This activity is designed to change: Competence, Performance.1.5hr(s)
Activity Format:

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Overview

Goal: The learner will be able to accurately screen for and identify hazardous substance use, direct patients with substance use problems to an appropriate level of care, and create and implement a brief intervention and education tailored to patients with substance use problems.

Professional Practice GapsAs many as 20% of primary care patients have substance use problems and primary care physicians 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). The rate of screening for illicit drug use is also inadequate; about a third of primary care physicians and psychiatrists surveyed in one study did not screen routinely for illicit drug use (Friedmann, et al., 2001). Brief intervention in primary care is effective and cost-efficient approach to reduce patients' alcohol use (Seale 2010; Madras 2009). There is growing evidence that brief intervention for illicit drug use may also lead to positive patient outcomes (Compton 2009, Volkow 2010). And evidence also supports the effectiveness of interventions by medical providers for tobacco (USPSTF, 2008). However, brief interventions happen even less often than screening; for example counseling for problem drinking without dependence was reported by only 13% of patients in the 1998 Healthcare for Communities survey (D'Amico, 2005). Appropriate follow-up is also happening less often than is optimal. For example, only a little less than 50% of problem drinkers in this study reported receiving follow-up. 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 physicians need to understand the different types of specialty treatment so that they can make appropriate referrals for their substance abuse patients (SAMHSA, 2008).

References:

Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.

D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005; 43(3):229-236.

Friedmann PD, McCullough D, Saitz R. Screening and Intervention for Illicit Drug Abuse. A National Survey of Primary Care Physicians and Psychiatrists. Arch Intern Med. 2001;161(2):248-251.

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.

Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23: 11-18.

The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. 2000. Columbia University. Available at: http://www.centeronaddiction.org/addiction-research/reports/national-survey-primary-care-physicians-patients-substance-abuse

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.

Substance Abuse and Mental Health Services Administration (SAMHSA). A Guide to Substance Abuse Services for Primary Care Clinicians: Concise Desk Reference. 2008. Treatment Improvement Protocol (TIP) Series #24.

U.S. Preventive Services Task Force Grade Definitions After May 2007. May 2008. http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions

Educational Objectives:

After completing this activity participants will be able to:
  • Employ motivational interviewing techniques to develop rapport with the patient

  • Interpret appropriate screening tools and intervention techniques for hazardous substance use problems based on patient history and characteristics

  • Implement a brief intervention that is tailored to the patient and the severity of the substance use problem

  • Triage patients to the appropriate level of care within your practice

  • Provide the patient with education and resources needed

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc.complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Clinical Tools, MD, MD (Company, CTI)Clinical Tools, Inc. (CTI) is a small, physician-run business dedicated to harnessing the potential of the Internet to create scalable, usable, and broadly available tools to improve the ability of physicians and other health care providers to care for patients. We achieve this goal by providing education and training to students and professionals and creating Web-based support tools for clinicians, researchers, and consumers. Information technology can and should serve as a stable framework that supports researchers and clinicians in their roles. We provide dissemination and management tools that empower clinicians and consumers to understand and control the vast amount of information related to making individual health choices. We serve our clients creatively, effectively, and with the highest quality of service.
Disclosure: Has disclosed no relevant financial relationships.
Karen Rossie, RN, PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University, and later, a PhD in Psychology from the Institute of Transpersonal Psychology. She taught and practiced oral pathology and oral medicine for 15 years at the Ohio State University and University of Pittsburgh, doing research in autoimmune disease, bone marrow transplantation, oral cancer, salivary gland disease, candidiasis, and diabetes. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Dane Libart, MSW
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:Editorial Review:
Tue, 12/10/2013Tue, 12/10/2013

Modules in this Training Activity

  • Basics of SBIRT in Primary Care (for providers in Oklahoma)

Module Practice Gap References
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35(1): 217-38. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19710631
Vinson DC, Manning BK, Galliher JM, Dickinson LM, Pace WD, Turner BJ. Alcohol and sleep problems in primary care patients: a report from the AAFP National Research Networ. The Annals of Family Medicine. 2010; 8:6: 484-492. Available at: http://www.annfammed.org/content/8/6/484.short

Audience and Accreditation

Audience:

Physicians & primary care providers

TypeEst. TimeReleasedExpires
DCBN1.5 hr(s)4/6/174/5/19
AMA PRA Category 1 Credit(s)™1.5hr(s)4/6/174/5/19

Designation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education by Clinical Tools, Inc.. Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 1.5 hour(s) of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942.
AMA PRA Category 1 Credit(s)™ Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
A letter of completion for up to 1.5 hour(s) is available for non-physicians.
A score of 70% on the post-test is required to complete the activity.
Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirement: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013. Available at: http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf Accessed on: 2013-06-26.
Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary care. World Health Organization: Department of Mental Health and Substance Dependence. Second Edition. 2001. Available at: http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf Accessed on: 2008-10-10.
Babor TF , Dolinsky ZS, Meyer RE, Hesselbrock M, Hofmann M, Tennen H. Types of alcoholics: concurrent and predictive validity of some common classification schemes. Br J Addict. 1992; 87(10): 1415-31. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1330126 Accessed on: 2013-10-24.
Blow FC, Brower KJ, Schulenberg JE, Demo-Dananberg LM, Young JP, Beresford TP. The Michigan Alcoholism Screening Test - Geriatric Version (MAST-G): a new elderly-specific screening instrument. Alcoholism: Clinical and Experimental Research. 1992; 16(2): 372. Available at: http://www.ncbi.nlm.nih.gov/books/NBK99192/
Bohn MJ, Babor TF, Kranzler HR. Validity of the Drug Abuse Screening Test (DAST-10) in inpatient substance abusers. Farmington, Conn: University of Connecticut Heath Center. 1991. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441940/
Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. Journal of the American Board of Family Practice. 2001; 14(2): 95-106. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11314930 Accessed on: 2013-10-24.
Brown RL, Leonard T, Saunders LA, Papasouliotis O. The prevalence and detection of substance use disorder among inpatients ages 18 to 49: an opportunity for prevention. Preventive Medicine. 1998; 27(1): 101-110. Available at: http://www.ncbi.nlm.nih.gov/pubmed/9465360 Accessed on: 2013-10-24.
Bush K, Kivlahan DR, McDonnell MB, et al.. The AUDIT Alcohol Consumption Questions (AUDIT-C): An effective brief screening test for problem drinking. Arch Internal Med. 1998; 3: 1789-1795. Available at: http://www.integration.samhsa.gov/images/res/tool_auditc.pdf Accessed on: 2015-09-25.
Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Chang G. Alcohol Screening Instruments for Pregnant Women. National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2001; 25(3): 204-9. Available at: http://pubs.niaaa.nih.gov/publications/arh25-3/204-209.pdf Accessed on: 2011-01-10.
Clinical Tools Inc.. AUDIT Screening Tool. Clinical Tools, Inc.. 2015. Available at: https://youtu.be/Xdsz__MaC1g Accessed on: 2015-09-25.
Clinical Tools, Inc.. Diagnosing Alcohol Use Disorder. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/zGuiEbaAk3g Accessed on: 2016-01-08.
Clinical Tools, Inc.. Motivational Interviewing. Clinical Tools, Inc.. 2016. Available at: https://www.youtube.com/embed/4_q9WPTnO4k Accessed on: 2016-01-08.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984; 252(14): 1905-1907. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6471323 Accessed on: 2013-10-24.
Fiellin DA, Reid MC, O'Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000 ; 160(13): 1977-89. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10888972 Accessed on: 2013-10-24.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. Available at: http://www.ncbi.nlm.nih.gov/books/NBK63952/ Accessed on: 2013-09-26.
Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the Drug Abuse Screening Test in the assessment of DSM-III drug disorders. Addiction. 2006; 84: 301-307.
Glynn TJ, Manley MW. How to help your patients stop smoking- a National Cancer Institute manual for physicians. Smoking and Tobacco Control Program, National Cancer Institute, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Bethesda, MD. 1998. Available at: http://books.google.com/books/about/How_to_help_your_patients_stop_smoking.html?id=TM1pAAAAMAAJ
Ingersoll KS, Wagner CC, Gharib S. Motivational groups for community substance abuse problems. Mid-Atlantic Addiction Technology Transfer Center, Center for Substance Abuse Treatment. 2000. Available at: http://people.uncw.edu/ogler/MI%20Groups%20for%20Com%20SA%20Prog.pdf Accessed on: 2013-10-24.
Knight JR, Sherritt L, Harris SK, Gates EC, Chang G. Validity of brief alcohol screening tests among adolescents: a comparison of the AUDIT, POSIT, CAGE, and CRAFFT. Alcohol Clin Exp Res. 2003; 27(1): 67-73.
Knight JR, Shrier LA, Bravender TD, Farrell M, Vander Bilt J, Shaffer HJ. A new brief screen for adolescent substance abuse. Archives of Pediatric and Adolescent Medicine. 1999; 153(6): 591-596. Available at: http://archpedi.jamanetwork.com/article.aspx?articleid=347094 Accessed on: 2010-08-25.
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.
Martino S, Grilo CM, Fehon DC. Development of the Drug Abuse Screening Test for adolescents (DAST-A). Addict Behav. 2000; 25(1): 57-70.
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.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior.. New York, NY; Guilford Press. 1991. Available at: http://www.amazon.com/Motivational-Interviewing-Preparing-Addictive-Behavior/dp/089862469X Accessed on: 2013-10-24.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Assessing Alcohol Problems: A guide for clinicians and researchers. NIH Publication No. 03–3745. 2003. Available at: http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/index.pdf Accessed on: 2013-10-24.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Helping Patients Who Drink Too Much: A Clinician's Guide, Updated 2005 Edition. Bethesda, MD. 2007. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf Accessed on: 2010-10-28.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Helping Patients Who Drink Too Much: A Clinician's Guide. Bethesda, Md. 2005 (Updated 2007). Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf Accessed on: 2013-10-24.
National Institute on Drug Abuse. The NIDA-Modified ASSIST. NIDA. 2010. Available at: http://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen Accessed on: 2011-04-08.
NIDA. The NIDA Quick Screen. Screening for Drug Use in General Medical Settings Resource Guide. 2012. Available at: http://www.drugabuse.gov/publications/resource-guide-screening-drug-use-in-general-medical-settings/nida-quick-screen Accessed on: 2013-12-18.
Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.
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.
Rollnick S, Miller WR. What is motivational interviewing?. Behav Cognitive Psychother. 1995; 23: 325-334. Available at: http://www.motivationalinterview.net/clinical/whatismi.html Accessed on: 2013-10-24.
Rosengren D, Wagner CC. Motivational interviewing: shall we dance? . In: Coombs R, ed. Addiction Recovery Tools: A Practitioner's Handbook. Sage Publications. 2001. Available at: https://us.sagepub.com/en-us/nam/addiction-recovery-tools/book9537 Accessed on: 2015-11-11.
Rounsaville BJ. Using motivational interviewing in routine care. Paper presented at: National Institute on Drug Abuse Conference--Blending Clinical Practice and Research. March 14, 2002. Available at: http://archives.drugabuse.gov/pdf/blending/Rounsaville.pdf Accessed on: 2010-06-15.
SAMHSA. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS . 2013. Available at: http://archive.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf Accessed on: 2014-11-26.
Saunders JB, Aasland OG, Babor TF. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption —II. Addiction. 1993; 88(6): 791-803. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8329970
SBIRT Oregon . Brief intervention: "Steve". YouTube. 2010. Available at: https://www.youtube.com/watch?v=b-ilxvHZJDc Accessed on: 2015-04-27.
SBIRTOregon.org. Readiness ruler. SBIRT Primary Care. 2013. Available at: http://www.sbirtoregon.org/tools.php Accessed on: 2013-12-20.
Skinner HA. The drug abuse screening test. Addiction Behavior. 1982; 7(4): 363-71. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7183189 Accessed on: 2013-10-24.
Smith PC, Schmidt SM, Saitz R. A single-question screening test for drug use in primary care. Annals Intern Med. 2010; 170(13): 1155-1160. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911954/ Accessed on: 2014-09-10.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2009 National Survey on Drug Use and Health. . (Office of Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4856Findings). Rockville, MD. Electronic Access and Copies of Publication. 2010. Available at: http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm#Ch7 Accessed on: 2011-04-13.
Trachtenberg AI, Fleming MF. Diagnosis and Treatment of Drug Abuse in Family Practice. American Family Physician monograph. National Institute on Drug Abuse. American Academy of Family Physicians. 1994. Available at: http://archives.drugabuse.gov/diagnosis-treatment/diagnosis3.html
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010 . 7th Edition, Washington, DC: U.S. Government Printing Office. 2010. Available at: http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf Accessed on: 2014-09-23.
USDHHS. Facing Addiction in America. The Surgeon General's Report on Alcohol, Drugs, and Health. Surgeon General Reports. 2016. Available at: https://addiction.surgeongeneral.gov/ Accessed on: 2016-11-17.
Wagner C, Conners W. Interaction techniques. Mid-Atlantic Addiction Technology Transfer Center. 2003c. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
Wagner C, Conners W. Motivational interviewing principles. Motivational Interviewing Website. 2003b. Available at: http://www.ourdailybreadmissions.org/Philosophy%20of%20MI.htm Accessed on: 2005-08-22.
World Health Organization. ASSIST V3.0. World Health Organization. 2004. Available at: http://www.who.int/substance_abuse/activities/assist_v3_english.pdf Accessed on: 2011-04-08.
Yudko E, Lozhkina O, Fouts A, et al. A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment. 2007; 32(2): 189-198. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17306727
FundingInitial development of this activity was supported by a contract from the National Institute on Drug Abuse (##HHSN271200900036C).