For the screening, emergency personnel ask patients about their drinking behavior. Doctors then have a conversation with patients who said they consumed alcohol prior to their emergency-room visit.

A growing number of health experts are using the emergency-room visit as a "teachable moment" to identify people with alcohol problems and direct them to resources where they can receive the help they need.

"It's a prime opportunity to reach people at risk," said Dr. Gail D'Onofrio, an emergency-room physician at Yale-New Haven Hospital in Connecticut. "Many people are young adults, and they don't use primary care, and they don't have insurance."

Research indicates that nearly a quarter of the people who come to an emergency room with some kind of trauma are intoxicated.

-From the New York Times

Nearly 9 of 10 adolescents go online, and about 10 percent of youths aged 9 to 18 report having visited a drug-prevention website at least once, according to a report from the federal Office of National Drug Control Policy (ONDCP) -- a figure that has not changed over the years despite investment in more sophisticated online resources.

Meanwhile, however, the alcohol industry recently doubled its annual spending on Internet banner ads, shelling out $21.6 million for about 50,000 such ads in 2002 alone. And a Fall 2003 study by the Center on Alcohol Marketing and Youth (CAMY) estimated that overall, 13 percent of visitors to websites maintained by alcohol companies were underage, with a few sites like the popular Bacardi.com receiving up to 60 percent of their traffic from people under the age of 21.

The alcohol industry, in particular, has been successful in driving traffic to its website by offering "trinkets and trash " -- features such as screensavers, cartoons, music, and contests -- similar to past real-world tobacco and alcohol marketing campaigns featuring baseball hats, t-shirts, and other youth-friendly items.

Helmuth describes the Internet as a "native environment" for youth, who surf effortlessly between downloading music, using Instant Messenger (IM) to communicate with friends, and researching topics for school or fun. More than half of youth surveyed say they go online to help them find out what's cool in fashion and music, for example.

Parental controls are of limited effectiveness in blocking youth access to objectionable content, especially given the growing number of places that youth can access the Internet. "The Internet by its nature is difficult to control: information wants to be free, and each generation of youth is more Internet-savvy," notes Helmuth.

"Will we match pro-drug and alcohol-industry websites? No," says Helmuth. "Even if we had the same money, we are not going to be as cool and enticing as the 'dark side.'" But he says, the same aspects of the online world that make it dangerous -- such as anonymity and freedom of information -- can work to the advantage of the prevention community.

"We need to develop next-generation online assessment and intervention tools that help kids 'too cool' to talk to an adult, who have a variety of issues, from curiosity to harmful use to early dependence," says Helmuth. "We must meet this very Internet-savvy audience in cyberspace with interactive content that goes beyond educating younger kids about the negative effects of drinking or drugs."

Some promising examples of this deeper interaction do exist, he notes. A number of colleges, for instance, are using Web-based alcohol education and intervention programs to teach incoming freshmen about the dangers of alcohol use and screen for signs of dependency among new students.

He also suggests other potential avenues for online prevention research and development. "Can we engage youth in peer-to-peer social marketing via chat rooms or IM? What about online support groups for youth? It may or may not be effective, but we have to find out."

Helmuth advises prevention groups to use their website as a 'flytrap' -- "a golden opportunity to engage the right people in a relationship, because they have sought you out." Prominently offering an e-mail newsletter on the home page is an especially effective way to build a relationship, and has the advantages of being easy to produce, scalable, fast and flexible, simple to forward to others, and excellent for driving traffic to your website. Helmuth also recommends that groups with a significant membership base consider working with an online customer-relationship management (CRM) firm to better understand and target their audience.

"Most people involved in prevention really don't do a lot of advocacy, even though we all believe in it. We are, by and large, not making much headway," he continues. "We must figure out how to recruit a much larger constituency, and the Internet is the best way to do it."

-From JoinTogether.org

"Illicit drugs and anesthesia can mix in some potentially hazardous ways," said Sue Carlisle, Ph.D., M.D., chief of anesthesia and perioperative care at San Francisco General Hospital in California. "Since few abusers of controlled substances readily admit drug use to their doctors, it's important for OMSs to recognize the signs and symptoms of drug abuse and be prepared to intervene."

According to Carlise, the signs and symptoms of alcohol and other drug misuse include unusual changes in blood pressure or heart rate, unexpected flushing of the skin, and exaggerated reaction to anesthetic drugs.

Since many patients are hesitant to report drug use to doctors, Carlise recommended that OMSs elicit information through non-threatening questions, such as "Do you smoke?" Those questions could lead into inquiries like, "Do you use any non-prescription drugs or street drugs?"

"If you work up to it gradually, patients will usually tell the truth."

- From the American Association of Oral and Maxillofacial Surgeons

1. Increase alcohol prices through taxes, particularly on beer.

2. Limit alcohol advertising and promotional activities that target young people.

3. Adopt laws that will prevent alcohol-related deaths and injuries among young people.

TREATING ADDICTION

4. Require and enforce equal insurance coverage for drug and alcohol treatment.

5. Support the development and use of effective medications for addiction treatment.

6. Make Screening for alcohol and drug problems a routine part of every primary care and emergency room visit.

7. Give higher payments to providers who get better results.

REDUCING AND PREVENTING CRIME

8. Require effective treatment and continuing, supervised aftercare programs instead of incarceration for non-violent drug and alcohol offenders.

9. Repeal policies that prevent ex-offenders from returning to full participation in society.

10. Support the work of community coalitions.

-From JoinTogether.org

For the Complete guide to "10 Drug and Alcohol Policies That Will Save Lives," click here

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Susie Vanderlip - Ken Vanderlip - Veronica Garcia
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