1. Impacting the Opioid Epidemic: Care Delivery Innovations from the Behavioral Health Community
Nick Szubiak, MSW, LCSW
Director, Clinical Excellence in Addictions
National Council for Behavioral Health

2. Care Delivery Innovations
Engagement
Collaborative Care
Evidenced Based Care
Recovery Supports

3. Collaborative Care
Primary Care is a golden opportunity to identify, engage, and treat
MAT
SBIRT
ED initiates to engage overdose survivors to treatment
CCBHCs = Certified Community Behavioral Health Clinics
CBHOs = Community Behavioral Health Organizations can provide ongoing care management and evidenced based psychosocial interventions
Reimbursement = improved outcomes, proactive care, workforce support
Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care
At 6 months, the proportion of participants who received any OAUD treatment was higher in the CC group compared with usual care 39.0% vs 16.8%
A higher proportion of CC participants reported abstinence from opioids or alcohol at 6 months 32.8% vs 22.3% (
Katherine E. Watkins, MD, MSHS1; Allison J. Ober, PhD1; Karen Lamp, MD2; et al

4. Medication Assisted Treatment
MAT is the gold standard for opioid use disorder (OUD) treatment:
Reduces drug use
Reduces risk of overdose
Prevents injection behaviors
Reduces criminal behavior
20.2 Million People Have SUD
Only a fraction of those that get treatment get MAT
300, ,000 people on methadone in a given year
40,000 on buprenorphine
5-10,000 on Naltrexone
Only 10% of the prospective MAT patients for (OUD) are receiving it

5. Why?
Perceptions: The perceptions of MAT and its value among patients, practitioners, and institutions – Bias and Discrimination
Providers: The availability of qualified practitioners and their capacity to meet patient demand for MAT
Payment: The availability and limits of insurance coverage for MAT
Coverage for ALL of the MAT medications approved by the Food and Drug Administration.
Prior authorization requirements
“fail first” policies

6. Recovery Supports – Part of the Healthcare Continuum
Recovery Housing
Recovery Education Programs
Recovery Employment
Peer Coaching
Essential Ingredients for Sustained Recovery:
Safe and affordable place to live
Steady employment and job readiness
Education and vocational skills
Life and recovery skills
Health and wellness
Recovery support networks
Sense of belonging and purpose
Community and civic engagement

7. Peer Recovery Support Services
Services to help individuals and families initiate, stabilize, and sustain recovery
Provided by individuals with “lived experience” of addiction and recovery 
Non-professional and non-clinical
Distinct from case management and treatment
Distinct from mutual aid support, such as 12-step groups
Provide links to professional treatment, health and social services, and support resources in communities

8. The Cascade Linkage to care among those diagnosed
Medication initiation among those entering care
Retention for at least six months among those initiating medication
Continuous abstinence among those retained
Diagnosis among those affected

10. Opioid Use Disorder is…
-not a moral or spiritual failing
-not lack of will or responsibility
-not a character defect
-not an addictive personality type
-does not have personality components such as denial, rationalization, evasion, defensiveness, manipulation, and resistance or any abnormally robust defense mechanisms
Is Primary Disease - meaning that it’s not the result of other causes such as emotional or psychiatric problems
Is Chronic Disease - like cardiovascular disease or diabetes it must be treated, managed and monitored over a life‐time.  
The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect. 2002;1(1):13–20. Available at: