SUD Treatment Overview With Integrative Chiropractic Care

Learn how SUD treatment, combined with integrative chiropractic care, can support recovery. Find the support you need for healing.

Abstract

Hello, I’m Dr. Alex Jimenez. In this educational post, I will explore the evolving landscape of Substance Use Disorder (SUD) care, drawing from the latest findings presented by leading researchers and clinicians in the field. Our journey will begin by examining the crucial and expanding role of Nurse Practitioners (NPs), who are increasingly at the forefront of providing accessible SUD treatment. We will then navigate the various settings where individuals seek help, from the familiar grounds of primary care to the critical environment of acute hospital settings. A significant focus will be on understanding and implementing best practices for care transitions—the often-precarious handoffs between different levels of care—and exploring innovative strategies to ensure continuity and prevent patients from falling through the cracks. We will delve into new research shaping the future of SUD management, including advancements in pharmacotherapy and patient-centered models. Throughout this discussion, I will integrate the philosophy and practice of integrative chiropractic care, demonstrating how our multidisciplinary approach at Injury Medical Clinic, in collaboration with our Medical Director, Dr. Maria Guadalupe Cardenas, MD, supports a holistic, whole-person recovery journey.

Our Collaborative and Integrative Model of Care

At Injury Medical Clinic PA, we have built a practice grounded in integrative, multidisciplinary care. I, Dr. Alex Jimenez, bring a unique, comprehensive perspective through my dual qualifications as a Doctor of Chiropractic (DC) and an Advanced Practice Registered Nurse (APRN), certified as a Family Nurse Practitioner (FNP-BC). My additional certifications in Functional Medicine (CFMP, IFMCP), Anti-Aging, Regenerative, and Functional Medicine (ATN), and Chiropractic Spinal Trauma (CCST) allow me to view patient health through a wide-angle lens, connecting musculoskeletal health, neurological function, metabolic balance, and overall well-being.

This comprehensive approach is medically grounded and supervised through our vital collaboration with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over four decades of clinical experience (NPI #1164426749, Texas MD License #J2933). As our Medical Director and Collaborative Physician at our practice, Mission Plaza Injury Medical Clinic in El Paso, Texas, she provides essential medical oversight to ensure our treatment plans are safe, evidence-based, and medically sound. This collaborative MD-DC model is a hallmark of modern integrative clinics, allowing us to seamlessly blend the best of conventional medicine with the holistic, non-invasive principles of chiropractic and functional medicine.

Our team integrates:

• Medical Oversight (Dr. Cardenas): Diagnosis, management of complex medical conditions, medication review, and ensuring all care aligns with established medical standards.
• Chiropractic and Neuromusculoskeletal Care (Dr. Jimenez): Addressing the physical manifestations of stress, pain, and dysfunction that often co-exist with and exacerbate SUDs. This includes spinal adjustments, soft tissue therapies, and rehabilitation.
• Functional Medicine: Investigating and addressing the root causes of imbalance, such as nutritional deficiencies, hormonal dysregulation, and gut health issues that can influence cravings, mood, and recovery.
• Personal Injury and Rehabilitation: Specialized care for individuals whose SUD may be linked to chronic pain resulting from an accident or injury.

This framework allows us to address the multifaceted nature of SUD, recognizing that recovery is not just about abstaining from a substance but about healing the entire person—body, mind, and spirit.

The Expanding Role of Nurse Practitioners in SUD Care

As both a chiropractor and a nurse practitioner, I am keenly aware of the unique and powerful role that NPs play in the healthcare landscape, particularly in the realm of substance use disorders. The latest data reveals a profession that is not only growing rapidly but is also fundamentally aligned with the core principles of effective SUD treatment.

A Growing Workforce on the Front Lines

The statistics are compelling. Over 258,000 Nurse Practitioners currently practice in the United States, and this number is projected to surge by an astonishing 45% over the next decade. This growth rate far surpasses that of many other professions, positioning NPs as an increasingly vital part of our healthcare infrastructure.

What makes this growth particularly significant for SUD care is where these NPs are practicing. More than 70% of NPs provide some form of primary care. This is a critical point. Primary care is often the first, and sometimes only, point of contact many individuals have with the healthcare system. Because they are deeply embedded in this setting, NPs are well positioned to serve as an accessible entry point for SUD treatment. Their presence is especially crucial in bridging gaps in care for rural and underserved populations, areas where access to specialized addiction services can be scarce.

The NP Model: A Foundation for Compassionate SUD Care

Beyond sheer numbers, the very philosophy underpinning NP education and practice makes us uniquely skilled providers of high-quality SUD care. The NP model is inherently patient-centered and holistic, values that are paramount when treating individuals with substance use disorders. Key tenets of our practice include:

• Valuing Patient Autonomy and Self-Determination: We are trained to partner with patients, respecting their goals and their readiness to change. We understand that lasting change cannot be imposed; it must be cultivated from within.
• Prioritizing Prevention and Education: A core function of the NP is to empower patients through knowledge. We educate individuals about their health, the risks associated with substance use, harm reduction strategies, and the benefits of treatment, so they can make informed decisions.
• Fostering Non-Judgmental Communication: The stigma surrounding SUD is a massive barrier to care. NPs are skilled at creating a safe, non-stigmatizing environment where patients feel comfortable disclosing their struggles without fear of judgment or punishment. This trust is the bedrock of any therapeutic relationship.
• Mastery of Motivational Interviewing: This evidence-based communication technique is not just a tool but a core component of compassionate NP practice. Motivational interviewing helps us explore a patient’s ambivalence about change and gently guide them toward their own motivations for recovery. It is a powerful method for supporting patients with SUDs.

Navigating the Prescribing Landscape

The ability to prescribe medications is a cornerstone of modern SUD treatment. State laws dictate the specifics of an NP’s scope of practice regarding controlled substances and whether a collaborative practice agreement with a physician is required. In our clinic, my practice as an FNP is in collaboration with Dr. Cardenas, ensuring a robust and medically sound approach to prescribing.

A landmark change in recent years has been the elimination of the X-waiver requirement for prescribing buprenorphine, a key medication for Opioid Use Disorder (OUD). This change officially recognizes that treating OUD with buprenorphine is firmly within the scope of primary care providers, including NPs. This has been a game-changer, dramatically expanding access to this life-saving treatment across many settings.

Methadone, another critical medication for OUD, operates under a different regulatory framework. Federal law mandates that methadone for OUD must be dispensed from a licensed Opioid Treatment Program (OTP). However, within these OTPs and in hospital settings, NPs can play a significant role. In accordance with state scope of practice laws, an NP can oversee the initiation or dose adjustment of methadone for a hospitalized patient who has OUD but was admitted for a different primary diagnosis. This supports continuity of care and helps prevent painful, dangerous withdrawal during a hospital stay.

The Need for Advanced Training and Specialization

Despite our foundational skills, I have observed that the time dedicated to SUD care in many NP curricula can be limited, often due to the many competing demands for curriculum space. To truly excel in this complex field, many of us seek out advanced training.

There are dedicated pathways for NPs to deepen their expertise:

• Certified Addiction Registered Nurse – Advanced Practice (CARN-AP): This specialized certification demonstrates an advanced level of knowledge and skill in addiction care. NPs can study for and sit for this exam to formally validate their expertise.
• Psychiatric-Mental Health Nurse Practitioners (PMHNPs): These NPs complete advanced specialty training and board certification focused on mental health. Their competencies inherently include in-depth training in the diagnosis and management of SUDs, as substance use and mental health conditions are so often intertwined.

The Healthcare System as a Risk Environment: Overcoming Stigma

To effectively treat SUD, we must first confront an uncomfortable truth: for many individuals who use substances, the healthcare system is not a place of healing but a risk environment. This perception is born from deeply ingrained stigma and repeated negative experiences. When patients with SUDs interact with the healthcare system, they often face:

• Stigma and Discrimination: They may be treated with suspicion, judgment, or disrespect by providers who lack understanding of addiction as a chronic brain disease.
• Fear of Punishment: Patients may worry that disclosing their substance use will lead to legal consequences, loss of custody of their children, or other punitive actions.
• Mistrust of Providers: A history of being dismissed, undertreated for pain, or labeled as “drug-seeking” erodes the trust necessary for a therapeutic alliance.

The consequences of this are devastating and far-reaching. It creates a vicious cycle of avoidance and escalating health crises:

• Delaying Care: Patients will avoid seeking help until their condition is dire, turning preventable issues into life-threatening emergencies.
• Non-Disclosure of Drug Use: Fear prevents patients from being honest with their providers, which can lead to dangerous drug interactions, incorrect diagnoses, and ineffective treatment plans.
• Minimizing Pain: Patients with a history of SUD may be so afraid of being seen as “drug-seeking” that they downplay their pain, leading to unnecessary suffering and a perception that their pain is not being taken seriously.
• Leaving Against Medical Advice: The hostile or uncomfortable environment can drive patients to leave the hospital or clinic before their treatment is complete, jeopardizing their health.

Ultimately, this cycle means that instead of engaging in preventative care and addressing health issues early, patients present later with more acute and complex illnesses. This results in increased morbidity and mortality, and it drives up costs for the entire healthcare system. Our first job as clinicians is to dismantle this perception by creating environments of safety, trust, and unconditional positive regard.

The Continuum of SUD Care: Finding the Right Level of Support

Treating substance use disorders is not a one-size-fits-all endeavor. The level of care a person needs depends on a multitude of factors, including the substance used, the severity of the disorder, their physical and mental health, and their social support system. Primary care often sits at the very center of this ecosystem, acting as a hub that connects patients to a spectrum of services based on their individual needs.

These auxiliary options form a continuum of care:

• Hospital/Inpatient Settings & Emergency Departments: These acute care settings are often where a health crisis related to substance use first becomes apparent. They serve as critical points for stabilization, treatment initiation, and transition to community-based resources.
• Specialty SUD Treatment Facilities: These include programs offering higher-intensity care, such as intensive outpatient programs (IOPs) or residential treatment facilities, which provide a structured, immersive therapeutic environment.
• Peer Support Networks: These networks, composed of individuals with lived experience in recovery, offer invaluable emotional support, guidance, and hope. They can be integrated into healthcare settings or function as standalone community resources.
• Dedicated Mental Health Services: Given the high rate of co-occurring mental health conditions (like depression, anxiety, and PTSD) with SUDs, access to specialized mental health care is often essential.
• Telehealth and Bridge Clinics: These innovative models provide low-barrier, immediate access to care. Bridge clinics are specifically designed to “bridge” the gap between an acute event (like an ER visit or hospital discharge) and long-term treatment, ensuring patients don’t fall through the cracks during this vulnerable transition.

The ASAM Criteria: A Framework for Personalized Care

To systematically determine the most appropriate level of care for a patient, clinicians often use the ASAM (American Society of Addiction Medicine) Levels of Care Criteria. This is not just a simple checklist; it is a comprehensive, strength-based, multidimensional assessment tool.

The ASAM criteria evaluate a patient across six dimensions:

1. Acute Intoxication and/or Withdrawal Potential
2. Biomedical Conditions and Complications
3. Emotional, Behavioral, or Cognitive Conditions and Complications
4. Readiness to Change
5. Relapse, Continued Use, or Continued Problem Potential
6. Recovery/Living Environment

This assessment is unique because it doesn’t just focus on a patient’s problems or deficits. It also considers their strengths, assets, resources, and support systems. By weighing both liabilities and strengths, the clinician can recommend a level of care that is tailored to the individual’s specific needs. The care continuum ranges from Level 1 (Outpatient Services), the least intensive, up to Level 4 (Medically Managed Intensive Inpatient Services), the highest level of care for patients with severe, unstable medical and psychiatric conditions.

Primary Care: The Untapped Epicenter of SUD Treatment

As we’ve discussed, the vast majority of NPs work in primary care, and Primary Care Providers (PCPs) represent the largest clinical workforce in the United States. This reality presents a monumental opportunity to revolutionize SUD care.

The Power of the Longitudinal Relationship

Primary care is such a powerful setting for SUD treatment because PCPs often have a unique longitudinal relationship with their patients. We don’t just see patients for a single crisis; we often care for them over many years, through different stages of their lives. This long-term relationship allows us to meet patients wherever they are on their journey with substance use.

This aligns perfectly with the Stages of Change model (Precontemplation, Contemplation, Preparation, Action, Maintenance). The intervention we provide can be tailored to the patient’s specific stage of readiness:

• For a patient in the contemplative stage, who is ambivalent about changing their substance use, our intervention might focus on harm reduction education (e.g., teaching about naloxone, safe use practices) and gently exploring the consequences of their use.
• For a patient who is ready for action, we can immediately move to discussing evidence-based treatments like medications (buprenorphine, naltrexone) and behavioral therapies to support their goal of disrupting use.

This ability to adapt our approach over time, building on a foundation of trust, is often difficult to replicate in more episodic or crisis-oriented care settings.

The Unmet Need: A Sobering Reality

Despite this immense potential, very few primary care settings in the U.S. offer a full range of SUD treatments. The statistics are staggering. For example, it is estimated that 86.6% of patients with opioid use disorder who could benefit from medication do not receive it. This represents a massive gap between what we know works and what is actually being delivered.

Why does this gap exist? A major contributing factor is the broader primary care crisis. We are facing a severe and growing shortage of primary care providers. The data from 2025 paints a grim picture:

• 2 million people in the U.S. live in a designated Primary Care Health Professional Shortage Area (HPSA).
• Only 5% of the need for primary care providers is currently being met.
• An additional 13,364 PCPs would be needed to fill this gap.

This shortage places an immense burden on existing providers, creating significant barriers to the integration of comprehensive SUD care:

• Time Constraints: In a busy primary care practice with short appointment slots, it can feel daunting to initiate a complex and sensitive conversation about substance use, let alone start and manage treatment.
• Low Reimbursement Rates: Historically, reimbursement for SUD counseling and management has been low, creating a financial disincentive for practices to invest in these services.
• Inability to Refer to Psychosocial Support: Many PCPs feel hesitant to start a patient on medication like buprenorphine if they feel they have nowhere to refer them for necessary counseling and behavioral support.
• Lack of Institutional Support: Without support from clinic management or hospital administration, providers may struggle to access the resources, training, and protected time needed to provide SUD care.
• Fears of Medication Diversion: Some providers worry that patients will divert their prescribed buprenorphine (sell it or give it to others), a fear that can be mitigated with proper education and program structure.
• Requirement for Concurrent Counseling: In some systems, patients must engage in counseling to be eligible for medication. While behavioral support is highly beneficial, making it a strict prerequisite can create an unnecessary barrier to life-saving medication.

Best Practices for Integrating SUD Care into Primary Care

Despite these challenges, many successful models for integrating SUD treatment into primary care have emerged. A systematic review of twelve such models identified four common components that are key to success:

1. Offering Pharmacologic Therapy: Providing on-site access to evidence-based medications like buprenorphine, naltrexone, and acamprosate.
2. Offering Co-located Psychosocial Services: Having mental health counselors, therapists, or social workers available in the same clinic, which reduces barriers to access.
3. Integrating Care Options: Creating a seamless system where medical and behavioral health providers work together as a unified team, sharing information and coordinating care plans.
4. Providing Education and Outreach: Proactively educating patients about SUD, treatment options, and harm reduction.

The most successful models almost always employ team-based approaches. A common and highly effective strategy is to use nurse care managers as the primary point of contact for patients receiving SUD treatment. These nurses can handle follow-up visits, manage refills, coordinate urine toxicology testing, and provide ongoing support, which frees up the prescribing provider’s time and provides the patient with a consistent, accessible contact person.

Furthermore, fostering a culture of support within the clinic is crucial. This means providing ongoing education for all staff, from the front desk to the medical assistants, and identifying and empowering SUD champions—providers who are passionate about this work and can mentor their colleagues.

Excellent resources exist to support this integration. The Provider’s Clinical Support System (PCSS), funded by SAMHSA, is a phenomenal program designed to help clinicians treat OUD. It offers free training, webinars, and, most importantly, a clinical mentoring program where any primary care clinician can sign up to be paired with an experienced mentor for guidance on complex cases and buprenorphine prescribing.

A Primary Care Case Study: James’s Journey

Let’s walk through a case that illustrates how these best practices can come together in a primary care setting.

The Patient: James is a 52-year-old man who comes to his primary care NP at a Federally Qualified Health Center (FQHC) for a routine follow-up on his diabetes and chronic pain. He has a known history of opioid use disorder.

The Interaction: The NP, trained in non-judgmental communication, doesn’t shy away from the topic. She asks open-ended questions about his history and specifically inquires if he has been having any cravings to use opioids, especially given his ongoing chronic pain. This creates a safe space for honesty. James discloses that he has recently returned to using illicit fentanyl. He identifies his primary drivers of use as his unmanaged pain and depression. He was on buprenorphine before but stopped, thinking he could “do it without support.” He now feels ready to try again and asks his NP for help.

The Response (Applying Best Practices):

1. Shared Decision-Making: The NP doesn’t just write a prescription. She sits down with James and discusses the options for restarting buprenorphine, including the risks, benefits, and different initiation strategies. They decide together to use a high-dose initiation strategy (a newer protocol for rapidly starting buprenorphine in the fentanyl era).
2. Co-located Services: The NP sends the buprenorphine prescription to the co-located pharmacy on the clinic campus, eliminating the barrier of traveling to another location.
3. Treating the Whole Person: Recognizing that the fentanyl use is a symptom of his underlying pain and depression, the NP discusses other supportive options. They agree to submit referrals to a mental health counselor and a Cognitive Behavioral Therapy (CBT) group for chronic pain, both of which are also offered on-site.
4. The Warm Handoff: This is a crucial step. Instead of just giving him a piece of paper with a phone number, the NP physically walks James down the hall and introduces him to the mental health counselor he will be seeing. This simple act dramatically increases the likelihood that James will follow through with the referral and helps him feel that his care team is truly integrated.

The Follow-Up:

• Leaving the Clinic: James leaves his appointment with his buprenorphine script in hand, a clear plan for starting it, a pharmacy check-in appointment the next day, and a telehealth follow-up with his NP. He also has scheduled appointments for counseling and the pain group.
• The First Few Weeks: Transitioning to buprenorphine, especially from fentanyl, can be challenging. Short-interval follow-up is critical. James has a telehealth visit with his NP and a phone call with the pharmacist. He reports that achieving the necessary level of moderate-to-severe withdrawal to start the high dose was difficult, but once he took the medication, he felt much better. They work together to slightly increase his dose.
• Building the Team: He is introduced by phone to a peer support specialist who can provide encouragement and guidance from lived experience. In the future, his care is managed through regular visits with a nurse care manager, who coordinates his buprenorphine refills and toxicology screens.
• The Outcome: James feels hopeful. He knows he can turn to his primary care team if he struggles. He is proud of himself for not using fentanyl in two days. He begins the deeper work of addressing the root causes of his use by treating his depression and learning new skills for pain management.

This case, while aspirational for some under-resourced settings, provides a powerful blueprint. It highlights the importance of treating the whole person, a principle at the heart of both NP practice and integrative chiropractic care. For many patients, however, primary care alone may not be enough. We must know our local referral resources and be ready to connect patients to a higher level of care when needed.

The Role of Integrative Chiropractic Care in Primary Care SUD Treatment

In a scenario like James’s, an integrative chiropractic perspective adds another vital layer of care. Chronic pain was a primary driver of his return to use. While the CBT group is an excellent tool for the psychological component of pain, his physical discomfort needs to be addressed directly.

As an integrative team, we would incorporate chiropractic care to:

• Perform a Comprehensive Musculoskeletal and Neurological Evaluation: We would assess James for underlying spinal misalignments (vertebral subluxations), muscle imbalances, and nerve irritation that could be contributing to his chronic pain.
• Provide Gentle, Specific Chiropractic Adjustments: These adjustments help restore proper joint motion, reduce nerve interference, and decrease pain signals. This can provide immediate relief and improve his overall function, reducing his perceived need for opioids.
• Incorporate Soft Tissue Therapies: Techniques like myofascial release, trigger point therapy, and therapeutic massage can release chronic muscle tension, improve circulation, and further alleviate pain.
• Develop a Rehabilitative Exercise Program: We would teach James specific stretches and strengthening exercises to improve his posture, stabilize his spine, and build resilience against future pain flare-ups. This empowers him with tools to manage his own physical health.

By directly treating the physical source of his pain, we are not just managing a symptom; we are addressing one of the root causes of his substance use. This physical healing process also has profound psychological benefits. It can help regulate the nervous system, reducing the “fight-or-flight” state of anxiety and stress that often accompanies both chronic pain and addiction. This creates greater parasympathetic (rest and digest) tone, which is more conducive to healing and recovery.

Specialty SUD Treatment: When More Support is Needed

When a patient’s treatment needs exceed what a primary care setting can provide, they may be referred to a specialty SUD treatment program. These programs offer a more intensive and structured level of care.

Examples of specialty treatment options include:

• Intensive Outpatient Treatment (IOP): Patients attend therapy sessions for several hours a day, several days a week, while still living at home. This provides more support than weekly therapy but allows them to maintain work and family responsibilities.
• Residential or Inpatient Rehab: Patients live at the treatment facility for a period, typically 30-90 days, allowing them to focus entirely on their recovery in a safe, substance-free environment.
• Office-Based Addiction Treatment (OBAT): These are specialty outpatient clinics that focus specifically on providing medications for SUD (like buprenorphine or Vivitrol) combined with counseling and case management.
• Opioid Treatment Programs (OTPs): These are the federally regulated clinics licensed to dispense methadone for the treatment of OUD. They also typically provide counseling and other supportive services.

A Critical Caveat: Medication First

Access to specialty treatment can be limited in many areas, with long waiting lists and insurance barriers. This makes it absolutely critical to remember a key principle of modern addiction medicine: participation in a behavioral program should not be a prerequisite for receiving medical treatment for SUD.

A patient can and should be started on buprenorphine or naltrexone for OUD without first being required to enroll in counseling. The medications themselves are life-saving. They reduce cravings, prevent withdrawal, and dramatically lower the risk of overdose death. While behavioral interventions are a mainstay of long-term recovery, withholding medication until a patient engages in counseling creates a dangerous and unnecessary barrier to care. The goal is to keep the patient alive and stable first, then build additional layers of support.

The Acute Care Setting: A Teachable Moment

Hospital emergency departments and inpatient units are often the front lines of the addiction crisis. An overdose, a serious infection from injection drug use, or a traumatic injury can be the event that finally brings a person into the healthcare system. These moments of crisis, while terrifying, are also profound teachable moments.

During a health crisis, an individual may re-evaluate their life and goals, making them more open to treatment than ever before. For a patient who has long avoided healthcare because of stigma, a positive, supportive interaction during a hospitalization can be transformative, rebuilding trust and opening the door to engagement.

The Gold Standard: Inpatient Addiction Consult Services

The gold standard for providing addiction care within a hospital is the Inpatient Addiction Consult Service. These are interdisciplinary teams of SUD experts who are called in to see patients with substance use disorders, much like a cardiology or infectious disease consult service.

These teams are powerful engines for change and healing. They typically consist of:

• An Addiction Medicine Clinician: A physician, NP, or PA with specialized training in addiction medicine who can assess the patient, manage withdrawal, and initiate medications like buprenorphine or methadone.
• A Social Worker or Counselor: This team member can conduct a comprehensive psychosocial assessment (like the ASAM), provide motivational interviewing, and begin connecting the patient to post-discharge treatment resources.
• A Care Coordinator: This person handles the complex logistics of setting up follow-up appointments, navigating insurance, and ensuring a smooth transition of care.
• A Peer Support Specialist: This is often the heart of the team. A peer is an individual with lived experience of addiction and recovery. They can connect with the patient on a deeply personal level, offer hope, provide non-judgmental emotional support, and help the patient navigate the often-intimidating hospital system.

The impact of these consult services is well-documented. Care from an addiction consult service has been shown to:

• Reduce hospital readmissions.
• Increase the number of patients who start and continue medications for OUD.
• Improve management of complex pain in patients with SUD.
• Decrease self-directed discharges (patients leaving against medical advice).

Beyond direct patient care, these services drive system-wide change. They can improve hospital policies, lead quality improvement initiatives, and provide crucial education to other providers, nurses, and staff throughout the institution, helping dismantle stigma and elevate the standard of care for all patients with SUD.

An Acute Care Case Study: Lisa’s Journey

Let’s examine a case that shows an addiction consult service in action.

The Patient: Lisa is a 32-year-old woman who presents to the emergency department with a swollen, red, and warm left leg that has been worsening for a week. She reports daily use of both intravenous and inhaled fentanyl and methamphetamines. Her last use was six hours ago, and she is starting to feel the intensely uncomfortable symptoms of opioid withdrawal. She is also extremely worried about her dog, who is staying with a friend who may not be able to keep him for long. A chart review reveals she has untreated Hepatitis C.

The Consult Service Response (within 24 hours):

1. The Medical Provider: An addiction medicine provider meets with Lisa. They conduct a thorough assessment and confirm diagnoses of severe opioid use disorder and methamphetamine use disorder. They discuss options for managing her withdrawal and treating her OUD. Using a shared decision-making approach, they decide to start methadone to stabilize her withdrawal quickly, with a plan to transition her to buprenorphine later in her stay. They also discuss harm reduction strategies and treatment options for her methamphetamine use.
2. The Social Worker: The social worker meets with Lisa and completes a full ASAM assessment to understand her needs and strengths. With Lisa’s permission, they may contact family to gather more information and build a support network. The social worker uses motivational interviewing to help Lisa feel supported and encourage her to stay in the hospital to complete her medical treatment—a critical intervention, as the stress and discomfort could easily lead her to leave against medical advice. They also begin discussing her goals and start the referral process for a residential treatment program for when she is discharged.
3. The Peer Support Specialist: The peer meets with Lisa and provides a compassionate, listening ear. They understand her anxiety about her dog is not a trivial concern but a major barrier to her care. The peer might provide a cell phone and help Lisa make calls to arrange more stable care for her pet. This practical and emotional support from someone who “gets it” can be the deciding factor that allows Lisa to relax and focus on her own health.

Ongoing Hospital Care with the Consult Team:

• Two Days Later: Lisa’s withdrawal is stabilized. Her medical team has diagnosed her with left lower extremity cellulitis and started IV antibiotics. The addiction consult team has initiated a low-dose buprenorphine start (a technique used to transition from methadone or full agonist opioids without precipitating withdrawal). A referral is placed for Hepatitis C treatment. She continues to report strong cravings for methamphetamines.
• Addressing All Facets of Her Health: The Addiction Consult Service (ACS) continues to support her.

• • For her cellulitis, they coordinate with her primary medical team and help find a post-discharge primary care provider who is knowledgeable about SUD care.
  • For her stimulant use disorder, they discuss evidence-based behavioral treatments like contingency management (which provides tangible rewards for negative toxicology screens). They may discuss off-label medications that can sometimes help with cravings.
  • For harm reduction education, they talk to her about the risk of fentanyl contamination in the methamphetamine supply, the critical importance of carrying naloxone (Narcan), and the danger of using substances alone. They also provide education on preventing the transmission of infectious diseases by not sharing paraphernalia.

This comprehensive, team-based approach transforms Lisa’s hospital stay from a frightening, isolating experience into a pivotal moment of healing and connection to long-term care.

Locating SUD Treatment Resources

Finding the right treatment can be a challenge. Two excellent national resources can help patients and providers locate services:

• SAMHSA Find Treatment Locator: This website allows you to search for licensed treatment facilities by location, type of care, and other criteria.
• Buprenorphine Practitioner Locator: Although the X-waiver is no longer required, this list remains a valuable tool for finding clinicians in your area who have experience and a commitment to prescribing buprenorphine.

Optimizing Your Wellness- Video

The Challenge of Care Transitions: Bridging the Gaps

A care transition occurs whenever a patient moves from one treatment setting to another. This could be a “step down” from an inpatient hospital stay to an outpatient clinic, or a “step up” from a primary care setting to a more intensive residential program. These transitions are notoriously vulnerable points in a patient’s recovery journey, where many are lost to follow-up.

Why Transitions are So Difficult

Several systemic issues make these handoffs challenging:

• Care Silos: Different healthcare organizations and clinics often operate in isolation, with poor communication and incompatible electronic health record systems. Information doesn’t flow easily between the inpatient and outpatient teams.
• Pervasive Stigma: Stigma can follow a patient from one setting to another, influencing how they are received and treated by the new provider.
• Lack of Staff and Resources: Both the sending and receiving agencies may be understaffed, making it difficult to dedicate the time needed for a thorough, warm handoff. This is especially true in community-based clinics that face provider shortages.
• Patient Resource Barriers: Patients face enormous obstacles, such as a lack of reliable transportation to new appointments or a lack of technology (a smartphone or internet access) needed for telehealth visits.
• Insurance Barriers: Prior authorizations, changes in coverage, or high co-pays can create insurmountable financial hurdles to accessing the next level of care.

Best Practices for Smoother Transitions

A scoping review that examined transitions from acute to community settings identified several best practices to mitigate these challenges. The most critical takeaway is the need for proactive and intentional coordination.

Wherever possible, we must:

• Leverage Existing Community Partnerships: Hospitals and clinics should build formal relationships with community treatment agencies. Knowing the people you are referring a patient to makes a world of difference.
• Establish Clear Lines of Communication: Don’t just send a faxed discharge summary. A phone call between the discharging and receiving provider to discuss the patient’s case, or a shared communication platform, can ensure critical information is not lost.

By actively managing these transitions, we can create a safety net that supports patients as they move along their continuum of care, ensuring that the progress made in one setting is not lost in the next. This dedication to continuity is a cornerstone of providing truly patient-centered, effective care for substance use disorders.

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References

• American Society of Addiction Medicine. (n.d.). The ASAM criteria.
• Provider’s Clinical Support System. (n.d.). Homepage.
• Substance Abuse and Mental Health Services Administration. (n.d.). Buprenorphine practitioner locator.
• Substance Abuse and Mental Health Services Administration. (n.d.). Find treatment for substance abuse.