Chronic Care Management in Primary Care for Patients with Substance Dependence Yields Little Benefit

Providing multidisciplinary patient-centered proactive care in the form of chronic care management (CCM) may be one way to reduce the adverse health consequences and high rates of health care utilization that are associated with substance use. This randomized controlled trial included 563 participants with alcohol, stimulant, or opioid dependence. Subjects assigned to CCM received care from a team that included a nurse, a social worker, internists, and a psychiatrist with addiction expertise; the CCM visits were separate from primary care visits. The control group received primary care at the same center, without additional services.

• There was no significant difference in the primary outcome measure of 30-day abstinence from stimulants, opioids, or heavy alcohol use at 12-month follow-up between the CCM (44%) and control (42%) groups.
• There was likewise no significant difference in Addiction Severity Index scores, quality of life measures, and hospital or emergency department utilization.
• Those assigned to CCM were significantly more likely to receive addiction pharmacotherapy (21% versus 15% in the control arm).

Comments:

It is disappointing that this model of care failed to show a significant benefit. This study does not suggest that primary care practitioners cannot help patients with substance dependence; the control group received primary care services and likely benefited from them. As the authors point out, a likely explanation for these results is that their study achieved a “small increase in use of addiction treatments that are modestly efficacious for only some subsets of people with addictions.” More clinical trials are needed to test other approaches.

Darius A. Rastegar, MD

Reference:

Saitz R, Cheng DM, Winter M, et al. Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial. JAMA. 2013;310(11):1156–1167.