Advancing addiction recovery through state/treatment-provider partnerships

In the first round of funding, the program will award six grants of up to $360,000 over a period of up to two years for effective practice implementation. Using the grants, providers and state agencies will partner to better provide patient care, with the guidance of Gustafson’s cross-disciplinary team.

“We are looking for systems changes that could be made both within state government and within the treatment agencies themselves that would be in the best interests of all involved,” Gustafson says.

Evidence shows that several existing treatment practices are effective for   overcoming addiction and preventing relapse, yet these practices are used infrequently in treatment because they put too much strain on the current system.

Advancing Recovery focuses on five areas of successful but underused treatment practices: medications, screening and intervention, psychosocial intervention, post-treatment care, and case management, including wraparound support services.

“We know that if you wrap a set of services around recovering addicts—helping them to find employment, housing, childcare, things like that—that there’s a greater chance that they’ll stay off drugs,” says Gustafson. “But a lot of treatment agencies just toss them out and say, ‘Good luck!’”

This lack of follow-up support results from treatment centers’ lack of resources to provide such services. Many treatment providers are afraid to report their shortcomings to the state, says Gustafson.

Both the state and the treatment providers want to improve the quality and availability of recovery care. But instead of cooperating, the two sides are often in conflict, says Gustafson. The state is unsatisfied with the care addicts are receiving, while the treatment providers feel hindered by the state.

This conflict causes frustration for both treatment providers and the state agencies that oversee them. However, if the two sides worked together, many roadblocks to effective treatment, such as funding and personnel shortages, could be removed.

"There are a lot of systems available to treatment agencies, and if those systems were modified or put into place, they could make it easy to implement these practices," says Gustafson. For example, if the state paid for medication and reimbursed for case management that provided wraparound service, then the treatment agencies could implement care practices that they know are effective but have been cost-prohibitive, he says.

“We’re trying to create a no-fault insurance program where the treatment providers and state agencies are willing to be honest with each other about their weaknesses and their strengths,” says Gustafson. The partnerships will require compromise, communication and commitment on both sides, but will result in practices that enable state agencies and treatment providers to operate more efficiently and in ways that ultimately benefit patients.

Gustafson anticipates that many of the program’s changes will be permanent and far-reaching. For example, one underused treatment is medications for alcoholism. Drugs such as naltrexone or disulfiram can curb patients’ desire to drink or induce sickness if they drink alcohol. Under the Advancing Recovery program, the state could cover prescriptions for such medications.

But the program’s purpose is not to fund treatment only for the duration of the grant; its goal is to help the state change its formulary so that those drugs are covered permanently, a move that would affect all treatment providers in the state.

“It’s very important that these organizations don’t see this as a project that’s going to end in 18 months,” says Gustafson. “We’re trying to build a kind of infrastructure and a level of trust so that when the funding from the project ends, the relationship is going to continue.”

Gustafson has been working with addiction treatment programs for four years. Since 2003, he has served as director of the Network for Improvement of Addiction Treatment (NIATx), which aims to help treatment programs improve systems and policies for better practices. He decided to co-direct the Advancing Recovery program because it would provide the opportunity to directly influence patient care.

“NIATx was focused on improving business processes that could improve access to and retention in treatment, but we were not explicitly engaging the way treatment takes place,” Gustafson explains. “This gives us the opportunity to look at both the clinical and non-clinical sides of treatment.” 

The UW-Madison Advancing Recovery team works in partnership with the Treatment Research Institute at the University of Pennsylvania, led by Tom McLellan.