Can Substance Use Disorders be Managed Using the Chronic Care Model? Review and Recommendations from a NIDA Consensus Group

Abstract

Brain imaging and genetic studies over the past two decades suggest that substance use disorders are best considered chronic illnesses. The passing of the Affordable Care Act in the United States has set the occasion for integrating treatment of substance use disorders into mainstream healthcare; and for using the proactive, team-oriented Chronic Care Model (CCM). This paper systematically examines and compares whether and how well the CCM could be applied to the treatment of substance use disorders, using type 2 diabetes as a comparator. The chronic illness management approach is still new in the field of addiction and research is limited. However comparative findings suggest that most proactive, team treatment-oriented clinical management practices now used in diabetes management are applicable to the substance use disorders; capable of being implemented by primary care teams; and should offer comparable potential benefits in the treatment of substance use disorders. Such care should also improve the quality of care for many illnesses now negatively affected by unaddressed substance abuse.

Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs

“…While there exists some evidence in support of SBIRT in primary care for patients with unhealthy drug use (Madras et al, 2009), there have been few such trials to date and more studies are needed to examine the efficacy of SBIRT in this population (Saitz et al, 2010; Pilowsky & Wu, 2012). Nonetheless, a consensus group convened by the National Institute on Drug Abuse recently came out in support of providing care for substance use disorders, including risky drug use, in primary care settings (McLellan et al, 2014). Moreover, the U.S. Preventive Services Task Force recommends that primary care providers (PCPs) routinely screen adult patients for alcohol use and provide brief behavioral counseling interventions to those engaged in risky or hazardous drinking (Moyer, 2013), echoing similar recommendations by the American Society of Addiction Medicine (American Society of Addiction Medicine, 1997), the National Institute on Alcohol Abuse and Alcoholism (National Institute on Alcohol Abuse and Alcoholism, 2007), the American College of Obstetricians and Gynecologists (American College of Obstetricians and Gynecologists, 2011), and the American Academy of Pediatrics (Levy & Kokotailo, 2011).…”

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

“…Chronic disease management, according to Kim et al (2011), "offers the potential to follow individuals longitudinally, monitor disease progression, and enhance treatment adherence" (p. 80). Foremost in these discussions are health challenges such as asthma, diabetes, and heart disease; yet, as McLellan et al (2014) noted, substance use fits solidly within this framework. Consistent with this approach, greater emphasis is placed on comprehensive care and extended services, which points to a potentially important role for case management (Chi, Parthasarathy, Mertens, & Werner, 2011;Dennis & Scott, 2007;Kim et al, 2011;McKay & Hiller-Sturmhofel, 2011;Pating et al, 2012).…”

Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial

“…Emerging literature suggests that substance use disorders may benefit from treatment that utilizes the chronic care model (CCM) first described by Bodenheimer, Wagner and colleagues (Bodenheimer et al, 2002). This model, shown to be effective in the treatment of chronic pain and diabetes, demonstrated more favorable outcomes with sustained coordinated therapeutic interventions when compared to acute treatment (Bodenheimer et al, 2002;Dobscha et al, 2009;McLellan et al, 2014;O'Connor et al, 2011). This treatment model suggests potential benefits of implementing TES over longer periods of time than that employed in the present study.…”