substance abuse ehr treatment

Psychosocial Supports in Medication-Assisted Treatment

The value of psychosocial supports in patients’ recovery has been studied for years and proven effective.  It is again reflected in the findings of a 2012 research study which concluded that “The clinical community has a growing array of psychosocial interventions with a strong evidence base available for the treatment of SUDs.”

Some common examples of such psychosocial supports are patient-advocacy groups, self-help groups, individual and group counseling, case management, medication management, cognitive behavioral therapy, skills training, contingency management, and behavioral interventions.

A 2018 study conducted by West Virginia University (formerly WESTAT) was intended to highlight different models of psychosocial supports in MAT for OUD. The study was the subject of July 2019 Issue Brief published by the Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE). 

The ASPE brief asserts that “Medication-assisted treatment (MAT) is a whole-patient approach to the treatment of opioid use disorder (OUD) that combines the use of medications and psychosocial supports” and “MAT effectively treats OUD by decreasing opioid use and opioid-related overdose deaths”.

The study sought to answer these three research questions:

  1. What psychosocial components of MAT are the most important to support positive patient outcomes in OUD treatment?
  2. What types of psychosocial support are providers currently using in practice?
  3. What factors facilitate or impede medical providers’ implementation of psychosocial support in MAT?

The research was conducted through site visits to five substance use disorder treatment providers. Two of the clinics are in West Virginia and one each in Connecticut, Pennsylvania and New Mexico.

The specific programs were chosen for their “diversity in geography, clinical setting and programmatic structure, as well as their strong emphasis on psychosocial services”. Each of the programs was in an integrated setting that offered both medical and behavioral care. Two were relatively new. One had just recently redesigned its entire approach to treatment just a few months prior to the visit.

The researchers’ goal was to gather as much data as possible regarding which psychosocial supports were implemented in the various medication-assisted treatment programs and how they were used.

In their report the researchers noted these important similarities between the five programs:

  • All programs provided medication-assisted treatment.
  • Each program recognized a “phased or stepped approach as patients move from initial engagement and progressed into longer-term recovery”.
  • They all reported making use of evidence-based practices such as cognitive-behavioral therapy and motivational interviewing.
  • All offered both medical and mental health services in the same facility.
  • Four provided all psychosocial supports on-site; one provided medical and mental health services but collaborated with a community-based agency for substance use counseling.
  • All five recognized the high rate of co-occurring medical and behavioral comorbidities.
  • All programs incorporated urine testing.
  • All used psychosocial supports.

Even with all programs sharing those similarities, though, the clinics were too diverse in their programmatic approaches to psychosocial supports in medication-assisted treatment. The specific supports used and to what degree varied widely across treatment settings. This resulted in the researchers being unable to achieve their goal.

Was the study a failure? No. It provided even more evidence that psychosocial supports are a valuable resource in the treatment of substance use disorder. It also justifies further research across a larger population in order to determine “how best to align treatment models to specific populations” and “how to adapt treatment models to different settings”

It also contributed to the Substance Abuse and Mental Health Services Administration (SAMHSA)’s response to the 21st Century Cures Act. The very first item in SAMHSA’s $5.6 billion proposed budget for Fiscal Year 2020 is for an investment to “Expand access to care for opioid use disorders (OUD) through continued investment in FDA-approved pharmacotherapies for OUD, also known as Medication-Assisted Treatment (MAT) in conjunction with psychosocial supports, expanded community supports, and strategies to prevent opioid abuse through evidence-based prevention approaches, including the use of the life-saving opioid overdose antidote, naloxone”.

The SUPPORT for Patients and Communities Act, which was written into law on October 24, 2018, also set out to combat the opioid crisis by advancing treatment and recovery initiatives. Specifically:

  • Requiring the Centers for Medicare and Medicaid Services (CMS) to research whether access to treatment could be improved by increasing the federal-matching rate for state expenditures related to the expansion of opioid use disorder treatment. (HR 5477)
  • Providing added incentives for Medicaid health homes for patients with substance use disorder. (HR 5810)
  • Instructing CMS to evaluate the utilization of telehealth services in treating substance use disorder. (HR 5603)
  • Providing access to medication-assisted treatment through Medicare in bundled payments for “holistic service” (HR 5776, section 2)
  • Allowing providers certified in addiction medicine or addiction psychiatry to immediately start treating 100 patients, eliminating the initial 30 patient cap. This rule, specifically, notes that “Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder.” (HR 3692)

Going back to that 2012 study, another one of its conclusions was that cost was a significant barrier to providing necessary psychosocial supports.

There is certainly continuity from that original 2012 study, through widely accepted use of evidence-based psychosocial supports in treatment, the enactment of the 21st Century Cures Act of 2016, the SUPPORT for Patients and Communities Act of 2018, the 2018 WESTAT study and culminating with SAMHSA’s budget calling for an investment in treatment in conjunction with psychosocial supports.

It will certainly be interesting to see how SAMHSA’s plans unfold and whether past and future research teams muster an effort to further their research. For now, evaluate which of the evidence-based psychosocial supports might best your organization and your patient population. 

 

Resources used:

https://aspe.hhs.gov/basic-report/psychosocial-supports-medication-assisted-treatment-site-visit-findings-and-conclusions

https://aspe.hhs.gov/system/files/pdf/262011/OptimalIB.pdf

https://aspe.hhs.gov/basic-report/optimal-utilization-psychosocial-supports-medication-assisted-treatment-opioid-use-disorder-issue-brief?mkt_tok=eyJpIjoiWm1VMFpqRTVPRE0wWldJMCIsInQiOiI1NHRDXC9cLzlZWkw1d2lLeHlsVmd0bllRRlEyODZWaTFDNkc3MXdOa2xTd25Ja2ZsaDZLM21Xczc1ZHNPV09ZbVgrM0VYdUoxYnJVSFM5WGNZQTl6S0tXZFVSdU9pQVV5NkdqRHpVWHRROG5oNjZEblwvQ0hjQVl6WkV4ZXpKeXIzZCJ9

https://www.govtrack.us/congress/bills/115/hr6/summary

https://www.congress.gov/bill/115th-congress/house-bill/5477

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362794/

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