Expand Early Intervention Strategies

Introductory Paragraph

Early intervention may be considered the bridge between prevention and treatment services. The goals of early intervention are to reduce the harms associated with substance use, to reduce risk behaviors before they lead to injury, to improve health and social function, and to prevent progression to a disorder. Early intervention consists of providing information about substance use risks, normal or safe levels of use, and strategies to quit or cut down on use. Early intervention can facilitate patient initiation and engagement in treatment. For individuals with more serious substance misuse, intervention can serve as a mechanism to engage them into treatment.

Early intervention can occur when a person is not seeking treatment for a substance use disorder. For example, intervention services can be provided when an individual presents for another condition within a medical or social services context. Community intervention can involve multi-sector partnerships and community leaders and members. Intervention services may be initiated in community settings such as clinics, schools, jails, workplaces, emergency rooms, social services, senior citizen centers, or campuses.

Key Information

The 2018 National Survey on Drug Use and Health reported on the continued use of substances across the U.S.

• In 2018, approximately 20.3 million people aged 12 or older had a substance use disorder (SUD) related to their use of alcohol or illicit drugs in the past year, including 14.8 million people who had an alcohol use disorder and 8.1 million people who had an illicit drug use disorder.

• The most common illicit drug use disorder was marijuana use disorder (4.4 million people). Within an estimated 2.0 million people with opioid use disorder, 1.7 million had a prescription pain reliever use disorder and 0.5 million had a heroin use disorder.

At-Risk Populations Who Should Receive Early Intervention

Early intervention differs from prevention efforts. Prevention targets the general population with a universal need to understand the risks of substance use disorder. Early intervention strategies focus on those who have just started experimenting or using substances. Likewise, certain individuals, age groups, or families have more risk factors. While the entire community can benefit from early intervention resources, there are populations which have been identified at a higher risk for substance use.

• Adolescents or adults at risk or who show signs of substance use or are experimenting with substances.
• Individuals who have suffered childhood trauma.
• Binge drinkers: In 2018, about 67.1 million Americans aged 12 or older were binge drinking in the past month, and about 1.2 million adolescents aged 12 to 17 reported binge drinking in the previous month.
• People who use substances while driving.
• Expectant mothers who use substances while pregnant.
• Senior citizens.
• Ethnic minorities who may not be receiving culturally relevant care.
• Individuals with co-occurring substance use and mental disorders.
• Homeless population.

Components of Early Intervention

• Screening, Brief Intervention and Referral to Treatment, or SBIRT.
• Screen for risk factors for substance use such as childhood trauma and ACEs.
• Reduce Stigma in Community.
• Pre-Arrest Diversion Programs.
• “Reachable Moments,” such as providing patient education when prescribing opioids for chronic pain.
• Utilize Prescription Drug Monitoring Programs (PDMPs) which are state-controlled electronic databases to track controlled substance prescriptions within a state. PDMPs also provide prescribing and patient behavior information to prescribers and other authorities who are granted access to the information.

Relevant Research

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. The following is taken from the section titled Importance of Prevention, Screening, Early Intervention, and Treatment: “Currently, few primary care providers screen for or treat substance use disorders. Additionally, it is common for people who misuse opioids to misuse other substances or to have multiple substance use disorders, childhood trauma, or co-occurring physical and mental disorders. This highlights the need for full clinical assessment and comprehensive treatment services that are matched to an individual’s needs.”

HHS Office of the Assistant Secretary for Planning and Evaluation published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." It includes information on screening and early intervention.

Community Catalyst: Expanding Substance Use Prevention and Early Intervention in Schools This online toolkit provides information and resources to mobilize communities to expand school-based services for substance use prevention and early intervention. It describes a set of tools for early intervention and strategies to implement and fund early intervention in schools and clinics.

The Police, Treatment, and Community Collaborative (PTACC) is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. Its mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. Their focus educates law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services that can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. Pre-arrest diversion provides law enforcement with an effective alternative through referral to community-based intervention.

Mental Health During Global Conflict. People across the world may find they struggle with their mental health during times of global conflict. This does not affect only those in active combat. These are humanitarian crises, impacting an entire community or region and beyond. This page addresses how mental health might be affected by major conflict events like war, terrorism, geopolitical tension, territorial disputes, and political instability.

Promising Practices

OhioSTART (Sobriety, Treatment, and Reducing Trauma)

The state of Ohio developed OhioSTART to help families dealing with substance use disorder avoid disruptive and costly out-of-home placements and to help keep families together. For parents who have lost custody of their children to foster care or another government-approved living arrangement,  the goal is to ultimately reunify and stabilize these families. The intervention program provides specialized victim services, such as intensive trauma counseling, to children who have suffered victimization with substance use of a parent being the primary risk factor. Additionally, the program assists those parents of those children with mentors who have firsthand experience with substance use disorder.

Project Engage - Delaware

ChristianaCare is a Delaware-based health system, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. Project Engage was designed to help hospital patients who may be struggling with alcohol or drug use. It provides early intervention and referrals to substance use disorder treatment. Project Engage integrates peers in recovery, who are called engagement specialists, into the clinical setting in the hospital to meet with patients at their bedside about their alcohol or drug use. Project Engage collaborates with hospital staff to identify and connect patients with community-based substance use disorder treatment programs and other resources. Project Engage has also formed a partnership with the construction industry to offer recovery support to employees from participating construction companies.

Project IMPACT

Oregon Health and Science University (OHSU) and its partners conducted a needs assessment to map patient and system needs to critical intervention components and develop a business case. Using their findings, the group identified issues address in addiction treatment and intervention:

• Hospitalization is a “reachable” moment: A survey of hospitalized adults conducted by OHSU revealed that 68% of high-risk drug users reported wanting to cut back or quit. Many patients also reported that they wanted to initiate medication-assisted treatment (MAT) while hospitalized, and that they wanted providers that understand addiction.

• Lack of usual pathways to treatment: OHSU Hospital lacked established referral pathways to outpatient addiction care, and wait times were often long.

Their findings resulted in an innovative intervention program: Project IMPACT, or the Improving Addiction Care Team. IMPACT includes two complementary components: First, an inpatient consult service gives patients a safe place to share their stories, improve patient engagement and trust, and to expand inpatient treatment options. Second, partnerships were forged with community providers to create rapid access pathways to treatment and a smooth transition to MAT.

---