Approaches that integrate addiction treatment with primary health care are needed now more than ever because:
1) we understand substance use disorder to be a chronic illness requiring ongoing recovery management rather than isolated episodes of treatment &
2) there has been a shift in health care to emphasize both effectiveness and lower costs
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If substance use disorders are to be treated as chronic diseases, as many experts have suggested, primary care will likely have to play a significant role. Primary care doctors already have ongoing, long-term follow-ups with their patients, and are well trained to make referrals to specialty treatment when it is needed.
Recently, accessibility to one’s primary care doctor has increased with the introduction of electronic documentation (e.g., health records) & communication (e-mail) platforms.
This technology increases the potential positive role primary care could play in helping individuals with substance use disorder manage their recoveries over time, particularly after they complete what are often short (2-6 week) episodes of addiction treatment.
This study by Weisner and colleagues tested whether a treatment designed specifically to increase patient activation, improved substance use and mental health outcomes for individuals in addiction treatment.
The patient activation intervention, called LINKAGE, consisted of groups two times per week for 3 weeks, for a possible total of six groups and was integrated into an existing 6-week outpatient substance use disorder (SUD) treatment. LINKAGE was compared to the usual medical education group that was already standard in the 6-week SUD treatment.
LINKAGE consisted of:
The intervention also allowed patients to ask for their therapists’ help in communicating with the primary care physician as needed. Patients were assigned to either LINKAGE or the usual medical education depending on when they entered treatment in 3-month segments, whereby the LINKAGE intervention was included in the substance use disorder (SUD) treatment then subsequently withdrawn (an “on/off” design).
The standard outpatient addiction treatment that all patients received involved:
The 252 individuals receiving LINKAGE and 251 individuals receiving usual medication education were compared on:
There were no statistically significant differences between the groups 6 months after they entered the study (4.5 months after they completed treatment) on their substance use disorder treatment attendance (79 days for LINKAGE vs. 71 days for usual medication education), abstinence rates (71 vs. 67%), heavy drinking in the past 30 days (13 vs. 19%), or in the proportion of the group with moderate to severe depression defined as a depression score 15 or higher (8 vs. 7%), or with psychiatric disorder in addition to substance use disorder.
Despite these similar substance use and mental health outcomes, LINKAGE patients were more engaged health care participants. They had twice as many log-in days to their patient portal during the intervention, an advantage maintained through the 6-month follow-up, and were also more likely to talk with their primary care physician about their alcohol and drug use at 6-month follow-up (71 vs. 51%).
While more of the LINKAGE patients with a co-occurring psychiatric disorder, such as major depressive disorder, had a meaningful increase in their patient engagement at the 6-month follow-up (3 or more points; 61 vs. 51%), this did not quite reach the threshold considered to be statistically reliable.
This study was an important step in our efforts to bridge specialty substance use disorder (SUD) treatment and primary health care.
As authors point out, it may take several more months (or years) to observe benefits of better engaging addiction treatment patients to primary health care. While there were better outcomes for individuals who attended all six LINKAGE sessions or for those who used the therapist facilitated health communication option, this could also reflect more motivation and eagerness to get well in this group.
Another study that attempted to improve health care engagement among individuals with substance use disorders (SUD) had similar types of results. The AHEAD trial tested chronic care management (CCM) to engage alcohol/drug addicted individuals with addiction treatment resources. Despite the chronic care management group’s increased addiction treatment utilization, they were not different on substance use outcomes compared to usual primary care, which included providing patients with a list of treatment resources despite increased addiction treatment utilization.
This lack of effectiveness was also true for those who had co-occurring psychiatric disorders in addition to substance use disorder, a study we reviewed in a previous Recovery Bulletin. One major difference between that study and the current study is that in LINKAGE, the intervention was delivered in specialty substance use disorder treatment and intended to engage individuals with primary care, while AHEAD was delivered in primary care and intended to engage individuals with substance use disorder treatment services.
Efforts to integrate substance use disorder (SUD) treatment and primary care lead to more overall health care engagement, but not better substance use or mental health outcomes.
The most important next step seems to be more extensive intervention or perhaps a different approach. Also, longer-term follow-up might be needed as 6 months may not be a sufficient amount of time to capture LINKAGE’s benefit. . One piece of that long-term follow-up would ideally include how quickly individuals are able to re-initiate abstinence or low-risk drinking with or without specialty care after relapse.
An intervention protocol known as “recovery management checkups”, for example, that checks in with patients following substance use disorder (SUD) treatment every 3 months over several years, has been shown as a cost-effective approach that gets people back into treatment sooner when they need it and improves outcomes over time.
Weisner, C. M., Chi, F. W., Lu, Y., Ross, T. B., Wood, S. B., Hinman, A., . . . Sterling, S. A. (2016). Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.0970
l
If substance use disorders are to be treated as chronic diseases, as many experts have suggested, primary care will likely have to play a significant role. Primary care doctors already have ongoing, long-term follow-ups with their patients, and are well trained to make referrals to specialty treatment when it is needed.
Recently, accessibility to one’s primary care doctor has increased with the introduction of electronic documentation (e.g., health records) & communication (e-mail) platforms.
This technology increases the potential positive role primary care could play in helping individuals with substance use disorder manage their recoveries over time, particularly after they complete what are often short (2-6 week) episodes of addiction treatment.
This study by Weisner and colleagues tested whether a treatment designed specifically to increase patient activation, improved substance use and mental health outcomes for individuals in addiction treatment.
The patient activation intervention, called LINKAGE, consisted of groups two times per week for 3 weeks, for a possible total of six groups and was integrated into an existing 6-week outpatient substance use disorder (SUD) treatment. LINKAGE was compared to the usual medical education group that was already standard in the 6-week SUD treatment.
LINKAGE consisted of:
The intervention also allowed patients to ask for their therapists’ help in communicating with the primary care physician as needed. Patients were assigned to either LINKAGE or the usual medical education depending on when they entered treatment in 3-month segments, whereby the LINKAGE intervention was included in the substance use disorder (SUD) treatment then subsequently withdrawn (an “on/off” design).
The standard outpatient addiction treatment that all patients received involved:
The 252 individuals receiving LINKAGE and 251 individuals receiving usual medication education were compared on:
There were no statistically significant differences between the groups 6 months after they entered the study (4.5 months after they completed treatment) on their substance use disorder treatment attendance (79 days for LINKAGE vs. 71 days for usual medication education), abstinence rates (71 vs. 67%), heavy drinking in the past 30 days (13 vs. 19%), or in the proportion of the group with moderate to severe depression defined as a depression score 15 or higher (8 vs. 7%), or with psychiatric disorder in addition to substance use disorder.
Despite these similar substance use and mental health outcomes, LINKAGE patients were more engaged health care participants. They had twice as many log-in days to their patient portal during the intervention, an advantage maintained through the 6-month follow-up, and were also more likely to talk with their primary care physician about their alcohol and drug use at 6-month follow-up (71 vs. 51%).
While more of the LINKAGE patients with a co-occurring psychiatric disorder, such as major depressive disorder, had a meaningful increase in their patient engagement at the 6-month follow-up (3 or more points; 61 vs. 51%), this did not quite reach the threshold considered to be statistically reliable.
This study was an important step in our efforts to bridge specialty substance use disorder (SUD) treatment and primary health care.
As authors point out, it may take several more months (or years) to observe benefits of better engaging addiction treatment patients to primary health care. While there were better outcomes for individuals who attended all six LINKAGE sessions or for those who used the therapist facilitated health communication option, this could also reflect more motivation and eagerness to get well in this group.
Another study that attempted to improve health care engagement among individuals with substance use disorders (SUD) had similar types of results. The AHEAD trial tested chronic care management (CCM) to engage alcohol/drug addicted individuals with addiction treatment resources. Despite the chronic care management group’s increased addiction treatment utilization, they were not different on substance use outcomes compared to usual primary care, which included providing patients with a list of treatment resources despite increased addiction treatment utilization.
This lack of effectiveness was also true for those who had co-occurring psychiatric disorders in addition to substance use disorder, a study we reviewed in a previous Recovery Bulletin. One major difference between that study and the current study is that in LINKAGE, the intervention was delivered in specialty substance use disorder treatment and intended to engage individuals with primary care, while AHEAD was delivered in primary care and intended to engage individuals with substance use disorder treatment services.
Efforts to integrate substance use disorder (SUD) treatment and primary care lead to more overall health care engagement, but not better substance use or mental health outcomes.
The most important next step seems to be more extensive intervention or perhaps a different approach. Also, longer-term follow-up might be needed as 6 months may not be a sufficient amount of time to capture LINKAGE’s benefit. . One piece of that long-term follow-up would ideally include how quickly individuals are able to re-initiate abstinence or low-risk drinking with or without specialty care after relapse.
An intervention protocol known as “recovery management checkups”, for example, that checks in with patients following substance use disorder (SUD) treatment every 3 months over several years, has been shown as a cost-effective approach that gets people back into treatment sooner when they need it and improves outcomes over time.
Weisner, C. M., Chi, F. W., Lu, Y., Ross, T. B., Wood, S. B., Hinman, A., . . . Sterling, S. A. (2016). Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.0970
l
If substance use disorders are to be treated as chronic diseases, as many experts have suggested, primary care will likely have to play a significant role. Primary care doctors already have ongoing, long-term follow-ups with their patients, and are well trained to make referrals to specialty treatment when it is needed.
Recently, accessibility to one’s primary care doctor has increased with the introduction of electronic documentation (e.g., health records) & communication (e-mail) platforms.
This technology increases the potential positive role primary care could play in helping individuals with substance use disorder manage their recoveries over time, particularly after they complete what are often short (2-6 week) episodes of addiction treatment.
This study by Weisner and colleagues tested whether a treatment designed specifically to increase patient activation, improved substance use and mental health outcomes for individuals in addiction treatment.
The patient activation intervention, called LINKAGE, consisted of groups two times per week for 3 weeks, for a possible total of six groups and was integrated into an existing 6-week outpatient substance use disorder (SUD) treatment. LINKAGE was compared to the usual medical education group that was already standard in the 6-week SUD treatment.
LINKAGE consisted of:
The intervention also allowed patients to ask for their therapists’ help in communicating with the primary care physician as needed. Patients were assigned to either LINKAGE or the usual medical education depending on when they entered treatment in 3-month segments, whereby the LINKAGE intervention was included in the substance use disorder (SUD) treatment then subsequently withdrawn (an “on/off” design).
The standard outpatient addiction treatment that all patients received involved:
The 252 individuals receiving LINKAGE and 251 individuals receiving usual medication education were compared on:
There were no statistically significant differences between the groups 6 months after they entered the study (4.5 months after they completed treatment) on their substance use disorder treatment attendance (79 days for LINKAGE vs. 71 days for usual medication education), abstinence rates (71 vs. 67%), heavy drinking in the past 30 days (13 vs. 19%), or in the proportion of the group with moderate to severe depression defined as a depression score 15 or higher (8 vs. 7%), or with psychiatric disorder in addition to substance use disorder.
Despite these similar substance use and mental health outcomes, LINKAGE patients were more engaged health care participants. They had twice as many log-in days to their patient portal during the intervention, an advantage maintained through the 6-month follow-up, and were also more likely to talk with their primary care physician about their alcohol and drug use at 6-month follow-up (71 vs. 51%).
While more of the LINKAGE patients with a co-occurring psychiatric disorder, such as major depressive disorder, had a meaningful increase in their patient engagement at the 6-month follow-up (3 or more points; 61 vs. 51%), this did not quite reach the threshold considered to be statistically reliable.
This study was an important step in our efforts to bridge specialty substance use disorder (SUD) treatment and primary health care.
As authors point out, it may take several more months (or years) to observe benefits of better engaging addiction treatment patients to primary health care. While there were better outcomes for individuals who attended all six LINKAGE sessions or for those who used the therapist facilitated health communication option, this could also reflect more motivation and eagerness to get well in this group.
Another study that attempted to improve health care engagement among individuals with substance use disorders (SUD) had similar types of results. The AHEAD trial tested chronic care management (CCM) to engage alcohol/drug addicted individuals with addiction treatment resources. Despite the chronic care management group’s increased addiction treatment utilization, they were not different on substance use outcomes compared to usual primary care, which included providing patients with a list of treatment resources despite increased addiction treatment utilization.
This lack of effectiveness was also true for those who had co-occurring psychiatric disorders in addition to substance use disorder, a study we reviewed in a previous Recovery Bulletin. One major difference between that study and the current study is that in LINKAGE, the intervention was delivered in specialty substance use disorder treatment and intended to engage individuals with primary care, while AHEAD was delivered in primary care and intended to engage individuals with substance use disorder treatment services.
Efforts to integrate substance use disorder (SUD) treatment and primary care lead to more overall health care engagement, but not better substance use or mental health outcomes.
The most important next step seems to be more extensive intervention or perhaps a different approach. Also, longer-term follow-up might be needed as 6 months may not be a sufficient amount of time to capture LINKAGE’s benefit. . One piece of that long-term follow-up would ideally include how quickly individuals are able to re-initiate abstinence or low-risk drinking with or without specialty care after relapse.
An intervention protocol known as “recovery management checkups”, for example, that checks in with patients following substance use disorder (SUD) treatment every 3 months over several years, has been shown as a cost-effective approach that gets people back into treatment sooner when they need it and improves outcomes over time.
Weisner, C. M., Chi, F. W., Lu, Y., Ross, T. B., Wood, S. B., Hinman, A., . . . Sterling, S. A. (2016). Examination of the Effects of an Intervention Aiming to Link Patients Receiving Addiction Treatment With Health Care: The LINKAGE Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.0970
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