The Importance of Integrated Care in Recovery from Addiction

This post was written by Anthony Nave, LCSW.

Integrated care is a term often used by healthcare professionals and represents a popular treatment model utilized by many providers. It’s generally been accepted as a successful approach to supporting clients living with co-occurring disorders. What can get lost in the shuffle in fast-paced treatment environments is what does the term mean, why is it important, and how is it possible to deliver this type of care effectively?

When an individual treatment provider or a whole agency loses sight of the integration of services, it impacts the clients the most. In such situations, the clients are struggling to heal from a complex mental health disorder, and professionals may struggle with burnout and can only offer one solution to what is a multisolution problem​ (SAMHSA, 2020)​​ (Smith, et al., 2018)​.

What Does Integrated Care Mean?

Unfortunately, this type of care has various meanings depending on the person using the term. A healthcare administrator will have a health system-based perspective, viewing it as a variety of health services a client can use for their unique health concerns, including prevention, education, assessment and monitoring, rehabilitation, and coordination of care within a continuum of services. A manager of a program within this system could view it as maintaining cross-department collaboration within the continuum or with outside community providers. A healthcare provider within the system might view integrated care as having various supporting treatments in sync with one another to provide a better quality of life for the client, while the client could view this model as planning care with professionals who work together to meet their treatment goals.

To be fair, integrated care can have an even broader meaning when discussing, “whole-system integration.” This happens when we are no longer focusing on a specific population being medically treated for a complex diagnosis, such as individuals struggling with substance use disorder. Whole-system integration looks at the entire population and is viewed through a person-centered approach for everyone such as the American Health Care System overall​ (Goodwin, 2016).

After peeling away all the layers of what integrated care could mean, two main traits remain The first involves trying to unify fragmented parts or services, and the other is viewing those parts or services holistically as they come together to deliver a system of care. For a provider supporting clients in addiction recovery, it’s easy to get lost in the many possible meanings of integrated care. This is why it’s crucial to identify your framework of care and values in order to build your own effective care system and avoid drifting back into fragmented treatment intervention​ (Goodwin, 2016)​.

Why Should You Care About Integrated Care?

SAMHSA’s ongoing research finds that more than half of the people (56%) struggling with substance use disorders (SUD) are also struggling with other mental health disorders, or comorbidity. Some experts rely on one co-occurring treatment model that initially treats SUD and then, once SUD symptoms are stable, gives referrals to other providers to treat symptoms related to the other co-occurring disorders. However, this fragmented model has been shown to be less effective than integrated care models that treat co-occurring disorders congruently. Providing multiple services from a variety of clinical professionals through a multi-disciplinary team approach leads to improved outcomes​ (SAMHSA, 2020)​​ (American Psychological Association, 2013). These include:

• Reduced or discontinued substance use

• Improvement in psychiatric symptoms and functioning

• Increased change for successful treatment and recovery for both disorders

• Better quality of life

• Decreased hospitalization

• Reduced medication interactions

• Increased housing stability

• Fewer arrests.

Interpersonal neurobiology (IPNB) is a framework that helps us understand why an integrated care model is effective. The mind is a system of parts that interact and relate to one another from continued moment-to-moment experiences. The brain works to integrate all the information from its different parts during these experiences to develop and survive. There is a continuous flow of information occurring between our Mind (Regulation), Brain/Body (Mechanisms), and Relationships (Sharing) that allows us to go about our day. There is no one part in this system that is more important than the other, and all parts are needed to function properly.

When someone is struggling with co-occurring disorders, there is a disruption in the flow of communication between the different brain areas, preventing healthy integration. Treating just one aspect of a client’s struggle, such as SUD, but not their major depressive disorder, may give some relief but it's almost like putting a band-aid on the entire issue. There will still be a barrier – the depression – that blocks the flow of information between mind, body, and relationships, making it hard to stop using substances. Our mind is always multitasking, so treatment is more effective when where there is a variety of support available to address and coordinate all concerns simultaneously​ (Siegel, 2015)​.

Addiction Essential Reads

From Substance Abuse to Sustained Recovery

Even Moderate Cannabis Use May Bring Negative Consequences

How to Deliver Integrated Care Effectively

First, a healthcare provider or agency should identify a framework such as IPNB to be the backbone of their integrated care model. This ensures that the organization provides consistent and comprehensive care across a complex treatment system. Likely, the main goal of all providers and agencies is to support a client in the healing process so they can navigate the world through an improved mental state built around a flexible flow and awareness of sensory information being shared between mind, body, and relationships. It often takes a team of skilled medical, clinical, and wellness professionals, as well as community supports, to help a client construct a balanced new lifestyle in which they can maintain long-term recovery (Siegel, 2015)​.

Each member who is a part of the integrated care team is supported by leadership to understand how they can provide a mind-body-and-relationships-based treatment plan through training and supervision. Leadership teams can create processes and introduce programming or interventions asking themselves, how will this support a client’s mind, body, and relationships. If it is not connected, then it is just adding unnecessary fragmented services to the care. If you have a well-constructed team that follows such a framework, it improves successful outcomes and also prevents staff burnout (Siegel, 2015)​​ (SAMHSA, 2020)​​ (U.S. Department of Health and Human Services: SAMHSA, 2022)​​ (Zubatsky, Pettinelli, Salas, & Davis, 2018)​.

What Does This Approach Look Like for the Client?

A scenario: A client beginning treatment with co-occurring disorders of opioid addiction and major depressive disorder (MDD) is struggling during the first week of a residential treatment episode. They are experiencing insomnia, depressed mood, cravings, negative thoughts, and a lack of motivation to wake up and engage in programming. The client is now at risk of leaving treatment early due to the lack of progress. Their clinician has tried multiple talk therapy interventions with limited results. In a fragmented care model, the clinician has limited ways to help a client, and the therapeutic relationships and interventions for the mind are not enough to mitigate symptoms of depression on top of SUD.

In an integrated care model, a clinician working with the client’s psychiatric provider can review a change in medication and then lean on the skills of a wellness professional to support the client through experiential interventions such as acupuncture. Such holistic practices can bring some immediate relief while the medications take time to reach their optimal effect. At the same time, the therapist is providing emotional support and education on how the other interventions can continue to help.

After two weeks of an integrated approach of psychiatric services, clinical services, and wellness services, the client feels an improvement in mood and cravings. The client’s mind and body settle, and she can reflect on how to cope with depression and SUD. In addition, she gains the motivation to interact with peers and participate in talk therapeutic interventions with her clinician. A fragmented approach of utilizing only talk therapy focusing on cravings and recovery would likely end with the client leaving treatment early due to lack of relief from symptoms related to co-occurring disorders. The lack of progress is frustrating and can be felt by both the client and staff. A secondary effect is often team burnout from watching clients struggle despite continued efforts to try to help.

Final Thoughts

Our brain works best when mind, body, and relationship systems are flexible and communicating well with one another. Care systems should reflect the flexible integration of the different parts and offer consilient therapeutic interventions, addressing co-occurring disorders that affect the recovery of many clients seeking help (SAMHSA, 2020)​​ (World Health Organization, 2018)​​ (Zubatsky, Pettinelli, Salas, & Davis, 2018)​.