You may have heard the old adage “an ounce of prevention is worth a pound of cure.” Well, in the realm of alcohol and substance use, it has a lot of validity. While those who battle addictions exhibit biological and neurological characteristics that often pre-dispose them to substance misuse (neuro-chemical imbalances, damage to – or inadequate development of – key areas of their brain responsible for judgment and impulse control, etc.), early detection and therapy to help arrest unhealthy patterns can often save individuals years of struggle. That’s a primary goal of Screening, Brief Intervention and Referral to Treatment, or SBIRT – a program that the Substance Abuse and Mental Health Services Administration (SAMSHA) has been promoting since 2003. And a new paper released by the Society for the Study of Addiction reveals that, when used as a sustained approach, SBIRT was associated with significant reductions in patient drug and alcohol use.
Previous studies have indicated that not only can SBIRT have a profound influence on patterns of alcohol and drug use, but it can help to make entire health systems more efficient and effective in the ways they treat the potentially deadly disease of addiction. However, there has been concern about the feasibility of maintaining SBIRT without government grant funding, and few studies have examined long-term, large-scale impacts. Until now…
The latest study was conducted by researchers from the University of Connecticut School of Medicine and the University of North Carolina at Greensboro and evaluated two SAMHSA cohorts that screened more than 1 million patients. The patients in the cohorts tended to be middle-aged and were more likely to be women. Alcohol abuse was the most commonly reported addiction, and although illicit drug use was reported less commonly, it was still prevalent, with 41.8 percent of the first cohort and 45.8 percent of the second cohort reporting a substance use disorder involving illicit drugs.
Early intervention programs can be a valuable resource to those who may suspect they have a substance use disorder. Programs like SBIRT focus on early identification of a substance use disorder and integrating the management of addiction into primary care. The program was initiated by SAMHSA’s Center for Abuse Treatment in 2003. Since then, the agency has funded 17 Medical Residency Cooperative Agreements, 32 State Cooperative Agreements, and 12 Targeted Capacity Expansion Campus Screening and Brief Intervention (SBI) Grants, and 14 SBIRT Medical Professionals Training grants.
For California State University of Fullerton, which was awarded a $258,823 grant from SAMHSA earlier this year to implement an SBIRT program, the opportunity aligned with their desire to “make an impact on patient’s health in primary care by starting to look at and ask questions about their substance use,” said Beverly Quaye, assistant professor in the university’s School of Nursing and College of Health and Human Development.
So, how well does it work? When comparing SBIRT patient outcomes to the results for treated groups in previous randomized clinical trials, the current study found that pre–post differences were clinically meaningful and significant for almost every measure of substance use. Mean scoring indicated that heavy drinking declined by 72% and illicit drug use by 80%. Further, the study found that greater intervention intensity was associated with larger decreases in substance use.
A unique component of SAMHSA’s program is its inclusion of a brief treatment option, which can work in conjunction with a referral to more intensive, specialized facilities for substance use disorders.
This latest study also looked at the effectiveness of brief interventions and brief therapy and found that while brief intervention is primarily effective with alcohol users, brief therapy had more of an impact in reducing illicit drug use.
A key question raised about SBIRT is viability and the feasibility of program operations after institutional funding ends. The current study, through interviews and follow up with staff at six of the seven cohort one programs, revealed that all six remained operation up to 18 months after SAMSHA funding ended. Sixty-nine percent of the total programs examined in the study adapted and redesigned program delivery after sources of external support had expired, and an additional 19 sites initiated SBIRT offerings during a period when no government funding was available. Researchers suggested that to sustain SBIRT programs, sites must typically find alternative sources of funding, or becoming integrated with established health care systems. They also identified four key factors to achieving long-term sustainability: the presence of program champions, funding that is made available, systemic change, and effective management of provider challenges. The study suggested that external factors including political climate, and the priority given to substance abuse treatment could affect the implementation of SBIRT programs across the country. Some institutions, like the University of Vermont, are finding ways to do it on their own, believing strongly that the program is a proactive investment in their greatest asset: their student community.
SBIRT programs are indicative of an important larger trend — one in which clinical research aided by new technologies and concepts have made the risks associated with alcohol abuse and drug abuse an important part of the agenda of mainstream practitioners. It often “takes a village,” in other words, and studies like this are starting to reinforce the importance and feasibility of that.