22 Apr 08 10:18 | PeterFriedmann said regarding ScreeningAndBriefIntervention:
SBI is an Evidence-Based Practice That Will Help Clinicians Overcome Their Reluctance To Address SUDs
As part of its quality mission, JCAHO should strongly support dissemination of SBI for substance use disorders (SUDs) into healthcare settings. Dr. Saitz has succinctly summarized the rationale, and I concur with his points. I would add that many physicians in healthcare settings are reluctant to address SUDs because of pessimism about prognosis that results directly from the lack of routine screening. Clinicians often believe that certain conditions, e.g. SUDs, have a poorer prognosis than research suggests because in clinical settings they see a prevalence sample - those currently with disease (Cohen & Cohen Arch Gen Psych 1984). The probability that a case will appear in a prevalence sample is proportional to its duration, thus clinicians' experience is biased toward seeing cases of long duration and greater intractability. Furthermore, since most clinical training occurs in hospital settings (inpatient or emergency departments), at an impressionable stage young physicians are exposed most to severe cases and relapsers (the so-called “frequent flyers”). Patients who get better generally do not return to these settings, or if they do, they do not offer their past history of a SUD unless they are directly and nonjudgmentally asked for fear of being stigmatized. This situation produces a cognitive bias (availability bias) in which severe cases inform the typical clinician's perceived prognosis of addiction. The lack of routine SBI means that only clinically apparent cases are detected (i.e. advanced disease). This phenomenon biases toward perception of poor prognosis. Using an example of cervical cancer, if we did not screen with Pap smear and intervene early, but only detected clinically-apparent Stage III or IV disease we would naturally conclude that cervical cancer has a poor prognosis. The widespread dissemination of SBI in healthcare settings has the promise to allow clinicians to identify patients with SUDs at all stages and see the successes. This effect would reduce pessimism and make clinicians more likely to address SUDs with their patients. This potential effect on clinicians attitudes and practices has enormous implications for the quality of care for SUDs and related disorders.