Policy Brief on Buprenorphine Treatment for Opioid Addiction

The most effective treatment for people addicted to opioids is substitution therapy combined with counseling services and other addiction recovery programs.

This policy brief produced by the Substance Abuse Policy Research Program (SAPRP) explores two medications used in substitution therapy: methadone, which has long been viewed as the gold standard for substitution therapy, and buprenorphine, a newly approved and effective alternative.

Recently enacted federal legislation has permitted buprenorphine treatment to be delivered by qualified physicians in their offices, in addition to specialty treatment programs. Although this change in the way treatment is provided has allowed substitution therapy to be offered to more patients, there remain numerous barriers that are limiting its impact on both the individual and societal burdens of opioid addiction.

Find more details on the policy brief at http://www.rwjf.org/pr/product.jsp?id=42469

Practice Improvement Materials

Dr. Mark Willenbring Discusses Alcoholism

Director of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Dr. Mark Willenbring discusses the different factors that can lead to alcoholism, including genetics and psychiatric disorders. Key points are the stigma associated with alcoholism; the importance of starting treatment; how to find it; and what constitutes effective treatment for alcoholism. Willenbring shares several resources that may help with treatment, as well as various support groups for addicts and family members. Additionally, new FDA-approved medications are discussed in this program that may help reduce the risk of relapse. Listen to Dr. Willenbring's interview.

National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices

With the understanding that consensus on effective treatment practices can focus the development of measures of quality, the National Quality Forum (NQF), with support from the Robert Wood Johnson Foundation (RWJF), undertook this project as one step to address the need for performance measures for the treatment of substance use conditions. The project is intended to enhance the adoption of NQF-endorsedTM evidence-based practices for patients with substance use conditions by focusing on the practices for which the evidence is strongest and most accepted and that are most likely to have significant impact on improving care. Read more. [PDF]

A Primer on Process Improvement

This Primer provides guidance for behavioral health treatment agencies to use in changing their organizations to improve access and retention. Some of the guidance offered here is based on evidence showing what factors lead to successful organizational change, and some guidance is based on the need to create a common framework to allow efficient communication within and among organizations. The improvement process being used relies heavily on The Model for Improvement in The Improvement Guide, by Langley, Nolan, Nolan, Norman, and Provost, San Francisco, Jossey-Bass Publishers, 1996. The guidance in this primer is also consistent with the approaches found in The Change Book, by the Addiction Technology Transfer Center (ATTC) National Network, and the Program Change Model, by Simpson, D.D. in the Journal of Substance Abuse Treatment, 22(4), 171–182. Read more.

Improving Substance Abuse Treatment Delivery

Often, the real obstacles keeping patients from treatment are the ways in which services are delivered (Institute of Medicine, 2005). Research shows that systemic and programmatic reasons controlled by the treatment facility accounted for 51 percent of the reasons clients cited for not accessing treatment (Joe et al., 1998; Ebener, 2003). “Business processes” such as complicated admission systems, poorly designed phone systems, and un-engaging reception staff created some of the barriers to treatment access. Read more. [PDF]

NIATx Business Case Series: Acadia Hospital, Bangor, Maine

Acadia Hospital is a freestanding non-profit psychiatric and substance abuse hospital with both inpatient and outpatient programs. Addiction services are provided at two sites, and include inpatient detox, an Intensive Outpatient Program, a dual diagnosis program, methadone and buprenorphine treatment, an extended shelter residential treatment program, and a variety of homeless and transitional housing options. Opioid dependence is the primary diagnosis of the majority of our addiction patients. Read more. [PDF]

Everything You Always Wanted to Know About …… Vivitrol

Vivitrol is an extended–release injectable medication assisted treatment for the disease of alcoholism. The active ingredient in Vivitrol is naltrexone, an opioid antagonist. Administered intramuscularly once a month by a healthcare professional, it reduces the problems often associated with daily medication compliance. In conjunction with psychosocial support, Vivitrol has been shown to reduce drinking days and days of heavy drinking. While generally well tolerated, the most common adverse reactions include nausea, vomiting, headaches, dizziness and injection site reactions. Vivitrol is contraindicated for patients with certain medical conditions, including those taking opiates or in opiate withdrawal. The cost per 380 mg injection is $695. Insurance (if available) may cover the cost of medication. Patients without insurance or financial resources can apply for the Vivitrol patient assistance program.

Source: www.vivitrol.com

Why Vivitrol?

The Network for Improvement of Addiction Treatment (NIATx) identifies understanding the customer as the first step in its process improvement model. One great way to do this is to survey the customer. River Region Human Services did just that! In a recorded interview with the first client admitted to the Vivitrol protocol at River Region, Renee Hellen, Director of Outpatient and Methadone Services, learns first hand how counseling in conjunction with Vivitrol is making a difference in one persons life: “It’s an added tool that I felt I needed to stop drinking. And its working.”

Listen to the interview [1.3K WAV file]

SAMHSA Launches Searchable Database of Evidence-Based Practices in Prevention and Treatment of Mental Health and Substance Use Disorders

The National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers.

The purpose of this registry is to assist the public in identifying approaches to preventing and treating mental and/or substance use disorders that have been scientifically tested and that can be readily disseminated to the field. NREPP is one way that SAMHSA is working to improve access to information on tested interventions and thereby reduce the lag time between the creation of scientific knowledge and its practical application in the field.

NREPP is a new registry and currently has several dozen reviewed interventions. New intervention summaries are continually being added as reviews are completed. The registry is expected to grow to a large number of interventions over the coming months and years. Please check back regularly to access the latest updates.

Helping Patients Who Drink Too Much

A Clinician's Guide, updated in 2005, from the U.S. Department of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism