UCSF researchers study effectiveness of integrating medical care with addiction treatment

By Twink Stern

A study led by a UCSF and Kaiser Permanente researcher examined the differences
in treatment outcomes between integrated and independent models of medical care
and substance abuse treatment, and concluded that not only do patients benefit
from integrated medical and substance abuse treatments, but the integration can
also be cost effective.

Medical care is seldom provided as part of substance abuse treatment; and
medical and substance abuse services are often separate and uncoordinated, the
lead author said.  However, there are some substance abuse-related medical
conditions (SAMC) requiring treatment including hypertension, coronary artery
disease, chronic liver disease, hepatitis C and psychiatric conditions
including depression and anxiety disorders.

“Our findings are relevant given the high prevalence and cost of medical
conditions among substance abuse patients, new developments in medical
treatments for addiction and recent legislation on equality of substance abuse
treatment with other medical benefits,” said lead author Constance Weisner,
DrPh, UCSF professor of psychiatry and investigator at Kaiser Permanente’s
Division of Research.

The study is published in the October 10 issue of the Journal of the American
Medical Association.

There are several reasons for increased interest in expanding the physician’s
role in treating addiction, Weisner said, including the high number of medical
conditions among substance abuse patients, new developments in medications, and
research showing sustained brain changes in individuals with addiction.

The two-year study included 592 men and women admitted to the Kaiser Permanente
Chemical Dependency Recovery Program (CDRP) in Sacramento, California.  The
participants were randomly assigned to receive treatment through either an
integrated model with primary health care included in the addiction treatment
program or to an independent treatment-as-usual model in which primary care and
substance abuse treatment were provided separately, Weisner said. 

Subjects were adult men and women meeting criteria for alcohol, other drug
abuse or dependence admitted to the CDRP between April, 1997 and December,
1998.  The six most prevalent substances of dependence were alcohol,
amphetamines, marijuana, narcotic analgesics, cocaine and sedatives/hypnotics. 
The prevalence of heroin use was low (1.4 percent) as in many private programs,
Weisner explained.

Both groups showed improvement on all drug and alcohol measures.  Overall,
there were no significant differences in total abstinence rates of patients
with or without Substance Abuse Medical Conditions (SAMCs) within the
integrated and independent care groups (68 percent versus 63 percent). 
However, patients with SAMCs were more likely to be abstinent in the integrated
care group than the independent care group (69 percent versus 55 percent). 
This was true for both those with medical and psychiatric SAMCs.

“Our randomized study produced findings that suggest that patients with
physiologic or behavioral conditions related to substance abuse can benefit
from having their medical and addiction treatment integrated,” Weisner said.
“There was significant reduction in inpatient use for SAMC integrated services,
but not for independent services.”

Co-authors of the study include Jennifer Mertens, MA, Sujaya Parthasarathy,
PhD, and Yun Lu, MPH, Division of Research, Kaiser Permanente Medical Center,
Northern Region, Oakland; and Charles Moore, MD, MBA, Kaiser Permanente
Chemical Dependency Recovery Program, Sacramento, Calif. 
The research was supported by a grant from the National Institute on Drug