Tobacco, alcohol, and drug use in a primary care sample: 90-day prevalence and associated factors

Background: Primary care settings are an ideal system in which to identify and treat substance use disorders. Objective: To ascertain the prevalence of tobacco, alcohol, and drug use in the office of 88 primary care clinicians by gender, age and ethnicity. Method: 21,282 adults ages 18-65 completed a self-administered Health Screening Survey while participating in a trial for early alcohol treatment. Results: The period prevalence of tobacco use was 27%. For alcohol: abstainers 40%, low risk drinkers 38%, at-risk drinkers 9%, problem drinkers 8%, and dependent drinkers 5%. Twenty percent of the sample reported using illicit drugs five or more times in their lifetime and 5% reported current illicit drug use. There were marked differences in alcohol use disorders by age and ethnicity. The majority of persons who smoked reported the desire to cut down or stop using tobacco. Significance: This is the first report on the combined prevalence of tobacco, alcohol and drug disorders in a large sample of persons attending community-based non-academic primary care clinics. This report confirms the high prevalence of these problems and suggests that patients will accurately complete a self-administered screening test such as the Health Screening Survey. The office procedures developed for this study provide Managed Care Organizations with a system of care that can be used to screen all persons for tobacco, alcohol and drug use disorders.