title: Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program.
abstract: Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.
authors.affiliation: a Visiting Research Scholar, Department of Public Health and Preventive Medicine , Oregon Health and Science University (OHSU) , Portland , OR.
authors.forename: Jan
authors.initials: J
authors.lastname: Klimas
authors.forename: John
authors.initials: J
authors.lastname: Muench
authors.forename: Katharina
authors.initials: K
authors.lastname: Wiest
authors.forename: Raina
authors.initials: R
authors.lastname: Croff
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckman
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D000701:Analgesics, Opioid; D016739:Behavior, Addictive / Q000175:diagnosis / Q000628:therapy; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy; D009922:Oregon; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011580:Psychological Techniques; D058996:Quality Improvement; D015813:Substance Abuse Detection / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: SBIRT; agonist treatment; alcohol; family medicine; implementation; opioids