Successful Integration of Alcohol Use Disorder Treatment into a Primary Care Clinic at a Safety-Net Hospital

Jennifer Lom; Lana Aleuy; Erica Heiman; Meredith H Lora; Lesley S Miller; Robin Klein

doi:10.1007/s11606-025-09775-1

Successful Integration of Alcohol Use Disorder Treatment into a Primary Care Clinic at a Safety-Net Hospital

J Gen Intern Med. 2025 Jul 25. doi: 10.1007/s11606-025-09775-1. Online ahead of print.

Authors

Jennifer Lom¹, Lana Aleuy², Erica Heiman³, Meredith H Lora², Lesley S Miller², Robin Klein²

Affiliations

¹ Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. jlom@emory.edu.
² Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.

PMID: 40715962
DOI: 10.1007/s11606-025-09775-1

Abstract

Background: While primary care-based alcohol use disorder (AUD) treatment models have shown promise, implementation of these resource-intensive models has been limited. Real-world, resource-conscious experience implementing AUD treatment within primary care is needed.

Objective: Evaluate the early implementation of a novel primary care-based AUD clinic (AUDC) to provide accessible AUD treatment in a safety-net health system.

Design: Evaluation study of the implementation of the AUDC using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Participants: Patients seen in the AUDC, January 2022 to February 2023.

Intervention: Embedded within the primary care clinic of a safety-net health system, the AUDC leverages existing resources to provide streamlined AUD treatment including medication for AUD (MAUD) and linkage to behavioral health (BH).

Main measures: Evaluation metrics include reach (individual level participation), effectiveness (patient engagement with MAUD and BH and changes in alcohol use and cravings), adoption (source of referrals), implementation (patient engagement across the AUDC care cascade), and maintenance (alcohol-related hospitalizations before and after AUDC engagement).

Key results: The AUDC reached 54 patients and of those, 38 patients (70%) received MAUD and 29 patients (58%) accepted BH services (implementation). In terms of effectiveness, 36 patients (67%) reported reduced alcohol use and cravings at follow-up. For maintenance, there was a difference in proportion of patients with at least one alcohol-related hospitalization in the 6 months before and after their initial AUDC visit (X² [df 1, N 54] = 15.4, p < 0.001) with 48.2% having an alcohol-related hospitalization before AUDC engagement compared to 13% following AUDC engagement. The AUDC received 109 referrals (adoption).

Conclusion: Evaluation of the AUDC suggests potential positive effects on patient engagement, AUD treatment uptake, and alcohol-related outcomes, including alcohol-related hospitalization. Using a streamlined approach and leveraging existing primary care resources may enable implementing AUD treatment in resource-conscious settings.

Keywords: Alcohol use disorder treatment; Alcohol-related disorders; Primary care; Resource-limited settings; Safety-net hospital.