Chronic Care for Substance Use Disorders
As with other chronic conditions, substance use disorders are better managed through comprehensive continuing care involving ongoing monitoring, collaborative care and extended services rather than an acute care approach. DOR researchers work with Kaiser Permanente’s Addiction Medicine Recovery Services programs and primary care departments to develop innovative ways to link patients in treatment with primary care, in part through patient activation, encouraging use of patient portals and improved communication with primary care clinicians.
Integration with Health Care and Implementation Research
Substance use problems have traditionally been treated in specialty clinics, although only around 10% of individuals who have a problem will end up receiving care. This makes interventions in primary care for patients with substance use problems critical for expanding access to treatment.
A major focus of DOR research has been implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT). It is an effective preventive health practice that is recommended in national practice guidelines but has not been widely implemented in general health care settings. DOR researchers have studied barriers to and facilitators of screening and developed large-scale approaches to implementing alcohol SBIRT in adult primary care, as well as use of SBIRT in pediatrics for adolescents with behavioral health problems. We are also studying innovative ways to increase the use of safe, effective pharmacological approaches to alcohol treatment in primary care.
DOR researchers also study approaches to integrating substance use treatment in psychiatry, obstetrics/gynecology, with HIV patients in primary care, in emergency departments, and for patients with chronic pain in primary care.
Our researchers are active participants and leaders in the Health Systems Node (HSN), a collaboration of investigators who conduct substance use and substance use disorder research embedded in 16 health systems across the United States, sponsored by the National Institute on Drug Abuse (NIDA) Clinical Trials Network. The HSN focuses on testing approaches to increase identification of substance use, substance use disorder, and engagement in treatment, and integrating treatment into medical settings
Addiction Medicine Treatment Interventions
Individuals whose substance use problems are sufficiently severe to require specialty treatment often have multiple other medical and mental health conditions.
DOR researchers also study outcomes for patients in substance use treatment. Research has examined linkages with primary care and assessed psychosocial services for patients receiving buprenorphine for opioid use disorder. DOR researchers explore how to effectively address patients with co-occurring clinical conditions, finding, for example, that bringing medical services into specialty substance use programs is cost-effective. On the whole, these studies find that substance use treatment is effective, and also reduces high cost emergency department and inpatient care.
Our investigators also conduct research on risk factors for substance use problems in adolescents and adults. They study risky use of alcohol and cannabis (and the rising rate of vaping), tobacco, prescription opioids, and other drugs, as well disorders with these substances. Our research on addiction follows patients longitudinally over many years, using both electronic health record data and patient-reported data. We conduct research over the life course, from studies on pregnant women and cannabis use to adolescent substance use to older adults’ alcohol use. These findings are used to develop effective approaches for diagnosing, treating and preventing substance use and related problems, and the management of long-term recovery. Vulnerable populations, such as those with substance use problems and comorbid mental health problems, pain, or HIV, have been found to be the groups most at risk for adverse effects and long-term use.
Several policy changes have occurred regarding the treatment of substance use in recent years. Both parity legislation and the Affordable Care Act have broadened access to health care and substance use treatment. Our researchers have examined how treatment access has changed for new patients with substance use disorders and those with and without HIV, smokers, and those with psychiatric diagnoses after new legislation and policy changes. They have examined the impact on substance use treatment of different deductible levels, and have studied the HEDIS performance measures for initiation and engagement of substance use treatment, as well as how treatment for substance use disorder changed after the COVID-19 pandemic. Importantly, DOR researchers have studied problems associated with cannabis use in adolescents and pregnant women after legalization of recreational use in California.