Psychiatry for Primary Care: An Update on Substance Use Disorders (Part 4) – Psychiatric Times
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© 2022 MJH Life Sciences and Psychiatric Times. All rights reserved.
© 2022 MJH Life Sciences™ and Psychiatric Times. All rights reserved.
The data on substance use disorders are staggering. What can primary care providers do to help?
(This is the last part of a 4-part series. The previous pieces provided an intro to the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference, as well as updates on attention-deficit/hyperactivity disorder and suicide risk assessment and prevention.—Ed.)
The data on substance use disorders (SUDs) and overdose deaths are staggering and deeply concerning. According to the National Center for Drug Abuse Statistics, “165 million, or 60.2% of Americans aged 12 years or older, currently abuse drugs,” which includes illegal drugs, misusing prescribing drugs, and abusing alcohol and tobacco.1
Dr Gumm is a clinical assistant professor at the University of Arizona College of Medicine Department of Psychiatry, the department’s director of the Addiction Medicine Fellowship, and the medical director of addiction services at the Southern Arizona Veterans Affairs Health Care System.
She developed the University of Arizona Addiction Medicine Fellowship in 2018, and, in 2020, she secured a $1.4 million Health Resources and Services Administration (HRSA) grant to expand the fellowship and further enhance the infrastructure of the program.
The Centers for Disease Control and Prevention’s National Center for Health Statistics shows that the number of overdose deaths has climbed from more than 70,000 in the 12-month period ending in January 2018 to more than 99,000 in the 12-month period ending September 2021. Preliminary reports indicate the number of drug overdose deaths in America increased 30% in 2020. In January 2021, drug overdose deaths exceeded homicides by 307%.2
The positive implications for screening for and treating individuals with SUDs are vast, from preventing HIV and hepatitis in injection-drug users to improving patients’ physical health, mental health, employment, and housing.
Elisa Gumm, DO, who is presenting on “Screening for Addiction in a 20-Minute Appointment” at the “Psychiatry for Non-Psychiatrists: The University of Arizona Update in Behavioral Medicine for Primary Care” conference, stated that “offering addiction interventions at every level reduces the overall costs to the person and society.”
According to the National Institute on Drug Abuse publication, Principles of Drug Addiction Treatment: A Research-Based Guide, “every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1.”3
In addition, there are studies showing that addiction treatment has ripple effects and can even improve the health of family members when the patient with addiction gets treatment.4
“Primary care teams should screen for addiction and assist their patients with care,” Gumm said. “When patients receive addiction treatment, comorbidities improve. It is difficult to treat medical conditions when a patient has an active substance use disorder, including nicotine and alcohol. It makes managing numerous diseases difficult and exhausting because there seems to be a hidden factor at play.”
Primary care providers should also consider cooccurring mental health disorders, per the correlation with substance use/abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that, of adults aged 18 or older in 2020, 29% (or 74 million people) had either any mental illness (AMI) or an SUD in the past year; 14% (or 36 million people) had AMI, but not an SUD; 8% (or 21 million people) had an SUD, but not AMI; and 7% (or 17 million people) had both AMI and an SUD”(Figure 1).5
The SAMHSA report also shows the percent of adults with mental illnesses and their substance use, as summarized in Figure 2.5
Gumm recommends primary care providers implement the Screening, Brief Intervention, and Referral to Treatment (SBIRT),6 as SBIRT is “proven successful in screening patients quickly and arming primary care doctors with treatment options when the screen is positive.” She also advises to, “be kind to all those involved. Soften the approach to asking patients about addiction.”
We hope you join us and Dr Gumm to learn more about helping patients with substance use disorders on Saturday, March 12. Find conference details, including the schedule, description of presenters, and registration at Psychiatry.arizona.edu/Psych4PCPs.
Dr Karp is professor and department chair of psychiatry at the University of Arizona College of Medicine. He is an expert in the fields of geriatric psychiatry, depression treatment, and suicide prevention. He is committed to educating health care providers about the principles of psychiatry and behavioral medicine. Ms Manser is the communication and marketing specialist for the University of Arizona College of Medicine Department of Psychiatry.
1. Drug abuse statistics. National Center for Drug Abuse Statistics. February 19, 2022. Accessed February 25, 2022.
2. Vital statistics rapid release provisional drug overdose death counts. Centers for Disease Control and Prevention. February 16, 2022. Accessed February 25, 2022.
3. Is drug addiction worth the cost? National Institute on Drug Abuse. January 2018. Accessed February 25, 2022.
4. Weisner C, Parthasarathy S, Moore C, et al. Individuals receiving addiction treatment: are medical costs of their family members reduced? Addiction. 2010;105(7):1226-1234.
5. Key substance use and mental health indicators in the United States: results from the 2020 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration. Accessed February 25, 2022.
6. Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: a brief review. J Psychoactive Drugs. 2012;44(4):307-317.