Alexander DeLuca, M.D.
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Brief Interventions: The Gateway to Change
by Fred Rotgers, Psy.D.; Smithers Treatment & Research Center; circa 2000. Reformatted 10/9/2004: [].

Starting the process of healthy change does not have to involve a lot of time or effort. Often, it simply means engaging the substance using patient in an open, non-judgmental dialogue about their substance use at a point when the patient is beginning to experience negative consequences resulting from their use. One of the most opportune times, for both therapists and patients, to begin this process of reconsideration is when patients are experiencing medical problems that may be impacted by their substance use.

For years, the value of brief interventions (as short as 30 minutes) with patients in medical settings (outpatient clinics, hospital emergency rooms and treatment units, doctorís offices) for alcohol and drug problems has been well known (see Bibliography for references). Research finds that in such settings 30-40% of patients have some sort of problem with alcohol or other drugs. Unfortunately, many medical settings and practitioners donít take advantage of this opportunity to engage their patients in a dialog about their alcohol or drug use, and how changing it may improve their health.

As part of our commitment to creating a broad range of services for patients at all levels of readiness to change, we at Smithers are beginning a program of screening and brief intervention with patients in the Roosevelt Hospital Medical/Surgical Clinics. The project will be led by Frederick Rotgers, Psy.D. Assistant Chief Psychologist in collaboration with Navneet Kathuria, M.D., Director of the Medical/Surgical Clinics. We will screen all clinic patients, and identify those who acknowledge alcohol or drug use above a critical level. Patients who screen positive for alcohol or drug use will be offered the opportunity to discuss their substance use with a trained counselor. The goal of this discussion will be to help the patient put his/her substance use in context with his/her medical condition, review the reasons for continuing to use alcohol/other drugs as before, as well as reasons why the patient might want to change alcohol/other drug use.

The brief intervention will last a total of two hours, the first hour consisting of a comprehensive assessment of the patientís alcohol/other drug use, and the second hour a motivational feedback interview in which the patient will receive feedback of the assessment results and have an opportunity to consider options with the counselor. Appointments will be coordinated with the patientís medical care visits so as to create minimal additional disruption to the patientís life. The focus of the intervention will be to enhance patient autonomy and self of personal effectiveness with respect to making changes to their substance use or getting help in doing so. The style of the intervention will be empathetic and understanding, rather than confrontational and insistent. Research has shown that this style of intervention is highly effective in helping patients reach a decision to either reduce/stop using on their own, or to enter treatment. Patients who opt to consider treatment will be offered a variety of treatment options, including enrollment in one of the programs here at Smithers. Finally, in keeping with our goal of integrating research and clinical practice, we will be gathering follow-up data on all patients we see hoping to determine whether or not this intervention has been effective in helping them make the decision to reduce or stop using substances.

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Bien, T.H., Miller, W.R., & Tonigan, J.S. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 315-336.

Brown, R.L., Leonard, T., Saunders, L.A. & Papasouliotis, O. (1998). The prevalence and detection of substance use disorders among inpatients ages 18-49: An opportunity for prevention. Preventive Medicine, 27, 101-110.

Canning, U.P., Kennell-Webb, S.A., Marshall, E.J., Wessely, S.C. & Peters, T.J. (1999). Substance misuse in acute general medical admissions. Quarterly Journal of Medicine, 92, 319-326.

Dunn, C.W. & Ries, R. (1997). Linking substance abuse services with general medical care: Integrated, brief interventions with hospitalized patients. American Journal of Drug and Alcohol Abuse, 23, 1-13.

Fleming, M.F., Barry, K.L., Manwell, L.B., Johnson, K, & London, R. (1997). Brief physician advice for problem alcohol drinkers: A randomized controlled trial in community-based primary care practices. JAMA, 277, 1039-1045.

Oliansky, D.M., Wildenhaus, K.J., Manlove, K., Arnold, T., & Shoener, E.P. (1997). Effectiveness of brief interventions in reducing substance use among at-risk primary care patients in three community-based clinics. Substance Abuse, 18, 95-103. 

Wilk, A.I., Jensen, N.M. & Havighurst, T.C. (1997). Meta-analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. Journal of General Internal Medicine, 12, 274-283.



Addiction, Pain, and Public Health website

Alexander DeLuca, M.D.

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Originally posted:  circa 2000

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