Substance Use Disorders Prevalent in Adult Primary Care Patients

• Integration of substance use disorder (SUD) services within primary care provides an opportunity to increase identification of SUD and improve access to treatment for patients.
• However, SUDs are typically under-detected in the primary care setting, and treatment is rarely actually offered.

Additionally, there is limited data about the extent of DSM-5 substance use disorders among primary care patients in the first place. This study aimed to address that information gap by analyzing data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2,000 adults aged 18 or older recruited from five primary care practices in four states (NIDA Clinical Trials protocol CTN-0059, the TAPS Tool study).

Prevalence and correlates of 12-month DSM-5 SUDs were examined, and results found the following:

75.5% of the sample used some kind of substance over the past 12 months:

• alcohol (62%)
• tobacco (44.1%)
• illicit drugs/nonmedical use of medications (27.9%), specifically marijuana (20.8%), cocaine (7.3%), opioids (4.8%), sedatives (4.1%), or heroin (3.9%)

36% experienced some type of substance use disorder, specifically:

• tobacco (25.3%)
• alcohol (13.9%)
• any illicit/nonmedical use (14%)

Of patients reporting any tobacco or drug use, a high proportion experienced:

• tobacco use disorder (57.4%);
• any drug use disorder (50.2%);

Of patients reporting any alcohol use, 22.4% met criteria for alcohol use disorder.

• Over 80% of adults with opioid/heroin use disorder met criteria for moderate/severe disorder.
• Also correlated with increased odds of having substance use disorder were younger ages, male sex, and low education.

Conclusions: Given the national movement toward the integration of primary care and SUD treatment, these findings have implications for clinical practice. Twelve-month SUDs were prevalent among primary care patients in this sample, which highlights a need to improve primary care providers’ training and willingness to provide screening and treatment for SUD. To improve that integration, research is needed to inform primary care physicians’ willingness to use validated tools for screening substance misuse, identify effective approaches for addressing SUDs in medical settings, and engage patients into SUD treatment.

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