Screening, Brief Intervention, Referral to Treatment for Drug Addiction

Call a Drug Rehab Directly

sbirtWhen we are desperate for help with drug addiction and alcoholism, the emergency department of a local hospital isn’t always a great avenue into drug rehab.  Doctors are now being trained in special procedures for addressing substance use disorders, and those procedures aren’t warm and fuzzy.

The federal Health and Human Services Administration’s Substance Abuse and Mental Health Services Administration promotes a training protocol called SBIRT for medical professionals. (Stay with me:  it’s HHSA’s SAMHSA’s SBIRT.)

SBIRT stands for “Screening, Brief Intervention, and Referral to Treatment” but I’m going to call it “Talk Fast” or TF for short (that’s a pun).

It’s actually pretty funny (and achingly sad) if you pay close attention to the language, and imagine how fast the ED doctor needs to jabber to cram all this into 5-10 minutes.

“Brief Intervention is a time-limited, patient-centered strategy that focuses on changing a patient’s behavior by increasing insight and awareness regarding substance use. Depending on severity of use and risk for adverse consequences, a 5-10 minute discussion…provides the patient with personalized feedback showing concern over drug and/or alcohol use. The topics discussed can include how substances can interact with medications, cause or exacerbate health problems, and/or interfere with personal responsibilities.  Brief intervention is designed to motivate patients to change their behavior and prevent the progression of substance use. During the intervention, patients are:

  • Given information about their substance use based on their risk assessment scores.
  • Advised in clear, respectful terms to decrease or abstain from substance use.
  • Encouraged to set goals to decrease substance use and to identify specific steps to reach those goals.
  • Taught behavior change skills that will reduce substance use and limit negative consequences.
  • Provided with a referral for further care, if needed.

Brief interventions are typically provided to patients with less severe alcohol or substance use problems who do not need a referral to additional treatment and services. In addition to behavioral health professionals, medical personnel (e.g., doctors, nurses, physician assistants, nurse practitioners) can conduct these interventions and need only minimal training.”

In some states, they talk really fast.  A medical consulting firm defines the BI in SBIRT as:

“A brief intervention, also referred to as a brief motivational conversation. Efficacy and effectiveness has been found for brief interventions lasting 3-5 minutes. However, one needs to provide a minimum of 15 minutes for payment under CPT and HCPC rules.  Brief interventions consist of feedback about personal risk, explicit advice to change, emphasis on patient’s responsibility for change, and provides a variety of ways to effect change.  Brief intervention techniques include an empathetic style and support for the patient’s perception of self-efficacy or optimism that they can change.”

SAMHSA’s SBIRT does go on to note that In the case of patients with addictions, more intensive interventions may be needed.” Whew.  Because I was getting a little nervous for the patient with the life threatening brain disease of addiction who’d gone to the ED desperate for help.  There is hope for help in hospital emergency departments now that more and more hospitals are employing recovery coaches who can offer more personalized assistance for longer than the 5 to 10 minutes allotted to SBIRT.

THE TAKEAWAY:  When turning to a healthcare professional for help with addiction, ask if the provider practices “Brief Intervention.” If the answer is yes, keep your expectations low.  Often, it’s simply more efficient to skip the ED and just call a drug addiction rehab directly.  

Reprinted with permission from  Copyright 2016