January 1–31, 2026 · Executive Brief
Substance Use Disorder Treatment Month 2026: Make Access, Ownership, and Continuity Visible
Use the observance to test whether a person can move from a first request for help to a timely, respectful, and accepted treatment connection without losing ownership at a boundary.
Leadership brief
Treatment works when the path works.
The Substance Abuse and Mental Health Services Administration observes Substance Use Disorder Treatment Month in January. For 2026, its theme is Treatment Works! Find the Path that Works for You. The month is organized around starting fresh, multiple pathways to recovery, wraparound services, and treatment-friendly communities. Those ideas give healthcare executives a practical question: can the organization support more than one evidence-informed route while keeping each route understandable, accountable, and connected?
The answer is not contained in a campaign calendar. It is visible in operating behavior. A person may first disclose a need in an emergency department, primary-care visit, inpatient unit, virtual visit, employee program, community organization, justice setting, or family conversation. If each entry point offers a different answer, a referral can become a transfer of responsibility rather than a connection to care. If the next provider does not accept the handoff, the person carries the coordination burden. If a coverage rule, language gap, travel requirement, or scheduling delay appears after the referral, a nominally available service may still be unusable.
Leaders can use the month to make those conditions visible. The work is not to select one preferred recovery pathway for everyone. Qualified clinicians and the people they serve make treatment decisions within applicable standards, evidence, individual goals, and local options. The leadership task is to remove preventable friction, define ownership, protect respectful choice, and measure whether the connection held.
Evidence view
A referral is not the same as treatment initiation.
National Medicaid claims analyzed by Nguyen and colleagues show why the distinction matters. Among emergency-department visits for opioid overdose in the study period, 6.4 percent were associated with a medication-for-opioid-use-disorder claim within 30 days. The observed rate varied across the reported racial and ethnic groups. The analysis cannot explain every individual decision or local condition, but it makes one leadership point clear: count conversion to an observable next step, not simply the number of referrals placed.2
MOUD initiation within 30 days after a Medicaid ED overdose visit
National claims, 2016–2020Executives should resist turning these values into a universal benchmark. Claims indicate billed services, not patient preference, clinical appropriateness, an unbilled service, or every step between a visit and treatment. The useful response is to reproduce the denominator locally, stratify it responsibly, and investigate where the conversion path differs. A system that does not know who reached the next accountable owner cannot reliably improve the gap.
Operating priority 1 · Access
Design the first step for real life, not the directory.
Access is more than the presence of a program. It includes the time, travel, cost, language, scheduling, digital, eligibility, documentation, and trust conditions required to use it. A geospatial study of New York treatment options found that recurring travel burden varied substantially by service model and rurality. A national facility study found that only 22 percent of surveyed substance use disorder treatment facilities reported services in Spanish, with availability failing to keep pace with some fast-growing Spanish-speaking communities.86 Those findings should not be generalized beyond their designs, but they show why a network list alone is an incomplete access assessment.
Start with the path a person actually encounters. Can the public-facing page explain the first step in plain language? Can staff describe the same route? Is there a response outside standard business hours? Can a person ask for an interpreter or an accommodation without restarting? Does a virtual option reduce travel or simply introduce broadband, device, privacy, and identity-verification barriers? Does the receiving program accept the insurance, referral type, age group, clinical need, and timing represented in the message?
Low-threshold and mobile models offer useful design signals. A bridge-clinic cohort separated transfer into observable steps: connection to the receiving clinic, completion of a visit, retention, and continued medication use among those still in care. A recent review of mobile addiction treatment units found that programs often reached populations facing homelessness, rural distance, justice involvement, and other facility-based barriers, but the studies were heterogeneous and did not support one pooled effect.118 The executive lesson is to lower avoidable entry friction and measure what happens after initial contact.
Access questions for the executive team
- Which entry points operate now, and which exist only in policy or communication?
- What is the next available appointment by service, payer, language, modality, and geography?
- Where do people encounter repeated screening, duplicate paperwork, or a requirement to call another number?
- Which barriers can be solved internally, and which require a payer, community, transportation, housing, or public-sector partner?
- How does the organization learn from people who never complete the first visit?
A pragmatic transportation study provides a useful caution. All participants with an identified transportation barrier were offered free rides; weekly text reminders did not significantly improve 12-week retention compared with the initial notification alone.7 A reminder may help some people, but it should not substitute for understanding schedule fit, treatment experience, cost, childcare, medication availability, or the burden of repeated visits. Improvement begins with a specific barrier and a testable theory, not a generic communication tactic.
Operating priority 2 · Ownership
Keep responsibility visible until another team accepts it.
Many treatment pathways cross organizational boundaries. An emergency clinician may initiate a conversation and medication, a peer specialist may support engagement, a navigator may arrange an appointment, a health plan may determine coverage, a community program may provide treatment, and a primary-care team may continue broader health needs. Each role can act correctly while the overall transition still fails.
The fix is not more ambiguous coordination. It is an explicit transfer standard. The sending team should know who is expected to receive the person, what information is needed, what consent and privacy requirements apply, and when acceptance is due. The receiving team should acknowledge responsibility or return a clear exception. Until that happens, the current owner remains visible and an escalation route stays active.
Need identified
Use respectful screening, self-request, or clinician judgment within local policy.
Choice clarified
Discuss available routes, preferences, urgency, language, and practical barriers.
Owner accepts
Name the receiving role, confirm acceptance, and keep the status visible.
First step occurs
Track completed contact or visit, not only the referral order.
Continuity protected
Resolve exceptions, support the next transition, and learn from drop-off.
Hospital evidence reinforces the value of accountable capability. In one retrospective academic-center study, addiction consultation was associated with more receipt of medications for opioid or alcohol use disorder and lower adjusted readmission risk. The observational design cannot prove that consultation caused every outcome, but it supports an operating model in which expertise is available, treatment ownership is defined, and discharge planning includes the next medication and care connection.4
Peer roles can strengthen this route when they are integrated into the operating system rather than used as a substitute for clinical or organizational responsibility. A seven-hospital Maryland analysis of a peer-led emergency-department intervention reported changes in subsequent utilization among people who received the intervention. Because the study was not randomized, leaders should interpret the association cautiously. The transferable design elements are universal screening, rapid peer engagement, medication initiation when appropriate, and facilitated linkage to community care.3
Why can a treatment connection lose ownership?
Qualitative, unranked categories for local investigation
Financing rules belong on the ownership map. In a survey of 33 states and Washington, D.C., fewer than one-third prohibited managed-care plans from requiring prior authorization for every treatment service examined. A separate qualitative study in West Virginia residential programs described administrative burden and shorter stays through the perspectives of administrators, clinicians, and peer specialists.109 These studies do not establish the effect of any one plan or authorization decision. They do show that coverage should be tested at the level of usable access. Assign an owner for authorization, denial, appeal, interim support, and escalation so the person is not left to coordinate the exception alone.
Operating priority 3 · Continuity
Support more than one path without fragmenting the system.
The observance theme recognizes multiple paths. That principle should appear in the care architecture. Depending on the person and setting, treatment may include medication, behavioral interventions, peer support, primary care, mental-health care, recovery housing, employment support, virtual services, mobile services, and other community resources. The appropriate combination is individualized. The executive responsibility is to make the available routes coherent and to preserve continuity when the combination changes.
Telemedicine is one option, not a complete access strategy. A small federally qualified health-center study found no significant difference in retention between telemedicine and in-person opioid-use-disorder treatment in the studied setting, but its cross-sectional, single-site design limits broad inference.12 Use virtual care where it improves fit, then monitor connectivity, privacy, interpreter access, digital skill, medication logistics, and conversion to in-person care when needed.
Co-occurring needs also affect continuity. A national facility analysis mapped access to integrated mental-health services and identified geographic and demographic differences in reported availability. A scoping review of recovery housing found that retention was related to a range of individual, social-network, mental-health, and house-fit factors, but the evidence base remained heterogeneous.1317 Leaders should therefore track whether needed services are connected, not merely whether they exist somewhere in the network.
Patient experience is an operating variable. Interviews with people using a Chicago mobile medication program after recent criminal-legal involvement emphasized convenience, speed, and compassion. A separate qualitative study with women and professionals identified financial, insurance, travel, and other physical access barriers.1416 These findings are local and qualitative. They should prompt listening in the organization’s own communities rather than assumptions about what every person values.
Language inside the organization also matters. In a randomized trial, medical students who read a stigmatizing clinical vignette made less effective fictional treatment choices than those who read neutral language. The effect was measured in trainees and hypothetical decisions, so it should not be treated as a direct estimate of practicing-clinician behavior. It still supports a low-cost safety practice: use person-first, clinically precise language in documentation, handoffs, meetings, training, public materials, and performance review.11
Respectful language checkpoint
Describe the person before the condition. Use clinically accurate terms. Avoid labels that imply blame, moral failure, or a fixed identity. Ask people how they want their goals and recovery described. Apply the same standard in the health record, a hallway conversation, a payer escalation, and a public campaign.
Operating model
Build a treatment-access operating system.
Programs often improve one piece of the route. Sustainable performance requires an operating system that connects those pieces. The model below places the person and their goals at the center, then surrounds that center with four management layers. It is not a clinical model. It is a way to assign executive responsibility across a complex path.
Access without ownership can create a list of doors that do not open. Ownership without continuity can create a successful first visit followed by an unsupported transition. Continuity without learning can preserve a route that works for some groups and fails others. A learning layer brings those conditions together by connecting operational data with the experience of people using and delivering the pathway.
Alcohol-use-disorder treatment illustrates why ownership should be explicit across specialties. In one academic-center provider survey, mental-health clinicians and substance-use-disorder clinicians described different assumptions about who should prescribe medications for alcohol use disorder and whether patients wanted them.15 The sample and response rate limit generalization, but the finding reveals a common risk: when two teams each believe the other owns a capability, the patient may receive neither. A local role map should define who assesses, discusses options, prescribes when qualified, monitors, and coordinates the next step.
Executive decisions
Put authority behind the pathway.
A reliable route needs more than agreement that access is important. It needs decisions about capacity, workforce, financing, partnership, and escalation. Those decisions should identify who has authority to change the process, how tradeoffs will be reviewed, and what happens when demand exceeds a service’s current ability to respond. Otherwise, frontline teams are asked to coordinate around constraints they cannot resolve.
1. Define a capacity response
When no timely appointment is available, staff need an approved next action. That may include another qualified service, an interim support route, a different modality, or escalation to a capacity owner. The specific response depends on clinical judgment and local requirements. The operating standard is that a full schedule creates a visible exception, not a silent dead end.
Review capacity by more than slot count. Consider the timing of intake, medication availability, language and accommodation needs, visit frequency, travel burden, digital requirements, and the receiving team’s ability to support co-occurring conditions. Mobile and low-threshold models can expand reach in some settings, but their value should be assessed through completed connections and continued engagement rather than vehicle visits or encounters alone.118
2. Support the workforce that owns the route
Clarify the contributions of clinicians, nurses, pharmacists, peers, social workers, navigators, access staff, interpreters, community partners, and payer-facing teams. Role clarity should include what each role can decide, what it must communicate, and when it must escalate. Training should address the actual workflow and documentation environment, not only awareness.
Audit language and treatment assumptions as part of workforce support. The randomized vignette evidence suggests that stigmatizing wording can influence trainee decisions, while the alcohol-medication provider survey shows how ownership assumptions can differ across specialties.1115 Use those findings to examine local practice without blaming individuals. Correct templates, role gaps, and supervision conditions that make the undesired behavior more likely.
3. Make financing friction an executive issue
Coverage, authorization, reimbursement, and contracting rules shape whether a route can be used. Create a recurring review of denials, prior-authorization turnaround, shortened approvals, network mismatch, and cases that require repeated escalation. Separate payer policy from local interpretation so the organization knows which barrier it can change directly and which requires external negotiation.
Do not treat a successful appeal as proof that the process works. Measure the time, staff effort, interim risk, and patient burden required to reach the result. The state-policy survey and West Virginia focus groups identify utilization-management variation and perceived administrative burden, but neither can determine the effect of a specific local plan.910 Local case review is still necessary.
4. Share design authority with community partners
Community organizations often see barriers that a health system’s internal dashboard misses. Include treatment providers, recovery organizations, public health, housing, transportation, language-access partners, and people with lived experience in pathway design. Define how input changes a decision, how concerns are protected, and how the organization will report back.
Partnership should not shift unfunded coordination work outside the organization. Establish a current contact, acceptance criteria, secure information route, response expectation, and escalation path for each dependency. When a partner cannot accept a referral, keep the exception visible inside the sending organization until another accountable plan exists. This is how a treatment-friendly community becomes an operating relationship rather than a campaign phrase.
These decisions create the conditions for improvement. They also expose tensions honestly. More open entry may increase demand before capacity grows. Stronger measurement may reveal disparities that were previously hidden. Clear ownership may show that a role lacks time or authority. Those findings are not failures of the observance. They are the information leaders need to allocate resources, change policy, and make the route more reliable.
Measurement
Use a denominator-based cascade and keep the caveats attached.
A measurement system should distinguish reach, initiation, engagement, continuity, experience, and equity. Do not collapse these into one success rate. The cascade framework developed by Ussery and colleagues supports standardized attention to linkage and retention, while the bridge-clinic study shows how a transfer can be decomposed into connection, completed visit, continued care, and medication status.51
Every measure needs a named owner, a stable definition, a source, exclusions, review cadence, stratification plan, and action threshold. Rates should retain their denominator. Counts should not be presented as improvement when the eligible population changed. Experience measures should include people who did not complete the route. Equity review should be protected by appropriate privacy, governance, and sample-size rules.
| Signal | Working definition | Owner | Equity and safety check | Limitation to report |
|---|---|---|---|---|
| Reach | People with an identified need or request who receive a documented response | Entry-point operational lead | Review by channel, language, disability access, geography, payer, and locally approved groups | Identification depends on documentation and contact opportunity |
| Accepted ownership | Referrals with a named receiving team and acknowledgment within the locally defined interval | Sending and receiving service leaders | Review returned and unacknowledged handoffs | Acknowledgment does not prove a completed visit |
| Initiation | Eligible people completing the locally defined first treatment step | Clinical and access leaders | Stratify only with governed, interpretable denominators | Definition varies by condition, setting, and treatment plan |
| Continuity | People remaining connected at a defined follow-up point or transitioning with accepted ownership | Continuity owner | Examine modality, practical barriers, and transition type | Retention alone does not capture treatment quality or individual goals |
| Experience | Reported respect, clarity, choice, burden, and confidence in the next step | Patient experience and community partner | Include people who discontinued or declined | Response bias and small samples require transparent interpretation |
| Exception closure | Authorization, capacity, travel, or other barriers resolved or escalated with a visible status | Named exception owner | Review age and recurrence by barrier type | Closed documentation may not equal a usable care connection |
Set local targets only after validating baseline data and operational capacity. External study results can sharpen questions, but they should not be imported as performance standards. The claims, facility, qualitative, and single-center studies in this brief answer different questions. Their value comes from disciplined synthesis, not forced comparability.
90-day leadership plan
Turn January attention into one verified operating change.
The plan below is a management sequence, not a clinical timeline. Select one meaningful pathway and one barrier that the organization can influence. Use the first month to see the current system, the second to test a redesigned route, and the third to implement and verify. If an immediate safety issue appears, use the organization’s established escalation process rather than waiting for the plan.
See the current route
- Name an executive sponsor, operational owner, clinical adviser, and community or lived-experience partner.
- Select one representative entry point and define the eligible population.
- Map every handoff, wait, decision, rejection, workaround, and unresolved state.
- Listen to people who completed the route, stopped, declined, or could not enter.
- Validate baseline definitions before reporting a rate.
Design and test
- Publish one plain-language first step and align staff instructions with it.
- Define the receiving role, acknowledgment method, response interval, and escalation owner.
- Test the route across business hours, after hours, language needs, payer types, and representative access conditions.
- Correct one verified point of friction, then test again.
- Document intended and unintended effects.
Implement and verify
- Launch the redesigned route with a small set of governed measures.
- Review unaccepted handoffs and aged exceptions at a defined cadence.
- Pair performance data with protected experience feedback.
- Confirm that the change works in more than one representative condition.
- Report what changed, what remains uncertain, and who owns the next action.
Executive action kit
Use these prompts in the next leadership meeting.
One route
Choose a high-friction pathway and trace it from first request through accepted treatment ownership. Do not begin with the ideal workflow. Begin with what people and staff experience now.
One owner
Name the role that stays accountable while a referral, authorization, appointment, or transfer is unresolved. Make escalation visible to every participating team.
One equity question
Ask where the route differs by language, geography, modality, payer, disability access, or another locally relevant condition. Protect privacy and avoid conclusions from unstable denominators.
One verified change
Close one observed gap, test the result, and report the evidence and limitations. A completed task is not the same as a reliable improvement.
Leadership commitment
During Substance Use Disorder Treatment Month, we will make one treatment-access route easier to enter, keep ownership visible at every transition, and verify whether people reached the next accountable step.
Authoritative resources
Start with official public information.
- SAMHSA: 2026 Substance Use Disorder Treatment Month toolkit
- SAMHSA: Substance use treatment information
- FindTreatment.gov
If someone may be in immediate danger, use established emergency procedures and local emergency services. Public resource links may change. Organizations should verify destinations and approved escalation language before reuse.
Peer-reviewed references
Evidence used in this brief
- Casey SK, Howard S, Regan S, et al. Linkage to care outcomes following treatment in a low-threshold substance use disorder bridge clinic. Substance Use & Addiction Journal. 2025;46(2):247–255. doi:10.1177/29767342241261609
- Nguyen T, Jiao Y, Lee SS, et al. Medicaid patients with ED visits for overdose: disparities in initiation of medications for opioid use disorder. Health Affairs. 2025;44(5):622–630. doi:10.1377/hlthaff.2024.00984
- Nordeck CD, Oros M, Raley H, et al. Changes in hospital utilization following peer-led intervention for substance use disorders in hospital emergency departments. American Journal of Emergency Medicine. 2025;95:167–172. doi:10.1016/j.ajem.2025.05.049
- Lambert E, Regan S, Wakeman SE. The impact of addiction consultation and medication for opioid or alcohol use disorder on hospital readmission. Journal of General Internal Medicine. 2025;40(12):2989–2996. doi:10.1007/s11606-024-09301-9
- Ussery EN, Rennick M, Vivolo-Kantor AM, et al. Developing a cascade of care framework and surveillance indicators to monitor linkage to and retention in care for substance use disorder. Public Health Reports. 2025;140(2–3):137–143. doi:10.1177/00333549241266994
- Pro G, Bautista T, Gu M, et al. Services provided in Spanish in substance use disorder treatment facilities: limited access in communities with fast-growing Spanish-speaking populations. Journal of Behavioral Health Services & Research. 2025;52(3):408–423. doi:10.1007/s11414-024-09922-2
- Chaiyachati KH, Mitra N, Grande D, et al. Text message reminders about free transportation for outpatient substance use disorder treatment: a pilot randomized encouragement study. Journal of General Internal Medicine. 2026;41(1):35–42. doi:10.1007/s11606-025-09508-4
- Bachhuber MA, Cunningham CO, Lincourt P, Jordan AE. Estimation and comparison of travel burden to outpatient, opioid treatment program, and residential substance use disorder treatment programs. Substance Use & Addiction Journal. 2026;47(2):556–563. doi:10.1177/29767342251370825
- Wallis R, Allen L, Davis SM, et al. Clinical and administrative perspectives on prior authorization for residential substance use disorder treatment: a qualitative analysis. Journal of Behavioral Health Services & Research. 2026;53(2):300–312. doi:10.1007/s11414-025-09956-0
- Peterson LA, Andrews CM, Abraham AJ, et al. Most states allow Medicaid managed care plans discretion to restrict substance use disorder treatment benefits. Health Affairs. 2024;43(7):1038–1046. doi:10.1377/hlthaff.2023.01023
- Sheth NK, Wilson AB, West JC, et al. Effects of stigmatizing language on trainees' clinical decision-making in substance use disorders: a randomized controlled trial. Academic Psychiatry. 2025;49(2):126–135. doi:10.1007/s40596-024-02103-5
- Maxwell JF, Feldman SS, Li L. Patient retention in a substance use disorder telemedicine clinic. Southern Medical Journal. 2024;117(7):374–378. doi:10.14423/SMJ.0000000000001709
- Pro G, Neighbors HW, Wilkerson B, Haynes T. Place-based access to integrated mental health services within substance use disorder treatment facilities in the US. Social Science & Medicine. 2025;369:117843. doi:10.1016/j.socscimed.2025.117843
- Martinford T, Watson DP, Messmer S, et al. “Convenience, quickness, and compassion”: experiences of people involved in the criminal-legal system accessing medications for opioid use disorder services from a mobile unit in Chicago. Health Expectations. 2026;29(1):e70552. doi:10.1111/hex.70552
- Kacmarek CN, Kreyenbuhl J, Hagedorn HJ, et al. Provider perspectives on medication for AUD in mental health and substance use disorder clinics. Journal of Dual Diagnosis. 2025;21(3):224–236. doi:10.1080/15504263.2025.2515026
- Skogseth EM, Brant K, Latkin C, Jones AA. Physical accessibility barriers to medications for opioid use disorder treatment: a qualitative study of perspectives from women with opioid use disorder and health and criminal legal professionals. Contemporary Drug Problems. 2025;52(3):325–343. doi:10.1177/00914509241309110
- Ellis J, Mirzaian M, Sudduth E, et al. Identification of retention in Oxford Houses and other types of recovery housing: a scoping review. Substance Use & Misuse. 2025;60(6):798–810. doi:10.1080/10826084.2024.2447935
- Barrera I, Wang G, Rajakumar B, et al. Mobile addiction treatment units: a narrative review. Addiction Science & Clinical Practice. 2025;20:99. doi:10.1186/s13722-025-00619-1