Structural opportunities for a health-informed approach to substance use

Issues National health care reform presents an important opportunity for re-thinking and re-shaping substance use services with a health-informed vision, to improve patient outcomes. However, health care providers remain largely uninvolved in promoting meaningful integration for this population, and prospects for integration represent a structural challenge for state health authorities, given the historically separate development of ‘substance abuse treatment' from health care institutions.

Description To articulate the challenges and opportunities for health care integration of substance use services, a three-pronged approach was adopted. First, a qualitative interview was administered to 100 clinicians caring for this population in primary and specialty care institutional settings. Interview topics investigated perspectives on patient care, health care reform, and drug treatment for addressing the health needs of patients with problem substance use. Second, a survey was distributed to authorized representatives in each of the 50 states querying plans for changes to local Substance Abuse Prevention and Treatment (SAPT) block grant fund allocation and treatment system adjustments in preparation for federal funding reductions and coverage expansion. Third, through collaboration with health policy researchers and advocates, innovative models and care integration opportunities were identified and described.

Lessons Learned Although health care providers described similar structural issues for improving care to this population, few clinicians are involved in organized policy work. Meanwhile, states are preserving treatment structures largely untouched, relying on ‘market forces' for change.

Recommendations Health care reforms could improve health outcomes for people with problem substance use, but innovation for structural integration must be systems approach.