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Benefits of Linking Primary Medical Care and Substance Abuse Services
Patient, Provider, and Societal Perspectives
Jeffrey H. Samet, MD, MA, MPH;
Peter Friedmann, MD, MPH;
Richard Saitz, MD, MPH
Arch Intern Med. 2001;161:85-91.
Individuals with alcohol and drug use problems may receive health care
from medical, mental health, and substance abuse providers, or a combination
of all three. Systems of care are often distinct and separate, and substantial
opportunities for benefit to patient, provider, and payer are missed. In this
article, we outline (1) the possible benefits of linking primary care, mental
health, and substance abuse services from the perspective of the major stakeholders—medical
and mental health providers, addiction clinicians, patients, and society—and
(2) reasons for suboptimal linkage and opportunities for improving linkage
within the current health care system. We also review published models of
linked medical and substance abuse services. Given the potential benefits
of creating tangible systems in which primary care, mental health, and substance
abuse services are meaningfully linked, efforts to implement, examine, and
measure the real impact should be a high priority.
From the Section of General Internal Medicine, Department of Medicine
(Drs Samet and Saitz), and the Department of Social and Behavioral Sciences
(Dr Samet), Boston University Schools of Medicine and Public Health, Boston,
Mass; and the Division of General Internal Medicine, Departments of Medicine
and Community Health, Brown University School of Medicine, Providence, RI
(Dr Friedmann).
Reprints: Jeffrey H. Samet, MD, MA, MPH, Clinical Addiction Research
and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical
Center, 91 E Concord St, Suite 200, Boston, MA 02118 (e-mail: jsamet{at}bu.edu).
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