By Robert Baillieu M.D., M.P.H., Physician and Senior Clinical and Practice Advisor, Center for Substance Abuse Treatment
In managing or preventing substance use disorders, nothing should occur in isolation. People and systems of care are complex. They require frequent observation, assessment and understanding. To this end, systems focused on medical models, statistics and abstract ideas do not take fully into account the reality of a patient’s situation and place too great an emphasis on the individual as being the source of their own suffering. Such paradigms, while accepting that individuals must make their own health decisions, perhaps negate the influence of social systems and existing policy on health outcomes. In working towards the prevention of substance use disorders, it is important to appreciate those social determinants of health, policies and actions that precipitate adverse outcomes. Furthermore, empowering stakeholders to engage with clinicians and policy makers on issues related to treatment and prevention, is an essential step in understanding what is needed, and how best practices might be implemented.
At SAMHSA’s Center for Substance Abuse Treatment (CSAT) we value the importance of not only providing evidence-based treatments for substance misuse, but also in treating ‘the whole person’. This means that our grantees and partners are encouraged to engage the assistance of counseling, behavioral therapies, case managers, vocational coaches, and peer-support networks, to name but a few, in assisting clients. This approach has been shown to augment the treatment experience and to maintain clients in long-term recovery. It also helps address the biologic, psychological and sociocultural factors that underlie substance misuse.
Preventative strategies also draw on biopsychosocial principles not only to warn against the harmful effects of those substances prone to misuse, but also in promoting systems of change. In this way, preventative and treatment strategies are aligned, while differing in their focus. A striking example of how alignment of these principals can produce an impact might be found in the opioid crisis. Treatment and prevention strategies are focused on the ‘whole-patient’ and the communities in which they live:
- CSAT promotes evidence-based training and mentoring in Medication Assisted Treatment (MAT) through the Providers Clinical Support System. MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of opioid use disorders. There are currently over 99,000 providers who are waivered to prescribe MAT. In the last year alone, over 23,000 providers received a DATA-Waiver.
- CSAT programs and grants can be found across the nation, providing patient-centered care and support to those in recovery. Grantees can be found in the criminal justice system, community, and at the state level. They work not only to provide treatment, but also to increase the prevalence and quality of long-term recovery support from substance use and addiction. They also provide access to important harm reduction tools such as Naloxone and Fentanyl Test Strips.
- To support clients, grant funds have been used to expand and enhance service capacity through the provision of addiction peer recovery support services. State funding has also supported mobile health units that target high risk and high need areas, including rural treatment deserts and high overdose areas.
- SAMHSA regularly produces guideline and advisory documents to promote evidence-based practices in diagnosing, treating and supporting patients who currently suffer from substance misuse, and those in recovery.
- These efforts are supported by prevention activities that complement treatment programs. Prevention information for young adults, families, and those with serious mental illness can be found on the SAMHSA website. These materials are augmented by public messaging highlighting risks associated with opioid misuse, and comprehensive survey data that reveals emerging trends in substance misuse and populations with increased need.
Being responsive to emerging trends and stakeholder needs is an important step in the creation of prevention and treatment strategies. Importantly, it helps policymakers understand individual requirements and how programs might be augmented. The voices of those who truly understand substance misuse also provides insight into the role of stigma at the individual, clinical and societal level. Stigma persists despite knowledge that there is no one type of person affected by a substance use disorder, and that substance misuse is a chronic condition amenable to treatment. Prevention strategies that seek to educate the general public about substance misuse play a role highlighting the issue and in reducing stigma. This brings people into treatment, where providers must be mindful of their actions in supporting treatment and recovery.
Drug overdose deaths and morbidity from substance use disorders continue to affect individuals, families and the communities in which they live. This is despite a reduction in opioid prescriptions, an increase in evidence-based screening and use of effective medications for opioid use disorder. As treatment for opioid use disorder expands across the nation, so too are prevention and harm reduction strategies. Continued coordination of these efforts, as well as involvement of stakeholders, has the potential to address change that improves community and individual health through innovative program design and insightful assessment of the issues that promulgate substance use disorders.