Over the past few years,  the news, medical literature, government and healthcare industry has increasingly discussed addiction and called attention to the massive negative impacts it has on our country. Still, things do not seem to be improving, and our past efforts are not sufficient to meet the vast need. Addiction, a serious, chronic and treatable condition continues to be underdiagnosed and undertreated.  This is unacceptable.

It is not possible to overstate the “entry to care” crisis for those living with substance use disorders (SUD). I took a spin through the recently released 2021 National Survey on Drug Use and Health (NSDUH) and the numbers remain devastating: 60 million people with past month binge alcohol use, 29.5 million people with an alcohol use disorder of which nearly 20 percent (1 in 5) had a severe use disorder, 8.7 million people who misused prescription pain medications in the past year and, remarkably, an estimated 1.8 million who initiated misuse of pain relievers in that time.

Against a backdrop of 43.7 million people – sons, daughters, spouses, parents, friends and colleagues – who needed substance use disorder treatment in the past year:

• Only 6.2 percent (2.7 million people) received any substance use treatment – that is, 94 percent did not receive treatment, and those who did may have had a single, rather than ongoing, intervention
• Of an estimated 17.2 million people living with a co-occurring SUD and mental health condition, just over half (9 million) received any treatment for either condition, and of those 9 million, only 1.4 million received substance use services through a specialty facility (i.e., inpatient or outpatient SUD treatment) or mental health center

In the context of NSDUH, any treatment includes any intervention at any location such as life-saving care in an emergency department that may or may not involve follow-up treatment or participation in self-help support programs. Unlike any other serious and chronic illness, we seem to tolerate addressing the acute phase of this illness without sufficient early intervention or ongoing care.

Today, individuals in need and their families often determine their own level of care by accident and occasionally, it’s the right care. Lacking knowledge of treatment options and worried about sharing concerns with others, people may enter care following a legal or medical crisis or they may quietly search online without necessarily knowing what they need. It’s like spinning a wheel of fortune “weighted” in the wrong direction and getting lucky with the right care by chance.  

If this was someone who had severe heart disease or suffered a heart attack, neither the lay nor the professional community would tolerate the risk of further harm from an unchecked health condition. In fact, with any other medical condition that has the morbidity and mortality of substance use disorder (SUD) this idea of uninformed, self-navigation would be unacceptable.

Admittedly, the factors associated with substance use conditions that contribute to the “entry to care” challenge include ambivalence and readiness for change. With conditions that require effort by the patient beyond taking a pill to get better, they need to initiate and maintain lifestyle changes. We see this behavioral component to treatment across a range of conditions, including obesity and its implications for diabetes or heart conditions. For a person with alcohol or other substance use disorder, the risk of serious harm can be imminent – accidental overdose or serious accidents due to impairment. Still, the desire for continuing to attend social events where friends are gathered but where there may also be significant use of alcohol or other substances can overshadow such concerns.  For those who are ready for change, the efforts involved in finding and entering the right care are daunting – especially when they know that the therapeutic work may be difficult. Unfortunately, we often hear about the experience of “slogging” through the system: long wait times for appointments (4-8 weeks), higher than expected costs (“wasn’t in my network, I was stuck with a big bill”), time away from work or family (“I thought I had to go away for treatment’), and similar pain points. Sadly, many – despite the ongoing risk of harm – simply give up.  

It is time to act.

We need to step in and render aid quickly – the reality is that SUDs are treatable and now we’re armed with a range of therapeutic goals and treatment options that did not exist a decade ago.

How can we help?  We need to change and drastically improve the entry and access to care.  Efforts to self-navigate online are painful. The system will serve up too much information, too many options – much of which is not applicable to the person needing services. It is hard to know what treatment to pursue when you are also working to understand your health condition, the associated treatment options (including both levels of care and types of care), and how insurance coverage for different services and levels of care works.  When a decision is made to make a call, the problem of timely appointments becomes another hurdle.

Now is the time to support timely entry to care with attention to sustained engagement in treatment. We should continue to actively lean into whole person care because medical, behavioral, social, and environmental factors all play a role in health outcomes. Let’s approach SUD intervention and care with the urgency and duration that such a serious, high-risk, chronic and treatable condition warrants. Collaboration is a good word, but it requires understanding of the different and essential purposes, processes, and strengths that each stakeholder brings to the solution. Such informed collaboration is the pathway to improved outcomes driven by effective, simplified, and efficient care.

At Navigator, we know and understand the system of care and we build bridges. Working across the health system, we:

Facilitate collaboration within the health care system (among payers, medical and behavioral providers, and members/patients)

Address Social Determinants of Health, including:

• Health literacy – provide information about evidence-based services including Medication Assisted Treatment (MAT); innovations in service delivery (virtual, in-home); and levels/intensity of care
• Transportation, Childcare – make timely connections to virtual resources
• Economic – leverage in-network and/or community-based resources aligned with the individual’s needs

Instill hope through human engagement by:

• Assessing, building, and maintaining motivation for change and readiness for treatment

• Scheduling appointments to initiate care within 48 hours of request

• Following-up to assess and mitigate barriers, support continued care

• Promoting use of peer support

The need for early and effective entry to care for treatment of SUD is both well-documented and, unfortunately, experienced every day in every community. For that reason, Navigator’s door is open 24/7 providing simple, compassionate navigation and informed collaboration within the healthcare system.

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Article written by: Deb Adler, CEO of Navigator Health, Inc.