Skip to main content


The Strengthening Treatment Access and Retention –State Implementation (STAR-SI) program, funded by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Treatment (CSAT) and The Robert Wood Johnson Foundation, is an infrastructure cooperative agreement program that promotes state-level implementation of process improvement methods to improve access to and retention in outpatient treatment. STAR-SI builds on the innovative work of the Network for the Improvement of Addiction Treatment (NIATx), a joint initiative of SAMHSA's CSAT and The Robert Wood Johnson Foundation. As part of the NIATx initiative, six states/payers participated in the State Pilot Project to Improve Addiction Treatment. During this pilot, addiction treatment payers and providers worked in partnership to: (1) Identify how states can exercise leadership roles to improve treatment quality; (2) Use demonstrated process improvement methods to design and test ways states and other payers can work with each other and with providers to improve treatment access and retention; and (3) Document and disseminate innovative practices used by states and payers in collaboration with treatment providers to improve performance quality.

The Need

The negative impacts of addiction on individual, social, and public levels are well documented. In dollar terms, the consequences of drug abuse alone cost $143.4 billion in the United States in 1998 (Office of National Drug Control Policy 2001b). Access to substance abuse treatment remains a major concern in the United States. In 2003, only slightly more than 10 percent of the estimated 22.2 million Americans age 12 and older who needed treatment for substance use disorders actually received treatment.

Outpatient treatment facilities account for 80 percent of all substance abuse treatment programs in the United States and serve 89 percent of the 1.1 million clients in care on any day (National Survey of Substance Abuse Treatment Services, SAMHSA, 2002). Outpatient treatment providers face tremendous challenges in their efforts to serve populations in need of treatment. States are in a unique position to effect system change by working together with outpatient substance abuse treatment providers to remove systems barriers, streamline administrative procedures, provide incentives, and assist provider networks in their efforts to improve access and retention performance outcomes. By leveraging their roles as major purchasers of addiction treatment services, states can spread practices that improve access and retention as well as guide performance improvement.


The STAR-SI Initiative expands on the results of the State Pilot Project to promote state-level implementation of process improvement methods and improve access and retention in outpatient (OP) treatment. Nine state-provider partnerships (grantees) are funded over a three-year period, beginning in October/November 2006. The NIATx State Diffusion Model will guide grantees in creating successful payer/provider partnerships, implementing collaborative learning models, applying process improvement techniques, and adopting best practices to improve treatment access and retention.

The NIATx State Diffusion Model serves as the theoretical foundation of the STAR-SI initiative. The five core components of the model, based upon lessons learned from the NIATx State Pilot Project to Improve Addiction Treatment, are: SSA and State leadership; payer/provider partnerships, access and retention process improvement network, state performance management, and sustainability and spread.

Principal Investigators:
David Gustafson Sr., Ph.D