Primary medical care and reductions in addiction severity: a prospective cohort study

Aims To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions. Design We studied a prospective cohort of adults enrolled in a randomized trial to improve linkage with primary medical care. Methods Subjects at a residential detoxification unit with alcohol, heroin or cocaine as a substance of choice, and no primary medical care were enrolled. Receipt of primary medical care was assessed over 2 years. Outcomes included (1) alcohol severity, (2) drug severity and (3) any substance use. Findings For the 391 subjects, receipt of primary care ( greater than or equal to 2 visits) was associated with a lower odds of drug use or alcohol intoxication (adjusted odds ratio (AOR) 0.45, 95% confidence interval (CI) 0.29-0.69, 2 d.f. chi(2) P = 0.002). For 248 subjects with alcohol as a substance of choice, alcohol severity was lower in those who received primary care [predicted mean Addiction Severity Index (ASI) alcohol scores for those reporting greater than or equal to 2, 1 and 0 visits, respectively, 0.30, 0.26 and 0.34, P = 0.04]. For 300 subjects with heroin or cocaine as a substance of choice, drug severity was lower in those who received primary care (predicted mean ASI drug scores for those reporting greater than or equal to 2, 1 and 0 visits, respectively, 0.13, 0.15 and 0. 16, P = 0.01). Conclusions Receipt of primary medical care is associated with improved addiction severity. These results support efforts to link patients with addictions to primary medical care services.