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Evidence-Based Approaches for Treating Concurrent Substance Use: Implications for Arizona Providers

Data from the 2020 National Institute on Drug Abuse highlights the prevalence of concurrent substance use

Concurrent substance use, the use of more than one substance within a given period, poses significant challenges for individuals struggling with addiction and the treatment providers who serve them. In Arizona and nationwide, a substantial proportion of individuals with substance use disorders (SUDs) use multiple substances, requiring a tailored treatment approach.

Prevalence of Concurrent Substance Use

Data from the 2020 National Institute on Drug Abuse highlights the prevalence of concurrent substance use:
  • 38.7% of individuals with a marijuana use disorder also had an alcohol use disorder.
  • 21.3% of individuals with a cocaine use disorder also had a marijuana use disorder.
  • Among individuals with prescription opioid use disorder, 35.2% had an alcohol use disorder, 17.6% had a marijuana use disorder, and 11.2% had a heroin use disorder.
Substance Use Perceptions of Great Risk Substance Use Disorder and Mental Health Measures_ Among People Aged 12 or Older in Arizona by Age Group Annual Average Numbers in Thousands 2021 and 2022
Arizona-specific data from 2021-2022 shows that 287 & 2411 adults in the state reported past-month concurrent use of illicit drugs and alcohol.

Evidence-Based Treatment Practices

Evidence-Based Treatment Practices

To address the complex needs of individuals with concurrent substance use, the Substance Abuse and Mental Health Services Administration (SAMHSA) recently published an evidence-based resource guide titled “Treating Concurrent Substance Use Among Adults.” The guide identifies three treatment practices that have shown promise in improving outcomes for this population:

  1. FDA-approved pharmacotherapy combined with counseling.
  2. Contingency management plus pharmacotherapy and counseling.
  3. Twelve-step facilitation (TSF) therapy plus pharmacotherapy and counseling.

FDA-Approved Pharmacotherapy with Counseling

SAMHSA’s guide reviewed several studies examining the use of FDA-approved medications, such as naltrexone, acamprosate, and buprenorphine, in combination with counseling for treating concurrent substance use.

Key findings include:

  • Individuals with alcohol and cocaine dependence receiving naltrexone and cognitive behavioral therapy (CBT) had significant reductions in both cocaine and alcohol use.
  • Individuals with opioid and cocaine dependence receiving buprenorphine and counseling showed significant reductions in opioid and cocaine use.

Contingency Management Plus Pharmacotherapy and Counseling

Contingency management (CM) is a behavioral intervention that uses tangible reinforcements to promote abstinence and treatment engagement. The guide found robust evidence supporting CM in combination with pharmacotherapy and counseling for individuals with concurrent opioid and cocaine use.

Across multiple studies, CM plus pharmacotherapy and counseling was associated with:

  • Reductions in cocaine and opioid use.
  • Increased duration of abstinence from both substances.
  • Improvements in treatment attendance.

Twelve Step Facilitation (TSF) Therapy Plus Pharmacotherapy and Counseling

Goals of Twelve-Step Facilitation Therapy
  • TSF therapy is a manualized approach that aims to engage individuals in 12-step mutual support groups as part of their comprehensive treatment plan.
  • The guide reviewed two studies examining TSF in combination with medication and counseling.
  • One study found that individuals with cocaine and opioid use receiving TSF therapy plus methadone and counseling had significantly greater reductions in cocaine use and increases in 12-step meeting attendance compared to those receiving standard care.

Implications and Recommendations for Arizona Providers

The evidence-based practices outlined in SAMHSA’s guide have important implications for enhancing the quality of care for Arizonans with concurrent substance use.

Firstly, Arizona treatment providers should ensure they are thoroughly assessing for and addressing all substances a person is using, not just their primary drug of choice. Screening tools like the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) can help identify concurrent substance use.

Secondly, providers should consider incorporating the treatment practices highlighted in the guide into their programs. This may involve:

  • Increasing access to FDA-approved medications for alcohol and opioid use disorders.
  • Implementing contingency management protocols to incentivize treatment engagement and abstinence.
  • Integrating TSF principles and facilitating 12-step involvement alongside other treatment modalities.

Doing so will require an investment in staff training, protocol development, and fidelity monitoring to ensure these practices are delivered as intended.

Finally, Arizona providers should prioritize care coordination and integration to address the multifaceted needs of individuals with concurrent substance use. Establishing formal partnerships and referral pathways with primary care providers, mental health professionals, and community-based organizations can help ensure individuals receive comprehensive, whole-person care.

Conclusion and Next Steps

Concurrent substance use is a significant and growing public health issue in Arizona, requiring a coordinated, evidence-based response from the state’s treatment providers and policymakers.

By implementing the practices outlined in SAMHSA’s resource guide (which is attached below), increasing access to medications for addiction treatment, and supporting further research specific to Arizona’s unique population needs, we can strengthen our state’s approach to this complex issue and improve outcomes for the many individuals struggling with concurrent substance use.

As a state, we must prioritize workforce development, expand insurance coverage for evidence-based treatments, and invest in ongoing evaluation to track progress and guide system improvements. Only through sustained collaboration and commitment can we hope to turn the tide on the addiction crisis and support long-term recovery for all Arizonans.

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Nirvana Recovery