Addiction Treatment Providers Research Articles

Implications of genetic attributions for addiction among addiction professionals

Given increasing emphasis on understanding the role of genes in the etiology of addictive disorders, the present study aimed to investigate the implications of genetic explanations of addiction for attitudes and beliefs about patients among addiction treatment providers. Participants were recruited from addiction-related professional organizations. The sample included professionals with medical backgrounds (n = 153) and with nonmedical backgrounds (n = 232). They viewed a description of a fictitious patient with either alcohol use disorder or gambling disorder, which was experimentally varied to indicate the presence or absence of a genetic cause. They completed measures of their genetic attributions for the patient's symptoms as well as their attitudes and beliefs about the patient. The presence of a genetic explanation increased genetic attribution ratings but did not significantly affect other measured variables. However, participants' genetic attributions for the patient's symptoms were associated with significantly lower ascriptions of blame to the patient and greater belief in the effectiveness of medication, but also with reduced confidence in the effectiveness of psychotherapy and with pessimism about the patient's prognosis. Geneticized, biomedical conceptualizations of addiction may have implications for treatment providers' attitudes toward patients.

Data from NAATP build case for value of extended residential treatment

On a conference day that National Association of Addiction Treatment Providers (NAATP) CEO Marvin Ventrell dubbed “science day,” one statistic stood out to qualify as the data point of the day. The chief science officer at Cumberland Heights Foundation, an active participant in NAATP's groundbreaking Foundation for Recovery Science and Education (FoRSE) outcomes project, cited 2023 readmission statistics across all levels of care in the Nashville‐based organization. At one‐year post‐discharge, patients whose treatment stay had been shorter than 30 days had a readmission rate of 25%. For those whose stay had been longer than 30 days, the readmission rate was only 3%.

Annual outcomes study out from NAATP

FoRSE, the research foundation of the National Association of Addiction Treatment Providers (NAATP), will release its annual summary report at this week's annual meeting, which ADAW will cover in person. The report provides NAATP members, as well as the public, with descriptive and graphic reports of the impact of addiction treatment. This will give them insight into how effective their programs are, compared to others across the country. The 42 page report, a copy of which was obtained by ADAW, is stunning in terms of content and presentation. The report is free. The focus is on outcomes. For anyone who has ever been asked “Does treatment work?” or “Does your treatment program work?” this report is invaluable. It breaks down the answers and includes the how and why. We asked Annie Peters, Ph.D., NAATP's director of research and education, for the top takeaways from the report. Her response.

Correction

The article on integrating mental health services in the April 8 issue incorrectly stated a facility'y membership status in the National Association of Addiction Treatment Providers. The Farley Center is a former, but not current, member of NAATP. ADAW regrets the error.

Just pass it: NAATP backs both SUPPORT Act versions

The SUPPORT Act reauthorization was passed five years ago, but has yet to be funded. In December before Congress went on vacation for the holiday, the House of Representations passed their version of the new bill, H.R. 4531 (H.R.4531 ‐ Support for Patients and Communities Reauthorization Act). Mark Dunn, lobbyist for the National Association of Addiction Treatment Providers (NAATP), reported back at the end of the year that this version “provides continued coverage for Medicaid individuals who are incarcerated and made positive changes to the IMD [Institution for Mental Diseases] exclusion,” as well as funding the previous programs. In the Senate, two committees advanced that version of the bill (S. 3393 SUPPORT Act). “The Senate bill provides a 70% increase in funding for training of mental health and substance use disorder professionals and a 25% increase in student loan forgiveness for counselors who practice in underserved areas,” Dunn reported. The Senate bill would require the federal government to study whether peer support individuals should be excluded if they have criminal histories, as some states already screen them out, which, as Dunn noted, “eliminates a segment of people in recovery.” NAATP has been advocating for passage and for many of the components included in both bills, Dunn said. “While all our priorities were not included, major advancements were made. We will continue to work with the various congressional leaders as the legislative process continues.” The next steps will be for the full Senate to consider and pass its version of the Support Act reauthorization, and then the two bodies will reconcile the two bills before final passage by both congressional bodies.

Re-examining provider perceptions of best pre-war practices: what elements can help opiate agonist therapy programs in Ukraine successfully survive the crisis?

This paper seeks to explore and understand what constitutes successful opioid agonist therapy (OAT) programs from the views of Ukrainian OAT providers in their context-specific accounts. Prior to the ongoing war the Ukrainian addiction treatment system made great strides to expand its OAT program and increase the number of patients. Since the beginning of the war there has been much alarm that those hard-earned successes will be destroyed. However, emerging evidence suggests that the Ukrainian OAT programs have shown signs of resilience in the face of adversity albeit at great cost. What aspects of the OAT programs developed prior to the crisis have been helpful to allow them to weather the storm? Using the data from 24 addiction treatment providers, this paper describes the essential elements of the OAT programs that preceded the current crisis which made them robust over time. By examining the narratives of the participants interviewed pre-war and pre-COVID-19 the paper reveals structural and cultural elements of the OAT programs before the perfect storm that are likely to endure. To the best of our knowledge, no one else has investigated OAT providers perspectives in Ukraine prior to the crisis which makes this paper extremely salient to understand both the robustness and the vulnerability of MAT programs in Ukraine during the war and going forward. The data come from qualitative semi-structured interviews with 24 OAT providers throughout 5 regions of Ukraine. Participants included front-line clinicians, head narcologists, and chief doctors from TB clinics, district hospitals and drug addiction centers. Using a coding scheme of 103 inductively developed categories we explored participants' perceptions of their OAT program. In the stories shared by clinicians pre crisis, three major interconnected themes focused on economic uncertainty at the institutional level (leading to under-staffing), structural capacity of the program, and clinicians' professional identity, shaping differing views on application of rules for administrative discharge, take-home dosing, and the potential for scale-up. Knowing the data collection was completely unbiased to the current crisis, interpreting the findings helps us understand that OAT clinicians have had "years" of training under conditions of duress in Ukraine to overcome barriers, find creative solutions and form a support network that became indispensable in surviving the current humanitarian catastrophe. In the discussion we point out that the current crisis magnified the pre-existing challenges as the providers approach toward overcoming them was already largely present before the crisis (just on a different scale). The underlying fragility of resources was a constant since OAT inception in Ukraine. Historically, providers in Ukraine operated in a system that was under-funded in the absence of solid governmental funding for OAT programs, yet they came up with solutions which required ingenuity that they took pride in. This gives hope that addiction treatment in Ukraine and OAT programs will not be casualties of this humanitarian crisis and providers and their patients will persevere.

Police Use of Discretion in Encounters with People with Opioid Use Disorder: a Study of Illinois Police Officers.

Police frequently encounter people with opioid use disorder (OUD), having a profound effect on their risk environment and health outcomes. Officers retain significant discretionary authority in their response to these encounters. To explore the factors that underlie these decisions, we surveyed a sample of Illinois police officers. We administered an online survey to Illinois police departments using a random sampling strategy, stratified by agency size and the rurality of their service areas. Our final sample was 248 police officers from 27 departments. We surveyed officers' beliefs about (1) influences and control over their decision making; (2) the approval of other actors in making referrals to treatment for addiction, and (3) the potential impacts of medication-assisted treatment (MAT). We analyzed the survey data using descriptive statistics and regression analyses. Most officers were highly influenced by the expectations of their supervisors when responding to subjects who appeared to have an OUD, and about half would take direction from addiction treatment providers. Police in urban departments perceived greater support for MAT and were more likely to believe MAT could reduce the need for future arrests. Our findings suggest ways police officers can be influenced to make discretionary decisions that improve the health outcomes of their encounters with people with OUD: (1) Supervisors should serve as champions to promote referrals to treatment for substance use disorders; (2) collaboration between law enforcement and community addiction treatment providers should be strengthened, and (3) MAT should be supported and expanded in rural areas.

NAATP survey shows professionalism in treatment workforce

The National Association of Addiction Treatment Providers (NAATP) last month released its annual salary survey, giving benchmarks for many aspects of the treatment workforce. The report is 71 pages long and available for purchase from NAATP. Of participating providers, 37% were for profit, and 63% were not‐for‐profit. Forty‐one percent of the programs were in the Western United States; the remainder were evenly distributed throughout other regions. Revenue was mostly in the $5 to $100 million range, with 17% reporting revenues of more than $100 million. Following are specific averages (ADAW has rounded and not included the full ranges and other details, which can be found in the report): 47 organizations reported CEO salaries with an average of 231,000; 23 organizations reported COO salaries with an average of $189,000; and 29 organizations reported CFO salaries with an average of $174,000. There are many, many more workforce listings, averages and ranges, all separated out by the organization's tax status. The report shows the high level of professionalism in the participating organizations. NAATP CEO Marvin Ventrell said: “At a time when our field is in transition relative to clinical modeling and business operations, including field consolidation, it is imperative that providers have reliable workforce data. Chief among our members' concerns and challenges is the changing face of workforce throughout health care. The NAATP Salary Survey has always been one of the most valued products and that it is even more in demand now. Historically we produce the survey biennially, but we published in both 2022 and 2023 due to demand. Going forward, we will go back to biennial production with a new benchmarking survey planned in alternating years.” A partial view of the NAATP 2023 Salary Survey is available at: https://www.naatp.org/resources/news/naatp‐releases‐14th‐edition‐national‐addiction‐treatment‐salary‐survey/sep‐26‐2023.

A Video Game Intervention to Prevent Opioid Misuse Among Older Adolescents: Development and Preimplementation Study.

Opioid misuse and mental disorders are highly comorbid conditions. The ongoing substance misuse and mental health crises among adolescents in the United States underscores the importance of widely scalable substance misuse preventive interventions that also address mental health risks. Serious video games offer an engaging, widely scalable method for delivering and implementing preventive interventions. However, there are no video game interventions that focus on preventing opioid misuse among older adolescents, and there are limited existing video game interventions that address mental health. This study aims to develop and conduct a formative evaluation of a video game intervention to prevent opioid misuse and promote mental health among adolescents aged 16-19 years (PlaySmart). We conducted formative work in preparation for a subsequent randomized controlled trial. We conducted development and formative evaluation of PlaySmart in 3 phases (development, playtesting, and preimplementation) through individual interviews and focus groups with multiple stakeholders (adolescents: n=103; school-based health care providers: n=51; and addiction treatment providers: n=6). PlaySmart content development was informed by the health belief model, the theory of planned behavior, and social cognitive theory. User-centered design principles informed the approach to development and play testing. The Exploration, Preparation, Implementation, and Sustainability framework informed preimplementation activities. Thematic analysis was used to identify themes from interviews and focus groups that informed PlaySmart game content and approaches to future implementation of PlaySmart. We developed a novel video game PlaySmart for older adolescents that addresses the risk and protective factors for opioid misuse and mental health. Nine themes emerged from the focus groups that provided information regarding game content. Playtesting revealed areas of the game that required improvement, which were modified for the final game. Preimplementation focus groups identified potential barriers and facilitators for implementing PlaySmart in school settings. PlaySmart offers a promising digital intervention to address the current opioid and mental health crises among adolescents in a scalable manner.

NAATP annual salary survey shows professionalism in treatment workforce

The National Association of Addiction Treatment Providers (NAATP) this fall released its annual salary survey, giving benchmarks for many aspects of the treatment workforce. The report is 71 pages long and available for purchase from NAATP. Of participating providers, 37% were for profit, and 63% not for profit. Forty‐one percent of the programs were in the Western United States; the remainder were evenly distributed throughout other regions. Revenue was mostly in the $5 to $100 million range, with 17% reporting revenues of more than $100 million. Following are specific averages (we have rounded and not included the full ranges and other details, which can be found in the report): 47 organizations reported CEO salaries with an average of 231,000; 23 organizations reported COO salaries with an average of $189,000; and 29 organizations reported CFO salaries with an average of $174,000. There are many more workforce listings, averages, ranges, all separated out by the organization's tax status. The report shows the high level of professionalism in the participating organizations. NAATP CEO Marvin Ventrell said: “At a time when our field is in transition relative to clinical modeling and business operations, including field consolidation, it is imperative that providers have reliable workforce data. Chief among our members' concerns and challenges is the changing face of workforce throughout healthcare. The NAATP Salary Survey has always been one of the most valued products and that it is even more in demand now. Historically we produce the survey biennially but we published in both 2022 and 2023 due to demand. Going forward, we will go back to biennial production with a new Benchmarking Survey planned in alternating years.” A partial view of the NAATP 2023 Salary Survey is available at: https://www.naatp.org/resources/news/naatp‐releases‐14th‐edition‐national‐addiction‐treatment‐salary‐survey/sep‐26‐2023.

Mindfulness‐oriented recovery: How to fight cravings in OUD

It is possible to fight cravings — whether for opioids due to addiction or opioids for pain relief — with mindfulness, according to Eric L. Garland, Ph.D., associate dean for research and a professor at the University of Utah in Salt Lake City, who presented to a packed plenary at the Cape Cod Symposium for Addictive Disorders on Sept. 9. The annual meeting of treatment professionals is an important gathering spot, and now, sponsored by HMP, included a lounge for the National Association of Addiction Treatment Providers (NAATP). The former sponsor, C4, used to be a direct competitor of NAATP for the conference space. “Mindfulness,” in terms of avoiding use of all substances including methadone and buprenorphine, played well into the notions of many of the attendees, who were looking for help for their patients beyond taking a pill.

John Driscoll named new president, CEO of Caron

Last week Caron Treatment Centers, based in Wernersville, Pennsylvania, announced the appointment of John Driscoll as its next president and chief executive officer (CEO). Driscoll is the former chair of the National Association of Addiction Treatment Providers (NAATP) and senior vice president of the Hazelden Betty Ford Foundation. He will take over from Caron's Chief Operating Officer Kristine Bashore, and Chief Clinical Officer David Rotenberg, who have been interim co‐CEOs since February.

In Case You Haven't Heard…

Last week we went to the Cape Cod Symposium, the annual confab, which, in the time of climate change, is still summery and beachy even in mid‐September. The exhibit hall was packed. The plenaries were overflowing. There was a lot of excitement about addiction treatment, and even a lounge for National Association of Addiction Treatment Providers' members. We stopped by the Brixadi booth, the Stop Stigma Now booth, a booth about using service animals for therapy, and many other booths, and attended a session on using mindfulness to deal with cravings (see story in next issue). Well done, HMP Education (the symposium provider).

Predicting and Responding to Change: Environmental Uncertainty among Addiction Treatment Providers

Predicting and Responding to Change: Environmental Uncertainty among Addiction Treatment Providers

In case you haven't heard…

The National Association of Addiction Treatment Providers (NAATP) last week commended the Biden administration for its willingness to enforce parity (see story, page 6), last week. NAATP has been a leader in calling for this enforcement. The proposed regulations would mandate that insurers analyze their coverage to ensure equivalent access to mental health care based on outcomes. “Insurance companies would have to look at how they respond to requests from doctors to authorize treatments for substance use disorder and mental illness, as compared to physical ones,” NAATP said. “They would also be required to analyze their provider networks and how much they reimburse providers out of network for these services compared to physical health. Reimbursement rates are a critical issue and have exacerbated the workforce challenges for substance use treatment providers. The rule would also establish when health plans are prohibited from requiring doctors to obtain the insurers’ prior authorization to prescribe a medicine or procedure, or otherwise put‐up roadblocks for patients seeking mental health, as well as substance use treatment. Insurers could face fines for failing to offer comparable coverage for mental health. NAATP has advocated for the ability to fine insurers who continually ignore the law with few consequences.”

Opioid use disorder treatment and the role of New Jersey Medicaid policy changes: perspectives of office-based buprenorphine providers

ABSTRACT Background: In the US, seventy percent of drug-related deaths are attributed to opioids. In response to the ongoing opioid crisis, New Jersey’s (NJ) Medicaid program implemented the MATrx model to increase treatment access for Medicaid participants with opioid use disorder (OUD). The model’s goals include increasing the number of office-based treatment providers, enhancing Medicaid reimbursement for certain treatment services, and elimination of prior authorizations for OUD medications. Objectives: To explore office-based addiction treatment providers’ experiences delivering care in the context of statewide policy changes and their perspectives on treatment access changes and remaining barriers. Methods: This qualitative study used purposive sampling to recruit office-based New Jersey medications for opioid use disorder (MOUD) providers . Twenty-two providers (11 females, 11 males) discussed treatment experiences since the policy changes in 2019, including evaluations of the current state of OUD care in New Jersey and perceived outcomes of the MATrx model policy changes. Results: Providers reported the MOUD climate in NJ improved as Medicaid implemented policies intended to reduce barriers to care and increase treatment access. Elimination of prior authorizations was noted as important, as it reduced provider burden and allowed greater focus on care delivery. However, barriers remained, including stigma, pharmacy supply issues, and difficulty obtaining injectable or non-generic medication formulations. Conclusion: NJ policies may have improved access to care for Medicaid beneficiaries by reducing barriers to care and supporting providers in prescribing MOUD. Yet, stigma and lack of psychosocial supports still need to be addressed to further improve access and care quality.

NAATP vows to carry momentum from outcomes project to advocacy

Building on the accomplishment of unifying its members around an unprecedented outcome research initiative, leaders of the National Association of Addiction Treatment Providers (NAATP) last week sought to fuel a similar commitment on other high‐priority issues, from equity in treatment services to a stronger presence in Washington, D.C.

Inaugural outcomes study released by NAATP

Designed as a long‐term project, the first report on the outcomes‐monitoring research done by the National Association of Addiction Treatment Providers (NAATP) has been released. In answer to the question, “Does treatment work?,” the report found that there was a decrease in severity of symptoms of substance use disorder (SUD), depression, and anxiety over the course of treatment and throughout the first year of follow‐up.

Treatment System Adaptations during War: Lessons from Ukrainian Addiction Treatment Providers

Background: The war in Ukraine has posed significant challenges to the healthcare system. This paper draws upon expert consultations, held between December 2022 and February 2023, focused on HIV/AIDS, addiction, and mental health service delivery during the first year of this war, and following the Global Mental Health Humanitarian Coalition panel discussion in May 2022. Objectives: This commentary presents the experiences of frontline healthcare workers in Ukraine, challenges, and local adaptations to meet the increased mental health needs of healthcare providers. We aimed to document the adaptations made in the addiction healthcare system and to acknowledge the changes in vulnerabilities and lessons learned. Results: Burnout among healthcare providers delivering addiction, HIV/AIDS and mental health services became more visible after the second half of 2022. Challenges included increased workload, contextual threats, lack of job relocation strategies, and money-follow-the-patient policies. Recommendations: The lessons from the first year of war in Ukraine hold significant generalizability to other contexts. These include enabling bottom-up approaches to tailoring services and allowing healthcare providers to respond to the dynamics of war in an effective and active manner. Other recommendations include departmental-specific resources and strategies, particularly as vulnerable groups and challenges are unstable in humanitarian contexts. Conclusions: Globally and in Ukraine, healthcare workers need more than applause. Along with monetary incentives, other strategies to prevent burnout, ensure sustainable capacity building, job relocation opportunities, and bespoke adaptations are imperative to protect healthcare providers’ wellbeing and overall public health.

NY treatment advocates to Hochul: 2.5% increase not enough

In a move uniting addiction and mental health treatment providers, advocates for New Yorkers with mental health and addiction needs, and the community‐based agencies that serve them acknowledge the overall and unprecedented support for mental health services in New York Governor Hochul's Executive Budget proposal, but say it's not enough.