Integration of Substance Abuse Treatment with Primary Care

People living with substance abuse may additionally suffer from physical health problems. For example, these individuals have a 9 times greater risk of congestive heart failure, a 12 times greater risk of liver cirrhosis and a 12 times greater risk of pneumonia. In addition, substance abuse is associated with complications to managing other chronic conditions, such as poor adherence to medications for Type 2 diabetes. Research suggests that addressing physical health and substance abuse together improves both conditions. However, 54 percent of addiction treatment programs have no physician.

Recent changes in Federal policies have led to differences in how substance abuse is treated. Addiction treatment is one of the categories of essential health benefits specified in the Affordable Care Act. This means more people have access to resources and services. The FDA has approved new medications for the treatment of addiction, and these medications are effective in both primary care and behavioral health settings. Additionally, providers have new and expanded treatment options for patients with addictions, though lack of funding and limited insurance reimbursement still prevent wider use of these options.

With recent and future changes in the health care system, providers offering integrated services will be in high demand. However, there are a few obstacles to achieving integrated care, including improving reimbursement and financing mechanisms and electronic health care management tools.

Stanley Street Treatment and Resources (SSTAR) was founded with the intention of treating alcohol addiction, but has grown to offer health care as need for integrated services arose. SSTAR provides chronic illness case management for a variety of disorders, including diabetes, hypertension, and HIV through a collaborative care model that involves a physician and frequent multidisciplinary team meetings. The SSTAR integration model has two main aims: (1) to provide improved health care for those with substance abuse-related diseases, and (2) to provide these services in a more seamless fashion while maintaining privacy. Every SSTAR physician has a waiver from the Drug Enforcement Administration for the provision of buprenorphine, as the use of the drug as a treatment for opioid use is a priority due to high rates of opiate abuse in the community. SSTAR has seen decreased wait times and dropout rates as a result of their decision to integrate, demonstrating some of the value of doing so.

Providers seeking to implement integrated care will have a number of questions in several domains:

  • Administrative questions (Have you developed a strategic plan for integration?);

  • Capacity and resource questions (Do you have the staff and other resources to treat primary care and substance-related disorders?);

  • Financing questions (What additional investments in people and equipment would be required?); and

  • Clinical supports documents (Are you using a certified electronic system?).

Learn more about resources for integration efforts from the Center for Integrated Health Solutions Clinical Practice and the Standard Framework for Levels of Integrated Care.

Further information can be found about integrating addiction and primary care services and treatment of substance use disorders in primary care.