Donald M. Hilty, Jose Feliberti, Juan Sosa, Vicken Totten and Martin H. Leamon,
Relevance: Substance use disorders (SUDs) are prevalent in medical and psychiatric populations and can lead to disastrous clinical outcomes (e.g., opioid crisis) for patients and families. Providers need additional training, flexible clinical approaches based on teams, and service delivery models that integrate care.
Approach/Methods: Evidence-based care, principles, and service delivery approaches from the literature are suggested for SUD patients, who pose many challenges in presentation/engagement (e.g., incomplete history, criminality, culture), diagnosis and treatment (e.g., recidivism; adherence/follow-up). The impact on teams, services, the community and public and population health levels are discussed, including dilemmas for administration (e.g., skill and workflow development, models of care, cost).
Results: Best practices for prevention, assessment and treatment of SUDs are needed for training and lifelong learning. These may include using a biopsychosociocultural model for engagement, tools for workflow (e.g., Screening, Brief Intervention, and Referral to Treatment (SBIRT)), use of interprofessional teams and standardized evaluation/quality improvement. Interprofessional team attitudes and skills are needed more than knowledge.
Providers in medical settings need help on evidence-, practice- and system-based levels, and this could include ongoing consultation with psychiatry/behavioral health.
Conclusions: Systems need curricular change, professional development, and change in service workflow to build a positive work culture. More research is needed to assess implementation outcomes, treatment approaches and models of care.