SBIRT Core Training Program - Whole Program: Screening, Brief Interventions, and Referral to Treatment

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 Clincal 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.

Audience and Accreditation

Audience

Primary care providers and couselors

Type: AMA PRA Category 1 Credit(s)™Estimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: NYS OASASEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: AAFPEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: DCBNEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: NBCCEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: FBMEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: FAPAEstimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: AMA PRA Category 1 Credit(s)™Estimated Time: 4 hour(s)Release Date: 4/15/14Expiration Date: 4/14/16
Type: NYS OASASEstimated Time: 4 hour(s)Release Date: 5/1/14Expiration Date: 5/1/16

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.
Credit Statement for AMA PRA Category 1 Credit(s)™: 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.
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.
Credit Statement for AAFP Credit: This Enduring Material activity, SBIRT Core Training Program - Whole Program: 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.
Credit Statement for DCBN Credit: 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.
Credit Statement for NBCC Credit: Clinical Tools, Inc. designates this enduring material for a maximum of 4 clock hour(s) of NBCC credit. Counselors should claim only the credit commensurate with the extent of their participation in the activity.
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.
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.
Credit Statement for AMA PRA Category 1 Credit(s)™: 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.
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.
  • 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 program.

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 GapsRead MoreAs many as 20% of primary care patients have substance use problems and primary care physicians could have a significant impact on their problems through providing screening, brief interventions, and referral to treatment (SBIRT) (Mersy, 2003). Unfortunately, PCPs screen less than half of their patients for tobacco use and less than a third for alcohol use (Seale et al 2010, Roche & Freeman 2004). The rate of screening for illicit drug use is also inadequate; about a third of primary care physicians and psychiatrists surveyed in one study did not screen routinely for illicit drug use (Friedmann, et al., 2001). Brief intervention in primary care is effective and cost-efficient approach to reduce patients' alcohol use (Seale 2010; Madras 2009). There is growing evidence that brief intervention for illicit drug use may also lead to positive patient outcomes (Compton 2009, Volkow 2010). And evidence also supports the effectiveness of interventions by medical providers for tobacco (USPSTF, 2008). However, brief interventions happen even less often than screening; for example counseling for problem drinking without dependence was reported by only 13% of patients in the 1998 Healthcare for Communities survey (D'Amico, 2005). Appropriate follow-up is also happening less often than is optimal. For example, only a little less than 50% of problem drinkers in this study reported receiving follow-up. There is also a practice gap in referral to treatment. Less than one-third of PCPs make a referral after identifying a substance abuse problem (CASA, 2000). 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, 2008).

References:

Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMSHA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
SAMHSA. Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. SAMHSA website http://www.samhsa.gov. 2011; April 1: . Available at: http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf Accessed on: 2012-05-18.
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20205740 Accessed on: 2014-07-28.
The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University, Survey Research Laboratory. Chicago, IL: University of Illinois at Chicago. 2000. Available at: http://eric.ed.gov/?id=ED452442 Accessed on: 2010-06-15.

This program is designed to change: Read More Competence, Performance, Patient Outcome.

Educational Objectives

After completing this program 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.

Program Activity Syllabus

Practice Gap References
American Academy of Pediatrics (AAP). Alcohol use by youth and adolescents: a pediatric concern. Pediatrics. 2010; 125(5): 1078-1087. Available at: http://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf Accessed on: 2010-10-29.
Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3): 7-30. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18077300 Accessed on: 2014-07-28.
Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMSHA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Koob GF, Volkow ND. Neurocircuitry of addiction. Neuropsychopharmacology. 2010; 35(1): 217-38. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19710631
Madras BK, Compton WM, Avula D, et al. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites. Drug Alcohol Depend. 2009; 99: 280-295. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/ Accessed on: 2011-03-24.
Mersy DJ. Recognition of alcohol and substance abuse. American Family Physician. 2003; 67: 1529-1532. Available at: http://www.aafp.org/afp/2003/0401/p1529.html Accessed on: 2013-10-24.
O'Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground.. Arch Intern Med. 2011; 171(1): 56-65. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21220662 Accessed on: 2013-10-24.
Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug and Alcohol Review. 2004; 23(1): 11-18. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14965883 Accessed on: 2013-10-24.
Seale JP, Shellenberger S, Velzsquez MM, Boltri JM, Okosun I, Guyinn M, Vinson D, Cornelius M, Johnson JA. Impact of vital signs screening and clinician prompting on alcohol and tobacco screening and intervention rates: a pre-post intervention comparison. BMC Fam Pract. 2010; 11:18: . Available at: http://www.ncbi.nlm.nih.gov/pubmed/20205740 Accessed on: 2014-07-28.
Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: National Findings. SAMHSA. 2008. Available at: http://www.oas.samhsa.gov/nsduh/2k7nsduh/2k7Results.cfm#3.1.9 Accessed on: 2008-10-10.
The National Center on Addiction and Substance Abuse (CASA). Missed Opportunity: National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University, Survey Research Laboratory. Chicago, IL: University of Illinois at Chicago. 2000. Available at: http://eric.ed.gov/?id=ED452442 Accessed on: 2010-06-15.
Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: obstacles and strategies for change. J Addict Dis. 2008; 27(3): 77-97. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18956531 Accessed on: 2014-07-28.

Review Dates

Content Review:
Mon, 12/02/2013
Editorial Review:
Mon, 12/02/2013

Participation Requirements

Read More Program Credit: Obtaining credit for participation in this program 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 program, 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 program. 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 program, you will need a computer, an Internet connection, and a Web browser. This program requires Chrome, Firefox, and IE7 or higher.

Funding

Initial development of this program was supported by a contract from the National Institute on Drug Abuse (#HHSN271200800038C).
Educational Activity References
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American Academy of Pediatrics. Policy statement. Substance use screening, brief intervention, and referral to treatment for pediatricians. Pediatrics. 2011; 128(5): e1330-e1340. Available at: http://pediatrics.aappublications.org/content/128/5/e1330.full Accessed on: 2011-12-13.
American Psychiatric Association. Substance-Related and Addictive Disorders. APA. 2013. Available at: http://www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20Sheet.pdf Accessed on: 2013-06-26.
Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary care. World Health Organization: Department of Mental Health and Substance Dependence. Second Edition. 2001. Available at: http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf Accessed on: 2008-10-10.
Babor TF , Dolinsky ZS, Meyer RE, Hesselbrock M, Hofmann M. Tennen H, Types of alcoholics: concurrent and predictive validity of some common classification schemes. Br J Addict. 1992; 87(10): 1415-31. Available at: http://www.ncbi.nlm.nih.gov/pubmed/1330126 Accessed on: 2013-10-24.
Blow FC, Brower KJ, Schulenberg JE, Demo-Dananberg LM, Young JP. Beresford TP, The Michigan Alcoholism Screening Test - Geriatric Version (MAST-G): a new elderly-specific screening instrument. Alcoholism: Clinical and Experimental Research. 1992; 16(2): 372. Available at: http://www.ncbi.nlm.nih.gov/books/NBK99192/
Bohn MJ, Babor TF, Kranzler HR. Validity of the Drug Abuse Screening Test (DAST-10) in inpatient substance abusers. Farmington, Conn: University of Connecticut Heath Center. 1991. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441940/
Brown RL, Leonard T, Saunders LA. Papasouliotis O, A two-item conjoint screen for alcohol and other drug problems. Journal of the American Board of Family Practice. 2001; 14(2): 95-106. Available at: http://www.jabfm.org/content/14/2/95.long Accessed on: 2013-10-24.
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Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMSHA). TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians. Rockville, MD. Center for Substance Abuse Treatment. 1997. Available at: http://www.ncbi.nlm.nih.gov/books/NBK64827/ Accessed on: 2010-06-15.
Chang G. Alcohol Screening Instruments for Pregnant Women. National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2001; 25(3): 204-9. Available at: http://pubs.niaaa.nih.gov/publications/arh25-3/204-209.pdf Accessed on: 2011-01-10.
Clemens KJ, Vendruscolo LF. Anxious to Drink: Gabapentin Normalizes GABAergic Transmission in the Central Amygdala and Reduces Symptoms of Ethanol Dependence. The Journal of Neuroscience. 2008; 28: 9087-9089. Available at: http://www.jneurosci.org/content/28/37/9087.long Accessed on: 2013-11-05.
Compton P. Urine toxicology screening: a case study. Emerging Solutions in Pain. 2009.
D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Medical Care. 2005; 43(3): 229-236. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15725979 Accessed on: 2013-10-24.
Emmons K, Rollnick S. Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11137778 Accessed on: 2013-10-24.
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Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984; 252(14): 1905-1907. Available at: http://www.ncbi.nlm.nih.gov/pubmed/6471323 Accessed on: 2013-10-24.
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O'Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground.. Arch Intern Med. 2011; 171(1): 56-65. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21220662 Accessed on: 2013-10-24.
Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning and monitoring compliance. Pain Med. 2008; 9: S145-S166.
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