Recent and active problematic substance use among primary care patients: Results from the alcohol, smoking, and substance involvement screening test in a multisite study

Abstract

Background: Primary care settings provide salient opportunities for identifying patients with problematic substance use and addressing unmet treatment need. The aim of this study was to examine the extent and correlates of problematic substance use by substance-specific risk categories among primary care patients to inform screening/intervention efforts. Methods: Data were analyzed from 2000 adult primary care patients aged ≥18 years (56% female) across 5 clinics in the eastern U.S. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Prevalence and ASSIST-defined risk-level of tobacco use, alcohol use, and nonmedical/illicit drug use was examined. Multinomial logistic regression models analyzed the demographic correlates of substance use risk-levels. Results: Among the total sample, the prevalence of any past 3-month use was 53.9% for alcohol, 42.0% for tobacco, 24.2% for any illicit/Rx drug, and 5.3% for opioids; the prevalence of ASSIST-defined moderate/high-risk use was 45.1% for tobacco, 29.0% for any illicit/Rx drug, 14.2% for alcohol, and 9.1% for opioids. Differences in the extent and risk-levels of substance use by sex, race/ethnicity, and age group were observed. Adjusted logistic regression showed that male sex, white race, not being married, and having less education were associated with increased odds of moderate/high-risk use scores for each substance category; older ages (versus ages 18–25 years) were associated with increased odds of moderate/high-risk opioid use. Conclusions: Intervention need for problematic substance use was prevalent in this sample. Providers should maintain awareness and screen for problematic substance use more consistently in identified high risk populations.

Keywords:

• Primary care
• ASSIST
• substance abuse
• tobacco
• alcohol
• drugs
• opioids

Acknowledgments

The authors thank the CTN-0059 study team and all study participants for their time and contributions.

Disclosure statement

Li-Tzy Wu also has received research funding from Patient-Centered Outcomes Research Institute and Alkermes Inc. William John also has received research funding from Patient-Centered Outcomes Research Institute. The other authors have no conflicts of interest to disclose.

Table 1. Prevalence of past 3-month substance use and level of risk based on the ASSIST scores by sex, race/ethnicity, and age group (n = 2,000).

Table 2. Multinomial logistic regression of level of substance risk based on the ASSIST scores.

Additional information

Funding

This study was made possible by the U.S. National Institutes of Health [Grant nos. UG1DA040317, UG1DA013034, UG1DA013035, U10DA013727, and R01MD007658]. The secondary data analysis and preparation of this manuscript was supported primarily by the National Institute on Drug Abuse [Grant no. UG1DA040317]. The sponsoring agency had no further role in the study design and analysis, the writing of the report, or the decision to submit the paper for publication. National Institute on Minority Health and Health Disparities.