Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
A Guide to Substance
Abuse Services for
Primary Care
Clinicians
Treatment Improvement Protocol (TIP) Series
24
,A Guide to
Substance Abuse
Services for
Primary Care
Clinicians
Treatment Improvement Protocol (TIP) Series
24
Eleanor Sullivan, Ph.D., R.N., F.A.A.N.
Michael Fleming, M.D., M.P.H.
Consensus Panel Co-Chairs
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857
,This publication is part of the Substance Abuse I.C.A.D.C., served as the CSAT government
Prevention and Treatment Block Grant technical project officer. Paddy Cook, Constance Grant
assistance program. All material appearing in Gartner, M.S.W., Lise Markl, Randi Henderson,
this volume except that taken directly from Margaret K. Brooks, Esq., Donald Wesson, M.D.,
copyrighted sources is in the public domain and Mary Lou Dogoloff, Virginia Vitzthum, and
may be reproduced or copied without Elizabeth Hayes served as writers. Special
permission from the Substance Abuse and thanks to Daniel Vinson, M.D., M.S.H.P., Mim J.
Mental Health Services Administration’s Landry, Mary Smolenski, C.R.N.P., Ed.D.,
(SAMHSA) Center for Substance Abuse MaryLou Leonard, Pamela Nicholson, Annie
Treatment (CSAT) or the authors. Citation of Thornton, Jack Rhode, Cecil Gross, Niyati
the source is appreciated. Do not reproduce or Pandya, and Wendy Carter for their
distribute this publication for a fee without considerable contributions to this document.
specific, written authorization from the Office of
The opinions expressed herein are the views of
Communications, Substance Abuse and Mental
the Consensus Panel members and do not reflect
Health Services Administration, U.S. Department
the official position of CSAT, SAMHSA, or
of Health and Human Services (DHHS). Copies
DHHS. No official support or endorsement of
may be obtained free of charge from the
CSAT, SAMHSA, or DHHS for these opinions or
National Clearinghouse for Alcohol and Drug
for particular instruments or software that may
Information (NCADI), (800) 729-6686 or (301)
be described in this document is intended or
468-2600; TDD (for hearing impaired), (800) 487-
should be inferred. The guidelines proffered in
4889, or www.health.org.
this document should not be considered as
This publication was written under contract substitutes for individualized client care and
number ADM 270-95-0013 from the Center for treatment decisions.
Substance Abuse Treatment of the Substance
Abuse and Mental Health Services DHHS Publication No. (SMA) 08-4075
Administration. Sandra Clunies, M.S., Printed 1997
Reprinted 2003, 2005, and 2008
, Contents
What Is a TIP?.......................................................................................................................................................... vii
Editorial Advisory Board........................................................................................................................................ ix
Consensus Panel ...................................................................................................................................................... xi
Foreword.................................................................................................................................................................. xiii
Executive Summary and Recommendations ..................................................................................................... xv
General Recommendations ............................................................................................................................... xvi
The Primary Care Clinician’s Opportunity.................................................................................................... xvii
Chapter 1—Substance Abuse and Primary Care..................................................................................................1
Alcohol Use Among Primary Care Patients........................................................................................................3
Other Drug Use Among Primary Care Patients .................................................................................................6
Understanding Substance Use Disorders in a Primary Care Context .............................................................8
Approach to Substance Abuse for Primary Care Clinicians.............................................................................9
Chapter 2—Screening for Substance Use Disorders.........................................................................................13
The Goal of Substance Abuse Screening ...........................................................................................................13
Factors To Consider in Selecting a Screening Instrument...............................................................................14
Screening Instruments .........................................................................................................................................15
Matching Screens With Patients .........................................................................................................................18
Screening Techniques...........................................................................................................................................21
Responding to Screens .........................................................................................................................................23
Chapter 3—Brief Intervention...............................................................................................................................25
Guidelines for Clinician Involvement in the Care of Substance-Abusing Patients .....................................25
Brief Intervention..................................................................................................................................................26
iii
Center for Substance Abuse Treatment
A Guide to Substance
Abuse Services for
Primary Care
Clinicians
Treatment Improvement Protocol (TIP) Series
24
,A Guide to
Substance Abuse
Services for
Primary Care
Clinicians
Treatment Improvement Protocol (TIP) Series
24
Eleanor Sullivan, Ph.D., R.N., F.A.A.N.
Michael Fleming, M.D., M.P.H.
Consensus Panel Co-Chairs
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
1 Choke Cherry Road
Rockville, MD 20857
,This publication is part of the Substance Abuse I.C.A.D.C., served as the CSAT government
Prevention and Treatment Block Grant technical project officer. Paddy Cook, Constance Grant
assistance program. All material appearing in Gartner, M.S.W., Lise Markl, Randi Henderson,
this volume except that taken directly from Margaret K. Brooks, Esq., Donald Wesson, M.D.,
copyrighted sources is in the public domain and Mary Lou Dogoloff, Virginia Vitzthum, and
may be reproduced or copied without Elizabeth Hayes served as writers. Special
permission from the Substance Abuse and thanks to Daniel Vinson, M.D., M.S.H.P., Mim J.
Mental Health Services Administration’s Landry, Mary Smolenski, C.R.N.P., Ed.D.,
(SAMHSA) Center for Substance Abuse MaryLou Leonard, Pamela Nicholson, Annie
Treatment (CSAT) or the authors. Citation of Thornton, Jack Rhode, Cecil Gross, Niyati
the source is appreciated. Do not reproduce or Pandya, and Wendy Carter for their
distribute this publication for a fee without considerable contributions to this document.
specific, written authorization from the Office of
The opinions expressed herein are the views of
Communications, Substance Abuse and Mental
the Consensus Panel members and do not reflect
Health Services Administration, U.S. Department
the official position of CSAT, SAMHSA, or
of Health and Human Services (DHHS). Copies
DHHS. No official support or endorsement of
may be obtained free of charge from the
CSAT, SAMHSA, or DHHS for these opinions or
National Clearinghouse for Alcohol and Drug
for particular instruments or software that may
Information (NCADI), (800) 729-6686 or (301)
be described in this document is intended or
468-2600; TDD (for hearing impaired), (800) 487-
should be inferred. The guidelines proffered in
4889, or www.health.org.
this document should not be considered as
This publication was written under contract substitutes for individualized client care and
number ADM 270-95-0013 from the Center for treatment decisions.
Substance Abuse Treatment of the Substance
Abuse and Mental Health Services DHHS Publication No. (SMA) 08-4075
Administration. Sandra Clunies, M.S., Printed 1997
Reprinted 2003, 2005, and 2008
, Contents
What Is a TIP?.......................................................................................................................................................... vii
Editorial Advisory Board........................................................................................................................................ ix
Consensus Panel ...................................................................................................................................................... xi
Foreword.................................................................................................................................................................. xiii
Executive Summary and Recommendations ..................................................................................................... xv
General Recommendations ............................................................................................................................... xvi
The Primary Care Clinician’s Opportunity.................................................................................................... xvii
Chapter 1—Substance Abuse and Primary Care..................................................................................................1
Alcohol Use Among Primary Care Patients........................................................................................................3
Other Drug Use Among Primary Care Patients .................................................................................................6
Understanding Substance Use Disorders in a Primary Care Context .............................................................8
Approach to Substance Abuse for Primary Care Clinicians.............................................................................9
Chapter 2—Screening for Substance Use Disorders.........................................................................................13
The Goal of Substance Abuse Screening ...........................................................................................................13
Factors To Consider in Selecting a Screening Instrument...............................................................................14
Screening Instruments .........................................................................................................................................15
Matching Screens With Patients .........................................................................................................................18
Screening Techniques...........................................................................................................................................21
Responding to Screens .........................................................................................................................................23
Chapter 3—Brief Intervention...............................................................................................................................25
Guidelines for Clinician Involvement in the Care of Substance-Abusing Patients .....................................25
Brief Intervention..................................................................................................................................................26
iii
