How to detect early harmful and hazardous substance use in workplace: a qualitative study. Background: Workers under the influence of psychoactive substances are more likely to commit unsafe acts which damage themselves, others' lives, and the organization. A question is how to detect substance misuse early in the workplace, without punitive or coercive actions. This study evaluated the implementation of a screening (S) and brief intervention (BI) of substance misuse through (1) the barriers faced and the solutions presented by occupational health professionals when implementing SBI, and (2) the feasibility to use the SBI in this environment for such a preventive procedure. Methods: An action research methodology was used in this study in a City Hall in a southern city of Brazil. First, 26 professionals of the Occupational Health Service were trained in a 20 h course about: psychoactive substances' effects, how screening (S) using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and how doing BI. After training, they received supervision in doing the task goal of applying SBI in their routine in a random sample of 5% of the employees (the total was 26,129). One year later, two focus group meetings were held with all professionals. Results: The trained professionals were 11 psychologists, 12 social workers, one organizational development analyst, one occupational therapist, and one cultural promoter; 99.2% female; 46 ± 4 years old; 80.6% married. During a one-year period, they detected, in a representative sample of employees (n=1,310), 144 individuals in risky use and 139 dependents on tobacco, alcohol and/or other substances. At three-month follow-up they observed a significant reduction in ASSIST scores. The action research improved the implementation of SBI for substance use in their routine. Professionals agreed that SBI facilitates talking about substances without prejudice or stigma, enabling earlier detection, intervention, and treatment referral. Conclusion: SBI was feasible in this workplace to prevent hazardous/ harmful substance use.

Despite effectiveness in research, the efficacy of screening and brief intervention (SBI) for risky substance users is not adequately understood in routine clinical practice. Primary healthcare professionals (n = 103) from three cities in a metropolitan area in Brazil were trained and supervised in SBI and then screened 40 patients. One year later, meetings were held in each city to obtain feedback. Twenty professionals who fulfilled the task (Yes [Y]) and 24 who did not (No [N]) were individually interviewed about their SBI experience. Reports were independently interpreted and codified by two researchers. The Y and N groups reported the same barriers and positive beliefs, but only the Y group reported no negative issues. The present study lasted from 2007 to 2009.