(13) Social Determinants of Health & Substance Use Disorder Treatment: Scoping Literature Review

Substance use disorders (SUD) are a growing public health crisis, with increasing mortality rates across the United States. Effective pharmacologic and/or psychosocial treatments exist, but about one-third of participants in clinical trials drop out of treatment, and retention is even poorer in practice. Numerous studies have demonstrated a correlation between adverse social determinants of health (SDoH) and worse outcomes related to SUD, including higher rates of substance use initiation and overdose and lower rates of SUD treatment initiation and retention. This suggests that integrating interventions that address SDoH, such as housing, employment, transportation, and social context into SUD treatment may facilitate patient retention and thereby improve patient outcomes. Integrated approaches may be especially relevant for historically disadvantaged racial, ethnic, and sexual minorities, which are more likely to face adverse SDoH. Addressing a broader range of needs to improve outcomes in patients with SUD is not a new idea, but understanding how to do this effectively can be challenging. While social service programs have long included referrals for SUD treatment as part of addressing the needs of their clients, health care settings have been less consistent in whether or how they incorporate non-medical factors as part of treatment. There are a number of approaches in the healthcare space – case management, recovery resources, bridge clinics – that do incorporate SDoH elements, but it is not always clear which elements are included or how the coordination occurs, making it difficult to identify clear models or relate to other approaches for addressing SDoH. To describe what is known about how SDoH can be addressed as part of SUD treatment programs, the presenters conducted a scoping review of peer-reviewed and gray literature, including conference proceedings, government reports and non-governmental sources. The scoping review captures a wide range of medical intervention programs and studies which have incorporated one or more SDoH elements aligned with the Heathy People 2030 definition, regardless of whether they use the term “SDoH”. The review describes the different interventions - including setting, substances, medical intervention strategy, which SDoH are addressed, mode of integration, and level of resources required – along with effectiveness studies (if available).Based on the review, this poster presentation will describe how SUD treatment programs have addressed specific SDoH, map the available research on the effectiveness of different strategies, and suggest a framework for thinking about how to integrate SDoH into practice.