Substance use disorders can look very different from one person to another, and there is no single silver bullet treatment that works for everyone. As the science behind treatment continues to improve, however, there are two things we can say with certainty.
First of all, there is a basic need to extend access to evidence-based care. The treatment most substance use disorder patients receive today is simply…nothing. Only 1 in 10 SUD patients receives care at a specialized treatment facility. Most individuals with SUDs are never referred to treatment, and for those 1 in 10 who are referred, many find that they are not offered a full range of treatment options. For certain vulnerable or institutionalized groups, such as pregnant women and prison inmates, access to treatment of any kind is particularly difficult.
Second, the need for an individualized and adaptable approach provides the common thread for interventions that effectively treat SUDs. Funders should be wary of any single approach that claims to have cornered the market on effective treatment, eschews all other interventions, and places the burden of failure solely on the “readiness” (or lack thereof) of a patient. High-quality, evidence-based treatment is not any single therapy, but the practice of drawing upon the full spectrum of what we know works.
In practice, that means integrating clinical expertise, patient values and preferences, and research evidence into the decision-making process for patient care. Evidence-based tools (sometimes called treatment modalities) include different types of talk therapy, incentives for reduced use, medications to reduce cravings, versions of 12-step therapy, and many more. In addition, many of these can be combined for a more-tailored fit. Case managers, for instance, can help patients access and balance the treatments that are right for them. Availability of a particular treatment is often unrelated to the strength of evidence for that treatment. For example, while evidence for the effectiveness of medication-assisted treatment is much stronger than that for the effectiveness of 12-step programs, the latter are much more widely available within treatment centers.
Help pregnant women, mothers, and their young children get the help they need
The most effective programs for women are residential, offer gender-specific programming, involve children and families, and provide housing and comprehensive support services. Such interventions can help women recover from their SUDs, gain parenting skills to strengthen their family, and retain/obtain custody of their children. They also ensure that newborns get the care they need to minimize harm from substance exposure and that young children receive specialized support. However, such intensive programming is expensive to provide and, therefore, rarely available to low-income women.
Break the cycle of substance use and incarceration by connecting inmates to the care they need
Low-income individuals in many states rely on Medicaid, which in most states is terminated during incarceration but can be renewed upon release. However, the difficulty in re-enrolling can present a major barrier to care. Connecting pre-trial detainees, current inmates, and formerly incarcerated individuals with Medicaid allows them to access mental health care, including SUD treatment, seamlessly upon re-entry into the community. This care can keep them alive and on track to recovery and a fresh start. Moreover, the concurrent reduced recidivism and lower health care costs can result in cost-savings to taxpayers.
Improve screening, prevention, and early intervention for SUDs
There is a simple protocol that allows health care providers to quickly identify risky or problematic substance use, intervene briefly if appropriate, and refer patients to more intensive treatments when warranted. Patients answer a few screening questions about use. For those who report risky use, the care provider follows up with a brief discussion about the risks of use and the options for cutting back. Finally, the provider gives a referral to treatment for those whose use is severe enough to warrant treatment. This is known as SBIRT (Screening, Brief Intervention, andReferral to Treatment), and it has shown promise in reducing alcohol use and related negative outcomes such as drunk driving and sexually transmitted infections. Moreover, studies have shown that every dollar spent on SBIRT can generate cost savings in health care of between $3.80 and $5.60. Excitingly, it’s also a promising avenue for research into SUD prevention among adolescents, a particularly high-risk group for new SUDs.
Integrate mental health care, including SUD treatment, with primary care
Originally developed for treating depression and mental health conditions, the Collaborative Care model is characterized by the following: care teams deliver evidence-based, patient-centered care; health care providers track outcomes for their entire patient population; and care providers are reimbursed for patient outcomes rather than volume of services provided. Collaborative Care can improve mental health and other risk factors for SUDS and, in some implementations, can directly improve access to quality SUD care. There is also a high potential for cost savings. In one study, every $1 spent on this strategy generated $6.44 in health care savings.