Expand Early Intervention in Communities for Substance Use Disorder

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The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder and subsequent need for specialty substance use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed. Early intervention services may be considered the bridge between prevention and treatment services. For individuals with more serious substance misuse, intervention in these settings can serve as a mechanism to engage them into treatment.[1]

Background

The 2018 National Survey on Drug Use and Health[2]reported on the continued use of substances across the U.S. 

  • In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder. 
  • The most common illicit drug use disorder was marijuana use disorder (4.4 million people). An estimated 2.0 million 1.7 million people with a prescription pain reliever use disorder and 0.5 million people with a heroin use disorder.[3]

Goals of Early Intervention

Early intervention reduces the harm associated with substance use, reduces risk behaviors before they lead to injury, improves health and social function, and prevents progression to a disorder and subsequent need for specialty substances use disorder services. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use and use-related risk behaviors, and facilitating patient initiation and engagement in treatment when needed.  

Prevention vs. Early Intervention

Early intervention differs from Prevention efforts, especially when it comes to general and at-risk populations. Prevention targets the general population with a universal need to understand the risks of substance use disorder.  While Early Intervention efforts can also engage the general population, it focuses on age groups, individuals, or families at risk for particular disorders like substance use, or those who may have just started experimenting or using substances.

Early Intervention in a Community Setting

  • Early intervention can be provided when an individual presents for another medical condition or social service need and is not seeking treatment for a substance use disorder.
  • Community intervention can involve multi-sector partnerships, community leaders and  members, and/or deliver services in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.[4]

At-Risk Populations Who Should Receive Early Intervention

While the entire community can benefit from early intervention resources, there are populations that have been identified at a high risk for substance use.

  • Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
  • Individuals who have suffered childhood trauma.[5]
  • Binge drinkers: In 2018, about 139.8 million Americans aged 12 or older were past month alcohol users, 67.1 million were binge drinkers in the past month. About 2.2 million adolescents aged 12 to 17 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period.[6]
  • People who use substances while driving.
  • Expectant mothers who use substances while pregnant. 
  • Senior citizens.
  • Ethnic minorities who may not be receiving culturally relevant care
  • Individuals with co-occurring substance use and mental disorders
  • Homeless population.

Components of Early Intervention:

  • Screening, Brief Intervention and Referral to Treatment, or SBIRT  [7]
  • Screen for risk factors for substance use such as childhood trauma and ACEs[8]
  • Reduce Stigma in Community [9]
  • Pre-Arrest Diversion Programs [10]
  • “Reachable Moments”,  such as providing patient education when prescribing opioids for chronic pain.[11]
  • Utilize Prescription Drug Monitoring Programs (PDMPs)[12] which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs  also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.
 

Promising Programs

Project Engage - Delaware

Project Engage - Delaware[13]

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs.  Designed to help hospital patients who may be struggling with alcohol or drug use, Project Engage provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

OhioSTART (Sobriety, Treatment, and Reducing Trauma)[14]

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and helps keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,  the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder. 

Project IMPACT, Portland, OR[15]

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

1. Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.

2. Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.  

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service giving patients a safe place to share their stories, while improving patient engagement and trust while expanding inpatient treatment options.  Second, partnerships with community providers to create rapid access pathways to treatment and create a smooth transition to MAT.

 

 

Tools + Resources

The Police, Treatment, and Community Collaborative (PTACC)[16] is an alliance of practitioners in law enforcement, behavioral health, community, advocacy, research, and public policy, whose mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors away from the criminal justice system and towards appropriate treatment or services can support these individuals, helping them avoid falling into the revolving door of the criminal justice system.  Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention.[17]

Facing Addiction in America: The Surgeon General’s Spotlight on Opioids,  “Importance  of Prevention, Screening, Early Intervention, and Treatment[18]

“Evidence-based interventions to prevent substance use, misuse and addiction target risk factors and enhance protective factors. Such interventions need to begin early in life to delay or prevent initiation of substance use and continue throughout the lifespan. For example, childhood trauma like adverse childhood experiences (ACEs) have been repeatedly linked to substance misuse. Primary prevention can also begin in the healthcare setting with prescribers using effective strategies to reduce overdoses involving prescription opioids such as safe prescribing practices. Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.”  

Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools:[19]  This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention.  Other resources describe a key set of tools for SBIRT early intervention plus strategies to implement and fund this intervention in schools and clinics.

Principles of Substance Abuse Prevention for Early Childhood, SAMHSA [20]

Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment, HHS Office of the Assistant Secretary for Planning and Evaluation, March 2019 [21]

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Sources


  1. ^ https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
  2. ^ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  3. ^ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  4. ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440941/
  5. ^ https://www.acesconnection.com/
  6. ^ https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  7. ^ http://ifi-wikis.com/IFI-OpioidCrisis/Expand_SBIRT_Program
  8. ^ https://www.acesconnection.com/
  9. ^ http://ifi-wikis.com/IFI-OpioidCrisis/Reduce_Stigma
  10. ^ https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
  11. ^ https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
  12. ^ https://www.asam.org/resources/publications/magazine/public-policy-statements/2018/04/24/prescription-drug-monitoring-programs-(pdmps)
  13. ^ https://christianacare.org/services/behavioralhealth/project-engage/
  14. ^ https://ohiostart.org/ https://www.pcsao.org/programs/ohio-star
  15. ^ https://news.ohsu.edu/2018/04/25/hospital-staff-experience-sea-change-in-addressing-substance-use-disorder
  16. ^ https://ptaccollaborative.org/
  17. ^ https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
  18. ^ https://addiction.surgeongeneral.gov/sites/default/files/OC_SpotlightOnOpioids.pdf
  19. ^ https://www.communitycatalyst.org/resources/tools/sbirt-resources
  20. ^ https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/table-contents
  21. ^ https://aspe.hhs.gov/pdf-report/best-practices-and-barriers-engaging-people-substance-use-disorders-treatment