Primary medical care and reductions in addiction severity: a prospective cohort study

Authors

  • Richard Saitz,

    Corresponding author
    1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine,
    2. Department of Epidemiology,
    3. Center to Prevent Alcohol Problems Among Young People,
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  • Nicholas J. Horton,

    1. Department of Mathematics, Smith College, Northampton, MA, USA
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  • Mary Jo Larson,

    1. Boston University School of Public Health, Boston, MA, New England Research Institutes, Inc., Watertown, MA and the
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  • Michael Winter,

    1. Center to Prevent Alcohol Problems Among Young People,
    2. Data Coordinating Center,
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  • Jeffrey H. Samet

    1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine,
    2. Departments of Social and Behavioral Sciences and
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Richard Saitz
Boston Medical Center
91 East Concord Street
Suite 200
Boston
MA 02118
USA
Tel: 617 414 7744
Fax: 617 414 4676
E-mail: rsaitz@bu.edu

ABSTRACT

Aims  To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions.

Design  We studied a prospective cohort of adults enrolled in a randomized trial to improve linkage with primary medical care.

Methods  Subjects at a residential detoxification unit with alcohol, heroin or cocaine as a substance of choice, and no primary medical care were enrolled. Receipt of primary medical care was assessed over 2 years. Outcomes included (1) alcohol severity, (2) drug severity and (3) any substance use.

Findings  For the 391 subjects, receipt of primary care (≥2 visits) was associated with a lower odds of drug use or alcohol intoxication (adjusted odds ratio (AOR) 0.45, 95% confidence interval (CI) 0.29–0.69, 2 d.f. χ2P = 0.002). For 248 subjects with alcohol as a substance of choice, alcohol severity was lower in those who received primary care [predicted mean Addiction Severity Index (ASI) alcohol scores for those reporting ≥ 2, 1 and 0 visits, respectively, 0.30, 0.26 and 0.34, P = 0.04]. For 300 subjects with heroin or cocaine as a substance of choice, drug severity was lower in those who received primary care (predicted mean ASI drug scores for those reporting ≥ 2, 1 and 0 visits, respectively, 0.13, 0.15 and 0.16, P = 0.01).

Conclusions  Receipt of primary medical care is associated with improved addiction severity. These results support efforts to link patients with addictions to primary medical care services.

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