This component examines continuing care for drug abuse by developing linkages between specialty drug treatment and primary health care. The intervention is grounded in a chronic care framework, linking patients to primary care and integrating drug treatment with the larger health care system. This broader perspective speaks to the multiple and complex needs of individuals with drug disorders, and places their ongoing services in the context of mainstream medical care. Our approach is consistent with chronic care models for other medical conditions and with recent Institute of Medicine reports. The study setting is the drug treatment and primary care clinics of the San Francisco Medical Center of Northern California Kaiser Permanente, a large integrated managed care health plan. We will assign 700 drug treatment patients to the program's Usual Care, or to Usual Care plus Continuing Care. The Continuing Care intervention includes two group sessions based on a patient activation approach to increase drug treatment patients'overall health behavior and facilitate engagement with primary care;a linkage phone call between the primary care physician, drug treatment clinician, and the patient;and an orientation session for primary care physicians. The health plan's electronic medical record facilitates linkages between patients in the Continuing Care condition and their providers (including drug treatment guidelines and referrals available, and reminders to PC physicians). We propose a quasi-experimental 2-month alternating off/on design over a 20 month period in which, after a random start, the Continuing Care condition alternately is added to Usual Care in the clinic and then removed. Study participant follow-up includes interviews at 6, 12, 18 and 24 months and urinalysis, combined with analysis of medical records to examine treatment effects on outcomes and costs. The research is innovative in its emphasis on patient activation and integrating drug treatment with mainstream health care, as well as in its use of an electronic medical record and related technologies used to facilitate service linkages, to provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures to facilitate durable links between drug treatment and primary care, and potential cost savings. We expect that the intervention vyill result in patients having higher patient activation scores, receiving more primary care services;having reduced drug use, including tobacco; improved health outcomes, and lower health care costs. If these outcomes are demonstrated, the Continuing Care intervention has the potential to be implemented in a variety of health care systems and to improve drug treatment services.

Public Health Relevance

The research is relevant to NIDA's strategic plan of integrating drug treatment into general health care. It is innovative in its emphasis on patient activation and linking with mainstream health care, as well as in its use of an electronic medical record and related technologies to facilitate service linkages, provide patients information, and to measure study outcomes. Key policy implications include improving health plan structures that facilitate links between drug treatment and PC, and potential cost savings.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Specialized Center (P50)
Project #
Application #
Study Section
Special Emphasis Panel (ZDA1-EXL-T)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Francisco
San Francisco
United States
Zip Code
Young-Wolff, Kelly C; Karan, Lori D; Prochaska, Judith J (2015) Electronic cigarettes in jails: a panacea or public health problem? JAMA Psychiatry 72:103-4
Ramo, Danielle E; Liu, Howard; Prochaska, Judith J (2015) A mixed-methods study of young adults' receptivity to using Facebook for smoking cessation: if you build it, will they come? Am J Health Promot 29:e126-35
Ramo, Danielle E; Young-Wolff, Kelly C; Prochaska, Judith J (2015) Prevalence and correlates of electronic-cigarette use in young adults: findings from three studies over five years. Addict Behav 41:142-7
Newville, Howard; Roley, Jason; Sorensen, James L (2015) Prescription medication misuse among HIV-infected individuals taking antiretroviral therapy. J Subst Abuse Treat 48:56-61
Martínez, Cristina; Guydish, Joseph; Le, Thao et al. (2015) Predictors of quit attempts among smokers enrolled in substance abuse treatment. Addict Behav 40:6-Jan
Nelson, J Craig; Baumann, Pierre; Delucchi, Kevin et al. (2014) A systematic review and meta-analysis of lithium augmentation of tricyclic and second generation antidepressants in major depression. J Affect Disord 168:269-75
Lisha, Nadra E; Carmody, Timothy P; Humfleet, Gary L et al. (2014) Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies. Addict Behav 39:637-43
Webber, Whitney L; van Erp, Brianna; Stoddard, Pamela et al. (2014) Determinants of exposure to secondhand smoke among Vietnamese adults: California Vietnamese Adult Tobacco Use Survey, 2007-2008. Prev Chronic Dis 11:E81
Cochran, Bryan N; Flentje, Annesa; Heck, Nicholas C et al. (2014) Factors predicting development of opioid use disorders among individuals who receive an initial opioid prescription: mathematical modeling using a database of commercially-insured individuals. Drug Alcohol Depend 138:202-8
Satre, Derek D; Leibowitz, Amy S; Mertens, Jennifer R et al. (2014) Advising depression patients to reduce alcohol and drug use: factors associated with provider intervention in outpatient psychiatry. Am J Addict 23:570-5

Showing the most recent 10 out of 221 publications