrew. “Both of us were already in recovery at the time. His low tolerance may have contributed to the overdose, as he had almost six months of total sobriety."

He also cites the film The Anonymous People as another influence on his commitment to advocate for people in recovery.

The day after seeing the movie, Andrew participated in a focus group for SAMHSA’s Maine State Adolescent Treatment Enhancement Dissemination (SAT-ED). SAT-ED works to improve treatment for 12-18 year olds with substance use disorders and co-occurring mental health issues. 

The focus group included parents as well as young people in recovery. “What resonated throughout the discussion was stigma and lack of information,” says Andrew.  “People didn’t know where to go or who to talk to.”

This combination of experiences fueled Andrew’s desire to make a difference in the state of Maine. He quickly connected with one of the founding members of YPR.  “And from there it was just on,” says Andrew. 

For Andrew, speaking up and reaching out as a member of Young People in Recovery is a way to channel his energy for positive change in Maine and across the nation. While the YPR chapter in Maine doesn’t maintain an official member list, its participants were among the 800 who attended the Maine Rally for Recovery in Portland this year. 

“That alone is proof of the strength of the organization and its message,” says Andrew.

Both Mariel and Andrew will be encouraging YPR members to submit a 60-second video to the “In My Own Words” video message contest. 

We’ve extended the deadline through the month of October to make this opportunity available to as many as possible.  Won’t you share the ATTC “In My Own Words” Video Message contest information with the people in recovery you know, too? 

Monday, September 15, 2014

A Recipe for Success

Roxanne Allen

SMART Recovery Meeting Facilitator


“The research evidence clearly demonstrates that a one-size-fits-all approach to addiction treatment typically is a recipe for failure.” 1

If the one-size-fits-all approach is a recipe for failure, what approach is needed for success?

Choices!

One of the central messages of the New Recovery Advocacy Movement is the declaration that there are many pathways and styles of long-term recovery from severe alcohol and other drug problems. 2

This concept applies not only to the many choices available for treatment options but also to the many choices now available for peer support. For many years the only options for addiction recovery peer support groups were based on a 12-step, external locus of control approach (AA, NA, GA, etc.)

One of the three mutual-aid groups featured at the recent ONDCP (Office of National Drug Control Policy) webinar, “Expanding Opportunities for Recovery: An Introduction to Three Secular, Abstinence-Based Mutual Aid Pathways,” was SMART Recovery®.

Self-Management and Recovery Training

Now in its 20th year, SMART Recovery (Self-Management And Recovery Training) is a science-based, international, self-empowering addiction recovery support group. Headquartered in the U.S., SMART Recovery exists to help people with all types of addiction and addictive behaviors including drug abuse and addiction, alcohol abuse, and addiction to other substances and activities.

SMART Recovery participants learn tools for recovery based on the latest scientific research. There are now 669 weekly face-to-face meetings held throughout the U.S. and an additional 630 elsewhere around the world. Interactive online meetings, an online message board and 24/7 chat room are also available to support anyone with Internet access.

SMART Recovery is an abstinence-based approach. It is open to individuals who are abstaining, and to those who are considering but have not yet committed to abstinence. SMART’s 4-Point Program encompasses the following areas:

  1. Building and Maintaining Motivation
  2. Coping with Urges
  3. Managing Thoughts, Feelings and Behaviors
  4. Living a Balanced Life

The SMART approach offers skills training for emotional and behavioral self-management. Using a variety of cognitive tools and a motivational interviewing style of interaction, SMART Recovery:

  • Teaches self-empowerment and self-reliance
  • Provides meetings that are educational, supportive, and include open discussions
  • Teaches techniques for self-directed change
  • Evolves as scientific knowledge of addiction recovery evolves
  • Supports the scientifically informed use of psychological treatment and legally prescribed psychiatric and addiction medication

In SMART Recovery’s self-empowering approach, participants are encouraged to take responsibility for their choices as they work on their individual recovery paths.

Participation

SMART Recovery meetings are structured to allow participation by all in attendance. Meetings start with the facilitator checking in with each participant after which an agenda is set based upon participant input. Open discussion follows and cross-talk is encouraged. All meeting facilitators and online volunteers complete a 30-hour training course in SMART Recovery tools and meeting practices.

Recognition

SMART Recovery is recognized as a resource for addiction recovery by numerous organizations including the National Institute on Drug Abuse (NIDA), US Department of Health and Human Services, American Society of Addiction Medicine (ASAM), American Academy of Family Physicians, and the National Association of Drug Court Professionals (NADCP).

For more information about how to participate in face-to-face or online meetings, or to learn how to start a SMART Recovery meeting in your area, visit www.smartrecovery.org.

1. National Center on Addiction and Substance Abuse at Columbia University, CASA Columbia 2012 Report on Addiction Treatment.

https://archive.org/stream/781862-casa-columbia-addiction-med/781862-casa-columbia-addiction-med_djvu.txt



2. A Message of Tolerance and Celebration: The Portrayal of Multiple Pathways of Recovery in the

Writings of Alcoholics Anonymous Co- Founder Bill Wilson; William White, M.A. and Ernest Kurtz, Ph.D. http://dbhids.org/assets/Forms--Documents/transformation/BillWhite/2010BillWilsonOnMultiplePathwaysOfRecovery.pdf

Roxanne Allen has been a volunteer for SMART Recovery since 2009. She is a co-developer of the SMART program for Family & Friends and currently serves on the Board of Directors.

Tuesday, September 9, 2014

FASD Awareness Day 2014: September 9



During September, events across the nation share the message of Recovery Month, that prevention works, treatment is effective, and people can and do recover.  Along with the 25th anniversary of SAMSHA’s National Recovery Month, 2014 also marks the 15th Annual observance of FASD Awareness Day, sponsored by SAMHSA’s FASD Center for Excellence. (http://www.fasdcenter.samhsa.gov)

As Frances M.Harding, Director of SAMHSA’s Center for Substance Abuse Prevention writes on the SAMHSA Blog, “When a pregnant woman drinks alcohol, so does her baby.” Yet the risks of maternal drinking during pregnancy and the link to Fetal Alcohol Syndrome Disorder  (FASD) have come to our attention fairly recently.  As Dr. Kenneth Warren, deputy director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) notes in this month’s ATTC Meet the Researcher Profile,

“At the time I entered the FASD field (mid-to-late 1970s), there lacked general acceptance by the medical community, scientific community, and the public, that alcohol posed risks for the unborn fetus.”

Current research is uncovering more and more evidence of the long-term consequences of prenatal exposure to alcohol. One recent study examines the link between FASD and childhood obesity. You can read a research brief of the full article “Prenatal alcohol exposure is associated with later excess weight/obesity during adolescence,” an Addiction Science Made Easy article for September 2014.

Research is also showing that children diagnosed with FASD are at greater risk for developing an alcohol or other substance use disorder later in life—and the problems with behavior and learning that often accompany FASD require modified treatment approaches.

The Centers for Disease Control and Prevention estimates that as many as 40,000 babies are born each year with FASD. To find out more about this preventable disorder, join the free webinars that the FASD Center for Excellence is presenting today, September 9:

Awareness of Fetal Alcohol Spectrum Disorders: Making the Connections!
1:00-2:00pm EDT 
Learn about the connections and progress of collaborative efforts from various perspectives of FASD.

Addressing Fetal Alcohol Spectrum Disorders
Treatment Improvement Protocol (TIP) 58
3:00-4:00pm EDT
Learn more about SAMHSA's new landmark publication Addressing Fetal Alcohol Spectrum Disorders, #58 in the Treatment Improvement Protocol (TIP) series, the first TIP in the series to directly address the topic of FASD.

To register for either or both webinars, go to: FASD Awareness Day 2014 Events

The webinars will be recorded, and the PowerPoints, transcript, and recording will be posted on the FASD Center for Excellence website (fasdcenter.samhsa.gov).


Thursday, September 4, 2014

Earth Day, Google Doodles, and the Recovery Movement



Kimberly Johnson, MSEd, MBA
NIATx Deputy Director
Co-Director, ATTC Network Coordinating Office


Earth Day image
At first, it seemed like a radical idea, with Rachel Carson and scientists talking about how industrialization was destroying our environment, but on the first Earth Day on April 22, 1970, 20 million Americans took part in rallies across the nation to demonstrate for clean air and water. A wave of legislation after the event created United States Environmental Protection Agency and led to the passage of the Clean Air, Clean Water, and Endangered Species Acts.

Earth Day raised consciousness and created fertile ground for research on ways to protect the environment. As a result, many environmental issues have improved in the U.S.: we have cleaner air and water, and thanks to recycling, we send much less garbage to landfills. Anyone that can remember the 1970’s knows that there has been a tremendous improvement in the environment here in the U.S. Earth Day is a now an international event that’s noted on calendars and even has its own Google doodle.

What if we could make the substance use disorders as rare as dumping chemical waste into the water? What if we applauded addiction recovery as widely as the return of an endangered species?

http://www.recoverymonth.gov/
This month marks SAMHSA’s 25th National Recovery Month, with the theme “Join the Voices for Recovery: Speak Up, Reach Out.” Events and activities across the country are encouraging people in recovery to “go public” about how they live recovered lives. One event that you won’t want to miss is SAMHSA’s live, interactive webcast at 12 noon CST on September 15, Recovery and Health: Echoing through the Community. SAMHSA is encouraging organizations to take action and set up “Echo Events”— community organized meetings held in tandem with the webcast. Find out how you can host your own Echo Event.

National experts on the SAMHSA webcast include recovery movement leader William White, who has also contributed the feature article “Tribute to the Recovery Movement” to the September ATTC Messenger. And our Third Thursday iTraining (September 18, 2pm EST) this month features speakers from Young People in Recovery.

You'll also want to mark your calendars for Wednesday, September 17, 2-4pm EST, when  the Office of National Drug Control Policy (ONDCP) is hosting Recovery at the White House. You're invited to host a viewing party of the event, which will be broadcast live on www.whitehouse.gov/live. This event will feature tweets with questions for panelists in recovery on stage. To find out more, contact Nataki MacMurray at RecoveryRSVP@ondcp.eop.gov

All of these activities underscore the message delivered in SAMHSA's Recovery Month Kick-off webcast on September 4. Combating the public health crisis of addiction requires a coordinated effort among addiction treatment providers, government officials, law enforcement, researchers, schools, churches, community groups, families…anyone and everyone affected by addiction.

I used to want a ribbon or a wristband for the Recovery Movement. Now I’m thinking Google Doodle. Why? Who cares? Because a symbol of recognition that reaches beyond those of us working in the field or in recovery ourselves is an important marker. If we are ever going to clean up our environment and make addiction rare and recovery lauded, we need to build the movement, gain the attention of the general public, all of whom are affected by substance abuse in some way, and make every month Recovery Month.

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. 


Tuesday, August 12, 2014

What we can learn from the McRib and wind power




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

I find it difficult to clearly explain why it is so important to go outside the field for ideas on how to improve and how to get those ideas. So I am going to try again. One of these days I will get it right.

A lot of people are becoming pretty good at understanding the needs of their customers. The walk-throughs are being used pretty extensively as well as nominal group and focus group meetings. It is exciting to see that happening. And of course it is natural to say: "Well, now that we understand the problem, let's solve it.” I love rapid-cycle improvement!

But there is a risk that we will jump to an obvious solution. The obvious solutions are very likely to have been tried in SUD before. And they may have worked, or they may have worked a little, or worked a lot for a while and then stopped working. So it probably does not hurt to take a one-hour detour to cast a wider net for solutions. Where do we find those solutions? From concepts and problem-solving efforts of people who are tackling a similar problem but in a different industry.

Suppose we were trying to find a way to get people to keep coming back for treatment. What other industries worry about getting people to come back on a regular basis? Lets think out of the box for a second. Well, there is television. They try to get us to come back to their shows. And there are fast food restaurants. Of course there are many others. But let's go with those two for a minute.

We have found the industries. Now we need to find the best of the best in those industries. In many cases they will be obvious. In fast foods, it is probably McDonalds. They must invest enormous amounts of effort in getting people to return. How do they do it? One of us knew the head of marketing for McDonalds, but you could just as easily Google. For instance, I Googled "How does McDonalds get people to return?" I found millions of responses because many people have studied McDonalds. One thing that comes up over and over again in the few summaries I read was that they segment their customers and find out what those people respond to. Then they target those things people respond to.

The first article pointed out the McRib. Its nutrition is terrible and a lot of people hate it. But a big segment (typically young guys) of McDonalds customers really like it. So what? Well, McDonalds thinks about what would bring those people back. They hit TV programs with a young guy who is going on his honeymoon and he gets a text from a friend saying McRibs are back. For a few seconds he debates whether he wants to go on his honeymoon with this wife watching, perplexed.

What can that story tell us about how to keep our patients coming back? McDonalds would say that one size does not fit all. In our field some may respond to threats, others to reminders, others rewards, etc. But rarely do the same things work for everyone. What if we began to create a database of what our customers respond to? Try some things, see what happens, and then put those results into the database, so we know what to try (or not try) to get each person back.

A similar approach could be taken by a behavioral health organization as it finds its place in the implementation of the Accountable Care Act; specifically attracting new third-party payers. What industries have a similar challenge? Maybe windmill manufacturers? They have always produced energy (initially for grinding grain).  Now they are moving aggressively into clean power. Who are the best of the best and how do they make that move? A quick Google Scholar search turned up several articles including one that followed adoption of wind power in Europe. 

They discussed three strategies that were important to its success:  

1) stimulating technological progress; 
2) minimizing administration and transaction costs of adoption, and 
3) gaining public acceptance for wind energy. 

The question is, how can we learn from that?  One might be to really make adoption very easy and inexpensive; to engage in a marketing effort to help the public get excited about the idea and have technological support systems, and maybe to help adopters track the benefits (and costs) of their decision in real time.

How long would it take you to: 1) Identify other industries that deal with a problem similar to ours? 2) Identify one of the best organizations at solving that problem in that industry? 3) Ask Google Scholar to identify what makes McDonalds (or whatever) so good? 4) Read at least the abstract of a couple of articles? 5) Ask, “What is it that they do that could be helpful for us?”

I would say one hour, two at most. I think it’s worth it.

An earlier version of this blog post originally appeared on the NIATx website in November 2011.