Linking alcohol- and drug-dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit
Article first published online: 25 MAR 2003
Volume 98, Issue 4, pages 509–516, April 2003
How to Cite
Samet, J. H., Larson, M. J., Horton, N. J., Doyle, K., Winter, M. and Saitz, R. (2003), Linking alcohol- and drug-dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit. Addiction, 98: 509–516. doi: 10.1046/j.1360-0443.2003.00328.x
- Issue published online: 25 MAR 2003
- Article first published online: 25 MAR 2003
- Submitted 27 February 2002; initial review completed 3 May 2002; final version accepted 10 October 2002
- alcohol dependence;
- drug abuse;
- injection drug user;
- primary care;
- randomized controlled trial
Aim Pragmatic approaches to integration of medical care and substance abuse treatment are desired. We assessed the effectiveness of a novel multi-disciplinary clinic for linking patients in a residential detoxification program to primary medical care.
Participants We enrolled patients undergoing in-patient detoxification from alcohol, heroin or cocaine who had no primary care physician into a randomized controlled trial. The intervention consisted of a clinical evaluation at the detoxification unit in the health evaluation and linkage to primary care (HELP) clinic by a nurse, social worker and physician and facilitated referral to an off-site primary care clinic. The primary outcome of interest was attendance at a primary care appointment within 12 months. Secondary outcomes assessed over 24 months were addiction severity, health-related quality of life, utilization of medical and addiction services and HIV risk behaviors.
Findings Of the 470 subjects enrolled, 235 were randomized to the HELP clinic intervention. Linkage to primary medical care occurred in 69% of the intervention group compared to 53% in the control group (P = 0.0003). The clinic was similarly effective for subjects with alcohol and illicit drug problems. Randomization to the HELP clinic resulted in no significant differences in secondary outcomes.
Conclusions The HELP clinic, a multi-disciplinary clinic located in a detoxification unit, effectively linked alcohol- and drug-dependent individuals to primary medical care. This intervention utilized a ‘reachable moment’, the period of addiction care, as a window of opportunity for linking substance abusers to medical care.