Addiction Medicine: Closing the Gap between Science and Practice

of errors such as false positives, contamination
or mislabeling exists.^56

Given these concerns, biological tests may be
most useful in verifying conclusions drawn from
other forms of screening and assessment
instruments^57 or in specific circumstances where
any substance use is sanctioned (e.g., use by
those who are underage, pregnant, have health
problems, in jobs that require sustained attention
and vigilance* or by juvenile or criminal
offenders).^58

Brief Interventions and Treatment Referrals .....................................................................

For those who screen positive for risky use of
addictive substances that does not meet the
threshold of clinical addiction, providing brief
interventions is an effective, low-cost approach
to reducing risky use.^59

Brief interventions generally include feedback
about the extent and effects of patients’
substance use and recommendations for how
they might change their behavior.^60 Brief
interventions often involve motivational
interviewing techniques† and substance-related
education; the exact approach may differ
depending on the target population.^61 Brief
interventions can be conducted face-to-face,
over the phone or via computerized feedback to
patients.^62 They can be performed by health
professionals after relatively limited training.^63
Providing brief interventions can save lives and
reduce a broad range of negative health and
social consequences including addiction.

• e.g., truck drivers, air traffic controllers, physicians.
  † Motivational interviewing is a patient-centered

approach to counseling. Counselors attempt to
initiate behavior change through reflective listening.
They help patients resolve any ambivalence toward
reducing their substance use through an empathetic
discussion of the discrepancies between their values
and self-image and their current substance use
behavior. Counselors stress ideas of self-efficacy and
optimism to their patients. (For a more detailed
discussion, see Chapter V.)

For individuals showing signs of addiction,

providing treatment or referral to specialty care‡

is critical to managing the condition and

preventing further health and social

consequences.^64

Tobacco ........................................................................................................................

Brief interventions for smoking and other

tobacco use can be provided by trained health-

care practitioners and generally occur in clinical

and primary-care settings.^65 According to

clinical guidelines, practitioners should provide

brief interventions based on the “Five A’s”:

 Ask. The process begins with inquiries

about tobacco use, which should be made

during every visit.

 Advise. Individuals who smoke should be

advised in a clear, strong and personalized

manner to quit.

 Assess. Practitioners should determine

whether or not a patient is willing to attempt

to quit.

 Assist. If the patient is willing to attempt to

quit, the practitioner should provide

assistance by helping patients create a quit

plan, providing counseling and

pharmaceutical treatment recommendations,

offering problem solving and skills training

and distributing supplementary educational

materials. One intervention approach is

known as the “Five R’s” where a technique

is implemented to help motivate patients to

quit smoking.^66

 Arrange. Schedule follow-up contact, either

in person or by phone.^67

‡ See Chapters V and VI.