Evaluation of California's Alcohol and Drug Screening and Brief Intervention Project for Emergency Department Patients

Abstract

Introduction: Visits to settings such as emergency departments (EDs) may present a “teachable moment” in that a patient may be more open to feedback and suggestions regarding their risky alcohol and illicit drug-use behaviors. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an 'opportunistic' public health approach that targets low-risk users, in addition to those already dependent on alcohol and/or drugs. SBIRT programs provide patients with comprehensive screening and assessments, and deliver interventions of appropriate intensity to reduce risks related to alcohol and drug use.Methods: This study used a single group pre-post test design to assess the effect of the California SBIRT service program (i.e., CASBIRT) on 6 substance-use outcomes (past-month prevalence and number of days of binge drinking, illegal drug use, and marijuana use). Trained bilingual/bicultural Health Educators attempted to screen all adult patients in 12 EDs/trauma centers (regardless of the reason for the patient's visit) using a short instrument, and then delivered a brief motivational intervention matched to the patient's risk level. A total of 2,436 randomly selected patients who screened positive for alcohol and/or drug use consented to be in a 6-month telephone follow-up interview. Because of the high loss to follow-up rate, we used an intention-to-treat approach for the data analysis.Results: Results of generalized linear mixed models showed modest reductions in all 6 drug-and alcohol-use outcomes. Men (versus women), those at relatively higher risk status (versus lower risk), and those with only one substance of misuse (versus both alcohol and illicit drug misuse) tended to show more positive change.Conclusion: These results suggest that SBIRT services provided in acute care settings are associated with modest changes in self-reported recent alcohol and illicit drug use.

Young adults who smoke cigarettes and marijuana: Analysis of thoughts and behaviors

“…It could also be important to assess young people’s perceptions of the interaction between cigarette and marijuana use to identify relapse risk and target prevention efforts accordingly (Ramo, Liu, & Prochaska, 2013). Finally, brief, motivational interventions matched to risk level such as Screening, Brief Intervention, and Referral to Treatment (SBIRT; Woodruff, Eisenberg, McCabe, Clapp, & Hohman, 2013) could be particularly helpful with young adults who may be at risk for problems associated with substance use but may not be physically dependent or willing to engage in more intensive treatment. SBIRT screens individuals with substance use and administers treatment tailored to risk: those with low risk are given a time-limited motivational interview to increase awareness of risks, while those with high risk are offered more intensive treatment.…”

A randomized study of the use of screening, brief intervention, and referral to treatment (SBIRT) for drug and alcohol use with jail inmates

“…Early randomized studies of brief intervention for drug use among adults found statistically significant effects for at least one of the primary outcomes (Baker et al, 2005; Bernstein et al, 2005; Copeland et al, 2001; Davis, Baer, Saxon, & Kivlahan, 2003; Humeniuk et al, 2012; McCambridge & Strang, 2004; Stephens, Roffman, & Curtin, 2000; Zahradnik et al, 2009), although some studies found no difference in outcomes (Marsden et al, 2006; Stein, Herman & Anderson, 2009; Woodruff et al, 2014). Also, published articles on SBIRT projects for drug use funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) reported significant reductions in drug use and other problems from baseline to follow-up (Gryczynski et al, 2011; InSight Project Research Group, 2009; Madras et al, 2009; Woodruff, Eisenberg, McCabe, Clapp, & Hohman, 2013), although use of a single-group design in these projects precludes strong conclusions about the causal effect of SBIRT on drug use. The positive findings from this earlier body of research, however, have not been supported by two recent large randomized trials that found no significant effect on illicit drug use in primary healthcare settings (Roy-Byrne et al, 2014; Saitz et al, 2014).…”

Treatment and outcomes of patients presenting to an adult emergency department involuntarily with substance misuse

“…; Woodruff et al . ). With only 27.9% of the AOD misuse population receiving intervention for their misuse, this would be an opportunity for improvement in the care provided to these patients in the ED.…”