title: Changes in health outcomes as a function of abstinence and reduction in illicit psychoactive drug use: a prospective study in primary care.
abstract: OBJECTIVE
  To test (1) whether abstinence and reduction in illicit psychoactive drug use were associated with changes in health outcomes in primary care patients and (2) whether these associations varied by drug type.
  
  
  METHODS
  Secondary analysis of data from a randomized controlled trial that tested a brief intervention for drug use in primary care patients (589 enrolled, 574 completed a 6-month assessment). Analyses were conducted overall and stratified by the most commonly self-identified main drugs (marijuana, cocaine and opioids).
  
  
  METHODS
  Patients who screened positive for illicit drug use at an urban primary care clinic in Boston, Massachusetts, USA.
  
  
  METHODS
  Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use, decreased use without abstinence and abstinence. Primary outcomes were 6-month changes in drug use consequences [Short Inventory of Problems scores (range 0-45)], depressive symptoms and health-related quality of life (HRQol).
  
  
  RESULTS
  Abstinence was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups (adjusted means, full sample: -8.11 versus -0.05, P < 0.001; cocaine: -13.33 versus +1.09, P < 0.001, opioids; -16.84 versus -2.10, P < 0.001). Differences were not significant between those who decreased use compared with those who continued or increased use. There were no significant associations between drug use and depressive symptoms or HRQol. Neither abstinence nor decreased use was associated significantly with consequences in the marijuana subgroup.
  
  
  CONCLUSIONS
  Among primary care patients in the United States who use illicit psychoactive drugs, abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Alpert Medical School and Rhode Island Hospital, Providence, RI, USA.|Department of Psychiatry and Human Behavior, Alpert Medical School and Rhode Island Hospital, Providence, RI, USA.
authors.forename: Tae Woo
authors.identifier: http://orcid.org/0000-0003-4545-6848
authors.initials: TW
authors.lastname: Park
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.|Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Lloyd-Travaglini
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
authors.affiliation: Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
authors.forename: Tibor P
authors.initials: TP
authors.lastname: Palfai
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.|Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: Richard
authors.identifier: http://orcid.org/0000-0002-2535-1427
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D001900:Boston; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D011619:Psychotropic Drugs; D011788:Quality of Life; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States; D014505:Urban Population
chemical_list: D013287:Illicit Drugs; D011619:Psychotropic Drugs
keywords: Abstinence; cocaine; consequences of drug use; marijuana; opioids; primary care; reduction in drug use