Primary Care Interventions for Alcohol Use Disorders

Links to other resources: Residential Treatment, Detox, Language Inequality in SUD Care

Experts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. The best drug and alcohol rehabs in Florida and around the country, including Florida Springs in Panama City, are often successful in helping patients begin a program of recovery from addiction and other substance use disorders, but many times there is still a communication gap between primary care health systems and programs like Florida Springs Wellness and Recovery Center.

To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington, a large primary healthcare provider in Washington State, partnered with addiction specialists and researchers to design a high-quality program of evidence-based care for unhealthy alcohol use: the Sustained Patient-centered Alcohol-related Care (SPARC) program. This SPARC program is designed to act as a successful intervention program for substance abuse, in its own right, but also work to improve cooperation between primary care practitioners and inpatient addiction treatment providers.

The Quality-of-Care Gap

If nothing else, programs like SPARC could help the SUD treatment industry bridge serious gaps in the quality of care received in primary care settings versus inpatient treatment settings, with our program at Florida Springs in Panama City being the latter. According to the authors of the SPARC study,

“Most health systems do not provide high-quality alcohol-related care. Most have not implemented routine SBI, and patients rarely are offered evidence-based prevention or treatment for unhealthy alcohol use.”

In this case SBI stands for Screening and Brief Intervention, which is a proven method for counteracting progression of problem drinking and is number 3 on the US Preventative Services Task Force’s list of primary intervention methods. With that said, while many primary care practitioners will address some patients who present with problem drinking with SBI, some do not, and barely any offer the most effective evidence-based treatments available for people with substance use disorders. For Alcoholism alone, there are three US Food and Drug Administration-approved medications, at least three common counseling methods (including motivational enhancement therapy, cognitive behavioral therapy, and couples counseling), and various highly-effective specialty alcohol treatments which would include 30-day inpatient care. The best drug and alcohol rehabs are built around this model of therapy, medication, counseling, and ongoing inpatient/outpatient treatment, but these methods remain rare when looking at primary care settings, such as family physicians.

The SPARC Program

According to this study from Washington,

“SPARC implementation intervention was designed to implement routine assessment of DSM-5 Alcohol Use Disorder symptoms among primary care patients with high-risk drinking and shared decision-making about evidence-based treatment options for those with active AUDs (e.g., medications and/or counseling in PC, as well as assistance accessing other AUD treatments). This alcohol-related care is referred to as “SPARC Clinical Care”.

So, they first want to close the communication gap and barriers of information between primary care facilities and providers of evidence-based treatment for alcoholism. In order to better communicate between different programs and facilities the SPARC program utilized “program coaches”. These were representatives with a substance use disorder treatment background who would be present within large primary health systems in order to implement these new strategies on the ground. These representatives were trained to provide services when a “handoff” was needed, where a patient would leave the primary care setting and transfer to an established evidence-based program, such as inpatient rehab. Program coaches also played a large role in reporting and feedback during the research that was conducted to measure the effectiveness of the SPARC program.

It is important to note that programs like this are not completely new. Many of the best drug and alcohol rehabs in Florida, including Florida Springs in Panama City, communicate with hospital systems about patient care. This SPARC program could still provide a roadmap for deceasing gaps in quality of care between primary care settings and intensive addiction treatment settings and increasing communication and cooperation between different levels of care.

By T.A. Cannon


From MEDLINE: “Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial)”. By: Glass JE, Bobb JF, Lee AK, Richards JE, Lapham GT, Ludman E, Achtmeyer C, Caldeiro RM, Parrish R, Williams EC, Lozano P, Bradley KA, Implementation science : IS, 1748-5908, 2018 Aug 06, Vol. 13, Issue 1