"We Need More General Practitioners Trained in Addiction": Patient Perspectives on Substance Use Disorder Treatment...

Outpatient substance use disorder (SUD) treatment is commonly delivered through integrated, colocated, or coordinated models. In integrated care, the primary care provider (PCP) manages both general health and SUD, while colocated and coordinated models involve a separate addiction specialist-either within the same clinic or at an external location, respectively. While coordinated care has historically been the norm, integrated models may reduce treatment barriers. However, little is known about patient preferences across these models. Understanding such preferences is essential to improving engagement and care delivery. This qualitative study explores patient preferences and the factors influencing their choices among the 3 models.

Fifteen adults with diagnosed SUD were recruited from an integrated, primary care-based addiction medicine clinic in an urban, academic medical center in California. Participants completed 45 to 60 minute interviews in-person or by phone. Data were analyzed using the socioecological model of health as a conceptual framework.

At the time of the interview, 3 participants were receiving integrated care, 7 colocated, and 5 coordinated. Most (n = 10) preferred integrated care when given the option. Among those favoring the colocated and coordinated models, over half were willing to consider integrated care if their PCP had addiction training. Factors shaping preferences included SUD severity, quality of the patient-provider relationship, clinic convenience, and clinician competency. Across all models, participants preferred nonjudgmental, affirming providers knowledgeable in addiction.

Most participants favored integrated care, highlighting its convenience and continuity with a trusted provider. However, concerns about PCP training in addiction care were common, suggesting the need for enhanced clinician preparation starting in medical school and residency. Regardless of model, participants emphasized the importance of wrap-around services, including peer recovery specialists, counseling, and care navigation, to support recovery and promote treatment engagement.