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Research Summary

Ongoing Primary and Specialty Care Is Associated with Improved Substance Use Outcomes

This study analyzed data from 2 randomized trials conducted in a private managed-care health plan: 1 study compared day-hospital treatment for substance use disorders with traditional outpatient treatment, and the other studied integrated delivery of medical and addiction services. Follow-up was at 1, 5, 7, and 9 years in both studies. The sample included 991 subjects (56% of the combined cohorts) who had at least 1 follow-up interview and were with the plan for at least 5.4 years after intake. The association between remission and service use (yearly primary care, psychiatric services, and substance abuse treatment) was examined using nonlinear mixed-effects multivariable logistic regression.

  • Baseline characteristics associated with remission included being female (odds ratio [OR], 1.44), being older (OR, 1.02), completing prior substance abuse treatment (OR, 2.72), and being married or living as married (OR, 1.38).
  • A yearly primary care visit was also positively associated with remission (OR, 1.39), as was continuing care (OR, 2.34), defined as:
    • having at least 1 yearly primary care visit,
    • completing substance abuse treatment or receiving further treatment,
    • receiving alcohol or drug treatment when the alcohol or drug Addiction Severity Index (ASI) score at last assessment was higher than 0, and
    • receiving psychiatric services when the psychiatric ASI score at last assessment was higher than 0.

Comments:

This study provides further support for the concept of substance use disorders as a chronic illness best treated with ongoing care and underscores the association between ongoing primary care and improved outcomes for this population. It would be interesting to see if patients receiving integrated care, like those in this study, have better remission outcomes than patients receiving nonintegrated care. Darius A. Rastegar, MD

Reference:

Chi FW, Parthasarathy S, Mertens JR, et al. Continuing care and long-term substance use outcomes in managed care: early evidence for a primary care-based model. Psychiatr Serv. 2011;62(10):1194–1200.

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