1. Screening, Brief Intervention and Referral to Treatment
SBIRT 101:
Screening, Brief Intervention and
Referral to Treatment
Felicia Beseka, MD, Chief Resident
Shari Leidig Holland M.A., L.P.C., Behavioral Science Coordinator
UPMC Mercy Family Medicine Residency

2. Overview & Introduction
I. Process Improvement
II. Relates to all Six Competencies
Patient Care
Medical Knowledge
Professionalism
Practice based Learning & Improvement
Interpersonal & Communication Skills
System Based Practice

3. Overview & Introduction
Misuse of alcohol and other drugs, before dependence develops is a problem that has not been well-addressed in primary care. The Substance Abuse and Mental Health Services Administration has launched a multi-million dollar national project to encourage physicians to address hazardous use in their routine medical care.

4. Overview & Introduction
Effective screening and brief intervention using the motivational interviewing approach creates many opportunities to help patients identify risky practices and adopt healthy behaviors.
With early detection and advice from a health provider, most people can change their behavior to low-risk levels of consumption.

5. SBIRT GOAL
The goal of SBIRT (Screening, Brief Intervention, and Referral to Treatment) is to identify substance misuse, decrease alcohol and drug use, increase utilization of recommended treatment when needed, and to increase the knowledge of healthcare workers regarding addiction.

6. Overview & Introduction
Reason for Intervention
Brief Intervention in a general medical setting is effective
Approx. 70% of American adults visit a physician once every two years. This suggests that primary care physicians can potentially identify and treat a substantial number of people with alcohol and drug misuse.

7. Overview & Introduction
Hazardous use of alcohol and drugs costs the United States more in healthcare spending and lost productivity every year than alcoholism and addictions to all drugs combined. There is good evidence that brief interventions in a physician’s office can reduce patients’ hazardous use to safer level.

8. Prevalence of Substance Abuse
22 million Americans have a substance use disorder
Examples: Alcohol, Cocaine, Heroin, Barbiturates, Benzodiazepines . . .
3.2 million are classified with dependence or abuse
14.8% of US adults have one episode of heavy drinking (>5 drinks) in the previous 30 days (especially during football season)
One Drink includes
12 ounce can/bottle of beer
4 ounce glass of wine
1.5 ounces of hard liquor

9. Prevalence of Substance Abuse
7.4% US adults have a diagnosable alcohol use disorder
Moderate to Heavy Alcohol use causes substantial morbidity and mortality in multiple systems which include:
Cardiovascular disease
Diabetes complication
Liver disease
Hypertension
Gastrointestinal Diseases
Kidney complications

10. PREVALANCE & IMPACT

11. The Process Model used: S.B.I.R.T.
Screening, Brief intervention, Referral, to Treatment
Use in general medical and other community settings for adult patients (>18yo) with substance abuse and dependence disorders

12. The Process Goals: Identification of substance misuse
Decrease alcohol and drug use
Accurately make referral to treatment when warranted
Increase adherence to treatment for patients referred

13. The Process Team approach Utilized Receptionist:
Provides the demographic and insurance information as needed
Distributes the Health Behavior Assessment questionnaire
The questionnaire asks the patients to answer the six short questions about their drug and alcohol use
Upon completion, the patient returns the form to the receptionist
During triage, the MA will score the form, and if warranted, ask the patient to complete the AUDIT (Alcohol Use Disorders Identification Test)

14. The Process Team Approach:
The completed questionnaire is placed on the chart for the physician, resident, or healthcare specialist to review
The health care provider will review the outcome with the patient
It is at this time that the Brief Intervention or Counseling is provided
If AUDIT outcome warrants treatment, the pt. will meet with the health care provider to determine their readiness for further assessment or a referral to treatment.

15. The Process Meeting the Patient where they are:
Can be a difficult task for health care professionals to approach patients about abuse of alcohol or other drugs
Therefore, it must be performed in a non-judgmental and sensitive manner in order to obtain a favorable response
Research shows that multiple brief assessments and interventions are effective and essential in order to succeed
Patients readiness to accept help via further assessment, counseling, or a referral to treatment can only be accomplished if a continued longitudinal effort is applied by all health care professionals working together

16. The Process We meet them where they are by:
Asking what their concerns are and what they are ready to do
Providing education if warranted
Providing multiple counseling sessions if they are not ready to pursue treatment
Providing a referral to treatment if they are ready and willing
Out-patient counseling
In-patient counseling and rehabilitation

17. Tools Utilized Our practice utilizes: AUDIT & DAST
Tools for Screening of Patients
AUDIT (Alcohol Use Disorders Identification Test)
DAST (Drug Abuse Screening Test)
CAGE
ONE QUESTION
Our practice utilizes: AUDIT & DAST

18. Tools Utilized AUDIT (Alcohol Use Disorders Identification Test)
Developed by WHO (World Health Organization)
Simple method for screening for excessive alcohol use to assist in brief assessment
Can help identify excessive alcohol use and dependence as the cause of presenting illnesses (as described above)
Provides a frame work for intervention to help hazardous and harmful drinkers reduce or cease consumption and thereby avoid the harmful consequences of drinking
In most cases, the AUDIT total score will reflect the patient’s level of risk related to their alcohol use

19. Tools Utilized DAST – 10 (Drug Abuse Screening Test)
Consists of 10 short questions answered yes or no
Each yes answer equals 1 point

20. Case Examples Case one - John and The readiness ruler
Case two – Anita and The second time around
Case three – David A work in progress

21. Outcome and Challenges
Outcomes of this process
For the Patient
Decreased drug & alcohol misuse
Decreased tobacco use
Improved overall health & well being of patient
Improved well being of patient’s family
Reduced long-term health risks
Improved treatment access for patients
Enhanced relationship with the physician
Prevent addiction

22. Outcomes and Challenges
Outcomes of this process
For the Physician or health care provider
More comprehensively address the health of patients
Increased knowledge of available community resources
Improve linkages among community providers
Improve skills in early identification of drug related problems

23. Outcomes and Challenges
Initially time was the main challenge/obstacle
To successfully integrate the process into the residency curriculum
To successfully integrate this into the culture of the family outpatient clinic both in residency setting and in the private office setting
Overall, it is our hope to provide better care for patients and decrease medical costs for the patient, their family, and society.

24. Questions / Discussion

25. Thank you for your
Time and Interest