title: Primary medical care and reductions in addiction severity: a prospective cohort study.
abstract: OBJECTIVE
  To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions.
  
  
  METHODS
  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.
  
  
  RESULTS
  For the 391 subjects, receipt of primary care (> or = 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 > or = 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 > or = 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.
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. rsaitz@bu.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Larson
authors.forename: Michael
authors.initials: M
authors.lastname: Winter
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000517:prevention & control*; D016896:Treatment Outcome