1. SBIRT – The 11,249 Foot View (From the Pacific N.W. Coast) 1.0 Title slide

2. 2.1 Clark

3. Hi Clark. How’s the beach retirement going? What do you do with your time up there? 2.2 Clark

4. It’s great. I usually hit golf balls on the beach in the morning and spend a couple hours playing pool at the bar before I go home for dinner. 2.3

5. That sounds really nice. Do you drink much when you’re playing pool at the bar? 2.4 Hmmm! That’s interesting

6. I might have a few beers. 2.5

7. In an average week, how many beers would you guess you might drink? 2.6

8. Hmmm... 1, 2, 3, 4... 2.7

9. Oh, around 70. 2.8

10. Ouch! Clark doesn’t seems to think this is hurting him. Is it? Is he an alcoholic? What can I do about it in our 15 minute visit? And why didn’t I know about this earlier? 2.9

11. 3.0 SBIRT: Definition Quickly assess the severity of substance use and identify the appropriate level of treatment. Increase insight and awareness of substance use; motivation toward behavioral change. Provide those identified as needing more extensive treatment with access to specialty care.

12. 4.1 Why SBIRT – WHO Risk Factors The 10 Leading Risk Factors for Disease In Developed Countries The World Health Report 2002 Percent of disability-adjusted life year s

13. Why SBIRT? Economic Burden

14. Institute of Medicine “Broadening the Base of Treatment for Alcohol Problems” 1990 Institute of medicine

15. USPSTF, 2004 USPSTF

16. Solberg et al. Am J Prev Med, Feb 2008

17. Six Characteristics of SBIRT Six characteristics of SBIRT 1.The services occur in a non-behavioral health setting 2.Brief 3.Screening is universal 4.One or more specific behaviors are targeted 5.It is comprehensive 6.Strong research or experiential evidence undergirds the model

18. SBIRT different from BAU How is SBIRT different from typical primary care treatment of alcohol misuse? 1. Screening systematized/universal 2. Alcohol misuse continuum & risk reduction model 3. Guiding vs. directing change talk

19. Spectrum pyramid Dependent Drinking causing problems Drinks too much Non-risky use of EtOH Abstention Alcohol misuse spectrum Consumption Consequences None Heavy Severe

20. Harm Reduction Staircase 20

21. Spectrum pyramid Dependent Drinking causing problems = harmful zone Drinks too much = risky zone Non-risky use of EtOH Abstention Alcohol risk stratification

22. Non-risky Harmful Dependent Risky Risky characteristics

23. Misuse Non-risky use Consumption quantities

24. What’s a standard drink?

25. Non-risky Risky Dependent Harmful Harmful characteristics

26. Non-risky Risky Harmful Dependent Dependent characteristics

27. Prevalence - zones Manwell, Journal of Addictive Disease, 1998 Non-risky 78% Dependent 5 % Harmful 8 % Risky 9 %

28. Prevalence – risky 78% 22% Manwell, Journal of Addictive Disease, 1998

29. Systematizing screening + + +

30. + + + Annual screen

31. Non-risky Misuse Annual screen

32. Annual screen: Alcohol

33. M5 W3 No Bradley, et al. 2003. Bush, et al. 1998 Annual screen: Alcohol

35. + + + Full screen

36. I II III IV Full screen

37. Agency for Healthcare Research and Quality, 2004 Full screen: Alcohol

38. Questions01234 1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week 2. How many drinks do you have on a typical day when drinking? 1 or 23 or 45 or 67 to 9 10 or more 3. How often do you have six or more drinks on one occasion? Never Less than monthly MonthlyWeekly Daily or almost daily 4. How often during the last year have you found that you were not able to stop drinking once you had started? Never Less than monthly MonthlyWeekly Daily or almost daily 5. How often during the last year have you failed to do what was normally expected of you because of drinking? Never Less than monthly MonthlyWeekly Daily or almost daily 6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never Less than monthly MonthlyWeekly Daily or almost daily 7. How often during the last year have you had a feeling of guilt or remorse after drinking? Never Less than monthly MonthlyWeekly Daily or almost daily 8. How often during the last year have you been unable to remember what happened the night before because of your drinking? Never Less than monthly MonthlyWeekly Daily or almost daily 9. Have you or someone else been injured because of your drinking? No Yes, but not in the last year Yes, during the last year 10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? No Yes, but not in the last year Yes, during the last year Full screen: Alcohol Clark’s Audit Answers

39. Screening III IV I Healthy 78% Dependent: 5% II Harmful: 8% Risky: 9%

40. So, Clark may not be an alcoholic, but he is clearly drinking in a way that will hurt his health, if not now, than certainly in the future. How can I best help him change? 2.9