The epidemic of substance use disorder (SUD) has become a plague on our society, resulting in countless deaths, overwhelming our health care and justice systems, and taking a terrible toll on the families of those suffering from this disease.
Dr. David Hans
While billions of dollars have been poured into drug and alcohol prevention campaigns and interventions designed to help those with SUD get treatment, none have been terribly effective. Despite this massive investment, in 2021 the U.S. still saw a record number of overdose deaths1 and sharp increases in drug and alcohol consumption2 over the last two years.
Perhaps the problem isn’t that we’re not doing enough to treat addiction – it’s that we’re not sufficiently addressing the root cause.
There is a clear, undeniable connection between mental health disorders and SUD. In fact, roughly 50% of those with an SUD have a co-occurring mental health disorder3 (or about 1 in 15 U.S. adults).4 These issues play a direct, predictable role in driving SUD development: research indicates that those with a mental health disorder are 5X to 18X more likely to develop an SUD5 – and those are just the ones we know about. Likely millions more suffer with undiagnosed and untreated mental illnesses, many turning to self-medicating their symptoms with alcohol, opioids or other illicit substances.
By focusing on early screenings and treatment for mental health disorders, we could prevent millions of people from developing SUDs and save countless lives. Here are six strategies that could stop SUD in its tracks by addressing the underlying cause before it becomes a deadly addiction:
1. Train Primary Care Providers (PCP) To Screen for Mental Health and Addiction Risk. While PCPs might ask patients about mental health and substance use during an annual well visit, many providers may be ill-equipped to respond appropriately if a patient admits to abusing drugs or alcohol. Training PCPs to ask the right questions about mental health and substance use and to respond appropriately to an affirmative response could provide a powerful first-line of defense in preventing a full-blown addiction from developing. Additionally, by becoming well-versed on holistic health, PCPs could screen for underlying mental health issues as part of their diagnostic workup and refer to appropriate providers immediately.
2. Raise Public Awareness of the Risks of SUD Genetic Predispositions. Evidence shows that those with a parent who’s abused alcohol or drugs have a 40-60% risk6 of developing an SUD themselves. By raising awareness of the genetic risk of SUD, we could encourage more people to seek treatment for their mental health disorders before they turn to drugs and alcohol.
Mental health is having “a moment” right now with increased awareness combating the stigma and emphasizing the importance of self-care. We should leverage this attention to encourage seeking treatment and expose the risks of substance use.
3. Provide Tools to Build Coping Skills and Mental Resilience. Stress levels continue to be at an all-time high7 for millions of Americans with social and political unrest, layoffs and economic uncertainty. It’s no wonder substance use has increased dramatically,8 putting so many people at risk for developing SUD.
Developing mental resilience is critical for effectively managing stress without substances. Health care providers, employers and health insurers should take an all-hands-on-deck approach to providing resources and tools to help us learn such coping skills as focusing on exercise, practicing mindful yoga, self-care, positivity and gratefulness. By cultivating a stronger foundation, grounded in firm mental and emotional fortitude, we could reduce the need for people to turn to substances to cope with stress.
4. Build Integrated Health Hubs. Integrated health hubs that co-locate PCPs and mental/behavioral health providers in the same building, or at least nearby, would allow providers to refer patients to a specialist right down the hall where they could be seen much faster and with greater certainty. This also provides a mechanism for follow-up and closed-loop feedback. Currently, if a PCP does refer a patient to a mental health specialist, they have no way of knowing if the patient even made the appointment. With an integrated health hub, PCPs could track whether patients attend their appointments and incorporate specialists’ feedback into patient charts and assessments.
5. Demonstrate Early Intervention Value to Payers. We know that early intervention drives better patient outcomes, but let’s face it: when it comes to insurance, money talks. Mental health crises and overdoses frequently send people to the hospital for emergency care, which is extremely expensive. Often the same patient will present for repeat incidents, racking up huge medical expenses and straining a system that’s already stretched thin.
As providers, we must demonstrate how investing in mental health treatment can avert these expensive health care encounters, thereby saving insurance providers money. By quantifying the ROI on early intervention, perhaps we can convince payers to invest more in preventative services. Right now, there isn’t even a mandate for small- to medium-sized insurers to provide mental health coverage, which is absurd. We certainly wouldn’t tolerate an insurer refusing to cover cardiac catheterization to reduce the risk of a heart attack. Why should mental health treatment to reduce the risk of an SUD be any different?
6. Incentivize Aspiring Providers. One of the biggest challenges in providing mental health services to prevent addiction is the availability of care. The behavioral health industry is suffering a severe shortage of qualified providers,9 especially in rural areas.
To get these vital, life-saving services into the communities that need them most, we must develop programs for encouraging young people to choose behavioral health as a career and incentivizing providers to work in underserved, high-risk communities. Tuition reimbursement, student loan forgiveness or perhaps a stipend to supplement compensation would make these careers more attractive and increase access to treatment.
Without a doubt, mental health screenings and access to early treatment are essential for turning the tide on the addiction crisis. However, doing so requires a collaborative response that includes government support, policy changes and participation from payers and providers. By taking a more holistic approach and mounting a comprehensive response, we can prevent SUD before it starts and save thousands of lives.
Dr. David Hans is the Chief Clinical Officer of American Addiction Centers (AAC), the nation’s leading addiction treatment provider. As CCO, Dr. Hans believes it is his duty to ensure AAC continues to consistently provide empirically based clinical services that effectively address the underlying factors and patterns of behavioral health issues. Dr. Hans brings his wide breadth of experience and skill set to expanding AAC’s clinical services, overall clinical excellence across programs, and maintaining a safe environment for patients to heal and grow.
Footnotes
- www.ama-assn.org/system/files/issue-brief-increases-in-opioid-related-overdose.pdf
- nida.nih.gov/research-topics/comorbidity/covid-19-substance-use
- americanaddictioncenters.org/co-occurring-disorders/assessment
- samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf
- americanaddictioncenters.org/blog/risk-substance-abuse-mental-illness
- nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction
- studyfinds.org/stress-americans-loneliness-mental-health/
- cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm
- aamc.org/news-insights/growing-psychiatrist-shortage-enormous-demand-mental-health-services
