Alcohol and Other Drug/Substance Use Disorders
Pathways to accessing Substance Use Disorder Services and Supports
Individuals, parents, family, friends and coworkers often ask “How can I get into treatment?” or “How can I get John/Jane into treatment?” After providing publicly and commercially funded substance use disorder (SUD) services for decades within California, why isn’t the answer to this question as well known as “How do I find a dentist?” What is so different or confusing about this health care service?
Let’s break it down so that you can be well prepared, regardless of the situation, to successfully assist in accessing these critical health care services. There are three main “pathways” that come instantly to mind.
Jurisdiction of the Court. Historically, many adolescents and young adults have been introduced to substance use treatment interventions via the justice system. Either as a direct result of court ordered consequences to an infraction of public safety laws, or as an outcome of an intake procedure that highlighted substance use conditions that would likely result in a failed outcome of the judicially applied penalty, treatment was mandated by a court officer. As California nears the full implementation of the Continuum of Care reform, we can now look towards a full and comprehensive behavioral health care assessment being conducted on each child, thusly identifying areas that will assist youth/family in dealing with the many issues before them. This pathway is helpful, because it has historically been the first attempt to require a person to deal with a personal condition that places health and safety conditions at jeopardy. At times, orders from the bench were seen as less helpful, because these sentences often times lacked a strong linkage to a medical examination, personal history, and linking the medical needs to the applied intervention. Parents and Caregivers should consider the possible benefits to their child if the court is made aware of substance use issues in the young person’s life, and can the weight of the court be applied to access needed treatment services. For those families and youth involved with child welfare, attention should be paid to the comprehensive nature of the initial assessment, and all eyes should be insuring that if a child has an emerging SUD issue, it is addressed in the months ahead.
Expanded Clinical Benefits. With the passage of the Affordable Care Act, there are now mandated health status screenings in place to assure both patients and medical providers that substance use patterns, and the early detection of possible substance use concerns, are delivered on an annual basis. The Screening, Brief Intervention and Referral to Treatment (SBIRT) program will slowly take hold in primary care, and we can look forward to future problems being reduced with an alliance between the patient and his/her primary care provider (e.g., family doctor). In addition to the screening access point, the “benefit package” now includes access to substance use treatments, including residential, outpatient, inpatient detox, medicated assisted treatments and aftercare. Both commercial plans and the Medi-Cal system are being expanded to include the basic services, and there will be growing interest in the oversight of these separate health care delivery systems to make available these services. Parents and caregivers should always consider involving their health care provider in the annual screening for substance use problem behaviors, and/or considering access through the basic benefits a medically determined level of care that will address these concerns.
The experiences of mental health treatment professionals over the last many years has validated the high incidence of “co-occurring” disorders. Though this medical terminology may not sit well with all, we should all be aware of the likelihood that emotional discomfort can easily be married to substance use as well. Our clinicians should be looking for these conditions. Effective treatment interventions will include a comprehensive assessment, and the development of specific supports that can address both the mental health and substance use concerns.
Family and Friends. Lastly, the “pathway” to substance use disorder treatments and/or community based supports oftentimes begins with family, friends and community members. Learning the basics about substance use disorders, understanding the scope of the problem today in our communities and the challenges faced by teens, young adults, and adults will prepare you for your role in the illuminating the pathway. By recognizing troubling behaviors that are linked to, or may be linked to, substance use involvement, you will promote early identification, and access to recovery. By learning the early warning signs that may indicate a substance use problem, by listening closely to ‘science’ associated with substance use treatments, understanding the “local” problems that the students and high schools are facing, you will be better prepared to initiate a conversation, and lend a hand to someone in need.
So, how to begin, or increase your toolkit options, let’s consider the following:
- Access the SUD health care benefits. These are basic health care benefits now, so the “no, we don’t do that” is no longer acceptable. These benefits can begin with the basic screening, brief treatments, and referral to more intensive services. Remember, there are as few as two questions that can be used as a screening tool, so all of us can begin to place someone on the pathway to care. The health care benefits of each plan, the county provider systems, or local private providers will all be easily accessed via your web search.
- Learn more about the illness, and the details associated with various aspects of substance use. There are many good internet sites designed to link individuals, friends and families with state-of-the-art information on substance use disorders. You can begin with one of the federal government sites: http://www.samhsa.gov/treatment/substance-use-disorders
- Look for allies, and be an ally. Whether engaging educational personnel, child welfare, juvenile probation, or the staff of our courts, look for opportunities to fully understand the treatment needs of an adolescent, and work together to access available, and the appropriate medically indicated services. Additionally, within your circle of friends and families, remember who has dealt with substance use issues in their own lives, understand that they can be a key component part in assisting someone who needs help. We all know the value of a peer, someone who has walked the path, and knows what might lie ahead. Remember – treatment works. Be hopeful, and be consistent in your supports.