**Abstract**

It is found that substance use and related complications extend from occasional mild risky/harmful/hazardous use to severe conditions. The screening instruments may help to identify them in the initial state. The brief intervention (BI) is to bring change in unhealthy or risky substance use. The intervention is carried out by a vast array of trained professionals in various settings and it is valid across substances, age and ethno-culture groups. It has six common elements summarized by the acronym FRAMES (Feedback, Responsibility, Advise, Menu for change, Empathy and enhancing Self-efficacy). The BI has shown significant evidence of efficacy reducing substances and their harmful consequences with improving functionality and quality of life.

**Keywords:** screening tools, readiness to change, motivation, brief intervention

## **1. Introduction**

Substance use disorders have become matters of global concern because of their impact on individual health, family dynamics, social consequences and criminal and legal problems. Broadly, substances can be classified based on their legal statuses as licit like alcohol, tobacco or illicit like opioids, cannabis, amphetamine and cocaine. World Drug Report (2022) say around 284 million people (aged 15−64) used drug in 2020 with a rise of 26% over the previous decade [1]. Globally around 2.3 billion people aged 15 and above are drinking alcohol [2]. Globally, approximately 39 deaths/100,000 populations are attributable to alcohol and illicit drug use (35 deaths to alcohol use, and 4 deaths to illicit drug use). The use of alcohol and illicit drugs accounts for almost 13 disability adjusted life years (DALYs) lost per 1000 population worldwide [3]. According to WHO, worldwide 3.3 million deaths every year result from harmful use of alcohol representing 5.9% of all deaths and 5.1% of the global burden of disease is attributable to alcohol consumption [2]. WHO research teams indicate that in South East Asia countries, one-third to one-fourth of male population drink alcohol with increasing trends among women [2]. The harmful use of alcohol

causes huge health problems and social and economic burdens in societies. The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions. Worldwide, 3 million deaths every year result from the harmful use of alcohol. This represents 5.3% of all deaths [4]. Alcohol use and cigarette smoking are rising rapidly in some of the developing regions [5]. Major increases in injecting drug use (opiate and amphetamine injection), which carries the highest health risks, were recorded in many regions of eastern European countries and South-East. Continuous tobacco use in any form may result in several cancer and data says that more than 8 million people die from tobacco use [6].

The use of cannabis is by far the most prevalent illicit substance used worldwide, next to the two licit substances tobacco and alcohol [1]. The effects of cannabis on mental health are multiple: multiple studies are available regarding cannabis and schizophrenia, cannabis and transient psychosis, affective disorders, panic, anxiety and amotivational syndrome [7]. The recently conducted largest national-level epidemiological study in India demonstrated that the prevalence figures of use of alcohol, cannabis and other illicit substances in males and females were 27.3 and 1.6, 5 and 0.6, and 4 and 0.2, respectively [8]. In India, the estimated numbers of alcohol users in 2005 were 62.5 million and among them, 10.6 million were dependent users. It has also revealed that 20–30% of all hospital admissions were due to alcohol-related problems [9]. Government statistics show only 21% of adult men and around 2% of women drink. But up to a fifth of this group, that is about 14 million people are dependent drinkers requiring 'help' [10]. It also reports that the percentage of drinking population aged under 21 years has increased from 2% to more than 14% in the past 15 years. The National Family Health Survey (NFHS) found changing trends between NFHS 2 (1998−1999) and NFHS 3 (2005−2006) reflecting an increase in alcohol use among males since NFHS 2, and an increase in tobacco use among women [11]. Tobacco use prevalence in India was high as 55.8% among male with maximum use in the age group 41−50 years. It is considered the primary licit substance of abuse in our country [8]. Studies on "bidi" smoking, the most common form of tobacco smoking in India, provide evidence towards causality of it as a carcinogenic substance [12]. Thus psychoactive substance use continues to take a significant toll, with valuable human lives and productive years of many persons being lost. Routine screening for substance use disorders could alter this statistic and get more people the help they need.

### **1.1 Workplace issues**

In the National Survey on Drug Use and Health (United State) 22.4 million illicit drug users (68.9% aged 18 and above) are employed fully or partially. In the same survey, it was found that most binge drinkers and heavy alcohol users were also employed [79.3% (41.2 million) and 76.1% (12.4 million) respectively] [13].

Substance Abuse and Mental Health Services Administration report that 67.9% of the adult population of illegal drug users employed full-time or part-time indulged in binge and heavy alcohol use [14]. Studies show that when compared with non-substance users, substance-using employees are more likely to be: [15] less productive, up to 40% of accidents at work involve or are related to alcohol use, absenteeism is two to three times higher among habitual substance users, change jobs frequently and file a 'workers' compensation claim.

Many problems are encountered at workplace due to the substance use pattern of the worker. Workers under the influence of psychoactive substances are more

*Screening and Brief Intervention in Substance Use Disorders: Its Clinical Utility and Feasibility… DOI: http://dx.doi.org/10.5772/intechopen.107441*

likely to commit unsafe acts that cause damage to their own life, others' lives and the organization. There are safety risks from intoxication, negligence and impaired judgment. Problems with co-workers through increased workload on the non-substance user, disputes, grievances, intimidation and violence are common problems associated with substance use at the workplace. In India, a study was conducted among male industrial workers from Goa, which showed that 21% had hazardous levels of alcohol consumption [16]. Such levels of alcohol consumption were significantly associated with head injuries and hospitalization. The Central Sector Scheme of Assistance for prevention of Alcoholism and Substance (drugs) abuse and for Social Defence Services, Ministry of Social Justice and Empowerment, Government of India highlighted the need for interventions at the workplace. It encourages programs for prevention of alcoholism and drug abuse in the workplace. It provides financial assistance up to 25% of the expenditure for the setting up of a 15-bedded or 30-bedded Integrated Rehabilitation Centre for Addicts (IRCA) to the industry/enterprise having strength of at least 500 workers or more in a particular area [17].

### **1.2 Harmful substance use and screening**

Screening aims to detect health problems or risk factors at an early stage before they have caused serious disease or other problems and is part of maintaining prevention practice activities in health care settings. Thus screening may be useful not only in the case of dependent but also for non-dependent users such as harmful or hazardous use [18, 19]. The limitations of using existing screening tests in primary care settings have been outlined, which are less useful for detecting harmful or hazardous use in non-dependent persons [20–22]. A large number of tools have been developed for identifying hazardous or harmful substance use. CAGE is a four-item validated questionnaire for identifying individuals with alcohol problems [23]. The Alcohol Use Disorders Identification Test (AUDIT) [24] is a screening tool for the identification of hazardous and harmful drinkers while the Fast Alcohol Screening Test (FAST) [25] is an abbreviated version of the AUDIT. There are many studies reporting success of AUDIT as screening and brief intervention (BI) in reducing alcohol-related problems in primary health care (PHC) settings [26]. However, it does not screen for other substances and related problems. This led to the development of ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) [27].

### **1.3 Alcohol, Smoking and Substance Involvement Screening Test**

WHO developed ASSIST as a simple scale for rapid screening of substance users to stratify them into three levels of risk severity (low, moderate and high risk) [27]. It is the first international screening test and an 8-item questionnaire that covers the use of all psychoactive substances and associated problems over the last 3 months. WHO-ASSIST was developed by an international group of addiction researchers and clinicians in response to the overwhelming public health burden associated with psychoactive substance use worldwide. The ASSIST has undergone significant testing in three sequential phases (I, II and III) to ensure that it is a feasible, reliable, valid, flexible, comprehensive and cross-culturally relevant tool. ASSIST is currently in its fourth phase aimed at worldwide dissemination. It helps in early identification of substance use-related health risks and substance use disorders in PHS, general medical care and other settings. Gryczynski et al. [28] did a study on validation and performance of ASSIST among adolescent primary care patients as it has only been

validated with adults and concluded that it is a promising as a research and screening/ brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. In another study, in Mexico, to determine the psychometric properties of the self-administered ASSIST test in university undergraduate students (*n* = 1176), the authors concluded that it is a valid screening instrument to identify at-risk cases due to substance use in this population [29]. Silva et al., did an integrative review including 26 articles to systematize the knowledge and the learning of how the instrument ASSIST has been applied. They concluded that ASSIST focused on helping the identification and classification of psychoactive substance use and highlighted its importance in screening the involvement with alcohol and other drugs and is effective in PHC [30].
