Alcohol
and drug abuse are major causes of morbidity and mortality in the
United States. With the multitude of injuries and health complications
associated with substance use disorders ( occurring in all age groups),
primary care providers are in an opportune position to provide early
intervention for patients suffering with substance related illnesses.
The
Substance Abuse and Mental Health Services (a division of the US
Department of Health and Human Services) publishes Treatment
Improvement Protocols as part of their mission to improve treatment of
substance use disorders by providing best practice guidelines to
clinicians, program administrators, and payees. This purpose of this
publication, TIP 24, A Guide to Substance Abuse Services for Primary Care Clinicians, is
to help physicians, nurses, physician assistants, and advanced practice
nurses screen their patients for substance use disorders, conduct brief
interventions for patients in the early stages of their
illness, and refer more severely affected patients for in-depth
assessment and treatment. TIP 24 also gives an overview of the types of
treatment available and outlines a primary care clinician’s role in
aftercare.
TIP
24 has a good review of the indications of substance abuse, choosing
appropriate screening and assessment instruments, how to discuss this
subject with your patient. On page 3 of this document is an algorithm
which gives the “patient flow through primary care and referral”. There
is also a section on how to perform an office-based intervention in
which you and your patient set mutually agreed upon goals and set up a
“contract” for your patient to stop or cut back on alcohol or other
drug use.
You can download this .pdf publication for free at http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17867
. Take a moment to download it and look through it. You may want to
distribute it throughout your office for clinical and support staff,
since it contains simple screening tools that anyone can use for
screening purposes.
