Despite the conceptual appeal of these models, the evidence of their efficacy is still limited270. For example, if primary care physicians are insufficiently reimbursed to provide interventions for SUDs, they are unlikely to offer them to most patients that might need them. Brief interventions are for individuals whose substance use causes mild to moderate interference, but who do not meet criteria for a moderate or severe SUD (pre‐addiction). The evidence for their efficacy is strongest for excessive alcohol use246. The US Preventive Services Task Force considers the evidence insufficient for other substances247.
How can I find help for co-occurring substance use and mental disorders?
- Since these individuals are likely to seek treatment for other conditions, such as infections or pain, screening for substance misuse in psychiatric and general medical settings is an effective way to identify SUDs146, 147.
- People may be diagnosed with post-traumatic stress disorder (PTSD) if their symptoms last for an extended period after a traumatic event and begin to interfere with aspects of daily life, such as relationships or work.
- Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions.
- This class of drugs includes, among others, heroin, morphine, codeine, methadone, fentanyl and oxycodone.
Some sites only provide supervised consumption, whereas others offer integrated services that include treatment for SUD, medical referrals, and housing, among others264. Mobile units ensure a more flexible deployment of services, but are limited in their capacity. Research on overdose prevention centers, while limited, has shown that they are effective in preventing overdose deaths in those who use them264.
Other life-changing complications
The term and strategy were inspired by the introduction of the term “pre‐diabetes” to bring attention to substance use disorder the early stages of a condition amenable to intervention, in order to halt the progression to the full‐blown disease. This resulted in policies in health care that now reimburse for early screening and intervention in pre‐diabetes and also incentivize education of health providers in its recognition and management. In parallel, studies are evaluating the effects of adverse environmental exposures, such as stress and neglect, on epigenetic modifications. These are relevant for understanding the mechanisms underlying the impact of such exposures on brain development and their enhancement of the susceptibility to addiction113. Biological risk for SUDs emerges early in life, changes at various life stages, and is differentially influenced by social factors and experiences during those different life stages and transitions78.
Why is NIMH studying PTSD?
There are no published studies on the efficacy of varenicline or electronic nicotine delivery systems. Studies of nicotine replacement treatments have not shown them to be more effective than placebo340. We are not aware of any controlled trials of medications for alcohol use disorder in pregnant women. Efficacious interventions for adolescents with substance misuse or SUD include family‐based treatments, motivational interviewing, and CBT.