System Transformation in Substance Use Disorder Care: New York State Progress and Priorities

The Surgeon General’s Report on Alcohol, Drugs, and Health (, issued in November 2016, is a landmark report for the substance use disorder (SUD) care system. This report makes clear the importance of identifying and treating substance use disorders and places emphasis on integration of treatment with physical health, prevention efforts, early intervention and the reduction of stigma. Only 1 in 14 people who have a substance use disorder access care. There are many reasons2 for this including: not knowing where to get care, not being sure that care is needed, worry about employer finding out and not being able to pay for care. The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) has been working with providers, plans, recovering individuals and family members affected by substance use disorder to ensure that Substance Use services are able to meet the challenges of the current opioid crisis and that we use this crisis to strengthen SUD services to meet challenges beyond the current crisis for all substances including alcohol. With all of this in mind OASAS will focus efforts in the coming year to consolidate gains made through Medicaid Re-design to improve access, better integrate substance use services and improve quality to ensure a welcoming environment for all individuals seeking help.

Physical health providers must improve identification of substance use which will improve health care outcomes, reduce costs and most importantly improve quality of life. In order to achieve that promise, we must all come together to recognize the problem, speak about it, intervene when someone is in trouble, and follow-through by getting help. Treatment options must be accessible, 21`which means that they are available when people are ready to reach out, and responsive and engaging regardless of where people are in recognition of substance use as a problem. Together physical health, mental health and specialty provides must ask questions about substance use and must have the confidence and competence to intervene.

We must build bridges from the community providers to primary care, emergency and specialty care providers so that the expertise of the SUD specialty system is available to other settings and that relationships are established to ensure bi-directional linkages to care. Providers must respond to the demands that greater identification and early intervention will create and they need to build the capacity to respond to urgent and emergency patient need at off-hours, in the community and with peers who can share experience and help to connect individuals to the right care. OASAS has been encouraging providers to join together to break down silos between treatment settings. We need everyone involved to solve problems with gaps in care in order to make a difference.

We need a continuum of care with easy access to the best place for care after a professional assessment. It is too hard for an individual who has made a decision to enter treatment to wait for that care for an extended time. OASAS has developed the treatment availability tool, at  (, so that individuals and family members can find treatment that is right for them. It is hard to know without professional advice what care is best for the person and that kind of professional assessment and consultation should be available 24 hours a day 7 days per week, regionally, and as locally as possible. People in an urgent situation, whether they are experiencing withdrawal or an event that has lead them to acknowledge a need for change, are still, too often, seen in emergency room settings where they will be stabilized but may never have an assessment or treatment. Most SUD concerns can be met in community settings, whether a person needs medication, group individual and family counseling, or an admission to an inpatient or residential setting. We know is that it is best to deliver that care as soon as possible.

We also need to better integrate the SUD continuum of care so prevention and recovery services are a part of the SUD system of care well and that the silos of treatment, recovery and prevention are broken down. Everyone is impacted by substance use, whether as a community member, family member or friend, a person needing help or a person in recovery. We see the large and integrated community of people within other health conditions working together to prevent, promote health and early intervention, treatment and support. We need this same community around substance use disorder.

Together, we need to change the narrative about substance use. The Surgeon General very directly identifies that stigma reduces access and marginalizes treatment and those impacted by the disorder. The way we talk about addiction and respond to it matters and we can encourage people to acknowledge problems with substances, seek treatment and continue to work towards long term recovery by discouraging the behavior of substance misuse but not ostracizing the person with the disorder. Addiction can happen to anyone who uses substances, including alcohol. Although we know that individuals who have genetic predisposition, a history of trauma or mental health disorder at higher risk. We must welcome people who are seeking help into care, not scare them away. Addiction shares a lot of similarities with diabetes in that behaviors impact the development of the disorder and difficult behavioral changes are required to attain remission and long-term recovery. We do not shame individuals with diabetes or other chronic health conditions, and we should not shame those who have a Substance Use Disorder.

Individuals with SUD need access to high quality care. In order to identify quality, we must develop measures of quality including system level metrics of access and identification, individual metrics of engagement, linkage to next levels of care following detox and inpatient care, medications treatment when an FDA approved medication is available, connection to recovery support, and positive response to treatment. OASAS is working with providers, payers, state partners and other stakeholders together with the National Center on Alcohol and Substance Abuse to develop meaningful measures. These measures of quality should be reflective of standards of care and reflect the best evidence available for successful treatment.

Individuals need to be able to be welcomed to care and have information provided in terms they understand in a way that is respectful and supportive. Like diabetes and other chronic health conditions, not everyone is ready to commit to treatment fully, others are in need of a structured and abstinence-based approach. Quality treatment is able to meet the needs of all individuals presenting for treatment, regardless of current commitment to change. Individuals seeking care should expect to be treated by qualified staff with treatments that are based on the best evidence available.

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