Substance Use
Substance-use screening and interventions in dental practices: Survey of practice-based research network dentists regarding current practices, policies and barriers

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ABSTRACT

Background

Dental visits represent an opportunity to identify and assist patients with unhealthy substance use, but little is known about how dentists are addressing patients’ use of tobacco, alcohol and illicit drugs. The authors surveyed dentists to learn about the role their practices might play in providing substance-use screening and interventions.

Methods

The authors distributed a 41-item Web-based survey to all 210 dentists active in the Practitioners Engaged in Applied Research and Learning Network, a practice-based research network. The questionnaire assessed dental practices’ policies and current practices, attitudes and perceived barriers to providing services for tobacco, alcohol and illicit drug use.

Results

One hundred forty-three dentists completed the survey (68 percent response rate). Although screening was common, fewer dentists reported that they were providing follow-up counseling or referrals for substance use. Insufficient knowledge or training was the most frequently cited barrier to intervention. Many dentists reported they would offer assistance for use of tobacco (67 percent) or alcohol or illicit drugs (52 percent) if reimbursed; respondents who treated publicly insured patients were more likely to reply that they would offer this assistance.

Conclusions

Dentists recognize the importance of screening for substance use, but they lack the clinical training and practice-based systems focused on substance use that could facilitate intervention.

Practical Implications

The results of this study indicate that dentists may be willing to address substance use among patients, including use of alcohol and illicit drugs in addition to tobacco, if barriers are reduced through changes in reimbursement, education and systems-level support.

Section snippets

Study design and population

We administered the survey to dentists who were members of the Practitioners Engaged in Applied Research and Learning (PEARL) network. The PEARL Network was one of three dental practice-based research networks (PBRNs) established in 2005 with a seven-year grant from the National Institute of Dental and Craniofacial Research, National Institutes of Health. PEARL Network members are practicing dentists who have expressed an interest in conducting research in their own clinical practices. PEARL

RESULTS

Of the 210 eligible dentists, 143 participated in the survey (68 percent response rate). Table 1 shows characteristics of respondents and their primary dental practices. We compared the member profiles of survey respondents with those of the entire PEARL Network and found no substantial differences between the two groups with regard to age, sex, race/ethnicity or practice setting. Most participants were in general practice settings, including four public health and two dental medicine clinics.

DISCUSSION

Our survey findings indicate that dentists in the PEARL PBRN approve of screening for substance use, and most reported that they conducted screening in their practices. As PBRN members, these practitioners already had expressed a strong interest in research, and they may be more likely to adopt newer practices such as screening and interventions for substance use. However, even among this group, reported rates of follow-up counseling and referrals for patients with positive screening results

CONCLUSIONS

The results of this study show that dentists in the PEARL Network recognized the importance of screening for substance use, but they did not consistently follow up screening results with effective interventions, and they perceived significant barriers to doing so. The most frequently cited barrier was a lack of knowledge/ training about substance-use assistance, and we could expect educational interventions (such as focused training in office-based brief counseling) to have a favorable impact

References (49)

  • E Tong et al.

    National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs (published online ahead of print May 27, 2010)

    Nicotine Tob Res

    (2010)
  • L Solberg et al.

    Repeated tobacco-use screening and intervention in clinical practice: health impact and cost effectiveness

    Am J Prev Med

    (2006)
  • MC Fiore et al.

    Treating tobacco use and dependence: 2008 update—U.S. Public Health Service Clinical Practice Guideline executive summary

    Respir Care

    (2008)
  • EP Whitlock et al.

    Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force

    Ann Intern Med

    (2004)
  • U.S. Preventive Services Task Force

    Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women

    (2009)
  • Tobacco Use and Dependence Guideline Panel, U.S. Public Health Service

    Treating Tobacco Use and Dependence: 2008 Update

    (2008)
  • U.S. Preventive Services Task Force

    Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse. Rockville, Md.: U.S. Preventive Services Task Force

  • U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality

    Medical Expenditure Panel Survey (MEPS)

    (2008)
  • SM Strauss et al.

    Identifying unaddressed systemic health conditions at dental visits: patients who visited dental practices but not general health care providers in 2008 (published online ahead of print Dec. 15, 2011)

    Am J Public Health

    (2012)
  • WJ Blot et al.

    Smoking and drinking in relation to oral and pharyngeal cancer

    Cancer Res

    (1988)
  • S Silverman et al.

    Oral and pharyngeal cancer control through continuing education (published online ahead of print March 5, 2010)

    J Cancer Educ

    (2010)
  • AG Christen

    Tobacco cessation, the dental profession, and the role of dental education

    J Dent Educ

    (2001)
  • T Hanioka et al.

    Association of total tooth loss with smoking, drinking alcohol and nutrition in elderly Japanese: analysis of national database

    Gerodontology

    (2007)
  • A Khocht et al.

    The influence of gingival margin recession on loss of clinical attachment in alcohol-dependent patients without medical disorders

    J Periodontol

    (2003)
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    Disclosure. None of the authors reported any disclosures.

    This research was supported by grants 5U10DA013046 and U10 DA13035 from the National Institutes of Health (NIH)/National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), Bethesda, Md., and by grant U01 DE016755 from the National Institute of Dental and Craniofacial Research, NIH. Dr. McNeely received support from NIH/NIDA grant K23DA030395 and from grant KL2RR029891 from the NIH/New York University Clinical and Translational Science Institute, New York City.

    The authors thank Damon Collie and Don Vena, The EMMES Corp., Rockville, Md., and George E. Bigelow, National Institute on Drug Abuse/Clinical Trials Network Publications Committee.

    The authors thank Nora Volkow, MD, director of National Institute on Drug Abuse, National Institutes of Health, and colleagues at the Clinical Trials Network for support and encouragement in exploring acceptability and sustainability of innovation in approaches to tobacco-use cessation.

    1

    Dr. McNeely is an assistant professor, Department of Population Health and Department of Medicine, Division of General Internal Medicine, New York University School of Medicine, 227 E. 30th St., Room 623, New York, N.Y. 10016

    2

    Ms. Wright is an assistant research scientist, Department of Psychiatry and Department of Population Health, New York University School of Medicine, New York City.

    3

    Dr. Matthews is a biostatistician, The EMMES Corp., Rockville, Md.

    4

    Dr. Rotrosen is a professor, Department of Psychiatry, New York University School of Medicine, and associate chief of staff for mental health research, Veterans Affairs New York Harbor Healthcare System, New York City.

    5

    Dr. Shelley is director, Research Development, and an associate professor, Department of Population Health, Division of Comparative Effectiveness and Decision Science, New York University School of Medicine, New York City.

    6

    Mr. Buchholz is a senior clinical research associate, PEARL Network, New York University College of Dentistry, New York City.

    7

    Dr. Curro is director of clinical operations, PEARL Network, and director of regulatory affairs, Bluestone Center for Clinical Research, New York University College of Dentistry, New York City. Address reprint requests to Dr. McNeely.

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