Screening and Brief Intervention News Feed from PubMed

Obstacles to alcohol and drug care - Are Medicare Locals the answer?

Aust Fam Physician. 2013 May;42(5):339-42

Authors: Berends L, Lubman DI

Abstract
BACKGROUND: Harms related to alcohol and drug use have an enormous cost on the community, yet most patients with substance use disorders do not receive care from primary healthcare providers. The establishment of a system of large primary healthcare organisations (Medicare Locals) across Australia provides an opportunity to address this service gap.
OBJECTIVE: This article considers barriers to delivering alcohol and drug interventions from primary healthcare settings, strategies for their resolution, and the ensuing benefits for patients.
DISCUSSION: Help seeking for alcohol and drug problems is low. Stigmatisation can be countered by policy development, training and support to increase staff awareness and skills, and building relationships with specialist services. Co-location, outreach clinics, and collaborative models simplify access, tailor intensity of interventions, and improve patient satisfaction and health outcomes. Screening and brief intervention at intake, with appropriate training and support for nursing staff, can advance the delivery of timely and effective care.

PMID: 23781538 [PubMed - in process]

Effectiveness of early interventions for substance-using adolescents: findings from a systematic review and meta-analysis.

Subst Abuse Treat Prev Policy. 2012;7:25

Authors: Carney T, Myers B

Abstract
BACKGROUND: Information on the impact of available interventions that address adolescent substance use and delinquency can inform investment choices. This article aims to identify and evaluate early interventions that target adolescent substance use as a primary outcome, and criminal or delinquent behaviours as a secondary outcome.
METHOD: A systematic review of early interventions for adolescent substance use and behavioural outcomes was conducted.
RESULTS: We identified nine studies using specific search strategies. All but one of the studies reported the use of brief intervention strategies. Only seven studies contained information which allowed for the calculation of an effect size, and were therefore included in the meta-analysis. The overall effect size for all outcomes combined was small but significant (g = 0.25, p < 0.001). The overall outcome for substance use was also small but significant (g = 0.24, p < 0.001). For studies with behavioural outcomes, the overall effect size reached significance (g = 0.28, p < 0.001). In general, subgroup analysis showed that individual interventions with more than one session had a stronger effect on the outcomes of interest.
CONCLUSIONS: Early interventions for adolescent substance use do hold benefits for reducing substance use and associated behavioural outcomes. Interventions are most promising if delivered in an individual format and over multiple sessions. One intervention in particular had large effect sizes. As all the interventions were tested in developed countries, further testing is needed in low- and middle-income countries where there is a lack of research on evidence-based interventions for adolescent risk behaviours. Additional recommendations for policy and practice are provided in this paper.

PMID: 22697269 [PubMed - in process]

Treatment fidelity instrument to measure a brief opportunistic intervention for prenatal substance use.

J Obstet Gynecol Neonatal Nurs. 2012 Nov-Dec;41(6):809-20

Authors: Torrey AR

Abstract
OBJECTIVE: To develop and psychometrically evaluate an instrument designed to measure the treatment fidelity associated with implementation of the I Am Concerned (IAC) brief opportunistic intervention by frontline, prenatal, primary care staff.
DESIGN: A methodologic approach framed development of the IAC Treatment Fidelity Instrument in a six-phase protocol.
SETTING: A simulated prenatal clinic with standardized patients portraying substance-using pregnant women.
PARTICIPANTS: Prenatal, primary care, frontline staff (N = 6), experienced in IAC implementation.
METHODS: Following development of the IAC treatment fidelity instrument, independent raters used the instrument to evaluate audio recordings (N = 49) of frontline staff implementing the IAC brief opportunistic intervention with standardized patients representing substance-using pregnant women.
RESULTS: Psychometric analysis provided evidence of content validity. Intraclass correlation coefficients calculated for inter-rater reliability were satisfactory for subscales (0.64) and (0.62) and ranged from -0.07 to 0.81 for individual items. Internal consistency alpha coefficients were satisfactory for the total scale (0.72) and lower than acceptable for adherence (0.54) and competence (0.56) subscales. Overall high rater percentage agreement and negatively skewed ratings distribution indicated reliability results were paradoxically low due to the base rate problem.
CONCLUSION: Results support revision and ongoing testing of the IAC treatment fidelity instrument. The impact on reliability statistics exerted by this study's skewed data distribution has implications for nursing research as low variance can be anticipated when measuring care provided to homogenous patient populations. It is important to recognize the resulting influence on inter-rater agreement to avoid making inaccurate interpretations about the reliability of an instrument's measurements.

PMID: 23030696 [PubMed - indexed for MEDLINE]

Screening and Brief Interventions for Hazardous and Harmful Alcohol Use among University Students in South Africa: Results from a Randomized Controlled Trial.

Int J Environ Res Public Health. 2013;10(5):2043-2057

Authors: Pengpid S, Peltzer K, van der Heever H, Skaal L

Abstract
The aim of this study was to assess the effectiveness of Screening and Brief Intervention (SBI) for alcohol problems among university students in South Africa. The study design for this efficacy study is a randomized controlled trial with 6- and 12-month follow-ups to examine the effects of a brief alcohol intervention to reduce alcohol use by hazardous and harmful drinkers in a university setting. The unit of randomization is the individual university student identified as a hazardous or harmful drinker attending public recruitment venues in a university campus. University students were screened for alcohol problems, and those identified as hazardous or harmful drinkers were randomized into an experimental or control group. The experimental group received one brief counseling session on alcohol risk reduction, while the control group received a health education leaflet. Results indicate that of the 722 screened for alcohol and who agreed to participate in the trial 152 (21.1%) tested positive for the Alcohol Use Disorder Identification Test (AUDIT) (score 8 or more). Among the 147 (96.7%) university students who also attended the 12-month follow-up session, the intervention effect on the AUDIT score was -1.5, which was statistically significant (P = 0.009). Further, the depression scores marginally significantly decreased over time across treatment groups, while other substance use (tobacco and cannabis use), self-rated health status and Posttraumatic Stress Disorder (PTSD) scores did not change over time across treatment groups. The study provides evidence of effective brief intervention by assistant nurses with hazardous and harmful drinkers in a university setting in South Africa. The short duration of the brief intervention makes it a realistic candidate for use in a university setting.

PMID: 23698697 [PubMed - as supplied by publisher]

Screening for At-Risk Alcohol Use and Drug Use in an Emergency Department: Integration of Screening Questions Into Electronic Triage Forms Achieves High Screening Rates.

Ann Emerg Med. 2013 May 17;

Authors: Johnson JA, Woychek A, Vaughan D, Seale JP

Abstract
STUDY OBJECTIVE: Previous studies have shown that brief interventions for at-risk alcohol and drug use are significantly more likely to occur if patients are screened with a standardized, validated instrument, but high screening rates have traditionally been difficult to attain. Use of very brief screens can enable brief intervention specialists to focus their efforts on assessing and assisting patients most likely to need a brief intervention or more intensive treatment. This study describes the results of integrating brief substance abuse screens into an urban emergency department's (ED's) triage process. METHODS: As part of a comprehensive initiative to increase alcohol and drug screening, brief intervention, and referral to treatment (SBIRT), 3 single-item screening questions were programmed into the electronic triage tool used in the ED to detect tobacco use, at-risk alcohol use, illicit drug use, or prescription drug misuse. Project staff conducted training sessions with nurses to ensure the questions were asked properly and ED supervisors provided ongoing performance feedback. Names of patients with positive responses to the alcohol or drug questions automatically populated a list forwarded to health education specialists, who provided assessments, brief interventions, and referrals. RESULTS: Screening was conducted with 145,394 of 151,597 eligible patients, a 96% screening rate. Electronic reports revealed an 89% screening rate 30 days postimplementation and gradually increasing and stabilizing at approximately 97%. The overall percentage of patients screening positive for alcohol or drug use was similar to that of other ED-based studies (22%) but varied substantially by patient demographics. CONCLUSION: High rates of screening can be achieved if properly integrated into a clinical setting's existing patient care processes with well-planned information technology support.

PMID: 23688769 [PubMed - as supplied by publisher]

Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients.

West J Emerg Med. 2013 May;14(3):263-270

Authors: Woodruff SI, Eisenberg K, McCabe CT, Clapp JD, Hohman M

Abstract
Introduction: Visits to settings such as emergency departments (EDs) may present a "teachable moment" in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use. Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis. Results: Results of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change. Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.

PMID: 23687546 [PubMed - as supplied by publisher]

A Randomized Clinical Trial of the Health Evaluation and Referral Assistant (HERA): Research Methods.

Contemp Clin Trials. 2013 May 7;

Authors: Boudreaux ED, Abar B, Baumann BM, Grissom G

Abstract
The Health Evaluation and Referral Assistant (HERA) is a web-based program designed to facilitate screening, brief intervention, and referral to treatment (SBIRT) for tobacco, alcohol, and drug abuse. After the patient completes a computerized substance abuse assessment, the HERA produces a summary report with evidence-based recommended clinical actions for the healthcare provider (the Healthcare Provider Report) and a report for the patient (the Patient Feedback Report) that provides education regarding the consequences of use, personally tailored motivational messages, and a tailored substance abuse treatment referral list. For those who provide authorization, the HERA faxes the individual's contact information to a substance abuse treatment provider matched to the individual's substance use severity and personal characteristics, like insurance and location of residence (dynamic referral). This paper summarizes the methods used for a randomized controlled trial to evaluate the HERA's efficacy in leading to increased treatment initiation and reduced substance use. The study was performed in four emergency departments. Individual patients were randomized into one of two conditions: the HERA or assessment only. A total of 4,269 patients were screened and 1,006 participants enrolled. The sample was comprised of 427 tobacco users, 212 risky alcohol users, and 367 illicit drug users. Fourty-two percent used more than one substance class. The enrolled sample was similar to the eligible patient population. The study should enhance understanding of whether computer-facilitated SBIRT can impact process of care variables, such as promoting substance abuse treatment initiation, as well as its effect on subsequent substance abuse and related outcomes.

PMID: 23665335 [PubMed - as supplied by publisher]

Screening for Unhealthy Alcohol and Other Drug Use by Health Educators: Do Primary Care Clinicians Document Screening Results?

J Addict Med. 2013 Apr 19;

Authors: Kim TW, Saitz R, Kretsch N, Cruz A, Winter MR, Shanahan CW, Alford DP

Abstract
OBJECTIVES:: Health educators are increasingly being used to deliver preventive care including screening and brief intervention (SBI) for unhealthy substance use (SU) (alcohol or drug). There are few data, however, about the "handoff" of information from health educator to primary care clinician (PCC). Among patients identified with unhealthy SU and counseled by health educators, the objective of this study was to examine (1) the proportion of PCC notes with documentation of SBI and (2) the spectrum of SU not documented by PCCs. METHODS:: Before the PCC-patient encounter, health educators screened for SU, assessed severity (Alcohol, Smoking, and Substance Involvement Screening Test), and counseled patients. They also conveyed this information to the PCC before the PCC-patient encounter. Researchers reviewed the electronic medical record for PCC documentation of SBI performed by the health educator and/or the PCC. RESULTS:: Among patients with the health educator-identified SU, only 69% (342/495) of PCC notes contained documentation of screening by the health educator and/or the PCC. Documentation was found in all encounters with patients with likely dependent SU, but only 62% and 59% of encounters with patients with risky alcohol and drug use, respectively. Documentation of cocaine or heroin use was higher than that of alcohol or marijuana use but still not universal. Although all SU-identified patients had received a brief intervention (from a health educator and possibly a PCC), only 25% of PCC notes contained documentation of a brief intervention. CONCLUSIONS:: Among patients screened and counseled by health educators for unhealthy SU, SBI was often not documented by PCCs. These results suggest that strategies are needed to integrate SBI by primary care team members to advance the quality of care for patients with unhealthy SU.

PMID: 23609212 [PubMed - as supplied by publisher]

Effects of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Education and Training on Nursing Students' Attitudes Toward Working With Patients Who Use Alcohol and Drugs.

Subst Abus. 2013 Apr-Jun;34(2):122-8

Authors: Puskar K, Gotham HJ, Terhorst L, Hagle H, Mitchell AM, Braxter B, Fioravanti M, Kane I, Talcott KS, Woomer GR, Burns HK

Abstract
ABSTRACT Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) can reduce alcohol use and negative health outcomes in patients with risky substance use. However, negative attitudes that some health care professionals have toward patients who use substances are a barrier to implementing SBIRT. Methods: The University of Pittsburgh School of Nursing, in partnership with the Institute for Research, Education, and Training in Addictions (IRETA), developed a curriculum to train baccalaureate student nurses to deliver SBIRT. Results: Following SBIRT education and training, students' perceived attitudes toward patients who use alcohol became more positive. Less robust changes were found for attitudes related to patients who use drugs. Conclusions: Nurses composing the largest group of healthcare workers are in key positions to screen, intervene, and provide education about substance use.

PMID: 23577905 [PubMed - in process]

Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients.

Addict Sci Clin Pract. 2013 Apr 8;8(1):8

Authors: Eisenberg K, Woodruff SI

Abstract
BACKGROUND: Screening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described.Methods/design: A randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs---their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation---are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age >=18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview. DISCUSSION: A comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome analysis has not yet been completed, but demonstrated programming and design successes have implications for future research and service delivery.Trial registration: NCT01683227.

PMID: 23566363 [PubMed - as supplied by publisher]

The Predictive Utility of a Brief Kindergarten Screening Measure of Child Behavior Problems.

J Consult Clin Psychol. 2013 Apr 1;

Authors: Racz SJ, King KM, Wu J, Witkiewitz K, McMahon RJ

Abstract
Objective: Kindergarten teacher ratings, such as those from the Teacher Observation of Classroom Adaptation-Revised (TOCA-R), are a promising cost- and time-effective screening method to identify children at risk for later problems. Previous research with the TOCA-R has been mainly limited to outcomes in a single domain measured during elementary school. The goal of the current study was to examine the ability of TOCA-R sum scores to predict outcomes in multiple domains across distinct developmental periods (i.e., late childhood, middle adolescence, late adolescence). Method: We used data from the Fast Track Project, a large multisite study with children at risk for conduct problems (n = 752; M age at start of study = 6.55 years; 57.7% male; 49.9% Caucasian, 46.3% African American). Kindergarten TOCA-R sum scores were used as the predictor in regression analyses; outcomes included school difficulties, externalizing diagnoses and symptom counts, and substance use. Results: TOCA-R sum scores predicted school outcomes at all time points, diagnosis of ADHD in 9th grade, several externalizing disorder symptom counts, and cigarette use in 12th grade. Conclusions: The findings demonstrate the predictive utility of the TOCA-R when examining outcomes within the school setting. Therefore, these results suggest the 10-item TOCA-R may provide a quick and accurate screening of children at risk for later problems. Implications for prevention and intervention programs are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

PMID: 23544679 [PubMed - as supplied by publisher]

Performance Measurement: A Proposal to Increase Use of SBIRT and Decrease Alcohol Consumption During Pregnancy.

Matern Child Health J. 2013 Mar 13;

Authors: O'Brien PL

Abstract
Alcohol consumption during pregnancy has negative implications for maternal and child health. Appropriate early universal Screening, Brief Intervention and Referral to Treatment (SBIRT) for pregnant women is necessary to identify women at risk and reduce the likelihood of continued drinking. Because SBIRT is not consistently used, the development and use of performance measures to assure implementation of SBIRT are key steps towards intervention and reduction of alcohol consumption during pregnancy. Practice guidelines provide ample support for specific instruments designed for SBIRT in prenatal care. An examination of existing performance measures related to alcohol consumption during pregnancy, however, reveals no comprehensive published performance measure designed to quantify the use of SBIRT for alcohol use in prenatal care. Process performance measures were developed that can determine the proportion of pregnant women who are screened during the course of prenatal care and the proportion of women requiring either brief intervention or referral to substance use disorder treatment who received those interventions. The measures require use of screening instruments validated for use with pregnant women. The two proposed measures would represent a significant step in efforts to assure appropriate intervention for women who drink during pregnancy, hold accountable providers who do not employ SBIRT, and provide a basis from which necessary systemic changes might occur. Pregnancy is a time when many women are motivated to stop drinking. That opportunity should be seized, with timely intervention offering assistance for pregnant women who have not stopped drinking of their own accord.

PMID: 23483413 [PubMed - as supplied by publisher]

Implementation of a screening, brief intervention, and referral to treatment program using the electronic medical record in a pediatric trauma center.

J Trauma Nurs. 2013 Jan;20(1):16-23

Authors: McKenna C, Gaines B, Hatfield C, Helman S, Meyer L, Rennick C, Schenkel K, Zaremski J

Abstract
The purpose of this project was to develop and implement a consistent process for (1) screening adolescents by history for alcohol and substance abuse and (2) providing a motivational interview for change and appropriate referrals as needed. In the 18 months since we implemented the program, 534 patients were eligible for screening. Of these, 442 actually underwent screening and of these, 32 screened positive, thus receiving a brief intervention by social work and referral for further treatment. Use of the electronic medical record was key to the implementation and sustainability of this project.

PMID: 23459427 [PubMed - in process]

Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review.

Addict Behav. 2013 Feb 4;38(5):2146-2153

Authors: Pilowsky DJ, Wu LT

Abstract
BACKGROUND: A review of the literature was conducted to examine substance use screening instruments commonly used with adolescents in medical settings, their comparative usefulness, and SBIRT (Screening, Brief Intervention, and Referral to Treatment). METHODS: We screened two databases (Ovid MEDLINE and PsycINFO) targeting journal articles dealing with screening for alcohol and drug use in adolescence as well as adolescent SBIRT. RESULTS: Adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses. The CRAFFT was the best studied instrument for screening for alcohol/drug use and related problems, and is the only tool with data to support its use in medical settings. Other screening instruments require more testing/evaluation in more representative samples of adolescents in primary care settings. Long term follow-up data to establish the efficacy of SBIRT in adolescence are not available. Innovative computerized approaches to screening for substance use in this population have recently been proposed. Although promising, they require further evaluation. CONCLUSIONS: The CRAFFT has the most consistent data to support its use in primary care settings. The effects of SBIRT in adolescence have not been adequately evaluated. Adolescents' opinions and preferences for SBIRT should be studied to improve their acceptance.

PMID: 23454877 [PubMed - as supplied by publisher]

Assessment of readiness to change and relationship to AUDIT score in a trauma population utilizing computerized alcohol screening and brief intervention.

Subst Abus. 2012;33(4):378-86

Authors: Lotfipour S, Cisneros V, Chakravarthy B, Barrios C, Anderson CL, Fox JC, Roumani S, Hoonpongsimanont W, Vaca FE

Abstract
Trauma patient readiness-to-change score and its relationship to the Alcohol Use Disorder Identification Test (AUDIT) score were assessed in addition to the feasibility of computerized alcohol screening and brief intervention (CASI). A bilingual computerized tablet for trauma patients was utilized and the data were analyzed using Stata. Twenty-five percent of 1145 trauma patients drank more than recommended and 4% were dependent. As many Spanish-speaking as English-speaking males did not drink, but a higher percentage of Spanish-speaking males drank more than recommended and were dependent. Half of patients who drank more than recommended rated themselves 8 or higher on a 10-point readiness-to-change scale. CASI also provided personalized feedback. A high percentage of trauma patients (92%) found CASI easy and a comfort in use (87%). Bilingual computerized technology for trauma patients is feasible, acceptable, and an innovative approach to alcohol screening, brief intervention, and referral to treatment in a tertiary care university.

PMID: 22989282 [PubMed - indexed for MEDLINE]

Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project.

J Grad Med Educ. 2012 Mar;4(1):58-63

Authors: Pringle JL, Kowalchuk A, Meyers JA, Seale JP

Abstract
BACKGROUND: The Screening, Brief Intervention and Referral to Treatment (SBIRT) service for unhealthy alcohol use has been shown to be one of the most cost-effective medical preventive services and has been associated with long-term reductions in alcohol use and health care utilization. Recent studies also indicate that SBIRT reduces illicit drug use. In 2008 and 2009, the Substance Abuse Mental Health Service Administration funded 17 grantees to develop and implement medical residency training programs that teach residents how to provide SBIRT services for individuals with alcohol and drug misuse conditions. This paper presents the curricular activities associated with this initiative.
METHODS: We used an online survey delivery application (Qualtrics) to e-mail a survey instrument developed by the project directors of 4 SBIRT residency programs to each residency grantee's director. The survey included both quantitative and qualitative data.
RESULTS: All 17 (100%) grantees responded. Respondents encompassed residency programs in emergency medicine, family medicine, pediatrics, obstetrics-gynecology, psychiatry, surgery, and preventive medicine. Thirteen of 17 (76%) grantee programs used both online and in-person approaches to deliver the curriculum. All 17 grantees incorporated motivational interviewing and validated screening instruments in the curriculum. As of June 2011, 2867 residents had been trained, and project directors reported all residents were incorporating SBIRT into their practices. Consistently mentioned challenges in implementing an SBIRT curriculum included finding time in residents' schedules for the modules and the need for trained faculty to verify resident competence.
CONCLUSIONS: The SBIRT initiative has resulted in rapid development of educational programs and a cohort of residents who utilize SBIRT in practice. Skills verification, program dissemination, and sustainability after grant funding ends remain ongoing challenges.

PMID: 23451308 [PubMed - in process]

Language and Addiction: Choosing Words Wisely.

Am J Public Health. 2013 Feb 14;

Authors: Wakeman SE

Abstract
Two recent articles in the American Journal of Public Health discussed the importance of educating trainees in social work(1) and medicine(2) in screening, brief intervention, and referral to treatment (SBIRT) technique for approaching patients with substance use disorders. In both articles the terms "substance use" and "substance abuse" were used somewhat interchangeably. Both articles contribute to the important recognition that training in addictions must be an integral part of any medical or social work training program. However, the language used to convey this educational content is important. (Am J Public Health. Published online ahead of print February 14, 2013: e1-e2. doi:10.2105/AJPH.2012.301191).

PMID: 23409913 [PubMed - as supplied by publisher]