It examines addiction treatment for people who simultaneously carry chronic physical illness, and it is direct about how poorly the current system handles them.
The report, published in 2026 as part of SAMHSA’s Mental Health Innovations Series, reviews models that combine medical and behavioral health care, the evidence behind them, and why so few have scaled.
Chronic Illness Runs Higher With Substance Use Disorders
People with a substance use disorder or mental illness have higher rates of co-occurring physical health conditions than people without them, according to the report.
That includes cardiovascular disease, diabetes, respiratory conditions, and communicable diseases such as HIV and AIDS. Prevalence estimates vary across studies, but they generally run higher in populations with more severe illness.
The report describes medical comorbidities as highly prevalent in these populations and as the leading cause of premature mortality among people with severe mental illness.
The mortality figure is the one worth sitting with. People with serious mental illnesses such as schizophrenia or bipolar disorder die 10 to 20 years earlier than the general population, the report notes, often because comorbid physical conditions went unrecognized or undertreated.
Why Two Systems Never Talked to Each Other
The explanation SAMHSA gives is structural. U.S. health care has historically separated the financing, organization, and delivery of behavioral health services from general medical care.
Someone managing both a substance use disorder and a chronic illness typically needs coordination across a specialty addiction or mental health provider, a primary care physician, and medical specialists.
Those providers usually sit in different delivery systems, are paid through different mechanisms, and often cannot see one another’s records.
The practical consequences compound. Engagement gets harder when housing or transportation is unstable. Siloed delivery reinforces the stigma already attached to these conditions. Fragmented care generates duplication and gaps that strain both patients and payers.
Scale matters here too. The report counts 48.4 million U.S. adults with a substance use disorder in 2024 and 21.2 million with both a mental illness and a substance use disorder. Fewer than 4 percent of adults with a substance use disorder received treatment that year.
Bringing Medical Care Into Addiction and Mental Health Settings
The report calls this reverse integration, and it is the model most relevant to someone already in behavioral health care. SAMHSA’s Primary and Behavioral Health Care Integration demonstration was built specifically to improve physical health for people with serious mental illness and substance use disorders.
Its core features included preventive primary care screening for conditions such as hypertension, obesity, and smoking, a registry tracking primary care needs and outcomes, person-centered care management, and wellness support.
The evidence was mixed. Access to integrated care was not directly associated with physical health improvements overall, though a small comparative effectiveness study found improvement in dyslipidemia, hypertension, and diabetes. Smoking and weight did not improve.
An analysis of the first three grantee cohorts found reduced emergency department visits, lower health care costs, and better follow-up after mental illness–related hospitalizations.
SAMHSA no longer funds that program directly, though it continues supporting integration through the Promoting Integration of Primary and Behavioral Health Care program.
Certified Community Behavioral Health Clinics carry some of this forward. They are not required to deliver primary care, but they must ensure the people they serve have a primary care provider, screen for common physical health conditions, monitor physical health status, and coordinate care.
A 2024 survey found 27.9 percent provide primary care directly and another 21.9 percent have a co-location agreement with a provider on site.
Bringing Addiction Treatment Into Medical Settings
The reverse direction is better established. The Collaborative Care Model pairs a primary care clinician with a behavioral health care manager and a psychiatric consultant.
A Cochrane review of 79 randomized controlled trials found it significantly improved depression and anxiety compared with usual care.
Evidence for substance use outcomes is thinner. One systematic review examined the model in people with both chronic pain and opioid use disorder, a population sitting squarely at the intersection this report is about.
Of 18 trials reviewed, 11 found significant improvements in pain outcomes, with variable effect sizes. Community health centers have moved fastest.
In a 2024 national survey, 66 percent reported offering substance use treatment on site and 62 percent reported offering medications for substance use disorder, up from 37 percent in 2018.
What This Means for Treatment Seekers
If chronic illness is part of the picture, the questions to ask a program change. Ask whether the program screens for and monitors physical health conditions, whether it can prescribe and manage medications for both the substance use disorder and the medical condition, and who coordinates with the primary care physician while someone is in treatment.
Ask what happens at discharge. The report’s evidence on reduced hospital readmissions came from programs that actively managed follow-up rather than assuming it would happen.
Finding the Right Rehab
Start with whether a facility offers dual diagnosis care and on-site medical services, then verify insurance coverage for addiction treatment and confirm which medications the program can manage.
Rehab.com’s directory lists verified treatment centers with details on levels of care, insurance accepted, accreditations, and staff credentials. Call
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