Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later

Abstract

Objectives-Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded Screening, Brief Intervention, Referral to Treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and six months after drug screening and interventions were administered.Design-SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a six month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.Results-Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/ problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6 month follow-up (4 of 6 sites), were 67.7% lower (p < 0.001) and heavy alcohol use was 38.6% lower (p < 0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p < 0.001), mental health (p < 0.001), employment (p < 0.001), housing status (p < 0.001), and criminal behavior (p < 0.001) were found. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptDrug Alcohol Depend. Author manuscript; available in PMC 2010 January 1. Conclusions-SBIRT was feasible to implement and the self-reported patient status at six months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.

Substance use outcomes of patients served by a large US implementation of Screening, Brief Intervention and Referral to Treatment (SBIRT)

“…Madras et al [1] noted that response rates were particularly low in two projects, one due to program interruption and the other to a significant shift in the program's follow-up model. We therefore calculated alternative response rates that were adjusted based on the timing of these events.…”

“…Follow-up interviews were conducted between 150 and 240 days after baseline screening and were administered either in person or by telephone. As noted in Madras et al [1] most were by telephone because projects found it difficult to have patients return to the original site after 6 months.…”

“…In the only published study of patient outcomes for SAMHSA's SBIRT initiative, Madras et al [1] reported preliminary outcomes for six of the first seven SAMHSA SBIRT projects. In analyses performed separately for each project, Madras et al found that past-month substance use outcomes were dramatically lower 6 months after exposure to SBIRT services than they were at the time of SBIRT screening.…”

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

“…3,[38][39][40][41][42][43] When a patient endorses pain, the physician must first determine the etiology of the pain and then decipher if the patient has risk factors for aberrant opioid use. The physician must then identify an appropriate treatment strategy for pain control, which may or may not include opioids.…”

Drugs of abuse among acute psychiatric and medical admissions: laboratory based identification of prevalence and drug influence

“…Obviously, there is a need for more evidence on effective interventions for substance using patients in acute care settings. A service program including screening, brief interventions and referral to treatment has shown very promising results with regard to substance use and related problems in a wide range of medical settings (110). Similar programs could be implemented and evaluated in acute psychiatric services as well.…”