Bernard J. McBride's commentary on treating heroin addiction was most informative regarding strategies to address substance use disorders ("City task force gauging heroin treatment needs," Feb. 4).
I agree that our current statewide treatment system, not just in Baltimore City, needs to better understand the scope of the unmet treatment needs. But that has to happen in an integrated manner.
Substance Abuse and Mental Health Administration estimates suggest that up to 7 million adults in this country have a combination of at least one co-occurring mental health and substance-related disorder in any given year.
According to SAMHSA's National GAINS Center, "prevalence rates of co-occurring disorders in the jail population are striking. With regard to the prevalence of substance use disorders among those with severe mental disorders, research indicates that both male and female detainees have a 72 percent rate of co-occurring substance use. In comparison to individuals with a primary mental or substance abuse disorder, individuals with co-occurring disorders tend to be more symptomatic, have multiple health and social problems, and require more costly care, including inpatient hospitalization. Many are at increased risk of homelessness and incarceration."
If we design our treatment system based on these statistics and concentrate on providing behavioral health-integrated treatment, and not just substance use disorders alone, we will increase our service capacity by providing standardized integrated screening instruments along with an array of evidenced based practices and standardized national outcomes measures that can be collected using common data elements.
These are only a few components. Integration with our partners in primary care hasn't even been mentioned. The true spirit of the Affordable Care Act reflects all of these approaches and supports a "no wrong door" approach.
Patricia Bayly Miedusiewski, Monkton
The writer is a former Maryland Department of Health and Mental Hygiene state program administrator for co-occurring substance use and mental disorders.