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Research Summary

Trends in Ambulatory Care for People with Substance Use Disorders

The extent to which behavioral therapy and pharmacotherapy are used in U.S. ambulatory care to treat people with substance use disorders is not known. In this brief report, researchers studied data from 2 large, nationally representative, cross-sectional surveys of physicians to identify ambulatory visits from 2001 through 2009 with alcohol and/or drug use disorders (abuse, dependence, intoxication, or withdrawal) as a reason for the visit. Behavioral therapy was defined as provision of mental health counseling, stress management, or psychotherapy at the visit. Pharmacotherapy was defined as provision of naltrexone, disulfiram, acamprosate, methadone, or buprenorphine at the visit.* The complex survey design allowed for national estimates.

  • Ambulatory visits for substance use disorders increased from 10.6 million in 2001–2003 to 18 million in 2007–2009; of these, visits for opioid use increased from 772,000 to 4.4 million.
  • Behavioral therapy was provided in about 60% of visits and did not change over time.
  • Pharmacotherapy was provided in 643,000 visits (6% of total) in 2001–2003 and 3.9 million visits (22% of total) in 2007–2009, with methadone and buprenorphine comprising 76% of medications prescribed.
  • No treatment for substance use disorders was provided in 36% of visits and did not change significantly over time.

* In a personal communication (6/14/2013), Dr. Frank notes: “Methadone recorded in our study likely represents 1) methadone on the patient's medication list but not prescribed by the treating physician, or 2) methadone treatment centers captured within [the survey] sampling frame.” Methadone is not approved for the treatment of opioid dependence through physicians’ offices, only via opioid treatment programs.


This study indicates a national increase in ambulatory care visits for substance use disorders from 2001 through 2009. It is not clear if this is due to an increase in the underlying population prevalence of substance use disorders, better recognition and coding by providers, or greater care seeking. Certainly, the pharmacotherapy data suggest the substantial upward trend for opioid use disorders may be due to increased provision of buprenorphine, which is encouraging. Although appropriateness of management cannot be discerned from these data, the large number of individuals who received no treatment suggests an opportunity for improving care. Kevin L. Kraemer, MD, MSc


Frank JW, Ayanian JZ, Linder JA. Management of substance use disorders in ambulatory care in the United States, 2001–2009. Arch Intern Med. 2012;172(22):1759–1760.