Why I believe in screening and brief intervention
Kerry B. Broderick, MD, Denver Health
I am a champion of SBIRT. My belief in screening and brief intervention is fueled by my day-to-day experience as an attending physician at the Denver Health Emergency Department, and an understanding of how it can transform the health of patients and healthcare.
Let’s say it’s the usual busy Saturday night in the ED. By 3 a.m. it’s apparent that 75 percent of the patients are here because of substance use, mostly alcohol—patients who were assaulted or involved in an accident, are there with traumatic brain injuries, lacerations or broken legs, alcohol poisoning, strokes, heart disease…. Broken dreams surround me, surround us, and the common factor is alcohol or other drug use.
The unfortunate fact is I could have said the same in 1981 when I was an emergency department nurse. But here I am today as an emergency medicine attending physician, still witnessing the devastation due to risky substance use.
As a nurse I saw that we were doing a wonderful job of talking to patients about laceration or cast care, but we ignored that they were impaired when the injury was sustained. We focused on their symptoms, not their disease or contributing factors.
At the Boston City Hospital, I worked as an emergency physician during a grant-funded screening, brief intervention and referral to treatment program. Two of the faculty, Ed Bernstein, MD and Gail D’Onofrio MD who have advocated for and pioneered advances in SBIRT, became my career mentors. I was informed and energized about intervening in an effective way with patients, to improve an individual’s health and life. Then, as an emergency attending at the Erie County Medical Center in Buffalo, New York, I began efforts to change how we speak with patients regarding substance use and it’s effect on health and life. This was my first step of being an advocate for screening and brief intervention.
In 1997, I conducted a research study assessing if a substance use discharge instruction sheet describing at-risk substance use was being used. With alcohol counselors who staffed the ED, patient education discharge instructions for substance use were developed. It became my practice to talk with patients about the health risks of substance use and I taught residents about the importance of this conversation.
Some days I find myself explaining the importance of describing a patient as intoxicated rather than ‘drunk’ or talking about the impact we can have by treating substance use as a healthcare issue rather than making a character judgment. I wonder how can we possibly change the thinking and doing of an entire system. But I know that since the days when I first witnessed the effect of substance use in the ER, we’ve made huge strides.
I absolutely understand that if we don’t ask, we don’t know. We cannot assume or make judgments but we must ask and talk to every patient. I’m happy to say that healthcare providers are now changing the way they think about substance use. There is a greater understanding of the effect of substance use on health. Studies demonstrate that screening alone decreases substance use by individuals. Healthcare professionals see the impact of simply asking individuals about their substance use, especially when followed by a brief conversation. I look forward to see what the next decade will bring as I continue to advocate for SBIRT.
Proven that even short conversations with a healthcare professional—nurse, physician assistant, physician, behavioral health professionals—can reduce a patient’s substance use.
Alcohol SBI yield a 400% return on investment within one year.
25% of individuals drink above moderate levels and may not show any obvious signs of risky use.