Improving Care for the Treatment of Alcohol and Drug Disorders

  • Dennis McCartyEmail author
  • David Gustafson
  • Victor A. Capoccia
  • Frances Cotter
Special Issue


The Network for the Improvement of Addiction Treatment (NIATx) teaches alcohol and drug treatment programs to apply process improvement strategies and make organizational changes that improve quality of care. Participating programs reduce days to admission, increase retention in care, and spread the application of process improvement within their treatment centers. More generally, NIATx provides a framework for addressing the Institute of Medicine’s six dimensions of quality care (i.e., safe, effective, patient-centered, efficient, timely, and equitable) in treatments for alcohol, drug, and mental health disorders. NIATx and its extensions illustrate how the behavioral health field can respond to the demand for higher quality treatment services.


process improvement quality of care alcohol and drug treatment 



An earlier version of this paper was presented at the 2006 Addiction Health Services Research Conference in Little Rock, Arkansas. The Network for the Improvement of Addiction Treatment (NIATx) was supported through grants from the Robert Wood Johnson Foundation and cooperative agreements from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. The National Evaluation Team at Oregon Health and Science University was supported through awards from the Robert Wood Johnson Foundation (46876 and 50165), the Center for Substance Abuse Treatment (through subcontracts from Northrop Grumman Corporation—PIC-STAR-SC-03-044, SAMHSA SC-05-110), and the National Institute on Drug Abuse (R01 DA018282). National Program Office activities at the University of Wisconsin were supported through awards from the Robert Wood Johnson Foundation (48364) and the Center for Substance Abuse Treatment (through a subcontract from Northrop Grumman Corporation—PIC-STAR-SC-04-035). The National Institute on Drug Abuse supports NIATx 200 (R01 DA 020832) and the Robert Wood Johnson Foundation supports Advancing Recovery (56762, 56891, 56894–56898, 57786). The Center for Substance Abuse Treatment and the Robert Wood Johnson Foundation support STAR-SI.


  1. 1.
    Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
  2. 2.
    Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.Google Scholar
  3. 3.
    Deming WE. Out of the Crisis. Cambridge, MA: MIT-CAES; 1986.Google Scholar
  4. 4.
    Imai M. Kaizen: The Key to Japan’s Competitive Success. New York: McGraw-Hill Publishing Company; 1986.Google Scholar
  5. 5.
    Juran JM. Juran’s Quality Control Handbook. New York: McGraw-Hill Publishing Company; 1988.Google Scholar
  6. 6.
    Barney M, McCarty T. The New Six Sigma: A Leader’s Guide to Achieving Rapid Business Improvement and Sustainable Results. Upper Saddle River, NJ: Prentice Hall PTR; 2003.Google Scholar
  7. 7.
    Eckes G. The Six Sigma Revolution: How General Electric and Others Turned Process Into Profits. New York: Wiley; 2001.Google Scholar
  8. 8.
    McLellan AT, Carise D, Kleber HD. Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment. 2003;25:117–121.PubMedCrossRefGoogle Scholar
  9. 9.
    Fishbein R, McCarty D. Quality improvement for publicly-funded substance abuse treatment services. In: Gibelman M, Demone HW, eds. Private Solutions to Public Problems: Volume 2. New York: Springer; 1997:39–57.Google Scholar
  10. 10.
    Patel KK, Butler B, Wells KB. What is necessary to transform the quality of mental care. Health Affairs. 2006;25(3):681–693.PubMedCrossRefGoogle Scholar
  11. 11.
    Young AS, Magnabosco JL. Services for adults with mental illness. In: Lubotsky Levin B, Petrila J, Hennessy KD, eds. 2nd edn. Mental Health Services: A Public Health Perspective. New York: Oxford University Press; 2004:177–208.Google Scholar
  12. 12.
    Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Disorders: Quality Chasm Series. Washington, DC: National Academy Press; 2006.Google Scholar
  13. 13.
    McCarty D, Gustafson DH, Wisdom JP, et al. The Network for the Improvement of Addiction Treatment (NIATx): Enhancing access and retention. Drug and Alcohol Dependence. 2007;88:138–145.PubMedCrossRefGoogle Scholar
  14. 14.
    Capoccia VA, Cotter F, Gustafson DH, et al. Making “stone soup”: How process improvement is changing the addiction treatment field. Joint Commission Journal on Quality and Patient Safety. 2007;33:95–103 February 1.PubMedGoogle Scholar
  15. 15.
    Wisdom JP, Ford J, Hayes RA, et al. Addiction treatment agencies’ use of data: A qualitative assessment. Journal of Behavioral Health Services & Research. 2006;33(4):394–407.CrossRefGoogle Scholar
  16. 16.
    Ford J, Green CA, Hoffman KA et al. Process improvement needs in substance abuse treatment: Admissions walkthrough results. Journal of Substance Abuse Treatment. 2007;33:379–389.PubMedCrossRefGoogle Scholar
  17. 17.
    Gitlow H, Gitlow S, Oppenheim A, et al. Tools and Methods for the Improvement of Quality. Homewood, IL: Irwin; 1989.Google Scholar
  18. 18.
    Shewart WA. Statistical Method from the Viewpoint of Quality Control. Lancaster, PA: Lancaster Press; 1939.Google Scholar
  19. 19.
    The Robert Wood Johnson Foundation. Substance Abuse: The Nation’s Number One Health Problem. Princeton, NJ: The Robert Wood Johnson Foundation; 2001.Google Scholar
  20. 20.
    Prescott DL, Madden LM, Dennis M, et al. Reducing mechanical restraints in scute psychiatric care settings using rapid response teams. The Journal of Behavioral Health Services & Research. 2007;34:96–105.CrossRefGoogle Scholar
  21. 21.
    Fixsen DL, Naoom SF, Blase KA, et al. Implementation Research: A Synthesis of the Literature. Tampa, Fl: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network; 2005.Google Scholar
  22. 22.
    Power EJ, Nishimi RY, Kizer KW. Evidence-Based Treatment Practices for Substance Use Disorders. Washington, DC: National Quality Forum; 2005.Google Scholar
  23. 23.
    Shojania KG, Grimshaw JM. Evidence-based quality improvement: The state of the science. Health Affairs. 2005;24(1):138–150.PubMedCrossRefGoogle Scholar
  24. 24.
    Coye MJ. No Toyotas in health care: Why medical care has not evolved to meet patient’s needs. Health Affairs. 2001;20(6):44–56.PubMedCrossRefGoogle Scholar
  25. 25.
    Chassin MR. Is health care ready for Six Sigma quality? The Milbank Quarterly. 1998;76(4):565–591.PubMedCrossRefGoogle Scholar

Copyright information

© National Council for Community Behavioral Healthcare 2008

Authors and Affiliations

  • Dennis McCarty
    • 1
    Email author
  • David Gustafson
    • 2
  • Victor A. Capoccia
    • 3
  • Frances Cotter
    • 4
  1. 1.Department of Public Health and Preventive MedicineOregon Health and Science UniversityPortlandUSA
  2. 2.NIATx National Program OfficeUniversity of WisconsinMadisonUSA
  3. 3.Open Society Institute–BaltimoreBaltimoreUSA
  4. 4.Center for Substance Abuse TreatmentSubstance Abuse and Mental Health Services AdministrationRockvilleUSA

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