The Substance‐Abusing Patient and Primary Care: Linkage via the Addiction Treatment System?

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Abstract
Our objective was to describe and assess the prevalence and characteristics of substance‐abusing persons without primary care physicians. We interviewed a convenience sample at one point in time. Patients/participants were persons presenting for addictions treatment in a public substance abuse treatment system. Of 5824 respondents, 41% did not have a physician. In a multivariable analysis, the following were associated with not having a physician: no health insurance [adjusted odds ratio (OR), 2.05; 95% confidence interval (CI), 1.79–2.35], no history of a chronic (OR, 1.70; CI, 1.47–1.97) or an episodic (OR, 1.20; CI, 1.05–1.39) medical illness, male gender (OR, 1.49; CI, 1.29–1.71), and younger age (by decade) (OR, 1.12; CI, 1.04–1.38). Prior addictions or mental health treatment or a recent emergency‐room visit were not significantly associated with having a physician. Many patients with addictions serious enough to prompt presentation for treatment stated that they did not have physicians. Although younger persons, males, and those without insurance or past medical illness were more likely to report not having a physician, neither prior addictions or mental health treatment nor a recent emergency‐room visit decreased this likelihood. To achieve improved linkage of substance‐abusing patients with primary medical care, all health‐care contacts should be utilized.