Product Type: eNewsletter or Blog

The Power We Hold The ATTC Network is funded by SAMHSA and the author’s opinions do not necessarily represent the opinions of SAMHSA or the ATTC. We respectfully offer this article to encourage healthy discussion to advance our field.  By Sandeep Kapoor, MD Northwell Health Without mainstream advocacy, like we witness for heart disease, diabetes, and cancer, substance use disorders (SUD) have long been viewed as an “individual’s problem,” not as a healthcare issue deserving of championship. The alarming stigma that plagues the chronic medical condition of SUD has driven inaction in many healthcare arenas. The lack of investment, education, and humanistic individualized care has created industry-wide fractures in how we approach those with a SUD. The cries of our families and our communities fall on deaf ears — ears that are attuned to understand diseases of the heart, pancreas, and cells — though are unable to understand the science behind addiction. The lack of medical education fuels the lack of motivation to change, very quickly making SUD a problem for individuals, having to navigate on their own, without the support or empathy of others. The journey we travel is populated by an inherent need for acknowledgement—that feeling of being heard, understood, respected, and valued. Click on View Resource to read the full article. 

HealtheKnowledge Learning Platform has New Look, Robust Course Offerings By Alex Skov ATTC Network Coordinating Office In the modern world, business is done online. From buying groceries and booking vacations to searching out do-it-yourself maintenance tips, the digital world is often intertwined with each aspect of daily life. Education is no exception, evolving rapidly with everyone from elementary school students to seasoned professionals utilizing the tools available at the touch of a button to learn new skills and refine their practices. In the realm of behavioral health and substance use disorders (SUD), studies have shown that teaching basic knowledge of SUD through e-learning results in higher test scores for all the educational objectives regardless of the learner’s previous subject familiarity, and that digital tools can serve as important supplementary companions to formal education in addiction studies. Likewise, there is evidence that online learning effectively reduces knowledge gaps and stigma for patients and providers when it comes to subjects such as hepatitis C. With online learning showing no signs of slowing down, the e-learning platform HealtheKnowledge recently debuted an update that prioritizes user-friendliness and easy navigation. The update signifies a new step in the platform’s successful history of administering continuing education courses and learning opportunities for organizations in the health care space while maintaining an active user base of approximately 35,000 individuals in any given six-month period. The learning platform’s new design features an updated theme that renews its aesthetic appeal and adds descriptive pictures to each of the nearly 150 courses offered on HealtheKnowledge, while the updated interface puts users in the driver’s seat of a simple-to-navigate experience from start to finish. Beginning with a new user sign-up display that is easier to find and complete than ever before, users can then choose their desired courses from a categorized list that expands to show overviews of individual courses, or search for specific course titles and topics...click on View Resource to read the full article.

African American Behavioral Health Center of Excellence: Building Equity in Responses to Substance Use Disorders, Mental Health and More By Alex Skov ATTC Network Coordinating Office As the past year’s public health crisis has raised our consciousness of the effects of historic inequities on the physical and behavioral health of African Americans, it has also demonstrated again and again that the need for accessible and culturally responsive services far exceeds our capacity. For example: In 2019, 6.5 million African Americans in the U.S. reported having first-hand experience with a substance use disorder, mental illness, or both, according to data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA). This marked a 10.1 percent increase over 2018. Similarly, overdose deaths caused by synthetic opioids have risen sharply among Black Americans during the past decade, with fentanyl-related overdose deaths climbing nearly 1,000 percent from 2013 to 2016 alone, per the Agency for Healthcare Research and Quality. The COVID-19 pandemic has further complicated these issues for racial and ethnic minority groups as it became more challenging to access mental health and substance use treatment services throughout 2020 and the first half of 2021. As the country strives to return to its pre-pandemic normalcy, the African American Behavioral Health Center of Excellence is prepared to help transform behavioral health services for African Americans by endeavoring to making these services safer and more culturally appropriate and responsive while also improving accessibility and effectiveness. “When we in behavioral health look at the racial, ethnic, gender and sexual minorities who often suffer from poor mental health outcomes, we sometimes need to dig deeper to see all the factors that are driving that,” the Center’s Principal Investigator Dawn Tyus said. “Yes, the inaccessibility of high-quality care is a significant problem, but that problem is being compounded by the taboo or stigma attached to needing or receiving...click on View Resource to read the full article.

September is recovery month; this is a time where we reflect on how far many individuals have come along in their journey to sobriety and their commitment to their recovery. It is also a time to be honest about what recovery looks like, and why it may not be inclusive to marginalized individuals who experience discrimination based on gender, race, and sexuality. So, you want to be an addictions counselor? You decided that you want to help people overcome adversities and help them become their best self. Congratulations, you have spent many years in school, interning at some of the best rehabilitation centers and medical facilities that you were able to get into, and now you have the degrees and certification to prove this. You’re all set to go! However, what if I told you that treating addiction requires more than what is brought to you in a classroom or clinical setting? What if I told you that in order to be an effective therapist you are going to have to do the inner work and dismantle your own white supremacy? Now, I know the knee-jerk reaction is to declare that you don’t contribute to white supremacy, or that you’re not racist. However, I encourage you to really look at how white supremacy and racism has contributed to the foundation of our society today, which includes the substance use and mental health treatment systems. We also must be mindful that to talk about white supremacy and colonialism, is to talk about the binary of gender and sexuality; we must be honest about how marginalized people are affected in every part of society, including in substance use treatment and recovery services. I have worked in HIV prevention for over a decade, with an emphasis on educating and advocating for transgender women of color; the issues of homelessness, substance use disorder, and mental health were some of the main themes that constantly reappeared whether it was on the prevention side of HIV or maintaining care.

Starting patients on buprenorphine for opioid use disorder (OUD) in the emergency department (ED), combined with linkage to outpatient care, is an effective strategy for reducing harm, including death, from opioid use. However, patients often face barriers to getting buprenorphine in a timely manner after leaving the ED, partly because many ED physicians don’t have the authorization needed to prescribe buprenorphine at discharge. Patients discharged without a prescription may experience a return of withdrawal symptoms before they have a chance to access follow-up care. The timing and dose of buprenorphine during induction may be a way to address that lack of timely follow-up care, however. This study, CTN-0069-A-1, aimed to find out if a higher dose (>12mg) of buprenorphine administered during ED induction was safe and tolerable in people with OUD experiencing opioid withdrawal symptoms and helped better bridge the gap between ED discharge and outpatient treatment. Click on the View Resource button above to read the full article.

In September 2021, AMERSA launched a 10-episode podcast series, AMERSA People & Passion, that explores the world of substance use education, research, care and policy. The podcast is sponsored by the ATTC Network and hosted by AMERSA then-Executive Director Doreen Baeder (who retired in December 2021). Seven of the episodes feature subject matter experts across a variety of topics. The remaining three episodes are focused around “legacy interviews” with Richard Saitz, MD, MPH; Marianne Marcus, EdD, RN; and Sidney H. Schnoll, MD, PhD — who all shared their experiences as AMERSA members and discussed the history of the organization. The ATTC Network Office spoke with Rebecca Northup, AMERSA Executive Director, about the vision behind the People & Passion Podcast.

By Greg Grisolano, for the ATTC Network.   Opioid overdose deaths among older Americans are roughly 11 times greater in 2019 than in 1999, according to new research published in JAMA Network Open on January 11. The study’s authors are: Maryann Mason, PhD, Department of Emergency Medicine at the Feinberg School of Medicine, Buehler Center for Health Policy and Economics, Northwestern University, Chicago; Rebekah Soliman, an undergraduate student at Northwestern University’s Weinberg College of Arts and Sciences, Evanston, Illinois; Howard S. Kim, MD, MS, Department of Emergency Medicine at the Feinberg School of Medicine, Buehler Center for Health Policy and Economics, as well as the Center for Health Services and Outcomes Research at the Feinberg School and an associate editor of JAMA Network Open; and Lori Ann Post, PhD, of the Department of Emergency Medicine at Feinberg School of Medicine, Buehler Center for Health Policy and Economics, Northwestern University. The cross-sectional study found nearly 80,000 Americans aged 55 and older died of opioid overdoses in the last 21 years. Of those, 79.97% were between the ages of 55 and 64, and nearly 60% were men. Click on View Resource to read the full article.

Alcohol use disorder is a significant public health problem, yet treatments demonstrate only modest efficacy.   Because those individuals diagnosed with alcohol use disorder exhibit considerable heterogeneity in terms of clinical presentation as well as patterns of consumption, profiles of risk (e.g., family history of alcohol-related problems, age of first drink), alcohol-related consequences, and patterns of comorbid psychopathology, it is unlikely that a single treatment approach will be best for all individuals with alcohol use disorder.   Click on View Resource above to read the full article.

Aware of the health disparities reported in Native communities, we feared this pandemic would hit these communities hard. We decided to increase our efforts to listen to our colleagues and initiated weekly listening sessions for BH professionals. In April 2020, the National AI/AN TTCs began providing myriad special virtual events across our departments (PTTC, ATTC, MHTTC, TOR, and K-12) inviting American Indian and Alaskan Native tribes from around the country to connect with colleagues, peers, and others, to share their experience, strength, and hope in the ominous shadow of a worldwide pandemic.   Click on View Resource above to read the full article.

Fear of “saying the wrong thing,” of “offending,” because providers don’t know the right word(s) to say, is a consistent theme that emerges during every LGBTQIA-focused training I’ve ever facilitated. So too is the related expectation that a single training will supply the Lavender Lingo Lexicon (nonexistent-to my knowledge), and having memorized that, all will be peace under the rainbow sticker displayed in the waiting area. The End. Alas, if knowing the right words were magic, and it was that easy! While knowing respectful words to use with and ways to address LGBTQIA people are certainly important for providers in establishing rapport and building trust, they by no means guarantee engagement or retention. That’s why the training we’re providing at Northeast & Caribbean ATTC is called “Serving LGBTQIA People - More Than Knowing the Current Lingo.” Click on View Resource above to read the full article.

The data is telling us it’s time for a new approach to OUD crisis By Kimberly A. Johnson, Ph.D.   When I was a provider, I thought, “If the state only gave me more money and reduced regulations, I could treat a lot more people. I know what works.” When I was the SSA in Maine, I thought, “If the federal government would only give me more money and not have such a reporting burden, I could treat a lot more people. I know what my state needs. I can’t believe what providers try to get away with. I need to write more rules!” When I was CSAT director, I thought, “If Congress would just give me the money and not micromanage the allocation, I could treat a lot more people. I can’t believe what the states and providers try to get away with. Why can’t they even tell me what they spent the money on?” Now I am a researcher. I watch what everyone is doing and wonder, “How do we fix this system? Where do we even begin?”   Click View Resource to read the full article.

As a behavioral health professional with over 40 years of experience, it is my strong feeling that identity is the foundation of developing positive “Minority Mental Health.” I say this as the middle son of five siblings born in the U.S. to Salvadoran immigrants. My dad was raised in a small, rural town in El Salvador. My mother was from a larger city, Santa Ana. My dad immigrated first in the early 1940’s as an art student. He changed career plans by enlisting in the U.S. Army, deploying to the Pacific in World War II. He would be engaged to my mother who had moved to Mexico City to be with relatives. For political reasons many of her family had immigrated to Mexico, and later, Costa Rica. In 1948, my mother would join my dad. They married and settled in California’s Bay Area, buying a home on the G.I. Loan in a working-class suburb of San Francisco. My dad went to work for Bethlehem Steel, while my mother was a homemaker and later provided elder care to a neighbor. My most intimate experience with acculturation/assimilation (Choy et al., 2021) was a struggle with my name. Like many immigrants, my parents wanted me to have an “American” name. They named me Freddie, a derivative of Alfredo, my uncle. During adolescence I experienced some dissonance with my name and identity.  I was an average student, played high school sports but became more aware of my family’s background.  I began feeling the need to embrace my Latino/Salvadoran identity.    Click View Resource to read the full article.

There is a common saying in the field of addiction science: “Nothing about us, without us.” An important reminder during Recovery Month and every month working in the addiction field. Yet there is still a pronounced absence of systematic feedback from patients in recovery and receiving treatment for substance use disorders (SUDs). Barriers to engaging individuals in recovery can include social stigma, confidentiality concerns, and fear of exposure or retribution. And yet patients have a wealth of information and guidance on treatment for SUDs and long-term recovery that can benefit the research community, clinicians, and providers, as well as other patients and families.

Oklahoma is home to thriving and diverse communities of American Indian (AI) peoples, including federally recognized AI tribes and over 300,000 residents, making it the state with the of AI Peoples. As researchers at Oklahoma State University, we are interested in developing and increasing access to culturally-relevant alcohol use treatments and research with AI communities through collaborative research partnerships with local tribes (termed community-based participatory research, or CBPR). An important step toward this goal is by sharing our work, “An overview of alcohol use interventions with American Indian/Alaska Native Peoples,” published in the Behavior Therapist, which summarizes research findings on drinking among AI peoples and describes cultural considerations when working with these communities on this sensitive topic.    Click the View Resource button above to read the full article.

Contingency management (CM) is an evidence-based practice that uses behavioral reinforcement, like rewards, to shape client behavior toward a treatment goal, such as attending counseling sessions or abstinence. As a therapeutic approach, CM has been studied extensively in addiction treatment settings for half a century and found reliably effective in the treatment of both opioid use disorder and methamphetamine use disorder, two major contributors to the current overdose epidemic in the U.S.   Click on View Resource to read the full article.

The COVID-19 pandemic has been a catalyst for seismic change. It has forced many to adapt to new technologies and to innovate solutions in the face of previously unthinkable challenges. In July, the ATTC Network launched a series of articles about how our centers have gone about meeting those changes while continuing to provide training and technical assistance to those who request it. The challenges of the COVID-19 pandemic became an opportunity to begin “Embracing Change.” We invite readers to explore the whole series on our blog. Links are included in this article.     

ATTC Embracing Change blog series post from Southeast ATTC. Like much of the substance use disorders (SUD) treatment field, South Carolina’s providers experienced the early impact of COVID-19 as a steep rise in the need for services combined with a steep decline in capacity to meet that need. In communities, fear, isolation, loneliness, and financial stress escalated, while social support diminished. Traditionally marginalized populations were disproportionately affected. Many individuals were already deeply troubled long before the pandemic hit. For decades, more and more people had been:  suffering the effects of early, chronic, intergenerational, historical, and/or racial trauma;  deeply affected by inequities and disparities in the social determinants of health, diminishing their resilience and resources; afflicted with multiple substance use disorders, mental health conditions, and chronic physical health conditions; and/or  bearing the social, psychological, and financial burdens of years spent in the foster care, juvenile justice, and/or criminal justice systems, or on the street.

ATTC Embracing Change blog series post from Mountain Plains ATTC The onset of the COVID-19 Public Health Emergency (PHE) in 2020 forced many Substance Use Disorders (SUD) treatment and recovery support providers to rapidly switch to virtual and/or telephone-based services. For some providers, as their proficiency and confidence grew, their adoption of videoconferencing and telephone to deliver services increased. Shore (2020) predicted that lessons learned during the quick virtualization of behavioral health services, due to the PHE, would create a new hybrid model of service delivery that benefits patients. In this hybrid model, treatment services are inclusive, providing a combination of in-person, online, and telephone sessions, including check-ins or consultations. The following narrative includes literature support for telephone-based services; guidance from the Office of Civil Rights (OCR) and recommendations for a new term; and a novel product for SUD treatment/recovery support providers in delivering telephone-based services created by the Pacific Southwest and Mountain Plains ATTCs. Read the full article by clicking on the 'View Resource' button above.

ATTC Embracing Change blog series post from Mid-America ATTC SAMHSA defines Harm Reduction as “a comprehensive approach to addressing substance use disorders through prevention, treatment, and recovery where individuals who use substances set their own goals. Harm reduction organizations incorporate a spectrum of strategies that meet people “where they are” on their own terms and may serve as a pathway to additional prevention, treatment, and recovery services.”  SAMHSA is increasingly encouraging the integration of harm reduction philosophy and programming in drug treatment and prevention programs. In response, the Mid-America ATTC partnered with Katie Burk, MPH, a managing consultant from Facente Consulting, to launch a harm reduction consultation pilot program in early 2022.   Read the full article by clicking on the 'View Resource' button above.

ATTC Embracing Change blog series post from National American Indian/Alaska Native ATTC Provisional data from the Centers for Disease Control and Prevention in 2022 showed a 39 percent increase in drug overdose deaths for Native people from 2019 to 2020. Only Black people had a higher increase (44 percent). Drug overdose deaths hit a record in 2021, with almost 108,000 deaths recorded. In late 2021, the CDC also reported that, although the overall suicide rate in the U.S. declined during the height of the COVID-19 pandemic, suicide deaths for young adult males and people of color increased – possibly (at least in part) because people of color were more likely to lose their jobs and have poorer access to both primary and mental health services. Read the full article by clicking on the 'View Resource' button above.

ATTC Embracing Change blog series post from Great Lakes ATTC One of the greatest aspects of NIATx process improvement is the adaptability of this model. Over the past several years, the Great Lakes ATTC, MHTTC, and PTTC have developed hybrid training series integrating NIATx principles with other in-demand technical assistance (TA) and intensive technical assistance (ITA) offered by our centers. Some of the special focus topics featured in these series are the National Culturally and Linguistically Appropriate Services (CLAS) Standards, suicide prevention, school-based mental health, recruitment and retention, telehealth services, and supporting the COVID-19 workforce. Behavioral healthcare and prevention professionals from our region who have participated in these hybrid courses consistently report greater success in implementing and applying the skills learned during training thanks to the inclusion of NIATx principles.   In the spirit of embracing change, I sat down with Alfredo Cerrato, Scott Gatzke, and Mat Roosa–three of the Great Lakes ATTC, MHTTC, and PTTC's subject matter experts and most experienced trainers–to better understand their considerations, planning processes, and experiences when it comes to "infusing" our TA and ITA content with NIATx principles and the Change Leader Academy (CLA) curriculum. Read the full article by clicking on the 'View Resource' button above.

ATTC Embracing Change blog series post from South Southwest ATTC Much of the work by the Addiction Technology Transfer Center network and their partners in behavioral health care systems focuses on making changes that improve the lives and health of communities, families, and individuals. Examples include providing intensive training, feedback and coaching to counselors working in substance use treatment programs in a specific evidence-based practice, such as Motivational Interviewing (MI), or supporting a primary care clinic in a change process to implement Screening, Brief Intervention and Referral (SBIRT) for substance use for all of their patients. Many times, change projects run up against unplanned system barriers that blunt positive outcomes: high turnover in staff results in loss of counselors with MI training and experience, policies and procedures at the primary clinic impede implementation of SBIRT. Read the full article by clicking on the 'View Resource' button above.

ATTC Pearls of Wisdom blog series post from Mid-America ATTC If there’s one thing Pat Stilen has learned in her decades’ long career, it’s the value of building relationships, and that starts by listening. “Building relationships and listening, that makes all the difference in the world,” she said. Stilen, a social worker, retired from her leadership role with the Mid-America Addiction Technology Transfer Center in March 2022. She joined MATTC in 1996, after building a relationship with the members of the staff. Read the full article by clicking on the 'View Resource' button above.

ATTC Pearls of Wisdom blog series post from Mountain Plains ATTC According to Benjamin Franklin, “For the best return on your money, pour your purse into your head.” This is sound advice and one that SAMHSA has followed through its funding of the Addiction Technology Transfer Centers (ATTCs). The ATTCs emphasize preparing the SUD workforce to use evidence-based practices when providing SUD services (harm reduction, treatment, and recovery support) to patients and their families through training and technical assistance activities. Preparing the SUD workforce targets both licensed/certified professionals as well as students. The Mountain Plains ATTC is one of the original 11 ATTCs. In 1993 the grant was located at the University of Nevada with Dr. Gary Fisher as the initial project director. Called the Mountain West ATTC it first served the states of Montana, Nevada, and Wyoming from 1993-1998. Five subsequent successful grant awards (1998 to present) included new partnerships and changes to the states served.  Currently, the Mountain Plains ATTC is housed at the University of North Dakota in partnership with the University of Nevada (Nevada) working with Region 8 which includes six states: Colorado, Montana, North and South Dakota, Utah and Wyoming. Read the full article by clicking on the 'View Resource' button above.