smoker’s likelihood of being able to quit.^32
Something as simple as keeping NRT products
behind the pharmacy counter where customers
would have to ask for them, or within view of
the pharmacist but accessible to customers,* is
related to a greater likelihood of pharmacist-
initiated smoking cessation counseling. In one
study, pharmacists who stored NRT products
behind the counter were 4.7 times likelier to
provide counseling† than pharmacists who stored
the products out of customers’ sight; those who
stored them within view but still accessible to
customers were three times likelier to offer
counseling than those who stored them out of
customers’ sight.^33
Current Practices Related to Alcohol and
Other Drugs. A national survey of patients
who had visited a general medical provider in
the past year found that only 29 percent were
asked about alcohol or other drug use; 9.2
percent were given the suggestion to stop using,
13.6 percent were given a brief intervention and
5.3 percent were referred to counseling. Of
those in the sample who reported having been
asked by a general medical provider about their
alcohol or other drug use and were identified as
risky drinkers, less than half (48.6 percent)
received any type of advice from their doctor
concerning their substance use.^34
Another study found that 19.6 percent of
patients who were identified by primary care
practitioners as misusing addictive substances
but who were not diagnosed with addiction did
not receive a recommendation for an active
intervention.^35
A national survey of current and former
drinkers, ages 18-39 years, found that 67 percent
saw a physician in the past year but only 49
percent of excessive drinkers‡ were asked about
- This approach might be less likely to deter
customers from purchasing the NRT products, since
some smokers may be hesitant to ask for assistance.
† To four or more customers per month.
‡ Those exceeding the National Institute on Alcohol
Abuse and Alcoholism’s (NIAAA) guidelines of no
more than four drinks per day or 14 drinks per week
for men and no more than three drinks per day or
seven drinks per week for women.
their drinking and only 21 percent of them were
counseled about risky drinking.§ While
respondents ages 18-25 years were most likely
to engage in excessive drinking, they were least
likely to be asked about their alcohol use (34
percent of excessive drinkers ages 18 to 25 years
vs. 54 percent of excessive drinkers ages 26 to
39 years).^36Efforts to educate patients and connect them
with needed services also are inadequate in
emergency departments (EDs).^37 The American
College of Surgeons Committee on Trauma
designated alcohol and other drug screening as
an “essential diagnostic test” at Level I and
Level II trauma centers,^38 yet many trauma
centers do not provide any screening or brief
intervention services for those who may need
them.^39 A national survey of ED directors found
that only 15 percent reported having formal
screening and intervention policies in their EDs.
While nearly two-thirds (64.5 percent) reported
routinely screening for risky alcohol use via a
serum alcohol level and 23.6 percent reported
using standardized screening instruments, only
nine percent reported offering brief interventions
by trained personnel for risky alcohol use.^40Although the majority of surgeons (89 percent)
say that alcohol is a major burden on their
trauma center (an estimated 40 to 50 percent of
trauma patients have positive blood alcohol
levels)^41 and 76 percent consider other drug use
to be a significant burden,^42 trauma center and
ED physicians often fail to address the
underlying alcohol and other drug problems that
cause patients’ injuries.^43Despite evidence of the effectiveness of ED-
based screening and brief interventions for
substance-using adolescents,^44 a study of
adolescents admitted to hospitals following
trauma injuries in which 15.5 percent screened
positive for alcohol in their blood found that
only 59 percent of those who screened positive
were referred for intervention services.^45§ 14 percent were advised about low-risk drinking
guidelines and seven percent were advised to cut
down.