Healthcare Initiatives

Description of Strategy

Health care employees are uniquely positioned to assist their patients and families with prevention, detection, and treatment of substance abuse. Clinicians have repeated contact with patients over the course of the year and have an opportunity at each visit to communicate with the patient regarding substance abuse. Furthermore, primary care clinicians commonly see patients with a range of alcohol-related risks and problems (Whitlock, Polen, Green, Orleans, & Klein, 2004). A brief intervention with high-risk patients may prevent future substance abuse.

Also known as...

Talk with your physician, brief interventions

Discussion of Effectiveness

Alcohol

Evidence generally supports effectiveness of brief, multi-contact interventions with primary care providers for reducing alcohol consumption (Kaner et al., 2009; Whitlock, Polen, Green, Orleans, & Klein, 2004). A systematic review (University of Wisconsin Population Health Institute, 2017) found strong evidence that brief interventions in primary care and general hospital settings can reduce alcohol use and excessive drinking in adults and that brief interventions in schools and colleges can reduce alcohol consumption in young adults. The study also found that these interventions modestly reduce alcohol-related injuries in young adults and adults.

Tobacco

A systematic review of the effectiveness of brief interventions in healthcare and school settings on adolescent tobacco use did not find a significant effect (Tait & Hulse, 2003). A 2008 review of tobacco interventions found that brief, clinical interventions increase overall tobacco abstinence rates (US Department of Health and Human Services, 2008).

Prescription & Other Drugs

There is limited literature on the effectiveness of healthcare initiatives on drug related outcomes. Two studies found that brief interventions were associated with reduced drug use post-intervention (Bernstein et al., 2005; Madras et al., 2009). However, the reduction was not significant for all types of drug use.

References

Strategy Description

Whitlock, E. P., Polen, M. R., Green, C. A., Orleans, T., & Klein, J. (2004). Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 140(7), 557–568.

Evidence Base

Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77(1), 49–59. doi:10.1016/j.drugalcdep.2004.07.006

Kaner, E. F. S., Dickinson, H. O., Beyer, F., Pienaar, E., Schlesinger, C., Campbell, F., … Heather, N. (2009). The effectiveness of brief alcohol interventions in primary care settings: A systematic review. Drug and Alcohol Review, 28(3), 301–323. doi:10.1111/j.1465-3362.2009.00071.x

Kentala, J., Utriainen, P., Pahkala, K., & Mattila, K. (1999). Can Brief Intervention through Community Dental Care Have an Effect on Adolescent Smoking? Preventive Medicine, 29(2), 107–111. doi:10.1006/pmed.1999.0512

Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99(1–3), 280–295. doi:10.1016/j.drugalcdep.2008.08.003

Moore, A. A., Blow, F. C., Hoffing, M., Welgreen, S., Davis, J. W., Lin, J. C., … Barry, K.L. (2011). Primary care-based intervention to reduce at-risk drinking in older adults: A randomized controlled trial. Addiction (Abingdon, England), 106(1), 111–120. doi:10.1111/j.1360-0443.2010.03229.x

Ozer, E. M., Adams, S. H., Orrell-Valente, J. K., Wibbelsman, C. J., Lustig, J. L., Millstein, S. G., … Irwin, C. E. (2011). Does delivering preventive services in primary care reduce adolescent risky behavior? The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 49(5), 476–482. doi:10.1016/j.jadohealth.2011.02.011

Tait, R. J., & Hulse, G. K. (2003). A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug. Drug and Alcohol Review, 22(3), 337–346. doi:10.1080/0959523031000154481

US Department of Health and Human Services. (2008). Tobacco use and dependence guideline panel. Treating tobacco use and dependence: 2008 Update. Rockville (MD).

University of Wisconsin Population Health Institute, County Health Rankings and Roadmaps (2017). Alcohol brief interventions. Retrieved October 9, 2017

Whitlock, E. P., Polen, M. R., Green, C. A., Orleans, T., & Klein, J. (2004). Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 140(7), 557–568.

 

Futher Reading

Babor, T. F., & Higgins-Biddle, J. C. (2000). Alcohol screening and brief intervention: Dissemination strategies for medical practice and public health. Addiction, 95(5), 677–686. doi:10.1046/j.1360-0443.2000.9556773.x