How Does Alcohol and Drug Use Affect Care for Chronic Illnesses? The PRISM Program

Can Primary Care Management of Chronic Illness be Improved by Identifying and Addressing Substance Abuse?

The Program of Research to Integrate Substance Use Issues into Mainstream Health Care (PRISM) was designed in two phases to examine and address issues around moderate use of alcohol and other drugs that might compromise the care and management of common chronic illnesses (e.g., diabetes, hypertension, sleep disorders, asthma).

In the first phase (2002–2006), PRISM commissioned recognized disease experts to perform seven systematic reviews of the relevant published medical evidence about the effects of alcohol and opioid use on seven common chronic illnesses.

Based upon this evidence, the second phase of PRISM (2005–2009) commissioned practice-based research projects designed by four major medical societies to measure and address some of the more significant problems recognized. The four primary care medical societies included the American Academy of Family Physicians; the American College of Physicians; the American Geriatrics Society; and the Society of General Internal Medicine.

PRISM resulted in 30 publications in prominent medical journals:

  • Twelve systematic reviews of: alcohol (8), opioid (2) and cannabis (2) effects on the care of various chronic illnesses and related medical problems
  • Two systematic reviews of interventions designed to reduce alcohol and other drug use in primary care settings
  • Four large field trials or database examinations
  • Ten additional studies or reviews of specific issues
  • Each of the four medical societies conducted research projects that informed strategies for integrating substance use information into primary care practice. The results from these are in submission or in press.