Substance Use Screening, Brief Intervention, and Referral to Treatment Expanding the ContinuumImprov

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Substance UseScreening, Brief Intervention, and
Referral to TreatmentExpanding the
Continuum-Improving Care
Stephen H. ONeil, MA Project Director Georgia
BASICS Department of Behavioral Health and
Developmental Disabilities Division of Addictive
Diseases
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A New Initiative

• Substance use screening, brief intervention,
  referral, and treatment is a systems change
  initiative requiring us to re-conceptualize, how
  we understand substance use problems,
• re-define how we identify substance use
  problems, and re-design how we treat substance
  use problems.

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Historically

• Substance use services have been focused in two
  areas
• Primary Prevention Delaying onset of substance
  use.
• Treatment Providing time, cost, and labor
  intensive services to patients who are acutely or
  chronically ill.

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Historically

• Substance use has been seen as
• A moral problem
• An individual problem
• A family problem
• A social problem
• A criminal justice problem
• A combination of one or more

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Substance Use Is
A Public Health Problem
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Learning from Health Care

• The health care system routinely screens for
  potential medical problems (cancer, diabetes,
  hypertension), provides preventative services
  prior to the onset of acute symptoms, and delays
  or precludes the development of chronic
  conditions.

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Why Not Substance Use

• ???????

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Support for SBIRT

• SBIRT is an evidenced based practice that is
  supported by
• The World Health Organization
• The American Preventative Task Force
• The American Trauma Nurses Association
• The American Medical Association
• The American College of Surgeons
• The Office of National Drug Control Policy

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The SBIRT Concept

• SBIRT uses a public health approach to universal
  screening for substance use problems.
• SBIRT provides
• Immediate rule out of non-problem users
• Identification of levels of risk
• Identification of patients who would benefit from
  brief advise, and
• Identification of patients who would benefit from
  higher levels of care.

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What Can SBIRT Accomplish?

• Prior studies have shown that substance use
  screenings and brief interventions can
• Reduce alcohol and/or other drug use for those
  making moderate or high-risk choices
• Prevent re-injury in trauma patients and,
• Help patients with more severe problems access
  intensive, community based chemical dependency
  services.

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National Drug Control Strategy

• There will never be enough funding to serve all
  those who need treatment.
• 100,000 new patients will receive treatment every
  year.
• There is a paradigm shift towards intervention
  among patients with substance use problems which
  can minimize psycho-social or health related
  problems and/or interrupt the progression of the
  disease and help reduce long-term adverse
  outcomes.

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Primary Goal

• The primary goal of SBIRT is not to identify
  those who are dependent and need higher levels of
  care.
• The primary goal of SBIRT is to identify those
  who are at moderate or high risk for
  psycho-social or health care problems related to
  their substance use choices.

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SBIRT Provides

• Identification of substance use problems using a
  public health approach and universal screening.
• Progressive levels of clinical interventions
  based on level of need and motivation for change
  (FB, BI, BT, and traditional treatment).

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The Moving Parts

• Pre-screening (universal).
• Full screening (for those with a positive
  pre-screen).
• Brief Intervention (for those scoring over the
  cut off point).

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The Moving Parts

• Brief Treatment (for those who have moderate
  risk, high risk, abuse, or dependence, would
  benefit from ongoing, targeted interventions, and
  are willing to engage).
• Traditional Treatment (for those who are
  dependent and are willing to engage).

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Georgia BASICS

• The Georgia BASICS (Brief Assessment, Screening,
  Intervention, and Continuum of Services) Project
  is a 5 year cooperative agreement between the
  state of Georgia and the Substance Abuse and
  Mental Health Services Administration, Center for
  Substance Abuse Treatment.

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Washington StateSBIRT

• Original Six-Month
• Follow-up Results

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Binge drinking in the past 30 days declined
significantly
The number of recent days of binge drinking
declined 46 for those who received only a brief
intervention and 51 for those who received a
brief intervention and were referred for further
therapy but did not go. Recent days of bingeing
declined 88 among high-risk users who sought out
brief therapy or CD treatment. plt.05
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Average days of alcohol use in the past 30 days
declined significantly
Recent use of alcohol declined significantly for
all three groups who received brief intervention
or therapy. Days of alcohol used dropped 26 for
those who received only a brief intervention, 40
for those who received a brief intervention and a
referral but did not seek any additional therapy,
and 77 the greatest decline for those
high-risk users who obtained brief therapy or CD
treatment. plt.05
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Illegal drug use in the past 30 days declined
significantly
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Abstinence from both alcohol and other drugs
increased for all interventions
The percent of WASBIRT participants who did not
use either alcohol or other drugs in the past 30
days increased six months after the receipt of an
intervention. Using chi-square analyses, the
change in abstinence for the moderate-risk
patients who received only a brief intervention
was found to be statistically significant.
Similar tests of significance could not be
performed in the two higher risk groups due to
their smaller sample sizes. Therefore, the
increases in abstinence for those two groups
should be interpreted with caution until tests of
significance are possible in later analyses.
plt.05