Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

Abstract

OBJECTIVE To review the literature on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice. METHODS Articles reporting on the use of SBIRT components (Screening, Brief Intervention, Referral to Treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995–2015. RESULTS A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups also are described. CONCLUSIONS Based on the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness. PRACTICE IMPLICATIONS Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Specialty addiction and psychiatry treatment initiation and engagement: Results from an SBIRT randomized trial in pediatrics

“…I. Campbell, Weisner, & Sterling, 2006; Satre, Campbell, Gordon, & Weisner, 2010), which may be a result of heightened stigma around mental health and substance use problems and treatment in some communities (Alegria, Carson, Goncalves, & Keefe, 2011; Gary, 2005; Knifton et al, 2010; Mulvaney-Day, DeAngelo, Chen, Cook, & Alegria, 2012; Rose, Joe, & Lindsey, 2011). Providers or health systems adopting SBIRT should consider whether non-white patients need additional support and encouragement to access needed specialty treatment (Manuel et al, 2015), and whether access to a BHC trained in substance use and mental health problems based in pediatric primary care may better meet their needs and preferences. Specialty treatment programs may need to assess whether current programming, treatment approaches and staffing are equipped to appeal to and meet the linguistic and cultural needs of increasingly diverse patient populations, and may need to do more outreach to these patient populations (Alegria, Alvarez, Ishikawa, DiMarzio, & McPeck, 2016).…”

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol

“…Project CAMI2, a RCT, fills a research and clinical gap by testing cultural adaptation in the context of an existing MI theory [36, 96]. Study findings have the potential to inform the field broadly on recommendations for culturally adapting evidence-based interventions with socially disadvantaged minority populations.…”

“…The process of treatment adaptation that we have completed in this overall program of research could be applied to pursue treatment adaptations for other social groups and target behaviors [36]. Because Project CAMI2 was manualized, it has the potential for dissemination.…”

“…Stated differently, successful adaptations must retain the key active ingredients of the original treatment while judiciously adapting what is necessary [35]. Despite these challenges, emerging results have supported cultural adaptation in addictions treatment [36, 37]. For example, Project CAMI1 (Culturally Adapted Motivational Interviewing), the foundation for the current study, reported that those who received a culturally adapted version of MI reported greater reductions in alcohol-related consequences than those who did not [37].…”

CONNECT: Implementation of a School‐Based Alcohol Screening and Brief Intervention for Youth in the Cherokee Nation

“…This public health approach incorporates early intervention for those with substance use disorders or those at risk for substance use disorders . Previous work with SBI has adapted it for use with adult and adolescent populations in a variety of settings including primary care clinics, emergency departments, behavioral health clinics, and addiction treatment centers . SBI is also used in school settings for early detection of substance use problems and other risk factors that begin in early to middle adolescence.…”