The integration of SBIRT into primary care
Carolyn Swenson, MSPH, MSN, FNP, Senior Project Manager, HealthTeamWorks

A primary care patient-centered medical home is the ideal place to address all aspects of health and wellness including alcohol. However, a recent report issued in January 2014 from the CDC found that very few healthcare professionals talk with their patients about alcohol.This despite the fact that the United States Preventive Services Task Force recommends that clinicians routinely screen patients for alcohol misuse and provide a brief intervention to promote adherence to moderate drinking levels. Why isn’t alcohol screening and brief intervention happening more often in primary care? Especially since drinking alcohol above moderate levels contributes to a wide range of health problems including cardiovascular disease, cancer, gastrointestinal diseases, unintended pregnancy, sexually transmitted infections, injury, domestic violence, depression and suicide. Some clinicians believe that they will recognize which patients are drinking too much alcohol without using a validated screening question. However, only four to five percent of adults in the U.S. have alcohol dependence, while approximately 25 percent drink above moderate levels and may not present with any obvious signs of problematic drinking. Sometimes this is the issue. The good news is that alcohol screening and brief intervention really is brief (five-10 minutes) in most cases. And when there is insufficient time to address alcohol, the issue can be addressed effectively at a follow-up visit. Also, different members of the healthcare team can be trained to help to carry out alcohol screening and brief intervention including medical assistants, nurses, health educators, behavioral health professionals and primary care clinicians. Some practices are concerned about getting reimbursed for the service. Fortunately alcohol screening and brief intervention is a reimbursable service and one of the covered prevention services under the Affordable Care Act. Most important to note is that this is an evidence-based practice that really does work to decrease the burden of disease and the enormous healthcare and other costs to society that are caused by excessive alcohol intake! So, let’s look forward to the day when every patient-centered medical home routinely talks with their patients about alcohol use.

“We championed SBIRT early on because we saw the benefits—better health, cost savings, reduce healthcare usage. And prevention is one of our priorities and we see alcohol screening as a critical element of that prevention effort.”

“Prevention is a cost-saving strategy and we view alcohol screening as a part of that prevention effort. Improving the overall health of our customers is a win-win.”

“Years ago, helping professionals were taught the job was always the last to go—people could hide addictions at work for decades, and very little could be done about it. Today, the message is changing to one of prevention: C-SEAP is committed to substance use screening, brief intervention and referral to treatment. We know it works. ”
—Randi C. Wood, LCSW, DCSW, CEAP, Director, Colorado State Employee Assistance Program

“Screening and brief intervention improves our care and treatment outcomes. It is cost-effective and truly belongs in the primary care setting. The most important change fostered is a shift in the culture of the healthcare professionals—encouraging open and honest dialogue in the exam room, removing judgment and stigma, treating each individual as a whole person and integrating behavioral healthcare into the healthcare setting.”
—Karen M. Wyatt, MD

USA TODAY: How much do you drink? Most say doctors never ask
Drinking is a health hazard, but not many doctors ask about it, survey shows. Most adults, including binge drinkers and pregnant women, say they have never been asked about their drinking by a doctor or other health professional, new survey data show.

Research shows that many problem drinkers — those who repeatedly drink more than they intend, sometimes have physical or psychological consequences from overdrinking, and may have difficulty controlling themselves — could benefit from brief interventions and practical advice about how to set better limits and change their drinking by cutting back.

What is recovery?
By Merlyn Karst, Board Secretary, Advocates for Recovery Colorado (AFR)

The question has long been debated, researched, and defined. With the passage of parity laws, more attention has been given to substance-use disorders, their treatment and recovery support. SAMSHA (Substance Abuse and Mental Services Administration) provides a definition of recovery: “Recovery is process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

SAMHSA has also delineated four major dimensions that support a life in recovery: Health; Home; Purpose; and Community.  Advocates for Recovery Colorado also believes in SAMSHA’s guiding principles. Four of those are that recovery: 1) emerges from hope; 2) is supported through relationship and social networks; 3) is person-driven; and 4) occurs via many pathways.

A non-profit, peer-based recovery community organization, Advocates for Recovery Colorado carries the message that recovery from addiction to alcohol and other drugs is a reality. Through education, training, and peer recovery coaching, recovery support is provided to individuals seeking to gain and sustain long-term recovery.

You have many opportunities to make healthy choices in your life. If you choose recovery, AFR has the experience, strength and hope to support you. At AFR you will see that recovery heals. Here are three actions you can take on your path in recovery.
• Go to LinkingCare.org to find the recovery support services you might need, such as housing, transportation assistance and treatment options.
• Call Advocates for Recovery at 720.550.6757. Staffed by individuals in long-term recovery, AFR offers support groups, Peer Recovery Coaches, and connections to other organizations to help in your recovery journey.
• Put a bee in your bonnet. That just means having
 a thought buzz around in your head when it’s most useful—like before you take that drink or drug.

At AFR we know that we can overcome the stigma and discrimination of addiction and recovery. We believe in the power of stories to present evidence that recovery from addiction  is a reality for millions. For those in long-term recovery we invite them to: come out, stand out, speak out, and be proud about it.

SBIRT and employee assistance: prevention for life
By Randi C. Wood, LCSW, DCSW, CEAP, Director of Colorado State Employee Assistance Program

Years ago, helping professionals saw that the job was always the last to go—people could hide substance use and mental health issues at work for decades, and very little could be done about it. Today, the message is changing to a preventive approach: through awareness, education and resources like EAPs. Employers understand the connection between health and behavior, and the bottom line, embrace prevention programs and create environments that recognize their employees—individuals—sometimes need help.

At the Colorado State Employee Assistance Program, we provide a full range of EAP services to Colorado’s state government workforce. Those services include SBIRT. We screen our clients who come to us for help for risky substance use. With SBIRT we can help employees who might be struggling with risky substance use. Substance use and mental health issues cost U.S. employers an estimated $80 to $100 billion in indirect costs alone. Prevention and early intervention provide the best avenues for tackling this growing concern.

C-SEAP believes in SBIRT and we understand how important it is to screen everyone who walks in the door. As a big part of how our EAP makes a difference in the lives of our employees, SBIRT
•    Creates awareness about how substance use affect an employee’s life—at work and at home.
•    Educates decision makers about the impact of substance use on the workplace, particularly with today’s do-more-with-less mandates.
•    Allows us to communicate with physicians, and share pertinent clinical information when we make a referral—with releases, of course.
•    And most importantly creates opportunities for employees to participate in meaningful conversations. Conversations that will help prevent injury, disease or more severe disorders.

The Colorado State Employee Assistance Program is committed to screening, brief intervention and referral to treatment for substance use—on a permanent basis. I invite other EAPs to join us in doing what works.

New York Times: Panel Reminds Doctors to Screen for Alcohol Misuse