What SUD Treatment Providers Can Learn from Oncology Care

This is an exclusive BHB+ story

Episodic treatment often defines the way substance use disorder (SUD) care is managed.

Patients get care at the time they most need it, then leave a treatment center or stop services. But when they leave addiction treatment, they’re not cured. In many ways, they’re in “remission” from their disease, following a similar path as oncology patients.

Oncology patients in remission frequently receive chronic care follow-ups, routine check-ins after they finish more structured care plans. During this time, they may also even have multidisciplinary teams working with them.

Addiction is a disease that really doesn’t have that same template, sources told Behavioral Health Business. But what SUD treatment and oncology care do have in common is the notion that “recovery is more sustainable when the full context of the patient’s life is addressed,” Dr. Gerald Busch, an assistant professor in the department of psychiatry at the Uniform Services University of the Health Sciences and faculty on the Behavioral Health Services Unit at Tripler Army Medical Center, told BHB.

“Structured follow-up care, similar to oncology survivorship plans, could significantly strengthen SUD outcomes,” Busch said. “Addiction treatment often ends with discharge from acute care without adequate follow-up. A system of scheduled check-ins, recovery milestones and relapse prevention planning – especially when integrated into primary care – would support long-term remission and reduce recurrence.”

Borrowing from an oncology template

The practice of oncology treatment significantly predates that of SUD care, and that is part of the issue with how the behavioral health field currently approaches addiction medicine, Dr. Pete Vernig, vice president of mental health services at Recovery Centers of America (RCA), told BHB.

“In a lot of ways, the behavioral health field is lagging behind the rest of medicine or the rest of health care,” Vernig said. “In oncology, you have a very systematized, structured system of care in a good way, because it is based on best practices. There is a very large body of research that has been conducted on treating cancer in an effective way.”

Pennsylvania-based RCA is a provider of addiction and mental health inpatient and outpatient services with locations across seven states.

“Screening, treatment and good follow-up really has improved the care of individuals in our society,” Vernig explained. “I think that type of real noticeable impact, both on society and on people’s lives, their families and communities, could be felt if we did this with substance use disorder.”

Viewing addiction care as a continuum and borrowing from cancer’s chronic care model, where patients do not lose touch completely with their care system after moving into remission and instead engage in periodic check-ins, light-touch monitoring and ongoing care, could improve outcomes.

And from a bottom-line perspective, offering wrap-around services and longitudinal care could create new revenue opportunities for providers.

“When you’re discharged from the hospital or a residential facility, you’re not cured,” Dr. Brian Hurley, immediate past-president of the American Society of Addiction Medicine (ASAM), told BHB. “People continue to have needs that are ongoing, and we need to deliver an ongoing care system that is accessible to patients with addiction.”

The ASAM Criteria for addiction medicine care recently added a pillar for long-term remission monitoring in its latest guidance, which advocates for a chronic care model that features “monitoring for patients in sustained remission, providing recovery management checkups and rapid reengagement in care when needed.”

“We should not be thinking about addiction in terms of 20-day residential stays or 90-day residential stays as being the end of treatment, but rather people stay in the intensity of care that is necessary for their individual circumstances,” Hurley said.

Rockville, Maryland-based ASAM is a professional medical society with a membership base of more than 7,000 addiction care clinicians and experts.

Restructuring practice, dismantling stigma

Reframing SUD treatment to be more in line with what patients who face chronic diseases receive in practice is met with several barriers to adoption.

Even with the revived guidance on remission care from ASAM, one of the nation’s oldest and largest addiction medicine organizations, stigma around providing that type of care persists.

When cancer rates rise, health care officials often look to research, establishing more resources within medical systems and increasing access to comprehensive treatment. When addiction rates rise, it’s a different conversation: more police, improved public safety, more jails.

Even though research shows that increased law and order around drug use doesn’t equate to fewer incidents, this is the approach the Trump administration has touted as a priority for addressing the opioid crisis.

“Typically, we think of cancer as something that’s not your fault,” Dr. Avik Chatterjee, assistant professor at Boston University School of Medicine and physician at Boston Health Care for the Homeless Program, told BHB. “Two people can live in the exact same conditions: One person gets cancer and the other doesn’t, and it’s because of the complex set of things like genetics and other factors that produce it. It’s the same with addiction, but we blame the people with addiction.”

Chatterjee noted that with oncology being an older field of medicine and more widely practiced, that comparatively, the access to fellowships for addiction medicine when he was going through residency were few and far between.

That means there’s a relative research gap.

In oncology, experts have identified the genetic BRCA tumor suppressor genes. Mutations of those genes can be passed on from parent to child and increase the risk of several cancers in both men and women. It’s commonplace to assess the risk in a child.

While addiction medicine does not have its own “BRCA gene” for detecting risk factors passed along this way, scientists have discovered genes that are inherited across addiction disorders regardless of the substance used.

“I think one area of growth for addiction medicine is to look at families and think about ways to understand, communicate and prevent risk in the children of parents who’ve had addiction in the same way that I think oncologists have gotten much better at over the years,” Chatterjee said.

Moving toward more proactive assessments and a continuum of remission care for addiction treatment also requires robust resources, data management systems and staff.

“A lot of providers don’t have the type of data systems they would need for this. In order to do this, you have to be able to track individuals over long periods of time. You have to be able to integrate new information. You would need to devote resources,” RCA’s Vernig said. “It takes training too, because you need to make sure you have the right person with the right training in a position like that. You need to be able to demonstrate the value to the individual in the system of approaching a substance use disorder in that way.”

The challenge with demonstrating value is also reimbursement issues – ones oncology care often doesn’t face in the same way.

“I think a robust payment system for addiction treatment will be a fertile ground for innovation,” Chatterjee said. “But you can’t be innovative with treatment if you’re constantly worried about going out of business because the government or an insurance company isn’t going to pay you for those services.”

Bringing addiction care fully into the fold of traditional medical settings, where every hospital has a dedicated department for this type of treatment and working to make addiction treatment as “a standard medical specialty” is one way forward, Dr. Jason Kirby, medical director of PursueCare, an online addiction and mental health service, told BHB.

“The field is going to have this stigma when we continue to put addiction medicine and addiction treatment, in general, in the shadows and behind the walls,” Kirby said. “People are going to fear that they’re lesser, and we need to break through that. That’s why I’m a proponent of putting addiction medicine in every hospital. Let’s get privileges for everybody. Let’s normalize this disease. Let’s have grand rounds. Let’s get over the fact that we all know somebody is battling this. So let’s work together and try to do something good.”