DSM-5 substance use disorders among adult primary care patients: Results from a multisite study. (1st October 2017) - Wu, Li-Tzy
Highlights: There are limited data of DSM-5 substance use disorders (SUDs) in primary care. Past-year illicit or nonmedical drug use was common (28%) in primary care patients. Over 1 in 3 (36%) adult primary care patients had a DSM-5 SUD. About 5% of primary care patients had opioid/heroin use disorder in the past year. The majority of adults with SUD had a moderate/severe use disorder. Abstract: Background: There are limited data about the extent of DSM-5 substance use disorders (SUDs) among primary care patients. Methods: This study analyzed data from a multisite validation study of a substance use screening instrument conducted in a diverse sample of 2000 adults aged ≥18 years recruited from five primary care practices in four states. Prevalence and correlates of 12-month DSM-5 SUDs were examined. Results: Overall, 75.5% of the sample used any substance, including alcohol (62.0%), 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 36.0% (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 7.0%); and any illicit/nonmedical drug 14.0% (mild 4.0%, moderate/severe 10.0%). Among past 12-month users, a high proportion of tobacco or 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. Conclusion: These findings reveal the high prevalence of SUDs in primary care and underscore the need to identify and address them.