Diversity, Equity,

and Inclusion (DEI)

Best Practices in
Addiction Treatment

STAGES OF
CHANGE MODEL AND
ORGANIZATIONAL

ASSESSMENT
TOOL

VOICE | VISION | LEADERSHIP

in personal recovery from Substance Use Disorders (SUDs) and mental health
issues, and they may draw upon their own experience to provide them with
passion and dedication for helping others.

Despite the commitment of many thousands
of ardent professionals, addiction continues
to be a serious national social, economic, and
public health crisis in the US that is not adequately
addressed, leaving 90% of those who need help
without services. We know that SUD is a chronic
biopsychosocial-spiritual brain disease; we know
that it is treatable, and we know that there exists
vastly disparate access to treatment based on
race and other social indicators. It is incumbent
upon us, therefore, to stand up in the truth of that
more of those who can be served by our work,
to recover.
When we work with patients seeking our services,
we know that an accurate and thorough initial
assessment is key to creating an effective plan for
service provision. In a parallel process, addiction
treatment and recovery support providers can
engage in self-exploration regarding our own
readiness for change in implementation of
practices that promote equity, justice, diversity,
inclusion, and belonging in the addiction treatment
industry. Addiction professionals often use
Prochaska and DiClemente’s Transtheoretical
(Stages of Change) Model when working with
clients with SUDs to explore their readiness for
change. Just as we “meet the client where they
are,” we can do this with ourselves.
The following Stages of Change Model for We cannot heal or help each other recover from
Diversity, Equity, and Inclusion (DEI) Best Practices discrimination, disparities, and inequities until we
in Addiction Treatment was created in consultation recognize the nature and impact of the problem
with the NAATP Diversity, Equity, and Inclusion and become ready to change.
(DEI) Advisory Committee. This Committee was
formed in 2020 and consists of behavioral health
leaders, researchers, and clinicians from across
the country. This Model was inspired by the Global
Diversity, Equity, and Inclusion Benchmarks1;
Motivational Interviewing2 principles and the
Stages of Change (Transtheoretical) Model3; and
the stages of racial identity development. This
Model was created to assist addiction/recovery
industry professionals in self-reflection on personal
and organizational awareness and readiness
for change with respect to diversity, equity,
and inclusion.

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As with clients, identifying an individual or an
organization as “Precontemplative” is not a value
judgment. Rather, it means that the person or
entity isn’t equipped with a perspective on the
need for and value of change in their lives and
work. In this stage, with respect to implementing
DEI best practices, individuals and organizations
may lack awareness that their current practice
contributes to inequities or a decreased sense of
belonging by diverse staff and clients. With the
intent of treating everyone equally, a colorblind
approach may be evident, resulting in harm
caused by microaggressions in both organizational
and clinical culture, milieu, treatment materials,
company policies, public relations, and business
development. This harm may or may not rise to the
attention of leadership and may be addressed (or
not) in staff and client day-to-day activities.
GOALS: Raise doubt and concern about current
beliefs and practices, increase perception of
problems with the current state, and practice
harm reduction strategies.
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Some recognition exists of privilege and
oppression and that current behavior is
problematic. Guilt or shame may be present.
Racism and other forms of discrimination may
be seen as occurring only in the past or currently
present against the dominant group as well. An
ambivalent, compliance-oriented mindset may be
present, with minimal changes made in DEI policies
and practices in response to outside pressures
or regulations.
GOALS: Explore ambivalence, identify reasons
for change and risks of not changing, and increase
grows, address guilt and shame through healing
practices.
We see the harms of structural racism on
communities of color, along with other intersecting
and compounding forms of structural oppression,
such as anti-Indigeneity, ableism, heteropatriarchy,
misogyny, and anti-immigrant animus. An
awareness has developed of privilege, injustice,
and the value of DEI best practices, but we may
look to others (e.g., people of color, transgender
people) to confront racism, cissexism, and other
forms of discrimination. Some systemic changes are
being made with the belief that changing behavior
will lead to a healthier organization.
GOALS: Set goals and develop a realistic plan
to take steps toward change. As awareness
continues to grow, continue healing practices
and sublimate guilt and shame into energy for
action and growth.
Intentional actions to counter the oppression
of historically marginalized communities. Some
systemic DEI changes have been implemented,
showing initial positive results and outcomes.
GOALS: Make changes and monitor progress.
Identify and use strategies to prevent relapse
to previous behaviors. As awareness continues
to develop, continue healing practices and use
recognition of ongoing disparities for the energy
to act, grow, and advocate for change with others.
Active pursuit of social justice. DEI best practices
are sustained for more than 6 months with the
intention to constantly improve DEI performance
and strategies and prevent drift to earlier stages.
GOALS: Continuously pursue personal and
professional agility and improvement as best
practices in DEI change over time. Continue
healing practices and help others through their
process of change.
The DEI Best Practices in Addiction Treatment Tool is largely based on the Diversity, Equity, and Inclusion
Spectrum Tool (Meyer Memorial Trust, 2018)4
and recovery support providers. Values of 0 through 4 have been assigned to the stages of change
to assist in identifying areas for improvement and monitoring progress. Because all organizations are
different sizes, serve different communities, and have different resources, the approach to moving
forward in DEI best practices will differ across organizations.

Organizational Policies & Leadership and

DEI Commitment Procedures Infrastructure Training Clinical Care Community Diversity Equity Inclusivity

Pre- Does not see DEI Does not have Members of Has not done any Treatment Doesn't express Doesn't see DEI-related metrics* No explicit effort
Contemplation as relevant to its any DEI-related management or training related materials and interest in are not collected is made to create
work, or does not organizational board have not to DEI, or staff modalities are not building stronger of leadership, or considered an inclusive
(0) have an interest policies beyond taken leadership on completes trainings commonly adapted partnerships with board, and staff in programs or atmosphere for
in advancing DEI non-discrimination DEI issues. as required for for different communities facing as a priority; may in operational diverse staff and
work. policies. compliance. individuals. disparities; may see be paralyzed by accountability patients.
it as an unrealistic the perceived mechanisms.
or unimportant to challenges or view it
the organization's as unattainable.
mission.

Contemplation Recognizes the Does not have, A few members Is contemplating Adaptations to Values the idea Has had initial Does not collect Values the idea of
importance of DEI but is interested of management, expanding treatment materials of building discussions about DEI-related metrics* being an inclusive
(1) to its work and is in developing, staff, or board are organizational DEI and modalities are partnerships with and values the idea in its programmatic organization but
contemplating next DEI-related leading internal training; individual made by some staff communities facing of diversifying its or operational work, tries to achieve this
steps. organizational DEI discussions, staff may have for diverse patients. disparities, but may leadership, board, but views this as a by encouraging
pollicies. but infrastructure delivered some not know how or and staff. future goal. diverse staff
to guide the internal training. have relationships and patients to
organization's to draw upon. participate in the
DEI work is not dominant culture or
established. represent their own
culture to educate
others.

Preparation Recognizes the May have some DEI- Individuals or Some staff, Culturally- Is beginning to The organization Collects some DEI- There is an
importance of DEI related language in small teams are leaders, and board responsive build partnerships attempts to related metrics* in appreciation of
(2) to its work and some organizational leading internal members have treatment materials with communities diversify its its programmatic the voice and
is in the process policies. DEI discussions participated in DEI- and modalities are facing disparities leadership, board, or operational perspective of
of developing a and consulting with related training. regularly integrated but has not yet and staff but may work, but not in diverse staff and
shared DEI vision leadership, but DEI into treatment established not know how to a systematic or patients, particularly
and strategic plan. work has not been plans. accountability to do it effectively or comprehensive way. in relation to the
integrated into the and meaningful have strategies and organization's DEI
organization as a partnerships with systems in place; work, but they are
whole. these communities. strategies may not still expected to
result in growing conform to the
diversity. dominant culture or
educate others.

* DEI-related metrics include:

1) Demographics of board,
management, staff, and
persons served, compared to
the population of individuals in
need of services;
2) Demographic analysis of initial
contacts, call-to-admission
ratio, admissions, AMA
discharges, transfer/referral
rates, and readmissions;
3) Demographic analysis of patient
outcomes and consideration of
social determinants of health;
4) Patient engagement/
satisfaction surveys addressing
respect for individual culture
and identity, whether the care
environment and services are
culturally-responsive, and
whether the care environment
and services are trauma-
responsive (empathic, safe,
transparent, collaborative,
compowering, and respectful of
choice and preference);
5) Staff engagement/satisfaction
surveys addressing the
organization’s inclusion
practices in policies, services,
and leadership, and whether
the work and care environments
and are culturally- and trauma-
responsive."

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 Organizational Policies & Leadership and
DEI Commitment Procedures Infrastructure Training Clinical Care Community Diversity Equity Inclusivity

Action Has developed Has DEI policies Has internal All management, Staff regularly Actively works to Actively works to Collects and The voice of diverse
a shared DEI that include committies or other staff, and board receive training build parternships increase diversity disaggregates staff and patients
(3) vision, and is expected behavior formal structues are involved in and supervision and trust with of leadership, comprehensive is valued and
working to align regarding focused on DEI training and on implementing communities facing board, and staff, demographic data integrated into
the organization's inclusivity in the integrating DEI into capacity building. culturally-adapted disparities; working resulting in growing in programmatic the organization.
programs and work and clincial the organization's Training includes to understand how diversity; has and operational Changes are
operations with environments, as work. All levels experiential treatment materials to provide value begun to institute work but may made to treatment
this vision. DEI is well as a process in of management, and healing and modalities. and support to retention strategies not know how materials/
incorporated into place for patients staff, and board are components and these communities. for diverse patients. to integrate the modalities, and
the strategic plan and staff for taking leadership covers topics Demographics information. well as the care/
with measurable on DEI issues. An including implicit of staff, local Changes may work environment,
goals. to inclusivity. Has equity analysis is bias, privilege, and community, and the be made to in response to
an organizational completed during microaggressions. larger community some clinical feedback from
DEI plan but may be the budgeting of individuals with or operational diverse patients
unclear how to fully process. the greatest need practices based on and staff. The
operationalize it. for service are this analysis. organization is in
An equity analysis compared, and transition from a
is completed plans are in place dominant culture
on policies & to better match to an inclusive/
procedures. service needs. multicultural
culture.

Maintenance Has integrated DEI Has DEI Work on DEI issues Fosters ongoing, Culturally-adapted Has strong, The demographic Changes are All staff and
in organizational policies and an is integrated into comprehensive DEI consistently patients feel valued
(4) mission and vision organizational every aspect of training, growth, treatment materials accountable, organization's staff made in clinical and all aspects of
statements which plan with clear organizational healing, and and modalities are and equitable and leadership programming, the organization
are actively being goals, strategies, cultura and leadership among routinely integrated partnerships approximates human resources
used to guide and indicators infrastructure. management, staff, into treatment with diverse practices, business contributions
the organization's of progress. Leadership and board. plans. Clinical staff organizations only of the local development and and interests of
programs and DEI policies are demonstrates and supervisors and leaders from community, but outreach activities, a multicultural
operations. regularly updated accountability to are evaluated on communities also of the larger and leadership constituency;
Progress toward based on equity patients, staff, and and accountable facing disparities. community of as appropriate, in the organization
goals is tracked analysis and other stakeholders. for culturally- The organization individuals with response to DEI- has transitioned
and leaders, Board, with input from responsive care. collaborates with the greatest related metrics*. to an inclusive/
and staff are patients, staff, the investment communities to need for service. multicultural culture
accountable for community, and in improving assess community The organization the organization is and has created
meeting goals. other stakeholders. inclusivity/ needs, and has policies and removing barriers systems, policies,
All leaders and staff belonging among raise awareness strategies for to opportunity and and practices
are clearly held staff and patients of services in strengthening reducing disparity/ to maintain this
accountable for and in improving a culturally- and maintaining disproportionality in culture.
policy adherence. equity in access to responsive manner. organizational access to services.
services. diversity, and
effective retention
strategies are
implemented.

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 References

Global Diversity, Equity & Inclusion Benchmarks.

www.centreforglobalinclusion.org.
2. Miller, WR, & Rollnick, S. (2013). Motivational
interviewing: Helping people change (3rd edition).
Guilford Press.
3. Prochaska, J, & DiClemente, C. (1983). Stages and
processes of self-change of smoking: toward an
integrative model of change. Journal of Consulting
and Clinical Psychology, 51(3), 390-395.
4. Meyer Memorial Trust (2018). Diversity, Equity, and
Inclusion Spectrum Tool. link to https://mmt.org/news/
understanding-meyers-dei-spectrum-tool

Terri Hayden (Co-Chair) Pride Institute Melanie Heu, Great Lakes

Zina Rodriguez,
MSW, LICSW, LADC Psychological Services
MSW, MCAP, CDE Philip Rutherford, BA (Co-Chair) Faces & Voices of Recovery
Annie Peters, PhD Vanina Hochman, MA, LMFT Family First Adolescent Services
Tania Bhattacharyya Lumos Marketing
Danielle Jackman, PhD Rick Hubbard Origins Behavioral HealthCare
Rev. Eyglo Bjarnadottir, Copenhagen Recovery
cand. theol. Counseling Danielle Jackman, PhD Aurora Mental Health Center
Carol Burrell-Jackson, The Refuge, A Healing Place Cecelia Jayme, MA, LADC Hazelden Betty Ford Foundation
MSW, PhD, LCSW, Basic ART
Felicia Kleinpeter Imagine Recovery
Dovie Coleman, Cumberland Heights
Meg Knapp, Fordham University
LADAC II, NCAC I
LMSW, PhD Candidate
John Crepsac, LCSW, ICADC JC Counseling & Consulting PC
Sara Matsuzaka, PhD, LCSW University of Virginia
Alex Denstman, MBA Ashley Addiction Treatment
Ester Nicholson Soul Recovery & SHE RECOVERS
Tori Dudley, PhD The Olori Group Foundation
Manuel Garcia, MA, LADC Hazelden Betty Ford Foundation Zina Rodriguez,
MSW , MCAP, CDE Z&D Consulting
Beck Gee-Cohen, Visions Adolescent Treatment
MA, CADC-II Center Damir Utrzan, Hazelden Betty Ford Foundation
PhD, LMFT, DAAETS
Shari Hampton Shari Hampton Consulting &
SHE RECOVERS Foundation

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