Addiction Medicine: Closing the Gap between Science and Practice

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Marijuana Cocaine Methamphetamine Heroin Other Drugs
P E R C E N T



  • Who report any illicit drug use at baseline.
    Source: Madras, B.K., Compton, W.M., Avula, D., Stegbauer, T, Stein, J.B.,
    Clark, H.W. (2009).
    Figure 4.A
    Pre- and Post-Past Month Use of Specific Drugs among
    Patients Exposed to Screening and Interventions
    Baseline
    6 Month Follow Up
    Another study found that a screening and brief
    intervention program
    for heroin and cocaine
    users implemented during a routine medical visit
    was related to greater abstinence among
    intervention versus control participants from
    cocaine use (22.3 percent vs. 16.9 percent) and
    heroin use (40.2 percent vs. 30.6 percent) six
    months following the intervention.^105
    Brief interventions also can reduce regular
    amphetamine use. Six months after screening
    positive for amphetamine use, individuals who
    received brief interventions† were significantly
    likelier to be abstinent than users who received
    only self-help booklets. Amphetamine users
    who received brief interventions also showed
    decreased psychiatric distress scores and
    depression levels.^106

  • Consisting of toxicological and questionnaire
    screening during routine care at an inner-city
    teaching hospital, as well as brief motivational
    interviews, active referrals, a list of treatment
    providers and a follow-up booster phone call.
    † In this study, each participant had four 45- to 60-
    minute individual therapy sessions guided by a
    therapist manual and a self-help booklet. The
    sessions included role-play and take-home exercises,
    concentrating on coping strategies and relapse
    prevention. The first session focused on increasing
    motivation to reduce drug use, the second on
    reducing cravings through muscle relaxation and self
    talk, the third on controlling thoughts about drug use
    and the fourth on coping with lapses and developing
    skills to use in high-risk situations.


Implementing Screening and Brief Interventions in Health Care and Other Settings .......


While screening and
brief interventions can
be provided in a broad
range of venues,^107
health care settings may
be the most effective.
Physicians and other
health care providers, including dental
professionals, nurses and pharmacists, typically
are a consistent, trusted and influential presence
in the lives of children and adults and their
professional position grants them the authority
and credibility to deliver effective, evidence-
based interventions to patients at risk for
complications related to their substance use,
including addiction. Part of the success of
incorporating these services for risky use of
addictive substances into standard medical
practice is that people tend to be more receptive
to health messages once they are in a health care
setting. Patients view additional screening,
information, brief intervention or referral to
treatment as part of the health care they sought
initially.^108 The use of technology to assist in
the completion of screening and brief
interventions holds promise for helping to
integrate these practices into routine health care
delivery.^109

Primary Care ................................................................................................................


About 80 percent of Americans‡ visited at least
one physician or other health care professional
in the past year,^110 and the American Society of
Addiction Medicine (ASAM) estimates that
more than two-thirds of people with addiction
are in contact with a primary or emergency care
physician about twice a year.^111 Integrating
screening and brief interventions into routine
medical check-ups can be an effective way of

‡ Ages 18 and older.
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