Skip to main content

Can Substance Use Disorders be Managed Using the Chronic Care Model? Review and Recommendations from a NIDA Consensus Group


Brain imaging and genetic studies over the past two decades suggest that substance use disorders are best considered chronic illnesses. The passing of the Affordable Care Act in the United States has set the occasion for integrating treatment of substance use disorders into mainstream healthcare; and for using the proactive, team-oriented Chronic Care Model (CCM). This paper systematically examines and compares whether and how well the CCM could be applied to the treatment of substance use disorders, using type 2 diabetes as a comparator. The chronic illness management approach is still new in the field of addiction and research is limited. However comparative findings suggest that most proactive, team treatment-oriented clinical management practices now used in diabetes management are applicable to the substance use disorders; capable of being implemented by primary care teams; and should offer comparable potential benefits in the treatment of substance use disorders. Such care should also improve the quality of care for many illnesses now negatively affected by unaddressed substance abuse.


  1. 1.

    Foll B, Gallo A, Strat Y, Lu L, Gorwood P. Genetics of dopamine receptors and drug addiction: a comprehensive review. Behav Pharmacol. 2009;20:1–17.

    Article  PubMed  Google Scholar 

  2. 2.

    Volkow N, Li TK. The neuroscience of addiction. Nat Neurosci. 2005;8:1429–30.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Moos R, Moos B. Participation in treatment and Alcoholics Anonymous: a 16-year follow-up of initially untreated individuals. J Clin Psychol. 2006;62:735–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:2038–44.

    Article  Google Scholar 

  5. 5.

    McLellan AT, McKay J. Integrating evidence-based components into a functional continuum of addiction care. In: Graham AW, Schultz T, (editors). Principles of Addiction Medicine (Fourth Edition). Chicago (IL): University of Chicago Press; 2008.

    Google Scholar 

  6. 6.

    Compton WM, Thomas YF, Stinson FS, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64:566–76.

    Article  PubMed  Google Scholar 

  7. 7.

    Reid MC, Fiellin DA, O’Connor PG. Hazardous and harmful alcohol consumption in primary care. Arch Intern Med. 1999;159:1681–9.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Saitz R, Horton NJ, Sullivan LM, Moskowitz MA, Samet JH. Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention. The screening and intervention in primary care (SIP) study. Ann Intern Med. 2003;138:372–82.

    Article  PubMed  Google Scholar 

  9. 9.

    Obama B. National Drug Control Strategy 2010. Collingdale (PA): DIANE Publishing; 2011.

    Google Scholar 

  10. 10.

    Braithwaite R, McGinnis KA, Conigliaro J, Maisto SA, Crystal S, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2006;29:1190–7.

    Article  Google Scholar 

  11. 11.

    Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140:211–9.

    Article  PubMed  Google Scholar 

  12. 12.

    Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE. Moderate alcohol consumption and the risk of breast cancer. N Engl J Med. 1987;316:74–80.

    Google Scholar 

  13. 13.

    Gourlay DL, Heit HA, Almahrezi A. Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med. 2005;6:107–12.

    Article  PubMed  Google Scholar 

  14. 14.

    Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.

    Article  PubMed  Google Scholar 

  15. 15.

    The Patient Protection and Affordable Care Act. P.L. 111–148. 23 March 2010.

  16. 16.

    Wellstone P, Domenici P. Mental Health Parity and Addiction Equity (MHPAE) Act. P.L. 110–343. October 2008.

    Google Scholar 

  17. 17.

    Buck JA. The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Aff (Millwood). 2011;30:1402–10.

    Article  Google Scholar 

  18. 18.

    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, part 2. JAMA. 2002;288:1909–14.

    Article  PubMed  Google Scholar 

  19. 19.

    Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, et al. Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA. 2009;301:1242–52.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    O’Connor PJ, Sperl-Hillen JM, Rush WA, Johnson PE, Amundson GH, et al. Impact of electronic health record clinical decision support on diabetes care: a randomized trial. Ann Fam Med. 2011;9:12–21.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Woltmann E, Grogan-Kaylor A, Perron A, Georges H, Kilbourne A, Bauer M. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012;169:790–804.

    Article  PubMed  Google Scholar 

  22. 22.

    Marsteller JA, Hsu YJ, Reider L, Frey K, Wolff J, et al. Physician satisfaction with chronic care processes: a cluster-randomized trial of guided care. Ann Fam Med. 2010;8:308–15.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Rosenthal MB, Beckman HB, Forrest DD, Huang ES, Landon BE, Lewis S. Will the patient-centered medical home improve efficiency and reduce costs of care? A measurement and research agenda. Med Care Res Rev. 2010;67:476–84.

    Article  PubMed  Google Scholar 

  24. 24.

    McLellan AT, O’Brien CP, Lewis DL, Kleber HD. Drug addiction as a chronic medical illness: implications for treatment, insurance and evaluation. JAMA. 2000;284:1689–95.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Wutzke SE, Shiell A, Gomel MK, Conigrave KM. Cost effectiveness of brief interventions for reducing alcohol consumption. Soc Sci Med. 2001:52;345–61.

    Article  Google Scholar 

  26. 26.

    Unutzer J, Schoenbaum M, Druss BG, Katon WJ. Transforming mental health care at the interface with general medicine: report for the presidents commission. Psychiatr Serv. 2006;57:37–47.

    Article  PubMed  Google Scholar 

  27. 27.

    Skolnick P, Volkow ND. Addiction therapeutics: obstacles and opportunities. Biol Psychiatry. 2012;72:890–3.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Goler NC, Armstrong MA, Osejo VM, Hung YY, Haimowitz M, Caughey AB. Early start: a cost-beneficial perinatal substance abuse program. Obstet Gynecol. 2012;119:102–10.

    Article  PubMed  Google Scholar 

  29. 29.

    Brownson CA, Hoerger TJ, Fisher EB, Kilpatrick KE. Cost-effectiveness of diabetes self-management programs in community primary care settings. Diabetes Educ. 2009;35:761–9.

    Article  PubMed  Google Scholar 

  30. 30.

    Alford DP, LaBelle CT, Kretsch N, Bergeron A, Winter M, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171:425–31.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Smith SA, Shah ND, Bryant SC, Christianson TJ, Bjornsen SS, et al. Chronic care model and shared care in diabetes: randomized trial of an electronic decision support system. Mayo Clin Proc. 2008;83:747–57.

    Article  PubMed  Google Scholar 

  32. 32.

    Sperl-Hillen JM, Averbeck B, Palattao K, Amundson J, Ekstrom H, et al. Outpatient EHR-based diabetes clinical decision support that works: lessons learned from implementing diabetes wizard. Diabetes Spectrum. 2010;23:150–4.

    Article  Google Scholar 

  33. 33.

    Gilmer TP, O’Connor PJ, Sperl-Hillen JM, Rush WA, Johnson PE, et al. Cost-effectiveness of an electronic medical record based clinical decision support system.” Health Serv Res. 2012;47:2137–58.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Arch Intern Med. 1998;158:1789–95.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Humeniuk R, Ali R, Babor TF, Farell M, Formigoni ML, et al. Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Addiction. 2008;103:1039–47.

    Article  PubMed  Google Scholar 

  36. 36.

    National Institute on Alcohol Abuse and Alcoholism. The physicians’ guide to helping patients with alcohol problems. Washington (DC): National Institutes of Health; 1995.

    Google Scholar 

  37. 37.

    Department of Veterans Affairs, Veterans Health Administration. Uniform mental health services in VA medical centers and clinics. VHA Handbook 1160.01. Washington (DC): VHA; 11 September 2008. Available from URL: (Accessed 10 February 2014).

    Google Scholar 

  38. 38.

    Gastfriend DR, Mee-Lee D. The ASAM Patient Placement Criteria. Baltimore (MD): Taylor and Francis; 2004.

    Google Scholar 

  39. 39.

    Cole B, Clark DC, Seale JP, Shellenberger S, Lyme A, et al. Reinventing the reel: an innovative approach to resident skill-building in motivational interviewing for brief intervention. Subst Abus. 2012;33:278–81.

    Article  PubMed  Google Scholar 

  40. 40.

    Netherland J, Botsko M, Egan JE, Saxon AJ, Cunningham CO, et al. Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009;36:244–51.

    Article  PubMed  Google Scholar 

  41. 41.

    Committee on Prevention, Diagnosis, Treatment and Management of Substance Use Disorders in the U.S. Armed Forces, Board on the Health of Select Populations, Institute of Medicine. Substance use disorders in the U.S. Armed Forces. 2012. Washington (DC): National Academy Press; 2013. Available from URL: (Accessed 10 February 2014).

    Google Scholar 

  42. 42.

    Cebul RD, Love TE, Jain AK, Hebert CJ. Electronic health records and quality of diabetes care. N Engl J Med. 2011;365:825–33.

    CAS  Article  PubMed  Google Scholar 

  43. 43.

    Leung GY, Zhang J, Lin W, Clark RE. Behavioral health disorders and adherence to measures of diabetes care quality. Am J Manag Care. 2011;17:144–150.

    PubMed  Google Scholar 

  44. 44.

    McKay JR, Lynch KG, Shepard DS, Pettinati HM. The effectiveness of telephone based continuing care for alcohol and cocaine dependence: 24 month outcomes. Arch Gen Psychiatry. 2005:62;199–207.

    Article  PubMed  Google Scholar 

  45. 45.

    Adams K, Greiner AC, Corrigan JM. The 1st annual crossing the chasm summit: a focus on communities. Washington (DC): National Academies Press; 2004.

    Google Scholar 

  46. 46.

    Baker MK, Simpson K, Lloyd B, Bauman AE, Fiatarone-Singh MA. Behavioral strategies in diabetes prevention programs: a systematic review of randomized controlled trials. Diabetes Res Clin Pract. 2011;91:1–12.

    Article  PubMed  Google Scholar 

  47. 47.

    Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Prev Med. 2003;37:23–32.

    Article  PubMed  Google Scholar 

  48. 48.

    Miller RW, Rollnick S. Motivational Interviewing: Preparing People for Change. Second Edition. New York (NY): Guilford; 2002.

    Google Scholar 

  49. 49.

    Bertholet N, Daeppen JB, Wietlisbach V, Fleming M, Burnand B. Reduction of alcohol consumption by brief alcohol intervention in primary care. Arch Intern Med. 2005;165:986–95.

    Article  PubMed  Google Scholar 

  50. 50.

    Diabetes Prevention and Control Alliance. About the program. A first-of-its-kind model for tackling diabetes, prediabetes and obesity. UnitedHealth Group. Available from URL: (Accessed 3 February 2014).

  51. 51.

    Morgenstern J, Blanchard KA, McCrady BS, McVeigh KH, Morgan TJ, Pandina RJ. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. Am J Pub Health. 2006;96:2016–23.

    Article  Google Scholar 

  52. 52.

    Humphreys K, Moos RH. Encouraging posttreatment self-help group involvement to reduce demand for continuing care services: two-year clinical and utilization outcomes. Alcohol Clin Exp Res. 2007;31:64–8.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to A. Thomas McLellan PhD.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit

The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

McLellan, A.T., Starrels, J.L., Tai, B. et al. Can Substance Use Disorders be Managed Using the Chronic Care Model? Review and Recommendations from a NIDA Consensus Group. Public Health Rev 35, 8 (2013).

Download citation

  • Published:

  • DOI:

Key Words

  • Substance use disorders
  • chronic illness
  • chronic care model
  • type 2 diabetes management
  • electronic health records
  • healthcare reform