Drug options may help primary care doctors treat alcoholism

Office care and medication are found effective for addiction, but specialists question what role primary care physicians should play.

By Victoria Stagg Elliott, AMNews staff. Aug. 25, 2003.

Addiction and alcoholism experts have long encouraged primary care physicians to screen and diagnose substance abuse problems. Now, a growing number also are suggesting that these conditions can be treated in the primary care setting.

A study in the July Archives of Internal Medicine suggested that primary care management combined with a prescription for naltrexone was as effective as a specialized setting approach that combined the drug with cognitive behavioral therapy.

"Primary care [doctors] to date have referred out and not managed these patients themselves. These data suggest that they could," said Stephanie O'Malley, PhD, lead author on the paper and professor of psychiatry at Yale University School of Medicine.

This finding, combined with the approval of buprenorphine last year allowing for office-based treatment of opiate addiction, has many experts saying that addiction and alcoholism treatment could shift to the primary care setting where it could be handled like chronic conditions such as diabetes or hypertension.

"Primary care is the ideal setting for addiction care," said Patrick G. O'Connor, MD, MPH, one of the paper's authors and also a Yale professor of medicine. "Addiction problems fit the chronic disease model perfectly. Chronic disease is primarily what primary care is all about."

But before treatment, the condition has to be diagnosed, and physicians long have struggled with this. Most experts say the reasons involve both the stigma associated with addiction as well as the time it takes to address such problems. Other experts caution that at a point it still is necessary for a patient to turn to a specialist.