US doctors get new helpline to deal with patients’ substance misuse

BMJ 2011; 342 doi: (Published 18 April 2011) Cite this as: BMJ 2011;342:d2520
  1. Janice Hopkins Tanne
  1. 1New York

The US National Institute on Drug Abuse has set up a free “warmline” to help primary care providers deal with their patients’ substance misuse problems.

The institute, part of the National Institutes of Health, and the American Society of Addiction Medicine, which coordinates the service, calls the service a “warmline” because it provides help within 24 hours rather than immediately, as hotlines do.

Substance misuse is a big problem in the United States. In 2009 about 22.5 million people aged 12 or older, or nearly 9% of this age group, were misusing or were dependent on legal or illegal substances, such as prescription and illegal drugs, alcohol, and tobacco, the Department of Health and Human Services’ national survey on drug use and health found.

The service, called the physician clinical support system for primary care, links primary care providers with experts in screening, treatment, and referral for adult patients who have problems with misuse of alcohol, drugs, or tobacco.

Nora Volkow, the institute’s director, said that the screening tool was a user friendly, interactive means to help providers screen patients for drug misuse.

The primary care doctor registers with the service by telephone or through the internet ( Within 24 hours the doctor is put in touch with an expert who can offer advice, help, and resources for dealing with the patient. The mentoring relationship can continue as long as the primary care provider wants.

Shirley Stimson, a spokeswoman for the National Institute on Drug Abuse, told the BMJ that the service was based on a successful programme set up to help healthcare providers use buprenorphine to treat patients with an opiate addiction.

She said that the new service builds on NIDAMED, the institute’s first comprehensive outreach programme to doctors. This programme, launched two years ago, provides health professionals with tools and resources to screen patients for substance misuse problems. It emphasises the importance of the patient-doctor relationship in identifying unhealthy behaviours before they become dangerous. NIDAMED also provides a substance abuse curriculum for medical students, junior doctors, and medical faculty members.

The institute has also launched a quick screening tool patients can use to identify substance misuse. A computer screen asks the patient, “In the past year, how many times have you used the following: alcohol (more than four or five drinks in a day for women or men, respectively); tobacco products; prescription drugs for nonmedical reasons; and illegal drugs?”

If the patient answers yes their doctor can use the institute’s full screening tool to investigate the patient’s use of the substance and to access guidance for treatment.


Cite this as: BMJ 2011;342:d2520

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