title: Integration of Care in the Implementation of the Affordable Care Act: Changes in Treatment Services in a National Sample of Centers Treating Substance Use Disorders.
abstract: This study examined patterns of medicalization in substance use disorder (SUD) that are aligned with the goals of the Affordable Care Act (ACA). Using a nationally representative sample of SUD treatment programs, we examined changes in several treatment domains. While observed changes were modest, they were in directions that support the thrust of the ACA. Specifically, we found an increase in the percentage of treatment referrals from other health care providers. We found an increase in the number of physicians for programs that did have a physician on staff, and an increase in counselors certified in treating alcohol and drug addiction. There was significant growth in the availability of oral and injectable naltrexone but not of other pharmacotherapies. There was a decrease in support for the 12-step model and an increase on the emphasis of a medicalized treatment model. Finally, we found a shift away from federal block grants and other public funding, consistent with the expectations of the ACA. These data indicate that, while progress is slow, the environment of the recent past has been supportive of the goal of SUD treatment's integration into mainstream medical care.
authors.affiliation: a Assistant Director, Center for Research on Behavioral Health and Human Services Delivery, Owens Institute for Behavioral Research , University of Georgia , Athens , GA , USA.
authors.forename: Lydia
authors.identifier: 0000-0002-1771-7791
authors.initials: L
authors.lastname: Aletraris
authors.affiliation: b Director and Regents Professor of Sociology, Center for Research on Behavioral Health and Human Services Delivery , Owens Institute for Behavioral Research, University of Georgia , Athens , GA , USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Roman
authors.affiliation: c Graduate Student, School of Social Work , University of Georgia , Athens , GA , USA.
authors.forename: Jana
authors.initials: J
authors.lastname: Pruett
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D062528:Medicalization / Q000639:trends; D009271:Naltrexone / Q000600:supply & distribution; D009292:Narcotic Antagonists / Q000600:supply & distribution; D058991:Patient Protection and Affordable Care Act; D010820:Physicians; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000639:trends; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone
keywords: Affordable Care Act; SBIRT; medical staffing; medication-assisted treatment; substance use disorder treatment