Substance Use Disorders and Primary Care Integration

Primary care providers play a critical role in the treatment of substance use disorders (SUD). They integrate early SUD prevention services, provide safe and effective pain management, and implement medication-assisted treatment (MAT) based opioid treatment programs as part of integrated behavioral health care services.

HRSA supports health centers to provide integrated SUD treatment services by:

  • Supporting expansion of integrated behavioral health services
  • Building a stronger health care workforce
  • Promoting telehealth services
  • Providing technical assistance and training

Health Center Behavioral Health Performance Measure Accomplishments

According to the 2017 Uniform Data System (UDS) Data,

Health Centers

  • Provided more than one million patients with Screening, Brief Intervention and Referral to Treatment (SBIRT) services
  • Provided 1.2 million visits for SUD services

Employees at Health Centers

  • SUD FTEs increased by 22% from 2016 (1,163) to 2017 (1,416)
  • Over 2,700 Drug Addiction Treatment Act (DATA)-waivered professionals provided MAT services to nearly 65,000 patients

Patients Served at Health Centers

  • Patients receiving SUD services increased by 19% to 168,508 patients
  • Since 2014, the number of patients receiving depression screening and follow-up services increased by more than 15%

Explore additional health center data and reporting information.

Substance Use Disorder Initiatives

Learn about supplemental funding opportunities to support SUD services at HRSA health centers.

See HRSA and HHS resources to inform health centers about SUD and treatment options.

Resources

National Institute on Drug Abuse (NIDA)
NIDA provides resources and materials on substance use and addiction based upon scientific research to improve the prevention and treatment of SUD and enhance public awareness of its unhealthy consequences.

  • NIDA for Medical & Health Professionals (NIDAMED)
    Provides medical and health care professionals access to online practical tools/resources, health education credits, patient resources, and clinical trial information.
  • NIDA Commonly Abused Drugs Charts
    These charts provide information about a variety of commonly misused drugs, possible health effects, and available treatment options.
  • Other Publications
    Access to downloadable full-text publications on addiction science, medical consequences, trends and statistics, and the link between drug use and HIV/AIDS.

CDC Guidelines for Prescribing Opioids for Chronic Pain
Resources and materials for medical health professionals prescribing opioid pain medication for patients 18 and older in primary care settings. Additional resources and materials include:

Provider Clinical Support Services (PCSS)
This SAMHSA-sponsored service provides a comprehensive set of resources, trainings, and tools on opioid treatment, including pain management. PCSS also provides access to coaching and mentoring services and offers buprenorphine waiver training for clinicians (physicians, nurse practitioners, and physician assistants).

National Center on Substance Abuse and Child Welfare
This SAMHSA-sponsored service technical assistance program provides expert consultation, information, and technical assistance to child welfare, dependency court and SUD treatment professionals to improve the safety, permanency, wellbeing and recovery outcomes for children, parents and families.

Technology Transfer Centers Network
SAMHSA’s Technology Transfer Centers Network (TTC) program develops and strengthens the specialized behavioral health care and primary health care workforce that provides SUD and mental health prevention, treatment, and recovery support services. The TTC Network includes the Mental Health Technology Transfer Center Network (described in the Trauma-Informed Care section below) as well as these groups:

  • Addiction Technology Transfer Center (ATTC) Network 
    Trains providers using the latest evidence-based practices, current research, and creates alliances among agencies and organizations that provide SUD treatment and recovery services.
  • Prevention Technology Transfer Center Network (PTTC)
    Develops and disseminates tools and strategies needed to improve the quality of SUD prevention efforts. Also provides intensive technical assistance and learning resources to prevention professionals to improve their understanding of prevention science, how to use epidemiological data to guide prevention planning, and selection and implementation of evidence-based and promising prevention practices. Finally, the PTTC network develops tools and resources to engage the next generation of prevention professionals.

CMS Behavioral Health Integration (BHI) Booklet (PDF- 253 KB)
Provides information about Medicare and Medicaid coverage of BHI services, including eligible providers documenting BHI services, billing for BHI services, and additional resources.

SAMHSA National Survey on Drug Use and Health (NSDUH)
Provides data that identifies the extent of SUD, mental health disorders, current trends, and need for treatment services.

  • 2017 NSDUH Annual National Report
    Presents the 2017 national estimates of use of alcohol, tobacco products, illicit drugs, SUD, and SUD treatment among people 12 years of age and older.

SAMHSA TIP 63: Medications for Opioid Use Disorder
A comprehensive review with practical information, tools, and resources on screening, assessment of appropriate level of care, MAT with dosing guidelines, behavioral health therapy, and peer supports.

SAMHSA Opioid Overdose Prevention Toolkit
This toolkit offers strategies to health care providers, communities, and local government officials for developing practices and policies to help prevent and manage opioid-related overdoses and deaths.

Agency for Healthcare and Quality (AHRQ) Academy for Integrating Behavioral Health and Primary Care
The AHRQ Academy provides resources to support health professionals implementing MAT for opioid use disorder in primary care settings.

Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings (PDF – 1.3 MB)
This technical brief from AHRQ is a go-to resource for MAT models of care delivery in primary care, including MA nurse care manager model and the Vermont hub-and-spoke model.

What is SBIRT? 
SAMHSA explains the SBIRT process and provides resources for training and implementing screening tools.

Motivational Interviewing: The Brief Intervention of SBIRT 
School-Based Health Alliance, a HRSA-funded National Cooperative Agreement (NCA), hosted a webinar focused on the four-step SBIRT model and brief negotiation interview tools for the child and adolescent population.

SBIRT with LGBT Patients: Identifying and Addressing Unhealthy Substance Use in Primary Care Settings 
The National LGBT Health Education Center, a HRSA-funded NCA, hosted a webinar focused on how to implement SBIRT in a primary care setting and explaining the disparities in substance use in LGBT populations.

CMS SBIRT Services Booklet (PDF – 2.73 MB)
Provides information about Medicare and Medicaid coverage of SBIRT services including eligible providers documenting SBIRT services, billing for SBIRT services, dual eligible, and additional resources.

NIDA Drug Screening Tool: NIDA-Modified ASSIST 
Guides providers through a series of questions to identify risky substance use in their adult patients.

Screening Tools for Depression, Drug and Alcohol Use, Bipolar Disorder, Suicide Risk, Anxiety Disorders, and Trauma
The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) provides guidance on evidence-based depression screening tools and workflow implementation.

Substance Use Clinician Warmline
The HRSA-supported Substance Use Warmline provides clinician-to-clinician consultation (via phone or online), assisting primary care clinicians and health center staff in addressing the challenging issues related to treating SUD, chronic pain, and behavioral health.

SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) 
This SAMHSA-supported center is a national training and technical assistance center focused on the integration of primary and behavioral health care and related workforce development.

Clinical Support System for Serious Mental Illness (CSS-SMI)
SAMHSA’s CSS-SMI offers expert consultation services and learning opportunities nationwide to support clinicians—including physicians, nurses, psychologists, recovery specialists, peer-to-peer specialists, and others—who provide evidence-based care for individuals with serious mental illness.

State Targeted Response-Technical Assistance (STR-TA) Consortium
This SAMHSA-supported consortium provides support and technical assistance to states’ and territories’ efforts to provide SUD prevention services and treatment.

SAMHSA's Programs and Campaigns
SAMHSA’s programs and campaigns offer information, training, and technical assistance to improve the quality and delivery of behavioral health services across the nation.

From 2017-2018, HRSA-sponsored the OAT ECHO: A national technical assistance program that supported primary care teams to enhance health center capacity to treat opioid use disorder (OUD). The program included bi-weekly virtual sessions with didactic training and the opportunity to present patient cases and receive interdisciplinary clinical expert input. The slides, audio recordings, and transcripts for the training sessions are below.

  • Overview of Opioid Use Disorder (OUD)
    Presentation (PDF – 1.63 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 301 KB)
  • Risk Reduction: Overdose Prevention and Management of Misuse/Risky Use of Opioids
    Presentation (PDF – 1.65 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 281 KB)
  • Trauma–informed Care and the role of Adverse Childhood Events in Predisposing to SUDs
    Presentation (PDF – 822 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 199 KB)
  • Introduction to Motivational Interviewing
    Presentation (PDF – 1.83 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 293 KB)
  • Evidence–based Screening and Use of SBIRT Techniques
    Presentation (PDF – 1.05 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 239 KB)
  • Medication Treatment of OUD, including Use of Evidence–based Treatment Guidelines for OUD
    Presentation (PDF – 1.02 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 216 KB)
  • Effective Team–based Care for OUD + Care Coordination and Addressing SDOH
    Presentation (PDF – 1.67 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 258 KB)
  • Office–based Management of OUD Part 1: Evaluation and Management of New Patients
    Presentation (PDF – 968 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 178 KB)
  • Office–based Management of OUD Part 2: Maintenance and Detecting/Dealing with Relapse
    Presentation (PDF – 1.51 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 274 KB)
  • Addressing SUD–related Comorbidities, such as Hepatitis, HIV, Depression, Anxiety, and PTSD
    Presentation (PDF – 3.07 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 266 KB)
  • Pain Management in People Who Have OUD; Acute vs. Chronic Pain
    Presentation (PDF – 1.33 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 217 KB)
  • OUD in Special Populations (Adolescents, Pregnancy)
    Presentation (PDF – 676 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 224 KB)

Adverse Childhood Experiences (ACEs)
CDC offers information on preventing and minimizing negative effects of ACEs.

SAMHSA Trauma-Informed Approach and Trauma-Specific Interventions
SAMHSA offers information on trauma-specific interventions and trauma-informed approaches to address the consequences of trauma and facilitate healing.

The Abyss: Addiction, Homelessness, and Trauma
The National Health Care for the Homeless Council, a HRSA-funded NCA, hosted a webinar examining the research and science behind the connections between SUD and trauma.

National Institute of Mental Health (NIMH) 
The NIMH offers information on mental disorders, a range of related topics, and the latest mental health research.

Mental Health Technology Transfer Center Network (MHTTC)
SAMHSA’s MHTTC network works with organizations and treatment practitioners involved in the delivery of mental health services to strengthen their capacity to deliver effective evidence-based practices to individuals, including the full continuum of services spanning mental illness prevention, treatment, and recovery support.

Mental Health and SUD
HHS provides information and resources on treatment and recovery of mental health problems and SUD.

Clinical Guidance for Treating Pregnant and Parenting Women with OUD and Their Infants
SAMHSA’s clinical guidance for medical professionals treating pregnant and parenting women with Opioid Use Disorder (OUD).

Obstetric Care for Women with OUD
HRSA-supported Alliance for Innovation on Maternal Health (+AIM) provides evidence-based practice safety bundles to improve obstetric care coordination for opioid dependent women.

CMS Innovation Center Maternal Opioid Misuse (MOM) Model Fact Sheet (PDF – 718 KB)
Aims to increase the quality of care of pregnant and postpartum Medicaid beneficiaries with OUD.

Pregnancy Risk Assessment Monitoring System (PRAMS)
This CDC resource provides data that can be used to plan programs and services aimed at reducing health problems among mothers and infants.

Linking Older Adults with Medication, Alcohol, and Mental Health Resources 
This SAMHSA toolkit helps service providers for the aging learn more about mental illness and SUD in older adults, including focus on alcohol and medication use.

Older Adults and Medication Safety (PDF – 948 KB)
The Administration on Community Living (ACL) provides resource materials discussing the safe use of medications for older adults and their caregivers.

Opioids and Older Adults Fact Sheet (PDF – 800 KB)
ACL provides a list of resources to help enhance the self-sufficiency, well-being, and health of older adults and their families.

Date Last Reviewed:  July 2019


Surgeon General’s Report on Alcohol, Drugs, and Health

This report discusses opportunities for integrating SUD treatment into physical health care to address a patient’s total health and wellbeing, as well as recommendations to prevent SUD.

Did You Know?

The National Health Service Corps supports the recruitment and retention of health professionals to expand access to SUD treatment and prevent overdose deaths.