Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs.
BACKGROUND
There exists substantial evidence that individuals with alcohol and drug disorders have heightened comorbidities and health care costs. However, little is known about the larger population of "hazardous" drinkers (those whose consumption increases their "risk of physical and psychological harm") and drug users.


METHODS
A sample of 1,419 patients from HMO primary care clinics was screened for hazardous drinking and drug use. Health plan databases were used to examine medical conditions and health care costs of hazardous drinkers and drug users in the year prior to screening, in comparison to 13,347 patients from the same clinics, excluding those screened.


RESULTS
We found a prevalence of 7.5% for hazardous drinking and 3.2% for drug use in primary care (10% had at least one of the two problems). Hazardous drinkers and drug users had heightened prevalences for eight medical conditions, including costly conditions such as injury and hypertension, and psychiatric conditions. Medical costs for the year examined were not higher, except for those who also had psychiatric conditions.


CONCLUSIONS
The prevalence of hazardous drinking and drug use was similar to hypertension and diabetes. Hazardous drinkers and drug users' heightened medical conditions, especially those related to alcohol and drug abuse, indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner. Optimal treatment and prevention of some medical disorders may require identification and intervention of underlying hazardous alcohol or drug use.
Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA. Jennifer.Mertens@kp.org
Jennifer R
JR
Mertens
Constance
C
Weisner
G Thomas
GT
Ray
Bruce
B
Fireman
Kevin
K
Walsh
D000328:Adult; D000428:Alcohol Drinking / Q000191:economics / Q000453:epidemiology; D000437:Alcoholism / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000453:epidemiology