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Addiction Medicine pp 847–874Cite as

Unhealthy Alcohol and Drug Use in Primary Care

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Abstract

We describe primary care practice and how the care of people with drug and alcohol use fits into it. The detection, evaluation, and short or long-term management of chronic behavioral problems are core functions of primary care that may be profoundly enhanced by the therapeutic relationship of primary care provider with patient. We describe screening for risky, unhealthy or problematic use of substances. The evaluation of patients who have positive screens dictates the next steps for provider and patient: this may include a brief intervention, the prescription of medications or referral for other specialty care. The management of concomitant or secondary psychiatric and medical illness is discussed. Finally, we provide guidance on the chronic management of routine medical conditions for patients in recovery.

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References

  1. Aertgeerts B, Buntinx F, Kester A (2004) The value of CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations. J Clin Epidem 57:30–39

    Article  CAS  Google Scholar 

  2. Agency for Healthcare Quality and Research (2007) Primary care doctors account for nearly half of physician visits but leSs than one-third of expenses. http://www.ahrq.gov/news/nn/nn042507.htm. Accessed 14 July 2008

  3. Akbik H, Butler SF, Budman SH, Fernandez K et al (2006) Validation and clinical application of the screener and opioid assessment for patients with pain (SOAPP). J Pain Symptom Manage 32:287–293

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association (APA) (2000) Diagnostic and statistical manual of mental disorders, 4th edn revision. American Psychiatric Association, Washington DC

    Google Scholar 

  5. Anton RF (2008) Naltrexone for the management of alcohol dependence. NEJM 359:715–721

    Article  PubMed  CAS  Google Scholar 

  6. Anton RF, Moak DH, Latham P et al (2005) Naltrexone combined with either cognitive behavioral or motivational enhancement therapy for alcohol dependence. J Clin Psychopharmacol 25:349–357

    Article  PubMed  CAS  Google Scholar 

  7. Anton RF, O’Malley S, Ciraulo DA et al (2006) Combined pharmacotherapies and behavioral interventions for alcohol dependence. The COMBINE study: a randomized controlled trial. JAMA 295(17):2003–3017

    Article  PubMed  CAS  Google Scholar 

  8. Arnold RM, Han PKJ, Seltzer D (2006) Opioid contracts in chronic nonmalignant pain management: objective and uncertainties. Am J Med 119:292–296

    Article  PubMed  Google Scholar 

  9. ASAM (American Society of Addiction Medicine) (2001) Patient placement criteria for the treatment of substance-related disorders (PPC-2R), 2nd edn. American Society of Addiction Medicine, Chevy Chase, MD

    Google Scholar 

  10. Aubin H-J, Bobak A, Britton JR et al (2008) Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomized open-label trial. Thorax 63:717–724

    Article  PubMed  Google Scholar 

  11. Balldin J, Berglund M, Borg S et al (2003) A 6 month controlled naltrexone study: combine effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence. Alc Clin Exp Res 27:1142–1149

    Article  CAS  Google Scholar 

  12. Banta-Green C, Jackson TR, Hanrahan N et al (2004) Recent drug abuse trends in the Seattle-King County area. Proc Community Epid Working Group 2:1–23

    Google Scholar 

  13. Beich A, Thorsen T, Rollnick S (2003) Screening in brief interventions trials targeting excessive drinkers in general practice: systemic review and meta-analysis. BMJ 327:536

    Article  PubMed  Google Scholar 

  14. Bernstein J, Bernstein E, Tassiopoulos K et al (2005) Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend 77(1):49–59

    Article  PubMed  Google Scholar 

  15. Bertholet N, Daeppen J-B, Wietlisbach V (2005) Reduction of alcohol consumption by brief alcohol intervention in primary care Arch Intern Med 165:986–995

    Article  PubMed  Google Scholar 

  16. Bien TH, Miller WR, Tonigan JS (1993) Brief interventions for alcohol problems: a review. Addiction 88:315–336

    Article  PubMed  CAS  Google Scholar 

  17. Bouza C, Angeles M, Ana M et al (2004) The efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction 99:811–828

    Article  PubMed  Google Scholar 

  18. Bradley KA, DeBenedetti AF, Volk RJ et al (2007) AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res 31:1209–1217

    Article  Google Scholar 

  19. Brady KT, Tolliver BK, Berduin ML (2007) Alcohol use and anxiety: diagnostic and management issues. Am J Psychiatry164:217–221

    Article  PubMed  Google Scholar 

  20. Brown RL, Leonard T, Saunders LA et al (2001) Two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract 14:95–106

    PubMed  CAS  Google Scholar 

  21. Brown RL, Rounds LA (1995) Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wisconsin Med J 94:135–140

    PubMed  CAS  Google Scholar 

  22. Buchsbaum DG, Buchanan RG, Centor RM et al (1991) Screening for alcohol abuse using CAGE scores and likelihood ratios. Annals Intern Med 115(10):774–777.

    CAS  Google Scholar 

  23. California Academy of Family Physicians (2006) Urine drug testing in clinical practice. http://www.familydocs.org/monographs.php. Accessed 28 Aug 2008

  24. Canagasaby A, Vinson DC (2005) Screening for hazardous or harmful drinking using one or two quantity-frequency questions. Alcohol Alcohol 40:208–213

    Article  PubMed  Google Scholar 

  25. Chan KK, Neighbors C, Gilson M et al (2007) Epidemiologic trends in drinking by age and gender: providing normative feedback to adults. Addictive Behaviors 32:967–976.

    Article  PubMed  Google Scholar 

  26. Cuijpers P, Riper H, Lemmers L (2004) The effects on mortality of brief intervention for problem drinking: a metaanalysis. Addiction 99:829–845

    Article  Google Scholar 

  27. De Micheli, Fisberg M, Formigoni ML (2004) Study on the effectiveness of brief intervention for alcohol and other drug use directed to adolescents in a primary health care unit. Rev Assoc Med Bras 50:305–313

    Article  PubMed  Google Scholar 

  28. DeSousa A, Desousa A (2005) An open randomized study comparing disulfiram and acamprosate in the treatment of alcohol dependence Alcohol Alcohol 40(6):545–548

    Article  CAS  Google Scholar 

  29. Fiellin, DA, Reid C, O’Connor PG (2000) Outpatient management of patients with alcohol problems. Ann Intern Med 133:815–827

    PubMed  CAS  Google Scholar 

  30. Fishman SM, Kreis PG (2002) The opioid contract. Clin J Pain 18(4):S70–S75

    Article  PubMed  Google Scholar 

  31. Fleming MF, Barry KL, Manwell LB et al (1997) Brief physician advice for problem alcohol drinkers: a randomized controlled trial in community-based primary care practices. JAMA 277:1039–1045

    Article  PubMed  CAS  Google Scholar 

  32. Fleming MF, Mundt MP, French MT et al (2000) Benefit-cost analysis of brief physician advice with problem drinkers in primary care settings. Medical Care 38:7–18

    Article  PubMed  CAS  Google Scholar 

  33. Fleming MF, Mundt MP, French MT et al (2002) Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res 26:36–43

    Article  PubMed  Google Scholar 

  34. Friedmann PD, McCollough D Chin MH et al (2000) Screening and intervention for alcohol problems. J Gen Intern Med 15:84–91

    Article  PubMed  CAS  Google Scholar 

  35. Friedmann, PD, Saitz R, Samet JH (1998) Management of adults recovering from alcohol or other drug problems: relapse prevention in primary care. JAMA 279:1227–1231

    Article  PubMed  CAS  Google Scholar 

  36. Garbutt JC, Kranzler HR, O’Malley SS et al (2005) Efficacy and tolerability of injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 293:1617–1625

    Article  PubMed  CAS  Google Scholar 

  37. Gawin FH, Ellinwood EH (1988) Cocaine and other stimulants. Actions, abuse, and treatment. N Engl J Med 318:1173–1182

    Article  PubMed  CAS  Google Scholar 

  38. Gonzales D, Rennard SI, Nides M et al (2006)Varenicline, an alph4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion or placebo for smoking cessation. JAMA 296:47–55

    Article  PubMed  CAS  Google Scholar 

  39. Hayashida M (1998) An overview of outpatient and inpatient detoxification. Alcohol Health Res World 22:44–46

    PubMed  CAS  Google Scholar 

  40. Humphreys K. (1999) Professional interventions that facilitate 12 step self-help group involvement. Alcohol Res Health 23:93–98

    PubMed  CAS  Google Scholar 

  41. Institute of Medicine (1994) Defining primary care: an interim report. http://books.nap.edu/openbook.php?record_id=9153&page=15. Accessed 14 July 2008

  42. Institute of Medicine (2006) Improving the quality of health care for mental and substance-use conditions. National Academies, Washington, DC

    Google Scholar 

  43. Johnson BA, Rosenthal N, Capece JA et al (2007) Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 298:1641–1651

    Article  PubMed  CAS  Google Scholar 

  44. Jorenby DE, Hayes JT, Rigotti NA et al (2006) Efficacy of varenicline, an alph4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation. JAMA 296:56–63

    Article  PubMed  CAS  Google Scholar 

  45. Katz N, Fanciullo GJ (2002) Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain 18(4):S76–S82

    Article  PubMed  Google Scholar 

  46. Kiefer F, Holger J, Tarnaske T et al (2003) Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism. Arch Gen Psychiatry 60:92–99

    Article  PubMed  CAS  Google Scholar 

  47. Kosten TR, O’Connor PG (2003) Management of drug and alcohol withdrawal. New Engl J Med 348:1786–1795

    Article  PubMed  CAS  Google Scholar 

  48. Kranzler HR, Burleson JA, Del Boca FK et al. (1994) Buspirone treatment of anxious alcoholics: a placebo-controlled trial. Arch Gen Psychiatry 51:720–731

    Article  PubMed  CAS  Google Scholar 

  49. Kypri K, Saunders JB, Williams SM et al (2004) Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial. Addiction 99:1410–1417

    Article  PubMed  Google Scholar 

  50. Mann K, Lehert P, Morgan MY (2004) The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals: results of a meta-analysis. Alc Clin Exp Res 28:51–63

    Article  Google Scholar 

  51. Mayo-Smith MF et al. (1997) Pharmacological management of alcohol withdrawal. A meta-analysis and evidence based practice guideline. American Society of Addiction Medicine Working Group on Pharmacologic Management of Alcohol Withdrawal. JAMA 278:144–151

    Article  PubMed  CAS  Google Scholar 

  52. McGlynn EA, Asch SM, Adams J et al (2003) The quality of health care delivered to adults in the United States. New Engl J Med 348:2635–2645

    Article  PubMed  Google Scholar 

  53. McKee SA, Falba T, O’Malley SS et al (2007) Smoking status as a clinical indicator for alcohol misuse in US adults. Arch Intern Med 167:716–721

    Article  PubMed  Google Scholar 

  54. Miller WR, Rollnick S (1991) Motivational interviewing: preparing people to change addictive behavior, 2nd edn. Guilford, New York

    Google Scholar 

  55. National Heart Lung and Blood Institute. Your guide to healthy sleep. DHHS Publication No. 06-5271 http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf. Accessed 14 June 2008

  56. National Institute on Alcohol Abuse and Alcoholism (2007) Helping patients who drink too much: a clinician’s guide. 2005 edn. NIH Publication No. 07-3769, Bethesda, MD

    Google Scholar 

  57. Nowinski J, Baker S, Carroll K. (1995) Project MATCH twelve step facilitation therapy manual. A clinical research guide for therapists treating individuals with alcohol abuse and dependence. USDHHS, Rockville

    Google Scholar 

  58. Nunes EV, Levin FR (2004) Treatment of depression in patients with alcohol or other drug dependence JAMA 291:1887–1896

    Article  PubMed  CAS  Google Scholar 

  59. O’Connor PG, Schottenfeld RS (1998) Patients with alcohol problems. New Eng J Med 338:592–602

    Article  PubMed  Google Scholar 

  60. O’Malley SS, Rounsaville BJ, Farren C et al (2003) Initial and maintenance naltrexone treatment for alcohol dependence using primary care versus specialty care. A nested sequence of 3 randomized trials. Arch Intern Med 163:1695–1704

    Article  PubMed  Google Scholar 

  61. Oregon Health Sciences University (OHSU) (2008) Chronic pain management http://www.ohsu.edu/ahec/pain/form.html. Accessed 28 Aug 2008

  62. Overman GP, Teter CJ, Guthrie SK (2003)Acamprosate for the adjunctive treatment of alcohol dependence. Ann Pharmacother 37:1090–1099

    Article  PubMed  CAS  Google Scholar 

  63. Paille FM, Guelfi JD, Perkins AC et al (1995) Double-blind randomized multicentre trial of acamprosate in maintaining abstinence from alcohol. Alcohol Alcohol 30:239–247

    PubMed  CAS  Google Scholar 

  64. Pettinati HM, O’Brien CP, Rabinowitz AR et al (2006) The status of naltrexone in the treatment of alcohol dependence; specific effects on heavy drinking. J Clin Pharmacol 26:610–625

    CAS  Google Scholar 

  65. Pettinati HM, Weiss RD, Dundon W et al (2005) A structured approach to medical management: a psychosocial intervention to support pharmacotherapy in the treatment of alcohol dependence. J Stud Alcohol Suppl(15):179–187

    Google Scholar 

  66. Reeves RR, Carter OS, Pinkofsky HB et al (1999) Carisoprodol (soma): abuse potential and physician unawareness. J Addict Dis 18:51–56

    Article  PubMed  CAS  Google Scholar 

  67. Reid MC, Engles-Horton LL, Weber MB et al (2002) Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med 17(3):173–179

    Article  PubMed  Google Scholar 

  68. Reinert DF, Allen JP (2002) The alcohol use disorders identification test (AUDIT): a review of recent research. Alcohol Clin Exp Res 26(2):272–279

    Article  PubMed  Google Scholar 

  69. Saitz R (2005) Unhealthy alcohol use. New Engl J Med 352:596–607

    Article  PubMed  CAS  Google Scholar 

  70. Samet JH, Rollnick S, Barnes H (1996) Beyond CAGE: a brief clinical approach after detection of substance abuse. Arch Intern Med 156:2287–2289

    Article  PubMed  CAS  Google Scholar 

  71. Sass H, Soyka M Mann K et al (1996) Relapse prevention by acamprosate: results from a placebo-controlled study on alcohol dependence. Arch Gen Psychiatry 53:673–680

    Article  PubMed  CAS  Google Scholar 

  72. Sellars EM, Naranjo CA, Harrison M, et al (1983) Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 34:822–826

    Article  Google Scholar 

  73. Sinclair JD (2001) Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol Alcohol 36(1):2–10

    Article  PubMed  CAS  Google Scholar 

  74. Skinner HA (1982) The drug abuse screening test. Addict Behav 7(4):363–371

    Article  PubMed  CAS  Google Scholar 

  75. Smith PC, Schmidt SM, Allensworth-Davies D, et al (2009) Primary care validation of a single-question alcohol screening test. J Gen Intern Med 24:783–788. Erratum: (2010) J Gen Intern Med 25(4):375

    Google Scholar 

  76. Solberg LI, Maciosek MV, Edwards NM (2008) Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness. Am J Prev Med 34(2):143–152

    Article  PubMed  Google Scholar 

  77. Standridge JB, Zylstra RG, Adams SM (2004) Alcohol consumption: an overview of benefits and risks. So J Med 97: 664–672

    Article  Google Scholar 

  78. Starosta AN, Leeman RF, Volpicelli JR (2006) The BRENDA model: integrating psychosocial treatment and pharmacotherapy for the treatment of alcohol use disorders. J Psychiatric Pract 12:80–89

    Article  Google Scholar 

  79. Streeton C, Whelan G (2001) Naltrexone, a relapse prevention maintenance treatment of alcohol dependence: a meta-analysis of randomized controlled trials. Alcohol Alcohol 36:544–552

    Article  PubMed  CAS  Google Scholar 

  80. Sullivan E, Fleming M (1997) A guide to substance abuse services for primary care clinicians. Treatment improvement protocol (TIP) 24. Department Health and Human Services Pub No. SMA 97–3139

    Google Scholar 

  81. Sullivan JT, Sykora K, Schneiderman J et al (1989) Assessment of alcohol withdrawal: the revised clinical institute withdrawal instrument for alcohol scale (CIWA-Ar). Br J Addiction 84:1353–1357

    Article  CAS  Google Scholar 

  82. Sullivan LE, Fiellin DA (2008) Narrative review: buprenorphine for opioid-dependent patients in office practice. Ann Intern Med 148:662–670

    PubMed  Google Scholar 

  83. US Department of Health and Human Services (2004) The confidentiality of alcohol and drug abuse patient records regulation and the HIPAA privacy rule: implications for alcohol and substance abuse programs. http://www.hipaa.samhsa.gov/download2/SAMHSA’sPart2-HIPAAComparisonClearedWordVersion.doc. Accessed 29 Aug 2008

    Google Scholar 

  84. US Department of Health and Human Services (2004) Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) 40. DHHS Publication No. (SMA) 04-3939

    Google Scholar 

  85. U.S. Preventive Services Task Force (2004) Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med 140:554–556, 557–568

    Google Scholar 

  86. Unutzer J, Katon W, Callahan CM, et al (2002) Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 288:2836–2845

    Article  PubMed  Google Scholar 

  87. Vinson DC, Kruse RL, Seale JP (2007) Simplifying alcohol assessment: two questions to identify alcohol use disorders. Alc Clin Exp Res 31:1392–1398

    Article  Google Scholar 

  88. World Health Organization (WHO) (2008) The effectiveness of brief interventions for illicit drugs linked to alcohol, smoking and substance involvement screening test (ASSIST) in primary health care settings: a technical report of phase III findings of the WHO ASSIST randomized controlled trial. http://www.who.int/substance_abuse/activities/assist_technicalreport_phase3_final.pdf. Accessed 28 Aug 2008

  89. Wilson JF (2007) Strategies to reduce opiate abuse. Ann Intern Med 146:887–890

    Google Scholar 

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Authors and Affiliations

  1. General Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Michael F. Bierer

  2. Harvard Medical School, Boston, MA, 02114, USA

    Michael F. Bierer

  3. Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA

    Richard Saitz

  4. Youth Alcohol Prevention Center and Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz

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  1. Michael F. Bierer
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Correspondence to Michael F. Bierer .

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  1. , Depts Psychiat & Neurobehav Sciences, Me, University of Virginia, Charlottesville, 22908, Virginia, USA

    Bankole A. Johnson

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Bierer, M.F., Saitz, R. (2010). Unhealthy Alcohol and Drug Use in Primary Care. In: Johnson, B. (eds) Addiction Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0338-9_42

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  • DOI: https://doi.org/10.1007/978-1-4419-0338-9_42

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