So we're all in the addiction treatment system. When you all hear the term prevention, what comes to mind? I can talk a little bit about that. At the clinic I work at we have someone that's trained in SBIRT, which is screening, brief intervention referral to treatment. So we screen everyone. She walks around all day and just randomly we don't identify people. So I think it's just asking, asking everyone what their history is. With that there's a component of education? Yes. Absolutely yes. If they're screening positive, then you would intervene in some way. But if they're negative, then there's room to let them know what's [inaudible] safe drinking. Right and stop people that have substance use disorders. That's not the point if its people that might be at risk. Before they. Identifying. That's right. Substance use disorder. As [inaudible] said that education part of it or the referral part of it that we need to do. I was just thinking they're at risk. Knowing who's at higher risk of developing a substance use disorder and being able to address that with them certainly through screening, but also if there is some flag for them to know to be talking with them if there's a strong family history of alcohol use disorder for instance, to let the person know that they're at higher risk even if their drinking is at lower levels right now or to think of certain populations that are at higher risk. So physicians, medical health care professionals have higher rates of substance use disorder or higher rates of suicide than the general population. So speaking to people just as groups that you've identified and letting them know their risk. The education is prevention and treatment is prevention, right? Yeah. Again I really think that changing the culture around the way that we talk about substance use so that if people are using substances at lower levels but are concerned about their own risk feeling comfortable asking how to prevent things from getting out of hand and I think that comes with culture change. I can't answer this question. So this is the question. Since these disorders often manifest themselves in adolescents, we don't have a pediatrician here. What is the roles of pediatricians in making their adolescents feel comfortable to talk with them about their incipient drug use? Part of it is again universal screening. So every child and adolescent that comes in for a well-child visit making it routine to talk to that individual without a parental figure in the room and really leveling the playing field and letting them know about what can remain confidential and what can't. That can be really important. Again we've talked a little bit about how hard it is just to get people into treatment doors. So there's a huge opportunity for community prevention as well. So I've been in educational interventions to arm coaches and guidance counselor and spiritual health providers and spiritual providers Etc with screening brief intervention, referral to treatment type techniques as well. So really thinking about the broader public health outside of the health care system is an important component of prevention. There's the prevention of the substance use disorder, but there's also the prevention of all of the associated complications or risks that come along with having a substance use disorder. So infectious disease or drinking and driving or whatever other negative consequences. Overdose. Overdose. Right. So that that's in framing this question we do a substance use treatment, right? But as you said treatment is prevention and preventing things is in a way it's providing a treatment. Whether it's an educational intervention or providing a Narcan kit or naloxone kit to prevent an overdose, much of what we do is actually prevention and getting comfortable with screening of adolescence. I also had a colleague who recently said when a patient comes in with new onset depression, I absolutely check to see if their thyroid is appropriate. I get up serum level of their thyroid. Why aren't we also just checking a urine drug screen and making sure because we know that depression is highly co-occurs with substance use disorders? But that's not something that we do. We don't necessarily monitor routinely, but we probably should. Perhaps we're not identifying things we should be. So this idea of screening and just making it more universal is in and of itself prevention and treatment. Although I wouldn't necessarily condone urine drug screening being the way at that, right? Questioning should be first-line and we want to avoid. Unless the patient knows you're screening them for that, I worry a little bit about again this idea that we're looking for something or we're on some a witch hunt and just being careful around that. Right. So if you're going to screen for a thyroid, you would let somebody know that you're going to be screening something and get their consent for that. Sure. It also does get at being able to interpret these things, right? As Robert has already mentioned. Just because there is a urine that's positive for cocaine does not mean somebody has a cocaine use disorder. Exactly. So what is that context and so it shouldn't be used in a vacuum. I'm going to pause with pediatrics. If pediatric patient is depressed and you start doing urine drug screens so I can open up a Pandora's box of conversations between you and the parents and the patient. So we have to use caution with that screening. Absolutely. So consent and patient autonomy. Right. Gets it a lot of this and the ethics.
