treatment.* The study found that brief
interventions, brief treatments or referrals to
specialty treatment for those who screened
positive for risky alcohol and/or illicit drug use
at baseline were associated with a 38.6 percent
reduction in rates of heavy alcohol use and a
67.7 percent reduction in rates of illicit drug use;
however, it is important to note that this study
was not a randomized controlled trial.^87
Screening and brief intervention services also
have proven effective in increasing entry rates to
specialized addiction treatment programs for
patients with addiction^88 and for patients who
are required to wait to enter standard treatment
programs.^89
Tobacco ........................................................................................................................
When clinics and medical offices require
screening for tobacco use, tobacco-using
patients are likelier to achieve smoking
cessation. This may be because clinics and
medical offices that have tobacco screening
systems in place are approximately 1.7 times as
likely to provide smokers with interventions as
offices that do not require patients to undergo
tobacco screening.^90
A systematic review of 31 studies examining the
effects of smoking interventions provided by
nurses in hospital settings found that the
smoking cessation rate of patients who received
brief interventions was 1.3 times the cessation
- All patients in the study were screened for alcohol
and other drug use; however, different instruments
were used in each study site and the thresholds for
being classified as being a risky substance user varied
considerably among the sites. Those with moderate
risk substance use patterns received brief
interventions such as the FRAMES intervention or
motivational interviews; those with heavy use
patterns received brief treatment which consisted of
brief but more intense interventions such as enhanced
motivational interviews (MI), motivational
enhancement therapy (MET) or cognitive behavioral
therapy (CBT) (see Chapter V for an explanation of
these therapies); and those who met clinical criteria
for addiction were referred to specialty treatment.
There was no control or comparison group in this
study.
rate of control group patients.† 91 Another large-
scale study found that smokers who reported that
they had received a brief smoking cessation
intervention from their primary care provider‡
were more than three times likelier to quit
smoking than those who did not receive such
counseling (34.9 percent vs. 10.5 percent among
patients without co-occurring addiction
involving alcohol or other drugs or mental health
disorders and 31.3 percent vs. 6.0 percent among
those with such co-occurring conditions).^92Alcohol .........................................................................................................................
Screening and brief interventions for risky
alcohol use have demonstrated efficacy in
primary care and emergency/trauma settings.^93
One study, conducted in a primary care setting
with patients who screened positive for risky
alcohol use, found a greater decline in the
number of people who reported binge drinking§
among those receiving a brief intervention (from
85.0 percent at baseline to 61.5 percent three
years after the first intervention) compared to
those in the control group (from 86.9 percent at
baseline to 70.7 percent three years after the first
intervention).** Likewise, there was a greater
decline in the number of people who reported
heavy drinking†† among those receiving the brief
intervention (from 46.7 percent at baseline to
23.2 percent three years after the first
intervention) compared to those in the control† The effects of the interventions appear to be
strongest among cardiac rehabilitation patients.
‡ As indicated by a positive response to the question,
In the past 12 months, did any of the general medical
providers talk to you about quitting or avoiding
smoking?
§ Defined in this study as consuming more than five
drinks on one occasion during the previous 30 days.
** The brief intervention included a health
information booklet, two face-to-face, 15-minute
intervention sessions with a physician spaced one
month apart and two follow-up calls from nurses
during the weeks following their interventions; the
control group only received the information booklet.
Patients were randomly assigned to one of these two
conditions.
†† Consuming more than 20 drinks during the past
week for men and more than 13 drinks during the
past week for women.