A Message from the Director

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1 Volume 2 Issue 13 A Message from the Director July 2011 The Utah Addiction Center Dedicated to research, clinical training, and education in chemical addiction SBIRT (Screening, Brief Intervention, and Referral to Treatment) lthough Utah is typically one A of the states with the lowest rates of drug abuse problems, an exception to this pattern has been the abuse of prescription medications. Because the vast majority of prescription drugs that are abused originate from legitimate sources such as healthcare providers who Glen W. Hanson, Ph.D, D.D.S are licensed to prescribe or dispense these medications, it is important to develop strategies to encourage these professionals to participate in finding and implementing solutions for these abuse problems. In addition, the very nature of drug dependence/addiction suggests that these professionals should also have the appropriate training to address issues of substance abuse in general. Thus, research has overwhelmingly proven that drug dependence/addiction has neurobiological consequences that disrupt brain systems necessary for healthy decision-making, control of impulsivity, memory and motivational systems. Report The Utah Addiction Center is based in the office of the University of Utah Senior Vice President for Health Sciences INSTITUTIONAL ADVISORY BOARD A. Lorris Betz, M.D., Ph.D. Louis H. Callister, J.D. Edward B. Clark, M.D. M. David Rudd, PhD, ABPP Patrick Fleming, LSAC, MPA Raymond Gesteland, Ph.D. Jay Graves Ph.D. John R. Hoidal, M.D. Glen W. Hanson Ph.D, D.D.S, Maureen Keefe, RN, Ph.D Jannah Mather, Ph.D. Chris Ireland, Ph.D. John McDonnell, Ph.D. Barbara N. Sullivan, Ph.D. Ross VanVranken, ACSW Kim Wirthlin, MPA Because of these biopathological factors, experts have concluded that problems associated with drug abuse/addiction are symptoms of diseases with biomedical bases. Consequently, as with other diseases, licensed healthcare professionals are particularly well trained to understand, and most strategically placed to effectively address, drug abuse-related issues. Thus, it is imperative that our healthcare providers do a better job contributing to the assessment and treatment strategies for dealing with problems of prescription abuse in particular, but substance abuse (including chemicals such as alcohol and nicotine) in general. This conclusion is supported by findings that in Utah only 5% of those entering public-funded treatment are referred by healthcare providers. This is significantly less than the national average of 7% and underscores the need to change the traditional role of healthcare providers in our efforts to deal with substance abuse. One effective mechanism to achieve this objective is the SBIRT (Screening, Brief Intervention, and Referral to Treatment) program. This is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders (SAMHSA, 2010). If done properly and consistently, SBIRT is an effective means of involving healthcare providers in efforts» See Welcome page 7 1

2 Screening, Brief Intervention and Referral to Treatment (SBIRT): A New Initiative for Utah Becky Barnett, LCSW Program Manager Utah State Division of Substance Abuse & Mental Health The Utah State Division of Substance Abuse and Mental Health has started statewide efforts to implement Screening, Brief Intervention and Referral to Treatment (SBIRT) in health care settings, clinics and hospitals in the State of Utah in SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. (SAMHSA, 2010). Furthermore, SBIRT is a part of a larger shift toward a public health model for addressing problems related to substance use. In the future, substance abuse treatment, mental health, primary care, and related services will be increasingly integrated in an effort to reach more people and provide them with a more seamless recovery-oriented system of care (World Health Organization, 2005). SBIRT Defined. Screening: Screening involves the use of a validated instrument to assess to risk level of substance use and identify individuals who might benefit from intervention. Brief Intervention (BI): Brief intervention occurs when initial screening indicates a risk level as moderate to high; the focus is on increasing insight and awareness regarding substance use and motivation toward behavioral change. Brief Treatment (BT): Brief treatment is similar to BI in emphasizing motivation to change and client empowerment. Referral to Treatment (RT): Referrals to treatment provides those at highest risk with access to specialty care (World Health Organization, 2005). Substance use is one of America s top preventable health issues. SBIRT is an evidenced based model which has been proven to be effective in reducing and preventing alcohol and drug use. Several organizations across the nation endorse SBIRT, including the Center for Substance Abuse Treatment, The World Health Organization, The American Medical Association, The Office of National Drug Control Policy, and others. The Utah State Division of Substance Abuse and Mental Health, Utah Addiction Center and Mountain West ATTC hosted their first webinar in the State of Utah on SBIRT on June 29. This webinar provided an introduction to SBIRT and implementation plans for Utah. More training will be forthcoming. For more information regarding the Utah State SBIRT Project, contact: Becky Barnett, LCSW Program Manager Utah State Division of Substance Abuse & Mental Health 195 North 1950 West, Salt Lake City, Utah Phone: (801) rbarnett@utah.gov The Utah Addiction Center Report 2

3 SBIRT: New Populations, New Effectiveness Data Rebecca A. Clay SAMHSA, U.S. Department of Health and Human Services The idea behind SAMHSA s Screening, Brief Intervention, and Referral to Treatment (SBIRT) program is deceptively simple: What if you could stop drinking and substance abuse problems before they became serious enough to destroy people s lives? Now SAMHSA s grantees are providing SBIRT services in an ever-growing list of venues. To ensure that the approach endures long after the grants end, the program is expanding to include the next generation of service providers through a new medical residency grant program. (See box on page 5.) And the field is amassing even more evidence that the SBIRT approach is an effective way to reduce alcohol and illicit drug use and save money. Promoting services like SBIRT to all parts of the Nation is a crucial part of SAMHSA s mission to reach everyone struggling with substance abuse issues, said H. Westley Clark, M.D., J.D., M.P.H., Director of SAMHSA s Center for Substance Abuse Treatment (CSAT). REACHING NEW POPULATIONS The basics of SBIRT are the same no matter where the services are provided. All patients in participating emergency rooms, primary health clinics, campus health centers, or other health care venues automatically undergo a quick screening to assess their alcohol and drug use. If they re at risk of developing a serious problem, they receive a brief intervention that focuses on raising their awareness of substance abuse and motivating them to change their behavior. Patients who need more extensive treatment receive referrals to specialty care. (See Screening Works: Update from the Field, SAMHSA News, March/April 2008.) CSAT s goal is to help spread the approach throughout the entire health system. A grant program that ended last year, for instance, brought SBIRT to a dozen community college and university campuses around the country. The nine state and tribal grantees currently providing SBIRT services are branching into new venues. In Colorado, for instance, a grantee is now bringing the SBIRT approach to HIV clinics (see page 4). Another project with Alaska Natives involves taking SBIRT to areas so remote they can only be reached by boat or airplane (see page 5). To help ensure SBIRT s sustainability, CSAT also has launched a medical residency grant program (see page 5). These grantees are developing a variety of tools for training medical residents, including lectures, Web-based programs with streaming video illustrations, and practice with standardized patients. These are the next generation of providers, explained Project Director Walker Reed Forman, M.S.W., the Lead Public Health Advisor in CSAT s Division of Services Improvement. Research shows that when you learn something at an early point in your career, you re more likely to adopt it once you re out in the wider medical community. PROVING SBIRT S EFFECTIVENESS A growing body of evidence about SBIRT s effectiveness and costeffectiveness could help SBIRT to expand even more. That research shows that SBIRT is an effective way to reduce drinking and substance abuse problems.» See SBIRT: New Populations, New Effecfiveness Data page 6 The Utah Addiction Center Report 3

4 Access to Recovery Utah Denise Leavitt ATR Administrator Utah Division of Substance Abuse and Mental Health Access to Recovery (ATR) provides a wealth of opportunities for clients, providers and the substance use disorders system. ATR offers Utah the opportunity to think outside our current understanding of how individuals get into and maintain recovery from substances. In addition, it allows us to offer new types of services in support of this new thinking. Over the next four years ATR will provide services to over 10,000 Utahns, increase the capacity of service delivery and break through barriers that have previously kept individuals from receiving services and providers from delivering services. ATR is a 4 year federal grant awarded to the Utah Department of Human Services, Division of Substance Abuse and Mental Health (DHS/ DSAMH) and implemented by both DHS/ DSAMH and the Local Substance Abuse Authorities for the participating counties. It provides $10.6 million to serve over 10,000 individuals residing in Weber, Salt Lake and Utah counties. The grant s focus includes: providing client choice of services and providers, implementing an open network of service providers and delivering services to qualified individuals. In addition, emphasis is placed on creating and building recovery support services delivered by faith-based and community based providers who have traditionally not been a part of the substance use disorders network. Residents of Weber, Salt Lake and Utah counties with a history of substance use are eligible for ATR. Choice is the cornerstone of ATR. Individuals will be assessed to determine the array of services available to them, after which they may choose which services they want to participate in and which providers they will receive those services from. All ATR participants will have access to a Case Manager who will help identify the array of services available, connect them with agencies and providers inside and outside of ATR and maintain contact with them throughout their ATR participation. The case manager will assist participants in making changes to their service array and/or providers based on client need and satisfaction. The Utah Addiction Center Report 4

5 Available services under ATR include: Transportation, such as bus passes. Medication Assisted Therapies including Methadone, Naltrexone, and Buprenorphine. Recovery Management to assist individuals in a group support setting to maintain their recovery Life Skills such as communication skills, anger management and communication skills. Childcare to allow parents the ability to attend ATR services or other self-help groups. Drug testing to reinforce abstinence. Emergency housing, a short-term solution for those individuals at immediate risk of losing their current housing situation and for which this will create a risk to use substances. Special needs which include items such as paying for birth certificates, state ID cards, co-pays and other items that will help individuals engage in or maintain recovery. Online recovery support provides web-based support to assist individuals in their recovery. ATR will expand the network of service providers. Historically, publicly funded substance use disorder services have been delivered by a small network of providers who focus service delivery on substance abuse treatment. ATR will open this network to all providers offering available services. By opening the network of service providers ATR seeks to increase choice for clients, expand capacity of services and provide new opportunities for agencies previously unable to receive public funding. ATR will also encourage current providers to un-bundle their services. By so doing, providers will be able to offer all clients they serve a menu of services to meet their individual needs at the appropriate level of care, including those individuals who do not require intensive treatment services. This will allow providers the option of continuing to serve clients longer as they complete their formal treatment but require additional supports to maintain their recovery. All three participating counties are currently enrolling both participants and providers. If you would like to receive ATR services or provide services to ATR participants please contact your local county coordinator, or program administrator. Denise Leavitt ATR Administrator 195 North 1950 West Salt Lake City, UT Office: dleavitt@utah.gov Jodi Delaney Salt Lake County Care Coordinator 2001 S State St. S2300 Salt Lake City, UT Office: Cell: jdelaney@utah.gov Shanel Long Utah County Care Coordinator 151 South University Ave, Suite 3200 Provo, UT Office: Cell: shlong@utah.gov Joshua Campbell Weber County Care Coordinator th Street Ogden, UT Office: Cell: jrcampbe@utah.gov The Utah Addiction Center Report 5

6 » SBIRT: New Populations, New Effectiveness Data continued from page 6 A 2009 article in the journal Drug and Alcohol Dependence, for example, found an almost 68-percent reduction in illicit drug use over a 6-month period among people who had received SBIRT services. The report s authors include Dr. Clark and other SAMHSA staff; Bertha Madras, Ph.D., former Deputy Director for Demand Reduction at the Office of National Drug Control Policy; and Wilson Compton, M.D., M.P.E., Director of the Division of Epidemiology, Services, and Prevention Research at the National Institute on Drug Abuse. The researchers reviewed data on 459,599 patients screened at various medical settings in six states. Almost 23 percent had drinking or drug problems or a high risk of developing them. Of those patients, almost 16 percent received a brief intervention; 3 percent received brief treatment; and almost 4 percent received referrals for more specialized treatment. In addition to significantly reducing illicit drug use, SBIRT also reduced individuals drinking. Among those who reported heavy drinking at baseline, the rate of heavy alcohol use was almost 39 percent lower at the 6-month followup. Those who received brief interventions or referrals to specialty treatment also reported other improvements, including fewer arrests, more stable housing situations, improved employment status, fewer emotional problems, and improved overall health. SHOWING COST-SAVINGS SBIRT can also save money, other research suggests. In one CSAT-funded study, for instance, the Washington State SBIRT grantee examined the approach s impact on Medicaid costs for emergency room patients. Researchers in the state s Department of Social and Health Services compared changes in costs for 1,315 disabled Medicaid recipients who received at least a brief intervention through the Washington SBIRT project and 8,972 who did not. The reduction in total Medicaid costs after receiving the intervention was $185 to $192 per person per month, the researchers found. The lowered costs came mostly from declines in inpatient hospitalizations. Although some modest costs are associated with providing SBIRT services, the researchers estimated that the state could potentially save up to $2.8 million a year by continuing to provide SBIRT services to working-age disabled patients. EDUCATING PROVIDERS Some challenges remain, including reimbursement for SBIRT services. Not all providers may be aware that there are now billing codes that can allow them to receive reimbursement for providing SBIRT, explained Mr. Forman. Providers are beginning to use the new, universally accepted Medicare codes, he said. And several third-party payers already accept the American Medical Association s new Current Procedural Terminology codes for SBIRT services. We re going to expand our efforts to educate providers on the funding support for doing SBIRT, said Mr. Forman. CSAT is planning a summit on financing policy in 2010, for example, which will educate state policymakers and health care decisionmakers about the codes and how to use them. Medicaid codes are a different story, Mr. Forman added. Each state has to review the use of the SBIRT code, review it against their budget, and make a decision about whether they ll adopt it, he explained. Although a few states have already adopted the Medicaid codes, the vast majority have not. That s a little more difficult road to travel, he said. For more information about CSAT s SBIRT program, visit SAMHSA s Web site at This article appears courtesy of SAMHSA News, Volume 17, Number 6, November/December SAMHSA News is the national newsletter of the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. The Utah Addiction Center Report 6

7 » Welcome continued from page 1 to prevent and reduce alcohol and substance abuse and its negative outcomes. An important tool to prepare healthcare professionals to incorporate SBIRT in their practices is through continuing medical education (CME) programs. To this end, the Utah Legislature in its 2011 session passed Senate Bill (SB) 61 to require that all healthcare drug prescribers, who have Utah Controlled Substance licenses, receive at least 4 hours of CME of substance abuse-related training approved by the Utah State Division of Substance Abuse & Mental Health (UHS/DSAMH) for each license-renewal cycle. To my knowledge, Utah is the first state to implement such a program, and the state has been praised by federal agencies for its vision in this regard. Another significant program to engage healthcare providers in SBIRT that is being implemented in parallel with SB61, is a 4-year ATR (Access to Recovery) federal grant awarded to the UHS/DSAMH. The Utah Addiction Center has been recruited to help develop and implement SBIRT programs as an important part of this ATR grant. It is intended that these efforts will serve as the initial steps to achieve broader implementation of SBIRT efforts throughout Utah s health care systems. This UAC Newsletter provides greater explanations of the purpose of these programs, how they work, and is intended to be a resource guide to professionals, policy makers and the general public in this regard. Referral: The Pathway to Treatment is Rarely Through Healthcare Providers The individual or organization that has referred a client to treatment is recorded at the time of admission. This source of referral into treatment can be a critical piece of information necessary for helping a client stay in treatment once there, because the referral source can often continue to have a positive infl uence on the client s recovery. The graphs below detail referral sources for fiscal years 2009 and 2010 for substance abuse and fiscal year 2010 for mental health. - Utah Division Of Substance Abuse and Mental Health 2010 Annual Report 80% Referral Source of Individuals in Substance Abuse Service Fiscal Years % 40% 20% 0% Self A&D Provider Other Health Care Provider DCFS * Community Referral Criminal Justice System Unknown Utah 2009 Utah 2010 National Average The Utah Addiction Center Report DCFS: Division of Child and Family Services A&D: Alcohol and Drug * Note: All other National categories are combined in Community Referral 7

8 Contact Us University of Utah Health Sciences Center 410 Chipeta Way, Suite 280 Salt Lake City, Utah Phone: (801) Fax: (801) Internet: Utah Addiction Center University of Utah Health Sciences Center 410 Chipeta Way, Suite 280 Salt Lake City, Utah Non-profit Organization U.S. POSTAGE PAID Salt Lake City, Utah Permit No. 1529