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Gaps in the Substance Use Disorder Treatment Referral Process

Provider Perceptions

Blevins, Claire E. PhD; Rawat, Nishi MD; Stein, Michael D. MD

doi: 10.1097/ADM.0000000000000400
Original Research

Objectives: The demand for substance use disorder treatment is increasing, fueled by the opioid epidemic and the Affordable Care Act mandate to treat substance use disorders. The increased demand for treatment, however, is not being met by a corresponding increase in access to or availability of treatment. This report focuses specifically on the treatment referral process, which we have identified as 1 of the key barriers to timely and effective treatment. Difficulties in referral to substance use disorder treatment are examined through the lens of providers who make referrals (ie, referral source) and individuals who work in substance use disorder facilities (ie, referral recipient).

Methods: Administrative officials, emergency department physicians, addiction physicians, government officials, providers, insurance officials, and mental health advocates (n = 59) were interviewed on the referral process protocol, challenges for providers and others making referrals, and issues with substance use treatment facility intake procedures.

Results: Several main themes were identified as barriers in the process: difficulties in determining patient eligibility, lack of transparency regarding treatment capacity, referral source knowledge/understanding of options, and issues with communication between referral source and recipient. We then proposed several solutions to address specific barriers.

Conclusions: Current gaps in the referral process cause delays to care. Improving systems would involve addressing these themes and expanding the use of appropriate treatments for the many patients in need.

Butler Hospital, Providence, RI (CEB, MDS); Warren Alpert Medical School of Brown University, Providence, RI (CEB); OpenBeds, Inc. Washington, DC (NR); Boston University, Boston, MA (MDS).

Send correspondence to Claire E. Blevins, PhD, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906. E-mail:

Received 18 October, 2017

Accepted 24 January, 2018

Funding: This work was supported by a grant from the National Institute of Health (NOA_1R44DA041944-01A1).

The authors declare no conflicts of interest.

© 2018 American Society of Addiction Medicine