For example, a recent study found that doctors continue to prescribe opioids for 91 percent of patients who suffered a non-fatal overdose, with 63 percent of those patients continuing to receive high doses 17 percent of these patients overdosed again within 2 years. When health care is not well integrated and coordinated across systems, too many patients fall through the cracks, leading to missed opportunities for prevention or early intervention, ineffective referrals, incomplete treatment, high rates of hospital and emergency department readmissions, and individual tragedies that could have been prevented. A wide range of health care settings is needed to effectively meet the diverse needs of patients. Mild substance use disorders may respond to brief counseling sessions in primary care, while severe substance use disorders are often chronic conditions requiring substance use disorder treatment like specialty residential or intensive outpatient treatment as well as long-term management through primary care. Thus, screening for substance misuse and substance use disorders in diverse health care settings is the first step to identifying substance use problems and engaging patients in the appropriate level of care. But individuals with substance use disorders often do access the health care system for other reasons, including acute health problems like illness, injury, or overdose, as well as chronic health conditions such as HIV/AIDS, heart disease, or depression.
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It is known that most people with substance use disorders do not seek treatment on their own, many because they do not believe they need it or they are not ready for it, and others because they are not aware that treatment exists or how to access it.
Health care systems are made up of diverse health care organizations ranging from primary care, specialty substance use disorder treatment (including residential and outpatient settings), mental health care, infectious disease clinics, school clinics, community health centers, hospitals, emergency departments, and others. Because these changes are still underway, much of the relevant research is still formative and descriptive information presented in this chapter often derives from reports and descriptive papers.
This chapter also describes the challenges to effective integration, as well as promising trends, such as in health information technology (health IT) that will facilitate it. This chapter describes the key components of health care systems historical reasons substance use and its consequences have been addressed separately from other health problems the key role that health care systems can play in providing prevention, treatment, and recovery support services (RSS) for substance use disorders and the recent developments that are leading to improved integration of substance use-related care with the rest of medicine. Integrating services for primary care, mental health, and substance use-related problems together produces the best outcomes and provides the most effective approach for supporting whole-person health and wellness. The systematic coordination of general and behavioral health care. Recent health care reform laws, as well as a wide range of other trends in the health care landscape, are facilitating greater integration to better serve individual and public health, reduce health disparities, and reduce costs to society. Effective integration of prevention, treatment, and recovery services across health care systems is key to addressing substance misuse and its consequences and it represents the most promising way to improve access to and quality of treatment. Because substance misuse has traditionally been seen as a social or criminal problem, prevention services were not typically considered a responsibility of health care systems i and people needing care for substance use disorders have had access to only a limited range of treatment options that were generally not covered by insurance. Services for the prevention and treatment of substance misuse and substance use disorders have traditionally been delivered separately from other mental health and general health care services.
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