Klimas Jan, Muench John, Wiest Katharina, Croff Raina, Rieckman Traci, McCarty Dennis
a Visiting Research Scholar, Department of Public Health and Preventive Medicine , Oregon Health and Science University (OHSU) , Portland , OR.
J Psychoactive Drugs. 2015 Jan-Mar;47(1):65-70. doi: 10.1080/02791072.2014.991859.
Problem alcohol use is associated with adverse health and economic outcomes, especially among people in opioid agonist treatment. Screening, brief intervention, and referral to treatment (SBIRT) are effective in reducing alcohol use; however, issues involved in SBIRT implementation among opioid agonist patients are unknown. To assess identification and treatment of alcohol use disorders, we reviewed clinical records of opioid agonist patients screened for an alcohol use disorder in a primary care clinic (n = 208) and in an opioid treatment program (n = 204) over a two-year period. In the primary care clinic, 193 (93%) buprenorphine patients completed an annual alcohol screening and six (3%) had elevated AUDIT scores. In the opioid treatment program, an alcohol abuse or dependence diagnosis was recorded for 54 (27%) methadone patients. Practitioner focus groups were completed in the primary care (n = 4 physicians) and the opioid treatment program (n = 11 counselors) to assess experience with and attitudes towards screening opioid agonist patients for alcohol use disorders. Focus groups suggested that organizational, structural, provider, patient, and community variables hindered or fostered alcohol screening. Alcohol screening is feasible among opioid agonist patients. Effective implementation, however, requires physician training and systematic changes in workflow.
问题性饮酒与不良健康和经济后果相关，尤其是在接受阿片类激动剂治疗的人群中。筛查、简短干预及转介治疗（SBIRT）在减少饮酒方面有效；然而，在阿片类激动剂治疗患者中实施SBIRT所涉及的问题尚不清楚。为评估酒精使用障碍的识别与治疗情况，我们回顾了在两年期间于一家初级保健诊所（n = 208）和一个阿片类治疗项目（n = 204）中接受酒精使用障碍筛查的阿片类激动剂治疗患者的临床记录。在初级保健诊所，193名（93%）丁丙诺啡患者完成了年度酒精筛查，6名（3%）患者的酒精使用障碍识别测试（AUDIT）分数升高。在阿片类治疗项目中，54名（27%）美沙酮患者被记录有酒精滥用或依赖诊断。在初级保健诊所（4名医生）和阿片类治疗项目（11名咨询师）中完成了从业者焦点小组访谈，以评估对阿片类激动剂治疗患者进行酒精使用障碍筛查的经验和态度。焦点小组访谈表明，组织、结构、提供者、患者及社区变量会阻碍或促进酒精筛查。对阿片类激动剂治疗患者进行酒精筛查是可行的。然而，有效的实施需要医生培训及工作流程的系统性改变。
