Journey's blog

SAMHSA Issues Final Rule Updating Substance Abuse Confidentiality Regulations


January 3, 2018 
by Heather Landi 

The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services (HHS), has finalized proposed changes to the Confidentiality of Substance Use Disorder Patient Records regulation, 42 CFR Part 2, aimed at supporting payment and healthcare operations activities while protecting the confidentiality of patients.

The finalized rule, posted to the Federal Register on Tuesday, where it is available for review, builds on changes to 42 CFR Part 2 made last year. In a final rule published last January, SAMHSA updated 42 CFR Part 2 rules by allowing patients to provide a general disclosure for substance abuse information, rather than limiting authorization to a specific provider.

The Confidentiality of Substance Use Disorder Patient Records, 42 Code of Federal Regulations Part 2 (Part 2) protects the confidentiality of records relating to the identity, diagnosis, prognosis, or treatment of any patient records that are maintained in connection with the performance of any federally assisted program or activity relating to substance use disorder education, prevention, training, treatment, rehabilitation, or research. Under Part 2, a federally assisted substance use disorder program may only release patient identifying information with the individual’s written consent, pursuant to a court order, or under a few limited exceptions.

The 42 CFR Part 2 regulations restricting how data of patients with substance use disorders (SUDs) is shared were written in 1975 out of concern that the information could be used against individuals, causing them to avoid seeking needed treatment.  But the way the regulation was written, it required the patient to consent every time their data was shared or accessed, which health information exchanges (HIEs) and healthcare organizations have found very difficult to implement.

The final rule published Tuesday will permit healthcare providers, with patients’ consent, to more easily conduct such activities as quality improvement, claims management, patient safety, training, and program integrity efforts, according to Elinore F. McCance-Katz, M.D., the nation’s first Assistant Secretary for Mental Health and Substance Use. “This final rule underscores our commitment to ensuring persons with substance use disorders receive integrated and coordinated care,” she said in a statement.

Dr. McCance-Katz said that modernizing Part 2 is one way that SAMHSA strengthens the nation’s efforts to reduce opioid misuse and abuse and to support patients and their families confronting substance use disorders. The rule also reflects an effort to better align Part 2 requirements with those of the Health Insurance Portability and Accountability Act (HIPAA), HHS officials said.

Major provisions in this latest rule include:

  • The final rule permits additional disclosures of patient identifying information, with patient consent, to facilitate payment and healthcare operations such as claims management, quality assessment, and patient safety activities.
  • The final rule permits additional disclosures of patient identifying information to certain contractors, subcontractors, and legal representatives for the purpose of conducting a Medicare, Medicaid, or CHIP audit or evaluation.
  • The final rule will assist users of electronic health records (EHRs) by permitting use of an abbreviated notice of prohibition on re-disclosure more easily accommodated in EHR text fields.


The rule SAMHSA issued a year ago updating 42 CFR Part 2 was the first major, substantive revisions to Part 2 in nearly 30 years, but many in the provider community criticized the approach taken and called for closer alignment with HIPAA.  In that rule, SAMHSA aimed to facilitate the sharing of information within the healthcare system to support new models of integrated healthcare. But some associations attested at the time that the rule makes sharing clinical information for treatment purposes more difficult.

As reported by Healthcare Informatics’ Contributing Editor David Raths last January, the Partnership to Amend 42 CFR Part 2, a coalition of nearly 30 healthcare organizations committed to aligning Part 2 with HIPAA, put out a statement saying that the final rule takes helpful steps to modernize Part 2, but it does not go far enough.

“The new final rule makes important updates, but more work needs to be done. We look forward to working with our partners and Congress this year to improve the confidentiality law so that it continues to offer important patient protections without impeding good care,” said Jeffrey Goldsmith, M.D., president of the American Society of Addiction Medicine, in a prepared statement.

Some health privacy lawyers and leaders in the behavioral healthcare communities have noted that the only way to align Part 2 rules with HIPAA is through legislation. And, there have been recent efforts in Congress to accomplish that. U.S. Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV) introduced the Protecting Jessie Grubb’s Legacy Act (Legacy Act) this week, legislation that aims to bring the regulations governing substance use treatment disorder records in better alignment with the privacy rules and protections for other medical records.

Faith: Finding our Way Back


A Spiritual Renewal: A Journey to Medjugorje

Review by Thomas Cirignano

For me, reading A Spiritual Renewal was truly uplifting and inspiring. To use those words to honestly characterize a literary work these days is quite rare. It was refreshing that there was no sensationalism to be found, just the author’s heartfelt description of events.

Coincidentally, my reading of Alberta Sequeira’s story was well timed. It was a point in my life when I needed to be reminded that faith is often renewed when we most need it. Does that happen because we, as human beings, search for answers during times of loss and chaos, or does a Higher Power search us out when we truly need it? I’m not overly religious. In fact, I’ve been called “Doubting Thomas” more times than I care to admit. But even I could relate to this story because special coincidences, which most people would consider miracles, have happened to me, just as they did in this author’s life. It was good to read that I am not unique in that respect.

One of the biggest questions we all ponder in life is whether loved ones who have passed on, or other heavenly entities, such as God, The Blessed Mother, or angels actually do watch over us during our lifetimes. All I can say is, read A Spiritual Renewal, look back at the events of your own life, and then decide for yourself.

Reading this book was time well spent.

Purchase A Spiritual Renewal at

Need a Speaker?



Substance Abuse Talks

Since 2007, a year after losing my daughter, Lori, I have been speaking at halfway homes, court-ordered programs, jails, substance abuse rehabs, to their families, schools, and to the public.

My heartwarming talks are reaching out to the alcohol and drug addicts. I want to help them believe in themselves, hold their heads up high, develop the desire to recover, to realize that no one is going to get them to sobriety but themselves. They need to hear someone say they can, so, here I go. “You can do it!”Believe it in your heart and think it in your mind. I teach them how and why to forgive. The importance of having God in their lives. They will never be alone. And most importantly, to never forget the one word: CHOICES! It’s a very powerful word. These are some of the topics that I cover. No blaming, no accusing, just giving them back their souls and remembering who they used to be.
References from the Bristol Correction Office at Faunce Corner Road in North Dartmouth, MA:
1. Rui M. Lima, MA, MSW, LICSW, Director of Substance Abuse & Social Servies Programs & Treatment: Telephone: 508-995-6400 ext. 2821
2. Matthew Robitaille, Director of Classification and Progams; Telephone: 5080995-6400 ext. 2504

Email me for a quote: [email protected]

My books on alcohol abuse can be purchased at

Spiritual Talks

I also talk to people on the spiritual side of life after stepping away from my faith after living fourteen years with an alcoholic husband and bringing my two daughters into a life of confusion, fear, and no security. Things I’m not proud of doing. 

We think God leaves us when in reality it is us who closes the door on Him. We have to open our hearts for Him to enter.

My talk focuses on watching my father, retired Brigadier General, Albert L. Gramm, die of cancer. I realize I let a tremendous amount of history go with him after he had been one of the commanding officers in the 26th Yankee Division during WWII fighting in Metz, Lorraine, and the famous Battle of the Bulge..

Three miracles get me to take a ten-day pilgrimage to Medjugorje in Bosnia where Our Lady has been appearing to six visionaries since 1981. She is giving them 10 secrets to be revealed to the world when they receive them. Two visionaries have one more secret to receive. The trip changed my life. I came to realize that I not only needed God in my life, but I wanted Him there. 

The story is in my memoir A Spiritual Renewal: A Journey to Medjugorje.

I speak at Churches of any religion, libraries, schools, private functions or any organization. 

Email me for a quote: [email protected]

My books on alcohol abuse can be purchased at


Is Our Faith Getting Weak?


With this modern world full of disasters, many have pushed faith and God out of their lives. They wonder why there are so many problems, especially the ones with no faith at all. 

We think we can live without God until something tragic happens to us or with a family member. That’s when we get on our knees and pray for a miracle. If our prayers are not answered the way we want or when then we give up on Him. God answers us in His way and time. Maybe He has other plans for us. 

Losing a loved one is the most painful thing to experience. When they are taken home to God, we don’t want to hear why. We just want them back. God gives us loved ones and then takes them home. We never know when He will knock on our door. 

Hard and painful times is when our faith comes into play. We have to be silent and listen to​ prayer. Praying is just talking to God; nothing more. You don’t need a rosary or novena’s, although, they bring us so close to God.

In A Spiritual Renewal; A Journey to Medjugorje, I wrote this story from my personal experiences with miracles that happened to me before and when I traveled to Medjugorje. It’s for the reader who has lost their faith. 

Since 1981, Our Blessed Mother has been appearing to six visionaries in Medjugorje in Bosnia, giving​ them ten secrets to be revealed to the world when they receive all of them.​ There are two visionaries left to receive one more secret.

How can we not believe when Our Lady is coming down from Heaven speaking directly to the visionaries to repeat to us how to return to her Son, Jesus ​before it’s too late?

This book is for anyone from any religion. Mary is calling all of us. Read about my ten-day pilgrimage to this little, remote town in Bosnia. Read the miracles that I experienced over there and how I returned back to Church after fifteen years being away.

Alberta​ Sequeira
Purchase at



Wrong Way Sign

Choices. It’s still a powerful word for every person around the world. Those choices make us into what we become in adulthood. 

I believe there are three reasons someone gets caught up in alcohol or drug abuse.

1. It is highly hereditary. In my past family, I had married into, YES! My husband’s mother, sister, brother (his three children) and my daughter, Lori. It trickled down to past generations.

2. An excuse to follow the crowd, after all, everyone is doing it. What’s the harm? I can quit anytime. If my family got off my back, it wouldn’t be a problem. Who am I hurting? It helps me function. EXCUSES!

3. This one I think should be number one. Something happened to you at a young age that you can’t talk about or handle yourself. Sexual abuse I would say is the number sadness that is bestowed on a child of innocence. 

Here is my advice to all of you suffering from mental or physical abuse from the past…..hold your heads up high. You have nothing to be ashamed of and it wasn’t your fault. The person who did this to you is sicker than you. 

Ask God to help you forgive this person. Yes, forgive. It’s not easy. Why do I say this? Because if you can’t forgive, you stay stuck. If you stay stuck, you can’t recover. This anger and hatred eat at the heart of your soul. You don’t have to stay in this person’s life.

Think of it…the person may not even know you are mad at them or knows and doesn’t care. Don’t let this person take your future of health and happiness away from you. 

Cling to your counselor, a sponsor, or a friend who wants sobriety as much as you do. Want recovery more than life itself.

If you need someone to tell you that you can do this, well, here I am. YOU CAN!

Choices when the invitation goes out to parties, or especially Christmas time and New Years, to join them. When you walk into the person selling the drugs, you have to STOP….think for a second, and remember CHOICES. They are yours. You own them. 

Family can only love and support you. This is your battle to come out of addiction.

Last advice? Pray to God for help, even if you don’t believe. He already knows that. Ask Him to show you the way into opening your heart for Him to enter it. Prayer is talking to God. Reach out to Him. The answer may not come when you want it or how, but it will be in His time and way.

Believe in yourself and have faith in God.

Alberta Sequeira

Buy Alberta’s books at
Email: [email protected]


A Christmas Side Gift

Yes, Christmas is around the corner.  It's a time to reach out to even your loved ones who are hooked on alcohol and drug abuse.  Why not purchase What is and isn't Working for the Alcoholic and Addict: In Their Own Words?  It's a book for counselors, family members, society, and substance abusers.  You don't have to talk to your sibling, son, daughter, husband, wife, or any other person.  The thirty-one contributors tell you what they think works and don't in their recovery.  What open us to what they need from family members; one, stop the enabling.  They want us to "LISTEN" to them; not yell, scream or lecture!

This is an honest book with emotions from the substance abusers. Out of thirty-four stories, one has to hit home. This is their lives, not mine. Losing Richard and Lori, I wanted to know what I missed to help them. This is a book you can give without explaining a thing to them.  

Go to my site to order and look at the other two memoirs on addiction: Someone Stop This Merry-Go-Round: An Alcoholic Family in Crisis. Go behind closed door to a family with two daughters who live in fear, confusion, and abuse.  Learn how enabling only brings the alcoholic deeper into their addiction.

The sequel: Please, God, Not Two: This Killer Called Alcoholism. Follow Lori as she goes down the same path as her father with addiction. The wrong crowd.  Hiding events that happened to her in the past bringing her into depression.  Developing being bulimic.  How a family struggles after losing two loved ones. This book also contains my speeches behind closed doors to the addicted.

Visit: for her memoirs and Narrative Non-Fiction.  


I am a Veteran

NOVEMBER 10, 2017

My father, Brigadier General, Albert L. Gramm


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What would I change differently?




What would I change after losing my husband, Richie and my daughter, Lori, from their alcohol and drug abuse? I’ve been asked that question numerous times.

There will never be any doubt in my mind that Alcoholism is a family disease. We are all affected. I don’t believe in the programs for AA members to go in one room, Al-Anon family mates in another, and the teenagers with Alateen behind the third, closed door. 

Then I was told to let the alcoholic go their own way until they reach rock bottom, or come to their senses that they have a problem. Lori and Richie, along with any substance abuser, should never be left to reach rock bottom. My families rock bottom was their death.

We need to stop and listen to what each of us needs to recover. We can’t learn anything if we do all the talking. Is this easy? No, but it’s a start. Enabling, yelling, accusing, and doing nothing is unhealthy and our loved ones go deeper into their addiction.

It’s not a time to blame. I also feel if the substance abuser does not want help or make any changes, we have to try to mentally and physically take care of ourselves. Sounds easy. Yeah, try it. 

I believe in the power of prayer. Yes, no one could have said as many rosaries and novenas like I did for them, but God had other plans for them. I hate to admit the fact, the alcoholic has to do the work to recover. We can only love and support them. 

So, my advice is to try listening and talking. Don’t break communication or the demon will win.

My book What is and isn't Working for the Alcoholic and Addict is an educational book for family members of the substance abuser, doctors, counselors, and the public to learn what they feel they need from us to desire taking the steps to recover. The books can be purchased at


Alberta Sequeira

Review on What is and isn't Working for the Alcoholic and Addict

Official Review: What is and isn't Working for the Alcoholic and Addict...

Post Number:#1 by Moniquejm » 21 Jun 2017, 08:43 

[Following is an official review of "What is and isn't Working for the Alcoholic and Addict" by Alberta Sequeira.]
Book Cover
4 out of 4 stars
Review by Moniquejm
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What is and isn’t Working for the Alcoholic and Addict by Alberta Sequeira is a non-fiction book. The book has something to do with the life and personal experiences of the author when she lost her husband and daughter because of addiction. The major content of the book was a series of testimonies of different people who experienced and overcome addiction.

I admire the author and those who shared their lives for having the courage in sharing their sufferings and difficulties they went through while recovering. I am very thankful that I have read this book because it helps me understand many things about addiction. This book gave some answers why people involved with addiction. It also gave ideas on how relatives and friends should properly handle and help these addicts overcome their alcohol or drug addiction.

My best experience while reading the book was there were sharing and discussions with my family members and friends. I keep on sharing to them every time I saw a sentence or paragraph that was inspiring or educational for them to learn from this book. From this story, we realized that sometimes the treatment towards the person involved from addiction is not the proper way, sometimes it worsens their situation. I can say that I really have a wonderful time reading this book because there was so much information I gained and I shared to others.

I rate this book What is and isn’t Working for the Alcoholic and Addict 4 out of 4 stars. I highly recommend this book for everyone because the challenges mentioned and lessons from the story can be applied to any difficulties in life. To the family members of those people who are struggling with addiction, I encouraged you to read the book because you will surely learn a lot on how you will handle, understand and support your family member in his/her critical situation. Also, this book provides awareness on the available support systems and other programs that can be extended and applied to achieve faster and higher possibility of addiction recovery.

To those people who are experiencing addiction and those who are currently recovering, I request you to read this book because it will help you a lot. It will open your mind and you will realize many things that will inspire you more to turn your back from alcohol or drug addiction.

What is and isn't Working for the Alcoholic and Addict 



Talking to men and women inmates at a jail


I’m due for a second meeting with counselors at the Bristol County Jail in Dartmouth, Massachusetts to share my story of losing my husband, Richard, and my daughter, Lori from their alcohol and drug abuse to their inmates. It will be the first time a family member has ever spoken to them.

It’s a shame from the results of their substance abuse that they are behind bars. But, after losing two family members, I remember back fearing they would kill someone or cause an accident from drinking. More so, do crime to get money to keep their habit going.

If only the ones being helped could realize how lucky they are being there and not on the streets. It’s a time to realize that doctors and counselors want to help you. Millions all over the world may never have the opportunity to have professionals by their sides to recover.

How to achieve recovery? Want it from the heart, more than life itself. Forgive who hurt you and put it in God’s hands. Move on without them. Don’t let a person who caused you harm years back hold you from moving in a healthy direction with getting sober. 

Don’t blame others for where you are in your life with addiction. We all have choices. Don’t be in a program or jail waiting for your time to end to get people off your back with harping on you with using. Don’t look at it as no choice by a court ordering your stay. Don’t take the help only to win back your marriage.

Do it for YOU! If not, you will be back on the streets looking for the drug dealer, who doesn’t care if his pills or needles kill you or you will be in your car going to that party you know will get you on the road of death again. 

CHOICES! A word not to forget every time you are faced with a phone call or personal invite. Which answer will you give? What step will you take? It's easy to take the familiar road instead of struggling up a hill to recover.  CHOICES! They’re yours alone. The one you make will either give you back your pride, health, and happiness. The other will be a shovel digging your grave. 

Alberta Sequeira

My books are in paperback and Kindle at

Email me with questions at:
is [email protected]

I love receiving emails, and especially, getting a review on Amazon.