S - Screening. BI Brief Intervention. RT Referral to Treatment

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3 S - Screening BI Brief Intervention RT Referral to Treatment

4 Continuum of Substance Use Severity ABSTAINERS and LOW-RISK USERS (70%) MODERATE TO HIGHER RISK 25% SEVERE and DEPENDENT (5%)

5 Universal prevention message Intense treatment for abusers Limited attention to patients at-risk for dependence/abuse

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9 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) Equivalent to 14 grams pure alcohol

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11 Identify patients at moderate or high risk for abuse Intervene rapidly Mobilize patient s resources for change

12 Two questions for all patients at intake, on alcohol and recreational drug use Follow up screen (10 questions) for those at risk (20-25% of patients) Language and protocols for discussing substance use effectively Confidence that health related substance issues are being raised

13 The SBIRT Method +

14 Rationale for Universal Screening Drinking and drug use are common Over-use increases risk of health problems and decreases safety Drinking and drug over-use is often undetected by providers Patients expect to be asked about substance use

15 93%: my doctor should feel free to ask me how much alcohol I drink 92%: if my doctor asked me how much I drink, I would give an honest answer 96%: expect doctor to advise them to cut down if alcohol is affecting their health (Miller, PM et al, 2006)

16 13-34% reduction in alcohol use at 12 months (Moyer et al, 2002; Whitlock et al, 2004; Bertholet et al, 2005) 20% fewer ED visits, 33% fewer nonfatal injuries, 37% fewer hospitalizations, 46% fewer arrests, 50% fewer motor vehicle crashes (Fleming et al 2000) Most effective approach for people not seeking treatment, based on meta-analysis of 360 trials (Miller et al, 2002)

17 US Preventative Services Task Force TOP 25 Interventions Tobacco Screening third highest intervention Alcohol Screening fourth highest intervention

18 Reimbursable through Medicare, Medicaid and private insurance In TN, some grant funding available for patients who need intensive treatment Not hard to incorporate into clinic or office practice Free training for office personnel and MDs

19 The SBIRT Method +

20 The SBIRT Method

21 The SBIRT Method

22 The SBIRT Method

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24 This is the primary intervention of brief intervention Guided Conversation Elicit the patient s motivation for change Focus on MEDICAL issues

25 Open Ended Questions Affirmation Reflective Listening Summarizing to Communicate

26 Ask Permission Provide Feedback Enhance Motivation Provide Advice Discuss Next Steps Close on Good Terms

27 Ask Permission I appreciate your answering our health questionnaire. Can we take a moment to discuss your results? Patient may answer yes or no

28 Provide Feedback Refer to MEDICAL evidence that demonstrates possible problem As your provider, I wanted to mention that drinking at this level can be harmful to your health, and possibly be related to the health problem for which you came in today. What do you make of that?

29 Enhance Motivation What are some of the good/not so good things about your substance use? On a scale of 1-10, how important is it that you cut back on your [substance] use? If > 0 - why that number (and not a lower /higher one) If so - Why If not What would have to happen for you to consider cutting back?

30 Provide Advice Focus on MEDICAL issues Symptoms / side effects / withdrawal Show them NIH chart for numbers of drinks a day If you go a day or 2 without using, do you ever get sick, shaky, have tremors/seizures, or see/hear things that are not there?

31 Discuss Next Steps If you were to make a change what would be your first/next step?

32 Close on Good Terms Summarize Emphasize patient s strengths Highlight change talk, and decisions made Arrange for follow up as appropriate Referral to Treatement

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34 Federal and Tennessee websites To participate in TN: Barbara Clinton: