Do you feed a fever and starve a cold or vice versa?
Brief interventions deemed ‘inadequate’ for unhealthy drug abuse…
There is this old adage: “Starve a cold, feed a fever”…many of us have heard our parents of grandparents offer this advice and when you drill them with a few questions it turns out that nobody is really sure what works best for treating a fever versus a cold. It happens that way in the medical field…everyone makes a call based on their experience.
It turns out that experts in the field of substance use disorder are still trying to determine how best to intervene when a patient presents with unhealthy drug use as opposed to unhealthy alcohol use. Should the medical provider offer the same course of treatment for both or do we have to look closer at the specific disorder?
New study conducted by the Boston University School of Public Health
In the August 6, 2014, edition of JAMA – The Journal of the American Medical Association the results of a new study were published: Screening and Brief Intervention for Drug Use in Primary Care, The ASPIRE Randomized Clinical Trial. The objective of this study was:
To test the efficacy of 2 brief counseling interventions for unhealthy drug use (any illicit drug use or prescription drug misuse)—a brief negotiated interview (BNI) and an adaptation of motivational interviewing (MOTIV)—compared with no brief intervention.
The lead researcher Dr. Richard Saitz is quoted in a statement:
…despite the potential for benefit with a brief intervention, drug use differs from unhealthy alcohol use in that it is often illegal and socially unacceptable, and is diverse—from occasional marijuana use, which was illegal during this study, to numerous daily heroin injections. “Prescription drug misuse is particularly complex, with diagnostic confusion between misuse for symptoms (e.g., pain, anxiety), euphoria-seeking, and drug diversion. Brief counseling may simply be inadequate to address these complexities, even as an initial strategy.”
Meet Dr. Saitz…
The JAMA Network offers a video interview with Dr. Saitz which explains the study and the results the researchers were able to verify. Take a few minutes to get a clearer understanding of the study’s parameters and results. Medical Daily quotes both Dr. Ralph Higinson from the National Institute on Alcohol Abuse and Alcoholism and Dr. Wilson Compton of the National Institute on Drug Abuse who offered editorial comments:
“Although these studies offer no direct evidence of effectiveness for universal drug screening, brief intervention, and referral to treatment in primary care settings, exploring drug use with patients should remain a priority in primary care. The goal for clinical research is to develop and test new interventions with potential for benefiting patients,” Dr. Ralph Higinson from National Institute on Alcohol Abuse and Alcoholism and Dr. Wilson Compton from the National Institute on Drug Abuse said in an accompanying editorial. “If brief interventions are insufficient, then easily accessible treatment services with long-term follow-up may be needed, as will development of efficient primary care referral approaches to address risky substance use and related physical and mental comorbidities.”
Some closing thoughts…
This study is what you might call a “conversation starter.” The observations provided by the researchers might well serve to be the jumping off point to discover new and more efficient ways to intervene when a patient presents and admits to using both legal and illegal substances, not just alcohol.
Family members know all too well how difficult it can be to talk to and interact with their loved one who is an alcoholic or drug addict. Working with a primary care physician may be the first step and perhaps down the road the services of a professional interventionist may be required.