title: The role of screening, brief intervention, and referral to treatment in the perinatal period.
abstract: Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, brief intervention, and referral to treatment is an evidence-based approach to manage substance use. In September 2012, the US Centers for Disease Control and Prevention convened an Expert Meeting on Perinatal Illicit Drug Abuse to help address key issues around drug use in pregnancy in the United States. This article reflects the formal conclusions of the expert panel that discussed the use of screening, brief intervention, and referral to treatment during pregnancy. Screening for substance use during pregnancy should be universal. It allows stratification of women into zones of risk given their pattern of use. Low-risk women should receive brief advice, those classified as moderate risk should receive a brief intervention, whereas those who are high risk need referral to specialty care. A brief intervention is a patient-centered form of counseling using the principles of motivational interviewing. Screening, brief intervention, and referral to treatment has the potential to reduce the burden of substance use in pregnancy and should be integrated into prenatal care.
authors.affiliation: Departments of Obstetrics, Gynecology, and Women's Health and of Psychiatry, University of Hawaii John A. Burns School of Medicine, Honolulu, HI. Electronic address: tewright@hawaii.edu.
authors.forename: Tricia E
authors.initials: TE
authors.lastname: Wright
authors.affiliation: Behavioral Health System, Baltimore, MD.
authors.forename: Mishka
authors.initials: M
authors.lastname: Terplan
authors.affiliation: Merrill-Palmer Skillman Institute, Departments of Psychiatry and Behavioral Neurosciences, and Obstetrics and Gynecology, Wayne State University, Detroit, MI.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ondersma
authors.affiliation: Division of Clinical Neuroscience and Behavioral Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Boyce
authors.affiliation: Departments of Psychiatry and of Obstetrics and Gynecology, and School of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yonkers
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Department of Veterans Affairs Boston Healthcare System, Brockton, MA.
authors.forename: Grace
authors.initials: G
authors.lastname: Chang
authors.affiliation: Department of International Health and International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy; D003376:Counseling / Q000379:methods; D005260:Female; D006801:Humans; D008403:Mass Screening; D062405:Motivational Interviewing / Q000379:methods*; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011295:Prenatal Care / Q000379:methods*; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000628:therapy; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000628:therapy
keywords: alcohol; brief intervention; opioid use; pregnancy; referral to treatment; screening; substance use disorders; tobacco