Skip to main content
SpringerLink
Log in

Other Drug Use

  • Chapter
  • First Online:
Addressing Unhealthy Alcohol Use in Primary Care

  • 1043 Accesses

Abstract

Unhealthy alcohol users are much more likely than the general population to have concurrent tobacco and illicit drug use. This chapter gives an overview of what clinicians need to know about recognizing other drug use and its attendant comorbidities, and providing preventive care and substance use interventions. Substance use is most likely to be uncovered through routine screening, which should be followed by an assessment that determines the degree and severity of use. Medical providers should be aware of common medical and psychiatric problems among tobacco and other drug users. They should be prepared to provide focused preventive care, and to educate patients on harm reduction strategies, including use of sterile injection equipment and overdose prevention. Importantly, medical providers can intervene directly to help patients reduce or stop using tobacco and other drugs, through pharmacotherapy coupled with counseling. Addressing tobacco and other drug use among patients with unhealthy alcohol use can enhance the success of alcohol interventions, and improve overall patient care by helping the provider to identify and treat associated medical conditions, avoid potentially harmful drug interactions, understand and improve adherence to treatment, and build trust.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 64.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 84.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.

    Article  PubMed  Google Scholar 

  2. Neumark YD, Van Etten ML, Anthony JC. Drug dependence and death: survival analysis of the Baltimore ECA sample from 1981–1995. Sust Use Misuse. 2000;35:313–27.

    Article  CAS  Google Scholar 

  3. Robert Wood Johnson Foundation and Schneider Institute for Health Policy. Substance abuse: the nation’s number one health problem. Princeton: Robert Wood Johnson Foundation; 2001. http://www.rwjf.org/files/publications/other/SubstanceAbuseChartbook.pdf. Accessed 5 May 2011.

  4. Centers for Disease Control and Prevention. Unintentional poisoning deaths--United States, 1999–2004. MMWR Morbid Mortal Wkly Rep. 2007;56:93–96.

    Google Scholar 

  5. Center for Substance Abuse Research (CESAR). Unintentional drug overdose deaths continue to increase; now second leading cause of unintentional deaths. CESAR Fax. 2011;20(19).

    Google Scholar 

  6. Substance Abuse and Mental Health Services Administration. Results from the 2009 National Survey on Drug Use and Health: National Findings. RockvilleMD: Office of Applied Studies, NSDUH Series H-38 A, HHS Publication No. SMA 10–4856Findings), 2010. http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm #7.3.2. Accessed 5 May 2011.

  7. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:557–68.

    Google Scholar 

  8. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse, ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34:143–52.

    Article  PubMed  Google Scholar 

  9. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alc Depend. 2009;99:280–95.

    Article  Google Scholar 

  10. Laine C, Hauck WW, Gourevitch MN, Rothman J, Cohen A, Turner BJ. Regular outpatient medical and drug abuse care and subsequent hospitalization of persons who use illicit drugs. JAMA. 2001;285:2355–62.

    Article  PubMed  CAS  Google Scholar 

  11. Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment: a randomized controlled trial. JAMA. 2001;286:1715–23.

    Article  PubMed  CAS  Google Scholar 

  12. O’Connor PG, Selwyn PA, Schottenfeld RS. Medical care for injection-drug users with human immunodeficiency virus infection. N Engl J Med. 1994;331:450–9.

    Article  PubMed  Google Scholar 

  13. Samet JH, Friedmann P, Saitz R. Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Arch Intern Med. 2001;161(1):85–91.

    Article  PubMed  CAS  Google Scholar 

  14. Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  15. Scott CK, Dennis ML, Laudet A, Funk RR, Simeone RS. Surviving drug addiction: the effect of treatment. Am J Public Health. 2011;737–44.

    Google Scholar 

  16. National Institutes of Health, National Institute on drug abuse. Strategic Plan; 2009. http://www.drugabuse.gov/StrategicPlan/StratPlan09/Index.html. Accessed 5 May 2011.

  17. Kuehn BM. Treatment given high priority in new white house drug control policy. JAMA. 2010;303:821–22.

    Article  CAS  Google Scholar 

  18. Agency for Healthcare Research and Quality. Helping smokers quit: a guide for clinicians. http://www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm. Accessed 5 May 2011.

  19. Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A single-question screening test for drug use in primary care. Arch Intern Med. 2010;170:1155–60.

    Article  PubMed  Google Scholar 

  20. Brown RL, Rounds LA. Conjoint screening questionnaires for alcohol and other drug abuse: criterion validity in a primary care practice. Wis Med J. 1995;94:135–40.

    PubMed  CAS  Google Scholar 

  21. Substance Abuse and Mental Health Services Administration (SAMHSA). Coding for SBI Reimbursement. http://www.samhsa.gov/prevention/SBIRT/coding.aspx. Accessed 5 May 2011.

  22. Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;153:591–6.

    PubMed  CAS  Google Scholar 

  23. National Institute on Drug Abuse (NIDA). Screening for drug use in general medical settings: a resource guide for providers. http://www.drugabuse.gov/nidamed/resguide/resourceguide.pdf. Accessed 14 May 2011.

  24. Humeniuk R. Validation of the Alcohol, Smoking and substance involvement screening test (ASSIST) and pilot brief intervention: A technical report of phase II findings of the WHO ASSIST Project. World Health Organization; 2008. http://www.who.int/substance_abuse/activities/assist_technicalreport_phase2_final.pdf.) Accessed 14 May 2011.

  25. Join Together. Drug screening.org questionnaire. http://www.drugscreening.org/about.aspx. Accessed 14 May 2011.

  26. National Institute on Drug Abuse (NIDA). NIDA Quick Screen: Clinician’s screening tool for drug use in general medical settings. http://ww1.drugabuse.gov/nmassist/. Accessed 14 May 2011.

  27. Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users: the keys to the ‘narc’ cabinet. J Gen Intern Med. 2002;17:327–33.

    PubMed  Google Scholar 

  28. The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Missed opportunity: National survey of primary care physicians and patients on substance abuse. April 2004. http://www.casacolumbia.org/articlefiles/380-Missed%20Opportunity%20Physicians%20and%20Patients.pdf. Accessed 5 May 2011.

  29. Mertens JR, Lu YW, Parthasarathy S, Moore C, Weisner CM. Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO. Arch Intern Med. 2003;163:2511–7.

    Article  PubMed  Google Scholar 

  30. Mertens JR, Weisner C, Ray GT, Fireman B, Walsh K. Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res. 2005;29:989–98.

    Article  PubMed  Google Scholar 

  31. Devlin RJ, Henry JA. Clinical review: major consequences of illicit drug consumption. Crit Care. 2008;12(1):202. (Epub 8 Jan. 2008)

    Article  PubMed  Google Scholar 

  32. Compton WM, Thomas YF, Stinson FS, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2007;64:566–76.

    Article  PubMed  Google Scholar 

  33. Pelucchi C, et al. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Res Health: J Nat Inst Alcohol Abuse Alcohol. 2006;29:193–8.

    Google Scholar 

  34. Kalman D, et al. Addressing tobacco use disorder in smokers in early remission from alcohol dependence: the case for integrating smoking cessation services in substance use disorder treatment programs. Clin Psychol Rev. 2010; 30:12–24.

    Article  PubMed  Google Scholar 

  35. Lee JD, McNeely J, Gourevitch MN. Management of associated medical conditions. In: Ruiz P, Strain E, editors. Substance abuse: a comprehensive textbook. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2011 [in press ].

    Google Scholar 

  36. Substance Abuse and Mental Health Services Administration. Results from the 2006 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-32, HHS Publication No. SMA 07-4293), 2007. http://oas.samhsa.gov/NSDUH/2k6NSDUH/2k6results.cfm#Ch8. Accessed 5 May 2011.

  37. Center for Substance Abuse Treatment. Identifying and helping patients with co-occurringsubstance use and mental disorders: a guide for primary care providers. SubstAbuse Brief Fact Sheet. 2006;4(2). http://kap.samhsa.gov/products/brochures/pdfs/saib_fall06_v4i2.pdf

  38. Ziedonis D, Brady K. Dual Diagnosis in primary care: detecting and treating both the addiction and mental illness. Med Clin North Am. 1997;81(4):1017–36.

    Article  PubMed  CAS  Google Scholar 

  39. Epstein J, Barker P, Vorburger M, Murtha C. Serious mental illness and its co-occurrence with substance use disorders. 2002. www.oas.samhsa.gov/CoD/Cod.htm. Accessed 14 May 2011.

    Google Scholar 

  40. Center for Substance Abuse Treatment. Substance abuse treatment and domestic violence. Treatment Improvement Protocol (TIP) Series 25. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration;1997.

    Google Scholar 

  41. McCauley JL, Danielson CK, Arnstadter AB, et al. The role of traumatic event history in non-medical use of prescription drugs among a nationally representative sample of US adolescents. J Child Psychol Psychiatry. 2010;51:84–93.

    Article  PubMed  Google Scholar 

  42. Miller BA, Downs WR, Gondoli DM. Spousal violence among alcoholic women as compared to a random household sample of women. J Stud Alcohol. 1989;50(6):533.

    PubMed  CAS  Google Scholar 

  43. Centers for Disease Control and Prevention. Fact sheet: drug-associated HIV transmission continues in the United Centers for States. http://www.cdc.gov/hiv/resources/Factsheets/idu.htm. Accessed 12 August 2009.

  44. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–14.

    PubMed  Google Scholar 

  45. U.S. Department of Health and Human Services, Public Health Service. HIV Prevention Bulletin: Medical advice for persons who inject illicit drugs. http://www.cdcnpin.org/Reports/MedAdv.pdf. Accessed 14 May 2011.

  46. Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA. 2008;300:520–29.

    Article  PubMed  CAS  Google Scholar 

  47. Warner-Smith M, Darke S, Lynskey M, Hall W. Heroin overdose: causes and consequences. Addiction. 2001;96:1113–25.

    Google Scholar 

  48. Piper TM, Stancliff S, Rudenstine S, Sherman S, Nandi V, Clear A, Galea S. Evaluation of a naloxone distribution and administration program in New York City. Sub Use Misuse. 2008;43:858–70.

    Google Scholar 

  49. Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville: U.S. Department of Health and Human Services, Public Health Service; 2008. http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf. Accessed 14 May 2011.

  50. Prochaska J, Delucchi K, Hall S. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. J Consult Clin Psychol. 2004;72:1144–56.

    Article  PubMed  Google Scholar 

  51. Joseph A, et al. A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment. J Stud Alcohol. 2004;65:681–91.

    PubMed  Google Scholar 

  52. Fiore MC, JC, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Quick reference guide for clinicians. Rockville: U.S. Department of Health and Human Services, Public Health Service; 2008.

    Google Scholar 

  53. Cooney N, et al. Smoking cessation during alcohol treatment: a randomized trial of combination nicotine patch plus nicotine gum. Addiction. 2009;104:1588–96.

    Article  PubMed  Google Scholar 

  54. Gunnell D, Wise L, Davies C, Martin RM. Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database. Br Med J. 2009;339:b3805.

    Google Scholar 

  55. Hays JT, et al. Varenicline for tobacco dependence treatment in recovering alcohol-dependent smokers: an open-label pilot study. J Subst Abuse Treatment. 2011;40:102–7.

    Article  Google Scholar 

  56. Center for Substance Abuse Treatment. A guide to substance abuse services for primary care clinicians. Treatment Improvement Protocol (TIP) Series 24. Rockville: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 1997. http://www.ncbi.nlm.nih.gov/books/NBK14386/. Accessed 14 May 2011.

  57. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140:557–68.

    Google Scholar 

  58. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse, ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34(2):143–52.

    Article  PubMed  Google Scholar 

  59. Kaner EFS, Beyer F, Dickinson HO, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;(2)CD004148.

    Google Scholar 

  60. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alc Depend. 2009;99(1–3):280–95.

    Google Scholar 

  61. Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug Alcohol Depend. 2005;77:49–59.

    Article  PubMed  Google Scholar 

  62. World Health Organization. The effectiveness of a brief intervention for illicit drugs linked to the 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. World Health Organization; 2008. http://www.who.int/substance_abuse/activities/assist_technicalreport_phase3_final.pdf. Accessed 14 May 2011.

  63. Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010;4:123–30.

    Article  PubMed  Google Scholar 

  64. Coups EJ, Gaba A, Orleans CT. Physician screening for multiple behavioral health risk factors. Am J Prevent Med. 2004;27(S1):34–41.

    Article  Google Scholar 

  65. Institute of Medicine. Primary care: America’s health in a new era. Washington, DC: National Academy Press; 1996.

    Google Scholar 

  66. National Quality Forum. National voluntary consensus standards for the treatment of substance use conditions: evidence-based treatment practices. Washington, DC: National Quality Forum; 2007.

    Google Scholar 

  67. Institute of Medicine. Federal regulation of methadone treatment. In: Rettig RA, Yarmolinsky A, editors. Washington, DC: National Academy Press; 1995.

    Google Scholar 

  68. Institute of Medicine. Treating drug problems, Vol. 1. In Gerstein DR, Harwood HJ, editors. Washington, DC: National Academy Press; 1990.

    Google Scholar 

  69. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55:569–80.

    Article  PubMed  CAS  Google Scholar 

  70. O’Connor PG, Oliveto AH, Shi JM, et al. A randomized trial of buprenorphine maintenance for heroin dependence in a primary care clinic for substance users versus a methadone clinic. Am J Med. 1998;105:100–5.

    Article  PubMed  Google Scholar 

  71. Substance Abuse and Mental Health Services Administration. The SAMHSA evaluation of the impact of the DATA Waiver Program: final summary report. Rockville: Center for Substance Abuse Treatment, US Dept. of Health and Human Services; 2006. www.buprenorphine.samhsa.gov/FOR_FINAL_summaryreport_colorized.pdf. Accessed 14 May 2011.

    Google Scholar 

  72. Alford DP, LaBelle CT, Richardson JM, et al. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med. 2007;22:171–6.

    Article  PubMed  Google Scholar 

  73. Kosten TR, Morgan C, Kosten TA. Depressive symptoms during buprenorphine treatment of opioid abusers. J Sub Abuse Treatment. 1990;7:51–54.

    Article  CAS  Google Scholar 

  74. Center for Substance Abuse Treatment (CSAT) Buprenorphine Information Center. http://www.buprenorphine.samhsa.gov/. Accessed 14 May 2011.

  75. Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2011;4:CD001333.

    Google Scholar 

  76. Sullivan MA, Vosburg SK, Comer SD. Depot naltrexone: antagonism of the reinforcing, subjective, and physiological effects of heroin. Psychopharmacology (Berl). 2006;189:37–46.

    Article  PubMed  CAS  Google Scholar 

  77. Comer SD, Sullivan MA, Yu E, Rothenberg JL, Kleber HD, Kampman K, Dackis C, O’Brien CP. Injectable, sustained-release naltrexone for the treatment of opioid dependence: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2006;63:210–8.

    Article  PubMed  CAS  Google Scholar 

  78. Krupitsky E, Nunes EV, Ling W, Illepereuma A, Gastfriend DR, Silverman BL. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomized trial. Lancet. 2011;377:1506–13.

    Article  PubMed  CAS  Google Scholar 

  79. Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment (CSAT). Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction: substance abuse and mental health services administration; 2004.

    Google Scholar 

  80. O’Connor PG, Nyquist JG, McLellan AT. Integrating addiction medicine into graduate medical education in primary care: the time has come. Ann Int Med. 2011;154:56–59.

    PubMed  Google Scholar 

  81. Pincus HA, Spaeth-Rublee B, Watkins KE. The case for measuring quality in mental health and substance abuse care. Health Affairs. 2011;30:730–36.

    Article  PubMed  Google Scholar 

  82. Croghan TW, Brown JD. Integrating mental health treatment into the patient centered medical home. (prepared by Mathematica Policy Research under Contract No. HHSA290200900019ITO2.) AHRQ Publication No. 10–0084-EF. Rockville: Agency for Healthcare Research and Quality; 2010.

    Google Scholar 

  83. Institute of Medicine. Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  84. Lanier D and Ko S. Screening in primary care settings for illicit drug use: assessment of screening instruments—a supplemental evidence update for the U.S. Preventive Services Task Force. Evid Synth. 2008;58(2):1–13 (AHRQ).

    Google Scholar 

  85. Skinner HA. The drug abuse screening test. Addict Behav. 1982;7:363–7.

    Google Scholar 

  86. Berman AH, Bergman H, Palmstierna T, Schlyter F. Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a swedish population sample. Eur Addict Res. 2005;11:22–31.

    Google Scholar 

  87. Tran N. Treating tobacco addiction. City Health Inf. 2010;29(suppl 3):1–8. http://www.nyc.gov/html/doh/downloads/pdf/chi/chi29-suppl3.pdf. Accessed 3 June 2011.

Download references

Author information

Authors and Affiliations

  1. Department of Population Health and Department of Medicine, Division of General Internal Medicine, NYU School of Medicine, New York, NY, USA

    Jennifer McNeely MD, MS & Joshua D Lee MD, MSc

  2. Department of Medicine, Division of General Internal Medicine, NYU School of Medicine, New York, NY, USA

    Ellie Grossman MD, MPH

Authors
  1. Jennifer McNeely MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joshua D Lee MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ellie Grossman MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer McNeely MD, MS .

Editor information

Editors and Affiliations

  1. , Section of General Internal Medicine, Boston Medical Center, Massachusetts Avenue, 2nd Floor 801, Boston, 02118-2335, Massachusetts, USA

    Richard Saitz

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

McNeely, J., Lee, J., Grossman, E. (2013). Other Drug Use. In: Saitz, R. (eds) Addressing Unhealthy Alcohol Use in Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4779-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-4779-5_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-4778-8

  • Online ISBN: 978-1-4614-4779-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation