Transcript SBIRT Introduction and Relevance to DGIM

SBIRT Introduction and
Relevance to DGIM
Jason Satterfield, PhD
SBIRT Collaborative Education Project
Funded by SAMHSA/CSAT
Grant 1U79TI020295-01
Outline/Roadmap
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SBIRT defined
Substance use epidemiology and
significance in primary care
SBIRT research support
How this will fit into clinical practice at
DGIM
What is SBIRT?
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Screening: quickly assess use and
severity of alcohol, illicit drugs, and
prescription drug abuse.
Brief Intervention: a 3-5 minute
motivational and awareness-raising
intervention given to risky or problematic
substance users.
Referral to Treatment: referrals to
specialty care for pts with substance use
disorders.
QUIZ: Your Clinic Panel?
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What percentage of your current clinic
patients would be classified with alcohol
abuse or dependence?
What percentage would be classified as
“at risk” drinkers?
What percentage of your current clinic
patients have used illicit drugs in the
past month?
QUIZ: Demographics
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How did your answers compare to
statistics for the general population?
 Percent
with alcohol abuse or
dependence
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7% or about 1 in 14
 Percent
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23% or nearly 1 in 4!
 Percent
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“at risk” drinkers
using illicit drug
8% or about 1 in 12
SAMHSA, National Survey on Drug Use and Health, 2008
Ages 12+ in the United States
Continuum of Substance
Use
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In Module 1, you learned about the continuum of
substance use ranging from:
 abstinence
 moderate use
 “at risk” use
 Abuse
 Dependence
Only Abuse and Dependence are considered “Substance
Use Disorders” (SUD)
Your initial job as a primary care provider is to assess
use, classify appropriately, and screen for possible comorbidities.
Tips for screening, intervening, and medical
management come in subsequent modules.
Substance Use Issues are
Highly Prevalent in Americans
Risky Drinking*
23%
Illicit Drug Use
8%
Substance Abuse or Dependence
9%
Alcohol
7%
Illicit Drugs
3%
*Defined in later slides.
SAMHSA, National Survey on Drug Use and Health, 2008
Ages 12+ in the United States
Health Impact – Alcohol/Drugs
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Trauma, disability
Hypertension, dyslipidemia, heart disease
Liver disease, gastritis, pancreatitis
Depression, anxiety, sleep dysfunction
Sexual and menstrual dysfunction
Risk for breast, colon, esophageal, head and
neck cancers
HIV/AIDS, other STIs, and other infectious
diseases
Psychosocial Aspects of
Substance Use Disorders
Violence/Crime:
 Alcohol is involved in one-half to two-thirds of all
homicides and at least one-half of serious assaults
(Martin, 1992).
 Opioids predispose patients to trauma (Stolbach,
2009).
 Adolescents who used cannabis committed more
crimes compared to those who never used cannabis.
These relationships declined with age but remained
significant (Fergusson).
Evidence for SBIRT
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A recent meta-analysis suggests an overall
reduction of 56% in number of drinks.
The effect size for a brief motivational
intervention of all types ranged from 0.25 to
0.57, with participants followed from 3 to 24
months
Burke et. al., 2003
Evidence for SBIRT
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Research has shown brief
interventions can reduce alcohol use
for at least 12 months in patients who
are not alcohol dependent.
10-30 % of patients can be expected
to change their drinking behaviors as a
result of a brief intervention.
Babor & Higgins-Biddle, 2000; Fleming and Manwell, 1999.
Brief Intervention (BI)
Effectiveness
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32 controlled studies found brief interventions
often as effective as more extensive
treatments.
Reduction in the following as a result of brief
intervention:
 Alcohol and other substance
consumption/use.
 Harmful physical consequences.
 Social consequences.
 Sick days, missed work.
 Hospitalization.
 Trauma/accidents/injuries.
Fleming & Manwell, 1999
Results for SBIRT Alcohol*
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Primary care - $950 net savings in 1 year continuing out
to at least 4 years; ROI >$4 per $1 spent
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ER/trauma centers - 47% reduction in recurrent alcoholrelated injury; nearly $4 ROI per $1 spent
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WA Medicaid disabled - $185 decrease in health
care costs per recipient per month x 12 months
*References on final slide
SBIRT Prospective Cohort
Study
4%
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6 clinical sites
19%
459,599 pts screened
At 6-month follow up
 Drug use 67.7% ↓
 Alcohol use 38.6% ↓
 Self reported
improvement in
general health, mental
health, employment,
housing and criminal
behavior
Negative Screen
Madras et al, Drug and Alcohol Dependence, 2009
77%
Brief Intervention
Specialty Treatment
Relevance to DGIM Clinic:
Screening
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Given the evidence supporting SBIRT in
primary care, DGIM has made a
commitment to screen every patient
once per year for alcohol, tobacco, illicit
drugs, and prescription drug abuse.
Starting in Fall 2010, you will see a
screening sheet attached to the front
every patient chart.
See Module 2 for more information and
Tips on Screening.
Relevance to DGIM:
Referrals and Interventions
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All patients who are classified as “at risk” or
“substance abusers” or “substance dependent”
should receive a 3-5 minute motivational
intervention.
Patients who meet criteria for abuse or
dependence should be referred for specialty
care if they agree to accept the referral (see
Module 3).
Patients who meet criteria for dependence may
be candidates for addiction pharmacotherapy
(see Module 4).
Relevance to DGIM:
Precepting
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All UCPC R2/R3’s will receive SBIRT
training. They will be required to screen
all patients and intervene when
appropriate.
Be sure to reinforce screening skills and
discuss brief, structured interventions.
Residents will also be trained in
addiction pharmacotherapy and may
need your guidance in initiating an Rx.
Relevance to DGIM:
Expert Backup
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Addiction Psychiatrists and Psychologists
are available to answer your clinical
questions. Please contact Kathleen
McCartney 476-5235 to set up a
consultation.
As always, you are welcome to contact
Jason Satterfield for assistance with
referrals and mental health/behavior
change issues.