Rationale –Evidence Base

Research Demonstrates Effectiveness A growing body of evidence about SBIRT’s effectiveness —including cost- effectiveness—has demonstrated its positive outcomes. The research shows that SBIRT is an effective way to reduce drinking and substance abuse problems. “Overall, it appears that SBIRT is an effective and cost-effective strategy.”

SBIRT Has 30 years of research demonstrating its efficacy as an evidence-based clinical preventive service For alcohol use, meta-analyses have found screening and brief intervention to decrease alcohol consumption by 34% result in 12% fewer adults reporting heavy drinking episodes result in 11% more adults reporting drinking less than the recommended limits reduce the use of emergency room services reduce the number of subsequent hospital days “Although the concept of SBIRT is new to many of us, there is a long history of research on brief intervention. Recent meta-analyses compiling these studies have found good evidence in support of SBIRT, particularly when SBIRT is done in primary care settings with alcohol use that is risky in nature. In these settings, SBIRT has been found to significantly reduce drinking frequency, episodes of risky drinking, and risky drinking status. It has also been found to reduce need for costly medical services.”

SBIRT is effective across cultures The World Health Organization (WHO) developed the tested Alcohol Use Disorder Inventory Test (AUDIT) across six countries and found it to be effective also studied brief interventions across cultures including European, Latin American, Asian, and African countries and found SBIRTto be effective In the U.S., SBIRT has been shown to be effective across cultures as demonstrated by a study of 500,000 diverse patients, including Alaska Natives, American Indians, African Americans, Caucasians, and Hispanics “SBIRT also appears to be effective across cultures. Trials have been conducted across several continents and, within the US SBIRT has been effectively implemented with many different ethnic and racial groups.”

Making a Measurable Difference Since 2003, SAMHSA has supported SBIRT programs, with more than 1.5 million persons screened. Outcome data confirm a 40% reduction in harmful use of alcohol by those drinking at risky levels 55% reduction in negative social consequences demonstrate positive benefits for reduced illicit substance use. “Although not technically a controlled trial, the Substance Abuse and Mental Health Services Administration has been implementing SBIRT within states across the country since 2003. Evaluation data from this effort show great promise with large reductions in both drinking and drug use.” (Based on review of SBIRT GPRA data, 2003−2011)

SBIRT Benefits: Primary Care Settings Measurable Reductions “Similarly, SAMHSA SBIRT data has also been shown to impact outcomes other than alcohol consumption. Studies show extent of reductions in alcohol-related health problems may exceed the extent of reduction in alcohol consumption itself, including ER visits, injuries, hospitalizations, and arrests.” (SAMHSA, 2012)

Alcohol Screening and Brief Intervention (SBI) ranks among the highest-performing preventive services based on cost effectiveness and health impact, yet remains one of the last implemented. “When we combine data regarding cost effectiveness with efficacy, we find that SBIRT is one of the highest-performing preventive services available.” (Coffield et al., 2001; Kuehn, 2008; Solberg, Maciosek, & Edwards, 2008)

American Journal of Prevention Medicine “These results make alcohol screening and counseling services one of the highest-ranking preventive services … evaluated using standardized methods.” “In a systematic review of more than twenty years of clinical trail data, SBIRT was one of the highest ranked preventive services available.”

American Journal of Prevention Medicine “… similar to screening for colorectal cancer, hypertension, vision (in adults over 65).” “In fact, the effects of SBIRT in terms of clinically preventable burden and cost effectiveness were comparable to screening for colorectal cancer, hypertension, and vision.”

American Journal of Prevention Medicine “… similar to influenza or pneumococcal immunization.” “And similar to immunization for flu and pneumonia.”

for both alcohol screening & USPSTF on alcohol SBI B for both alcohol screening & brief intervention with adults & pregnant women insufficient evidence for adolescents “The U.S. Preventive Services Task Force has already looked at both the screening and brief intervention components of SBIRT, and given it a “B” rating, which means there is good evidence to recommend these processes. The evidence applies to adults and pregnant women. There is not yet enough evidence to determine the effectiveness of SBI with adolescent patients, or with Referral to Treatment in general.” Citation: United States Preventative Services Task Force: “Final Recommendation Statement Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care.” http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care (USPSTF, 2004 & 2013)

Brief Interventions and Drug Use JAMA Editorial Rigorous studies show null effect for BIs towards adult drug use in medical settings “exploring drug use with patients should remain a priority” “New evidence suggests that while screening tools have validity towards drug use in primary acre settings, brief interventions towards these patients are shown to be less promising.” Citation: Ralph Hingson, ScD, MPH; Wilson M. Compton, MD, MPE. Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care - Back to the Drawing Board. JAMA August 6, 2014 Volume 312, Number 5. http://www.sa4docs.org/wp-content/uploads/2014/08/Hingson-Compton-SBIRT-for-drug-use-in-primary-care-back-to-drawing-board-JAMA-8-5-14.pdf (Hingson et al, 2014)

Evidence for SBIRT with drug use is mixed Several studies show SBIRT to be effective; other studies show no effect Two studies show promise Study 1 found that those receiving BI had reduced ASSIST scores for all ASSIST measures (Humeniuk et al., 2012) Study 2 found that teens/young adults in an ED setting who received SBI were more likely to be abstinent at 30 days & have reduced substance abuse at 12 months (Bernstein et al., 2009) “The evidence regarding SBIRT for drug use is less clear. There have been some positive and negative studies. Some of this may be due to the fact that there is a smaller band of people who use drugs in a risky manner but do not have a substance use disorder. Regardless, identifying drug use is extremely important in both medical and mental health settings, and we need skills in order to effectively intervene or refer patients to more intensive services. The question is whether SBIRT is sufficient to accomplish this or whether we may need something different or more intensive.”