Strategies to improve treatment utilization for substance use disorders: A systematic review of intervention studies

Abstract

Background: Many people who need specialty treatment for substance use disorders (SUDs) do not receive it. Clinical interventions could increase treatment utilization but are not routinely used. This systematic review aimed to describe clinical interventions that may increase SUD specialty treatment utilization (i.e., treatment initiation, attendance, meaningful engagement) and to determine which intervention(s) most consistently increase treatment utilization. Methods: We conducted a systematic review of clinical intervention studies (published in English between 2000 and 2017) reporting outcomes relevant to specialty SUD treatment utilization. Outcomes were treatment initiation, attendance, and meaningful engagement. Risk of bias was assessed using Cochrane guidelines and randomized controlled trials (RCTs) with bias scores < 3 were included in a synthesis of results. Proportions of positive to negative utilization outcomes were calculated for each low-bias RCT; studies with 50% positive outcomes or more were considered "majority-positive". Studies were categorized by theory-based approach. Results: Twenty-three RCTs had low risk of bias and were synthesized. Among intervention types with two or more studies, cognitive-behavioral (100% majority-positive) and coordinated care (67% majority-positive) interventions were most likely to increase treatment initiation, while 12-step promotion interventions were most likely to increase treatment attendance (50% majority-positive). One study (12-step promotion) measured meaningful engagement, with majority-positive outcomes. Conclusions: A systematic review and narrative synthesis of clinical interventions promoting specialty SUD treatment utilization provided preliminary evidence that cognitive-behavioral and coordinated care interventions may increase treatment initiation, while 12-step promotion interventions may promote treatment attendance. More quality studies and greater consistency in treatment utilization measurement are needed.

Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018

“…Similarly, NA programs have been found to enhance treatment retention, including adherence to medications for opioid use disorder, as well as abstinence (Lookatch et al, 2019 ; Monico et al, 2015 ). Self-help groups have been associated with SUD treatment attendance (Vogel et al, 2020 ) and other positive clinical outcomes (Kelly et al, 2020 ), but other studies found no effects of these programs (Bog, 2017 ; Miller, 2008 ). Cohort declines in self-help use could be yet another signal of needed investments in the SUD treatment system to increase treatment uptake both in primary care and specialty settings.…”

Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel

“…We used four key publications selected by project staff to represent different aspects of care coordination research (clinical integration, implementation of technological advances, social network analysis of provider relationships and interpersonal relationships between providers) as seed articles for a forward search 1 2 6 7. We screened studies included in 127 systematic reviews on care coordination to obtain a broad range of care coordination approaches 3–5 8–131. The reviews addressed common chronic conditions managed in primary as well as specialty care, cancer care, palliative care, comorbidity and complexity, personnel specialising in care coordination, frameworks and strategies to promote coordination, technology supporting coordination, settings for temporary care such as emergency departments and care models applied to specific populations.…”

Perceptions Diverge on Aspects Related to Substance use Disorder: An Analysis of Individuals in Recovery, Physicians, Nurses, and Medical Students

“…2 Efforts to improve treatment utilization for persons with SUD justifiably receive focus in policy and research. 3 The rate of overdose deaths has risen globally, with opioids playing a central role. 4 The prevention and treatment of Opioid Use Disorder (OUD) has become a vital priority, resulting in numerous enacted policies across the United States.…”

“…8 Access to effective treatment for individuals with SUD remains crucial for successful recovery. 3 Unfortunately, individuals with SUD may experience feelings of mistrust and suspicion of healthcare providers during treatment and recovery. 8 Stigma from providers toward individuals with SUD can lead to negative impacts on the quality of care for this vulnerable population, 9 with subsequent low rates of treatment participation.…”