American Society of Addiciton Medicine
Jan 19, 2024 Reporting from Rockville, MD
Government Strategies to Foster Ethical Addiction Treatment
Jan 19, 2024
The ethics of medicine and public health, however, call for upholding the individual patient-clinician relationship, informed consent, and addressing social determinants of health. Thus, ASAM urges policymakers to prioritize policies that foster quality addiction treatment and enact long-term government strategies to address persistent unethical practices.

Government Strategies to Foster Ethical Addiction Treatment.Substring(0, maxlength)

American Society of Addictin Medicine


Government Strategies to Foster Ethical Addiction Treatment



America is at a crossroads with confronting addiction, which is one of the most prevalent medical conditions in the country, and poses socially and politically complex policy challenges.1 While almost one in five individuals had a substance use disorder (SUD) in 2022, on a lifetime basis, nearly one in three Americans meets criteria for alcohol use disorder, making alcohol a major underprioritized and costly public health problem.1–3 The prevalence of high potency synthetic substances, including opioids, in unregulated drug markets has caused unrivaled overdose deaths,4 while solutions remain elusive. Simultaneously, billions of dollars are beginning to flow into American communities from opioid litigation settlements, but risk becoming an opportunity squandered, if not spent wisely.5,6

The practice of medicine is buoyed by the four pillars of medical ethics – patient autonomy, nonmaleficence, beneficence, and justice.7 Codes of ethics assist clinicians with the complex ethical dilemmas that arise in the practice of medicine.8 While ASAM has adopted the Principles of Medical Ethics of the American Medical Association, with annotations delineating the ethical responsibilities unique to the practice of addiction medicine, addiction medicine clinicians practice in environments where powerful economic, political, social, and other drivers can undermine ethical principles, fostering instances of fraudulent and abusive business practices, racial bias in services and disparate access to care,9 coercive strategies causing harm,10 excessive and unfair profit-seeking (or profiteering), and subquality approaches in addiction treatment.8,11,12

Well-recognized factors hindering ethical addiction treatment like stigma and discrimination, underfunding, and ‘siloed’ systems of care have also created substantial difficulties in measuring – and thus, verifying – the quality of addiction care.13 Addiction treatment has historically been relegated to operating outside general medical care, receiving scant attention to its regulation, delivery, coverage, or outcome measurement.14 Therefore, despite efforts to define addiction in medical terms and employ rigorous scientific methods for improving its medical treatment, significant challenges remain in finding quality addiction care. This has immense consequences for individuals with addiction, who have a shorter life expectancy than compared to those without addiction.15

Historically, the politics around addiction have devalued its medical treatment,16–18 resulting in common paternalistic and moralistic treatment methods that would be unconventional anywhere else in medical care.19 This has been justified through the state’s authority to protect those who are vulnerable (parens patriae) and public health and safety (police power).20,21 The ethics of medicine and public health, however, call for upholding the individual patient-clinician relationship, informed consent,22 and addressing social determinants of health.10,20,22 Thus, ASAM urges policymakers to prioritize policies that foster quality addiction treatment and enact long-term government strategies to address persistent unethical practices.




Instances of fraudulent and abusive business practices involving addiction treatment

While instances of fraudulent and abusive practices are not unique to the field of addiction medicine, seeking addiction treatment is often under emergency circumstances, making individuals with addiction particularly vulnerable to fraudulent and abusive business practices. These practices include call center employees obtaining personal information patients submit online and brokering it to the highest bidding treatment provider.23,24 Internet search engines have taken steps to block related online tactics, including partnering with a monitoring and certification firm.25–28 Patients also may be enticed to enter, stay, or switch addiction treatment programs with payments or gifts.24 Perhaps most egregiously, addiction services may be provided in exchange for sex or labor, which is commonly known as human trafficking.24,29,30 In response, governments have passed laws banning such practices and implemented voluntary sober home licensure and certification programs to help eliminate patient brokering and human trafficking in connection with addiction treatment.31–35

Some addiction treatment programs may file false or fraudulent insurance claims for services not rendered, and these practices have increased in conjunction with the expansion of health insurance coverage of addiction treatment benefits.36–38 The U.S. Department of Justice Criminal Division launched the Sober Homes Initiative31 that has targeted almost $1 billion in allegedly false and fraudulent claims in connection with addiction treatment facilities or sober homes in its first two years.39,40


The role of coercion in addiction treatment

Addiction41 affects behaviors and decision-making, but does not make individuals with addiction wholly incapable of making decisions about their treatment.42 Nevertheless, coercive strategies that consist of legal, formal, and informal “social controls”[1] aimed at causing a person to take a prescribed action through the use of force or threats, rely on an assumption that addiction undermines individuals’ autonomy and capability to make well-reasoned decisions.10,42 These types of coercive strategies often accompany addiction treatment or make participation in it contingent on compliance.10,43,44 Others contend that such coercive strategies can sometimes be effective nonetheless, or are justified by the ethical principle of beneficience.45,46 The assumed efficacy of social controls involving force or threats is woven throughout the fabric of addiction treatment, including related social services programs, as well as legislative practices.47 Social controls involving force or threats are widespread in addiction treatment, but have not been sufficiently studied.10 Research is often based on how individuals are referred to or monitored in treatment, and rarely includes how these coercive strategies are perceived or experienced, whether they affect individuals’ motivation, interest, and intent to pursue and engage in treatment, and the impact on long-term outcomes in addiction treatment and population health.10,47–51 Some theories suggest that individuals have a fundamental need for autonomy to change behavior, including in social contexts.10,52 Thus, well-rounded research is needed on the role and efficacy of social controls, using force or threats, in addiction treatment.51


Profiteering in addiction treatment

Complex ethical questions have long been raised over the evolving relationship between medical and for-profit commercial enterprise.53 Against this backdrop, ASAM has adopted the ethical principle of supporting access to medical care for all individuals with addiction, and the affordability of quality addiction treatment, and relatedly, the lack of health insurance parity between mental health/addiction services and medical/surgical services, are direct challenges to this principle.12,54–60 Individuals’ financial well-being is often affected by the time they seek addiction treatment and their receipt of evidence-based addiction treatment should be based on their need for it, rather than the ability to pay.61 (Moreover, many do not have access to health insurance, particularly in states that have not expanded Medicaid.62) Yet, up-front payment is often required by residential addiction treatment programs, with some for-profit programs charging more than twice as much as nonprofit programs.63 Generally, cash is the most commonly accepted form of payment at addiction treatment facilities, surpassing private insurance, Medicaid, and Medicare.64 While cash’s prominence may be intuitive, the significant administrative burden that accompanies accepting health insurance and low reimbursement rates in addiction treatment likely contribute to the persistent disparities among forms of payment accepted in addiction treatment.65,66 Some clinicians and programs in addiction treatment do not accept health insurance at all.67 Sometimes cash-only practices can lead to perverse incentives that could cause harm.67 Furthermore, plans’ limits on mental health/addiction services benefits that are more restrictive than those imposed on medical/surgical (or physical health) benefits are not in compliance with parity requirements.68 Unfortunately, noncompliance remains widespread within public and private plans, in part due to the complexities of insurance coverage.69,70


Suboptimal approaches and lack of quality measurement in addiction treatment

Despite the historical lack of consistency of addiction treatment with evidence-based practices,68 over the last half a century, options for addiction treatment have expanded from abstinence alone to multiple medications with proven efficacy in treating substance use disorders.69 However, uptake of these evidence-based medications remains quite poor in addiction treatment – only one in three specialty addiction treatment facilities offer medications for opioid use disorder, and far fewer offer all forms of addition medications.70,71

In medical practice, the use of nationally-recognized performance measures,[2] or tools to improve transparency, accountability, and overall quality of health care, can help to ensure the quality of the treatment provided; when quality measurement does not exist, differences in levels of quality of care cannot be well understood, and claims can be made about care that are not true.13,72–75 Accrediting and certifying bodies provide third-party recognition of competency to perform certain tasks and can develop quality measures across health care delivery, including for addiction treatment.74,76,77 Improvements to the historic lack of insurance coverage of benefits and to the few medical treatments available for addiction treatment have put a spotlight on the need for effective performance measures in addiction treatment.72,74,78–85 While not necessarily exclusive to the practice of addiction medicine, certain deterrents to the adoption of performance measures in addiction treatment include policies that separately finance general medical and addiction care and do not align addiction treatment program licensing at the state level with nationally recognized program standards, as well as burdensome reporting requirements for quality measures for value-based care.86,87 For measures to be used in federal programs, they must be endorsed through the National Quality Forum’s (NQF) rigorous assessment process.88[3] ASAM published performance measures after the release of the Standards of Care for the Addiction Specialist Physician, which have not been endorsed by the NQF.86,89 Renewed efforts will be required to identify effective performance measures in addiction treatment, to ensure measures are patient-centered,90 accurately reflect positive patient outcomes and cost-effective care, and anticipate and mitigate potential adverse and unintended consequences.87,91 CMS’ noteworthy effort to align quality measurement across its programs, with preliminary Universal Foundation Measures, include initiation and engagement in addiction treatment.92 

While the adoption of electronic health records (EHR) provides clinicians with access to standardized, shareable, legible, and complete patient data, the adoption of certified EHRs and associated data standards in addiction treatment has been slow for a variety of reasons, including the exclusion of such providers from federal incentive programs, interoperability barriers, including privacy laws necessitating that substance use disorder (SUD) records be segregated within EHRs, and financial challenges.93–96 Yet, developing and testing clinical quality measures require conceptual and technical specifications definition, testing to ensure reproducibility across diverse systems, consideration of data elements and inclusion/exclusion criteria, and further testing in existing, capable healthcare systems with large datasets, which are facilitated by EHR adoption. Misalignment of federal and state regulations governing the privacy of addiction treatment records also poses challenges to using large datasets for quality measurement in addiction treatment.95 Significant intellectual and financial capital will be required for the development and testing of a core set of measures for national endorsement and use. (Fifteen years ago, the costs of refinement, testing, and analysis for developing a measure ranged between half a million and four million dollars, depending on the measure type.97)

Lastly, the heterogeneity in the organization, oversight, and financing of addiction treatment systems contributes to high variability in the quality of care delivered.14 While The ASAM Criteria is a comprehensive guideline for conducting multidimensional patient assessments, identifying an appropriate level of care based on patient needs, and defining the services that should be provided at each level of care, including capacity to support broad access to addiction medications, it is not always accurately, effectively, and comprehensively deployed.



The American Society of Addition Medicine recommends that:

1. Governments at all levels implement multifaceted strategies to foster high-quality, evidence-based, ethical addiction treatment that is accessible to all who need it.

2. Federal, state, or local governments establish confidential mechanisms to field and investigate patient, family, and provider reports of unethical practices involving addiction care, and as is prudent, align those efforts with the sober homes enforcement initiative at the federal level.

3. The federal government ensure fair and truthful advertising for addiction treatment programs on the internet, encourage internet search engines to work with addiction treatment stakeholders to ensure that certification fee scales for participation in internet advertising are not unfairly prohibitive, and ensure certifiers have well-established accreditation and certification standards.

4. To inform addiction policy and practice, governments fund research on the role and efficacy of coercive strategies that consist of social controls aimed at causing a person to take a prescribed action through the use of force or threats, which includes patient perceptions and experiences and the impact of such social controls on their motivation, interest, and intent to pursue and engage in addiction treatment.

5. Governments enact policies that facilitate and incentivize addiction clinicians and treatment programs to accept public and commercial insurance, such as increasing reimbursement rates for addiction treatment services, fully extending federal mental health and addiction parity protections under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicare, all of Medicaid, and TRICARE, and enforcing parity laws. 

6. The federal government provide the resources necessary to advance long-term strategies for the development and testing of a core set of performance measures in addiction treatment, for the purpose of national endorsement and use.

a. The federal government convene an interagency working group supported by a consortium of stakeholders to renew efforts for quality measurement of addiction treatment, drawing from CMS’s Universal Foundation Measures as is sensible.

b. Congress pass legislation amending the Public Health Service Act to extend health information technology (IT) assistance eligibility to mental health and addiction professionals and facilities. In addition, federal agencies provide guidance to states on available federal authorities and resources to promote adoption and interoperability of IT in mental health and addiction care.98

c. Governments ensure any such national or state-level quality or performance measures for addiction treatment outcomes are patient-centered and align with addiction as a chronic disease, remission as a treatment goal, and recovery as an ongoing process, and refrain from using as the desired or measured outcome, “completion of treatment” or cessation of professional services.

d. State governments enact policies to better harmonize state regulations governing the privacy of SUD treatment records with federal regulations. The federal government continue to take actions to ensure 42 CFR Part 2 regulations do not impede coordination of care or the adoption of EHRs in addiction treatment.101,102

7. Congress pass legislation directing the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop and regularly update national model standards for state licensure of addiction treatment programs that meet the nationally-recognized program standards in the most current edition of The ASAM Criteria.103 In the absence of Congressional action, the Office of National Drug Control Policy (ONDCP) should fund the development of such national model standards for use in state licensure.

8. Congress pass legislation that would encourage states to adopt such model standards for licensure, including the most current edition of The ASAM Criteria’s level of care nomenclature, as well as educate individuals and families on the importance of matching patients with the appropriate level of care.103

a. SAMHSA align the addiction service settings in its online treatment locator104 with ASAM levels of care.



[1] Legal strategies include civil commitment, court-ordered treatment and diversion-to-treatment programs, as adjuncts or alternatives to criminal sanctions. Formal strategies are not issued by the criminal legal system, but include institutional facilitation of treatment, like mandatory referrals from employee assistance programs that require drug testing, social assistance, like government benefits or custody of children made contingent on treatment attendance. Informal strategies include family and friends initiating persuasive interpersonal threats and ultimatums (see Wild, 2006).

[2] Classic quality or performance measures are structural, which indicates capacity, systems, and process; process, which indicates what one does to maintain or improve health and reflect generally accepted recommendations for clinical practice; and outcome, which reflects the impact of services on patients (see AHRQ, 2015), but measures important to addiction treatment also include: access, which assesses the extent to which a person who needs and wants care is able to obtain it; composite, which combine results of measures for comprehensively assessing quality care across systems; contextual, which define the context for other measures’ interpretation, and patient experiences of care, which record patients’ perspectives and satisfaction with care received (see ASAM, 2015).

[3] The NQF develops consensus through the independent review of a multistakeholder panel of measures’ importance, scientific acceptability, feasibility, and usability for quality improvement.


Adopted by the ASAM Board of Directors on January 19, 2024.  

  © Copyright 2024. American Society of Addiction Medicine, Inc. All rights reserved. Permission to make digital or hard copies of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for commercial, advertising or promotional purposes, and that copies bear this notice and the full citation on the first page. Republication, systematic reproduction, posting in electronic form on servers, redistribution to lists, or other uses of this material require prior specific written permission or license from the Society. ASAM Public Policy Statements normally may be referenced in their entirety only without editing or paraphrasing, and with proper attribution to the society. Excerpting any statement for any purpose requires specific written permission from the Society. Public Policy statements of ASAM are revised on a regular basis; therefore, those wishing to utilize this document must ensure that it is the most current position of ASAM on the topic addressed. 



1. Tucker JA, Chandler SD, Witkiewitz K. Epidemiology of Recovery From Alcohol Use Disorder. Alcohol Res. 2020;40(3):02. doi:10.35946/arcr.v40.3.02
2. Substance Abuse and Mental Health Services Administration. Results from the 2022 National Survey on Drug Use and Health: A Companion Infographic. Published online 2022.
3. Centers for Disease Control and Injury Prevention. Excessive Drinking is Draining the U.S. Economy. Published April 14, 2022. Accessed March 22, 2023.
4. Ahmad F, Cisewski J, Rossen L, Sutton P. Provisional drug overdose death counts. Published online 2023.
5. Johns Hopkins School of Public Health. Principles for the Use of Funds from the Opioid Litigation | JHSPH. Opioid Principles. Published 2021. Accessed March 23, 2023.
6. Maximizing the Impact of Opioid Litigation Settlements. O’Neill. Accessed April 23, 2023.
7. Beauchamp TL. Methods and principles in biomedical ethics. Journal of Medical Ethics. 2003;29(5):269-274. doi:10.1136/jme.29.5.269
8. Bloch S, Kenn F, Lim I. Codes of ethics for psychiatrists: past, present and prospect. Psychol Med. 52(7):1201-1207. doi:10.1017/S0033291722000125
9. American Society of Addiction Medicine. Advancing Racial Justice Policy Series. Default. Published 2022. Accessed November 25, 2023.
10. Wild TC. Social control and coercion in addiction treatment: towards evidence-based policy and practice. Addiction. 2006;101(1):40-49. doi:10.1111/j.1360-0443.2005.01268.x
11. American Psychiatric Association. Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. Published online 2013.
12. American Society of Addiction Medicine. Medical Ethics with Annotations Applicable to Addiction Medicine. Public Policy Statements. Published January 23, 2019. Accessed October 23, 2023.
13. McLellan AT, Chalk M, Bartlett J. Outcomes, performance, and quality—What’s the difference? Journal of Substance Abuse Treatment. 2007;32(4):331-340. doi:10.1016/j.jsat.2006.09.004
14. Guyer J, et. al. Speaking the same language: a toolkit for strengthening patient-centered addiction care in the United States. American Society of Addiction Medicine. Published November 9, 2021. Accessed October 31, 2023.
15. Iturralde E, Slama N, Kline-Simon AH, Young-Wolff KC, Mordecai D, Sterling SA. Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system. General Hospital Psychiatry. 2021;68:1-6. doi:10.1016/j.genhosppsych.2020.11.002
16. Nathan PE, Conrad M, Skinstad AH. History of the Concept of Addiction. Annual Review of Clinical Psychology. 2016;12(1):29-51. doi:10.1146/annurev-clinpsy-021815-093546
17. Olsen Y. What Is Addiction? History, Terminology, and Core Concepts. Medical Clinics. 2022;106(1):1-12. doi:10.1016/j.mcna.2021.08.001
18. Owens C. The politicization of the fentanyl crisis. Axios. Published September 11, 2023. Accessed September 20, 2023.
19. Volkow ND. Making Addiction Treatment More Realistic and Pragmatic: The Perfect Should Not be the Enemy of the Good. National Institute on Drug Abuse. Published January 4, 2022. Accessed March 13, 2022.
20. Testa M, West SG. Civil Commitment in the United States. Psychiatry (Edgmont). 2010;7(10):30-40.
21. Coleman L, Solomon T. Parens Patriae Treatment: Legal Punishment in Disguise. Hastings Const LQ. 1975;3:345.
22. Childress JF, Faden RR, Gaare RD, et al. Public health ethics: mapping the terrain. J Law Med Ethics. 2002;30(2):170-178. doi:10.1111/j.1748-720x.2002.tb00384.x
23. Enos G. One CEO attacks bait-and-switch marketing tactics. Published November 3, 2014. Accessed September 17, 2023.
24. Eleanor Health Foundation. Patient Brokering: The New Human Trafficking.
25. Recent Focus on Patient Brokering Is Encouraging, But A Long Road is…. Caron Treatment Centers. Accessed October 24, 2023.
26. Horton J. Google and the Treatment Field: Addiction Treatment Certification. Published online 2018.
27. LegitScript. Fact Sheet: Addiction Treatment Certification | LegitScript. Published online 2023.
28. National Association of Addiction Treatment Providers. Code of Ethics. Published April 21, 2016. Accessed September 17, 2023.
29. Michaelis A, Lundstrom M, Henderson A. The Role of Addictive Substances in Different Types of Sex Trafficking in Urban Areas in the U.S.: A Study of Control. 2022;3(1).
30. U.S. Department of State, Office to Monitor and Combat Trafficking in Persons. THE INTERSECTION OF HUMAN TRAFFICKING AND ADDICTION. Published online June 2020.
31. Clingan SE, D’Ambrosio B, Davidson P. Patient Brokering in Substance Use Disorder Treatment: A Qualitative Study with People with Opioid Use Disorder and Professionals in the Field. SSRN Journal. Published online 2022. doi:10.2139/ssrn.4093882
32. Rothenberg Z. Trends in Combating Fraud and Abuse in Substance Use Disorder Treatment. Published online October 2018.
34. Ashford RD, Brown AM, Curtis B. Systemic barriers in substance use disorder treatment: A prospective qualitative study of professionals in the field. Drug Alcohol Depend. 2018;189:62-69. doi:10.1016/j.drugalcdep.2018.04.033
35. Substance Abuse and Mental Health Services Administration. Best Practices for Recovery Housing. Published online September 1, 2023.
36. Aronberg D. Affordable Care Act Is Exploited to Foster Opioid Relapse | Time. Published September 20, 2017. Accessed September 20, 2023.
37. Ovalle D. Sober homes promised help and shelter. Some delivered fraud, officials say. Washington Post. Published September 18, 2023. Accessed September 19, 2023.
38. Healy J. They Wanted to Get Sober. They Got a Nightmare Instead. The New York Times. Published November 11, 2023. Accessed November 11, 2023.
39. Department of Health and Human Services, Department of Justice. Annual Report of the Departments of Health and Human Services and Justice: Health Care Fraud and Abuse Control Program FY 2020. Published online October 2021.
40. Department of Health and Human Services, Department of Justice. Annual Report of the Departments of Health and Human Services and Justice Health Care Fraud and Abuse Control Program FY 2021. Published online July 2022.
41. American Society of Addiction Medicine. The Definition of Addiction.
42. Uusitalo S, Van Der Eijk Y. Scientific and conceptual flaws of coercive treatment models in addiction. J Med Ethics. 2016;42(1):18-21. doi:10.1136/medethics-2015-102910
43. White W, Scott CK, Dennis ML, Boyle M. It’s Time to Stop Kicking People Out of Addiction Treatment. Counselor. Published online April 2005.
44. Israelsson M, Gerdner A. Compulsory Commitment to Care of Substance Misusers: International Trends during 25 Years. European Addiction Research. 2012;18(6):302-321. doi:10.1159/000341716
45. Sullivan MA, Birkmayer F, Boyarsky BK, et al. Uses of Coercion in Addiction Treatment: Clinical Aspects. American Journal on Addictions. 2008;17(1):36-47. doi:10.1080/10550490701756369
46. Caulkins JP, Humphreys KN. New Drugs, Old Misery: The Challenge of Fentanyl, Meth, and Other Synthetic Drugs. Manhattan Insititute. Published November 9, 2023. Accessed November 25, 2023.
47. Urbanoski KA. Coerced addiction treatment: Client perspectives and the implications of their neglect. Harm Reduct J. 2010;7(1):13. doi:10.1186/1477-7517-7-13
48. Urbanoski KA, Wild TC. Assessing self-determined motivation for addiction treatment: Validity of the Treatment Entry Questionnaire. Journal of Substance Abuse Treatment. 2012;43(1):70-79. doi:10.1016/j.jsat.2011.10.025
49. Wild TC, Newton-Taylor B, Alletto R. Perceived coercion among clients entering substance abuse treatment: structural and psychological determinants. Addictive Behaviors. 1998;23(1):81-95. doi:10.1016/S0306-4603(97)00034-8
50. Wild TC, Yuan Y, Rush BR, Urbanoski KA. Client Engagement in Legally-Mandated Addiction Treatment: A Prospective Study Using Self-Determination Theory. Journal of Substance Abuse Treatment. 2016;69:35-43. doi:10.1016/j.jsat.2016.06.006
51. Harris J, McElrath K. Methadone as Social Control: Institutionalized Stigma and the Prospect of Recovery. Qual Health Res. 2012;22(6):810-824. doi:10.1177/1049732311432718
52. Deci EL, Ryan RM. Self-Determination Theory. In: Wright JD, ed. International Encyclopedia of the Social & Behavioral Sciences (Second Edition). Elsevier; 2015:486-491. doi:10.1016/B978-0-08-097086-8.26036-4
53. Medicine (US) I of, Gray BH. Ethical Dilemmas of For-Profit Enterprise in Health Care. In: The New Health Care for Profit: Doctors and Hospitals in a Competitive Environment. National Academies Press (US); 1983. Accessed October 26, 2023.
54. Department of Labor. FY 2022 MHPAEA Enforcement Fact Sheet. DOL. Published 2022. Accessed September 20, 2023.
55. Kaiser Family Foundation. Mental Health Parity at a Crossroads. Published August 18, 2022. Accessed September 20, 2023.
56. Department of Health and Human Services. HHS’s New Mental Health and Substance Use Disorder Benefit Resources Will Help People Seeking Care to Better Understand Their Rights. Published April 27, 2022. Accessed September 20, 2023.
57. ParityTrack. State Parity Enforcement Actions. Published 2022. Accessed September 20, 2023.
58. Goddell S. Enforcing Mental Health Parity | Health Affairs Brief. Published October 9, 2015. Accessed September 20, 2023.
59. Gold J. Advocates Say Mental Health ‘Parity’ Law Is Not Fulfilling Its Promise. KFF Health News. Published August 3, 2015. Accessed September 20, 2023.
60. Assistant Secretary for Public Affairs, Department of Health and Human Services. Mental Health and Substance Use Insurance Help. Published November 10, 2021. Accessed September 20, 2023.
61. Jones-Sanpei HA, Nance RJ. Financial Capability in Addiction Research and Clinical Practice. Substance Use & Misuse. 2020;56(2):214-223. doi:10.1080/10826084.2020.1853776
62. Lewis R, Baugher AR, Finlayson T, et al. Healthcare Access and Utilization Among Persons Who Inject Drugs in Medicaid Expansion and Nonexpansion States: 22 United States Cities, 2018. The Journal of Infectious Diseases. 2020;222(Supplement_5):S420-S428. doi:10.1093/infdis/jiaa337
63. Beetham T, Saloner B, Gaye M, Wakeman SE, Frank RG, Barnett ML. Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US. Health Affairs. 2021;40(2):317-325. doi:10.1377/hlthaff.2020.00378
64. Cantor JH, DeYoreo M, Hanson R, et al. Patterns in Geographic Distribution of Substance Use Disorder Treatment Facilities in the US and Accepted Forms of Payment From 2010 to 2021. JAMA Network Open. 2022;5(11):e2241128. doi:10.1001/jamanetworkopen.2022.41128
65. Sahni NR, Gupta P, Peterson M, Cutler DM. Active steps to reduce administrative spending associated with financial transactions in US healthcare. Health Affairs Scholar. Published online October 11, 2023:qxad053. doi:10.1093/haschl/qxad053
66. Lugo M. Addiction and mental health vs. physical health: Analyzing disparities in network use and provider reimbursement rates. Published online 2017.
67. Van Zee A, Fiellin DA. Proliferation of Cash-Only Buprenorphine Treatment Clinics: A Threat to the Nation’s Response to the Opioid Crisis. Am J Public Health. 2019;109(3):393-394. doi:10.2105/AJPH.2018.304899
68. National Council for Behavioral Health. The Essential Aspects of Parity: A Training Tool for Policymakers. Published online 2021.
69. Department of Labor D of H and HS. Warning Signs: Plan or Policy Non-Quantitative Treatment Limitations (NQTLs) That Require Additional Analysis to Determine Mental Health Parity Compliance.
70. American Society of Addiction Medicine KF. ASAM Joins Letter to CMS Highlighting Widespread Parity Noncompliance in Medicaid Managed Care and CHIP. Default. Published November 27, 2023. Accessed December 16, 2023.
71. Institute of Medicine (US) Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. National Academies Press (US); 2006. Accessed September 27, 2023.
72. Blanco-Gandía MC, Rodríguez-Arias M. Pharmacological treatments for opiate and alcohol addiction: A historical perspective of the last 50 years. European Journal of Pharmacology. 2018;836:89-101. doi:10.1016/j.ejphar.2018.08.007
73. Knudsen HK, Roman PM, Oser CB. Facilitating Factors and Barriers to the Use of Medications in Publicly Funded Addiction Treatment Organizations. J Addict Med. 2010;4(2):99-107. doi:10.1097/ADM.0b013e3181b41a32
74. Abraham AJ, Andrews CM, Harris SJ, Friedmann PD. Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA. Neurotherapeutics. 2020;17(1):55-69. doi:10.1007/s13311-019-00814-4
75. Garnick DW, Horgan CM, Acevedo A, McCorry F, Weisner C. Performance measures for substance use disorders – what research is needed? Addict Sci Clin Pract. 2012;7(1):18. doi:10.1186/1940-0640-7-18
76. Agency for Healthcare Research and Quality. Types of Health Care Quality Measures. Published July 2015. Accessed September 29, 2023.
77. Pincus HA, Scholle SH, Spaeth-Rublee B, Hepner KA, Brown J. Quality Measures For Mental Health And Substance Use: Gaps, Opportunities, And Challenges. Health Affairs. 2016;35(6):1000-1008. doi:10.1377/hlthaff.2016.0027
78. Berenson RA. Achieving the Potential of Health Care Performance Measures. Urban Institute, Robert Wood Johnson Foundation. Published online May 2013.
79. The Role of an Accreditation Body. ISO Update. Published May 25, 2015. Accessed October 29, 2023.
80. NQA Global Certification Body. Accessed October 31, 2023.
81. Harris AHS. The primitive state of quality measures in addiction treatment and their application. Addiction. 2016;111(2):195-196. doi:10.1111/add.13096
82. Garfield RL, Lave JR, Donohue JM. Health Reform and the Scope of Benefits for Mental Health and Substance Use Disorder Services. PS. 2010;61(11):1081-1086. doi:10.1176/ps.2010.61.11.1081
83. Abraham AJ, Andrews CM, Grogan CM, et al. The Affordable Care Act Transformation of Substance Use Disorder Treatment. Am J Public Health. 2017;107(1):31-32. doi:10.2105/AJPH.2016.303558
84. Pating DR, Miller MM, Goplerud E, Martin J, Ziedonis DM. New Systems of Care for Substance Use Disorders: Treatment, Finance, and Technology Under Health Care Reform. Psychiatric Clinics. 2012;35(2):327-356. doi:10.1016/j.psc.2012.03.004
85. Creedon TB, Cook BL. Access To Mental Health Care Increased But Not For Substance Use, While Disparities Remain. Health Affairs. 2016;35(6):1017-1021. doi:10.1377/hlthaff.2016.0098
86. Saloner B, Bandara SN, McGinty EE, Barry CL. Justice-Involved Adults With Substance Use Disorders: Coverage Increased But Rates Of Treatment Did Not In 2014. Health Affairs. 2016;35(6):1058-1066. doi:10.1377/hlthaff.2016.0005
87. Saloner B, Karthikeyan S. Changes in Substance Abuse Treatment Use Among Individuals With Opioid Use Disorders in the United States, 2004-2013. JAMA. 2015;314(14):1515-1517. doi:10.1001/jama.2015.10345
88. Thomas CP, Garnick DW, Horgan CM, et al. Advancing performance measures for use of medications in substance abuse treatment. J Subst Abuse Treat. 2011;40(1):35-43. doi:10.1016/j.jsat.2010.08.005
89. American Society of Addiction Medicine. Performance Measures for the Addiction Specialist Physician. Published online July 2015.
90. Center for Financing Reform and Innovation. Exploring Value-Based Payment for Substance Use Disorder Services in the United States. Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration. Published online November 2023.
91. Patel MM, Brown JD, Croake S, et al. The Current State of Behavioral Health Quality Measures: Where Are the Gaps? Psychiatr Serv. 2015;66(8):865-871. doi:10.1176/
92. Harris AHS, Weisner CM, Chalk M, Capoccia V, Chen C, Thomas CP. Specifying and Pilot Testing Quality Measures for the American Society of Addiction Medicine’s Standards of Care. Journal of Addiction Medicine. 2016;10(3):148. doi:10.1097/ADM.0000000000000203
93. Marchand K, Beaumont S, Westfall J, et al. Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review. Substance Abuse Treatment, Prevention, and Policy. 2019;14(1):37. doi:10.1186/s13011-019-0227-0
94. Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Internal Medicine Journal. 2012;42(5):569-574. doi:10.1111/j.1445-5994.2012.02766.x
95. Jacobs DB, Schreiber M, Seshamani M, Tsai D, Fowler E, Fleisher LA. Aligning Quality Measures across CMS — The Universal Foundation. New England Journal of Medicine. 2023;388(9):776-779. doi:10.1056/NEJMp2215539
96. Atasoy H, Greenwood BN, McCullough JS. The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization. Annual Review of Public Health. 2019;40(1):487-500. doi:10.1146/annurev-publhealth-040218-044206
97. Spivak S, Strain EC, Cullen B, Ruble AAE, Antoine DG, Mojtabai R. Electronic health record adoption among US substance use disorder and other mental health treatment facilities. Drug and Alcohol Dependence. 2021;220:108515. doi:10.1016/j.drugalcdep.2021.108515
98. MACPAC. Report to Congress on Medicaid and CHIP | Chapter 4: Encouraging Health Information Technology Adoption in Behavioral Health: Recommendations for Action. Published online June 2022.
99. Coffey RM, Buck JA, Kassed CA, et al. Transforming mental health and substance abuse data systems in the United States. Psychiatr Serv. 2008;59(11):1257-1263. doi:10.1176/ps.2008.59.11.1257
100. Hoflund AB, Farquhar M. Challenges of democratic experimentalism: A case study of the National Quality Forum in health care. Regulation & Governance. 2008;2(1):121-135. doi:10.1111/j.1748-5991.2007.00031.x
101. Substance Abuse and Mental Health Administration. Fact Sheet: SAMHSA 42 CFR Part 2 Revised Rule. Published July 13, 2020. Accessed July 6, 2023.
102. Substance Abuse and Mental Health Services Administration. HHS Proposes New Protections to Increase Care Coordination and Confidentiality for Patients With Substance Use Challenges | SAMHSA. Published November 28, 2022. Accessed November 26, 2023.
103. American Society of Addiction Medicine. ASAM Criteria. Accessed March 19, 2023.
104. Substance Abuse and Mental Health Administration. Published 2023. Accessed September 20, 2023.