Just the Facts: Marijuana Lit

December 12, 2014
Maureen Fitzgerald,
ATTC Network Coordinating Office

With marijuana legalization so much in the news these days, SUD treatment professionals face a big task in separating fact from marijuana fiction. What's more, what we currently know about marijuana may no longer be true, since existing studies were conducted years ago  on much less powerful pot.

Central Kansas Foundation: The value of integrating SUD services


December 9, 2014
Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

Some might not expect to find one of the country’s most advanced examples of integrated care in a small Midwestern town. But in Salina, Kansas (population 47,846) the Central Kansas Foundation has been integrating its services with other health care providers in the area since 2009. Today, CKF has integrated recovery services into acute and primary care settings at two local hospitals and collaborates with a health network of 15 critical access hospitals. Les Sperling, CEO of CKF, shared some insights on what he’s learned about integrating SUD services in a panel presentation and in one of the Ignite Talks at the recent ATTC Forum on Advancing the Integration of SUD Services and Health Care.

A Seminal Study Asks: Should our paradigm for treatment be expanded? Are we doing enough?


November 24, 2014

Michael T. Flaherty, Ph.D.
Ernest Kurtz, Ph.D.
William L. White, M.A.
Ariel Larson, M. A.


The addiction treatment field and the larger alcohol and drug problems arena have historically drawn their knowledge from two sources: 1) the study of drugs and their personal, biological, and social precursors and consequences, and 2) the study of the clinical and social interventions designed to  prevent, intervene in, or treat those consequences. These pathology and intervention paradigms are the foundation for policy, funding, research, and treatment in most of the world today. But is this enough? Are these paradigms offering the best opportunity to attain wellness? Is there a better paradigm?

ATTC Network Forum 2014: What Participants are Saying

November 12, 2014

Maureen Fitzgerald
ATTC Network Coordinating Office


At The ATTC Network Forum 2014: Advancing the Integration of Substance Use Disorder Services and Health Care (November 4-5)  participants spent two days thinking in new ways about the Network. Presentations from plenary speakers and other presenters are now available for viewing on the Advancing Integration page of the ATTC website:

ATTC Network Forum 2014 Day 1: Igniting the Spark



November 6, 2014

Maureen Fitzgerald
Communications Coordinator, ATTC
Network Senior Editor, NIATx
What do we know about the integration of health care and SUD services? 

Mady Chalk, Research Director, TRI
 "Things are moving fast and we need to pay attention," said Mady Chalk of TRI, who opened the ATTC Network Forum 2014 with a plenary presentation on emerging issues in health care. These issues have huge implications for the ATTC Network's role in meeting the needs of the behavioral health workforce. But will the Network step up to the challenge?

New Medication Shows Promise for Effective Treatment of Alcoholism and Depression



October 30, 2014
Meg Brunner, MLIS Librarian
Alcohol & Drug Abuse Institute, University of Washington
http://adai.uw.edu

CTN Dissemination Library
http://ctndisseminationlibrary.org

Alcoholism is often accompanied by co-occurring mental health disorders such as depression. While evidence-based medications for alcoholism treatment are effective in reducing cravings and preventing relapse, a single medication to treat alcoholism and co-occurring depression has not been available.

Integrating SUD Services with Health Care: the ATTC Network's Role



October 29, 2014
Maureen Fitzgerald
Communications Coordinator
ATTC Network Coordinating Office

There’s a new feature on the ATTC website that we hope you’ll take time to explore:
ATTC Network: Advancing the Integration of Substance Use Disorder Services and Health Care.
This section marks the launch of a new ATTC initiative that has two primary goals:
  • Ensure that efforts to integrate behavioral health care with physical health care include SUD services
  •  Build recognition of the ATTC Network as a vital national resource for disseminating evidence-based practices for SUD services in integrated care settings

Making MAT a Routine Part of Addictions Care


October 20, 2014

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

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.

Are better outcomes worth a loss of privacy?




October 15, 2014
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.

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


September 30, 2014
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. 

A Recipe for Success


September 15, 2014
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!

FASD Awareness Day 2014: September 9


September 9, 2014

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Editor, NIATx

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)

Earth Day, Google Doodles, and the Recovery Movement


September 4, 2014

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. 


What addiction treatment can learn from the McRib and wind power


August 12, 2014
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 Affordable 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.

Connect, learn, and implement with the new Network of Practice


August 4, 2014
Kim Johnson
NIATx Deputy Director
ATTC Co-Director (WI)

Have you ever been frustrated by the whole evidence-based practice (EBP) thing? First, are EBPs really worth it? Does the difference for the clients make EBPs a worthwhile investment? And then, which ones do we use? Because really, it will probably take more than one anyway, right? So then the question becomes which combination of EBPs work together best for our particular clients. And if you’re the supervisor and you talk to the clinicians in your practice, they all say, “I’m already doing that,” and they’re insulted if you suggest that they aren’t, as they should be—because they are probably doing it as well as they can, given the resources they have. 

It can get to be overwhelming.
But many states have started to require contracted treatment organizations to demonstrate that they have implemented evidence-based practices, and other funders are now requiring improved treatment outcomes. 

Implementing evidence-based practices is probably in your future, even if it hasn’t been in your past.
Back in 2011, NIATx and the ATTC held a series of focus groups around the country to ask providers, CEOs, clinical supervisors, and direct service staff about the barriers they face in implementing EBPs. We asked what would help overcome those barriers. Then we looked at the implementation science literature (yes, there is an implementation science) and we developed a web tool called The Network of Practice: http://networkofpractice.org/
What we heard the most in our focus groups with treatment providers was that they wished they had someone to talk to—someone who knew about a specific EBP and how to implement it. The Network of Practice is home to a new electronic community that will connect you to your peers and the researchers that develop EBPs. You can use these forums to ask questions, get and give advice, and just talk with each other about how to improve your treatment outcomes.
Over the past month, we had a group of users test the Network of Practice materials and start the conversation. We hope you will join in and share your wisdom and experience, as well as your hopes and frustrations. 

In return, we promise to find the answers to your questions, welcome your ideas and suggestions, and keep the pages fresh with the latest information about EBPs. 
The Network of Practice features other tools we developed to address issues people raised in the focus groups.
The cost benefit survey can help you figure out if the benefits of EPB for the clients outweigh the costs to your agency. You can use another tool, the readiness for implementation scale (RIS), to identify your organization’s strengths and weaknesses in terms of implementing a new EBP. 


We also linked to other web tools and resources such as SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) and NIATx and ATTC materials. And we organized all the tools and info in a step-wise process that will guide you from your initial thinking about a particular EBP through the process of testing and adopting it throughout your organization.
Post a comment or question three times during the month of September, and you’ll be entered in a drawing to win one of 3 Kindle Paperwhites. Visit the site today, and let us know what you think!


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. 

Change is easy. Staying changed? Not so much


July 28, 2014

Jay Ford, PhD, FHIMSS, FACHE
Director of Research
Center for Health Enhancement Systems Studies/NIATx 
University of Wisconsin-Madison
fordii@cae.wisc.edu

But staying changed can be a challenge.   

Maybe you’ve seen it happen in your own organization: an improvement project has an initial success…then fades into improvement project oblivion a few months later.

Just as losing weight doesn't mean that it will stay lost, implementing an organizational change doesn’t guarantee that it will be sustained. Studies indicate that only 40 to 70% of changes are sustained[i].A change not sustained is a direct waste of invested resources, creates costs associated with missed opportunities, and affects your organization’s ability to implement change in the future.

Despite these challenges, we are learning more about what makes change “stick,” or the attributes that influence sustainability of organizational change. But before I tell you about these attributes, I want to clarify two important related concepts: maintenance of change and organizational capacity to maintain the benefits of a change.  How do they differ? 

I like to define maintenance of change as “the extent an evidence-based intervention can deliver its intended benefits over an extended period of time.[ii]” 

Take a look at weight loss. For a dieter, maintenance of change might be the ability of reduced calories and increased activity to deliver the intended benefit (a healthy weight) over time. For an organizational improvement project to reduce appointment no-shows, maintenance of change might be the extent to which using reminder phone calls reduces no-shows, once that practice is adopted as standard procedure.  

Organizational capacity to maintain the benefits of change refers to the existence of structures and processes that allow a program to leverage resources to effectively implement and maintain evidence-based policies and activities.[iii]” In other words, how does the organization’s environment support sustaining the improvements made?  Creating a culture of change can make all the difference in sustaining a new business process or an evidence-based practice.

Long-term success

What I do know is that the longer your organization maintains the benefits of a change, the more likely those benefits to become the “new normal.”   

 Let’s say you make changes to reduce waiting time for first appointments from 28 to 7 days. After testing a few promising practices such as reminder phone calls, double booking appointments, and offering same-day service, you successfully reducing waiting time to 7 days.  Even better, you maintain that improvement over a 12-month period! Admissions are up, and more clients are continuing in treatment. The increase in billable hours has boosted revenue, and your board of directors is pleased. The expected appointment wait time of 7 days is now the new normal for your organization, and you would measure any efforts to improve wait time further against this internal benchmark.

A sustainability focus
Two aspects of sustainability do not get enough attention in quality improvement projects: lack of focus on sustainability early in the implementation process and sustainability planning.  Think of yo-yo dieting: a person might achieve a dramatic weight loss by severe restricting calories and increasing activity. But can both changes be maintained over time? Does the dieter have a plan already in place for counting calories and staying active once the weight loss goal is achieved?

Organizations need to go into implementation believing that the change will be successful and should be sustained. The ideal time to start thinking about sustainability will vary, but once the change has been implemented and appears to be successful, it’s time for an organization to assess its capacity to sustain the change. Now’s the time to identify internal barriers to sustainability. I know about two tools to help assess your organizations’ sustainability capacity: (1) the British National Health Service Sustainability Index and (2) the Program Sustainability Assessment Tool. Regardless of the tool used, recruit four to eight staff persons in your organization to complete the tool to ensure that multiple opinions are considered when assessing sustainability capacity.

A sustainability plan
Use the results from the assessment to focus on sustainability planning. A sustainability plan identifies specific actions that an organization might take to support sustainability.

In my opinion, a sustainability plan should be simple and concise. It should formalize the infrastructure and identify the resources to support sustainability. For example, the plan should identify a sustain leader and the process that will be used to regularly monitor the impact of the change over time. The sustain plan can been seen as your “relapse prevention plan” should the change begin to fail. Similar to when a fire alarm is pulled and you need to evacuate the building, the sustain plan should identify the red flags or triggers that will stimulate action.

Let’s go back to the example of the organization that reduced waiting appointment wait time to 7 days. Your organization decided that the red flag would be appointment wait time creeping up to 10 days for two consecutive weeks. Your sustain plan should clearly define immediate steps to take when that happens. These steps could include reconvening the change team in 48 hours to study the problem, identifying the source of the increase in appointment wait time, and then taking correctable actions.

These are some of my thoughts related to sustainability. Now it would be great to hear from you. Do you have a success story to share related to sustainability? What attributes influenced your organizational capacity to sustain change? How long have you been able to maintain the benefits from an implemented change? Are some changes easier to maintain than others? If so, what types of changes? Let’s start a dialogue so everyone benefits from our collective knowledge.

Dr. Jay Ford’s current research applies health systems engineering principals and techniques to improve health care delivery systems within behavioral health. Current projects involve community-based treatment providers, states, and the Veterans Administration. He serves as a coach for projects such as the Wisconsin Mental Health Learning Collaborative and BHBusiness. Previously, Dr. Ford led the research and data analysis for NIATx 200 and STAR-SI projects that focused on spreading and sustaining organizational change in addiction treatment organizations and systems. He was also a member of the team that developed and tested the NIATx model in the Robert Wood Johnson Foundation-funded and CSAT-funded Paths to Recovery and STAR projects






[i] Scheirer, M. A. and J. W. Dearing. 2011. “An agenda for research on the sustainability of public health programs.” American Journal of Public Health 101(11): 2059-67
[ii] Chambers DA, Glasgow RE Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013 Oct 2; 8:117
[iii] Schell S, Luke D, Schooley M, Elliott M, Herbers S, Mueller N, et al. Public health program capacity for sustainability: A new framework. Implement Sci., 2013 Feb 1; 8:15.

How baseball and Twitter brought research to the real world


July 18, 2014

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

Last month (June 2014), I attended a great workshop on science writing and communication skills for the 21st century. One of the featured speakers was Lee Aase, director of the Center for Social Media at Mayo Clinic. His workshop “You Are Now the Media. Really” was about how social media is revolutionizing health care.

Aase got the Mayo Clinic started with social media, launching podcasts in 2005, Facebook in 2007, and Twitter in 2008. A TwitterChat about wrist surgery that Mayo Clinic hosted with USA Today (featuring the wrist recovery of Philadelphia Phillies outfielder Jason Werth) encouraged other people with similar wrist injuries to inquire about the surgery.

Dr. Richard Berger, who pioneered this surgery (called the UT split), later wrote to Aase that several doctors had trained with him to learn the procedure because of the TwitterChat

Berger said:

“Social media has driven this into practice in less than 2 years, when it takes 17 years on average!”

Could social media have the same effect on the spread of evidence-based practices in behavioral health?

Mayo Clinic also has a YouTube channel and several blogs. One of its most successful videos (with millions of views) was of an older couple playing the piano. You can watch the video and read the story of these “Octogenarian Idols” here.

Social media has been so successful that today Mayo Clinic has an entire department dedicated to it, the Social Media Health Network.

Aase says that before social media, the most effective communication channel for the Mayo Clinic was not paid advertising or TV spots, but word of mouth—patients referring one other to the clinic’s doctors.

Social media are the word-of-mouth of the 21st century.

In the 21st century environment of health care reform, behavioral health care organizations have to market their services and compete with one another. Social media, in all its forms—Facebook, LinkedIn, Twitter, YouTube, and blogging, to name just a few—have become essential and affordable marketing tools.

Has your organization made the leap?

If you’re looking for ideas and inspiration, check out the four-part social media webinar series Marketing with Social Media on the NIATx website. The first is a presentation by Lee Aase similar to the one I attended.

Aase also offers some fun and informative resources on his  Social Media University, Global (SMUG) website. For example, Twitter101: Intro to Twitter is just under three minutes and gives a great overview. You’ll be happily tweeting away before you know it.  

Oh, and by the way, be sure to "follow" us on Twitter:


and "like" us on Facebook: 

…and we’ll be sure to follow you and like you back!

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.