DSM-5 substance use disorders among adult primary care patients: Results from a multisite study.

There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients. This study analyzed 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 Network protocol CTN-0059, the TAPS Tool study. Prevalence and correlates of 12-month DSM-5 SUDs were examined. Results found that overall, 75.5% of the sample used any substance, including alcohol (62%), tobacco (44.1%), or illicit drugs/nonmedical medications (27.9%) in the past 12 months (marijuana 20.8%, cocaine 7.3%, opioids 4.8%, sedatives 4.1%, heroin 3.9%). The prevalence of any 12-month SUD was 36% (mild disorder 14.2%, moderate/severe disorder 21.8%): tobacco 25.3% (mild 11.5%, moderate/severe 13.8%); alcohol 13.9% (mild 6.9%, moderate/severe 7%); and any illicit/nonmedical drug 14% (mild 4%, moderate/severe 10%). Among past 12-month users, a high proportion of tobacco and drug users met criteria for a disorder: tobacco use disorder 57.4% (26.1% mild, 31.3% moderate/severe) and any drug use disorder 50.2% (14.3% mild, 35.8% moderate/severe); a lower proportion of alcohol users (22.4%) met criteria for alcohol use disorder (11.1% mild, 11.3% moderate/severe). Over 80% of adults with opioid/heroin use disorder met criteria for a moderate/severe disorder. Younger ages, male sex, and low education were associated with increased odds of having SUD.

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.

Related protocols: CTN-0059