People Change

1
People Change
2
Risk and Exposure
3
At-Risk Substance Use
Alcohol
Per Week
Any Occ
Men
Women
65yo
12 oz beer 5-6 oz wine 1-1.5 oz liquor
Illicit Drugs - any use
Prescription Drugs - any misuse
4
Substance Use Continuum
LOWRISKUSE
AT-RISKUSE
ABST
ABUSE
DEP
Use Consequences Repetition Loss of control,
preoccupation, compulsivity,/- physical
dependence
- - -
- -
-/ -


5
Continuum of CareClinically-appropriate
interventions in medical settings
Generalist (Medical care)
Specialist
S c r e e n i n g
Non-Drug Users, Non-Drinkers, Low Risk Drinkers
Treatment
At-Risk Drug Users Drinkers
High Risk Drug Users Drinkers
Dependent Users
6- Mo. F/U
Referral
Brief Treatment
Brief Intervention Boosters
Prevention/Education
6
Substance Use and ProblemsNot the Usual Suspects

• Persons with substance use dependency experience
  the most harm
• But there are many more persons who use
  substances in a manner that causes harm, but are
  not dependent (non-dependent users)

7
Non-Dependent Users

• They can reduce their substance use through brief
  intervention
• They do not perceive themselves as having a
  problem
• Nor do most medical providers, who are more
  likely to address dependent users

8
Problem Public Health

• Substance abuse is rarely diagnosed, treated
  or monitored by medical staff in any setting
  ---trauma, emergency or primary care

9
Top 10 Leading Causes of Death in the United
States for 2001, by Age Group (NHTSA, 2004)