1. Professor Carmel Clancy
Screening, Brief Intervention and Referral for Treatment (SBIRT)
Inter professional Symposium

2. For persons with substance use disorders
What is SBIRT?
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for substance use disorders (SUDs)
For persons with substance use disorders
Those at risk of developing these disorders
Primary care centres, trauma or A/E centres, Maternity Services and other community settings provide opportunities for early intervention with at-risk substance users

3. SBIRT: Core Clinical Components
Screening: Very brief screening that identifies substance related problems
Brief Intervention: Raises awareness of risks and motivates client toward acknowledgement of problem
Referral to Treatment: Referral of those with more serious SUDs

4. Provides opportunity for education, early intervention
Benefits of Screening
Provides opportunity for education, early intervention
Alerts provider to risks for interactions with medications or other aspects of treatment
Offers opportunity to engage patient further
Has proved beneficial in reducing high-risk activities for people who are not dependent

5. Distribution of Alcohol (or Drug) Problems

6. Engagement – the first stage
What is engagement?
Building a working relationship
Showing that you care (do you?)
Working towards mutual acceptable goal
Building rapport
Building trust
Analysing any ‘counter-transference’ that may occur and detaching from any instinctive feelings, if necessary.

7. explain[and provide] confidentiality Interview individually
How to Engage People
explain[and provide] confidentiality
Interview individually
Appropriate setting
Flexible approach
Be non-confrontational
Be non-judgmental
Be yourself

8. Getting onto the Subject….
Broad to narrow
General to specific
Giving permission

9. ASSIST http://www.who.int/substance_abuse/activities/assist/en/
The ASSIST (version 3.1) is an 8 item questionnaire designed to be administered by a health professional or generic worker to a client using paper and pencil, and takes about 5-10 minutes to administer.
It is culturally neutral and useable across a variety of cultures to screen for use of the following substances:
tobacco products
Alcohol
Cannabis
cocaine
amphetamine-type stimulants (ATS)
sedatives and sleeping pills, (e.g benzodiazepines)
hallucinogens
Inhalants
opioids
‘other’ drugs

10. Assist
ASSIST obtains information from clients about lifetime use of substances, and use of substances and associated problems over the last 3 months.
It can identify a range of problems associated with substance use including acute intoxication, regular use, dependent or ‘high risk’ use and injecting behaviour.

11. ASSIST
It determines the risk score for each substance which is used to start a discussion (brief intervention) with clients about their substance use.
The score obtained for each substance falls into a ‘lower‘, ‘moderate’ or ‘high’ risk category.
The low to high score determines the most appropriate intervention for that level of use (‘no treatment’, ‘brief intervention’ or ‘referral to specialist assessment and treatment’ respectively).

12. Standard introduction

13. Question 1

14. Question 2

15. Question 3

16. Question 4

17. Question 5

18. Question 6

19. Question 7

20. Question 8

21. Scoring the ASSIST

24. Stages of Change

25. u Reestablish self-efficacy and commitment
Prochaska & DiClemente: Stages of Readiness to Change
Stage Description Counseling Objectives
Pre-contemplation Not considering change u Identify patient’s goals
u Provide information
u Bolster self-efficacy
Contemplation Ambivalent about change u Develop discrepancy between goal & behavior u Elicit self-motivational statements
Determination Cognitively committed to u Strengthen commitment to change
change u Plan strategies for change
Action Involved in change u Identify and manage new barriers
u Recognize relapse or impending relapse
Maintenance Behavior change is stable u Assure stability of change
u Foster personal development
Relapse Undesired behaviors occur u Identify relapse
u Reestablish self-efficacy and commitment
u Develop new behavioral strategies
Termination Change is very stable u Assure stability of change

26. Risk areas
Violence
Suicide
Deliberate self harm
Accidental overdose
Injecting/sharing paraphernalia
Physical health
Vulnerability to abuse/exploitation
Accidental injury
Self neglect
Social isolation Breakdown in relationships Sexual health Criminal behaviour Poor contact with services Medication compliance Child protection

32. Reaching a diagnosis – ICD-10 harmful use
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected drugs) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

33. Reaching a diagnosis – ICD-10 dependent use
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:

34. Reaching a diagnosis – ICD-10 dependent use
A strong desire or sense of compulsion to take the substance;
Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
A physiological withdrawal state when substance use has ceased or have been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill non tolerant users);
Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

35. When to refer on….factors that might determine this
Complexity of presentation
Competency/capabilities of assessor/services
Clients choice

36. Post sessional work
Check out the IPL platform in mylearning – key resources will be available including examples of screening & assessment tools