Links between primary care, addiction services may help treatment

Researchers say more integrated care may mean better outcomes and improve doctor involvement in the diagnosis and treatment of substance abuse.

By Victoria Stagg Elliott, AMNews staff. Jan. 29, 2001.

When Jeffrey Samet, MD, MPH, sees a primary care patient who also needs substance abuse treatment, he makes one phone call to the Boston Public Health Commission's Addiction Services, paging a counselor who will either be in his office or on the phone to speak to the patient within 15 minutes.

At the inpatient detoxification unit at his hospital, the Boston Medical Center, there is a twice-weekly clinic with a physician, a nurse and a social worker to address patients' medical problems in addition to their addiction. If patients do not have a primary care physician, one is found for them and an appointment made.

"Does it work? We don't know, but it's a system we're trying to implement to see if we can provide better services within primary care for alcohol and drug problems," Dr. Samet said. "And for our dependent patients who get into a detox, there are a lot of medical issues. If they're not getting into medical care, but they are getting into the substance abuse system, take advantage of it."

These steps are just two ways to integrate what are usually distinct systems, said Dr. Samet, associate professor of medicine and public health at Boston University School of Medicine and primary author of an investigation into the benefits of linking primary care with substance abuse services. His findings are published in the Jan. 8 Archives of Internal Medicine.

Substance abusers can access medical care. Medical patients can access addiction treatment. "It's not by any one particular mechanism," Dr. Samet said. "But there should be a commitment to moving toward more interaction between the two systems. The linkage can take place in lots of ways. Be creative. Patients benefit. Docs benefit. Addiction treatment places benefit. Society benefits." [...]