Screening and Intervention for Alcohol and Illicit Drug Abuse

Abstract

This study attempts to determine how internal medicine housestaff screen and intervene for problematic alcohol and illicit drug use, as well as identify factors correlating with favorable practices. A cross-sectional survey was administered to 93 medical housestaff. Of 64 (69%) respondents, 94% reported routinely screening new patients for alcohol or illicit drug use, while only 52% routinely quantified alcohol consumption and 28% routinely used a screening instrument. Housestaff were unfamiliar with national guidelines and felt unprepared to diagnose substance use disorders, particularly prescription drug abuse. Most routinely counseled patients with alcohol (89%) or illicit-drug problems (91%), although only a third of these patients were referred for formal treatment. More thorough screening practices were associated with greater treatment optimism, while favorable referral practices were associated with greater optimism about 12-step program benefit and difficulty with management. These findings suggest areas to be addressed in residency curricula on substance abuse.

Frequency of 5+/4+ Drinks as a Screener for Drug Use and Drug-Use Disorders

“…Whereas some primary and specialty care physicians routinely ask new patients about alcohol and illicit drug use, this does not always entail quantifi cation or use of a standard screening instrument (Friedmann et al, 2001;Gunderson et al, 2005;Maheux et al, 1999;Schermer et al, 2003). Questioning about illicit drug use is more common in specialty areas such as psychiatry and obstetrics/gynecology than in family medicine practices (Friedmann et al, 2001), but even in specialty settings, accurate and effi cient assessment is often lacking.…”

Teaching physicians to address unhealthy alcohol use: A randomized controlled trial assessing the effect of a Web-based module on medical student performance

“…Some data suggest that providers' attitudes and confidence affect delivery of substance abuse counseling (Geller et al, 1989;Gunderson et al, 2005;Marcell, Halpern-Felsher, Coriell, & Millstein, 2002). In our evaluation, students' attitudes and confidence improved similarly in both treatment groups, while performance differed.…”

“…Screening and brief intervention is associated with a 13% to 34% reduction in heavy alcohol use (Whitlock et al, 2004). Despite this, medical education is still largely focused on the medical consequences of excessive drinking and generally provides inadequate and inconsistent training in identifying and treating the underlying substance use problem (Frost-Pineda, VanSusteren, & Gold, 2004;Isaacson, Fleming, Kraus, Kahn, & Mundt, 2000;Miller, Sheppard, Colenda, & Magen, 2001;Gunderson, Levin, & Smith, 2005).…”

“I Feel Uncomfortable ‘Calling a Patient Out’”: Educational Needs of Palliative Medicine Fellows in Managing Opioid Misuse

“…Although guidelines exist for identifying high-risk behavior and managing opioid prescribing in chronic nonmalignant pain, 14,15 there are no recommendations addressing risk management in chronic cancer pain or noncancer pain in the setting of a lifelimiting illness. In primary care, medical trainees and practicing physicians have been shown to lack competence in diagnosing substance use disorders (SUDs) and setting limits on opioid prescribing in cases of misuse. 16,17 There are no studies of hospice and palliative medicine (HPM) trainees' skill or confidence in this area. We sought to assess the need for opioid misuse and addiction curricula in HPM fellowships by asking fellows how frequently they encounter patients who are at risk for opioid misuse, their training in opioid misuse and addiction, and their perceived competency in treating pain in this population.…”