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SAMHSA News - January/February 2006, Volume 14, Number 1

Screening Adds Prevention to Treatment - photo of health educator practicing screening questions with a colleague as a patient

To someone with an injury or sudden illness, a visit to a hospital emergency room can seem an endless stretch of anxiety and frustration punctuated by periods of boredom.

But to a health educator, the time a patient spends waiting to see a doctor can be a prime "teachable moment." In a hospital setting, patients are strongly focused on their health and highly attuned to hearing and acting on the advice they receive.

So powerful is the patient's receptivity within the medical encounter that SAMHSA's Center for Substance Abuse Treatment (CSAT) granted $108 million over 5 years to six states and one tribal council so that they can harness it to reduce drug and alcohol abuse.

Known as Screening, Brief Intervention, Referral, and Treatment (SBIRT), this CSAT initiative shifts the emphasis to alcohol and drug users whom the traditional system has largely ignored—those who consume more than the medically accepted limits but are not yet dependent.

Rejecting the notion that only people with serious levels of abuse or dependency need targeted interventions, SBIRT assumes that everyone, regardless of current level of alcohol or drug consumption, can benefit from learning the facts about safe alcohol consumption and knowing how their own usage compares to accepted limits.

SBIRT further assumes that many people who consume amounts above those limits do not understand the risks they face but can and will change their behavior when they find out. For that reason, providing education about the consequences of substance abuse is a major part of the program.

The brief interventions made possible by the SBIRT grants "can reorient many people away from behavior that, unchecked, can lead to addiction," says SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. Starting in 2003, the seven jurisdictions received renewable grants to bring SBIRT services to hospitals, clinics, and other general medical settings. (See Current SBIRT Projects.)

One of these programs, California SBIRT (CASBIRT), is testing the model by integrating uniform alcohol and drug abuse screening services into 16 emergency rooms, trauma centers, and health clinics in San Diego County. CASBIRT staffers conduct a private interview with every patient who arrives at these facilities and provide each person with an individualized intervention appropriate to the level of risk for abuse.

They have screened more than 225,000 people since January 2004, with impressive results.

"More than half of the people who have that single interaction change their alcohol consumption," and months later they are still consuming less than before contact with SBIRT, says Tom Stegbauer, M.B.A., a lead public health analyst in the CSAT Division of Systems Improvement.

Such results show that the medical encounter is "too good an opportunity not to deliver a prevention message," says Linda Peek, Associate Director for Altam Associates, the San Diego company that administers the CASBIRT program under contract with the state of California.

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Adding Screening

photo of a CASBIRT counselor and doctor conferring about a patient's level of substance abuse

Norma Devonish, Assistant Operations Manager for Altam Associates, informs Dr. Susan Panah at North County Health Services about her patient's high-risk alcohol and drug use and the referral she just made for brief treatment services with a CASBIRT counselor.


SBIRT brings the same approach to alcohol and drug abuse as is used with other chronic conditions, Mr. Stegbauer says. "We want to catch people early on, talk to them about their consumption of alcohol and drugs. Think of what we do in treating diabetes or what we do with cardiology patients. We don't wait for the third heart attack to tell people they need to get the cholesterol out of their bloodstream. We screen with cholesterol tests, then we talk to them about diet. We talk to them about their consumption."

Screening for heart disease or diabetes risk, however, is accepted medical practice. Systematic screening for alcohol and drug abuse has not attained that status, despite the drastic effects of such abuse on health. In addition, physicians have been slow to adopt this new service in their medical encounters with patients.

The most effective way of getting SBIRT services into busy emergency rooms and clinics, Ms. Peek says, is to add "a new member to the health care team" who is exclusively dedicated to providing these services. Known as a peer health educator, this new team member "looks like everybody else" in the medical setting, says J.R. Ayala, CASBIRT Operations Manager.

The secret to an effective SBIRT program is combining the science that supports the screening and intervention protocols used in the interviews with a strong ability to build rapport with patients, Mr. Ayala adds.

Between arriving at an emergency room and receiving treatment from a physician, "a stream of people" come in contact with the patient, Ms. Peek explains. "One of those individuals is a member of our [CASBIRT] staff wearing the same surgical scrubs and hospital ID as other emergency room personnel," she continues. "This person is going to be friendly, engaging, and empathetic to the patient."

The peer health educator is "well trained to be non-judgmental and non-threatening," and "well scripted" on how to conduct interactions that produce accurate screening results and effective interventions, Ms. Peek adds.

The notable friendliness is no accident, because no part of the CASBIRT encounter is left to chance. "Intense and specific" training guides peer health educators on everything from facial expressions and body language to responses to what patients say, Mr. Ayala states. "The empathy that we provide within the scientifically scripted forms" results in fewer than 1 percent of patients who decline to undergo screening.

Top Image Caption: Maggie Robles, a Health Educator Supervisor, roleplays screening questions with "patient" Juana Aguilar.

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Inside This Issue

Screening Adds Prevention to Treatment
Part 1
Part 2

From the Administrator: The Value of Screening

Officials Plan for Flu Pandemic

Mental Health Campaign for Hurricane Survivors

Transforming State Mental Health Systems

The Road Home: Veterans Conference Planned

Two Reports: Substance Use Among Veterans

Town Hall Meetings Planned on Underage Drinking

Underage Drinkers Seek Help in Emergency Rooms

SAMHSA Grant Opportunities

"Fine Line" Detailed in Portraits

Rebuilding Afghanistan's Mental Health System
Part 1
Part 2

Statistics Released on School Services

Adolescents, Adults Report Major Depression

Guidelines Released on Marijuana Counseling

2006 Recovery Month Web Site Launched

Reach Out Now!

Advisory Available on Acamprosate

SAMHSA News Information

SAMHSA News - January/February 2006, Volume 14, Number 1

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