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

Brief Intervention and Referral to Treatment

Brief Intervention

No Intervention

Dependent Use

Harmful or Risky Use

Low Risk Use or Abstention

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; 2006Adapted 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”?12-oz glass of beer (one can) 5-oz glass of wine

(5 glasses in one bottle)

1.5-oz spirits 80-proof

1 jiggerEquivalent 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 InstrumentsReimbursement 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 _____?