What constitutes "behavioral health"? Perceptions of substance-related problems and their treatment in primary care.

BACKGROUND: Integrating behavioral health in primary care is a widespread endeavor. Yet rampant variation exists in models and approaches. One significant question is whether frontline providers perceive that behavioral health includes substance use. The current study examined front line providers': 1. definition of behavioral health, and 2. levels of comfort treating patients who use alcohol and other drugs. Frontline providers at two primary care clinics were surveyed using a 28-item instrument designed to assess their comfort and knowledge of behavioral health, including substance use. Two questions from the Integrated Behavioral Health Staff Perceptions Survey pertaining to confidence in clinics' ability to care for patients' behavioral health needs and comfort dealing with patients with behavioral health needs were used for the purposes of this report. Participants also self-reported their clinic role. Responses to these two items were assessed and then compared across roles. Chi square estimates and analysis of variance tests were used to examine relationships between clinic roles and comfort of substance use care delivery. RESULTS: Physicians, nurses/nurse practitioners, medical assistants, and other staff (N = 59) participated. Forty-nine participants included substance use in their definition of behavioral health. Participants reported the least comfort caring for patients who use substances (M = 3.5, SD = 1.0) compared to those with mental health concerns (M = 4.1, SD = 0.7), chronic medical conditions (M = 4.2, SD = 0.7), and general health concerns (M = 4.2, SD = 0.7) (p < 0.001). Physicians (M = 3.0, SD = 0.7) reported significantly lower levels of comfort than medical assistants (M = 4.2, SD = 0.9) (p < 0.001) caring for patients who use substances. CONCLUSIONS: In a small sample of key stakeholders from two primary care clinics who participated in this survey, most considered substance use part of the broad umbrella of behavioral health. Compared to other conditions, primary care providers reported being less comfortable addressing patients' substance use. Level of comfort varied by role, where physicians were least comfortable, and medical assistants most comfortable.

Health-related internet use among opioid treatment patients.

The Internet and smartphones have become commonplace and can be effective in overcoming traditional barriers to accessing health information about substance use disorders (SUD), and their prevention or treatment. Little is known, however, about specific factors that may influence the use of these technologies among socioeconomically disadvantaged populations with SUDs. This study characterized the use of digital technologies and the Internet among individuals receiving treatment for opioid use disorder, focusing on identifying predictors of Internet use for health-related purposes. Participants came from an urban opioid replacement therapy program and completed a face-to-face survey on Internet and technology use. We examined the association between online health information seeking and technology acceptance variables, including perceived usefulness, effort expectancy, social influence, and facilitating conditions (e.g., availability of devices/services and technical support). Participants (N = 178, ages 18-64) endorsed high rates of current smartphone ownership (94%) and everyday Internet use (67%). 88% of participants reported searching online for information about health or medical topics in the past 3 months. Predictors of Internet use for health-related purposes were higher technology acceptance for mobile Internet use, younger age, current employment, and less bodily pain. Our results demonstrate high acceptance and use of mobile technology and the Internet among this sample of socioeconomically disadvantaged individuals with SUDs. However, these findings also highlight the importance of identifying barriers that disadvantaged groups face in using mobile technologies when designing technology-based interventions for this population.