Primary care providers need to be better equipped at addressing substance use disorders

Opioid overdoses are the number one cause of accidental death in the United States, and rates of mental health diagnoses are rising exponentially.

Primary care providers have had to take on the front-line assessment of these conditions, especially in rural areas where access to resources is limited. Yet, PCPs are well behind the curve to effectively manage these conditions. The current mental health and addiction education in medical school, let alone preparation, is limited at best. And although we’re trying to catch up, the truth is, depressive and substance use disorders don’t wait for available treatment, they only exacerbate.

With a shortage in mental health specialists in nearly half the country, according to the Kaiser Family Foundation, and a lack of services in rural communities altogether, there is an increased demand for expanded mental health and substance use disorder assessment in primary care. So, with time being the most limited commodity when taking care of patients, a little advanced preparation can produce a meaningful and purposeful office visit for someone with substance use issues.

As we attempt to keep up with the ever-increasing needs in the U.S., here is how we can better support these individuals with substance use and mental health disorders to improve overall outcomes for these individuals in immediate need.

Expand addiction and mental health education during medical and residency training

Incorporate broader educational opportunities to understand behavioral health treatment modalities and medication options. Expanding the understanding of treatment modalities such as cognitive behavioral therapy, dialectical behavioral therapy and eye motion desensitization and reprocessing, for example, expedites treatment for patients with these disorders. Pharmaceutical mastery for mental health and substance disorders is a necessity at the training level, and ethics in behavioral health and addiction awareness is a must. Even in health care, there are some that still carry judgment and perpetuate stigma when treating individuals with addiction and mental health disorders.

Be prepared with resources

Resources are highly community specific and difficult to navigate even for the professional “in charge.” Don’t wait until someone is in crisis or reaching out for help to try and find a detox center, a rehabilitation facility or even a therapist or psychiatrist to manage medications. A day later, and it can already be too late. As simple as it may seem, know what is available in your immediate community. This includes peer recovery support services, group therapy such as Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery, Recovery Dharma, and Parents of Addicted Loved Ones, as well as many other options. United Way and 211.org are also excellent resources for individuals trying to reestablish themselves.

Be prepared to counsel

This is where our listening skills become the most critical. When someone expresses a behavioral change or they are concerned about their substance use, it is time to pull up a chair and tune in. Of course, screening as part of their overall health assessment is just as important. Many times, the family members need the assistance, the resources and the counseling, so there is no shortage of needs. The key is to be prepared to handle this delicate and vulnerable conversation and be ready to provide the help they are seeking.

Use mental health and substance use disorder assessment tools

It is important to be prepared with the multitude of downloadable assessment and screening tools available. The NIH has developed easily accessible screening tools for health professionals. With the staggering number of individuals with substance use disorder and behavioral health changes, these tools are a necessity and no longer just an option.

Build your local network

Invite your local crisis intervention or mental health deputies to a designated meeting. Coordinate care with your local therapists, psychologists and psychiatrists. Learn how to navigate your detox and rehabilitation facilities. Learn more about the Law Enforcement Assisted Diversion programs preventing individuals with substance use disorder and mental health from being housed in jail. Learn more about the American Society of Addiction Medicine’s Six Dimensions of Multidimensional Assessment used for service planning and treatment.

A new and more challenging reality has created the need to paint a different picture so that we can become the front line that we desperately need to be. This epidemic is now part of our daily practice of medicine, and we need to rise up to meet the challenge.

References:

• CDC. Understanding drug overdoses and deaths. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed Oct. 6, 2023.
• Saunders H. Kaiser Family Foundation. A look at strategies to address behavioral health workforce shortages: Findings from a survey of state Medicaid programs. https://www.kff.org/mental-health/issue-brief/a-look-at-strategies-to-address-behavioral-health-workforce-shortages-findings-from-a-survey-of-state-medicaid-programs. Published Jan. 10, 2023. Accessed Oct. 6, 2023.