Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care—elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.
From the Clinical Addiction Research and Education (CARE) Unit (RS, JR, JHS), Boston Medical Center, Boston, MA; Section of General Internal Medicine, Department of Medicine (RS, CL, JHS), Boston Medical Center and Boston University School of Medicine, Boston, MA; Department of Epidemiology, and the Youth Alcohol Prevention Center (RS), Boston University School of Public Health, Boston, MA; New England Research Institutes, Inc. (MJL), Watertown, MA; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health, Boston, MA.
Ms. Richardson is now at the Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY.
Received May 20, 2007; revised December 28, 2007; accepted December 28, 2007.
Send correspondence and reprint requests to Richard Saitz, MD, MPH, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118; e-mail: email@example.com
Drs. Saitz, Samet, and Larson were supported in this work by grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (R-01 AA 10870) and the National Institute on Drug Abuse (NIDA) (R-01 DA 10019). In addition, Dr. Saitz is supported by grants from the NIAAA (R-01s AA. 13216, AA 14258, AA 14713, R25, AA 13822, and P60 AA 13759), the Substance Abuse and Mental Health Services Administration (SAMHSA) UT 9 TI018311, and the National Center for Research Resources (NCRR) (K30 RR 22252). Dr. Samet is supported by grants from NIAAA (R-01 AA 016059, K-24 AA 015674, and R-21 AA 014821), NIDA (R-01 DA 019841 and R-25 DA 13582), and (SAMHSA) (1 U79T8 018311), and Dr. Larson is supported by a grant from the NIDA (R01 DA 016929).
This work was presented in part at the annual meeting of the Research Society on Alcoholism, July 7–12, 2007, Chicago, IL.