Chronic Care Model of Management of Alcohol Problems in Primary Care Settings

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Screening, Brief Intervention, Referral, and
Treatment(SBIRT)
Division of Services Improvement Organization and
Financing Branch

• Juli Harkins
• June 26, 2005

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Consider these facts

• 20 million Americans (8) of the population aged
  12 or older were current users of illicit drugs.
• 3 million 1st time marijuana users (each day an
  average of 7K, mostly ltage 18)
• 2 million current cocaine users
• 1 million current hallucinogen users
• 119,000 current heroin users
• 6 million current users of psychotherapeutic
  drugs taken non-medically
• Source 2003 NSDUH

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Most People Who Needed Treatment for an Illicit
Drug Problem Did Not Feel a Need for Treatment
Female
Male
Felt No Need for TX
Felt Need for TX
Received TX
2002 NSDUH
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Most People Who Needed Treatment for Alcohol
Problems Did Not Feel a Need for Treatment
Female
Male
Felt No Need for TX
Felt Need for TX
Received TX
2002 NSDUH
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Why SBIRT?The research suggests

• Substance use and abuse have significant medical,
  social, and financial consequence to our society.
• Effective treatments exist but fewer than half of
  those who need treatment for substance use
  disorders receive the appropriate treatment.
• Early and brief intervention is more effective
  clinically and much more cost efficient than the
  traditional more intensive treatment necessary if
  the use progresses to addiction.
• Excessive drinking and illicit drug use are often
  undiagnosed by medical professionals and go
  untreated, leading to a more chronic, severe
  condition.

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SBIRT Encourages Moving from Research to Practice
and from Science to Service in Medical Care
Settings.

• Emergency services, chest pain, urgent care
• Trauma inpatient
• Primary care
• Dental services, pre-natal, breast exam clinics,
  adolescent clinics

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Integrated Spectrum of Users and Services
GeneralistSystem
Prevention
Specialist System
Intervention
Treatment
Abuse Disorder
Non-Users and Low Risk Users
At-Risk Users
Dependence Disorder
Assessment, Treatment, Support
Brief Intervention and Boosters
Education, Information (Brief Advice) and Boosters
Linkages by uniform decision rules permeable
boundaries
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SBIRT Goals as a Conceptual Model and Planning
Tool

• Increase access to clinically appropriate care
  for nondependent as well as dependent persons
• Link generalist and specialist treatment systems
• Combine prevention, intervention, and treatment
  toward a consistent continuum of care.
• Diminish barriers to access to care
• Increase the numbers of screenings and BIs.
• Reduce Prevalence of Alcohol, Drug, and
  Medications Related Disorders
• Building coalition between health care services
  and alcohol and drug treatment services

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SBIRT Core Clinical Components

• Screening Very brief screening provides
  identification of substance related problems.
• Brief Intervention Raises awareness of risks
  and motivation of client toward acknowledgement.
• Brief Treatment Cognitive behavioral work with
  clients who acknowledge risks and are seeking
  help.
• Referral Referral of those with more serious
  addictions.

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FFY 2003 Cooperative Agreement Awards made to 6
States and 1 Tribal Organization
California 3.485m Cook Inlet Tribal
Council 1.672m Illinois 3.500m New
Mexico 3.500m Pennsylvania 2.970m Texas
3.500m Washington 2.970m
Awards are renewable for up to five years,
depending on performance and availability of
funding.
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Recommended S-BIRT Awards FY 2003
WA

PA


IL
CA

NM
TX
AK AI/AN
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SBIRT GPRA Summary (6/22/05)
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SBIRT Grants

• Expanding the States continuum of care to
  include screening,brief intervention, brief
  treatment, and referral services in medical and
  other community settings
• Supporting clinically appropriate treatment
  services for nondependent substance users
• Developing collaborative linkages between
  providers of SBIRT services and the more
  traditional substance abuse treatment providers
  to build resilience and facilitate recovery and
• Identifying opportunities for system and policy
  change to improve access to care and ensure a
  life in the community for everyone.

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SBIRT Evaluation

• CSAT has funded Cross-site evaluation team
  contractors Johnson, Bassin Shaw (JBS), RTI
  International, and the University of Connecticut
  Health Center (UCHC)
• Purpose to understand how SBIRT will work best
  in various settings and under different
  approaches and examine which SBIRT models offer
  the greatest potential to improve the U.S.
  healthcare system
• Evaluation Plan is under development

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SBIRT ACTIVITIES
Current Involvement Uniform Accident and
Sickness Policy and Provision Law Studies CMS
Coding National Highway Transportation and Safety
Administration Office of National Drug Control
Policy American Society of Addiction Medicine
Around the Corner College University Grants New
Fall Grants Worldwide Collaboration