Primary Care Integrated with Substance Abuse Treatment and Ongoing Primary Care Utilization are Associated with Remission at 5 Years

A 2001 randomized controlled trial among patients with substance use disorders (N=598) demonstrated that substance abuse treatment integrated with primary care increased abstinence at 6 months for patients with substance abuse-related medical conditions (SAMCs) but not for patients without SAMCs. In a follow-up study of the same sample, researchers sought to determine whether the original integrated care intervention combined with ongoing primary care services was associated with remission from substance use disorders at 5-year follow-up.

• Older age, increased medical problem severity at baseline, and assignment to the integrated care model in the original study were associated with remission at 5 years.

• Among the subsample of subjects with SAMCs at baseline in the original study (n=458), ongoing primary care utilization (2–10 versus 0–1 visits) was associated with remission at 5 years.

Comments:

This extended observational follow-up study found increased remission from substance use disorders with integrated care, regardless of SAMC status—an effect not apparent in the original trial—and increased remission among patients with SAMCs with greater primary care engagement. These findings support efforts to integrate substance abuse treatment with primary care and to manage substance use disorders as chronic diseases.

Alexander Y. Walley, MD, MSc

Reference:

Mertens JR, Flisher AJ, Satre DD, et al. The role of medical conditions and primary care services in 5-year substance use outcomes among chemical dependency treatment patients. Drug Alcohol Depend. 2008;98(1–2):45–53.