Initial and Maintenance Naltrexone Treatment for Alcohol Dependence Using Primary Care vs Specialty Care

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Abstract
PROBLEM DRINKING is prevalent in primary care settings, and general internists and other primary care physicians are uniquely suited to identify and treat problem drinkers.1,2 In one study3 of primary care patients, 1 of 6 were problem drinkers, and in another study,4 30% of drinkers met criteria for alcohol dependence. Strategies for addressing alcohol problems in primary care have focused on screening and referral to treatment.5 Research6,7 suggests that primary care physicians may help nondependent patients reduce alcohol consumption by using brief counseling techniques. A recent randomized trial3 performed in physicians' offices demonstrated that drinking and health resource utilization can be decreased with the use of brief physician advice. Although these studies showed the benefits of brief counseling for nondependent problem drinkers, alcohol-dependent patients were generally excluded. Thus, the role of general internists and other primary care physicians in the treatment of alcohol dependence is uncertain.