Author Affiliations: Division of General Internal Medicine, Rhode Island Hospital, Providence.
For many years physicians shunned addiction care—traditionally
the turf of chemical dependency counselors and mental health professionals.
But over the past quarter century, physicians have become more involved in
research and clinical care of patients with substance use disorders. Generalist
physicians in particular have been drawn to the addiction field for 4 reasons.
First, there is growing awareness of the epidemiology of substance use disorders.
Epidemiologic studies indicate high lifetime prevalence of substance use disorders
and, particularly in regard to alcohol, that persons with lower-severity problems
greatly outnumber those who meet formal criteria for abuse or dependence.1 Generalist physicians have long been aware of the
episodic infectious and traumatic complications that bring such patients to
emergency departments and of the difficulties in engaging such patients in
primary care.2 Nonetheless, more than two thirds
of individuals with substance use disorders have seen a primary care physician
in the previous 6 months, offering the possibility of beginning a therapeutic
Stein MD, Friedmann PD. Generalist Physicians and Addiction CareFrom Turfing to Sharing the Turf. JAMA. 2001;286(14):1764-1765. doi:10.1001/jama.286.14.1764