Transcript HEALTHSOUTH Harmarville

OVERVIEW: SCREENING BRIEF
INTERVENTION AND REFERRAL
TO TREATMENT
Holly Hagle, PhD
Director of the Northeast ATTC
OBJECTIVES FOR THIS WORKSHOP
1.Compare and contrast alcohol and other drug
(AOD) use as it relates to the continuum of use,
abuse, and dependency.
 2. Describe the principles of screening, brief
intervention, and referral to treatment (SBIRT)
process.
 3. Review the stages of change and Motivational
Interviewing (MI) strategies and their implication for
the intervention process.
 4. Examine the elements of effective brief
interventions.
 5. Examine SBIRT for at risk individuals.

2
3
SBIRT
AN EFFECTIVE APPROACH
Screening
Brief
Intervention
Referral
Treatment
Intro to SBIRT
creening
• Quickly
assess the
severity of
substance use
and identify
the
appropriate
level of
treatment.
rief
nterventi
•on
Increase
insight and
awareness of
substance use;
motivation
toward
behavioral
change.
Source: SBIRT Oregon Residency Program, 2012
eferral to
reatment
• Provide those
identified as
needing more
extensive
treatment
with access to
specialty care.
ALCOHOL AND US

Annual cost of alcohol related injuries: $130 billion(1)

Substance abuse is strongly associated with health
problems, disability, death, accident, injury, social
disruption, crime and violence (1)

30% of trauma center admissions are intoxicated (1)

24.255 of high school students have 5 or more drinks in
a row on at least 1 day during a month (2)

49% of men who identified as homosexual ages 25-29,
reported binge drinking (3)
Sources:
1. H. Gill Cryer, MD, Chief of Trauma, UCLA Medical Center
2. CDC study - http://www.cdc.gov/hiv/youth/
3. CDC
5
studyhttp://www.cdc.gov/mmwr/preview/mmwrhtml/ss6014a1.htm?s_cid=ss6014
a1_e
ALCOHOL AND US
National data indicates that the rate of STD among
female heavy drinkers was 7.3% (highest for
women 18-25 years old) (1)
 79,000 deaths were attributable to excessive
alcohol use in the US (2)
 Excessive alcohol use is the third leading life-style
related cause of death for the US (2)

Sources:
1. CDC - http://www.cdc.gov/ncbddd/fasd/research-preventing.html
2. CDC - http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
6
DRUG USE AND US






Injection drug users (IDUs) account for more than 60 percent
of all new hepatitis C virus (HCV) infections in the United
States. (1)
Fifty to eighty percent of new IDUs are infected within 6 to 12
months of initial injection. (1)
Of an estimated 15.9 million people who inject drugs
worldwide, up to 3 million are infected with HIV (2)
20.8% of students reported use of marijuana at least one time
in the last month (3)
Ecstasy use in the past year (from 6 percent in 2008 to 10
percent in 2010).
Marijuana use among teens increased by a disturbing 22
percent (from 32 percent in 2008 to 39 percent in 2010).
Sources:
1.
CDC- U.S. Centers for Disease Control and Prevention - http://www.thebodypro.com/content/art22608.html
2. Mathers, B. et al. (2008)
http://www.unodc.org/documents/frontpage/Facts_about_drug_use_and_the_spread_of_HIV.pdf
7
3. CDC - http://www.cdc.gov/hiv/youth/
4.
Join together online - http://www.drugfree.org/join-together/addiction/national-study-confirms-teen-druguse-trending-in-wrong-direction
SCOPE OF THE PROBLEM

Alcohol and/ drugs are a factor in:

60-70% of homicides

40% of suicides

40-50% of fatal motor vehicle crashes

60% of fatal burn injuries

60% of drownings

40% of fatal falls
Source: Virginia department of Health, Division of Injury and Violence
Prevention, retrieved from
http://www.vahealth.org/Injury/data/reports/documents/2008/pdf/Alco
hol%20and%20Injury%20Report.pdf
8
WHY SBIRT?
SBIRT is a comprehensive, integrated, public
health approach to the delivery of early
intervention and treatment services
For persons with substance use disorders
Those who are at risk of developing these
disorders
Primary care, mental health, AOD and other
community settings provide opportunities for
intervention with at-risk substance users
Before more severe consequences occur
Source: The Pacific Southwest Addiction Technology Transfer Center - SBIRT webinar
slides March 2010
SBIRT EFFECTIVENESS
Rates of illicit drug use dropped by 67.7 percent six
months after patients using illicit drugs had received
help through a SBIRT program.
 Heavy alcohol use dropped by 38.6 percent.
 Illicit drug users receiving brief treatment or referral
to specialty treatment also reported other quality of
life improvements:






29.3 percent reported feeling generally healthier
31.2 percent reported experiencing fewer emotional problems
15.4 percent reported improved employment status
64.3 percent reported fewer arrests
45.8 percent who were homeless reported no longer being
homeless
Madras, B.K., Compton, W.M., Avula, D. Stegbauer, T., Stein, J.B., Clark, H.W., Drug
and Alcohol Dependence Volume 99, Issues 1–3, 1 January 2009, Pages 280–295.
SBIRT EFFECTIVENESS
Study - Moyer et al, 2002; Whitlock et al, 2004; Bertholet et al,
2005; Ppt. Source – SBIRT Oregon Residency Program, 2012
WHY SBIRT?
At-risk drinking and
alcohol problems are
common
Alcohol and other drugs
significantly impact
patient and public
health
SBIRT
SBIRT is proven to be
effective
Substance use is one of
America’s top
preventable health
issues
Source – SBIRT Oregon Residency Program, 2012
LET’S LOOK AT THE CONTINUUM
OF USE
13
Use
SCREENING
Dependent
Harmful
5%
8%
Risky
9%
78%
Healthy
Source – SBIRT Oregon Residency Program, 2012
The Drinkers’
Pyramid
3-7 % alcohol dependent or harmful
users
10- 15% hazardous,
at-risk users
35- 40% low-risk
drinkers
40% abstainers
16
Source: World Health Organization (WHO)
WHAT IS A LOW-RISK LIMIT?

No more than two
standard drinks a day

Do not drink at least
two days of the week
NIAAA Guidelines
17
WHAT IS A LOW-RISK LIMIT?
 When
operating machinery
 When
driving
 When
taking certain medicines
 If
you have certain medical conditions
 If
you cannot control your drinking
 If
you are pregnant
18
There are times when even one or two drinks
can be too much:
AT RISK DRINKING
 Men:
more than 14 drinks per week or consuming
more than 4 drinks per occasion
19
 Women
(and anyone age 65+): more than 7
drinks per week or consuming more than 3 drinks
per occasion
 Drinking:
more than 2 standard drinks per day
w/o abstaining for at least 2 days per week
NIAAA Guidelines
Source: NIAAA Guidelines
Abuse
Substance Abuse vs. Substance
Dependence
Substance Abuse: the misuse of an illicit drug, prescription
drug or over-the-counter medication.
Substance abuse often involves a pattern of harmful drug
use for mood altering purposes.
A person diagnosed with substance abuse is not considered
to be addicted or dependent (otherwise the diagnosis would
be substance dependence).
22
DEFINITIONS: DRINKING EPISODES

A drinking “binge” is a pattern of drinking that brings
blood alcohol concentrations (BAC) to 0.08 or above.

Typical adult males: 5 or more drinks in over a 2 hour
period

Typical adult females: 3 or more

For some individuals, the number of drinks needed to
reach “binge” level BAC is lower

University of Oklahoma “Police Notebook” BAC
Calculator www.ou.edu/oupd/bac.htm
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Addiction
CHEMICAL DEPENDENCY

According to the National Epidemiologic Survey on
Alcohol and Related Conditions

8.5 percent of adults in the United States meet the
criteria for an alcohol use disorder

2 percent of adults met the criteria for a drug use
disorder

1.1 percent of adults met the criteria for both
25
26
STEREOTYPE
27
LINCOLN ON ALCOHOLISM
“In my judgment such of us who
have never fallen victim (of
alcoholism) have been spared
more by the absence of appetite
than from any mental or moral
superiority over those who
have.” (remarks to the Springfield, Illinois Washingtonian
Society, February, 1842)
Addiction is Manageable
Recovery Happens
Addiction is Manageable and, with treatment, has good
outcomes.
….all this bad news!
Is there no hope?
Of course there is hope! Recovery is all
around us.
“No known cure” doesn’t mean not “untreatable.” We don’t
cure diabetes, we manage it with proper diet, blood sugar
monitoring and other acts of discipline.
32
RECOVERY
 Recovery
from alcoholism and drug addiction is a
process of change through which an individual
achieves abstinence and improved health, wellness,
and quality of life. (SAMHSA/CSAT)
WHY DON’T WE SCREEN AND
INTERVENE?
34
DON’T ASK-DON’T TELL?
Alcohol and Drug Abuse problems are often
unidentified
In a study of 241 trauma surgeons, only 29%
reported screening most patients for alcohol
problems*
 In a study of 7,371 primary care patients, only 29%
of patients reported being asked about their use of
alcohol or drugs in the past year**

(*Danielson et al., 1999; **D’Amico et al., 2005)
35
QUESTION TO THE GROUP
What barriers get in
the way of screening?
36
WHY WE DON’T SCREEN & INTERVENE:
37
BARRIERS

Lack of awareness and
knowledge about tools
for screening

Discomfort with
initiating discussion
about substanceuse/misuse

Sense of not having
enough time for
carrying out
interventions
WHY WE DON’T SCREEN & INTERVENE:
38
BARRIERS

Healthcare negative
attitudes toward
substance abusers

Pessimism about the
efficacy of treatment

Fear of losing or
alienating patients

Lack of simple
guidelines/procedures
for brief intervention
WHY WE DON’T SCREEN & INTERVENE:
BARRIERS
39

Uncertainty about referral
resources

Limited or no insurance
company reimbursement for
the screening for alcohol and
other drug use.

Lack of education and
training about the nature of
addiction or addiction
treatment
WHY WE DON’T SCREEN & INTERVENE:
OPPORTUNITIES

When AOD screening
becomes more routine,
you typically can
expect:

Greater patient and
family satisfaction

Better patient
management and followup
40
WHY WE DON’T SCREEN & INTERVENE:
OPPORTUNITIES
41

The concern shown by
healthcare providers, even
during brief intervention, can
provide patients with
significant motivation for
change or referral for further
assessment and treatment.
WHY WE DON’T SCREEN & INTERVENE:
OPPORTUNITIES

The costs of AOD counseling
for patients in relation the
costs for AOD related
hospitalization are small, but
the value in terms of
prevention may be great.
42
ROLE OF HEALTHCARE PROFESSION IN DRUG
AND ALCOHOL USE–
WHAT CAN WE DO TO HELP?
1. Identify use, misuse, and problematic use; screen
with simple direct methods
2. Connect use/misuse to health related issues
3. Encourage consumption reduction
4. Conduct a Brief Intervention
5. Refer for formal assessment
43
IDENTIFICATION OF USE, MISUSE, AND
PROBLEMATIC USE:
HOW CAN WE APPROACH THIS PROCESS?
There are many screening tools that are brief and
easy to use that can help to determine the
involvement of a person with AOD.
44
Goals of Screening

Identify both hazardous/harmful drinking or drug use
and those likely to be dependent

Use as little patient/staff time as possible

Create a professional, helping atmosphere

Provide the patient information needed for an
appropriate intervention

Use “teachable moments”
45
46
SBIRT
AN EFFECTIVE APPROACH
 Screening
 Brief
Intervention
 Referral
 Treatment
SBIRT EFFECTIVENESS
“Alcohol screening and counseling (is) one of
the highest-ranking preventive services
among the 25 effective services evaluated
using standardized methods. Since current
levels of delivery are the lowest of comparably
ranked services, this service deserves special
attention by clinicians and care delivery
systems.”
- American Journal of Preventive Medicine
SBIRT EFFECTIVENESS
Rates of illicit drug use dropped by 67.7 percent six
months after patients using illicit drugs had received help
through an SBIRT program.
 Heavy alcohol use dropped by 38.6 percent.

Madras, et.al. (2009)
Harris County (Texas) Hospital District Study:
 Patients reporting any days of heavy drinking dropped
from 70% at intake to 37% at 6-month follow-up
 Patients reporting any days of drug use dropped from
82% at intake to 33% at follow-up
Spence, et. al. InSight Project Research Group (2009)
SBIRT SAVES MONEY

Literature reports a 4 to 1 savings with SBIRT approach

2002 study published in the journal Alcoholism: Clinical
and Experimental Research (Vol. 26, No. 1), researchers
found that every dollar invested in an SBIRT-like
approach saved $4.30 in future health care costs. These
reduced costs are associated with changes in:





Alcohol use
ED visits
Hospital days
Legal events
Motor vehicle accidents
SBIRT as a Response Option
Primary
Prevention
Brief
Intervention
AODA
Treatment
50
LETS LOOK AT THE SCREENING
INSTRUMENTS
51
SCREENING

Involves the use of …

Alcohol and/or drug abuse screening tools
52
SCREENING VS.
ASSESSMENT

Screening: determining the possibility that a condition
exists

Assessment: confirming the existence of a condition and
its severity.
WE TAKE A LOOK AT MANY FACTORS





pattern(s) of use
negative consequences
context of use
control of use/ motivation
previous treatment
SCREENING TOOLS
CAGE
3
question AUDIT
3 question drug screen
1 question binge drinking question
BAC
55
C.A.G.E.
Please answer yes or no to each item that best describes how you
have felt and behaved over your whole life.
1. Have you ever felt you should Cut down on your
drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you had an Eye-opener first thing in the morning to
steady nerves or get rid of a hangover?
If there is a yes answer to any of these questions please complete the
full AUDIT.
Ewing JA. (1984). Detecting alcoholism, the CAGE questionnaire. Journal of the American Medical
Association, 252(14), 1905-1907.
56
ALCOHOL USE DISORDERS TEST - AUDIT
 Full
AUDIT 10 question instrument
 Brief
3 question version
 Screens
for hazardous drinking,
harmful use and alcohol dependency
57
THE AUDIT – 3 QUESTION VERSION
Add the number for each question to get the total score for items 1, 2, & 3
A score of 4 or more for men and 3 or more for women is considered positive.
(Generally, the higher the score the more likely it is that the patient’s drinking is affecting
his/her health and safety)
1. How often do you drink anything containing alcohol?
(0 )Never (1) Less than monthly (2) Monthly
(3) Weekly (4 ) 2-3 times a week (5) 4-6 times a week (6) Daily
2. How many drinks do you have on a typical day when you are drinking?
(0) 1 drink (1) 2 drinks (2) 3 drinks
(3) 4 drinks (4) 5-6 drinks (5) 7-9 drinks (6) 10 or more
3. How often do you have four or more drinks on one occasion?
(0) Never (1) Less than monthly (2) Monthly
(3 ) Weekly (4) 2-3 times a week (5) 4-6 times a week (6) Daily
Babur, T.F., Higgins-Biddle, J.C., Saunders, J.B., Maristela G. Monteiro, M.G. (2001). The alcohol use disorders
identification test guidelines for use in primary care.
(2nd ed.). World Health Organization, Department of Mental Health and Substance Dependence.
58
DOMAINS AND ITEM CONTENT OF THE
FULL AUDIT
Domains
Question
Number
Item Content
Hazardous Alcohol
Use
1
2
3
Frequency of drinking
Typical quantity
Frequency of heavy drinking
Dependence Symptoms
4
5
6
Impaired control over drinking
Increased salience of drinking
Morning drinking
Harmful Alcohol Use
7
8
9
10
Guilt after drinking
Blackouts
59
Alcohol-related injuries
Others concerned about drinking
INTERPRETATION OF AUDITDegree of Problems
0-7
No Problems at this time
8-15
Hazardous & Harmful Alcohol Use
16-19
20-40
High Level of Alcohol Problems and
Possible Dependence
Possible Alcohol Dependence
60
Score
DRUG ABUSE SCREENING TEST (DAST)

DAST – 10 items used to screen for potential
involvement in the use of drugs.

Three question pre-screen for drug use.
61
THREE QUESTION PRE-SCREEN
FOR DRUG USE
If there is a yes response to any item please use full
DAST.
1. In the last year have you used drugs other than
those required for medical reasons?
Yes No
2. In the last year, have you used prescription or
other drugs more than you meant to?
Yes No
3. Which drug do you use most frequently?
_________________________________
62
ONE QUESTION SCREEN FOR BINGE DRINKING
When was the last time you had more than x (x=5
for men; x = 4 for women) drinks on 1 occasion?
Williams, R.H., Vinson, D.C. (2001). Validation of a single question screen for problem drinking. Journal of
Family Practice 50(4), 307-312.
63
BRIEF INTERVENTION
64
Brief
interventions are those
practices that aim to identify a real
or potential alcohol or other drug
(AOD) problem and to motivate an
individual to do something about it.
THE BRIEF INTERVENTION:
 Short
dialogues between the medical
provider and the patient that typically
involve:
 Feedback
 Client engagement
 Simple advice or brief counseling
 Goal-setting
 Follow-up
66
Brief
Negotiated Interview
FRAMES Approach
FLO – Feedback, Looking for
Change, Options
5A’s – Ask, Advise, Assess, Assist,
Arrange
WORLD HEALTH ORGANIZATION
(AM J PUB HEALTH 1996)
“A cross-national trial of brief interventions with
heavy drinkers”
•
•
•
Multinational study in 10 countries (n=1,260)
Interventions included simple advice, brief and extended
counseling compared to control group
Results: Consumption decreased
– 21% with 5 minutes advice, 27% with 15 minutes
compared to 7% controls
– Significant effect for all interventions
68
ASSESSING READINESS: STAGES OF CHANGE



It’s important to assess for stage of change so you
can determine the right kind of intervention.
Intervention matching individualizes the approach
to readiness aspects
The model describes 5 stages of change
Precontemplation
Contemplation
Preparation
Action
Maintenance
69
Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy toward a more integrative model of
change. Psychotherapy: Theory, Research and Practice, 19(3), 276-287.
3 TASKS OF A BRIEF INTERVENTION
FLO
Feedback
Listen
and Understand
Options
Explored
Source of information for slides 62-80,82,86: The Pacific
Southwest Addiction Technology Transfer Center - SBIRT
PDF 2010
TASK #1: FEEDBACK
Give the Patient Feedback Using:
Range
o Accurate Information
o Normal Ranges
o Give their score
o Elicit reaction
o
71
EXAMPLE
 Range:
“BAC can range from 0 (no alcohol
detected) to .4 (usually lethal)
 Accurate
Information: “.08 defines drunk
driving (heavy drinking)
 Normal:
“Normal drinking range is .03-.05
 Give
their score: “Your level was…”
 Elicit
reaction: “What do you make of that?”
72
FEEDBACK
 Your
job is to deliver the feedback
 Let
the patient decide where to go
with it
73
FEEDBACK
Handling resistance…
•
•
•
•
•
Look, I don’t have a drinking problem
My dad was an alcoholic; I’m not like him
I can quit anytime I want to
I don’t know why I had such a high BAC, I
hardly drank anything
As hard as I work, I have a right to drink and
relax
74
FEEDBACK
To avoid this…
Let Go!!!
75
FEEDBACK
Easy Ways to Let Go…
o
I’d really like to hear your thoughts..
o
I’d just like to give you some
information..
o
What you do is up to you.
76
FEEDBACK
Finding a Hook
o
o
o
o
o
o
Ask about their concerns
Be non-judgmental
Watch for signs of discomfort with the status
quo
Always ask: “What role do you think
alcohol played in your injury?”
Let the patient decide what they want to do
Just bringing up the subject is helpful
77
TASK #2: LISTEN AND UNDERSTAND

Listen to what the situation sounds like from
the patient’s perspective
 Show
that you understand where they are
coming from
 Listen
to assess readiness to change
78
LISTEN AND UNDERSTAND
Useful Tools to Promote Change
o
Pros and Cons
o
Importance/Readiness/Confidence
Rulers
79
PROS AND CONS
 What
do you like about drinking?
 What
do you see as the downside?
 What
else?
Summarize both pros and cons…
“On the one hand you said…, on the
other hand you said…
80
THE RULERS
Importance/Readiness/Confidence
81
0 1
2
3
4
Not at all Important
5
6
7
8
9
10
Very Important
On a scale from 0 to 10, where 0 is not at
all important and 10 is very important, how
important is it to you to ______ your
drinking right now?
82
0 1
2
3
Not at all Ready
4
5
6
7
8
9
10
Very Ready
On a scale from 0 to 10, where 0 is not at
all ready and 10 is very ready, how ready
are you to ______ your drinking right now?
83
0 1
2
3
4
Not at all Confident
5
6
7
8
9
10
Very Confident
On a scale from 0 to 10, where 0 is not at all
confident and 10 is very confident, how
confident are you right now that you can
meet your goal of ________ ?
84
THE RULERS
For each ask…
“Why didn’t you give it a lower number?”
“What would it take to …”
85
TASK #3: OPTIONS EXPLORED
o
What do you think you will do?
o
What changes are you thinking about making?
o
What do you see as your options?
o
Where do we go from here?
o
What happens next?
86
OFFER A MENU OF OPTIONS

Manage your drinking (cut down to low-risk limits)

Stop drinking

Never drink and drive (reduce harm)

Nothing (no change)

Seek help (refer to treatment)
87
EXPLORE PREVIOUS SUCCESSES

“Have you stopped/cut back drinking/drug use
before?”

“How were you able to do it?”

“Who helped and supported you?”

“Have you made other kinds of changes in your life
in the past?”

“How did you do that?”
88
THE ADVICE SANDWICH

Ask permission

Give Advice/Suggest Options

Ask for a response
89
CLOSING THE CONVERSATION- SEW

Summarize the patient’s statements in favor of
change

Emphasize their strength and ability to change

What agreement was reached?
90
SPIRIT OF MOTIVATIONAL INTERVIEWING

Collaboration (vs. Confrontation)
Meeting of aspirations
 Neither exhortation nor persuasion


Evocation (vs. Education)



Drawing out
Neither instilling nor installing
Autonomy (vs. Authority)
Personal responsibility
 Neither imposition nor coercion

92
A GOOD OUTCOME FROM BI

Reduction or cessation of use
(even temporary)

Starting to think about reducing

Agreeing to accept referral
IT MATTERS HOW YOU TALK TO THE
PATIENT
You are singing off key if you find yourself…









Challenging
Warning
Finger-wagging
Shaming
Labeling
Confronting
Being Sarcastic
Moralizing
Giving unwanted advice
93
Source – SBIRT Oregon Residency Program, 2012
REFERRAL TO TREATMENT
95
SPECIALTY TREATMENT NEAR YOU
o
o
o
o
Do you have a current listing of substance
abuse treatment centers?
Have you developed a referral relationship
with them?
Are you able to do a “warm handoff”?
Do you have information about 12-Step and
other recovery programs in your area?
96
SBIRT IN VARIOUS SETTINGS
Universal SBIRT –
Where can you use SBIRT?
97
LET’S USE SBIRT
98
ROLE PLAYS RELEVANT TO THE SITES
(LARGE AND SMALL GROUP DISCUSSIONS)
Setting: Develop scenario relevant to the your primary
worksite or the target population you work with
(community health clinic, school, hospital, EAP, Jail,
ER, Others???)
Example scenario –
Age
 Gender
 Other descriptive features (cultural, marital status, stressors, etc.)
 Circumstances leading to the interview
 AUDIT score 8-15 or DAST 3-5
 Use BI Observation Sheet as a guide (role play)

THANKS FOR YOUR ATTENTION
Questions?
Holly Hagle, PhD
Director, Northeast
Addiction Technology Transfer
[email protected]
100
SELECTED REFERENCES
Babur, Thomas et al., (2001) AUDIT: The Alcohol Use Disorders Identification Test
– Guidelines for Use in Primary Care. World Health Organization, Department
of Mental Health and Substance Dependence, Second Edition.
Babur, Thomas and Higgins-Biddle, John C. (2001) Brief Intervention For
Hazardous and Harmful Drinking: A Manual for Use in Primary Care. World
Health Organization, Department of Mental Health and Substance
Dependence.
D’Amico, E. J., Miles, J. N. V., Stern, S. A., & Meredith, L. S. (2008). Brief
motivational interviewing for teens at risk of substance use consequences: A
randomized pilot study in a primary care clinic. Journal of Substance Abuse
Treatment, 35, 53-61.
Dennis, M. ( 2006, April). The current renaissance of adolescent treatment. Talk
101
given at Project Fresh Light Partnership Meeting, Madison, WI. Retrieved from:
www.chestnut.org/LI/Posters/1The_Current_Renaissance_of_Adolescent_Treatment_4-17-06.pps.
Selected References (cont.)
Knight, J. R. (2006, March). Adolescent substance abuse: New strategies for
early identification and intervention in primary medical care. Presentation to
the Joint Meeting on Adolescent Treatment Effectiveness, Baltimore, MD.
Knight, J. R., Sherritt, L., Shrier, L. A., Harris, & Chang, G. (2002). Validity of the
CRAFFT substance abuse screening test among adolescent clinic patients.
Archives of Pediatric and Adolescent Medicine, 156, 607-614.
Knight, J. R., Sherritt, L., Van Hook, S., Gates, E. C., Levy, S. & Chang, G.
(2005). Motivational interviewing for adolescent substance use: A pilot study.
Journal of Adolescent Health, 37, 167-169.
Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing
people for change (Second edition). New York: Guilford Press.
102
Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological
analysis of clinical trials of treatments for alcohol use disorders. Addiction,
97(3), 265-277.
Selected References (cont.)
Monti, P. M., Colby, S. M., & O’Leary, T. A. (Eds.). (2001). Adolescents, alcohol,
and substance abuse: Reaching teens through brief interventions. New York:
Guilford Press.
O’Leary Tevyaw, T., & Monti, P. M. (2004). Motivational enhancement and other
brief interventions for adolescent substance abuse: Foundations,
applications, and evaluations. Addiction, 99(Suppl. 2), 63-75.
Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy
toward a more integrative model of change. Psychotherapy: Theory,
Research and Practice, 19(3), 276-287
Stern, S. A., Meredith, L. S., Gholson, J., Gore, P., & D’Amico, E. J. (2007).
Project CHAT: A brief motivational substance abuse intervention for teens in
primary care. Journal of Substance Abuse Treatment, 32, 153-165.
103
.
Selected References (cont.)
Substance Abuse Tool Box: Information for Primary Care Providers, (2004).
Virginia Department of Mental Health, Mental Retardation and Substance
Abuse Services,2nd Edition White, W., & Kurtz, E., (2006). Recovery,
Linking Addiction Treatment & Communities of Recovery: A Primer For
Addiction Counselors and Recovery Coaches. IRETA, Pittsburgh, PA.
Source: SAMHSA webinar (2011) Health Care Reform: Implications for
Behavioral Health Providers
http://www.youtube.com/watch?v=D0z1T3CRh_8
Winters, K. C. (2005). Expanding treatment options for drug-abusing
adolescents using brief intervention. Retrieved from: www.tresearch.org/
resources/specials/2005Jan_AdolescentTx.pdf.
Understanding Drug Abuse and Addiction: What Science Says. National
Institute on Drug Abuse (NIDA). National Institute of Health.
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