Stephen O’Neil is on a mission to redefine substance use, particularly alcohol abuse. O’Neil addressed an audience of health professionals, students and community members on December 6 at Williamsburg Place. He asked the audience to reconsider preconceived notions of substance abuse including identification and treatment.
“Substance use is a public health epidemic. Alcohol use is the third leading cause of preventative death in the United States,” O’Neil says. “If I said that the third leading cause of death was something like the flu, there would be uproar. People don’t believe substance use is a healthcare issue, so we don’t take preventative measures.”
O’Neil has worked in this field for 30 years and proposed Screening, Brief Intervention and Referral to Treatment (SBIRT) as a way to address this major national health problem. “SBIRT is a systems change initiative,” O’Neil says. “We need to change how we think about substance use. This requires that we re-define how we identify it.”
O’Neil said current rules for identifying alcohol dependency separates individuals into ‘red light’ and ‘green light’ patients. The ‘red light’ patients are considered dependent on alcohol and ‘green light’ patients have no problem. This fails to recognize the people in the middle who may become dependent on alcohol in the future.
‘Yellow light’ patients are individuals who have excessively used alcohol. “We should be talking about the people in the middle,” O’Neil says. “We should talk with them about their risk status and potential changes they could make. If a doctor identifies someone who is likely dependent, they can refer them to a specialist.”
The first step to this method is preventative screening. “Health professionals should screen for it regularly that way we can be more proactive before problems happen,” he said. He equates screening for substance abuse to the way medical professionals screen for high blood pressure by regularly checking patients’ blood pressure.
According to O’Neil, screenings are important to identify people at risk of substance abuse and continue substance education. “Most people are going to be low risk for substance abuse. But if we do regular screenings, we can discuss the issue across a lifetime,” O’Neil says. “If we talk to them for a few minutes they’re likely to change their behavior.”
By using SBIRT, O’Neil hopes to intervene before the issue becomes worse. “By using this method, many patients would seek preventative treatment,” O’Neil says.
Identifying your habits: Are you a green, yellow or red light?
What qualifies as excessive alcohol use? O’Neil defines responsible drinking. For healthy men under 65, four or fewer drinks per day or 14 drinks per week is considered drinking responsibly. For healthy women under 65, three or fewer drinks per day or seven drinks per week is an acceptable amount. A single shot of alcohol is considered a standard drink.
Redefining Alcohol Abuse as a Health Problem
