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October 10, 2001

Generalist Physicians and Addiction Care: From Turfing to Sharing the Turf

Author Affiliations

Author Affiliations: Division of General Internal Medicine, Rhode Island Hospital, Providence.

JAMA. 2001;286(14):1764-1765. doi:10.1001/jama.286.14.1764

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 relationship.3