Integrated Health Care Cuts Addicts' Relapse Rate

Combining traditional medical care with substance-abuse treatment works well, studies say

WEDNESDAY, Oct. 17, 2001 (HealthDayNews) -- If you're an addict, you might have more luck getting off drugs or alcohol if you combine your medical care with your addiction treatment, new research suggests.

Traditional health care separates out addiction treatment by sending substance abusers to outpatient clinics or residential programs. But a combination of medical care and addiction treatment seems to triple the ability of adults to stay off drugs or alcohol, the study shows.

"There's very strong literature showing people with addiction conditions have a higher rate of other medical conditions when compared to the general population," says Constance Weisner, a professor of psychiatry at the University of California at San Francisco.

"One of the concerns is that many primary care physicians who are treating their patients for health care may be completely unaware of a patient's addictions and therefore are not assessing the patient for other related conditions. And there is also a large body of literature that shows that primary care physicians seldom screen for addiction or substance abuse problems," she adds.

Although the American Medical Association and the World Health Organization recognize addiction as a medical condition, "the addiction treatment system is traditionally separate from the medical treatment system," Weisner explains. "We wanted to test whether integrating the two treatments would result in better outcomes."

Weisner and her colleagues assigned 285 patients to an integrated program where their medical care was combined with addiction treatment and managed by a primary care physician. Another 307 patients received traditional substance abuse treatment at the regular clinics. Both groups were required to attend 12-step programs. The researchers followed them through eight weeks of treatment and 10 months of aftercare, then examined the abstinence rates and medical costs for both groups.

Those who received the integrated health care were about three times more likely to remain abstinent, Weisner says, "which is very large in these kinds of studies."

Integrated health care, however, does cost more money, she adds. "The integrated model is somewhat more expensive -- about $1,500 a patient -- but the potential for the long term is that there may be less medical costs down the road. More research needs to be done on that."

A second study shows that a primary care physician can also be useful in much more serious addiction treatments. People who are successfully undergoing methadone treatment for heroin addiction can be transferred to their own doctors to continue treatment, with equally successful results and greater satisfaction.

The result could mean more treatment resources for heroin addicts, says Dr. Richard Schottenfeld, a professor of psychiatry at Yale University. "It's been very hard to expand current treatment opportunities, so one of the main impetuses of our study was to look for an alternative location to provide both access and treatment," he says.

Schottenfeld and his colleagues randomly assigned 46 heroin addicts who were doing well with methadone treatment to either stay in the program or transfer to a primary care physician to continue the treatment. During the six months they participated in the study, the addicts were tested for illicit drug use.

"Patients did about as well when they moved to a physician's office when compared to a regular program," Schottenfeld reports. Four of the 22 patients assigned to a primary care physician started using narcotics again on a regular basis, compared to five who got their methadone from a clinic.

"There were some advantages to primary health care in terms of patient satisfaction," Schottenfeld says. Almost 75 percent of the patients in primary care said they were very satisfied with the office-based treatment, compared to only about 10 percent of those in regular treatment.

"And satisfaction is one of the things that leads people to enter and stay in treatment, so we consider that important," Schottenfeld adds.

Both studies were published in the Oct. 10 issue of the Journal of the American Medical Association.

In an accompanying editorial, Drs. Michael Stein and Peter Friedman with Rhode Island Hospital say both studies provide necessary data on the benefits and costs of primary care physicians' involvement in addiction treatment. The role for general care physicians may be similar to the role of those who care for people infected with AIDS, they write.

"In the HIV/AIDS arena, a relatively small number of physicians -- willing to overlook financial and administrative disincentives -- provide the great majority of care to patients with more complicated clinical pictures. The system of care for substance-using patients will likely take shape in the same way as new therapies become available," Stein and Friedman write.

But doctors need sensitive skills for addiction treatment to succeed, they add.

"Physicians -- whether generalists or addiction specialists -- who provide an ongoing, trusting relationship, if they have learned the requisite skills, may be able to evoke from patients reasons for changing and commitment to change that endure," Friedman and Stein conclude. "Time will tell how many generalist physicians really want a share of this turf."

What to Do: For more on addiction treatment, see the National Institute on Drug Abuse or the Addiction Resource Guide.

SOURCES: Interviews with Constance Weisner, Dr.P.H., professor of psychiatry, University of California, at San Francisco; Richard Schottenfeld, M.D., professor of psychiatry, Yale University, New Haven, Conn.; Oct. 10, 2001, Journal of the American Medical Association
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