Introduction to Medication Assisted Treatment of Alcohol or Opioid Dependence in Primary Care

Medical providers in primary care settings can play an important role in treating patients who have a substance use problem. Medical providers who identify a patient with a drug or alcohol problem may refer the patient to a specialized drug or alcohol treatment program. These programs may include

• counseling in an outpatient or inpatient setting;
• self‑help groups, such as Alcoholics or Narcotics Anonymous;
• a methadone program for patients with opioid dependence.

However, many patients are unable to stop or reduce alcohol or other drug use with counseling and self-help alone, and some patients are not interested in going to a methadone or specialty treatment program—and therefore risk receiving no treatment at all.

FDA-approved medications, including extended-release, injectable naltrexone (Vivitrol®) for alcohol dependence and buprenorphine/naloxone (Suboxone®) for opioid dependence, are now available for primary care doctors in their offices to treat appropriate patients. The addition of these medications to a standard drug or alcohol counseling program or self-­‐‑help program may improve outcomes over counseling or support alone.

Also, recent research has shown that patients who receive medication plus brief physician‑delivered counseling and advice (medical‑management counseling), without participation in formal treatment, can achieve similar outcomes to patients receiving specialized counseling.

Therefore, medication plus brief physician counseling is an option for patients who are not willing or able to participate in a specialized drug or alcohol treatment program or self-help program, such as Alcoholics Anonymous. This guide provides a brief overview on identifying potential patients and introducing them to the program, as well as an overview of the medical-management counseling process.