Unhealthy alcohol use in primary care patients who screen positive for drug use

ABSTRACT

Background: Unhealthy alcohol use (UAU) is common among people who use other drugs; however, little information is available about UAU among patients who screen positive for drugs in primary care, where the clinical priority might be assumed to be drug use. This study aimed at describing the occurrence of UAU and its association with substance use–related outcomes in such patients. Methods: This cohort study is a secondary analysis of data from a randomized trial of brief intervention for primary care patients screening positive for drug use. UAU was assessed at baseline; the main independent variable was any heavy drinking day in the past month. Outcomes including drug use characteristics and substance use–related consequences were assessed at baseline and 6 months later. Results: Of 589 primary care patients with drug use, 48% had at least 1 past-month heavy drinking day. The self-identified main drug was marijuana for 64%, cocaine for 18%, and an opioid for 16%. Any heavy drinking at baseline was negatively associated with number of days use of the main drug at 6 months (incidence rate ratio [IRR] = 0.75, 95% confidence interval [CI]: 0.62–0.91), but positively associated with the use of more than 1 drug (IRR = 1.73, 95% CI: 1.17–2.55) and unsafe sex (odds ratio [OR] = 1.90, 95% CI: 1.21–2.98). Conclusion: Unhealthy alcohol use is common among patients identified by screening in primary care as using other drugs. Unexpectedly, UAU was negatively associated with days of main drug use. But, as expected, it was positively associated with other drug use characteristics and substance use–related consequences. These findings suggest that attention should be given to alcohol use among primary care patients who use other drugs.

KEYWORDS:

• Alcohol-related disorders
• primary health care
• substance-related disorders
• unsafe sex

Acknowledgments

We thank Jacqueline S. German, MPH, Boston Medical Center, for her help and advice with project management and manuscript preparation. Dr. Maynié-François reported no conflict of interest. Dr. Cheng reported having served on data monitoring committees for Johnson & Johnson/Janssen. Dr. Samet reported no conflict of interest. Ms. Lloyd-Travaglini reported no conflict of interest. Dr. Palfai reported no conflict of interest. Dr. Bernstein reported no conflict of interest. Dr. Saitz reported having received grants from the National Institutes of Health (NIH), having consulted as editor to BMJ, having received speaking fees from academic and governmental institutions and professional societies, and having consulted as an expert witness on alcohol and drug topics.

Funding

This study was supported in part by a grant from the National Institute on Drug Abuse (award number R01DA025068). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Author contributions

Dr. Maynié-François designed the study and wrote the paper. Dr. Saitz reviewed and edited the study design, the first drafts of the paper, and its final version. Dr. Samet, Dr. Palfai, and Dr. Bernstein reviewed and edited the study design. Dr. Cheng reviewed and edited the study methods and analytic plan. Ms. Lloyd-Travaglini ran the statistical analysis. Dr. Cheng, Dr. Samet, Ms. Lloyd-Travaglini, Dr. Palfai, Dr. Bernstein, and Dr. Saitz reviewed and edited the final paper.