Addiction Medicine: Closing the Gap between Science and Practice

 Planning ahead to limit drinking and other
drug use;

 Pacing one’s use; and

 Learning to cope with the everyday
problems that may lead to substance use.^75

Helping patients understand how they can
change their behavior and encouraging them to
be optimistic about their ability to do so are
important components of most brief
interventions.^77 Interventions delivered in an
empathetic counseling style are more effective
than those that rely on confrontation or
coercion.^78 While brief interventions can avert
the development of a more serious substance use
problem,^79 individuals with the disease of
addiction require more intensive care and should
be treated or referred to specialty care.

Effectiveness of Screening and Brief Interventions...........................................................

The combination of screening and brief
interventions* has shown positive results for
tobacco,^80 alcohol,^81 illicit drugs and the misuse

• Sometimes referred to as SBI.

of controlled prescription drugs,^82 across many

settings and population groups.† 83

Several large-scale studies have explored the

effectiveness of screening and brief

interventions in reducing the consumption of

addictive substances as well as the serious

problems and costs that accompany such

behavior, including visits to emergency

departments, hospitalization, high-risk^ injection

drug use, criminal activity,^ psychiatric stress

and depression.^84 One study found that adult

patients‡ receiving a brief intervention after a

positive screen by their primary care physicians

for risky alcohol use experienced 20 percent

fewer emergency department visits and 37

percent fewer days of hospitalization than

patients who did not receive the intervention.^85

Participants who received screening and brief

interventions also had significantly fewer arrests

for alcohol or controlled drug violations (two vs.

11 arrests).^86

A large-scale study conducted in a broad range

of medical settings across six states found that

22.7 percent of the patients in the study screened

positive for risky alcohol or other drug use or

addiction. Sixteen percent of the patients who

were screened received a recommendation for a

brief intervention, 3.2 percent received a

recommendation for brief treatment and 3.7

percent received a referral to specialty

† It is difficult to compare the effectiveness rates of

different research trials and programs as many of

them use restricted populations and vary in the length

and intensity of the intervention. Despite these

methodological discrepancies, there are strong data

showing the effectiveness of screening and brief

interventions in addressing risky use of addictive

substances. Studies reporting successful outcomes

tend to reflect situations where participation was

voluntary and may not reflect outcomes in a

population with mandatory participation.

Furthermore, most of these studies examine the use

of screening and brief interventions in primary care

settings as it pertains to alcohol use and not to other

drug use.

‡ Between the ages of 18 to 65 who visited a

physician’s office for routine care.

“FRAMES”:

Key Elements of a Brief Intervention for

Reducing the Risky Use of

Alcohol and Other Drugs^76

A frequently-used brief intervention for the risky

use of alcohol and other drugs includes six core

elements identified and verified through

empirical research that can be summed up by the

acronym “FRAMES”:

 Feedback regarding personal risk or

impairment;

 Responsibility for change;

 Advice to change;

 Menu of options for reducing substance use;

 Empathetic counseling style; and

 Self-efficacy in terms of ability and

responsibility to change.