Governor Greg Gianforte and Department of Public Health and Human Services (DPHHS) Director Adam Meier announced today Montana has contracted with six treatment providers to pilot an integrated, evidence-based program to expand the

State’s capacity to treat stimulant use disorders, such as methamphetamine use, and fill a much-needed gap in the behavioral health continuum of care.

Providers are now working to implement the components of the new program called TReatment of Users of STimulants (TRUST) and are beginning to serve clients. Over the next two years, up to 420 clients could receive treatment in the program.

“The impact that meth and other stimulants have in Montana is immense,” Governor Gianforte said. “The drug crisis we face is ripping apart our families and devastating our communities. It’s critical we invest in treatment to effectively address the impact of these toxic substances on the brain and to support patients in their long-term recovery from this chronic illness. I appreciate the effort that has gone into launching TRUST, and look forward to following the progress in the months and years ahead.”

The program is an important piece of Governor Gianforte’s Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative. The HEART Initiative directs state and federal funding to expand the State’s behavioral health continuum. TRUST is funded primarily through a near $1 million federal grant from the Substance Abuse and Mental Health Services Administration. The state has also proposed in the HEART Waiver to use Medicaid funding to cover this evidence-based practice upon federal approval. This would make the program more widely available. 

Those in year one of the pilot project include two state-approved SUD treatment providers, three Federally Qualified Health Centers, and one hospital. Each organization is required to have two clinicians and one clinical supervisor participate in all training and mentoring/coaching sessions.

The providers are Benefis Health System in Great Falls, Alternatives, Inc. in Billings, Rimrock Foundation in Billings, Bullhook Community Health Center in Havre, Southwest Montana Community Health Center in Butte, and Alluvion Health in Great Falls.

“The goal for our SUD patients is always long-term sobriety, but there are many factors that go into achieving that,” said Megan Bailly, Alluvion Health SUD Clinical Manager. “The TRUST program aligns with Alluvion Health’s integrated care model to help patients get through the most difficult parts of recovery. Through tangible incentives and a focus on components of overall health, this grant is a great step toward impacting substance use in our state.

TRUST is a multi-component program that uses behavioral health strategies with evidence of efficacy in assisting individuals to reduce and/or discontinue their stimulant use. The program is designed for an initial 12-week intensive intervention, followed by up to nine months of assistance to support continued recovery and stabilization.

It aims to increase access to quality treatment for methamphetamines and other stimulants, support long term recovery, and reduce the risk of overdose and overdose death.

The program incorporates contingency management, cognitive behavioral therapy, community reinforcement approach, motivational interviewing, physical exercise, and self-help mutual support.

The pilot sites received intensive training and ongoing technical assistance from national expert Dr. Richard Rawson of the UCLA Department of Psychiatry and Research Professor at the Vermont Behavior and Health.

Rawson also worked in Montana on a methamphetamine technical assistance project with several Native American reservations, and provided oversight of a federal multi-state trial of the Matrix Model that included Montana.

Rawson said the contingency management component of the program is one of the most powerful methods to help a person stop using stimulant drugs. He also said community reinforcement has been employed for 35 years, and helps individuals rearrange their lifestyles so that healthy, substance-free living becomes more rewarding that substance use.

As part of the TRUST rollout in Montana, Dr. Rawson and colleague Al Hasson, MSW are working with Montana treatment providers to implement the TRUST model. The effort also includes collaboration with Michael McDonell, PhD, Sarah Parent, PhD and others from Washington State University to provide training in the use of contingency management (CM).

“Contingency management is, without question, the most effective approach for helping people addicted to methamphetamine and cocaine develop a successful recovery program,” Dr. Rawson said. “In combination with the other behavioral strategies included in our TRUST protocol, we think Montana has an excellent approach to expanding effective treatment for individuals who use stimulants.”

The effort to launch TRUST is a collaboration with DPHHS, the Montana Primary Care Association (MPCA), and the Behavioral Health Alliance of Montana (BHAM). The team developed a strategic training and technical assistance plan to deliver evidenced-based treatment to clients with stimulant use disorder. 

Stimulant use disorders include a range of problems associated with the use of methamphetamine, cocaine, and other amphetamines leading to clinically significant impairment or distress, from mild to severe.

 Several key statistics describe the impact in Montana:

  • While opioids still account for the largest percentage of drug overdoses in the state, methamphetamine related deaths, hospitalizations and emergency department visits in Montana have increased over the last few years. Approximately 12,900 adolescent and adult Montanans used methamphetamine in the period 2009 - 2019.
  • In 2019, the annual methamphetamine-related death rate in Montana was 7.2 per 100,000 people, exceeding the national average of 5.7 per 100,000 people.
  • Furthermore, over 65 percent of Child and Family Services Division substance-use related placements list methamphetamine as the primary drug.

Meier estimates that approximately 79,000 Montanans have a substance use disorder, realistically only a fraction of these people would seek treatment in any given year.

DPHHS will expand the pilot project by contracting with another six new treatment providers by January 2022. Eligible treatment providers can apply to become a TRUST pilot site by responding to a Request for Proposal that will be released in October 2021. If TRUST is approved for Medicaid billing, many more sites could be added in the coming years.

“The pilot project will provide DPHHS the opportunity to test out the program across the state in a number of different provider settings, and evaluate its efficacy in treating stimulant use disorders,” Meier said.

Meier said client success will be measured by a reduction in mental health symptoms, decreased use of stimulants, increased retention in treatment, changes in risky behaviors, decreased criminal justice involvement, and positive changes in overall health, including social connectedness and quality of life.