• Anjani T Reddy, Ronald M Andersen, and Lillian Gelberg.
• Department of Family Medicine at the David Geffen School of Medicine at UCLA (ATR, LG), UCLA Fielding School of Public Health, and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; and Department of Health Policy and Management of the UCLA Fielding School of Public Health and UCLA Department of Sociology (RMA), Los Angeles, CA.
• J Addict Med. 2015 Nov 1; 9 (6): 447-53.

ObjectivesIntegration of behavioral health including substance use problems into primary care is an essential benefit that federally qualified health centers (FQHCs) will offer as part of the Affordable Care Act. This study explores FQHC primary care clinicians' beliefs and practices regarding illicit drug use assessment and treatment.MethodsWe administered a 10-minute questionnaire to 68 primary care clinicians of 5 FQHCs in Los Angeles.ResultsClinicians expressed limited confidence in their ability to address patients' illicit drug use, scoring on average 3.31 on a 5-point Likert scale. Two thirds reported that they assess for drug use routinely "at every visit" and/or "at annual visits." When asked how often they counsel regarding drug use (on a 5-point Likert scale from "never" to "always"), the median response was 4 ("usually"). Regarding their perspectives on the best practical resource for addressing drug use in their clinics, 45.6% named primary care clinicians. A minority (29.4%) of clinicians had completed a clinical rotation dealing with substance use, and 27.2% reported receiving more than 10  hours of training regarding substance use problems. Having a substance use rotation was associated with greater confidence in drug use assessment and treatment (P < 0.01). More hours of substance use training was associated with greater confidence (P = 0.01) and routinely addressing substance use in their patients (P = 0.04).ConclusionsAlthough two thirds of the surveyed clinicians assess for drug use routinely, and on average, report that they usually address drug use, clinicians' confidence in substance use care seems to be suboptimal, but both confidence and routinely addressing substance use are associated with increased substance use education. Improving clinicians' training and integrating drug use care in FQHCs may improve confidence in substance use care and facilitate the Affordable Care Act's mandate to integrate behavioral health into routine FQHC primary care.

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