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Quick Guide
For Clinicians

Based on TIP 6
Screening for Infectious
Diseases Among
Substance Abusers

-----------------------------------------------
Contents
Why a Quick Guide?  . . . . . . . . . . . . . . . . . . . 2
What is a TIP?  . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction  . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Initial Patient Contact . . . . . . . . . . . . . . .5
The Role of the Counselor  . . . . . . . . . . . . . . 9
Legal and Ethical Issues  . . . . . . . . . . . . . . 21
Resources  . . . . . . . . . . . . . . . . . . . . . . . . . 30
Glossary  . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

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Quick Guide
For Clinicians

This Quick Guide is based almost entirely on information con
tained in TIP 6, published in 1993 and based on information
updated through approximately 1991. No additional research
has been conducted to update this topic since publication of
the original TIP.
Based on TIP 6
Screening for Infectious
Diseases Among Substance
Abusers

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2
Screening for Infectious Diseases Among Substance Abusers

WHY A QUICK GUIDE?

This Quick Guide was developed to accompany
Screening for Infectious Diseases Among
Substance Abusers, Number 6 in the Treatment
Improvement Protocol (TIP) Series published by
the Center for Substance Abuse Treatment (CSAT),
Substance Abuse and Mental Health Services
Administration. This Quick Guide is based entirely
on TIP 6 and is designed to meet the needs of the
busy clinician for concise, easily accessed how-to
information.

The Guide is divided into six sections (see
Contents) to help readers quickly locate relevant
material. Terms related to infectious diseases
among substance abusers are listed on page 32
in the Glossary. Clinicians can use the Resources
beginning on page 30 to keep updated with cur
rent information in screening for infectious dis
eases.

For more information on the topics in this Quick
Guide, readers are referred to TIP 6.

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What Is a TIP? 3

WHAT IS A TIP?

The TIP series has been in production since 1991.
This series provides the substance abuse treat
ment and related fields with consensus-based,
field-reviewed guidelines on substance abuse
treatment topics of vital current interest. TIP 6

 Addresses concerns of a broad range of read
ers, including clinicians, social workers, medical
personnel, mental health workers, program
administrators, and policymakers
 Includes extensive research
 Lists numerous resources for further informa
tion
 Provides a comprehensive reference on screen
ing for infectious diseases among substance
abusers
See the inside back cover for information on how
to order TIPs and other related products.

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4
Screening for Infectious Diseases Among Substance Abusers

INTRODUCTION

There is a vital need for the integration of sub
stance abuse treatment and infectious disease
screening, testing and counseling. Drug use is an
important risk factor for infectious diseases, since
it is commonly associated with such risk behav
iors as the sharing of contaminated needles and
other drug paraphernalia, and with unsafe sexual
practices that contribute to transmission.

This Quick Guide is designed to provide helpful
information about transmission, symptoms, and
indications for screening of a number of these
conditions. It also contains basic guidelines for
effective counseling, along with information about
reporting infectious diseases where mandated by
Federal, State and/or local regulations. 

Please remember: Many drug users are reluctant
to become involved with traditional medical
providers because of previous poor treatment,
and/or may have had minimal or no medical care
before enrolling in a treatment program.
Substance abuse treatment providers must be
sensitive to and knowledgeable about the experi
ences, concerns and needs of these individuals.

For more detailed information, see TIP 6, pp. 13.

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The Initial Patient Contact 5

THE INITIAL PATIENT CONTACT

Goals 
The goals of the initial patient contact are to 

 Lay the foundation for a positive relationship
between treatment staff and the patient 
 Obtain a thorough and complete medical, sexu
al, psychosocial, and drug use history 
 Prepare for initial physical examination and
infectious disease screening 
 Begin treatment planning 
Studies show that an open, trusting relationship
with treatment staff helps the patient remain in
and benefit from treatment services. The inter
viewer can begin creating this supportive relation
ship during the first contact by

 Being accepting and nonjudgmental 
 Providing complete information about assess
ment and diagnostic procedures 
 Answering the patient's questions 
 Being open to and understanding of the needs
and concerns of the patient
A comfortable rapport encourages the patient to
trust the interviewer with sensitive and personal

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6
Screening for Infectious Diseases Among Substance Abusers

information. To further facilitate patient respon
siveness, the interviewer can 

 Begin the process of taking a history with the
least stressful areas of questioning (e.g., gather
ing general demographic information first, then
addressing drug use, sexual practices, and
infectious disease testing) 
 Introduce the objectives of the interview and
explain to the patient that the questions asked
are intended to help both treatment staff and
the patient develop appropriate care 
 Explain to the patient how Federal, State and
local regulations affect the confidentiality of
drug treatment information, infectious disease
test results, contact tracing and partner notifica
tion procedures, and medical records 
 Inform the patient that testing for infectious dis
eases, including HIV, is voluntary 
Patient History
Medical History
 History of and treatment for infectious diseases
 Vaccination status
 Current medical treatments
 Obstetrical/gynecological status

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The Initial Patient Contact 7

History of Drug Abuse
 History of injection drug use
 History of sharing needles and other drug para
phernalia
Psychosocial History
 Family history of infectious disease(s)
 Psychiatric disorders
 Socioeconomic and housing status
Sexual History
 Number and background of sexual partners
 High-risk sexual practices
 Sexual activity while under the influence of 
alcohol or illicit drugs
It may be helpful during this process to assure the
patient that a sexual history provides the treat
ment team with information that can be critical for
the prevention and treatment of infectious dis
eases and that this is the only purpose for gather
ing such information.

The Medical Examination 
Every patient entering substance abuse treatment
should have a thorough physical examination to

 Assist medical staff to diagnose infectious dis
eases in patients 

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8
Screening for Infectious Diseases Among Substance Abusers

 Provide a basis for infectious disease testing 
 Assist medical staff to plan for and provide
medical care for patients with infectious dis
eases
 Provide a basis for planning preventive interven
tions 
 Provide a basis for planning follow-up medical
care 
 Develop a comprehensive drug treatment plan
(with the patient's input) 
For more detailed information, see TIP 6, 
pp. 3133.

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The Role of the Counselor 9

THE ROLE OF THE COUNSELOR

Screening for infectious diseases in the treatment
setting requires not only medical management but
supportive counseling. 

Pre-Test Counseling
The counselor should 

 Create an environment that conveys trust and
acceptance, encourages communication, and
validates feelings 
 Stress the benefits of testing
 Discuss the process of testing, possible out
comes and treatment resources
 Explain confidentiality procedures and reporting
requirements
 Discuss infection containment and risk reduc
tion strategies
 Discuss retesting and the circumstances under
which it may be indicated 
 Discuss contact tracing and partner notification 
 Help the patient make the best decisions in
obtaining medical care 
Patients may be particularly anxious about how
and when test results will be provided, and they
may experience some distress while waiting. The

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10
Screening for Infectious Diseases Among Substance Abusers

counselor should assure the patient that, if the
results are positive, medical treatment is available
and can be effective.

Post-Test Counseling
Because of the severe distress some patients
experience while waiting for test results, coun
selors are advised that they only have 10 to 60
seconds to communicate information that will be
comprehended by the patient after the test result
is reported. A second post-test session may be
needed after the patient gets over the initial ela
tion or depression.

Patients With Positive Test Results
Patients infected with TB, viral hepatitis, syphilis
or other sexually transmitted diseases (STDs)
need emotional support and counseling. The
counselor can assist these patients in the follow
ing ways: 

 Discuss the importance of following all proce
dures, keeping appointments for checkups, and
taking medications.
 Make sure the patient is familiar with the right
to confidentiality, while being aware of the need
to inform health department infectious disease
practitioners of all contacts and partners who
may be at risk for infection.

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The Role of the Counselor 11

 Inform the patient about the signs and symp
toms of disease, routes of transmission, and
short- and long-term effects. 
 Discuss safer sexual practices and abstinence
from drugs as important risk-reduction behav
iors.
Patients With Negative Test Results
Patients need a careful explanation of the mean
ing of negative test results. In some cases, repeat
tests may be needed on a regular basis. With
many patients, a negative test result provides a
non-threatening window of opportunity for impor
tant education and counseling about protection
from infectious disease. This may be particularly
important for adolescent drug users, who might
otherwise continue high-risk behaviors without
being concerned about infection risks.

Patients With Negative HIV Test Results
In such cases, the counselor should discuss the
possible need for retesting. Although HIV-antibody
tests are extremely accurate when properly done,
(re)testing may be advisable for 

 Persons who strongly deny any risk factors and
are unwilling to accept an initial positive result 
 A patient who may have been infected with HIV
in the recent past (8 to 12 weeks), since the HIV

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12
Screening for Infectious Diseases Among Substance Abusers

tests may be falsely negative because of the
incubation period before seroconversion 
 A person with known HIV risk factors (the HIV
test should be repeated in 3 months and again
in 6 to 12 months) 
 As long as a patient engages in behavior associ
ated with risk of exposure to HIV (retested every
3 to 6 months) 
 The children of HIV-infected women
HIV-Positive Patients
HIV is dealt with separately because the severity
of the illness and the stigma surrounding it make
this condition an especially difficult one for
patients to accept and deal with. 

Begin with the facts: Patients with a positive HIV
test result have HIV infection and must deal with
questions about AIDS. The progression of illness
in individual patients is unpredictable, but proper
medical care may significantly slow this process. 

The counselor should advise the patient that he or
she is infectious and must follow precautions to
prevent the transmission of the virus to others,
especially via sexual contact or injection drug use. 

Patient responses to this information can vary
greatly, from intense anxiety, guilt and feelings of

-----------------------------------------------
The Role of the Counselor 13

physical and social isolation to anger, fear and
concerns about loss of relationships and support
systems. The counselor should reassure patients
that these feelings are understandable and nor
mal. 

Employ additional methods as necessary to help
the patient maintain a positive approach to coping
with HIV: 

Discuss withdrawal and self-imposed isolation.
Being HIV positive is associated with being viewed
as someone who engages in high-risk sexual
behavior and/or drug abuse. Patients are often
faced with extreme isolation because of misunder
standings about modes of transmission. They may
need assistance to maintain an existing network
of friends and family or to develop a support net
work. 

Assess suicide potential and provide referral to
mental health care. Patients who are HIV positive
may contemplate suicide at some point following
their diagnosis. It is imperative that substance
abuse treatment programs have a well-defined
protocol to respond to all suicidal thoughts or ges
tures. 

Emphasize risk-reduction behaviors. Of particular
concern is the risk of infection with a different and
potentially more virulent and resistant strain of

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14
Screening for Infectious Diseases Among Substance Abusers

HIV, which can hasten the progression of HIV to
AIDS. In addition, drug use may further impair the
immune system.

Support the patient in joining an HIV support
group. The patient who is HIV positive may benefit
from the help and understanding provided by a
community-based HIV support group. The coun
selor can encourage and facilitate attendance by
patients and family members during treatment
and after its completion. 

Support the patient and family members in
anticipatory mourning and other feelings.
Feelings of impending loss and grief can be fright
ening and may lead to the further debilitation and
isolation of the patient. Patients need assurance
that these feelings are a part of a healthy coping
process. Patients and their family members may
also confront employment, physical, and financial
concerns. Counseling and referrals to community-
based resources can provide the assistance need
ed to maintain a positive lifestyle. 

Contact Tracing and Partner Notification
Once positive test results are received, patients
should be encouraged to provide the names and
locations of sexual partners, injection drug-sharing
partners, or contacts at risk for infection. For
reportable diseases, contact tracing and partner

-----------------------------------------------
The Role of the Counselor 15

notification are conducted by health department
personnel regardless of the wishes of the infected
person.

It is helpful for patients to have opportunities to
discuss their fears about contact and partner noti
fication. Patients may fear the loss of a relation
ship, physical violence, the loss of housing or
other physical or emotional support, and the loss
of confidentiality and misuse of the information. 

When patients do choose notification, they may
need assistance to develop effective ways to com
municate with these individuals. Using techniques
such as role-playing, patients can be prepared for
potentially uncomfortable situations:

 Adolescents may be particularly embarrassed
about their infection and may continue risky
behaviors. The counselor can discuss referral
options to community-based services to address
needs such as housing and financial assis
tance, peer support groups, and mental health
care. 
 Some may fear abandonment, or physical or
emotional abuse from a partner, if their test
results are revealed. The counselor can discuss
referral options to community-based services to
address needs such as legal intervention, hous-

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16
Screening for Infectious Diseases Among Substance Abusers

ing assistance, child care services, and financial
assistance. 
 Patients may fear that contacts will be able to
discern their identity and that confidential and
sensitive information will be misused, and thus
may be unwilling to provide information, or may
provide information that is incorrect or incom
plete. The counselor can acknowledge the
patient's concerns and be reassuring about the
confidentiality of treatment records. 
Risk Reduction 
Every patient should receive risk reduction educa
tion and counseling to help prevent future infec
tion in patients who test negative and reduce the
risk to others from patients who test positive. The
experiences of drug treatment programs suggest
that the following broad principles can effectively
guide counselor-based risk reduction activities: 

 Establish a warm and trusting relationship with
the patient, based on mutual respect and
regard. 
 In the overall treatment program, incorporate
risk-reduction approaches that emphasize the
benefits of preventive health behaviors. 
 Provide risk reduction education and counseling
that is sensitive to the cultural values, religious
beliefs and traditions of the individuals being

-----------------------------------------------
The Role of the Counselor 17

served, as well as their socioeconomic and day
to-day realities.
 Understand that it is fairly easy to change
knowledge, more difficult to change attitudes,
and extremely difficult to change behavior.
 Forego scare tactics: They are usually ineffec
tive, especially when dealing with adolescents
and young adults.
 Expect modest levels of change. 
 Encourage participation in an HIV/AIDS self-help
group for HIV-positive patients.
Safer Sexual Practices
The initiation of safer sexual practices is a primary
risk reduction strategy. Factors associated with a
return to high-risk sexual practices include

 Higher levels of unsafe sexual activity prior to
behavioral change 
 Perceptions that behavioral change does not
offer protection from infection 
 Failure to use condoms with a steady and "safe"
sexual partner 
 Negative attitudes concerning condom use 
 Use of alcohol or illicit drugs 
 A lack of enjoyment of sexual activity using
safer sex methods 

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18
Screening for Infectious Diseases Among Substance Abusers

 A preference for high-risk sexual activities, such
as unprotected anal intercourse 
 Social support for high-risk behavior 
Beyond sexual abstinence, the consistent and
proper use of condoms is currently the most effec
tive way to prevent HIV and other STDs. For more
information, refer to Table 1, Recommendations
for the use of condoms, p. 16 of TIP 6.

The following examples of counselor-based activi
ties can also promote safer sexual behavior by
patients:

 Educate patients about the risk of infection
through unprotected sex, particularly with injec
tion drug users and multiple partners.
 Incorporate ethnic and cultural perspectives to
circumvent barriers to the use of condoms.
 Provide materials that offer sex-positive mes
sages that make safer sex appealing to
patients. 
 Educate both women and men about the poten
tial impact of infection on a developing fetus or
newborn infant (infection may occur at concep
tion, but there is continued risk throughout the
pregnancy).

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The Role of the Counselor 19

 Assist women to assess and avoid possible
domestic violence should they initiate unwel
come changes in sexual practices. 
 Offer coping skills and assertiveness training
that assist patients in resisting pressures from
partners to engage in unsafe sexual practices.
 Stress that maintaining safer sexual practices
and not returning to high-risk behaviors is an
ongoing, lifelong challenge. 
Retention in Treatment 
Studies and clinical experience show that the
longer patients stay in treatment, the better the
outcome and the less likely relapse becomes. For
patients not in long-term therapy, it is vitally
important to make sure they know who the local
health care provider is and how to get there. 

The patient should be in the habit of accessing
care and making return visits, and should know
how and where to reenter the drug treatment sys
tem. During treatment, information should be pro
vided about community-based programs that deal
with ongoing recovery needs. 

A counselor should work out insurance benefits
with the patient. If the patient is not eligible for
insurance, that patient should know how to get
care for medical emergencies. In addition, the
counselor can

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20
Screening for Infectious Diseases Among Substance Abusers

 Encourage and support the patient to make a
commitment not to use non-prescribed drugs
while in treatment.
 Encourage the patient's participation in self-
help groups.
 Provide skills training that is oriented to chronic
and complex life problems, such as job-seeking.
 Provide aggressive diagnosis and treatment for
comorbid psychiatric disorders, particularly
depression and anxiety.
 Provide comprehensive counseling that includes
drug avoidance skills.
 Help the patient develop coping strategies, such
as anger management and social skills develop
ment. 
 Teach patients self-management and social
skills that assist them to create steady and self-
affirming social supports and drug-free con
tacts, resist coercion, and improve decision
making.
 Teach patients relaxation and meditation tech
niques to combat the stress and tension that
can lead to drug use.
 Understand that it is never appropriate to dis
charge a patient solely on the basis of drug use
while in treatment.
For more detailed information, see TIP 6, pp. 1117.

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Legal and Ethical Issues 21

LEGAL AND ETHICAL ISSUES

Treatment Access 
The following practices can discourage drug users
from seeking treatment and are likely to violate
Federal and State nondiscrimination laws (not to
mention being unethical): 

 Requiring individuals to be tested for infectious
diseases as a condition of admission to treat
ment 
 Providing differential treatment to such patients
 Refusing to admit otherwise eligible individuals
However, to protect the safety and health of other
patients and staff, an individual seeking treat
ment who is thought to have infectious TB or any
other highly contagious disease (such as chicken
pox) may be denied admission until it has been
medically determined if the patient needs treat
ment.

Some accommodations by treatment providers
may be needed to enable individuals to partici
pate in and benefit from treatment services.
Providers are required by Federal nondiscrimina
tion laws to make reasonable accommodations for
clients with disabilities, but not to change the
basic nature of the services offered or incur
undue financial hardship.

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22
Screening for Infectious Diseases Among Substance Abusers

Segregating persons with HIV or AIDS, or providing
differential treatment to such patients under the
guise of protecting others from infection, must
generally be avoided. Other, nondiscriminatory
means are usually available to protect patients
and staff. 

Appropriate infection control and prevention
measures include education and training for staff
about transmission modes for HIV and other com
municable diseases and about preventive prac
tices such as those detailed by the Centers for
Disease Control and Prevention (CDC) and the
Occupational Safety and Health Administration
(OSHA).

Confidentiality, Disclosure and 
Informed Consent 
The benefits of the therapeutic relationship
depend, in part, on maintaining strict confidential
ity for all patient information. Patients in treat
ment rely on this and they trust that their medical
and personal records will be protected from
unwarranted and unwanted disclosure. 

Federal laws and regulations now protect drug
treatment patient records, and some State
statutes may equal or exceed these Federal
requirements. Treatment staff members need to
be familiar with these laws, and a discussion of

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24
Screening for Infectious Diseases Among Substance Abusers

out patient consent, each of which have their own
requirements and limitations. In general, permit
ted disclosures are those made as follows: 

 With the written informed consent of the patient 
 Pursuant to internal program communications 
 Pursuant to a medical emergency 
 In response to a special court order following a
court hearing in which disclosure is authorized 
 For the purpose of reporting a crime at the
treatment program or against program person
nel 
 For research or audit purposes 
 In the course of reporting child abuse or neglect 
 Pursuant to a qualified service organization
agreement (QSOA)
 In response to a request for non-patient-identify
ing information
State confidentiality laws may also limit the ability
of persons to testify in court based on information
obtained when providing professional services
(testimonial privilege).

Informed Consent
Informed consent consists of communicating to
the patient the risks involved and benefits to be

-----------------------------------------------
Legal and Ethical Issues 25

derived from a test in a way that allows the
patient to make a decision about whether or not
he or she will have the test done. The practitioner
involved in securing the patient's informed con
sent will generally include a note in the patient's
record. 

Written informed consent requires the patient's
signature on a document that specifies the above
elements in a language that the patient is com
fortable with. If there is any question about the
process, legal counsel should be sought.

State laws generally govern whether and what
form of informed consent is required for medical
testing (including infectious disease testing).
Informed consent is required for HIV testing in
many jurisdictions. In some States, minors can
give informed consent without parental agree
ment. Drug treatment providers should make sure
their consent forms for HIV or other infectious dis
eases testing comply with applicable State laws.

Some patients may choose not to undergo testing.
Treatment providers need to be respectful of
these choices. Patients generally have this right,
and they cannot be denied access to or continua
tion of treatment services based solely on that
refusal.

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26
Screening for Infectious Diseases Among Substance Abusers

HIV Issues 
The unfortunate discrimination that persists for
many HIV-positive individuals makes it imperative
that treatment providers act with great care to
inform patients of their legal rights concerning
testing. Patients need to receive professional
counseling before reaching a decision about HIV
testing. In some States, HIV laws mandate pre
and post-test counseling. Under current Federal
law, mandatory HIV testing is required

 Upon entrance to the military 
 For donors of blood, organs, and tissue 
 For Federal prisoners
 For persons seeking immigration to the U.S.
States may also require mandatory HIV testing of
individuals under certain circumstances, such as
marriage applicants, mentally ill or mentally
retarded patients, injection drug users, and sex
offenders. 

Anonymous Testing
For patients who agree to HIV-antibody testing,
confidential as well as anonymous procedures are
available in many communities and should be dis
cussed as alternatives. Anonymous testing
assigns a unique identifier to each patient, and
results are not traceable to an individual. 

-----------------------------------------------
Legal and Ethical Issues 27

Confidential testing, on the other hand, links the
individual by name to test results, and confiden
tiality safeguards protect the test results. In States
that require the reporting of HIV-positive individu
als by name to health authorities, patients may
choose to use anonymous testing sites.

Contact Tracing and Partner Notification 
Public health statutes in States usually authorize
or require contact tracing for STDs. Most States
currently do not classify HIV infection as an STD,
although some States have specifically authorized
or required such tracing. The informed consent of
the patient must be sought for contact tracing and
partner notifications in circumstances where
statutes are silent. 

All notifications that are accomplished by persons
other than the patient, regardless of the reporting
requirement, are performed without revealing the
identity of the patient (although it may be inferred
by the partner in some situations). 

These notifications may place patients in treat
ment at risk for negative consequences, such as
physical abuse or abandonment. Treatment
providers should exercise care to protect patient
confidentiality when counseling about, assisting
with, or performing partner notifications and con
tact tracing.

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28
Screening for Infectious Diseases Among Substance Abusers

"Duty to Warn" 
In spite of strict ethical codes and legal require
ments for the confidentiality of patient informa
tion, some treatment providers may find them
selves subject to a "duty to warn" that requires a
breach of confidentiality. 

"Duty to warn" refers to the legal duty of a physi
cian, health care worker, or other professional to
protect another individual from harm. The legal
basis for warning an individual in order to protect
that person from severe or deadly harm may be
provided by State law. If so, it is likely that the
State statute will allow, but not require, that a
warning be made.

The moral duty to warn conflicts with the legal and
professional sanctions against unauthorized dis
closure of confidential patient information. Drug
treatment providers must keep in mind that, even
if State law permits or requires disclosures of
patient-identifying information in "duty to warn" sit
uations, they may make such warnings only in
ways that are permitted by the Federal drug confi
dentiality laws and regulations. 

Treatment providers should be aware of applica
ble State laws, have procedures in place that sup
port legally required actions, and understand that
a breach of confidentiality is punishable by law.

-----------------------------------------------
Legal and Ethical Issues 29

Record Keeping 
Treatment programs have a duty to maintain 
adequate patient records. These are useful in
monitoring patient progress, case management,
seeking funding and reimbursement, and evaluat
ing program effectiveness. In States in which
there are laws covering disclosure of HIV in health
records, drug treatment programs need to comply
with restrictions about mentioning HIV diagnosis
and treatment in such records.

A number of approaches are possible, and treat
ment providers should ensure that the approach
selected meets all Federal and State confidentiali
ty requirements. Options include 

 Maintaining a single, comprehensive record with
integrated test results and limiting access to
medical staff and others authorized by consent
of the patient 
 Maintaining infectious disease and/or HIV test
results separately from the main part of the
patient's record and limiting access to medical
staff and others authorized to have access to
medical information 
 Maintaining all medical information separately
from the main part of the patient's record and
limiting access to medical personnel and others
authorized to have access to medical informa
tion
For more detailed information, see TIP 6, pp. 1924.

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30
Screening for Infectious Diseases Among Substance Abusers

RESOURCES 
Listed below are a number of related resources
for infectious disease screening, counseling and
treatment.

The National Institute on Drug Abuse (NIDA)
(301) 443-1124; NIDA Clearinghouse: 1-800-729-
6686
The Federal alcohol and drug clearinghouses list
ed below can all be reached through one tele
phone number: 1-800-788-2800. Individual num
bers are also listed.

CDC National Prevention Information Network
(formerly known as the CDC National AIDS
Clearinghouse) 1-800-458-5231; TTY: 1-800-243-
7012; Information on AIDS clinical trials: 1-800-
874-2572; online at www.cdcnac.org

Centers for Disease Control and Prevention
(CDC) online at www.cdc.gov

Drug Information and Strategy Clearinghouse  
1-800-578-3472 or (301) 251-5154

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Resources 31

The National Drug and Alcohol Treatment
Referral and Routing Service (formerly known as
the Drug Abuse Information and Treatment
Referral Line)
1-800-662-4357; Spanish: 1-800-662-9832

Drug-Free Workplace Helpline 1-800-843-4971

SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) 1-800-729-6686

National Institutes of Health (NIH) online at
www.nih.gov

For more detailed information, see TIP 6, 
pp. 137138.

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32
Screening for Infectious Diseases Among Substance Abusers

GLOSSARY
Anonymous Testing: Testing which assigns a
unique identifier to each patient, with the results
not being traceable to an individual. 

Disclosure: A communication that identifies an
individual as having participated in, participating
in, or seeking to participate in drug or alcohol
abuse treatment. 

Duty to Warn: The legal duty of a physician,
health care worker or other professional to protect
another individual from harm.

EIA: Abbreviation for enzyme immunoassay, a type
of screening test for certain infectious diseases. 

Informed Consent: Communicating to the patient
the risks involved and benefits to be derived from
a test in a way that allows the patient to make a
decision about whether or not he or she will have
the test done. 

Qualified Service Organization Agreement
(QSOA): A contract that, under certain conditions,
permits a substance abuse treatment provider to
share patient-identifying information with an out
side service provider. 

-----------------------------------------------
Ordering Information
TIP 6  Screening for 
Infectious Diseases 
Among Substance 
Abusers

TIP 6-Related Products
KAP Keys for Clinicians
based on TIP 6

Do not reproduce or distribute this publication for a fee without spe
cific, written authorization from the Office of Communications,
Substance Abuse and Mental Health Services Administration, U.S.
Department of Health and Human Services.

Easy Ways to Obtain Free Copies 
of All TIP Products
1. Call SAMHSA's National Clearinghouse for Alcohol
and Drug Information (NCADI) at 800-729-6686, 
TDD (hearing impaired) 800-487-4889
2. Visit CSAT's Website at www.csat.samhsa.gov

-----------------------------------------------
Other Treatment Improvement
Protocols (TIPs) that are relevant to
this Quick Guide:

See the inside back cover for ordering information for all
TIPs and related products.

DHHS Publication No. (SMA) 01-3553
Printed 2001
TIP 11, Simple Screening Instruments for
Outreach for Alcohol and Other Drug Abuse and
Infectious Diseases (1994) BKD143
TIP 16, Alcohol and Other Drug Screening of
Hospitalized Trauma Patients (1995) BKD164
TIP 18, The Tuberculosis Epidemic: Legal and
Ethical Issues for Alcohol and Other Drug Abuse
Treatment Providers (1995) BKD173
TIP 37, Substance Abuse Treatment for Persons
With HIV/AIDS (2000) BKD359