Obama praises Washington substance-abuse sessions

A brief counseling session on substance abuse offered to trauma patients in emergency rooms has proved so successful in Washington state that it was cited as a model in President Obama's 2011 National Drug Control Strategy.

The 108-page strategy report, released Monday, focuses on prescription-medication abuse among high-risk groups such as military personnel, veterans, women and college students.

The Washington program cited as one of the models for the new national strategy began at Harborview Medical Center in the early 1990s with the work of Dr. Larry Gentilello, then Harborview's associate director of trauma intensive care.

Working with other hospital leaders, Gentilello found that a brief counseling session for those who came into the ER with trauma injuries greatly reduced the chances they would return with new injuries.

A few obstacles were in the way — not the least, a state law allowing insurers to refuse to pay charges for patients injured while under the influence. Lawmakers repealed that provision in 2004, and medical providers have since helped refine how best to conduct the "brief intervention" sessions, which several studies have showed work well for patients and save money.

Nine hospitals in six counties in the state now use the program, called Screening, Brief Intervention and Referral to Treatment (SBIRT), in their emergency departments.

Dr. Richard Ries, director of the division of addictions at the University of Washington and Harborview, said the ER interventions are semi-structured but very low-key.

For example, a patient might come in with a broken leg from an accident. An intervention worker would seek the patient's cooperation, ask some low-stress questions to find out whether alcohol or drugs might have been involved, and if so, whether the patient is motivated to do something about it.

"They are going to be very careful about being too pushy," Ries said.

The president's new strategy was released by the Office of National Drug Control Policy, whose director, Gil Kerlikowske, is a former Seattle police chief. Kerlikowske said the policy will expand its reach from last year while remaining focused on prevention and treatment.

The 2011 strategy will encourage support for special courts designed for veterans with mental illness and substance issues, he said.

Ramping up efforts to reduce drugged driving will be another priority, through public-awareness campaigns, advancing testing methods for driving under the influence and helping states lower the legal burden of proof for impaired-driving convictions.

The report noted the importance of early intervention — such as Washington's program.

As part of that program, if a patient is what Ries calls a "contemplator" — someone thinking along the lines of "You know, I kind of wondered about whether I drank too much" — or is actively wanting to change, the counselor would supply information and treatment referrals.

Studies in Washington showed that patients who got the brief intervention were significantly more likely to enter a chemical-dependency treatment program within the year than those who didn't get the counseling. Data also showed lower death rates and medical costs for working-age disabled Medicaid patients compared with similar patients who didn't get the counseling.

The trauma or crisis can provide a turning point for patients, say doctors who see patients with substance-abuse problems.

Lying on a gurney, staring at the ceiling and feeling some pain can be a catalyst for these patients to change their lives, doctors say, if they're given information and a gentle nudge.

Material from Bloomberg News was included in this report.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com