While those of us in the addictions field already understand the concept of total abstinence from all addictive substances for those that have addictions; SAMHSA has now shown a prevention model that addresses those at mild and moderate risk, with the hopes of preventing drinking/use from progressing (About Screening, Brief Intervention, and Referral to Treatment (SBIRT), 2015). SBIRT is the acronym used for: Screening (using the AUDIT/DAST), Brief Intervention (with an SBIRT clinician spending roughly 15-20 mins with the patient); and Referral to Treatment and recovery meetings (for those patients that are actively addicted and need to go into treatment).
The way in which this is being carried out, is substance abuse/addictions therapists (called SBIRT clinicians) are placed in primary care settings (hospitals, clinics, etc.) where patients are arriving (typically) for symptoms/issues not related to drinking or using other drugs. While in the Emergency Department at the hospital for example, the nurse will ask all patients 2-4 questions from the AUDIT/DAST to see if the patient then meets criteria to meet with an SBIRT clinician. They will meet criteria if they land in the mild, moderate or severe categories. From there, patients are asked the remaining questions by an SBIRT clinician, who will then speak with the patients using motivational interviewing in order to seek a reduction in the patient’s reported drinking/drug use. The SBIRT clinician seeks agreement with the patient as to how the patient is willing to cut back—using pros/cons revealed by the patient.
An example of a Brief Intervention may look like this:
Clinician: “I know you didn’t come to the E.R. for this, but I wanted to speak to you about your drinking and how it affects your overall heath. Your drinking is in the mild risk category—can we talk about what some of the pros and cons are of your drinking?”
Patient: “Well, I’m only drinking 2-3 glasses of wine a night—to help me take the edge off after the kids go to bed—it’s not like I’m drinking tons or anything.”
Clinician: “I hear that—it sounds like it helps you unwind at the end of a busy day—parenting is a difficult job and we need to be able to relax after a busy day. So what are some cons of your drinking?”
Patient: “I don’t see any cons of it.”
Clinician: “Okay, I’m going to talk to you about some cons you may not be aware of. For women, more than 3 drinks/night, or over 7/week, puts you in mild risk for some potential health conditions. You came in today for chest pains, and I see you have a history of high blood pressure. You may not know this, but drinking for prolonged periods of time, even if you don’t feel like you are drinking a lot, can lead to, or exacerbate high blood pressure. Did you know that?”
Patient: “Really? No…it’s not like I drink that much. “
Clinician: “I know—it doesn’t take that much. So that being said, since you are above that 7/week limit for that mild risk, how willing are you on a scale of 1 to 10 to make a change? With 1 being not willing, and 10 being totally willing?”
Patient: “I guess a 5.”
Clinician: “Wow, that’s great, you are halfway there—so why not a 3 or 4?”
Patient: “I guess because I didn’t know it would affect my blood pressure.”
Clinician: “So that being said, how would you be willing to cut back?”
Patient: “I guess I could cut back to 1 glass a night.”
Clinician: “That sounds great—1 glass a night keeps you at that 7/week, and less than 3/night. Can I give you some pamphlets to take with you to help with this?”
Clinician: “Okay, here you go. I’d like to follow up with a call to you in a week to see how you are doing.” What is the best number for you and the best time to call?”
From there, the clinician will call back and check in with the patient, and see if the patient would like to come in for individual sessions with the clinician, or get another phone call to check in from the clinician. The ultimate goal is to have those in the abuse phase, cut back before they reach the stage of addiction. However, for those already addicted, it is designed to refer them to treatment, or see them for several sessions until they may agree to seek treatment.
About Screening, Brief Intervention, and Referral to Treatment (SBIRT). (06/04/2015) In SAMHSA. Retrieved Jan. 29,2017, from https://www.samhsa.gov/sbirt/about Summer Jeirles is a Licensed Professional Counselor and a Certified Advanced Alcohol and Drug Counselor with a background in addictions and co-occurring disorders in adults. She currently practices in Virginia.