Closing the Gap in Substance Use Care: An SUD-First Approach

In today’s rapidly evolving economic landscape, organizations face the challenge of making strategic benefit choices that align with both financial resources and employee well-being. In an era where healthcare costs continue to rise, it’s crucial for organizations to navigate the complex terrain of benefits and make informed decisions that prioritize employee health, both mental and physical, while also driving cost savings. Among the many considerations, the rising prevalence of substance use disorders (SUDs) and their associated costs have made choosing the right level of substance use care a critical organizational decision.

The Benefits Mix: Substance Use Care, Mental Health, and EAPs 

Within today’s mix of employee benefits, three essential components stand out: substance use care, mental health care, and employee assistance programs (EAPs).  While most companies have robust mental health programs, a glaring gap exists when it comes to dedicated substance use management. A report from the 2023 Pelago Annual State of Substance Use Management Trend Report revealed that approximately 62 percent of workers believe their employers should offer dedicated support for substance or alcohol use management, yet only 17 percent report having access to such a benefit. This deficiency in addressing substance use leaves significant costs and productivity issues unaddressed, as attempts to tackle SUDs and related mental health problems through EAPs or mental health care often fall short.

The Mental Health Care Challenge

The boundaries between mental health care and substance use care have blurred, while the gap between the care needed and the care accessed has widened. Thus, it’s essential to distinguish between mental health and substance use disorders. Substance use benefits provided through EAPs or other behavioral health programs predominantly focus on the mental health aspects of substance use disorders. They also tend to “pick up” a substance use disorder through surveys that then refer the employee out to more specialized providers using a referral process. Unfortunately, even “next-gen” EAPs are ill-equipped to provide the specialized care necessary to effectively treat substance use disorders and deliver validated outcomes supported by clinical expertise and guaranteed performance outcomes.

Not Just Another Mental Health Disorder

A substance use disorder is not simply another mental health disorder. SUDs have unique characteristics and implications that require specialized care. Despite the prevalence of co-occurring mental health disorders, many individuals with SUDs go undetected or receive inadequate treatment in mental health settings.

Research from Serowick et al., 2020 found detection rates for alcohol and drug use disorders among adult populations ranging from 11% to 37% reported across studies of non-SUD specialty treatment settings, indicating that as many as 63% to 89% of adults with SUDs go undetected. 

The annual minimum cost of substance use disorders, estimated at over $35 billion, represents just the tip of the iceberg. It doesn’t account for costs related to absenteeism, presenteeism, job retention, or the severe health consequences and complications of underlying, undiagnosed SUDs such as pancreatitis, liver disease, cardiovascular issues, obesity, depression, and anxiety.

Solving the Gap in SUD Care

Closing the gap in SUD care requires a dedicated, integrated approach to early SUD treatment. For instance, for alcohol use disorder (AUD), research shows that the onset of mild AUD often precedes the onset of mood and anxiety disorders, underscoring the importance of early, easily accessible intervention. This suggests that virtual SUD care serves as an optimal digital front door for preventing the development of commonly associated mental health problems such as mood and anxiety disorders.

Unfortunately, care quality and outcomes for individuals with co-occurring SUDs and mental health disorders are typically poorer in mental health settings. A lack of preparedness and knowledge among mental health clinicians regarding the treatment of co-occurring SUD further exacerbates the issue.

Best Practices and Keys to SUD Treatment Success

Achieving success in dedicated substance use management hinges on three critical outcome drivers: 

1. Proper Assessment via a digital SUD front door
2. Care Quality with certified high-quality care and validated outcomes
3. SUD Medication Access for opioid, alcohol, and nicotine, including MAT for adolescent opioid use

Pelago has successfully addressed these challenges by making SUD care accessible and producing comparable clinical outcomes for individuals with co-occurring mental health problems.

The Pelago Approach: Clinician-Directed Care Pathway

Pelago’s approach emphasizes the human touch in assessing and determining appropriate care, rather than relying solely on surveys. Members receive immediate, in-person (virtual) access to qualified professionals who guide them through the care evaluation process. Pelago’s care model is in line with integrated treatment principles, ensuring clinically validated, cost-effective care.

In addition to addressing SUDs, Pelago offers care coordination for certain mental health conditions and has demonstrated its effectiveness through peer-reviewed studies and a randomized controlled trial. This approach has resulted in impressive outcomes, including a 52 percent verified tobacco quit rate at four weeks, a 62 percent abstinence rate or drinking below safe limits after three months for alcohol, and a 67 percent opioid abstinence rate at 90 days.

SUD-First Care: Outcomes, Cost Savings, and Guaranteed ROI

The costs of SUDs, both human and financial, are significant and increasing. A mental health-first approach falls short of meeting the comprehensive needs of employees. The majority of members require dedicated substance use management to effectively address the top three drivers of SUD costs: alcohol, opioids, and tobacco.

Pelago’s substance use management program offers a complete and personalized ecosystem of care, guiding each member through a tailored pathway. The advantages of Pelago’s approach include performance guarantees, validated outcomes, cost savings, and return on investment. This includes our recently demonstrated healthcare cost savings of $9,367 with 3x ROI in the first ever ROI study conducted on the impact of a substance use management program in an employer population across multiple clients with a large sample size.

These benefits surpass what EAPs and mental health plans can offer, making Pelago an essential component of a holistic behavioral health strategy.

Pelago is at the forefront of revolutionizing substance use management. With a mission to break down barriers to effective substance use care, Pelago has already helped over 750,000 members reclaim their lives. The company delivers its virtual clinic to employers, health plans, and members, offering a Substance Use Management Platform that reduces unnecessary rehab admissions and ensures post-discharge outpatient follow-up care. Pelago stands as the only provider with validated outcomes and a demonstrated commitment to delivering care that works.

Untreated SUDs lead to annually compounding health costs, absenteeism, lower productivity, and increased turnover. 

If your benefits team or health plan is looking for ways to significantly decrease the direct and hidden costs of employee substance use, contact us for a free claims analysis and ask about our 100% of fees-at-risk ROI guarantee.