Social Determinants of Health: Making an Impact in Addiction Care

In this episode of ASAM Practice Pearls, Drs. Stephen Taylor and Sharon Stancliff explore the role of social determinants of health (SDoH) in addiction care. They discuss the biopsychosocial model of addiction and emphasize the importance of understanding social factors such as housing, transportation, and economic stability when providing effective care. They highlight the need for clinicians to engage with patients in their environments, advocate for policy changes, and address racial disparities in addiction treatment, offering practical strategies clinicians can use to support patients facing social challenges.  

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Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Sharon Stancliff, MD  

Dr. Stancliff is Associate Medical Director for Harm Reduction in Health Care at the AIDS Institute, NYSDOH and sees patients at a shelter in New York City. Dr. Stancliff has been working with people who use drugs since 1990, including the provision of primary care, drug treatment, HIV care, and syringe access. She is currently focused on opioid overdose prevention through expanding access to naloxone and expanding access to buprenorphine in primary care and in less traditional settings, such as syringe exchange programs. Dr. Stancliff graduated from the School of Medicine at the University of California at Davis, did her Family Practice residency at the University of Arizona, and completed the AIDS Institute-sponsored Nicolas Rango HIV Clinical Scholars Program at Beth Israel Medical Center in New York City. She is board-certified in Family Medicine and in Addiction Medicine. She served on the Public Policy Committee of ASAM. 

📖 Show Segments

• 00:05 - Introduction 
• 02:29 - The Role of SDoH in Addiction 
• 06:00 - Prioritizing Competing Social Needs
• 08:57 - The Clinician’s Role in Addressing SDoH
• 12:11 - Making Your Voice Heard
• 14:09 - The Impact of Race on Addiction Treatment
• 16:38 - Tailoring Treatment to Social Context
• 19:31 - Navigating Social Networks and Environmental Challenges
• 22:30 - Key Takeaways
• 24:50 - Conclusion and Additional Learning Opportunity 

📋 Key Takeaways

• View addiction through a biopsychosocial lens: Addiction involves complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. It doesn’t develop solely from biological factors, making it essential to address SDoH during treatment. 
• Prioritize patients’ social needs: Housing instability, poverty, transportation access, food insecurity, and other environmental factors significantly impact a patient’s ability to engage in treatment and are often overlooked. 
• Focus on safety, stability, and patient goals: Abstinence-only approaches are outdated. Treatment should prioritize whether patients are safer, more stable, and more engaged in care, even if they're still using substances. Focusing on harm reduction and incremental progress promotes patient-centered care and improves engagement. 
• Engage patients in the community and provide low-threshold care: Meet patients where they are, shelters, streets, and needle exchanges, to better understand their challenges and build trust with populations that might