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.
