Update in Addiction Medicine for the Primary Care Clinician

Abstract

The United States Preventive Services Task Force recommends that primary care clinicians assume a major role in screening, identification, treatment, and referral to treatment of unhealthy alcohol and other drug (AOD) use—the spectrum from use that risks health consequences to AOD disorders (abuse and dependence)—in generalist settings.1 In the United States, nicotine dependence, alcohol use, and drug use are the first, third, and ninth leading causes, respectively, of preventable deaths.2 Despite the harmful effects of addiction and improved options for office-based treatments and referral, not all primary care clinicians routinely address AOD use in their patients. The objectives of this paper are to identify and examine important recent advances in addiction medicine that have implications for primary care clinicians and that emphasize primary care clinicians’ role in the identification, treatment and/or referral of patients with addictions. We conducted an electronic database (PubMed) search to systematically identify recent (June 1, 2006 to January 1, 2008) human subject, English language, peer-reviewed, research publications that are relevant to generalist care for patients with addiction disorders. We also surveyed the publications that were reviewed by a NIH-funded newsletter that, in an attempt to identify articles that address the health impact of alcohol and drugs, systematically reviews the core general medical, infectious disease, public health, and addiction subspecialty journals.3 Similar to our prior review,4 authors (A.G., D.F., R.S.) were provided a title listing of articles with addiction-related key words within the reference time frame, and then secondary searches and consensus deliberations were used to identify articles that may impact the care provided by primary care clinicians in the categories of 1) alcohol use and disorders and 2) opioid use and dependence. Articles were categorized as impacting primary care clinicians if they studied primary care settings or could impact such settings and had practice-changing findings or implications.