Overview

Goal: The learner will be able to appropriately screen for and identify substance abuse, plan and implement a tailored brief intervention, and will apply the SBI approach to substance abuse problems by individualizing these clinical skills to different patients. The learner will be able to improve care management and referral skills for patients with relatively more severe substance use problems and improve follow-up and brief treatment skills for patients with substance use problems. The learner will apply all SBIRT clinical skills learned in several simulated cases with a variety of substance use problems.
Professional Practice Gaps

Approximately 20 to 25% of primary care patients are likely to have a current substance use problem or health problem related to tobacco, alcohol, or drug use (Madras et al., 2009; Pilowsky & Wu, 2012). Providing components of screening, brief interventions, and referral to treatment (SBIRT) to all patients is effective in reducing alcohol, drug, and tobacco use (Agerwala & McCance-Katz, 2012; Pilowsky & Wu, 2012). Brief intervention in primary care is an effective and cost-efficient approach to reduce patients' alcohol use (Seale et al., 2010; Madras et al., 2009). SBIRT was originally designed for patients with alcohol and tobacco use, but there is growing evidence that brief intervention for illicit drug use may also lead to positive patient outcomes (Compton, 2009). Unfortunately, PCPs screen less than half of their patients for tobacco use and less than a third for alcohol use (Roche & Freeman, 2004; Seale et al., 2010). Brief interventions happen even less often than screening (NDCP, 2008). In patients who screened positive for substance use, less than 75% received a brief intervention. A lack of adequate training is the most frequently reported barrier to screening and brief intervention (Le et al., 2015). Appropriate follow-up is also happening less often as well (D'Amico et al., 2005). Only 48% of people with excessive alcohol use reported receiving follow-up, with most simply being told to "stop drinking". There is also a practice gap in referral to treatment. Less than one-fifth of PCPs make a referral after screening positively for substance abuse or risky substance use (Madras et al., 2009). Primary care physicians need to understand the different types of specialty treatment so that they can make appropriate referrals for their substance abuse patients (SAMHSA, 1997).

References:


This activity is designed to change: Competence, Performance, Patient Outcome.
4 hr(s)

Educational Objectives

After completing this activity participants will be able to:
  • Select and utilize tobacco, alcohol, and drug use screening tools with patients.

  • Perform brief interventions for tobacco and substance use problems with patients.

  • Refer patients to the appropriate type of substance abuse treatment center and/or specialist

  • Follow-up with and reassess patients who receive treatment for substance abuse or tobacco use

  • Apply the SBIRT approach to substance use problems at a comprehensive and integrated level by individualizing screening, brief interventions, and referral for different patients.

Authors

As an ACCME accredited provider of continuing medical education, Clinical Tools, Inc. complies with the Standards for Commercial Support issued by the ACCME and requires disclosure of and resolution of any conflicts of interest for those in control of content.
Clinical Tools, Inc MD (Company, CTI)Clinical Tools, Inc. (CTI) is a small, physician-run business dedicated to harnessing the potential of the Internet to create scalable, usable, and broadly available tools to improve the ability of physicians and other health care providers to care for patients. We achieve this goal by providing education and training to students and professionals and creating Web-based support tools for clinicians, researchers, and consumers. Information technology can and should serve as a stable framework that supports researchers and clinicians in their roles. We provide dissemination and management tools that empower clinicians and consumers to understand and control the vast amount of information related to making individual health choices. We serve our clients creatively, effectively, and with the highest quality of service.
Disclosure: Has disclosed no relevant financial relationships.
Karen Rossie, DDS PhD (Research Scientist, Clinical Tools, Inc. )Karen Rossie, DDS, PhD, directs projects at Clinical Tools. She majored in biology at Cleveland State University and studied dentistry at Case Western Reserve University followed by completing a Masters in pathology at Ohio State University. She taught and practiced oral pathology and oral medicine for 12 years at the University of Pittsburgh, doing research in autoimmune disease, transplantation, cancer, salivary gland disease, and diabetes. An interest in the psychological aspects of disease led her to obtain a PhD in psychology at the Institute of Transpersonal Psychology in Palo Alto where she now teaches psychology part time in a distance learning program. She has used this diverse background to lead or contribute to CTI projects related to tobacco cessation, opioid abuse treatment, anxiety, dementia care, alcohol use disorder, screening and brief interventions for substance abuse, obesity, and pain and addiction.
Disclosure: Has disclosed no relevant financial relationships.
Steve Applegate, MEd MEdMr. Applegate has experience in substance use counseling, state initiatives impacting substance use, and professional training. His prior positions include director of higher education and instructional design at the North Carolina Governor's Institute on Alcohol and Substance Abuse, project director of the North Carolina Initiative of the Mid-Atlantic Addiction Technology Transfer Center, and program director of the Addiction Sciences Center (an outpatient substance abuse treatment center at the University of Virginia Health Sciences Center). Mr. Applegate works as an on-site consultant and travels to the Clinical Tools (CTI) office on a monthly basis from his office in Richmond, VA. Mr. Applegate helped design the CTI Instructional Manual and works to continue to revise it as we expand our Instructional Design methodology. Mr. Applegate has extensive experience with online education and training, especially in the area of substance abuse. He often pushes the envelope of technology and brainstorms with Clinical Tools how we can utilize new technology within our products. He helped guide development of the curriculum plan and assessments in Phase I of the current project.
Disclosure: Has disclosed no relevant financial relationships.

Reviewers

Ted Diedrich, MSc (SBIRT Progarm Coordinator; PhD Student, Denver Health and Hospital Authority, Denver, CO University of Colorado at Denver)
Disclosure: Has disclosed no relevant financial relationships.
Timothy John McGrath, MD (Family Physician, Private Practice)Dr. McGrath is currently in private practice in Mebane, North Carolina. He earned his undergraduate degree at Drew University and his medical degree at the Medical College of Georgia. He completed his residency at the University of North Carolina at Chapel Hill, where he served as Chief Resident in the Department of Family Medicine. His interests include preventive medicine and disease modifying lifestyles, medical delivery systems, and medical economics. He is currently enrolled in the Kenan Flagler executive master of business administration program at UNC. Dr. McGrath is an active member of the NCAFP, AAFP, and AMA.
Disclosure: Has disclosed no relevant financial relationships.

Review Dates

Content Review:
Fri, 04/15/2016
Editorial Review:
Wed, 11/25/2015

Training Activity Syllabus

Module Practice Gap References

Audience and Accreditation

Audience

Primary care providers and couselors

TypeEst. TimeReleasedExpires
NYS OASAS4 hr(s)4/15/144/14/17
AAFP4 hr(s)4/15/144/14/17
DCBN4 hr(s)4/15/144/14/17
NBCC4 hr(s)4/15/144/14/17
FBM4 hr(s)4/15/144/14/17
FAPA4 hr(s)4/15/144/14/17
AMA PRA Category 1 Credit(s)™4 hr(s)4/15/144/14/17
AMA PRA Category 1 Credit(s)™4 hr(s)4/14/114/30/14

Designation Statement: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education by Clinical Tools, Inc.. Clinical Tools, Inc. is accredited by the ACCME to provide continuing medical education for physicians.
NYS OASAS Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 hour(s) of NYS OASAS credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAFP Credit Statement: This Enduring Material activity, SBIRT Core Training Activity: Screening, Brief Interventions, and Referral to Treatment, has been reviewed and is acceptable for up to 4 prescribed credit(s) by the American Academy of Family Physicians. AAFP accreditation begins August 1, 2011. Term of approval is for two years from this date with the option of yearly renewal. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
DCBN Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 hour(s) of DCBN credit. Clinical Tools, Inc. is an approved provider by the District of Columbia Board of Nursing and is registered with CE Broker, Provider #50-1942. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NBCC Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 clock hour(s) of NBCC credit. Clinical Tools, Inc. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6161. Activities that do not qualify for NBCC credit are clearly identified. Clinical Tools is solely responsible for all aspects of the activity.
FBM Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 hour(s) of FBM credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
FAPA Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 hour(s) of FAPA credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AMA PRA Category 1 Credit(s)™ Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AMA PRA Category 1 Credit(s)™ Credit Statement: Clinical Tools, Inc. designates this enduring material for a maximum of 4 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • A letter of completion for up to 4 hour(s) is available for non-physicians.

A score of 70% on the post-test is required to complete the activity.

Participation Requirements

Activity Credit: Obtaining credit for participation in this activity requires that you complete the pre-assessments, work through the modules (including all in-module interactive activities), complete the post-assessments with a 70% score on the post-test, and then request credit. At the end of the activity, you will be instructed on how to print out a certificate for your records.

Time Requirement: Keep track of the amount of time it takes you to complete this activity. You will be required to spend a set amount of time in order to claim credit. You should claim credit only for the time actually spent in the activity.

Technical Requirements: To participate in this activity, you will need a computer, an Internet connection, and a Web browser. This activity requires Chrome, Firefox, and IE7 or higher.

Training Activity References
Funding
Initial development of this activity was supported by a contract from the National Institute on Drug Abuse (#HHSN271200800038C).