Addiction Medicine: Closing the Gap between Science and Practice

All opioid maintenance therapy facilities are
required by federal law to obtain certification
from the U.S. Department of Health and Human
Services’ Substance Abuse and Mental Health
Services Administration (SAMHSA)
demonstrating compliance with established
standards for opioid maintenance therapy
programs.^154 It is a pre-requisite of certification
that a program be accredited by an organization
approved by SAMHSA.* 155

Accreditation Requirements.......................................................................................

In lieu of or in addition to state licensure,
addiction treatment facilities and programs may
be accredited by a national accreditation
organization. While adopting these standards
largely is voluntary,^156 some states grant licenses
to programs that have been accredited,^157 such
that the program is deemed to have met the state
licensure requirements because it has been
approved by a national accrediting body.† 158 By
granting “deemed status” licenses to accredited
programs, the state essentially delegates to the
accrediting body its responsibility for ensuring
that the facility or program meets state licensure
requirements.^159 Accreditation standards are
more detailed than state licensing requirements
and while some require facilities and programs
to use evidence-based practices or to analyze
patient outcomes,^160 not all do. Furthermore,
accreditation standards do not require staff to be
qualified to provide a full range of evidence-
based treatment, and accreditation does not
necessarily ensure that quality care is
delivered.^161

The accreditation process entails a review of the
facility’s or program’s structure and operational
practices and evaluation of the organization’s
clinical care processes and outcomes to confirm
that they comply with standards set by the

• To be approved by SAMHSA to accredit opioid

maintenance therapy programs, an accrediting
organization must demonstrate how its accreditation
process will ensure that programs meet the standards
described in federal regulations.
† Select examples of states that allow providers to

have deemed status for state license or require
accreditation for Medicaid include: AL, AK, AZ, AR,
CT and DE.

accrediting body.^162 Accreditation generally is

considered a higher standard of oversight than

state licensing, in that it incorporates “ideal or

optimum” standards rather than minimum

standards, and focuses on continuous quality

improvement.^163

A 2007 study of the association between

accreditation and nine indicators of quality care

(categorized as staff-to-patient ratio, treatment

comprehensiveness and treatment sufficiency) in

566 outpatient addiction treatment programs

found only several correlations between

accreditation and quality of care measures.^164

Another study that examined the adoption of

evidence-based dosing practices in methadone

maintenance programs found that voluntary

accreditation was strongly related to adoption of

these practices; however, after accreditation

became mandatory in 2000, this relationship

disappeared. The authors speculated that

programs that voluntarily seek accreditation tend

to be resource-rich (in funds, staff and training)

and more motivated to improve their quality of

care, and therefore more likely to adopt

evidence-based practices.^165

The five organizations that accredit addiction

treatment programs and facilities in the United

States are:

 The Commission on Accreditation of

Rehabilitation Facilities (CARF). CARF is

an independent, nonprofit organization that

offers accreditation for addiction treatment

programs and facilities and integrated

addiction/mental health treatment programs

and facilities; it is^ the largest accreditor of

addiction treatment programs and

facilities.^166 CARF accreditation is widely

accepted by state licensing agencies toward

the fulfillment of licensing requirements for

addiction treatment programs and

facilities.^167

 The Joint Commission on Accreditation of

Healthcare Organizations (Joint

Commission). The Joint Commission is the

largest accreditor of all health care services

in the U.S.^168 and the second largest

accreditor of addiction treatment programs