Opening Plenary Speaker: Interventions Require “Highest Level of Evidence”

Richard Saitz, M.D.: "What I'm really in favor of is practice that is based in science, but we need to know what that science is in order to then base practice on it."

Richard Saitz, M.D.: “What I’m really in favor of is practice that is based in science, but we need to know what that science is in order to then base practice on it.”

Ask Richard Saitz, M.D., M.P.H., FACP, FASAM, if he is for or against screening and brief intervention for alcohol and drug disorders, and he’d call your question silly.

“If anything, I have a bias in favor of these practices having value. What I’m really in favor of is practice that is based in science, but we need to know what that science is in order to then base practice on it,” says Dr. Saitz, a Primary Care Internist who has been training primary care physicians to conduct such screenings for decades.

Dr. Saitz gave the R. Brinkley Smithers Distinguished Scientist Lecture Award, “Screening and Brief Intervention for Unhealthy Alcohol and Other Drug Use: Where the Evidence Is…and Isn’t” during Friday morning’s Opening Plenary.

Screening and brief intervention has been promoted widely for a range of substances, severity, and settings, and he looked at the evidence as a means to inform practice.

Dr. Saitz is a Professor of Medicine and Epidemiology at Boston University Schools of Medicine and Public Health; Director of the Clinical Addiction, Research, and Education Unit at Boston Medical Center; and Director of the Division of Clinical Research Resources, Clinical Translational Science Institute, and Associate Director of the Office of Clinical Research at Boston University Medical Center.

Dr. Saitz says 10 common arguments are evidence for the efficacy of screening and brief intervention (SBI) or screening, brief intervention and referral to treatment (SBIRT): 10. Unhealthy alcohol use is a common problem. 9. It is the cause of health problems. 8. It often goes unrecognized. 7. Most people don’t receive help. 6. We aren’t helping people with problems before they develop. 5. SBI seems unlikely to be harmful. 4. SBI should work because there is a teachable moment in health care. 3. “Treatment” works. 2. SBI is relatively inexpensive, and we can do it. 1. What should we do? Nothing?

“SBI is a population-wide service,” he says. “We need the highest level of evidence—things like systematic reviews of randomized trials. We also need evidence for patient characteristics or settings that we suspect might alter effectiveness.”

According to Dr. Saitz, too often physicians seek research that supports what they think. “We need to be careful,” he says, “but I’m not naïve to think that evidence is the only thing that we need to practice. It’s necessary, but then we have to add more information.”

SBI has efficacy, he says, for nondependent unhealthy alcohol use when there are multiple contacts in the primary care setting, but its effectiveness is unclear for others, such as those using other drugs, seeing someone outside primary care, having single or very brief contact, and drinking heavily.

Inroads are being made. Substantial national service delivery and training efforts have been instituted; billing codes for SBI have been added; accreditation has been put in place as a result of data from trauma centers; and performance measures tied to incentives are now being developed in ambulatory settings, general health settings and hospitals.

Three leaders from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), and U.S. Department of Health & Human Services (USDHHS) also provided updates from their organizations: Kenneth R. Warren, Ph.D., Acting Director of NIAAA; Wilson M. Compton, M.D., M.P.E., Director of the Division of Epidemiology, Services and Prevention Research at the NIDA, and RADM Peter J. Delany, Ph.D., LCSW-C, Director of the Center for Substance Abuse Treatment, Substance Abuse Mental Health Services Administration, USDHHS.

Question of the Day: What Did You Find Most Interesting About Friday’s Opening Scientific Plenary Session? 

Winsberg“It’s just fascinating to see how many people on a national level are working in addiction from so many different angles. While I can’t point to one specific thing from the session, it was incredible to hear all the things different addiction specialists are doing, and it’s great to be a part of it.”

Mark Winsberg, M.D.
Rochester, N.Y.

Fuller“The lecture on the screening and brief invention was wonderful, and for Dr. Saitz to highlight that showed its importance. It was useful that he described the difference between screening and brief intervention and the SBIRT [Substance Abuse and Mental Health Services Administration’s Screening, Brief Intervention, and Referral to Treatment] initiative.”

Elizabeth Fuller, M.S.
Sandpoint, Idaho

Johnson_Farris“I am excited about the changes in policy. We are looking more scientifically at the disease of addiction and looking at outcomes so that we become more scientifically based rather than empirically based.”

Farris Johnson, M.D.
Athens, Ga.

Boone“The screening and brief invention talk by Dr. Saitz really made me realize that we take so many things for granted, and we really don’t have the scientific basis to know whether it is true or not. It makes me want to re-examine the things I believe.”

Daniel Boone, M.D.
Hunt, Texas

Vinson“I have been following Dr. Saitz’ work for some time and appreciate his rigorous attention to what the science actually does say. My first reaction is that it makes my depression about this worse to think that we really don’t know the scientific base.”

Daniel Vinson, M.D.
Columbia, Mo.

Casoy“This session showed all the effort and updates going on about how scientific evidence is being properly integrated in all sectors from academia to government to industry. It is very important.”

Julio Casoy, M.D.
Waltham, Mass