Holly Hagle, IRETA
When considering the question “What are the advantages of integrating substance use disorder treatment into mainstream medical care?” I immediately see many advantages. In fact the first thing that I thought of when reading over the guidelines for this issue was a recent report on Interprofessional Collaborative Practice (2011). This report came to my mind because it espouses the importance of advancing patient centered and community/population oriented health care systems. I have recently been teaching this concept as part of my work at the Institute for Research, Education and Training in Addictions (IRETA) as part of several educational grants that we are currently facilitating. I am more and more convinced talking with advanced practice health professional students (medical students, nursing students, dental students and other allied health professionals) that integrating addiction services is the only way we will tackle the misuse and abuse of substances in the U.S.
Consider the role substances play in relation to physical and mental health -
• More deaths are caused each year by tobacco use than by human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.
• Excessive alcohol use is the third leading lifestyle-related cause of death for the nation.
• Excessive alcohol use is responsible for 2.3 million years of potential life lost annually, or an average of about 30 years of potential life lost for each death.
• Over 5 million emergency room visits were related to drug use, a 100 percent increase since 2004.
• Cigarette use continues to be the leading preventable cause of death in the United States.
• The smoking rate is much higher among persons with mental illness and substance use disorders than among those who do not have these problems. On average, smokers die 10 years earlier than nonsmokers.
• Alcohol and drug abuse is a complicating factor in treatment or patient compliance for many physical health conditions (e.g., asthma, diabetes, tuberculosis).
• One in three depressed people also suffer from some form of substance abuse or dependence.
• Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness (CDC, 2013, SAMHSA, 2012, 2013).
Considering the spectrum of substance use ranges from – social and non-problematic use, misuse, abuse, problematic use and addiction, and the plethora of substances that can be abused: legal (tobacco, alcohol, and marijuana in some states); illicit drugs (cocaine and ecstasy); and prescription drug misuse, the scope of the problem is huge. It touches all of us individually and as part of communities.
Which brings me back to my original statement that teaching healthcare practitioners about treating people who have problems with substances will advance patient-centered care and will improve health for individuals and communities. We cannot ignore the role substances play in health and behavioral health. And as such we need to have the broadest approach to substance use possible, including addressing substances in all facets of society, especially medical care settings. Addressing substance use in medical care settings is part of health promotion, prevention, and early intervention.