UC finds integrating substance use disorder treatment into clinic-based internal medicine expands access to care

New approach also provides hands-on training and boosts physician confidence

Researchers at the University of Cincinnati found that embedding addiction treatment into primary care training clinics may be a promising approach to addressing substance use disorders (SUDs).

Published in the journal Academic Medicine, the study shows how integrating SUD treatment into an internal medicine resident practice could not only expand access to primary care addiction treatment for patients but also significantly boost physician confidence in treating addiction.

Based on the 2024 National Survey on Drug Use and Health (NSDUH), approximately 48.4 million Americans aged 12 and older (about 16.8% of the population) experienced SUD. Yet, fewer than 1 in 4 individuals received addiction treatment.

Integrated addiction clinic improves physician confidence

The research team launched a structured, clinic-based training experience in 2023 within a UC resident primary care practice.

The core clinical team included attending physicians Binder and Carolyn Chan, MD; clinical pharmacists Marisa Brizzi, PharmD, and Bailey Francis, PharmD; addiction fellows Ross Lawson, MD, and Aastha Singh, MD; medical assistant supervisor Shantel Voelker; and UC internal medicine resident physicians.

The study evaluated data from the clinic's first 15 weeks, including both patient care metrics and resident education outcomes. During that period, the clinic recorded 73 patient visits, with opioid use disorder and alcohol use disorder among the most common diagnoses.

Researchers also surveyed participating residents before and after their rotation. Results from 11 of the 18 residents showed marked improvements in confidence when diagnosing SUDs, interpreting urine drug tests, initiating treatment with and adjusting medication (such as buprenorphine) for opioid use disorder, and providing harm-reduction counseling.

"For many residents, this was their first time actually starting medications for opioid use disorder or counseling patients on harm reduction," Binder said. "After just a few weeks, we saw substantial gains in their confidence to do these things independently."

Expanding access to addiction treatment and reducing stigma

Unlike specialty addiction centers, this clinic operates within a standard internal medicine practice, making addiction treatment more accessible in primary care settings and reducing stigma for patients.

"Integrating addiction treatment into primary care helps normalize it," Binder said. "Patients can receive care for substance use disorders in the same place they manage diabetes or hypertension, which can lower barriers and improve engagement."

This practical response to gaps in ddiction medicine training for internal medicine residents augments the training received in residency to meet the growing need for robust clinical experiences in SUD treatment.

What does this mean for the future of addiction care?

Researchers emphasize that this is an early evaluation, and future work will examine long-term patient outcomes and the impact of addiction training on physician practice after residency.

"This is a first step," Binder said. "Our goal is to better understand how experiences like this shape not only physician confidence, but also patient care over time."

The team hopes the model can be adapted by other academic medical centers seeking to expand access to evidence-based addiction treatment and improve physician training.

"Ultimately, we need more clinicians who feel prepared to treat substance use disorders," Binder added. "Embedding this care into primary care training is one way to help make that happen."

'Invaluable' experience helps residents and patients alike

Ellen Jochum, chief physician resident who practiced in the clinic, said that she had limited formal training in addiction medicine and SUD treatment within a primary care setting before participating.

"In medical school, we learned about the medications used for opioid use disorder and alcohol use disorder and how to treat alcohol withdrawal, but this was in the context of inpatient care, not outpatient, and certainly not by a primary care physician," she said, adding that the same went for residency outside this clinic and one elective rotation.

"This was an incredible and invaluable experience for me. The doctors in the clinic provided great education, going more into depth about medications, reactions to expect and how to counsel patients," she added.

Ellen Jochum Chief physician resident

The clinic experience also strengthened her ability to communicate with patients experiencing substance use disorders, addiction recovery challenges and other vulnerable health situations.

She emphasized that the hands-on training, outpatient substance use treatment experience and patient counseling opportunities helped build confidence in delivering evidence-based addiction treatment and connecting patients with community support resources and recovery services.

"I feel much more prepared because of my experiences and now feel comfortable starting treatment for patients with a substance use disorder, knowing resources available to them," she said. "I am going to be starting as a primary care physician this summer, and I am so grateful I have this training and education to incorporate into my future practice."

Featured photo provided by iStock.

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