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SAMHSA News - March/April 2008, Volume 16, Number 2

In Alaska: Screening Is Part of Routine Care

By Rebecca A. Clay

To Shannon R. Sommer, Director of Recovery Services for the Cook Inlet Tribal Council, Inc., one reason for SBIRT’s success is its strategy of making drug and alcohol screening just as routine as screening for heart problems or diabetes. That approach helps battle stigma, she said.

The Council received a 5-year SBIRT grant in 2003 to offer SBIRT to Alaska Natives and others in Anchorage.

“If you incorporate the screening into regular appointments, people don’t think, ‘Oh, my goodness, they must know that I use or think I have a problem,’ ” said Ms. Sommer.

The process typically begins when a patient comes to the council’s partner organization, the Southcentral Foundation, for primary health care.

A medical assistant asks a few questions to assess the patient’s risk level, then passes the results on to a behavioral health consultant.

Patients who need brief interventions receive two to five 15-minute sessions. Others receive brief therapy, which consists of about half a dozen weekly sessions. Those with the most serious problems receive referrals to substance abuse treatment.

The goal of brief interventions and brief therapy is to motivate the person to change.

“As in many other cultures, direct confrontation doesn’t work very well with this population,” said Ms. Sommer. “It tends to shut people down.” As a result, the interventions emphasize motivational interviewing and negotiation.

The results have been “almost unbelievable,” said Ms. Sommer, noting that 25 percent of those screened have alcohol or drug problems.

Between intake and a 6-month followup, the percentage of individuals with no past-month substance use more than doubled—from almost 26 percent to 57 percent.

The percentage of patients reporting no or reduced consequences from alcohol or illegal drug use jumped from almost 77 percent to almost 94 percent. Improvements also included the percentages of individuals who had stable housing, who had jobs or were in school, and who had no involvement in the legal system.

“Just this one basic screening has a phenomenal impact,” said Ms. Sommer.

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