Implementation Protocol To Increase Problematic Alcohol Use Screening and Brief Intervention in Brazil’s National Health System

  • Sean J. HaleyEmail author
  • Karen Athié
  • Katarzyna E. Wyka
  • Manoela Alves Salgado
  • Débora Silva Teixeira
  • Kali Alves
  • Vitor Aguiar Lobato de Carvalho
  • Daniel Storti Netto Puig
  • Sandra Fortes
Original Article


Heavy drinking, defined as the consumption of five or more doses of alcoholic beverages on a single occasion by men or four for women at least once in the last 2 weeks (Macinko et al. 2015), has become a major health issue in Brazil. In primary care settings, screening and brief intervention reduces heavy drinking (Kaner et al. 2018; Soares and Vargas 2019), yet it is rarely used in Brazil (Macinko et al. 2015). This protocol describes a screening and brief intervention implementation feasibility study to be implemented in Rio de Janeiro’s Family Health Strategy primary care units.


alcohol screening, brief intervention, and referral to treatment primary care low/middle income countries 



The authors would like to thank the senior mental health and addictions staff within the city of Rio de Janeiro, the area coordinators, managers, and the staff at the primary care health units in programmatic areas 1.0 and 2.2. The authors would also like to thank the Fulbright Commission, CAPES, UERJ, staff at the Coordinating Study Centers, and the following individuals for their support of the project: Bianca Pereira de Souza, Adriana Teixeira dos Santos, Gabriella Souza Oliberia Freitas, Angela Machado da Silva, Alice Lopes do Amaral Menezes, and Natalia Lelou Fazzioni.

Funding Information

Fulbright Scholars Award and in-kind support from Universidade do Estado do Rio de Janeiro.

Compliance with Ethical Standards

The study received ethical approval from the respective Brazilian and American Universities and was submitted for ethical approval to the city of Rio de Janeiro on July 25 and approved on November 8, 2018.

Conflict of Interest

The authors declare that they have no conflicts of interest.


  1. Abreu, Â. M. M., Jomar, R. T., Taets, G. G. d. C., Souza, M. H. d. N., & Fernandes, D. B. (2018). Screening and brief intervention for the use of alcohol and other drugs. Revista Brasileira de Enfermagem, 71, 2258–2263.Google Scholar
  2. Advancing Integrated Mental Health Solutions Center. (2011). Patient-centered integrated behavioral health care principles & tasks. Seattle, WA: University of Washington.Google Scholar
  3. Albright, K., Gechter, K., & Kempe, A. (2013). Importance of mixed methods in pragmatic trials and dissemination and implementation research. Academic Pediatrics, 13(5), 400–407. Scholar
  4. de Almeida-Pititto, B., Dias, M. L., de Moraes, A. C. F., Ferreira, S. R., Franco, D. R., & Eliaschewitz, F. G. (2015). Type 2 diabetes in Brazil: epidemiology and management. Diabetes, Metabolic Syndrome and Obesity: targets and therapy, 8, 17.Google Scholar
  5. Alves, L. (2018). Brazil’s government cuts social programs to subsidize fuel, business. The Rio Times Retrieved from Accessed 31 Jan 2019.
  6. Anderson, P., & Clement, S. (1987). The AAPPQ revisited: the measurement of general practitioners’ attitudes to alcohol problems. British Journal of Addiction, 82(7), 753–759.Google Scholar
  7. Anderson, P., Wojnar, M., Jakubczyk, A., Gual, A., Reynolds, J., Segura, L., … Newbury-Birch, D. (2014). Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners. Alcohol and Alcoholism, 49(5), 531–539.Google Scholar
  8. Anderson, P., Kaner, E., Keurhorst, M., Bendtsen, P., Steenkiste, B. v., Reynolds, J., et al. (2017). Attitudes and learning through practice are key to delivering brief interventions for heavy drinking in primary health care: analyses from the ODHIN Five Country Cluster Randomized Factorial Trial. International Journal of Environmental Research and Public Health, 14(2), 121. Scholar
  9. Associacao Fundo de Incentivo a Pesquisa, Fundacao de Apoio a Universidade Federal de Sao Paulo, Universidade Virtual do Estado de Sao Paulo, Univerisdade Federal de Sao Paulo, Secretaria National de Politicas Sobre Drogas, & Ministerio de Justica e Cidadania. (2018). Sistema para detecção do Uso abusivo e dependência de substâncias Psicoativas Encaminhamento, intervenção breve, Reinserção social e Acompanhamento. Retrieved from Accessed 20 Feb 2019.
  10. Athié, K., do Amaral Menezes, A. L., da Silva, A. M., Campos, M., Delgado, P. G., Fortes, S., & Dowrick, C. (2016). Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study. BMC Health Services Research, 16(1), 532.Google Scholar
  11. Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7–30. Scholar
  12. Ballester, D. A., Filippon, A. P., Braga, C., & Andreoli, S. B. (2005). The general practitioner and mental health problems: challenges and strategies for medical education. São Paulo Medical Journal, 123(2), 72–76.Google Scholar
  13. Beyer, F., Lynch, E., & Kaner, E. (2018). Brief interventions in primary care: an evidence overview of practitioner and digital intervention programmes. Current Addiction Reports, 5(2), 265–273. Scholar
  14. Burton, R., & Sheron, N. (2018). No level of alcohol consumption improves health. The Lancet, 392(10152), 987–988.Google Scholar
  15. Campos, G. W. d. S., Onocko-Campos, R. T., & Del Barrio, L. R. (2013). Políticas e práticas em saúde mental: as evidências em questão. Ciência & Saúde Coletiva, 18, 2797–2805.Google Scholar
  16. Carlini, E. A., Galduróz, J. C. F., Noto, A. R., & Nappo, S. A. (2002). II Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 108 maiores cidades do país. São Paulo: Cebrid/Unifesp.Google Scholar
  17. Carneiro, A. P. L., & Souza-Formigoni, M. L. O. (2018). Country-wide distance training for delivery of screening and brief intervention for problematic substance use: a pilot evaluation of participant experiences and patient outcomes. Substance Abuse, 39(1), 102–109.Google Scholar
  18. Carneiro, A. P. L., Ronzani, T., Avallone, D. D. M., & Autor, M. L. O. d. S. F. (2017). AUDIT & AUDIT C Eixo Instrumentos Portal Alberta: Portal de formacao a distancia: Sujeitos, contextos e drogas. Retrieved from Accessed 26 April 2018.
  19. Corradi-Webster, C. M., Laprega, M. R., & Furtado, E. F. (2009). Do psychiatry residents document outpatients’ alcohol problems? Revista de Psiquiatria do Rio Grande do Sul, 31(3), 187–191.Google Scholar
  20. Creswell, J. W., Fetters, M. D., & Ivankova, N. V. (2004). Designing a mixed methods study in primary care. The Annals of Family Medicine, 2(1), 7–12. Scholar
  21. Creswell, J. W., Fetters, M. D., Plano Clark, V. L., & Morales, A. (2009). Mixed methods intervention trials. n S. Andrew & E. J. Halcomb (Eds.) methods research for nursing and the health sciences (pp. 161-180). Hoboken: Blackwell Publishing.Google Scholar
  22. Cruvinel, E., Richter, K. P., Bastos, R. R., & Ronzani, T. M. (2013). Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice. Addiction Science & Clinical Practice, 8(1), 4. Scholar
  23. Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217–226.Google Scholar
  24. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.Google Scholar
  25. Departamento de Informática do Sistema Único de Saúde. (2018). Cadastro Nacional de Estabelecimentos de Saúde (CNES). from SUS Accessed 29 Jan 2019.
  26. D'onofrio, G., Nadel, E. S., Degutis, L. C., Sullivan, L. M., Casper, K., Bernstein, E., & Samet, J. H. (2002). Improving emergency medicine residents' approach to patients with alcohol problems: a controlled educational trial. Annals of Emergency Medicine, 40(1), 50–62.Google Scholar
  27. Elwy, A. R., Horton, N. J., & Saitz, R. (2013). Physicians’ attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients’ drinking outcomes. Substance Abuse Treatment, Prevention, and Policy, 8(1), 17.Google Scholar
  28. Fortes, S., Menezes, A., Athié, K., Chazan, L. F., Rocha, H., Thiesen, J., Ragoni, C., Pithon, T., & Machado, A. (2014). Psiquiatria no século XXI: transformações a partir da integração com a Atenção Primária pelo matriciamento. Physis: Revista de Saúde Coletiva, 24, 1079–1102.Google Scholar
  29. Funk, M., Wutzke, S., Kaner, E., Anderson, P., Pas, L., McCormick, R., …, W. H. O. B. I. S. (2005). A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study. Journal of Studies on Alcohol, 66(3), 379–388.Google Scholar
  30. Garcia, L. P., & Freitas, L. R. S. d. (2015). Consumo abusivo de álcool no Brasil: resultados da Pesquisa Nacional de Saúde 2013. Epidemiologia e Serviços de Saúde, 24, 227–237.Google Scholar
  31. GBD 2016 Alcohol Collaborators. (2018). Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet, 392(10152), 1015–1035. Scholar
  32. Glasgow, R. E. (2013). What does it mean to be pragmatic? Pragmatic methods, measures, and models to facilitate research translation. Health Education & Behavior, 40(3), 257–265.Google Scholar
  33. Graever, L. (2013). A assistência ao indivíduo com problemas relacionados ao uso de álcool e drogas ilícitas na Estratégia Saúde da Família (Doctoral Dissertation). Google Scholar
  34. Guimarães, F. J., Fernandes, A. F. C., & Pagliuca, L. M. F. (2015). Intervenções para enfrentamento do abuso de álcool: revisão integrativa. [Interventions to cope with alcohol abuse: integrative review]. Revista eletrónica de enfermagem, 17(3), 1–11.Google Scholar
  35. Harzheim, E., Lima, K. M., & Hauser, L. (2009). Reforma da atenção primária à saúde na cidade do Rio de Janeiro: avaliação dos primeiros três anos de clínicas da família: pesquisa avaliativa sobre aspectos de implantação, estrutura, processo e resultados das Clínicas da Família na cidade do Rio de Janeiro. Organização Pan-Americana da Saúde Retrieved from Accessed 30 Jan 2019.
  36. Holmes, M. (2017). WHO alcohol brief intervention training manual for primary care. Copenhagen, Denmark: World Health Organization Retrieved from Accessed 27 Dec 2018.
  37. Institute of Behavioral Research. (2002). TCU workshop evaluation form (TCU WEVAL). Fort Worth, TX: Texas Christian University.Google Scholar
  38. Kaner, E. F., Dickinson, H. O., Beyer, F. R., Campbell, F., Schlesinger, C., Heather, N., … Pienaar, E. D. (2007). Effectiveness of brief alcohol interventions in primary care populations. Retrieved from The Cochrane Library
  39. Kaner, E., Bland, M., Cassidy, P., Coulton, S., Dale, V., Deluca, P., et al. (2013). Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. British Medical Journal, 346, e8501.Google Scholar
  40. Kaner, E. F., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., … Burnand, B. (2018). Effectiveness of brief alcohol interventions in primary care populations (Publication no. Retrieved from Cochrane Library Accessed 15 Jan 2019.
  41. Laranjeira, R., Pinsky, I., Sanches, M., Zaleski, M., & Caetano, R. (2010). Alcohol use patterns among Brazilian adults. Brazilian Journal of Psychiatry, 32(3), 231–241.Google Scholar
  42. Leite, D. C., Andrade, A. B., & Bosi, M. L. M. (2013). The integration of psychology in units of support for the family health program. Physis: Revista de Saúde Coletiva, 23(4), 1167–1187.Google Scholar
  43. Lewis, E., Baumann, A., Gerke, D., Tabak, R., Ramsey, A., Small, S., & Proctor, E. I. J. (2017). Eight toolkits related to dissemination and implementation. D&I Research Designs Retrieved from Accessed 4 Jan 2019.
  44. Machado, Í. E., Monteiro, M. G., Malta, D. C., & Lana, F. C. F. (2017). Pesquisa Nacional de Saúde 2013: relação entre uso de álcool e características sociodemográficas segundo o sexo no Brasil. Revista Brasileira de Epidemiologia, 20, 408–422.Google Scholar
  45. Macinko, J., & Harris, M. J. (2015). Brazil’s family health strategy—delivering community-based primary care in a universal health system. New England Journal of Medicine, 372(23), 2177–2181.Google Scholar
  46. Macinko, J., Mullachery, P., Silver, D., Jimenez, G., & Neto, O. L. M. (2015). Patterns of alcohol consumption and related behaviors in Brazil: evidence from the 2013 National Health Survey (PNS 2013). PLoS One, 10(7), e0134153.Google Scholar
  47. Magnabosco, M. d. B., Formigoni, M. L. O. d. S., & Ronzani, T. M. (2007). Avaliação dos padrões de uso de álcool em usuários de serviços de Atenção Primária à Saúde de Juiz de Fora e Rio Pomba (MG). Revista Brasileira de Epidemiologia, 10, 637–647.Google Scholar
  48. Major, B., & O’brien, L. T. (2005). The social psychology of stigma. Annual Review of Psychology, 56, 393–421.Google Scholar
  49. Malta, D. C., Santos, M. A. S., Stopa, S. R., Vieira, J. E. B., Melo, E. A., & Reis, A. A. C. d. (2016). Family health strategy coverage in Brazil, according to the National Health Survey, 2013. Ciência & Saúde Coletiva, 21(2), 327–338.Google Scholar
  50. de Mattos, R. A. (2001). Os sentidos da integralidade: algumas reflexões acerca de valores que merecem ser defendidos. In R. P. Pinheiro & R. A. de Mattos (Eds.), Os Sentidos da Integralidade: Ena atenção e no cuidado à saúde. Rio de Janeiro: UERJ. (Reprinted from: 8th Edition).Google Scholar
  51. de Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., & Crippa, J. A. S. (2009). Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychology & Neuroscience, 2(1), 83–97.Google Scholar
  52. de Menezes, R. F., Bergmann, A., de Aguiar, S. S., & Thuler, L. C. S. (2015). Alcohol consumption and the risk of cancer in Brazil: a study involving 203,506 cancer patients. Alcohol, 49(7), 747–751.Google Scholar
  53. Ministério da Saúde. (2010). Diretrizes do NASF: Núcleo de Apoio a Saúde da Família. Cadernos de Atenção Básica. Rio de Janeiro: Ministério da Saúde Retrieved from Accessed 2 Feb 2019.
  54. Ministério da Saúde, & Secretaria de Atenção à Saúde, D. d. A. B. (2015). Histórico de cobertura da saúde da família. Ministério da Saúde Brasília.Google Scholar
  55. Moretti-Pires, R. O., & Corradi-Webster, C. M. (2011). Implementation of brief intervention for problematic alcohol use in primary health in the amazon context. Revista Latino-Americana de Enfermagem, 19(SPE), 813–820.Google Scholar
  56. Morse, J. M. (2015). Analytic strategies and sample size. Los Angeles: SAGE Publications Sage.Google Scholar
  57. Moyers, J., Manual, T., & Ernst, D. (2014). Motivational Interviewing Treatment Integrity Coding manual 4.2.1: Retrieved from Accessed 26 Nov 2018.
  58. NICE. (2010). Alcohol-use disorders: preventing the development of hazardous and harmful drinking. London: NICE.Google Scholar
  59. Oliveira, M. d. S., Andretta, I., Rigoni, M. d. S., & Szupszynski, K. P. d. R. (2008). A entrevista motivacional com alcoolistas: um estudo longitudinal. Psicologia: Reflexão e Crítica, 21(2), 261–266.Google Scholar
  60. Paim, J., Travassos, C., Almeida, C., Bahia, L., & Macinko, J. (2011). The Brazilian health system: history, advances, and challenges. The Lancet, 377(9779), 1778–1797.Google Scholar
  61. Patel, V., Belkin, G. S., Chockalingam, A., Cooper, J., Saxena, S., & Unützer, J. (2013). Grand challenges: integrating mental health services into priority health care platforms. PLoS Medicine, 10(5), e1001448.Google Scholar
  62. Pechansky, F. (1995). Treatment for alcohol and other drug problems in Brazil: a puzzle with missing pieces. Journal of Psychoactive Drugs, 27(1), 117–123.Google Scholar
  63. Pereira, M. O., Anginoni, B. M., da Costa Ferreira, N., de Oliveira, M. A. F., de Vargas, D., & de Almeida Colvero, L. (2013). Efetividade da intervenção breve para o uso abusivo de álcool na atenção primária: revisão sistemática. Revista brasileira de enfermagem, 66(3), 420–428.Google Scholar
  64. Pillon, S. C., & Laranjeira, R. R. (2005). Formal education and nurses’ attitudes towards alcohol and alcoholism in a Brazilian sample. São Paulo Medical Journal, 123(4), 175–180.Google Scholar
  65. Pillon, S. C., Luis, M. A. V., & Laranjeira, R. (2003). Nurses’ training on dealing with alcohol and drug abuse: a question of necessity. Revista do Hospital das Clínicas, 58(2), 119–124.Google Scholar
  66. Pope, C., Ziedland, S., & Mays, N. (2000). Qualitative research in health care: analysing qualitative data. British Medical Journal, 320(7227), 114–116.Google Scholar
  67. Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34. Scholar
  68. Ritsher, J. B., & Phelan, J. C. (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research, 129(3), 257–265.Google Scholar
  69. Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in health care: helping patients change behavior. New York: Guilford Press.Google Scholar
  70. Ronzani, T. M., Rodrigues, T. P., Batista, A. G., Lourenço, L. M., & Souza-Formigoni, M. L. O. d. (2007). Estratégias de rastreamento e intervenções breves para problemas relacionados ao abuso de álcool entre bombeiros. Estudos de Psicologia (Natal), 12, 285–290.Google Scholar
  71. Ronzani, T. M., Higgins-Biddle, J., & Furtado, E. F. (2009a). Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Social Science & Medicine, 69(7), 1080–1084.Google Scholar
  72. Ronzani, T. M., Mota, D. C. B., & Souza, I. C. W. d. (2009b). Alcohol prevention within primary care in municipalities in the state of Minas Gerais, Southeastern Brazil. Revista de Saúde Pública, 43, 51–61.Google Scholar
  73. Saitz, R. (2007). Screening and brief intervention enter their 5th decade. Substance Abuse, 28(3), 3–6.Google Scholar
  74. Saitz, R., Friedmann, P. D., Sullivan, L. M., Winter, M. R., Lloyd-Travaglini, C., Moskowitz, M. A., & Samet, J. H. (2002a). Professional satisfaction experienced when caring for substance-abusing patients: faculty and resident physician perspectives. Journal of General Internal Medicine, 17(5), 373–376. Scholar
  75. Saitz, R., Friedmann, P. D., Sullivan, L. M., Winter, M. R., Lloyd-Travaglini, C., Moskowitz, M. A., & Samet, J. H. (2002b). Professional satisfaction experienced when caring for substance-abusing patients. Journal of General Internal Medicine, 17(5), 373–376.Google Scholar
  76. Schmidt, M. I., Duncan, B. B., Silva, G. A., Menezes, A. M., Monteiro, C. A., Barreto, S. M., . . . Menezes, P. R. (2011). Chronic non-communicable diseases in Brazil: burden and current challenges. The Lancet, 377(9781), 1949–1961.Google Scholar
  77. Schwartz, D., & Lellouch, J. (1967). Explanatory and pragmatic attitudes in therapeutical trials. Journal of Clinical Epidemiology, 20(8), 637–648.Google Scholar
  78. Secretaria Municipal de Saúde. (2017). Coleção Guia de Referência Rápida Álcool e Outras Drogas: Tratemento e acompanhamento de pessos come probelmas relaciondos ao uso de álcool e outras drogas. Rio de Janeiro: Secretaria Municipal de Saude Retrieved from Accessed 1 Dec 2018.
  79. Secretaria Municipal de Saúde. (2018). Subpav. Retrieved September, 2018, from Rio Prefeitura, Accessed 27 Feb 2019.
  80. Serafim, T. d. S., Jesus, E. d. S., & Pierin, A. M. G. (2010). Influence of knowledge on healthy lifestyle in the control of hypertensive. Acta Paulista de Enfermagem, 23(5), 658–664.Google Scholar
  81. Shorter, G., Heather, N., Bray, J. W., Giles, E., Holloway, A., Barbosa, C., et al. (2017). The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) framework: protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention. Trials, 18(1), 611.Google Scholar
  82. Signor, L., Pierozan, P. S., Ferigolo, M., Fernandes, S., Mazoni, C. G., & Barros, H. M. T. (2013). Efficacy of the telephone-based brief motivational intervention for alcohol problems in Brazil. Revista Brasileira de Psiquiatria, 35(3), 254–261.Google Scholar
  83. Silva Souza, L. G., de Andrade, A. L., Smith, M. C., Rogério, M. P., Menandro, M., & Apostolidis, T. (2015). Perceptions of primary health care professionals towards alcoholic patients: an exploratory study in a Brazilian municipality. Universitas Psychologica, 14(3), 1045–1054.Google Scholar
  84. Soares, J., & Vargas, D. d. (2019). Effectiveness of brief group intervention in the harmful alcohol use in primary health care. Revista de Saúde Pública, 53, 04.Google Scholar
  85. de Souza, M. L. P. (2005). Expansão do Programa Saúde da Família (PSF) e identificação de problemas relacionados ao uso de álcool no Brasil. Revista Brasileira de Psiquiatria, 27(4), 342–343.Google Scholar
  86. Spencer, L., & Ritchie, J. (2002). Qualitative data analysis for applied policy research. In R. G. Burgess & A. Bryman (Eds.), Analyzing qualitative data (pp. 187-208). New York: Routledge.Google Scholar
  87. Sullivan, E. J., & Fleming, M. F. (1997). A guide to substance abuse services for primary care clinicians: Treatment Improvement Protocol (TIP) Series. (SMA 97-3139). Rockville: Department of Health and Human Services.Google Scholar
  88. The World Bank. (2019). Brazil overview. Retrieved from Accessed 5 Jan 2019.
  89. Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.Google Scholar
  90. Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence, 131(1–2), 23–35.Google Scholar
  91. Veach, T., & Chappel, J. (1990). The Brief SAAS: a short form of the Substance Abuse Attitudes Survey (SAAS). Paper presented at the AMERSA Conference Washington, DC.Google Scholar
  92. Viana, M. C., & Andrade, L. H. (2012). Lifetime prevalence, age and gender distribution and age-of-onset of psychiatric disorders in the São Paulo Metropolitan Area, Brazil: results from the São Paulo Megacity Mental Health Survey. Brazilian Journal of Psychiatry, 34(3), 249–260.Google Scholar
  93. Watts, J. (2016). Brazil’s health system woes worsen in economic crisis. Lancet, 387(10028), 1603–1604.Google Scholar
  94. WONCA. (2018). Core competencies of family doctors in primary mental health care Retrieved from Accessed 20 Feb 2019.
  95. Woolf, S. H., & Johnson, R. E. (2005). The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. The Annals of Family Medicine, 3(6), 545–552.Google Scholar
  96. World Health Organization. (2010). Atlas on substance use (2010): resources for the prevention and treatment of substance use disorders. Geneva: World Health Organization Retrieved from Accessed 29 Jan 2019.
  97. World Health Organization. (2017). mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings-version 2.0 (for field testing). Geneva: World Health Organization Retrieved from Accessed 26 April 2018.
  98. World Health Organization. (2018). Global status report on alcohol and health 2018. Geneva: World Health Organization Retrieved from Accessed 29 Jan 2019.
  99. Zerbetto, S. R., & Maciel, L. D. (2017). Importancia de Capacitação sobre a problemática do álcool: percepção crítica dos profissionais de saúde. Saúde (Santa Maria), 43(1), 31–40.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sean J. Haley
    • 1
    Email author
  • Karen Athié
    • 2
  • Katarzyna E. Wyka
    • 3
  • Manoela Alves Salgado
    • 2
  • Débora Silva Teixeira
    • 2
  • Kali Alves
    • 2
  • Vitor Aguiar Lobato de Carvalho
    • 2
  • Daniel Storti Netto Puig
    • 2
  • Sandra Fortes
    • 2
  1. 1.Department of Health Policy and ManagementCity University of New York’s Graduate School of Public Health and Health PolicyNew YorkUSA
  2. 2.Interdisciplinary Research Laboratory on Primary CareUniversidade do Estado do Rio de JaneiroRio de JaneiroBrazil
  3. 3.Department of Epidemiology and BiostatisticsCity University of New York’s Graduate School of Public Health and Health PolicyNew YorkUSA

Personalised recommendations