Seek Early Intervention Opportunities in Health Care

 2012 NATIONAL DRUG CONTROL STRATEGY

Introduction

Early intervention is essential to reducing drug use and its costs to society. Screening, Brief Intervention, and Referral to Treatment (SBIRT) provides an evidence-based approach to early intervention, addressing chronic diseases in medical settings. Research shows that in some instances a brief motivational intervention appears to facilitate abstinence from heroin and cocaine use at a 6-month follow up interview, even in the absence of specialty addiction treatment.27 SBIRT also reduces the time and resources needed to treat conditions caused or worsened by substance use, making our health systems more cost-effective.28 For example, participants in the Washington State Screening, Brief Intervention, and Referral to Treatment (WASBIRT) program experienced significant cost savings. Participants that received a brief intervention experienced a reduction in total Medicaid costs ranging from $185-$192 per month. Participants that experienced inpatient hospitalizations from emergency department admissions saw reductions in associated costs ranging from $238-$269 per month. WASBIRT also found a reduction in the number of days of patient hospitalization. Perhaps even more impressive is that, when used with frequently hospitalized patients with chronic conditions, SBIRT reduced future hospital costs related to their care.29

Accomplishments

Screening for illicit drug use and the use of prescription drugs enables physicians to guard against possible drug interactions and start a conversation about the negative effects of illicit drug use on health. Computer SBIRT holds promise for decreasing several types of illicit drug use in hospitalized women after childbirth.30 Providing SBIRT in health systems including primary care, hospitals, and urgent care settings and ensuring these systems include specialty treatment or referral to treatment brings medical care for substance use disorders into the broader health system as envisioned in the Affordable Care Act.

Catching Substance Use Disorders Early Saves Lives and Money

Expand and Evaluate Screening for Substance Use in All Health Care Settings (2.1.A.) In 2011, the SAMHSA Center for Substance Abuse Treatment (CSAT) continued to fund 30 SBIRT grantees for substance use disorders. This included nine new awards of 5-year grants to eight states and one territory to expand systems that use SBIRT.31 In partnership with CSAT, the Health Resources and Services Administration (HRSA) provided technical assistance to grantees seeking guidance with integrating behavioral health into their primary care settings. Further, as part of the technical assistance, a training curriculum was made available for use by health care providers to become proficient in SBIRT.

Increase Adoption and Reimbursement of SBIRT Codes (2.1.B.) To insure for SBIRT services, and to further implementation of SBIRT, efforts have been made to encourage states to adopt SBIRT as a reimbursable service with an available set of codes. HRSA has included SBIRT in the Uniform Data Systems to track activity in Federally Qualified Health Center grantees related to substance use disorder screening. SAMHSA has partnered with the Centers for Medicare and Medicaid Services to develop and disseminate the codes available for billing SBIRT services to Medicaid (if adopted by the state) and Medicare to all health care providers in the states. This will help promote the provision of these important screening services.

ALCOHOL

Standard Drink and Readiness for Change Chart, developed by NIAAA, provides detailed standard drink measurements, safe drinking guidelines, and a readiness to change 

A Pocket Guide for Alcohol Screening and Brief Intervention is a detailed flowchart also created by NIAAA for alcohol screening and brief interventions.

Brief Alcohol Screening and Brief Intervention Pocket Guide is a two-page guide created by the SBIRT Colorado project that provides information on brief screening questions, guidelines on problem drinking amounts, and brief intervention statements. 

Alcohol Use: Reducing Risks is a tool created by the California SBIRT project that provide guidelines and resources clinicians can use with clients during brief interventions. This document also provides information on standard drink sizes, lists of short and long term effects of alcohol use and abuse, as well as activities to engage clients during brief interventions.

SBIRT Colorado Readiness for Change Pocket Card provides a ruler to assess client confidence to make changes in alcohol use, as well as examples of statements that healthcare professionals can use to encourage clients to reduce their drinking. 

Youth Screening Pocket Guide is condensed from the NIAAA Guide, Alcohol Screening and Brief Intervention for Youth: A Practitioner Guide. It was produced in collaboration with the American Academy of Pediatrics and provides an easy to use flow-chart of screening youth for alcohol related problems.

DRUGS AND ALCOHOL

Screening, Brief Intervention, Referral to Treatment: Strategies for Implementing SBIRT in Clinical Practicesdeveloped by HealthTeamWorks provides primary care administrators and clinicians with information and points of consideration for implementing any SBIRT process.

Colorado Guideline for Alcohol and Substance Use Screening, Brief Intervention, Referral to Treatment is a full flowchart for the entire SBIRT process for both drugs and alcohol.

Physician Positive Alcohol Screen Flowchart for Alcohol and Drugs is a full flowchart for the entire SBIRT process for both drugs and alcohol that also includes a readiness for change ruler.

Brief Intervention Workflow Pocket Card, developed by SBIRT Colorado, provides decision guidelines for the brief intervention component of SBIRT.

Drug Use: Reducing Risks, a tool created by the California SBIRT project, provides guidelines and information for clinicians to provide to clients during brief interventions, including information on common drugs of abuse and activities to help engage clients during brief interventions.

FETAL ALCOHOL SPECTRUM DISORDER

Fetal Alcohol Spectrum Disorder Workflow Chart is a flowchart of the entire SBIRT process for women of childbearing age