Would You Be Surprised If This Patient Died This Year? Advance Care Planning in Substance Use Disorders

  • Michelle J. FleshnerEmail author
  • Amy J. Kennedy
  • Peter J. Veldkamp
  • Julie W. Childers


Primary care physicians are increasingly incorporating screening tools for substance use disorders (SUDs) and referral to treatment into their practice. Despite efforts to provide access to treatment, patients with SUDs remain at an increased risk of mortality, both from overdose and from general medical conditions. Advance care planning (ACP) is recommended for patients with chronic, progressive medical conditions such as malignancies or heart failure. Though SUDs are widely acknowledged to be chronic diseases associated with an increased risk of mortality, there has been little discussion on ACP in this population. ACP is a discussion regarding future care, often including selection of a surrogate decision-maker and completion of an advanced directive. ACP has been associated with better quality of end-of-life and care more consistent with patient preferences. Studies in other vulnerable populations have shown that marginalized and high-risk individuals may be less likely to receive ACP. Similarly, patients with SUDs may employ different decision-makers than that defined by law (i.e., friend vs. family member), increasing the importance of discussing patient values and social structure. Physicians should routinely conduct ACP conversations with patients with SUDs, especially those with chronic, progressive medical conditions and/or severe, uncontrolled substance use disorders.


advance care planning substance use disorders (SUDs) medical decision-making addiction advance directives 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Michelle J. Fleshner
    • 1
    Email author
  • Amy J. Kennedy
    • 1
  • Peter J. Veldkamp
    • 2
  • Julie W. Childers
    • 1
    • 3
  1. 1.Division of General Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Division of Infectious DiseasesUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Section of Palliative Care and Medical EthicsUniversity of Pittsburgh Medical CenterPittsburghUSA

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