The doctor will see you now…

Dr Who - Rooners Toy Photography

Perhaps because of our work on the Street Talk project, which looked to see whether youth workers could use an evidence based screening tool and Motivational Interviewing to reduce substance misuse, I’ve noticed a lot more about the use of brief interventions.

Quite a lot of what I’ve been hearing and reading about is focused on getting the health care system to take up and use brief interventions.  Whether that’s GPs or in Emergency Departments there seems to be a strong enough evidence base for using this approach, particularly with adults.

Up until today I’ve thought that this was unlikely to be an effective way of reaching young people, believing that they’re much less likely to us GP services in particular than adults.  But when I read this briefing from CADCA, an American organisation that helps to build community coalitions to prevent substance misuse, I thought I should check my assumptions.

CADCA come at it from the position that the American Academy of Pediatrics recommend screening teens for substance use and say that while that doesn’t always happen where it does they can demonstrate positive outcomes.  They say:

When health care practitioners did ask students to report on their drinking, tobacco, and other drug use, they were more likely to share information on the associated health risks and to recommended limiting or abstaining from those behaviors. Similar to the findings related to drinking, students who reported higher levels of tobacco and other drug use were more likely to be provided with this information from their practitioner.

So this sent me off to try to find out if my assumptions about accessing healthcare were based in reality, and it turns out that they probably aren’t.

The Health and Social Care Information Centre have data on the trends in consultation rates in General Practice which suggest that teenagers are only marginally less likely to go to their GP as many other age groups.

Consultation rate per person year in 2008 by sex and age

So next I turned to what the General Medical Council have to say in their advice to doctors on what good medical practice entails for treating 0-18 year olds.  Substance misuse is mentioned, but only in the context of sharing information with other agencies about using drugs or alcohol to influence young people to “engage in sexual activity when they otherwise would not.”

The BMA in their report Drugs of Dependence are reasonably positive about the use of brief interventions for young people making clear that while the evidence is not yet comprehensive:

Some authors have shown positive impact of brief interventions for use of individual drugs in young people, while one UK study showed these benefits simultaneously derived across   number of different drugs, which may also have useful implications for the busy primary care or emergency department setting.

And later pointing out:

Brief interventions are intended to prevent or reduce drug use, through getting patients to think differently about drug use and possible treatment. These interventions aim to increase the motivation of drug users to change their behaviour. The spectrum of advice ranges from stopping drug use to using drugs in ways that are less risky.

There may be other guidance out there that I’ve not yet seen which is more explicit in encouraging GPs to screen and offer brief interventions to young people, but if not then perhaps this is something we can think about developing.

PS – I know that the SIPS Junior programme is developing an evidence base for these types of intervention in Emergency Departments, which I’m sure will be very helpful, and that there has been more work done on alcohol specific brief interventions in Scotland.


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