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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%. [ABSTRACT FROM AUTHOR]

Forget about the meaningless term "behavioral health" (even though you'll see it everywhere). It's not a standard of care for people with addiction. This is especially true for peers. Would you want someone with depression you in your recovery from addiction? Or, would you want someone with addiction helping you in your recovery from depression? [ABSTRACT FROM AUTHOR]

A bill introduced this month in the California State Assembly would end harm reduction's exclusivity as the approach to addressing persons with substance use issues who live in housing developed under state's Housing First guidelines. If approved, the legislation would allow up to 25% of state housing funds to be allocated to drug‐free housing under an abstinence model. [ABSTRACT FROM AUTHOR]

The question of whether state‐mandated licensure would serve as an ideal vehicle for guaranteeing that recovery community organizations (RCOs) meet accepted standards for delivering peer recovery support is about to receive a thorough examination in Pennsylvania. State Rep. Tarik Khan of Philadelphia is gathering co‐sponsor support in advance of introducing a bill that would require any RCO that receives public funds to be licensed, in a measure that also would designate RCO services as Medicaid‐reimbursable. [ABSTRACT FROM AUTHOR]

A new document written by the National Association of State Alcohol and Drug Abuse Directors (NASADAD) for the National Council for Mental Wellbeing and released last month highlights the best practices for treatment of adolescent substance use disorders (SUDs). Replete with many links, the document will help not only treatment providers but also policymakers, schools, and more. The document is researched and footnoted. [ABSTRACT FROM AUTHOR]

New York Governor Kathy Hochul has proposed cutting the budget of the state's Office of Addiction Services and Supports (OASAS) by more than 13% and supplanting the funding with money from the opioid settlement fund. This, according to treatment providers and other experts, is not good policy. [ABSTRACT FROM AUTHOR]

Some might use the term "alphabet soup" or even the more derisive "wild, wild West" to characterize the growth of the peer recovery support workforce in substance use treatment. Amid the array of training and credentialing opportunities offered to individuals who want to give back, but not in a clinician role, it is unmistakable that the peer has become a more influential presence both within and outside of mainstream treatment operations. [ABSTRACT FROM AUTHOR]

The Modernizing Opioid Treatment Access Act (MOTAA), which would allow physicians certified in addiction medicine to prescribe methadone for opioid use disorder (OUD) from their offices, has many supporters. Faces & Voices of Recovery is one of the most recent. [ABSTRACT FROM AUTHOR]

Last month the Substance Abuse and Mental Health Services Administration (SAMHSA) released a "best practices" outline for recovery housing that is both an update of a previous guideline (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32517) and a response to a White House order for the new guideline to exclude substance use disorder (SUD) treatment services. [ABSTRACT FROM AUTHOR]

The federal Department of Health and Human Services (HHS) has a policy, called the exclusion program, of banning health care providers from billing Medicare or Medicaid for five years, even if they are in recovery, cooperate with the courts, are abstinent, pass regular drug tests, have their medical licenses back, and have never harmed a patient. Last week, ADAW interviewed two such providers —a doctor and a nurse — who agreed to go public with their stories. [ABSTRACT FROM AUTHOR]

Leaders of a home‐based substance use treatment company that experienced substantial growth during the COVID‐19 pandemic said they are establishing important models in both service delivery and payment structure. Most of the media attention to Aware Recovery Care's work has focused on counteracting the notion that addiction care must take place in a facility, but the company's CEO also pointed out that its pioneering managed care contract brings the field closer to value‐based payment for services. [ABSTRACT FROM AUTHOR]

Results of a new study based on in‐depth interviews with 23 Narcotics Anonymous (NA) attendees in South Africa suggest that treatment and recovery programs should pay closer attention to potentially problematic substitute behaviors in recovery. Nineteen of the 23 participants reported engaging in a substitute behavior, with nicotine the most common replacement substance and binge eating/overeating the most common non‐substance behavior. [ABSTRACT FROM AUTHOR]

Motivation has long been considered key to sending substance use disorder (SUD) patients in the direction of recovery. But how do you motivate an adolescent, to whom motivational approaches may feel like a call to battle — or even worse, an excuse for running away? Lauren Sbarbaro, Ph.D., a psychologist licensed in alcohol and drug treatment who trained at Hazelden, shared some insights with attendees at the Cape Cod Symposium on Addictive Disorders (CCSAD) in Hyannis, Massachusetts last week. [ABSTRACT FROM AUTHOR]

Groups Recover Together (Groups), founded in 2014, is a quickly expanding enterprise. It is a bricks‐and‐mortar buprenorphine treatment program, funded mainly by venture capital and with a business model that can't fail: If patients don't recover, the payer gets their money back. Now relying on this "value‐based contracting" method, an easy sell to many Medicaid authorities, the organization has 12 facilities and treats 20,000 patients a week, according to Cooper Zelnick, chief revenue officer. [ABSTRACT FROM AUTHOR]

In the last issue, we wrote about research using craving reduction as a measure of recovery from drug addiction (see ADAWhttps://onlinelibrary.wiley.com/doi/10.1002/adaw.34167), based on coverage at the College on Problems of Drug Dependence (CPDD) from National Institute on Drug Abuse (NIDA) researchers. We wanted to find out whether craving reduction can also be used as a measure of recovery from alcohol use disorder (AUD). So we asked George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), who, with Laura E. Kwako, Ph.D., chief of NIAAA's treatment, health services and recovery branch, responded to our questions. [ABSTRACT FROM AUTHOR]

Recovery housing, with guidelines issued recently by the Substance Abuse and Mental Health Services Administration (SAMHSA) (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.32517 and https://onlinelibrary.wiley.com/doi/10.1002/adaw.33879), is not really open for people with opioid use disorder (OUD) who need to take medications for opioid use disorder (MOUD), namely methadone or buprenorphine, according to a report from Georgetown University's (GU) Addiction and Public Policy Initiative of the O'Neill Institute at Georgetown Law. And this policy of not allowing medications, which exists in many of the country's 18,000 recovery homes, is a violation of federal civil rights laws, noted the report, authored by Regina LaBelle, director of the Addiction and Public Policy Initiative at the O'Neill Institute of Georgetown Law. [ABSTRACT FROM AUTHOR]

The measures have changed since 2020, so the 2022 National Survey on Drug Use and Health (NSDUH) can't be compared to previous years before then. Still, the survey, released last week by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides some useful information about how people living in the United States report their experience with substance use and treatment (the survey also includes mental health measures, as it has for years). [ABSTRACT FROM AUTHOR]

Never has the phrase "braided funding" been so relevant as in the current "recovery housing" topic. Even "recovery housing" as a phrase itself embodies two siloes: housing/homelessness, and substance use disorder (SUD) treatment. [ABSTRACT FROM AUTHOR]

The American Society of Addiction Medicine (ASAM) has not missed a chance to promote the Modernizing Opioid Treatment Access Act (M‐OTAA) that would allow office‐based physicians to prescribe methadone for opioid use disorder (OUD). Only opioid treatment programs (OTPs) can prescribe and dispense methadone for OUD, and pharmacies are not allowed to dispense. (OTPs are not opposed to pharmacies dispensing methadone, but they are opposed to office‐based physicians prescribing it.) For more on M‐OTAA, see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33716. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Carol McDaid, until recently with Capitol Decisions as the preeminent lobbyist for recovery and addiction, retired last month. An icon of parity for substance use disorder (SUD) treatment, confidentiality for patients, and reimbursement for treatment providers, McDaid has been a tireless champion for the SUD field, patients, and people who just need help with SUDs. ADAW remembers her from many in‐person meetings, as well. In long‐term recovery herself, she recently told us that she was getting much hope from working with people in recovery, alongside her husband, John Shinholser. [ABSTRACT FROM AUTHOR]

A new report suggests that environments that would be expected to be the most compassionate toward people who use drugs or are in recovery can often be the most stigmatizing. Based on an online survey conducted last June, the report states that only around 1 in 3 health care workers consider a person who currently uses substances problematically as having a high chance of maintaining recovery. [ABSTRACT FROM AUTHOR]

In December, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a notice of proposed rulemaking (NPRM) that would make permanent the take‐home exemptions for methadone under which, due to COVID‐19, it was possible for "less stable" patients to receive more take‐homes (https://onlinelibrary.wiley.com/doi/10.1002/adaw.33643). In addition, the proposal would remove the one‐year requirement for opioid use disorder (OUD), remove the reliance on toxicology tests and the length of time in treatment, and allow telehealth inductions by methadone. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Novel treatments for substance use disorders (SUDs) include rapid‐acting psychotherapeutics, in particular, psychedelics, and a "Perspective" published in Neuropsychopharmacology June 22, that was written by the heads of federal research agencies calls for evaluating these approaches. [ABSTRACT FROM AUTHOR]

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) issued TIP (Treatment Improvement Protocol) number 64. This TIP is devoted to integrated peer support services into clinical treatment for substance use disorder (SUD). Coming on the heels of its model standards for peers (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33806), the TIP will provide useful information for treatment programs seeking to use peers, especially during a time of workforce inadequacy. The 237‐page document includes many useful resources, as well, but ultimately, states will have to rely on their own systems for reimbursement. [ABSTRACT FROM AUTHOR]

Craving is a great measure for outcomes for substance use disorders (SUDs) with one exception: how to measure it? Researchers at last week's College on Problems of Drug Dependence (CPDD) conference discussed the important topic. [ABSTRACT FROM AUTHOR]

A combination of residential treatment for substance use disorders (SUDs) and the cessation of drinking resulted in increased abstinence rates from drugs in general, a recent study of "situational factors" linked to abstinence from drugs has found. In addition, even for patients not in residential treatment, employment and the cessation of drinking were linked to increased abstinence rates. The patients in the study excluded those with alcohol use disorders (AUD). The study was conducted in Japan, where drug use is illegal and strictly enforced. [ABSTRACT FROM AUTHOR]

An array of initiatives targeting San Franciscans experiencing some combination of a substance use disorder, homelessness and serious mental illness are being introduced during a tumultuous time in policy making for the city–county government. Some view the often‐contentious debate that has unfolded in recent months as a struggle between advocates of harm reduction and tougher drug enforcement, while others point to an equally compelling discussion of the merits of a "Housing First" approach vs. a greater emphasis on treatment and support services to break the cycle of homelessness. [ABSTRACT FROM AUTHOR]

New Jersey provider agencies treating patients with co‐occurring substance use and mental health disorders are among the target recipients in a training initiative to promote the use of recovery‐oriented cognitive therapy. State officials' provision of $500,000 to conduct the training and ongoing mentoring of clinicians is designed to encourage wider use of a strengths‐based treatment seen as particularly suited to individuals who hesitate to engage in treatment due to mistrust, a history of institutionalization or other common barriers. [ABSTRACT FROM AUTHOR]

Recently Pennsylvania's governor Josh Shapiro approved the first state‐licensed mobile unit to treat substance use disorder (SUD). Gaudenzia is the treatment provider. [ABSTRACT FROM AUTHOR]

Researchers have found that abstinence‐based policies in sober living homes should include a ban on cannabis use as well as alcohol and other drug use. The study was meant to look more closely at the evidence suggesting that cannabis may be "safer" than other drugs. However, cannabis legalization has put sober homes in a difficult position regarding cannabis use among residents. [ABSTRACT FROM AUTHOR]

The Foundation for Recovery Science and Education (FoRSE) is a nonprofit organization created by the National Association of Addiction Treatment Providers (NAATP) to examine the impact of addiction treatment. The most recent FoRSE findings show that long‐term residential treatment is beneficial (see ADAWhttps://onlinelibrary.wiley.com/doi/10.1002/adaw.34135). This is based on outcome data from more than 80 treatment centers across the country. [ABSTRACT FROM AUTHOR]

On April 4, the House Committee on Energy and Commerce sent a letter, a copy of which was obtained by ADAW, to Miriam E. Delphin‐Rittmon, Ph.D., director of the Substance Abuse and Mental Health Services Administration (SAMHSA), seeking "a full accounting ... for the influx of funds provided through COVID‐19 supplemental relief, and more particularly, details on SAMHSA's performance in launching the 988 suicide prevention hotline, the extent of SAMHSA's support for providing clinical treatment for patients with serious mental illness, and SAMHSA's Office of Recovery." The Office of Recovery includes recovery from SUD (substance use disorder) and mental illness (https://onlinelibrary.wiley.com/doi/10.1002/adaw.33460). [ABSTRACT FROM AUTHOR]

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) published a new web tool last week showing how each state uses State Opioid Response (SOR) funding to address opioid and stimulant misuse and use disorders. The SOR grant is $1.52 billion a year and is provided in addition to the Substance Abuse Prevention and Treatment (SAPT) block grant, which for decades has been under $2 billion a year. [ABSTRACT FROM AUTHOR]

The news that more naloxone than the standard 2‐mg dose is needed in many overdose victims is largely tied to the potent illicit fentanyl. Typically, the first responder waits to make sure the naloxone is working, that the patient starts breathing again, and if not, administers a second dose. But some people now say that it's important to give enough right away, and that those moments without oxygen can be damaging. Naloxone has no effect on someone without opioids in their system; on someone who has overdosed, it pushes the opioids off the receptors and reverses the overdose. On someone who is physically dependent on opioids, it will also produce withdrawal symptoms. Either way, the victim recovers, but if the naloxone is given in a high enough dose to someone who is dependent, that recovery will come with unpleasant withdrawal symptoms. [ABSTRACT FROM AUTHOR]

A physicians' group that grew out of concerns a decade ago that addiction treatment had become too medication‐focused continues to operate largely out of the limelight. The group, Like Minded Docs, has preferred to exert its influence mainly through its own ranks, hoping that its messaging on the importance of psychosocial and spiritual interventions in recovery resonate within members' treatment facilities and communities. [ABSTRACT FROM AUTHOR]

At the end of July, the Senate Committee on Appropriations released a draft copy of the fiscal year (FY) 2023 funding which, like the House version (see Recovery set‐aside in approps bill for SAPT BG, ADAW July 19; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33137), includes a recommendation for a 10% set‐aside in the Substance Abuse Prevention and Treatment (SAPT) block grant, and an additional $500 million for the SAPT block grant. [ABSTRACT FROM AUTHOR]

As the name suggests, screening, brief intervention, and referral to treatment (SBIRT) for alcohol can both identify people who are at risk for, or who have alcohol‐related problems, and for those who need treatment, provide connections, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported last week. But more is needed, and a recent study showed that primary care follow‐ups and checkups can work for alcohol use disorder (AUD). [ABSTRACT FROM AUTHOR]

Even the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is getting in on the harm reduction act. In fact, for heavy drinkers, or any drinkers, reducing the amount consumed is a benefit. Requiring abstinence can scare people away from treatment altogether, and those are generally the people who need it most. Now, the NIAAA, which has talked to ADAW in the past about the pros and cons of attempts to reduce drinking (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33179), has come out with advice for the public on the benefits of reducing heavy alcohol consumption. [ABSTRACT FROM AUTHOR]

Abstinence is not a necessary requirement for improving measures of health and recovery among people with stimulant use disorder, according to a study published last week in Addiction. The study, "Reduced drug use as an alternative valid outcome in individuals with stimulant use disorders: Findings from 13 multisite randomized clinical trials," analyzed trials for treatment for methamphetamine and cocaine use disorders. The National Institute on Drug Abuse (NIDA) funded the study. [ABSTRACT FROM AUTHOR]

It will be many years and decision‐making cycles before community leaders can draw firm conclusions on whether proceeds from litigation against opioid manufacturers, distributors and pharmacies prove to be a boon to substance use disorder (SUD) services. For the moment, observers have expressed cautious optimism that states are taking important steps to ensure no repeat of the empty promises that characterized the national tobacco settlement of the 1990s. [ABSTRACT FROM AUTHOR]

Physicians' use of data within prescription drug monitoring programs (PDMPs) continues to increase steadily, likely a result of state mandates around use, suggests a newly published study based on results of a survey of office‐based physicians. The study's lead author told ADAW the study also illustrates that a substantial number of physicians continue not to be maximizing the availability of PDMP data, with overall workload cited as a major contributor. [ABSTRACT FROM AUTHOR]

A key element of the National Drug Control Strategy released last month by the Office of National Drug Control Policy (ONDCP) is the addiction treatment workforce — specifically, building it and the infrastructure that supports it. [ABSTRACT FROM AUTHOR]

Last week, President Joe Biden sent the White House National Drug Control Strategy, his first, to Congress. At a time when opioid overdoses have reached a record high, the strategy, as expected, includes much language relating to saving lives, including the administration's three‐pronged harm‐reduction strategy: naloxone, fentanyl test strips and syringe exchange programs. [ABSTRACT FROM AUTHOR]

The emergence of recovery residences in the continuum of support for individuals with substance use disorders has been marked by numerous advances and setbacks, often occurring not far apart. The tenets governing sober living are so often misunderstood, or purposely mischaracterized, that even in states where funding and policy support for recovery homes has been strong, threats in the form of changes in state administration, or siting opposition from municipalities, still loom large. [ABSTRACT FROM AUTHOR]

The U.S. Department of Health and Human Services (HHS) has proposed significant changes to 42 CFR Part 2, known as Part 2, in a Notice of Proposed Rulemaking (NPRM) issued last year (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33678, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33661, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33637, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33628). [ABSTRACT FROM AUTHOR]

A new report suggests that reducing stigmatization of justice‐involved individuals with substance use disorders requires participation of individuals with lived experience at multiple levels — from educating justice professionals to assisting in the development of support strategies to working in treatment initiatives as peers. A leading justice expert who was among many contributors to the report considers reducing stigma against this population essential in order to remove a key barrier to pursuing the treatment that can reduce substance use and recidivism. [ABSTRACT FROM AUTHOR]

President Biden's first State of the Union (SOTU) message last week held promise for treatment, including support of the workforce, and hope and support for patients in recovery. [ABSTRACT FROM AUTHOR]

Chronic pain is threatening the healthy recovery of a striking number of individuals with substance use disorders (SUDs), including one in four people whose illness is in remission, a new study suggests. Moreover, the study's lead author believes, current multidisciplinary strategies to assist patients with SUD and chronic pain hold no hope of making inroads with this complex population. [ABSTRACT FROM AUTHOR]