Is SBIRT Effective?
A 35-year-old man visits his doctor. In the course of the exam, the physician discovers the patient has severe high blood pressure, which is news to the patient. The doctor prescribes medication for hypertension, tells patient to exercise more, reduce salt intake, eat healthier and come back in two weeks. Since he is at risk for stroke and heart attack, the physician cautions the patient to visit the hospital if he experiences further symptoms.
The physician doesn’t ask the patient if he drinks or how much. If she had, chances are she would have prescribed different medications — and perhaps suggested a treatment program. Drinking heavily for just six months to a year can increase blood pressure significantly. Entering recovery can reduce blood pressure even faster.
The same thing happens when a patient presents with diabetes. While it appears drinking alcohol moderately (one drink a day for women; two for men) may reduce the risk of type 2 diabetes, over time heavy drinking inflames the pancreas, impairing its ability to produce insulin while increasing the risk of diabetes. Knowing whether and how much alcohol a patient drinks can determine the right treatment.
Excessive alcohol consumption exacerbates other conditions, which physicians may overlook during time-pressured primary care visits. A very quick screen, imbedded in a health assessment, tells a physician whether to question a patient more in-depth.
Ask these three questions. In the past 12 months, did you:
- Drink more than a few sips of alcohol?
- Smoke marijuana?
- Use anything else to get high?
If the patient answers “yes” to any of the questions, the Screening, Brief Intervention and Referral to Treatment (SBIRT) tool identifies risky alcohol and drug abuse before an addiction develops. Screening utilizes a validated tool, such as Alcohol Use Disorder Identification Test (AUDIT), to assess the severity of alcohol or other substance abuse. Many staff members can perform such tests using a variety of formats.
If the screening indicates a moderate risk, a brief intervention using motivational and awareness components help the patient understand the need for change. Patients who need more motivation may benefit from brief therapy that includes additional assessment, education and problem solving to motivate reduced use. Patients at high risk receive referral for treatment that ranges from an outpatient support group to a residential addiction treatment program.
By implementing early interventions, healthcare providers head off many detrimental outcomes associated with substance abuse and addiction, including comorbidities, lost jobs, family disruption and criminal activity. Waiting until there is a clear addiction imperils the health and well-being of patients.
Experts classify only 5 percent of the population at the level of “dependent use,” which is where traditional interventions begin. SBIRT flags 20% of patients at the “harmful use” level and an additional 35% who are at risk. The brief intervention or therapy help individuals in these groups see their substance use in a different light and increase awareness of the negative effects it has on their lives. Both groups require less time and money to treat effectively and experience better outcomes.
Studies show that SBIRT works. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), following exposure to SBIRT, the number of patients reporting abstinence from drugs and alcohol triples, quality-of-life measures improve, unprotected sexual encounters decline and injection drug use drops by half.
Other studies indicate that SBIRT and similar interventions also reduce the risk of trauma, emergency department visits and hospital stays. They increase the percentage of patients who enter specialized substance abuse treatment programs. Investment in SBIRT has a 3 to 1 return on investment, measured by healthcare costs savings.
When healthcare organizations offer SBIRT, they unite primary care, behavioral health and specialty addiction services in a rewarding partnership.
Learn more about SBIRT on the SAMHSA website. A free SBIRT app is also available.To see how a screening is done, please check out these videos: