1. Taking drugs if you have ___ is BAD

2. Increased rates transmission Unprotected sex –Anal intercourse Group sex or multiple partners Internet partners Injection drug users High or intoxicated during sex Sex work Sex with serodiscordant partner

3. Substance Treatment in the USA Forty million Americans ages 12 and older (16 percent) only about 1 in 10 people receive treatment Addiction treatment programs are not adequately regulated

4. Substance abuse treatments Psychological Pharmacological Combination Public Health

5. FDA approved pharmacologic Alcohol –disulfram (antabuse) –Acamprosate –naltrexone Nicotine –Buproprion –Varenicline –nicotine replacement

6. FDA approved pharmacologic Opioid –Methadone maintenance –Buprenorphine –Naltrexone (PO/IM) –Buprenorphine/naltrexone

7. Psychology of Substance User Impulsive Fearless Incapable of delayed gratification Opposite of people who go into health care!!!

8. Traditional counseling Immediate and Total Abstinence Provider set goals Confrontational Dichotomis –Good (What I say) –Bad (What you do) Nearly Completely Ineffective!!

9. Transtheoretical Model Gradual Behavioral Change Conceptualized stages –Identify patient’s current stage –Strategies to advance the stage Understanding of backward and forward progress of change –Reduced provider frustration –Increased patient acceptance

10. Primary care Intervention

11. Primary Care Intervention toxicological and questionnaire screening brief motivational interviews active referrals a list of treatment providers follow-up booster phone call.

12. Risk Diagnosis Questionnaire Starting point for clinical interaction Simple self report instrument –13 questions –Clinically validated Rapidly elicits risk behavior without appearing judgmental Callahan 2007

13. http://www.motivationalinterview.org/ http://pubs.niaaa.nih.gov/publications/MATCHSeries3/ Project MATCH