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Effect of primary medical care on addiction and medical severity in substance abuse treatment programs

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Abstract

OBJECTIVE: To examine whether the availability of primary medical care on-site at addiction treatment programs or off-site by referral improves patients’ addiction severity and medical outcomes, compared to programs that offer no primary care.

DESIGN: Secondary analysis of a prospective cohort study of patients admitted to a purposive national sample of substance abuse treatment programs.

SETTING: Substance abuse treatment programs in major U.S. metropolitan areas eligible for demonstration grant funding from the federal Substance Abuse and Mental Health Services Administration.

RESPONDENTS: Administrators at 52 substance abuse treatment programs, and 2,878 of their patients who completed treatment intake, discharge, and follow-up interviews.

MEASUREMENTS: Program administrators reported whether the program had primary medical care available on-site, only off-site, or not at all. Patients responded to multiple questions regarding their addiction and medical status in intake and 12-month follow-up interviews. These items were combined into multi-item composite scores of addiction and medical severity. The addiction severity score includes items measuring alcohol and drug use, employment, illegal activities, legal supervision, family and other social support, housing, physical conditions, and psychiatric status. The medical severity score includes measures of perceived health, functional limitations, and comorbid physical conditions.

MAIN RESULTS: After controlling for treatment modality, geographic region, and multiple patient-level characteristics, patients who attended programs with on-site primary medical care experienced significantly less addiction severity at 12-month follow-up (regression coefficient, −25.9; 95% confidence interval [95% CI], −43.2 to −8.5), compared with patients who attended programs with no primary medical care. However, on-site care did not significantly influence medical severity at follow-up (coefficient, −0.28; 95% CI, −0.69 to 0.14). Referral to off-site primary care exerted no detectable effects on either addiction severity (coefficient, −9.0; 95% CI, −26.5 to 8.5) or medical severity (coefficient, −0.03; 95% CI, −0.37 to 0.44).

CONCLUSIONS: On-site primary medical care improves substance abuse treatment patients’ addiction-related outcomes, but not necessarily their health-related outcomes. Further study is needed to discern the mechanism through which on-site primary care might improve the addiction-related outcomes of substance abuse treatment.

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Authors and Affiliations

  1. the Division of General Internal Medicine, Departments of Medicine and Community Health, Brown University School of Medicine and Rhode Island Hospital, Providence, RI

    Peter D. Friedmann MD, MPH & Michael D. Stein MD

  2. Washington Office, The National Opinion Research Center of the University of Chicago, Washington, D.C.

    Zhiwei Zhang PhD, James Hendrickson MA & Dean R. Gerstein PhD

Authors
  1. Peter D. Friedmann MD, MPH
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  2. Zhiwei Zhang PhD
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  3. James Hendrickson MA
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  4. Michael D. Stein MD
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  5. Dean R. Gerstein PhD
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Corresponding author

Correspondence to Peter D. Friedmann MD, MPH.

Additional information

This research was supported by National Institute on Drug Abuse (NIDA) grants K08 DA00320 and R01 DA13615. Dr. Friedmann is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. The National Opinion Research Center of the University of Chicago in collaboration with the Research Triangle Institute collected the NTIES data under Contract No. ADM 270-92-0002 from Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT). The views expressed in this article are the authors’ and not necessarily those of the NIDA, SAMHSA/CSAT, or the Department of Health and Human Services.

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Friedmann, P.D., Zhang, Z., Hendrickson, J. et al. Effect of primary medical care on addiction and medical severity in substance abuse treatment programs. J GEN INTERN MED 18, 1–8 (2003). https://doi.org/10.1046/j.1525-1497.2003.10601.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.10601.x

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