Primary care providers, such as general practitioners, are often the first port of call for people seeking physical and mental health treatment. This provides a suitable opportunity to conduct substance use assessments and referrals to treatment. State-specific strategies are being implemented to improve access to addiction treatment through this pathway.
Why primary care plays a key role in addiction treatment
Primary care can play a crucial role in substance use disorder (SUD) treatment. Many people with a SUD experience barriers to treatment, such as stigma, lack of knowledge of available services, or a reluctance to seek specialist support. Because of this, reportedly only around 20% of people with an SUD receive treatment. [1][2]
Many people with SUDs receive healthcare services from a primary care provider, who might identify SUD treatment needs during an appointment about other mental or physical health concerns. This means that primary care settings can provide an important opportunity to recognize SUD treatment needs that might otherwise go unnoticed and make necessary referrals and recommendations. [2]
What the NASHP report found
The National Academy for State Health Policy (NASHP) published a report analyzing current state-level strategies for care coordination between primary and SUD treatment settings. They found that screening, brief intervention, and referral to treatment (SBIRT) has expanded among primary care providers, but challenges remain. [2]
Identified challenges include: [1][2]
- SUDs continue to go largely untreated, causing many health, societal, and economic consequences.
- Referral to treatment is not routinely happening, leaving people unsupported.
- Treatment engagement and retention are not consistent.
- There is a lack of active support and connection between primary and SUD treatment providers, creating disjointed pathways and gaps in engagement and follow-up.
- Primary care providers lack necessary training or time to effectively manage complex referrals.
Recognized practices
Some states were recognized in the report for utilizing successful referral models, such as: [2]
- New Hampshire: The Screen and Intervene initiative was introduced to improve training and implementation of SBIRT.
- Oregon: University-developed SBIRT training, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has been expanded across the state to improve screening, referrals, and care coordination, alongside financial incentives.
- Kentucky: Peer support integrated into primary care, including recovery coaching and outreach.
- Massachusetts: Grant-funded initiative to improve working relationships between SBIRT staff and SUD treatment providers, including hospitals, clinics, and local and government agencies.
Key recommendations from the report include: [2]
- Referral to treatment should provide active ongoing support after hand-off, including peer and community support and follow-up.
- Improve information access so primary care providers can quickly and effectively identify and refer to appropriate services.
- States can financially compensate primary providers who follow up with and track patients after referral, to help improve retention and engagement.
SBIRT: The foundation of effective referrals
SBIRT is the foundation for ensuring individuals are linked to necessary services. After identifying SUD treatment needs through screening, individuals should be supported in the handover to an appropriate service. However, this process is seemingly fragmented at present, failing to provide integrated pathways. [2][3]
Improving training and incentives for implementing the referral process can facilitate effective, active, and streamlined connections from primary care to SUD care. Various state-level initiatives are being enacted to improve the transition from screening to treatment. [2][3]
Strategies that improve treatment connections
Strategies to improve treatment connections include: [2][3]
- “Warm hand-offs”: Introducing individuals to the SUD treatment team or specialist during a primary care appointment to provide in-person hand-offs and active connections. This also presents an opportunity for streamlined communication and clarification between all parties.
- Multi-disciplinary approaches: Incorporating a range of treatment providers in the development of an individual’s treatment plan that bridges gaps between primary, SUD, and community support services.
- Inter-organizational relationship development: Providing training, funding, and opportunities for care providers to meet one another, to develop working relationships and integrate treatment approaches.
- Financial reimbursement and incentivization: Reimburse or incentivize primary care providers to offer continued or follow-up care that bridges treatment gaps and ensures effective referral processes.
- Digital networks: Increase access and utilization of technology to improve information gathering, treatment plan development, and patient tracking and follow-up.
Overcoming common barriers to referral success
A common barrier to referral success is time constraints. Utilizing a multidisciplinary team helps to distribute workload and responsibilities across various professional disciplines. Similarly, databases and registries can reduce time spent identifying treatment resources and ensure a quick and effective referral process. [2][3]
Another common barrier is the level of disengagement, failure to attend, or drop-outs. Various strategies are being implemented to overcome this. Warm hand-offs and well-supported transitions help individuals feel trust in the team and increase the likelihood of attending the next appointment. [2]
Likewise, implementing patient-centered approaches and using modalities such as motivational interviewing and harm reduction techniques increases engagement, reduces stigma, and increases trust.
Databases and online networks can speed up the process of scheduling next appointments. This also helps improve engagement and attendance, particularly if appointments are scheduled within a short period of the screening appointment. [2]
What patients should expect when talking to their doctor
Primary care physician visits regarding SUDs should involve clear discussions around confidentiality, with supportive, compassionate communication. The doctor will conduct a screening assessment to determine the individual’s SUD severity and treatment needs, and they can jointly discuss and decide on appropriate options.
Incorporating the individual’s preferences and their assessment results, the doctor will make a referral to SUD services that can meet their needs. This should involve developing a clear plan that guides the pathway from primary to SUD treatment implementation and details about long-term integrated professional and peer support. [3]
Final thoughts
For people who are concerned about their substance use, a primary care provider can be a supportive and accessible starting point for receiving assessment and referral to suitable services.
Ongoing improvements to local services and their connections with SUD treatments will continue to strengthen this process and streamline pathways, ultimately improving SUD treatment outcomes.
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