The Rationale for Screening, Brief Intervention and Referral in the Medical Setting

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The Rationale for Screening, Brief Intervention
and Referral in the Medical Setting
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WHY EARLY INTERVENTION FOR HIGH-RISK AND
DEPENDENT DRINKING?

• High-risk and dependent drinking reduces quality
  and length of life, and is costly to individuals
  and society.
• The medical encounter is too important a
  prevention opportunity to miss.
• Physician feedback advice is a powerful
  motivator.
• Intervention results in improved prognosis.
• Intervention reduces ED utilization cost.

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Alcohol Other Drug Dependence, A Chronic
Illness

• lt30 of patients with adult onset asthma, HTN,
  diabetes adhere to prescribed diet and/or
  behavioral changes
• 50 of adults with these chronic conditions
  experience recurrence of sx yearly, requiring
  additional medical care
• 50-60 of patients discharged from substance
  abuse treatment are abstinent at 1 year
• As in other chronic diseases, poor adherence and
  relapse is predicted by low SES, co-morbid psych
  conditions and lack of family and social supports
• Substance abuse should be insured, monitored,
  treated and evaluated like other chronic diseases

McClellan AT, Lewis DC, et al. JAMA 2000
2841689-1695.
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Health Care Settings UsingBrief Motivational
Intervention

• Trauma Centers
• Emergency Departments
• General Medical Practice
• Family Medicine Primary Care
• Pediatrics Adolescent Medicine
• Inpatient Consult Service
• Oral and Maxillofacial Surgery
• Psychiatric Services
• Student Health Centers
• Physical Medicine and Rehabilitation

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Public Health Paradigm

• The primary goal of brief intervention is to
• reduce alcohol use to low-risk levels
• encourage abstinence in persons who are
  alcohol-dependent

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BRIEF INTERVENTION A REVIEW

• Chafetz et al, 1961
• Randomized, controlled trial (n200)
• 65 of those receiving brief intervention in the
  MGH ED kept a subsequent appointment for
  specialized treatment compared to 5 of controls.
  
• 40 kept 5 appointments.

(Establishing treatment relations with
alcoholics. J Nerv Ment Dis
1962 134 390-410.)
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ALCOHOL TREATMENT WORKS

• McClellan (1982) showed treatment effects at 6
  months f/u on ASI measures of alcohol use, drug
  use, family interactions, work, legal and
  psychological function
• 54 reduction in drinking days
• 67 reduction in days intoxicated
• 41 of participants abstinent for 30 days prior
  to follow-up
• 151 increase in income

McClellan TA, Luborsky L, O