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What is this S-B-I-R-T? Why do you keep using it like I’m supposed to know what it means?
We hate to admit it, but it’s our tendency to throw around a lot of…jargon. Okay, it’s true. SAMHSA this, NAADAC that. CBT, MAT, ATTC. ROSC, which of course we pronounce rosk. NIAAA, which those of us in the know call N-I Triple A. Obviously.
Of course, there are people concerned with substance use and addiction that aren’t breathing this lingo every day. Rather, they’re curiously googling and Youtube-ing. Talking to friends, family, trusted healthcare providers. Maybe they’re even getting information from their clients or students.
IRETA works to offer accurate information about substance use and substance use disorders and we know that the information hardly matters if it doesn’t make sense to you. When we say, “SBIRT is a public health response to unhealthy substance use and related harms” and you say…
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Most likely many of you are familiar with the recently published studies on SBIRT published in the Journal of the American Medical Association (JAMA). Although these studies contain some very solid research data, their focus does not do justice to the benefits SBIRT brings to behavioral health. In case you have not seen the articles, the two studies (and the related editorial) are attached. SAMHSA believes these two papers are of substantial interest. However, it is important to look at the papers from the proper perspective.
Both papers focused on the Brief Intervention (BI) part of SBIRT, not the Screening part and not the referral to treatment (RT) part. These two studies were well done and elaborate. However, the value of SBIRT could not be challenged by either study. Furthermore, the value of SBIRT to behavioral health and primary care providers is the ability of SBIRT to identify when a patient is in need. When patients have chronic medical problems, there are multiple opportunities to address the issue of substance use. Roy-Byrne noted the majority of his participants had a single brief intervention contact, with only 47% receiving a follow-up booster call. Saitz reported a single session approach for his two test conditions.
During the 11 years since SAMHSA’s SBIRT program has been in existence, over 2 million people have been screened. Of those, only a small percentage screened positive for any “at risk” behaviors, with about 11 percent of those screened receiving a brief intervention. Without screening many of these people might have remained invisible. SBIRT gives providers and primary care physicians an opportunity to identify potential alcohol and substance misuse or abuse and, through brief intervention, an opportunity to use that “teachable moment” to educate patients and, potentially, change the behavior of “at risk” individuals for the better.
Roy-Byrne’s title “Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings” really is applicable to both papers. Ninety-one percent of Roy-Byrne’s participants were unemployed, while 81% of Saitz participants were on Medicaid or Medicare. Fifty-six percent of Roy-Byrne’s participants had greater than one ICD-9 Mental Illness code, while 46% of Saitz’s participants had a co-morbid mood disorder. Saitz required his participants to have an ASSIST score of greater than 4 in order to participate. That is understandable, since the World Health Organization (WHO) recommends that an ASSIST score of 4 to 26 should result in brief intervention and a score of 27+ should result in more intensive treatment.
It is important to remember brief intervention does not work for everyone. For many, learning the consequences of their “at risk” behavior or abuse can provide the wake-up call they need to either stop using or seek appropriate treatment. For individuals with more severe and complex substance use disorders, brief intervention will most likely not be sufficient to change their behaviors. For this group it is important that a treatment referral be made.
When dealing with complex patients with complex problems, is it reasonable to expect BI to “cure” the substance use disorder? No. The question for SBIRT is whether it is feasible to screen for drug use disorders in primary care, just as it is feasible to screen for alcohol use disorders. Both papers implicitly say “Yes.” Thus, if it is feasible, the next question is whether it should be done. We believe that if we are to promote integrated treatment, primary care providers (PCPs) must have the basic skills necessary to identify SUDs in primary care settings. SAMHSA’s SBIRT program accomplishes this. SBIRT is not a panacea, it is an important process that can help primary care providers identify alcohol and drug use problems. We have to wait for research on more representative populations to determine whether BI works.
In response to these articles, Dr. Clark authored a blog on SBIRT. You can access it via this link:
You can view the abstracts of the two articles below:
Patients want to trust that their physicians aren’t judging them or talking about them behind their backs
Getting the opportunity to come back to Pittsburgh after four years of undergraduate work there was incredible. The city has come so far; it’s slowly growing into one of the more popular destinations in the nation and I couldn’t be happier about it. So participating in the Scaife Advanced Medical Student Fellowship in Alcohol and Other Drug Dependency was a great chance to enjoy a lovely city in addition to broadening my horizons on the subject of addiction.
There was no time to be shy. On the second day, we were given a pair of standardized patients and asked to motivationally interview them. For those unfamiliar with this technique, it is simply a way to gain the patient’s trust in a short period of time with the desire to focus…
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Are you trying to make the case for the use of Screening, Brief Intervention and Referral to Treatment in a hospital setting? Maybe we can help.
Last year, we released a one page snapshot on the six R’s that support the use of SBIRT in hospitals. What are those R’s? Rules, Reimbursement, Reform, Results, Retention, Resources.
Click here to access a downloadable PDF of Hospital SBIRT: The Reasons.
We hope, with this snapshot in hand, you’ll feel empowered to champion SBIRT as a public health approach to risky substance use in settings where unhealthy or dependent use is common, like hospitals. So, please:
Check it out
Print it out
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Your ongoing relationship with your patient makes you the ideal person to monitor substance use and refer to specialty treatment as needed
The latest issue of The Bridge, an e-publication of the National Addiction Technology Transfer Center Network, focused a very meaningful topic for us at IRETA: how can we get folks to actually do SBIRT?
Sure, Screening, Brief Intervention and Referral to Treatment is quite a mouthful to say, but the idea itself is simple–and good. If we can discuss substance use and associated risks before substance use disorders and other harms occur, we can improve public health.
Paul Roman, Editor of The Bridge, says it so well here:
“We wanted to assure that our discussion was close ‘to where the rubber meets the road.’ In other words, hardly anyone would oppose the implementation of SBIRT, and most would agree that it’s a good idea that…
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We cannot ignore the role that substances play in physical health and behavioral health. As such, we need to have the broadest approach to substance use possible, which means addressing substances in all facets of society, especially medical care settings. Addressing substance use in medical care settings is part of health promotion, prevention, and early intervention.
Teaching healthcare practitioners about treating people who have problems with substances will advance patient-centered care and will improve health for individuals and communities. Furthermore, to successfully address these issues, healthcare practitioners must engage in Interprofessional Collaborative Practice, defined by the World Health Organization as: “When multiple health workers from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality of care.” A recent report on Interprofessional Collaborative Practice espouses its importance in advancing patient centered and community/population oriented health care systems. I have been teaching…
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An occasional email update from the National SBIRT ATTC .
June 25, 2014
Tools for Practice