S creening, B rief I ntervention, and R eferral to T reatment S creening Martha J. “Molly” Faulkner PhD, APRN, LCSW, Assistant Professor PI, Project Director, Trainer SBIRT RUHPS Training Grant Division Of Community Behavioral Health UNM Department Of Psychiatry And Behavioral Sciences May 4, 2017
Obj Object ectives 1. Examine the public health impact of substance use in the patient population of New Mexico. 2. Apply the SBIRT model to effectively screen for risky substance use. 3. Identify challenges providers face in utilizing SBIRT. 2
Goal The primary goal of SBIRT is to identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use . 3
What I Is SBIRT RT? • A comprehensive, integrated, evidence-based approach and model to the delivery of early intervention and treatment services for individuals who have substance use problems or at risk for them. Burge et al, 2009 4
SBIRT SCREENING Promptly identifies patients who need further assessment for unhealthy levels of drinking or drug use (risky, mild/mod use) BRIEF INTERVENTION Increases patient’s awareness of unhealthy use and enhances motivation to change REFERRAL TO TREATMENT Assists ready patients with an action plan for change , e.g., behavioral, pharmacologic, or referral to specialized care 5
Epidemiol olog ogy Sub ubstance A e Abu buse U se US • Estimated that there are 23.3 million people age 12 or older who meet criteria for a substance use disorder (SUD) – nearly 9% of the United States population. • Untreated, SUDs may account for a disproportionate amount of medical and mental health concerns. • Early detection of SUDs, particularly within the PC setting, can lead to successful management, and may prevent progression of both mental health and medical concerns. 6
Ep Epidemiology o of Substan ance Abuse i in NM • Nationally THE HIGHEST • For ages 12 to 17 among the the alcohol-related death rate for HIGHEST Rates Nationally in past 30 years Past Month Illicit Drug Use Past Year Marijuana Use • Last decade, Past Year Cocaine Use • NM either No. 1 or No. 2 in the nation for drug overdose death rates. 7
Epid idemio iolo logy o of Bing nge e Drink nking ng in N NM M Binge drinking definition 5 or more drinks on single occasion for men 4 or more drinks on single occasion for women Underage drinkers consume more drinks per drinking occasion than adult drinkers. Reported by males >females. More Hispanic males than other ethnicities. 8
Public H c Health I Impact in NM Eight of the ten leading causes of death in New Mexico are at least partially caused by the abuse of alcohol, other drugs or tobacco ALCOHOL DRUGS TOBACCO Heart Disease X X Malignant Neoplasms X X Cerebrovascular Dx X X Chronic Liver Dx/Cirrhosis X Unintentional Injuries X X Suicide X X Pneumonia X Influenza X Lower respiratory dx X 9
Rethinking Sub ubstance e Use P e Problem ems s Fro rom a a Public Health P Persp spec ective 10
The Pr Preve vention Paradox Highest success rate for treatment >50% health consequences of alcohol occur
Why Is SBIRT Important for Beha havioral a and H d Health C h Care P e Provider ders in A All Set etting ngs?
. Ev Every pr provider er is a an addictions pro rovider Behavioral health and medical providers are in key positions to screen, intervene, and provide education about substance use. The best evidence for efficacy is in primary care, where screening is done by a patient’s clinician In a context the patient knows and visits longitudinally for their preventive and comprehensive care. 13
Patien ents s Are Open T n To Discuss ussing ng T Their S Substanc nce e Us Use e To Hel Help T Thei heir Hea Health Agree/Strongly Agree “I f my do c to r a ske d me ho w muc h I drink, I wo uld g ive 92% a n ho ne st a nswe r.” “I f my drinking is a ffe c ting my he a lth, my do c to r sho uld 96% a dvise me to c ut do wn o n a lc o ho l.” “As pa rt o f my me dic a l c a re , my do c to r sho uld fe e l 93% fre e to a sk me ho w muc h a lc o ho l I drink.” Disagree/Strongly Disagree “I wo uld b e a nno ye d if my do c to r a ske d me ho w muc h 86% a lc o ho l I drink.” “I wo uld b e e mb a rra sse d if my do c to r a ske d me ho w 78% muc h a lc o ho l I drink.”
Stigma ma Misperceptions and myths about substance use, alcoholism and addiction are still widely believed today This makes it more difficult for people with the disease to come forward for treatment 15
Imagine someone for whom alcohol is a problem A patient? Someone you know? A family member? 16
When y hen you hea hear t r the he word rds: “alcoholic” “drug addict” What are the first responses that come to your mind? 17
“alcoholic?” “drug addict? ” 18
“alcoholic?” *Alcohol & prescription drug abuse in adults 60+ is one of the fastest growing health problems *In US est 2.5 million older adults have alcohol problems *Adults age 65 + consume more prescribed/OTC meds than other age group “drug addict?” * On an average day during the past year an average of 5,784 adolescents used prescription pain relievers non- medically for the first time. *Prescription drugs- second-most abused after marijuana 19
Relapse se R Rates es: C Commo mmon a and S Simi milar for Drug ug A Addi dict ction n & & Ot Other C r Chron onic Illnes nesse ses Drug addiction should be treated like any other chronic illness with relapse serving as a trigger for renewed intervention 20
SBIR IRT I Is s a a Hig ighly ly F Fle lexib ible le Inter erven ention SBIRT Settings Ag ing / Se nio r Se rvic e s I npa tie nt Be ha vio ra l He a lth Clinic Prima ry Ca re Clinic Co mmunity He a lth Ce nte r Psyc hia tric Clinic Co mmunity Me nta l He a lth Ce nte r Sc ho o l-Ba se d/ Stude nt He a lth Drug Ab use / Addic tio n Se rvic e s T ra uma Ce nte rs/ T ra uma Units E me rg e nc y Ro o m Urg e nt Ca re F e de ra lly Qua lifie d He a lth Ce nte r Ve te ra ns Ho spita l Ho me le ss F a c ility Othe r Ag e nc y Site s Ho spita l OBGYN- Pre g na nc y 21
PATIENTs At Risk o of S SUD UD Patient history, social history • Escalating-use patterns may have common patterns • Requests for one particular • Repeated absences from school or medication work • “Lost prescriptions” • Multiple problems with interpersonal and professional • Misrepresentation of relationships, medical illnesses • Ongoing legal difficulties 22
PATIENTs At t Risk o of f SUD D • Frequent and unexplained accidental musculoskeletal injuries that are associated with trauma Specific psychiatric complaints • Gout complication of alcohol abuse. Depression • Rhinitis and frequent "allergies" can accompany drug use that involves snorting Anxiety substances Sexual dysfunction • Cardiovascular-type symptoms , such as labile hypertension, chest pain, Sleep disorders palpitations, or stroke-like symptoms • Family history of addiction 23
Making a g a Measu surable Di e Differ eren ence • Since 2003, SAMHSA has supported SBIRT programs, with more than 1.5 million persons screened. • Outcome data confirm a 40 percent reduction in harmful use of alcohol by those drinking at risky levels and a 55 percent reduction in negative social consequences. • Outcome data also demonstrate positive benefits for reduced illicit substance use. 24
Step eps i in n SBIR BIRT • Screening: a healthcare professional assesses a patient for risky substance use behaviors using standardized screening tools. Screening can occur in any healthcare setting • Brief Intervention: a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice • Referral to Treatment: a healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services 25
Scr creening Pati tients ts f for Substance ce U Use i in Your P Pract ctice Setting • Screening is the first step of the • The result of a screen allows the SBIRT process and determines the provider to determine if a brief severity and risk level of the intervention or referral to patient’s substance use treatment is a necessary next step for the patient. 26
When S Scr creening, I It’s Useful T To C Clarify W What One D Drink Is! s! 27
How ow M Much I Is “One D Drink”? 5-oz glass of wine (5 glasses in one bottle) 12-oz glass of beer (one can) 1.5-oz spirits 80-proof 1 jigger E quivale nt to 14 gr ams pur e alc o ho l 28
Unhealthy u use se – how ow mu much i is too m oo much? Drinking OR drugging becomes too much when it… Causes or raises the risk for alcohol/drug-related problems Complicates management of other health problems Increased risks for alcohol-related problems occur for… Men < 65 who drink > than 4 standard drinks/day ( or>than 14 per week) Women or men >65 who drink > than 3 standard drinks/day (or>than 7 per week) 29
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