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| Alcohol and Drug Use Screening, Intervention, and Referral: Changing the Nation's Approach to Comprehensive Healthcare |
| Stacia Murphy, President, National Council on Alcoholism and Drug Dependence (NCADD)
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| Wednesday, April 21, 2004, 3:00-4:00 pm EST |
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This Web chat is designed to foster discussion of topics raised in the Alcohol and Drug Use Screening, Intervention, and Referral: Changing the Nation's Approach to Comprehensive Healthcare Webcast that was broadcast on April 7, 2004. This program highlights the innovative efforts to educate health care professionals on appropriate screening, intervention, and referral procedures that can easily be incorporated into clinical settings.
To view the Webcast, visit http://www.recoverymonth.gov/2004/multimedia/w.aspx?ID=246.
Chat Transcript
MODERATOR: The Web chat will begin in 5 minutes.
Welcome to the Road to Recovery: Alcohol and Drug Use Screening, Intervention, and Referral: Changing the Nation's Approach to Comprehensive Health Care Web chat. Our host today is Stacia Murphy, President, National Council on Alcoholism and Drug Dependence (NCADD).
This Web chat will highlight the innovative efforts to educate health care professionals about appropriate screening, intervention, and referral procedures that can easily be incorporated into clinical settings.
Please note that the views and opinions expressed by non-CSAT staff members in the Web chats and Webcasts should not be interpreted as official CSAT policy, but as the views and opinions of the individuals participating in these events.
Now we are ready for the first question.
MODERATOR: This question was previously submitted.
First time offense drug or alcohol related crimes should require mandatory treatment for the offender, not just screening, to help ease the overcrowding of prisons, jails, etc. What are your thoughts on this approach? All the money poured uselessly into incarceration for human beings with substance abuse problems could be more wisely and compassionately spent on rehabilitation.
Stacia Murphy: That is a very good question. I think that what we are trying to get legislators and communities [to] understand [is] that we cannot incarcerate our way out of this problem. Addiction to alcohol and other drugs requires treatment, and not punishment. I also agree that the amount of money we are spending building prisons could be more wisely spent in helping us solve a critical public health issue and providing hope in the lives of individuals and families affected by alcohol and drug dependence.
MODERATOR: This question was previously submitted.
Are there any treatment communities that provide information or materials in the Caribbean?
Stacia Murphy: Yes. Actually, there is a lot of information in Puerto Rico, San Juan, [and] the Island of St. Thomas in [the] U.S. Virgin Islands. There is also a new treatment center in Antigua called Crossroads. In addition to providing treatment, [it] has a strong education program for individuals and families. Additionally, in most of the Caribbean islands, there is some form of self-help program available for individuals needing help and information.
Terry: What steps are being taken at the national level to teach individuals about the new emphasis on brief interventions, treatment, and referral?
Stacia Murphy: One of the steps [being] taken right now is this chat. There was also a Webcast aired on April 7 involving this issue. If you log onto the SAMHSA Web site, it is still active for you to watch. There are several communities around the country-in particular, [communities in] Connecticut and Pennsylvania-that are doing a lot of work in brief intervention screening and interventions. I believe that this is a very effective way of getting individuals the help they need earlier.before the problem becomes so damaging to both the individual and those that he/she are associated with. We at the national level, at NCADD, will be doing a lot of work in local communities [along with] our affiliates to promote this. In fact, many of our affiliates have been doing this early intervention and screening for many, many years.
GUS!: I was surprised to hear that screenings and interventions occur more often in specialty areas. Who currently is doing most of the screenings and interventions? Which kinds of specialists?
Stacia Murphy: Screenings are done by a variety of public health professionals, some in hospital settings [but] many in local, community-based organizations and some public health clinics. One of our goals is to increase the environment in which screenings are done because our experience is telling us they work, or are extremely helpful in interrupting the progression of the problem. A significant number of screenings are done [by] NCADD affiliates around the country.
lisa: What are the main barriers to moving screening and brief interventions into mainstream settings vs. specialty areas?
Stacia Murphy: I think that some of the barriers have to do with [a] lack of info about how effective brief interventions can be. Providing this information to a number of diverse environments that would be qualified to do this.it is just a matter of making sure that the information is widely distributed and individuals are given the help they need in providing these kinds of interventions. So, it is a public education issue.
lisa: How can recovery community support groups help engage the recovering community?
Stacia Murphy: I think a very important role for the recovery community is finding ways to engage them.is a good point.it is a matter of education and finding those environments where the recovery community is likely to be-and that can be almost any environment-and providing information that may be helpful to them. It is a matter of us understanding that information is power and the more we are able to disseminate information as a matter of course, the more people will be exposed to this information since this problem courses through our entire society. Where ever you put information, it will reach the recovery community.
MODERATOR: This question was previously submitted.
What can we do to get primary care physicians to talk to their patients more about how alcohol and illicit drugs affect your health?
Stacia Murphy: I think there are two ways to [solve] that problem. Start with your own primary care physician and have a discussion about this problem and the effectiveness of brief interventions. Also have local groups or local organizations who work in addiction schedule brown bag or short-duration educational sessions in hospitals [and] health clinics to inform doctors about brief intervention, what they do, and the importance of them to help solve this problem and reduce the incidence of alcohol and drug use. They are an ideal target to do this due to their role and status in the lives of people. It is a simple thing to do; it will take a matter of seconds, but would clearly improve the quality of the care they are trying to provide to their clients as well as do a major service. In addition, they should.if they are not a part of a local American Society of Addiction Medicine chapter or group. should contact and illicit their help in addressing this.
GUS!: It was very interesting to hear in the Webcast that among teens there is less stigma associated with screening and intervention. What has led to this, and how do you see this affecting screening and intervention over the next 10 years or so when many of today's teens will become health practitioners?
Stacia Murphy: I think teenagers are more susceptible to the information and screenings because they have less experience with alcohol and other drugs and [because] the issue of progression has not occurred as it may have in an older person. It is an excellent place to start and provides an opportunity to begin the educational process of young people that will have a lasting effect on them as they mature into adulthood. Often, [a] person who experiences problems with alcohol and other drugs begins to show up in treatment environments in their middle and later years, which means the disease has progressed to a state of perhaps becoming unmanageable. Younger people have less of that experience since they have not lived that long, and I think [they] are a prime target for early intervention and prevention.
MODERATOR: This question was previously submitted.
What are some tips for conducting a family intervention when the teenager is the abuser? Are there special considerations?
Stacia Murphy: Certainly, when we think of teens, we are dealing with them in a special developmental stage of their lives so we have to address that in the context of not only where they are developmentally, [but] their habits and how they process info, [too]. We want to engage them; we want to not blame or judge them, get them to look at what is happening to them in terms of the quality of their individual lives and how they are functioning. We cannot give them mixed messages-not a do as I say not as I do. We have to set an example. We have to be able to listen to them; we have to be able to help them work through resolving their own conflicts and ambivalence, particularly as it relates to their peers and their own self-esteem issues. We also need to be aware that we may be dealing with issues relating to depression, and I think we have to show a lot of empathy and concern. But we are also collaborating with them to understand the problem in their lives and working with them to resolve the problem. They are not adults; they are young people.
Pat: Did you receive screening from a health care professional before you decided you wanted to rid yourself of your alcohol problems?
Stacia Murphy: Yes, I did. Actually, I was referred to a doctor, and in addition to a good medical exam, he talked with me about my problem and we worked together to see what I would begin to do to try to solve it. It is not always necessary to do it that way, but that was the way I did it-and it was very effective.
Terry: At what age would an intervention be an effective way of confronting a person with an alcohol or drug problem, since kids have problems early these days?
Stacia Murphy: Two things to be mindful of.the first observation is that the child may be having problems, and there is a lot of information out there [that] gives indications of that. When you engage the person.when dealing with brief interventions, confronting is not a good word [as] it implies a certain kind of aggressiveness that brief interventions are not designed for.they are a process of engagement and the sense that there is collaboration and cooperation between two individuals-one with the problem and the other who is not having the problem. Clearly, as early as you see signs and symptoms, you [should] begin to intervene and engage the person. Age does not matter.
Pat: The Webcast focused on online self screening resources. What offline screening tools are recommended, and where can people find them?
Stacia Murphy: There are any number of professional organizations and communities [that] deal with addiction problems [and] use screening tools that are useful and helpful in this process. I am not sure that we have special screening tools for brief interventions. It is just a matter of helping people, through a screening process, begin to determine if they are in need of some additional help. It is important that people understand that addiction to alcohol and drug dependence is progressive [and] signs and symptoms begin to reveal themselves sometimes very early. So it is not so much the screening, but the idea of the person who begins to experience problems when using alcohol and drugs that [the problems are] not normal [and] to get into an environment that may help them confirm that, indeed, if they keep doing this, they may end up having a very serious dependence problem.
Pat: Lots of Web sites have self screening tools. How can you tell which ones are most legitimate? What should you look for?
Stacia Murphy: When you are looking at screening tools, they ask certain kinds of questions related to problems that you are experiencing when using alcohol and drugs. They're fairly common, the signs and symptoms. If you are taking a test and there are 20 questions, you will show up in some of the questions and get the indication you need to talk to someone. [The tests] are designed to detect problems and not mask them, so I feel comfortable in saying that most screening tools for early intervention are fairly accurate.
mary: What steps does an organization have to take in order to offer brief intervention services?
Stacia Murphy: I think that the steps the org[anization] has to take [are] to first decide that it is important to do and then [to] have an organizational commitment to making it happen. And then, obviously, reach out to local health organizations, reach out to SAMHSA or some other group in the community to get information to set up a system for doing that. It is very important [for] more org[anization]s in the community [that] deal with clients and health issues [to] make a commitment to doing this. It would significantly help in us getting a handle on the enormous cost of drug dependence in this country.
Pat: The new Access to Recovery grant program is expected to expand access to care and increase substance abuse treatment capacity. How do you think Access to Recovery will influence screening and intervention?
Stacia Murphy: I think the Access to Recovery initiative provides another opportunity-and an important one-to bring additional resources to the community and community settings and provide the kind of information that influences and expands our approach to drug dependence problems. I think that the Access to Recovery initiative provides an opportunity to increase an awareness of drug dependence as a harmful problem and [allows us to] find some additional avenues to address it.
cathy: As a teacher, how can I encourage a student who has a drug and alcohol problem to seek help?
Stacia Murphy: I think that teachers are-I believe-our best hope in the educational setting for helping our young people because of their status, role, and potential for influence...they are key to this. Understand something. We are not talking about deep psychological counseling. We really are understanding the stages of change when a person is having a problem, when Johnny went from being an A student to being late, to being aggressive. Something has changed, [and] 9 times out of 10 it has something to do with alcohol or drugs. [Teachers] provide [students], in what we hope is a trusting environment, [the opportunity] to [walk away from] the ledge, and I think it is their responsibility to do it. It is really not complicated. You're engaging that person in a conversation about health concerns, behavioral changes that you have noticed, and you're wanting to see if you can get them to talk about it and get them the help they obviously seem to need.
MODERATOR: This question was previously submitted.
Do you think that health campaigns have been strong and direct enough to make the link between alcohol/drug abuse and health implications to the general public?
Stacia Murphy: I am pleased with the number of health campaigns I see, but I don't think we have gone far enough. I say that because of the tremendous impact alcohol and drugs have on our society. We have created a culture of drinking and drug taking that still condones it and does not take seriously the harmful consequences that taking drugs can cause. You just look at alcohol. It releases aggression, impairs judgment, lowers inhibitions, and so when using that drug as well as any other drug, you are in an altered state, which puts you at risk. [This] does not even mean you have a dependence problem, but in an altered state, you are at risk for all kinds of harmful consequences. So I don't think we go deep and wide enough to really address this issue.
Brady: What continuing education on this topic is offered for physicians, nurses, pharmacists, and other health care professionals?
Stacia Murphy: Continuing ed is provided in university settings. Treatment centers around the country offer this-Betty Ford, Hazelton-but I think that, more importantly, this is not a continuing ed problem. I believe this should be part of the curriculum of all medical schools and should be a part of the orientation and education of persons going into the medical/health field-not as an afterthought, but as an important part of medical care in this country as any other disease requires and is given. I don't think we make a lot of progress if we do not see this problem as a part of the health challenges that we have in this country-such as cancer, diabetes, and hypertension-and provide the kind of information at the important places and environments that will allow us to take this a lot more seriously than we do.
Pat: How are organizations like NCADD increasing awareness of screening, interventions, and referral as a way to potentially reduce the number of alcohol-related accidents and injuries?
Stacia Murphy: One of the well-known facts is that we have 94 affiliates around the country, and many of them have been using brief interventions. Though they were not called that for many years, it is a part of their ongoing education in the communities and is done onsite when they go out and do educational settings in schools, hospitals, [and] communities. What we do plan to do, since we see this as being important, is to increase this activity and dissemination of information in communities so they are aware that the service exists. It was spoken extensively by our founder, Marty Mann, when she traveled around the country educating people and setting up local councils. We at the national office are making a commitment to ensuring there is a broader dissemination of this information as well as tools for which we think will be extremely effective in helping people, but also reducing stigma. I believe it will be one of the most effective tools we can use to mainstream addiction in this country.
MODERATOR: Our hour is coming to an end. Our host would like to make some closing remarks.
Stacia Murphy: First, it has been my pleasure to do this Web chat. The questions were very good, thoughtful, substantive, and demonstrate a real commitment of an interest out in the community to get a handle on this problem. I hope that my responses have been helpful, and I would like to reiterate something I said earlier. Brief interventions and screenings will begin to help us change the quality of health care in many of our communities around the country and it will significantly help us to reduce the stigma associated with a medical condition that we still have a tendency to address as a moral failing. I thank you for your thoughtfulness and your concern.
MODERATOR: Our hour has concluded. For more information, visit CSAT's Recovery Month Web site at http://www.recoverymonth.gov. Visit the multimedia area (http://www.recoverymonth.gov/2004/multimedia/) to view transcripts of Web chats and Webcasts on various topics from the 2004 Recovery Month season. You can also watch the Webcast that complements this Web chat at http://www.recoverymonth.gov/2004/multimedia/w.aspx?ID=246. Join us next month for our next show, Rethinking the Demographics of Addiction: Helping Older Adults Find Recovery.
We would like to thank our host Stacia Murphy, President, National Council on Alcoholism and Drug Dependence for her participation in this online event. We would also like to thank our participants for their questions. This transcript will be available shortly so that others may benefit from the dialogue.
The chat has now officially ended.
Flier for Webcast on 4/7/04 and Web chat on 4/21/04: Alcohol and Drug Use Screening, Intervention, and Referral: Changing the Nation's Approach to Comprehensive Healthcare
Download this flier and use it to help promote Road to Recovery multimedia events. You can use this as a handout at meetings, in information racks, as well as other public venues.
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