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Brief intervention for unhealthy alcohol and other drug use

Richard Saitz, MD, MPH, FACP, DFASAM
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Unhealthy alcohol and other drug use are among the most common causes of preventable death [1]. “Unhealthy use” describes use of amounts that risk adverse consequences, have resulted in consequences, or meet DSM-5 criteria for a substance use disorder [2]. Despite their frequent presentation in primary care, unhealthy alcohol and other drug use often go unrecognized. The combination of screening all adult primary care patients to identify individuals with unhealthy use and a brief counseling intervention has been proposed as a population-wide, preventive intervention in primary care [3]. Clinical trials support the use of screening and brief intervention for unhealthy alcohol use for adults.

The DSM-IV-TR diagnoses, substance abuse and substance dependence, were replaced by one diagnosis, substance use disorder, in DSM-5 [2]. Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to substance use disorder, moderate to severe subtype, while substance abuse is similar to the mild subtype.

This topic reviews treatment with brief intervention of adult primary care patients identified by screening to have unhealthy alcohol or other drug use. Screening for unhealthy alcohol and other drug use is described separately. The epidemiology, clinical manifestations, and diagnosis of substance use disorder are described separately as are pharmacotherapy and psychosocial interventions for the disorders. (See "Screening for unhealthy use of alcohol and other drugs in primary care" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Pharmacotherapy for opioid use disorder" and "Cannabis use and disorder: Clinical manifestations, course, assessment, and diagnosis".)


The goals of a brief intervention for people without a moderate to severe disorder include either reduction of use or abstinence, as well as change in related behaviors (eg, avoiding bars). The goals will depend on patient readiness and negotiation. Ideal goals are described below:

Unhealthy alcohol use — “Unhealthy use” refers to use that can result in adverse health consequences, from use that risks adverse consequences, to use with consequences that do not reach a diagnostic threshold for substance use disorder (SUD), to use that meets DSM-5 criteria for an SUD. (See "Screening for unhealthy use of alcohol and other drugs in primary care", section on 'Unhealthy alcohol or drug use'.)


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Literature review current through: Jul 2017. | This topic last updated: Aug 16, 2017.
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