Substance use and abuse are severe issues that have become an epidemic worldwide. The Substance Abuse and Mental Health Services Administration (SAMHSA) recorded that 21.9% of Americans over 12 used illicit drugs in 2021. That means 61.2 million people may need substance use treatment.
Getting help for a substance use disorder can be complicated even with the right resources and support, and people may struggle to find health care providers or treatment facilities that will meet their needs.
Treatment facilities and mental health referrals are so essential. Substance use treatment provides direct care offering patients access to medical providers and mental health professionals who understand both substance abuse and mental health care.
A lot goes on behind the scenes of getting the right referral, and doctors must clearly understand their role in the referral process and how best to guide patients through finding treatment providers for substance abuse and mental health issues.
Making an appropriate referral requires in-depth knowledge of available treatment options, but do doctors have the right tools and resources to make those referrals?
Let’s take a closer look at what goes on behind the scenes regarding finding a person with drug, alcohol, and or illicit drug use history a treatment provider.
Key Components of Health Care Systems
The National Institute on Drug Abuse (NIDA) reported that approximately 2.7 million Americans aged 12 and older had an opioid use disorder in 2020, and overdose deaths involving opioids surged to 80,411 counts in 2021. Opioid use disorder is one of the many substance use disorders that must be treated.
Depending on the drug used and the severity of the disorder, users may need different types and levels of treatment services. Healthcare systems are crucial in addressing substance abuse and providing the necessary resources and support to ensure patients receive the best treatment.
There are varying approaches from detoxification to medication assisted treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) utilizes Screening, Brief Intervention, and Referral to Treatment (SBIRT) to offer early intervention from from an emergency room, primary care setting, trauma center and the like.
There are actual billing codes for doctors to utilize for substance use treatment, but most importantly every treatment provider can be a self imposed preventive services task force by learning risk factors and doing the brief interventions.
These universal screenings for alcohol and/or substance abuse, structured screenings and brief intervention services are based on 15 minute increments.
Additional approaches include:
- Using screening tools to identify patients with drug abuse or substance use disorders
- Providing interventions to prevent substance misuse and other behavioral health conditions
- Offering early intervention to stop substance misuse from escalating to substance use disorder
- Providing effective treatment services
- Treating substance use disorders, regardless of how severe they are
- Connecting patients to recovery support services
- Providing long-term monitoring and regular follow-ups
- Coordinating with social services systems, such as housing and employment support, criminal justice, and child welfare
- Offering continuing care and support, including relapse prevention programs
- Creating partnerships with community centers and other organizations to increase access to care
These are some ways health systems can address substance abuse. Additionally, it’s critical to involve key components to ensure that the right resources are available for addiction treatment referral.
Health Care Settings Addressing Substance Use Disorders
Healthcare systems consist of diverse settings where patients receive various types of clinical care. These include:
- Primary care settings
- Mental health and behavioral health care
- Specialty care for substance use disorders
- Residential treatment centers
- Outpatient treatment programs
- Infectious disease control centers
- Hospitals
- Emergency medicine departments
- Community health centers
- School clinics
- Home health care services
- Long-term care facilities
- And more
All of these settings offer different levels of care and services. It is essential to understand the purpose of each healthcare setting to accurately refer patients and provide referrals for the appropriate type and level of substance use disorder treatment.
Most people dealing with alcohol and drug use disorders hesitate to seek treatment help, believing they don’t need to, are not yet ready, or can handle the situation alone. On the other hand, some are unaware that treatment options exist or don’t know how to access them.
However, patients suffering from substance use disorders need timely treatment, as drug abuse and addiction can lead to numerous negative consequences, including:
- Acute health problems, such as injuries and illnesses
- Chronic health conditions, such as HIV/AIDS, hepatitis C, heart disease, and other infectious diseases
- Mental health issues, such as depression, anxiety, paranoia, and suicidal thoughts
- Social isolation and relationship problems
- Financial problems and unemployment
- Family difficulties
- Legal issues
- Increased risk of suicide, violence, and criminal behavior
Hospital Workforce
Aside from diverse healthcare settings, hospitals and other health systems can train and educate all staff in recognizing alcohol use and abuse, substance use and abuse, as well as injection drug use, and to note in their medical record the screening tool they used to assist in the referral process to to find help.
These vital individuals include:
- Doctors
- Physicians
- Nurses
- Nurse practitioners
- Medical assistants
- Psychologists
- Licensed counselors
- Social workers
- Behavioral health specialists
- Health educators
- Care managers
- Peer workers
These professionals can create a comprehensive plan for each patient with substance use disorder based on their unique needs. They can also provide vital information on the patient’s health condition, such as underlying health problems and mental illnesses that may be linked to substance use. Additionally, they can help connect patients with community resources, recovery support, and other treatment services.
Structural and Financing Models
Healthcare structures and financing models are essential in incorporating substance use disorder treatment into healthcare systems. Some of these models include:
- Health homes
- Accountable care organizations (ACOs)
- Managed care
- Coordinated care organizations (CCOs)
- Pay-for-performance
- Shared-savings models
Federal and state governments are developing and testing different models to determine the most effective way to improve health outcomes among those needing substance use treatment.
Finding effective and sustainable financing models for substance use disorder treatment is critical to providing high-quality and cost-effective care.
Technology Integration
Technology can also be instrumental in connecting patients with appropriate resources and tracking their progress. Some tools that can help healthcare workers provide better and more efficient care include:
- Electronic health records (EHRs)
- Telemedicine platforms
- Patient registries and medical records
- Health information exchanges (HIE)
- Mobile applications
- Web-based platforms
- Secure messaging systems
These technologies provide many advantages in supporting the integration of the healthcare system components. They can:
- Extend access to care and the reach of the healthcare workforce
- Promote quality assessment and improvement
- Streamline treatment services and prevention interventions
- Track patient outcomes and progress
- Monitor patients’ health status and care plans
- Help connect patients with appropriate treatment and referral resources
- Identify trends in the health system
- Engage hesitant patients in getting treatment
Technology can significantly improve access to care and provide comprehensive treatment for those with alcohol and drug addictions.
Role of the Primary Care Physician in Substance Use Disorder Treatment
With the millions of people affected by alcohol and drug addiction, it’s inevitable that primary care physicians encounter patients with substance use disorder. People who use drugs can be of any sex or age and can come from different ethnic, religious, and socioeconomic backgrounds. They usually do not disclose substance use during regular check-ups. That’s why primary care providers must know and recognize the signs of drug abuse or relapse to appropriately diagnose and refer patients to who need addiction resources.
Medical providers reported that primary care visits are often the first point of contact for identifying and intervening with substance abuse and addiction. Initial diagnosis and treatment of substance use disorder usually occur in the primary care setting, and the physician can help provide personalized referrals for more specialized and intensive services.
Primary care physicians have a significant role in treating patients with substance use disorders, and they can make all the difference in a patient’s successful recovery and long-term sobriety.
Early detection of excessive alcohol and drug use can help prevent it from progressing into a more severe condition. Early intervention for substance use disorder can drastically reduce the risks of health problems, overdose, and death.
By recognizing addiction and providing appropriate referrals for treatment, primary care physicians can help reduce the stigma surrounding substance use disorder and support those struggling with addiction.
Recognizing the Alcohol and Drug Problems
Drug users may be hard to identify because of the sensitive nature of their addiction. However, there are general ways to tell if someone is using drugs, such as:
- Possession of alcohol, marijuana, or other drugs
- Lack of interest in activities they used to enjoy
- Changes in physical appearance
- Changes in behavior and mood swings
- Bloodshot eyes and unusual smells on their breath
- Slowed physical response time and coordination
- Poor decision-making skills
- Gaps in memory or confusion
- Inability to concentrate and focus
- Withdrawal from social settings
- Social withdrawal and isolation
- Unexplained disappearances or absences
- Family and relationship issues
- Financial and legal problems
Those struggling with an addiction to injection drugs can often be identified by needle marks on the body, track marks, and signs of injection sites such as skin discoloration. However, some people may be more discreet and inject in hidden areas that are more challenging to detect. They are also prone to infection and can suffer from blood-borne diseases.
Some people who use drugs prefer to snort or smoke drugs. When this is the case, signs of drug abuse manifest in bloodshot eyes, runny nose, and changes in breathing patterns. They are susceptible to respiratory problems, atrophic rhinitis, and nasal septal perforation. Some may even have dental issues from drug use, such as tooth decay or gum disease.
Many people that use drugs also develop an addiction to prescription medications. For example, a person taking prescription opioids may start taking higher-than-prescribed doses, leading to prescription opioid use disorder. One way to identify this type of addiction is to look for signs, such as repeated doctor visits, pharmacy hopping, frequent refills, forged prescriptions, and requests to increase medication dosage.
Screening Patients
Screening patients for illicit drug use and addiction is vital to refer them to the appropriate provider. The United States Preventive Services Task Force (USPSTF) also recommends screening adults, including pregnant women, for alcohol use disorders in primary care settings. They also advise as stated above utilizing the brief intervention. Knowing local behavioral counselors to refer people with risky drinking habits, as they treat excessive alcohol use and prevent alcohol use disorder.
CAGE Questionnaire
One way of screening for substance use disorder is through the CAGE-AID Questionnaire, widely used to detect and diagnose alcohol problems. The acronym CAGE stands for “cut down,” “annoyed,” “guilty,” and “eye-opener,” and AID stands for “adapted to include drugs.” “illness,” and “depression.” It helps detect early signs of substance abuse in patients by asking basic questions, such as:
- C: Have you ever tried to cut down on your alcohol or drug consumption?
- A: Do you get annoyed when people comment about your drinking or drug use and habits?
- G: Do you feel guilty about drinking or using drugs and what you have done while under the influence?
- E: Do you need an eye-opener to get started in the morning? Or, Have you ever had a drink or used drugs first thing in the morning?
If the patient says yes to one or more of these questions, that results in a positive screening test and indicates the possibility of a substance abuse problem. Further evaluation is needed to be sure and provide the patient with appropriate referrals for treatment.
Primary care providers must act immediately when a patient displays these symptoms or behaviors.
Substance Use Treatment Facilities
It doesn’t take long for people who use drugs to feel the effects of their addiction, and they know the risks and consequences of continued use. Unfortunately, quitting once they’re physically dependent on the drug can be complex and extremely challenging. The stigma attached to addiction can also make it harder for them to seek help.
The desire to quit drug use or alcohol use is the first step in becoming motivated to seek and accept help. Addiction only worsen when someone knows they have a problem and they don’t stop their substance use, leading to more medical and behavioral issues.
It’s vital to be understanding, supportive, empathetic, and compassionate when talking to them about the importance of treatment.
When someone agrees that their alcohol use or drug use is a problem, they must receive help right away. Substance use treatment should be tailored to fit the individual’s needs and include evidence-based treatment, medications if needed, counseling, therapy, and other behavioral interventions. It’s also essential to find treatment providers and facilities with expertise in the individual’s drug of choice since different drugs require different treatment approaches.
Detoxification
The first step in the journey to recovery is medical detoxification. Detox helps to rid the body of any drugs and alcohol. The patient must be in a safe environment with trained professionals who can provide proper medical care during this difficult phase.
Uncomfortable or dangerous withdrawal symptoms often accompany the detox period. To help minimize the likelihood of relapse, medication-assisted treatment (MAT) may be administered during this time.
Medication-assisted Treatment
MAT involves using buprenorphine, methadone, and naltrexone that reduce cravings and withdrawal symptoms for opiate addiction. Vivitrol is used for both opioid and alcohol use disorders.
MAT also helps to provide a safe and reliable way of managing addiction without the risks associated with traditional drug and alcohol treatments. Additionally, MAT can be used with counseling, therapy, social support groups, and individualized treatment plans to promote long-term sobriety.
Long-term Treatment
Long-term treatment is often recommended for those with more severe or deep-rooted addictions. This treatment typically involves residential care, intensive outpatient treatment (IOP), and aftercare services such as sober living and relapse prevention programs. Long-term care aims to help individuals achieve sobriety by providing structure and support while they learn the skills to sustain it.
Family Medicine and Addiction Care
Addiction is severely stigmatized not just in the healthcare industry but by society. Because of this, many people who are struggling refuse to seek the appropriate treatment they need to overcome their addiction.
Of the million Americans suffering from addiction, only 10% receive evidence-based treatment from formal addiction and behavioral healthcare facilities.
Expanding addiction care to the primary physician allows patients to receive treatment options in the comfort and safety of a more familiar setting without fearing discrimination. Primary care patients are more likely to have open conversations about addiction with their physicians than in specialized clinics, which can be intimidating.
Further, as primary care physicians become educated and willing to offer comprehensive care, including mental health referrals, physical exams and screenings, prescription medications, and referrals for substance abuse, health care providers become the nucleus of the patients well being.
This doesn’t mean that specialized institutions will become secondary. Primary care can be a medium to help patients get acquainted with the specialized services available for their substance abuse treatment.
Barriers To Expanding Addiction Services in Primary Care
There are multiple barriers identified preventing the expansion of addiction interventions in primary care. Here are some of the most commonly encountered hurdles:
- Stigma in the rural community: Substance abuse is still highly stigmatized in rural areas, and patients tend to be ashamed or embarrassed to discuss it even with professionals. Despite the countless movements to destigmatize addiction, rural areas still have a long way to go.
- Lack of mental healthcare education: Mental healthcare is a complicated and emotionally exhausting practice. It takes specialized training to adequately assess and diagnose patients with substance abuse, something most primary care physicians don’t have.
- Accidentally triggering patients: Concerning our previous point, providers without training and education on addiction care may inadvertently say something that re-traumatizes or dismisses patients’ experiences. This might set back the patient’s recovery process, further alienating them from seeking help.
- Lack of privacy: Many patients are afraid of exposing their addiction history and may be hesitant to seek treatment in a practice that is not explicitly geared toward addiction care.
Methods for Overcoming Barriers for Addiction Services in Primary Care
Despite these barriers, there are several ways we can reinforce our current healthcare system to be more holistic and effective in treating addiction. Here are some methods that can help.
Building a Better-prepared Workforce
Robust and comprehensive efforts to spread medical training across different healthcare providers can bridge the gap in addiction care. This can be done through web-based training, workshops, or simulations to help physicians and practice staff become more familiar with addiction healthcare.
From emergency medicine to internal medicine, primary care providers will benefit significantly from having a comprehensive understanding of substance abuse care, diagnosis, and treatment. Further, this will also reduce the stigma and fear of the unknown from both the patient’s and provider’s perspectives.
Creating Financial Incentives and Supportive Policy
Creating legislation and incentives to support practices financially will make it easier for primary care providers to expand their services. This could include policies that relax restrictions on Medicaid funding and provide increased payments for specific addiction-related treatments and medications.
Moreover, these regulations should also support primary healthcare physicians and research staff members to receive incentivized training to promote and encourage more providers to incorporate addiction screening at the very least into their practices.
Addiction is a sensitive topic and a complicated societal and healthcare issue. Because of its delicate nature, policymakers should have an in-depth awareness of the persisting issue to make better legislation that will benefit the patients and the providers.
Benefits of Integrating Substance Use Disorder Treatment With Mainstream Healthcare
Incorporating substance use screening into mainstream healthcare could benefit the entire healthcare system and make quality mental healthcare treatment accessible. Here are some of the primary benefits it could provide.
Minimized Disparities
Discrepancies in healthcare occur when providers lack access to the necessary patient resources to provide quality care, no matter where patients receive treatment. Integrating substance use screening with primary healthcare could significantly reduce disparities in diagnosis and care while providing much-needed support to help patients recover from addiction safely.
Interconnected Mental and Physical Health
Substance use is not just a behavioral or mental health issue; long-term cases of addiction also impact a person’s physical health. Integrating addiction health care into primary care will make it easier for providers to identify cases of substance use disorder and refer patients to the appropriate treatments.
Accessibility and Cost-effectivity
Integrating substance use disorder treatment into primary healthcare gives patients much better access to necessary treatments while reducing overall costs. Moreover, providers can increase revenue streams by providing more comprehensive physical and mental health services.
Better Healthcare Coordination
Communication is crucial in healthcare, especially when it comes to substance use. Integrating addiction care into mainstream healthcare will streamline communication between primary care providers and specialists, ensuring everyone is on the same page regarding patient treatments and progress.
This will result in better patient outcomes and faster recovery.
Turning Point of Tampa and Substance Use Disorder
At Turning Point of Tampa, we recognize the complexity of addiction and its impact on individuals. We understand that reaching out may be difficult. Our professional team always strives to provide the necessary support and resources to help those affected by addiction and let them know how we can help.
Turning Point of Tampa provides evidence-based treatments tailored to the patient’s health and concerns. We employ different approaches to ensure long-term recovery, including detoxification, accelerated resolution therapy, group therapy, and motivational interviewing.
Our medical providers are trained in addiction medicine and psychiatry.
Medical Director Dr. Singh has been listed multiple times ad one of Tampa’s Top Doctors
Dr. Hardeep Singh has served as the Medical Director at Turning Point of Tampa since 2016. Turning Point provides inpatient detox, residential, day and intensive outpatient treatment for addiction, dual diagnosis and eating disorders. Dr. Singh was named a Top Doctor in the Tampa Bay area in Addiction Medicine for the fourth year.
“I am honored to have once again received this award from my peers,”
Dr. Singh says. “Helping patients live a happier and healthier life, especially during these challenging times, is gratifying. It is humbling to be a part of a great team at Turning Point of Tampa.”
Turning Point of Tampa’s focus is to cover substance abuse disorder and help patients rebuild their relationships with family, friends, society, and themselves. We help them regain the strength and confidence needed to get back on their feet.
Contact Turning Point of Tampa Today and Get the Help You Need
With the help of advancing technology and support from the medical community and various governments, doctors and other healthcare providers are now better equipped to provide quality care for those suffering from substance use disorder.
At Turning Point of Tampa, we understand the struggles of addiction and have the resources to help people on their journey toward sobriety. We are an in-network provider of major insurance plans, offering all levels of care and treatment for substance use disorder.
We help patients and medical professionals alike with treatment and referral sources.
Contact us today to learn more about our treatment services.
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