The Substance‐Abusing Patient and Primary Care: Linkage via the Addiction Treatment System? 1

Abstract

Our objective was to describe and assess the prevalence and characteristics of substance‐abusing persons without primary care physicians. We interviewed a convenience sample at one point in time. Patients/participants were persons presenting for addictions treatment in a public substance abuse treatment system. Of 5824 respondents, 41% did not have a physician. In a multivariable analysis, the following were associated with not having a physician: no health insurance [adjusted odds ratio (OR), 2.05; 95% confidence interval (CI), 1.79–2.35], no history of a chronic (OR, 1.70; CI, 1.47–1.97) or an episodic (OR, 1.20; CI, 1.05–1.39) medical illness, male gender (OR, 1.49; CI, 1.29–1.71), and younger age (by decade) (OR, 1.12; CI, 1.04–1.38). Prior addictions or mental health treatment or a recent emergency‐room visit were not significantly associated with having a physician. Many patients with addictions serious enough to prompt presentation for treatment stated that they did not have physicians. Although younger persons, males, and those without insurance or past medical illness were more likely to report not having a physician, neither prior addictions or mental health treatment nor a recent emergency‐room visit decreased this likelihood. To achieve improved linkage of substance‐abusing patients with primary medical care, all health‐care contacts should be utilized.

Keywords

health services accessibility primaiy health care substance abuse mental health services insurance health community health services health facilities health promotion preventive health services

Get full access to this article

View all access options for this article.

References

Secretary of Health and Human Services. 1993. Eighth Special Report to the US Congress on Alcohol and Health, Alexandria, VA: US Department of Health and Human Services Contract ADM‐281–91–0003.

Cherubin

and Sapira

. 1993. The medical complications of drug addiction and the medical assessment of the intravenous drug usen 25 years later. Ann Intern Med, 119: 1017–1028.

Stein

. 1990. Medical complications of intravenous drug use. J Gen Intern Med, 5: 249–257.

Liebshutz

, Mulvey

and Samet

. 1997. Victimization among substance‐abusing women. Worse health outcomes. Arch Intern Med, 157: 1093–1097.

Van Hasselt

, Morrison

and Bellack

. 1985. Alcohol use in wife abusers and their spouses. Addict Behav, 10: 127–135.

Anthony

and Helzer

. 1991. “Syndromes of drug abuse and dependence”. In Psychiatric Disorders in America. The Epidemiologic Catchment Area Study, Edited by: Robins

and Reiger

. 116–154. New York: Free Press (Macmillan).

Bien

, Miller

and Tonigan

. 1993. Brief interventions for alcohol problems: A review. Addiction, 88: 315–336.

Haverkos

and Lange

. 1990. Serious infections other than human immunodeficiency virus among intravenous drug abusers. J Infect Dis, 161: 984–992.

Rabeneck

, Risser

JMH

Murray

NGB

. 1993. Failure of providers to vaccinate HTV‐infected men against hepatitis B: A missed opportunity. Am J Gastroenterology, 88: 2015–2018.

10.

US Preventive Services Task Force. 1996. Guide to Clinical Preventive Services, Alexandria, VA: International Medical Publishing.

11.

ACP Task Force on Adult Immunization and Infectious Diseases Society of America. 1994. Guide for Adult Immunization, 3rd ed, Philadelphia: American College of Physicians.

12.

Centers for Disease Control and Prevention. 1990. The use of preventive therapy for tuberculosis infection in the United States: Recommendations of the advisory committee for elimination of tuberculosis. MMWR, 39: RR‐8

13.

Samet

, Retondo

, Freedberg

, Stein

, Heeren

and Libman

. 1994. Factors associated with initiation of primary medical care for HIV‐infected persons. Am J Med, 97: 347–353.

14.

Delbanco

. 1992. Patients who drink too much. Where are their doctors?. JAMA, 267: 702–703.

15.

Kern

and Baile

. 1986. “Patient compliance with medical advice”. In Principles of Ambulatory Medicine, 2nd ed., Edited by: Barker

, Burton JR and Zieve

. 41–57. Baltimore, MD: Williams and Wilkins.

16.

National Institute on Drug Abuse. 1993. Annual Emergency Room Data, 1992, Data from the Drug Abuse Warning Network (DAWN), Rockville, MD: US Department of Health and Human Services.

17.

Fox

, Merrill

, Chang

and Califano

. 1995. Estimating the cost of substance abuse to the Medicaid Hospital Care Program. Am J Public Health, 85: 48–54.

18.

Cherpitel

. 1992. Drinking patterns and problems: A comparison of ER patients in an HMO and in the general population. Alcohol Clin Exp Res, 16: 1104–1109.

19.

Cherpitel

. 1994. Alcohol and injuries resulting from violence: A review of emergency room studies. Addiction, 89: 157–165.

20.

Mor

, Fleishman

, Dresser

and Piette

. 1992. Variation in health service use among HIV‐infected patients. Med Care, 30: 17–29.

21.

Rice

, Kelman

, Miller

and Dunmeyer

. 1990. Economic Costs of Alcohol and Drug Abuse and Mental Illness: 1985, San Francisco: Institute for Health and Aging, University of California.

22.

Bindman

, Grumbach

Osmond

. 1995. Preventable hospitalizations and access to health care. JAMA, 274: 305–311.

23.

Shea

, Misra

, Ehrlich

, Field

and Francis

. 1992. Predisposing factors for severe, uncontrolled hypertension in an inner‐city minority population. N Engl J Med, 327: 776–781.

24.

Samet

, Libman

Steger

. 1992. Compliance with zidovudine in patients infected with human immunodeficiency virus type 1: A cross‐sectional study in a municipal hospital clinic. Am J Med, 92: 495–502.

25.

Schlenger

, Kroutil

Roland

. 1992. National Evaluation of Models for Linking Drug Abuse Treatment and Primary Care: Linking Drug Treatment and Primary Care: A Casebook., Research Triangle Park, NC: Research Triangle Institute. Report prepared for the National Institute on Drug Abuse under Contract 283–90–0001

26.

Selwyn

, Feingold

Iezza

. 1989. Primary care for patients with human immunodeficiency virus (HIV) in a methadone maintenance program. Ann Intern Med, 110: 761–763.

27.

O'Connor

, Molde

, Henry

, Shockor

and Schottenfeld

. 1992. Human immunodeficiency virus infection in intravenous drug users: A model for primary care. Am J Med, 93: 382–386.

28.

D'Aunno

and Vaughn

. 1995. An organizational analysis of service patterns in outpatient drug abuse treatment units. J Substance Abuse, 7: 27–42.

29.

Moy

, Bartman

and Weir MR . 1995. Access to hypertensive care. Arch Intern Med, 155: 1497–1502.

30.

American College of Physicians. 1990. Access to health care. Ann Intern Med, 112: 641–661.

31.

Batten

, Prottas

Horgan

. Feb 12 1992. Drug Services Research Survey, Final Report: Phase II, Feb 12, Report submitted to the National Institute on Drug Abuse, Institute for Health Policy, Brandeis University.