In both the January 26 and March 23 issues of this newsletter, integrated care was introduced, identifying specific barriers to its adoption and implementation. This issue delves into three additional barriers:  lack of incentives for providers; training of health care professionals about addiction and mental health; and need for local and state leadership.

One way to encourage integrated care is to develop and implement payment structures that incentivize and support provider behavior change and team-based care. These strategies can be very effective, especially when used in conjunction with sanctioned and paid training on evidence-based practices. In order to partner effectively, behavioral health clinicians need to be knowledgeable and current on the interplay of behavioral and physical health, particularly in regard to the growing prevalence of chronic diseases and aging population. Alcohol and drug misuse play an important role in the progression of heart disease, cancer, diabetes and other chronic conditions and these conditions are more easily managed once the SUD is addressed.

While the provision of training to behavioral health providers is vital, physical health care professionals must receive more training about mental health and substance use disorders. They, too, need to know how alcohol and drugs affect the leading causes of mortality as well as chronic diseases such as diabetes, hypertension, and asthma. Further, they must develop the knowledge and skills to effectively and efficiently identify and intervene in patients who have or who are at risk of developing SUDs. In February 2017, the national office of the Addiction Technology Transfer Center published a white paper, Preparing Students to Work in Integrated Health Care Systems, which discusses substance use related competencies for health professionals. It can be downloaded here.