Identifying and Addressing Unhealthy Substance Use Rhode Island College School of Social Work RI-SBIRT Resource Center

RI-SBIRT Training & Resource Center Supported by RIC SSW and BHDDH: to build statewide SBIRT awareness and capacity to Implement and integrate SBIRT into diverse settings and organizations Promote clinician SBIRT skills and competency MASBIRT TTA works with a variety of healthcare orgs, to train and prepare sites for SBIRT implementation. including OB GYN depts., primary care sites, ED’s, CHC’s, school nurses, housing sites for elderly, etc. The MASS Clearing house has many great pt. education materials that you can order for free. Includes the SBIRT toolkit, as well as toolkits for screening adolescents and women of child bearing age.

AGENDA What is SBIRT? Why is it important? How is it done? How/where is it implemented? SBIRT & your profession

Introductions Name Where you work/intern; your position On a 1-10 scale, how much do you know about SBIRT What would you like to learn about SBIRT today?

What is SBIRT? Screening: Identify patients with unhealthy substance use Brief Intervention: Conversation to motivate patients who screen positive to consider healthier decisions (e.g. cutting back, quitting, or seeking further assessment). In schools: BI for prevention for all who are screened. Referral to Treatment: Actively link patients to resources when needed

Unhealthy Substance Use in Clinical Settings 1 in 6 patients talk with their doctor, nurse or other health professional about their drinking1 In a January 2014 Centers for Disease Control Vital Signs report, they cited that only 1 in 6 patients talk with a healthcare professional about their drinking. Which leaves 5 out of every 6 patients NOT talking about their drinking with a healthcare provider. This creates an elephant in the room in which alcohol use isn’t being talked, which isn’t great. Goal acknowledge the elephant in the room and create the opportunity to have a meaningful conversation about it. SBIRT really removes the elephant by talking and asking EVERYONE about substance use, and then providing further assessment and guidance as needed. 1. CDC Vital Signs. National Center for Chronic Disease Prevention and Health Promotion. January 2014. 6

Addiction: Historical Perspective Problem No Problem Addiction: Historical Perspective

What is addiction anyway? Short Definition of Addiction: (American Society of Addiction Medicine, 2011) Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

Paradigm Shift: Chronic Disease 9/13/2019 Unhealthy Alcohol and Drug Use Disease Pre-Disease/ Higher Risk Low / No Risk Alcohol binging (NIAAA) Men (<65) more than 4 drinks/day Women (& anyone >65) more than 3 drinks/day Any illicit drug use Any prescription drug misuse (taking more than prescribed or for ‘non-medical reasons’) 9

What’s a Drink?