Alcohol/Other Drug Problems Screening and Intervention by Rehabilitation Physicians

West, Steven L.; Luck, Richard S.; EdD, C. Fred Capps; Cifu, David X.; Graham, Carolyn W.; Hurley, Jessica

doi:10.1080/07347320903008166

Cited by 3 publications

(3 citation statements)

References 55 publications

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“…Of those who do, as many as 40% who diagnose individuals with substance use disorders do not refer for treatment. 32 To aid in this process, the to bolster motivation to change or education regarding relapse prevention skills. Recent research regarding unassisted recovery from alcoholism indicates that selfchange may be an effective strategy for some patients.…”

Section: Treatment Implicationsmentioning

confidence: 99%

Preinjury alcohol and drug use among persons with spinal cord injury: Implications for rehabilitation

Stroud

Bombardier

Dyer

et al. 2011

The Journal of Spinal Cord Medicine

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Context/objective: To describe preinjury alcohol and drug use and opportunities for secondary prevention among persons with recent spinal cord injury (SCI). Design: Survey. Setting: Acute inpatient rehabilitation program. Participants: Participants were 118 (84.8%) of 139 consecutive admissions who met inclusion criteria and were screened for preinjury alcohol and drug use. Interventions: None. Outcome measures: Alcohol and drug use, toxicology results, alcohol problems, readiness to change, and treatment preferences. Results: Participants were on average 37 years old, 84% were men, and 85% were white. Fifty-one percent of the sample was considered 'at-risk' drinkers. Significant lifetime alcohol-related problems were reported by 38% of the total sample. Thirty-three percent reported recent illicit drug use and 44% of the 82 cases with toxicology results were positive for illicit drugs. Seventy-one percent of at-risk drinkers reported either considering changes in alcohol use or already taking action. Forty-one percent reported interest in trying substance abuse treatment or Alcoholics Anonymous (AA). Motivation to change alcohol use was significantly and positively associated with self-reported indicators of alcohol problem severity. Conclusion: Preinjury alcohol and drug abuse are common among persons with recent SCI. Substance abuse screening is feasible and detects not only salient clinical problems but also significant motivation to change and interest in AA or treatment, all of which represent an important window of opportunity for appropriate brief interventions and referrals. In contrast with the idea that alcoholism is a 'disease of denial', the majority of atrisk drinkers with new onset SCI indicate they are considering making changes.Keywords: Alcohol, Drug, Substance-related disorders, Spinal cord injuries, Rehabilitation, Paraplegia, Tetraplegia, Toxicology screening Alcohol and drug abuse or dependence is a common comorbid condition among newly injured persons with spinal cord injury (SCI). Preinjury alcohol use and abuse has been shown to be higher among individuals who sustain SCI compared to the general population, with approximately one-third of newly injured persons with SCI reporting a history of alcohol-related problems.1 A significant proportion of persons with SCI report that preinjury alcohol or drug use contributed to their injury, 1 while estimates of intoxication at the time of injury range from 17 to 62%. 2-4Preinjury alcohol or drug use among persons with SCI has been associated with adverse medical and rehabilitation outcomes. Preinjury alcohol problems have been related to less functional independence at rehabilitation admission and discharge as well as slower progress during inpatient rehabilitation.5 Persons with SCI who have a history of problem drinking also report spending less time in productive activities (including rehabilitation therapies) during inpatient rehabilitation. 6History of preinjury alcohol and drug use predicts poorer Rates of post-injury alcohol abuse among pe...

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Section: Treatment Implicationsmentioning

confidence: 99%

Preinjury alcohol and drug use among persons with spinal cord injury: Implications for rehabilitation

Stroud

Bombardier

Dyer

et al. 2011

The Journal of Spinal Cord Medicine

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“…Our search yielded 9308 studies published between January 1, 1960, and October 5, 2021, with 1280 remaining after removal of duplicates and 552 assessed for eligibility (eFigure 1 in Supplement 1). Of 283 studies…”

Section: Resultsmentioning

confidence: 99%

“…Alcohol (86 studies), nicotine (30 studies), and opioids (104 studies) were most often studied alone. Among studies reporting on multiple drugs (44 studies), alcohol was included most often (38 studies…”

Section: Resultsmentioning

confidence: 99%

Physician Reluctance to Intervene in Addiction

Campopiano von Klimo,

Nolan,

Corbin

et al. 2024

JAMA Netw Open

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ImportanceThe overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.ObjectiveTo describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.Data SourcesA literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.Study SelectionPublications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.Data Extraction and SynthesisTwo reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.Main Outcomes and MeasuresThe primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.ResultsA total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.Conclusions and RelevanceIn this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

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