The Role of Spirituality and Faith in the Treatment and Healing of SUDs

Dawn Tyus, LPC, MAC, NCC
Director, Southeast ATTC

Celene Craig, MPH, MS

Over the past decade, there has been an emphasis on addressing the acute alcohol and drug addiction crisis in the United States. In 2016, more than 63,000 drug overdose deaths occurred in the U.S., a 21.5% increase from 2015. As of 2018, 20.1 million Americans age 12 or older have a substance use disorder (SUD) involving alcohol or illicit drugs. Within this estimation, 2.1 million people had an opioid use disorder (OUD), according to Substance Abuse and Mental Health Services Administration. Though it may seem that life-saving medicines and psychological interventions are important biological aspects in helping a person with a SUD, treating the inner, spiritual side of healing through recovery is also a central part of the continuum of addiction healthcare.

From 2002 to 2018, recognition has increased for evidence-based studies that focus on the importance of patient spirituality in treatment and healing of SUDs due to a mandate by the Joint Commission on Accreditation and Healthcare for the administration of a spiritual assessment by healthcare providers for patients and their families. Evidence-based studies have demonstrated the positive impact of faith on health and wellbeing — such as leading to lower levels of substance abuse and reducing the likelihood of using various drugs — in the course of a lifetime. These findings make including a body-mind-spirit integrated model of intervention essential, and indispensable in substance abuse prevention and recovery. Addiction specialists have found that 73% of addiction treatment programs in the United States include a spirituality-based element and faith-based volunteer support groups contribute up to $316.6 billion in savings to the economy every year. According to an overview of the available evidence-based studies on the effectiveness of faith-based substance use support programs, conducted by Brian and Melissa Grim in 2019, 84% of the studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed.

Faith-based organizations fill the gap where federal and state agencies are logistically unable to effectively and comprehensively confront the substance use epidemic. It shows that these organizations are able to reach beyond the person with a SUD and wrap support around their family and community.

“The value of faith-oriented approaches to substance abuse prevention and recovery is indisputable and the current decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern,” Grim said.

For the past 17 years, the Southeast Addiction Technology Center’s (SATTC) vision has been to transfer technology to faith leaders; increase the SUD workforce capacity within faith settings; and increase assessment, referral and engagement to care. SATTC has collaborated with communities of faith through the facilitation of conferences, learning academies, listening sessions, webinars and SUD workshops. It has been our mission to:

  • Dialogue and strengthen the substance use disorder knowledge for people working in communities of faith.
  • Teach communities of faith how to be catalyst for change in their communities.
  • Teach faith communities how to spark the conversation that “recovery is real, and treatment does work”
  • Bridge the gap between faith systems and community providers.
  • Empower faith communities to reduce the stigma associated with substance use disorders.
  • Provide measurable results for our target population.
  • Build capacity associated with substance use disorders that will aid in creating powerful and sustainable recovery ministries.
  • Promote access to services and resources that will empower communities and their partners, to create a welcoming and supportive environment.

We are committed and eager to bridge the gap between community providers and communities of faith to dispel the stigma around addiction and increase the knowledge capacity of faith leaders in the Southeast region. Through our intensive technical assistance program-development process, learning communities and trainings, we are able to equip faith leaders with the knowledge and skills to be change agents in their communities and help all people suffering with a substance use disorder.

NIATx Principle #2: Fix Key Problems (And Help the CEO Sleep at Night)

Mat Roosa, LCSW-R
NIATx Coach

The NIATx model is driven by five principles that research has shown to be the hallmarks of successful improvement projects. These five principles emerged from an analysis of decades’ worth of research that gathered data from 640 organizations in 13 industries, examining 80 factors on why certain projects fail while others succeed.

Principle 1, Understand and Involve the Customer, is the single most important action a change team can take to set up a project for success. In fact, the NIATx research analysis showed that this one principle has a greater impact on success than the other four combined. (See related blog post: Why Understanding and Involving the Customer Matters in Behavioral Health.)

Lose sight of your customer (your client), and you lose sight of success. 

Principle 2: Fix Key Problems (And Help the CEO Sleep at Night) switches the focus to leadership. If a change project is to be successful, it needs the full support of the agency’s leadership. The way to ensure that support is by addressing the problems that truly matter to the CEO.

Kim Linwood of Milwaukee learned the NIATx principles at
NIATx Change Leader Academy in Madison, WI, June 2019.

Change Project Pitfall: Lack of executive sponsorship
Often when change leaders are completing the NIATx project charter, they come to the “executive sponsor” box, and simply fill in the name of their supervisor.

Many are fond of saying that “team” is more of a verb than a noun. It is the act of “teaming” that creates results. The executive sponsor role in relation to the change team reflects this same truth. That is why we need to ask a critical follow-up question: Who is the Executive Sponsor, and what are they doing to ensure the success of the change project?

If everything is a priority…
We all know the second half of this statement: then nothing is a priority.

Executive Sponsors create and maintain priorities. One of the most powerful functions of the Executive Sponsor can be expressed in the following contrasting statements from two Executive Sponsors:

  • ES #1: “This change project is important, but make sure you keep doing everything else that we are already working on.”
  • ES #2: “This change project is important, so I am going to reassign a couple of tasks to make sure that you have the time you need for the change project to succeed.”

Strong Executive Sponsors like #2 approve the new project for takeoff, and they clear the runway to make sure that the project can pick up the speed it needs to lift off. It is critical to have the ES at the table during the formative stages of the project development to ensure adequate engagement and support. When an ES is reluctant to come to the table beyond a simple approval of the project, the Change Leader can help by reminding the ES of their critical role:

  • We need you to role model support for the change project.
  • We need you to dedicate resources to this effort.
  • We need you to remove the obstacles to our success.
  • We need you to encourage our team.

Change projects with weak executive sponsorship often fail to get off the ground. Change projects with strong executive sponsorship can soar.

About our Guest Blogger 
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in the areas of quality improvement, organizational development and planning, evidence-based practice implementation, and also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. 
You can reach Mat at:

Hepatitis C (HCV) Current Initiative Prepares New Trainers

Meet the Trainer: Jess Draws

Maureen Fitzgerald
Great Lakes ATTC

Back/Middle Row from left: Cindy Christy, Erin Winstanley, Joe McAdams, Kurt Begaye, Brian Hartzler, Hannah Eckes, Jace Dyckman, Lucas Piper, Diana Padilla (master trainer), Ed Johnson, Chris Harsell, Grant Hovik, Al Hasson, Maxine Henry, Robert Peralta, Holly Hagle, Robert Jope

Front row from left: Tammy Wenz, Ahani Valenzuela, Jess Draws, Taylor D’addario, Jude Dean, Kelly Reinhardt, Jayce Dykeman 

More than 20 team members from across the ATTC Network gathered in San Diego in April for the HCV Current Initiative Training of Trainers (ToT). The three-day training was led by master trainer Diana Padilla of the Northeast and Caribbean ATTC, who prepared the group to present the new and updated HCV Current curriculum—soon to be available on the ATTC Network website.

Jess Draws of the Great Lakes ATTC was among the group of trainers-in-training. Jess joined the Great Lakes ATTC team in November 2018 as a technology transfer specialist for the Opioid Response Network, covering Ohio. Jess earned an MSW in 2017 from the UW-Madison School of Social Work. Previous work experience includes youth restorative justice, phone counseling for sexual assault survivors at the Dane County Rape Crisis Center, and student services and advocacy work for LGBT students. With an interest in learning more about the opioid epidemic and related health issues, Jess jumped at the chance to attend the HCV Current ToT.

Before attending, Jess took the online course, HCV Snapshot: Introduction to Hepatitis C for Health Care Professionals, available on HealtheKnowledge. “The HCV Snapshot course helped me prepare for the ToT and gave a good overview of hepatitis C prevention, treatment, and recovery,” says Jess.

Interactive Training Tapped In To Participants’ Expertise

Arriving at the training, Jess was impressed by the expertise of the fellow participants. “The group included doctors and nurses with 10 to 15 years of experience working with people with hepatitis c,” Jess explains. “I felt a little bit like a fish out of water, but knew that this would be a great learning opportunity.”

The first day of the session, Diana Padilla took the group through the HCV Current online and face-to-face training content.

“Diana’s training style is very interactive, and she really tapped in to the expertise in the room to bring in insider knowledge from the perspective of a nurse, addictions counselor, or physician,” says Jess.

Jess also noted how Diana deftly folded the participants’ knowledge into the training modules, as well as into the revision of the HCV Current curriculum.

“Every time someone had a question we stopped and talked about it, so we could learn how to teach to various audiences,” says Jess. “Diana talked about nuances of the information for those of us who would be teaching families or other social workers rather than nurses or physicians,” adds Jess. “Stopping to take in everybody’s perspective as a presenter is something that I hope to incorporate into my training style.”

Jess’s Top Three Take-aways

  1. Personal Take-away: Attend a Training of Trainers, even if you don’t consider yourself a subject matter expert (SME). “I felt out of place at first, but left with a higher level of confidence after watching others and getting tips and great feedback during the teach-back. Even though I came to the ToT without the technical expertise on hepatitis C, I was able to make meaningful contributions to the content based on my knowledge and experiences. So even if you are not an SME and think you never will be, remember that we always need to hear from different voices who can translate the content in terms that are relevant to a specific audience."
  2. Take-away about hepatitis C: “Many may not be aware of the advances in HCV treatment. It used to require taking medication with truly debilitating side effects for a year or longer, with a cure rate of only 30 to 50%. But today, HCV treatment is considered one of the miracles of modern science—it is the only viral infection that is curable.”
  3. Take-away for health care professionals: “We, as trainers, are hoping to get physicians and addiction treatment counselors to make testing for HCV more accessible. Because there are so many factors that elevate the risk of infection, include information about HCV prevention, treatment, and recovery along with information on HIV and sexually-transmitted diseases. “Patients could check a box on a form, asking “Would you like to be tested for hepatitis C today?” Substance use disorder professionals could add this question to the intake process. Health care professionals also need to share the message getting tested and treated for hepatitis C can radically improve a person’s quality of life and life expectancy.”

HCV Current Updated Content

Jess is looking forward to putting her new skills to use with the newly revised HCV Current curriculum. The updated content includes the latest information on HCV treatment options, along with information on the intersection between the opioid epidemic and increase in HCV infection rates.

World Hepatitis Day: July 28, 2019

The World Health Organization has designated July 28 as World Hepatitis Day, dedicated to increasing awareness of viral hepatitis prevention, treatment, and recovery. It’s a perfect time to explore HCV Current. Interested in setting up an HCV Current face-to-face training? You can find Jess Draws and other HCV Current trainers on the ATTC Network Trainer Registry!

AMERSA Conference: Reflecting back on 2018 highlights and looking ahead to this year's conference

Claire Anne Simeone, DNP, FNP
Matthew Tierney, RN, MSN, NP
Shannon Mountain-Ray, LICSW
Scott E. Hadland, MD, MPH, MS

AMERSA (The Association of Multidisciplinary Education and Research in Substance use and Addiction) held its 42nd annual conference at the InterContinental Mark Hopkins Hotel in San Francisco on November 8-11, 2018, with sponsorship support from the ATTC Network as well as NIH, NIDA CTN, and SAMHSA. With 375 attendees from the fields of nursing, social work, behavioral health, psychiatry, medicine, pharmacy, research and policy, the conference provided a platform for the presentation of current challenges and innovations in research, education and clinical practice in substance use disorder prevention and treatment, as well as opportunities for collegial discussion and networking.

AMERSA, founded in 1976, is a non-profit professional organization whose mission is to improve health and wellbeing through interdisciplinary leadership in substance use education, research, clinical care and policy. A key goal is to improve education and clinical practice in the identification and management of substance-related problems by promoting leadership, mentorship and collaboration among multiple healthcare professions. AMERSA members represent numerous disciplines including physicians, nurses, social workers, psychologists, dentists, pharmacists and public health professionals. The annual conference attracted national and international attendees and provided opportunities for networking, mentorship, collaboration, and receiving feedback on work in progress.

During the pre-conference day on Wednesday, many early arriving attendees participated in pre-planned local site visits to agencies doing innovative work in the field. These included avant-garde opioid treatment programs at the San Francisco Veteran’s Administration and Zuckerberg San Francisco General Hospital, San Francisco’s Behavioral Health Access Center, and the Tenderloin Health Service’s planned safe injection facility. On Wednesday evening, a couple dozen AMERSA members attended a screening of the documentary movie “The Providers” by film-makers Laura Green and Anna Moot-Levin. The movie screening, sponsored by the ATTC who also provided popcorn and snacks, features three healthcare providers, an NP, a PA, and an MD, who care for people living on the margins in a rural American community struggling with a shortage of providers and the health and social problems associated with alcohol and drug use.

The formal conference began with a plenary on neural pathways that play a role in stigma presented by Deborah Finnell, DNS, CARN-AP, FAAN from Johns Hopkins School of Nursing. Dr. Finnell engaged the audience in a discussion of the neural basis of the complex interplay between stigma, disgust, prejudice, bias and discrimination, including implications for policy and clinical practice.

Jalie Tucker, PhD, MPH of the University of Florida, the 2018 recipient of AMERSA’s Betty Ford Award, presented a plenary entitled The Many Pathways to Recovery from Substance Use Disorders: Contributions from Psychology, Public Health and Behavioral Economics. The audience was captivated by Dr. Tucker’s discussion of natural recovery, the principles of behavioral economics and the importance of considering choice biases when developing interventions for problematic alcohol use.

A multi-disciplinary panel of experts affiliated with San Francisco’s justice system presented information on local collaborative justice and substance use treatment services. The panel included Lisa Lightman, MA, Judge Eric Fleming from the Collaborative Courts of San Francisco’s Superior Court, Angelica Almeida, PhD, Linda Wu, MSW, LCSW and Charles Houston from the SF Department of Public Health.

A second panel of experts presented Cannabis: Updates, Neurobiology and Public Health. Garth Terry, MD, PhD from the University of Washington and VA Puget Sound’s Mental Illness Research, Education and Clinical Center set the stage with an overview of cannabis neurobiology. Tista Gosh, MD, MPH from the Colorado Department of Public Health and Environment and Rick Garza from the Washington State Liquor and Cannabis Board shared key aspects of policy challenges, successes and surveillance during marijuana legalization in their respective states.

Current research in stimulant use epidemiology and interventions was the focus of the third interdisciplinary panel. Glenn Milos-Santos, PhD, MPH from the University of California San Francisco (UCSF) School of Nursing, Elise Riley, PhD, from UCSF School of Medicine, David Olem, MS from UCSF Division of Preventive Services and Walter Gomez, MA, MSW, PhD from University of California Berkeley School of Social Welfare each presented their ongoing research addressing treatment approaches to methamphetamine and cocaine use disorders in marginalized populations, including homeless women, and men who have sex with men.

It is an AMERSA conference tradition to have a “spicy debate” on a controversial topic in the field of substance use and addiction. Our 2018 topic, Are Safe Consumption Spaces a Necessity for Public and Personal Health? was debated by Lindsay LaSalle, JD from the Drug Policy Alliance and John Lovell, JD from the Law Offices of John Lovell. The debate was very spicy indeed, and covered the pro and con arguments currently being hotly debated in public forums in communities across the country. Ongoing energetic discussions were overheard throughout the conference on this topic where scientific evidence, drug laws, and public opinion often clash.

Kevin Kunz, MD, MPH, DFSAM, Executive Vice President of the American College of Academic Addiction Medicine and the American Board of Addiction Medicine received AMERSA’s prestigious John P. McGovern award. He presented his vision for the field of addiction treatment through an inspiring talk on the cycle of drug epidemics and transformative change.

Saturday morning was rich with brief plenaries from AMERSA award winners who presented their innovative work in the categories of best research abstract, best curriculum and quality improvement abstract and best workshop. Winners included Julie Netherland, PhD and Sheila Vakharia, PhD, MSW for “Becoming an Effective Drug Policy Reform Advocate”, Rachel H. Alinsky, MD for “Receipt of Addiction Treatment Following Opioid-Related Overdose among Medicaid-Enrolled Youth”, Christopher S. Stauffer, MD for “Oxytocin- Enhanced Motivational Interviewing Group Therapy for Methamphetamine Use Disorder in Men who have Sex with Men: Preliminary Results from a Randomized Controlled Trial”, Jessica A. Kattan, MD, MPH for “New York City Health Department’s Multi-Pronged Approach to Expanding Buprenorphine Treatment Capacity” and Rachel Winograd, PhD for “Missouri’s Implementation of a ‘Medication First' Treatment Model for Opioid Use Disorder."

Beyond the provocative plenaries, the conference was rich with opportunities to review and discuss current trends in educational, clinical, research and policy work by both established and early-career professionals working in the field. The Thursday evening scientific poster session was held in the hotel’s beautiful “Room of the Dons.” The cozy space provided ample opportunity to review excellent posters, and to network with fellow AMERSA members. Numerous workshops and brief oral presentations throughout the conference offered a broad spectrum of topics in substance use and addiction from a variety of disciplinary perspectives.

Special interest group meetings (nursing, social work and behavioral health, physicians, adolescent and youth initiative, hospital-based addiction consult services, and medication for substance use disorders initiative) and mentor-mentee opportunities provided additional learning platforms, and rounded out the successful conference.

The 2018 AMERSA Annual conference was the largest annual conference to date and included many first-time attendees.

Preparations are underway for the 2019 annual conference which will be held in Boston at the Hyatt Regency on November 7th to 9th, with continued sponsorship support from the ATTC Network. The theme of the conference will be: Challenges and New Horizons in Addressing Substance use and Addiction.

Plenary presentations will address important challenges including a discussion by Ayana Jordan, MD, PhD. of Yale University on health disparities in accessing substance use treatment. Elizabeth Miller, MD, PhD, FSAHM of University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh and Lynn Sanford, LICSW will present novel, evidence-based healing and resiliency-centered approaches to trauma treatment. Panelists Christopher Stauffer, MD, of University of California San Francisco, Matthew W. Johnson, PhD and Mary P. Cosimano, MSW both of Johns Hopkins University School of Medicine will present on the use of psychedelics in addiction treatment. In addition, presentations will be made by winners of the Betty Ford award - Gail D'Onofrio, MD, MS, the John P. McGovern award, Daniel P. Alford, MD, MPH, and Best Abstract Awards as well as a variety of skills-based workshops and oral presentations covering a breadth/diversity of topics in the field of substance use and addiction.

The highly anticipated “Spicy Debate” will be on “Tapering Opioids: Compassionate Care or Punitive Policy?” Anna Lembke, MD of Stanford University and Stefan Kertesz, MD of University of Alabama at Birmingham School of Medicine will review current research including gaps in knowledge and areas for future research, identify needs in health professional education, and discuss the clinical and public health impact of policy on both sides of the debate.

Conference attendees will have the opportunity to attend site visits highlighting various diverse and innovative resources and programs available to youth and adults in the Boston area on Wednesday, prior to conference opening.

As is AMERSA’s tradition, there will be several opportunities for attendees to network and connect as a community such as the daily Fun Run-Walk and Saturday yoga session. New members and first-time attendees will be invited to attend an orientation to AMERSA. Mentor/mentee meetings will be held throughout the conference. In addition, luncheons for the seven special interest groups and the annual conference award/auction luncheon, a breakfast for attendees interested in planning for AMERSA 2020 and a Thursday evening welcome and scientific poster session will be held.

AMERSA 2019 is shaping up to be one of our best conferences yet!

The 5 NIATx Principles: Principle #4 — Get ideas from outside the organization or field

Mat Roosa, LCSW-R
NIATx Coach

When a substance use disorder clinic is struggling to engage and retain clients, we might understand why they would reach out to a more successful clinic for assistance.

But what about asking a hotel or an amusement park?

Many industries, especially in the health and human service sector, have remained highly isolated, with limited opportunities to consider applying the innovations of other sectors. With its roots in process engineering, NIATx was founded on some of the core process improvement methodologies that drove the rapid advancements in manufacturing following WWII. As NIATx began to work with behavioral health providers, this encouragement to look beyond familiar territory opened up a whole new world of improvement for the early adopters of NIATx.

The Venn diagram below offers a means of considering ideas from outside. Ideas from within the smallest circle of providers who offer the same service are the most familiar and easiest to understand and implement. At the other extreme are services provided in different industries. These are the least familiar and often the most challenging to understand.

So why not just stick with familiar territory and explore improvements by learning about the best practices of successful peers who provide the same service?

While there may be plenty to learn from those who provide the same service, those services represented by the larger circles allow us to reframe how we see things, and consider ideas that we would never have considered otherwise. It makes sense to try to think outside of the circle of the familiar.

The table below offers another perspective on this spectrum of services from more to less familiar. As we move farther away from the familiar, the corresponding questions in the right column allow us to consider new ideas. These broader questions can spark new and creative visions. In departing from the familiar, our questions focus less on improving what we do now and more on doing something new.

Consider the actions of a fine hotel determined to make you a loyal customer. Hotel staff greet you with warmth, carry your bags, offer you courtesy beverages and snacks, and thank you for staying with them. Fine hotels ensure that the environment is attractive and that every customer’s encounter with staff results in a pleasant experience and a positive outcome.

Now imagine if an SUD clinic sought to maintain this same standard of customer service. What would be the costs and the return on investment related to such an effort? How might this approach improve client engagement and retention? How can we do what they do?

Exploring and acting on these questions will uncover valuable opportunities. Ideas from outside shine a light upon new paths of action, leading to innovations with powerful results.

Has your organization tried out ideas from other organizations or industries? What were the results? Share your story in the comment section below.

About our Guest Blogger
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in the areas of quality improvement, organizational development and planning, evidence-based practice implementation, and also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration.
You can reach Mat at:

The South Southwest ATTC Consortium of Higher Education Institutions

Maureen Nichols
Director, South Southwest ATTC

In 1993, the South Southwest ATTC formed an educational consortium of community colleges across Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma and Texas) to impact the quality of clinical addiction care by enhancing academic preparation for new counselors entering the addictions treatment field and to support the recruitment and retention of minority counselors.

Initially, it was the Texas public behavioral health agency that identified a need for a closer alignment between the racial and ethnic composition of addiction treatment program staff compared to the high percentage of minority clients served. Treatment programs reported particular difficulty in hiring bilingual counseling staff. The SSW ATTC identified community based institutions of higher education with a large percentage of minority students and recruited them to offer addictions coursework to equip students with the competencies for delivery of evidence based practices and to provide for internship placements in local treatment programs.

We realized this partnership was also a mechanism for embedding long-term technical assistance of evidence-based practices into the field in a multi-faceted way. Faculty at the consortium schools developed course content based on evidence-based practices promoted by SAMHSA, including TIP 21. The coursework is reviewed by staff from the SSW ATTC to ensure its fidelity to current best practices. Faculty develop long-term working relationships with local treatment providers in their community and place practicum students at the community treatment sites. Faculty also provide ongoing technical assistance in areas such as implementing evidence-based practice with fidelity, best practices in supervision of clinical staff and program evaluation to those local providers.

Today, these local colleges and universities, located across multiple states, still provide pre-service education and training in partnership with their professional communities. The ability to work with those institutions and instructors training our newest counselors and providing them with field experience, allows us to amplify our impact in implementing the latest evidence-based practices into the field. It also enhances our states and local communities’ ability to recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that is reflective of and responsive to the populations they serve.

The consortium remains a stable collaboration that meets annually to share curriculum strategies, technical assistance plans, and student recruitment and placement plans. In 25 years, over 30,000 students have participated and now populate treatment programs throughout the region. The program is very popular with low-income students who can take courses in affordable community colleges located in their locality. Faculty of these programs have become resources in their local communities for the latest addictions and treatment practices. The information gained from faculty and students continues to guide the South Southwest ATTC in our needs assessment, goal setting and implementation processes to improve the lives of those impacted by addiction.

To learn more about the current members view our Education Consortium page or contact the South Southwest ATTC at

Welcome to the New National Hispanic and Latino Addiction Technology Transfer Center

Pierluigi Mancini, Phd, MAC
Director, National Hispanic and Latino ATTC
National Hispanic and Latino ATTC

Welcome to the New National Hispanic and Latino Addiction Technology Transfer Center, (National Hispanic and Latino ATTC) the latest member of the Addiction Technology Transfer Center network (ATTC). The National Latino Behavioral Health Association (NLBHA), the grant recipient, was established to fill a need for a unified national voice for Latino populations in the behavioral health arena and to bring attention to the great disparities that exist in areas of access, utilization, practice-based research and adequately trained personnel. (

The Latino population in the United States combines very diverse populations. The major groups are Mexican Americans (who constitute 63.0% of Latinos), mainland Puerto Ricans (9.2%), and Cubans (3.5%). The Census Bureau's code list of subgroups other than the major groups contains over 30 Hispanic or Latino subgroups, including Brazil, South America’s largest country.

There are also individuals who were born in the United States of America who identify themselves as Hispanic or Latino.

The various Latino groups concentrate in different regions of the U.S. and they constitute a large proportion of the foreign-born population, slightly more than half (53.1%) of the total foreign-born population is composed of immigrants from Latin American and Caribbean nations.

Latino groups also differ in nativity status. About one-third (36%) of Hispanics of Mexican origin are foreign-born, as compared with more than half of Cubans and Dominicans (59% and 57%, respectively). Among Puerto Ricans living in the United States, one-third (31%) were born on the island. In addition, there is substantial heterogeneity across Latino groups in terms of immigration history and patterns.

The National Hispanic and Latino ATTC will be addressing the diverse needs that this heterogeneous community faces when it comes to seeking and finding addiction treatment, prevention and recovery services. Besides country of origin we will be addressing issues of acculturation, limited English proficiency, health literacy, or the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

We plan to train the behavioral health workforce that will be serving Hispanic/Latino communities and developing and/or adapting the evidence-based practices and services that these professionals will be using in order to bring meaningful change to the lives of these individuals.

We will serve individuals and organizations who provide behavioral health services to Hispanic/Latino populations throughout the United States. The center will provide training and technical assistance to a wide range of public, nonprofit and private organizations in culturally and linguistically appropriate practices and programs effective in serving Latino populations including evidenced based, community defined evidence, and other best or emerging practices.

Finally, we will make sure that the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) are recognized. Training and hiring protocols will be implemented to support the culture and language of all subpopulations (English, Spanish or Portuguese), with a focus on the diverse Hispanic/Latino populations.

For additional information, please don’t hesitate to contact Project Director, Pierluigi Mancini PhD, MAC, at or at 678-883-6118


Acosta, YD., De la Cruz, GP. Brief ACSBR/10-15. US Dep. Commer., Econ. Stat. Adm., US Census Bur; 2011. The foreign born from Latin America and the Caribbean: 2010.

Ennis, SR., Rios-Vargas, M., Albert, NG. Brief C2010BR-04. US Census Bur; 2011. The Hispanic population 2010.

Brown, A., Patten, E. Hispanics of Puerto Rican origin in the United States, 2011. Pew Res Cent, Hisp Trends. 2013 Jun 19.

Great Lakes ATTC: Process Improvement Focus Helps Organizations Implement Evidence-Based Practices

Todd Molfenter, Ph.D.
Director, Great Lakes ATTC

The mission of the ATTC Network includes “accelerating the adoption and implementation of evidence-based and promising addiction treatment and recovery-oriented practices and services.”

At the Great Lakes ATTC, we’re applying our background in implementation science and process improvement to help accelerate the adoption and implementation of EPBs in our region and beyond.

Implementing EPBs can be challenging for organizations of any size. Emerging research from implementation science tells us that successful EPB implementation needs:
  1. more than training alone,
  2. coaching and feedback; and
  3. standardized improvement model.
See related article, Water into Sand: OUD Pharmacotherapy and Implementation Science: Why Training on Evidence-Based Practices is Never Enough

The NIATx Model

A fundamental tool in the Great Lakes ATTC’s effort to accelerate EPB implementation is the NIATx model, developed in 2003 as a demonstration project supported by the Robert Wood Johnson Foundation and SAMHSA. A seminal article written by McCarty et al. in 2007 described the impact of the NIATx model on access and retention in addiction treatment settings. Since then, more than 50 peer-reviewed articles have documented the use of the NIATx model in adopting evidence-based practices in addiction treatment, mental health, HIV treatment, child welfare, criminal justice, and other human services settings.

The NIATx Change Leader Academy

To teach the NIATx model, we offer the NIATx Change Leader Academy (CLA): a one-day, face-to-face workshop followed by three months of peer networking and support from a NIATx coach. The CLA teaches organizations how to use the NIATx model of process improvement to lead change projects that focus on improving systems or implementing EBPs.

Based on customer feedback (and applying NIATx Principle #1: Understand and Involve the Customer), we continue to refine this training session to make it focused, team-based, and interactive. Participants leave the skill-building workshop with tools they can use to start a change project as soon as they get back to the office.

Available in our region and beyond

During our first year as the Great Lakes ATTC, we conducted NIATx CLAs in each state in our region. These events were a great way to build relationships with our stakeholders and to introduce more behavioral health providers to the NIATx model.

Organizations in our region are using the NIATx approach for a wide range of change projects, including implementation of medication-assisted treatment for opioid use disorder and Screening, Brief Intervention, and Referral to Treatment. NIATx tools are helping to build Recovery-Oriented Systems of Care in Ohio, Indiana, Illinois, and soon, we hope, in other states in our region. Organizations can use the NIATx approach to implement other EPBs, such as those listed in SAMHSA’s Evidence-Based Practices Resource Center.

Photo: NIATx Change Leader Academy, MARRCH, April 3, 2019

The NIATx model also provides a framework for making changes to administrative processes. In Minnesota, a recent NIATx CLA marked the launch of a strategic initiative by the Minnesota Associations of Resources for Recovery and Chemical Health (MARRCH): a statewide Change Leader Learning Community that will help Minnesota providers adapt to policy changes coming to the state.

Read the related news story: NIATx Change Leader Academy Launches Minnesota Learning Collaborative

We offer the NIATx CLA regularly in the states throughout our region; check the Great Lakes ATTC calendar for info on upcoming offerings. And if you are interested in hosting a NIATx CLA in our region, give us a call!

Why Understanding and Involving the Customer Matters in Behavioral Health

Mat Roosa, LCSW-R
NIATx Coach

Treatment organizations continue to face the challenge of improving access to and retention in treatment. NIATx (originally known as The Network for the Improvement of Addiction Treatment) was developed specifically to help treatment providers make simple, powerful changes that can improve service delivery.

NIATx is based on five principles. The first principle, Understand and Involve the Customer, is number one for a reason. According to the research that was foundational to NIATx, this principle has more impact on the success rates of change implementation than all of the other four principles combined!

Listening to the voice of the customer
Everyone has heard the old business adage, “the customer is always right.” Many of us struggle with this concept. While a shoe store might take back a pair of shoes with half the sole worn off, do we really think that the customer is “right” to ask for the refund? Principle #1 helps us to understand just how right the customer always is.

There is no more important vision and voice than that of the customer. The customer is the only one who can tell us what they feel and what they want. The customer is always right about their perceptions of their experience, and that perception is the most important concern when we are trying to engage and help them. The best product or service will not be successful unless it is embraced by the customer.

So, what steps can we take to engage and involve the customer better?
I recall being at a meeting during which a veteran administrator was asked how recipients of services would feel about a major change. As he waxed on about a number of variables, I could see a supervisor of peer services, a woman with a great deal of lived experience as a service recipient, growing more and more frustrated. When he took a breath, she simply said, “Why don’t you just ask them?”

Why don’t we spend more time “just asking them”? The asking of customers requires that we treat them as partners at the table of service development and service improvement. While most would say they are willing to ask, fewer are willing to invest the time and ready to relinquish the control that is required for genuine asking. The walk-through, the Empathy Map and the Nominal Group Technique are three tools that will help teams to build a culture that values customer input.

The walk-through
One essential NIATx tool is the walk-throughThis role play exercise in which staff walk through the client experience is typically conducted at the beginning of the change project and helps teams see treatment barriers and process problems that are often hiding in plain sight. Walk-through exercises have uncovered issues such as an incorrect phone number listed as the agency contact information, poor directions to the treatment location, confusing signage at the facility, unwelcoming waiting areas, and lengthy intake sessions that require excessive or duplicative paperwork.

Here are a few tips for ensuring a successful walk-through:

1. Inform your staff: The team should be prepared for the experience. You want to see the process at its best, and then consider how it can be improved.

2. Stay in your role: complete the process in an authentic fashion.

3. Note the details of the process, and your emotional experiences

4. With each step of the process ask two questions: Is this necessary? If yes, Is it the best that it can be?

The Empathy Map
What do your customers say, think, feel, and do? What are their goals? Draw a large version of the Empathy Map grid, and ask your team members to write single ideas on sticky notes to be placed in the five sections of the grid. This tool will cultivate empathy for your customers’ experiences. It can serve as a way to gather all of the wisdom that customers have shared with administrative and treatment staff over time, and can help to identify key themes that will lead toward improvements. These questions are also an excellent structure for asking customers for feedback through interviews or focus groups.

The Nominal Group Technique
Using the Nominal Group Technique (NGT), another essential NIATx tool, is an excellent way to brainstorm with a team that includes customers, The structure of the process is designed to create inclusive participation among the team members. The four steps of the NGT process are intended to ask a powerful question and encourage listening to all of the answers offered. It can empower customers, and teach staff members about the value of the customer voice.

Four steps of the NGT

The walk-through, Empathy Map, and the NGT: three critical tools for understanding and involving the customer, and understanding just how right the customer is.

About our guest blogger:
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in the areas of quality improvement, organizational development and planning, evidence-based practice implementation, and also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration.

You can reach Mat at: