SBIRT: In Practice
Goal:

Providers will be able to apply the SBIRT approach to substance abuse problems by individualizing screening, brief interventions, and referral for different patients.

: 1 hr

After completing this activity participants will be able to:

  • Apply screening, brief interventions, and referral skills with patients.

  • Modify screening, brief interventions, and referrals for substance use problems according to an individual patient's needs.

  • Modify screening, brief interventions, and referrals for substance use problems according to the focus patient subpopulation and address other limitations.


Professional Practice Gaps

As many as 20% of primary care patients have substance use problems and primary care providers could have a significant impact on their problems through providing screening, brief interventions, and referral to treatment (SBIRT) (Mersy, 2003). Unfortunately, PCPs screen less than half of their patients for tobacco use and less than a third for alcohol use (Seale et al 2010, Roche & Freeman 2004). Brief intervention in primary care is an effective and cost-efficient approach to reducing patients' alcohol use (AAP 2010; Seale 2010; Madras 2010). There is growing evidence that brief interventions for illicit drug use may lead to positive patient outcomes (Compton 2009, Koob & Volkow 2010). However, primary care providers are not conducting brief interventions with their patients substance abuse (Yoast et al 2008). There is also a practice gap in referral to treatment. Less than one-third of PCPs make a referral after identifying a substance abuse problem (CASA, 2000). Primary care providers need to understand the different types of specialty treatment so that they can make appropriate referrals for their substance abuse patients (SAMHSA, 2008).

References
American Academy of Pediatrics (AAP). Alcohol use by youth and adolescents: a pediatric concern. Pediatrics. 2010; 125(5): 1078-1087. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf Accessed on: 2010-10-29.
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35(1): 217-38. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19710631
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20205740 Accessed on: 2014-07-28.
Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: National Findings. SAMHSA. 2008. Available at: http://druggeddriving.org/pdfs/NationalSurveyonDrugUseandHealth2007.pdf Accessed on: 2015-04-20.
The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University, Survey Research Laboratory. Chicago, IL: University of Illinois at Chicago. 2000. Available at: http://eric.ed.gov/?id=ED452442 Accessed on: 2010-06-15.
Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: obstacles and strategies for change. J Addict Dis. 2008; 27(3): 77-97. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18956531 Accessed on: 2014-07-28.