title: Unhealthy alcohol use in primary care patients who screen positive for drug use.
abstract: Unhealthy alcohol use (UAU) is common among people who use other drugs; however, little information is available about UAU among patients who screen positive for drugs in primary care, where the clinical priority might be assumed to be drug use. This study aimed at describing the occurrence of UAU and its association with substance use-related outcomes in such patients.
  
  
  
  This cohort study is a secondary analysis of data from a randomized trial of brief intervention for primary care patients screening positive for drug use. UAU was assessed at baseline; the main independent variable was any heavy drinking day in the past month. Outcomes including drug use characteristics and substance use-related consequences were assessed at baseline and 6 months later.
  
  
  
  Of 589 primary care patients with drug use, 48% had at least 1 past-month heavy drinking day. The self-identified main drug was marijuana for 64%, cocaine for 18%, and an opioid for 16%. Any heavy drinking at baseline was negatively associated with number of days use of the main drug at 6 months (incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI]: 0.62-0.91), but positively associated with the use of more than 1 drug (IRR = 1.73, 95% CI: 1.17-2.55) and unsafe sex (odds ratio [OR] = 1.90, 95% CI: 1.21-2.98).
  
  
  
  Unhealthy alcohol use is common among patients identified by screening in primary care as using other drugs. Unexpectedly, UAU was negatively associated with days of main drug use. But, as expected, it was positively associated with other drug use characteristics and substance use-related consequences. These findings suggest that attention should be given to alcohol use among primary care patients who use other drugs.
authors.affiliation: a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine , Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston , Massachusetts , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Maynié-François
authors.affiliation: a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine , Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston , Massachusetts , USA.|b Department of Biostatistics , Boston University School of Public Health , Boston , Massachusetts , USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine , Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston , Massachusetts , USA.|c Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine , Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston , Massachusetts , USA.|d Data Coordinating Center, Boston University School of Public Health , Boston , Massachusetts , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.affiliation: e Department of Psychology , Boston University , Boston , Massachusetts , USA.
authors.forename: Tibor
authors.initials: T
authors.lastname: Palfai
authors.affiliation: c Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Bernstein
authors.affiliation: a Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine , Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston , Massachusetts , USA.|c Department of Community Health Sciences , Boston University School of Public Health , Boston , Massachusetts , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D015813:Substance Abuse Detection / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Alcohol-related disorders; primary health care; substance-related disorders; unsafe sex