Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women

Abstract

Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period. The increase in alcohol use and risk drinking poses unique and serious consequences for women. Women have a more rapid progression to alcohol-related problems and alcohol use disorders (AUD) than men, and if pregnant, women can potentially expose the fetus to alcohol. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based, integrated public health approach used to identify and address risky alcohol use among women in a variety of health and social service settings. This article presents the current status of SBIRT among girls ages 12 and older, women of childbearing age, and older women. Screening instruments, brief interventions, and implementation issues specific to women of all ages are described. Through this review of the current literature, care providers can determine best practices for the prevention and treatment of risk drinking in women of all ages presenting in health care settings.

Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women

“…Finally, misuse of maternal alcohol or illicit drugs worldwide is associated with inadequate prenatal care, poor nutrition, poorer educational attainment, increased rates of unemployment, benefit dependence, mental illness, a history of sexual and physical abuse, and ongoing domestic violence (7,8,17,72,76,107). Children who live in environments, particularly in the first 1,000 days, where there is maternal mental illness or poverty, without any substance use, are at risk of poorer health, mental health, and developmental outcomes (108).…”

“…With the advancement of mobile technologies and the nearuniversal access to these technologies, has come the opportunity to provide alcohol and drug services to a typically hard to reach and underserved group of women. Technology in the form of apps and social media is increasingly used to facilitate SBIRT with encouraging preliminary evidence particularly among studies of adolescent girls and women (107,125,126). The emerging evidence for the potential effectiveness and usability of SBIRT delivered through mHealth technology (sometimes referred to as e-SBI) to reduce alcohol and illicit substance use in women during pregnancy or the early post-partum period has largely come from reports by one research group (32)(33)(34)(35)(36)(37)(38)(39)(40)(127)(128)(129)(130).…”

“…Challenges include time constraints, lack of buy-in by clinicians, privacy issues, lack of adequate training and lack of intra- and interorganizational communication and collaboration. Additional challenges to implementation of SBIRT that prenatal care providers identified included lack of rapport between providers and women presenting for an initial prenatal consultation; misperception that there is a low prevalence of alcohol and other drug use during pregnancy; perception that women will under report their use and therefore screening is of little use; and providers worrying they will create guilt or anxiety in their patients ( 20 , 41 , 107 ).…”

From the Editors

“…In “Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women,” Hammock, Velasquez, Alwan, and von Sternberg provide a comprehensive review of the effectiveness of this evidence-based, public health approach to identifying and intervening in heavy/harmful alcohol use across the life span, specifically examining SBIRT for girls, women of childbearing age, and older women. 19 This clinically relevant, evidence-based article offers information on age-appropriate screening tools and intervention approaches. 19 It also summarizes facilitators and barriers to SBIRT implementation in social service and health care settings, 19 including recently identified unanticipated consequences of state-level policies related to alcohol use during pregnancy.…”

“… 19 This clinically relevant, evidence-based article offers information on age-appropriate screening tools and intervention approaches. 19 It also summarizes facilitators and barriers to SBIRT implementation in social service and health care settings, 19 including recently identified unanticipated consequences of state-level policies related to alcohol use during pregnancy. 20 …”