Health Care and Brief Intervention

One of the early and surprising findings in our research on behavioral self-control training was that significant behavior change often followed from relatively brief interventions that we had originally thought of as control groups (Apodaca & Miller, 2003; Schmidt & Miller, 1983).  It is now widely demonstrated that heavy and at-risk drinkers can and do respond to brief interventions by making significant reduction in their alcohol use (Bien, Miller & Tonigan, 1993).

            This expanded the concept of “treatment” well beyond traditional counseling and psychotherapy settings (Christensen et al., 1978).  If such brief interventions are effective, then it is feasible to implement them outside traditional addiction treatment systems, in other settings where contact is characteristically brief, such as health care (Ernst et al., 2007; Miller, 2005; Miller et al., 2006), social services (Miller & Weisner, 2002), emergency services (Schermer et al., 2006), and work-based assistance programs (Miller, Jackson & Karr, 1994).

            It has also been a mission for me to have health practitioners in general, and behavioral health clinicians in particular, to regard addictions as falling within their area of responsibility for care (Miller & Brown, 1997; Miller & Weisner, 2002).  Through the peculiar evolution of alcohol/drug treatment within the United States, these services developed almost entirely outside ordinary health care and mental health care systems.  Helping people with alcohol/drug problems came to be regarded as solely the domain of addiction specialists, and not within the remit of front-line psychologists, social workers, and medical providers.  Yet the addiction treatment methods that are effective are well within the usual scope of skills of behavioral health clinicians, and most people with addictions also have other health and psychosocial problems that are best addressed together.  It is simply strange that the second most common DSM/ICD diagnosis (after depression) that behavioral health providers will encounter throughout their careers should be addressed only by referral to stigmatized specialist treatment agencies.

Publications on Health Care and Brief Intervention  (in chronological order).

Christensen, A., Miller, W. R., & Munoz, R. F. (1978).  Paraprofessionals, partners, peers, paraphernalia, and print: Expanding mental health service delivery.  ProfessionalPsychology, 9, 249-270.

Schmidt, M. M., & Miller, W. R. (1983).  Amount of therapist contact and outcome in a multidimensional depression treatment program.  Acta Psychiatrica Scandinavica, 67, 319-332.

Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993).  Brief interventions for alcohol problems: A review.  Addiction, 88, 315-336.

Miller, W. R., Jackson, K. A., & Karr, K. W. (1994).  Alcohol problems: There’s a lot you can do in two or three sessions.  EAP Digest, 14, 18-21, 35-36.

White, R. E., Luckie, L. F., & Miller, W. R. (1996).  Suppose they offered an alcohol abuse intervention, and nobody came?  Federal Practitioner, 13, 51-57.

Miller, W. R., & Brown, S. A. (1997).  Why psychologists should treat alcohol and drug problems.  American Psychologist, 52, 1269-1279.

Miller, W. R., & Willoughby, K. V. (1997).  Designing effective alcohol treatment systems for rural populations: Cross-cultural perspectives.  In Bringing Excellence to Substance Abuse Services in Rural and Frontier America, Technical Assistance Publication Series, Volume 20 (pp.83-92).  Rockville, MD: Center for Substance Abuse Treatment.

Miller, W. R. (2002).  Educating psychologists about substance abuse.  (Strategic plan for interdisciplinary faculty development among the nation==s health professional workforce for a new approach to substance use disorders.)   Substance Abuse, 23(3), 289-303.

Miller, W. R.  (2002).  Is Atreatment@ the right way to think about it?  In W. R. Miller & C. Weisner (Eds.), Changing substance abuse through health and social systems(pp. 15-27)  New York: Kluwer/Plenum.

Miller, W. R., & Weisner, C. (Eds.) (2002).  Changing substance abuse through health and social systems.  New York: Kluwer/Plenum.

Apodaca, T. R., & Miller, W. R. (2003).  A meta-analysis of the effectiveness of bibliotherapy for alcohol problems. Journal of Clinical Psychology, 59, 289-304.

Pettinati, H. M., Weiss, R., Miller, W. R., Donovan, D., & Rounsaville, B. J. (2004). Medical Management (MM) treatment manual: A guide for medically-trained clinicians providing pharmacotherapy as part of the treatment for alcohol dependence.  Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism.

Miller, W. R. (2005).  Enhancing patient motivation for health behavior change.  Journal of Cardiopulmonary Rehabilitation, 25, 207-209.

Miller, W. R., Baca, C., Compton, W. M., Ernst, D., Manuel, J. K., Pringle, B., Schermer, C.R., Weiss, R. D., Willenbring, M. L., & Zweben, A. (2006).  Addressing substance abuse in health care settings.  Alcoholism: Clinical and Experimental Research, 30, 292-302.

Schermer, C. R., Moyers, T. B., Miller, W. R., & Bloomfield, L. A. (2006).  Trauma center brief interventions for alcohol disorders decrease subsequent driving under the influence arrests.  Journal of Trauma, 60, 29-34.

Apodaca, T. R., Miller, W. R., Schermer, C. R., & Amrhein, P. C. (2007). A pilot study of bibliotherapy to reduce alcohol problems among patients in a hospital trauma center. Journal of Addictions Nursing, 18, 167-173.

Ernst, D., Miller, W. R., & Rollnick, S. (2007).  Treating substance abuse in primary care: A demonstration project.  International Journal of Integrated Care, 7, 10 October 2007, ISSN 1568-4156, http://www.ijic.org.