UC Cincinnati's Integrated Addiction Clinic Shows How Primary Care Can Transform Substance Use Treatment

When Michael Binder, MD, started his internal medicine residency, he noticed something troubling. Despite the fact that nearly 17% of Americans experience substance use disorder at some point in their lives, the actual hands-on training residents received in addiction care was minimal. "In traditional training, addiction care is often taught in theory rather than practice," Binder explained. That observation would eventually lead to a groundbreaking approach at the University of Cincinnati that is now showing promising results for both patients and physicians.

A New Model for Addiction Care

In 2023, Binder and his colleagues launched something deceptively simple: an addiction medicine clinic integrated directly into a primary care resident practice. Unlike specialized addiction centers that require patients to seek out separate facilities, this clinic operates within the familiar confines of a standard internal medicine practice. Patients receiving treatment for opioid or alcohol use disorder sit in the same waiting rooms as those managing diabetes or hypertension.

The core team Binder assembled reflects the multidisciplinary reality of modern addiction care. Alongside attending physicians, the clinic includes clinical pharmacists, addiction fellows, medical assistants, and—critically—the internal medicine residents themselves. During the clinic's first 15 weeks of operation, the team recorded 73 patient visits. Opioid use disorder and alcohol use disorder emerged as the most common diagnoses, though the clinic treats the full spectrum of substance use conditions.

Measuring What Matters

What makes this study particularly valuable is its dual focus. The research team tracked not only patient care metrics but also resident education outcomes—an approach that addresses two persistent gaps in American healthcare simultaneously.

The results from resident surveys tell a compelling story. Before rotating through the clinic, many residents had never actually initiated medication-assisted treatment for opioid use disorder. They had learned about buprenorphine in lectures, perhaps observed a prescribing session during an elective, but had not personally counseled patients on harm reduction or adjusted medication regimens based on clinical response.

After just a few weeks in the integrated clinic, the change was measurable. Residents reported marked improvements in confidence across multiple domains: diagnosing substance use disorders, interpreting urine drug tests, initiating and adjusting medications for opioid use disorder, and providing harm-reduction counseling. For many, it was their first time actually starting patients on treatment or discussing strategies to reduce overdose risk.

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

Breaking Down Barriers

The implications of this model extend beyond medical education. By embedding addiction treatment into primary care, the clinic addresses one of the most persistent challenges in substance use care: stigma.

When patients can receive addiction treatment in the same setting where they manage other chronic conditions, the experience becomes normalized. There is no separate facility to visit, no additional insurance authorization to navigate, no need to explain to employers or family members why they are visiting a specialized addiction center. The person seeking help for heroin use sits alongside the person seeking help for high blood pressure.

"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 approach also addresses workforce shortages that have plagued addiction treatment for decades. The United States has approximately 48.4 million people with substance use disorders but fewer than 1 in 4 receive any treatment at all. Part of the problem is sheer numbers—there simply are not enough addiction specialists to meet demand. But another part is distribution. Addiction specialists tend to cluster in urban academic medical centers, leaving vast swaths of rural and suburban America underserved.

Training primary care physicians to provide evidence-based addiction treatment could dramatically expand access. If the UC model proves replicable, it suggests that every internal medicine residency in the country could become a pipeline for addiction-capable physicians.

The Resident Perspective

Ellen Jochum, a chief physician resident who trained in the clinic, offers a window into how this experience differs from traditional medical education. Before her rotation, she had limited formal training in addiction medicine within a primary care context. Medical school had covered the medications used for opioid and alcohol use disorder, but primarily in the context of inpatient care—managing withdrawal in hospitalized patients, not providing ongoing outpatient treatment.

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

The hands-on training changed not only her clinical skills but her comfort level with a patient population that many physicians find challenging. She learned to communicate effectively with people experiencing substance use disorders, addiction recovery challenges, and other vulnerable health situations. By the end of her rotation, she felt prepared to start treatment for patients with substance use disorders and connect them with community resources.

"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."

Looking Forward

The research team is careful to note that this remains an early evaluation. The initial 15-week pilot provides proof of concept, but longer-term studies will be needed to examine patient outcomes over time and to determine whether the confidence gains residents experience during training translate into sustained practice patterns after graduation.

Still, the early results are promising enough that the team hopes other academic medical centers will consider adapting the model. The basic infrastructure—a primary care clinic, willing faculty, a structured curriculum—is already present at most teaching hospitals. What the UC experience suggests is that with intentional integration, these existing resources can be leveraged to address one of healthcare's most pressing needs.

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

For a healthcare system struggling to address an epidemic that claims tens of thousands of lives annually, that pathway could not come soon enough.