Society For The Study Of Addiction



Dennis McCarty, Ph.D., professor emeritus of public health and preventive medicine in the OHSU School of Medicine and the OHSU-Portland State University School of Public Health. (OHSU)

Institute of Medicine reports

The Institute of Medicine (now called the National Academy of Medicine) contracts with federal agencies (and other entities) to complete reviews of controversial issues. Committee members are chosen to minimize the potential for unrecognized bias or conflicts of interest.

Institute of Medicine (1997). Edmunds, E., Frank, R., Hogan, M., McCarty, D., Robinson-Beale, R., & Weisner, C. (Eds.) Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: National Academy Press.

The Center for Substance Abuse Treatment sponsored the Institute of Medicine’s Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Careto develop a framework “to assist in the purchase and delivery of the most effective managed behavioral health care at the lowest appropriate cost for consumers of publicly and privately financed care” (p. v). The Committee’s recommendations addressed the structure and financing of behavioral healthcare, approaches to monitor quality of care, contracting strategies, roles of federal and state government, provider and consumer involvement, cultural competence, services for special populations including children and adolescents, practice guidelines, linkages with primary care, ethical concerns and research needs. The Committee concluded that well designed behavioral health carveouts enhanced the quality and effectiveness of care.

Institute of Medicine (1998). Lamb, S., Greenlick, M. R. & McCarty, D. (Eds.). Bridging the Gap between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment. Washington, DC: National Academy Press.

The Center for Substance Abuse Treatment and the National Institute on Drug Abuse sponsored the Institute of Medicine’s Committee on Community-based Drug Treatmentto examine a) treatment strategies, promising research approaches and ways to link treatment with research, b) mechanisms for treatment programs to participate in research and the adoption of the research in practice, c) technology transfer strategies, d) barriers that inhibit research within and the application of research to treatment practices, e) barriers that slow integration of treatment practices with research and f) innovative strategies to circumvent the. The Committee’s first recommendation advocated for development of a community-based clinical trials network that tested emerging research-based research in the complexity of real-world addiction treatment settings. The recommendation led supported the National Institute on Drug Abuse’s creation of the National Drug Abuse Treatment Clinical Trials Network.

National Drug Abuse Treatment Clinical Trials Network

The Clinical Trials Network (CTN) began in 1999 to improve the quality of care using science and test emerging drug abuse treatment innovations and document their effectiveness in the complexity of clinical settings and as a vehicle. I was an active investigator in the CTN from 2000 when I joined the Oregon Node of the CTN through my retirement in 2018 and I continue to informally advise, consult and participate.

Amass, L., Ling, W., Freese, T.T., Reiber, C., Annon, J. J., Cohen, A. J., McCarty, D., Reid, M., Brown, L.S., Clark, C., Ziedonis, D.M., Krejci, J., Stine, S., Winhusen, T., Brigham, G., Babcock, D., Muir, J., Buchan, B.J. & Horton, T. (2004). Bringing buprenorphine-naloxone detoxification to community treatment providers: The NIDA Center for Clinical Trials Network field experience. American Journal on Addictions, 13, S42 – S66. PMCID: PMC1255908.

Analyses documented the safety and effectiveness of an opioid detoxification taper using buprenorphine within 12 specialty addiction treatment settings (n = 234). The first multi-site test of buprenorphine within specialty clinics. Encouraged adoption of buprenorphine for detoxification from opioid use disorders. CTN-0001 and CTN-0002.

McCarty, D., Fuller, B., Arfken, C., Miller, M., Nunes, E.V., Edmundson, E., Copersino, M., Floyd, A., Forman, R., Laws, R., Magruder, K.M., Oyama, M., Prather, K., Sindelar, J., Wendt, W.W. (2007) Direct care workers in the National Drug Abuse Treatment Clinical Trials Network: Characteristics, opinions and beliefs. Psychiatric Services, 58,181 – 190. PMCID: PMC2861362.

Fuller, B.E., Rieckmann, T., Nunes, E.V., Miller, M., Arfken, C., Edmundson, E. & McCarty, D.(2007). Organizational readiness for change and opinions toward treatment innovations. Journal of Substance Abuse Treatment, 33, 183 – 192. PMCID: PMC2031859.

A survey of the CTN workforce (n = 1,757; 71% response rate) found that women made up two-thirds of the workforce and one-third reported a graduate degree. Managers and supervisors were more supportive of evidence-based therapies and support staff were least supportive. Analysis of the Organizational Readiness for Change found greater support for evidence-based practices in programs where staff perceived more need for improvement, better internet access, higher levels of peer-influences and more opportunities for professional growth. The paper provides the most comprehensive analysis of the addiction treatment workforce. CTN-0008

Tai, B., Straus, M.M., Liu, D., Sparenborg, S., Jackson, R. & McCarty, D. (2010). The first decade of the National Drug Abuse Treatment Clinical Trials Network: Bridging the gap between research and practice to improve drug abuse treatment. Journal of Substance Abuse Treatment, 38 (3), Supplement 1, S4 – S13.PMID: 20307794; PMCID: PMC2994254.

During the CTN’s first 10 years, the Network developed a collaborative structure and completed 20 trials with more than 11,000 study participants. The paper provides an overview of the CTN and its research protocols. Multiple CTN protocols.

NIATx and Advancing Recovery

NIATx (initially called the Network for Improvement of Addiction Treatment) taught specialty addiction treatment centers process improvement strategies to enhance the quality of treatment services for alcohol and drug use disorders. For the initial demonstration initiative, community treatment programs with awards from the Robert Wood Johnson Foundation and Center for Substance Abuse Treatment sought to reduce days to treatment and enhance retention in care. Subsequent awards from the National Institute on Drug Abuse supported follow-up assessments and a scale up to 200 treatment centers in five states. Advancing Recovery, with support from the Robert Wood Johnson Foundation, extended the NIATx model with the participation of public and commercial payers to facilitate the adoption of evidence-based psychosocial and pharmacotherapies for treatment of alcohol and opioid use disorders.

McCarty, D., Gustafson, D.H., Wisdom, J.P., Ford, J., Choi, D., Molfenter, T., Capoccia, V., Cotter, F. (2007). The Network for the Improvement of Addiction Treatment (NIATx): Enhancing access and retention. Drug and Alcohol Dependence, 88, 138 – 145. PMCID: PMC1896099.

The primary results from the first NIATx demonstration with 13 participating treatment centers documented a 37% reduction in days to treatment (from 19.6 to 12.4 days). Retention in care improved 18% between the first and second session of care (72% to 85%) and the third session of care (62% to 73%). Incremental changes in treatment processes led to reductions in wait times and gains in retention. Provided a proof of concept that process improvement could be applied to addiction treatment services.

Hoffman, K.A., Ford, J.H., Choi, D., Gustafson, D.H. & McCarty, D. (2008). Replication and sustainability of improved access and retention within the Network for the Improvement of Addiction Treatment. Drug and Alcohol Dependence,98, 63 – 69. PMID: 18565693; PMCID: PMC2607248. See paper summary and comments on the paper on the Drug and Alcohol Findings website

Replication of the initial NIATx results in a second cohort of 10 programs with a 38% reduction in days to treatment (30.7 days to 19.4 days) and better retention in care at the second session (75.4% to 85.0%), third session (69.2% to 77.7%) and fourth session (57.1% to 67.5%). A sustainability analysis determined that the initial cohort of 13 programs maintained the reduction in days to treatment and the enhanced retention in care during a 20-month follow-up period. A replication and extension of the initial NIATx results.

Schmidt, L.A., Rieckmann, T., Abraham, A., Molfenter, T., Capoccia, V., Roman, P., Gustafson, D.H. & McCarty, D. (2012). Advancing Recovery: Implementing evidence-based treatment for substance use disorders at the systems level. Journal of Studies on Alcohol and Drugs, 73 (3), 413 – 422. PMCID: PMC3594882.

See also paper summary and comments on the Drug and Alcohol Findings website The Robert Wood Johnson Foundation listed this paper as one of the most influential 2012 papers:

A mixed method analysis of strategies to promote adoption of evidence-based psychosocial therapies and pharmacotherapies for the treatment of alcohol and drug use disorders. Partnerships between 12 state/county agencies that funded and regulated addiction treatment services and their treatment providers participated in a 3-year implementation study extending the NIATx model to include payers. Most sites increased the number of patients receiving evidence-based practices using a variety of top-down and bottom-up strategies testing incremental changes in processes. Adding payers to the partnership promoted changes in treatment processes.

Gustafson, D.H., Quanbeck, A.R., Robinson, J.M., Ford, J.H., Pulvermacher, A., French, M.T., McConnell, K.J., Batalden, P.B, Hoffman, K.A., & McCarty, D. (2013). Which elements of improvement collaboratives are most effective? A cluster-randomized trial. Addiction, 108, 1145 – 1157. doi: 10.1111/add.12117 PMCID: PMC3651751.

The primary outcome analysis from the NIATx 200 study. Outpatient treatment centers (n = 201) were randomized to either interest circles, coaching, learning sessions and all three interventions to enhance treatment services. Wait-time declined among sites assigned to the coaching (4.6 days per clinic), learning sessions (3.5 days per clinic) and the combination of interventions (4.7 days per clinic). New admissions increased in the coaching (19.5%) and combination intervention (8.9%). Sites in the interest circle intervention had no evidence of improved services. Coaching and the combination intervention were equally effective but coaching alone was more cost-effective. NIATx can be scaled for broad application.

Ford, J.H., Abraham, A., Lupulescu-Mann, N., Croff, R., Hoffman, K.A., Alanis-Hirsch, K., Chalk, M., Schmidt, L. & McCarty, D. (2017). Promoting adoption of medication for opioid and alcohol use disorders through system change. Journal of Studies on Alcohol and Drugs, 78, 735 – 744. doi/10.15.288/jsad.2017.78.735 PMCID: 5675424

The Medication Research Partnership extended the Advancing Recovery model to include a commercial health plan that wanted contracted treatment providers to increase the use of medication for patients with alcohol or opioid use disorders. A difference-in-differences analysis compared nine participating treatment centers to 15 comparison sites that declined the opportunity to participate. The Medication Research Partnership sites increased the proportion of eligible patients on medication from 13.2% to 31.7% during a three-year implementation period; comparison clinics had a more modest increase (17.6% to 23.5%). The increases were most pronounced for patients with opioid use disorder in the intervention sites (17.0% to 36.8%); there was minimal change in the comparison sites (23.2% to 24.0%). The Advancing Recovery model provided a framework for public and commercial payers to collaborate with treatment programs and increase patient access to medication.

Policy Evaluations

I have been involved in assessing policies addressing alcohol and drug prevention and treatment services. Policy evaluations examined the impacts of changes in legislation addressing services for individuals arrested for driving while intoxicated, the use of managed behavioral carve-outs for publicly funded services, parity in treatment benefits for mental health and substance use disorders, and healthcare reforms that affect access to prevention and treatment services.

McCarty, D., Argeriou, M. & Blacker, E. (1985). Legislated policies and recidivism for driving under the influence of liquor in Massachusetts. Journal of Studies on Alcohol, 46, 97‑102.

An analysis of arrest records compared three-year arrest records of individuals arrested for driving under the influence of liquor (1973; n = 522) two years prior to a 1975 change in court processes and two years following the change (1976 n = 716; 1977 n = 690). Massachusetts legislation (1975) permitted courts to continue the cases of individuals arrested for driving under the influence of liquor without a finding if defendants were placed on probation and assigned to a driver alcohol education program. Following the change, more offenders were arrested and 70% of the cases were continued without a finding. Probability of arrest increased substantially between 1971 and 1980. Re-arrests, however, declined following the legislative change and the increased access to educational interventions. An early policy evaluation that supported additional changes in treatment of drunken drivers.

Daley, M., Argeriou, M., McCarty, D., Callahan, J .J., Shepard, D. S., & Williams, C. N. (2000). The costs of crime and the benefits of substance abuse treatment for pregnant women. Journal of Substance Abuse Treatment, 19,445 – 458. PMID: 11166509;

The Massachusetts MOTHERS (Medicaid Opportunities To Help Enter Recovery Services) initiative, a Health Care Financing Administration (now Centers for Medicare and Medicaid Services) demonstration program, included a waiver from the IMD (Institute for Mental Disease) exclusion that prohibited Medicaid reimbursement for services provided in a residential alcohol and drug treatment service. The initiative provided Medicaid reimbursement for residential care for pregnant women with substance use disorders. This analysis documented improvements in birth weight among women who received residential care while pregnant and the need to eliminate the IND exclusion.

Ettner, S. L., Argeriou, M., McCarty, D., Dilonardo, J. & Liu, H. (2003). How did the introduction of managed care for the uninsured affect the use of substance abuse services? Journal of Behavioral Health Services & Research, 30(1), 26 – 40. PMID: 12645495;

McCarty, D. & Argeriou, M. (2003). The Iowa Managed Substance Abuse Care Plan (IMSACP): Access, utilization and expenditures for Medicaid recipients. Journal of Behavioral Health Services & Research, 30 (1), 18 – 25. PMID 12633002.

The State Substance Abuse and Mental Health Managed Care Evaluation reviewed managed behavioral health carveouts in Arizona, Iowa, Maryland and Nebraska. Analyses found improved access to care without substantial increases in Medicaid expenditures. The analysis encouraged expansion of state managed care initiatives for mental health and substance use disorders.

McConnell , K.J., Gast, S.H.N., Ridgely, S., Wallace, N.; Natalie, J., Rieckmann, T.; McFarland, B.F. & McCarty, D. (2012). Behavioral health insurance parity: Does the Oregon experience presage the national experience with the Mental Health Parity and Addiction Equity Act? American Journal of Psychiatry, 169, 31 – 38. doi:10.1176/appi.ahp.2011.11020320. PMCID: PMC3263406.

Health insurance coverage for behavioral health was generally more restrictive for behavioral health disorder than for other medical concerns. Oregon legislation required parity in coverage for behavioral health services and aggressively enforced the requirement. A policy evaluation found that increases in spending for mental health and substance use disorders was associated with a general increase in expenses and was not due to the implementation of parity. Results were consistent with an evaluation of Federal parity legislation.

McConnell, K.J., Renfro, S., Chan, B.K.S., Meath, T.H.A., Mendelson, A., Cohen, D., Waxmonsky, J., McCarty, D., Wallace, N. and Lindrooth, R.C. (2017). Early performance in Medicaid Accountable Care Organizations: A comparison of Oregon and Colorado. JAMA Internal Medicine, 177(4), 538 – 545. doi:10.1001.jamainternmed.2016.9098. PMCID: PMC5440252.

State healthcare reforms following the passage of the Federal Affordable Care and Patient Protection Act tested new models for financing care and encouraging primary care to reduce total costs of care. An analysis of reforms in Colorado and Oregon documented reductions in the use of emergency visits, preventable hospital admissions, and enhanced access to care. Early analysis of results and promoted continued efforts to control healthcare costs.

McCarty, D., Gu, Y., Renfro, S., Baker, R., Lind, B.K., McConnell, K.J. (2018). Access to treatment for alcohol use disorders following Oregon’s health care reforms and Medicaid expansion. Journal of Substance Abuse Treatment, 94, 24 – 28. PMCID: 6205746

McCarty, D., Gu, Y., McIlveen, J.W., & Lind, B.K. (2019). Medicaid expansion and treatment for opioid use disorders in Oregon: An interrupted time-series analysis. Addiction Science & Clinical Practice, 14, 31, 1 – 8. Open Access. PMCID: in process.

The Affordable Care and Patient Protection Act authorized states to expand Medicaid eligibility in 2014. Analyses of Oregon Medicaid data found improved access to treatment services for alcohol and opioid use disorders and changes in service utilization with increased access to medications for alcohol and opioid use disorders. Documented the value of Medicaid expansion to address alcohol and opioid use disorders.

Literature Reviews

McCarty, D., Argeriou, M., Heubner, R.B., & Lubran, B. (1991). Alcoholism, drug abuse, and the homeless. American Psychologist, 46, 1139 ‑ 1148.

Literature review conducted in collaboration with the National Institute on Alcohol Abuse and Alcoholism’s McKinney Homelessness Community Demonstration Initiative examined a) the prevalence of alcohol and drug problems among individuals who were homeless, b) public policy and treatment for individuals who were homeless and diagnosed with substance use disorders and c) critical needs for comprehensive interventions for housing, mental health disorders and women with children. The analysis supported additional efforts to address the complex needs of persons without housing.

Humphreys, K., Wing, S., McCarty, D., Chappel, J., Gallant, L., Haberle, B., Horvath, A. T., Kaskutas, L. A., Kirk, T., Kivlahan, D., Laudet, A., McCrady, B. S., McLellan, A. T., Morgenstern, J., Townsend, M. & Weiss, R. (2004). Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy. Journal of Substance Abuse Treatment, 26, 151 – 158. PMID: 15063905;

Consensus statement developed by a Substance Abuse and Mental Health Services Administration workgroup reviews the effectiveness of self-help services and the implications for stakeholders, consumers, and policy makers. The analysis encourages development of policies that support self-help participation including the adoption of validated referral strategies and menus of the local options for self-help services. The paper continues to be cited.

McCarty, D., Braude, L., Lyman, D.R., Dougherty, R.H., Daniels, A.S., Ghose, S.S. & Delphin-Rittmon, M.E. (2014). Substance abuse intensive outpatient programs: Assessing the evidence. Psychiatric Services. 65 (6), 718 – 726. doi: 10.1176/ PMID: 24445620. PMCID: 4152944.
Reissued in Hector Colon-Rivera and Lisa B. Dixon (Eds.) Psychiatric Services Editor’s Choice,July 2019, Substance Use Disorders.

A systematic review compared treatment outcomes from studies that randomly assigned participants with alcohol or drug use disorders to receive either intensive outpatient care or residential care. Outcomes from intensive outpatient and residential services had comparable reductions in alcohol and drug use. Intensive outpatient programs appear to be as effective as residential treatment for most individuals. Supports limitations on the use of residential care for the treatment of alcohol and drug use disorders.

Korthuis, P.T., McCarty, D., Weimer, M., Bougatsos, C., Blazina, I., Zakher, B., Grusing, S., Devine, B. & Chou, R. (2017). Primary care-based models for the treatment of opioid use disorder: A scoping review. Annals of Internal Medicine, 166, 268 – 278. doi.10.7326/M16-2149. PMCID: PMC5504692.

A scoping review examined models for integrating medications for opioid use disorder into primary care settings. Twelve representative models were identified and described. Common elements in the models of care included medications for opioid use disorder, provider and community education, coordination of care to address medical and behavioral health needs and delivery of psychosocial services to facilitate recovery. Serves as a guide for implementation of services to address opioid use disorders in primary care settings.

McCarty, D., Priest, K. & Korthuis, P.T. (2018). Treatment and prevention of opioid use disorder: Challenges and opportunities. Annual Review of Public Health, 39, 525 – 541. PMCID: PMC5880741. Open access at:

Review commissioned for the 2018 Annual Review of Public Health examines the evolution of U.S. policies affecting treatment for opioid use disorders and the development of treatment services beginning in the early 20thCentury. Discusses the development of opioid agonist and opioid antagonist therapies and rapid rates of return to use when medications for opioid use disorder are not provided or available. The paper advocates for greater use of medication for opioid use disorder and better integration with medical and behavioral healthcare.