Recovery incentives program: California's contingency management benefit.

OBJECTIVE: The role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. METHODS: The Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. RESULTS AND CONCLUSIONS: The California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths.

Virtual training and technical assistance: a shift in behavioral health workforce access and perceptions of services during emergency restrictions.

BACKGROUND: To respond to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration-funded Technology Transfer Centers had to rapidly adapt to ensure that the behavioral health workforce had continuous access to remote training and technical assistance (TTA). Although the Technology Transfer Centers have historically relied partially upon virtual methods for delivering TTA, the shift to a strictly virtual approach necessitated by COVID-19 restrictions has raised new questions for how to best proceed with services when social distancing guidelines are relaxed. The objective of this exploratory paper was to compare TTA provision in the six-month period prior to (9/1/19 thru 2/28/20) and during (4/1/20 thru 9/30/20) early COVID-19 restrictions to determine the extent to which the shift to virtual service provision impacted the behavioral health and medical workforce. Specifically, we examined participants' access to TTA, geographic reach of TTA, and workforce perceptions of satisfaction and utility with TTA provision. METHOD: Participant and event-level data were analyzed to compare the following metrics before and during the COVID pandemic: number of events and attendees; participant demographics; zip codes reached; coverage of rural, suburban, and urban areas; and perceptions of satisfaction with and utility of training. RESULTS: Findings showed a 40% increase in the number of events delivered (p < .001) and a 270% increase in the number of attendees (p < .001) during the COVID period when TTCs relied exclusively on virtual delivery. Geospatial analyses linking zip codes to a schematic of rural, suburban, and urban classifications throughout the United States revealed significant increases in the number of zip codes reached during the COVID time period. Satisfaction levels were comparable before and during the pandemic. CONCLUSIONS: Findings show that expanded access to TTA services via virtual formats resulted in reach to more diverse attendees and regions, and did not come at the expense of satisfaction. Results suggest that virtual TTA should continue to be an important component of TTA offerings post-pandemic.

Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys.

Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?" Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations.

California's Recovery Incentives Program: Implementation strategies.

INTRODUCTION: Due to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit. METHODS: The Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch. RESULTS: The present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program. CONCLUSION: The California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

Editors' introduction: Identifying and assessing promising practices for criminal justice clients--California Substance Abuse Research Consortium (SARC) meetings, 2010.

Although some practices clearly have stronger supporting evidence than others, a single authoritative list of evidence-based practices (EBPs) that can be applied in the treatment of criminal justice clients does not exist. Nationally, use of EBPs is low, and such practices are generally only implemented under certain circumstances. To clarify these issues, experts from around the nation were invited to California for two research-to-policy meetings focused on EBP identification and implementation. Their presentations and the resulting series of articles in this special theme issue describe the current state of EBP research for criminal justice clients. To advance the field beyond the compilation of EBP lists, which can only represent a partial solution at best, next steps should include a greater focus on quality of implementation, intensity of quality assurance and monitoring, and training for underlying skills and principles.

Adoption of medications in substance abuse treatment: priorities and strategies of single state authorities.

Research has confirmed the effectiveness of medications, when used in conjunction with ongoing counseling, to treat substance abuse disorders. This article describes a national, mixed-methods research project designed to investigate single state authorities' (SSAs) perceptions of adoption of evidence-based practices in substance abuse treatment. Results are focused specifically on medication-assisted treatment, one of five evidence-based practices defined by the National Quality Forum. Medication-assisted treatment (MAT) is an important and effective part of comprehensive care options available to clients who are chronically ill with alcohol and other drug disorders. Despite mounting clinical evidence and increased availability, overall rates of implementation and sustained adoption of medications to treat addiction remain limited. The results illustrate that the SSA representatives who fund public treatment programs believe MAT is a priority and worthy of system-wide implementation. Current strategies utilized by SSAs to support the adoption of MAT are detailed, as are barriers to adoption and implementation.

"I've been NIATxed": participants' experience with process improvement.

Process improvement strategies provide industries with a method for improving outcomes and performance at a low cost and with minimal training. In Los Angeles County, two process improvement projects were implemented as a way to improve access to, and engagement and retention in, alcohol and other drug abuse treatment. A qualitative evaluation was completed after the Phase II pilot project to assess how the providers felt about the project, what worked, what did not work, what was learned, and the degree to which process improvements changed program operations. Semistructured interviews were conducted with 33 individuals, representing every level of staff participation in the project. Overall, comments indicated a positive experience for staff, administrators, and clients. Providers noted the relative ease of implementation and how quickly changes resulted in impressive improvements. Challenging issues included resistant staff or a lack of additional resources to pay for the project; however, most noted that these issues were resolved. Interview participants also requested more training on data collection and a reduction in the frequency of the project conference calls. This study gives support to the idea of process improvement being a tool that dramatically improves services to consumers of addiction treatment services.

Using ECHO Clinics to Promote Capacity Building in Clinical Supervision.

INTRODUCTION: Project Extension for Community Healthcare Outcomes (ECHO™) is a hub-and-spoke knowledge-sharing network, led by expert teams who use multipoint videoconferencing to conduct virtual clinics with community providers in order to improve the quality of care. For this project, members of the Addiction Technology Transfer Center network applied this model in order to enhance workforce capacity to deliver clinical supervision for the treatment of substance use disorders. METHODS: Clinical supervisors (n=66) employed in substance use disorder treatment programs were recruited to participate in this pilot study. The virtual ECHO clinic consisted of 12 total sessions, each lasting 1 hour and comprising a 15-minute mini-lecture on a clinical supervision topic and a 45-minute case presentation and review. All data were collected and analyzed between September 2016 and June 2017. RESULTS: Forty-eight staff attended at least one ECHO session (mean=6.38) and results are presented for 20 staff who completed the follow-up survey. Participants were highly satisfied with the overall intervention, organization of the clinic and the facilitation of Hub experts, relevance of the technical assistance to their work, and with the impact of the intervention on their effectiveness as a supervisor. Results also indicate that there were significant self-reported improvements in clinical supervision self-efficacy following participation in the ECHO clinic. CONCLUSIONS: Results from this pilot study suggest that ECHO virtual clinics are feasible to implement for the purpose of workforce development, are well liked by participants, and can enhance clinical supervision self-efficacy among participants. Further research should explore the impact of self-efficacy on the effective implementation of clinical supervision practices. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

Real-World Strategies to Engage and Retain Racial-Ethnic Minority Young Men Who Have Sex with Men in HIV Prevention Services.

Racial/ethnic minority young men who have sex with men (YMSM)-particularly African Americans and Hispanics/Latinos-are at particularly high risk for HIV infection. Devising strategies to improve engagement and retention in HIV prevention services among minority YMSM is critical if the United States is going to achieve the National HIV/AIDS Strategy goal of reducing HIV health-related disparities. This article presents findings from a national summit on racial/ethnic YMSM services convened by the Substance Abuse and Mental Health Services Administration-funded Center of Excellence on Racial and Ethnic Minority Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Populations (YMSM + LGBT CoE) in September 2015. The summit included (1) subgroup discussions focused on issues related to treatment access, outreach/engagement/retention, continuing care/recovery support, and health literacy for minority YMSM; and (2) a ranking process, where the NIATx Nominal Group Technique was used to identify the strategies and approaches that summit participants believed to be most promising for engaging and retaining minority YMSM in HIV prevention services. Analyses of results from summit activities highlight four key cross-cutting strategies-utilizing peers, providing holistic care, making services fun, and utilizing technology-as critical for engaging minority YMSM in HIV prevention care. Examples of programs that utilize these strategies and implications of these findings for policy and practice are discussed.

California Substance Abuse Research Consortium, September 2005: update on recent methamphetamine trends in four California regions.

California Substance Abuse Research Consortium (SARC) meetings have become a mainstay in supporting the exchange of new alcohol and other drug information on research to policy and other initiatives throughout the state. A cornerstone of SARC is a discussion of regional substance abuse patterns and trends. This article provides readers with a brief overview of recently released methamphetamine statistics, as well as a more detailed review of the methamphetamine information presented during the substance abuse epidemiology portion of the September 2005 meeting, as presented for Kern County, Los Angeles County, San Diego County, the San Francisco Bay Area, and the state of California.

Improving client engagement and retention in treatment: the Los Angeles County experience.

This article discusses a two-phase demonstration project focused on the implementation of the Network for the Improvement of Addiction Treatment model of process improvement among substance abuse treatment providers in Los Angeles County, California. A total of 30 Change Teams from 12 county-contracted treatment agencies planned and executed one or more rapid-cycle change projects to reduce wait time to treatment, reduce no-shows to scheduled appointments, increase admissions, or improve continuation in treatment. The findings and lessons learned illustrate the importance of a concrete and straightforward methodology and consistent peer-to-peer interaction provided in a learning collaborative environment. In addition, both ongoing technical assistance and coaching are essential for successful implementation of this innovative, low-cost, evidence-based process improvement strategy.

The prevalence of methamphetamine and amphetamine abuse in North America: a review of the indicators, 1992-2007.

INTRODUCTION: This paper reviews epidemiological information about methamphetamine production and use in North America. METHODS: Information is drawn from a range of sources, including, but not limited to, historical accounts, peer-reviewed papers, population surveys and large national databases. RESULTS: Methamphetamine and amphetamine use in North America is characterised by geographic variations, with different types of the drug, different routes of administration and different types of users at various times. Unlike some other drug use patterns in North America, the nature of methamphetamine use in Canada, Mexico and the United States has been linked closely in terms of production and supply of the drug. According to their national household surveys, the annual prevalence for 'speed' use in Canada was 0.8% in 2004, 0.3% for 'anfetaminas' and 0.1% for 'metanfetaminas' in Mexico in 2002, and 1.4% for 'stimulants' in the United States in 2006. DISCUSSION: Although the data sources in the three North American countries are not consistent in methodology, terminology or frequency of reporting, all show similar trends. The type of stimulant most used has shifted from non-medical use of pharmaceutical amphetamine to use of powder methamphetamine and then to use of 'ice'. The indicators show the problem is greatest in the western parts of the countries and is moving eastward, but the decreased availability of pseudoephedrine may have a significant impact on the nature of the epidemic in the future. Nevertheless, use of methamphetamine poses a number of risks for users and specialised treatment resources for these various populations are needed.