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Sadie Roestenburg, PharmD, BCPS |
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Audrey Wadhwani, PharmD |
The prevalence of substance use disorders (SUD) in the United States over the past year surpassed 20 million1 patients. Among those patients with SUD only 4.2 million received any substance use treatment in the last year1. Integrating routine screening across primary care and emergency care practice settings allows for a holistic approach to identify patients with SUD for early intervention.2 Pharmacists, being among the most accessible health care providers, can help reduce stigma, increase patient engagement/satisfaction, lower health care costs and improve outcomes by offering routine screening. The Substance Abuse and Mental Health Services Administration (SAMHSA) supports a research-based comprehensive behavioral health screening, brief intervention, and referral to treatment (SBIRT) method.2
SBIRT Method:
Pharmacists should feel empowered to discuss SUD and utilize the SBIRT method during patient visits in any type of care setting. Utilizing SBIRT and the respective screening tools is a way to increase measurement-based care and track outcomes. SBIRT allows health care professionals to address the spectrum of SUD even when the patient is not actively seeking an intervention or treatment.
SAMSHA defines this comprehensive SBIRT model to include the following characteristics:
Screening (S):
Screening for SUD typically takes 5 to10 minutes and can be repeated at various intervals to determine changes in patients’ progress over time. A recent study found that asking a single question related to drug use was effective in detecting drug use among primary care patients.2 Thus, familiarization with screening can be immensely effective at identifying patients who qualify for treatment. The most commonly used and recommended rating scales within SBIRT for alcohol and drug use include: Alcohol Use Disorder Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Alcohol, Smoking, Substance Involvement, Screening Test (ASSIST) and Cut Down, Annoyed, Guilty, Eye-Opener (CAGE).
Brief Intervention (BI):
The goal of brief intervention focuses on increasing patient insight and awareness about risks related to unhealthy substance use, enhancing motivation towards healthy behavioral change, and utilizing harm reduction strategies. BI can include motivational interviewing, prescribing medications for SUD, and offering other resources (i.e., Alcoholics Anonymous, Narcotics Anonymous, cognitive behavioral therapy, etc.) for the patient to consider.
Referral to Treatment (RT):
Referral to treatment helps facilitate access to SUD assessment and treatment. Understanding facility and community resources available is an important aspect of this stage of SBIRT. (One resource to find available treatment options can be found at www.findtreatment.gov).
How to Avoid the “Judgement Zone”
As health care providers, we can counter stigma by using accurate, nonjudgmental language to describe SUD and those it affects.3
Table 1. Changing the Conversation3
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Instead of saying… |
Consider saying… |
Avoid Labeling Patients |
Mr. X is a drunk and/or alcoholic |
Mr. X has an alcohol use disorder |
That patient is a problem drinker |
That patient is drinking alcohol above the recommended limits |
|
Avoid Judgmental Terminology |
You have to stop your alcohol habit |
I would like to help you get treatment for your challenges with alcohol use |
Be Supportive |
There is no cure for your disease |
Recovery is achievable |
I can’t help you if you choose to keep using alcohol |
We understand that no one chooses to develop alcohol use disorder. We consider this a medical disorder that can be managed with treatment |
In summary, using SBIRT in routine pharmacist visits can allow for early intervention and timely referral to treatment and encourages more conversations related to SUD by helping patients recognize and achieve their goals.
References