The single screening question recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) accurately identifies unhealthy alcohol use in a sample of primary care patients, supporting use of this brief screen in primary care, according to the results of a cross-sectional study reported in the March 12, 2009 Online First issue of the Journal of General Internal Medicine.
TWEAK is a five-item scale developed originally to screen for risk of drinking during pregnancy. See also TWEAK for high tolerance individuals and TWEAK for those who can hold more than 5 drinks.
CSAT’s RFA for the SBIRT Medical Residency Program (TI-08-003). [Applications were due April 30,2008.] This announcement shows the details of the SBIRT programs. CSAT will fund ten SBIRT Medical Residencs Programs to develop and implement training to teach medical residents skills toprovide evidence-based screening, brief intervention, brief treatment andreferral to specialty treatment for patients who have, or are at risk for, asubstance use disorder. Another purpose of the program is to promote adoptionof SBIRT through delivery of training to local and Statewide medicalcommunities for wider dissemination of SBIRT practices.
What do you do if your patient screens positive on the CAGE? This article, by Jeffrey H. Samet, M.D., et. al., is a brief overview of how to tailor your response to be most effective to the particular patient. Arch Intern Med 1996; 156: 2287-2293.
Resources for health professionals from NIDA, the National Institute on Drug Abuse. NIDA is part of the National Institutes of Health (NIH). Its mission is to lead in bringing the power of science to bear on drug abuse and addiction with two key components: (1) strategic support and conduct of research across a broad range of disciplines, and (2) ensuring the rapid and effective dissemination and use of the results of that research to significantly improve prevention, treatment and policy as it relates to drug abuse and addiction.
A 2002 NIAAA alert with an overview of screening techniques for alcohol problems.
Research by Bertha K. Madras et. al. published in Drug and Alcohol Dependence. Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered. Drug and Alcohol Dependence 2009; 99:280–295.
Study and analysis of 29 male VA outpatients in a general internal medical clinic who screened positive for alcohol related problems. This is an interesting and illustrative analysis of audio taped interviews between patients and providers. Three themes were identified: 1) patients disclose information about alcohol use and providers often fail to explore patient comments, 2) the advice about alcohol was typically vague, and 3) the discomfort of the providers was evident in alcohol-related discussions. J Gen Int Med 2006; 21:966-972.
From Boston University, the core curriculum Helping Patients Who Drink Too Much is a new, freely available web-based training curriculum geared toward generalist clinicians. This evidence-based curriculum is a tool used for teaching skills for addressing unhealthy alcohol use (e.g. screening, assessment, brief intervention, and referral) in primary care settings, and emphasizes knowledge and skills regarding cross-cultural efficacy. It has been designed to be taught in 45 minute sessions or expanded into longer or multiple sessions. It consists of a power point slide presentation, complete with trainer notes, and three case-based videos demonstrating skills for addressing unhealthy alcohol use in primary care settings. The curriculum has been piloted with target audiences (practicing primary care physicians and physicians in training). In addition, key primary care faculty nationwide are being trained to implement and disseminate the ACT curriculum.
Written for primary care and mental health clinician, and produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with guidance from physicians, nurses, advanced practice nurses, physician assistants, and clinical researchers, this Guide helps treating physicians determine how much drinking is "too much" and what are suitable interventions. With this Guide, you have what you need to begin incorporating alcohol and screening and intervention into your practice.
National survey by Peter D. Friedmann, M.D. and others of 1082 physicians to learn whether they asked about drug use and what they did if the diagnosis of drug abuse was made. Arch Intern Med 2001;161:248-251.
The CRAFFT is a behavioral health screening tool for use with children under the age of 21 and is recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents. It consists of a series of 6 questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is a short, effective screening tool meant to assess whether a longer conversation about the context of use, frequency, and other risks and consequences of alcohol and other drug use is warranted. Screening using the CRAFFT begins by asking the adolescent to "Please answer these next questions honestly"; telling him/her "Your answers will be kept confidential"; and then asking three opening questions.If the adolescent answers "No" to all three opening questions, the provider only needs to ask the adolescent the first question—the CAR question. If the adolescent answers "Yes" to any one or more of the three opening questions, the provider asks all six CRAFFT questions. CRAFFT is a mnemonic acronym of first letters of key words in the six screening questions. The questions should be asked exactly as written. A list of references is included on the second page of the document.
The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids: 5-12 mild withdrawal; 13-24 moderate; 26-36 moderately severe; more than 36 severe withdrawal. Available as a PDF document from CSAM-ASAM.
Clinical Institute Withdrawal Assessment of Alcohol Scale–Alcohol Revised (CIWA-Ar) measures and scores 10 symptoms that indicate the severity of a patient's withdrawal. It requires 2 minutes to perform.
(See also AUDIT survey and AUDIT info and scoring.) The AUDIT was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in brief assessment. It can help in identifying excessive drinking as the cause of the presenting illness. This manual, offered here as a PDF from the WHO website, is written primarily for health care practitioners, but other professionals who encounter persons with alcohol-related problems may also find it useful. It is designed to be used in conjunction with a companion document that provides complementary information about early intervention procedures, entitled “Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care”. Together these manuals describe a comprehensive approach to screening and brief intervention for alcohol-related problems in primary health care.