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APHA Scientific Session and Event Listing

Recorded presentation

Edward Bernstein, MD and Judith Bernstein, PhD, RNC. Youth Alcohol Prevention Center, Boston University School of Public Health, 715 Albany St., Boston, MA 02115, 617-534-3453, ebernste@bu.edu

Substance abuse (SA) is a chronic disease. Although treatment success is comparable to outcomes for diabetes and hypertension, US SA policy focuses on acute events (i.e., overdose), and lacks a HP2010 objective comparable to the one for diabetes diagnosis (increase the number diagnoses from 68% to 80%). Parity, quality and access to SA services must be addressed. There is an enormous contrast between what patients need (universal screening, substance abuse treatment services, mental health services and social supports) and what they get. SA screening is not commonly practiced even among those who should be easily targeted. For example, among 1175 persons with documented heroin or cocaine use recruited from Boston Medical Center (BMC), only 34% had any medical record mention of a drug-related diagnosis during a two-year period. Despite a Massachusetts treatment gap of 39,000+ persons with clinically severe problems but no treatment, the state cut spending for SA treatment from FY '01 to ‘03 by $17.7 million. Medicaid spending decreased by 6% from '02 to '03, and a third of existing detox beds were lost. A strategic solution was the translation of best practices. Project Link, a RCT of a peer model program for screening ED patients, motivating them and linking them to SA services, has been shown to be cost-effective, independent of referrals to the treatment system. Brief intervention for SA provides an opportunity to meet people with drug problems ‘where they are at' and can be implemented in a variety of medical settings.

Learning Objectives:

• Describe lack of access to substance abuse and mental health treatment as a human rights issue;
• Identify racial and ethnic disparities within access issues; and
• List the elements in peer delivered brief motivational interventions that protect the human rights of patients with a substance abuse problem.

Keywords: Screening, Intervention

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation