While there’s encouraging data to suggest that the United States may be experiencing a reprieve in the decades-long trend of opioid overdose deaths, the last several years has seen a big jump in patients struggling with ongoing substance use.
Similarly, after years of headlines telling us that ‘America Eschews the Booze’, deaths related to alcohol use are still significantly above where they were a decade ago.
Collectively, Americans struggling with addiction to alcohol, opioids, or other drugs are dealing with Substance Use Disorders (SUDs), which is considered an emerging condition for treatment by the Collaborative Care model.
What Do We Mean by ‘Emerging’?
While the efficacy of the Collaborative Care model has been studied since the 1990s, investigation of the model to treat SUDs is more recent. But these things are relative—the model has been demonstrating efficacy in treating patients with SUDs for nearly a decade.
And about five years ago, Cecilia Livesey, MD, summarized the state of affairs for the American Medical Association: “The collaborative care model has proven successful for mild-to-moderate depression, anxiety, alcohol-use disorder, and has shown promise with other conditions, including opioid-use disorder, which is currently under investigation at Penn Medicine and several other institutions.”
More research is needed, and will continue. But it will take time, because of the relative difficulty in conducting large, rigorous studies on patients with SUDs. Enrolling a large number of patients in a randomized clinical trial for SUDs and following them continually over a period of several months poses challenges far beyond those of studying Collaborative Care to treat depression or anxiety, for example.
Is Collaborative Care a Fit?
Research shows that when compared to ‘usual care’ (which might involve a non-integrated referral and longer wait times), patients diagnosed with SUD and treated with the Collaborative Care approach show a meaningful difference: “After six months, participants in the collaborative care group were more likely than people receiving usual care to receive an evidence-based OAUD treatment (39 percent versus 17 percent) and more likely to be abstinent from opioids or alcohol (33 percent versus 22 percent), the authors reported.”
While the model is never assumed to be a fit for all patients—those with extreme acute needs or in medical crisis will need other prompt interventions—there are reasons to believe that Collaborative Care can have a positive impact on a large swath of people. We know that patients diagnosed with SUD often have comorbid behavioral health conditions, so ensuring that these patients have access to both behavioral health and psychiatric resources means that care teams focus on whole-patient care.
Adaptation and Clinician Training is Needed
One of the reasons why headlines still say that Collaborative Care “may” improve outcomes for patients with SUDs is that the model benefits from adaptation for specific use cases, and is expected to be less effective without adaptations. SUDs are different from anxiety, trauma, suicide risk, and other conditions, and so clinicians treating with the Collaborative Care model benefit from training and development to ensure that treatment is maximally effective.
When studying Collaborative Care
for treating SUDs, the efficacy question
may be less a matter or concept
and more of execution.
The American Psychiatric Association has summarized the considerations and the ways in which screening, diagnosing, and treating with evidence-based approaches may differ for patients presenting with SUDs as compared to a more generalized approach. In this sense, when studying Collaborative Care for treating SUDs, the efficacy question may be less a matter or concept and more of execution. Attention to workforce development and staying on top of the latest developments in substance use research will help ensure the likelihood of success.
Don’t Accept the Status Quo
New research continues to arrive. Just this summer, JAMA Psychiatry published results of a new study finding that “collaborative care that treats both opioid use disorder and co-occurring mental health symptoms is more effective at reducing the number of days of nonmedical use of opioids (but not mental health–related quality of life) than collaborative care that only treats co-occurring mental health symptoms.”
The research on efficacy and the adaptation and application of the model onto SUDs is ongoing. We should not only expect it, but welcome it. By integrating behavioral health treatments and collaborating across care teams, we can both engage and effectively treat more patients struggling with substance use.