Integration of substance use disorder services with primary care: health center surveys and qualitative interviewsReport as inadecuate

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Substance Abuse Treatment, Prevention, and Policy

, 9:15

First Online: 28 March 2014Received: 31 October 2013Accepted: 21 February 2014DOI: 10.1186-1747-597X-9-15

Cite this article as: Urada, D., Teruya, C., Gelberg, L. et al. Subst Abuse Treat Prev Policy 2014 9: 15. doi:10.1186-1747-597X-9-15


BackgroundEach year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder SUD services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services.

MethodsPrimary survey and qualitative interview data were collected from the population of federally qualified health centers FQHCs in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey 78% response rate, four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients n = 18 from these organizations to collect further qualitative information on the barriers and facilitators of integration.

ResultsCompared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity.

ConclusionsEfforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable.

KeywordsSubstance use disorders Substance abuse Integrated care Health policies  Download fulltext PDF

Author: Darren Urada - Cheryl Teruya - Lillian Gelberg - Richard Rawson


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