Early Intervention

Early intervention is not a strategy listed on the Institute of Medicine’s (IOM) Continuum of Care; however, it edges between prevention and treatment and is often used in both areas of service. In the IOM prevention category, early intervention is focused on indicated populations — those who have initiated some form of substance use. In the IOM treatment category, it is associated with case identification. In bridging the two IOM categories, early intervention is intended to either prevent the onset of use of other substances and the need for treatment or as a referral method to engage people in treatment. By definition, within the prevention domain, intervention is reactive to specific behavior, including early signs of use, such as experimentation. A subset of prevention education programming targets indicated populations and the delivery is often provided in school systems. However, within the medical system, there is room for, and a need for, more universal screening. The increased adoption of universal screening serves both to reduce stigma and to increase the number of people who could benefit from early intervention or treatment.

There are eight strategies in the early intervention articles. The first strategy covers screening and early intervention generally and the second addresses the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT), a widely used strategy. The last two strategies contained in this section are directed at screening for two specific objectives — opioid use and improved maternity care.

Below are more information about what is covered in each:

• "Expand Early Intervention Strategies" defines the intervention process generally and as a bridge between prevention and treatment. It highlights different types of methods which health providers and schools can use.
• "Expand SBIRT Program" unpacks the three elements within the SBIRT approach — The S of Screening, the B-I of Brief Intervention, and the R-T of Referral to Treatment.
• "Improve and Expand Screening and Testing for Misuse and Dependency" covers elements associated with screening which are specific to opioid use, such as practices associated with treating chronic pain.
• "Expand Motivational Interviewing" describes an early intevention approach that incorporates priniciples of harm reduction, which builds upon a desire to make positive changes by inspiring incremental steps to behavior change. As a positive psychology model, it is person-driven and empowering, which builds assets to address stigma and other challenges associated with substance use.
• "Expand Law Enforcement and First Responder Assisted Diversion" defines the difference between diversion and deflection approaches and provides examples of the benefits of both types of programs for law enforcement and first responders.
• "Expand Community Service Alternatives to Incarceration" delineates four major types of incarceration alternatives and outlines five benefits of these alternatives as more than half of those in U.S. prisons and jails meet the criteria for substance use disorders.
• "Adopt Universal Screening for Pregnant People" delineates a variety of effects of substance use during pregnancy and advocates for universal screening.
• "Improve Identification and Data Collection for NAS" details the benefits of system-level changes, such as universal screening and a national NAS data registry.