title: Estimating demand for primary care-based treatment for substance and alcohol use disorders.
abstract: While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care).
  
  
  
  Randomized survey-embedded experiment.
  
  
  
  US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting.
  
  
  
  A total of 42 451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history.
  
  
  
  Willingness to enter treatment across vignettes by condition.
  
  
  
  Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI) = 0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI = -2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI = -4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI = -4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed.
  
  
  
  In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.|Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.|Department of Veterans Affairs' Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.affiliation: Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.|Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.affiliation: Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.|VA Connecticut Healthcare System, West Haven, CT, USA.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D019966:Substance-Related Disorders / Q000628:therapy; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Alcohol use disorders; collaborative care; economics; financing; primary care; substance use disorders