Using Choice Architecture to Integrate Substance Use Services with Primary Care: Commentary on Donohue et al.

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At a time when death and disability linked to problematic substance use have reached crisis levels, integration of substance use disorder (SUD) services into primary care settings is a clear national priority. Incentive-based interventions can catalyze such adoption, but have thus far demonstrated limited efficaciousness. Behavioral Economics can inform efforts to incentivize healthcare providers to adopt SUD interventions. Choice architecture principles dictate pegging rewards to defined quality metrics, improving provider information about effective and cost-effective practices, and reducing barriers to SUD service provision through technological tools, tackling stigma, and addressing real and perceived regulatory burdens and risks. Additional research is needed to inform these and other key elements in the choice environment designed to facilitate the integration of SUD care into primary care. Success in the deployment of the “cascade of care” model in primary care settings during the HIV/AIDS epidemic provides room for optimism, but also underscores the urgency of rapid scale-up in diagnostic and treatment services for SUD to address the burgeoning opioid crisis.

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