Integrated Substance Use Research Articles

Evaluation of the outcomes of equity-deserving individuals receiving services and support from integrated substance use health and mental health services: a pilot study protocol

BackgroundGiven the close relationship that can exist between substance use health and mental health (SUHMH) concerns, the need for more integrated services and support has been identified. However, research on the effective integration of SUHMH services and their impact on outcomes of individuals accessing them remains limited. In particular, the unique outcomes of individuals facing significant structural inequities in the health care system, i.e., Indigenous Peoples in Canada, including First Nations, Inuit and Métis (FNIM), and equity-deserving (ED) groups, have not been evaluated while receiving integrated SUHMH services. This paper describes the protocol for a pilot research project, which will evaluate the change in clinical and social outcomes of individuals receiving integrated SUHMH services in relation to their intersectionality status, a linear score ranging from identifying with no FNIM and ED groups to identifying with one or multiple groups.MethodsThis study recruits 100 individuals who receive SUHMH services and support from a community health center in Ottawa, Canada and assessed their FNIM and ED status and clinical and social outcomes at baseline and three-month follow-up. At the time of writing this manuscript, the baseline data collection was completed. Follow up assessment occurs three months after baseline data was collected. A smaller group of these participants will be purposefully selected match the proportion of FNIM and ED groups from the two-time assessment. They will be invited to participate in a post-data analysis validation consultation session to ensure that the findings are reflective of the experiences of individuals receiving SUHMH services, alternative interpretations are brought forward, and implications are driven by those who will be most impacted. This consultation may also inform knowledge mobilization activities and future studies. This study also recruited staff in different roles from the providing center to rate the implementation of key dimensions of equity-oriented care into their practices and their level and capability to provide integrated services and support to individuals with cooccurring substance use disorders and mental illnesses.DiscussionThe results of this study will inform integrated SUHMH services by emphasizing equity and inclusive approaches, and engagement with the community. Substance use health; Mental health; Integrated services and support; Equity-deserving populations; Equity-oriented care.

Bereavement and problematic alcohol use: Prevalence and predictors among a national sample of bereaved adults.

Problematic alcohol use (PAU) is highly prevalent in the United States. Although bereavement, a highly stressful and ubiquitous experience across the lifespan, is believed to increase the risk for PAU based on a small number of studies, research using large diverse samples of bereaved adults has yet to be conducted. Therefore, relations between PAU and bereavement remain poorly understood, hampering the reach and effectiveness of alcohol interventions. The current study addresses this limitation by investigating rates and correlates of PAU and service utilization among a large national sample of bereaved adults. Participants were adults who reported the death of a significant other in their lifetime (N = 1529). Most participants identified as female (69.1%) and White (68.2%), with an average age of 44.7 (SD = 16.29). Online self-report surveys assessed the prevalence of PAU using the AUDIT-C, mental health service utilization, and associated characteristics. Nearly one-third (n = 463; 30.3%) screened positive for PAU, which surpasses rates found in the general US population. After accounting for other characteristics, time since the death (OR, 3.63; 95% CI, 2.59-5.08) and meeting presumptive criteria for depression (OR, 2.28; 95% CI, 1.64-3.18) and prolonged grief disorder (PGD; OR, 1.66; 95% CI, 1.13-2.25) significantly increased risk for PAU among the bereaved. Approximately half (n = 244; 52.7%) of bereaved adults with PAU received any mental health service since the death. Time since the death (OR, 4.19; 95% CI, 2.38-7.48) and presumptive depression (OR, 2.16; 95% CI, 1.25-3.74) were associated with service utilization after accounting for other characteristics. The high prevalence of PAU among bereaved adults, particularly among those with a diagnosis of PGD, and limited use of support services underscore the need for greater empirical attention and integrated substance use care for bereaved adults.

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care. Among 10,557 PWH (2010-2021) from 8 academic clinical sites nationally we examined longitudinal associations of substance use severity and number of substances used (measured using AUDIT-C and modified ASSIST) with patient-reported ART adherence (visual analog scale). Alcohol (68% any use, 18% unhealthy use [AUDIT-C > 4 men, > 3 women]), marijuana (33%), and methamphetamine (9%) use were most reported. Polysubstance use was common (32%). Both higher severity substance use and higher number of substances used were associated with lower ART adherence. Severity of methamphetamine use had the strongest dose-response association with ART adherence (low severity [ASSIST 1-3]: -3.05%, 95% CI: -4.23%, -1.87%; moderate [ASSIST 4-26]: -6.20%, 95% CI: -7.08%, -5.33%; high [ASSIST > 26]: -10.77%, 95% CI: -12.76%, -8.78%). Severe substance use, especially methamphetamine, and higher number of illicit drugs used were associated with declines in adherence at levels that were likely clinically meaningful in the modern era of ART. Findings support integrating substance use care with HIV care and potential benefits of harm reduction strategies for improving adherence such as encouraging lower levels of substance use and fewer number of substances used.

Outcomes of an adapted prolonged exposure psychotherapy for people with early phase psychosis, substance misuse, and a history of adversity: the PE + trial

BackgroundSeveral adversity-focused treatment trials have reported improvements to adversity sequelae (e.g., PTSD symptoms) and decreases in psychotic symptoms among individuals with psychotic disorders. Yet, no trials have examined the impact of adversity-focused treatment on substance use or examined the outcomes among an early phase psychosis population. These gaps in both the research literature and clinical practice have resulted in less knowledge about the outcomes of adversity-focused treatment at this stage of illness, including the impact on substance use.MethodsThe outcomes of an adapted prolonged exposure protocol (PE+) among an early phase psychosis population were examined using a multiple-baseline design. Nineteen adults with a psychotic disorder, current substance misuse, and a history of adversity were recruited from an early psychosis program. Participants were randomized to treatment start time and participated in a 15-session course of PE + therapy. Ten assessments were completed focusing on primary outcomes (i.e., adversity sequelae, negative psychotic symptoms, substance misuse) and secondary outcomes (i.e., functioning, hopelessness, experiential avoidance). The Reliable Change Index (RCI) was used to establish whether there were clinically significant changes to primary or secondary outcomes.ResultsHalf or more of treatment completers experienced clinically significant changes to most domains of adversity sequelae, no participants experienced improvements in negative psychotic symptoms, and substance misuse increased for several participants. In terms of secondary outcomes, functioning and experiential avoidance were improved for a number of participants, while hopelessness decreased for only one participant. Participants reported high satisfaction with the PE + treatment, and exposure and coping skills were rated as the most helpful elements of treatment.ConclusionsReductions in adversity sequelae were observed following PE + treatment, suggesting that adversity-focused treatment may be beneficial for an early psychosis population. Yet, few positive changes to psychotic symptoms or substance use were observed. Further integrating treatment strategies for psychosis and substance use into PE + may be required to effectively treat the links between psychosis, adversity sequelae, and substance use. Future studies should make efforts to integrate substance use strategies into adversity treatment trials for people with psychotic disorders.Trial registrationClinicaltrials.gov, NCT04546178; registration posted 11/09/2020, https://clinicaltrials.gov/ct2/show/NCT04546178?term=NCT04546178&draw=2&rank=1.

Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital

BackgroundAdolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity.MethodThis study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions.DiscussionUnderstanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.

Integrating substance use disorder screening in primary healthcare in Georgia: online survey of providers’ attitudes, knowledge, practice, and perceived barriers

ABSTRACT Background The study aimed to explore the attitudes, knowledge, and practices of primary healthcare providers in Georgia regarding screening and management of patients with substance use disorders (SUD). Methods An online survey of primary healthcare providers, descriptive statistics, bivariate analysis, and odds ratio calculations were used. Results The final sample consisted of 96 providers, vastly females, from 19 primary healthcare clinics in 7 cities. About one in five believed that family doctors need not systematically screen patients for risky or problematic use of any psychoactive substances. Only 1%–4% reported feeling fully ready to identify patients with illicit substance use concerns. Attitudes and practices varied depending on the type of substance being assessed, with the majority of respondents stating that illicit substance use is not a priority area and falls outside of their responsibilities. The most cited barrier for SUD screening was providers’ belief that patients do not truthfully disclose their substance use. Almost a third believed that people who use drugs were criminals. Conclusion Our study highlights the urgent need for targeted interventions to improve provider knowledge, attitudes, and practices related to SUD screening and management, with a focus on addressing stigma and implementing evidence-based screening protocols in primary healthcare settings.

Impact of the Coronavirus Disease 2019 Pandemic on Substance Use Disorder Risk Among People Living With Human Immunodeficiency Virus (HIV) Enrolled in HIV Care in the United States: An Interrupted Time Series Analysis.

Rising overdose deaths globally and increased social isolation during the coronavirus disease 2019 (COVID-19) pandemic may have disproportionately impacted people with human immunodeficiency virus (PWH) with substance use disorders (SUD). We examined trends in SUD risk among PWH before and after the COVID-19 shelter-in-place (SIP) mandate. Data were collected between 2018 and 2022 among PWH enrolled across 8 US sites in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We evaluated changes in moderate/high SUD risk after SIP using interrupted time series analyses. There were 7126 participants, including 21 741 SUD assessments. The median age was 51 (interquartile range, 39-58) years; 12% identified as Hispanic or Latino/Latina, 46% Black/African American, and 46% White. Moderate/high SUD risk increased continuously after the pandemic's onset, with 43% (95% confidence interval [CI], 40%-46%) endorsing moderate/high SUD risk post-SIP, compared to 24% (95% CI, 22%-26%) pre-SIP (P < .001). There were increases in the use of heroin, methamphetamine, and fentanyl, and decreases in prescription opioids and sedatives post-SIP. Further, there was a decrease in reported substance use treatment post-SIP compared to pre-SIP (P = .025). The rising prevalence of SUD through late 2022 could be related to an increase in isolation and reduced access to substance use and HIV treatment caused by disruptions due to COVID-19. A renewed investment in integrated substance use treatment is vital to address the combined epidemics of substance use and HIV following the COVID-19 pandemic and to support resilience in the face of future disruptions.

Changes in alcohol, tobacco, cannabis, and other substance use and its association with mental health during the COVID-19 pandemic among sexual minority men in Eastern European and Central Asian countries

BackgroundThe COVID-19 pandemic had a particularly negative impact on mental wellbeing of vulnerable individuals, such as sexual minority men (SMM) living in Eastern Europe and Central Asia (EECA), where the social-political climate may be restrictive for SMM. Alcohol, tobacco, and other drugs (ATOD) use may be another factor contributing to exacerbated mental health among SMM in this region. MethodsSecondary analyses were conducted using data collected as part of the COVID-19 disparities survey from active users of Hornet, a popular geo-social networking app for SMM in late 2020. Using a subset of SMM living in EECA (n = 3209) and pre-validated scales (AUDIT-C and PHQ-4), we used multivariable logistic regression models to examine the relationship between changes in participants' use of ATOD and their mental wellbeing. ResultsBased on AUDIT-C, 35.1 % SMM screened for alcohol use disorder (AUD), 18.6 % reported an increase in alcohol use since the pandemic began. Over 30 % screened for depressive symptoms and anxiety based on PHQ-4 (30.4 % and 30.7 %, respectively). In multivariable models, AUD was significantly associated with screening positive for depressive symptoms and anxiety. Other factors associated with mental distress included lower socioeconomic status, unemployment, ethnic minority identity, IPV victimization, and financial and economic vulnerability. LimitationsCross-sectional data cannot be used to infer causality. ConclusionsOur results support the needs for integrated substance use reduction and mental health services tailored for SMM in EECA. Programs aimed at promoting mental wellbeing among SMM in EECA must consider both interpersonal and structural barriers.

System restructuring in Iowa would integrate substance use care

Mental health advocates in Iowa have expressed cautious optimism that a proposed system restructuring that is under consideration in the state legislature would result in more equitable and navigable services for the state's residents.

Integrating substance use peer support and screening brief intervention and referral to treatment services in the emergency department: a descriptive study of the ED leads program

BackgroundThe ED Leads program was introduced to 11 emergency departments (EDs) within New York City public hospitals from 2018 to 2019 to address a need for addiction support services in the ED. The purpose of this study is to (i) describe the ED Leads blended licensed-clinician and peer counselor team model in the ED at three hospitals, (ii) provide a descriptive analysis of patient engagement and referrals to substance use disorder (SUD) care post-intervention, and (iii) highlight potential barriers and facilitators to implementing the model.MethodsThe program intended to combine Screening Brief Intervention and Referral to Treatment and peer support services. The authors analyzed electronic medical records data for patients encountered by ED Leads in the first 120 days of program launch. Data included the outcome of an encounter when a patient was engaged with one or both staff types, and 7-day attendance at an SUD treatment appointment when a patient accepted a referral within the 11-hospital system.ResultsThere were 1785 patients approached by ED Leads staff during the study period. Engagement differed by staff type and patient demographics, and encounter outcomes varied significantly by hospital. Eighty-four percent (N = 1503) of patients who were approached engaged with at least one staff type, and 6% (N = 86) engaged with both. Patients were predominantly male (N = 1438, 81%) with an average age of 45 (SD = 13), and enrolled in Medicaid (N = 1062, 59%). A majority (N = 801, 45%) had alcohol use disorder. Of the patients who accepted a referral within the system (N = 433), 63% received treatment services within 7 days of the ED Leads encounter, a majority at detoxification treatment (N = 252, 58%).ConclusionsThis study describes the potential value and challenges of implementing a blended peer counselor and licensed clinician model in the ED to provide SUD services. While teams provided a high volume of referrals and the analysis of post-intervention treatment follow up is promising, the blended team model was not fully realized, making it difficult to assess the benefits of this combined service. Further research might examine patient outcomes among ED patients who are offered services by both a peer counselor and licensed clinician.

Integrating recovery-oriented mental health and addictions services directed by clients.

This article focuses on the planning, process, and outcomes of integrating multiple services into a system that is based on the client's journey. It demonstrates the incorporation of the client voice and shared decision-making throughout the process. This article provides guidance for leaders looking for ways to engage clients in the planning process. The discussion describes the process used by Frontenac Community Mental Health and Addiction Services to implement a client designed and centred, functionally integrated substance use and mental health service using the Mental Health Commission of Canada's recovery-oriented strategy. The reality is that although integrated services are evidence based best practices, in only rare cases has this translated into practice. Key messages are that the client voice and direction can be used successfully in designing an integrated mental health and substance use system.

National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020.

We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n=4744; 2018 n=4626; 2020 n=4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR=1.16, 95% CI=1.06-1.27, p<0.01). Notable associations included offering integrated substance use treatment (versus none, aOR=2.95, 95% CI=2.70-3.22, p<0.0001) and offering trauma therapy (versus none, aOR=2.05, 95% CI=1.85-2.27, p<0.0001). The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.

Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic

ObjectivesFew are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors.MethodsThe current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow’s Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors.ResultsSociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP.ConclusionHealth and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.

It’s Complicated: Contextualizing Substance Use in Social Work Education

ABSTRACTThis paper aims to understand the impact on student learning of redesigning an elective substance use course with the intent of contextualizing the topic by modeling a structural critical lens. In addition, we look at how this shift impacts students’ approaches to working with clients who use substances. Secondary data from student course evaluations were used to determine themes. The findings reinforce the value of a social work approach, the need to rebalance individual and society’s responsibility for substance use, the necessity of a critical structural lens, new skills students learned, and the existing gaps students have identified in relation to integrated substance use practice.

Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19.

The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.

A Call to Prioritize Integrated Suicide Interventions in Adolescent Substance Use Treatment

ABSTRACT Substance use is identified as a risk factor for suicidal thoughts and behaviors among adolescents. Scholars have developed and investigated the feasibility, acceptability, and effectiveness of combined suicide and substance use interventions for adolescents psychiatrically hospitalized following a suicidal crisis who also have co-occurring substance use problems. However, little research has been done to develop and investigate the effectiveness of combined suicide and substance use interventions within outpatient substance use settings for adolescents. Because social workers are well-positioned to deliver integrated interventions, greater focus is needed on teaching and implementing integrated substance use and suicide interventions at an individual and institutional level.

The effect of substance uses on antiretroviral treatment adherence in primary health care.

Adherence to antiretroviral treatment (ART) is the primary factor determining how an individual responds to their treatment. Unfortunately, individuals who use substances experience suboptimal adherence to their treatment, but little is known about the exact effects of their use on ART adherence in primary health care settings. The authors used a prospective cohort study to evaluate substance use's effects on ART adherence among people living with HIV (PLWH) who attend primary health care services in the Mthatha region of South Africa. During the study period, 601 PLWH were followed up for 6 months. The participant's mean age was 38.5 (standard deviation [s.d.] = 11) years, with a mean CD4 count of 491.7 (s.d. = 241). Suboptimal ART adherence and default rates were 20.2% and 9.3%, respectively. Among the substance users, suboptimal adherence to ART was statistically significantly higher than non-users (24.6% and 15.9%, respectively,p= 0.007). The authors also observed suboptimum ART adherence among people who presented with clinical comorbidities. Substance use has negatively affected ART adherence among PLWH who attend primary health care services in the Eastern Cape province of South Africa. Therefore, an integrated substance use management strategy in primary health care is recommended to achieve optimal adherence to ART.Contribution:Substance use disorder significantly affected the adherence to ART in primary health care. This is important since primary care is the gateway to the HIV care continuum. The study highlighted the role of integration of substance use management in primary care.

Integrating substance use and mental health services

People living with HIV have an increased prevalence and frequency of medical, psychiatric, and substance-use disorders that result in increased age-matched morbidity and mortality. 1 Altice FL Kamarulzaman A Soriano VV Schechter M Friedland GH Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010; 376: 367-387 Summary Full Text Full Text PDF PubMed Scopus (350) Google Scholar Alcohol, tobacco, and other substance use often co-occur with depression, anxiety, and chronic pain. This constellation of alcohol, substance, and mood-related (CASM) conditions disproportionately affects people with HIV. 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response and contribute to the goal of ending AIDS by 2030. 3 Bulstra CA Hontelez JAC Otto M et al. Integrating HIV services and other health services: a systematic review and meta-analysis. PLoS Med. 2021; 18e1003836 Crossref Scopus (8) Google Scholar In The Lancet HIV, Anna Bershteyn and colleagues 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar showed that primary care providers of people with HIV in the USA should consider comprehensive diagnostic assessment of CASM if one or more conditions screen positive, a strategy that could increase life expectancy by nearly a year, exceeding life expectancy gains from benchmark preventative care recommendations. 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling studyPrimary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. Full-Text PDF

Integration of Substance Use Disorder Treatment Into a Traditional Community Mental Health Treatment System.

In response to the opioid crisis, Catholic Charities of Baltimore sought to integrate substance use disorder treatment into their outpatient community mental health clinics. The agency developed a systematic practice improvement strategy that included a competency-based curriculum and supervision plan for psychiatric providers and therapists. Psychiatric providers developed competency with medications used to treat substance use disorders, and therapists developed competency in therapeutic modalities to treat substance use disorders, all of which were gradually integrated into outpatient clinics. This column demonstrates that integration of substance use disorder treatment into outpatient community mental health care is feasible and beneficial.

Advancing the behavioral health workforce: An innovative integrated care and substance use disorder training model to improve outcomes for people in medically underserved communities.

It is critical that we strengthen the ability of the behavioral health workforce to better manage the complex behavioral and physical health needs of people in medically underserved areas. Despite the knowledge that integrated care (IC) models improve patient outcomes and experience, provider satisfaction, and health care costs, educational and experiential training in IC is limited, limiting workforce capacity to deliver this care. Through the Health Resources and Services Administration-funded Rutgers University Integrated Substance Use Disorder Training Program (RUISTP), we partner with community-based primary care clinics to implement an interprofessional fellowship program for psychologists, social workers, physician assistants, and advanced practice nurses. The RUISTP simultaneously provides training and implements IC within these community-based systems. Our multiple-methods evaluation design examines data-driven indicators of feasibility, uptake, and program success during implementation and sustainability phases and assesses changes in organizational beliefs and practices, provider competencies, and service utilization throughout the project period. This article describes the significance and innovation of (a) an IC training program, (b) an implementation plan for sustained change within systems of care, and (c) evaluative methodology to assess and improve IC and SUD service delivery and training. These data will be used to create a template for other academic and health care systems nationally. It is the mission of this program to use an innovative training, implementation, and evaluation design to enhance IC and SUD services, bolster the behavioral health workforce trained to provide high-quality IC, and inform replications of this model in other geographic and clinical settings, particularly those in medically underserved communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).