Addiction is a health issue that contributes to mental health challenges and the burden of care for individuals, communities and governments. According to the American Society of Addiction Medicine (2019), addiction is a treatable, chronic ailment entailing complex interactions between cognitive circuits, environment, genetics and the person’s life experiences. Addictions make the victims adopt compulsive behaviors and continue with use despite the harmful effects. According to Substance Abuse and Mental Health Services Administration (2021) statistics, approximately 43 million persons, representing 16.5% of the population, met the substance use disorder criteria as per DSM-5 description, with about 1 million succumbing to death due to drugs, alcohol or suicide between 2010-2019. Effective patient care influences the ability of addiction patients to recover, with highly effective treatment options coming in handy to treat people with substance use disorders. The implication is that poor patient care creates a gap between “what is” and “what should be” for persons who have a substance use disorder and related mental health disorders (Hoover et al., 2022). This paper focuses on patient care for persons with addiction, providing insights into the importance of ensuring they receive the right and timely care.
PICO Question
In adult individuals with substance use disorders (P), does the implementation of an interdisciplinary approach to patient care (I), compared to traditional segmented care ©, impact the quality of care, patient outcomes, and the identification of co-occurring mental health disorders in healthcare settings (O)?
Research Question
How does instituting an interdisciplinary approach to patient care, compared to traditional segmented care, influence the quality of care and patient outcomes for adults with substance use disorders?
Literature review
Addiction and substance use disorders have been on the surge in the first few years. This trend has been prevalent since 2016, with the COVID-19 pandemic compounding the issue (Hoover et al., 2022). Patient care for patients who have an addiction is characterized by gaps, as care for such patients in healthcare facilities has only been directed at severe medical concerns. This occurs amidst persons with substance use disorder experiencing high rates of comorbidities that necessitate the need for frequent medical care and hospitalization (Schranz et al., 2019). Thus, patient care for this vulnerable population lacks a holistic strategy to address co-occurring social determinants of health that predominantly contribute to poor outcomes and representation in healthcare facilities. This occurs amidst reports of increasing stigma for this group when receiving care, reducing their likelihood that they will seek treatment (Hall et al., 2021). Dual diagnosis is akin to greater symptom severity, increased reliance on medication and reduced quality of life. Therefore, barriers to care worsen when there is dual diagnosis for drug addicts and substance use disorders.
Therefore, it is critical to institute effective patient care to overcome such barriers and improve patient outcomes. An interdisciplinary approach has been recommended as a practical approach to supporting improved care quality for addiction and substance use disorder patients (Hoover et al., 2022). Also, integration between mental health and substance use services and other healthcare services would be critical in driving early diagnosis through routine screening in primary care settings. This is achievable through networking and assimilation of diverse treatment approaches to facilitate patient-centered care and integrated care models (Fantuzzi & Mezzina, 2020). This proposal is critical to addressing gaps that have been persistent due to a healthcare system that is designed in such a way that mental health and other drug services have been delineated from each other during care delivery. Such segmentation in care has led to restricted treatment resource capacity, encompassing clinical skills and the absence of clinician-related willingness to deal with comorbid conditions and practice competencies. With siloed health services contributing to a lack of understanding of substance use within the mental health clinicians fraternity and misunderstanding of mental disorders among the drug and alcohol practitioners, an integrated intervention approach creates a platform for timely screening and assessment of mental health or substance abuse disorders (Alsuhaibani et al., 2021). Nurses, psychiatrists, and their colleagues can collaborate to provide integrated care while encouraging their healthcare facility leadership to provide resources and opportunities for their peers to learn specialized skills to assess and treat all mental health conditions.
Nurses are constantly interacting with patients across all the healthcare services frontiers. Therefore, as the largest cluster in the mental health workforce, their frontline services position them as key players in patient interaction (Australian Institute of Health and Welfare, 2021). Psychiatric nurses can also play a unique role by facilitating therapeutic effects through interpersonal nurse-patient relationships while promoting mental health and well-being by initiating human connections in a trauma-informed way, imparting kindness and espousing respect for the personal lived experiences of the patient (Anandan et al., 2020). Psychiatric nurses can also play the advocacy role by promoting the interests of drug addicts within the facility and at the state and national level, where they can contribute to policy formulation and improvement of the existing ones. All these efforts should go concurrently to achieve optimal results.
Methodology
A qualitative research approach was used by conducting a literature review. Different databases were consulted to access journal articles and other scholarly articles that met the selection criteria, which factored in the CRAAP test (Currency, Relevance, Authority, Accuracy, and Purpose) to evaluate their credibility and relevance. The databases used for the search included CINAHL, MEDLINE, Embase, and The Cochrane Library. These databases were considered the most plausible as they are renowned for hosting high-quality academic content and covering a wide range of health-related disciplines. Keywords that were used in the search included Keywords:“ interdisciplinary approach,” “addiction, “substance use disorders,” “Patient care,” “Mental health,” “Quality of care,” and “Addiction treatment.” The search filters applied within the selected databases included Peer-reviewed articles, Publications within the last five years, English language, and Research articles and reviews.
Results
The study reveals that addiction and substance abuse are on the increase, requiring a change in approach to patient care. The literature review indicates the need for collaboration and integrated patient care where psychiatric nurses must work with their counterparts to advocate for the integration of substance use disorders and mental health into routine care.
This would drive early screening and ensure the patients receive care early. Dual diagnosis is a challenge that must be tackled by enhancing nurse skills and training in the area.
Discussion
With statistics indicating that addiction and substance abuse are treatable conditions, policymakers and the government must move away from the current system where the condition is criminalized. This would help minimize stigma on the group and direct more resources to the healthcare system to help tackle the pandemic. Healthcare service providers and psychiatric nurses should work together to produce a new system that connects the missed gaps in the traditional segmented system to ensure complete, coordinated, patient-centered care (Richert et al., 2020). The engagement of patients, their families and the community would also be critical to continuing post-hospital care while eliminating possible stigmatization of the issue.
Conclusion
Addiction is a health problem that requires concerted efforts to reverse the current trend characterized by increasing numbers and deaths. The initial touchpoint for such changes is the healthcare facilities moving from the traditional models of care that segment the process. Treating addiction and substance abuse as a separate condition from mental health or any other health issue has culminated in the severity of the patient’s condition as cases are dealt with when it is too late into the process. Therefore, there is a need to integrate the addiction patient care process into the mainstream system to facilitate early screening and assessment. Nurse psychiatrists should champion the process and ensure the hospital leadership and other stakeholders know the existing challenges and the need for correction.
References
Anandan, R., Cross, W., & Olasoji, M. (2020). Mental health nurses’ attitudes towards consumers with co-existing mental health and drug and alcohol problems: A scoping review. Issues in Mental Health Nursing, 42(4), 346–357. https://doi.org/10.1080/01612840.2020.1806964
Australian Institute of Health and Welfare. (2023). Alcohol, Tobacco & Other Drugs in Australia, about. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/summary
Alsuhaibani, R., Smith, D. C., Lowrie, R., Aljhani, S., & Paudyal, V. (2021). Scope, quality and inclusivity of international clinical guidelines on Mental Health and substance abuse in relation to dual diagnosis, social and Community Outcomes: A systematic review. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03188-0
American Nurses Association. (2021). Addictions nursing: Scope and standards of practice (2nd ed.).
Beckett, M., Hering, R., & Urbanoski, K. (2022). Inpatient Care Provider Perspectives on the development and implementation of an addiction medicine consultation service in a small urban setting. Substance Abuse Treatment, Prevention, and Policy, 17(1). https://doi.org/10.1186/s13011-022-00497-9
Fantuzzi, C., & Mezzina, R. (2020). Dual diagnosis: A systematic review of the organization of Community Health Services. International Journal of Social Psychiatry, 66(3), 300–310. https://doi.org/10.1177/0020764019899975
Hall, N. Y., Le, L., Majmudar, I., & Mihalopoulos, C. (2021). Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug and Alcohol Dependence, 221, 108651. https://doi.org/10.1016/j.drugalcdep.2021.108651
Hoover, K., Lockhart, S., Callister, C., Holtrop, J. S., & Calcaterra, S. L. (2022). Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients’ and Hospital-based providers’ Perspectives. Journal of Substance Abuse Treatment, 138, 108708. https://doi.org/10.1016/j.jsat.2021.108708
Miller, B., Hurley, B., & Guyer, J. (2022). Strengthening patient-centered addiction and mental health care in the United States. Forefront Group. https://doi.org/10.1377/forefront.20220118.445937
Richert, T., Anderberg, M., & Dahlberg, M. (2020). Mental health problems among young people in substance abuse treatment in Sweden. Substance Abuse Treatment, Prevention, and Policy, 15(1). https://doi.org/10.1186/s13011-020-00282-6
SAMHSA. (2023, January 4). SAMHSA announces national survey on drug use and health (NSDUH) results detailing mental illness and substance use levels in 2021. HHS.gov. https://www.hhs.gov/about/news/2023/01/04/samhsa-announces-national-survey-drug-use-health-results-detailing-mental-illness-substance-use-levels-2021.html
Schranz, A. J., Fleischauer, A., Chu, V. H., Wu, L.-T., & Rosen, D. L. (2018). Trends in drug use–associated infective endocarditis and heart valve surgery, 2007 to 2017. Annals of Internal Medicine, 170(1), 31. https://doi.org/10.7326/m18-2124
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