The Substance‐Abusing Patient and Primary Care: Linkage via the Addiction Treatment System?

Abstract

Our objective was to describe and assess the prevalence and characteristics of substance-abusing persons without primary care physicians. We interviewed a convenience sample at one point in time. Patients/participants were persons presenting for addictions treatment in a public substance abuse treatment system. Of 5824 respondents, 41% did not have a physician. In a multivariable analysis, the following were associated with not having a physician: no health insurance [adjusted odds ratio (OR), 2.05; 95% confidence interval (CI), 1.79-2.35], no history of a chronic (OR, 1.70; CI, 1.47-1.97) or an episodic (OR, 1.20; CI, 1.05-1.39) medical illness, male gender (OR, 1.49; CI, 1.29-1.71), and younger age (by decade) (OR, 1.12; CI, 1.04-1. 38). Prior addictions or mental health treatment or a recent emergency-room visitwere not significantly associated with having a physician. Many patients with addictions serious enough to prompt presentation for treatment stated that they did not have physicians. Although younger persons, males, and those without insurance or past medical illness were more likely to report not having a physician, neither prior addictions or mental health treatment nor a recent emergency-room visit decreased this likelihood. To achieve improved linkage of substance-abusing patients with primary medical care, all health-care contacts should be utilized.

The Case for Chronic Disease Management for Addiction

“…24,90 Conversely, patients in medical settings are often not identified or referred to addiction treatment. [91][92][93] In 1991, a Federal conference concluded that better linkage should be pursued by colocating services and improving the effectiveness of referrals. 94 This conclusion remains relevant today.…”

Linkage with Primary Medical Care in a Prospective Cohort of Adults with Addictions in Inpatient Detoxification: Room for Improvement

“…Assessments included demographics, health care utilization, social support, barriers to primary care linkage, beliefs about primary care, substances used, addiction severity (Addiction Severity Index [ASI] alcohol, drug, and psychological sub-scales) (McLellan et al 1992), consequences of drug use (Inventory of Drug Use Consequences ) (Miller and Tonigan 1995), readiness to change substance use (using the Stages of Change Readiness and Treatment Eagerness Scale, [SOCRATES 8AOD]) (Miller and Tonigan 1996), depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] scale) (Radloff 1977), health-related quality of life ) (Ware 1993), and questions regarding comorbid medical diagnoses (Stein et al 1998;Saitz, Mulvey, and Samet 1997).…”

“…In the distributive pattern, medical and addictions care are delivered in separate locations, and patients and information are transferred from one location to another (Samet, Saitz, and Larson 1996). Yet this flow is anything but seamless (Samet, Friedmann, and Saitz 2001), since receipt of addictions care is not always associated with linkage to primary medical care (Saitz, Mulvey, and Samet 1997). In substance abuse programs opportunities to link patients with primary care are being missed.…”

“…A greater understanding of which patients with addictions are more or less likely to link with medical care would help target such interventions and help in the design of additional efforts to link patients with primary medical care. In a retrospective cross-sectional study of patients entering addiction treatment, those more likely to have primary medical care were older, female, had health insurance, and had medical illness (Saitz, Mulvey, and Samet 1997). The study was limited, however, due to an inability to distinguish the temporal relationship between risk factors and linkage and to characterize those who link to medical care after contact with the addiction treatment system.…”

“…Therefore, the objective of this study was to examine, using a prospective design, characteristics and health care experiences of adults with addictions associated with linkage to primary medical care. We hypothesized that greater addiction severity and access barriers (e.g., lack of insurance, ethnicity, incarceration) would interfere with linkage to primary medical care (Saitz, Mulvey, and Samet 1997;McGeary et al 2000;French et al 2000;Conklin, Lincoln, and Tuthill 2000;Hargraves, Cunningham, and Hughes 2001). We also hypothesized that women, those recognizing their substance problem and having social support for recovery, those believing medical care was important, those with worse health status, and those who had prior contacts with addiction, episodic medical or mental health specialty care, would be more likely to link with primary medical care (Saitz, Mulvey, and Samet 1997;McCarthy et al 2002;Diamant et al 2001).…”