Transcript How To Do… Screening Screening: Why do SBIRT? “Who are the addicts?”

How To Do…
Screening
Screening: Why do SBIRT?
“Who are the addicts?”
Screening: Why screen universally?
Drinking and drug use…
• are common
• often go undetected
• can increase risks to safety and health problems
Routine screening for other potential medical problems (e.g. cancer,
diabetes, hypertension). Why not for alcohol and drug use?
*People are more open to change than we might expect.
Criteria for Screening
• Significant morbidity/mortality
• High prevalence
• Long asymptomatic period
• Valid, feasible screening test
• Early intervention better (than later)
• Available and effective treatments
Screening: Benefits
• Detect current health problems related to at-risk
alcohol and drug use
• Detect alcohol and drug use patterns that can
increase risk of future injury/illness
• Intervene and educate about risky alcohol
and drug use
• Prevent medical and prescribing errors
Targeted Intervention
Dependent Use
Brief Intervention and
Referral to Treatment
Harmful or
Risky Use
Brief Intervention
Low Risk Use
or Abstention
No
Intervention
Drinkers who screen positive may
meet criteria for…
• Alcohol Misuse (at-risk drinking)
▫ hazardous drinking (no consequences yet)
▫ harmful drinking (consequences experienced)
• Alcohol Abuse
• Alcohol Dependence
What is Alcohol Dependence?
DSM-IV-TR Criteria
• Evidence of tolerance or symptoms of withdrawal
• Sweating, increased pulse rate, hand tremor, anxiety, nausea
• A prior patient history that includes a pattern of
compulsive use, high levels of alcohol intake, and
increased alcohol-related problems
• Devoting substantial periods of time to obtaining and
consuming alcohol
• Often drinking more than intended to
• Unsuccessful efforts to cut-down or control intake
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth
edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.
What is Alcohol Abuse?
DSM-IV-TR Criteria
• Diagnosed after the absence of alcohol dependence as
been established
• A maladaptive pattern of use leading to significant
clinical impairments within the past 12mos., including
one or more of the following:
•
•
•
•
Failure to fulfill role obligations
Recurring use of alcohol in hazardous situations
Recurring alcohol-related legal problems
Continued alcohol use despite recurrent interpersonal problems
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth
edition. Test Revision (DSM-IV-TR). Arlington, VA: American Psychiatric Association, 2000.
The medical setting is a good home
for screening & intervention
• Alcohol & drug use contributes to injury & illness
• Alcohol & illicit drugs interact with prescribed
medications
• Alcohol & drug use affects families & communities
• Early intervention may reduce health consequences
and save health care dollars
• For many patients, SBI alone may be sufficient
Patients Are Open to Discussing Their
Substance Use to Help Their Health
Survey on Patient Attitudes:
Agree/Strongly Agree
“If my doctor asked me how much I drink, I would give an
honest answer.”
92%
“If my drinking is affecting my health, my doctor should
advise me to cut down on alcohol.”
96%
“As part of my medical care, my doctor should feel free to
ask me how much alcohol I drink.”
93%
Disagree/Strongly Disagree
“I would be annoyed if my doctor asked me how much
alcohol I drink.”
86%
“I would be embarrassed if my doctor asked me how much
alcohol I drink.”
78%
Source: Miller, PM, et al. Alcohol & Alcoholism; 2006
Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)
Introduction to Screening
• Hello, I’m ______, a Health
Promotion Advocate here at ____.
• As a part of your medical team, my
job is to ask all patients some
personal questions to help you get
the best care possible.
• You do not have to answer them if
you feel uncomfortable.
It’s Useful to Clarify What is One Drink!
How Much Is “One Drink”?
5-oz glass of wine
(5 glasses in one bottle)
1.5-oz spirits
80-proof
1 jigger
12-oz glass of beer (one can)
Equivalent to 14 grams pure alcohol
NIAAA Definitions for Unhealthy Drinking
At-risk for increase in illness & injury
• men: >14 drinks/wk or 5+ drinks/occasion
• women: >7 drinks/wk or 4+ drinks/occasion
• elders (+ 65): >7 drinks/week or 2+ drink/day
• pregnant women: any use of alcohol
Brief Alcohol and Drug Screening Questions
Alcohol:
Frequency
1) On average, how many days per week
do you drink alcohol? (beer, wine,
liquor)
Alcohol:
Quantity
2) On a typical day when you drink, how many
drinks do you have?
Heavy
Episodic
Drinking
(HED)
3) In the last month: What is the maximum
number of drinks you had in a 2-hour
period?
Drugs:
Any Use
4) In the past year: How many times have you
used an illegal drug, or used a prescription
medication for nonmedical reasons?
Validated Screening Instruments
Reimbursement requires using validated
screening instruments
• AUDIT, AUDIT-C
• DAST
The AUDIT
• Developed by WHO
• Evaluated over 20 yrs
• Accurate measure of risk
across gender, age, &
cultures
• 3 domains of drinking
• Scores 8 > indicate risky
drinking (give BNI)
• Scores 20 > may indicate
need for treatment
AUDIT-C
(shorter version)
The DAST
Enter scores into
electronic medical
records for billing
Transition to Brief Intervention
Thanks so much for answering those
questions.
I was wondering if it would be okay if we
talked a little bit more about _____?