Alcohol screening among opioid agonist patients in a primary care clinic and an opioid treatment program.

Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, this study, partially funded by the Western States Node of the National Drug Abuse Treatment Clinical Trials Network, reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n=208) and in an opioid treatment program (n=204) over a two-year period.

In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n=4 physicians) and the opioid treatment program (n=11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening.

Conclusions: Training health professionals in alcohol screening and intervention is a feasible and acceptable way of improving care for opioid agonist patients. Effective implementation requires systematic changes at multiple levels targeting obstacles specific to patient population or setting. Strategies that support implementation of SBIRT among opioid agonist patients, and similar vulnerable populations, include structural changes, interactive workshops, clinical guidelines, improved medical records, and clinic work-flows. These lessons learned from implementation of alcohol screening within a primary care clinic can be adapted for specialty care and should be promoted and tailored to the specific population or setting under study.