New systems of care for substance use disorders: treatment, finance, and technology under health care reform

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Behavior, Addictive; Counseling; Delivery of Health Care, Integrated; administration; Health Care Reform; Health Services Accessibility; Health Services Needs and Demand; Healthcare Disparities; Humans; Insurance Coverage; Insurance, Health; Mass Screening; Medical Informatics; Outcome Assessment (Health Care); Patient-Centered Care; Primary Health Care; Substance-Related Disorders; United States


Health Services Research | Mental and Social Health | Psychiatric and Mental Health | Psychiatry | Psychiatry and Psychology


This article outlined ways in which persons with addiction are currently underserved by our current health care system. However, with the coming broad scale reforms to our health care system, the access to and availability of high-quality care for substance use disorders will increase. Addiction treatments will continue to be offered through traditional substance abuse care systems, but these will be more integrated with primary care, and less separated as treatment facilities leverage opportunities to blend services, financing mechanisms, and health information systems under federally driven incentive programs. To further these reforms, vigilance will be needed by consumers, clinicians, and policy makers to assure that the unmet treatment needs of individuals with addiction are addressed. Embedded in this article are essential recommendations to facilitate the improvement of care for substance use disorders under health care reform. Ultimately, as addiction care acquires more of the "look and feel" of mainstream medicine, it is important to be mindful of preexisting trends in health care delivery overall that are reflected in recent health reform legislation. Within the world of addiction care, clinicians must move beyond their self-imposed "stigmatization" and sequestration of specialty addiction treatment. The problem for addiction care, as it becomes more "mainstream," is to not comfortably feel that general slogans like "Treatment Works," as promoted by Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment during its annual Recovery Month celebrations, will meet the expectations of stakeholders outside the specialty addiction treatment community. Rather, the problem is to show exactly how addiction treatment works, and to what extent it works-there have to be metrics showing changes in symptom level or functional outcome, changes in health care utilization, improvements in workplace attendance and productivity, or other measures. At minimum, clinicians will be required to demonstrate that their new systems of care and future clinical activity are in conformance with overall standards of "best practice" in health care.

DOI of Published Version



Psychiatr Clin North Am. 2012 Jun;35(2):327-56. Link to article on publisher's site

Journal/Book/Conference Title

The Psychiatric clinics of North America

Related Resources

Link to Article in PubMed