Abstract
There are significant gaps in the identification and engagement in care and prevention services of people who use illicit substances. Care continuum models have proven to be useful tools in the evaluation of care for HIV and other conditions; numerous issues in substance-related care and prevention resemble those identified in other continua models. Systems of care for substance misuse and substance use disorders (SUDs) can be viewed as consisting of a prevention and care continuum, reflecting incidence and prevalence of substance misuse and SUDs, screening and identification, medical and psychosocial evaluation for treatment, engagement in evidence-based treatment, treatment retention, relapse prevention, timeliness of step completion, and measures of overall and substance use-related specific morbidity and mortality. Care and prevention continuum models could potentially be applied at program, local, regional, state, and national levels. We discuss important lessons that can be drawn from applications of continuum models in other fields. The development and use of a substance-related care and prevention continuum may yield significant patient care, program evaluation and improvement, and population-level benefits.
Highlights
Substance misuse and substance use disorders (SUDs) contribute to significant morbidity and mortality [1,2,3]
Gaps in the implementation of substance use treatment have implications for other conditions; lower county-level access to buprenorphine is associated with county-level vulnerability to HIV epidemics [7]
Estimates of the proportion of persons progressing through sequential continuum steps are useful for revealing net programand population-level effectiveness of the specific aspects of health-care systems that may contribute to suboptimal individual and public health outcomes
Summary
Substance misuse and substance use disorders (SUDs) contribute to significant morbidity and mortality [1,2,3]. Estimates of the proportion of persons progressing through sequential continuum steps are useful for revealing net programand population-level effectiveness of the specific aspects (e.g., screening, linkage to care, and treatment) of health-care systems that may contribute to suboptimal individual and public health outcomes. These estimates can inform interventions to improve identified gaps may have population-level health benefits. The application of a continuum construct to substance use, misuse, and SUD treatment and prevention more generally at program and population levels, and in particular as an explicit part of public health and health systems evaluations, may have unfulfilled potential [28,29,30, 32,33,34,35]. We will use the term “substance-related prevention and treatment continuum” with the understanding that critical distinctions and decisions will need to be made
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