Addiction Medicine: Closing the Gap between Science and Practice

identifying smoking, risky drinking and other
drug use before negative consequences occur,
including the development of addiction.^112

Although the most promising research findings
regarding the benefits of implementing these
services in health care and other settings have
been found in primary care settings, clinical
trials are lacking in this area.^114 Given the
strong scientific evidence to date supporting the
use of screening and brief interventions,
particularly for smoking and risky alcohol use,
several national medical societies already have
endorsed this approach, including:

 The American Society of Addiction
Medicine (ASAM) has identified screening
and brief interventions as an effective
method for catching substance-related
problems early and preventing the
development of addiction; ASAM
encourages medical and insurance
professionals to redesign their primary care
and funding practices to accommodate these
programs.^115

 The American Academy of Family
Physicians recommends that adults,
including pregnant women, be screened for
tobacco use and provided with cessation
interventions or brief counseling and that
screening and brief interventions for alcohol
use be used in health care settings as well.^116

 The American College of Obstetricians and

Gynecologists’ Committee on Ethics

declared that obstetrician-gynecologists

have an ethical obligation to conduct

universal screening, brief intervention and

referral to treatment for their patients.^117

 The American Dental Association advises

dentists to address the issue of risky use and

addiction with patients and refer them to

appropriate addiction treatment if needed.^118

Even the United States Preventive Services Task

Force (USPSTF), which is constrained by

available medical evidence, has recommended

screening and brief intervention for risky alcohol

use for all adults in primary care settings,* 119

and that all adults, including pregnant women,

be screened for tobacco use and receive

appropriate cessation counseling.† 120 And, the

National Quality Forum has endorsed screening

and brief interventions for tobacco and alcohol

use in general health and mental health-care

settings.^121

Adolescent Health Care. Screening the

adolescent population for substance use may be

the single most effective preventive step that can

be taken to address the problem of risky use and

* The USPSTF recommends this service with a B

rating, indicating that the net benefits of the

intervention outweigh any potential harms.

† The USPSTF recommends this service with an A

rating, indicating that the net benefits of the

intervention substantially outweigh the harms; for

pregnant women, the Task Force recommends that

the counseling services be tailored to pregnancy. As

a result of limited research on the topic, the USPSTF

concluded that there currently is insufficient clinical

evidence to determine the balance of benefits and

harms of routine (asymptomatic) screening or

interventions for tobacco or alcohol use among

adolescents or for screening individuals for illicit

drug use in primary care practice settings. A recent

report by the USPSTF, however, identified 11 high-

priority areas in preventive medicine that have

critical evidence gaps that, if addressed through

targeted research, are likely to result in

recommendations for practice. Among these 11

high-priority areas are screening and providing

counseling for adolescent alcohol use and screening

all individuals for illicit drug use.

The 2010 National Drug Control

Strategy Recommends:

 Increasing health care providers’

knowledge and use of screening and brief

intervention techniques through enhanced

medical and nursing school educational

programs;

 Increasing screening and early intervention

for substance use in all health care settings;

and

 Increased reimbursement for screening and

brief interventions in primary care.^113