Adolescent Substance Use Treatment: How Can We Expand Access and Support PCPs?

Amidst an ongoing epidemic of drug overdose deaths in the United States,¹ the demand for accessible and affordable adolescent substance use treatment in 2024 is likely to be greater than ever before. Yet, a recent National Institutes of Health (NIH)-supported study² has confirmed what so many American families are already facing first-hand: adolescent access to essential substance use disorders (SUDs) treatment facilities is only getting more complex. 

The Search for Residential Adolescent Substance Use Treatment Facilities

According to the NIH study, only half (54%) of residential treatment facilities – live-in care centers that offer essential treatment for SUDs – have an available bed for adolescent patients with opioid use disorder (OUD).² Even when beds are available, costs are often prohibitive, with an average monthly reported cost of treatment of over $26,000.²

In the face of such scarce resources, alternative models are essential to expand care access and support earlier intervention for OUD and SUDs more broadly. Searching for a residential treatment program or facility for adolescents often requires diligence, patience, and a substantial financial investment. As noted in the NIH study, almost half of the programs contacted by researchers asked for up-front payment from self-pay patients before admission, and the average cost per day of the facilities providing cost information was $878.²

These costs are a major barrier for many patients, families, and caregivers – especially those who are already underserved by mental health and behavioral health resources. Vulnerable populations are disproportionately at risk, as Hispanic and Black adolescents have experienced the most significant increase in drug overdose deaths in recent years.³

Expanding Access – Child Psychiatry Access Programs

Given the major barriers patients face in accessing residential facilities for adolescent substance use treatment, researchers and clinicians suggest that better support for primary care providers (PCPs) can aid in the early identification and management of SUD among children and adolescents.

As noted by the NIH study authors, PCPs are integral to expanding treatment access for patients, particularly in under-served areas.² As the first clinical point of contact for many children and adolescents, PCPs play a crucial role in identifying and addressing SUDs through screening for OUD during physicals and well-child visits. 

As with other health conditions, early intervention through primary care can help address SUDs and prevent progression into more severe cases – which ultimately require more specialized and costly treatment options. In the case of OUD, previous research has demonstrated that interventions to improve PCPs’ comfort in prescribing buprenorphine – a first-line treatment for OUD – to adolescents could expand access and improve long-term recovery prospects.²

The establishment of child psychiatry access programs (CPAPs) as a national care model supports this goal of informing and empowering PCPs to treat adolescent SUDs. Through federal, state, and alternative funding sources, CPAPs are state-based services that provide specialty mental and behavioral health education, care coordination, and consultation to PCPs managing child and adolescent patients.

The 5 key elements of CPAPs are as follows:⁴

1. PCP access to on-demand telephone consultation by child and adolescent psychiatrists and/or other licensed children’s mental health professionals within a defined region/population regarding the diagnosis and management of mental health and SUDs
2. Real-time response (anywhere from 30 minutes to the same workday)
3. Assistance with resource navigation and provision of referrals
4. Access to expedited psychiatric evaluations (in-person or telehealth)
5. Continuing education sessions for PCPs and assistance with integrate behavioral health into their practice

Operating across 47 states,⁵ CPAPs stretch available child and adolescent psychiatric care resources by enabling PCPs to deliver more specialized care. A recent review of available evidence on CPAPs found that several studies identified an improvement in PCP knowledge and skill, as well as self-efficacy in managing mental health conditions in primary care, after using CPAP services.⁶

A Potential Solution – SUD Access Programs

Historically, CPAPs have primarily focused on non-substance-related mental and behavioral health conditions,⁶ yet SUDs are often a co-occurring element of adolescent mental health care. Having already expanded services to maternal mental health care through perinatal access programs,⁷ some state access programs are looking to increase specialty resources for adolescent substance use treatment.

By connecting PCPs with specialty care and referral resources, SUD access programs offer the potential to scale resources and deliver affordable, accessible early interventions that are so direly needed for adolescents and families who are struggling with substance use. 

Policy measures are already being explored to ensure a higher baseline comfort level among all providers in managing SUDs. In 2021, the US House of Representatives introduced the Medication Access and Training Expansion (MATE) Act of 2021 which requires all physicians without specialty board certification in addiction medicine or addiction psychiatry – including PCPs and many psychiatrists – to undergo additional substance use training.⁸

From 2013 to 2022, only 759 physicians were certified in addiction psychiatry and 3916 in addiction medicine.⁹ Given the scarcity of addiction specialists in the US, such interventions are likely a welcome step in upskilling both PCPs and the many psychiatrists who do not have specialty addiction medicine training.

This also highlights the distinctive role that CPAPs can play in supporting community care for SUDs. Child and adolescent psychiatrists who are enrolled in the access program may be best utilized in supporting PCPs who do not have specialty addiction training with the many psychiatric comorbidities and social factors that often accompany SUDs.

Moving forward, efforts to staff CPAPs with addiction psychiatrists will be vital in expanding community access to specialty training, particularly for complex cases that neither PCPs nor general child and adolescent psychiatrists can manage. Accessibility to licensed social workers with SUD expertise and insight will be invaluable for optimal care coordination, ensuring PCPs are directed to the appropriate specialty addiction services in the community.

Increasing Funding for Adolescent Substance Use Treatment Programs

If such initiatives are to succeed, increased funding from state and federal agencies will be critical for improved patient outcomes. In February of this year, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced a commitment of $28 million in funding opportunities to support expanded treatment services for SUDs – a significant investment into programs of this nature.¹⁰ This funding source offers increased resources through adult and family treatment courts and pilot programs for pregnant and postpartum women. Similar funding for adolescent substance use treatment – including support for specialty addiction medicine and/or psychiatry training and staffing resources – will be essential to adequately address existing care gaps.

With the incidence of SUD-related harm and mortality outstripping the availability of care, digital systems that facilitate increased connectivity between providers are increasingly important.  As one piece of the care system puzzle, these platforms can integrate complex SUD care, allowing providers to devote essential time and resources to the adolescents who need it most. 

This article originally appeared on Psychiatry Advisor