Patient Factors Associated With Substance Use Disorder Treatment in Primary Care

General medical settings are an ideal place to identify and treat substance use disorders. The authors of this study sought to determine the patient-level predictors of initiation of medication for alcohol use disorder (AUD) or opioid use disorder (OUD) in primary care. This was a secondary data analysis of a randomized controlled trial that tested the effectiveness of a dual intervention strategy combining organizational readiness and collaborative care to integrate evidence-based treatment of AUD and OUD into primary care in a federally qualified health center. The mean age of participants was 42; 79% were male, 44% were white, and 43% described themselves as “other or multiple races.”

• Of the 392 participants enrolled in the study, 23% initiated brief behavioral treatment and 13% initiated medications for AUD or OUD.
• Patient factors associated with initiation of medications for AUD or OUD were: older age (odds ratio [OR], 1.07), being female (OR, 3.05), having a DSM-IV diagnosis of heroin abuse or dependence (with or without alcohol abuse or dependence, compared with alcohol dependence only [OR, 3.03]), and having received at least one session of behavioral treatment (OR, 6.42).

Comments: Aside from the need to replicate these findings and trying harder to initiate treatment for younger men with AUD only, encouraging behavioral treatment to improve medication initiation has some promise. But the most striking finding that needs serious efforts is the small proportion of patients who initiated medications for AUD or OUD, particularly in a study that included attention to organizational context. Further innovation will be needed to address this major deficit.

Jeanette M. Tetrault, MD

Reference: Ober AJ, Watkins KE, McCullough CM, et al. Patient predictors of substance use disorder treatment initiation in primary care. J Subst Abuse Treat. 2018;90:64–72.