When Dr. Jennifer Thomas, a family medicine physician, started her first job after residency, she confessed she had “no clue” how often she would encounter patients with substance use disorder (SUD) in the primary care setting. Over time, Thomas has witnessed firsthand just how common these needs are, and she has become a leading advocate for integrated substance use disorder care in primary care. Now serving as co-national medical director for integrated care at the Collaborative Family Healthcare Association (CFHA), Thomas is part of a growing movement aiming to embed behavioral health, including SUD care, seamlessly into the primary care workflow.
The Need for Systematic Screening and Early Intervention
Dr. Thomas stresses that integrated care teams should strive to make behavioral health and substance use screenings standard at every patient visit. “If we systematically screen the population, we’ll catch folks a lot earlier and have a better chance at intervening early, decreasing morbidity and mortality,” she told Addiction Treatment Business. Early detection is critical because substance use disorders often go unnoticed until they cause significant health problems, and delayed intervention reduces the chances for effective treatment.
The CFHA, which brings together behavioral health providers, medical clinicians, payers, and other stakeholders, is dedicated to making integrated substance use disorder care in primary care the standard of care nationwide. Their cross-disciplinary approach reflects the reality that physical health, mental health, and substance use are deeply interconnected, and treating them in silos misses opportunities for more comprehensive care.
Collaborative Care: A Proven Team-Based Model
Thomas’s commitment to integrated substance use disorder care in primary care grew through specialized training and research. She completed an online fellowship focused on psychiatry for primary care physicians and later joined a collaborative care research study at the University of Washington’s AIMS Center. This program offers coaching and tools to implement collaborative care, an evidence-based integrated care model.
Collaborative care brings together a team of providers — including a psychiatric consultant, behavioral health care manager, and the primary care physician — to work collaboratively with the patient. Using measurement-based care, this model tracks patient progress with validated tools and adjusts treatment accordingly.
Originally developed to address perinatal depression, collaborative care’s success encouraged Thomas to focus on patients with opioid use disorder (OUD) and co-occurring mental health conditions. Now, she personally prescribes buprenorphine to 20 to 30 patients and has provided integrated care to hundreds more with SUDs.
Screening and Treatment Workflow in Practice
In her clinical practice, Thomas and her team screen every adult patient with a brief opioid screener asking, “Are you using any opioids prescribed or otherwise?” If the answer is yes, the team follows up with the formal use disorder diagnostic criteria. Patients who also have co-occurring depression or anxiety are then eligible for collaborative care services.
This integrated approach to OUD treatment has transformed outcomes for many patients who previously struggled without coordinated care. Thomas also highlights the impact of SUBLOCADE, a monthly injectable form of buprenorphine, which improves treatment adherence by reducing the burden of daily medication.
Geisinger’s Integrated SUD Care Model
Geisinger Health System provides another example of successful integrated substance use disorder care in primary care, backed by substantial federal funding. Supported by a $2.8 million grant from the U.S. Health Resources and Services Administration, Geisinger is training social workers and advanced practitioners in SUD care. These clinicians form teams with primary care doctors to offer withdrawal management, medications, and counseling, tailored to patient needs.
Dr. Margaret Jarvis, chief of addiction services at Geisinger Addiction Medicine and the Geisinger Neuroscience Institute, notes that “much of addiction care has to be team-based.” Patients with SUD often have significant social determinants of health challenges and psychiatric or physical comorbidities. Addressing these comprehensively improves overall health outcomes and makes the primary care physician’s work more effective.
Addressing the Challenge of Stigma in SUD Care
Despite clinical advances, stigma remains a formidable barrier to quality SUD care. Jarvis emphasizes the importance of exposing healthcare practitioners to SUD treatment early in their careers. Early exposure and education reduce stigma and increase clinicians’ confidence and willingness to engage in integrated substance use disorder care in primary care.
In addition to education, improving the language used around addiction and training clinicians to recognize and reduce bias are key strategies. The goal is to foster a more compassionate, patient-centered culture that treats substance use disorders with the same seriousness as other chronic illnesses.
The Crucial Role of Follow-Up Care in Sustaining Recovery
Screening and referral are only the first steps. Research increasingly shows that ongoing follow-up after initial treatment engagement plays a critical role in sustained recovery. A study published in Alcohol: Clinical and Experimental Research demonstrated that patients who received regular recovery management checkups had significantly higher rates of treatment retention and abstinence compared to those who only received traditional screenings, brief interventions, and referrals (SBIRT).
Dennis Watson, senior research scientist at Chestnut Health Systems, explains that recovery management checkups involve ongoing engagement through a linkage manager who uses motivational interviewing techniques to help patients work through ambivalence about treatment. The manager does not pressure patients but keeps the door open for future discussions.
Once a patient agrees to treatment, the linkage manager arranges transportation to a treatment facility within 24 to 48 hours and maintains frequent contact—via calls or texts—to watch for relapse risks. Follow-up frequency gradually decreases over time but continues on a quarterly basis to maintain support.
This approach treats addiction as a chronic disease requiring ongoing management rather than an acute episode to be fixed quickly. It helps patients stay connected to care and recover more successfully.
Overcoming Billing and Reimbursement Barriers
Billing remains a major obstacle to widespread adoption of integrated substance use disorder care in primary care. While some billing codes exist for collaborative care, reimbursement often does not reflect the true time and effort required.
Dr. Jarvis highlights the frustration that when reimbursement is minimal — for example, $1.50 for a 10-15 minute activity — clinicians and clinics struggle to sustain these services financially.
Dennis Watson echoes this, noting that direct billing mechanisms for integrated care would be more helpful than value-based care incentives, which have not yet evolved enough to cover integrated behavioral health effectively.
For now, fee-for-service models might best support integration, although the field continues to explore more sustainable and comprehensive payment approaches.
The Road Ahead: Experimentation and Innovation
Clinicians, healthcare organizations, and researchers broadly recognize the critical importance of integrated substance use disorder care in primary care. However, no single model has yet emerged as the definitive solution.
Dr. Jarvis aptly sums it up: “There are different groups experimenting with different ways of creating integration. It is experimentation. We don’t know which models will work best yet. The good news is we’re trying.”
As integrated care models evolve, the hope is to create systems that can detect substance use disorders early, offer accessible and effective treatment options, reduce stigma, provide ongoing support, and sustainably fund these services.
Conclusion
Integrated substance use disorder care in primary care is transforming how patients receive help for addiction. By embedding systematic screening, team-based care, ongoing follow-up, and stigma reduction into routine primary care, providers like Dr. Jennifer Thomas and organizations like CFHA and Geisinger are changing lives.
This holistic, patient-centered approach not only improves addiction outcomes but also enhances management of co-occurring mental and physical health conditions. Though challenges remain—particularly around billing and stigma—the growing momentum behind integrated substance use disorder care in primary care promises a future where SUD care is no longer siloed but is an inseparable part of comprehensive health care.
